Here, we report a case of acute liver failure and a drastic increase of liver enzyme in a pediatrician with COVID-19 infection without a history of preexisting liver disease. Unfortunately, the patient passed away several days after intensive care unit (ICU) admission.

In the last two years, SARS-CoV-2 infection, commonly called COVID-19, has taken a jump from being rarely talked about to becoming a household name. Making it to history as the 5th global pandemic, this public health crisis has taken millions of lives all over the world. Right from the time of identification of patient zero, the pandemic has been a series of waves of infection, causing a domino effect whose impact has been felt in all walks of life. Global efforts have been underway to combat this pandemic and minimize its repercussions, resulting in the development of efficient vaccines and drugs to control and treat the disease. However, making the benefits of these efforts available to everyone and walking the path towards the end of the pandemic remains a challenge. Keeping this in view, this review intends to present aspects of sequential development of the pandemic, different types of variants, risks associated with different categories of population, drugs currently in use, recent advancements in diagnostics and treatment, and the challenges that continue to remain in overcoming this pandemic. However, the task of controlling and managing the impact of such a massive pandemic goes well beyond the boundaries of what present-day technology in the field of medicine and health-care can offer. A collaborative and integrative approach between academic, scientific, social, and economic factors, along with close supervision and reinforcement of the current public safety protocols, can help to ensure a better management strategy to control the progression of COVID-19.

Drinking water sources have higher water quality requirements because of their special uses. Many drinking water sources in the world have been polluted or are being polluted for a long time, resulting in eutrophication. We define the approaches that have been developed in the last 10 years and achieved good effect as innovative restoration approaches. In this paper, the traditional, and frequently used restoration approaches in recent 30 years were briefly reviewed, and the innovative technologies and methods were summarized and evaluated in detail. In light of the impact of COVID-19, we have also put forward rational suggestions on water quality restoration of transboundary rivers to provide scientific reference for global public health safety and protection.

Myositis is one of the uncommon adverse events following COVID--19 vaccination, and its mechanism is still unclear. In the hope of aiding in its better understanding, we present a case of myositis following the first dose of the ChAdOx1 nCoV-19 Corona Virus Vaccine, evidenced by serology and MRI.

A document by Hong Liu. Click on the document to view its contents.

COVID-19 showed different characteristics and many cases showed clinical manifestations that could not be attributed to other conditions. We present a 22-year-old female had an uneventful recovery from COVID-19 and after that, she developed a cytokine storm and a worsening clinical condition two days after dental root canal therapy.

Background: In the face of this threatening epidemic, the health behaviors of people gain great importance in terms of both minimizing the prevalence and reducing possible life losses. perception of health affects health behavior. Psychological resilience is key in combating a challenging situation that threatens both physical and psychological health. Objective: This study was aimed to examine the correlation between psychological resilience and health perception in terms of some variables in the case of the COVID-19 pandemic. Methods: This cross-sectional study was carried out using quantitative and general screening models. In data collection, an Individual Information Form, the Brief Resilience Scale (BRS) and the Perception of Health Scale (PHS) were used. Results: The participants had a mean age of 33.24 ± 10.95, with 35.7% males. Mean scores were 52.68 ± 6.80 for PHS and 20.11 ± 4.24 for BRS. We found that the health perceptions of the participants increased in parallel with their psychological resilience (p<0.05). Conclusion: The participants were found to have moderate levels of health perception and psychological resilience. Their measures against the epidemic and certain socio-demographic characteristics led to differences in their psychological resilience and health perceptions. Knowing the psychological resilience and health perceptions of individuals can improve the quality of treatment and care.

The ongoing COVID-19 pandemic has highlighted the central role of diagnostic tests in pandemic control. Although reverse transcriptase quantitative real-time PCR (RT-qPCR) is the gold standard for the diagnosis of COVID-19, several rapid antigen tests (RAT) have been commercialized as rapid point-of-care diagnostics. To the best of our knowledge, there are limited data on the effect of patient’s clinical and laboratory parameters on RAT performance and no studies exist that tested the importance of combining laboratory measurements in patient’s blood in enhancing the performance of RAT. Here we tried to fill these gaps by evaluating the diagnostic performance of the RAT “Standard ™ Q COVID-19 Ag” in participant’s subgroups studying the influence of viral load, sampling time-post symptoms, clinical and laboratory features on test performance. Eighty-three nasopharyngeal and oropharyngeal swabs were tested for sever acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) by both RT-qPCR and RAT. Diagnostic accuracy of the RAT was evaluated for participant’s subgroups that have various features. Support vector machine model was then used to investigate whether laboratory measurements in subject’s blood would enhance the predictive accuracy of this RAT. The sensitivity, specificity and accuracy of the RAT were 78.2, 64.2 and 75.9%, respectively. Samples with high viral load and those that were collected within one week post-symptom showed the highest sensitivity and accuracy. Measuring Laboratory indices did not enhance the predictive accuracy of this RAT. It is concluded that “Standard ™ Q COVID-19 Ag” should not be used alone for COVID-19 diagnosis due to its low diagnostic performance. This RAT is best used at early disease stage and in patients with high viral load.

Morbidity and mortality due to COVID-19 is due to0 severe acute respiratory distress syndrome(SARDS). Majority of victims dies on way to hospital or in ambulance for want of oxygen and ventilator bed. Here we report A case recovered without oxygen irrespective of oxygen saturation 74%.

The COVID-19 pandemic is a major health issue and patients with underlying conditions are more susceptible to catastrophic outcomes. Toxic epidermal necrolysis (TEN) is a severe systemic disease caused by immune system hypersensitive reaction. We present a case of TEN that later complicated with COVID-19,Deep Vein Thrombosis(DVT),Pulmonary Emboli(PE),and death.

Background: The coronavirus disease 2019 pandemic (COVID-19) has caused an unprecedented upsurge in the publication of scientific studies as the global community has collaborated to control the spread of the disease. Methods: We conducted a bibliometric analysis to evaluate the research trends and identify the core content based on publication output, the geographic distribution, collaborations and keywords. We searched for articles published from 1900 to June 30, 2020 based on the Science Citation Index Expanded (SCIE) and Social Sciences Citation Index (SSCI) in the Web of Science. Results: Our analysis revealed the following: (1) The number of publications clearly increased after the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) outbreaks and sharply increased during the COVID-19 outbreak. Compared with SARS and MERS, COVID-19 generated a more dramatic and prolonged upsurge in publication. (2) Compared with SARS and MERS, COVID-19 had a more widespread and powerful effect on countries and territories, with a rapid onset. Countries and territories engaged in more international collaboration and communication to cope with the epidemics, and the COVID-19 pandemic led to marked increases in research advancements. (3) Based on the keywords, we found that multiple methods were used to address the COVID-19 pandemic that were based on biology, especially the immune response. Conclusions: Epidemics lead to an extreme acceleration and changes in research.

The coronavirus diseases 2019 (COVID-19) pneumonia may cause cystic features of lung parenchyma which can resolve or progress to larger blebs. Spontaneous pneumothorax (SP) was reported as a complication of COVID-19 with an incidence of 1% in hospitalized patients, in 3% of patients hospitalized with pneumonia, in 6% mechanically ventilated patients and in 1% of decased patients. Pneumothorax was more likely in patients with neutrophilia, severe lung injury and a prolonged clinical course. We present 11 cases of SP managed with chest tube thoracostomy (CTT) or high dose oxygen therapy. Isolated SP was detected in all cases. Eight cases were male and three cases were female. There were bilateral ground-glass opacities or pulmonary infiltrates in the parenchyma of the ten cases. We detected neutrophilia, lymphopenia and increased CRP, Ferritin, LDH, D-Dimer, IL-6 levels in almost all cases. CTT was sufficient to treat pneumothorax in our nine of case. In two cases, pneumothorax healed with high dose oxygen therapy. Favipiravir and antibiotic treatment were given to different ten patients. In our institution, all patients with COVID-19 infection were placed on prophylactic or therapeutic anticoagulation, unless contraindicated. The treatments of patients diagnosed with secondary spontaneous pneumothorax during the pandemic period and those diagnosed with secondary spontaneous pneumothorax in the previous three years were compared with the durations of tube thoracostomy performed in both groups. The increased number of cases of pneumothorax suggests that pneumothorax may be a complication of covid-19 infection. During medical treatment of covid-19, pneumothorax may be the only reason for hospitalization. Although tube thoracostomy is a sufficient treatment option in most cases, clinicians should be aware of the difficulties that may arise in diagnosis and treatment.

Letter to the editor

COVID-19 outbreak is the recently reported worldwide pandemic threat. As part of our interventions with molecular simulation approaches, we report the inhibitory effect of thirty compounds reported from the sacred plant Aerva lanata and compare their activity with the one of the present medication, hydroxy chloroquine, on the main protease (PDB:6YB7) of SARS-CoV-2. Our studies pointed out the effectiveness of the plant with twenty seven compounds having potential activity against the main protease compared to the reference HCQ. The robustness of some of the phytochemicals such as ervoside, which is only present in Aerva lanata computed to have very high anticoronavirus activity. The results are indicative of potential natural antivirus source, which subsidizes in thwarting the invasion of coronavirus into the human body. Many phytochemicals which are computed to be effective towards SARS-CoV-2 in this study are used as drugs for various other diseases. Perhaps these compounds could be attractive for the management of COVID-19, but clinical trials must be performed in order to validate this observation.

At the beginning of the Coronavirus disease (COVID-19) pandemic due to the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), scientists primarily have focused on diagnostic tests. At the 9th month of the pandemic, discussions are being continued on preventive and therapeutic drugs. Meanwhile, vaccine development strategies like “operation warp speed” gave their early results in developed countries. Nowadays, these vaccines are at the forefront of the world health agenda. Numerous social media posts, conspiracy theories, and some health professional’s statements that raise vaccination hesitancy are the equipment of anti-vaxxers propaganda. On the other hand, declarations like ballyhoo of nationalism with the claims of scientific quacksalvers have intertwined, and that has been led to the loss of trust in the scientific community to the vaccine. We have to admit that this propaganda has affected millions of people in an unwanted direction. Scientific declarations have to rely on researches that have accurate and reliable statistical methods supported with basic biological knowledge. Scientific research results should be disclosed transparently and its methods must have reproducibility to provide replicability. Here, we scrutinize the biological features of the respiratory transmitted and successfully prevented measles virus (MV) and variola virus (smallpox virus) and their vaccines to compare them with the SARS-COV-2 virus and vaccine. Next, we will discuss the statistical details of measuring the effectiveness of an improved vaccine.

Thrombotic complications of SARS-CoV-2 have been increasingly recognized as an important component of COVID-19 in adults; however, they have been less evident in children. We report a case of a teenager with positive SARS‐CoV‐2 RT–PCR and underlying prothrombotic risk factors, including aromatase inhibitor therapy, who developed deep vein thrombosis resulting in pulmonary embolism. Laboratory tests revealed deranged coagulation parameters (high D-dimers and Factor VIII and low antithrombin). The patient required intensive care and was managed with anticoagulants, dexamethasone and antithrombin concentrate. Clinical condition and hemostatic profile gradually improved. A review of the available literature for similar cases is presented.

SARS coronavirus 2 (SARS-CoV-2) in the viral spike (S) encoding a SARS-COV-2 SPIKE D614G mutation protein predominate over time in locales revealing the dynamic aspects of its key viral processes where it is found, implying that this change enhances viral transmission. It has also been observed that retroviruses infected ACE2-expressing cells pseudotyped with SG614 that is presently affecting a growing number of countries markedly more efficiently than those with SD614. The availability of newer powerful computational resources, molecular modeling techniques, and cheminformatics quality data have made it feasible to generate reliable algebraic calculations to design new chemical entities, merging chemicals, fragmentizing natural products, and a lot of other substances fuelling further development and growth of this AI-quantum based drug design field to balance the trade-off between the structural complexity and the quality of such biophysics predictions that cannot be obtained by any other method. In this paper, we strongly combine topology geometric methods targeting at the atomistic level the protein apparatus of the SARS-COV-2 virus that are simple in machine learning anti-viral characteristics, to propose computer-aided rational drug design strategies efficient in computing docking usage, and powerful enough to achieve very high accuracy levels for this in-silico effort for the generation of the AI-Quantum designed molecule the RoccustyrnaTM small molecule, a multi-targeting druggable scaffold 2‐({[fluoro({[(2E)‐5‐oxabicyclo [2.1.0]pentan‐2‐ylidene]cyano‐lambda6‐sulfanyl}) methyl]phosphorylidene} amino)-4,6‐dihydro‐1H‐purin‐6‐onetargeting the COVID-19-SARS-COV-2 SPIKE D614G mutation using Chern-Simons Topology Euclidean Geometric in a Lindenbaum-Tarski generated QSAR automating modeling and Artificial Intelligence-Driven Predictive Neural Networks.

It is thought that all of the rich content in the present-day Universe based on an array of recent observations developed through gravitational amplification of primeval density fluctuations generated in the very early phase of cosmic evolution. In this paper, we strongly combine machine learning characteristics to achieve very high accuracy levels for the in-silico generation of the RoccuffirnaTM small molecule, a ligand targeted the SARS-COV-2 virus main protease (M pro ) using Quantum Kerr-(A)dS and Myers–Perry black microBlackHole-Inspired Gravitational for both Euclidean and Lorentzian signatures in Practice. We provide also an extensive toolbox of methods for performing quantum schrodinger inspired docking algorithms, teleportation and other information-theoretic tasks in MathCast programming language, and compared these algorithms by means of mean percentile free energy ranking, in a new recall-based evaluation metric for the in-silico design of the Novel Series of the RoccuffirnTMQMMMCoRoNNARRFr anti-(nCoV-19) ligands. In this paper we in-silico designed new drug leads that target the COVID-19 virus main protease (M pro ). M pro, a key CoV enzyme, which plays a pivotal role in mediating viral replication and transcription, and discuss various general results including Galilean transformation to a rigid QMMM heuristic horizon topology, and near-horizon fragmentation symmetry ranging from supergravity theories to Lorentzian signatures in order to enhance the Roccuffirna’s gravity to trap the SARS-COV-2 viruses in practice.

Since the beginning of the current coronavirus 2019 (COVID-19) outbreak, an intense number of studies have been done in an attempt to discover effective therapies, not only from the point of view of discovering new drugs, but also from its repurposing. Recent studies have proposed tranexamic acid (TXA), a hemostatic drug widely used in clinical practice, as a potential therapeutic option for COVID-19 as it reduces plasmin levels. Thus, this letter to the editor aims to provide a critical overview on the use of TXA in the treatment of the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection.

Objective: Preoperative testing for COVID-19 has become widely established to avoid inadvertent surgery on patients with COVID-19 and prevent hospital outbreaks, however, there is limited evidence underpinning new protocols. We wished to study the effectiveness of preoperative COVID-19 testing during and after the first wave of the pandemic in Ireland. Design Prospective cohort study. Setting: 2 university hospitals in the Republic of Ireland. Participants: Patients undergoing otolaryngology surgery and the otolaryngologists performing surgery. Main outcome measure: Incidence of COVID-19 within 30 days of surgery. Results: 173 patients (56% male) were recruited. 123 (71%) patients “cocooned” for 14 days prior to surgery. All patients completed a questionnaire prior to hospital admission. 156 patients (90%) had reverse transcriptase-polymerase chain reaction (RTPCR) nasopharyngeal swabs, 14 patients (8%) had CT thorax. No cases of COVID-19 were detected among patients followed up at 30 days. Two surgeons developed COVID-19 early during the study period not considered to be related directly to contact within the hospital. Conclusion: Current pre-operative testing protocols consisting primarily of questionnaires and RT-PCR resulted in zero cases of COVID reported in this cohort. It is possible that COVID-19 restrictions and high proportion of patients cocooning preoperatively were factors in ensuring a low rate of COVID-19 postoperatively. Ongoing data collection is required to confirm these findings in the setting of further disease surges.

Introduction: COVID-19 pandemic caused by the novel coronavirus SARS-CoV-2 increasingly involves people worldwide. Probiotics can improve immune system functions via different mechanisms. We proposed that Synbiotic Lactocare® may also reduce SARS-Cov2 infection in high risk medical staff working in COVID-19 hospital wards. Method: In a randomized, controlled trial, 60 hospital staff without any history of clinical or laboratory evidence of SARS-Cov2 infection were received either once daily oral synbiotic capsule (Lactocare®) that contains 1 billion CFU/Cap of L. (Lactobacillus) casei, L. rhamnosus, Streptococcus thermophilus, Bifidobacterium breve, L. acidophilus, Bifidobacterium infantis, L. bulgaricus, and Fructooligosacharide (Zist Takhmir, Tehran, Iran) or placebo with the same appearance for 30 days. They were followed for two months. Result: During the two month period of this study, SARS-COV-2 RT-PCR test results were positive in three participants (9.67%) in placebo group compared to zero positive test in synbiotic group. The differences were not statistically significant (p= 0.238). During the study, two persons (7 %) of placebo group had respiratory complaint such as cough, rhinorrhea and/or dyspnea, compared with one in synbiotic group (p= 0.492). Conclusion: This study showed that overall frequency of SARS-COC2 infection in participants receiving synbiotic and those receiving placebo did not differ significantly. However, 3 hospital staff in placebo group compared to no one in synbiotic group had SARS-COV2 infection. Further studies with greater power and alternative probiotic strains and mixture are warranted to determine whether Synbiotic can prevent COVID-19 in at-risk hospital staff. Keywords: COVID-19, Synbiotic, prevention, Lactocare, SARS-Cov2

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a member of the Coronaviridae family that causes the novel coronavirus disease (COVID-19). SARS-CoV-2 is an RNA enveloped virus that firstly emerged in Wuhan, China, in December 2019 over the 21st century. It is rapidly spread by human-to-human transmission through droplets or airborne particles. COVID-19 can be complicated by acute respiratory distress syndrome (ARDS) and severe pneumonia, depending on ACE2 and Spike protein (as viral surface protein). It is required a proper defense mechanism for the body to be healthy in fighting back against infectious diseases, especially COVID-19. Since there are no wholly approved drugs, vaccines, or clinical prevention for this disease at the moment, it is essential to focus on natural resistance systems, which play critical roles in supporting the immune system defense function against COVID-19. The severity of COVID-19 is characterized by an increase in acute phase reactants and pro-inflammatory cytokines; ferritin, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and IL-1β. Numerous shreds of evidence propose that immune homeostasis, genetic susceptibility, dietary interventions, supplementation, and the environment can have an imperative role in controlling the severity of SARS-CoV-2 infection and infected patients’ prognosis. In the current study, we proposed a comprehensive overview of the considerable part of natural resistance in the COVID-19 forecast, whether it may afford protection to COVID-19. All in all, multidisciplinary investigations have been done and need to be done to identify the clinical implications of natural interventions and natural resistance potential in COVID-19 susceptibility

Introduction With the COVID-19 pandemic, a “new normal” on how surgeons and intensivists perform tracheotomy in COVID-19 patients is essential. We aim to summarize the recommendations and present the supporting evidence of these recommendations. Methods A search of published works on tracheotomy, tracheostomy, COVID-19, novel coronavirus, SARS-CoV-2 was performed on PubMed/MEDLINE/Cochrane Library. Articles relevant to the practice of tracheotomy on patients with COVID-19 were selected. The articles were then reviewed and divided into 4 key categories: 1) Personal protective equipment (PPE) in COVID-19 positive patients, 2) Adjunctive measures of airway management before definitive intervention in COVID-19 positive patients; 3) Timing of tracheotomy in COVID-19 positive patients; and 4) Perioperative considerations in performing tracheotomy in COVID-19 positive patients. Results and key points Firstly, enhanced PPE is recommended during tracheotomy of COVID-19 positive patients. Secondly, adjunctive airway management before definitive intervention includes the use of high flow nasal cannulas (HFNC). Thirdly, non-invasive ventilation via continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) machines are not recommended. Fourth, the general consensus suggests that timing of tracheotomy should be at least 10 days after intubation. Finally, percutaneous dilatational tracheotomy (PDT) is likely to be associated with a lower risk of transmission of the virus to healthcare workers (HCW) than a surgical tracheotomy (ST). Other key precautions would include minimizing the use of diathermy. Conclusions The “new normal” workflow summarizes the ideal recommendations across published societal guidelines. Enhanced PPE should be recommended whenever possible. Adjunctive measures before definitive intervention of COVID-19 patients should be limited to the use of HFNC, and CPAP/BiPAP should be avoided. Tracheotomy should be performed after 10 days, although the long term sequelae of tracheal stenosis and pulmonary fibrosis should be ascertained with this approach.

We report the clinical outcomes following implementation of initial COVID-19 treatment guidelines in Thailand. A composite poor outcome was defined as death, ICU admission, requiring intubation, or high-flow oxygen. 744 COVID-19 patients (48.8% male) were included, median (IQR) age was 37 (27-48) years [8.4% >60 years] and 21.4% had pneumonia at admission. Admission <4 days from symptom onset had a reduced risk of poor outcome. In a subgroup analysis, favipiravir use reduced the risk of a poor outcome for patients admitted <4 days from symptom onset (OR 0.320 (0.152-0.662), P=0.003). Thai guidelines now include favipiravir to treat all symptomatic COVID-19 patients.