Background: The Coronavirus disease 2019 caused by SARS-CoV2 virus has rapidly spread worldwide becoming one of the most important challenges humans are facing nowadays. Risk factors for severe outcomes have been identified, but asthma seems not to be one of them. Objectives: To analyze lifestyle before the pandemic in severe pediatric asthma patients in treatment with a monoclonal antibody, belonging to Castellon’s Universitary General Hospital Health’s Department, and investigate the prevalence of COVID-19 in these patients in order to see if their lifestyle may have influenced the probability of being infected by COVID-19. Methods: A questionnaire was developed asking about: their lifestyle before the pandemic; suggestive COVID-19 symptoms and exposition to the disease; and patients’ behavior, asthma control and treatment during the pandemic. Total SARS-Cov-2 antibody tests were performed to all patients. Results: A total of 15 patients were included. All patients had a high social exposure before the pandemic. 2 patients had direct contact with positive COVID-19 patients. Both experienced mild symptoms that could be attributed to the disease, but neither of them had a positive serological test. Most patients followed asthma treatment correctly before and during the pandemic. 13 patients referred good asthma control. Most patients continued monthly monoclonal antibody administration. Serological tests were negative for all patients. Conclusion: Severe asthma pediatric patients in treatment with MAB, do not have an increased susceptibility for being infected by the virus, but in the case that they contracted the disease, evidence says they would have shown very weak symptoms.

Aim: We aimed to present the patients who had COVID-19 infiltrations incidentally detected in the lung basal sections in patients with abdomen CT due to flank pain in the urology outpatient clinic during the pandemic process. Methods: A total of 276 patients admitted to the Siirt Training and Research Hospital Urology outpatient clinic between March 15, 2020, and August 09, 2020, with a complaint of flank pain and underwent non-contrast abdomen CT were analyzed from this data retrospectively. A total of 10 patients with Covid-19 compatible findings in CT were determined as the study group. A control group was formed from 10 patients with only urological pathologies (kidney stones, ureteral stones, hydronephrosis … etc) without Covid-19 compatible appearance on CT. Results: Ten (3.6%) patients with COVID-19 disease pneumonic infiltrations were detected in the lung basal regions entering the abdomen CT cross-section. The visual analog scale (VAS) score was higher in the control group, who had urological pathology and did not have Covid-19 findings in the lung bases in abdominal CT, and it was statistically significant. During the admission to the urology outpatient clinic, there were no signs of COVID-19 disease such as fever, cough, and shortness of breath. Conclusion: If the severity of pain is not very high in patients who apply to urology outpatient clinics with flank pain during the pandemic period, and if no urological pathology is observed in the Abdomen CT, Covid-19 should be kept in mind in the differential diagnosis.

Background: COVID-19 is considered a widespread concern in global public health. Diagnoses of COVID-19 in some cases are necessary due to severe prognosis. In this study, clinical and demographic characteristics of patients with COVID-19 were studied in Taleghani Hospital, Urmia, Iran. Methods: This descriptive-analytical cross-sectional (retrospective) study carried out on 215 patients with COVID-19 during March and April 2020.. Approved COVID-19 case was considered as a person with a positive respiratory sample performed by at least one of two RT-PCR methods or genetic sequencing. Results: The mean age of patients was 50.93±17.92 years. The mean hospital stay, the temperature at admission, and onset of symptoms were 4.91±3.68 days, 37.40±0.96 0C, and 5.88±4.80 days, respectively. Shortness of breath and cough were found in 62.8 % and 49.3 % of patients. Regarding lung involvement, 33 patients (33%) were normal, most of the patients (n=71) had 5-25% involvement in their lung and a minority of patients (n=13) had a severe condition of 50-75% lung involvement. .Spo2 can increase the risk of death by 16% with each unit reduction. Kidney involvement increases the chance of mortality by 1.386 times (95% CI: 11.010-2.704). Hemoglobin was also significantly marginal, with a 35% risk of death per unit reduction in blood hemoglobin, which is a very important finding in this study. The odds ratio of spo2 and hemoglobin for mortality due to COVID-19 was 1.16 (95% CI: 1.073-1.262) and 1.350 (95% CI: 0.989-1.842), respectively. Conclusion: COVID-19, like other viral diseases, can involve different organs of the body with different severity. In the meantime, smoking was not a risk factor for the virus or associated with severe manifestations of the disease. Patients with high creatinine and CPK, pulmonary involvement above 25%, and hypoxemia had a higher mortality

Peptoniphilus indolicus is not usually seen in the eye but is a commensal of the human vagina and gut. However, with COVID-19, eye infections and other unusual complications are possible with unsuspected bacteria. The patient presented here spontaneously drained this bacteria through the skin, an uncommon occurrence with orbital abscesses.

OBJECTİVE In this study, we aim to investigate the thoughts and attitudes of individuals towards the future COVID-19 vaccine. METHODS This descriptive study was carried out on the web between 10/06/2020 - 10/07/2020. The sample constitutes all individuals above 18 years of age using social media and smartphone. The e-survey form was shared by the researchers via the web for a month, and those who completed the survey were included in the study and formed the sample of the research. RESULTS 759 were participated. 49.7% of the participants stated to be vaccinated; 38.4% of them stated to be vaccinated their children against COVID-19; if the vaccine for COVID-19 is developed. The request for the COVID 19 vaccine had relationship with gender, occupation, health insurance, anxiety level, having children, willing to get vaccinated for their children. “Afraid of the side effects of vaccine”, “don’t think it can be reliable as it will be a new vaccine” and “COVID-19 infection is a biological weapon and the vaccine will serve those who produce this virus” were the most common reasons for rejection of vaccine. CONCLUSION In our study afraid of the side effects of vaccine and not thinking it can be reliable as it will be a new vaccine is the most reasons of indecision and rejection about COVID 19 vaccine. In order for the future COVID 19 vaccination campaign to not fail, media, politicians, healthcare professionals should closely follow the vaccination development processes, inform the public transparently and consider public’s concerns.

Following respiratory viral infections, there is a brief window in which a host has less susceptibility to other respiratory viruses. This is essential, as it may take up to 1 year to develop a vaccine. Most people get SARS-CoV-2 from their infected relatives at home, particularly during the first two weeks after exposure. Self-quarantine does not necessarily reduce the level of exposure for the relatives interacting with infected patients. The new infection may happen at least 10-14 days after the first infection. We propose to induce other viral respiratory infections such as non-fatal, mild, and self-limited Rhinoviruses or Coronavirus, which cause the common cold, prior to exposure to COVID-19. This would be beneficial for surrounding community members of infected individuals. In conclusion, theoretically we may protect immediate relatives of an infected person for at least two weeks, during active screening, by inducing temporary-immunity through the administration of non-fatal respiratory viruses.

The COVID-19 pandemic has had far-reaching consequences beyond the disease itself, including economic, social, political, religious and psychological implications. This novel coronavirus has been shown to have cardiovascular manifestations in the form of arrhythmias, conduction disturbances, myocarditis, stress cardiomyopathy, myocardial injury and myocardial ischemia or infarction from increased microvascular and/or macrovascular coagulopathy. However, in addition to these direct effects, we are now starting to recognize indirect cardiovascular effects of COVID-19 in the form of increased incidence of Takutsobo cardiomyopathy in patients without any evidence of coronavirus infection. In this case series, we present two post-menopausal women, presenting with chest pain and acute coronary syndrome, who are finally diagnosed with stress cardiomyopathy, triggered by increased emotional stress related to the pandemic. There is data from a retrospective cohort analysis showing a four-fold increase in the incidence of acute coronary syndrome resulting from stress cardiomyopathy during the pandemic period compared to similar times periods before the pandemic. Hence, health care providers need to cognizant of the emotional ramifications of the ongoing pandemic in the form of increased risk of Takotsubo cardiomyopathy. Moreover, urgent measures need to be taken to help at-risk population cope with the ongoing stressors to help decrease the incidence of this cardiomyopathy.

Objective: To investigate the changes in the psychological status of infertile women and men who had infertility treatment interrupted or postponed because of the COVID-19 pandemic. Design: Cross-sectional study (NCT04400942) performed between April and June 2020. Population: Patients having in-vitro fertilization (IVF) treatments at our institution interrupted or postponed due to the COVID-19 emergency. Methods: An electronic survey was e-mailed to investigate presence, severity of anxiety and depression using the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Subjects with pre-existing psychiatric disorders diagnosed by DSM-V criteria were excluded from the analysis. Main Outcome Measures: Presence, severity of anxiety and depression; risk factors related to these psychological disorders. Results: Overall, 524 out of 646 patients (80.9%) completed the survey. The prevalence of anxiety and/or depression was significantly higher in women (41.5%, p=0.012), in particular, if aged more than 35 years (50.2%, p=0.023) and with a previous IVF attempt (57.6%, p=0.031). The occurrence of these psychological disorders was significantly associated with the time spent on COVID-19 related news per day (> 1 hour per day, p=0.034) and partner with evidence of psychological disorder (p=0.017) and, in females, with a diagnosis of poor ovarian reserve (p=0.052), diagnosis of endometriosis (p<0.001) or uterine fibroids (p=0.037). Conclusions: The psychological impact of the COVID-19 pandemic on the infertile couples who should have undergone IVF treatment was significant. IVF centers should systematically offer these couples an adequate psychological counseling to improve quality of life and mental health. Funding: - Keywords: INFERTILITY: ASSISTED CONCEPTION; PSYCHOLOGY

Background: Coronavirus disease-2019 (COVID-19) could be associated with morbidity and mortality in immunocompromised children. Objective: To measure the frequency of SARS-COV-2 infection among hospitalized children with cancer and detect the associated clinical manifestations and outcomes. Methodology: A prospective non-interventional study including all hospitalized children with cancer conducted between mid-April and mid-June 2020 in Ain Shams University hospital, Egypt. Clinical, laboratory and radiological data were collected. SARS-CoV2 infection was diagnosed by RT-PCR tests in nasopharyngeal swabs. Results: Fifteen of 61 hospitalized children with cancer were diagnosed with SARS-COV-2. Their mean age was 8.3±3.5 years. Initially, 10(66.7%) were asymptomatic and 5(33.3%) were symptomatic with fever and/or cough. Baseline laboratory tests other than SARS-COV-2 RT-PCR were not diagnostic; the mean absolute lymphocyte count was 8.7±2.4 x109/L, C-reactive protein was mildly elevated in most of patients. Imaging was performed in 10(66.7%) patients with significant radiological findings detected in 4(40%) patients. Treatment was mainly supportive with antibiotics as per the febrile neutropenia protocol and local Children Hospital guidance for management of COVID-19 in children. Conclusion: Pediatric cancer patients with COVID-19 were mainly asymptomatic or with mild symptoms. A high index of suspicion and regular screening with nasopharyngeal swab in asymptomatic hospitalized cancer patients is recommended. 

Cytomegalovirus (CMV) infection exists in 50-80% of the world’s population in clinically undetected form due to their immunocompetent status. Here we report a case of a 42-year-old COVID-19 patient with no past medical history, who received tocilizumab, which led to a massive lower gastrointestinal bleeding not responded to medical management.

The impact of the COVID-19 outbreak had devastating consequences globally with 20,675,770 affected and 749,061 dead. Despite different measures to restrict transmission, the death toll continues to rise. The SAARC group of countries comprising eight nations—Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka, where 23.75% of the world population reside, implemented containment measures at different stages of the outbreak with varying consequences. In this review, we examined the onset and transmission of the virus in each country at an early stage and critically appraised their response with respect to their medical facilities for diagnosis and management. We found that countries that succeeded to contain the spread of COVID-19 were able to do so by prioritizing non-pharmaceutical interventions (e.g. early and stricter lockdowns). Currently, the epicentre of COVID-19 appears to be shifting to India (the largest SAARC nation), the death toll is likely to steeply increase if effective and aggressive measures are not taken urgently. The authors believe that authorities of each of the SAARC countries should act decisively and cooperatively as a matter of urgency increasing the regional collaboration in an eloquent and durative way.

Background Pharmaceutical interventions are being investigated as possible treatment options for COVID-19. Antimalarial drugs-Hydroxychloroquine and chloroquine are also being investigated in clinical trials due to their antiviral effects though their efficacy in the treatment of COVID-19 is largely inconclusive. This study assessed the knowledge, perception and practice of prescribing these drugs in the treatment of COVID-19 by practicing medical doctors in Nigeria. Materials and methods The survey was conducted online using Google forms sent via a link on WhatsApp© and Facebook© through the authors’ contacts to medical doctors in the six geo-political zones of Nigeria from April-May, 2020. Ethical issues were addressed by ensuring the anonymity of respondents, voluntary participation and non-incentivized. Descriptive statistics were used to determine the mean and frequencies of data generated using SPSS version 22. Results Responses were obtained from 145 medical doctors with mean age 37.78±6.47 years and 10.9±5.58 years of practice experience. All the respondents knew that the virus affects the lungs. Over 48% of the doctors believed in the efficacy of the antimalarial drugs and more than half of them thought it would be more effective for mild disease presentation. About 46.8% of respondents agreed to prescribe the drug to COVID-19 patients and most based their decisions on case reports, recommendations of NCDC or WHO. However, 75.9% believed a randomized control trial should be conducted to determine the efficacy and safety of the drugs. Conclusion Practicing doctors in Nigeria are knowledgeable on COVID-19 and their perceptions and decision to prescribe antimalarial drugs are largely dependent on clinical trial outcomes.

Purpose: COVID-19 pandemic has created a serious psychological impact worldwide since it has been declared. This study aims to investigate the level of psychological impacts of COVID-19 pandemic on Turkish population and to determine related factors. Methods: The study was carried out by using an online questionnaire using the virtual snowball sampling method. The sociodemographic data were collected on the following subjects: Participants’ experience on any signs of infection within the last month, the history of COVID-19 contact-treatment-quarantine, level of compliance with precautionary measures, the sources of information and level of knowledge about the pandemic process and their belief levels on the knowledge they acquire. Besides, questions that take place in the depression, anxiety, stress scale (DASS-21), and impact of events scale (IESR) were asked. Results: Of the 3549 participants, anxiety was found in 15.8%, depression in 22.6%, stress in 12.9%, and psychological trauma in 20.29%. Female gender, young age, higher education level, being single, high monthly income, presence of psychiatric illness, a high number of people living together, having any signs of infection, and contact history with COVID-19 infected person or contaminated object are identified as risk factors that may increase psychological impact. Compliance with the rules was found to reduce the risk of psychological response. Conclusions: During the pandemic, reducing the spread of the virus and knowing the risk factors in protecting the mental health of individuals will be guided in determining the measures to be followed and the policies to be followed.

Using a qualitative approach, we explored the protective roles of joint and nuclear families in shaping the life outcomes of children during COVID-19. Sixteen full-time mothers of children aged 9-12 years (8 each from joint and nuclear families) were interviewed and thematic analysis revealed five major themes viz., negative impacts, differences in positive engagement, emotional protective roles, promotion of positive health habits and activity management. Findings suggest that joint families carry more resources to positively engage their children in creativity, studies, exercise and entertainment as compared to nuclear families. Contrary to nuclear families, joint families gave emphasis to resolve emotional grievances, promote positive emotional engagement and support emotionally. The joint and nuclear families also differed in attending food habits, health grievances and physical exercise of children. The joint families played more positive roles in managing play behaviours, sleep habits, television watching and other activities of children compared to nuclear families. Keywords: children; COVID-19; joint family; life outcomes; nuclear family; thematic analysis.

We thank Medina et al. for their interest in our recent work on QTc prolongation associated with treatment of COVID-19 patients with hydroxychloroquine and azithromycin. As they appropriately point out in their letter, genetic variation is likely a significant determinant of QT prolongation in the population at large and in COVID-19 patients specifically. While drugs causing acquired long QT syndrome and torsades de pointes are generally blockers of IKr, repolarization results from the aggregate of multiple inward and outward currents. Patients with sub-clinical defects in any of these ion channels can have normal or only slightly prolonged baseline QT intervals, but may possess decreased repolarization reserve leading to an exaggerated response to IKr blockade (1).  In our study, a baseline QTc of > 460 ms was associated with excessive QTc prolongation, and this likely represents a group of patients with sub-clinical cardiac ion channel mutations (so called “first hit”) (2). We also agree that many patients with latent mutations demonstrate a normal baseline QT, which gets prolonged with the addition of a drug or a change in the clinical condition “second hit” (3). The patients in our study who exhibited QTc prolongation were generally acutely ill, and displayed “multiple hits” that led to QTc prolongation and it is certainly plausible that many may have had sub-clinical cardiac ion mutations. We therefore wholeheartedly agree that pharmacogenetics should be considered in studies of drug-induced QT prolongation, however this information is rarely available to include for acutely ill patients. And while it makes sense to obtain genetic profiles prior to administration of QT-prolonging medications, that can only be performed in the elective outpatient setting, while taking into consideration medical, ethical and social issues related to asymptomatic genetic screening (e.g. cost, reimbursement, informed consent, etc…). There is significant interest in building genomic databases, and when this becomes a reality for the population at large we believe that genetic information should certainly be included in studies of QT prolongation.Roden DM Long QT syndrome: reduced repolarization reserve and the genetic link. J Intern Med. 2006 Jan; 259(1):59-69.Napolitano C, Schwartz PJ, Brown AM, et al. Evidence for a cardiac ion channel mutation underlying drug-induced QT prolongation and life-threatening arrhythmias. J Cardiovasc Electrophysiol. 2000;11:691–6Sauer AJ and Newton-Cheh C. Clinical and genetic determinants of torsade de pointes risk. Circulation. 2012;125:1684-94.

Objective: To determine the association of sleep duration and screen time with anxiety among pregnant women under COVID-19 pandemic scenario. Design: Cross-sectional study. Population: A total of 1794 pregnant women cover the whole pregnant period. Methods: We conducted one large-scale, multicenter cross-sectional study which recruited 1794 pregnant women across China. The demographic factor, lifestyle, and mental health of participants were submitted online in self-reported manner by the pregnant women during 6 February to 8 May, 2020. We further investigated the association of sleep duration and screen time with the risk of anxiety by multivariable logistic regression analysis and linear regression analysis after adjusting the potential confounders. Moreover, stratification analysis was subsequently conducted for controlling potential confounders. Main outcome measures: the dependent and interactive effect of sleep duration and screen time with anxiety among pregnant women. Results: Our data revealed that 35% of pregnant women suffered from anxiety during the COVID-19 pandemic. Sleep duration was dose-dependently associated with lower risk of anxiety among pregnant women (OR 0.418: 95%CI 0.276-0.630), while screen time exhibited conversed effect (OR 2.017: 95%CI 1.008-4.399). Notably, sleep duration(>7h/day) together with screen time(3-6h/day) diminished the risk of anxiety (OR 0.708: 95%CI 0.503-0.997). Conclusion: Taken together, sleep duration and screen time were independently and jointly associated with anxiety. Therefore, promoting more active lifestyle and maintaining higher sleep quality could protect mental health of pregnant women, especially under public health emergency. Funding: This work was funded by National Key R&D Program of China (2018YFC1004300, 2018YFC1004304).

Background Even though children seem to be less vulnerable to the COVID-19 infection, still a diverse range of clinical presentations and symptoms have been reported. We therefore aimed to have a comprehensive study on the evaluation of clinical and paraclinical characteristics of infected children. Methods We included all likely, suspected, and confirmed cases of COVID-19 referred to the Ali-ibn-Abitaleb Hospital of Zahedan. Patients were evaluated at admission time and during hospitalization. Clinical, imaging, and laboratory results were collected and statistically analyzed using SPSS version 23.0. Results Out of the 42 studied children, 32 cases (76% of patients) developed pneumonia. Fever (39 cases, 92.9% of patients), cough (26, 61.9%), tachypnea at admission (24, 57.1%), and pharyngeal erythema (22, 52.4%) were the most common clinical presentations seen in more than 50% of patients. Regarding the imaging findings, ground-glass opacity, seen in CT scan, was the most common (23, 54.8%). Chest X-ray also showed bilateral haziness in 19 patients (45.2%). The mean hospitalization duration was 7.55 nights, and patients on average had fever for 5.55 days. In laboratory findings, anomaly was more noticeable for CRP (79% of patients) and ESR (69% of patients). Conclusion Even though our population was small, most of the findings matched other studies conducted on pediatric cases in Iran or other countries. It was also found that some clinical features such as pneumonia, cough, diarrhea, and tachycardia at admission time were statistically different among age groups.

Recently Frazier et al detected SARS-CoV-2 virus in autopsy samples from middle ear and mastoid of COVID-19 deceased. Our article presents an anatomical model for the possible route by which SARS-CoV-2 may pass into the middle ear cavity and hence to the mastoid cavity. The anatomic correlation explained in this article will not only help in explaining the pathological basis of the findings presented by Frazier et al but will also imply for the precautionary measures to be taken while dealing with COVID-19 patients with otolaryngeal problems.

Resumen:La pandemia por coronavirus COVID-19 ha representado una enorme crisis de salud global. La industria farmacéutica actualmente está desarrollando nuevos tratamientos dirigidos al COVID-19 y en ausencia de algún fármaco aprobado por la FDA dirigido al tratamiento específico de COVID-19 la comunidad médica está probando una variedad de terapias que poseen efectos antivirales e inmunomoduladores para prevenir y tratar esta enfermedad. Algunas de las drogas implementadas en el tratamiento de pacientes con enfermedad por Coronavirus han sido recientemente desarrolladas y aún se encuentran en proceso investigación, y algunas otras son drogas ampliamente utilizadas en infecciones por SARS-COV y MERS-COV cuyos mecanismos de acción pueden resultar beneficiosos en el tratamiento de COVID-19, estos datos han sido descritos en estudios observacionales y están siendo utilizados anecdóticamente en base a evidencia in vitro o extrapolada. Es importante reconocer que no hay datos controlados que respalden el uso de ninguno de estos agentes y su eficacia para el COVID-19 es desconocida por lo que se están llevando a cabo una serie de estudios de investigación para el desarrollo de fármacos dirigidos al tratamiento antiviral del COVID-19. Por esta razón la práctica médica exige la búsqueda sistemática de información actualizada para dar respuestas a las interrogantes que surgen en el ejercicio de la actividad profesional durante el tratamiento de pacientes con infección por CODIV-19, para lo cual la medicina basada en la evidencia tiene una amplia aplicación en la toma de decisiones terapéuticas implementadas en el tratamiento de la enfermedad por COVID-19.Palabras clave: Coronavirus, Infecciones por coronavirus, Enfermedad por Coronavirus 2019-nCoV, Terapeutica

2019-nCoV and SARS-CoV seriously threatened human health. In order to know the genetic relations of the two dangerous clades and genetic mechanism of origin of 2019-nCoV, we compared whole genomic sequences of SARS-CoV and 2019-nCoV clades, and dissected phylogenetic histories of them. To our surprise, we found that the two clades may frequently exchange their genetic materials through homologous recombination in recent decades, resulting in 2019-nCoV and its sister branch represented by CoVZC45. Particularly the 2019-nCoV lineage might thereby acquire the receptor-binding domain from the SARS-CoV clade, enabling it to make use of angiotensin-converting enzyme 2 as well and thus spread rapidly in humans. Our findings suggest the accomplice role of a virus of SARS-CoV clade in COVID-19 and warn of the possible emergence of more mosaic CoVs capable of launching severe epidemic.

Objectives To determine the perceived threats, psychological stress and economic concerns among practicing otolaryngologists in low and middle income countries facing the furry of COVID-19 pandemic, exposing the soft underbelly of healthcare systems in resource limited economies. Design A cross sectional anonymous, self-reported questionnaire-based study was carried out among otolaryngologists in India over a period of 3 weeks during the countrywide lock-down. Setting An online platform was used to host a questionnaire, publicized using various social media platforms. Participants A total of 178 participants landed on the page, 73 were excluded at the first question itself, in all 105 otolaryngologists, who were allowed to proceed, completed the questionnaire. Main Outcomes and Measures There are clear indications of psychological stress among the practicing otolaryngologists. Main reasons being anxiety about risk of infection from patients for self, staff members and family, and economic impact of the increased protective measures needed in view of pandemic. Results Out of the 105 Otolaryngologists who completed the survey, 57 (52.8%) were from private sector. Significantly (p=0.001) higher number of private doctors (66.7%) feared about escalated cost of running out-patient clinics compared to government doctors (33.3%). Majority (80.8%) were against routine surgeries during pandemic and difference between private and government doctors was not significant (p=0.765). Increased stress during this pandemic was perceived by 73.1%. Conclusions It can be safely concluded based on this survey based study that to alleviate fears of otolaryngologists in low middle income countries; a comprehensive policy intervention is the need of the hour.

Objective: To compare mothers’ satisfaction at birth and intrapartum care during COVID-19 pandemic compared to a pre-COVID cohort. Design: Prospective cohort study Setting: Low risk maternity unit in Northern Italy Population: Women who delivered during COVID-19 pandemic compared to a pre-COVID cohort recruited in the same setting in February-May, 2018. Methods: Italian version of the Birth Satisfaction Scale-Revised (I-BSS-R) was used. Main Outcome Measures: Satisfaction at birth in relation to socio-demographic characteristics, obstetric history and intrapartum care variables. Results: 377 women were included (277 pre-COVID and 100 during COVID pandemic). A higher rate of induction [40%, COVID versus 25% pre-COVID, p 0.004], fewer active phases >12 h [6% COVID versus 15% pre-COVID, p 0.018] and more acceleration with oxytocin [35% COVID versus 24.9% pre-COVID, p 0.05] were found. No differences in terms of satisfaction at birth were reported (I-BSS-R mean 27.0, SD 5.3 versus mean 27.6, SD 6.1, p 0.34). Intrapartum variables that significantly reduced maternal satisfaction were the same in the two groups: epidural analgesia (p< 0.0001 in both groups), prolonged active phases (p < 0.0001 in both), oxytocin administration (p<0.0001 in both) and operative delivery (p 0.0009 versus p 0.0019). The lowest scores in COVID era were found in those who underwent induction of labor, active phases >12 h and CS in labor. Conclusions: No differences were reported concerning global satisfaction at birth, despite an increased rate of active intrapartum intervention. Keywords: Childbirth experience, COVID-19, intrapartum intervention

Background: Increased risk of thromboembolism during COVID-19 disease is confirmed. Case: A 40-year-old hypertensive otherwise healthy male with COVID-19 disease, presented with exacerbating dyspnea, demonstrated two large mural thrombus in right atrial appendage and right ventricular apex accompanied by pulmonary thromboembolism in imaging studies. He underwent anticoagulant therapy with significant reduction in thrombus sizes. Conclusion: Hypercoagulation state of COVID-19 disease may lead to serious cardiopulmonary injury.

Dear editor, Cases of newly diagnosed diabetes have been observed in people with the novel coronavirus disease (COVID-19), often with severe hyperglycaemia and diabetic keto-acidosis. An international group of leading diabetes researchers participating in the CoviDIAB Project calls for a global registry of patients with Covid-19–related diabetes (covidiab.e-dendrite.com) 1. It is indeed difficult to determine whether these are exacerbations of existing diabetes or new-onset diabetes. The glycohaemoglobin A1c test indicates a patient’s average blood sugar levels for the past two to three months. If the newly diagnosed diabetes is indeed of recent onset, the test values should be relatively low. In addition, performing the test every month thereafter and comparing the results with the initial results may provide a clue to the timing of diabetes onset. Therefore, COVID-19 patients should have their glycohaemoglobin A1c measured on admission, and if necessary, every month thereafter.ReferenceRubino F, Amiel SA, Zimmet P, et al. New-Onset Diabetes in Covid-19 [published online ahead of print, 2020 Jun 12]. N Engl J Med . 2020;NEJMc2018688. doi:10.1056/NEJMc2018688