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Rationale: Current guidelines recommend peanut introduction to high-risk infants. However, compliance and rates of new peanut allergy (PA) require further study. Methods: Participants aged 4-11 months with no prior peanut exposure and (i) diagnosis of non-peanut food allergy, (ii) moderate-severe atopic dermatitis, or (iii) first degree relative with PA were enrolled. PA status was determined by skin testing and food challenge. Participants without PA were advised to consume 2 grams of peanut protein three times/week. Monthly questionnaires were administered, with follow-up visits at 18 and 30 months. Results: At baseline, 35/326 (11%) participants were peanut allergic. Of 291 without PA, 78 (27%) discontinued peanut at least temporarily 115 times during follow-up because of suspected participant reaction (40%), fear of reaction (3%), reaction or fear of reaction in a family member (21%), participant refusal (9%), peanut introduction was too much work (3%), or other reasons (23%), including the COVID-19 pandemic. Six of 291 participants (2.1%) who consumed peanut developed PA (2 consistent with FPIES). Among 291 participants without PA at baseline, none of the 17 participants with initial skin prick test of at least 4 mm and <10 mm developed PA. Conclusions: New PA after early introduction recommendations was rare, confirming the LEAP study findings. Transient discontinuation was common, mostly due to suspected participant reaction. High-risk children may require substantial support to keep peanut in their diet.
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Introduction: The impact of the social determinants of health (SDOH) on hospitalized cancer patients and hospital length of stay is unknown. At our institution, a hospital-wide SDOH survey that examined patient-specific barriers to various domains of SDOH and facilitated hospital discharge was integrated into the electronic medical record. This study reports the effect of the SDOH survey on length of stay for oncology patients and the outpatient referrals generated to facilitate the discharge. Method(s): We examined length of stay index data on inpatient oncology patients and 2 compara-tor services (bone marrow transplant, internal medicine). We evaluated the length of stay using a 2-sample t test, and the rate of referrals per discharge using a 2-sample Poisson test. Result(s): Compared to the baseline length of stay, after the launch of the SDOH survey, there was a significant (8.9%) decrease in the average length of stay for oncology patients (8.14 to 7.41 days, P = 0.004), the LOS decrease for the bone marrow transplant was a nonsignificant trend only (P > 0.1). Average referrals per discharge increased from baseline 1.063 per discharge to 1.159 after implementation (P = 0.004), and the mean values increased by 9%. Conclusion(s): The SDOH survey tool assisted in a timely examination of patient-specific barriers to discharge, leveraged care coordination, and facilitated a safe hospital discharge. Such efforts increase the efficiency of health care service delivery in response to public health threats, such as the COVID-19 pandemic. Copyright © 2022 Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.
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Given the enormous global impact of the COVID-19 pandemic, outbreaks of highly pathogenic avian influenza in Canada, and manifold other zoonotic pathogen activity, there is a pressing need for a deeper understanding of the human-animal-environment interface and the intersecting biological, ecological, and societal factors contributing to the emergence, spread, and impact of zoonotic diseases. We aim to apply a One Health approach to pressing issues related to emerging zoonoses, and propose a functional framework of interconnected but distinct groups of recommendations around strategy and governance, technical leadership (operations), equity, education and research for a One Health approach and Action Plan for Canada. Change is desperately needed, beginning by reorienting our approach to health and recalibrating our perspectives to restore balance with the natural world in a rapid and sustainable fashion. In Canada, a major paradigm shift in how we think about health is required. All of society must recognize the intrinsic value of all living species and the importance of the health of humans, other animals, and ecosystems to health for all. © 2022 Authors: Mubareka, Amuasi, Banerjee, Carabin, Jack, Jardine, Jaroszewicz, Keefe, Kotwa, Kutz, McGregor, Mease, Nicholson, Nowak, Reed, Saint-Charles, Simonienko, Weese, Parmley, and The Crown.
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Portfolio optimization is one of the important problem classes in finance sector. As the world economy recovered and reaching the pre-COVID levels and is still continuing to grow, it is imperative to understand what kind of impact COVID-19 had on portfolio optimization and how quantum computers can be used in doing so. Hybrid quantum algorithms like variational quantum eigen solver (VQE), quantum approximate optimization algorithm (QAOA) have been tried for identifying optimal portfolios. In the present work, we employ these algorithms to carry out portfolio optimization for different time intervals (which includes pre and during COVID-19 periods) and unravel the impact of COVID19 on the same, across different industries. Our results show that the companies' stocks were growing steadily more on a sideways movement from 2016-2017. The stocks start to pick momentum from 2018-2019 and in 2020 early months as dip can be observed, however all the stocks recover to normal levels and even reaching lifetime highs from second half of 2020.
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Background: Electrical storm (ES) characterised by multiple episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) represents an increasingly difficult management problem in critical care. (1) Although, it occurs more frequently in adults, there are reports of its occurrence in children. Common causes of ES include genetic, structural heart disease and few reversible causes like endocarditis, myocarditis. In post corona virus (COVID) era, multisystem inflammatory syndrome in children (MISC) represents common cause of myocarditis in children. MISC can also be associated with superadded bacterial infection, of which endocarditis represent life threatening entity. Acinetobacter endocarditis is a rare causative agent of endocarditis in children. (2) We present an interesting case of ES in MISC state with endocarditis. Case report: A 2 month old child presented to the emergency department (ED) with hemodynamically significant ventricular tachycardia (VT) which was reverted with electrical cardioversion. Amiodarone and propranolol therapy was initiated, despite which the child suffered four episodes of hemodynamically significant VT in next 24 hours requiring electrical cardioversion and was put on elective invasive ventilation. Echocardiography revealed intracardiac hyperechoic oscillating mass attached to anterior mitral leaflet with normal left ventricular systolic function. (Fig 48) Blood investigations revealed raised anti COVID antibody with high inflammatory markers. Blood culture drawn at admission was positive for Acinetobacter and was treated with appropriate antibiotics. The child had VT free period of four days with pulse methylprednisolone and amiodarone. The child was gradually weaned from ventilator and put on non-invasive ventilation (NIV). While on NIV the child suffered another cardiac arrest, cause of which could not be ascertained. During this episode, the child suffered from irreversible neurological damage and eventually succumbed in the next 24 hours. Conclusion(s): MISC myocarditis and endocarditis both represent a state of high mortality, compounded more by electrical storm which can be difficult to manage, as in our case. [Formula presented] Copyright © 2022
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Background: Cardiac calcification is a broad entity encompassing calcific deposits in the valves, coronary arteries, aortic root, myocardium, endocardium, or pericardium. It is reported in approximately 19 percent of post myocardial infarction (MI) patients. (1) Coronary artery disease is by far the commonest cause of endo-myocardial calcification, other causes include endomyocardial fibrosis, myocarditis, metastatic calcification in chronic kidney disease patients. Post - acute coronavirus (COVID) syndrome is defined as the persistence of symptoms even beyond 4 weeks of onset of acute symptoms. (2) A recent study has shown that, beyond the first 30 days after infection, individuals with COVID are at increased risk of incident cardiovascular disease including cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure and thromboembolic disease. (3) This study cited the risk and additional burden of ischemic heart disease outcome as an hazard ratio of 1.66 (95% confidence interval of 1.52 - 1.80) and 7.28 (95% confidence interval 5.8 - 8.88) per 1000 population respectively. (3) We present an interesting case of a forty-three-year-old man with endo-myocardial calcification with ischemic cardiomyopathy (ICMP) and severely reduced left ventricular (LV) global longitudinal strain (GLS) in post COVID syndrome. Case report: A forty - three-year-old man presented to us with gradually worsening dyspnea on exertion - New York Heart Association (NYHA) grade II at present - and pedal edema since the past 6 months. He had a history of COVID infection prior to that for which he received institutional care and was discharged uneventfully - not requiring any intensive care stay during the hospitalization. On presentation now a 12-lead electrocardiogram was done which revealed left bundle branch pattern. He underwent - an echocardiogram which showed a reduced ejection fraction of 38 % along with regional wall motion abnormality in anterior, apical and lateral wall;a computed tomogram of thorax which did not reveal any lung disease but endo - myocardial calcification. (Fig 3) He further underwent myocardial strain imaging using echocardiography, which revealed a severely reduced LV GLS. (Fig 4) Routine blood investigations including inflammatory markers and Troponin levels were within normal limit, brain natriuretic peptide (BNP) levels were found to be very high. The patient underwent coronary angiogram which revealed significant disease in distal left main coronary artery and ostio-proximal left anterior descending and left circumflex artery. After detailed heart team discussion along with patient relatives the patient was advised coronary artery bypass grafting. The patient took discharge and went to a different hospital to undergo the same. Conclusion(s): Acute Coronavirus infection has already been wreaking havoc all around the globe since the past 3 years. We have now showcased a unique and devastating consequence of the post COVID state in a relatively young man. [Formula presented] [Formula presented] Copyright © 2022
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Background and Objectives: Pregnancy, an altered physiological state, is specifically vulnerable to psychological distress (PD), more so during the coronavirus disease 2019 (COVID-19) pandemic. This can impart detrimental consequences to both mother and child. This study assessed the magnitude of PD and associated factors among pregnant women in rural West Bengal. The proportion of pregnant women with COVID-19 symptomatology and its relationship with PD was also determined. Methods: This cross-sectional study was done among 130 pregnant women availing antenatal care in health centers during August-October 2020. Patient Health Questionnaire (PHQ-4) was used to assess PD and a 'Perception on COVID-19 Pandemic' (PCP) Scale was used to assess the perception of the COVID-19 pandemic (Cronbach's alpha = 0.75). Statistical analyses were done in SPSS Inc., SPSS for Windows, Chicago, USA. Results: The proportion of study participants with PD was 49.2%. Unsatisfactory antenatal care (AOR = 19.4, CI = 2.5-152.7), COVID-19 case within family/neighborhood (AOR = 6.3, CI = 1.2-34.9), strenuous spousal relationship (AOR = 7.3, CI = 1.1-50), increasing score in perceived susceptibility domain of PCP Scale (AOR = 1.3, CI = 1.1-1.6), and decreased daily sleep duration (AOR = 2.8, CI = 1.6-4.9) were found to be associated with PD. 38.5% of participants reported COVID-19 related symptoms. Conclusion: The magnitude of PD among pregnant women in the study area is high. Thus, proper counseling of pregnant mothers during antenatal visits by public health nursing personnel to alleviate fears about the pandemic would go a long way to reduce the negative impact of PD on mother and child. © 2022 Medical Journal of Dr. D.Y. Patil Vidyapeeth ;Published by Wolters Kluwer - Medknow.
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SARS-CoV-2 virus primarily affects the respiratory system, although other organ systems are also involved. Though pulmonary arterial hypertension (PAH) has been described in as a sequela of COVID pneumonia in adults, only a coincidental association between pre-existing PAH and SARS-CoV-2 infection in children has been reported. To our knowledge, severe COVID pneumonia-causing PAH in children, especially in infancy has not been reported yet. With the meteoric spread of the pandemic and rapid development of newer mutated variants, the timely discovery of new drugs is near impossible. The idea of repurposing existing drugs to treat COVID-19 is an attractive strategy, especially if they are already approved (for other indications) and have well-established safety profiles. Sildenafil specifically targets pulmonary vasodilation, endothelial function, and vascular remodelling. It hence has emerged as an effective first-line oral therapeutic agent for patients with symptomatic PAH in all age groups. We present a case series of four cases where Sildenafil has been repurposed for the treatment of PAH associated with severe COVID-19 pneumonia in infancy. Copyright © 2022 by author(s).
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Background and Aims: The aim of this project was to compare the performance of Addenbrooke's acute stroke team from September 2018 - September 2021 to the UK National Stroke Service Model time-targets for hyperacute stroke management. This period was chosen to cover performance before and during COVID, because the pandemic instigated radical changes in hyperacute stroke management processes and team structure in Addenbrooke's Hospital. From this audit, we hoped to determine the effects of these changes - the strengths and weaknesses of different team and process permutations to advise the development of an ideal stroke service model. Method(s): Data on door-to-1st responder time, door-to-CT time, door-to-thrombolysis time, door-to-thrombectomy time and door-toconsultant time for patients presenting during working hours (Mon-Fri, 0900-1700) from September 2018 to September 2021 was extracted from Addenbrooke's Hospital SSNAP database. Statistical analysis revealed a non-parametric distribution, thus median time and IQR were calculated for comparison between different covering teams. Kruskal- Wallis analysis was used to compare data of different teams, and subsequently, if significance was identified, pairwise Mann-Whitney U tests were conducted to determine statistically different groups. Result(s): Door-to-1st responder, door-to-CT, door-to-thrombolysis, door-to-thrombectomy, and door-to-consultant time varied over the 3 years depending on cover. Group 4 was identified as having significantly lower door-to-1st responder and door-to-consultant times. Conclusion(s): Better staffing and top-down prioritisation for consultant review were identified as factors supporting quicker management. Reduction of door-to-CT time, simplification of CT algorithm for rapid thrombolysis and expansion of thrombectomy services were identified as changes which could potentially improve hyperacute stroke management in Addenbrooke's Hospital. (Figure Presented).
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Introduction: Management of T1D with BD during lockdown was challenging. Objective(s): To explore parents' experience in managing CYP with T1D & BD during the lockdown and its influence in this cohort. To understand the effect of lockdown on emotional health for providing better care in the future. Method(s): The parents were randomly selected (n = 10) from the diabetes clinic. The data were collected using structured open and closed-ended questionnaires. Thematic analysis & deductive coding techniques were used to construct a theory. Result(s): Most parents believe that the risk of COVID-19 was higher than that of T1D complications, leading to delays in seeking medical attention. Fear, anxiety, and helplessness were the most common emotions linked to uncertainty, conflicting information and unending speculation based on daily media reports of fatalities. Most parents described isolation, restricted physical activity, and stress-induced eating behavior as responsible for weight gain and poor diabetes control. Parents universally stated reduced quality of life, worsening symptoms of autism and attention deficit hyperactivity disorder, explained partly by the suspension of traditional care during the lockdown. Parents reported CYP as having more frequent episodes of meltdowns, arguments, emotional outbursts, destructive behavior, deliberate self-harm, and sleep disturbances and anxiety around losing family members to COVID-19. Additionally, loss of extended family support/peer support in school during the lockdown and a 'toxic' home environment aggravated behavioral deterioration. Furthermore, the suspension of traditional consultant-led clinics and unfamiliarity with remote consultations were other influencers of anxiety. Conclusion(s): Parents reported a significant deterioration in the behavior of CYP with T1D & BD during the lockdown, which may affect their T1D control. Future studies are required to better understand the health need of this unique cohort so that resources can be aptly diverted to deliver patient-focused diabetes care.
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ObjectiveExamine the relationship between symptoms and exercise physiological parameters in patients with long covid.MethodsPatients with long covid symptoms 6–12 months after covid19 infection referred to the long covid clinic were invited for Cardiopulmonary Exercise Testing (CPET). None had required ventilatory support during covid19 infection. All patients had normal transthoracic echocardiograms and normal resting flow-volume curves and gas transfer measurements. All patients underwent standard cycle ergometer symptom-limited CPET. Treatment guided by the CPET was offered and follow-up CPET was performed at 3 months.Results32 patients had a first CPET. The commonest symptoms were breathlessness (30/32), fatigue (26/32), cough (7/32), ‘brain fog’ (6/32) and chest pain (5/32). The main CPET physiological abnormalities were a borderline low peak oxygen uptake (mean 82.5% predicted), a low anaerobic threshold (AT, mean 47.6% of predicted maximal oxygen uptake) and a low oxygen uptake/work rate slope (mean 9.4 ml/min/W). The oxygen pulse curve flattened early in exercise, but peak oxygen pulse was normal (mean 88.9%).20 patients underwent a second CPET. 14 patients had improved symptoms: breathlessness (11/20), fatigue (9/20), cough (2/20), ‘brain fog’ (3/20) and chest pain (0/20). Symptom improvement was associated with a rise in peak oxygen uptake (to mean 85.3% predicted) and oxygen pulse (to mean 94.1% predicted) although both remained within the normal range. The AT remained low (mean 46.4% predicted maximal oxygen uptake). The ventilatory equivalent for carbon dioxide (VE/VCO2) was normal 28.6 L/L at AT.6 patients with unchanged symptoms had a reduction in oxygen pulse to mean 81.5% predicted compared to the first CPET but a rise in VE/VCO2 to 33.7 L/L at AT.ConclusionsLong covid is associated with impaired peak oxygen uptake, AT and oxygen pulse. This suggests an oxygen delivery or uptake disorder or deconditioning. The transthoracic echocardiograms were normal suggesting a disorder at the muscle level.A targeted treatment programme based on CPET improves symptoms and physiological parameters in long covid patients.Patients with unchanged symptoms after 3 months of treatment had persistent physiological abnormalities but appeared to develop features of dysfunctional breathing syndrome.
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Background: The COVID-19 pandemic had a significant impact on the quality of healthcare provision across all specialities and disciplines. However, there are limited data on the scale of its disruption to cardiac procedure activity from a national perspective and whether procedural outcomes different before and during the COVID-19 pandemic. Methods: Major cardiac procedures (n=374,899) performed between 1st January and 31st May for the years 2018, 2019 and 2020 were analysed, stratified by procedure type and time-period (pre-COVID: January-May 2018 and 2019 and January-February 2020 and COVID: March-May 2020). Multivariable logistic regression modelling was undertaken to examine the odds ratio (OR) of 30-day mortality for procedures performed in the COVID period (vs. pre-COVID). Results: There was a deficit of 45,501 procedures during the COVID period compared to the monthly averages (March-May) in 2018–2019. Cardiac catheterisation and cardiac electronic device implantations were the most affected in terms of numbers (n=19,637 and n=10,453) while surgical procedures including mitral valve replacement, other valve replacement/repair, atrial and ventricular septal defect repair, and CABG were the most affected as a relative percentage difference (D) to previous years' averages. TAVR was the least affected (D-10.6%). No difference in 30-day mortality was observed between pre-COVID and COVID time-periods for all cardiac procedures except cardiac catheterisation (OR 1.25 95% confidence interval (CI) 1.07–1.47, p=0.006) and cardiac device implantation (OR 1.35 95% CI 1.15–1.58, p<0.001). Conclusion: There was a significant decline in national cardiac procedural activity in England during the COVID-19 pandemic, with a deficit in excess of 45000 procedures over the study period. However, there was no increase in risk of mortality for most cardiac procedures performed during the pandemic. While health service pressures are gradually easing given the increased roll out of vaccination and decline in infection rates, there is a need for major restructuring of cardiac services deal with this significant backlog of procedures, which would inevitably impact longer-term morbidity and mortality. Funding Acknowledgement: Type of funding sources: None.Figure 1
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Background: Long Covid is associated with multiple symptoms and impairment in multiple organs [1]. Cardiac impairment has been reported to varying degrees by varying methodologies in cross-sectional studies. Using cardiovascular magnetic resonance (CMR), we investigated the 12-month trajectory of cardiac impairment in individuals with Long Covid. Purpose: We conducted a prospective, longitudinal, 1-year study in individuals with Long Covid to investigate 1) the characteristics and trajectory of cardiac impairment;2) the impact of acute hospitalisation for COVID-19 on cardiac impairment;and 3) pathways for designing and improving clinical management for individuals at risk of cardiac impairment. Methods: 534 individuals with Long Covid underwent baseline CMR (quantitative T1 and T2 mapping, cardiac mass, volumes, function, and strain) and multi-organ MRI at 6 months (IQR 4.3,7.3) since first post-COVID-19 symptoms. If abnormal findings were reported at baseline, individuals were rescanned at 12.6 months (IQR 11.4, 14.2) (n=330). Symptoms, standardised questionnaires, and blood samples were collected at both timepoints (Figure 1). Cardiac impairment was defined as one or more of: low left or right ventricular ejection fraction (LVEF and RVEF), high left or right ventricular end diastolic volume (LVEDV and RVEDV), impaired left ventricular global longitudinal strain (GLS), or elevated native T1 in ≥3 cardiac independent AHA segments. A significant change over time was reported by comparison with 92 healthy controls. Results: The technical success of this multiorgan assessment in a non-acute setting was 99.1% at baseline, and 98.3% at follow-up, with 99.6% and 98.8% for CMR, respectively. Of individuals with Long Covid, 19% had cardiac impairment at baseline;70% had complete paired data at 12 months. Of those with paired data, 58% presented with ongoing cardiac impairment at 12 months. High sensitivity cardiac troponin I and B-type natriuretic peptide were not predictive of CMR findings, symptoms, or clinical outcomes. At baseline, low LVEF, high RVEDV and reduced GLS were associated with cardiac impairment;however, while elevated T1 was associated with less symptom severity at 12 months, individuals with low LVEF at baseline were associated with ongoing cardiac impairment 1 year post-infection (Figure 2). Conclusion: Cardiac impairment, other than myocarditis, is present in 1 in 5 individuals with Long Covid at 6 months, persisting in over half of those at 12 months. Cardiac-related blood biomarkers are unable to identify cardiac impairment in Long COVID. Subtypes of disease (based on symptoms, examination, and investigations) and predictive biomarkers are yet to be established. Interventional trials with pre-specified subgroup analyses are required to inform therapeutic options. Funding Acknowledgement: Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Radical (EU) and Innovative UK (UK national) (and others)Figure 1Figure 2
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Purpose: This paper investigates the influence of three different sentiment indicators on the time-varying stock–bond correlation of 15 countries during the global crisis period of the coronavirus disease 2019 (COVID-19) pandemic. Design/methodology/approach: The author uses the time-varying correlation estimated using the autoregressive moving average -dynamic conditional correlation - generalised autoregressive conditional heteroskedasticity (ARMA-DCC-GARCH) model to achieve this aim. The impact of investor sentiment on the stock–bond correlation was analysed using the Markov regime-switching regression. Findings: The study results show that the sentiment indicators of fear, uncertainty and distress have a pronounced negative impact on the stock–bond correlation. They further provide evidence of a strong regime effect on the stock–bond correlation with sentiment indicators. Practical implications: The paper has a relevant impact on policymakers and fund managers. First, the policymakers now have more insightful evidence of how the stock and bond markets react during crises. Second, the fund managers need to focus on behavioural variables as they may be driving factors in crisis periods that may impair portfolio management. Originality/value: To the best of my knowledge, the paper is the first to throw light on the behaviour of the stock–bond correlation for 15 countries during the COVID-19 period. © 2022, Emerald Publishing Limited.
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Tea harbours more than 700 bioactive compounds viz, different classes of polyphenols, unique amino acid L-Theanine, alkaloids (Caffeine, Theobromine), and Volatile Flavor Compounds (VFC). Tea's polyphenols make its inherent therapeutic potential unlimited. Tea's significance in managing cancer, diabetes, stomach ulcer, influenza, neurological diseases, etc. is well-documented. However, advantageous biochemical capabilities of tea have yet to be fully utilised. Hence, this review aims at to examine tea's variety, drinking habits, biochemistry, and therapeutic qualities. A number of significant online resources, including Google Scholar, Pub Med, Science Direct, and others, were searched for various research works on tea and its health-promoting qualities by using keywords like tea, health benefits, bioactive components against diseases, etc. Current review highlighted that drinking a cup or more green tea is recommended for improving antioxidant status and to manage diabetes and obesity related problem. However after detailed review work on tea it become clear that not only green tea but also other varies of tea like black, white tea are also harbour lots of bioactive molecules since they are processed from same plant. Tea improves antioxidant status and manages diabetes and obesity. It also helps prevent and cure heart disease, malignancy, digestive dysfunction, and metabolic disorders including obesity and diabetes. Epigallocatechin Gallate (EGCG), found in tea, has been shown to reduce complications from Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV 2) infection. When taken in its traditional form to manage ailments, tea is sometimes controversial due to a lack of confirming evidence of its benefits. The paper covers the numerous health advantages of tea, focusing on the specific components contributing to such benefits, and stresses the value of diverse brewing processes. © 2022 The Author(s). Published by Enviro Research Publishers.