Novel coronavirus disease 2019 (COVID-19) has spread across the globe; and surprisingly, no potentially protective or therapeutic antiviral molecules are available to treat severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. However, zinc (Zn) and copper (Cu) have been shown to exert protective effects due to their antioxidant, anti-inflammatory and antiviral properties. Therefore, it is hypothesized that supplementation with Zn and Cu alone or as an adjuvant may be beneficial with promising efficacy and a favorable safety profile to mitigate symptoms, as well as halt progression of the severe form of SARS-CoV-2 infection. The objective of this review is to discuss the proposed underlying molecular mechanisms and their implications for combating SARS-CoV-2 infection in response to Zn and Cu administration. Several clinical trials have also included the use of Zn as an adjuvant therapy with dietary regimens/antiviral drugs against COVID-19 infection. Overall, this review summarizes that nutritional intervention with Zn and Cu may offer an alternative treatment strategy by eliciting their virucidal effects through several fundamental molecular cascades, such as, modulation of immune responses, redox signaling, autophagy, and obstruction of viral entry and genome replication during SARS-CoV-2 infection.

COVID-19 is an overwhelming pandemic which has shattered the whole world. Lung injury being the main clinical manifestation, it is likely to cause COPD (chronic obstructive pulmonary disease) and ARDS (acute respiratory distress syndrome). The possible cause behind this might be redox imbalance due to viral infection. Elevation in Glutathione (GSH) levels by administration of its promolecule might be effective. N-acetylcysteine is one such drug with potency to scavenge Reactive Oxygen Species, least side effects, and an effective precursor of glutathione. Consequently we hypothesize that N-acetylcysteine along with the conventional treatment may be treated as a potential therapeutic solution in cases of COVID-19 patients.

BACKGROUND Diabetics show a high prevalence of magnesium deficiency. For type 2 DM patients, hypomagnesemia has a deleterious effect on blood glucose regulation and insulin sensitivity as well as on the development of complications such as retinopathy, nephropathy, neuropathy and atherosclerosis. The objective of this research is to evaluate the prevalence of hypomagnesemia in patients with type 2 DM and their associations with diabetes microvascular complications such as retinopathy, nephropathy, neuropathy and macrovascular complications like ischemic heart disease, hypertension and cerebrovascular accident. METHODS The research population was formed by patients with type 2 DM admitted to Maharishi Markandeshwar Medical College and Research Institute. The sample size was 50 cases of diabetes and 50 non-diabetic controls. Calamite dye method was used to test the concentration of serum magnesium. RESULTS Prevalence of hypomagnesemia was 42 percent in study subjects. Between hypomagnesemia and diabetic retinopathy, nephropathy, neuropathy, a major correlation was found. Co-morbidities such as ischemic heart disease, hypertension and cerebrovascular accident have not found any significant associations. Low concentrations of serum magnesium are common in type 2 DM. Hypomagnesemia is linked to diabetic retinopathy, nephropathy and neuropathy. CONCLUSIONS Hypomagnesemia prevalence in type 2 diabetics is 42% which is significantly higher than non-diabetic controls. For patients with microvascular diabetic complications, the prevalence of hypomagnesemia is higher than in those without macrovascular complications. Retinopathy, neuropathy and nephropathy are significantly associated with hypomagnesemia. For ischemic heart disease, diabetes, and cerebrovascular disease, no substantial correlation was seen. Prevalence of hypomagnesemia was high in patients with HbA1c>7%. Hypomagnesemia was more common in males. There was no significant association of diabetes duration with hypomagnesemia.

Objective: To evaluate the applicability of modified early warning (MEWS) Score for prediction of hospital outcomes of medical emergency patients. Design: Prospective hospital based observational study. Setting: A tertiary care level medicine emergency unit in a medical college of North India. Study Population: 300 Patients admitted in medicine emergency. Method: Patients of both sexes of age more than 18 years who were admitted in medical emergency unit at MMIMSR, Ambala were evaluated. Patients who were in cardiac arrest at arrival and those who died within the first 24 hours were excluded and 300 patients were included. Modified Early Warning Score based on physiological parameters was recorded at admission for each patient and monitored over the next 24 hours in the emergency unit. Hospital outcome of the patient in terms of mortality, need for critical care, prolonged stay and uneventful discharge were recorded and correlated with MEWS scores over the first 24 hours in the emergency unit. Receiver Operating Characteristic (ROC) curves was generated to evaluate the utility of MEWS as a tool to predict patient outcome in medical emergency setting. Result: Of the 300 patients studied, the mean age of patients was 49 years, and the majority of the patients were male (61%). A MEWS Score of >5 at 24 hours of admission was associated significantly with in-hospital mortality of patients ( p < 0.0001). The ROC (Receiver Operator Characteristic) curve revealed that in those patients who had a 24 hours MEWS >/= 5, the area under curve was (AUC) = 0.9. (95% CI: 0.95-0.98). Thus, MEWS was an effective predictor of in hospital mortality with sensitivity (78%) and specificity (94%). Conclusion: MEWS, a scoring system based on easily recordable physiological parameters can be used as an effective tool to triage and monitor patients in medical emergency units, to identify patients who are at greater risk of clinical deterioration and need close monitoring or early transfer for critical care or other timely interventions. Thus, application of MEWS in medical emergency units can be a useful tool to improve patient care, ensure optimal utilization of resources and prevent inappropriate discharge or neglect of sick patients.