N-acetylcysteine (NAC) is an abundantly available antioxidant with a wide range of antidotal properties currently best studied for its use in treating acetaminophen overdose. It has a robustly established safety profile with easily tolerated side effects and presents the Food and Drug Administration's approval for use in treating acetaminophen overdose patients. It has been proven efficacious in off-label uses, such as in respiratory diseases, heart disease, cancer, human immunodeficiency virus infection, and seasonal influenza. Clinical trials have recently shown that NAC's capacity to replenish glutathione stores may significantly improve coronavirus disease 2019 (COVID-19) outcomes, especially in high risk individuals. Interestingly, individuals with glucose 6-phosphate dehydrogenase deficiency have been shown to experience even greater benefit. The same study has concluded that NAC's ability to mitigate the impact of the cytokine storm and prevent elevation of liver enzymes, C-reactive protein, and ferritin is associated with higher success rates weaning from the ventilator and return to normal function in COVID-19 patients. Considering the background knowledge of biochemistry, current uses of NAC in clinical practice, and newly acquired evidence on its potential efficacy against COVID-19, it is worthwhile to investigate further whether this agent can be used as a treatment or adjuvant for COVID-19.

Thymosin alpha 1 is a peptide naturally occurring in the thymus that has long been recognized for modifying, enhancing, and restoring immune function. Thymosin alpha 1 has been utilized in the treatment of immunocompromised states and malignancies, as an enhancer of vaccine response, and as a means of curbing morbidity and mortality in sepsis and numerous infections. Studies have postulated that thymosin alpha 1 could help improve the outcome in severely ill corona virus disease 2019 patients by repairing damage caused by overactivation of lymphocytic immunity and how thymosin alpha 1 could prevent the excessive activation of T cells. In this review, we discuss key literature on the background knowledge and current clinical uses of thymosin alpha 1. Considering the known biochemical properties including antibacterial and antiviral properties, time-honored applications, and the new promising findings regarding the use of thymosin, we believe that thymosin alpha 1 deserves further investigation into its antiviral properties and possible repurposing as a treatment against severe acute respiratory syndrome coronavirus-2.

Background: Poor quality sleep and emotional disturbances are expected in times of crisis. COVID-19 has severely impacted healthcare worldwide and with that comesThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Background: Current literature lacks characterization of the post-recovery sequelae among COVID-19 patients. This review characterizes the course of clinical, laboratory, radiological findings during the primary infection period, and the complications post-recovery. Primary care findings are presented for long-COVID care. Methods: Adhering to PRISMA guidelines, 4 databases were searched (PubMed, Embase, CINAHL Plus, Scopus) through December 5, 2020, using the keywords “COVID-19 and/or recovered and/or cardiovascular and/or long-term and/or sequelae and/or sub-acute and/or complication.” We included published peer-reviewed case reports, case series, and cross-sectional studies providing the clinical course of COVID-19 infection, and cardiopulmonary complications of patients who recovered from COVID-19, while making healthcare considerations for primary care workers. Results: We identified 29 studies across 9 countries including 37.9% Chinese and 24.1% U.S. studies, comprising 655 patients (Mean Age = 45) with various ethnical backgrounds including Asian and European. Based on the WHO COVID-19 severity classification scale, initial disease severity was mild for 377 patients and severe for 52 patients. Treatments during primary infection included corticosteroids, oxygen support, and antivirals. The mean value (in days) for complication onset after acute recovery was 28 days. Complete blood counts and RT-PCR tests were the most common laboratory results described. In 22 of the studies, patients showed signs of clinical improvement and were prescribed medications such as anticoagulants or corticosteroids. Conclusion: Post-recovery infectious complications are common in long-COVID-19 patients ranging from mild infections to life-threatening conditions. International thoracic and cardiovascular societies need to develop guidelines for patients recovering from COVID-19 pneumonia, while focused patient care by the primary care physician is crucial to curb preventable adverse events. Recommendations for real-time and lab-quality diagnostic tests are warranted to establish point-of-care testing, detect early complications, and provide timely treatment.

To the Editor,The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2),

As technology advances, sharing data instantaneously is becoming easier than ever and opportunities for international collaborations are becoming more and more easily available on a virtual level. Amongst the numerous areas of expertise that could benefit from this development, surgery stands out to be an esoteric one given the challenges faced as one embarks on collaboration in surgical education and research. Herein, we delve into the challenges faced when such international collaborations are attempted and provide insight as to how different areas across the globe could collaborate to improve outcomes in surgical education and research.

Objective: COVID-19 has varying impact on different groups of people based on age, gender, race and comorbidities. Although the implications of COVID-19 on chronic pulmonary and cardiovascular disease have been extensively studied, the impact on neurological disease remains unclear. We attempt to identify the outcome and challenges of COVID-19 in patients with chronic neurological conditions.   Methods: We conducted a systematic review and meta-analysis of 15 studies and 11,011 patients to compare composite poor outcome and mortality between patients with and without neurological comorbidities. We also analyzed the different clinical presentations and outcome of COVID-19 in different neurological conditions.     Results: We found a markedly higher incidence of composite poor outcome (Odds Ratio: 5.57, 95% CI: 3.81-8.12, P = 0.02) and a higher mortality (Odds Ratio: 6.47, 95% CI: 3.94 - 10.63, P = 0.008) among patients with pre-existing neurological disease, and no significantly different outcomes between patients with cerebrovascular disease and dementia. Linear Meta-regression analysis revealed that the impact of chronic neurological disease on COVID-19 was independent of chronic cardiovascular disease (P=0.406), hypertension (P=0.458), diabetes mellitus (P=0.512), COPD (P=0.281), and advanced age (p=0.066).   Conclusion: Patients with chronic neurological disease seem to develop moderate/severe COVID-19 more frequently, and have an increased mortality rate, independent of other comorbidities. They also show atypical clinical presentation in SARS-CoV-2 infection. Advanced age, cognitive dysfunction, immunosuppression, and respiratory muscle weakness might be responsible for the adverse COVID-19 outcomes in these patients.

Central nervous system (CNS) tumors are identified as tumors of the brain and spinal cord. The associated morbidity and mortality of cerebrospinal tumors are disproportionately high compared to other malignancies. While minimally invasive techniques have initiated a revolution in neurosurgery, artificial intelligence (AI) is expediting it. Our study aims to analyze AI's role in the neurosurgical management of cerebrospinal tumors. We conducted a scoping review using the Arksey and O'Malley framework. Upon screening, data extraction and analysis were focused on exploring all potential implications of AI, classification of these implications in the management of cerebrospinal tumors. AI has enhanced the precision of diagnosis of these tumors, enables surgeons to excise the tumor margins completely, thereby reducing the risk of recurrence, and helps to make a more accurate prediction of the patient's prognosis than the conventional methods. AI also offers real-time training to neurosurgeons using virtual and 3D simulation, thereby increasing their confidence and skills during procedures. In addition, robotics is integrated into neurosurgery and identified to increase patient outcomes by making surgery less invasive.Artificial intelligence, including machine learning, is rigorously considered for its applications in the neurosurgical management of cerebrospinal tumors. This field requires further research focused on areas clinically essential in improving the outcome that is also economically feasible for clinical use. The authors suggest that data analysts and neurosurgeons collaborate to explore the full potential of AI.