Since December 2019, an outbreak of novel corona virus disease was reported in Wuhan, which has subsequently affected more than 160 countries worldwide. The ongoing outbreak has been declared as a pandemic by WHO, a global public health emergency. Several countries are successfully fighting with the pandemic by taking strict measures like nationwide lockdown or by sequestering the areas that were suspected of having risk of community spread. The corona virus pandemic has upended our educational system worldwide [1-3]. The academic calendar all over the world has been disturbed as a result of lockdown. Even after lockdown it would take probably many more months for universities, colleges and schools to reinstate. Caught in the turmoil, some parts of urban Indian education system have turned towards delivery of education via internet or online education. The NCAER skills report 2018 discussed the immense potential of online learning, conversely as complementary to more traditional methods. Centuries old, lecture based approaches, institutional biases, and outmoded classrooms changed. Covid 19 has become an impetus for educational institutions worldwide to search for innovative solutions in a relatively short duration. In the prevailing situation, online education is turning out as an alternative to traditional modes [2,4,5]. Contemporary/E-learning prepares students across all curriculum and learning stages with skills and potential to flourish in a rapidly changing and interlinked world. It connects students and engages their sense of inquisitiveness. E-teachers know and understand the needs and talents of their students. They are trained, flexible and select from a wide range of effective teaching strategies based on need. The new learning environment and resources galvanize students to be leaders of their independent learning. Thus students collaborate and use critical and creative thinking to solve complex problems and become apprehensive and sentient global citizens [4-6]. In physiotherapy, apart from traditional institution based learning, there implies a need for technological inputs and E-learning as a need to develop critical, creative thinking and reasoning. These technological arrays do provide better concepts and understanding regarding academics and practice [6]. As physiotherapy is advancing and growing in academics, research and practice, the need for an interlinking platform through which learning becomes unconditional and globally accessible was never addressed. Covid- 19 lockdown and strategies imposed us to think apart from institutional mode, ostensibly got a worldwide acceptance. Research suggests that online learning has been shown to increase retention of information, and take less time. On average, students retain 25% - 60% more information when learning online compared to only 8% - 10% in a classroom. E-learning requires 40-60% less time to learn and understand than in a traditional setting, because students can learn at their own pace, re-reading, skipping or accelerating through concepts as they choose. Contemporary learning or E-learning at present situation is intended to have the desired effect such as physical distancing, schedule flexibility, cost effective, fast learning, course variety, boost memory, reasoning and innovative teaching [2,4]. Adoption of online learning will continue to persist post pandemic, and how such a shift would impact the worldwide education market should be studied. Some believe that the unplanned and rapid move to online learning with no training, insufficient bandwidth, and inadequate preparation will result in a poor user experience that is deleterious to sustained growth [5,8]. The current crisis has acted as a thwack to encourage digital education among physiotherapy institutions. However, to achieve its prospective in the long run, physiotherapy institutions and universities should implement a digital platform, training as well as a curriculum regulation. “We believe that, the integration of information technology, E-learning in education will be further accelerated and eventually transpire to an integral component of physiotherapy education and practice”.

Introduction: The disease outbreak of COVID-19 has had a great clinical and microbiological impact in the last few months. In the preanalytical phase, the collection a sample from of a respiratory tract at the adequate moment and from the correct anatomical site is essential for a rapid and precise molecular diagnosis with a false negative rate of less than 20%. Materials and methods: We conducted a descriptive study of COVID-19 disease with a persistently negative RT-PCR test in patients seen at the National Institute of Respiratory Diseases (INER) in Mexico City in the period of March through May of 2020. 38 patients were registered with negative RT-PCR test obtained through nasopharyngeal and oropharyngeal swabbing. We evaluated the distribution of data with the Shapiro-Wilk test of normality. The non-parametric data are reported with median. The nominal and ordinal variables are presented as percentages. Results: The average age of our cohort was 46 years and 52.63% were male (n = 20). Diabetes Mellitus was documented in 34.21% (n = 13) of the patients, Systemic Hypertension in 21.05% (n = 8), Obesity in 31.57% (n = 12) and Overweight in 42.10% (n = 16). Exposure to tobacco smoke was reported in 47.36% (n = 18) of the patients. The median initial saturation of oxygen was 87% at room air. The severity of the disease on admission was: mild 71.05% (n = 27), moderate 21.05% (n = 8) and severe or critical in 7.89% (n = 3) of the cases respectively. 63.15% (n = 24) sought medical care after 6 or more days with symptoms. Lymphopenia was documented in 78.94% (n = 30). Median LDH at the time of admission was 300, being elevated in 63.15% (n = 24) of the cases. The initial tomographic imaging of the chest revealed predominantly ground glass pattern in 81.57% (n = 31) and predominantly consolidation in 18.42% (n = 7). The registered mortality was 15.78% (n = 6). Conclusion: Patients with COVID-19 and a persistently negative RT-PCR test with fatal outcomes did not differ from the rest of the COVID-19 population since they present with the same risk factors shared by the rest of patients like lymphopenia, comorbidities, elevation of D-Dimer and DHL on admission as well as a tomographic COVID-19 score of severe illness, however we could suggest that the percentage of patients with a mild form of the disease is higher in those with a persistently negative RT-PCR test.

Spontaneous pneumomediastinum (SPM) is a rare condition, more commonly seen in patients with history of asthma, chronic obstructive pulmonary disease, infections, or drug users. Today, we face one novel virus that has cause an outbreak of acute respiratory illness, affecting over a million individuals worldwide. New knowledge is been gained of the virus and possible complications are been seen. Following, we present the case of a 71-year-old man with diagnosis of COVID-19 pneumonia complicated with spontaneous pneumomediastinum.

The harmattan season, which is a period characterized by low temperature, dry air and increased air pollution leads to widespread airborne disease and exacerbation of pre-existing conditions, should be recognized as a period of potential risk of high COVID-19 infection rates. This period also coincides with the Christmas season which comes with so many festivities and can become a COVID-19 super-spreader. With many Nigerians now abandoning the non-pharmaceutical protection measures against COVID-19, the harmattan season and the forthcoming spike in social gatherings might usher in the second wave of the virus which can potentially be more catastrophic. There is need for the Nigerian government to start planning and instituting new protection measures and guidelines for safe Christmas celebration while also educating and encouraging the populace to adopt the protection measures recommended by experts.

Introduction: COVID-19 is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 and it was first reported in China. The aim of this study was to compare clinical features, chest CT findings and laboratory examinations of suspected COVID-19 inpatients according to RT-PCR analysis. Methods: Demographics, comorbidites, symptoms and signs, laboratory results and chest CT findings were compared between positive and negative groups. The study included 292 patients (134 females, 158 males) suspected of COVID-19. All statistical calculations were performed with SPSS 23.0. Results: 158 (54.1%) of the cases were male and 134 (45.9%) were female. Their ages ranged from 17 to 95 years, with an average of 50.46 ± 20.87. A symptom or sign was detected in 86.3% of all patients. The chest CT images of 278 patients were analyzed. Chest CT was negative in 59.2% of patients with positive RT-PCR and 43.9% of patients with negative RT-PCR results. Chest CT findings were atypical or indeterminate in 22.4% of patients with positive RT-PCR results and 20% of patients with negative RT-PCR analysis. ALP, bilirubine, CRP, eosinophil count, glucose, CK-MB mass and lactate were significantly lower in patients with positive RT-PCR test. LDH, lipase, MCV, monocyte, neutrophil count, NLR, platelet, pO2, pro-BNP, procalcitonin, INR, prothrombin time, sodium, troponin T, urea, WBC were significantly lower in patients with positive RT-PCR test results. Conclusion: The diagnosis of COVID-19 is based on history of patient, typical symptoms or clinical findings. Chest CT, RT-PCR and laboratory abnormalities make the diagnosis of disease stronger.

Introduction: the perennial pandemic: There are serious challenges posed by the SARS-CoV-2 virus and COVID-19 as the disease. With the persistence of the pandemic over one and half year, it is being feared that the COVID-19 may have become the new reality associated with human existence world over and the mankind may have to live with it for years or even decades. Further, the grievous nature of the disease is evolving further with genomic changes in the virus in form of mutations and evolution of variants, with enhanced infectivity and probably virulence. Acute and chronic phases of COVID-19: Epidemiologically, it is becoming clear that apart from the advanced age and pre-existing conditions, such as diabetes, cardiovascular, pulmonary, and renal diseases, certain constituent factors render some patients more vulnerable to more severe forms of the disease. These factors influence the COVID-19 manifestations, its course, and later the convalescence period as well as the newly defined ‘Long COVID phase. The substantial continuing morbidity after resolution of the infection indicates persisting multisystem effects of ‘Long Covid’. Lung damage associated with COVID-19: COVID-19 is primarily a respiratory disease presenting with a broad spectrum of respiratory tract involvement ranging from mild upper airway affliction to progressive life-threatening viral pneumonia and respiratory failure. It affects the respiratory system in various ways across the spectrum of disease severity, depending on age, immune status, and comorbidities. The symptoms may be mild, such as cough, shortness of breath and fevers, to severe and critical disease, including respiratory failure, shock, cytokine crisis, and multi-organ failure. Implications for the post-COVID care: Depending on the severity of respiratory inflammation and damage, as well as associated comorbidities, duration of injury and genetics, the progressive fibrosis leads to constriction and compression of lung tissues and damage to pulmonary microvasculature. Consequently, the COVID-19 patients with moderate/severe symptoms are likely to have a significant degree of long-term reduction in lung function. Depending on the severity of the disease, extensive and long-lasting damage to the lungs can occur, which may persist after resolution of the infection. Managing the long COVID’s challenges: Given global scale of the pandemic, the healthcare needs for patients with sequelae of COVID-19, especially in those with lung affliction are bound to increase in the near future. The challenge can be tackled by harnessing the existing healthcare infrastructure, development of scalable healthcare models and integration across various disciplines with a combination of pharmacological and non-pharmacological modalities. Following clinical and investigational assessment, the therapeutic strategy should depend on the disease manifestations, extent of damage in lungs and other organs, and associated complications.

Introduction - evolution of SARS-CoV-2 variants: With the unrestrained pandemic for over last one-and-half year, SARS-CoV-2 seems to have adapted to its habitat, the human host, through mutations that facilitate its replication and transmission. The G variant incorporating D614G mutation, potently more transmissible than the ancestral virus arose during January 2020 and spread widely. Since then, various SARS-CoV-2 variants of concern (VOCs) and variants of interest (VOIs) with higher infectivity or virulence or both, have evolved on the background of G variant, and spread widely. SARS-CoV-2 infection and the immunodynamics: As the virus becomes more transmissible, its lethality may drop. Apart from the humoral immunity, T-cell recognition from a previous SARS-CoV-2 infection or vaccination may modify the disease transmission correlates and its clinical manifestations. On the other hand, the immunity generated may reduce probability of re-infection as well as limit evolution of adaptive mutations, and emergence of highly infectious and immune-escape variants. There are complex issues related to the SARS-CoV-2 evolutionary dynamics and host’s immunodynamics. Trending etiopathoimmunological correlates: The evolution potential of SARS-CoV-2 is limited because of proofreading function of nsp14. The S protein mutations affect transmissibility, virulence, and vaccine efficacy. The D614G mutation in G variant with higher infectivity has turned the Chinese epidemic into a pandemic. Other SARS-CoV-2 variants, such as Alpha, Beta, Gamma, and Delta seem to have evolved as result of adaptation to selective pressures during periods of prolonged infections and subsequent transmission. Further, there is issue of convergent association of mutations. Basics of immunity and immune system failure: The nature of the immune response after natural SARS-CoV-2 infection is variable and diverse. There are pre-existing neutralizing antibodies and sensitized T cells elicited during previous infection with seasonal CoVs influencing the disease susceptibility and course. The virus has evolved adaptive mechanisms to reduce its exposure to IFN-I and there are issues related to erratic and overactive immune response. The altered neutralizing epitopes in the S protein in SARS-CoV-2 variants modify the immune landscapes and clinical manifestations. Conclusion: current scenarios and prospects: Presently, the SARS-CoV-2 infection is widespread with multiple evolving infectious variants. There is probability of its transition from epidemic to endemic phase in due course manifesting as a mild disease especially in the younger population. Conversely, the pandemic may continue with enhanced disease severity due to evolving variants, expanded infection pool, and changing immunity landscape. There is need to plan for the transition and continued circulation of the virus during the endemic phase or continuing pandemic for indefinite period.

COVID-19 pandemic soon apparently proved to be havoc and a great stressor. During such a stressful time, mental health is in threat. Here, we intend to review the presenting problems/ symptoms as shared in psychiatry helpline of a Teaching Hospital in eastern Nepal during the second week of lockdown and to reflect on to emotional, including mood problems. It is an institute based period observation noted for all psychiatry helpline calls during 1 week of lockdown days of COVID-19. Their concerns and problems were listened and symptoms clarified by a consultant psychiatrist to help them as far as possible through the telephonic conversation. Maintaining the confidentiality, basic information were noted down in a semi-structured proforma to record certain socio-demographic and clinical information (including mood and other emotional symptoms). We received 102 helpline calls of 60 clients for psychiatry in 1 week, from 14 districts. More patients being discussed were males (35/60), average age being 34.15 (15 - 70) years. More patients were regular follow-up cases with some new issues (24/60) and 18/60 each were new clients and regular follow-up cases. Majority had exacerbated symptoms in the wake of COVID-19 as: emotional (47/60; mood 24/60, anxiety/worry 23/60) symptoms along with disturbed sleep (32/60); treatment/service issues (31/60) and changed routines. Most common mental problems were Bipolar affective disorder, Psychosis, Anxiety and Depression and advices included Antipsychotics, Benzodiazepines, Antidepressants, along with some Psycho-education. Most common concerns were about OPD service, worsening symptoms and local unavailability of medicines. Many had mood and emotional symptoms in this stressful time, both simple amenable to telephonic advices and severe requiring to be called to emergency service.

This paper focuses on the mental health burden on medical and healthcare residents during the 1st wave of COVID-19 pandemic crisis in 2020 describing the activities of a mental health service for residents (NAPREME) in a public university, UNIFESP, Sao Paulo, Brazil; and a preliminary study showing an increasing of depressive symptoms and depression among residents. Data is related to the screening interviews of medical residents and healthcare multi-professional residents who sought the mental health service from March to December 2020. A comparison was conducted with the same period in 2019 (covering a period when Covid-19 was not affecting the Brazilian population). There was a 22% demand increase in 2020. Of the total amount who sought treatment: 23% were medical residents, 22% nursing residents, and the remaining distributed among other professions; and 58% were first year residents and 34% second year. Data from the BDI questionnaire showed some variance between the two years: the mean score for 2020 was 24.67 (± 7.86) which is in the depression range, higher than the mean score of 19.91 points in the previous year (± 10.15) which is only in the depressive symptoms range (p < 0.005). In the pandemic period there was an increase in residents with depression from 49% to 70%. Depression, anxiety, stress and burnout syndrome were observed, demanding psychological and psychiatric care for this population. Assessment of residents’ mental health will continue during 2021, during the 2nd wave of COVID-19 and an additional analysis will be conducted along the year.

In the late of 2019, there is an outbreak of novel coronavirus disease (COVID-19) in Wuhan, China. The patients appear respiratory symptoms, fever, and cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death. A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans and is transmitted mostly via droplets or contact. People of all ages are susceptible to the virus. Up to the middle of February 2020, the number of infected persons in China is over 65,000. The case fatality rate was 2.38%, and elderly men with underlying diseases were at a higher risk of death [1].

We know that Corona Virus develops in animals, birds and humans’ body. Now it is a pandemic and many people are dying with each passing day and a number of patients are increasing every hours. If we do not control it then it is dangerous for humanity. As we know that incubation period for COVID-19 is 1 to 14 days and it’s live in the environment for 12 to 14 hours. The only solution to spread of virus is by social distancing. As we know that it affects person with low immunity so it is advised for all people to have balance diet, exercise daily and spend time in meditation for increasing immunity. I want to share a natural method to develop and increase the immunity power by the bile juice of animals, birds and we can try for corona virus too.

We have been hearing for centuries that ‘fever is not a disease but a symptom’. Physicians say that fever is a symptom of diseases like flu to cancer.

Among the abounding lessons we learned from the SARS-C0V-2 pandemic is the uttermost determinant that people are not equal before the severity of COVID-19. Indeed, the disease course differs with age, gender, ethnicity, underlying clinical conditions and virus variants. Other diseases modifying factors are associated with genetic traits such as those driving the immune response, the blood groups, the coagulation system and the ACE2 receptor variants [1-4].

The outbreak of new coronavirus acute respiratory disease (SARS-CoV-2) has been a major global challenge for the scientific community to save humanity. While, the unviability of the vaccine keeps most classes of society, especially African countries, suffer from the healthcare problem. Conventional medicine plants become the alternative method for the therapeutic because it contains valuable bioactive compounds. This brief review devoted the importance of medicinal plants such as Citrus, olive, garlic, ginger, green tea, woad, broad-leaf privet, Japanese torreya, and saffron crocus, by their antiviral effects (anti-SARS coronavirus, anti-HSV, and anti-HIV diseases) and their promising uses as probable boosters of the immune and anti-inflammatory response from SARS-CoV-2 infection. Based on scientific reports, bioactive compounds could inhibit 3-chymotrypsin-like cysteine protease and human protein ACE2, where these facts can be attractive to develop effective drugs. 

Background: The rapid spread of “Coronavirus Disease 2019’ (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-type 2 (SARS-CoV-2) significantly impacted health care facilities all across the globe. To assess impact on urology practice in our country, we developed a questionnaire based on relevant questions in current scenario for information regarding challenges and changes urologists were facing in their practices. Material and methods: We conducted an online survey to find out the impact of COVID-19 on urology practice in Indian scenario. The questionnaire comprised of total 18 questions, which were relevant to day to day practice. Results: Total 310 urologists across the India participated and consented to being part of the study. The majority admits change in their practice due to the recent COVID-19 outbreak. The majority admitted to attend fixed numbers of patients per day with prior appointment and to keep detailed records. The majority responded in positive that attendees will not be allowed, opted to wear N-95 mask in OPD, opted to take the relevant history, opted for thermal screening, opted for patients to wear a mask before entering OPD room, opted for using the new prescription at new visit and opted to avoid physical examination unless very necessary. The majority wanted to take consent from the patients that they may get infected by COVID-19 in the hospital and agreed on performing COVID-19 testing for every patient posted for surgery. The majority agreed to assign a separate operation theatre to operate patients with positive COVID-19 test and also preferred open surgery over minimal invasive surgery. Conclusion: Our survey revealed that the recent pandemic led to significant impacts on urology practice in our country. The urologists working in different setups are facing different challenges in this difficult condition. They have made certain changes in their practice to safely provide effective care to their patients.

Bladder carcinomas have a great propensity for divergent differentiation with more that 90% being Transitional cell carcinoma. Several histological variants have been have described so far; they are not only morphologically unique but also have significant prognostic and therapeutic differences making their timely identification of paramount importance. Osteoclastic giant cell variant of urothelial carcinoma is very rare type with controversial management. Studies from China have documented higher incidence and severity of illness in COVID-19 positive cancer patients. We report an unusual case of Osteoclastic giant cell variant of urothelial carcinoma in a 63 yrs old male patient associated with simultaneous COVID-19 infection.

Ephedra, an ancient herb, is applied to treat common cold and influenza for such a long time in China. Pseudoephedrine is a main active ingredient from Ephedra which is used for relieving nasal congestion clinically. We previously reported that pseudoephedrine showed a potent anti-inflammatory effect other than sympathomimetic effects. In the present study, we aimed to investigate whether pseudoephedrine could protect mice from the H1N1 virus infection. The mice were infected with a 20% LD50 influenza A virus (IAV) suspension via intranasal administration to establish a virus infection model. Further, the mice were orally administered pseudoephedrine or oseltamivir for 4 days from one day after infection. Our results showed that pseudoephedrine improved lung pathological damage during the IVA infection period, and it dramatically increased the survival rate and attenuated loss of body weight compared with the virus-infected control group. In addition, pseudoephedrine inhibited the cytokine storms and mRNAs expression of the TLR7 signaling pathway. Surprisingly, pseudoephedrine showed an inhibitory effect on the replication of IAV. These results give clear evidence that pseudoephedrine is a potential anti-influenza drug by blunting cytokine storms and inhibition of replication of IAV, and following these results, we speculate that it should be tested in the novel coronavirus pneumonia (COVID-19, a severe epidemic in China currently) in which the cytokine storms play a key role to damage bronchi and lung in the early stage.

Research on psychological risk factors for upper respiratory tract illnesses (URTIs) has been conducted for over fifty years. Early studies failed to control for exposure and also often relied on self-report rather than clinical and virological assessment. A universal policy used in the current COVID-19 pandemic has been to restrict exposure by social isolation. This leads to increased stress and removal of social interaction. In addition, information overload about the disease, and incorrect information, can also reduce wellbeing. Studies of experimentally-induced URTIs have shown that stress increases susceptibility to infection. Other research has shown that stress due to job insecurity and few social contacts are key risk factors for infection. This suggests that while social isolation will reduce exposure, it will also lead to an increased risk of illnesses, due to increased stress and reduced social support, should the person become infected with the virus. Other research has shown that infection and illness lead to changes in behaviour. These effects include greater negative affect and impaired attention and slower speed of response. Such effects are not only present when the person is symptomatic but also occur with sub-clinical infections, during the incubation period and after the illness. People with the illness are also more sensitive to other negative influences such as fatigue, and this has implications for safety critical jobs such as those carried out by healthcare professionals treating those with COVID-19.

Among all the countries, Yemen is free of corona virus, and no single case has been recorded till today. Yemen is characterized by its mother geographical location on the Red Sea and its population is approximately 30 million people and an area of ​​555,000 square kilometers.

COVID-19 virus structural components: The 2019-nCoV, also called SARS-CoV-2, was first reported in Wuhan, China in December 2019. The disease was named Coronavirus Disease 2019 (COVID-19) and the virus responsible for it as the COVID-19 virus, respectively, by WHO. The 2019-nCoV has a round, elliptic or pleomorphic form with a diameter of 60–140 nm. It has single-stranded RNA genome containing 29891 nucleotides, a lipid shell, and spike, envelope, membrane and hemagglutinin-esterase (HE) proteins. Steps in progression of COVID-19 illness: Once inside the airways, the S protein on the viral surface recognizes and mediates the attachment to host ACE-2 receptors and gains access to endoplasmic reticulum. The HE protein facilitates the S protein-mediated cell entry and virus spread through the mucosa, helping the virus to attack the ACE2-bearing cells lining the airways and infecting upper as well as lower respiratory tracts. With the dying cells sloughing down and filling the airways, the virus is carried deeper into the lungs. In addition, the virus is able to infect ACE2-bearing cells in other organs, including the blood vessels, gut and kidneys. With the viral infestation, the activated immune system leads to inflammation, pyrexia and pulmonary edema. The hyperactivated immune response, called cytokine storm in extreme cases, can damage various organs apart from lungs and increases susceptibility to infectious bacteria especially in those suffering from chronic diseases. The current therapeutics for COVID-19: At present, there is no specific antiviral treatment available for the disease. The milder cases may need no treatment. In moderate to severe cases, the clinical management includes infection prevention and control measures, and symptomatic and supportive care, including supplementary oxygen therapy. In the critically ill patients, mechanical ventilation is required for respiratory failure and hemodynamic support is imperative for managing circulatory failure and septic shock. Conclusion: Confusion, despair and hopes: There is no vaccine for preexposure prophylaxis or postexposure management. There are no specific approved drugs for the treatment for the disease. A number of drugs approved for other conditions as well as several investigational drugs are being canned and studied in several clinical trials for their likely role in COVID-19 prophylaxis or treatment. The future seems afflicted with dormant therapeutic options as well as faux Espoir or false hopes. As obvious, not all clinical trials will be successful, but having so many efforts in progress, some may succeed and provide a positive solution. Right now, though, confusion and despair prevail.