More than two years since the first SARS-CoV-2 infection were reported, the COVID-19 pandemic remains an acute global emergency. The COVID-19 pandemic has deeply affected the lives of people across the world. Its health, economic, political, educational, and societal consequences have disproportionately affected the most vulnerable. Apart from being a global health concern, COVID-19 is having major consequences on the world economy. The pandemic has challenged local, national, regional and global capacities to prepare and respond. Health systems globally have employed three common approaches to rapidly scale up health system infrastructure, namely by constructing new treatment facilities, converting public venues and reconfiguring existing medical facilities to provide care for patients with COVID-19. Considerable efforts were being made behind the scenes to develop new strategies to ensure adequate public healthcare infrastructure and workplace capacities. Hospitals have repurposed and reallocated internal space and redeployed resources to manage COVID-19 patients. Countries discharged many patients from hospitals to their homes and postponed non-critical treatment and elective procedures. Almost all hospitals adopted a strategy of hospital approach to COVID-19 with the different primary and secondary goals. In this article we present a strategy of Mikaelyan University Hospital located in Yerevan, Armenia in managing patients with COVID-19. Preparing for patients’ admission, developing of internal and external hospital communications, reconstruction, redistribution of human resources was carried out in parallel with trainings of health care workers, patients’ education, etc. Mikaelyan University Hospital laboratory was reorganized to implement the new approaches and goals in managing of unprecedented number of patients and to secure quality control. The number of intensive care unit beds has been increased, also all possible efforts have been made to obtain all the required equipment and maintenance. Overall, the strategy can be considered successful as it was based on the multidisciplinary and multisectoral approach including academic sector, clinicians, leadership, patients, decision makers, nurses, radiologists, psychologists, intensivists, etc.

The coronavirus disease 2019 pandemic continues to exert a significant impact on global health care systems, causing devastating mortality and morbidity. As time passes and our understanding of this novel respiratory virus deepens, it is increasingly clear that its effects extend beyond that of the respiratory system. The link with endocrine disorders was noticed quite early when it was found that patients with diabetes and uncontrolled hyperglycemia were at an increased risk of severe disease as well as mortality from COVID-19. However, the other endocrine manifestations of COVID-19 probably were more subtle and information about them emerged more gradually over a period of time. Thyroid diseases are common endocrine disorders, and accordingly, a lot of attention has gone into the study of how COVID-19 affects the thyroid. Although the majority of mild to moderate COVID-19 patients remain euthyroid, a significant proportion of those with severe disease manifest with abnormalities in thyroid function. These manifestations include low thyroid stimulating hormone and low T3 levels, whereas low T4 levels were observed less commonly. Apart from this, several reports of subacute thyroiditis following COVID-19 have also been published. Similarly, Graves’ disease has been reported to occur in patients who had recovered from COVID-19. We present a case of a 55-year-old woman who presented to the emergency department and her physical examinations and laboratory results were significant for myxedema coma and the patient was given levothyroxine with improvement of symptoms and mild change in thyroid hormone levels during hospitalization.

COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the recent global pandemic, with increasing number of cases reported globally. Our understanding of this novel respiratory virus deepens, it is increasingly clear that its effects extend beyond that of the respiratory system and can be extended to the almost all organ systems. SARS-CoV-2 causes lung inflammation which progresses to cytokine storm in the most severe cases. The lungs of patients with COVID-19 show extensive alveolar and interstitial inflammation. COVID-19 causes a spectrum of complications, with frequent involvement of the hemostatic system and there is a high incidence of venous thromboembolism in hospitalized COVID-19 patients, particularly those with severe illness. There is evidence of current body knowledge that COVID-19 induced by microvascular angiopathy can lead to a wide range of tissue pathology and clinical complications, such as Kawasaki disease, Buerger’s syndrome and other systemic inflammatory disorders. Thromboangiitis obliterans (TAO) or Buerger’s disease is a segmental occlusive inflammatory condition of arteries and veins, characterized by thrombosis and recanalization of the affected vessels. Limb infection at diagnosis was associated with a 4-fold higher risk of amputation. Smoking cessation was strongly associated with a lower rate of vascular events and amputation. TAO appears more likely to be a systemic disorder rather than a localized vasculopathy. Therefore, treatment protocols based on systemic treatment of TAO patients may be more helpful than localized treatment, such as bypass surgery and endovascular procedures. We present a case of a 53-years-old male with positive SARS-CoV-2 PCR test. Furter examination showed that patient had pneumonia, moreover, based on the duplex scan results the diagnosis of thromboangiitis obliterans (TAO) or Buerger’s disease was confirmed. This disease itself is associated with a high risk of thrombosis and alongside with COVID-19 can cause unpredictable outcome. Patient underwent the day-round observation, received the appropriate treatment and was successfully discharged from the hospital on the day 11.

Background: Necrotizing fasciitis is a potentially life-threatening soft tissue infection, characterized by necrosis of the fascia, subcutaneous tissue, adipose tissue and can be fatal. NF is most common in immunocompromised hosts but may also occur in healthy patients without apparent antecedent injury. It is usually caused by either Group A streptococci or a polymicrobial, synergistic infection. The case that we present is unique in the Republic of Armenia, necrotizing fasciitis of the face in a child. Methods: We report the case of 3,5-year-old children who were treated for NF in our unit, inclusive, were reviewed retrospectively. Information recorded included medical history, clinical characteristics, diagnostic procedures, treatment methods, and the outcome. Results: The essence of the treatment was to prevent further development of necrosis, taking the child out of the state of general intoxication, in connection with, early surgical debridement, anti-intoxication, antibacterial therapy were carried out in several stages. In result, auto transplantation by full thickness skin autograft has been done, maintaining the aesthetic appearance of the wound. Conclusion: Because necrotizing fasciitis is a surgical emergency, the patient should be admitted immediately to a surgical intensive care unit, where the surgical staff is skilled in performing extensive debridement and reconstructive surgery. Despite the fact that it is rare in children, according to our data, it turned out that the reason for the penetration of microorganisms may be an incomplete injection. Clinicians should be aware of these infections, as early treatment can increase survival.