Bone marrow necrosis and fat embolism syndrome in sickle cell disease during COVID-19 infection treated successfully with sequential red cell and plasma exchange.

Fat embolism syndrome (FES) is a rare life-threatening condition that is particularly seen in milder forms of sickle cell disease (SCD). Widespread systemic fat emboli are generated in the context of extensive bone marrow necrosis. Multi-organ failure with a high morbidity and mortality may quickly develop. Infection with Parvovirus B19 is a common precipitant. Here, the authors report the case of a 35-year-old Afro-Caribbean man with HbSC disease who presented with FES having tested positive for SARS-COV-2. He rapidly became critically ill and required admission to the intensive care unit for organ support. He was treated with red cell exchange and plasma exchange and made a good recovery to leave hospital at week 7.

COVID19: A blessing in disguise for European stock markets?

This study aims to bridge the gap that has remained unfilled after the initial scrutiny and reporting of the damaging effects of Covid-19 on financial markets. The study analyzes 10 European stock markets and compares their pre and post covid return dynamics. Our findings are surprisingly pleasant, albeit counterintuitive to some. We observe a quick and unprecedented recovery in the European stock market, yielding significantly higher returns post covid, given a reasonably large holding period. We also observe an alteration and change in the status quo of countries while transmitting or receiving cross-market spillovers.

A Case of Neuroretinitis following Inactivated Virion COVID-19 Vaccination.

PURPOSE: We report a rare presentation of neuroretinitis following vaccination with inactivated virion vaccine (COVAXIN). METHODS: Interventional Case Report. OBSERVATION: A 14-year-old female presented with sudden unilateral vision loss 3 days following COVID-19 vaccination. The clinical and radiological evaluation was consistent with classical neuroretinitis; the serological and immunological workup was negative. The patient responded well to the pulse steroid therapy and regained complete vision. CONCLUSION: The COVID-19 vaccine related adverse ocular events are beginning to emerge slowly and thus warrants close monitoring of all such cases. Also, ophthalmologists should be encouraged to seek vaccination status of patients presenting with inflammatory ocular conditions.

Impact of Covid-19 on Corporate Solvency and Possible Policy Responses in the EU.

The massive contagion of new coronavirus (Covid-19) has disrupted many businesses across the European Union. This has resulted in an immense drag on the revenues and cash flows that may lead to a significant increase in corporate bankruptcies. In this paper, we investigate the impact of Covid-19 on the solvency profile of the firms in the EU member states. We introduce multiple stress scenarios on the non-financial listed firms and report a progressive increase in the probability of default, an increase of debt payback, and declining coverages. Our results indicate that the solvency profile of all firms deteriorates. The manufacturing, mining, and retail sector are most vulnerable to a decline in market capitalization and a reduction in sales revenues. The paper also examines the possible policy interventions to sustain solvency at a pre Covid-19 level. Our findings suggest that for a moderate deterioration in economic conditions, a tax deferral is sufficient. However, in the event of exacerbating business shocks, there should be hybrid support through debt and equity to avoid a meltdown. This study has important implications for policymakers, corporate managers, and creditors.

Bone marrow necrosis and fat embolism syndrome in sickle cell disease during COVID‐19 infection treated successfully with sequential red cell and plasma exchange

Fat embolism syndrome (FES) is a rare life‐threatening condition that is particularly seen in milder forms of sickle cell disease (SCD). Widespread systemic fat emboli are generated in the context of extensive bone marrow necrosis. Multi‐organ failure with a high morbidity and mortality may quickly develop. Infection with Parvovirus B19 is a common precipitant. Here, the authors report the case of a 35‐year‐old Afro‐Caribbean man with HbSC disease who presented with FES having tested positive for SARS‐COV‐2. He rapidly became critically ill and required admission to the intensive care unit for organ support. He was treated with red cell exchange and plasma exchange and made a good recovery to leave hospital at week 7.

Long-term outcomes of transcutaneous retrobulbar amphotericin B in COVID-19-associated mucormycosis.

Purpose: To describe the long-term outcomes of transcutaneous retrobulbar amphotericin B (TRAMB) in COVID-19-associated mucormycosis. Methods: In total, 18 cases of COVID-19-associated mucormycosis were reviewed. In addition to the recommended treatment protocol, all patients were to be given 3.5 mg/ml/day of TRAMB for five days. Results: Of the 18 patients, 2 presented with stage 3a disease, 13 had stage 3c disease, and 3 patients had central nervous system (CNS) involvement (stage 4a and 4c). In addition to planned retrobulbar doses, five patients were given more while two patients received fewer injections (i.e., <5). At the last mean follow-up of 34.67 (±8.88) weeks, 11 patients were in radiological regression and 4 had stable disease while 2 patients had to undergo exenteration; one mortality was observed because of disease progression. Clinical regression in terms of visual and ptosis improvement was seen in seven and nine patients, respectively. Conclusion: Rhino-orbito-cerebral mucormycosis is a serious condition which warrants an aggressive treatment strategy. In unprecedented situations witnessed recently, TRAMB turned out to be an effective and economical alternative. Though large randomized studies are needed to establish its efficacy, TRAMB still manages to halt progression and salvage the globe in significant number of patients, and hence its use should be encouraged on a case-to-case basis especially in developing countries with limited resources.

Jeelo Dobara (Live Life Again): a cross-sectional survey to understand the use of social media and community experience and perceptions around COVID-19 vaccine uptake in three low vaccine uptake districts in Karachi, Pakistan.

OBJECTIVE: To gather preliminary insights through formative research on social media usage, and experiences, attitudes and perceptions around COVID-19 and COVID-19 vaccination in three high-risk, underserved districts in Karachi, Pakistan. DESIGN: Cross-sectional mixed-method design. PARTICIPANTS: 392 adults (361 surveys and 30 in-depth interviews (IDI)) from districts South, East and Korangi in Karachi, Pakistan. MAIN OUTCOME MEASURES: Social media usage and knowledge, perception and behaviour towards COVID-19 infection and vaccination. RESULTS: Using social media was associated with an increased probability of getting vaccinated by 1.61 units. Most of the respondents (65%) reported using social media, mainly to watch videos and/or keep in touch with family/friends. 84.76% knew of COVID-19 while 88.37% knew about the COVID-19 vaccination, with 71.19% reported vaccine receipt; reasons to vaccinate included belief that vaccines protect from the virus, and vaccination being mandatory for work. However, only 56.7% of respondents believed they were at risk of disease. Of the 54 unvaccinated individuals, 27.78% did not vaccinate as they did not believe in COVID-19. Despite this, 78.38% of respondents scored high on vaccine confidence. In IDIs, most respondents knew about COVID-19 vaccines: 'This vaccine will create immunity in your body. Therefore, I think we should get vaccinated', and over half knew how COVID-19 spreads. Most considered COVID-19 a serious public health problem and thought it important that people get vaccinated. However, there was a low-risk perception of self as only a little over half felt that they were at risk of contracting COVID-19. CONCLUSION: With our conflicting results regarding COVID-19 vaccine confidence, that is, high vaccine coverage but low perception of risk to self, it is likely that vaccine coverage is more a result of mandates and coercion than true vaccine confidence. Our findings imply that interactive social media could be valuable in fostering provaccine sentiment.

COVID-19 policy actions and inflation targeting in South Asia.

In this paper, we examine the impact of policy actions undertaken by governments during the COVID-19 pandemic on Consumer Price Index (CPI) in five major South Asian nations, namely, Bangladesh, India, Nepal, Pakistan and Sri Lanka. Using panel fixed effects regression with robust standard errors, we show the relative importance of monetary and financial interventions on reducing CPI while fiscal interventions, direct grants and aid are insignificant. Further, delving into nature of policy interventions, our study finds evidence of negative impact of Credit Support, and Healthcare Support on CPI in South Asian nations. While our investigation is preliminary, it provides insights into additional understanding of effectiveness of policy actions on inflation targeting.

Management of Dental and Orthodontic Practice in the COVID-19 Scenario

The coronavirus disease-2019 (COVID-19) pandemic due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has casted a deep impact on every aspect of the human life all over the world. The healthcare professionals dealing with the patients have been at the greatest risk of exposure. Dental practitioners fall among the highest risk practitioners because of their field of operation being around the oropharyngeal region of patients, as well as due to the risk of generation of aerosols during various dental procedures. There is a continuous urgent need of modifying the dental practice in accordance with the guidelines issued by the health authorities time to time. Meticulously planned approaches, and adequate precautions and modifications need to be introduced into dental practice. The field of orthodontics also demands a high level of practice modification in order to ensure proper infection control for patients, practitioners, and dental staff.

Safe haven properties of green, Islamic, and crypto assets and investor's proclivity towards treasury and gold

A search for a safe haven inspired by investors' loss aversion significantly exacerbates in times of turbulence. The same happened during the crisis of Covid-19 when recurring losses forced investors to alter their investment strategies, and the search for alternative investment classes picked momentum. This study evaluates the safe haven properties of Green financial products, Islamic assets, and Cryptocurrencies, which gained prominence in financial markets after the global financial crisis, coupled with the long-acknowledged safe haven assets like Gold, Silver, and Treasuries. We employ a quantile VAR framework to examine the connectedness between the assets' markets during stressed, normal, and euphoric periods. Our results show that both Green and Islamic Bonds only act as a safe haven during the normal market condition;however, US Treasury, cryptocurrencies, and gold emerged as safe-haven assets under bearish or extreme volatility periods. While proclivity towards US Treasury and gold supports the phenomenon of flight-to-safety, we find cryptos have also become investors' preference amid bearish trends finding their way into the list of safe havens for investors.

Just When We Thought That COVID Was Over: A Systematic Review.

As the globe continues to grapple and scuffle with new emerging strains of COVID every day, a set of recovered patients continue to show persistent enervating symptoms. Many patients never fully recovered after COVID and had neurological and psychiatric symptoms for weeks or months. The emphasis of our study is on these long haulers, particularly on the two critical organ systems of the body, i.e., the central nervous system and the muscular system. Depending upon the severity of the disease, many signs and symptoms continue to linger, ranging from weeks to months. A total of 29 studies are included in our review after thorough screening, application of inclusion and exclusion criteria, and quality appraisals. The total number of patients included is 6012. We found many long-term effects, but the emphasis of our study continued to remain on the two main organ systems that resulted in prolonged COVID with debilitating symptoms and thus affected the quality of life of these patients. Various factors and underlying pathophysiologic manifestations result in the predominance of these signs and symptoms. Furthermore, the patient's underlying medical conditions and other environmental factors may add to it. More focus is required on the quality of life post-COVID, and this requires a team of specialists. There are still many unanswered questions like which ethnicity is affected more, why females are more prone to the long symptoms, and the effects of various treatments on the long-term signs and symptoms.

Intranasal Xylitol for the Treatment of COVID-19 in the Outpatient Setting: A Pilot Study.

It is well known that acute COVID-19 infection can present with a variety of symptoms, including fever, cough, rhinitis, loss of taste, and the cardinal sign of loss of smell (anosmia). Recently, nasal irrigations with saline and other agents have shown promise for the treatment of COVID-19. Xylitol has been shown to display virucidal effects against SARS-CoV-2. This study aimed to examine the efficacy of xylitol as an adjunct treatment for COVID-19 in an outpatient setting. In a randomized controlled double-blinded fashion, a total of 50 participants (F=30) consented to participate in this study. It was a population of 18 to 65 years of age, with polymerase chain reaction confirmed for SARS-COV-2 by nasopharyngeal swab, less than three days from the start of symptoms. This study's primary endpoint was time to clinical recovery, defined as the change from baseline to end of treatment in COVID-19 symptoms. Outcome variables were the changes in visual analog scale (VAS) and daily symptoms score (DSS) on Days 1-7, 14, and 28 after the initiation of the 14-day treatment. There were no differences between the treatment groups in any demographic and subject characteristics-related variables, including vaccination status. None of the patients were hospitalized, or required emergency visits in addition to no adverse reactions were reported. There were no statistically significant interactions found for VAS (P=0.124), DSS (P=0.448), and sense of smell (P=0.667). The proportion of patients reporting nasal congestion was higher (X2=5.05; P=0.025) in the xylitol (XYL) group (73.1%) vs. the saline (SAL) group (41.7%) on Day 4, and on Day 7 (X2=5.72; P=0.017) XYL group (50.0%) vs. SAL group (17.4%). During Day 28 a total of two patients in the SAL group had anosmia vs. no patients with anosmia in the XYL group, although this difference did not reach statistical significance (X2=5.72; P=0.133). Results demonstrate that both xylitol and saline were equally effective in decreasing the time of symptom resolution and preventing hospitalizations, yet, persistent anosmia was only seen in the SAL group. Intranasal xylitol might play a pivotal role in preventing persistent olfactory abnormalities in post-COVID-19 patients.

Do green supply chain management practices improve organizational resilience during the COVID-19 crisis? A survival analysis of global firms.

This study investigates whether green supply chain management (GSCM) practices help companies to be resilient against the buffer effect in the context of COVID-19. Building on the instrumental version of stakeholder theory, companies implementing GSCM practices should build environmental skills and competitive advantage to cope with a crisis caused by supply chain disruptions. Our survival analysis, conducted on 5,696 firms headquartered in 35 countries, shows clear evidence that GSCM companies' market prices recover quickly from the shock. Considering mounting pressure on environmental issues, this study documents the new benefits of GSCM for companies confronted with a global financial shock. By applying a large sample, the study has originality and implications for stakeholders, including investors, governments, and policymakers, to push firms to become more eco-friendly and resilient.

Management of Dental and Orthodontic Practice in the COVID-19 Scenario.

The coronavirus disease-2019 (COVID-19) pandemic due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has casted a deep impact on every aspect of the human life all over the world. The healthcare professionals dealing with the patients have been at the greatest risk of exposure. Dental practitioners fall among the highest risk practitioners because of their field of operation being around the oropharyngeal region of patients, as well as due to the risk of generation of aerosols during various dental procedures. There is a continuous urgent need of modifying the dental practice in accordance with the guidelines issued by the health authorities time to time. Meticulously planned approaches, and adequate precautions and modifications need to be introduced into dental practice. The field of orthodontics also demands a high level of practice modification in order to ensure proper infection control for patients, practitioners, and dental staff.

Dithymoquinone Analogues as Potential Candidate(s) for Neurological Manifestation Associated with COVID-19: A Therapeutic Strategy for Neuro-COVID.

The COVID-19 era has prompted several researchers to search for a linkage between COVID-19 and its associated neurological manifestation. Toll-like receptor 4 (TLR-4) acts as one such connecting link. spike protein of SARS-CoV-2 can bind either to ACE-2 receptors or to TLR-4 receptors, leading to aggregation of α-synuclein and neurodegeneration via the activation of various cascades in neurons. Recently, dithymoquinone has been reported as a potent multi-targeting candidate against SARS-CoV-2. Thus, in the present study, dithymoquinone and its six analogues were explored to target 3CLpro (main protease of SARS-CoV-2), TLR4 and PREP (Prolyl Oligopeptidases) by using the molecular docking and dynamics approach. Dithymoquinone (DTQ) analogues were designed in order to investigate the effect of different chemical groups on its bioactivity. It is noteworthy to mention that attention was given to the feasibility of synthesizing these analogues by a simple photo-dimerisation reaction. The DTQ analogue containing the 4-fluoroaniline moiety [Compound (4)] was selected for further analysis by molecular dynamics after screening via docking-interaction analyses. A YASARA structure tool built on the AMBER14 force field was used to analyze the 100 ns trajectory by taking 400 snapshots after every 250 ps. Moreover, RMSD, RoG, potential energy plots were successfully obtained for each interaction. Molecular docking results indicated strong interaction of compound (4) with 3CLpro, TLR4 and PREP with a binding energy of -8.5 kcal/mol, -10.8 kcal/mol and -9.5 kcal/mol, respectively, which is better than other DTQ-analogues and control compounds. In addition, compound (4) did not violate Lipinski's rule and showed no toxicity. Moreover, molecular dynamic analyses revealed that the complex of compound (4) with target proteins was stable during the 100 ns trajectory. Overall, the results predicted that compound (4) could be developed into a potent anti-COVID agent with the ability to mitigate neurological manifestations associated with COVID-19.

Oleuropein as a Potent Compound against Neurological Complications Linked with COVID-19: A Computational Biology Approach.

The association of COVID-19 with neurological complications is a well-known fact, and researchers are endeavoring to investigate the mechanistic perspectives behind it. SARS-CoV-2 can bind to Toll-like receptor 4 (TLR-4) that would eventually lead to α-synuclein aggregation in neurons and stimulation of neurodegeneration pathways. Olive leaves have been reported as a promising phytotherapy or co-therapy against COVID-19, and oleuropein is one of the major active components of olive leaves. In the current study, oleuropein was investigated against SARS-CoV-2 target (main protease 3CLpro), TLR-4 and Prolyl Oligopeptidases (POP), to explore oleuropein potency against the neurological complications associated with COVID-19. Docking experiments, docking validation, interaction analysis, and molecular dynamic simulation analysis were performed to provide insight into the binding pattern of oleuropein with the three target proteins. Interaction analysis revealed strong bonding between oleuropein and the active site amino acid residues of the target proteins. Results were further compared with positive control lopinavir (3CLpro), resatorvid (TLR-4), and berberine (POP). Moreover, molecular dynamic simulation was performed using YASARA structure tool, and AMBER14 force field was applied to examine an 100 ns trajectory run. For each target protein-oleuropein complex, RMSD, RoG, and total potential energy were estimated, and 400 snapshots were obtained after each 250 ps. Docking analyses showed binding energy as -7.8, -8.3, and -8.5 kcal/mol for oleuropein-3CLpro, oleuropein-TLR4, and oleuropein-POP interactions, respectively. Importantly, target protein-oleuropein complexes were stable during the 100 ns simulation run. However, an experimental in vitro study of the binding of oleuropein to the purified targets would be necessary to confirm the present study outcomes.

Chlorpheniramine, an Old Drug with New Potential Clinical Applications: A Comprehensive Review of the Literature.

Chlorpheniramine Maleate (CPM), also known as chlorphenamine, is a potent alkylamine first-generation H1 antihistamine that has been around since the 1950s. CPM is a widely popular drug commonly used to treat allergic conditions, given its antihistamine properties. Although mainly used in over-the-counter treatment for cough and colds, various studies discuss a wide range of CPM's clinical uses, such as treating asthma, plasma cell gingivitis, chronic urticaria, depression, among others. This antihistamine is usually taken orally; however, intravenous, intramuscular, and subcutaneous routes have been documented. Intranasal routes have recently been explored, especially due to its antiviral properties against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Accordingly, given CPM's extensive medical and safety profile, the present review explores this versatile drug's current and potential clinical applications. Although it is widely used mainly for treating common colds and aforementioned allergic conditions, it can be concluded that CPM can be considered to be used for other clinical indications. The repurposing of CPM for other clinical indications such as COVID-19 needs to be further explored through more extensive studies.

The impact of COVID-19 on the valuations of non-financial European firms.

This paper assesses the impact of the COVID-19 pandemic on non-financial firms' valuations in the European Union (EU) using a stress testing approach. Notably, the paper investigates the extent to which the COVID-19 may deteriorate non-financial firms' value in the ten EU countries to provide a robust anchor to policymakers in formulating strategic government interventions. We employ a sample of 5342 listed non-financial firms across the selected member states that have consistent analyst coverage from 2010 to 2019. First, we estimate the input sensitivities of free cash flow and residual income models using a random effect panel employed to in-sample data. Second, based on these sensitivities, we compute the model-driven ex-post valuations and compare their robustness with actual price and analyst forecasts for the same period. Finally, we introduce multiple stress scenarios that may emanate from COVID-19, i.e., a decline in expected sales and an increase/decrease in equity cost. Our findings show a significant loss in valuations across all sectors due to a possible reduction in sales and an increase in equity cost. In extreme cases, average firms in some industries may lose up to 60% of their intrinsic value in one year. The results remained consistent regardless of the cash flow or residual income-driven valuation.