Background: Stroke is reported as a consequence of SARS-CoV-2 infection. However, there is a lack of regarding comprehensive stroke phenotype and characteristics Methods: We conducted a multinational observational study on features of consecutive acute ischemic stroke (AIS), intracranial hemorrhage (ICH), and cerebral venous or sinus thrombosis (CVST) among SARS-CoV-2 infected patients. We further investigated the association of demographics, clinical data, geographical regions, and countrie's health expenditure among AIS patients with the risk of large vessel occlusion (LVO), stroke severity as measured by National Institute of Health stroke scale (NIHSS), and stroke subtype as measured by the TOAST criteria. Additionally, we applied unsupervised machine learning algorithms to uncover possible similarities among stroke patients. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least one eligible stroke patient. Out of 432 patients included, 323(74.8%) had AIS, 91(21.1%) ICH, and 18(4.2%) CVST. Among 23 patients with subarachnoid hemorrhage, 16(69.5%) had no evidence of aneurysm. A total of 183(42.4%) patients were women, 104(24.1%) patients were younger than 55 years, and 105(24.4%) patients had no identifiable vascular risk factors. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144(37.8%) presented to the hospital with chief complaints of stroke-related symptoms, with asymptomatic or undiagnosed SARS-CoV-2 infection. Among AIS patients 44.5% had LVO; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median NIHSS (8[3-17], versus 11[5-17]; p=0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; p<0.001) in countries with middle to high-health expenditure when compared to countries with lower health expenditure. The unsupervised machine learning identified 4 subgroups, with a relatively large group with no or limited comorbidities. Conclusions: We observed a relatively high number of young, and asymptomatic SARS-CoV-2 infections among stroke patients. Traditional vascular risk factors were absent among a relatively large cohort of patients. Among hospitalized patients, the stroke severity was lower and rate of mechanical thrombectomy was higher among countries with middle to high-health expenditure.

Summary The coronavirus disease 2019 (Covid‐19) pandemic has had devastating effects on public health worldwide, but the deployment of vaccines for Covid‐19 protection has helped control the spread of SARS Coronavirus 2 (SARS‐CoV‐2) infection where they are available. The common side effects reported following Covid‐19 vaccination were mostly self‐restricted local reactions that resolved quickly. Nevertheless, rare vaccine‐induced immune thrombotic thrombocytopenia (VITT) cases have been reported in some people being vaccinated against Covid‐19. This review summarizes the thromboembolic events after Covid‐19 vaccination and discusses its molecular mechanism, incidence rate, clinical manifestations and differential diagnosis. Then, a step‐by‐step algorithm for diagnosing such events, along with a management plan, are presented. In conclusion, considering the likeliness of acquiring severe SARS‐CoV‐2 infection and its subsequent morbidity and mortality, the benefits of vaccination outweigh its risks. Hence, if not already initiated, all governments should begin an effective and fast public vaccination plan to overcome this pandemic.

Coronavirus disease 2019 (COVID‐19) caused by severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) has become a significant health problem globally. The virus has spread widely and become a global pandemic. The pathophysiology for SARS‐CoV‐2 has not been explained clearly. It has been associated with several multiorgan symptoms, among which its dermatological manifestations are of great interest. Primarily, there has been no report of skin features among COVID‐19 patients. Nevertheless, recently there have been several reports regarding COVID‐19 patients who presented with cutaneous manifestations. In the current review, we focus on the various cutaneous manifestations of COVID‐19 infection.

Objectives Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the COVID-19 pandemic. The majority of patients experience asymptomatic to mild self-limited disease, but some cases progress to respiratory and multi-organ failure. However, so far, no approved antiviral therapy has been available for treatment of COVID-19. Sofosbuvir/velpatasvir (SOF/VEL) is an approved anti-HCV drug that is capable of suppressing other families of positive-sense RNA viruses with conserved polymerase and may be effective against SARS-CoV-2. This study was conducted to evaluate the efficacy of the SOF/VEL combination in addition to the national standard of care versus the national standard of care alone (hydroxychloroquine and lopinavir/ritonavir as well as supportive care) in patients with moderate to severe COVID-19 infection. Methods This single-centre, randomized, open-labelled, prospective clinical trial was done in patients with moderate to severe COVID-19 admitted to Farabi Hospital in Kermanshah Province, Iran. Eligible patients were randomly assigned in a 1:1 ratio to the SOF/VEL arm (SOF/VEL plus the national standard of care) or the control arm (the national standard of care alone). The main outcome of the study was the mortality on Day 28 after randomization. Secondary outcomes were time from the start of medication to clinical improvement, hospital length of stay, need for mechanical ventilation, duration of mechanical ventilation and conversion of RT–PCR results from positive to negative from the time of randomization to discharge. Adverse events were evaluated in all patients who started their assigned treatment. Results Between 11 April and 8 June 2020, 80 patients were recruited and randomly assigned into the SOF/VEL (n = 40) and control (n = 40) arms. The primary outcome was not significantly different between the two arms (P = 1.00). Secondary outcomes, including time to clinical improvement, hospital length of stay, need for mechanical ventilation, duration of mechanical ventilation and RT–PCR conversion, were not significantly different between arms either (P &gt; 0.05). SOF/VEL treatment and the national standard of care were tolerated similarly. Conclusions Although treatment with SOF/VEL was safe, adding SOF/VEL to the standard of care did not improve the clinical status or reduce mortality in patients with moderate to severe COVID-19. However, larger randomized clinical trials including more parameters are needed for accurate estimation of the efficacy of SOF/VEL.

Guillain–Barré syndrome (GBS) is an inflammatory disorder and an acute immune-mediated demyelinating neuropathy that causes reduced signal transmissions, progressive muscle weakness, and paralysis. The etiology of the syndrome still remains controversial and uncertain. GBS can be initiated and triggered by respiratory tract infections such as influenza, and intestinal infections such as Campylobacter jejuni. In addition, there is considerable evidence suggesting links between influenza vaccination and GBS. As reported previously, the incidence of GBS in individuals receiving swine flu vaccine was about one to two cases per million. Despite the influenza vaccine efficacy, its association with an immune-mediated demyelinating process can be challenging as millions of people get vaccinated every year. In this review we will discuss the association between influenza infection and vaccination with GBS by focusing on the possible immunopathological mechanisms.

Coronavirus disease 2019 (COVID‐19) vaccines significantly impacted world health and well‐being. However, various adverse events have been observed following severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccination. Cutaneous reactions have been prevalent following many vaccines, including COVID‐19 vaccines. Here, we present a case of new‐onset lichen planus in a patient who received the COVID‐19 vaccine at the same time as being infected with SARS‐CoV‐2. A 52‐year‐old woman presented to the clinic with extensive pruritic skin lesions. The eruptions had appeared a week after her second dose of the Sinopharm COVID‐19 vaccine. She mentioned a history of SARS‐CoV‐2 infection approximately 10 days following the first dose of her vaccine, causing a 1‐month delay in getting the second dose. Her past medical history was not significant. On examination, erythematous and squamous papules were demonstrated predominantly on the extremities, including inguinal and axillary folds. Moreover, desquamation of the lips was visible, and buccal lesions were also found. After consultation with a dermatologist, a skin biopsy was indicated for the patient, but she refused to undergo the procedure. Therefore, considering the typical appearance of the eruptions, lichen planus was suspected, for which she was treated with oral antihistamines and topical corticosteroids.

Coronavirus disease 2019 , caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 1 has influenced a significant impact on public health, with approximately 175 million confirmed cases and more than 3 million deaths worldwide as of June 12, 2021. 2 Predominant pulmonary characteristics are the hallmark of this infection. Extrapulmonary symptoms have been reported worldwide in patients with COVID-19, including cardiovascular, 3 central nervous system (CNS), 4 renal, 5 gastrointestinal, 6 and hematologic manifestations. 7 In addition, various cutaneous manifestations have lately appeared in the setting of COVID-19 due to adverse effects of medications or increased immune response, one of which is the psoriasis flare-up. 8,27 Here, we present an unusual case of pustular psoriasis in a 32-year-old woman with a newly diagnosed COVID-19 infection.

Fatality rate of COVID-19 in patients with malignancies: a sytematic review and meta-analysis Dear Editor, With great interest, we read the recently published letter by Ma et al. (2020) 1 who describe the demographics, clinical features, and prognosis of cancer patients with COVID-19 infection. In this study fatality rate of the COVID-19 in patients with malignancies reported as 13.5%. To have a better estimation of fatality rate, in this letter, we aimed to summarize the fatality rate among cancer patients with COVID-19 infection using meta-analysis. It is currently well known that one of the most important risk factors for COVID-19 morbidity and mortality is comorbid conditions, of which, immunosuppression might be the most challenging one. There are limited evidences about the relationship between COVID-19 severity and cancer. However, few available publications indicated more fatality rate and poorer prognosis of this novel virus in cancer patients compared to general population. Also, it has been observed that patients with cancer are more likely to be admitted to the intensive care unit (ICU), to require invasive ventilation, and even more likely to die. 2 Case fatality rate (CFR) is the likelihood of an infection to result in death. We conducted a systematic search on published studies limited to ones between December 30, 2019 and May 7, 2020 in PubMed, EMBASE, and Scopus. EndNote X8.0 0 0 software was used to manage the records and exclude duplicates. We used the search MeSH terms and relevant text-words including (2019 novel coronavirus OR COVID-19 OR SARS-CoV-2 OR nCoV-2019) AND (cancer OR neoplasms OR malignancy OR tumor OR carcinoma) AND (mortality OR fatality OR death). Eligible articles were those that described the case fatality rate (CFR) of COVID-19 in cancer patients. The two investigators (MN, Z MA), independently extracted data from the literature. We extracted the following variables: author, date, age, sex, number of total patients with malignancy, the proportion of death among them in each study. Case fatality was calculated as percentage of patients with cancer and infected by COVID-19 who died within hospitalization period. The meta-analysis was performed using R version 3.2.3. Pooled case fatality rates and their 95% confidence intervals (95% CIs) were used to summarize the weighted effect size for each study grouping variable using the random-effects model. Publication bias was assessed by funnel plot and Egger's test of asymmetry. From all 122 papers, 9 studies reported fatality rate of cancer patients with COVID-19 in hospital. A total of 805 patients from three countries including Iran (n = 1), 3 China (n = 7), 1 , 2 , 4-8 and USA (n = 1) 9 were studied. The most frequent malignancies was breast cancer (n = 95). Two studies didn't report the type of the malignancies. Seven studies reported the mean age of the patients. Among