Manifestations Of COVID-19 Disease Research Articles

Retinal and Corneal OCT Results of Patients Hospitalized and Treated in the Acute Phase of COVID-19.

Objective: This study aimed to assess changes in the morphology of the retina and cornea in patients treated and hospitalized during the acute active phase of SARS-CoV-2 infection. Methods: A total of 24 patients with symptomatic early COVID-19 disease and 38 healthy participants from a control group were enrolled in our study. Among them, 20 received oxygen therapy at flow rates ranging from 1-10 L, while four received high-flow intranasal oxygen therapy (HFNOT). Some patients were treated with other types of therapy, such as Remdesivir, COVID-19 convalescent plasma therapy, or Tocilizumab. In the study, we focused on the analysis of optical coherence tomography (OCT) images of the cornea and retina including corneal thickness, central retinal thickness, retinal nerve fiber layer (RNFL), and optic disc parameters. The measurements were acquired using Spectral-domain OCT REVO FC 130. Results: The analysis did not show significant changes between the examined ophthalmological parameters before and after therapy. Furthermore, there were no detected significant differences between the tested parameters of the retina and cornea in COVID-19-positive patients compared to the control group. Conclusions: No ophthalmological manifestations of COVID-19 disease were observed during the study. Taking into account the results of other publications, the lack of an unambiguous position on this topic requires further research.

Dermatološki izazovi u pandemiji kovida 19 - značaj dermokozmetičkih preparata

Introduction. Although COVID-19 is present in a milder form nowadays, systemic disorders caused by the virus lead to multiple organ malfunctions. Skin manifestations are the consequence of the disease itself but also the result of preventative measures taken to avoid the infection. They generally do not require pharmacotherapy except in severe cases. Depending on the severity of COVID-19-related skin disorder, cosmeceuticals are often recommended in their management. In this study, we highlighted skin adverse events related to all aspects of COVID-19 pandemic aiming to provide a comprehensive overview and enlighten the role of cosmeceuticals in the treatment of those skin issues, according to published studies and guidelines. Methods. Different steps were conducted in preparation of this review-identification of all factors that affect skin in pandemics (protective measures, disease itself, post-COVID syndrome), selection and classification of reported skin symptoms which could be managed using cosmeceuticals, according to relevant papers and guidelines. Discussion. Skin challenges in COVID-19 pandemics could be divided into three main categories: 1) Cutaneous manifestations of COVID-19 disease; 2) Cutaneous symptoms as a result of wearing protective equipment and using disinfectants, and 3) Cutaneous symptoms related to the post COVID-19 syndrome. Conclusion. Cosmeceuticals, a unique category of products between cosmetics and pharmaceuticals, are highly recommended in literature for the management of the aforesaid changes except in severe skin disorders. Since the introduction of cosmeceutical concept, those topicals have become an extremely important part of dermatologist's armamentarium. COVID-19 pandemic confirms their importance.

COVID Pneumonia, Non-ST Elevation Myocardial Infarction, QRS Fragmentation, and Electrocardiographic Wavy Triple or Yasser's Sign in Hodgkin Lymphoma-Prognostic Influence and Serious Outcome

Rationale: The COVID-19 virus with severe acute respiratory syndrome (SARS) has a remarkable effect on morbidity and mortality. Non-ST elevation myocardial infarction (NSTEMI) is a category of acute coronary syndrome (ACS) that may represent a primary cardiac manifestation of COVID-19 disease. The QRS-complex fragmentation had been considered a hallmark of structural heart disease. Wavy triple, an electrocardiographic sign (Yasser’s sign) is a new specific diagnostic sign and therapeutic guide for hypocalcemia. Immunosuppression is a shared criterion for both cancers such as lymphomas and COVID-19 virus infection. Objectives: This case study aimed to clarify the role of COVID-19 viral pneumonia, chemotherapy, and Hodgkin lymphoma in the probability of the current case deterioration. Patient concerns: A 70-year-old, housewife, widow female, Egyptian patient was presented to the emergency department with COVID-19 pneumonia with Non-ST elevation myocardial infarction recently diagnosed as Hodgkin lymphoma. Methods: This is a retrospective-observational case study. Diagnosis: COVID pneumonia with Non-ST elevation myocardial infarction, QRS-complex fragmentation, and Wavy triple electrocardiographic sign (Yasser’s sign) in Hodgkin lymphoma disease. Interventions: CT pulmonary angiography, electrocardiography, and oxygenation. Outcomes: Bad response and poor outcomes in the presence of numerous remarkable serious risk factors were the results. Lessons: Hypocalcemia with Wavy triple electrocardiographic sign (Yasser’s sign) and not hypercalcemia is a new description association that may be present in a malignancy. The association of COVID pneumonia with the recent use of chemotherapy in Hodgkin lymphoma is highly interesting in case of deterioration and away to death. An elderly age, female sex, COVID-19 pneumonia, Non-ST elevation myocardial infarction, sinus tachycardia, QRS-complex fragmentation, Wavy triple electrocardiographic signs (Yasser’s sign), and Hodgkin lymphoma disease are constellation serious risk factors.

Antibiotics and Antivirals in COVID-19: Clinical Outcomes

The clinical manifestations of COVID-19 disease are mainly caused by an irregular host response associated with excessive expression of inflammatory markers. Patients with mild, moderate, and severe symptoms of COVID-19 with or without comorbidities use a combination of antiviral drugs and antibiotics. This study aimed to determine the relationship between the use of antiviral drugs and antibiotics on the clinical outcomes of COVID-19 patients. The research design used a cross-sectional study with retrospective data collection. The inclusion criteria were COVID-19 patients hospitalized at Panti Waluya Sawahan Malang Hospital with or without comorbidities, positive RT-PCR results, and receiving antibiotic and antiviral therapy. The clinical outcome is a patient improvement if the length of stay is 14 days, and the patient worsens if it is >14 days. There is no relationship between antibiotics and antiviral drugs on the clinical outcomes of COVID-19 patients (p>0,05).
 Highlights:
 
 Excessive expression of inflammatory markers contributes to the clinical manifestations of COVID-19.
 Combination therapy of antiviral drugs and antibiotics is commonly used for COVID-19 patients.
 The study found no significant relationship between the use of antibiotics and antiviral drugs and the clinical outcomes of COVID-19 patients
 
 Keywords: antibiotics, antiviruses, COVID-19, clinical improvement, clinical deterioration

Ultrastructural analysis and three-dimensional reconstruction of cellular structures involved in SARS-CoV-2 spread.

The cytoskeleton not only deals with numerous interaction and communication mechanisms at the cellular level but also has a crucial role in the viral infection cycle. Although numerous aspects of SARS-CoV-2 virus interaction at the cellular level have been widely studied, little has been reported about the structural and functional response of the cytoskeleton. This work aims to characterize, at the ultrastructural level, the modifications in the cytoskeleton of infected cells, namely, its participation in filopodia formation, the junction of these nanostructures forming bridges, the viral surfing, and the generation of tunnel effect nanotubes (TNT) as probable structures of intracellular viral dissemination. The three-dimensional reconstruction from the obtained micrographs allowed observing viral propagation events between cells in detail for the first time. More profound knowledge about these cell–cell interaction models in the viral spread mechanisms could lead to a better understanding of the clinical manifestations of COVID-19 disease and to find new therapeutic strategies.

Awareness and knowledge of ocular manifestation in COVID-19 patients among health care workers (HCWs) in Central India

To know the awareness and knowledge of ocular manifestation in COVID-19 patients among health care workers (HCWs) in central India A web-based survey, cross-sectional study was conducted to obtain responses from health care workers (HCWs) in central India from the month of May – July 2020 to access the awareness and knowledge of ocular manifestation in COVID 19 patients among HCWs in central India. This survey was divided into three parts: (i) Participant characteristics (ii) awareness / knowledge of COVID-19 disease (iii) awareness / knowledge regarding ocular manifestation of COVID 19 patients and their source of information. Knowledge regarding ocular manifestation of the disease was assessed by questions focusing on COVID-19 signs / symptoms and risk in eyes, its transmission, and prevention. Ethical clearance was taken and electronic informed consent was taken and confidentiality of each person was maintained throughout the study. A total of 408 healthcare workers participated in the study, in which approximately 59.06% (n = 241) of males and 40.94% (n= 167) females, majority of them belong to urban area 74% (n= 302). Most of the HCWs 39.9% were between 35-44 years of age, in which 51.71% (n = 211) were Doctors, 35.04% (n =143) were nursing staff and 6.61%, 1.47% were hospital attendant and sanitary workers respectively Almost all participants (n=408) had heard about COVID-19, out of which 92.15% agreed that corona patients can recover completely. The study reviled that most of HCWs had good knowledge about the disease and its transmission. However, 336 (82.35%) HCWs were aware that the disease can also affect the eye and 278 (68.13%) accepted that it can cause conjunctivitis. The study revealed that 193 doctors (91.46%), 120 (83.91%) nursing staff and only 23 allied health workers (42.59%) thought that COVID-19 can affect eyes. In which (n=119) 56.39% doctors, (n=61) 42.65% nursing staff, and only (n=19) 35.18% allied health care workers believed that corona can spread through tears. Most doctors (n=165, 78.19%) agreed that COVID 19 can cause conjunctivitis, Which was not same in the case of nursing staffs and other allied Health care workers. Hence, there was a knowledge gap between doctors and other HCWs regarding ocular manifestation of COVID-19 disease. The study concluded that most of the HCWs were aware about the disease (COVID-19) and had good knowledge about the general condition of the disease but participant’s knowledge regarding ocular manifestation of the disease was comparatively less, though most of the HCWs agreed that COVID-19 could also affect the eyes.

SARS-CoV-2 Infection and the Risk of Suicidal and Self-Harm Thoughts and Behaviour: A Systematic Review.

ObjectiveThe COVID-19 pandemic has had a complex impact on risks of suicide and non-fatal self-harm worldwide with some evidence of increased risk in specific populations including women, young people, and people from ethnic minority backgrounds. This review aims to systematically address whether SARS-CoV-2 infection and/or COVID-19 disease confer elevated risk directly.MethodAs part of a larger Living Systematic Review examining self-harm and suicide during the pandemic, automated daily searches using a broad list of keywords were performed on a comprehensive set of databases with data from relevant articles published between January 1, 2020 and July 18, 2021. Eligibility criteria for our present review included studies investigating suicide and/or self-harm in people infected with SARS-CoV-2 with or without manifestations of COVID-19 disease with a comparator group who did not have infection or disease. Suicidal and self-harm thoughts and behaviour (STBs) were outcomes of interest. Studies were excluded if they reported data for people who only had potential infection/disease without a confirmed exposure, clinical/molecular diagnosis or self-report of a positive SARS-CoV-2 test result. Studies of news reports, treatment studies, and ecological studies examining rates of both SARS-CoV-2 infections and suicide/self-harm rates across a region were also excluded.ResultsWe identified 12 studies examining STBs in nine distinct samples of people with SARS-CoV-2. These studies, which investigated STBs in the general population and in subpopulations, including healthcare workers, generally found positive associations between SARS-CoV-2 infection and/or COVID-19 disease and subsequent suicidal/self-harm thoughts and suicidal/self-harm behaviour.ConclusionsThis review identified some evidence that infection with SARS-CoV-2 and/or COVID-19 disease may be associated with increased risks for suicidal and self-harm thoughts and behaviours but a causal link cannot be inferred. Further research with longer follow-up periods is required to confirm these findings and to establish whether these associations are causal.

Ophthalmic Manifestation of COVID-19 Disease

Coronavirus is the novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). It's a non-segmented enveloped positive sense RNA virus with 82 percent genetic similarity to the SARS coronavirus (SARSCoV), which sparked an outbreak in early 2003. Respiratory droplets are assumed to be the primary mechanism of transmission because the virus is found in respiratory secretions. Conjunctival transmission and aerosol transmission have also been proposed, however they are also problematic. Fever, tiredness, and dry mouth are the three most prevalent COVID-19 clinical symptoms. In several patients, however, conjunctivitis was the initial symptom. The disease's respiratory complications have been the focus of diagnostic and therapeutic efforts, However, a number of ocular concerns have surfaced. Infected patients' tears have been confirmed to contain SARSCov2 RNA, and studies indicate that the virus is spreading. For viral transmission, the ocular surface could serve as both an entry point and a reservoir. COVID-19 has been linked to mild conjunctivitis, which can be the disease's first and only symptom. Ocular symptoms can be treated with observation without therapy, antibacterial eye drops, antiviral eye drops, and antiallergic eye drops, according to clinical trials. As a result, the only recommended treatment for COVID-19 related ocular manifestations is close observation. The motivation behind this examination was to investigate the event of visual appearances in patients who had been determined to have COVID illness 2019 (coronavirus) because of serious intense respiratory condition.

Oral antivirals for the prevention and treatment of SARS-CoV-2 infection.

Vaccines and antivirals are the classical weapons deployed to contain, prevent, and treat life-threatening viral illnesses. Specifically, for SARS-CoV-2 infection, vaccines protect against severe COVID-19 disease manifestations and complications. However, waning immunity and emergence of vaccine escape mutants remains a growing threat. This is highlighted by the current surge of the omicron COVID-19 variant. Thus, there is a race to find treatment alternatives. We contend that oral small molecule antivirals that halt SARSCoV- 2 infection are essential. Compared to currently available monoclonal antibodies and remdesivir, where parenteral administration is required, oral antivirals offer treatments in an outpatient setting with dissemination available on a larger scale. In response to this need at 2021's end, regulatory agencies provided emergency use authorization for both molnupiravir and nirmatrelvir. These medicines act on the viral polymerase and protease, respectively. Each is given for 5 days and can reduce disease progression by 30% and 89%, respectively. The advent of additional oral antivirals, the assessment of combination therapies, the formulation of extended-release medications, and their benefit for both early treatment and prophylaxis will likely transform the landscape of the COVID-19 pandemic.

Pre-Existing Pancreatitis and Elevated Risks of COVID-19 Severity and Mortality

Pre-Existing Pancreatitis and Elevated Risks of COVID-19 Severity and Mortality

A review on oral manifestations of COVID-19 disease.

COVID-19, a multi-system-affecting disease presents with an extensive clinical spectrum, ranging from no symptoms at all to fatal lung involvement. Several orofacial manifestations have also been reported, among which dysgeusia is one of the earliest reported symptoms. Several other manifestations of extensive variety have also been reported by various authors worldwide since the outbreak of the disease. This comprehensive review dispenses a synopsis of the orofacial manifestations of COVID-19 along with a working classification, the knowledge of which is of utmost importance to medical and dental professionals for early detection and prevention of transmission of the disease.

Unveiling the Dermatological Manifestations of COVID-19 Infections

Background: There have been over 86 million global confirmed cases to date, and the disease is known to have a 2.2% case fatality rate, having claimed over 1.87 million lives. They were initially regarded as a purely respiratory disease with symptoms of viral pneumonia such as fever, fatigue, dry cough, and lymphopenia. The widespread coronavirus disease is aimed at the Arial route of the tramsmission. Furthermore, the constant mutations in the virulence factors of the virus lead to the effectiveness of the treatment regimens. Covid-19 disease is mainly known to be a pulmonary infection, giving rise to pulmonary fibrosis, focuses and leads to severe pneumonia and ulyimately gives a fatal result iof not treated promptly. The pulmonary but extrapulmonary manifestations of this disease are also seen—cardiovascular, renal, nervous and dermatological, and immune system. The exact pathogensis and the etiology of the extra pulmonary manifestation of covid to the cutaneous prognosis are not yet well known. The virulence factors, the antigens of the virus that exacerbate the dermatological symptoms. The virus causes dermatological symptoms in urticarial rashes, eczematous infections, and mucocutaneous depositions. The exact mechanisms of the disease’s progress to the dermatological variant are not known; however, this review will concentrate on the cutaneous manifestations of Covid-19 disease and the variant nature of the infection. The widespread coronavirus disease is aimed at the Arial route of transmission. Furthermore, the constant mutations in the virulence factors of the virus lead to the in effect ness of the treatment regimens. Covid-19 disease is mainly known to be a pulmonary infection, giving rise to pulmonary fibrosis, focuses and leads to severe pneumonia and ultimately gives a fatal result iof not treated promptly. The pulmonary but extrapulmonary manifestations of this disease are also seen—cardiovascular, renal, nervous dermatological and immune system. The exact pathogenesis and the etiology of the extrapulmonary manifestation of covid to the cutanenous prognosis is not yet well known. The virulence factors, the antigens of the virus that exacerbate the dermatological symptoms. The virus causes dermatological symptoms in urticarial rashes, eczematous infections, and mucocutaneous depositions.

Divergent COVID-19 Disease Trajectories Predicted by a DAMP-Centered Immune Network Model.

COVID-19 presentations range from mild to moderate through severe disease but also manifest with persistent illness or viral recrudescence. We hypothesized that the spectrum of COVID-19 disease manifestations was a consequence of SARS-CoV-2-mediated delay in the pathogen-associated molecular pattern (PAMP) response, including dampened type I interferon signaling, thereby shifting the balance of the immune response to be dominated by damage-associated molecular pattern (DAMP) signaling. To test the hypothesis, we constructed a parsimonious mechanistic mathematical model. After calibration of the model for initial viral load and then by varying a few key parameters, we show that the core model generates four distinct viral load, immune response and associated disease trajectories termed “patient archetypes”, whose temporal dynamics are reflected in clinical data from hospitalized COVID-19 patients. The model also accounts for responses to corticosteroid therapy and predicts that vaccine-induced neutralizing antibodies and cellular memory will be protective, including from severe COVID-19 disease. This generalizable modeling framework could be used to analyze protective and pathogenic immune responses to diverse viral infections.

Pathophysiological and molecular considerations of viral and bacterial infections during maternal-fetal and –neonatal interactions of SARS-CoV-2, Zika, and Mycoplasma infectious diseases

During pregnancy, a series of physiological changes are determined at the molecular, cellular and macroscopic level that make the mother and fetus more susceptible to certain viral and bacterial infections, especially the infections in this and the companion review. Particular situations increase susceptibility to infection in neonates. The enhanced susceptibility to certain infections increases the risk of developing particular diseases that can progress to become morbidly severe. For example, during the current pandemic caused by the SARS-CoV-2 virus, epidemiological studies have established that pregnant women with COVID-19 disease are more likely to be hospitalized. However, the risk for intensive care unit admission and mechanical ventilation is not increased compared with nonpregnant women. Although much remains unknown with this particular infection, the elevated risk of progression during pregnancy towards more severe manifestations of COVID-19 disease is not associated with an increased risk of death. In addition, the epidemiological data available in neonates suggest that their risk of acquiring COVID-19 is low compared with infants (<12 months of age). However, they might be at higher risk for progression to severe COVID-19 disease compared with older children. The data on clinical presentation and disease severity among neonates are limited and based on case reports and small case series. It is well documented the importance of the Zika virus infection as the main cause of several congenital anomalies and birth defects such as microcephaly, and also adverse pregnancy outcomes. Mycoplasma infections also increase adverse pregnancy outcomes. This review will focus on the molecular, pathophysiological and biophysical characteristics of the mother/placental-fetal/neonatal interactions and the possible mechanisms of these pathogens (SARS-CoV-2, ZIKV, and Mycoplasmas) for promoting disease at this level.

COVID-19-ASSOCIATED MENINGOENCEPHALITIS TREATED WITH STEROIDS AND REMDESIVIR

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: The novel coronavirus, named SARS-CoV-2, is known to have emerged in Wuhan, China in late 2019. A wide variety of organs have been found to be involved with SARS-CoV-2 infection. Recent reports indicate that the CNS is not spared. Headache, dysguesia and hyposmia, some more serious neurologic manifestations including encephalopathy Guillain Barre syndrome and stroke are now being reported as the number of patients with COVID-19 across the globe. We report a case of meningoencephalitis associated with SARS-CoV-2 who presented with altered mental status. CASE PRESENTATION: 43-year-old male with a PMH significant for insulin-dependent diabetes presented with altered mental status. In Emergency department was noted to have rhythmic jerking movements and his gaze was deviated to the right, concerning for seizure activity. Upon admission it was confirmed to have COVID-19 via detection of SARS-CoV-2 viral nucleic acid in a nasopharyngeal swab specimen using the Simplexa SARS-CoV-2 assay. Neurological examination revealed confusion with orientation only to self, inability to follow commands, and no apparent focal neurological deficits. Otherwise, general examination was unremarkable and vital signs were within normal. CT head was negative for any acute pathology. His cerebrospinal fluid (CSF) was clear and color less with an elevated CSF cell count and lymphocytic predominance suspicious for viral encephalitis.The CSF glucose (70 mg/dL) was increased and CSF protein levels (19 mg/dL) were decreased. A CSF PCR panel including Cryptococcus neoformans, HSV, varicella zoster virus, Streptococcus pneumoniae, Neisseria meningitidis and enterovirus was negative. The SARS-CoV-2 CSF PCR was negative. Labs were significant for elevated ferritin, LDH, C reactive protein and Di dimer. EEG shows diffuse slowing in the theta range indicative of encephalopathy and lacked any epileptogenic activity. Patient started on steroids, Remedesivir with concern of COVID 19 meningoencephalitis. Within the next 3 days, his mentation progressively improved;he was able to communicate, and was following commands. DISCUSSION: The neuroinvasive nature of human coronavirus has been previously reported during the 2002–2003 SARS-CoV pandemic when viral nucleic acids were found in the human brain upon autopsies. It was postulated by scientists in China that SARS-CoV-2, a novel coronavirus from the SARS-CoV family, could also infect the brain when they observed neurologic signs among patients with COVID-19 related respiratory illness. CONCLUSIONS: Although rare, meningoencephalitis should be considered as a possible manifestation of COVID-19 disease. A suspicion for SARS-CoV-2 meningitis or encephalitis should be high among patients presenting with neurological symptoms during this era of pandemic. SARS-CoV-2 testing should be included as part of the workup in addition to other infectious causes. REFERENCE #1: Gu J., Gong E., Zhang B. Multiple organ infection and the pathogenesis of SARS. J Exp Med. 2005;202(3):415–424. doi: 10.1084/jem.20050828 REFERENCE #2: Moriguchi T., Harii N., Goto J. A first case of meningitis/encephalitis associated with SARS-coronavirus-2. Int J Infect Dis. 2020;94:55–58. doi: 10.1016/j.ijid.2020.03.062 DISCLOSURES: No relevant relationships by Ajay Adial, source=Web Response No relevant relationships by Muhammad Azaz Cheema, source=Web Response No relevant relationships by Asma Iftikhar, source=Web Response No relevant relationships by Hamza Quadri, source=Web Response

Dermatological Manifestations of COVID-19: Data from a tertiary care hospital of Pakistan dedicated for COVID-19 Patients

Background: Cutaneous manifestations of COVID-19 disease are poorly characterized around the globe. Data from Pakistan is lacking.&#x0D; Objective: To describe the cutaneous manifestations of COVID-19 disease in Pakistani population.&#x0D; Introduction: SARS-CoV-2 virus has rapidly spread reaching the level of a pandemic disease. COVID-19 can affect different organ systems including the skin. There is a wide variety of descriptions of the cutaneous manifestations of COVID-19. However, cutaneous manifestations of COVID-19 disease are poorly characterized around the globe. The data from Pakistan is especially lacking. Our study was aimed at describing the cutaneous manifestations of COVID-19 disease in Pakistani population.&#x0D; Materials and Methods: This cross sectional study was carried out at Benazir Bhutto Hospital from March 2020 till December 2020. A total of 150 patients were screened by senior dermatology postgraduate trainees who were deployed for the care of COVID-19 patients. The demographics, rash if any along with its complete history and description and laboratory investigations were noted on a preformed performa. The pictures of the rash were taken after verbal consent of patient or surrogate. The pictures were then discussed with the consultant for appropriate categorization.&#x0D; Results: A total of 150 patients with the diagnosis of COVID-19 were screened. The mean age of the subjects was 51.9 ± 17.2 years. There were 94 (62.7%) males and 56 (37.3%) females. The mean duration of illness at the time of screening was 12.5 ± 9.7 days. Only 7 (4.7%) COVID-19 patients showed skin lesions. These included generalized bullous pemphigoid like (1 patient), urticarial lesions (1 patient), vesicular eruption (1 patient), skin necrosis (1 patient) and maculopapular rash (3 patients). The average duration of illness at the time of dermatological manifestation of COVID-19 was 6.31 ± 2.3 days. Skin necrosis was associated with severe disease.&#x0D; Conclusion: The skin manifestations of COVID-19 patients in Pakistan are less as compared to reports and data from western world. However, they are in accordance with the data reported from few Asian countries. Regardless of this, the type, distribution and association of skin lesions with COVID-19 appear to be universal. This difference of frequency can be attributed to the racial differences or the variety of COVID-19 viral strains predominant in different countries. However, further studies are required to prove this association. &#x0D; Key Words: COVID-19, Dermatology, Skin Manifestations, Cutaneous Manifestations

COVID-19 gastrointestinal manifestation presenting as acute surgical like abdomen

COVID-19 disease is caused by severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) which can cause respiratory symptoms more. It can cause gastrointestinal symptoms also due to this RNA virus protein binding to the angiotensin converting enzyme 2 (ACE2) receptors which are abundantly present in stomach, small intestine, large intestine and liver. The gastrointestinal manifestations of COVID-19 disease can present as acute surgical abdomen which can create diagnostic dilemma. We presented a case of COVID-19 disease, admitted in our hospital. Later he had symptoms of acute surgical abdomen symptoms like sudden onset abdominal pain, nausea, vomiting and loose stool without blood. He was properly evaluated and conservatively managed. The gastrointestinal manifestations of COVID-19 disease can present as acute surgical abdomen. So, these patients properly evaluated and then only surgical plan will be made according pathology.

Liver Damage and Exposure to Toxic Concentrations of Endogenous Retinoids in the Pathogenesis of COVID-19 Disease: Hypothesis.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a marked tropism for the biliary tract; it damages the bile ducts and hepatocytes and can lead to liver decompensation, cirrhosis, and sepsis. The pathogenesis of liver damage and its association with damage to the lung, heart, and brain and to the other protean manifestations of COVID-19 disease are not fully understood. In particular, tissue damage from thinning and leaky blood vessels appears to result from an inflammatory response to the virus rather than the virus itself. This article outlines a new hypothesis of the nature of the inflammatory factor responsible for tissue damage in COVID-19. Review of the literature reveals that COVID-19 disease closely resembles an endogenous form of hypervitaminosis A. We propose that SARS-CoV-2 virus-induced liver damage causes retinoic acid and stored retinyl esters to be released into the circulation in toxic concentrations, unbound to protein, with resulting damage to organs including the lungs, heart, blood vessels, and skin. Several lines of evidence support this model of disease causation. Subject to testing, strategies for the effective treatment and prevention of COVID-19 could include targeting the action and accumulation of retinoids.

The Duplicitous Nature of ACE2 in COVID-19 Disease.

The Duplicitous Nature of ACE2 in COVID-19 Disease.

Portal Vein Thrombosis-a Rare Complication of SARS-CoV-2 Infection.

The SARS-CoV-2 is the causative organism for COVID-19 disease. It primarily affects the respiratory system. With time, some new extra-pulmonary manifestations of COVID-19 disease have been identified. Recent studies have shown that patients with SARS-CoV-2 infection may have a hypercoagulable state which explains the increased incidence of thrombotic events in these patients without any known risk factors. The most common thrombotic event described in these patients is pulmonary embolism. Intra-abdominal thrombosis is a rare thrombotic complication of COVID-19 disease. Here, we report a case of COVID-19 disease associated with acute portal vein thrombosis.