Exploring the bioactive compounds of Feiduqing formula for the prevention and management of COVID-19 through network pharmacology and molecular docking

Background:To explore the effective chemical constituents of Feiduqing formula for prevention and treatment of coronavirus disease 2019(COVID-19).Methods:The compounds and action targets of twelve herbal medicines in Feiduqing formula were collected via Traditional Chinese Medicine Systems Pharmacology Database and Analytic Platform.The genes corresponding to the targets were queried through the UniProt database.The“herbal medicine-ingredient-target”network was established by Cytoscape software.The Gene Ontology function enrichment analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis were performed by Database for Annotation,Visualization and Integrated Discovery.Molecular docking was used to analyze the binding force of core active compounds of Feiduqing formula with PTGS2,HSP90AA1,SARS-CoV-23CL hydrolase and angiotensin converting enzyme II(ACE2).Results:The“herbal medicine-ingredient-target”network included 434 nodes and 1948 edges,including 222 components such as quercetin,kaempferol,luteolin,etc.The key targets are PTGS2,HSP90AA1,PTGS1,ESR1,AR,NOS2,etc.Gene Ontology function enrichment analysis revealed 2530 items,including RNA polymerase II-specific,response to oxidative stress,transcription factor activity,etc.Kyoto Encyclopedia of Genes and Genomes pathway enrichment screened 169 signal pathways,including Human cytomegalovirus infection,Kaposi sarcoma-associated herpesvirus infection,Hepatitis B,Hepatitis C,IL-17,TNF,etc.The results of molecular docking showed that quercetin,luteolin,β-sitosterol,stigmasterol and other core active compounds have a certain degree of affinity with PTGS2,HSP90AA1,SARS-CoV-23CL hydrolase and ACE2.Conclusion:The active compounds of Feiduqing formula may have a therapeutic effect on COVID-19 pneumonia through the action on PTGS2,HSP90AA1,SARS-CoV-23CL hydrolase and ACE2,and regulating many signaling pathways.

Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline(updated version)

The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnosis and treatment guidelines for clinicians caring for patients are needed.In the early stage,we have issued"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline.We formed a working group of clinical experts and methodologists.The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas:chemoprophylaxis,diagnosis,treatments,and discharge management.We searched the literature for direct evidence on the management of COVID-19,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Recommendations were either strong or weak,or in the form of ungraded consensus-based statement.Finally,we issued 34 statements.Among them,6 were strong recommendations for,14 were weak recommendations for,3 were weak recommendations against and 11 were ungraded consensus-based statement.They covered topics of chemoprophylaxis(including agents and Traditional Chinese Medicine(TCM)agents),diagnosis(including clinical manifestations,reverse transcription-polymerase chain reaction(RT-PCR),respiratory tract specimens,IgM and IgG antibody tests,chest computed tomography,chest X-ray,and CT features of asymptomatic infections),treatments(including lopinavirritonavir,umifenovir,favipiravir,interferon,remdesivir,combination of antiviral drugs,hydroxychloroquine/chloroquine,interleukin-6 inhibitors,interleukin-1 inhibitors,glucocorticoid,qingfei paidu decoction,lianhua qingwen granules/capsules,convalescent plasma,lung transplantation,invasive or noninvasive ventilation,and extracorporeal membrane oxygenation(ECMO)),and discharge management(including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge).We also created two figures of these recommendations for the implementation purpose.We hope these recommendations can help support healthcare workers caring for COVID-19 patients.

Perceived infection transmission routes, infection control practices, psychosocial changes, and management of COVID-19 infected healthcare workers in a tertiary acute care hospital in Wuhan: a cross-sectional survey

Background:Many healthcare workers were infected by coronavirus disease 2019(COVID-19)early in the epidemic posing a big challenge for epidemic control.Hence,this study aims to explore perceived infection routes,influencing factors,psychosocial changes,and management procedures for COVID-19 infected healthcare workers.Methods:This is a cross-sectional,single hospital-based study.We recruited all 105 confirmed COVID-19 healthcare workers in the Zhongnan Hospital of Wuhan University from February 15 to 29,2020.All participants completed a validated questionnaire.Electronic consent was obtained from all participants.Perceived causes of infection,infection prevention,control knowledge and behaviour,psychological changes,symptoms and treatment were measured.Results:Finally,103 professional staff with COVID-19 finished the questionnaire and was included(response rate:98.1%).Of them,87 cases(84.5%)thought they were infected in working environment in hospital,one(1.0%)thought their infection was due to the laboratory environment,and 5(4.9%)thought they were infected in daily life or community environment.Swab of throat collection and physical examination were the procedures perceived as most likely causing their infection by nurses and doctors respectively.Forty-three(41.8%)thought their infection was related to protective equipment,utilization of common equipment(masks and gloves).The top three first symptoms displayed before diagnosis were fever(41.8%),lethargy(33.0%)and muscle aches(30.1%).After diagnosis,88.3%staff experienced psychological stress or emotional changes during their isolation period,only 11.7%had almost no emotional changes.Arbidol(Umifenovir;an anti-influza drug;69.2%)was the drug most commonly used to target infection in mild and moderate symptoms.Conclusion:The main perceived mode of transmission was not maintaining protection when working at a close distance and having intimate contact with infected cases.Positive psychological intervention is necessary.

Antiviral,immunomodulatory,and anticoagulant effects of quercetin and its derivatives:Potential role in prevention and management of COVID-19

The coronavirus disease 2019(COVID-19)pandemic caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection has caused a devastating health crisis worldwide.In this review,we have discussed that prophylactic phytochemical quercetin supplementation in the form of foods or nutraceuticals may help manage the COVID-19 pandemic.The following evidence supports our argument.First,nuclear factor erythroid-derived 2-like 2(NRF2)agonists abrogate replication of SARS-CoV-2 in lung cells,and quercetin is a potent NRF2 agonist.Second,quercetin exerts antiviral activity against several zoonotic coronaviruses,including SARS-CoV-2,mainly by inhibiting the entry of virions into host cells.Third,inflammatory pathways activated by nuclear factor kappa B,inflammasome,and interleukin-6 signals elicit cytokine release syndrome that promotes acute respiratory distress syndrome in patients with COVID-19,and quercetin inhibits these pro-inflammatory signals.Fourth,patients with COVID-19 develop thrombosis,and quercetin mitigates coagulation abnormalities by inhibiting plasma protein disulfide isomerase.This review provides a strong rationale for testing quercetin for the management of COVID-19.

Medical management of COVID-19 clinic

The start of the global pandemic secondary to the novel SARS-CoV-2 virus was a time of uncertainty and fear as it claimed the lives of many across the world.Since then,there has been a plethora of research designs and trials in order to understand what we can do to stop the spread of the disease.Scientists and health care providers have utilized old medications and revamped them for current use such a convalescent plasma and steroids,as well as creating novel therapeutics,some with promising results.In this article,we review the major therapeutic options currently available and look into what the future still holds in order to further our understanding of this mysterious disease.

Complexities of diagnosis and management of COVID-19 in autoimmune diseases:Potential benefits and detriments of immunosuppression

Recent advances in our understanding of coronavirus disease 2019(COVID-19)and the associated acute respiratory distress syndrome might approximate the cytokine release syndrome of severe immune-mediated disease.Importantly,this presumption provides the rationale for utilization of therapy,until recently reserved mostly for autoimmune diseases(ADs),in the management of COVID-19 hyperinflammation condition and has led to an extensive discussion for the potential benefits and detriments of immunosuppression.Our paper intends to examine the available recommendations,complexities in diagnosis and management when dealing with patients with ADs amidst the COVID-19 crisis.Mimicking a flare of an underlying AD,overlapping pathological lung patterns,probability of higher rates of false-positive antibody test,and lack of concrete data are only a part of the detrimental and specific characteristics of COVID-19 outbreak among the population with ADs.The administration of pharmaceutical therapy should not undermine the physical and psychological status of the patient with the maximum utilization of telemedicine.Researchers and clinicians should be vigilant for upcoming research for insight and perspective to fine-tune the clinical guidelines and practice and to weigh the potential benefits and detrimental effects of the applied immunomodulating therapy.

The application of feedforward control in the nursing emergency management of COVID-19

Objective:To explore the application of feedforward control in the nursing emergency management of COVID-19.Methods:The feedforward control theory was applied to the emergency management of COVID-19 nursing,including grasping the latest epidemic information,preparing for the early stage,formulating nursing workflow,implementing flexible management,standardizing isolation and protection measures,unifying nursing document record format,and implementing humanistic care.Results:During the period of support to Wuhan,the nursing work in the isolated area was orderly,the nursing staff's job satisfaction was high,no nursing errors and hospital infections occurred.Conclusion:Efficient feedforward control in the nursing emergency management that could avoid work blindness to a certain extent and play a guiding role in maintaining the normal operation of treatment and nursing work and protecting the safety of patients and medical staff in the ward during the epidemic period of COVID-19.

Role of cardiac magnetic resonance imaging in the diagnosis and management of COVID-19 related myocarditis: Clinical and imaging considerations

There is a growing evidence of cardiovascular complications in coronavirusdisease 2019 (COVID-19) patients. As evidence accumulated of COVID-19 mediatedinflammatory effects on the myocardium, substantial attention has beendirected towards cardiovascular imaging modalities that facilitate this diagnosis.Cardiac magnetic resonance imaging (CMRI) is the gold standard for thedetection of structural and functional myocardial alterations and its role inidentifying patients with COVID-19 mediated cardiac injury is growing. Despiteits utility in the diagnosis of myocardial injury in this population, CMRI’s impacton patient management is still evolving. This review provides a framework for theuse of CMRI in diagnosis and management of COVID-19 patients from theperspective of a cardiologist. We review the role of CMRI in the management ofboth the acutely and remotely COVID-19 infected patient. We discuss patientselection for this imaging modality;T1, T2, and late gadolinium enhancementimaging techniques;and previously described CMRI findings in other cardiomyopathieswith potential implications in COVID-19 recovered patients.

Healthcare practice strategies for integrating personalized medicine:Management of COVID-19

Personalized medicine is the tailor-made clinical treatment to the individual characteristics of each patient.It may be considered an extension of traditional approaches to knowing and treating diseases.Personalized medicine has the potential to change the way of identification and management of health problems.Coronavirus disease 2019(COVID-19)is an infectious disease that primarily affects the patients’lungs.The first case of pneumonia of unknown cause was reported in Wuhan,China on December 31,2019.As thus,we are quickly approaching the era of personalized medicine.This review discusses the practices currently used in the management of COVID-19 and how they relate to person-alized medicine.

Impact of X-radiation in the management of COVID-19 disease

Coronaviruses are a diverse group of viruses that infect both animals and humans.Even though the existence of coronavirus and its infection to humans is not new,the 2019-novel coronavirus(nCoV)caused a major burden to individuals and society i.e.,anxiety,fear of infection,extreme competition for hospitalization,and more importantly financial liability.The nCoV infection/disease diagnosis was based on non-specific signs and symptoms,biochemical parameters,detection of the virus using reverse-transcription polymerase chain reaction(RTPCR),and X-ray-based imaging.This review focuses on the consolidation of potentials of X-ray-based imaging modality[chest-X radiography(CXR)and chest computed tomography(CT)]and low-dose radiation therapy(LDRT)for screening,severity,and management of COVID-19 disease.Reported studies suggest that CXR contributed significantly toward initial rapid screening/diagnosis and CT-imaging to monitor the disease severity.The chest CT has high sensitivity up to 98%and low specificity for diagnosis and severity of COVID-19 disease compared to RT-PCR.Similarly,LDRT compliments drug therapy in the early recovery/Less hospital stays by maintaining the physiological parameters better than the drug therapy alone.All the results undoubtedly demonstrated the evidence that X-ray-based technology continues to evolve and play a significant role in human health care even during the pandemic.

Practical points that gastrointestinal fellows should know in management of COVID-19

Pandemics obligate providers to transform their clinical practice.An extensive effort has been put to find out feasible approaches for gastrointestinal diseases and also to manage coronavirus disease 2019(COVID-19)related gastrointestinal conditions.Diarrhea,hepatitis,and pancreatitis can be seen in the COVID-19 course.Endoscopic procedures increase the risk of contamination for medical staff and patients despite precautions,therefore indications should be tailored to balance risks vs benefits.Furthermore,whether the immunosupression in inflammatory bowel diseases,liver transplantation,and autoimmune liver diseases increases COVID-19 related risks and how to modify immunosupression are topics of ongoing debate.This review aims to provide most up to date practical approaches that a gastrointestinal fellow should be aware on the problems and management of gastrointestinal and hepatobiliary diseases during the COVID-19 pandemic.

Emerging therapeutics in the management of COVID-19

Abstract The severe acute respiratory syndrome coronavirus 2(coronavirus disease 2019,COVID-19)pandemic has placed a tremendous burden on healthcare systems globally.Therapeutics for treatment of the virus are extremely inconsistent due to the lack of time evaluating drug efficacy in clinical trials.Currently,there is a deficiency of published literature that comprehensively discusses all therapeutics being considered for the treatment of COVID-19.A review of the literature was performed for articles related to therapeutics and clinical trials in the context of the current COVID-19 pandemic.We used PubMed,Google Scholar,and Clinicaltrials.gov to search for articles relative to the topic of interest.We used the following keywords:“COVID-19”,“therapeutics”,“clinical trials”,“treatment”,“FDA”,“ICU”,“mortality”,and“management”.In addition,searches through the references of retrieved articles was also performed.In this paper,we have elaborated on the therapeutic strategies that have been hypothesized or trialed todate,the mechanism of action of each therapeutic,the clinical trials finished or inprocess that support the use of each therapeutic,and the adverse effects associated with each therapeutic.Currently,there is no treatment that has been proven to provide significant benefit in reducing morbidity and mortality.There are many clinical trials for numerous different therapeutic agents currently underway.By looking back and measuring successful strategies from previous pandemics in addition to carrying out ongoing research,we provide ourselves with the greatest opportunity to find treatments that are beneficial.

Endothelial and Autonomic Assessments in the Management of COVID-19

Background: The goal of this peer review is to outline the benefits of the TM Flow system and Lifeprobes Kiosk assessing the endothelial and autonomic system functions in the management of COVID-19 for triage of the patients at risk and diagnostic of autonomic nervous system dysfunction to understand the long COVID symptoms. Material and Methods: The TM Flow system is a non-invasive medical device that relies on pulse oximetry, blood pressure measurements, and very low electrical current stimulation of the skin via disposable electrodes to provide instantaneous assessments of patients’ vital signs, endothelial function, sudomotor and autonomic nervous system functions, and ankle brachial index measurements. The Lifeprobes Kiosk performs automated pre-consultation patient assessments via an online patient check-in form and medical questionnaire, as well as determines the patient’s vital signs, endothelial function markers and estimated body composition. COVID-19: Current Scientific Data: In the majority of cases, COVID-19 infection will manifest through mild to moderate symptoms (such as cough, runny nose, sore throat, headache, muscle aches, and fever) which would resolve without the need for special treatment or hospitalization. On the other hand, older individuals and those who suffer from underlying medical conditions—such as obesity, diabetes, cardiovascular disease, chronic respiratory disease, and/or cancer—are more susceptible to developing serious illness, often with a fatal outcome. Available evidence further indicates that COVID-19 vaccines reduce the number of new cases, while also lessening the risk of complications that would require hospitalization. However, these findings do not apply to the new delta variant, which leads to more severe complications in younger people than previous variants, even in those who have been vaccinated and/or do not have any underlying medical problems. Research conducted to date indicates that COVID-19 complications result from endothelial dysfunction or damage. In addition, COVID-19 patients are increasingly reporting a wide range of debilitating conditions long after they have tested negative for the presence of the virus, giving rise to the term “Long COVID” which has been attributed to autonomic nervous system dysfunction and small fiber neuropathy. TM Flow markers have been investigated by several clinical studies in the US, India, and Brazil. The clinical studies showed the relevance of the TM Flow endothelial and autonomic nervous markers. Conclusion: Findings yielded by peer-reviewed clinical studies confirm that the TM Flow system and Lifeprobes Kiosk are beneficial and effective non-invasive tools that provide immediate results. Therefore, both should be employed for the triage of COVID-19 patients to expediently identify those at risk of complications, as this would reduce the hospitalization and mortality rates. The TM Flow system is also capable of diagnosing “Long COVID” symptoms related to the autonomic nervous system and small fiber neuropathy.

An Observational Study on the Management of COVID-19 Patients in Limited-Resource Hospitals

Background:The purpose of this study was to evaluate the effectiveness of limited-resource hospitals in managing mild and moderate hospitalized cases of COVID-19 with comorbidities and in preventing their progression to severe illness.Methods:Data were obtained from 88 moderate COVID-19 patients with comorbidities who were admitted to limitedresource hospitals.The data were classified into several parts:comorbidities,chronic medication before hospital admission,symptoms of COVID-19 before and during hospitalization,clinical features,laboratory findings on hospital admission,complications during hospitalization,as well as worst laboratory values during hospitalization,hospital stay,and outcomes.The clinical features,laboratory results,type of oxygen therapy used,and the final treatment outcome were all evaluated to assess for any potential relationship.Results:All patients were alive upon discharge.Before admission,the majority of patients(60.2%)received COVID-19 treatment,and the average hospital stay was 12 days.The most common symptoms were fever(88.7%),cough(95.5%),shortness of breath(90.9%),myalgia(84.1%),confusion(63.6%),headache(62.5%),sore throat(88.7%),rhinorrhea(17%),chest pain(58%),diarrhea(19.3%),nausea and vomiting(38.6%),anosmia(62.5%),as well as dysgeusia(64.8%).Based on chest radiograph or computed tomography(CT)scan,9.1%of the patients had unilateral pneumonia,90.9% had bilateral pneumonia,and 96.6% had multiple mottling and ground-glass opacity.Age was found associated with a significant increase in headache(p=0.005),rhinorrhea(p=0.013),chest pain(p=0.007),and the need for positive airway pressure(p=0.008).Between pre-and post-hospital admissions,there was a significant increase in lactate dehydrogenase and ferritin but a decrease in platelet,D-dimer,hemoglobin,lymphocytes,neutrophils,and total leucocyte count(p<0.001).There was a significant association between hospital stay and D-dimer level(p=0.05).Conclusion:Limited-resource hospitals in Egypt were efficient in managing mild and moderate hospitalized cases of COVID-19 with comorbidities.Many of these cases did not escalate to severe illness and were all alive upon discharge.Early management of COVID-19 tends to delay the disease progression to severe illness and improves patients5 chances of survival.Treating COVID-19 or using oxygen therapy at home can also delay the need for hospitalization in mild or moderate cases.

Characteristics of hospitalized patients with confirmed COVID-19 and their hospital management

Objective:To determine the risk factors of mortality among hospitalized COVID-19 patients.Methods:This retrospective study used hospitalization records collected by the Indonesia Health Social Security Administrator Agency(Badan Penyelenggara Jaminan Sosial Kesehatan-BPJS Kesehatan).A total of 38277 eligible patients with confirmed COVID-19 were analyzed.The dependent variable of the study was the discharge status(death or recovery)of COVID-19.Independent variables were history of morbidity and disease-related occurrence,type of room health facilities,length of stay and demographic variables(sex,age).The analyses use bivariate and multivariate logistic regression to determine the dominating variable associated with all these variables.Results:Of the 38277 inpatients with PCR-confirmed COVID-19,31051(81.1%)were discharged and 7226(18.9%)died.Risk of death was positively associated with older age(aOR 5.74,95%CI 4.20-7.87 for 19-64 years old;aOR 13.75,95%CI 9.99-18.92 for 65 years above),male sex(aOR 1.13,95%CI 1.07-1.19),treated in ICU without ventilator(aOR 5.84,95%CI 5.41-6.30)and had comorbid respiratory diseases(aOR 5.39,95%CI 4.93-5.90),but negatively associated with hospital stay of 15 days or longer(aOR 0.39,95%CI 0.36-0.43).Conclusions:COVID-19 related death during hospitalization was associated with duration and type of treatment,and existing medical condition among the inpatient individuals during COVID-19 pandemic in DKI Jakarta.The findings of the study suggest importance of appropriate and timely medical intervention and care.

COVID-19 and the Vascular Elderly Subject: Illustration of Therapeutic Management with Corticosteroids in an Elderly Diabetic Patient with COVID-19

Introduction: The severity of Sars-Cov-2 infection is associated with the development of acute respiratory distress syndrome (ARDS). The progression to ARDS appears to be driven by a major inflammatory mechanism potentially sensitive to corticosteroids. Observation: This article describes the case of an elderly patient was admitted to emergency departments for intense asthenia, accompanied by motor diarrhoea, dyspnoea with desaturation in ambient air, in a context of strong suspicion of infection linked to COVID-19. The article also reviews the existing literature on the diagnosis and treatment of this severe form of the disease. Conclusion: Corticosteroids, and in particular dexamethasone, have been shown to be effective in the management of patients with COVID-19, an oxygen-releasing disease.

Digestive and breast cancer patients managed during the first wave of COVID-19 pandemic:Short and middle term outcomes

BACKGROUND The first wave of coronavirus disease 2019(COVID-19)pandemic in Spain lasted from middle March to the end of June 2020.Spanish population was subjected to lockdown periods and scheduled surgeries were discontinued or reduced during variable periods.In our centre,we managed patients previously and newly diagnosed with cancer.We established a strategy based on limiting perioperative social contacts,preoperative screening(symptoms and reverse transcriptionpolymerase chain reaction)and creating separated in-hospital COVID-19-free pathways for non-infected patients.We also adopted some practice modifications(surgery in different facilities,changes in staff and guidelines,using continuously changing personal protective equipment…),that supposed new inconveniences.AIM To analyse cancer patients with a decision for surgery managed during the first wave,focalizing on outcomes and pandemic-related modifications.METHODS We prospectively included adults with a confirmed diagnosis of colorectal,oesophago-gastric,liver-pancreatic or breast cancer with a decision for surgery,regardless of whether they ultimately underwent surgery.We analysed short-term outcomes[30-d postoperative morbimortality and severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection]and outcomes after 3 years(adjuvant therapies,oncological events,death,SARS-CoV-2 infection and vaccination).We also investigated modifications to usual practice.RESULTS From 96 included patients,seven didn’t receive treatment that period and four never(3 due to COVID-19).Operated patients:28 colon and 21 rectal cancers;laparoscopy 53.6%/90.0%,mortality 3.57%/0%,major complications 7.04%/25.00%,anastomotic leaks 0%/5.00%,3-years disease-free survival(DFS)82.14%/52.4%and overall survival(OS)78.57%/76.2%.Six liver metastases and six pancreatic cancers:no mortality,one major complication,three grade A/B liver failures,one bile leak;3-year DFS 0%/33.3%and OS 50.0%/33.3%(liver metastases/pancreatic carcinoma).5 gastric and 2 oesophageal tumours:mortality 0%/50%,major complications 0%/100%,anastomotic leaks 0%/100%,3-year DFS and OS 66.67%(gastric carcinoma)and 0%(oesophagus).Twenty breast cancer without deaths/major complications;3-year OS 100%and DFS 85%.Nobody contracted SARS-CoV-2 postoperatively.COVID-19 pandemic–related changes:78.2%treated in alternative buildings,43.8%waited more than 4 weeks,two additional colostomies and fewer laparoscopies.CONCLUSION Some patients lost curative-intent surgery due to COVID-19 pandemic.Despite practice modifications and 43.8%delays higher than 4 weeks,surgery was resumed with minimal changes without impacting outcomes.Clean pathways are essential to continue surgery safely.

COVID-19 and liver injury:Pathophysiology,risk factors,outcome and management in special populations

The coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus-2 is an ongoing health concern.In addition to affecting the respiratory system,COVID-19 can potentially damage other systems in the body,leading to extra-pulmonary manifestations.Hepatic manifestations are among the common consequences of COVID-19.Although the precise mechanism of liver injury is still questionable,several mechanisms have been hypothesized,including direct viral effect,cytokine storm,hypoxic-ischemic injury,hypoxiareperfusion injury,ferroptosis,and hepatotoxic medications.Risk factors of COVID-19-induced liver injury include severe COVID-19 infection,male gender,advanced age,obesity,and underlying diseases.The presentations of liver involvement comprise abnormalities in liver enzymes and radiologic findings,which can be utilized to predict the prognosis.Increased gamma-glutamyltransferase,aspartate aminotransferase,and alanine aminotransferase levels with hypoalbuminemia can indicate severe liver injury and anticipate the need for intensive care units’hospitalization.In imaging,a lower liver-to-spleen ratio and liver computed tomography attenuation may indicate a more severe illness.Furthermore,chronic liver disease patients are at a higher risk for severe disease and death from COVID-19.Nonalcoholic fatty liver disease had the highest risk of advanced COVID-19 disease and death,followed by metabolic-associated fatty liver disease and cirrhosis.In addition to COVID-19-induced liver injury,the pandemic has also altered the epidemiology and pattern of some hepatic diseases,such as alcoholic liver disease and hepatitis B.Therefore,it warrants special vigilance and awareness by healthcare professionals to screen and treat COVID-19-associated liver injury accordingly.

Impacts of COVID-19 on tourism and management response from Banff National Park,Canada

The COVID-19 pandemic posed challenges to the tourism sector globally.We investigated changes in visitor demographics,satisfaction level,and its determinants pre-and peri-COVID-19.Data were collected using questionnaire surveys in 2019 and 2021 within Banff National Park(BNP).The data analyses were based on a sample size of 1183 respondents by conducting factor analysis,correlation analysis and stepwise regression analysis.Results highlight that there were fewer international visitors and more local and domestic visitors during the pandemic.Park attributes were evaluated at a higher satisfaction level peri-COVID-19.The quality of the Park facilities and services were the most important satisfaction determinants pre-and peri-COVID-19,and all the Park COVID-19 measures and actions received positive experience from visitors.This research fills this knowledge gap by developing a better understanding in the change of visitor demographics and satisfaction level in BNP under the context of the pandemic.It also provides implication for both scholars and practitioners to understand the impacts of the pandemic on Park visitation.The study can provide insights for utilizing the pandemic as a transformative strength and for mitigating its negative impact on tourism industry.

Clinical profile,etiology,management and outcome of empyema thoracis associated with COVID-19 infection:A systematic review of published case reports

Objective:To explore the clinical features,diagnosis,etiology,treatment,and outcomes of COVID-19 related empyema.Methods:Using PRISMA statement,a systematic search of relevant case reports published between December 2019 and April 2023 was performed through seven databases.The collected data included demographics,clinical manifestations,diagnostic findings,treatment,and outcomes.Results:Thirty-six case reports were identified with 43 cases of empyema.The included cases had a median age of 55 years(range:12-78 years)and 79.1%(34/43)were males.The majority of cases presented during hospitalization for management of acute COVID-19 infection(29/43,67.4%)and Charlson comorbidity index<3(40/43,93.0%).Pseudomonas aeruginosa was the most commonly isolated microorganism from the pleural fluid(9/43,20.9%)and 16.3%of the cases(7/43)had polymicrobial infections.Chest drainage was performed in all cases while surgery was indicated in 24 cases(55.8%).The most common complication of COVID-19-related empyema was broncho-pleural fistula(2/43,4.7%).The mortality rate was 23.3%(10/43).Sepsis and/or multi-organ failure were the most commonly reported causes of death.On univariate analysis,no statistically significant risk factor for mortality was identified.Conclusions:COVID-19-associated empyema has a variety of predisposing factors,time of presentation,clinical features,and causative organisms.Invasive or minimally invasive surgical procedures are performed more frequently than isolated chest drainage.Empyema in COVID-19 patients worsens their prognosis and can lead to serious complications.