Anosmia (smell failure) and dysgeusia (taste distortion) in COVID-19: it is genetic.

The COVID-19 pandemic is a very contagious respiratory illness with has affected millions of individuals worldwide. In addition to the well-known symptoms of any respiratory virus, COVID-19 can present with anosmia (failure to smell) and dysgeusia (distortion of the sense of taste). It appears to be a genetic link to the biological mechanisms underlying COVID-19-related anosmia and dysgeusia. Significant locus in the vicinity of the UGT2A1 and UGT2A2 genes are currently considered as the main culprit of the symptoms. However, more studies are needed to delineate a clear pathophysiology.Communicated by Ramaswamy H. Sarma.

Corneal Langerhans cells in children with celiac disease.

Celiac disease (CeD) is a common small bowel enteropathy characterized by an altered adaptive immune system and increased mucosal antigen presenting cells. This study aims to establish if quantification of corneal Langerhans cells (LCs) using corneal confocal microscopy (CCM) could act as a surrogate marker for antigen presenting cell status and hence disease activity in children with CeD. Twenty children with stable CeD and 20 age-matched controls underwent CCM and quantification of central corneal total, mature and immature LC density. There was no difference in age (11.78 ± 1.7 vs. 12.83 ± 1.91; P = 0.077) or height (1.38 ± 0.14 vs. 1.44 ± 0.13; P = 0.125). BMI (18.81 ± 3.90 vs. 22.26 ± 5.47; P = 0.031) and 25 OHD levels (43.50 ± 13.36 vs. 59.77 ± 22.45; P = 0.014) were significantly lower in children with CeD compared to controls. The total (33.33(16.67-59.37) vs. 51.56(30.21-85.42); P = 0.343), immature (33.33(16.67-52.08) vs. 44.79(29.17-82.29); P = 0.752) and mature (1.56(0-5) vs. 1.56(1.04-8.33); P = 0.752) LC density did not differ between the CeD and control groups. However, immature (r = 0.535, P = 0.015), mature (r = 0.464, P = 0.039), and total (r = 0.548, P = 0.012) LC density correlated with age. Immature (r = 0.602, P = 0.038) and total (r = 0.637, P = 0.026) LC density also correlated with tissue transglutaminase antibody (Anti-TtG) levels assessed in 12/20 subjects with CeD. There was no difference in corneal LC density between children with CeD and controls. However, the correlation between corneal LC density and anti-TtG levels suggests a relationship with disease activity in CeD and requires further study.

Letter to the Editor: COVID-19 utilization of ACE-2 receptor to enter the host cell.

Communicated by Ramaswamy H. Sarma.

Can virus-virus interactions impact the dynamics of the covid-19 pandemic?

Viral respiratory infections can occur in pandemics and can spread rapidly within communities resulting in health concerns globally. Several respiratory viruses co-circulate at one specific time. However, interface between different viruses has not been clearly established. This interaction is crucial to delineate, especially during pandemics, including the one relate to covid-19. This commentary will provide a brief description of how respiratory viruses interact and the outcome of this interaction on a pandemic.Communicated by Ramaswamy H. Sarma.

COVID-19 vector-based vaccine causing thrombosis.

The number of people affected by COVID-19 is staggering and countries are rushing and competing to vaccinate their populations. However, there has been a concern about the association between COVID-19 vector-based vaccines and thrombosis. The proposed mechanism by which a COVID-19 vector-based vaccine can cause thrombosis is called vaccine-induced immune thrombotic thrombocytopenia (VITT). This commentary will provide an easy sketch of VITT as well as presentation of thrombosis after COVID-19 vaccines and proposed treatment.Communicated by Ramaswamy H. Sarma.

Corneal confocal microscopy identifies a reduction in corneal keratocyte density and sub-basal nerves in children with type 1 diabetes mellitus.

PURPOSE: To assess whether alterations in stromal keratocyte density are related to loss of corneal nerve fibres in children with type 1 diabetes mellitus (T1DM). METHODS: Twenty participants with T1DM and 20 age-matched healthy controls underwent corneal confocal microscopy. Corneal sub-basal nerve morphology and corneal keratocyte density (KD) were quantified. RESULTS: Corneal nerve fibre density (CNFD) (p<0.001), corneal nerve branch density (p<0.001), corneal nerve fibre length (CNFL) (p<0.001) and inferior whorl length (IWL) (p<0.001) were lower in children with T1DM compared with healthy controls. Anterior (p<0.03) and mid (p=0.03) stromal KDs were lower with no difference in posterior KD (PKD) in children with T1DM compared with controls. Age, duration of diabetes, height, weight and body mass index did not correlate with anterior (AKD), mid (MKD) or PKD. Inverse correlations were found between glycated haemoglobin and PKD (r=-0.539, p=0.026), bilirubin with MKD (r=-0.540, p=0.025) and PKD (r=-0.531, p=0.028) and 25-hydroxycholecalciferol with MKD (r=-0.583, p=0.018). CNFD, CNFL and IWL did not correlate with AKD, MKD or PKD. CONCLUSION: This study demonstrates a reduction in corneal nerves and anterior and mid stromal KD in children with T1DM, but no correlation between corneal nerve and keratocyte cell loss.

From COVID-19 to clot: the involvement of the complement system.

In December 2019, the world observed an unexpected outbreak of an emerging disease named coronavirus (COVID-19) that was first reported in Wuhan city of Hubei province of China. Recent literature has shown the association between COVID-19 infection and derangement in the coagulation profile. In this paper, we are discussing thrombo-genesis, especially the role of the complement system in the immune response against COVID-19 and the pathogenesis associated with tissue inflammation and thrombosis. This role can stipulate a groundwork for further investigation of the pathophysiologic importance of complement in COVID-19, and could propose targets for specific intervention. In addition, we delineated current treatments for thrombosis and the potential therapies by using agents to block the terminal complement pathway. Low molecular weight heparin for all (unless contraindicated) hospitalized COVID-19 patients can be lifesaving. Agents that inhibit the terminal events of the complement cascade might be crucial for ensuring an efficient treatment, decrease clots and permit early discharge in relation to COVID-19.Communicated by Ramaswamy H. Sarma.

Delta variant of COVID-19: A simple explanation.

Severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease (COVID-19), has undergone numerous mutations since its initial identification, leading to challenges in controlling the pandemic. Till date, several variants of concern have been identified. However, currently, the Delta variant (B.1.617.2) is the most dreaded one owing to its enhanced transmissibility and increased virulence. In addition, this variant can potentially facilitate fusion of the spike protein to cells or inhibit antibodies from binding to it. In this commentary, we have simplified the complexity of the nomenclature of variants related to COVID-19, concentrating on the Delta variant including its transmissibility, response to vaccines, and prevention.

Parenting style in a rapidly developing country: A report from the state of Qatar.

OBJECTIVE: To investigate the different styles of parenting in the State of Qatar, a country that is considered a cosmopolitan hub with rapid development. MATERIALS AND METHODS: A cross-sectional study was conducted at Sidra Medicine, the only tertiary pediatric hospital in Qatar. Parents of children 3-14 years old were offered a questionnaire. RESULTS: A total of 114 questionnaires were completed (response rate = 95%). Approximately 65% of parents were between 30 and 39 years of age. Almost 90% of parents state that they are confident of their parenting ability. More than 90% of the participating parents stated that they are responsive to their child's feeling and needs, give comfort and understanding when their child is upset, praise their child when well-behaved, give reasons why rules should be followed, help children understand the impact of their behavior, explain consequences of bad behavior, take into account their child's desire before asking him/her to do something, encourage their child to freely express him/herself when disagreeing with his/her parents, and show respect to their child's opinion. However, 60% of parents sometimes scold, yell, and criticize their child when he/she misbehaves but less than 50% of them use threats as a consequence with little or no justification. Furthermore, two-thirds of parents give consequences by putting their child off somewhere with little or no explanation. Moreover, one in four participants gives in to their child when he/she causes a commotion about something, threatens their child with consequences more often than actually giving them, and states consequences to their child and do not actually do them. CONCLUSION: Residents in Qatar have a mixed type of parental style (authoritative, authoritarian, and permissive). This study will guide us to raise the awareness about the types of parenting style in Qatar, in order to provide professional parenting counseling taking into consideration the cultural background.

Parental perception of medications safe storage in the State of Qatar.

PURPOSE: The purpose of this study is to identify parental perception of household medication storage. METHODS: A prospective cross-sectional study utilizing a questionnaire was carried out at Hamad Medical Corporation, the solely tertiary pediatric hospital in the State of Qatar at the time of the study. Qatar is a young developing country with limited data on the awareness of medication storage among adults with children at home and on the safety practices regarding medication storage. RESULTS: Three hundred and five questionnaires were completed. The vast majority of parents were married, one-third of them were males, and more than three quarters were college graduates and younger than 40 years of age. Almost 80% of the parents had more than three children but less than seven. In addition, 23% of participants were health-care workers. Almost 90% of the participants stored medications in a place that is easy to reach. However, the same percentage stated that those medications were stored in a locked place and that children did not have access to them. Approximately 10% of caregivers store multiple medications in one bottle, and the same percentage of participants do not check the expiration date on the medication labels. In terms of the most common medications stored at home, antihypertensives were on top of the list. Our study has shown that parental education and being a health-care worker were each associated with the difficulty in reaching medications (P = 0.006 and P = 0.011, respectively). Moreover, the percentage of participants who shared medications was significantly higher among those who were not working in the health-care section compared to those who were (P = 0.004). In addition, being a female parent and a college graduate was associated with the possibility of keeping excess or leftover medications at home (P = 0.025). CONCLUSION: Parents residing in the State of Qatar have some deficiencies in knowledge about medication storage. Parent's attitudes and perceptions are deemed vital objectives for population's health intervention.

Understanding multiseptated gallbladder: A systematic analysis with a case report.

Multiseptated gallbladder (MSG) (also known as "Honeycomb gallbladder") is a rare condition that was first described by Knetsch in 1952, and there are around 150 cases described over the world. MSG has been described as a congenital anomaly in most of the cases and as acquired in a few. Moreover, the phenomenon was described with a variety of different symptoms and management. The aim of this article is to have better understanding of this condition and management approach. We are reporting a 4-year-old girl, who presented to Sidra Medicine, Qatar with MSG. We have also included 97 cases for review and analysis. The median age of presentation of the condition was 27 years but may present in neonates and in the elderly, while gender was not a risk factor. Abdominal pain is the most common presenting symptom, but it can present without symptoms. Certain congenital anomalies were detected in the pancreaticobiliary system in few patients with MSG. Medical treatment was reported in eight symptomatic patients, four of whom failed therapy. Cholecystectomy was performed in 40 patients, which resulted in resolutions of symptoms in 13 of them. Based on the available literature, congenital MSG is probably due to in-pouching of gallbladder wall to its own cavity forming septa containing muscular fibers. MSG can be diagnosed solely via imaging, and ultrasound appears to be an effective and feasible mode of diagnosis. Medical treatment efficacy is not well-known, but cholecystectomy has resulted in complete resolution in symptomatic patients.

Maternal and neonatal outcomes in mothers with diabetes mellitus in qatari population.

BACKGROUND: Diabetes Mellitus (DM) is a major cause of maternal, fetal, and neonatal morbidities. Our objective was to estimate the effect of both pre-pregnancy and gestational DM on the growth parameters of newborns in the Qatari population. METHODS: In this population-based cohort study, we compared the data of neonates born to Qatari women with both pre-pregnancy and gestational diabetes mellitus in 2017 with neonates of healthy non-diabetic Qatari women. RESULTS: Out of a total of 17020 live births in 2017, 5195 newborns were born to Qatari women. Of these, 1260 were born to women with GDM, 152 were born to women with pre-pregnancy DM and 3783 neonates were born to healthy non-diabetic (control) women. The prevalence of GDM in the Qatari population in 2017 was 24.25%. HbA1C% before delivery was significantly higher in women with pre-pregnancy DM (mean 6.19 ± 1.15) compared to those with GDM (mean 5.28 ± 0.43) (P <0.0001). The mean birth weight in grams was 3066.01 ± 603.42 in the control group compared to 3156.73 ± 577.88 in infants born to women with GDM and 3048.78 ± 677.98 in infants born to women with pre-pregnancy DM (P <0.0001). There was no statistically significant difference regarding the mean length (P= 0.080), head circumference (P= 0.514), and rate of major congenital malformations (P= 0.211). Macrosomia (Birth weight > 4000 gm) was observed in 2.7% of the control group compared to 4.8% in infants born to women with GDM, and 4.6% in infants born to women with pre-pregnancy DM (P= 0.001). Multivariate logistic regression analysis demonstrated that higher maternal age (adjusted OR 2.21, 95% CI 1.93, 2.52, P<0.0001), obesity before pregnancy (adjusted OR 1.71, 95% CI 1.30, 2.23, P<0.0001), type of delivery C-section (adjusted OR 1.25, 95% CI 1.09, 1.44, P=0.002), and body weight to gestational age LGA (adjusted OR 2.30, 95% CI 1.64, 2.34, P<0.0001) were significantly associated with increased risk of GDM. CONCLUSION: Despite the multi-disciplinary antenatal diabetic care management, there is still an increased birth weight and an increased prevalence of macrosomia among the infants of diabetic mothers. More efforts should be addressed to improve the known modifiable factors such as women's adherence to the diabetic control program. Furthermore, pre-pregnancy BMI was found to be significantly associated with gestational DM, and this is a factor that can be addressed during pre-conceptional counseling.

Parents attitudes toward the human papilloma virus (HPV) vaccine: A new concept in the State of Qatar.

BACKGROUND: Human papillomavirus (HPV) is one of the leading causes of cervical and genital cancer in both genders. PURPOSE: To delineate parental attitude regarding HPV in Qatar. METHODS: A cross-sectional study using a questionnaire was conducted at Sidra Medicine, Qatar. RESULTS: A total of 334 questioners were completed. More than 60% of the parents were not aware that HPV can cause cervical and genital cancer. When asked about the level of comfort in giving their children a vaccine that would prevent them from getting genital cancer, 77% of the participants answered "very comfortable." Interestingly, less than 4% of the parents stated that their children's primary care physicians ever mentioned that such a vaccine exists. When asked about the most preferable mode of receiving information regarding the HPV vaccine, 54% preferred the clinician's office, followed by 34% of whom preferred social media. In terms of the preferred age to receive the vaccine, 45% of the participants preferred to administer the vaccine to their children before they were mature enough to understand sexual relations, while 22% recommended vaccination right before marriage and 15% preferred to wait till they were grown up and decide for themselves. Furthermore, only 42% of the caregivers agreed that it is important to explain to their children that the vaccine can protect against some of the sexually transmitted infections. Finally, approximately 20% of the participants were not convinced about the HPV vaccine. CONCLUSION: A large proportion of parents residing in Qatar have a positive perception regarding the HPV vaccine. TheParents' attitudes and perceptions are considered indispensable targets for community health intervention. We will share the result of our study with the ministry of public health in Qatar with a goal to incorporate the HPV vaccine in the National Immunization Schedule.

Medication take-back programs in Qatar: Parental perceptions.

PURPOSE: To identify parental perception of a take-back program for medications. MATERIALS AND METHODS: A cross-sectional study using a questionnaire was conducted at Hamad Medical Corporation, the only tertiary pediatric hospital in the State of Qatar at the time of the study. Qatar is a rapidly developing country with limited national data on the awareness of medication misuse among adults living with children at home and on the safety practices regarding medication disposal. RESULTS: 305 questionnaires were completed (response rate = 90%). More than 80% of parents were in between 20 and 39 years of age, 70% of them were females, and 80% were college graduates. Approximately 90% of participants have immediate relatives who were taking medications for chronic diseases. Almost 60% of parents stated that they keep unused medications at home, whereas 10% were not aware of the fate of the left over medications. Approximately 95% of the parents dispose the expired medications. In terms of the mode of disposing the medications, 66% of caregivers dispose the medication bottle or package in the trash can, whereas 14% remove the medications from the bottles or packages and throw them in the trash, and 15% put them through the drain. When asked if participants read disposal measures in the medication pamphlet, only 10% answered "always," whereas 26% answered "sometimes." Participants were asked if they have heard of any medications take-back programs, 75% answered no, whereas 14% were not sure. However, almost 60% of them will use the take-back program if available and 18% were not sure. CONCLUSION: Parents residing in the State of Qatar have deficiencies in knowledge about medication disposal. Parent's attitudes and perceptions are considered indispensable targets for community health intervention. Our next step is to share our data with the ministry of health to spread awareness about the proper disposal of medicines and take-back programs in Qatar.

Omouma: a prospective mother and child cohort aiming to identify early biomarkers of pregnancy complications in women living in Qatar.

BACKGROUND: Pregnancy is governed by multiple molecular and cellular processes, which might influence pregnancy health and outcomes. Failure to predict and understand the cause of pregnancy complications, adverse pregnancy outcomes, infant's morbidity and mortality, have limited effective interventions. Integrative multi-omics technologies provide an unbiased platform to explore the complex molecular interactions with an unprecedented depth. The objective of the present protocol is to build a longitudinal mother-baby cohort and use multi-omics technologies to help identify predictive biomarkers of adverse pregnancy outcomes, early life determinants and their effect on child health. METHODS/DESIGN: One thousand pregnant women with a viable pregnancy in the first trimester (6-14 weeks of gestation) will be recruited from Sidra Medicine hospital. All the study participants will be monitored every trimester, at delivery, and one-year post-partum. Serial high-frequency sampling, including blood, stool, urine, saliva, skin, and vaginal swabs (mother only) from the pregnant women and their babies, will be collected. Maternal and neonatal health, including mental health and perinatal growth, will be recorded using a combination of questionnaires, interviews, and medical records. Downstream sample processing including microbial profiling, vaginal immune response, blood transcriptomics, epigenomics, and metabolomics will be performed. DISCUSSION: It is expected that the present study will provide valuable insights into predicting pregnancy complications and neonatal health outcomes. Those include whether specific microbial and/or epigenomics signatures, immune profiles are associated with a healthy pregnancy and/or complicated pregnancy and poor neonatal health outcome. Moreover, this non-interventional cohort will also serve as a baseline dataset to understand how familial, socioeconomic, environmental and lifestyle factors interact with genetic determinants to influence health outcomes later in life. These findings will hold promise for the diagnosis and precision-medicine interventions.

Covid-19 induced superimposed bacterial infection.

Viral respiratory infections are very common and they are frequently eliminated from the body without any detrimental consequences. Secondary serious bacterial infection has been an apprehension expressed by health care providers, and this fear has been exacerbated in the era of Covid-19. Several published studies have shown an association between Covid-19 illness and secondary bacterial infection. However, the proposed mechanism by which a virus can develop a secondary bacterial infection is not well delineated. The aim of this commentary is to update the current evidence of the risk of bacterial infection in patients with Covid-19. We present several clinical studies related to the topic as well as a brief review of the potential pathophysiology of secondary infections that could present with Covid-19.Communicated by Ramaswamy H. Sarma.

Remdesivir in the treatment of coronavirus disease 2019 (COVID-19): a simplified summary.

The pandemic of COVID-19 (Coronavirus Disease-2019) is an extremely contagious respiratory illness due to a novel coronavirus, SARS-CoV-2. Certain drugs have several protein targets and many illnesses share overlapping molecular paths. In such cases, reusing drugs for more than one objective and finding their novice uses can considerably decrease the time in finding new cures for unforeseen diseases. Remdesivir has been recently a strong candidate for the treatment of Covid-19. In this commentary, we have portrayed the structure of the coronavirus in a simple way as well as the site where remdesivir acts. We have also displayed the ongoing clinical trials, as well as a published study that was conducted on compassionate base. The covid-19 pandemic might wean down by the end of summer 2020, but the risk of seasonality exists. Therefore, future disposal of agents such as remdesivir might be crucial for ensuring an efficient treatment, decrease mortality and allow early discharge.Communicated by Ramaswamy H. Sarma.

Parental perceptions of child's healthy diet: Evidence from a rapidly developing country.

BACKGROUND: There are no studies in Qatar or in the Middle East to investigate parental perception of healthy diet in childhood. PURPOSE: To investigate parental perception of childhood healthy diet in the State of Qatar. METHODS: Cross-sectional prospective study at Hamad Medical Corporation, State of Qatar. Parents of children <14 years old were invited to complete a questionnaire. RESULTS: A total of 398 parents agreed to participate, while 22 parents refused (response rate 94%). About 80% of parents were between 20 and 39 years of age, and 77% were females. Around 230 (58%) parents had ≥1 housemaid to help with housework, including food preparation. Whilst 151 children (37%) fell into the overweight and obese category, only 68 parents (17%) perceived that their child was in this category. Less than half the participants (n = 179, 45%) stated that childhood weight should be monitored prior to 5 years of age, while around 35% stated the same, but for children ages 5-14 years. Most participants (n = 324, 81%) agreed that parental eating habits could influence childhood weight. In terms of food preparation at home, mothers cooked almost 50% of the times, housemaids 30%, followed by grandmothers (16.6%), and fathers (3.4%). When asked about the frequency of school meals being prepared at home, 237 parents (60%) prepared their children's lunch box only 1-2 times per week. Moreover, 63% of parents chose the quality of food based on nutritional values, while 44% and 35% chose it based on safety and taste, respectively. When queried about whether the child's pediatrician or the primary care physician counsel families regarding childhood healthy diet, 187 families (47%) had not received counseling by their children's health care providers. Most families agreed that healthy diets lead to better school performance (n = 372, 94%) and better physical activity quality (n = 379, 96%). Compared to families living in the rural areas, parents living in the capital Doha had better insights that healthy diets result in better in school performance (p = 0.032). CONCLUSION: Parental perception is an important target for public health interventions. Within the current sample, families were aware of the positive impact of healthy diet on overall wellbeing. Qatar is a well-resourced country and it would be cost effective to train and professionally develop pediatricians and primary care physicians to be more proactive in tackling childhood obesity.