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Background The COVID-19 pandemic has negatively affected many aspects of the healthcare system. Many meta-analysis studies showed that surgical training and medical education have faced the most negative effects. Aim In this study, we aim to study the impact of the COVID-19 pandemic on residency and fellowship training in terms of clinical load, surgical exposure, medical education, and research opportunities. Methodology This retrospective study was conducted at King Khaled Eye Specialist Hospital (KKESH), Riyadh, Saudi Arabia, to assess the effects of COVID-19 on the training program by comparing the years 2018 and 2019 before the COVID-19 pandemic to 2020 and 2021 after the COVID-19 pandemic. The sample was inclusive, including 117 KKESH graduates (residents and fellows in the surgical subspecialties) from 2018 to 2021. All the sample populations were included. The data was collected in a specifically designed form. All participants were ensured to have a full surgical logbook with no missing data in the documentation. Outpatient visits were collected through electronic records in the hospital registry. The teaching activities and grand rounds were collected through the residency and fellowship program. Results During 2018-2021, 18,669 surgeries were performed. The total number of surgeries performed was 3,980, 4,898, 4,813, and 4,978 in 2018, 2019, 2020, and 2021, respectively. There was a 23.1% (N = 918) increase in the number of surgeries done by trainees from 2018 to 2019, then a 1.7% (N = 85) reduction from 2019 to 2020, followed by an increase of 3.4% (N = 165) from 2020 to 2021. The mean number of surgeries performed by fellows showed a 25.2% (N = 1,042) increase from 2018 to 2019, a 7.3% (N = 107) reduction from 2019 to 2020, and a 15.1% (N = 550) increase (p = 0.018). In the case of residents, there was a 10.7% (N = 136) reduction from 2018 to 2019, a 2.1% (N = 24) increase from 2019 to 2020, and a 40% (N = 783) reduction in the total number of phacoemulsification surgeries (p < 0.001).In total, there was a 25.1% (N = 8,215) increase in the number of patients seen in outpatient clinics from 2019 to 2020. All activities were on-site during 2018 and 2019. A gradual shift occurred from on-site to virtual over 2020 and 2021 without any effect on the number. From 2019 to 2020, there was an increase in the number of papers submitted by the trainees. There was an increase of 25% (N = 10), 20% (N = 2), and 6.3% (N = 3) in the retrospective research, prospective research, and case reports, respectively. Conclusions The surgical exposure has not affected the fellows and residents of the hospital. However, the number of surgeries for the residents has been affected due to the stoppage of overseas surgical courses during the pandemic. The volume of the outpatient clinic has increased after the pandemic, which could be caused by the increased number of referrals to our tertiary hospital, mainly after the pandemic effect on other hospitals in the kingdom and the implementation of the virtual clinic and telephone call. Interestingly, research activity has also increased after the pandemic., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alyahya et al.)

SARS-COVID-19 is known to manifest with a wide variety of symptoms, most of which are respiratory. Myalgias are a common symptom of COVID-19, but cases of severe virus-induced inflammatory muscle injury leading to rhabdomyolysis and polymyositis have also been reported. Here, we present and discuss a case of a 56-year-old woman who presented with an initial presentation of COVID-19 infection with inflammatory polymyositis leading to rhabdomyolysis. The patient was first treated for rhabdomyolysis with aggressive fluid resuscitation with intravenous normal saline without improvement in symptoms. She was then started on high-dose intravenous methylprednisolone for presumed immune-mediated polymyositis. An MRI of the bilateral lower extremities and a biopsy of the left thigh confirmed inflammatory myositis. After the initiation of steroids, liver function tests and creatinine kinase levels trended down, and symptoms improved. The patient was discharged with a prednisone taper and completely recovered at a follow-up six months later. Post-COVID severe musculoskeletal involvement, including polymyositis or rhabdomyolysis, is rare, with only a few other cases published so far. Viral myositis, supported by myopathological evidence, should be considered carefully in patients with a recent COVID-19 infection after ruling out more common causes of myositis. Some proposed mechanisms include direct infection of the muscle or an environmental event triggering autoimmunity. Treatment generally involves corticosteroids that are gradually tapered., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Reddy et al.)

Importance Over the last two years, dermatology has undergone significant reforms in the residency application process in efforts to reduce applicant stress, increase equity, and due to the COVID-19 pandemic.  Objective We aimed to determine applicant and program director (PD) perspectives in implementing these changes over the last two application cycles.  Design, setting, and participants Anonymous online surveys were administered by the Association of American Medical Colleges (AAMC) to PDs and applicants from the 2021-2022 dermatology residency application cycle. These results were compared with similar online surveys distributed after the 2020-2021 cycle. Results Coordinated interview release was introduced in the 2020-2021 dermatology application cycle. At that time, 57% of PDs and 84% of applicants wished that more programs participated in the release, compared to 53% and 84%, respectively, in the 2021-2022 cycle. In 2021, 28% of PDs reported matching applicants from their home institution higher on their list compared to 14% in 2022. In 2021 and 2022, 94% of PDs reported that diversity was an explicit goal in their application process. However, in 2021, 33% of PDs reported that they matched no UIMs (underrepresented in medicine) in their cohort, which grew to 39% in 2022. Conclusions This study identifies key trends in applicant and PD perspectives associated with changes in the application process such as coordinated interview release, virtual interviews, and emphasis on diversity. Additional data is needed from subsequent cycles in order to determine the efficacy of these reforms., Competing Interests: Drs. Rosenblatt, Rosman, Worswick and Ahmed are on the Association of Professors of Dermatology Residency Program Directors Section Steering Committee. Otherwise, no COI to report., (Copyright © 2024, Rinderknecht et al.)

Healthcare providers, particularly during the COVID-19 crisis, have been forced to make difficult decisions and have reported acting in ways that are contrary to their moral values, integrity, and professional commitments, given the constraints in their work environments. Those actions and decisions may lead to healthcare providers' moral suffering and distress. This work outlines the development of the Moral Distress Virtual Reality Simulator (Moral Distress VRS) to research stress and moral distress among healthcare workers during the COVID-19 pandemic. The Moral Distress VRS was developed based on the agile methodology framework, with three simultaneous development streams. It followed a two-week sprint cycle, ending with meetings with stakeholders and subject matter experts, whereby the project requirements, scope, and features were revised, and feedback was provided on the prototypes until reaching the final prototype that was deployed for in-person study sessions. The final prototype had two user interfaces (UIs), one for the participant and one for the researcher, with voice narration and customizable character models wearing medical personal protective equipment, and followed a tree-based dialogue scenario, outputting a video recording of the session. The virtual environment replicated an ICU nursing station and a fully equipped patient room. We present the development process that guided this project, how different teams worked together and in parallel, and detail the decisions and outcomes in creating each major component within a limited deadline. Finally, we list the most significant challenges and difficulties faced and recommendations on how to solve them., Competing Interests: VB has received research support from CIHR, BBRF, MOH Innovation Funds, RCPSC, DND, Canada, NFRF, AMS HealthCare, and from Roche Canada, Novartis and Eisai., (Copyright © 2024, Torres et al.)

This case report details a 43-year-old female diagnosed with the collapsing variant of focal segmental glomerulosclerosis (FSGS) post-infection with coronavirus disease 2019 (COVID-19). The patient contracted COVID-19 after returning from a trip to Florida and initially presented to the emergency department with gastrointestinal symptoms. Thereafter, the patient was diagnosed with COVID-19 and was admitted for acute kidney injury and worsening COVID-19 infection. FSGS is a glomerulopathy that consists of glomerular scarring that leads to nephrotic syndrome, secondary to podocyte effacement. FSGS has many causes, as well as distinct variants, but is noted to have an association with some viruses, most notably HIV and cytomegalovirus (CMV). Although the association between FSGS and HIV or CMV is well established, the evidence is minimal in regard to other viruses. This case report serves to highlight the potential association of COVID-19 with FSGS., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Thomas et al.)

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but detrimental syndrome that has been most commonly reported after the administration of vaccination for the prevention of viral infections. VITT often presents with thrombosis at unusual sites such as cerebral venous sinuses, portal, splanchnic or hepatic veins, in association with thrombocytopenia and elevated anti-platelet factor 4 (aPF-4) antibodies. We describe the case of a young male patient who developed thrombocytopenia, cerebral sinus venous thrombosis, and intracerebral bleed 12 days after receiving the Ad26.COV2.S (Janssen/Johnson&Johnson) COVID-19 vaccine., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Bellamy et al.)

In addition to respiratory symptoms, SARS-CoV-2 infection has been linked to numerous neurologic sequelae including acute necrotizing encephalopathy. Here we present the case of a 33-year-old woman infected with SARS-CoV-2 who arrived at the hospital unresponsive. She was comatose with intact brainstem reflexes, and brain imaging was consistent with acute necrotizing encephalopathy affecting the bilateral thalami, medial temporal lobes, and pons. She was treated quickly with intravenous corticosteroids and plasmapheresis and regained neurologic function over weeks. Acute necrotizing encephalopathy is a rare para-infectious syndrome characterized by rapidly progressing encephalopathy, seizures, and/or coma caused by multifocal inflammatory central nervous system (CNS) lesions. The mechanism(s) underlying this condition remain unclear, though cytokine storm and disruption of the blood-brain barrier has been proposed as initiating event. This report presents a case of adult acute necrotizing encephalopathy in the early period after SARS-CoV-2 infection, adding to the literature on this rare condition and its relation to SARS-CoV-2 infection. We also report on the clinical outcome of treatment with prompt immunosuppression., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Gadani et al.)

Cerebral vein thrombosis (CVT) is a rare condition equivalent to deep vein thrombosis of the intracranial veins. Delayed diagnosis will result in severe and disabling complications. We report a case of a 59-year-old man with CVT with no significant past medical or surgical history. On admission, he reported right-sided numbness and weakness concerns, preceded by the sudden onset of bilateral vision loss and dysarthria. Magnetic resonance imaging and computed tomography scans confirmed the diagnosis of CVT. The most interesting relative risk factor was flying overseas twice a month for the last 10 years; each flight was longer than eight hours. Another possible contributing factor to our patient's condition was polycythemia, with a hemoglobin level of 19, but the most questionable and puzzling is the recent coronavirus disease 2019 (COVID-19) vaccination two months, eight months, and one year prior to admission. Our case highlights a rare COVID-19 vaccine-related CVT diagnosis and that close monitoring for new symptoms and signs is vital to prevent life-threatening complications, herniation, and hemorrhagic transformation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Alsallamin et al.)

Coronavirus disease 2019 (COVID-19) is a febrile respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It may develop into respiratory failure or pneumonia. Antimicrobials have facilitated medical progress for decades. However, antimicrobial resistance (AMR) limits our ability to treat diseases and undermines efforts to attain health-related sustainable development and universal health coverage objectives. Antimicrobial resistance is a major concern that must be addressed immediately. The principles of appropriate prescription, optimal use of antimicrobials, quality diagnosis and treatment, and infection reduction and prevention have led to antimicrobial stewardship initiatives. During the current COVID-19 epidemic, there are possible hazards to antimicrobial stewardship measures and drug resistance. Many people with mild illnesses but without pneumonia or moderate infections with pneumonia are administered antibiotics. Antimicrobial therapy has no documented benefit in COVID-19 patients without microbial co-infection. COVID-19 patients may have an increased risk of developing concomitant microbial infections, which would necessitate antibiotic treatment. This review evaluated the role of empiric antibiotics in COVID-19 patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Lingas et al.)

Coronavirus disease 2019 (COVID-19) was a novel virus that originated in China in November 2019 and is most known for its respiratory compromise; however, many patients have experienced vascular thrombosis as sequelae of COVID-19. It is thought that the virus causes endothelial cell damage and increased platelet and leukocyte adhesion, causing a hypercoagulable state. While the most common presentation of hypercoagulability associated with COVID-19 is venous thrombosis, there are reports of patients who present with acute limb ischemia. We present a case of acute leg ischemia in an otherwise asymptomatic patient with no atherosclerotic risk factors., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Gaisinskaya et al.)

Introduction: The exact incidence of neurologic manifestations in coronavirus disease 2019 (COVID-19) patients is not clear. The New York City Hospital system has been severely affected by the COVID-19 pandemic between December 2019 and 202. A large number of patients were treated at these centers. This study aims to investigate the incidence of such neurologic manifestations. Secondly, we wanted to find out if there is a correlation between comorbidities and neurologic manifestations in patients with COVID-19., Methodology: A retrospective analysis of 5,455 Electronic Medical Records of patients with a positive polymerase chain reaction (PCR) result admitted to Elmhurst Hospital, Queens Hospital Center, Jacobi Medical Center, and North Central Bronx Hospitals, four of the 11 teaching hospitals in the NYCHH (New York Health + Hospitals) between 3-1-2020 to 8-31-2020 was carried out. Comprehensive data were collected using medical documentation in five categories: demographic details, comorbidities, symptoms, laboratory findings, and radiologic examinations. All neurologic manifestation keywords were provided to the statisticians by two trained and board-certified physiatrists. Neurologic manifestations were categorized into central nervous system (CNS) manifestations and peripheral nervous system (PNS) manifestations. Results; Out of the 5,455 patients, 285 patients (5.2%) had central nervous system manifestations, a prevalence in people older than 50, and had a high incidence of comorbidities. We found increased D-dimer and high C reactive protein levels. Our findings agree with two of the three authors with significant case volume., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Nori et al.)

Hyperinflammation is a key component of severe coronavirus disease 2019 (COVID-19) and is associated with poor outcomes. It is imperative to distinguish severe COVID-19 from hyperinflammatory syndromes such as multisystem inflammatory syndrome (MIS) and hemophagocytic lymphohistiocytosis. There is a subset of post-COVID-19 patients who present with some symptoms characteristic of MIS in adults (MIS-A) yet do not meet all the criteria for a diagnosis. We describe the unique case of a patient with this kind of presentation who clinically improved following tocilizumab and corticosteroid usage., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Selvaraj et al.)

In clinical practice, there are a lot of variations in disease manifestations. Diseases are constantly evolving, and one negative test cannot completely rule out a disease. Erythema multiforme (EM) is a common mucocutaneous disease that can be linked to a lot of etiologies, with the most common being herpes simplex virus (HSV) types 1 and 2, Mycoplasma pneumoniae , and the use of various drugs. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new virus, and traditionally it is not the first differential for EM eruptions. We report the case of a 52-year-old female patient with a history of multiple drug use, pneumonia-like symptoms, an initial negative viral panel for SARS-CoV-2, followed by a positive polymerase chain reaction (PCR) test, asymptomatic coronavirus disease 2019 (COVID-19) clinical course, and break-out of typical targetoid lesions of EM. Throughout her hospital stay, the patient maintained her oxygenation levels and improved clinically with steroids and symptomatic treatment. She regained her health and was counseled to quit smoking, alcohol, and opioid usage at the time of discharge from the hospital, and a regular follow-up with her primary care practitioner (PCP) was advised., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Tahir et al.)

Background The COVID-19 pandemic is one of the largest global healthcare crises in nearly a century. To face this global health emergency, health institutions have had to readjust their functioning while ensuring the continuity of care and protecting medical staff and patients. Our aim in this study was to assess the consequences of the COVID-19 outbreak on family medicine and its practice in Saudi Arabia. Methods This cross-sectional study was conducted during the period from June 30, 2020, to July 20, 2020, by posting an online survey on social media platforms (WhatsApp and Twitter) and emailing physicians individually to collect data on the impact of the COVID-19 pandemic on family medicine and primary care practices during the period of lockdown in Saudi Arabia. Results A total of 382 primary healthcare (PHC) providers participated in the study (males: 213 (55.8%); females: 169 (44.2%)). The mean age and standard deviation of the population were 38.27±7.46. Most participants were from governmental health sectors. Participants revealed that they have a good level of knowledge regarding COVID-19. However, they indicated confusion regarding the knowledge due to changing recommendations or multiple-source information. Only 57.3% of respondents received relevant training on the use of personal protective equipment (PPE). The most frequently used PPE were surgical masks (100%) and gloves (98.4%). The highly protective N95 masks were used by only 55.7%. Many health care workers indicated a high rate of stress and anxiety about the COVID-19 pandemic. Data obtained are suggestive that there was a reduction in outpatient visits and a reduction in consultation time. Canceled physical examinations of the patients during the consultation were encountered most of the time. There was no shortage of medications, nasopharyngeal swabs, or sanitizers. However, an occasional lack of PPEs occurred. 64.4% of the respondents used online consultations with their patients. A shortage of health care workers during the pandemic in family medicine clinics was encountered by 63.3% of the participants. Conclusion Family medicine practices are adversely affected by pandemics and lockdowns following them. It has been reported that COVID-19 interferes with preventive, chronic, and acute care visits and increases mental health visits. Outpatient visits have also decreased as well as the amount of time spent in consultations. In addition, the transition from in-person clinics to telemedicine has happened. Perhaps these changes will delay the diagnosis and prescription refills., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Shatla et al.)

Background and objectives The novel coronavirus disease 2019 (COVID-19) pandemic has challenged healthcare systems worldwide. Various studies have revealed the negative impact of the pandemic on the education and mental health of medical students and residents. In this study, we aimed to explore the effects of the COVID-19 pandemic on medical interns' educational experience, clinical practice, and mental health. We also engage in a discussion on the compensatory methods that have been adopted to improve medical interns' learning processes during the ongoing pandemic. Methods This cross-sectional survey-based study was conducted at the King Saud University Medical City (KSUMC) in Riyadh, Kingdom of Saudi Arabia (KSA) from March to October 2020. The participants consisted of medical interns. The survey collected information on participants' demographics, training, and the educational and psychological impact of the pandemic. Results The survey was distributed to 480 medical interns, of whom 345 (71.8%) participated. Most of our sample (75.6%) believed that the COVID-19 pandemic has negatively impacted their cumulative experience. Regarding the pandemic's impact on training and education, it was found that the emergency department rotation was the most affected rotation (60.3%). The majority of the participants (55.9%) believed that all tracks have received equal education and the volume of patients seen by interns decreased by 91.9%. As for the compensatory methods, 73.3% reported the utilization of remote platforms. Regarding the pandemic's mental health impact, 36% believed that it has affected their mental health, where increased stress levels were noticed in 47.8% of participants. Statistical significance was found in both Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) scores, which indicated that during the pandemic, 20.6% of the participants suffered from depression, and 13.9% had moderate to severe anxiety. Conclusions This study highlights the negative educational and psychological impact of COVID-19 on medical interns. With emerging infectious diseases on the rise, recognizing the impact of COVID-19 on medical interns is vital to improving interns' educational experiences and mental health during future crises., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, AbuDujain et al.)

Background The incidence of sexually transmitted diseases (STD) has increased in recent years, especially in the young population. Urethritis is one of the most common clinical presentations of STD in emergency departments. During the SARS-COV-2 pandemic, in Spain lockdown lasted almost three months, and mobility was greatly restricted. This is the first study of these characteristics conducted in Spain. Methods A cross-sectional study of all patients treated for clinical symptoms of urethritis between March and June 2019 and between March and June 2020 was conducted. We evaluated patients' sociodemographic and clinical variables. Results Seventy-nine patients were included in the study: 37 in 2019 and 38 in 2020 of whom 94.9% were men. The main symptoms were urethral discharge (59.5%) followed by dysuria (26.6%). Risky sexual relations were reported by 63.2% of patients in 2019, and this percentage decreased to 43.9% in 2020. Conclusions The number of patients attending an emergency department in our health region for urethritis did not undergo any variations between 2019 and 2020. No significant reduction in the number of cases of urethritis was observed, probably because people continued with unsafe sexual relations despite the social restrictions and difficulties posed by the lockdown., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Yuguero Torres et al.)

Immunocompromised status Is often associated with severe coronavirus infection given the inability of the immune system to combat the deadly severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients with multiple comorbidities such as diabetes mellitus, hypertension, and chronic kidney disease along with patients on immunosuppressants or chemotherapy are at higher risk of getting infected during the ongoing pandemic with more probability of adverse outcomes. However, we report a rare case of a renal transplant recipient who was on sirolimus and contracted coronavirus disease (COVID-19). His immunosuppressants were continued and he was managed with antiviral, steroids and low molecular weight heparin and the patient responded well to the treatment and recovered completely after a span of one week. Use of sirolimus in a patient with renal transplant recipient helped in preventing intensification of the severity in COVID-19 attributing to its inhibiting effect on mammalian target of rapamycin (mTOR) which he was using post his renal transplant, therefore, proving to be a blessing in disguise., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Talwar et al.)

In our everyday practice with COVID-19 patients, we noticed that they are not tachycardic even when critically ill and shocked on pressors they are bradycardic. Most of them are in sinus rhythm. However, some of them go into advanced degree heart block and had cardiac arrest related to complete heart block. A 72-year-old female with a history of hypertension and diabetes admitted with COVID-19 bronchopneumonia. The hospital course has been complicated by respiratory failure requiring mechanical ventilation and septic shock requiring norepinephrine. It was noted that she is bradycardic in the 50s in sinus rhythm, her heart rate dipped down to 30 for about six seconds, and her telemetry strip showed evidence of complete heart block, and then she was back in sinus rhythm. The decision was made to follow-up, given that it was for a short time and did not recur. The next day she had cardiac arrest related to a complete heart block, and a temporary trans-venous pacemaker was placed, Later when her condition improved, her heart rate started recovering gradually. At first, she was in junctional tachycardia, and one week later, she was back in sinus rhythm. The temporary pacemaker was removed, and she was discharged on a ZIO monitor for two weeks with no further evidence of bradycardia. Bradycardia in COVID-19 patients is frequently reported. It is not always benign and should be managed promptly when there is evidence of advanced heart block., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Mohamed et al.)

The presence of myocardial injury in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection is common. The cardiac complications of SARS-CoV2 infection are varied and distinguishing between them can be complicated.  A 55-year-old man with recent diagnosis of SARS-CoV2 infection presented with chest pain, syncope, and was found to have saddle pulmonary embolism (PE). Marked elevation in cardiac enzymes prompted a coronary angiogram which was normal. Cardiac MRI revealed late gadolinium enhancement (LGE) in the anterolateral wall consistent with myocardial infarction (MI). He was diagnosed with paradoxical embolism causing MI. The differential for elevated cardiac enzymes is wide in patients with SARS-CoV2 infection. This case illustrates that sometimes multiple diagnoses exist, and that a high index of suspicion is required to continue work-up., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Yu et al.)

Emerging cases of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) have been associated with a variety of disorders including respiratory failure, immune reactive syndrome, multiorgan failure, and hypercoagulable states. COVID-19 induces a severe global inflammatory response which can result in endothelial damage leading to hypercoagulability. Most COVID-19 cases of hypercoagulable states reported venous thrombosis. We report here a case of a 65-year-old Hispanic male diagnosed with bilateral acute lower limb ischemia and renal infarcts secondary to a severe COVID-19 infection., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Narvaneni et al.)

Background On April 16, 2020, the Japanese government declared a state of emergency due to the spread of COVID-19 infection, leading prefectural governors to announce a stay-at-home order for 39 days until May 25, 2020. As physical inactivity is a risk factor for osteoporosis, we investigated the short-term impact of the stay-at-home order on bone health among patients with osteoporosis in our hospital in Kanagawa prefecture. Methods Thirty patients with osteoporosis with no delays in their regular medication who received care at our hospital's osteoporosis outpatient clinic within one month after the end of the state of emergency were included. Lumbar spine and femur proximal bone mineral density (BMD) were measured at the last follow-up date (May 25 to June 30, 2020; 0M) and six (6M) and 12 months (12M) before the last follow-up using dual-energy X-ray absorptiometry. Bone alkaline phosphatase (BAP), Tartrate-resistant Acid Phosphatase 5b (TRACP5b), calcium and phosphorus were assessed at the same time points. Results Serum BAP concentrations were significantly lower at 0M than 12M (p=0.040), but were comparable between 0M and 6M (p=0.527). Serum TRACP5b was significantly lower at 6M than 12M (p=0.009), but was similar between 0M and 6M (p=1.000). Serum calcium and phosphorus did not differ among the time points (p=0.516 and p=0.358, respectively). Similarly, lumbar spine and femoral neck BMD were comparable (p=0.679 and p=0.076, respectively). Conclusion Bone health in patients with osteoporosis was maintained during the short-term COVID-19 stay-at-home order among patients who experienced no delays in medication. However, larger and long-term studies are needed., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Yokozeki et al.)

Multiple public health problems have been caused by various coronavirus strains over the last few years, such as the middle eastern respiratory syndrome (MERS), severe acute respiratory syndrome (SARS), and COVID-19. COVID-19, which is also known as coronavirus disease 2019, was first detected in Wuhan, China, and has significantly impacted people's health and lives. Additionally, it has led to a pandemic, and the virus has spread to over 121 countries worldwide. There is numerous information available regarding this virus. A detailed and extensive study of the morphological and histopathological findings will help understand and diagnose the disease. As it is a new disease, it is challenging to understand the mechanism of the action and disease pathology due to the limited availability of data from autopsies or biopsies. However, as the detailed mechanism of injury remains unclear, this paper aims to review the postmortem gross and histopathological findings of various organs that have been affected with coronavirus, focusing on the pulmonary, cardiac, and hematologic findings. This paper emphasizes the postmortem findings of the effect of the coronavirus disease on multiple organ systems. Advance search of the keywords on PubMed was used, limiting the search to the last five years. The eligible article is narrowed based on relevance containing postmortem findings of the novel virus; COVID-19. A total of 25 full-text articles were selected and used in the review of this paper., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Eketunde et al.)

Background: The novel coronavirus disease 2019 (COVID-19) has impacted many countries across all inhabited continents, and is now considered a global pandemic, due to its high rate of infectivity. Research related to this disease is pivotal for assessing pathogenic characteristics and formulating therapeutic strategies. The aim of this paper is to explore the activity and trends of COVID-19 research since its outbreak in December 2019., Methods: We explored the PubMed database and the World Health Organization (WHO) database for publications pertaining to COVID-19 since December 2019 up until March 18, 2020. Only relevant observational and interventional studies were included in our study. Data on COVID-19 incidence were extracted from the WHO situation reports. Research output was assessed with respect to gross domestic product (GDP) and population of each country., Results: Only 564 publications met our inclusion criteria. These articles came from 39 different countries, constituting 24% of all affected countries. China produced the greatest number of publications with 377 publications (67%). With respect to continental research activity, Asian countries had the highest research activity with 434 original publications (77%). In terms of publications per million persons (PPMPs), Singapore had the highest number of publications with 1.069 PPMPs. In terms of publications per billion-dollar GDP, Mauritius ranked first with 0.075., Conclusion: COVID-19 is a major disease that has impacted international public health on a global level. Observational studies and therapeutic trials pertaining to COVID-19 are essential for assessing pathogenic characteristics and developing novel treatment options., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Chahrour et al.)