Omicron variant in COVID-19 current pandemic: a reason for apprehension.

COVID-19 emerged in Wuhan, China, but was caused by the original coronavirus, severe acute respiratory syndrome associated coronavirus-2 (SARS-CoV2). In early 2020, there was a widespread breakout of cases well over world, resulting in an epidemic that rapidly escalated to become a pandemic. This abruptly shook the global healthcare system. The emergence of the alpha, beta, and delta SARS-CoV-2 were associated with new waves of infections, sometimes across the entire world but until this month i.e., between Nov-Dec, 2021, Delta variant reigned supreme until the emergence of a newer variant i.e., Omicron (B.1.1.529) of SARS-CoV-2. Delta had 13 mutations. Of these, nine are in the spike protein, the protrusion on the surface of the virus that helps it latch onto human cells. Specifically, two are in a molecular hook, called the "receptor-binding domain". Omicron, a creation caused by monstrous mutations. At least 32 mutations are in the spike protein and 10 in the receptor-binding domain. was designated a COVID-19 variant of concern (VoC) by the World Health Organization (WHO) on 26th November 2021. Structurally, the omicron variant has shown too mutated at antibody binding sites which would leverage them for escaping the possible immune response by the body. We don't yet know much about the other alterations and how they might affect the virus's behavior. Omicron COVID-19 strain after identifying individuals with symptoms that were not the same as those seen in the Delta form. People with night sweats have also been reported. The new omicron variant has more mutations than the prevailing rampant delta virus. This makes the newer variant more transmissible, better able to evade itself from various vaccines readily available in the current scenario. These overall increases in the percentage changes in a single day cases of COVID-19 reported cases can be attributed to the beginning of third wave or can be speculated as newer surge of omicron variant cases. Yet another new variant has been detected in France with 46 mutations and 37 deletions in its genetic code, many affecting the spike protein. 'B.1.640.2' is the current nomenclature for this variation.

An overview of prognostic value of neurologic and cardiac biomarkers in patients with COVID-19 sequelae.

Many studies conducted after the pandemic period revealed that, while COVID-19 primarily injured the lungs, it also affects other organs in the form of cardiovascular complications, metabolic derangements, renal damage, and so on. Although we know that inflammatory cascades, complement activation, and pro-inflammatory cytokines are all involved in vasculitic processes that cause organ damage, we do not know the exact mechanism of complications such as acute respiratory distress syndrome (ARDS), cardiovascular ischemia, deep vein thrombosis, pulmonary thromboembolism, and brain injuries (embolism) that are frequently observed in COVID 19. The currently available biomarkers do not predict the severity of the aforementioned complications. As a result, more specific biomarkers such as serum calcium binding protein (S100B), glial fibrillary acid protein (GFAP), myelin basic protein (MBP), neuron-specific enolase (NSE), hs-TNI, (highly sensitive cardiac troponin) - HBDH, (Hydroxybutyrate Dehydrogenase), CK-MB (creatine kinase myocardial band), ST2 (suppression of tumorigenicity 2) are in need for early detection & improved clinical outcome.

COVID 19 vaccine in patients of hypercoagulable disorders: a clinical perspective.

COVID 19 is an infectious disease caused by severe acute respiratory syndrome corona virus 2. Thromboembolism has been a characteristic manifestation in most of the severely ill COVID-19 patients. Thromboembolism in COVID 19 infection is attributed to injury to the vascular endothelial cell, hypercoagulability and blood stasis. The hypercoagulable state of blood and thrombophilic diseases leads to hypercoagulability. COVID 19 infected patients with pre-existing hypercoagulable disorders have higher risk of developing thrombosis and thromboembolism and such thrombotic episodes may prove to be severely morbid in these patients. As immune-prophylaxis COVID 19 vaccines are being administered to the public. The known side effects of the COVID 19 vaccine are mild to moderate and include fever, chills, nausea, vomiting, headache, fatigue, myalgia, malaise, pain and swelling at injection site and diarrhea. Thrombosis with thrombocytopenia has been noted as a rare side effect of COVID 19 vaccine. Such side effect of COVID 19 vaccine in patients of hypercoagulable disorder may prove to be fatal. The health care workers should be cautious and judicious in managing such patients. A detailed lab profile for coagulable state of blood should be carried out in all patients COVID 19 infected patients with pre-existing hypercoagulability diseases. The patients should also be health educated regarding side effects of vaccine especially with those indicating thrombosis and they should be warranted to receive immediate medical care in case of any side effects or complications. Paucity of literature gave us an impetus to review management profile in patients of hypercoagulable disorders.

Patients with Sticky Platelet Syndrome, Sickle Cell Disease and Glanzmann Syndrome May Promulgate Severe Thrombosis if Infected with Covid-19.

Covid-19 pandemic has been a very serious cause of health concern worldwide. Thrombosis has been a critical manifestation in severe Covid-19 infection. The increased arterial and venous thrombosis in patients with Covid-19 is proving to be life threatening. Sticky platelet syndrome and sickle cell disease are genetic disorders with procoagulant nature of the disease, while in Glanzmann syndrome there is an enhanced bleeding tendency, with pathological defect leading to altered platelet aggregation and delayed clot formation. Considering the thrombotic episodes of Covid-19, we decided to review the literature on data bases such as PubMed and Medline for knowing the coagulant status in genetically associated diseases such as sticky platelet syndrome, sickle cell disease and Glanzmann syndrome. We planned to review various published studies with the aim to find whether the coagulant profiles in these conditions alter the thrombotic manifestations and prognosis if these patients contract Covid-19. Various research studies revealed that patients with sticky platelet syndrome develop arterial and venous thrombosis, while those with sickle cell disease are known to develop complications such as deep vein thrombosis and pulmonary embolism. Moreover, patients with Glanzmann syndrome who usually have a bleeding tendency also rarely present with severe venous and arterial thrombosis and pulmonary embolism. Patients with sticky platelet syndrome and sickle cell disease and,, occasionally those with Glanzmann syndrome have a higher risk for thrombosis if infected with Covid-19. More studies are needed to better understand the clinical manifestations and designing standard management protocol for patients with sticky platelet syndrome, sickle cell disease and Glanzmann syndrome who contract Covid-19 infections.

Imminent risk of COVID-19 in diabetes mellitus and undiagnosed diabetes mellitus patients.

Diabetes mellitus is a non-infectious disease and has affected about 425 million adults globally and nearly 15.9 million of them reside in Africa. Moreover, the prevalence of undiagnosed diabetes mellitus is very high in Africa and approximates to around 62%. Nearly 75% of the total deaths due to diabetes are in individuals lesser than 60 years of age. The multifaceted disease of diabetes mellitus produces chronic complications such as, neuropathy, nephropathy, retinopathy, microangiopathy etc. These patients of diabetes mellitus are more susceptible to infections due to compromised immune system. Hence these patients of diabetes mellitus and undiagnosed diabetes mellitus are at greater risk of contracting COVID-19 infections. The dual impact of pathophysiology of COVID-19 infections in diabetes mellitus may increase morbidity and mortality in these patients. Hence there is need of health awareness in diabetics as well in the high-risk group for diabetes such as persons with hypertension and obesity. The scarcity of health resources, shortage of trained medical personnel and disease burden of infectious and non-infectious diseases has laid a heavy impact on the economy in Africa and this has been further strained due to the COVID-19 pandemic. The practice of preventive measures by the risk group of Undiagnosed Diabetes Mellitus patients will prevent them from getting infected by COVID-19 and at the same time decrease mortality rates and hence the undiscovered group that is the patients of undiagnosed diabetes mellitus needs to be vigilant regarding safe preventive practices.

Implications of COVID-19 infections in sickle cell disease.

Sickle cell disease is a major concern of public health significance in Africa. Nearly 2/3rd of the global burden of sickle cell disease (SCD) is found to be in sub-Saharan Africa. There is increased mortality risk in sickle cell disease patients in Africa due to associated complications such as acute chest syndrome, asthma, pulmonary emboli and sepsis. Sickle cell disease management is the major contributor of financial burden on the government. Moreover, there is a shortage of medical specialists in Africa. COVID-19 pandemic has further led to devastating impact on economy and health globally. The chances of SCD patient contracting COVID-19 infections are higher as these patients are immunocompromised and may be at a higher risk of mortality. Practicing preventive measures including isolation and social distancing by these patients will prevent mortality rates as well as economic burden on government in the present unprecedented COVID-19 pandemic.