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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide and has seriously threatened public health by causing significant morbidity and mortality. Patients with coronavirus disease (COVID-19) with preexisting endothelial dysfunction caused by aging, diabetes, hypertension, and obesity are at high risk for life-threatening thromboembolic complications. This suggests a possibility that reduced endothelial nitric oxide (NO) production and NO bioavailability could be a common underlying pathology for the progression of COVID-19. Increasingly, evidence from experimental and clinical studies of SARS-CoV-2 infection shows that NO inhibits the pathogenesis of COVID-19, including virus entry into host cells, viral replication, host immune response, and subsequent thromboembolic complications. Restoring NO bioavailability may have the potential to be a preventive or early-treatment option for COVID-19. This review aims to provide in-depth discussion of NO bioavailability to prevent SARS-CoV-2 infection, particularly by focusing on lifestyle factors such as nitrate-rich diets, physical exercise, and nasal breathing, which could be easily performed on a daily basis to boost NO bioavailability.

Solid organ transplant recipients are at high risk for the development of severe forms of COVID-19. However, the role of immunosuppression in the morbidity and mortality of the immune phenotype during COVID-19 in transplant recipients remains unknown. In this retrospective study, we compared peripheral blood T and B cell functional and surface markers, as well as serum antibody development during 29 cases of mild (World Health Organization 9-point Ordinal Scale (WOS) of 3-4) and 22 cases of severe COVID-19 (WOS 5-8) in solid organ transplant (72% kidney transplant) recipients hospitalized in our center. Patients who developed severe forms of COVID-19 presented significantly lower CD3+ (median 344/mm3 (inter quartile range 197; 564) vs. 643/mm3 (397; 1251), and CD8+ T cell counts (124/mm3 (76; 229) vs. 240/mm3 (119; 435). However, activated CD4+ T cells were significantly more frequent in severe forms (2.9% (1.37; 5.72) vs. 1.4% (0.68; 2.35), counterbalanced by a significantly higher proportion of Tregs (3.9% (2.35; 5.87) vs 2.7% (1.9; 3.45)). A marked decrease in the proportion of NK cells was noted only in severe forms. In the B cell compartment, transitional B cells were significantly lower in severe forms (1.2% (0.7; 4.2) vs. 3.6% (2.1; 6.2). Nonetheless, a majority of transplant recipients developed antibodies against SARS-CoV-2 (77% and 83% in mild and severe forms respectively). Thus, our data revealed immunological differences between mild and severe forms of COVID 19 in solid organ transplant recipients, similar to previous reports in the immunocompetent population., Graphical abstract

Introduction Symptoms of COVID-19 vary in severity and presentation. When admitting patients to the hospital, it is desirable to isolate patients with COVID-19 from those without the disease. However, reliably identifying patients with COVID-19 in the emergency department before hospital admission is often limited by the speed and availability of testing. Previous studies determined a low lymphocyte count is commonly found in patients with COVID-19. We sought to explore the sensitivity of absolute lymphocyte count in patients presenting to the emergency department requiring subsequent hospitalization who were found to have COVID-19. Methods A retrospective chart review was performed on 312 patients with laboratory-confirmed COVID-19 who were admitted to the hospital from the emergency department. The absolute lymphocyte count for these patients was used to calculate sensitivities at various cut-off values. The relationships between absolute lymphocyte count and variables, including age, sex, need for intubation, and mortality, were also explored. Results Cut-off values for absolute lymphocyte count ranged from 1.1 K/uL to 2.0 K/uL, with sensitivities of 72% and 94%, respectively. Additionally, lower mean absolute lymphocyte counts were identified in males, patients who required intubation, and patients who died. Conclusion Knowing the sensitivity of absolute lymphocyte count in patients with COVID-19 may help identify patients who are unlikely to have the disease. Additionally, absolute lymphocyte count can be used as a marker of disease severity in patients with COVID-19.

BackgroundThe COVID-19 pandemic has resulted in a high death toll. We aimed to describe the place and cause of death during the COVID-19 pandemic.MethodsThis national death registry included all adult (aged ≥18 years) deaths in England and Wales between 1st January 2014 and 30th June 2020. Analyses were based upon ICD-10 codes corresponding to the underlying cause of death as stated on the Medical Certificate of Cause of Death. Daily deaths during COVID-19 pandemic were compared against the expected daily deaths estimated using Farrington surveillance algorithm for daily historical data between 2014 and 2020, by place and cause of death.FindingsBetween 2nd March and 30th June 2020, there was an excess mortality of 57,860 (a proportional increase of 35%) compared with the expected deaths, of which 50,603 (86.2%) were COVID-19 related. Almost half the excess deaths occurred in care homes (25,611 deaths) where deaths were 55% higher than expected. One fifth of the excess deaths occurred in hospital (15,938 deaths; a proportional increase of 21%) with the remainder occurring at home (16,190 deaths; a proportional increase of 39%). At home, only 14% of 16,190 excess deaths were related to COVID-19, with 5,963 deaths due to cancer and 2,485 deaths due to cardiac disease, very few of which involved COVID-19. In care homes or hospices, 61% of the 25,611 excess deaths were related to COVID-19, 5,539 of which were due to respiratory disease and most of these (4,315 deaths) involved COVID-19. In hospital, there were 16,174 fewer deaths than expected which did not involve COVID-19, and there were 4,088 fewer deaths due to cancer and 1,398 fewer deaths due to cardiac disease than expected.InterpretationThe COVID-19 pandemic has resulted in a substantial increase in the absolute numbers of deaths occurring at home and care homes. There was a huge burden of excess deaths occurring in care homes, which were poorly characterised, and were likely to be, at least in part, the result of undiagnosed COVID-19. There was a smaller but important and ongoing excess in deaths at home, particularly from cancer and cardiac disease, which suggests avoidance of hospital care for non-COVID-19 conditions.FundingThe study is unfunded.

Introduction Coronavirus disease (COVID-19) can lead to severe disease or death and is characterized by a wide range of mild to severe symptoms. In addition to the lungs, studies have reported the involvement of the stomach, intestine, and angiotensin-converting enzyme 2 receptors in the heart. Case report We present a case of a patient with COVID-19 who died soon after developing multi-organ failure and myocardial injury due to COVID-19-associated pneumonia. A 71-year-old man who contracted COVID-19 was admitted to the hospital after presenting with fever for 7 days and developed dyspnea. Following treatment, his respiratory status worsened. Thus, he was transferred to our hospital for intensive care on day 11. Physical examination revealed fever, dyspnea, respiratory distress, and no chest pain. Invasive positive pressure ventilation was initiated for acute respiratory distress syndrome on day 14. On day 15, we observed renal, liver, and coagulation dysfunction, indicating multi-organ failure. Chest radiography did not show clear signs of an increased cardiothoracic ratio or pulmonary congestion. An electrocardiogram (ECG) showed signs of myocardial infarction, which was confirmed by elevated troponin I and creatine kinase levels. The patient's circulatory dynamics did not improve on medication, and he died on day 16. Conclusions We report the case of a patient with severe COVID-19 who died from an exacerbation of myocardial injury. Clinicians should not only evaluate respiration but also assess the heart by performing a 12-lead ECG, echocardiogram, and myocardial injury marker examination. Together, these tools can help predict which patients will develop severe COVID-19.

INTRODUCTION: COVID-19 has radically changed the delivery of healthcare in Australia. Central to a tertiary paediatric institution's (The Royal Children's Hospital Melbourne (RCH) response was a digital health approach comprising a broad suite of informatics and technology solutions including optimising a fully integrated electronic medical record (EMR). METHODS: This comprehensive approach spanned all patient care areas and encompassed a broad range of hospital operations. They included patient triage, registration, COVID-19 screening clinic operations, electronic ordering, prescribing and documentation, telehealth, reporting and analytics and research. DISCUSSION: This paper outlines key aspects of our COVID-19 digital health strategy, highlighting the rapid transition to telehealth and the development of a remote "virtual telehealth" strategy for clinicians which proved popular and allowed true "working from home". CONCLUSION: COVID-19 has inadvertently focussed the spotlight on the utility of digital health for clinical care. The speed and uptake of digital health within this pandemic has been remarkable and unprecedented in both an Australian and global setting. Whilst many of these changes have been beneficial, some may have been rushed or forced with minimal consideration of ongoing governance. Key stakeholders and enablers should be identified for post-pandemic consideration in future digital health implementation and adoption strategies.

COVID-19 caused by SARS-CoV-2 is an ongoing global pandemic. SARS-CoV-2 affects the human respiratory tract's epithelial cells, leading to a proinflammatory cytokine storm and chronic lung inflammation. With numerous patients dying daily, a vaccine and specific antiviral drug regimens are being explored. Probiotics are live microorganisms with proven beneficial effects on human health. While probiotics as nutritional supplements are long practiced in different cuisines across various countries, the emerging scientific evidence supports the antiviral and general immune-strengthening health effects of the probiotics. Here, we present an overview of the experimental studies published in the last 10 years that provide a scientific basis for unexplored probiotics as a preventive approach to respiratory viral infections. Based on collated insights from these experimental data, we identify promising microbial strains that may serve as lead prophylactic and immune-boosting probiotics in COVID-19 management.

Highlights • SARS-CoV-2 virus was present in the air in the ICU. • Virus may be discharged in aerosol for days after patients test negative. • The finding may be one of the reasons for patients` re-detectable positive. • The clinical guidelines for recovered COVID-19 patients need to be improved., As coronavirus disease 2019 (COVID-19) is spreading worldwide, there have been arguments regarding the aerosol transmission of its causative agent, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Moreover, some re-detectable positive (RP) patients have been reported. However, little attention has been given to the follow-up of recovered patients, and there is no environmental evidence to determine whether these patients continue to shed the virus after they test negative. Therefore, with an objective to test the hypothesis of airborne transmission of SARS-CoV-2, it is necessary to 1) determine whether SARS-CoV-2 particles are present in the indoor air and 2) determine whether recovered patients are still shedding virus, thus providing much-needed environmental evidence for the management of COVID-19 patients during the recovery period. In this study, surface and air samples were collected from an intensive care unit (ICU) containing one ready-for-discharge patient. All surface samples tested negative, but the air samples tested positive for SARS-CoV-2. This implies that SARS-CoV-2 particles may be shed in aerosol form for days after patients test negative. This finding may be one of the reasons for the observation of RP patients; therefore, there is a need for improved clinical and disease management guidelines for recovered COVID-19 patients.

Background According to expert consensus, the time interval between Hymenoptera venom immunotherapy (VIT) injections can be extended up to 12 weeks, without significant impact on efficacy and safety. However, the COVID-19 pandemic caused longer delays, and no recommendations are available to manage this huge extension. Objectives Our study aims to provide advice on how to resume VIT safely after a long delay from the last injection considering the potential risk factors for side effects (SE), without starting again with the induction phase. Methods All the patients who delayed VIT due to pandemic were consecutively enrolled in this single-centre study. The time extension was decided according to their risk profile (e.g. long pre-pandemic time interval, severe pre-VIT reaction, older age, multi-treatments), and correlation analyses were performed to find potential risk factors of SE. Results The mean delay from the pre- (7 weeks) to the post-pandemic VIT interval (15.5 weeks) was 8.5 weeks. The total amount of the pre-pandemic VIT maintenance dose was safely administered in one day in 78% of patients, while only three experienced SE, out of 87, and their potential risk factors were identified in bee venom allergy and recent VIT initiation. Conclusions In a real-world setting, long VIT delays may be safe and well-tolerated, but more caution should be paid in resuming VIT in patients with long pre-pandemic maintenance interval, severe pre-VIT reaction, recent VIT initiation, older age, multi-drug treatments, and bee venom allergy. This is useful in any case of long, unplanned, and unavoidable VIT delay., Highlights box What is already known about this topic? The COVID-19 pandemic raised the need to extend venom immunotherapy (VIT) time intervals safely. However, no guidelines are currently available on how to manage long extensions of intervals between VIT administrations (i.e. > 3 months). What does this article add to our knowledge? Our results show that long VIT delay may be tolerated in clinical practice, if key risk factors are considered: bee venom, long time interval between injections, severe pre-VIT reaction, date of VIT initiation, age, multi-treatments. How does this study impact current management guidelines? A safe and effective protocol to resume VIT after a long interruption is useful in case of unexpected delays in treatment. A new build-up phase may be safely avoided in most cases, with compliance and cost advantage.

Highlights • MMR vaccine uptake rates have dropped between 25.64% - 73.55% during COVID-19. • A measles epidemic is a possibility due to reduction in community herd immunity. • Urgent public health efforts are needed to maintain efficacious vaccine coverage., Although the direct health impact of Coronavirus disease (COVID-19) pandemic on child health is low, there are indirect impacts across many aspects. We compare childhood vaccine uptake in three types of healthcare facilities in Singapore - public primary care clinics, a hospital paediatric unit, and private paediatrician clinics - from January to April 2020, to baseline, and calculate the impact on herd immunity for measles. We find a 25.6% to 73.6% drop in Measles-Mumps-Rubella (MMR) uptake rates, 0.4 – 10.3% drop for Diphtheria-Tetanus-Pertussis-inactivated Polio-Haemophilus influenza (5-in-1), and 8.0-67.8% drop for Pneumococcal conjugate vaccine (PCV) across all 3 sites. Consequent herd immunity reduces to 74 - 84% among 12-month- to 2-year-olds, well below the 95% coverage that is protective for measles. This puts the whole community at risk for a measles epidemic. Public health efforts are urgently needed to maintain efficacious coverage for routine childhood vaccines during the COVID-19 pandemic.

Since the beginning of the COVID-19 pandemic, accumulating mutations have led to marked changes in the genetic sequence of SARS-CoV-2. Of these, mutations in the spike (S) protein can alter the properties of the virus, particularly transmissibility and antigenicity. However, it is difficult to detect antigenic variants of the SARS-CoV-2 S protein by immunoassay. Here, we developed an ACE2-based biosensor designed to detect both SARS-CoV-2 S1 mutations and neutralizing antibodies. In "binding mode", the biosensor works by detecting binding of the S protein to an immobilized ACE2 receptor. The ACE2-based biosensor was able to detect S1 proteins of the alpha (500 pg/mL) and beta variants (10 ng/mL), as well as wild-type S1 (10 ng/mL), of SARS-CoV-2. The biosensor distinguished wild-type SARS-CoV-2 S1 from the S1 alpha and beta variants via color differences. In addition, a slight modification to the protocol enabled the ACE2-based biosensor to operate in "blocking mode" to detect neutralizing antibodies in serum samples from COVID-19 patients. Therefore, the ACE2-based biosensor is a versatile test for detecting wild-type S1, S1 mutants, and neutralizing antibodies against SARS-CoV-2. This approach to targeting both the mechanism by which SARS-CoV-2 enters host cells and the subsequent adaptive immune response will facilitate the development of various biosensors against SARS-CoV-2.

The objective of this retrospective study was to identify the clinical risk factor associated with uric acid elevation in coronavirus disease (COVID-19) patients treated with favipiravir. Uric acid elevation was defined as an unexplained increase of ≥1.5 times in the patient's uric acid level from baseline. Twenty-nine COVID-19 patients were included in the study. Uric acid elevation developed during favipiravir therapy in 12 (41.4%) patients and the median onset time was 4.5 days after starting favipiravir. In multiple logistic regression analysis, the favipiravir dosage (adjusted OR = 1.69 [1.02-2.81], P = 0.044) and younger patient age (adjusted OR = 0.91 [0.83-0.99], P = 0.040) were significant clinical risk factors for uric acid elevation. No significant between-group difference was noted in the uric acid elevation and non-elevation groups in the clinical recovery after favipiravir therapy. The uric acid levels of patients administered with favipiravir should be monitored closely.

Our main aim was to examine the evidence of the effects of coronavirus disease confinement on the sleep of children aged 12 years and younger. A systematic review was conducted following the recommendations for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. MEDLINE, Cumulative Index for Nursing and Allied Health Literature, Excerpta Medica Database, Psychological Information Database, and Web Of Science were systematically searched between the period of January 2020 and March 2021. The quality assessment was analysed with the Newcastle-Ottawa quality assessment scale and the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. The appraisal tool for cross-sectional studies was applied to cross-sectional studies and each longitudinal study was assessed with the critical appraisal skills programme. Data analysis was carried out through a narrative review. Eight studies were included in the review. Seven studies reported changes in sleep routines and five studies focused on sleep disturbances during confinement. The most important findings were a longer duration of sleep time, an increase in sleep latency, and daytime sleepiness. Whether or not the adverse changes to sleep patterns and bedtime routines seen during the home confinement period have any long-term consequences for children's sleep and daytime functioning remains unknown.

Objective This study aimed to assess the immediate stress and psychological impact experienced by healthcare workers and other personnel during the Coronavirus disease (COVID-19) pandemic. Method The sample consisted of 2554 hospital workers (i.e., physicians, nurses, allied health professionals, and auxiliary staff members) who were working in Yeungnam University Hospital in Daegu, South Korea. The Impact of Event Scale-Revised (IES-R) was administered to the hospital workers twice over a 2 week interval. A high-risk group, identified on the basic of first total IES-R, was assessed further with the Mini International Neuropsychiatric Interview (MINI) and the Clinical Global Impressions-Severity (CGI—S) scale and was offered periodic psychiatric consultations on a telephone. Results The participating nurses and auxiliary staff members had significantly higher IES-R scores (p, Highlights • The healthcare workers reported experiencing high levels of psychological stress during the pandemic period. • Higher levels of stress were reported by the nonmedical staff workers than by the physicians. • These findings underscore the need to provide sufficient information and support to nurses, other staff members. • Psychiatrists will play an important role in implementing rapid and effective psychiatric interventions during a pandemic.

Background There is inconclusive and controversial evidence of the association between allergic diseases and the risk of adverse clinical outcomes of coronavirus disease 2019 (COVID-19). Objective We sought to determine the association of allergic disorders with the likelihood of a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test result and with clinical outcomes of COVID-19 (admission to intensive care unit, administration of invasive ventilation, and death). Methods A propensity-score–matched nationwide cohort study was performed in South Korea. Data obtained from the Health Insurance Review & Assessment Service of Korea from all adult patients (age, >20 years) who were tested for SARS-CoV-2 in South Korea between January 1, 2020, and May 15, 2020, were analyzed. The association of SARS-CoV-2 test positivity and allergic diseases in the entire cohort (n = 219,959) and the difference in clinical outcomes of COVID-19 were evaluated in patients with allergic diseases and SARS-CoV-2 positivity (n = 7,340). Results In the entire cohort, patients who underwent SARS-CoV-2 testing were evaluated to ascertain whether asthma and allergic rhinitis were associated with an increased likelihood of SARS-CoV-2 test positivity. After propensity score matching, we found that asthma and allergic rhinitis were associated with worse clinical outcomes of COVID-19 in patients with SARS-CoV-2 test positivity. Patients with nonallergic asthma had a greater risk of SARS-CoV-2 test positivity and worse clinical outcomes of COVID-19 than patients with allergic asthma. Conclusions In a Korean nationwide cohort, allergic rhinitis and asthma, especially nonallergic asthma, confers a greater risk of susceptibility to SARS-CoV-2 infection and severe clinical outcomes of COVID-19.

Graphical abstract, Highlights • Explores the pandemic nature, morphology and viral hijacking of COVID-19 against host cells. • Highlights the possibilities of organ failure due to the attack of SARS-CoV2. • Illustrates the risk for COVID-19 attack in comorbid patients and their prognosis under medications. • Discusses the possible therapeutic strategies for the COVID-19., The current pandemic outbreak of COVID-19 originated from Wuhan, China. It is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with significant mortality and morbidity rate. The severe risk factors are commonly detected in patients of older age and with medical comorbidities like cancer and diabetes. Scientists and doctors have scrambled to gain knowledge about the novel virus and its pathophysiology in order to discover possible therapeutic regimens and vaccines for COVID-19. The therapeutic strategies like targeting the viral genome emphasize the promising approach to target COVID-19. Additionally, blocking the receptor, ACE2 via the neutralizing antibodies for viral escape that prevents it from entering into the cells provides another therapeutic regimen. In this review article, we have presented the effect of SARS-CoV-2 infection in comorbid patients and discussed organ failure caused by this virus. Based on the data available from the scientific literature and ongoing clinical trials, we have focused on therapeutic strategies. We hope that we would fill the gaps that puzzled the researchers and clinicians with the best of our knowledge collected for the betterment of the patients for the coming future.

We report the case of a 12-years-old patient who subacutely developed a positive and negative myoclonus of limbs and face, drowsiness and memory deficits after getting infected by SARS-CoV-2. On admission, nasopharyngeal swab for SARS-CoV-2, brain and spinal MRI with and without contrast, EEG, chest X-ray and abdominal ultrasound were negative. CSF physical-chemical examination, culture, PCR testing for SARS-CoV-2 and other pathogens, and oligoclonal IgG bands were negative as well. A full panel blood test, including clotting, autoimmunity and paraneoplastic blood studies, did not show any alteration. The neuropsychological examination showed an impairment in memory, visual-motor coordination, inductive reasoning skills, attention, and concentration. The patient was first treated with clonazepam and then with intravenous methylprednisolone for five days, with poor response. For this reason, he then received a cycle of IVIG, thus reaching a gradual and complete recovery. To date, this is the first case of a COVID-19 associated myoclonus affecting a paediatric patient.

Background multiple sclerosis (MS) patients are treated with immunomodulatory treatments that can influence their ability to develop a protective antibody response to the SARS-CoV-2 vaccine. Vaccine efficacy is important for treatment decision and for patients’ reassurance. The main objective is to assess antibody response to SARS-CoV-2 vaccine in MS patients treated with cladribine. Methods Serology response was tested in 97 participants, 67 MS patients and 30 healthy controls (HCs), using two independent methods, 2–3 weeks following the second dose of the BNT162b2 vaccine. Results HCs (n = 30) and MS patients treated with cladribine (n = 32) had 100% positive serology response against the SARS-CoV-2 spike protein following the second vaccine dose (mean S1/S2-IgG and RBD-IgG:284.5 ± 104.9, 13,041±9411 AU/mL and 226.3 ± 121.4, 10,554±11,405 AU/mL respectively). Comparable findings were observed for untreated MS patients, and interferon beta-1a-treated MS patients (mean S1/S2-IgG: 282.1 ± 100.1, 276.9 ± 94.31 AU/mL respectively). No correlation was found between lymphocyte counts, treatment duration, or time between cladribine dose and vaccination, and serology response or antibody titers. Conclusion and relevance Cladribine treated MS patients are able to produce antibodies to the SARS-CoV-2 mRNA vaccine. In the era of the COVID-19 pandemic, it is reassuring and important for both patients and physicians and will allow to develop consensus guidelines.

COVID-19 is a pandemic disease that began to rapidly spread in the US with the first case detected on January 19, 2020, in Washington State. March 9, 2020, and then increased rapidly with total cases of 25,739 as of April 20, 2020. The Covid-19 pandemic is so unnerving that it is difficult to understand how any person is affected by the virus. Although most people with coronavirus 81%, according to the U.S. Centers for Disease Control and Prevention (CDC), will have little to mild symptoms, others may rely on a ventilator to breathe or not at all. SEIR models have broad applicability in predicting the outcome of the population with a variety of diseases. However, many researchers use these models without validating the necessary hypotheses. Far too many researchers often "overfit" the data by using too many predictor variables and small sample sizes to create models. Models thus developed are unlikely to stand validity check on a separate group of population and regions. The researcher remains unaware that overfitting has occurred, without attempting such validation. In the paper, we present a combination algorithm that combines similar days features selection based on the region using Xgboost, K Means, and long short-term memory (LSTM) neural networks to construct a prediction model (i.e., K-Means-LSTM) for short-term COVID-19 cases forecasting in Louisana state USA. The weighted k-means algorithm based on extreme gradient boosting is used to evaluate the similarity between the forecasts and past days. The results show that the method with K-Means-LSTM has a higher accuracy with an RMSE of 601.20 whereas the SEIR model with an RMSE of 3615.83.

The spike (S) protein mutations of SARS-CoV-2 are of major concern in terms of viral transmission and pathogenesis. Hence, we developed a PCR-based method to rapidly detect the 6 mutational hotspots (H49Y, G476S, V483A, H519Q, A520S, and D614G) in the S protein and applied this method to analyze the hotspots in the viral isolates from different geographical origins. Here, we identified that there was only the D614G mutation in the viral isolates. As of September 30, 2020, the analysis of 113,381 sequences available from the public repositories revealed that the SARS-CoV-2 variant carrying G614 has become the most prevalent form globally. Our results support recent epidemiological and genomic data demonstrating that the viral infectivity and transmission are enhanced by the S protein D614G mutation., Graphical abstract Unlabelled Image

Background Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic. The ability to predict cardiac injury and analyze lymphocyte immunity and inflammation of cardiac damage in patients with COVID-19 is limited. We aimed to determine the risk factors and predictive markers of cardiac injury in these patients. Methods Data from 124 consecutive hospitalized patients with confirmed COVID-19 were collected. We compared the proportion of cardiovascular disease history in moderate, severe, and critical cases. We obtained high-sensitivity cardiac troponin I (hs-cTn I) results from 68 patients. Patients were divided into two groups based on positive hs-cTn I result: those with cardiac injury (n = 19) and those without cardiac injury (n = 49). Results Compared with the group with moderate disease, hypertension, coronary heart disease, and smoking were more common in severe and critical cases. Diabetes mellitus was most common in the critical group. Age older than 65 years, presence of chronic kidney disease, and lower blood lymphocyte percentage were independent risk factors of cardiac injury. The total T- and B-lymphocyte counts and CD4+ and CD8+ T-cell counts were significantly lower in those with cardiac injury. A minimal lymphocyte percentage, Highlights • Lymphocyte percentage may become a predictive marker for cardiac injury. • Total T and B cells and CD4+ and CD8+ cells decreased in the cardiac injury group. • Interleukin 6 levels increased in patients with cardiac injury. • Cardiac injury is related to lymphocyte immunity dysfunction and inflammation.

Coronavirus 2019 (COVID-19) has globally affected the human mortality rate and economic history of the modern world. According to the World Health Organization, COVID-19 has caused a severe threat to the health of the vulnerable groups, notably the elderly. There is still some disagreements regarding the source of the virus and its intermediate host. However, the spread of this disease has caused most countries to enforce strict curfew laws and close most industrial and recreational centres. This study aims to show the potential positive effects of COVID-19 on the environment and the increase of renewable energy generation in Malaysia. To prevent the spread of this disease, Malaysia enacted the Movement Control Order (MCO) law in March 2020. Implementation of this law led to a reduction in environmental pollution, especially air pollution, in this country. The greenhouse gases (GHG) emission , which was 8 Mt CO2 eq. from January 2020 to March 2020, reduced to, Graphical abstract, Highlights • Show the positive potential effects of COVID-19 on the environment and increase the Renewable Energy Generation in Malaysia. • Reduction in environmental pollution, especially air pollution, in Malaysia. • Reduction in air pollution allowed more sunlight to reach photovoltaic panels and increased renewable energy generation.

A public health emergency of current international concern is the outbreak of a severe respiratory illness, that is, coronavirus disease (COVID-19). The disease initially started in Wuhan, China, and it rapidly spread to most regions of the world. Herein, we report a case of critical COVID-19 pneumonia treated with extracorporeal membrane oxygenation from symptom onset day 19 (SOD#19) to SOD#30. We describe the patient's clinical course, from mild symptoms at the time of illness onset to symptoms of severe pneumonia as the illness progressed. We provide important information regarding our clinical experience for further understanding of management discrepancies, as treatment with extracorporeal membrane oxygenation or pharmacotherapy (e.g., antivirals, immunomodulators, and glucocorticoids) is often dependent on the severity of symptoms., Highlights • A critical case of 76-year-old female with COVID-19 pneumonia. • No significant clinical benefits of lopinavir-ritonavir and peramivir treatment. • The pneumonia rapidly progressed to acute respiratory distress syndrome. • Extracorporeal membrane oxygenation from illness day 21–31 lead to recovery.