Innovative Ingredients Fortified Nutrients Enriched Biscuits and Cookies: Quality and Sensory Analyses

Global suffering from COVID-19 has necessitated augmenting the immunity systems of humans through consumption of macro-micro-nutrients and antioxidant-enriched fortified foods. In this article, fortifications of popular bakery products, viz. biscuits, cookies, have been reviewed, encompassing the novel fortifying ingredients and innovative methods employed with an emphasis on the overall enrichment in the final product quality. A few notable features concerning novel fortified biscuit and fortified cookie have been decisively summarized. Wheat flour blended with 40% sesame-cake flour resulted in a fortified biscuit possessing higher protein (16.6%), crude fat (16.95%), and dietary fiber (8.2%) with acceptable sensory characteristics. About 9% toting up of chicken-eggshell dried-powder could result in high Ca content in biscuits with customary changes in texture and sensory properties. A remarkable 5% addition of bee pollen to wheat flour appreciably improved the nutrient compositions (carbohydrate 65.18%, protein 7.32%, and total dietary-fiber 1.47%) along with high polyphenol and antioxidant potentials. Notably, mixing fish fillet protein concentrate with wheat flour could yield enhanced nutritional content (protein 14.63-19.52%, fat 16.2-16.5%), as well as augmented amino acids. Remarkably, wheat flour fortified with fermented jack bean flour resulted in an overall fortified biscuit with substantial carbohydrate, crude protein, fat, fiber, ash, and appreciable macro-micro mineral contents and sensory characteristics. Innovative fortified cookies were made by blending wheat flour or Brewer's spent grain flour with one or more ingredients, e.g. full fat soya, mushroom, cardamom powder, moringa leaves, coconut, sweet potato flour rendering amplified values of nutrients, superior physical properties, increased mineral and flavonoid contents and organoleptic qualities.Copyright © 2023 Bentham Science Publishers.

Sars-Cov-2 Vaccine from Infected Plant Attenuated Virus Using Acer Cincinatum (Vine Maple)

Purpose of study Proposal for an oral (or if required, parenteral) COVID-19 vaccination based upon this described technology. Investigational theory under study for the past 9 months of COVID-19 growing season. Coronavirus can attack and infect plant species. It was found that SARS-CoV-2 can infect various plant species. Others have found plants, for example tobacco as a good growth medium for Coronavirus and SARS-CoV-2. This current study has found various plants species infected with SARS-CoV-2 by rPCR. As the plants were located beside a well used hiking trail for humans, and were infected along the trail including various species with SARS-CoV-2, hypothesized that human airborne contact had caused infection in the bordering plants. Humans were observed to be coughing while walking on the trail, and were not wearing masks. The plant leaves developed small circular colonies of the virus, which became self-limited at several millimeters in diameter. All of the plants were clear of these lesions before the COVID-19 Pandemic. The plants 'immune' system produced antiviral agents, including lectins which limited the growth of the colonies and prevent death of the leaf and whole plant. The fungal cultures of the 'spots' were negative. The rPCR of all spots tested in the present series was positive for SARS-CoV-2. Hypothesis, that self-augmentation of the virus occurred by the natural culturing in plant leaves that produce antiviral agents as part of their 'immune system.' Hypothesis, a symbiotic type relationship developed between the plant using its chemical immune system, and the virus allowed to replicate in an augmented fashion to allow both the virus and the host to survive and grow. As the top candidates for the oral vaccine are nontoxic, hypothesis involves the maceration of the infected leaves, mixing with a nontoxic adjuvant and flavoring to promote assimilation and palatability, with the proposed route of entry being mastication, thus exposing the oral-nasal mucosa to the vaccine, with the probable best of immunity to usual exposure to the SARS-CoV-2 virus, that is the oral-nasal mucosal and upper airway route. As many types of animals are now infected with SARS-CoV-2, it is further hypothesized that this oral vaccine could also be mass produced to add to various animals by feedstock and oral route. Methods used Hypotheses formed through observations. Testing of observations by pPCR, viral cell culture, fungal culture, light and electron microscopy. Summary of results pPCR SARS-CoV-2 positive, cell culture 'lysis experiment' positive, EM and light microscopy positive, fungal culture negative. Conclusions TABLE OF HYPOTHESES AND STUDY RESULTS (HYPOTHETICAL, OBSERVED, PROVEN) 1. The first hypothesis that the virus is attenuated by the plant, using its innate chemical immune system. Similarly, Pasteur used chemical such as phenol to attenuate viruses for wome of the first successful vaccines. Observed. 2. Hypothesis, the plants 'immune' system produced antiviral agents, including lectins, flavonoids, and others, which limited the growth of the colonies and prevent death of the leaf and whole plant. Proven. 3. Hypothesis is that the nontoxic plants, such as Vine Maple sp.(Acer cincinatum), could be used to produce and oral plant attenuated vaccine. Hypothesis. 4. Hypothesis involves the maceration of the infected leaves, mixing with a nontoxic adjuvant and flavoring to promote assimilation and palatability, with the proposed route of entry being mastication, thus exposing the oral-nasal mucosa to the vaccine, with the probable best of immunity to usual exposure to the SARS-CoV-2 virus, that is the oral-nasal mucosa, upper airway. (Figure Presented).

Unilateral multiple facial angiofibromas as a solitary manifestation of tuberous sclerosis

We describe the case of a 12-year-old boy who presented via teledermatology with a 5-6-year history of multiple lesions on the right side of his face. They were unchanged since their initial appearance at 6 years of age but were slowly increasing in number across his right cheek and extending onto the chin. Although the lesions were asymptomatic, growing older had made him feel increasingly self-conscious. He was otherwise fit and well, and attended mainstream school, with no past medical history or family history of note. Perinatal and birth history were also uneventful. On examination, he had multiple, 1-2-mm, erythematous papules confined to the right cheek and right chin. Dermoscopy showed an unusual pattern of vessels with nonspecific globules in between. The rest of the skin, hair and nails were entirely normal in appearance. There were no systemic symptoms and a detailed general and systemic examination, as well as radiological imaging, did not reveal any abnormality. An excisional biopsy was taken of one of the lesions, with histological examination demonstrating focal superficial telangiectasia with associated bland round-tospindle cell proliferation, appearances most in keeping with an angiofibroma. This correlated well clinically, apart from unilateral facial angiofibromas being the solitary finding in our patient. Facial angiofibromas - also called adenoma sebaceum - are well described as part of the cutaneous manifestations of tuberous sclerosis (TSC). Classically, these appear as a facial rash in the form of small pink or red spots across the cheeks and nose in a butterfly distribution, at between 3 and 10 years of age, increasing in size and number until adolescence. TSC is an autosomal dominant disorder with defective mammalian target of rapamycin (mTOR) signalling, characterized by hamartomas in many organs, particularly the skin, central nervous system, renal and cardiovascular systems. The clinical presentation is variable, with other well known and frequently reported cutaneous findings such as shagreen patches, ash-leaf macules and periungual fibromas. Unilateral multiple facial angiofibromas in the absence of other cutaneous or systemic manifestations of TSC - as in our patient - are rare, with only 13 reported cases. These may form part of the clinical spectrum of TSC as a probable consequence of cutaneous mosaicism in which a postzygotic genetic mutation has occurred. Our patient was referred for genetic testing, but this has been delayed as a result of the COVID-19 pandemic. Topical sirolimus 1% - an mTOR inhibitor - has been used with good effect for facial angiofibromas, and our patient also responded well to this.

Short term impact of COVID19 pneumonia on cardiovascular profile

Introduction: COVID19 pneumonias have significantly contributed to short and long-term patient morbidity. Their impact on patients' cardiovascular profile following hospital discharge remains unclear. Aim(s): To investigate the short-term impact of COVID19 pneumonias on patients' atheromatic index (AI), Pulmonary Artery Systolic Pressure (PASP) and lipid profile at 4 weeks following hospital discharge. Material(s) and Method(s): We prospectively reviewed patients in our postCOVID19 outpatient clinic at 4 weeks following hospital discharge. All patients were previously admitted due to COVID19 pneumonia. Thoroughly review of all medical records and the local registry followed. Result(s): 237 patients attended their first outpatient appointment at 4 weeks post discharge (11.2020-12.2021) (103 males, 134 females, mean age 54 years). We reviewed 3 cardiovascular parameters: AI (chol/HDL), PASP and lipid profile. Increased PASP (30> mmHg) was reported in 7.17% (17/237) who were previously PASP naive and increased AI (>3.5) was reported in 37.7% (61/237 patients) who were also previously AI naive. Only 62% patients were compliant in undergoing a lipid profile investigation and 64% of them presented with increased levels of cholesterol (>200mg/dl), triglycerides (>150mg/dl), LDL (>150mg/dl). Conclusion(s): COVID19 pneumonia leaves a cardiovascular footprint at 4 weeks post hospital discharge in cardiovascular naive patients. Overall, these patients seem to be at an increased risk for cardiovascular diseases that increases with age. Our study is prospectively continued to investigate the impact at 3 and 6 months post hospital discharge.

Preparation and FTIR-ATR combined with chemometrics analysis of self-emulsifying loaded sungkai extract from Peronema canecens

The use of immunomodulators is one strategy in maintaining the immune system during the Covid-19 pandemic. Sungkai leaf extract from Peronema canecens keeps the immune system in good shape. Therefore, in this study, we formulated a self-emulsifying loaded sungkai leaves extract (SE-SLE) with oleic acid and virgin coconut oil (VCO) oil phases, span 80 and tween 80 as surfactants and co-surfactants in the form of PEG-400 and PG. Chemometric analysis was conducted by observing the typical pattern in each FTIR-ATR spectra. The pattern is divided into several groups based on the wavenumber and analyzed using principal component analysis (PCA) to identify the compounds contained therein. Grouping based on chemical properties via IR spectra on SE-SLE resulted in two large groups. The results obtained are beneficial as initial information in developing and optimizing the self-nano emulsifying drug delivery system formula.Copyright © RJPT All right reserved.

A Review of Phytochemistry and Pharmacology on Moringa Oleifera

Natural extracts have been of very interest since ancient times due to their enormous medicinal use and research attention. Moringa oleifera is well known as miracle tree as it consists of high nutritive values. Originally from India is widely distributed in many tropical regions, in the pacific region, west Africa as well as central America. India is the major supplier of Moringa worldwide, accounting for around 80% of global demand. It is a multipurpose plant cultivated for medicinal applications. It contains rich sources of Vit- A, B1, B2, B3 and C, It also has calcium, potassium, iron, magnesium, zinc and phospherus. Moringa species contain various phytoconstituents such as alkaloids, saponins,tannins, steroids.phenolic acids( gallic, vanillic and p-coumaric acids) and flavanoids(catechin), tocopherol ,glucosinolates and terpenes. Investigations of ethanol extract of the leaves gives lutein, B-carotene,phytyl fatty acids, esters, poly phenols, B- sitosterols,triglycerols,fatty acids and saturated hydrocarbons. Leaves were obtained by super critical extraction with CO2 using ethanol as a cosolvent, temperature 35-80 0C.The phenolic acids( gallic, vanillic and p- coumaric acids) and flavanoids(catechin) were identified in all extracts. Extracts obtained at 35 degrees shows the highest values of total phenolic compounds. The activities of plant include Anti-oxidants, anti-cancer, anti-microbial, anti-viral,anti- hyperglycemic,anti-hyperlipidemic,anti-inflammatory,anti-hypertension, anti-spasmodic and others. Due to covid-19 pandemic, the global Moringa products market size is estimated to be worth USD 5167.2 million in 2022. Leaf powder is expected to exceed USD 6 billion by 2025 on account of increasing demand in the dietary supplement and food applications.

A Brief Review on Guduchi (Tinospora Cordifolia)

Guduchi (Tinospora cordifolia) is an essential drug of the Ayurvedic medicine system used in different Ayurvedic formulations to treat a variety of ailments. Guduchi is a member of the Menispermaceae family and is widely produced in tropical and sub-tropical countries such as India, Sri Lanka, China, Myanmar, Philippines, South Africa, Thailand, Bangladesh, and several south-east Asian continents such as Indonesia, Malaysia. All parts of Guduchi have nutritional value and medicinal importance, including the roots, stem, bark, and leaves. A different class of phytochemicals like alkaloids, glycosides, aliphatic compounds, diterpenoids, sesquiterpenoids, phenolic compounds, steroid and polysaccharides, etc., are found in Guduchi. Tinosporaside, tinosporine, magnosporine, berberine, choline, Jatrorrhizine, palmatine, beberine, giloin, giloinsterol, and other beneficial biomarkers are present in this herb. Guduchi is used to treat cold, fever, headache, jaundice, digestive disorder, among other things, and it shows several proven pharmacological activities such as anti-oxidant, anti-inflammatory, antidiabetic, immunomodulatory activity, anti-toxic, hepatoprotective, anticancer, cardioprotective activity, radioprotective, antimicrobial, anti-stress, anti-HIV and many more. This review article majorly highlights the phytochemical present in Guduchi, analytical works and pharmacological activities of Guduchi. Copyright © 2022 are reserved by International Journal of Pharmaceutical Sciences and Research.

Molecular simulation of compounds from n-hexane fraction of Sonchus arvensis L. leaves as SARS-CoV-2 antiviral through inhibitor activity targeting strategic viral protein

Context: COVID-19 was caused by the spread and transmission of SARS-CoV-2 at the end of 2019 until now. The problem comes when antiviral drugs have not yet been found and patients infected with SARS-CoV-2 can trigger a cytokine storm condition due to the effects of viral replication. Indonesia has various kinds of medicinal plants, such as Sonchus arvensis L., which are used as medicinal plants. Aim(s): To analyze the activity of the inhibitor as SARS-CoV-2 antiviral agents from n-hexane fractions of S. arvensis leaves. Method(s): The sample was collected from GC-MS analysis, PubChem, and Protein Databank database, then drug-likeness identification using Lipinski Rule of Five server and bioactive prediction of bioactive compounds as inhibitor activity was conducted by Molinspiration server. Furthermore, the docking simulation was performed using PyRx 0.9.9 software to determine the binding activity, molecular interaction by Discovery Studio software to identify position and interaction type, 3D molecular visualization by PyMol 2.5. software, and dynamic by CABS-flex 2.0 server to predict interaction stability. Result(s): alpha-Amyrin and beta-amyrin from n-hexane fractions of S. arvensis leaves had activity as SARS-CoV-2 inhibitors through interactions on helicase, RdRp, Mpro, and RBD-Spike, both compounds had more negative binding affinity than control drug and can produce stable chemical bond interactions in the ligand-protein complexes. However, the results were merely computational, so they must be validated through an in vivo and in vitro research approach. Conclusion(s): Sonchus arvensis L. leaves were predicted to have SARS-CoV-2 antiviral through inhibitor activity by alpha-amyrin and beta-amyrin. Copyright © 2022 Journal of Pharmacy & Pharmacognosy Research.

The effect of Stewed Sungkai Leaves (Peronema canescens Jack) on the decrease in Inflammatory Symptoms of Covid-19 patients

Objective: Sungkai extract contains flavonoids. It has an analgesic, anti-inflammatory, and antipyretic function. The research objective was to determine the effect of stewed sungkai leaves on the decrease in inflammatory symptoms of COVID-19 patients. Method(s): The research design used a quasi-experimental one-group pre-post-test. The computerized Wilcoxon test processed the data obtained, and the Cronbach alfa test was used to ensure reliability. Sampling was done by using an accidental sampling technique with the following criteria: confirmed positive for COVID-19;agreed with informed consent;did not use other traditional medicines;and a total of samples from 14 people that were carried out at the Reksodiwiryo Padang Hospital. The patients were given stewed sungkai leaves by taking five pieces of young sungkai leaves boiled in 3 cups of water to make 1 cup of drink to be consumed twice a day 5, 12 patients had no inflammatory reaction. Result(s): The results showed that giving stewed/ boiled sungkai leaves decreased inflammatory symptoms of COVID-19 patients with a p-value (<0.05). The result of the normality test is 0.00. Conclusion(s): Thus, it can be concluded that boiled sungkai leaves have the potential as an anti-infection that can increase leukocytes. Copyright © RJPT All right reserved.

COVID-19 and multiple sclerosis: a thematic analysis of the unique experiences of people with multiple sclerosis during the COVID-19 pandemic

Introduction: The impact of the COVID-19 pandemic on people living with multiple sclerosis (MS) is expected to be significant. Whilst quantitative research in this area has been undertaken, there is a paucity of qualitative research;this study will therefore provide valuable insights into individual experiences and perceptions of people with MS (PwMS) in the United Kingdom (UK) during this unique period. Objective(s): The ongoing global health crisis leaves us all in a state of uncertainty that requires constant adaptation to the new 'normal' we are living in, and it is important that the challenges faced by the MS community are recognised and addressed as part of this learning process. We explore self-reported data gathered during the pandemic to reach conclusions regarding the impact of the crisis on PwMS. Aim(s): To enhance understanding of the experiences of PwMs during the COVID-19 pandemic and identifying potential areas where further support could be beneficial. Method(s): Between March 3 and October 29, 2020, 1,685 free-text comments regarding the unique experiences of PwMS were collected online by the UK MS Register (UKMSR). Thematic analysis of 1,000 randomly selected responses made by 682 individuals was used to investigate the perceived impact of COVID-19 on the participants, following a constructivist approach. Result(s): Five main themes were identified in the data: connectedness, attitudes towards change, mental health, stigma, and information and advice. Results of the thematic analysis were varied, with significant numbers reporting positive experiences of the pandemic. Conclusion(s): Individual levels of connectedness and attitude towards change significantly influence how PwMS experience life during the COVID-19 outbreak. The data showed the impact of COVID-19 on mental health to be mixed among PwMS. The pandemic hashighlighted that some PwMS remain fearful of being stigmatised in the workplace because of their condition.

Implementing Simulation Based Learning (SBL) to Reduce the Gap in Surgical Training, A Theoretical Evaluation Approach

Background: The current Surgical training is severely affected by COVID-19 pandemic with redeployment and reduced number of elective procedure across NHS hospitals, this has affected both core and higher Surgical trainees, rendering The traditional apprenticeship model obsolete. It became evident that The future of Surgical training and innovation will require a combination of simulation and operative exposure to overcome The obstacle of reduced exposure in Surgical education and operative training. Discussion(s): In our theoretical analysis, we will discuss The efficacy, safety and impact of relying on SBL to fill The gaps in Surgical training. Clinical exposure alone will not be sufficient to train procedure based speciality trainees to their highest proficiency. SBL is one design that is supported by learning theories such as Transformational Learning and Experiential Learning Theory. Ina highfidelity simulation, such as laparoscopic simulation courses, all concepts of facilitated learning are fulfilled which strongly supports our hypothesis. on balance, given The complexity of skills learnt, it remains difficult to measure The efficacy of transferring The learnt capabilities into practice and standardise this among learners. SBL also leaves non-technical skills un-assessed in depth. Conclusion(s): The disruption of training due to COVID-19 affected our procedure based learning, this leaves us with a dilemma to catch-up with these unmet training needs. SBL could be one of The adjuncts that fill in The gaps on The short and medium term. Implementing SBL in Surgical training curriculum, should be evaluated for efficacy and cost effectiveness.

Screening and evaluation of cytotoxicity and antiviral effects of coviba dawa against SARS-CoV-2 Delta

Background: Bersama abyssinica is a common tree in Africa, with diverse medical uses in different areas. The plant is well-known in Tanzania for treating respiratory disorders such as TB, tonsillitis, bronchitis and asthma, The plant has lately been utilized for treatment of COVID-19 symptoms. Water extract of leaf and stem bark has been registered as a herbal medication known as 'Coviba Dawa' for the treatment of viral and bacterial respiratory infections due to its broad medical benefits. The aim of this work was to test for the cytotoxicity and antiviral effects of bioactive ingredients from B. abyssinica extracts against the Delta variant of the SARS-CoV-2 coronavirus. Method(s): Bersama abyssinica leaves and stem barks were dried under shade in room temperature and then pulverized to obtain small pieces before soaking into different solvents. One hundred grams of each, leaves and stem barks were extracted in petroleum ether, dichloromethane, ethyl acetate and ethanol. Water extract was obtained by decoction of 100g of stem bark into water. Phenols, flavonoids, tannins with antioxidant activity were confirmed as components of the extracts. Analysis of aqueous extracts of bark stem bark and leaves was done by LC-MS/MS (Q-orbitrap-Ultra High Performance Thermofisher Company). Antiviral screening and cytotoxicity experiments were conducted in a Biosafety Level 3 (BSL-3) Laboratory facility according to previously established Standard operating procedures (SOPs). Result(s): The existence of four phenolic compounds in B. abyssinica water extract;2,4-di-tert-butylphenol, 4-formyl-2-methoxyphenyl propionate, 7,8-Dihydroxy-4-methylcoumarin, and 2,3, 6-trimethoxyflavone with antioxidant activity was confirmed by LC-MS/MS analysis. In-vitro testing of the extracts revealed antiviral activity against coronavirus the delta B1 variant of SARS-CoV2. Conclusion(s): We recommend further studies to characterize the medicinal value of B. abyssinica metabolites as potential antiviral and antibacterial agents.

Diagnostic Tools in COVID-19-Associated Mucormycosis: Do We Need 3-dimensional Computed Tomography

Introduction: Early detection of COVID-19-associated mucormycosis (CAM) is critical for accurate staging and optimal treatment. Three-dimensional computed tomography (3D CT) reconstruction of the face has recently come up as a newer diagnostic tool in CAM. Method(s): This clinical study was done to evaluate the efficacy of 3D CT in diagnosing and managing CAM. We compared 3D CT reconstruction with conventional 2D CT. One hundred twenty-three confirmed cases of mucor were subjected to 3D CT reconstruction in addition to contrastenhanced magnetic resonance imaging after comprehensive clinical workup. The involvement of maxillary walls, alveolus, palate, orbital floor, zygomatic process, and other facial skeleton were noted. The plan of management was decided after assessing the extent in 3D CT. Result(s): Anterior maxillary wall was found to be the commonly involved (9.7%). Involvement of the lateral maxillary wall was noted in 8.1% of subjects. Sixty-seven subjects underwent endoscopic endonasal debridement, 19 underwent total maxillectomy, 3 had infrastructure maxillectomy, 8 had orbital exenteration, and 12 had combined endoscopic and open surgeries. In 21 patients (17%), open surgery was done based on additional 3D CT findings at the first instance and revision surgeries were avoided. Conclusion(s): 3D CT face was found to be superior to conventional CT in diagnosing the extent of disease and plays an important role in preoperative surgical planning of CAM. Minor cortex erosions are not picked up by conventional CT;it also does not show finer details and leaves the surgeon imagining the disease extent. 3D CT decreases delay in diagnosis, facilitates the surgical plan, and reduces the need for multiple surgeries. It is a valuable tool in the assessment of revision cases and follow-up.

DURAL VENOUS SINUS THROMBOSIS: A RARE PRESENTING CONSEQUENCE OF COVID-19

SESSION TITLE: Post-COVID-19 Infection Complications SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: The severe acute respiratory syndrome coronavirus (SARS-COV2) and its resulting coronary virus 2019 syndrome (COVID-19) has resulted in an unprecedented global pandemic affecting more than 250 million people and resulting in at least 5 million deaths worldwide. Clinical manifestations of the Covid-19 disease process include but are not limited to respiratory dysfunction and failure, coagulopathy, malaise and cytokine storm. We report a case of dural sinus thrombosis (DST) as a sequelae to COVID-19. CASE PRESENTATION: A 26-year-old woman with a history of migraines presented with sudden diffuse headache and photosensitivity. She reported no palpitations, oral ulcers, dizziness, diaphoresis, slurred speech, weakness, paresthesias or recent head trauma. Her presenting vital signs were within normal range. Physical exam was negative for focal neurologic deficits, weakness, or sensory loss. A rapid pregnancy test was negative. D-dimer was 7,200 ng/mL (reference <500 ng/mL). A COVID test was positive. A computed tomography (CT) of the head revealed diffuse hypodensity in the torcula and the transverse sinuses bilaterally extending into the cerebellar folia, suspicious for DST, which was confirmed on magnetic resonance venography. A full hypercoagulable panel resulted negative. It was determined that the patient's coronavirus disease infection resulted in a prothrombotic state and her dural sinus vein thromboses. The patient was started on a high intensity heparin drip for seven days, then transitioned to Dabigatran and Topiramate for management of headache upon discharge. DISCUSSION: COVID-19 typically manifests as fever, hypoxia, and dyspnea. If coagulopathy were to occur, the most common of them are deep vein thromboses. Cerebral thrombotic events, specifically, a DST has been underreported in literature. It is suspected that the burden of cerebral thrombosis in COVID-19 patients is 0.08%. In the same study, it was also identified that 31% of those who developed a cerebral thrombosis also had other hypercoagulable risk factors not present in this patient. Advancement in neuroimaging has allowed these thrombotic issues to be identified, however, early recognition, especially with a lack of risk factors, creates a less straightforward management plan. Our patient manifested a DST in the setting of an active COVID-19 infection. Higher levels of evaluation are required in patients who test positive for Covid-19 when clinically indicated. Such indications include headaches that are new in onset, severe in nature, and diffuse. Delayed diagnosis and management can be permanently damaging. CONCLUSIONS: Dural venous sinus thrombosis is a rare, yet deadly complication of COVID-19. All risk factors and other etiologies of hypercoagulable states should be ruled out followed by early detection based on clinical and physical exam, and accompanied by appropriate imaging followed by prompt intervention. Reference #1: Baldini, T., Asioli, G. M., Romoli, M., Carvalho Dias, M., Schulte, E. C., Hauer, L., Aguiar De Sousa, D., Sellner, J., & Zini, A. (2021). Cerebral venous thrombosis and severe acute respiratory syndrome coronavirus-2 infection: A systematic review and meta-analysis. European journal of neurology, 28(10), 3478–3490. https://doi.org/10.1111/ene.14727 Reference #2: Hemasian, H., & Ansari, B. (2020). First case of Covid-19 presented with cerebral venous thrombosis: A rare and dreaded case. Revue neurologique, 176(6), 521–523. https://doi.org/10.1016/j.neurol.2020.04.013 Reference #3: Thompson, A., Morgan, C., Smith, P., Jones, C., Ball, H., Coulthard, E. J., Moran, E., Szewczyk-Krolikowski, K., & Rice, C. M. (2020). Cerebral venous sinus thrombosis associated with COVID-19. Practical neurology, practneurol-2020-002678. Advance online publication. https://doi.org/10.1136/practneurol-2020-002678 DISCLOSURES: No relevant relationships by Steven Douedi No relevant relationships by slam Elkherpitawy No relevant relationships by Justin Ilagan No relevant relationships by David Kountz No relevant relationships by Anton Mararenko No relevant relationships by Mihir Odak

Impact of Covid-19 on Pediatric Ibd Patients Receiving Infusions

As the SARS-CoV-19 pandemic continues in the United States, it has become evident that people of all ages are affected. Overall, children typically have a mild course of illness when infected with COVID-19. Available literature reports that children with IBD are not at a higher risk of contracting COVID-19 when compared to the general population, however, research is limited. Our study explored the COVID-19 pandemic in relation to pediatric IBD patients as there are significant knowledge gaps in incidence, association, and effect on the mental health of the patient, and outcome of COVID -19 in these populations. It is widely known that adult patients with comorbidities are at a higher risk for developing a more severe COVID-19 disease course. An international pediatric and adult database collecting data on COVID-19 in IBD patients named the Surveillance Epidemiology of Coronavirus Under Research Exclusion (SECURE-IBD), has been monitoring outcomes of patients with IBD that were COVID-19 positive. In a study published in 2021, data from 209 children and adolescents showed a 7% hospitalization rate among pediatric IBD patients who tested positive for COVID-19, a rate much lower than the overall hospitalization rate of adult IBD patients with COVID-19. Factors that resulted in hospitalization included comorbid conditions, steroid use, moderate to severe IBD, and specific GI symptoms from COVID-19. Similarly, a study published in 2021 consisting of 290 pediatric IBD patients revealed only a minority of IBD patients had mild symptoms, and none of them required hospitalizations or treatment modification. We attempted to look into the impact of Covid-19 in our patients receiving infusions at the hospital infusion center. We offered a survey to 39 patients in our infusion center, 32 of which were included in our analysis. 4 patients refused to take part in the study, 1 consent form was not signed, and 2 were excluded for being older than 21 years of age. The majority of these patients received infliximab/Remicade infusions. Males-44%,females-56%. 72%-Crohn's disease, 28% -Ulcerative colitis. None of the patients required any specific treatments or hospitalizations based on survey responses. 3 patients required ER visits and no changes in medications were made in IBD management due to covid-19. 1 patient required a change in the schedule of the infusion due to Covid-19 symptoms. About 66% of patients either received the vaccine or intended to take it if eligible at the time of the survey. With continued research data on the safety and efficacy of vaccination, we expect this number will go up. While there was some anxiousness reported about the Covid-19 pandemic, there was a negative trend seen in the mood and feeling questionnaire across all questions (table 2). Overall, our study confirmed that the covid-19 pandemic so far had minimal impact on IBD management but identified a need to improve mental health for overall quality of life. Our study was only limited to patients receiving infusions at our hospital which leaves a significant number of patients receiving other modes of therapy or home infusions for IBD. Further ongoing research will be needed to identify the long-term impact of Covid-19 on IBD patients on a larger scale.

Mutation Pattern in the Receptor Binding Motif of SARS-Cov-2 Variants and the Effect on Molecular Interactions in Docked Ligand Complexes

The spike glycoprotein of SARS-Cov-2 is a therapeutic target for Covid-19 and mutations in the Receptor Binding Motif (RBM) may alter the binding properties of ligands proposed to inhibit viral entry. This study aimed to identify the existence of a mutation pattern in the RBMs of SARS-Cov-2 variants and study the effect on ligand binding interactions. RBM sequences were obtained using NCBI BLASTP and subjected to multiple and pairwise sequence alignment analysis. Hypothetical generations were drawn from the phylogenetic tree. The effect of mutation on ligand binding was studied by docking zafirlukast on selected RBMs. Molecular dynamics simulations were conducted to explain molecular interactions. The sequences at the same phylogenetic level showed higher similarity with the observed differences defined by the crystallized chain length. 6XDG_E, a leaf node sequence was 76% similar to 7NXA_E, a branch from the root, and had the highest mutation. Differences in sequence similarity across successive generations were based on mutations and crystallized chain length and the amino acid substitution is not predictable. Different bond types and binding affinities were observed as well as varying Root Mean Square Deviation (RMSD), Root Mean Square Fluctuation (RMSF), and Region of Gyration (RoG) values for the RBMs in different variants. The RMSD, RMSF, and RoG did not differ significantly in the bound and free states of RBM from specific variants suggesting that the observed differences are attributable to amino acid substitutions. This information is crucial for drug development intended to block SARS-Cov-2 entry.

Immunostimulating Study of Active Agent Fraction from Sungkai (Peronema canescens Jack.) Leaf from SARS-COV-2 Virus Antigen Exposure to NK and CD8+T Cells

Introduction: Sungkai (Peronema canescens Jack.) plant had been used as an immune system enhancer. Aim: In this study, the effect of Sungkai leaf extracts from 4 different fractions, namely n-hexane, ethyl acetate, butanol and residual water with 3 variations in doses of 1,10 and 100 mg/kg bw on the activity of NK and CD8+T cells in male white mice that have been exposed to SARS-Cov-2 virus antigen was investigated. Methods: The experimental animals used were 60 animals divided into 12 groups with 14 days of treatment which had previously been induced with SARS-Cov-2 virus antigen (Moderna) and given with Sungkai leaf extracts for 14 days and evaluated on day 15. The evaluation results of NK cells concentrations sequentially were 2.96;4.66;5.38;5.43;4.05;2.89;3.56;4.21;2.88;1.99;2.07;4.40;3.21;3.40;and 6.93 ng/ml. On the other hand, the evaluation results of CD8+T cells concentrations sequentially were 27.47;28.96;29.19;27.90;21.85;25.79;27.98;23.50;23.39;26.56;22.62;25.19;23,55;26,75;and 29,69 ng/ml. One-way ANOVA and Duncan test were used for the data analysis. Results: The results showed significant increase of concentration (p<0.05) towards concentration of NK cells in the butanol fraction at a dose of 1 mg/kg BW and CD8+T cells in the residual water fraction at a dose of 100 mg/kg BW. Conclusion: It can be concluded that fraction from sungkai (Peronema canescens Jack.) at doses of 1,10 and 100 mg/kg bw shows immunostimulatory activity.

DEVELOPMENT of INFLAMMATORY MYOPATHY after COVID-19

Background: It has been more than a year and a half since the WHO announced a pandemic of a new coronavirus infection caused by SARS-CoV-2. The virus belongs to the respiratory group, but it it can damage various organs and tissues of the body. COVID-19 infection is characterized by pathological activation of immunity, violated synthesis of pro-infammatory, immunoregulatory, anti-infammatory cytokines, such as interleukins-1 and-6, tumor necrosis factor α and others. These features contribute to the development of rheumatic diseases and syndromes in people who have had COVID-19. Cellular and humoral immune responses are also of primary importance in the pathogenesis of infammatory myopathies. Objectives: Description of a case of severe dermatomyositis after COVID-19. Methods: The 34-year-old female patient complained of pain and weakness in the proximal muscles of the upper and lower extremities, difficulty swallowing solid and liquid food, rash on the face, neck, chest and arms. In August 2020 she had a mild case of COVID-19. A month later, faky erythematous papules like Gottron's sign appeared on the extensor surfaces of the metacarpophalangeal joints and proximal interphalangeal joints of the hands. Six months later, sore throats, hoarseness of voice, belching of air, choking on solid food and episodes of subfebrility joined. Refux esophagitis, duodenitis was detected by fbrogastroduodenoscopy. After 9 months, there were muscle pains and muscle weakness, erythema on the face, neck and chest, the patient lost 11 kg. She was hospitalized in the rheumatology department with suspected dermatomyositis. Results: On objective examination: proximal myopathy, erythematous rashes on the face, neck, chest, Gottron's erythema on the hands. In the analyses: clinical analysis of blood and urine without pathology, ANA 1:1280, creatinkinase 5370 IU/l, with an increase in dynamics up to 9260 IU/l, CRP 0.03 mg/dl, LDH 1023 IU/l, rheumatoid factor and anti-ds DNA were negative. Nasal regurgitation was detected during radiography of the pharynx with contrast. Instrumental examination revealed no signs of a tumor process. Fibrogastroduodenoscopy-superfcial refux-esophagitis, duodenitis, Chest CT-interstitial pneumonitis, abdominal ultrasound without pathology, ECG-sinus rhythm, normal EOS position, accelerated A-V conduction, echocardiography-minor separation of pericardial leaves (up to 5 mm), colonoscopy-dolichosigma. The patient was diagnosed with idiopathic dermatomyositis of high activity. Because of progressive myopathy and increasing dysphagia, pulse therapy with methylpredniso-lone500 mg for 3 days and rituximab 1000 mg was performed. She also received metipred 48 mg per day orally, methotrexate 15 mg per week subcutaneously and folic acid 5 mg per week. Against the background of therapy, positive dynamics was noted: swallowing normalized, the severity of myopathy decreased, after 10 days CKdecreased to 2049 IU/l. After 6 months during the control examination: there are no skin rashes, muscle strength is restored, CK 300 IU/l. The dose of methylprednisolone is reduced to 10 mg per day, the patient continues injections of methotrexate 15 mg per week. Conclusion: COVID-19 may be a trigger for the development of infammatory myopathy. In this clinical case there are features of the course and therapy of infammatory myopathies in patients after coronavirus infection.

Kratom-induced cholestatic liver injury: A pandemic within a pandemic?

Objectives: Mitragyna speciosa (commonly known as kratom) has both opioid and stimulant-like effects. Recently, Thailand decriminalized the possession and sale of kratom, led to people in many areas earned income selling Kratom at a time of widespread unemployment due to COVID-19. Here, we report a patient with post-Covid syndrome who developed mixed cholestatic-hepatocellular liver injury secondary to kratom. Materials and Methods: A 23-year-old Thai man was seen for evaluation of fatigue and nausea, followed soon after with pruritus, dark urine and jaundice. The patient had no known underlying disease but had been treated with mild COVID-19 pneumonia in the past 2 months. He reported taking kratom recreationally for 2 weeks as a treatment for his post-COVID insomnia. Kratom was bought from his friend and used as a homemade iced cocktail called ''4 9 100'' that consists of Coca-Cola, tea made from boiled kratom leaves, and diphenhydramine-containing cough syrup which has been popular in Southernmost provinces of Thailand. On workup, his total bilirubin was noted to be 10.6 mg/dL, aspartate aminotransferase was 642 U/L, alanine aminotransferase 1,635 U/L. Extensive workups including viral etiologies was negative. Abdominal ultrasound revealed only fatty liver without cirrhosis. Results: The patient had been managed conservatively for 5 days in the hospital. Urine toxicology screening confirmed the presence of only mitragynine. At two weeks later, serum total bilirubin was decreased to 1.5 mg/dL, aspartate aminotransferase was 112 U/L, alanine aminotransferase 404 U/L. He was in a stable condition and normalized liver function tests at 3 months after discharge. Conclusion: There is growing evidence that kratom is safe if used as pure kratom products or brewed herbal decoction in small doses and for a limited period of time. However, the polydrug patterns of kratom use could lead to severe liver injury.