Viruses are considered as one of the primary drivers for human evolution. Humans in return have also offered them an ideal habitat for their growth and evaluation. However, both, humans and viruses are diverse, astute, competitive, and avaricious in nature, which engage them in a never-ending battle. Today, the world goes to win the battle against COVID-19 for sure. However, this never ending merciless battle between viruses and humans looks like an arms race for their survival in which neither a virus wins nor a human but each battle provides them an opportunity to bounce back for the next.

Since coronavirus disease 2019 (COVID-19) was reported globally pandemic, dentistry is known as one of the most critical disciplines. Teledentistry as a sub branch of telemedicine which can be a useful modality is defined by using any telecommunication technology facility, including digital photo and video to deliver oral care to isolated patients in distant places by low cost(1). Although teledentistry has been introduced as a valid tool to prevent unnecessary referrals, policy makers have not shown much interest on it yet (2,3).Diagnosis, treatment, and monitoring could be performed, meanwhile research and continuing education or public education could be done via teledentistry. In COVID-19 pandemic, teledentistry can prevent human and non-human resources burden. Oral chronic diseases like vesiculobullous and painful conditions are so dreadful and exhausting needing more care. Pediatric patients and those who are suffering from cancer are no more exceptions to this point. Tablets, smart phones, and all types of electronic gadgets can facilitate virtual communication which is helpful in telehealth.Traditional visual examination is a gold standard, in order to reach a better diagnosis and treatment plan. In teledentistry, intra oral or other high quality cameras can provide essential documents. There are so many investigations to compare visual and virtual examination, which showed only some problems in diagnosing interproximal carious lesions which is solved by digital radiography (3).Teledentistry examinations are valid, feasible, and comparable to visual examination for oral screening. Data storage is another crucial part in teledentistry due to privacy policies (2,3).Pediatric dentistry, oral medicine, orthodontics, and periodontics are the most common disciplines that have studied the efficacy of teledentistry rather than effectiveness. In developing countries, where emergency care is more important than preventive care, conservatism of decision makers, lack of resources and ICT infrastructure are the most common problems in providing teledentistry (4).Meanwhile there is a hidden advantage for teledentistry and telemedicine that it can avoid feelings of isolation and stress for patients; so, it can be more useful during COVID-19 quarantine (5).Teledentistry performs in two ways; asynchronous by transmission intraoral or extraoral images that are not used in real time; also, known as the store and forward method, synchronous by use of real-time interactive technologies, such as video or photoconferencing, and mobile health care services via smartphone apps and text messages.All the process should be recorded in patients file for further information. Accurate triage is another prominent advantage of teledentistry, which is so important during COVID-19.For people in need of care like geriatrics or patients with special needs telemedicine can eliminate some barriers (6).Besides to teledentirstry’s advantages, especially in a situation like a pandemic infection even with very primary facilities teledentistry can be performed and be useful for triage. By introducing dentistry as a very dangerous discipline, teledentistry can play a very specific role to solve the majority of patients’ problems as a helpful facility in this crisis and may be it can also persuade policy makers to perform teledentistry in a vast program.

The coronavirus disease 2019 (COVID-19) pandemic has touched almost every continent. Personal protective equipment (PPE) is the final line of protection of healthcare workers (HCW). There is variation as well as controversy of infection control recommendation with regards to the use of PPE for HCW between institutions. The aim of this narrative review is to of examine and summarise the available evidence to guide recommendation for the safety of HCW. A literature search was conducted on the PubMed, MedLine, and Embase databases with the keywords “personal protective equipment”, “COVID 19”, “n95”, “health care worker”, and “mortality”. SARS-nCoV-2 is highly contagious. 3.5-20% of HCW has been reported to be infected. The mortality ranges from 0.53-1.94%. PPE is part of the measure within a package of prevention and control of pandemic, rather than a replacement of. Respirators are more effective than masks in preventing aerosol transmission to HCWs. Extended use may be considered if guidelines are adhered. PAPRs if available should be used in high risk procedures. Transmission of viruses is multimodal, and in the setting of a novel pathogen with high case fatality with no proven effective interventions, PPE that affords the best protection should be available to HCWs.

Background The WHO recommends testing any suspected person with Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV-2), in order to limit the spread of the epidemic. In Italy, some Regions opted for extensive testing, whereas others limited tests to selected subjects. To assess the influence of different strategies, we examined the incidence of death and severe cases in Italy. Methods Data on new cases of SARS-CoV-2, number of tests, deaths, and admissions to Intensive Care Units (ICU) were retrieved in each Italian Region, from February 24th to March 18th, 2020. As an index of different screening strategies, the number of tests/positive test results (T/P) ratio as of March 7th, 2020, was considered. The cumulative number of deaths and of new severe cases, between March 23thand 25th was recorded. The association of those two outcomes with the number of T/P ratio was assessed using linear regression models. Results In the interval between March 23th-25th, recorded deaths (*million inhabitants) were 14(3-54), whereas severe cases were 31(10-112). Both the number of deaths and that of severe cases showed a significant correlation (R2 .38 and .37, with p<.01) with the T/P ratio. Deaths and severe cases were associated with higher mean personal income and lower density of General Practioners (GPs). The association of T/P with severe cases and deaths retained statistical significance after adjusting for mean personal income (R2 .20 and .21, respectively; both p=.04) and GPs density (R2.22 and .21, respectively; both p=.03). Conclusions A more aggressive screening strategy for SARS-Cov-2, was associated with lower rates of death and severe disease in Regions of Italy.

SARS-CoV-2 has infected millions of people around the world, with most cases recorded among adults. The cases reported among children have been acknowledged to be minimal in comparison to adults. Nevertheless, COVID-19 has been reported to affect children at all ages, including newborns. The symptoms among children have also been identified to be similar to those observed among adults, although pediatric patients have been noted to display spectrum of clinical features ranging from asymptomatic through mild to moderate symptoms. Despite ample publications on the ongoing pandemic, the literature is only replete with guidelines on treating SARS-CoV-2 infection among older people. In this narrative review, comprehensive updates on the infection in children have been discussed. The latest information on the spread of the disease among children around the world, the clinical features observed among the pediatric population, as well as recommended pharmaceutical treatments of COVID-19 among this special group of patients have been covered. Further, expert consensus statements regarding the management of this highly contagious disease among pregnant women and neonates have been discussed. It is believed that this comprehensive review will provide updated information on the epidemiology and clinical features of the ongoing pandemic among pediatric patients. Additionally, the guidelines for handling SARS-CoV-2 among pregnant women and children, as reviewed in this article, are anticipated to be useful to frontline clinicians battling this fatal disease around the globe.

Background : Critically ill patients with coronavirus disease 2019（COVID-19）was surging and far outnumbered existing beds. Aims :  To describe how to rapidly convert general wards to intensive care units for critically ill patients with COVID-19. Materials & Methods :  Comprehensive assessment and analysis of available resources and standard requirements. Results : The ICUs were successfully assembled in four days. The conversion included environment reconstruction, configuration and management of equipment, information system construction and human resource allocation. A total of 172 critically ill patients had been admitted to the contemporary ICUs and none medical staff was infected. Discussion :  The epidemic situation of COVID-19 poses a great challenge to various management departments of the hospital, especially for critically ill patients with high mortality rate. To save more critically ill patients, the conversion of a general ward to a quarantine ICU ward must be completed in a short time, and the optimal allocation of resources must be appropriate to ensure that the medical team works effectively and is of high quality. In face of the overloaded medical system, the ideal non-negative pressure ward is hard to achieve. However, we have demonstrated with evidence that our conversions are effective in both providing care to the critical patients and protecting the safety of our staff. Conclusion:  The conversion is successful and the running experience would be a reference for hospitals in other areas nationally or globally.

AIM: to determine if patients with heart failure and preserved ejection fraction (HFpEF) and type 2 diabetes mellitus (T2DM) have a higher comorbidity burden than those without T2DM, if other comorbidities are preferentially associated with T2DM, and if these conditions confer a worse patient prognosis. METHODS AND RESULTS: Cohort study based on the RICA Spanish Heart Failure Registry, a multicenter, prospective registry that enrolls patients admitted for decompensated HF and follows them for 1 year. We selected only patients with HFpEF, classified as having or not having T2DM, and performed an agglomerative hierarchical clustering based on variables such as the presence of arrhythmia, chronic obstructive pulmonary disease, dyslipidemia, liver disease, stroke, dementia, body mass index (BMI), hemoglobin levels, estimated glomerular filtration rate, and systolic blood pressure. 1,934 patients were analyzed: 907 had T2DM (mean age 78.4+/-7.6 years) and 1,027 did not (mean age 81.4+/- 7.6 years). The analysis resulted in 4 clusters in patients with T2DM, and 3 in the reminder. All clusters of patients with T2DM showed higher BMI, and more kidney disease and anemia than those without T2DM. Clusters of patients without T2DM had neither significantly better nor worse outcomes. However, among the T2DM patients, clusters 2, 3 and 4 all had significantly poorer outcomes, the worst being cluster 3 (HR 2.0, 95% CI 1.36-2.93, p=0.001). CONCLUSIONS: Grouping our patients with HFpEF and T2DM into clusters based on comorbidities revealed a greater disease burden and prognostic implications associated with the T2DM phenotype, compared to those without T2DM.

Dear Editor,Since December 2019, coronavirus 2019 (COVID-19) has spread worldwide.1 Some data have suggested that the prevalence and mortality of COVID-19 are different among races. 2However, this analysis did not account for potential confounding factors.Since chronic kidney disease (CKD) is common, the number of COVID-19 patients with CKD will increase. However, there are scarce data about outcomes in CKD patients. We herein investigated the outcomes from COVID-19 in AAs compared to those in whites.We analyzed Mount Sinai Health System (MSHS) medical records up to April 5, 2020, using Epic SlicerDicer software. We extracted data from patients who had positive for the COVID-19 reverse-transcription polymerase chain reaction (RT-PCR) test. Sex, age, race, and comorbidities (hypertension, diabetes mellitus, ischemic heart disease, heart failure, and atrial fibrillation) were extracted using the 10th revision of the International Statistical Classification of Diseases code. Mortality and intensive care unit (ICU) admission were tracked through April 12, 2020. Relative risks (RR) and 95 % confidence interval (CI) in each race stratified by age groups and comorbidities were calculated using a Fisher’s exact test. MSHS waived Institutional Review Board approval since this research used only deidentified, aggregate-level data.During the study period, 1,269 AAs COVID-19 patients with 105 CKD patients and 1,450 whites COVID-19 patients with 80 CKD patients were detected. AAs were younger (median 66, IQR 55-76) than whites (median 75, IQR 65-83) (p< 0.001). There was no significant difference in mortality between AAs and whites (0.65 [0.36-1.15]). This tendency was observed after stratification by age and medical conditions. Similarly, AAs did not have an increased risk of ICU admission (0.84 [0.6-1.18])) even after stratification by age and comorbidities (Table).To the best of our knowledge, this is the first study that compared the risk of severe outcomes among races in CKD patients. Although it has been suggested that there might be racial disparity in COVID-19, our study did not show any significant differences in outcomes, even after stratifying patients by age and comorbidities. Our data suggested that we do not need to stratify these patients by race.The racial and ethnic diversity in NYC enabled us to investigate differences in outcomes among races in the same cohort. However, our study has several limitations. First, the number of patients was relatively small. Second, we did not access individual data, which prevented us from performing multivariate analyses. The fact that AAs were younger might mask differences among races.In conclusion, AAs with CKD did not have a higher risk of mortality or ICU admission than whites with CKD. This trend was consistent after stratification by age, sex, or comorbidities.Acknowledgements: noneConflict of Interest Disclosures: TY reports no conflict of interest. TM reports no conflict of interest. NC reports no conflict of interest. HM reports no conflict of interest. SC repots no conflict of interest. SM reports no conflict of interest.Reference1. Team CC-R. Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 - United States, February 12-March 28, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(13):382-386.2. Health N. Age adjusted rate of fatal lab confirmed COVID-19 cases per 100,000 by race/ethnicity group as of April 6, 2020 (Accessed Aprio 12, 2020). 2020.

Background: Macrophages play a crucial role in the pathogenesis of rheumatoid arthritis (RA). Growth differentiation factor-15 (GDF-15) acts as an autocrine regulator of macrophage activation. Objective: The aim of this study was to assess serum level of GDF-15 as a potential biomarker for detecting RA activity. Method: A total of 100 female RA patients and 55 age matched healthy control females were enrolled. The serum level of GDF-15 was measured using enzyme-linked immunosorbent assay by an eBioscience kit. Results: Serum levels of GDF-15 in RA patients with high, moderate, low and no disease activity were 989.0±161.9, 505.6±220.5, 349.2±155.9 and 349.0±144.0 pg/ml, respectively. GDF-15 with a cut-off value higher than 705 pg/ml was indicative of high RA activity with sensitivity of 96% and specificity of 92%. Conclusion: GDF-15 serum levels may be used as a biomarker to predict high RA disease activity.

Methods: We systemically and comprehensively retrieved the eligible study evaluating clinical difference between severe versus non-severe Covid-19. Main effect sizes were demography characteristics, comorbidities, signs and symptoms, laboratory findings as well as radiological features in chest CT. Results: 14 studies with a total of 2,566 individuals (771 in Severe group and 1,795 in Non-severe group) were eligible for this meta-analysis. It was demonstrated that older and male person was more susceptible to severe Covid-19. Patients with underlying comorbidity, such as hypertension, diabetes, heart disease and COPD were associated with significantly increased susceptibility of severe Covid-19. Patients with dyspnea were more likely to be severe illness. Depressed total lymphocytes were observed in this article. Meanwhile, although reticulation (30.8%), intrathoracic lymph node enlargement (56.4%) and pleural effusions (30.8%) were relatively rarely seen, meta-analysis revealed that patients with these presentations in chest CT were associated with increased risks of severe Covid-19. Conclusions: There are significant differences in clinical characteristic between the severe and non-severe Covid-19 patients. Many factors are related to the severity of the disease, which can help clinicians to differentiate severe patient from non-severe patient.

Aim: A worldwide pandemic of coronavirus disease 2019 (COVID-19) which emerged in China in December 2019 affects the world very seriously. We aimed to evaluate the benign prostatic hyperplasia (BPH) patients who were admitted and treated to our hospital due to COVID-19. Methods: Between March 18, 2020 and April 5, 2020 , 18 patients admitted with COVID-19 who has BPH and are using medication for this were included in the study and analyzed retrospectively. Diagnosis was confirmed by COVID-19 nucleic acid test by sampling sputum or nasopharyngeal swab. Standard COVID-19 treatment protocol determined by our Ministry of Health was applied to all patients according to their risk groups. Epidemiological, clinical, radiological features, additional diseases, laboratory tests, complications and outcome data of all patients were recorded. Results: Mean age of patients was 59.6 (range: 56-73). As the mode of transmission, 10 (55.5%) of patients were infected in hospital, 5 (27.7%) patients had a relative with COVID-19 and 3 (16,6%) was unknown. During follow-up, 2 (11.1%) patients were transferred to intensive care unit (ICU). One of these patients dramatically progressed and died. Patients who survived and were not transferred to ICU had lesser comorbidities and were relatively young. Mean duration of hospitalization was 14.2 days (range 12-19). Conclusion: We think that COVID-19 patients with BPH had a low mortality rate and did not have a poor prognosis in this patient group. It is crucial to take comprehensive preventive measures to control COVID-19 transmission via hospital route.

ABSTRACT Purpose In our study, we aimed to evaluate the sleep disorders, sleep quality of the patients who applied to family health centers, to determine the situations that might be related with insomnia and to determine the insomnia rates of the general population in primary care. Methods This study is a descriptive research and conducted in Ankara Güdül, Antalya Değirmenözü, Bursa Sırameşeler, Gaziantep Family Health Center policlinics. The study population consisted of all patients over 18 years of age who were admitted to the family health centers for any reason. A 10-question questionnaire, Berlin questionnaire, Pittsburgh sleep quality index and insomnia severity scales were collected by the researchers from October to December 2017 using face-to-face interview method. Results 299 people participated in study and 54.5% of them were women. According to the results of Pittsburgh Sleep Quality Scale, it was found that 27.1% of the participants’ sleep quality was good and 72.9% of them were poor; according to the Berlin sleep questionnaire, 27.4% had high OSAS risk and 72.2% had a low OSAS risk. According to total Insomnia Severity Index, 27.1% had insomnia lower threshold, 15.4% had moderate insomnia, 3.7% severe insomnia was detected. Conclusions In this context, it will be very effective in terms of the quality of life of patients in order to determine the conditions that disrupt sleep hygiene and to perform the necessary interventions which can be intervened in the primary health care institutions and the other patients to be delivered to the related upper levels.

Aim: The COVID pandemic is caused by infection with the SARS-CoV-2 virus. The major mutation detected to date in the SARS-CoV-2 viral envelope spike protein, which is responsible for virus attachment to the host and is also the main target for host antibodies, is a mutation of an aspartate (D) at position 614 found frequently in Chinese strains to a glycine (G). We sought to infer health impact of this mutation. Result: Increased case fatality rate correlated strongly with the proportion of viruses bearing G614 on a country by country basis. The amino acid at position 614 occurs at an internal protein interface of the viral spike, and the presence of G at this position was calculated to destabilize a specific conformation of the viral spike, within which the key host receptor binding site is more accessible. Conclusion: These results imply that G614 is a more pathogenic strain of SARS-CoV-2, which may influence vaccine design. The prevalence of this form of the virus should also be included in epidemiologic models predicting the COVID-19 health burden and fatality over time in specific regions. Physicians should be aware of this characteristic of the virus to anticipate the clinical course of infection. What is known about this topic? Nothing is known about the health significance of the D614G SARS-CoV-2 variant. What does this article add? A molecular clue to viral molecular pathogenesis of COVID-19 disease.

Introduction Erectile Dysfunction (ED) is common in older age and in diabetes (DM). Phosphodiesterase type 5-inhibitors (PDE5-is) are the first-line for ED. We investigated how type of diabetes and age of males affects the PDE5-i use in the primary care setting. Methods 2018-19 general practice level quantity of all PDE5-i agents were taken from the GP Prescribing Data set in England. The variation in outcomes across practices was examined across one year, and for the same practice against the previous year. Results We included 5,761 larger practices supporting 25.8million men of whom 4.2million≥65 years old. Of these, 1.4million had T2DM, with 0.8million of these>65. 137,000 people had T1DM. 28.8million tablets of PDE5-i were prescribed within the 12 months (2018-19) period in 3.7million prescriptions (7.7 tablets/prescription), at total costs of £15.8million (£0.55/tablet). The NHS ED limit of 1 tablet/user/week suggests that 540,000 males are being prescribed a PDE5-i at a cost of £29/year each. With approximately 30,000 GPs practising, this is equivalent to one GP providing 2.5 prescriptions/week to overall 18 males. There was a 3x variation between the highest decile of practices (2.6 tablets/male/year) and lowest decile (0.96 tablets/male/year). The statistical model captured 14% of this variation and showed T1DM males were the largest users, while men age<65 with T2DM were being prescribed 4 times as much as non-DM. Those T2DM>65 were prescribed 80% of the non-DM amount. Conclusion There is wide variation in use of PDE5-is. With only 14% variance capture, other factors including wide variation in patient awareness, prescribing rules of local health providers, and recognition of the importance of male sexual health by GP prescribers might have significant impact.

A document by İzzet Fidancı. Click on the document to view its contents.

The 2019–20 coronavirus (COVID-19) pandemic was affirmed to have spread to Bangladesh on March 2020. The initial three known cases were accounted for by the nation’s Institute of Epidemiology, Disease Control and Research (IEDCR) on 7 March 2020. As of 15th April 2020, the Government of Bangladesh has reported that there is a total of 1,231 confirmed cases, 49 recoveries, and 50 deaths in the whole country. In this research, I try to forecast the COVID-19 outbreak in Bangladesh by using a well-known epidemiological model, Susceptible-Infectious-Recovered (SIR) model.

COVID-19 is a disease which is sweeping the globe, often with devastating consequences. The more we understand, the more it appears that infection has a very wide clinical spectrum from totally asymptomatic to life threatening. Without widespread community testing it is impossible to ascertain true infection rates and develop strategies which reduce or prevent transmission without the need for on-going draconian measures such as complete national lockdown. These measures are mandatory at the time of writing, however widespread adoption of face masks has been shown to help prevent transmission of other respiratory pathogens, and also infections acquired by healthcare staff. Combining mass testing with a combination of social distancing and face mask use might offer a way forward until a mass COVID-19 vaccination programme can be established.

Background: Fangcang hospital (cabin hospitals) played a key role in isolation and control of the infection sources during COVID-19 epidemic. The patients at Fangcang hospitals were complicated, and many had different symptoms of COVID-19, some had comorbidities or mental stress, and many were confused with the drug usages etc. Objective: Due to the limitation and high work pressure of first line medical workers, patients’ various problems couldn’t be explained well. Under this circumstance, online pharmaceutical care was provided by clinical pharmacists. This study was a retrospective study to evaluate the role and usefulness of clinical pharmacists at Jianghan Fangcang Hospital. Besides, this new mode of service was also introduced in detail to provide options for pharmacists in other hospitals. Methods: The pharmaceutical care included medication education via broadcast station, and medication reconciliation, optimization of drug use, monitor of adverse drug events, and psychological comfort via WeChat® one-to-one service. In this study, we analyzed patients’ characteristics and drug usages, concluded almost 200 patients’ problems classified into 6 aspects solved by clinical pharmacists, and also assessed the patients’ satisfaction with our service. Results: The clinical pharmacist help patients solved almost 200 questions, which mainly focused on the drug related problems including drug usage (65.38%), medication reconciliation (55.13%), drug precautions (23.1%), adverse drug reactions (35.9%), and psychological counseling (32.05%). Through 35 days’ services, Most patients were satisfied with clinical pharmacist service(66.7%great, 18.0%good). Besides, most patients thought the service had positive effect on their mental stress(16.7%great, 43.6%good, 26.9%fair). Conclusion: The results of the retrospective study indicated that clinical pharmacist can effectively reduce and prevent drug-related, life-related and COVID-19-related problems for COVID-19 patients. This work may provide possible work patterns for clinical pharmacist in other hospital and give more professional service for Fangcang hospital patients.