Congenital Adrenal Hyperplasia (CAH) is managed with long-term corticosteroid and is suggested to higher dose, based on the general sick day principles. I presented a 5-year-old CAH case by pneumonia managed in our pediatrics department. Considering stress doses of cortisone in management of CAH patients with COVID19 should be considered.

Aim :  To evaluate the need for Post obturation analgesia (acetaminophens) requirements in patients vaccinated against Covid-19, as the role of the NASID’s is still controversial, and the most recommended drug is acetaminophens after Covid-19 Vaccination. Material and Methods: 50 patients vaccinated against Covid-19 undergoing root canal treatments for symptomatic pulpits in molar teeth, were divided into two groups of 25 each on the basis of gender (Group M for males and Group F for females.) Each patient was given a prescription for 650 mg of acetaminophen tablets to be taken 8 hourly with instructions to avail the same only if needed for pain. They were instructed to keep a record of the number of tablets consumed as per record sheet 1, and if the pain did not subside then a stronger analgesic Ketorolac DT 10mg twice a day had to be taken and recorded. In case the pain was accompanied by swelling, the patient was given a prescription of amoxicillin 500mg TDS along with analgesics. Results: In Group M and Group F the mean number of analgesic tablets required was 0.44±0.65, 0.80±1.08 respectively, and the difference was statistically insignificant (p=0.360). The statistical analysis was done by student’s t-test using SPSS (Statistical Package for Social Sciences) Version 20.0 statistical Analysis Software. Conclusion: Within the limitations of this study, this is concluded that acetaminophen is effective in relieving post-obturation pain in patients vaccinated against COVID-19. Keywords: NSAID’s, Acetaminophen, Root Canal Treatment, COVID-19 vaccination, Covisheild

AIM: Some of the patients with COVID-19 disease have persistent symptoms and there is limited information about the long-term health consequences of those who have recovered. The aim of this study is to investigate persistent symptoms of health care workers after COVID-19 disease and the relationship with demographic and clinical characteristics of the patients. METHOD: Healthcare workers who had symptomatic COVID-19 disease proven by RT-PCR and were diagnosed at least 12 weeks ago were included in the study. Demographic characteristics, comorbidities, symptoms at time of diagnosis and symptoms that persisted more than 3 weeks were examined in detail with a conducted questionnaire. RESULTS: Of 121 patients included in the study, the mean age was 33.5 (22-59) and the mean time since participants were diagnosed with COVID-19 disease was 30.3 weeks (12.7-56.9). 92% (n=112) of the participants were followed up as outpatients. 63.6% (n=77) of our patients had symptoms lasting more than 3 weeks and the most common symptom were fatigue , loss of smell and attention deficit/concentration disorder. 19 of 77 patients (24.6%) stated that their persistent symptoms lasted longer than 24 weeks, with the most common symptoms being loss of smell. CONCLUSION: All these findings show that even in young patients with mild and moderate COVID-19 infection, post-COVID symptoms are at a rate that will affect their quality of life and health services should be planned for the rehabilitation of these patients. WHAT’S KNOWN? The initial symptoms and clinical course of COVID-19 are well known, but information about the long-term follow-up post-COVİD symptoms, especially in mild and moderate patients, is limited. WHAT’S NEW? Our study contributes to the literature on the frequency of long-term symptoms at 3 months and 6 months in most young patients with mild COVID-19.It also provides data on the situation of post-COVID syndrome in Turkey.

Background: This study assessed the perceptions and attitudes of the Brazilian adult population about COVID-19 vaccines, seeking to identify which factors are associated with vaccine hesitancy and lack of trust in vaccines, in order to support individual or collective strategies for welcoming and guidance. Methods: This is a national survey using a self-report web instrument in a representative sample of the Brazilian adult population (N=1700). The survey included sociodemographic and quality of life (QoL) questions, general information on COVID-19, and a vaccine-specific questionnaire. Results: The vast majority of our sample expressed favourable opinions regarding COVID-19 vaccination, but there was also a small fraction (2.2%) of respondents who are hesitant about COVID-19 vaccination. Most of them were males within age range of 30 to 59 years and reported that their reasons for vaccine hesitation are mainly due to uncertainty about safety (57.9%) and efficacy (36.8%) of vaccines, followed by concern with how they were developed, that is, the issue of timing and the adoption of a new development technology (28.9%). Further, while the impact of groups and peers on those who hesitate to vaccinate was not clear, their perception of a low risk of contracting the disease is evident. Conclusions: The uncertainty about the safety and efficacy of vaccines, the issue of timing and the adoption of a new development technology and the effect of these perceptions on the vaccine COVID-19 acceptance suggests the need to develop targeted strategies to increase effective communication about the risks and benefits of COVID-19 vaccines.

Corticosteroids and COVID-19 vaccine: a challenging issue

The impact of the Covid-19 pandemic on the care of children with cancer in LMIC is of great concern, particularly on diagnosis and abandonment of treatment rates. Data supporting this concern however is limited to survey and anecdotal information. A retrospective with two cohorts design was used to compare new diagnosis and monthly abandonment rate in Java, Indonesia. We found that new diagnoses rates had dropped significantly during Indonesia’s first wave as compared to a pre-pandemic cohort [rate ratio 0.57, 95th (CI) 0.41-0.79)] and that as the first wave progressed, abandonment rates also rose in a statistically significant manner.

Introduction: One of the most important risk factor for COVID-19 infection is malignancy especially hematologic ones. Focusing on the clinical, radiological and laboratory characteristics of COVID-19 infected cancer patients remain largely important. Materials and Methods: In this retrospective study, we analyzed the data of 194 patients with hematologic malignancy and COVID-19 pneumonia. We categorized patients based on the type of the hematologic malignancy and phase of the treatment. All associated and important laboratory data including complete blood count, pro-inflammatory markers, and computerized tomography scan findings were reported to assess the risk factors associated mortality. Results: From January 2020 to March 2021, a total of 194 COVID-19 infected patients with hematologic malignancies were included in different phase of treatments. Median age was 44 (15-81) years. 135 of the cases were male and 59 of the cases were female. Acute myeloid leukemia was the most frequent cancer type (43.8%). A total of 119 patients had severe COVID-19 and 61 patients were admitted to intensive care unit. A total of 92 deaths occurred among all cases for an overall case fatality rate of 47%. Male gender (P=0.03), pre-induction and induction phase of the treatment (P<0.001), Intensive care unit admission (P<0.001), low level of oxygen saturation at the onset of COVID-19 disease (P<0.001) and high level of fibrinogen (P=0.002) were associated with COVID-19 mortality among patients with hematologic malignancies. Conclusion: The results of this study showed male gender, pre-induction and induction phase of the treatment, Intensive care admission, low levels of oxygen saturation at the onset of COVID-19 disease, RH positivity and higher fibrinogen level were associated with the risk of death. Identification of factors potentially associated with mortality for cancer patients are important in assessment strategy in these high risk group.

Bullous hemorrhagic Sweet syndrome induced by SARS-CoV-2 Oxford AstraZeneca vaccineT. Zagar1, N. Hlaca1,2, I. Brajac1,2, L. Prpic-Massari1,2 , S. Peternel1,2, M. Kastelan1,21Department of Dermatovenerology, Clinical Hospital Centre Rijeka, Rijeka, Croatia; and 2Faculty of Medicine, University of Rijeka, Rijeka, CroatiaCorresponding author:Nika Hlača, MDDepartment of dermatovenerology, Clinical Hospital Centre RijekaFaculty of Medicine, University of Rijeka, Rijeka, Croatiae-mail: [email protected]: +38551658283mobile: +385915607690Word count: 596Figures: 2Competing interestsThe authors declare that they have no competing interests.AcknowledgementAll authors read and agreed to the final version of this manuscript. TZ, NH, SP and MK conceived the original idea and wrote the final version of manuscript. IB and LPM have been involved in drafting the manuscript and revising it critically for important intellectual content.Informed consent was obtained from the patient for publication of this report.To the editor,Concurrent to the increasing use of COVID-19 vaccines, the number of vaccine-related adverse reactions has also increased1. We report a case of a 49-year-old male patient who presented with a 10-day-history of generalized painful cutaneous eruption. He denied any preceding respiratory or gastrointestinal symptoms or introduction of any medications, however, ten days before the rash onset, he received the first dose of the SARS-CoV-2 Oxford-AstraZeneca vaccine. Upon physical examination, we observed symmetrically distributed erythematous to violaceous vesicular papules and targetoid plaques on the lower part of the trunk and extremities, along with multiple grouped hemorrhagic blisters on both hands and feet (Figure 1A). Fingers of the right hand were edematous with large tense hemorrhagic bullae, while the left hand was less affected (Figure 1B). The patient was subfebrile and reported mild arthralgia, no other extracutaneous symptoms were present. Initial laboratory tests showed leukocytosis with neutrophilia, while C-reactive protein, liver and renal function tests, urine analysis, ANA, ANCA, cryoglobulins, rheumatoid factor were all within the reference range. The SARS-CoV-2 RT-PCR test was negative, while IgG SARS-CoV-2 antibodies were positive (895.3 AU/ml). Serology tests for viral and bacterial agents were all negative. Chest X-ray and abdominal ultrasound were unremarkable. Histopathological analysis revealed dense perivascular and periadnexal to diffuse neutrophilic infiltrate with marked leukocytoclasia involving the upper and mid-dermal layers. There was massive edema of papillary dermis resulting in subepidermal blister along with extravasated erythrocytes (Figure 2A-B). These findings were consistent with Sweet syndrome (SS). Thus, intravenous methylprednisolone (0.8 mg/kg/d) was initiated and most of the existing lesions started to recede in the next few days. Due to suspected secondary ischemia of the right-hand fingers, the vascular surgeon recommended antithrombotic prophylaxis with low-molecular-weight heparin and acetylsalicylic acid in addition to hyperbaric oxygen therapy. After two weeks of ongoing treatment, there was remarkable improvement in clinical status. The patient was discharged from the hospital with methylprednisolone 32 mg daily therapy and slow tapering over the following eight weeks.Up to date, the most commonly reported cutaneous adverse events of SARS-CoV-2 vaccines are mild to moderate injection-site reactions occurring as a result of nonspecific stimulation of inflammation1. To our knowledge, there are only ten cases of SS induced by any vaccine reported in the literature, three with seasonal influenza, two with pneumococcal, two with tuberculosis, two with smallpox, one with influenza A2. Additionally, three cases of acute febrile neutrophilic dermatosis induced by SARS-CoV-2 Pfizer-BioNTech mRNA vaccines have been reported so far. In the reported cases, the time from vaccination to the onset of the skin lesions ranged from 12 hours to 15 days1,3,4. Our patient developed SS 10 days after the first dose of the Oxford-AstraZeneca vaccine. Generally, local and systemic reactions to the Oxford-AstraZeneca vaccine were mild and reported more often after the first dose and more frequently in adults aged 18-651. Vaccination with Oxford-AstraZeneca is linked to thromboembolic events and very rarely to prothrombotic immune thrombocytopenia with cutaneous lesions similar to drug-induced cutaneous vasculitis1.The bullous variant of SS, seen in our case, is a rare form of the disease. Drugs, tumors or infectious agents may start a network of cytokines involved in the onset of SS5. SARS-CoV-2 infection may also trigger SS as reported recently6. To our best knowledge, this is the first case of SS induced by the Oxford-AstraZeneca vaccine. Balancing the possible link between vaccination and SS, we decided to contraindicate the second dose of vaccine for our patient. Because of the ongoing pandemic and introduction of new vaccines, it is of great importance that all potential side effects are reported and considered.ReferencesCastells MC, Phillips EJ. Maintaining Safety with SARS-CoV-2 Vaccines. N Engl J Med 2021;384: 643-649.Pedrosa AF, Morais P, Nogueira A, Pardal J, Azevedo F. Sweet’s syndrome triggered by pneumococcal vaccination. Cutan Ocul Toxicol 2013;32:260-261.Darrigade AS, Théophile H, P, Sanchez-Pena P, Milpied B, Colbert M, Pedeboscq S, Pistone T, Jullié ML, Seneschal J. Sweet syndrome induced by SARS-CoV-2 Pfizer-BioNTech mRNA vaccine. Authorea March 12 2021. doi: 10.22541/au.161553544.40263874/v1.Banerji A, Wickner PG, Saff R, Stone CA Jr, Robinson LB, Long AA, Wolfson AR, Williams P, Khan DA, Phillips E, Blumenthal KG. mRNA Vaccines to Prevent COVID-19 Disease and Reported Allergic Reactions: Current Evidence and Suggested Approach. J Allergy Clin Immunol Pract 2021;9:1423-1437.Heath MS, Ortega-Loayza AG. Insights Into the Pathogenesis of Sweet’s Syndrome. Front Immunol 2019;10:414.Taşkın B, Vural S, Altuğ E, Demirkesen C, Kocatürk E, Çelebi İ, Ferhanoğlu B, Alper S. Coronavirus 19 presenting with atypical Sweet’s syndrome. J Eur Acad Dermatol Venereol 2020;34:e534-e535.Figure 1. Clinical presentation of Sweet syndrome; a) edematous red-violet papules and targetoid plaques on the trunk and lower extremities, b) violaceous, edematous plaques and hemorrhagic blisters on hands.Figure 2. Skin biopsy from the lower trunk showing (a) subepidermal blister and diffuse dermal inflammatory infiltrate (H&E, 100x) consisting of (b) predominantly neutrophils with pronounced leukocytoclasia (b, 400x).

Background: Since the COVID-19 outbreak, pulmonary involvement was one of the most significant concerns in assessing patients. In the current study, we evaluated patient’s clinical and laboratory findings on the first visit to predict the severity of pulmonary involvement and their outcome. Methods: Four hundred seventy-eight COVID-19 patients with positive real-time reverse-transcriptase-polymerase chain reaction (RT-PCR) or highly suggestive symptoms with computed tomography(CT) imaging results with typical findings of COVID-19 were enrolled in the study. The clinical features, initial laboratory, CT findings, and short-term outcomes (ICU admission, mortality, length of hospitalization, and recovery time) were recorded. In addition, the severity of pulmonary involvement was assessed using a semi-quantitative scoring system (0-25). Results: Among 478 participants in this study, 353 (73.6%) were admitted to the hospital, and 57 (11.9%) patients were admitted to the ICU. A review of chest CT scans showed that Ground Glass Opacity (GGO) (58.5%) and consolidation (20.7%) were the most patterns of lung lesions. Among initial clinical and laboratory findings, anosmia (P = 0.01), respiratory rate (RR) ≥ 25 (P = 0.001), C-reactive protein (CRP) ≥ 91 (P = 0.002), white Blood Cell (WBC) >10,000 (P = 0.009), and SpO2 ≥ 93 (P = 0.04) was associated with higher chest CT score. Lung involvement and consolidation lesions on chest CT scans were also associated with more extended hospitalization and recovery period. Conclusions: Initial assessment of COVID-19 patients, including symptoms, vital signs, and routine laboratory tests, can predict the severity of lung involvement and unfavorable outcomes.

The aim of this study is to evaluate the performance of CURB-65, qSOFA, and NEWS2 scores in predicting mortality in COVID-19 patients and to investigate potential components of a COVID-19-specific prognostic score. A total of 502 patients diagnosed with severe COVID-19 in the emergency department of a pandemic hospital between 01.04.2020 and 01.02.2021 and hospitalized in the intensive care unit were analyzed retrospectively. Demographic, clinical and laboratory data of the patients were obtained from the hospital registry system. The CURB-65, qSOFA and NEWS2 scores of each patient were calculated separately. These patients were divided into two groups as those who survived and those who died. All parameters and calculated risk scores were statistically compared between these two groups. When the CURB-65, NEWS2, qSOFA scores were compared between the two patient groups, a significant difference was found (P<0.001). Compared with CURB-65 and qSOFA, sensitivity of 92.3% and NPV of 90.2% were detected when NEWS2≥8. The CURBLFPC score reached the highest mortality predictive power among other scores with an AUC value of 0.91. Because the NEWS2 score is superior to CURB-65 and qSOFA for predicting mortality, it can be used in the triage of severe COVID-19 patients, predicting prognosis and improving outcomes.In more comprehensive and prospective studies, new models such as CURBFPC can be created and a specific prognostic score for COVID-19 can be developed.

The COVID-19 pandemic decreased the hospitalizations rate for acute coronary syndromes. The origin was multifactorial. In parallel, the incidence of mechanical complications after acute myocardial infarction increased. Is presented the case of a 54-years-olds female with COVID-19 and acute anterior myocardial infarction, apical aneurysm, and interventricular septal rupture. The surgical repair consisted of ventriculoplasty, septal rupture closure with a pericardial patch, and it was impossible to perform coronary revascularization.

Drug repositioning studies in recent decades have revealed a growing number of antimicrobials effective at treating infection types tangential to their original antimicrobial classification. Such ‘pan-pathogen antimicrobials’ (or ‘broad-spectrum anti-infectives’) have not yet been formally characterised. This review examines historical limitations of the canonical antimicrobial lexicon in light of the contemporary model for infectious disease and propounds a taxonomy that defines antimicrobials according to the host-pathogen interactome, not the pathogen. By doing so, antimicrobials that are effective at treating multiple infection types are highlighted, namely azithromycin, ivermectin, niclosamide, and nitazoxanide. Recognition of the pan-pathogen nature of these antimicrobials can stimulate a more unified approach to antimicrobial development cognisant of generalised anti-infective mechanisms within the host-pathogen interactome and anticipatory of future pandemics and bioterrorist attacks.

Background and aim: Coronavirus disease 2019 (COVID-19) has spread rapidly all over the world and has become a pandemic. Although negative reports have been reported about the use of hydroxychloroquine (HCQ) in patients with moderate to severe disease and hospitalized COVID-19 patients, its effect on RT-PCR negativity is unknown, mostly in mild disease and outpatients. In this study, the effects of HCQ and favipiravir on RT-PCR negation were compared. Methods: In this multicenter, retrospective, cross-sectional study, consecutively presenting COVID-19 patients who were positive for RT-PCR between 13 March 2020 and 15 January 2021 were analyzed. Negative RT-PCR results and times were recorded in the follow-up of the patients. All of the patients included in the study consisted of heathcareworkers and the patients were divided into two groups as HCQ or favipiravir users. Results: The favipiravir and HCQ patient groups were similar in terms of age, gender, comorbidities, and hospitalization rate. The median number of PCR-negative cases on the seventh day of treatment was significantly higher in the HCQ group (p = 0.007). The median RT-PCR negation time was 9 days in the HCQ group versus 10 days in the favipiravir group (p = 0.006). Conclusion: The use of HCQ shortens the RT-PCR negative time compared to favipiravir in patients who are in the relatively young age group and have a definite diagnosis of COVID-19. This result is important in terms of viral spread and contamination. There were no side effects that required a change in treatment in either drug group.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that causes coronavirus disease 2019 (COVID-19) is a public health problem and may have co-infection with other pathogens such as influenza virus.This study aims to assess the co-infection of SARS-CoV-2 with influenza among COVID-19 cases.The all relevant studies were collected from international databases. For improving the quality of the present literature, the all studies were evaluated by two reviewers in order to confirm all of the studies have inclusion criteria. Finally, all articles with sufficient quality scores were included in meta-analysis. Assessment of heterogeneity among the studies of primary studies was performed using the statistic chi‐squared test (Cochran’s Q) and I2 index. In this results, random or fixed effect model were used for determination of heterogeneity test. All statistical analyses were performed using Comprehensive Meta-Analysis (CMA), V.2 software.This meta- analysis included 9 primary studies investigating the co-infection of SARS-CoV-2 with influenza among COVID-19 cases. Pooled prevalence (95% confidence interval) of co-infection is shown that the prevalence of influenza A is higher than influenza B. 2.3(0.5-9.3) vs 0.1 (0.4-3.3). Using the fixed effect model the frequency of fever was (80.6% [95% CI 76.1–84.40, p < 0.153]) and it is shown that fever is the most prevalent symptom in patients.Patients admitted to hospital with COVID-19 also infected with influenza virus. Thus, the current research provides a better understanding about the control and treatment of co-infection with SARS-CoV-2 and the influenza virus.

Covid-19 vaccines in pregnancy：weigh the pros and consRui-Hong Xue 1,2,3

Animals are common hosts for many coronaviruses where bats and rodents are commonly regarded as primary reservoirs. The unquestionable emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a yet unknown animal host - in addition with reports of further anthropogenic spread and sustained transmission in mustelids, captive felids, and domestic dogs and cats owned by people previously tested as SARS-CoV-2-positive, rise some concerns about possible continuous maintenance of the virus in nature and domestic species. In this review, we discussed the current data about coronaviruses in domestic and farming animals, recombination events, animal species susceptibility, virus-cell receptor interactions, and clinical signs of most relevant Coronaviridae members of each genera. Also, we present what is known about SARS-CoV-2 in animals and what will be the potential role of those species in COVID-19 epidemiology. Apparently, the virus can infect pets on some occasions, where cats look to be more susceptible than dogs. Thus, pet infection by sick owners is not only likely but expected given the numerous opportunities for spill-over during a massive outbreak. Regarded to farm animals, attention should be focused on breeding species of the Mustelidae family since they are those that have been shown to be more susceptible in experimental infections and have also effectively exhibited animal-to-human transmission. Other intensively bred species such as poultry, swine, horses and ruminants seem to present little or no epidemiological risk so far. The continuous monitoring of SARS-CoV-2 in animals in close contact with people with COVID-19 may be a key in the understanding of this emergent disease and the animal’s role in epidemiology in the future. It is possible that some species will serve as important reservoirs and source of infection of COVID-19 for humans making it re-emergent in the future, as is theoretically proposed for the origin of SARS-CoV-2.

Background: In the SARS-CoV-2/COVID-19 pandemic, we need to understand the impact of immunomodulatory medications on COVID-19 symptom severity in patients with inflammatory diseases, including the Type 2/Th2 polarized skin disease, atopic dermatitis/AD. Since it is believed that Type 1/Th1immunity controls viral infections, and that there is a Th1/Th2 counter-regulation, we hypothesized that Th2 targeting with the IL-4Rα-antagonist, dupilumab, in patients with moderate-to-severe AD rebalances Th1/Th2 axis, potentially leading to attenuated COVID-19 symptoms. Methods: 1,237 moderate-to-severe AD patients in the Icahn School of Medicine at Mount Sinai Department of Dermatology were enrolled in a registry. Patients were screened for COVID-19-related symptoms and assigned a severity score (asymptomatic[0]-fatal[5]). Scores were compared among 3 treatment groups: dupilumab (n=632), other systemic treatments (n=107), and limited/no treatment (n=498). Demographic and comorbid covariates were adjusted by multivariate logistic regression models. Results: The dupilumab-treated group showed reduced incidence and severity of COVID-19 symptoms versus other treatment groups. Dupilumab-treated patients were less likely to experience moderate-to-severe symptoms versus patients on other systemics (p=0.01) and on limited/no treatment (p=0.04), and less likely to experience any symptoms versus patients on other systemics (p=0.01). This effect was seen in our entire cohort and in the subgroup of patients with verified COVID-19 or high-risk exposure. Conclusions: Patients on dupilumab experienced less severe COVID-19 manifestations and lesser symptoms compared to patients on other systemics and on limited/no treatment. These results suggest that Th2 modulation with dupilumab may have a protective effect on anti-viral immune response in AD patients.

COVID-19 is a disease that has changed the scenario in emergency departments worldwide. Cardiac involvement should be considered in certain cases making ultrasound a mandatory tool to aid in diagnosis, follow-up, and treatment.

Introduction Nitazoxanide is a broad-spectrum antiparasitic that has been tested for COVID-19 due to the anti-inflammatory effects and in vitro anti-viral activity and promising clinical benefits against influenza and other viruses. The aim of this study was to synthesize the best evidence on the efficacy and safety of nitazoxanide as treatment for patients with COVID-19. Methods Searches for studies were performed in peer-reviewed and gray literature. The following elements were used to define eligibility criteria: (1) Population, individuals with laboratory-confirmed SARS-CoV-2 infection; (2) Intervention, nitazoxanide; (3) Comparison, placebo; (4) Outcomes: positive RT-PCR status, composite measure of disease progression (severe COVID-19, ICU admission or invasive mechanical ventilation), death, serum biomarkers of inflammation (C-reactive protein, IL-6, and IL-8), and any adverse events; (5) Study type: blinded, placebo-controlled, randomized clinical trials (RCT). Treatment effects were reported as relative risk (RR) and mean difference (MD) with 95% confidence intervals (CI). Results Four blinded, placebo-controlled RCT were included in the meta-analysis and enrolled individuals with mild or moderate SARS-CoV-2 infection. We found no difference between nitazoxanide and placebo in the frequency of positive RTP-PCR results (RR = 0.83; 95% CI 0.58 to 1.17) and there was no decreased risk for disease progression (severe COVID-19, ICU admission or invasive mechanical ventilation) (RR = 0.40; 95% CI 0.08 to 2.13) and deaths (RR = 0.55; 95% CI 0.18 to 1.68) among patients receiving nitazoxanide. There were no differences for patients treated with nitazoxanide and placebo in the levels of inflammatory markers. Conclusions In this study, we found no current evidence from blinded, placebo-controlled, RCT on the efficacy of nitazoxanide in treating patients with COVID-19. This living systematic review should be updated as soon as the results of ongoing RCT are published.

Lots of meta-analysis emphasize that a great number of hospitalized patients with moderate and severe forms of COVID-19 developed acute myocardial damage, defined as an increase of cardiac biomarkers, such N-terminal pro–B-type natriuretic peptide (NT-pro-BNP), creatine kinase-myocardial band (CK-MB) and of all type of troponins. The highest mortality rate is related with progressively increasing biomarkers levels and with a history of cardiovascular disease. In fact, the biomarkers dosage should be considered as a prognostic marker in all patients with COVID-19 disease at admission, during hospitalization and in the case of clinical deterioration. The purpose of this review is to evaluate cardiovascular prognostic factors in COVID-19 disease throughout the analysis of cardiac biomarkers to early identify the most serious patients and to optimize their outcomes.

Aim COVID-19 pandemic changed the priorities in medical field. Many elective surgeries for renal cell cancers (RCC) have been postponed. In this study, we aimed to examine the effects of the COVID-19 pandemic on the surgical treatment of RCC in Turkey. Methods 457 patients that underwent surgery for kidney tumor in the 2-year period between March 1, 2019 and February 28, 2021 in 9 centers in Turkey were analyzed retrospectively. Results The number of surgical treatments for RCC during the COVID-19 pandemic has decreased significantly compared to the same period before COVID-19. No significant differences were found between the two periods in terms of admission symptoms (p=0.32). However, while the rate of application due to hematuria was 6.1% in the pre-COVID-19 period, it was 13.1% during the COVID-19 period. Despite not being significant, this difference was still proportional. Two study periods differed significantly in terms of the rate of metastatic RCC detected in preoperative imaging (13.1% vs 6.1%, during COVID-19 and pre-COVID-19, respectively) (p=0.01). Moreover, the study periods differed significantly in terms of time between imaging and operation (55.98±51.02 vs 40.30±34.9 days, during COVID-19 and pre-COVID-19, respectively) (p=0.01). However, there was no significant difference between the two periods in terms of tumor size, type of surgery, and pathological stage (p>0.05). Conclusion There was a significant decrease in the number of RCC-related surgeries over 1-year period during the pandemic. However, the rate of surgery for metastatic disease increased. Covid-19 is a pandemic that continues to affect the whole world. Oncological diseases are negative affected in this process in terms of early diagnosis and treatment.

Objective: To evaluate the efficacy of TruScreen (TS) detecting cervical intraepithelial neoplasia (CIN) in cytology of atypical squamous cells (ASC) and low-grade squamous intraepithelial lesion (LSIL) women during COVID-19 post-pandemic. Design: Prospective, single-center study. Setting: Changsha, China. Population: ASC and LSIL women from December 2020 to May 2021. Methods: Participants underwent TS, colposcopy examination and biopsy in turn. Diagnostic value of TS, high-risk human papillomavirus (hrHPV) and TS combined with hrHPV were compared. Differences of TS regarding cervical transformation zone (TZ) type and menopause, correlations between TS and p16, Ki-67 were assessed. Main outcome measures: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under curve (AUC) for diagnostic value. Spearman coefficient for correlation. Results: A total of 483 patients were enrolled. Specificity of TS detecting CIN1+, CIN2+, CIN3+ were 77.1% (95% CI, 70.4%-82.7%), 66.7% (95% CI, 61.5%-71.5%), 62.7% (95% CI, 57.8%-67.4%) and all were significantly higher than hrHPV test (P<0.001). TS had a high sensitivity (68.0% vs 52.0%, P>0.05) and significantly higher specificity (70.0% vs 48.5%, P<0.05) and NPV (89.6% vs 73.3%, P<0.05) in women with incomplete cervical TZ type (II and III) than TZ type I in detection of CIN2+. Conclusion: TS is an effective triage screening method for cervical cytology of ASC and LSIL women during COVID-19 post-pandemic, especially for incomplete cervical TZ type women. Funding: Supported by National Natural Science Foundation Project of China (81771546) and Hunan Science and Technology Innovation Project (2020SK53404). Keywords: TruScreen; Cervical cancer screening; Cervical transformation zone; CIN; COVID-19.

On 31 December 2019, pneumonia of unknown cause was detected in Wuhan, China, and was first reported to the WHO Country Office in China. On 30 January 2020, the outbreak was declared a Public Health Emergency of International Concern. (1) It was an outbreak of severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infection that occurred in Wuhan, Hubei Province, China and got spread across China and beyond. WHO officially named the disease - Corona virus Disease 2019 (COVID-19) on February 12, 2020. (2) It has been spreading worldwide for a period of atleast a year & half (3) This review article addresses the current scenario caused by the SARS- Co V along with the treatment protocols and ongoing vaccines.

This article briefly reviews ocean and seas as huge and novel biomedical resources for anti-infection, which includes tuberculosis, H. Pylori, and HIV infection as well as SARS-CoV-2, and as promising biomedical resources for infection-induced major non-communicable diseases (mNCDs), such as cardiovascular disease, diabetes, and cancer. These marine natural products (MNPs) and organisms include sea cucumbers, sea snake, sponge, marine algae and microalgae, etc. As key biomedical resources for the discovery of marine drugs, bioactive molecules, and agents for treatment of infectious diseases and mNCDs, MNPs have bioactive potentials of antioxidant, anti-infection, anti-inflammatory, anticoagulant, anti-diabetic effects, and cancer treatment. In addition, their anti-inflammatory mechanisms for infectious diseases are also involved. It’s time to protect ocean ecosystem for human better sustainable development in the new era of ocean economy.