COVID-19: Gastrointestinal Manifestations and Complications

The virus responsible for the COVID-19 pandemic is the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which belongs to the genus Betacoronavirus. This genus also includes the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV). The common symptoms of COVID-19 infection are fever and respiratory symptoms, but it can also involve the gastrointestinal tract (GIT), resulting in manifestations such as diarrhea, nausea and/or vomiting and abdominal pain. The emergence of COVID-19 led to public health emphasis on droplet transmission and precautions of contact with respiratory secretions. However, mounting evidence demonstrates detection of SARS-CoV-2 RNA in stool samples of COVID-19 patients. It has also been demonstrated that the host receptor angiotensin-converting-enzyme-2 (ACE-2) is highly expressed not just in respiratory cells but also in gastrointestinal sites involving the glandular cells of gastric, duodenal, and rectal epithelium. This suggests that SARS-CoV-2 can infect the digestive system, serving as another route of transmission. This review aims to study the prevalence of some of the gastrointestinal manifestations following COVID-19 infection and findings of positive SARS-CoV-2 RNA in stool specimens while making parallels to the severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS) infection. We will also discuss the possible pathophysiology of COVID-19 related gastrointestinal involvement.

Biofilm Formation and blaOXA Genes Detection Among Acinetobacter baumannii from Clinical Isolates in a Tertiary Care Kirtipur Hospital, Nepal

(1) Background: Acinetobacter baumannii has emerged as a leading cause of nosocomial infections as they are capable of evolving resistance to various classes of antibiotics. The ability of A. baumannii to form biofilm might also be associated with increased antibiotic resistance and hence treatment failure. This study was carried to associate the biofilm formation with the drug resistance pattern of A. baumannii and to detect blaOXA-23, blaOXA-24, and blaOXA-51 from carbapenem resistance isolates. (2) Methods: Among different clinical samples, a total of 19 Acinetobacter spp. were identified with conventional microbiological procedures. The biofilm production was determined by a quantitative adherence assay. The antimicrobial susceptibility test was carried out by the Kirby-Bauer disc diffusion method, carbapenemase production detection was confirmed by Modified Hodge Test. And target resistant genes were detected by polymerase chain reaction. (3) Results: Out of 90 clinical specimens, 64.44% (58/90) showed bacterial growth. Whereas, 32.75% (19/58) isolates were identified as A. baumannii. Among all A. baumannii isolates, 84.21% (16/19) were multidrug-resistance and 63.16% (12/19) carbapenem resistance phenotypically. blaOXA-51 was detected in all the isolates and blaOXA-23 was detected only in 63.16% (12/19) isolates. However, blaOXA-24 was not detected in any of the isolates. Among A. baumannii, 89.47% (17/19) isolates produced biofilm with 47.37% (9/19) strong biofilm producers. (4) Conclusions: In the majority of MDR A. baumannii, blaOXA-51 and blaOXA-23 were detected as the determinant factor for carbapenem resistance having a direct relation with biofilm formation. This study provided a valuable clue for the management of A. baumannii infections in clinical settings.

COVID-19: An Updated Situation from Singapore

Since the first reports of COVID-19 in 2019, the viral respiratory disease has spread across nations, sending the world into a global pandemic. The pandemic has heavily impacted the public health of the global community. Over 237 million confirmed cases have been reported, and more than 4.8 million lives have been lost due to the novel coronavirus. In Singapore, the government quickly took action in the early stages of the pandemic to limit the spread of the virus to protect the local communities from the disease. Singapore has been able to keep their confirmed COVID-19 cases and deaths at low numbers by implementing movement restrictions, raising public awareness, mask mandates, social distancing, providing free vaccinations for the public, and utilizing advancements in technology for contact tracing. The public has also upheld their social responsibility in cooperating with the Singaporean government to control the disease spread. COVID-19 is now moving into an endemic phase in Singapore as the vaccination rates are at an all-time high resulting in lower death rates, and the confirmed cases are primarily mild to asymptomatic. Singapore has set a precedent for how pandemics can be handled in the future to minimize mortality rates and protect public health.

Insights into COVID-19 Delta variant (B.1.617.2)

Since beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), different variants of concern (VOC) have been discovered. One of the variants that stood out was the Delta variant (B.1.617.2), first found in India. It caught worldwide attention due to its greater transmissibility than the progenitor strain and the first variant of concern (VOC)- Alpha variant (B.1.1.7). B.1.617.2 spread rapidly across the globe and became a VOC due to its high transmissibility, clinical implications, and impact on vaccine efficacy. This review discusses the background and prevalence of B.1.617.2 and its sensitivity to convalescent sera and vaccinated individuals. We will provide an insight into the impact B.1.617.2 has on vaccine efficacy and discuss the level and type of protection an individual could get by being vaccinated. We will also discuss briefly on the COVID-19 vaccine booster doses and whether it is needed.

Oral Dietary Supplements Use among Healthcare Workers during the COVID-19 Pandemic in Malaysia

Healthcare workers (HCWs) must be aware of the latest data supporting or refuting the use of oral dietary supplements (ODS) in order to disseminate evidence-based health information and help patients make informed decisions. Nevertheless, there is relatively scant data on the prevalence of dietary supplement use among HCWs, the types of dietary supplements recommended to patients by HCWs, and their reasons for recommending these products, particularly during the COVID-19 outbreak. This study examined the prevalence of ODS use among surveyed HCWs, considered the types of ODS used and recommended by those HCWs, identified the reasons given by those HCWs for using or not using ODS, and determined whether those HCWs were recommending or not recommending ODS to their patients during the COVID-19 pandemic. This cross-sectional study targeted all HCWs working at a district hospital in Malaysia and was conducted via a self-administered online survey. The survey revealed that 67.3% of HCWs did not recommend ODS for patient use during the pandemic, despite 55.3% of HCWs reported personal use of ODS during the pandemic. Type of HCWs (P=0.001), monthly household income (P=0.019), prior ODS use (P<0.001) and recommendation of ODS to patients (P<0.001) were significantly associated with personal ODS use during the pandemic. Vitamin C was the most commonly used (81.3%) and recommended (95.0%) ODS. “To maintain overall health and wellness” was the most common reason for personal ODS use and recommendation to patients (83.3% & 79.2%). Given the increasing rate of ODS use during the pandemic, further research should be done so that evidence-based recommendations can be formulated to ensure patient safety.

Incidence, Antibiotic Susceptibility and Characterization of Vibrio parahaemolyticus Isolated from Seafood in Selangor, Malaysia

Vibrio parahaemolyticus is one of the major foodborne pathogens owing to its cause of infectious diseases such as gastroenteritis. These diseases are often associated with the consumption of contaminated seafood. This study aims to investigate the presence of V. parahaemolyticus, their virulence, antibiotic profiles, and plasmid profiles from 77 different kinds of shellfish samples collected from wet markets and supermarkets in Selangor, Malaysia. High densities of Vibrio species ( > 5 log CFU/g) were found in 14/16 groups of shellfish. Among 77 presumptive V. parahaemolyticus isolates, 43 (55.8%) were positive for the toxR gene, confirming the identity of the isolates at the species level. However, none of the V. parahaemolyticus isolates harboured the virulence tdh and trh genes. The antibiotic susceptibility of the V. parahaemolyticus isolates revealed that most of them were resistant to ampicillin (95.3%), ampicillin-sulbactam (81.4%), cefotaxime (37.2%) and imipenem (23.3%). The plasmid profiles of the V. parahaemolyticus isolates showed that 41.9% (18/43) possess at least one plasmid. Our results indicate the V. parahaemolyticus isolates are continuously exposed to various antibiotics in the environments, thus consuming the seafood carries a potential health risk to consumers. The antibiotic resistance conferred by the species necessitates an immediate plan to approach the usage of antibiotics differently.

COVID-19 Vaccination during Pregnancy in Southeast Asia

Southeast Asia is rapidly becoming the region hit hardest by coronavirus disease (COVID-19), as evidenced by the surging daily number of new confirmed cases and deaths. The COVID-19 crisis continues to worsen with the entry of the more transmissible variants of concern, primarily the Delta variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which was first identified in India. Pregnant women are among the vulnerable population groups at risk of suffering from severe COVID-19 and may experience poor pregnancy and neonatal outcomes due to the infection. Vaccination seems to be the most effective strategy to curb the pandemic and secondarily by social distancing, wearing face masks and practising hand hygiene. There has been limited yet reassuring evidence in support of vaccinating pregnant women against COVID-19. We sought to review the latest evidence regarding the safety, immunogenicity and reactogenicity of COVID-19 vaccines in pregnant women as well as the recommendations and guidance provided by the public health authorities in the countries in Southeast Asia.

Positive Impacts of the COVID-19 Pandemic and Public Health Measures on Healthcare

In the midst of the COVID-19 pandemic, several unexpected positive outcomes have surfaced. The WHO public health measures have positively transformed people’s behaviour and lifestyles. The pandemic has prompted more focus on self-care and health awareness. Hand hygiene practice has been greatly emphasised. The acceptance rate for the use of personal protective equipment, such as face masks, has been remarkable. People with co-morbid conditions are paying more attention to their primary illnesses by improving diets and exercise methods. People are more willing to accept and act on public health messages. The pandemic lockdowns have not only successfully mitigated the transmission of coronavirus, but they have also indirectly reduced the hospital admission rates for endemic community respiratory infections and trauma-related emergencies like motor vehicle accidents. Fetomaternal health and wellness have significantly improved during the pandemic. The abrupt emergence of COVID-19 has also led to a massive societal shift on tobacco smoking cessation. Smokers are compelled to reflect on the harmful effects of cigarette smoking in relation to COVID-19. Issues of mental, relational and sexual health are put in the spotlight during the pandemic. People are investing more time in themselves, family and relationships. The world has seen an unprecedented global race in healthcare innovation and technology development in tackling the same global issue. Artificial intelligence, including robots and drones, have been rapidly developed and employed for healthcare as well as food and delivery services in order to minimise human physical contact. This article discusses several unforeseen positive impacts on healthcare that emerged from the COVID-19 public health measures that have been implemented. The positive impacts of the COVID-19 pandemic should be highlighted in order to provide hope to our community.

COVID-19: Malaysia's fight against this deadly virus

Malaysians are facing the biggest challenge in 2021 - the rise in COVID-19 cases and its variant of concern (VOC) strains. The scale and impact of this coronavirus disease are unimaginable, scary, and full of sorrows. Many lost their loved ones, relatives, friends, and children are becoming orphaned overnight. Now our only hope is on the available vaccines to control this deadly virus infection. When this Review article was in press, over 170 million confirmed cases with 3.5 million deaths were reported worldwide. Malaysia is dealing with spikes in the number and severity of new cases. A record toll of new cases and fatalities for consecutive weeks has pushed Malaysia's total cases to a soaring 500,000 confirmed cases with 2300 deaths – the third highest in Southeast Asia behind Indonesia and the Philippines. The healthcare system in Malaysia is currently under heavy pressure to control the disease as the number of confirmed cases is rising exponentially. A National COVID-19 Immunization Program was launched in February 2021 in the hope of providing immunity to 80% of the population in Malaysia and achieve herd immunity. This review discusses the alarming COVID-19 situation in Malaysia, the management strategies, and the vaccinations program.

Stories from the East: COVID-19 Situation in India

The war against COVID-19 is still ongoing since the first report in December 2019. On 1st May 2021, India has reported over 400,000 new COVID-19 cases within 24 hours. The situation in the country continued to progress, which was associated with the reporting of the variant-of-concern and the variant-of-interest, including the B1.617 viruses. The government has taken public health measures, including campaigns to increase awareness about mask-wearing and physical distancing as well as lockdown plans to prevent further spread of the disease in the densely populated country. Furthermore, the countrywide vaccination program has begun in early 2021, while the government of India continues to monitor the COVID-19 situation in the country. The current review aims to provide a brief situation report in India before discussing management strategies taken and different phases of the vaccination program.