Morbidity and mortality of coronavirus disease 2019 (COVID-19) are due in large part to severe cytokine storm and hypercoagulable state brought on by dysregulated host-inflammatory immune response, ultimately leading to multi-organ failure. Exacerbated oxidative stress caused by increased levels of interleukin (IL)-6 and tumor necrosis factor α (TNF-α) along with decreased levels of interferon α and interferon β (IFN-α, IFN-β) are mainly believed to drive the disease process. Based on the evidence attesting to the ability of glutathione (GSH) to inhibit viral replication and decrease levels of IL-6 in human immunodeficiency virus (HIV) and tuberculosis (TB) patients, as well as beneficial effects of GSH on other pulmonary diseases processes, we believe the use of liposomal GSH could be beneficial in COVID-19 patients. This review discusses the epidemiology, transmission, and clinical presentation of COVID-19 with a focus on its pathogenesis and the possible use of liposomal GSH as an adjunctive treatment to the current treatment modalities in COVID-19 patients.
Acute cholecystitis is one of the most common reasons for acute surgical intervention in the emergency setting [1]. Rarely, pathological examination of the surgical specimen reveals incidental gallbladder cancer and even more infrequently metastasis of gallbladder from a distant site. We present a case of a patient with a known history of inflammatory breast carcinoma, who presented with symptoms of right upper quadrant pain and jaundice and diagnostic work-up consistent with acute cholecystitis, subsequently found to have metastatic breast cancer to the liver and gallbladder.
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