Introduction: Folic acid is the most important dietary determinant of homocysteine (Hcy). Hcy serves as a critical intermediate in methylation reactions. It is created from methionine and either converted back to methionine or transformed into cysteine. This process is aided through several enzymes and three vitamins,

Coronaviruses belong to the family Coronaviridae order Nidovirales and are known causes of respiratory and intestinal disease in various mammalian and avian species. Species of coronaviruses known to infect humans are referred to as human coronaviruses (HCoVs). While traditionally, HCoVs have been a significant cause of the common cold, more recently, emergent viruses including severe acute respiratory syndrome coronavirus (SARS-CoV-2) has caused a global pandemic. Here, we discuss COVID-19 biology, pathology, epidemiology, signs and symptoms, diagnosis, treatment, and recent clinical trials involving promising treatments.

The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for health care providers skilled in rapid and flexible decision making, effective and anticipatory leadership, and in dealing with trauma and moral distress. Palliative care (PC) workers have been an essential part of the COVID-19 response in advising on goals of care, symptom management and difficult decision making, and in supporting distressed health care workers, patients, and families. We describe Global Palliative Education Collaborative (GPEC), a training partnership between Harvard, University of California San Francisco, and Tulane medical schools in the U.S.; and two international PC programs in Uganda and India. GPEC offers U.S.-based PC fellows participation in an international elective to learn about resource-limited PC provision, gain perspective on global challenges to caring for patients at the end of life, and cultivate resiliency. International PC colleagues have much to teach about practicing compassionate PC amidst resource constraints and humanitarian crisis. We also describe a novel educational project that our GPEC faculty and fellows are participating indthe Resilience Inspiration Storytelling Empathy Projectdand discuss positive outcomes of the project.

Palliative care teams and intensive care teams have experience providing goals-of-care guidance for critically ill patients and families. Critical coronavirus disease 2019 (COVID-19) infection is defined as infection requiring intensive care unit care, respiratory support, and often multiorgan involvement. This case presents a 53-yearold critically ill COVID-19 patient in multisystem organ failure who appeared hours from death despite best medical efforts. Comfort-focused care and compassionate extubation were offered after all medical teams felt near certain that death was imminent. Overnight, while options were being considered by the family, the patient began to markedly improve hemodynamically and was extubated several days later. Weeks later, the patient survived the hospital stay and was discharged to rehabilitation. After rehabilitation he returned home, able to walk, communicate freely, and independently perform all activities of daily living. Dialysis was no longer necessary and was stopped. The challenges of assisting in goals-of-care conversations for patients with serious COVID-19 infection are discussed.

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