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.

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.

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.

SARS-CoV-2: ACE inhibitors, disastrous or desirable?

Background: The world has a current total of 6,663,304 confirmed cases of COVID-19 with a death count of 392,802 deaths according to the WHO (6 June 2020). Various risk factors for the acquisition and subsequent development of deadly complications due to the virus have been established. One such risk factor is the presence of cardiovascular disease, particularly hypertension as a comorbidity. It must be noted that JNC 8 advise the use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers as first line drugs for the management of hypertension. ARDS is caused by the activation of angiotensin I, angiotensin II and AT1 receptor pathway, however stimulation of Mas receptor, MRGPR receptors, AT2 receptor and the ACE-2-angiotensin (1-7), pathways is found to be defensive.  Mas receptor exerts an inhibitory effect on inflammation and cellular growth and vascular mechanisms.  This research aims to examine the relationship between ACE inhibitors and the risk of COVID-19 infections with the goal of determining whether this relationship is spurious in association or whether it is causative in nature? More specifically, in this research article we will determine whether the SARS-CoV-2 virus has an affinity for ACE 2 receptors in humans. Furthermore, it will be determined whether ACE inhibitors would inhibit or facilitate an imminent COVID-19 infection in individuals as well as to  determine whether patients currently using ACE inhibitors should continue or discontinue the drug therapy in order to minimize their susceptibility to acquiring COVID-19, and whether patients should start ACE inhibitor therapy if required during this pandemic. Conclusion: It is evident that ACE 2 receptors are the portal of entry for SARS-CoV-2. It is recommended that the use of RAAS inhibitors, viz ACE inhibitors and angiotensin receptor blockers is not stopped or decreased despite the ongoing pandemic as the results thereof may lead to the worsening of the patient’s comorbidity and may hasten death.

ABO blood groups as determinants to patient outcomes in SARS-CoV-2

Background: Blood group antigens are present on the red blood cell surface. O, A, and B are the major blood groups. A, B, AB, and A1 are the antigens. An ample amount of research supports the close association of blood groups with diseases. A new school of thought and finding seems to be indicating that certain blood groups are more susceptible to the COVID-19 infection in comparison to others. Current evidence suggests that SARS-CoV-2 positive cases are more prevalent in individuals with blood group A as compared to those with blood group O. This finding, however, was only relevant for the Rh (+ve) positive blood types. Genetic association reveals that the ABO blood group locus and a chromosome 3 gene cluster are associated with severe acute respiratory syndrome in coronavirus (SARS-CoV-2) respiratory failure patents. This was found in an Italian- Spanish genome-wide association analysis. Various associations between the patients' blood groups when comparing the data with that of physiologically healthy individuals from the same geographical region helped to get a clear comparative picture. Associations that were cross-replicating in nature were determined at chromosome 3p21.31 and chromosome 9q34. The association at chromosome 9q34 was identified at the ABO blood group locus. The difference in the susceptibility could be correlated to the circulating anti‐A antibodies, which inhibit or interfere with the virus-cell adhesion process. Conclusion: It is evident that the research conducted to date is supportive and does suggest that humans of the Blood group O are less likely to be infected in the COVID-19 pandemic as when compared to other blood groups. The SARS-CoV-2 situation is evolving rapidly, discoveries and anomalies are being reported daily. Therefore, it is advised that more definitive and consolidatory research is to be conducted to further elucidate the underlying mechanism of action for the protection in blood group O.

COVID19: Dexamethasone;death or deliverer therefrom?

Background: A multitude and wide array of various drugs have been postulated and some even attempted to be used as effective treatments against the virus.  The drugs have ranged from antimalarials used in India as a prophylaxis to the disease;namely chloroquine and hydroxychloroquine, to the use of broad-spectrum antiviral drugs such as Remdesivir. Dexamethasone, a cheap, widely available, long acting corticosteroid has been gaining popularity and to some extent fame in the treatment of COVID19 patients. The benefits and use thereof were made apparent after very successful research conducted by the University of Oxford. The Recovery trial, which is one of the world’s largest clinical trials. This trial reported on June 16, 2020 that patients on Dexamethasone at a dosage of 6 mg per day for 10 days have a dramatically reduced mortality particularly in the COVID patients on ventilators. The dexamethasone proved very beneficial in the milder cases of the disease as well and reduced death by 20% in those cases. The proposed mechanism of action by which the dexamethasone drug acts is via impeding the dangerous cytokine storm, an intense immune response that severely renders the lungs damaged. This intense cytokine storm is attributed to the severe complications and respiratory failure noted in COVID19 patients. The long acting dexamethasone would suppress this autoimmune destruction and intense inflammatory reaction, thereby sparing the lungs and the patient’s life. Conclusion: It is therefore of paramount importance that the use of dexamethasone in COVID19 cases is further studied and understood. The benefits of the use of dexamethasone are undeniable and therefore the drug should be implemented into the treatment regime with a guarded approach. 

The changing pattern of COVID-19 in Nepal: A Global concern- A Narrative Review.

This narrative review of the literature aims to assess the impact of COVID-19 on the younger age group in terms of the Global mortality of COVID-19 in comparison to Nepal. An extensive literature survey of English literature was conducted using Pubmed, Medline, Google Scholar, Embase, WHO Nepal Situation Updates on COVID-19, Situation update report, Ministry of Health and Population-Nepal from January 25, 2020 to June 20, 2020. According to the Ministry of Health and population of The Government of Nepal, as of June 20, 2020, out of a total of 8,605 laboratory confirmed cases reported to date, the pattern shows that most of the cases fell into the cohort of 21-30 years (37.72%), followed by 11-20 years (24.35 %), 31-40 years (21.97%) and 41-50 years (9.2%). To date Nepal has recorded a total of twenty-two deaths. At first evaluation these figures may not strike one as alarming, but on further investigation it is noted that the mean age is 42. 32 ± 19.632 SD years, and out of which male patients accounted for 77.3% and female accounted for 22.7%. The current situation of COVID-19 and how it develops in Nepal should be closely monitored and could be of international concern as it may be the early indicator of a changing pattern in COVID-19 infections. Nepal may therefore act as a global watch dog, due to the fact that the world could very possibly expose the younger age group under the notion that they are more resilient to the virus, when in reality that notion may be changing. This trend must be monitored and further investigated in order to establish the risk of the events unfolding in Nepal.