BackgroundThis systematic review and meta-analysis was aimed to evaluate the therapeutic benefits and safety of tocilizumab (TCZ) in treating severe coronavirus disease 2019 (COVID-19) and associated health complications.MethodsThe electronic search was performed using PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials (RCTs), and Google scholar databases to identify the retrospective observational reports. The studies published from 01 January 2020 to 30th September 2020 involving comparison of TCZ group with SOC/control treatment group were included. The studies included in this work involve RT-PCR confirmed cases of COVID-19 (Population), having tocilizumab and corresponding SOC/control as interventions (Intervention), comparison between tocilizumab versus SOC/control (Comparison) for the parameter of interest. Mortality, incidences of ICU admission, need of mechanical ventilation (MV), length of stay in the hospital (LOS), and length of stay in the ICU (LOS-ICU), and the incidences of super-infection, bacteraemia, fugleman, pneumonia, and pulmonary thrombosis were evaluated as the primary outcomes. The comparison will be between TCZ versus standard of care (SOC)/placebo.ResultsBased on the inclusion criteria there were 24 retrospective studies involving 5686 subjects were included. The outcomes of the meta-analysis have revealed that the TCZ has reduced the mortality (Mantel-Haenszel (M-H), random effects risk difference (RE-RD) of - 0.11 (-0.18 to -0.04), at 95% CI, p = 0.001, I2 = 88%) and increased the incidences of super-infections (M-H, RE-Risk ratio (RR) of 1.49 (1.13 to 1.96) at 95% CI, p=0.004, I2 = 47%). However, there is no significant difference in ICU admissions rate (M-H, RE-RD of -0.06 (-0.23 to 0.12) at 95% CI, p=0.54, I2 = 93%), need of MV (M-H, RE-RD of 0.00 (-0.06 to 0.07) at 95% CI, p=0.96, I2 = 74%), LOS (Inverse variance (IV): -2.86 (-0.91 to 3.38) at 95% CI, p=0.37, I2 = 100%), LOS-ICU (IV: -3.93 (-12.35 to 4.48) at 95% CI, p=0.36, I2 = 100%), and incidences of pulmonary thrombosis (M-H, fixed effect odds ratio (FE-OR) of 1.01 (0.45 to 2.26) at 95% CI, p=0.99, I2 = 0%) compared to SOC/control.ConclusionThis meta-analysis was performed using retrospective clinical reports on the use of tocilizumab in COVID-19 and based on the outcomes of the meta-analysis we can conclude that administration of TCZ would reduce the risk of mortality, and however there is no much difference observed between the TCZ and SOC/control groups in other parameters such as ICU admission rate, need of mechanical ventilation and length of hospital stay (ICU and Non-ICU). On the other hand, TCZ treated subjects possess higher chances of super-infections and pneumonia compared with SOC/control group. However, there is a need for multi-centric randomized trials to determine the potential therapeutic role of TCZ in mitigating COVID-19 and associated health complications.

SummaryObjective: To investigate if the factor V Leiden mutation (F-V-LM) and/or the prothrombin gene G 20210 A variant (P-G20210A-V) are risk factors for acute stroke in Austrian children. Patients: 33 children with acute ischemic stroke documented by computer tomography and/or magnetic resonance imaging of the brain were enrolled in an open multicenter survey. Results: 6/33 children had F-V-LM (5 heterozygous, 1 homozygous). This represents 18% (95% CI: 6.7-39.9%) of our pediatric stroke population and thus exceeds the expected prevalence in the Austrian population of 4,6% (Fischer’s exact test, p = 0.01). F-V-LM was not found in 11 children with neonatal stroke but in 6/22 children with stroke after the neonatal period. 5/6 children with F-V-LM had an underlying disorder that is a risk factor for stroke in children. The P-G20210A-V was detected in 1/26 (3.85%; 95% CI: 0.1-21.4%) patients. Comparison of the prevalence of P-G20210A-V in our study with that in the general population of Austria of 1% revealed no statistical significance (Fischer’s exact test, p = 0.38). Conclusion: Our data suggest that the F-V-LM is a risk factor for acute stroke in Austrian children beyond the neonatal period. The P-G20210A-V apparently does not represent a risk factor for stroke in Austrian children.

Since the dawn of time, medicinal plants have been employed by local populations as a source of healing throughout the healthcare system to demonstrate their efficacy. Some of the results have sparked the development of plant-based medications. The most intricate of interactions would be the investigation of how plants work. This essay examines the function of contemporary pharmacology in relation to a variety of plant derived medicines that has been used for millennia and were know to ancient civilizations. The skill of pharmacists and doctors to engage to the challenges that have arose with the propagation of professional services in the assistance of mans life has increased as a result of wisdom of the development of ideas related to the use of herbal medicines as well as the evolution of awareness. It has been noticed that the plant contained antibacterial, antioxidant, analgesic antifungal, antiasthmatic ,smooth pain reliever, locomotor depressant, anti convulsant and muscle relaxing actions as well as anti inflammatory characteristics. It is now thought of as a useful source of distinctive natural compounds for the creation of medicines against different diseases. According to phytochemical studies, the main chemical components of Curcuma aromatica and Curcuma caesia are terpenoids, flavonoids, phenolic compounds, tannins, inorganic compounds, organic acids and anthocyanin.

A 50 years old woman was referred to hospital with complaints of bluish black discoloration of skin or multiple ecchymosis since 6 days and skin rashes, pink changes or petechiae changes since 1 week, dark color stools since 3 days. She had a history of COVID-19 positive on past ‘‘3 months’’ back and she received the corticosteroids, antiviral drugs, broad spectrum antibiotics, anticoagulants, and vitamin B and C supplements. Now patient is admitted and investigated for further management. Her bone marrow examination reveals marrow cytological features are compatible with immune thrombocytopenic Purpura and peripheral examination reveals red cells are microcytic hypochromic with elongation forms, platelets are markedly reduced and elevation of CRP, reduction of the Hb, PCV, MCH, MCV, MCHC, APTT, Serum vitamin B12, Lymphocytes and her HRCT-Chest shows CORADS 5, Rapid antigen test shows positive. A review on introduction of the disease, etiology, pathogenesis, pathophysiology, mechanism of thrombocytopenia in COVID-19 patients and grading is explained in literature review.

Hyperlipidaemia is an condition that increases the chance of coronary heart disease (CHD) and atherosclerotic disease (ASHD) in blood vessels. Hyperlipidaemia occurs in response to smoking, obesity, sedentary lifestyle, and other risk factors to extend CHD. Cardiovascular disease (CVD) is the reason for death. Hyperlipidaemia is divided into two broad classifications: Primary (familial) and Secondary (acquired). Primary hyperlipidemia has been generated by hereditary defects and climatic factors or by undisclosed mechanisms. Secondary hyperlipidemia concern to the metabolic disorders linked with the diabetes mellitus, liver complication, thyroid, and kidney complications. Hyperlipidemia also refers to as elevated levels of lipids within the blood. Circulating lipid are carried in lipoproteins that transport the lipids to varied tissues for energy use, lipid deposition, hormone production, and steroid formation. The lipoprotein consists of esterified and unesterified cholesterol, triglycerides, phospholipids, and protein. The general public who have hyperlipidemia experience no symptoms. Hyperlipidemia is most oftenly correlated with high-fat diets, a stationary lifestyle, obesity and diabetes mellitus. Four different classes of cholesterol-lowering drugs namely, statins, niacin, resins, and fibrates are available to treat hyperlipidemia; however, statins are now considered to be the first line therapy. The preventable causes of hyperlipidemia can include: Smoking, Being overweight, Physical inactivity, Steroid use, Alcohol consumption & Diet high in saturated fat, & cholesterol such as cheese, meat, fried & processed foods and egg yolk. The treatment of hyperlipidemia includes statins, bile acid sequestrants, fibric acids, niacin, and cholesterol absorption inhibitors. There are some of the novel drugs which are selected for the treatment of hyperlipidemia which includes: Evolocumab, Alirocumab, Bempedoic acid, Lomitapide, Evinacumab, and Sebelipase alfa.

Scleroderma is a rare heterogenous group of autoimmune fibrosing disorder that mainly exists in two forms; localized scleroderma (LS) and systemic sclerosis (SSc). It involves thickening of the skin at fingers region extending from proximal to metacarpophalangeal joints. The diagnostic criteria of scleroderma include past history of patient, symptoms of patient, serology, and skin biopsy. The morbidity and mortality are much worse for SSc with the patients are at risk for life threatening lung, heart and other visceral organ fibrosis and vasculopathy. There is no drug that can cure or stop scleroderma over fibrosis, but certain drugs regulate the symptoms associated with it and boost the patient's quality of life, particularly steroidal creams that help alleviate swelling, joint pain, loosen tight skin; blood pressure drugs that dilate blood vessels; immunosuppressive agents. If the disease is severe amputation is necessary.