Post COVID syndrome: A novel challenge and threat to international health.

The global pandemic caused by the SARS-CoV-2 virus has affected every continent worldwide. The novelty of this virus, its mutations and the rapid speed and unprecedented rate at which it has torn through the global community has in turn lead to an innate lack of knowledge and information about the actual disease caused and the severity of the complications associated with COVID-19. The SARS-CoV-2 virus has been infecting individuals since 2019 and now as of 2022 has been circulating for just over 2 years within the global populous. As the number of cases have risen globally over this period (some of which having contracted the virus twice) further endeavours have been undertaken to better understand the pathogenesis and natural progression of the disease. A condition reported in some cases with extended bouts of sickness or symptoms following the initial infection with COVID was labelled "long COVID" towards the earlier phases of the pandemic (in the spring of 2020), but has only recently gained the global media and medical attention due to its affliction of more individuals on a global basis and has thus warranted further investigation. Long COVID is described as a persistent, long-term state of poor health following an infection with COVID-19. The effect of Long COVID is multisystemic in nature with a wide array of signs and symptoms. The most commonly reported clinical features of long COVID are: headaches, myalgia, chest pain, rashes, abdominal pain, shortness of breath, palpitations, anosmia, persistent cough, brain fogs, forgetfulness, depression, insomnia, fatigue and anxiety. This research aims to explore the symptomatology, pathophysiology as well as the treatment and prevention of Long COVID.

Epidemiologic characteristics, clinical management, and public health implications of Coronavirus Disease 2019 (COVID-19) in pregnancy: A Systematic Review and Meta-analysis.

BACKGROUND: The novel Coronavirus Disease 2019 (COVID-19) outbreak, caused by the pathogenic severe acute respiratory syndrome-2 (SARS-CoV-2) virus, is exponentially spreading across the globe. METHODS: The current systematic review was performed utilising the following electronic databases PubMed, MEDLINE and EMBASE. We searched for the keywords "COVID-19 AND "pregnancy" between January 1, 2020 until December 31, 2020. RESULTS: Out of 4005 records which were identified, 36 original studies were included in this systematic review. Pooled prevalence of vertical transmission was 10%, 95% CI: 4-17%. Pooled prevalence of neonatal mortality was 7%, 95% CI: 0-21%. CONCLUSION: The contemporary evidence suggests that the incubation period of COVID-19 is 2-14 days, and this infection could be transmitted even from the infected asymptomatic individuals. It is found that the clinical presentation of pregnant women with COVID-19 infection is comparable with the infected non-pregnant females, and the frequent symptoms were fever, cough, myalgia, sore throat and malaise. Some cases have severe maternal morbidity and perinatal deaths secondary to COVID-19 infection. Under these circumstances, pregnant women should focus on maintaining personal hygiene, proper nutrition and extreme social distancing to reduce the risk of COVID-19. Therefore, systematic data reporting for evidence based clinical assessment, management and pregnancy outcomes is essential for preventing of COVID-19 infection among pregnant women.

Mucormycosis and COVID-19 an epidemic in a pandemic?

Mucormycosis and aspergillosis are rare, invasive and life-threatening infections primarily caused by Rhizopus arrhizus and Aspergillus fumigatus with higher case fatality rates (>50%), respectively. Invasive Aspergillosis and Mucormycosis have been established and recognized as complications of the SARS-CoV-2 infection. Such cases have been intimately linked and related to prior corticosteroid therapy. With the new highly infectious Delta strain (B.1.617.2 and B.1.617.2.1 or AY.1) of the coronavirus which is running rampant throughout India causing unprecedented death tolls, a new crisis is evolving. Invasive "black fungus" (Mucormycosis) is creating an epidemic within a global pandemic. The unique socio-economic, genetic and health status of Indian population culminates into a melting pot which sustains the viable triad for the "black fungus" infection to gain a stronghold. Diabetes mellitus, immunosuppression and the current COVID-19 global pandemic with its massive surges in the country have produced the "perfect storm." Ophthalmologist across India have reported a surge in invasive Mucormycosis cases with a rise in orbital compartment syndrome often calling for radical procedures such as enucleation surgeries. The "black fungus" pandemic and invasive Mucormycosis resulted in the sinister secondary infections and complications are closely linked with the COVID-19 infection in India. It is therefore of the upmost importance that neighbouring countries particularly Nepal and other Asiatic nations take great cognizance of this indolent "black fungus killer" and ensure new screening and testing protocols for early identification to ensure effective management.

COVID-19: Lockdown and its impact on medical students: A cross sectional study from a medical school in Mauritius.

BACKGROUND: The objectives of the study were to identify the psychological impacts of lockdown on medical students due to COVID-19 and to discover the educational perplexities being faced by these students during the lockdown. METHODS: A cross-sectional study was conducted at Sir Seewoosagur Ramgoolam Medical College (SSRMC), Mauritius. Questions were designed after an extensive review of the literature, so as to ensure relevance to meet the objectives of the study. RESULTS: Out of 700 undergraduate medical students, 663 participated, which equates to a response rate of 95%. 348 (52.5 %) of the students were stationed in their hometown and the remaining 315 (47.5 %) were stationed in Mauritius. 464(70%) of the students suffered from the psychological impacts of lockdown whereas 634(95.6%) of students suffered from the educational impact thereof. Mauritian students suffered a greater educational impact aOR4.236[1.606-11.173]. Psychological impacts aOR 1.280 [0.917-1.789] and educational impacts aOR 2.464 [1.076-5.647] were more prevalent in hometown-based students. Students pursuing their clinical studies had aOR1.219 [ 0.531-2.798] a greater educational impact as compared to preclinical studies. CONCLUSION: Lockdown triggered both educational and psychological impacts on medical students. On a psychological basis it was proven that the lockdown induced a feeling of guilt and had a greater psychological impact in pre-clinical students. The COVID-19 situation was simultaneously indicated to be a motivator in the majority of students; however, juxtaposed to this was the fact that various students felt as if they couldn't study at the same level that they were accustomed to due to the uncertainty of the situation.

Development and implementation of a potential coronavirus disease 2019 (COVID-19) vaccine: A systematic review and meta-analysis of vaccine clinical trials.

BACKGROUND: To date, there is no comprehensive systematic review and meta-analysis to assess the suitability of COVID-19 vaccines for mass immunization. The current systematic review and meta-analysis was conducted to evaluate the safety and immunogenicity of novel COVID-19 vaccine candidates under clinical trial evaluation and present a contemporary update on the development and implementation of a potential vaccines. METHODS: For this study PubMed, MEDLINE, and Embase electronic databases were used to search for eligible studies on the interface between novel coronavirus and vaccine design until December 31, 2020. RESULTS: We have included fourteen non-randomized and randomized controlled phase I-III trials. Implementation of a universal vaccination program with proven safety and efficacy through robust clinical evaluation is the long-term goal for preventing COVID-19. The immunization program must be cost-effective for mass production and accessibility. Despite pioneering techniques for the fast-track development of the vaccine in the current global emergency, mass production and availability of an effective COVID-19 vaccine could take some more time. CONCLUSION: Our findings suggest a revisiting of the reported solicited and unsolicited systemic adverse events for COVID-19 candidate vaccines. Hence, it is alarming to judiciously expose thousands of participants to COVID-19 candidate vaccines at Phase-3 trials that have adverse events and insufficient evidence on safety and effectiveness that necessitates further justification.

COVID-19 and mutations a threat level assessment.

A mutation is defined as an alteration in the DNA or RNA sequences of a genome which may consequently confer a new phenotypic and or genotypic advantage both increasing the virulence as well as the survival of a virus or pathogen. At this current point in time there are 4 known major variants of the original SARS-CoV-2 virus, namely the English variant (B.1.1.7), the South African variant (B.1.351), Brazilian variants (VOC202101/02 (P.1) and VUI202101/01) and a variant similar to that of the South African variant found in North America (B.1.526), all of which have varying levels of resistance and infectivity. It is evident that the SARS-CoV-2 variants pose an international health risk, the mutations of E484K and N501Y are the two most implicated mutations. E484K being the most concerning as it aids in immune evasion and drastically causes the efficacy of the current vaccines to be reduced by large margins. The most worrisome variant is the South African or B.1.351 which harbors the above mutations. It is of the upmost importance that targeted vaccines are synthesized to ensure that immunized individuals have effective protection against these variants. Until these specific targeted vaccines are synthesized the current vaccines offer little long-term protection, however do confer a level of immunity to stop severe infections. It is thus advised that current vaccination programs should continue in earnest as a degree of protection is conferred.

A contemporary insight of metabolomics approach for COVID-19: Potential for novel therapeutic and diagnostic targets.

The Coronavirus disease 2019 (COVID-19) pandemic is caused by rapidly spreading pathogenic virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that affects vast majority of population worldwide. Although, around 80% of the cases had mild infection but still remaining 20% had developed respiratory failure and dysfunction of other organs that necessitate urgent oxygen therapy or specific interventions. Therefore, it is imperative to establish novel prognostic approaches to screen patients at high-risk of developing severe complications. The primary focus of current research for COVID-19 is to discover safe and efficacious vaccine for prevention and effective treatment for better management of the patients to overcome the pandemic. To achieve this goal, it is imperative to have better understanding of the molecular pathways involved in the pathophysiology and progression of severe COVID-19. The surge for reliable diagnostics and therapeutics targets for COVID-19 highlighted the great potential of high-throughput approach like metabolomics which may enable the development of personalized medicine.

COVID-19: Recent advances in epidemiology, virology, etiopathogenesis, clinical trials and vaccine development

Background:The causative virus of COVID-19 has been named SARS-CoV-2. It is the seventh coronavirus that is pathogenic to humans and the third in the series of human pathogenic beta coronaviruses. Patient zero was identified to have contracted the virus in Wuhan, China. Shortly after the initial identification of the virus and its symptoms, multiple studies concluded that the virus originated from the “Wuhan seafood market”, a notorious market place for illegal wildlife trade based in Wuhan, a city in the Hubei region of the People’s Republic of China. Globally, as of 7:02 pm CEST, 29 May 2020, there have been 5704736 confirmed cases of COVID-19, including 357736 deaths, reported to the WHO. The transmission of COVID-19 is primarily by way of respiratory droplets, which can be developed via means of coughing or sneezing, hence spreading the disease from one person to another person. The research proposed indicates the possibility of bats as being the natural cistern of SARS-CoV-2, hence making COVID-19 a zoonotic disease. The most suspected intermediate host is the Malayan pangolin. SARS-CoV-2 is a single-stranded RNA virus that has an affinity for ACE2 receptors in humans, causing severe pathological symptoms. Symptoms like anorexia, dyspnea, fatigue, pyrexia, cough, headache, dizziness, nausea, productive sputum, abdominal pain, myalgia, sore throat, diarrhea, and vomiting. Vaccines that are currently in the clinical evaluation are the Adenovirus type 5 vector, mRNA-1273, Inactivated alum, ChAdOx, LNP-mRNA, DNA plasmid vaccine with electroporation and Inactivated vaccines. A Phase III randomized multicountry clinical trial comprising of 100 countries known as “Solidarity” (ISRCTN83971151) has been initiated by the WHO to achieve the unified goal of producing an adequate treatment for COVID-19. The present Solidarity trial focuses on the following drugs: Remdesivir, Lopinavir/Ritonavir with or without interferon beta-1a, Chloroquine, or hydroxychloroquine. Conclusion: It is invariably essential to promote research in this field of study and find an appropriate solution to the virus to allow individuals worldwide to lead a secure and healthy life.