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The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began in December 2019 in Wuhan, China. To date, the virus has infected roughly 5,000,000 people and caused approximately 345,000 deaths worldwide, and these numbers are increasing rapidly. Because of the rapid spread and the rising disease burden, several antiviral drugs and immunomodulators are in clinical trials, but no drugs or vaccines have yet been approved against this deadly pandemic. At present, computed tomography scanning and reverse transcription (RT)-PCR are used to diagnose COVID-19, and nanotechnology is being used to develop drugs against COVID-19. Nanotechnology also plays a role in diagnosing COVID-19. In this article, we discuss the role of nanotechnology in diagnosing and potentially treating COVID-19.

In late 2019, a pandemic crisis started in Wuhan, China, swept the whole world. The disease is caused by the SARS-CoV-19 virus that belongs to the corona family of viruses. The virus mainly caused failure of respiration, and led to many deaths worldwide. The main focus of research and medicine is to find more about the virus, as well as the development of effective preventive and therapeutic measures. While many trials and opinions have been published, which might support or contradict each other, this article tries to provide a simplified viewpoint about the disease. We highly recommend the therapeutic strategies to include drug combinations that can target the pathogenesis at many levels. For example, a combination of an effective anti-viral Remdesivir, soulable ACE2, and an immune modulator.

The new coronavirus SARS-CoV-2 that causes different infections in humans has become a challenge for humanity because it has caused many deaths worldwide. This new virus is considered as a zoonotic infectious particle, the clear mechanisms of the pathogenicity and transmissibility of this virus are not exactly known. Therefore, here some characteristics of a possible transmission are analyzed for house flies.

Introduction: HIV infection leads to metabolic disorders. The objective of this work was to study the lipid profile of HIV + patients followed at the University Teaching Hospital of Kinshasa (UTHK). Methods: This study analyzes the lipid profile of HIV + patients, aged at least 18 years, followed at the UTHK from January 1, 2008 to December 31, 2014. The medians of different types of lipids, the frequency of lipid disorders, the general clinical characteristics of patients and factors associated with dyslipidaemia were studied. Haemoglobin (Hb), White Blood Cells (WBC), Leukocyte Formula (LF), Blood Sugar, Urea, Creatinine, Transaminases, Uric Acid, CD4s+ count were analyzed. Results: The lipid balance was performed in 38.8% of patients; 38.1% of them had dyslipidaemia. Total hypercholesterolaemia (28.6%), elevated LDL-C (19%), hypertriglyceridemia (23.8%) and HDL hypocholesterolaemia (42.9%) were observed. The medians of TG (128 mg / dL), HDL-C (51 mg/dL) and LDL-C (78 mg/dL) were high. Risk factors associated with dyslipidaemia were represented by WHO stage 4, tuberculosis (TB) and hyperglycaemia. The highest levels of LDL-C and TG and the lowest HDL-C were seen when CD4s+ were below 200 elements/µL. Conclusion: The HIV/AIDS dyslipidaemia characterized in this study by HDL-C hypocholesterolaemia, hypertriglyceridemia and total and LDL hypercholesterolemia can be considered as an indicator of the progression of HIV infection.

The pandemic of Coronavirus Disease (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) continues to rise around the globe. As per 15th July 2020, the World Health Organization (WHO) reported 13,119,239 confirmed COVID-19 cases along with 573,752 confirmed deaths globally.

The outbreaks and resurgence: The disease which reportedly began in the Chinese city Wuhan in November-December 2019, soon spread to various parts of the world, and was named and declared a pandemic disease by WHO. While the European countries were recovering from the epidemic, the disease took hold in the USA, the South American countries, Arabian countries, and South Asian countries, predominantly affecting Brazil, Peru, Iran, and India. Presently, many European countries are witnessing a resurgence and recurrent outbreaks of COVID-19. Spread and evolving new insights: Whereas there is workplace-related infection rise as people are returning to their offices, in other places the outbreaks are related to the people crowding and meeting care-freely and trying to resort back to their earlier way of life. The reopening of the educational facilities across the continents may make matters worse. Impact on health and healthcare: Most cases of COVID-19 infections go unnoticed and are followed by self-recovery. But what may appear good from the clinical perspective, appears to complicate epidemiological efforts to contain the outbreak. With the evolving information about the disease, there seem to be certain possible outcomes such as control and containment, or the persistence of the disease as global endemic accompanied with outbreaks and resurgent episodes. Gnetic factors linked to disease severity: With the COVID-19 pandemic, not all infected patients develop a severe respiratory illness. Further, there is a large variation in disease severity, which may be due to the genetic factors underlying the variable response to the virus. It is becoming clear that apart from the advanced age and pre-existing conditions, certain genetic constituent factors render some patients more vulnerable to the more severe forms of the diseases. Integration of virus into human genome: A significant part of the human genome is derived from viruses especially the RNA viruses. In fact, about 8 percent of the human genome is made up of endogenous retroviruses (ERVs), which are viral gene sequences that have become a permanent part of the human lineage after they infected our ancient ancestors. With this background, a novel concept emerging that if COVID-19 persists for several generations, its genetic material is projected to be integrated or assimilated into human genome. The involved mechanisms are conceptualized through the transposons or transposable elements of the SARS-CoV-2.

Since December 2019, entire world is facing problem of corona-virus pandemics and its impact on the people and their social life has been phenomenal. Each part of the world is ‘almost’ hit by COVID-19 infection. Most of the COVID-19 victims were aged people followed by consequence of high death ratios as shown in data [1]. Not only aged people but people with some secondary diseases or disorder were of major concern. A special case comes across which are patients with intellectual disabilities (ID) are the most vulnerable group. They also have extra multiple disorders including respiratory diseases, diabetes, obesity, These individuals face more complications and stand at high risk of because, such people are usually mentally lethargic and have almost no literacy in to follow proper health care and access health facilities

The nemesis: SARS-CoV-2 pandemic: Leaving in its wake millions of infections, accompanied by an immense magnitude of morbidity and multitude of mortality, and an unfathomable economic toll, the COVID-19 pandemic has led to a global calamity. An effective and safe COVID-19 vaccine is urgently needed to prevent the disease, thwart the complications and avert deaths resulting from unrestrained transmission of the infection. The hubris: Vaccine development: While most of the platforms of vaccine candidates have focused on the spike (S) protein and its variants as the primary antigen of COVID-19 infection, various techniques involved include nucleic acid technologies (RNA and DNA), non-replicating viral vectors, peptides, recombinant proteins, live attenuated and inactivated viruses. There are novel vaccine technologies being developed using next-generation strategies for precision and flexibility for antigen manipulation relating to SARS-CoV-2 infection mechanisms. The elpis: Updates and prospects: There were nine different technology platforms under research and development to create an effective vaccine against COVID 19. Although there are no licensed vaccines against COVID-19 yet, there are various potential vaccine candidates under development and advanced clinical trials. Out of them, one having undergone phase III clinical trials, has become available in some countries for use among the high-risk groups following emergency use authorization. Other COVID-19 vaccines may soon follow the suit. Conclusion: Hopes and concerns: The hope of benefiting from the vaccine to the extent that it may be the only way to tide over and control the COVID-19 pandemic, is accompanied by the likely fear of adverse effects and opposition in public for COVID-19 vaccination, including the vaccine hesitancy. Further, there is concern among scientific circles that vaccine may have opposite of the desired effect by causing antibody-dependent disease enhancement.

Introduction: SARS-CoV-2 life cycle: The disease which reportedly began in Chinese city Wuhan in November-December 2019 manifesting as severe respiratory illness, soon spread to various parts of the world, and was named COVID-19, and declared a pandemic by WHO. The life cycle of SARS-CoV-2 begins with membrane fusion mediated by Spike (S) protein binding to the ACE2 receptors. Following viral entry and release of genome into the host cell cytoplasm there occurs replication and transcription to generate viral structural and non-structural proteins. Finally, VLPs are produced and the mature virions are released from the host cell. Immunogenicity of the spike protein: The S protein is considered the main antigenic component among structural proteins of SARS-CoV-2 and responsible for inducing the host immune response. The neutralising antibodies (nAbs) targeting the S protein are produced and may confer a protective immunity against the viral infection. Further, the role of the S protein in infectivity also makes it an important tool for diagnostic antigen-based testing and vaccine development. The S-specific antibodies, memory B and circulating TFH cells are consistently elicited following SARS-CoV-2 infection, and COVID-19 vaccine shots in clinical trials. The emerging SARS-CoV-2 variants: The early genomic variations in SARS-CoV-2 have gone almost unnoticed having lacked an impact on disease transmission or its clinical course. Some of the recently discovered mutations, however, have impact on transmissibility, infectivity, or immune response. One such mutation is the D614G variant, which has increased in prevalence to currently become the dominant variant world-over. Another, relatively new variant, named VUI-202012/01 or B.1.1.7 has acquired 17 genomic alterations and carries the risk of enhanced infectivity. Further, its potential impact on vaccine efficacy is a worrisome issue. Conclusion: THE UNMET CHALLENGES: COVID-19 as a disease and SARS-CoV-2 as its causative organism, continue to remain an enigma. While we continue to explore the agent factors, disease transmission dynamics, pathogenesis and clinical spectrum of the disease, and therapeutic modalities, the grievous nature of the disease has led to emergency authorizations for COVID-19 vaccines in various countries. Further, the virus may continue to persist and afflict for years to come, as future course of the disease is linked to certain unknown factors like effects of seasonality on virus transmission and unpredictable nature of immune response to the disease.

Corona Virus Disease-2019 (COVID-19) has become one of the most serious diseases in the history of mankind. It has captured the entire world and solutions are yet to be discovered to fight this global crisis. The outcomes of COVID-19 are influenced by a variety of pre-existing factors. The secondary microbial infections are one of the prominent ones that are major contributors for Antimicrobial Resistance (AMR) as they warrant the use of antimicrobial medications. The present review aimed at exploring the potential relationship between AMR under such circumstances and COVID-19 related outcomes. The published literature across the globe has delineated that the impact of COVID-19 may have worsened by a great degree due to the presence of secondary infections majorly bacterial ones. The consequences of COVID-19 have been fatal and a significant proportion can be a major attributor to AMR, either directly or indirectly. Although, there is a dearth of studies that can establish a very strong and direct relationship between AMR and negative COVID-19 outcomes so in-depth research on this topic is required to further explain this relationship in detail. 

Introduction: Sepsis is an important cause of morbidity and mortality among neonates. Neonatal sepsis can alter the glucose level and both hypoglycemia and hyperglycemia may occur. A high or low blood glucose level may have a significant effect on the outcomes in patients of neonatal sepsis. Aims: The aim of the study to see the glycaemic status and its effect on outcome of neonatal sepsis. Material and Methods: This hospital based prospective observational cross-sectional study was conducted in Neonatal Intensive Care Unit in Universal College of Medical Sciences, a tertiary care hospital over a period of 4 months, from May 2019 to August 2019. A total of 220 Neonates suspected sepsis under the age of 28 days admitted in NICU, were studied and included in our study. Clinically suspected neonatal sepsis cases were enrolled in the study. Venous blood was collected before giving any intravenous fluid, dextrose or antibiotics and blood sugar, complete blood counts, CRP levels and blood culture were send to laboratory within half hour of collection. All patients included in this study were treated accordingly and followed up strictly. Blood glucose level and mortality of neonates having hypoglycemia, hyperglycemia were analyzed among CRP and culture positive patients. Quantitative data were expressed as mean and standard deviation. Qualitative data were expressed as frequency and percentage and comparison carried by Chi-square (χ2) test. Results: A total of 220 patients clinically diagnosed as neonatal sepsis were studied. 118 (53.6%) patients were found CRP positive and 56 (25.5%) patients were blood culture positive. Glycaemic status was analyzed among CRP and culture positive patients. Majority (55.9%) patients were found normoglycemic, 35.5% were found hypoglycemic and 8.6% were found hyperglycaemic in this study. 182 (82.73%) patients were cured and 38 (17.27%) died. Mortality was high in hypoglycaemic patients (34.4%) compared with normoglycaemic patients (9.82%), but the difference was not statistically significant (p > 0.05) between two groups, the mortality was high in hyperglycaemic patients (58.33%) compared with normoglycaemic patients (9.82%) and the difference was statistically significant (p < 0.05) between two groups. Conclusion: Alteration of glycaemic status occurred in septic newborn. Mortality is higher among the septic newborn with hyperglycemia. The present study found that majority of neonate with sepsis had high mortality rate when blood glucose level were either more than 145 mg/dl or less than 45 mg/dl. This signifies the importance of meticulous blood glucose estimation in cases of neonatal sepsis to improve mortality outcome.

Background: The number of childhood cancer survivors (CCSs) is increasing due to improved survival. Most suffer at least one treatment-related late effect, even decades after treatment, thus lifelong long-term follow-up (LTFU) care is a necessity. Currently no standardized LTFU programme for CCSs exists in South Africa. Study purpose: This study investigated current LTFU care of CCSs in South Africa. Methods: A survey was conducted amongst 31 South African paediatric oncologists using the SurveyMonkeyTM online tool. Information obtained included: training/experience, LTFU practices, late effects knowledge and opinion regarding the importance of a standardized LTFU programme. Results: The response rate was 74% (23/31). Respondents had an average of 9 years’ experience. All (22/23; 96%) regarded LTFU as important. Only half (12/23; 52%) discussed late effects at diagnosis. Infertility and second malignancy risks were discussed by a third. Less than half (48%) used LTFU guidelines; the majority (9/11; 82%) adjusted them to the local context. Most survivors were followed by a paediatric oncologist (17/23; 74%). About half of respondents (47.8%) shared LTFU with colleagues in private practice (50%), secondary (66.7%) or primary care facilities (25%). Almost half of respondents (10/23; 43.5%) regarded their late effects knowledge and LTFU experience as good, 8/23 (34.8%) as adequate and 3/23 (13%) as inadequate. All agreed that a national LTFU programme would be very important (87%) or important (13%). Almost half of the respondents (48%) understood what a Survivorship Passport was. Conclusion: It is essential to develop a national standardized LTFU programme for CCSs in South Africa to ensure appropriate care for all survivors.

Purpose: Children with autism spectrum disorder are at an increased risk for developing seizures, which can be triggered by classical antipsychotics. Aripiprazole is an atypical antipsychotic that has a safer drug profile. The objective is to present the experience with seizure control in autistic children who are placed on Aripiprazole. Methods: Series of consecutive autistic children with comorbid epilepsy treated with Aripiprazole were identified prospectively over a 3-year period. Monthly follow up by one pediatric neurologist was performed to document seizure control. Results: 56 autistic children with comorbid epilepsy were placed on Aripiprazole. Most children (59%) were seizure free for at least 6 months. The initial Aripiprazole dose was 5 mg in all patients. Follow up ranged between 5-8 months (mean 6.9). A total of 5 (9%) children developed seizure provocation (3/5) or worsening seizure control (2/5). There were 3 males and 2 females with ages ranging between 6-11.5 years (mean 8.5). Three of these children had a previous history of seizure worsening with other antipsychotic drugs (respiridone in 2 and haloperidol in 1). One child with seizure provocation developed status epilepticus 5 days after introducing Aripiprazole that required intensive care admission. The drug was stopped in all 5 children with no long-term effects. Conclusion: Seizure provocation or worsening seizure control is not uncommon following the introduction of Aripiprazole in autistic children with controlled epilepsy. Although the risk is low, parents should be warned and advised on what to do, particularly in the first month of therapy.

Child neglect is a global problem that involves large costs for both the individual and for society. This article is based on published reviews and meta-analyses in the field of child neglect between 1980 and 2018. Of a total of 433 articles, 13 was included, main Data bases has been PubMed, Scopus, Web of Science, Psych Info, ERIC, CINAHL. The prevalence in the normal population was found to be between 16% and 26%, while the prevalence in clinical groups seem to be significantly higher. For example, was the prevalence of neglect 50% among patients with eating disorder. It is especially important to know who is reporting neglect. Research shows that neglect is strongly associated with among other things, depression, one of the most common illnesses among the general public. The theoretical models that are used are ecological. Risk factors can be found at all levels when using ecological models. Research shows that factors involving the relationship parent-child are among the most important. Neglect is more common in low-income countries than in high income countries. Most studies point to the importance of prevention. Existing preventive programs are most often of family and parental character. More research is needed, especially as concerns the development of preventive programs that can identify specific types of neglect and present suitable preventive measures, both at the societal and family level. Key points 1. Neglect is a global problem. 2. Prevalence depends on the measurement method and can vary between about 16% and 76%. 3. Prevalence is higher when negligence is self-reported than when reported by professionals. 4. The most common and most serious risk factors are present in the microsystem. Parenting and interactions between child and parent are considered important. 5. There is a link between neglect and, above all, depression, but also anxiety, self-harm and eating disorders.

A term neonate was transferred from a Local Neonatal Unit to our surgical Neonatal Intensive Care Unit on Day 2 due to abdominal distension with radiological appearances suggestive of intestinal obstruction. He was born by Caesarean section with no risk factors for sepsis. He was intubated at birth for increased work of breathing and failed planned extubation on Day 1. 

Despite critical care advances, robust antibiotic therapy and improved strategies in early detection and prevention of infection, the incidence of morbidity and mortality from neonatal sepsis worldwide in preterm and low birth weight neonates remains overwhelmingly high. Neonatal sepsis is characterised by a clinical syndrome of systemic signs of infection and bloodstream bacteraemia in newborns within the first months of life. The risk of sepsis in neonates is inversely proportional to gestational age and birth weight due to deficiency in humoral immunity and the need for more invasive supportive neonatal intensive care unit interventions. Adverse effects such as necrotising enterocolitis associated with antimicrobial therapy are serious enough to warrant exploration of alternative therapeutic strategies. Immunoglobulin replacement therapy offers hope of enhancing immune competence and reducing infection rates in vulnerable populations. It is evident from the relevant studies to date that the benefits offered by intravenous immunoglobulin prophylaxis may not be significant enough for routine hospital implementation. Further research to better understand the mechanisms underlying immunodeficiency will lead to the realisation of alternative therapeutic and prophylactic interventions.

Background: In Wilms’ tumor, the time elapsed between clinical diagnosis and the start of treatment is clearly associated with morbidity and mortality. As treatment delay can influence patient survival, identification of possible causes can mitigate the consequences arising from prolonged diagnostic uncertainty. Objective: To ascertain whether an initial diagnosis of Wilms’ tumor in the emergency department influences patient prognosis depending on the type of referral for definitive treatment. Patients and methods: Retrospective chart review of 98 children receiving treatment for Wilms’ tumor at the Brazilian National Cancer Institute (INCA) between April 2003 and December 2016. Patients were categorized into two groups: those referred directly from an emergency public department to INCA and those first transferred to another hospital before being referred to INCA. Results: Of the 98 cases included in the study, 42.9% were direct referrals and 57.1% were indirect referrals. Presence of an abdominal mass was the most common presenting complaint, followed by abdominal pain. In cases with larger tumors, the mean tumor volume was greater than reported elsewhere in the literature, suggesting longer disease duration. Significantly higher tumor volumes were observed in patients with a palpable abdominal mass as compared to those with the second most frequent complaint (abdominal pain). Conclusion: The findings of this study support the hypothesis that patients diagnosed with kidney masses in the emergency department are at greater risk of delayed diagnosis when they are referred first to a non-specialized outside hospital than when referred directly to a specialized cancer treatment unit.

Introduction: Sepsis remains a major cause of death in neonatal period. Although significant advances in diagnosis, therapeutic and prevention strategies have been noted, sepsis remains a common concern in clinical practice especially in low-resource countries. The aim of this study was to determine the predictors of mortality in neonatal sepsis in Lubumbashi city (Democratic Republic of Congo). Methods: The records of newborns with sepsis managed in Neonatal Intensive Care Units in two University Hospitals between November 2019 and October 2020 were studied. Binary and multiple logistic regressions have been used to observe the association between independent variables and dependent variable. Results: A total of 162 cases of neonatal sepsis were reviewed. The mortality rate of neonatal sepsis was 21% of babies admitted. Very low birth weight (< 1500 grams) and primiparity were significantly associated with mortality in neonatal sepsis (AOR = 12.66; 95% CI 2.40 to 66.86; p = 0.003 and AOR = 3.35; 95% Cl 1.31 to 8.59; p = 0.012, respectively). Conclusion: The mortality rate of neonatal sepsis was 21%. Very low birth weight and primiparity were significantly associated with mortality in neonatal sepsis.

Introduction: Lipoprotein (a) [Lp(a)] is a marker for cardiovascular disease, involved in pathogenesis and progression of atherosclerosis. In selected high-risk patients, lipoprotein-apheresis could optimize secondary prevention and improve prognosis. Aim: We presented the case of a 49-year-old man with high lipoprotein (a) levels and recurrent cardiac adverse events, despite maximal pharmacological therapy. Case report: Four years before the admission at our Centre, he presented an anterior STEMI, treated with angioplasty and implantation of a drug eluting stent on left anterior descending artery, at the age of 47 years, in September 2012; one month later, the patients presented a new episode of angina, and exams showed a critical stenosis in the right coronary artery, treated by angioplasty and implantation of drug eluting stent. Because of high Lp(a) plasma levels, patient was subsequently on regularly 7-10 day lipoprotein apheresis. Results and discussion: A thrombophilic screening was performed, showing the simultaneous presence of heterozygous V Leiden mutation and prothrombin G20210A mutation. He referred to our Centre in order to optimize therapy; we performed an endothelial function assessment showing a severe dysfunctional pattern. Because of these findings, we prescribed dual antiplatelet therapy, and we added omega-3 fatty acids and association with nicotinic acid/laropiprant. According with current guidelines, considering the high risk of bleeding, we preferred not to administer anticoagulant therapy. At 6-month and 1-year follow up the patient continued lipoprotein apheresis and was asymptomatic for other cardiovascular events. Conclusions: The assessment for the eventual presence of thrombophilia might become a useful tool in clinical practice for high-risk selected patients.

Background: Vitamin D deficiency in pregnancy increases several risks of breastfed mothers. To prevent these adverse events, vitamin D supplementation during pregnancy and lactation is recommended, but suggested dose ranges vary. Objective: To determine whether vitamin D3 1,800 IU/d supplementation in lactating mothers improves the vitamin D status of their breastfed infants. Materials and Methods: A randomized, placebo–controlled trial with Thai pregnant women was conducted. Lactating mothers (n=72) and their breastfed infants with insufficient maternal 25 hydroxyvitamin D (25(OH)D) levels in the third trimester were randomly assigned to two groups, one of which received 1,800 IU/d vitamin D supplementation and the other a placebo. Maternal serum 25(OH)D during lactation, cord blood, and 6-week breastfed infant serum were measured using LC-MS/MS. Results: Mean maternal age (±SD) was 27±5 years, and pre-gestational BMI was 22.29±5 kg/m2. Maternal serum 25(OH)D at baseline was 22.29±7.15 nmol/L. At 6 weeks, both maternal 25(OH)D and infant 25 (OH)D levels had increased significantly in the vitamin D supplement group of mothers and infants (68.30±15.40, 40.40±12.56 nmol/L) compared to those in placebo groups (55.15±13.57, 24.28±17.20 nmol/L) (p <0.001, p<0.001). The changes in infant 25(OH)D levels increased substantially in the vitamin D supplement group but decreased in placebo(17.49±16.27 ng/ml compared to -1.34±19.23 nmol/L in the placebo group, p<0.001). The change of maternal 25(OH)D were positively correlation to the change of 25(OH)D level in breastmilk mothers and infants by r=0.697, p<0.001 and r=0.379, p=0.003 respectively. Conclusions: Vitamin D3 supplementation to breastfed mother during lactation can increase serum 25(OH)D level in Thai breastfed mother and infants. Further work is needed to determine the optimum duration of vitamin D supplementation to normalized breastfed infants with 25(OH)D level >75 nmol/L.