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.

Pediatric multisystem inflammatory syndrome associated with COVID-19: Insights in pathogenesis and clinical management

The pandemic caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection has been a major challenge to be faced in recent years.While adults suffered the highest morbidity and mortality rates of coronavirus disease 2019,children were thought to be exclusively asymptomatic or to present with mild conditions.However,around April 2020,there was an outbreak of a new clinical syndrome related to SARS-CoV-2 in children-multisystemic inflam-matory syndrome in children(MIS-C)-which comprises a severe and uncon-trolled hyperinflammatory response with multiorgan involvement.The Centers for Disease Control and Prevention considers a suspected case of MIS-C an individual aged<21 years presenting with fever,high inflammatory markers levels,and evidence of clinically severe illness,with multisystem(>2)organ involvement,no alternative plausible diagnoses,and positive for recent SARS-CoV-2 infection.Despite its severity,there are no definitive disease management guidelines for this condition.Conversely,the complex pathogenesis of MIS-C is still not completely understood,although it seems to rely upon immune dysregu-lation.Hence,in this study,we aim to bring together current evidence regarding the pathogenic mechanisms of MIS-C,clinical picture and management,in order to provide insights for clinical practice and implications for future research directions.

Cross-border issues and technology and management solutions during COVID-19

Critical cross-border issues have emerged during the COVID-19 pandemic,especially pertaining to security,supply chain,and education,which has led to several new challenges for management.The balance between potential risks and economic benefits has attracted the attention of both industry and academia.Hence,we invited three panelists to participate in the 2021 Association for Information Systems(AIS)Special Interest Group(SIG)on Information Systems in Asia Pacific(ISAP)workshop.The suggested solutions include the right Internet approach,multi-national cooperation to develop flexible global operations,and people’s education(especially refugees)to mitigate risks.These solutions encompass three levels,i.e.,technology,management,and society.

Clinical Internship Teaching Management During the COVID-19 Epidemic

Against the backdrop of the global COVID-19 pandemic,the teaching and management of clinical medical interns have been facing tremendous challenges.When interns majoring in clinical medicine enter the internship position,they lack self-protection awareness and have limited ability to respond to unexpected public health events.This article explores the cognitive situation,existing problems,and improvement measures of clinical medical interns in the post-epidemic era.Therefore,this article proposes a series of improvement measures,including strengthening epidemic training and education for interns,enhancing personal protective awareness,and lastly achieving the role transition from intern to doctor.

Exploring impacts of COVID-19 on spatial and temporal patterns of visitors to Canadian Rocky Mountain National Parks from social media big data

COVID-19 posed challenges for global tourism management.Changes in visitor temporal and spatial patterns and their associated determinants pre-and peri-pandemic in Canadian Rocky Mountain National Parks are analyzed.Data was collected through social media programming and analyzed using spatiotemporal analysis and a geographically weighted regression(GWR)model.Results highlight that COVID-19 significantly changed park visitation patterns.Visitors tended to explore more remote areas peri-pandemic.The GWR model also indicated distance to nearby trails was a significant influence on visitor density.Our results indicate that the pandemic influenced tourism temporal and spatial imbalance.This research presents a novel approach using combined social media big data which can be extended to the field of tourism management,and has important implications to manage visitor patterns and to allocate resources efficiently to satisfy multiple objectives of park management.

Stressors in Nurse Students’ Formation in the New Normality Post COVID-19

Background: Mental health has been impaired and at risk due to the worldwide COVID-19 pandemic. The consequences due to confinement impacted every scenario, which directly influenced the daily routine of nurse students;in each setting students faced stressors that trigger fear, anxiety and others, since being in confinement learning of topics moved to the home, laboratory practices in hospitals were cancelled leaving the room that is uncertain up to their return to in-person activities. It is important to highlight the need for innovation and strengthening of theoretical-pedagogic aspects centered at the student’s context as a human being with their own needs and problems, who will interact with others in the continuous process of health-illness. Objective: the aim was to identify the stressors in the nurse students’ formation in the new normality post-COVID-19. Methods: Qualitative and phenomenological research with 27 participants aged 20 - 25 years, nurse students of a public university. The information collection was through four focal groups of 6-7 members each, data analysis was done according to Miles & Huberman after signed informed consent of each participant, and authorized by the chairperson of the Nurse’ career. Results: Category 1, Cumulative stressors with sub-categories 1.1 Uncertainty, 1.2 Isolation, 1.3 Invisibility, 1.4 Mockery, 1.5 Exclusion. Category 2, Expectancy states with sub-categories 2.1 Low self-esteem, 2.2 Insecurity, 2.3 Anxiety, 2.4 Depression, 2.5 Temporary leave, 2.6 Search for authenticity. Category 3, Internalization processes with sub-categories 3.1 Social rejection, 3.2 Self-censorship, 3.3 Discrediting, 3.4 Disempowerment. Category 4, Academic aspects affected with sub-categories 4.1 Deficient studying habits, 4.2 Deficient assimilations of knowledge, 4.3 Archived knowledge in the computer, 4.4 Absence of practice in previous semesters. Conclusion: Once identified the stressors in nurse students in the new normality post-COVID-19, it will allow the creation of settings that help in getting confidence for students, i.e., a safe surrounding promotes the development of abilities and competencies during formation, as well as recommendations of teachers in the classroom and laboratories that contribute to filling space that students perceive as empty, and to intensifying the companionship in clinical settings where students perceive most aggressiveness.

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.

COVID-19 infection and liver injury:Clinical features,biomarkers,potential mechanisms,treatment,and management challenges

It is hypothesized that liver impairment caused by coronavirus disease 2019(COVID-19)infection might play a central role in severe clinical presentations.Liver injury is closely associated with severe disease and,even with antiviral drugs,have a poor prognosis in COVID-19 patients.In addition to the common hepatobiliary disorders caused by COVID-19,patients with pre-existing liver diseases demand special considerations during the current pandemic.Thus,it is vital that upon clinical presentation,patients with concurrent pre-existing liver disease associated with metabolic dysfunction and COVID-19 be managed properly to prevent liver failure.Careful monitoring and early detection of liver damage through biomarkers after hospitalization for COVID-19 is underscored in all cases,particularly in those with pre-existing metabolic liver injury.The purpose of this study was to determine most recent evidence regarding causality,potential risk factors,and challenges,therapeutic options,and management of COVID-19 infection in vulnerable patients with pre-existing liver injury.This review aims to highlight the current frontier of COVID-19 infection and liver injury and the direction of liver injury in these patients.

Gastrointestinal and hepatic diseases during the COVID-19 pandemic:Manifestations,mechanism and management

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is considered the causative pathogen of coronavirus disease 2019(COVID-19)and has become an international danger to human health.Although respiratory transmission and symptoms are still the essential manifestations of COVID-19,the digestive system could be an unconventional or supplementary route for COVID-19 to be transmitted and manifested,most likely due to the presence of angiotensin-converting enzyme 2(ACE2)in the gastrointestinal tract.In addition,SARS-CoV-2 can trigger hepatic injury via direct binding to the ACE2 receptor in cholangiocytes,antibodydependent enhancement of infection,systemic inflammatory response syndrome,inflammatory cytokine storms,ischemia/reperfusion injury,and adverse events of treatment drugs.Gastrointestinal symptoms,including anorexia,nausea,vomiting,and diarrhea,which are unusual in patients with COVID-19,and some digestive signs may occur without other respiratory symptoms.Furthermore,SARS-CoV-2 can be found in infected patients’stool,demonstrating the likelihood of transmission through the fecal-oral route.In addition,liver function should be monitored during COVID-19,particularly in more severe cases.This review summarizes the evidence for extra-pulmonary manifestations,mechanisms,and management of COVID-19,particularly those related to the gastrointestinal tract and liver.

Worldwide management of hepatocellular carcinoma during the COVID-19 pandemic

The coronavirus disease 2019(COVID-19)pandemic has impacted hospital organization,with the necessity to quickly react to face the pandemic.The management of the oncological patient has been modified by necessity due to different allocation of nurses and doctors,requiring new strategies to guarantee the correct assistance to the patients.Hepatocellular carcinoma,considered as one of the most aggressive types of liver cancer,has also required a different management during this period in order to optimize the management of patients at risk for and with this cancer.The aim of this document is to review recommendations on hepatocellular carcinoma surveillance and management,including surgery,liver transplantation,interventional radiology,oncology,and radiotherapy.Publications and guidelines from the main scientific societies worldwide regarding the management of hepatocellular carcinoma during the COVID-19 pandemic were reviewed.

Management of an endoscopy center during the outbreak of COVID-19:Experience from West China Hospital

Since the outbreak of the coronavirus disease 2019(COVID-19),various measures have been taken to protect against the infection.As droplet and contact transmission are the main routes of COVID-19 infection,endoscopy centers are considered to be high-risk areas for exposure to COVID-19.We have undertaken several countermeasures in our endoscopic center during the pandemic,and have gained significant experience in terms of prevention and control of COVID-19.We here present our experience and strategies adopted for preventing hospital infection in our endoscopy center during the COVID-19 pandemic.We describe our management of the environment,endoscope,patients,and medical staff,and our self-made masks.

COVID-19:A pluralistic and integrated approach for efficient management of the pandemic

The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),which triggered the ongoing pandemic,was first discovered in China in late 2019.SARSCoV-2 is a respiratory virus responsible for coronavirus disease 2019(COVID-19)that often manifests as a pneumonic syndrome.In the context of the pandemic,there are mixed views on the data provided by epidemiologists and the information collected by hospital clinicians about their patients.In addition,the literature reports a large proportion of patients free of pneumonia vs a small percentage of patients with severe pneumonia among confirmed COVID-19 cases.This raises the issue of the complexity of the work required to control or contain the pandemic.We believe that an integrative and pluralistic approach will help to put the analyses into perspective and reinforce collaboration and creativity in the fight against this major scourge.This paper proposes a comprehensive and integrative approach to COVID-19 research,prevention,control,and treatment to better address the pandemic.Thus,this literature review applies a pluralistic approach to fight the pandemic.

The Role of Whole-Process Quality Management Mode in the Self-Protection and Safety of First-Line Medical Staff of COVID-19

At present, the COVID-19 has spread all over the world. In the face of sudden outbreak, it has brought great challenges to the management of nosocomial infection prevention and control. In this battle, how to do well the prevention and control of hospital epidemic situation scientifically and reasonably is the key to hospital management and an important link to ensure the safety of first-line medical staff. Through the clinical practice of our hospital to combat the COVID-19 epidemic situation, we summarize the key points and functions of quality management, and provide management strategies for domestic and foreign countries.

Management experience of care workers during epidemic prevention and control of COVID-19

Since the rapid spread of COVID‑19,our hospital has actively implemented the idea of“preventing the coronavirus from entering.”We paid close attention to details,rapidly carried out personnel and material management at all levels,and strived to do a good job in the prevention and control of the epidemic,so as to achieve zero infection.Patients’carers are an important part of quality care.Lacking of protection knowledge of infectious diseases would increase the risk of nosocomial infection.Therefore,our nursing department set up a team of epidemic prevention and control management.The team made the revision on contingency plans and care management regulations during the outbreak of COVID‑19,strengthened epidemic prevention and control knowledge training,carried out the supervision inspection work,and paid attention to humanized management measures to provide an important guarantee for victory over the COVID‑19.

Nursing emergency management practice of COVID-19 in a traditional Chinese medicine hospital

Nursing work is an integral part of hospital work.Under the challenge of the COVID-19 epidemic,it is particularly important to establish a timely and efficient nursing management system.The nursing department of our hospital used the theory and method of feedforward control to formulate the emergency plan for epidemic prevention and control and to conduct drills.The plan includes the establishment of the emergency management system for epidemic nursing and key prevention and control positions,rational allocation of human resources,and strengthening personnel training,so as to ensure the efficient operation of nursing epidemic prevention and control work and provide a reference for nursing management mode during the epidemic.

Management strategy of prevention and control of nosocomial infection of COVID-19 in blood purification center

There are many patients in the blood purification center who need maintenance hemodialysis to maintain life. Those patients generally havelow resistance and are easily exposed to coronavirus because they go back and forth the hospital and residence three times a week andclosely contact with family, caregivers, community personnel, people in various means of transportation, medical staff, and other patientsvisiting hospital. Therefore, the blood purification center has become a high‑risk environment for the spread of COVID-19 infection. In viewof this, our center quickly responded to the formulation and implementation of infection prevention and control measures suitable for thecharacteristics of the blood purification center and continuous renal replacement therapy (CRRT) emergency plan for fever and suspectedpatients. According to these measures, we have a positive effect on preventing and controlling nosocomial infection in the blood purificationcenter.

Fever Outpatient Service of General Hospital Applies “1 + 3 + 3” Emergency Management Mode to Deal with COVID-19 Pandemic

Purpose: To discuss the effect of “1 + 3 + 3” emergency management mode to deal with COVID-19 pandemic in fever outpatient service of general hospitals. Method: This paper analyzes and summarizes the problems encountered by fever outpatient service in dealing with the COVID-19 pandemic from three aspects of “One Team”, “Three-Key” Control and “Three Mosts”. Results: The application of “1 + 3 + 3” emergency management mode can effectively boost the orderliness and efficiency of fever outpatient service in dealing with COVID-19 pandemic. Conclusion: The “1 + 3 + 3” emergency management mode provides a new management mode and idea for dealing with COVID-19 pandemic, so the fever outpatient service of general hospitals can better improve the national overall anti-pandemic situation.

Recommendations for perinatal and neonatal surgical management during the COVID-19 pandemic

Coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2 has spread rapidly around the world and is a significant threat to global health.Patients in the Neonatal Surgery Department have rapidly progressing diseases and immature immunity,which makes them vulnerable to pulmonary infection and a relatively higher mortality.This means that these patients require multidisciplinary treatment including early diagnosis,timely transport,emergency surgery and intensive critical care.The COVID-19 pandemic poses a threat to carrying out these treatments.To provide support for the health protection requirements of the medical services in the Neonatal Surgery Department,we developed recommendations focusing on patient transport,surgery selection and protection requirements with the aim of improving treatment strategies for patients and preventing infection in medical staff during the current COVID-19 pandemic.

Standardization of critical care management of non-critically ill patients with COVID-19

The large global outbreak of coronavirus disease 2019(COVID-19)has seriously endangered the health care system in China and globally.The sudden surge of patients with severe acute respiratory syndrome coronavirus 2 infection has revealed the shortage of critical care medicine resources and intensivists.Currently,the management of non-critically ill patients with COVID-19 is performed mostly by non-intensive care unit(ICU)physicians,who lack the required professional knowledge,training,and practice in critical care medicine,especially in terms of continuous monitoring of the respiratory function,intervention,and feedback on treatment effects.This clinical problem needs an urgent solution.Therefore,here,we propose a series of clinical strategies for non-ICU physicians aimed at the standardization of the management of non-critically ill patients with COVID-19 from the perspective of critical care medicine.Isolation management is performed to facilitate the implementation of hierarchical monitoring and intervention to ensure the reasonable distribution of scarce critical care medical resources and intensivists,highlight the key patients,timely detection of disease progression,and early and appropriate intervention and organ function support,and thus improve the prognosis.Different management objectives are also set based on the high-risk factors and the severity of patients with COVID-19.The approaches suggested herein will facilitate the timely detection of disease progression,and thus ensure the provision of early and appropriate intervention and organ function support,which will eventually improve the prognosis.