The novel coronavirus disease 2019 (COVID-19) clinically manifests as respiratory and gastrointestinal presentations, most commonly vomiting, diarrhea, and abdominal pain. Although the impaired liver function is prevalent in COVID-19, it is poorly understood. We report the first case of hepatitis B virus (HBV) reactivation caused by COVID-19 in a young adult with altered mental status and severe transaminitis. The patient was asymptomatic, hypothermic, his skin was jaundiced with the icteric sclera, with very high levels of aspartate aminotransferase (AST; 4,933 U/L), alanine aminotransferase (ALT; 4,758 U/L), and total bilirubin (183.9 mmol/L) levels. It is warranted that patients with abnormal liver functions tend to have an increased risk of COVID-19. Thus, increased attention should be paid to the care of patients with abnormal liver functions, and testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA is warranted in the COVID era.

Gestational diabetes (GD) is a common complication during pregnancy. Metabolic changes in GD affect fetal development and fetal glucose homeostasis. The present study utilized a rat model of GD to evaluate the effects of nicotinamide on diabetic parameters; antioxidant gene expression viz, superoxide dismutase (SOD) and catalase (CAT); reactive oxygen species (ROS) production by neutrophils and enhancement of lymphocyte mediated immune response. Nicotinamide (50, 100 and 200 mg/kg) was orally supplemented to gestational diabetic rats from days 6 through 20 of gestation. After GD induction, the control group had elevated glucose and reduced insulin while nicotinamide (100 & 200 mg/kg) supplementation reversed these changes. The same doses of nicotinamide upregulated mRNA expressions of SOD and CAT genes in liver but reduced the oxidative burst activity of neutrophils in response to phorbol myristate acetate (PMA), N-formyl-methionyl-leucyl-phenylalanine (FMLP) or E. coli activation. Nicotinamide (100 & 200 mg/kg) supplementation also increased expression of activated T helper (CD4+CD25+) cells and induced proliferation of splenocytes. These findings provide evidence for utilizing nicotinamide as supplement or adjunct to support existing therapeutic agents for gestational diabetes and in pregnant individuals with weakened immune systems.

Acute pancreatitis (AP) is an uncommon potential complication of severe hypertriglyceridemia (HTG). We reported a case of a 45-year-old man admitted with HTG-induced AP (HTG-AP). The patient was a known diabetic (glycated hemoglobin levels: 9.5%), his triglycerides level was 3587.2 mg/dl, and the lipase level was 242 IU/L. A CT scan revealed AP. The patient was treated with a low-dose insulin infusion (0.05 unit/kg/hr) with dextrose for six days. His triglycerides came down to 673.1 mg/dl, and he was discharged. Further investigations are needed to understand the efficacy of low-dose insulin in the management of HTG-AP.