BACKGROUND Coronavirus disease 2019 (COVID-19) has left a significant impact on the world's health, economic and political systems; as of November 20, 2020, more than 57 million people have been infected worldwide, with over 1.3 million deaths. While the global spotlight is currently focused on combating this pandemic through means ranging from finding a treatment among existing therapeutic agents to inventing a vaccine that can aid in halting the further loss of life. AIM To collect all systematic reviews and meta-analyses published related to COVID-19 to better identify available evidence, highlight gaps in knowledge, and elucidate further meta-analyses and umbrella reviews that are yet to be performed. METHODS We explored studies based on systematic reviews and meta-analyses with the key-terms, including severe acute respiratory syndrome (SARS), SARS virus, coronavirus disease, COVID-19, and SARS coronavirus-2. The included studies were extracted from Embase, Medline, and Cochrane databases. The publication timeframe of included studies ranged between January 01, 2020, to October 30, 2020. Studies that were published in languages other than English were not considered for this systematic review. The finalized full-text articles are freely accessible in the public domain. RESULTS Searching Embase, Medline, and Cochrane databases resulted in 1906, 669, and 19 results, respectively, that comprised 2594 studies. 515 duplicates were subsequently removed, leaving 2079 studies. The inclusion criteria were systematic reviews or meta-analyses. 860 results were excluded for being a review article, scope review, rapid review, panel review, or guideline that produced a total of 1219 studies. After screening articles were categorized, the included articles were put into main groups of clinical presentation, epidemiology, screening and diagnosis, severity assessment, special populations, and treatment. Subsequently, there was a second subclassification into the following groups: gastrointestinal, cardiovascular, neurological, stroke, thrombosis, anosmia and dysgeusia, ocular manifestations, nephrology, cutaneous manifestations, D-dimer, lymphocyte, anticoagulation, antivirals, convalescent plasma, immunosuppressants, corticosteroids, hydroxychloroquine, renin-angiotensin-aldosterone system, technology, diabetes mellitus, obesity, pregnancy, children, mental health , smoking, cancer, and transplant. CONCLUSION Among the included articles, it is clear that further research is needed regarding treatment options and vaccines. With more studies, data will be less heterogeneous, and statistical analysis can be better applied to provide more robust clinical evidence. This study was not designed to give recommendations regarding the management of COVID-19.
Twenty-six persons from five families comprising 34 members residing in different areas of Saptari district of the eastern region of Nepal developed symptoms of epidemic dropsy over 6-8 weeks. Seventeen patients were studied during July-August 1996. The age of affected individuals varied from 3 to 75 years. Members who had not consumed food cooked in mustard oil or who were not residing with the family were spared. Mustard oil, which was used for cooking, was found to be contaminated with oil of Argemone mexicana seeds. Sanguinarine was detected in all mustard oil samples collected from the homes of affected families. Gastrointestinal symptoms were present in 82 per cent of cases a week or so prior to the onset of pedal oedema. Pitting oedema of the lower limbs, fever, and darkening of the skin were the most consistent features, found in all cases. Other prominent features such as local erythema (82 per cent) and tenderness (88 per cent) of the lower limbs were present in most cases. Two striking features not previously noted were perianal itching (100 per cent) and severe carditis (35 per cent) with congestive cardiac failure (29 per cent). Other unique features noted were 'sarcoid' skin changes (18 per cent), bilateral pleural effusion, and Roth's spots and subhyloid haemorrhages in the fundus in one patient. Other important findings were anaemia (88 per cent), hepatomegaly (41 per cent), pneumonia (35 per cent) and ascites (12 per cent). There were no deaths due to epidemic dropsy. In the majority of cases, oedema, cutaneous changes, and carditis showed a marked improvement in 2-3 weeks and patients were well after 6-8 weeks of follow-up.
The orientation and relaxation dynamics of flexible polymers in an electric field is analyzed by following the change in electric birefringence with time. The polymer chain is represented by two beads ͑dipole͒ connected by a Hookean spring and interacts with the electric field through a local induced dipole which is proportional to the end-to-end distance between the beads. Equations of motion are written for the beads taking into account ͑a͒ the hydrodynamic drag force, ͑b͒ the Brownian force, ͑c͒ the spring force, and ͑d͒ the electric force acting on the molecule. The electric field produces a strong anisotropic orientation of the polymer chain. Thus, equations are derived and analytically solved to yield the time dependence of the rise of birefringence in the electric field, the relaxation of the birefringence from a nonequilibrium state, and the change in the mean-squared end-to-end distance of the molecule with time. The dynamics are found to be governed by the dimensionless number 0 E 2 /H, where 0 is a constant related to the polarizability of the molecule, E is the electric field strength, and H the Hookean spring constant. A merit of this analysis lies in the fact that expressions for the time course of the birefringence rise in the presence of an orienting field of strength E as well as relaxation in the presence of a reduced electric field, E r (E r ϽE) can be readily derived; hence cases other than the field-free decay ͑E r ϭ0͒ can be interpreted. Moreover, for a biological system, a state of equilibrium with E r ϭ0 may never be reached. Finally, the field dependence of the birefringence and the orientation and relaxation time constants has been obtained using the model and comparison of the steady state and relaxation behavior of Hookean and finitely extensible nonlinear elastic ͑FENE͒ polymer chains has been carried out.
Diabetic ketoacidosis is typically associated with type I diabetes mellitus, but it can be associated with type II diabetes mellitus under the conditions of extreme stress or as a presenting manifestation of ketosis-prone type II diabetes mellitus. A 38-year-old prediabetic male presented to the emergency room with hyperglycemia six weeks after recovery from coronavirus disease 2019 (COVID-19) pneumonia. Laboratory results showed severe hyperglycemia, metabolic acidosis, positive ketones in urine and blood, and elevated fasting C- peptide level. COVID-19 polymerase chain reaction (PCR) was negative, and immunoglobulin G (IgG) antibodies were positive. The workup was completely unremarkable for acute infection. Hemoglobin A1C increased from 6.1% to 10.8% within six weeks. The mechanism by which COVID-19 infection may trigger the onset of full-blown diabetes mellitus remains unknown. Viral infection may cause the direct destruction of pancreatic beta cells or trigger the changes in the body that induce the state of insulin resistance. Antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may cross-react or interfere with the functioning of endogenous insulin. The association between type II diabetes and COVID-19 infections needs additional investigations to ascertain the exact mechanism by which COVID-19 infection triggers the onset of full-blown diabetes mellitus.
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