Canadian Journal of Medicine

Myocarditis, or inflammation of the muscle layer in the heart wall, is caused by several factors including viral infection. Although the literature briefly alludes to a method of viral entry into cardiomyocytes, this work provides further detail into subsequent novel mechanisms leading to the development of myocarditis following infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The keywords "COVID-19”, “SARS-CoV-2”, “Myocarditis”, “viruses”, and “human” were used to run searches on OVID Medline, as well as Google Scholar. Resulting papers were subject to further analysis. SARS-CoV-2 binds to the angiotensin-converting enzyme 2 (ACE2) receptor which is found on type 2 pneumocytes and cardiomyocytes. Infection of cardiomyocytes can overregulate the immune response resulting in a cytokine storm: an uncontrolled increase of proinflammatory cytokines, as is commonly seen in respiratory infections. Cytokines can enter established biological pathways, creating positive feedback, which causes increased inflammation leading to myocarditis. SARS-CoV-2 viral envelope (E) proteins present an alternate association with myocarditis. Less severe myocarditis manifests common symptoms, and detecting it before it worsens may be difficult. Understanding the pathogenesis of myocarditis in COVID-19 could help find and implement preventative measures during future treatment.

Uncertainty about the future, fear of losing a loved one, and countless lockdowns and social distancing restrictions have created great stress for almost everyone during the COVID-19 pandemic. As a result, the wellbeing of individuals has been negatively impacted. Maintaining stable wellbeing is important as is an avoidance of excessive alcohol use, as both factors can potentially harm individual health and lead to death. However, an increase in alcohol purchases and alcohol consumption has been noted globally during the COVID-19 pandemic. Thus, this article explores the possible connections between affected wellbeing and alcohol usage during the COVID-19 pandemic.  

As life expectancy continues to increase, it is critical to investigate ways to age successfully physically, mentally, and socially. Senior citizens (65 years and older) tend to struggle with lower mental health and wellbeing and suffer higher incidences of loneliness compared to the younger population. As a result, the COVID-19 pandemic has put them at higher risk, not only of contracting the virus, but also of experiencing feelings of loneliness and depression. Music participation, specifically music therapy, has been known to be an effective tool to promote wellbeing and mental health, especially among the elderly. Thus, this article investigates the changes in mental health and wellbeing among elderly people when participating in music to explore the importance of conducting virtual music participation programs during the COVID-19 pandemic.   

Thyrotoxic Periodic Paralysis (TPP) is an acute potentially lethal emergency in patients with hyperthyroidism who present with sudden muscle weakness and hypokalemia. It is commonly precipitated by high carbohydrate or high salt content meals, strenuous exercise, stress, trauma, glucocorticoids, epinephrine, alcohol, or respiratory infections. COVID-19 infection or vaccination may represent a novel trigger for TPP. Furthermore, COVID-19 infection or vaccination may incite inflammatory processes leading to thyrotoxicosis, which can manifest as TPP. While COVID-19 causing subacute thyroiditis, euthyroid sick syndrome, Hashimoto’s disease, or Graves’ disease have been well documented in the literature; there have only been six case reports of post-COVID-19 TPP. Notably, all cases thus far have been restricted to male patients, and there is paucity of literature from North America. The purpose of this paper is to outline the first case of post-COVID-19 TPP in a female patient, who presented to the emergency department with acute paralysis and severe hypokalemia (2.2 mmol/L) three months after COVID-19 infection. Investigations in the emergency department showed thyrotoxicosis. She was treated with potassium replacement, which improved her paralysis. Subsequent investigations revealed severe hyperthyroidism from Graves’ disease, which is currently managed with metoprolol and methimazole. Her hyperthyroidism improved without recurrent hypokalemia or paralysis. In addition, we outline the epidemiology, pathophysiology, precipitants, and management of TPP, with a particular focus on COVID-19 infection or vaccination precipitating TPP. We discuss post-COVID-19 TPP cases thus far described in the literature. Knowing that North American COVID-19 infection waves lagged Asia, we could anticipate additional future TPP cases.

Recent research has unveiled and confirmed the deleterious age-related changes of the immune system which result in diminished ability of older adults to effectively respond to pathogens and infection. This degradation is defined by the term immunosenescence. Immunosenescence can also bring with it reduced vaccine efficacy. In an era where the population of older adults is growing exponentially, it is apparent why such dysfunction is concerning. Adding even more pertinence is the COVID-19 pandemic. Since March of 2020, older adults across the globe have borne witness to the disproportional effects of COVID-19 infection on their mortality rates versus younger adults and children. In order to bring the pandemic to an end, the global population must be inoculated. However, concerns have been raised about the effectiveness of the COVID-19 vaccines on the elderly. This article aims to provide a brief overview of immunosenescence, the COVID-19 pandemic, and what research has shown thus far about vaccine efficacy for older adults. As well, potential methods to combat immunosenescence will be explored.

The COVID-19 pandemic has illuminated a need for accessible, home-based therapies for mental health. In an era of social distancing, lockdowns, and declining global mental health, one promising candidate is transcranial Direct Current Stimulation (tDCS). tDCS is a non-invasive, portable, targeted brain stimulation technique that uses electrical currents to modulate cortical excitability. It has been heavily explored as a treatment for major depressive disorder (MDD) and other mental health issues in recent years. However, before such a treatment may become widespread, certain research questions must be addressed, and safety outcomes must be thoroughly evaluated. This article aims to provide a brief overview of tDCS, the COVID-19 pandemic’s impact on mental health, and tDCS’ potential to be used in such a situation. The article also explores some of the drawbacks and challenges that lie in the way of tDCS being normalized as a mental health therapeutic.

The Canadian residency match process has been dramatically restructured due to COVID-19. The impact of these changes on specialty choice and access to career-development opportunities among Canadian medical students remains largely unknown. The objective of this study was to assess whether students’ strategy and level of confidence entering the Canadian residency match have changed as a result of the pandemic. A 28-item online survey was distributed to Canadian medical students from the classes of 2021-2024, as well as the class of 2020 graduates planning to enter the 2021 CaRMS (Canadian Resident Matching Service) match. The survey was developed based on existing literature and included questions on demographics, access to educational opportunities, and personal strategies for matching. Descriptive statistics, t-tests, and Spearman’s correlations were used to analyze the data. Eleven percent of respondents reported a change in specialty preference due to COVID-19. Forty-three percent of respondents reported changing their strategy for the CaRMS match. Respondents interested in a surgical specialty were more likely to report a change in their match strategy (p = .0150), including applying to more programs (p = .0012) and exploring other specialties (p = .0118). Clerks were also more likely to report a change in their matching strategy (p = .0195) and specialty choice (p = .0194) compared to pre-clerks. Medical students felt that COVID-19 negatively impacted their ability to access scholarly opportunities and confidence regarding the match, which may have long-term implications for trainee well-being, residency match logistics, and long-term physician resource planning.
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Evidence-based medicine rests upon the pillars of scientific evidence, clinical expertise, and patient values. Evidence comes from various avenues including clinical trials; a branch of experimental research studying interventions in human participants. Clinical trials evaluate the safety and efficacy of interventions, including medications, devices, and procedures that are administered according to a detailed plan. A control group such as no-treatment, placebo, or standard-of-care is used for comparison. A clinical trial determines whether one intervention is better, worse, or no different than another in the specific context and demographics of enrolled participants. Safety and efficacy are established by measuring clinically significant outcomes. Ultimately, the goals of clinical research are to advance medical knowledge and improve patient care through the development of preventative measures, diagnostic and screening tools, treatments, and supportive care. In the rapidly evolving landscape of medical literature, clinicians increasingly consult clinical trials to guide their practice. As such, medical students and trainees stand to benefit from developing a strong understanding of research design and logistics during their training. This article presents a general overview of key elements and practical considerations in clinical trials.

International students are one of the most vulnerable social groups during the COVID-19 pandemic, ignored by social and financial welfare programs. The use of statistics, governmental statements, and academic literature outline the additional hardships faced by post-secondary international students to propose interventions to reduce precarity. The hospitality of educational institutions and response programs towards international students would be crucial for upholding commitments to social justice during these challenging times. This paper can contribute to understanding the role of social work in serving groups most vulnerable to COVID-19.

Coronavirus disease (COVID-19) is an ongoing global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Many systematic reviews and meta-analyses discussed the correlation of COVID-19 with a different disease. Given the urgent need for data, some meta-analyses containing datasets included many manuscripts, but their providence was not clearly reported. The possible overlap between some of the studies included in the analyses is a significant issue for conducting systematic reviews during the COVID-19 pandemic.

The advent of COVID-19 has radically transformed conventional affairs in numerous facets of life across the world. The reverberation of such alterations has presented a myriad of challenges to dermatology services worldwide. Dermatology services have attempted to suppress the dissemination of COVID-19 by reducing in-person consultations and non-essential procedures. Teledermatology has been utilised to mediate patient triage to ensure patients are promptly referred to the appropriate service. Additionally, a plethora of cutaneous sequelae of COVID-19 have been identified and exhibit considerable heterogeneity in skin inflammatory findings compared to viral infections with known cutaneous effects. There has been a longstanding demand to efficiently capitalise on limited expertise allied to dermatology services. The COVID-19 pandemic has illuminated the urgent need to extend the dermatological competence of several primary care clinicians. Ultimately, the developing COVID-19 pandemic may provide the impetus to revolutionise dermatology services in the next five years to transcend current challenges in clinical practice. 

In December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei province, China [1, 2]. According to the literature, the coronavirus was found to interact with autophagy pathways [3–6]. The autophagy process (recycling pathway) is very important for the degradation of cytosolic compounds and the creation of building blocks in cells [7]. During starvation conditions, this process can be activated. It delivers the cytosolic components, including the damaged cellular organelles and mis-folded proteins, into lysosomes by establishing autophagosomes, where the degradation takes place [3, 8]. It is reported to have a paradoxical role in protecting cells from viral and bacterial infections, depending on the types of pathogens and the host cells [3, 9]. Commonly known processes are xenophagy (viral particle degraded) and virophagy (degradation of neosynthesized components from virus), and innate- adaptive immune induction, by which autophagy contributes to the antiviral response [8, 10, 11].

The covid-19 pandemic is one of the most serious worldwide concerns, which has created many problems in health, economics, and other aspects of human life around the world. Coronavirus has shown to have a lot of manifestations during the infection, among which some of them are more critical. Cardiac complications can be considered one of the major and serious problems caused by coronavirus infection… .

Heparin is an anticoagulant medicine that prevents the formation of harmful blood clots in the vessels. Following the outbreak of the novel coronavirus disease 2019 (COVID-19), heparin has helped to improve the health of affected patients beyond its anticoagulant effects. The potential antiviral activity of heparin has attracted speculation due to its highly sulfated profile, which allows it to have a high binding affinity to a wide range of viral components. Heparin’s successful binding to the ZIKA virus, human immunodeficiency virus, as well as the SARS CoV and MERS CoV spike proteins have demonstrated its potential to inhibit the entry of SARS-CoV-2 into the body. A high degree of sequence homology also enables heparin to have inhibitory binding potential on viral components. The SARS-CoV-2 virus exhibits significant differences in its spike glycoprotein (SGP) sequence compared to other coronaviruses. The SGP sequence in SARS-CoV-2 contains additional potential glycosaminoglycan (GAG) binding domains that may drive differences in the attachment and entry process of the virus. Findings from unbiased computational ligand docking simulations, pseudotyped spike protein experiments, and cell to cell fusion assays have also opened possibilities to investigate the antiviral properties of heparin in clinical trials

COVID-19 management still lacks a protocol of proven efficacy, and we present a novel COVID-19 immunomodulatory protocol based on our early pioneering article, re-purposing nitazoxanide/azithromycin combination for early COVID-19 diseases. Our findings were followed by two articles to justify the addition of non-steroidal anti-inflammatory drugs to nitazoxanide/azithromycin. Furthermore, another recent article of ours illustrated the potential immunomodulatory mechanisms by which all the drugs used in this manuscript might be beneficial for COVID-19 patients. We presented a case series of 34 confirmed and highly suspected COVID-19 patients. It is noteworthy that 13 PCR-confirmed COVID-19 patients were included while the others were diagnosed by other measures and all cases were managed by telemedicine. The patients included adult males and females as well as children. All patients have received a short 5-day-regimen of NSAIDs / nitazoxanide/ azithromycin +/- cefoperazone either in full or in part. The primary endpoint of this protocol was a full relief of all debilitating COVID-19 clinical manifestations, and it was fully achieved within two weeks. Most of the patients who were treated early have fully recovered during their described five days; the leucocytic/lymphocytic counts were significantly improved for those with prior abnormalities. Neither significant adverse effects nor post/para COVID-19 syndrome was reported. In conclusion, we present a pioneering 5-day protocol for the safe and effective treatment of COVID-19 using economic FDA-approved immunomodulatory drugs.  We recommend conducting double-blind, randomized clinical trials with sufficient strength at the earliest opportunity.

The main objective of the present study is to summarize the research output about COVID-19. The search was conducted in Scopus, the largest abstract and citation database of peer-reviewed literature, and later it was analyzed on VOSviewer. Total 34716 research documents have been published about COVID-19 till September 2020. We focused on three parameters, i.e., co-authorship pattern, citations, and co-words analysis. Based on the total number of publications, h-index, total citations, and citations per document, we provided the list of the top ten authors, institutes, and countries. Based on the total number of publications, the top-ranked author is Wiwanitkit, V., and the top institute is Harvard Medical School, USA. It is worthy to note that more than 150 countries have contributed to research output. Based on the total publications, citations, and h-index, we provided details for each continent. Later, we provided the list of the top ten countries. The highest documents are published by the USA (25.35%). We analyzed the 343682 keywords from all publications to provide a general overview or the common trends in publications. We also analyzed the top 2000 most cited documents and provided the details of the top ten authors, institutes, and countries. Based on the VOSviewer' analysis, the information on the co-occurrence of words in titles, abstracts, and keywords is provided. This may help to depict the common trends in research publications. Based on the bibliometrics results, significant work has been published on pathogenesis, diagnosis, treatment, and prevention of this pandemic.

In the early stages of the COVID-19 pandemic, many researchers have investigated non
pharmaceutical interventions for restricting the transmission of severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2), including sunlight. Regarding the lack of effective
medicines for SARS-CoV-2, the scientific community works to evaluate the effects of physical
features of sunlight such as electromagnetic radiation and thermal energy on viral strains.
Sunlight gained a considerable amount of attention, including an infamous mention in the
White House. Since then, little has become known about further research on the effect of
sunlight on SARS-CoV-2. Existing evidence focuses on germicidal wavelengths of the
Ultraviolet (UV) and the stimulation of vitamin D production. UV radiation types B and C
have a high germicidal capacity but are blocked by the atmosphere due to their harmful effect
on living species. UV radiation type A, which reaches the surface of the earth, has a quite
lower germicidal potential. The contribution of vitamin D in the immune response against
COVID-19 is yet to be discussed. With the third spike of the pandemic affecting more and
more countries worldwide, understanding the effect of sunlight on COVID-19 can help public
health officials to design their action plans. At the same time, shedding light on this matter
will contribute to debunking popular myths circulating since the onset of the pandemic and
draw a clear line between health literacy and misinformation.