• COVID-19

ABSTRACT Acute appendicitis (AA) is a frequent cause of abdominal pain requiring surgical treatment. During the COVID-19 pandemic, surgical societies considered other therapeutic options due to uncertainties in the evolution of the disease. The purpose of this study is to assess the treatment of AA by members of two Brazilian surgical societies in this period. A common questionnaire was sent in 2020. There were 382 responses. Most surgeons had more than 15 years of profession (68.3%) and treated more than five cases per month (44.8%). About 72.5% would indicate chest CT to investigate COVID-19 in patients with AA. For those patients sustaining uncomplicated AA, without COVID-19, 60.2% would indicate laparoscopic appendectomy (VLA), followed by open appendectomy (OA) (31.7%) and non-operative management (NOM) (1.3%). For those with mild COVID-19, OA was suggested by 51.0%, followed by VLA (29.6%) and NOM (6.0%). For those with severe COVID-19, OA was proposed by 35.3%, followed by NOM (19.9%) and VLA (18.6%). For patients with periappendiceal abscesses, without COVID-19, VLA was suggested by 54.2%, followed by OA (33.2%) and NOM (4.4%). For those with mild COVID-19, OA was proposed in 49.5%, followed by VLA (29.3%) and NOM (8.9%). In those with severe COVID-19, OA was proposed in 36.6%, followed by NOM (25.1%) and VLA (17.3%). This information, based on two recognized Brazilian surgical societies, can help the surgeon to select the best approach individually. RESUMO A apendicite aguda (AA) é causa frequente de abdome agudo cirúrgico. Durante a pandemia de COVID-19, devido às incertezas na evolução da doença, sociedades consideraram outras opções terapêuticas. Nosso objetivo é descrever o tratamento da AA por membros do CBC e SBAIT neste período. O questionário foi enviado em 2020. Houve 382 respostas. A maioria dos profissionais tinha mais de 15 anos de profissão (68,3%) e atendia mais de cinco casos por mês (44,8%). Cerca de 72,5% realizariam TC de tórax para investigação de COVID-19 em pacientes com AA. Nos com AA não complicada, sem COVID-19, 60,2% optariam pela apendicectomia videolaparoscópica (AVL), seguido de apendicectomia aberta (AAB) (31,7%) e tratamento não operatório (TNO) (1,3%). Nos com COVID-19 leve, AAB foi proposta por 51,0%, seguido da AVL (29,6%) e TNO (6,0%). Nos com COVID-19 grave, a AAB foi proposta por 35,3%, seguido de TNO (19,9%) e AVL (18,6%). Nos com AA complicadas com abscesso, sem COVID-19, AVL foi sugerida por 54,2%, seguida da AAB (33,2%) e TNO (4,4%). Nos com COVID-19 leve, a AAB foi proposta em 49,5%, seguidos da AVL (29,3%) e TNO (8,9%). Nos com COVID-19 grave, a AAB foi proposta em 36,6%, seguido de TNO (25,1%) e AVL (17,3%). Estas são opções de cirurgiões de duas sociedades cirúrgicas reconhecidas e podem auxiliar o colega que está na linha de frente a definir a melhor conduta individualmente.

臨床・病理・血清学的にネコ伝染性腹膜炎(FIP)と診断され死亡したネコ4例および仔ネコの実験接種例14例について, 腸病変とウイルス抗原あるいはウイルス粒子の所在を検索した. 自然例2例および実験例12例が下痢を発した. 多くの病例の小腸・大腸粘膜は水腫性に肥厚し, 腸内容は水様～粘液状であった. 自然例3例および実験例12例の小腸・大腸病変は粘膜上皮の変性・剥離・増生を特徴とする比較的表在性の変化で, 固有層には浮腫, 少数の好中球お上び単核細胞浸潤がみられ, 隣接上皮細胞相互の癒合もしばしばみとめられた. しかし, 他の自然例1例および実験死亡例2例では, 小腸・大腸ともに炎症病変は激しく粘膜深部に及んでいた. これらの自然例および実験例の腸上皮細胞細胞質にはウイルス特異蛍光がみられ, 電顕ではコロナウイルス粒子が検出された. コロナウイルス粒子は自然例および実験例の糞便中にも検出された. 以上のことから, 腸病変部から排出されたウイルスが糞便を介して伝播する可能性が示唆された.

The coronavirus family (Coronaviridae) is a positive-sense single-stranded RNA, with a size of 27 kb. These viruses have a potential species specificity and interspecies transmission. The interspecies transmission of viruses from one host species to another is a major factor responsible for the majority of emerging and reemerging infections. The Coronaviridae is one of the most popular emerging viral families that threaten to the public health.

Coronaviridae Study Group of the International Committee on Taxonomy of Viruses* The present outbreak of a coronavirus-associated acute respiratory disease called coronavirus disease 19 (COVID-19) is the third documented spillover of an animal coronavirus to humans in only two decades that has resulted in a major epidemic. The Coronaviridae Study Group (CSG) of the International Committee on Taxonomy of Viruses, which is responsible for developing the classification of viruses and taxon nomenclature of the family Coronaviridae, has assessed the placement of the human pathogen, tentatively named 2019-nCoV, within the Coronaviridae. Based on phylogeny, taxonomy and established practice, the CSG recognizes this virus as forming a sister clade to the prototype human and bat severe acute respiratory syndrome coronaviruses (SARS-CoVs) of the species Severe acute respiratory syndrome-related coronavirus, and designates it as SARS-CoV-2. In order to facilitate communication, the CSG proposes to use the following naming convention for individual isolates: SARS- CoV-2/host/location/isolate/date. While the full spectrum of clinical manifestations associated with SARS-CoV-2 infections in humans remains to be determined, the independent zoonotic transmission of SARS-CoV and SARS-CoV-2 highlights the need for studying viruses at the species level to complement research focused on individual pathogenic viruses of immediate significance. This will improve our understanding of virus–host interactions in an ever-changing environment and enhance our preparedness for future outbreaks. pon U a viral outbreak, it is important to rapidly establish whether the outbreak is caused by a new or a previously known virus (Box 1), as this helps decide which approaches and actions are most appropriate to detect the causative agent, con- trol its transmission and limit potential consequences of the epi- demic. The assessment of virus novelty also has implications for virus naming and, on a different timescale, helps to define research priorities in virology and public health. For many human virus infections such as influenza virus 1 or norovirus 2 infections, well-established and internationally approved methods, standards and procedures are in place to identify and name the causative agents of these infections and report this infor- mation promptly to public health authorities and the general public. In outbreaks involving newly emerged viruses, the situation may be different, and appropriate procedures to deal with these viruses need to be established or refined with high priority. Here, we present an assessment of the genetic relatedness of the newly identified human coronavirus 3, provisionally named 2019- nCoV, to known coronaviruses, and detail the basis for (re)naming this virus severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2), which will be used hereafter. Given the public interest in nam- ing newly emerging viruses and the diseases caused by these viruses in humans, we will give a brief introduction to virus discovery and classification — specifically the virus species concept — and the roles of different bodies, such as the World Health Organization (WHO) and the International Committee on Taxonomy of Viruses (ICTV), in this process. We hope this will help readers to better understand the scientific approach we have taken to arrive at this name, and we will also discuss implications of this analysis and naming decision. Classifying and naming viruses and virus species Defining the novelty of viruses is one of the topics that virus classification deals with. The classification of RNA viruses needs to consider their inherent genetic variability, which often results in two or more viruses with non-identical but similar genome sequences being regarded as variants of the same virus. This immediately poses the question of how much difference to an existing group is large enough to recognize the candidate virus as a member of a new, distinct group. This question is answered in best practice by evaluating the degree of relatedness of the candidate virus to previously identified viruses infecting the same host or established monophy- letic groups of viruses, often known as genotypes or clades, which may or may not include viruses of different hosts. This is formally addressed in the framework of the official classification of virus taxonomy and is overseen and coordinated by the ICTV 4. Viruses are clustered in taxa in a hierarchical scheme of ranks in which the spe- cies represents the lowest and most populous rank containing the least diverged groups (taxa) of viruses (Box 2). The ICTV maintains a Study Group for each virus family. The Study Groups are respon- sible for assigning viruses to virus species and taxa of higher ranks, such as subgenera, genera and subfamilies. In this context they play an important role in advancing the virus species concept and highlighting its significance 5. Virus nomenclature is a formal system of names used to label viruses and taxa. The fact that there are names for nearly all viruses within a species is due to the historical perception of viruses as causative agents of specific diseases in specific hosts, and to the way we usually catalogue and classify newly discovered viruses, which increasingly includes viruses that have not been linked to any known disease in their respective hosts (Box 1). The WHO, an agency of the United Nations, coordinates international public health activities aimed at combating, containing and mitigating the consequences of communicable diseases—including major virus epidemics—and is responsible for naming disease(s) caused by newly emerging human viruses. In doing so, the WHO often takes the traditional approach of linking names of specific diseases to viruses (Box 1) and *A list of authors and their affiliations appears at the end of the paper. assessing virus novelty by an apparent failure to detect the causative agent using established diagnostic assays. Apart from disease, geography and the organism from which a given virus was isolated also dominate the nomenclature, occasionally engraving connections that may be accidental (rather than typical) or even stigmatizing, which should be avoided. Establishing a universal nomenclature for viruses was one of the major tasks of the ICTV when it was founded more than 50 years ago 4. When the species rank was established in the taxonomy of viruses 6, ICTV’s responsibility for naming viruses was shifted to naming and establishing species. ICTV Study Groups may also be involved in virus naming on a case-by-case basis as an extension of their official remit, as well as using the special expertise of their members. As virus species names are often very similar to the name of the founding member of the respective species, they are frequently confused in the literature with names of individual viruses in this species. The species name is italicized, starts with a capital letter and should not be spelled in an abbreviated form 7; hence the species name Severe acute respiratory syndrome-related coronavirus. In contrast, this convention does not apply to virus names, hence severe acute respiratory syndrome coronavirus, or SARS-CoV, as it is widely known. {"references": ["1. Krammer, F. et al. Influenza. Nat. Rev. Dis. Primers 4, 3 (2018).", "2. Zheng, D. P. et al. Norovirus classification and proposed strain nomenclature. Virology 346, 312 - 323 (2006).", "3. Wu, A. et al. Genome composition and divergence of the novel", "5. Gorbalenya, A. E., Lauber, C. & Siddell, S. Taxonomy of Viruses, in Reference Module in Biomedical Sciences (Elsevier, 2019) https: // doi. org / 10.1016 / B 978 - 0 - 12 - 801238 - 3.99237 - 7.", "49. ICD- 11 (World Health Organization, 2018).", "4. Adams, M. J. et al. 50 years of the International Committee on Taxonomy of Viruses: progress and prospects. Arch. Virol. 162, 1441 - 1446 (2017).", "6. Van Regenmortel, M. H., Maniloff, J. & Calisher, C. The concept of virus species. Arch. Virol. 120, 313 - 314 (1991).", "7. ICTV Code. The International Code of Virus Classification and Nomenclature https: // talk. ictvonline. org / information / w / ictv-information / 383 / ictv-code (2018)."]} Published as part of Gorbalenya, Alexander E., Baker, Susan C., Baric, Ralph S., de Groot, Raoul J., Drosten, Christian, Gulyaeva, Anastasia A., Haagmans, Bart L., Lauber, Chris, Leontovich, Andrey M., Neuman, Benjamin W., Penzar, Dmitry, Perlman, Stanley, Poon, Leo L. M., Samborskiy, Dmitry V., Sidorov, Igor A., Sola, Isabel & Ziebuhr, John, 2020, The species Severe acute respiratory syndromerelated coronavirus: classifying 2019 - nCoV and naming it SARS-CoV- 2, pp. 536-544 in Nature Microbiology 5 on pages 536-537, DOI: 10.1038/s41564-020-0695-z, http://zenodo.org/record/3725837

This chapter will describe the biological nature of viruses belonging to the Coronaviridae family. Coronavirus disease or COVID-19 which, with its ever-expanding attack around the globe has become the topic of discussion of the current era. The disease is caused by a SARS-CoV-2 virus which belongs to the Coronaviridae family. This family of the virus has a history of pandemic significance through its attacks of SARS and MERS since the year 2000. They are known to have affinity towards respiratory tract and any disease that erupts out of their group have caused mild and severe respiratory infections globally. Thus, understanding the virus by learning the characteristics of its familial strain will help us to combat their attack even after mutation in the future. This chapter also discusses the pathogenesis of each virus organism in this family, as well as their clinical characteristics and diagnostics, in order to understand their disease-causing pattern and the efficacy of vaccination in mitigating the worst outcomes of the disease.