For detailed contents in Chinese, please refer to the Taiwan Stroke Society Guideline and Taiwan Emergency Medicine Bulletin.COVID-19 has changed our lives as we knew it. The world is not naive to infectious disease outbreaks, having experienced pandemics such as the H1N1 outbreak in 2009 with up to 400,000 deaths, and the “Spanish flu” in 1919 with up to 50 million deaths worldwide respectively (https//www.euro.who.int/en/health-topics/communicable-diseases/influenza/pandemic-influenza/past-pandemics). However, this outbreak caused by the severe acute respiratory syndrome coronavirus-2 has taken the world by storm since it was first reported in end 2019. With the numbers of confirmed cases of COVID-19 and death toll rising every day, it raises the question of when will we be fully equipped to handle a pandemic of such a mammoth scale. A multi-pronged approach has to be undertaken by not only healthcare organisations and pharmaceuticals, but also government agencies and legislation in order to overcome the repercussions and mitigate the effects of an infectious disease outbreak. In this article, we share our experience in Singapore and Singapore General Hospital against COVID-19 and our ongoing efforts to keep the virus at bay.

Lactic acidosis (LA) can be categorized as type A, which occurs in the presence of tissue hypoxia, or type B, occurring in the absence of tissue hypoxia. Hematologic malignancies are an uncommon cause of type B LA.

A 63-year-old man, HIV-negative, with a history of diabetes mellitus, hypothyroidism, and non-alcoholic fatty liver disease (NAFLD), presented to the ED complaining of acute-on-chronic lumbar pain, and was found to have high serum anion gap (AG) LA. The rest of chemistry and infectious workup was within normal limits. Despite bicarbonate therapy and fluid resuscitation, the patient remained with persistent AG metabolic acidosis and increasing lactic acid up to 14.5mmol/L. An abdominal computerized tomography (CT) revealed multiple bilateral enhancing lesions in the kidneys, as well as gastric wall thickening. Upper gastrointestinal endoscopy with biopsy showed a high-grade Burkitt’s lymphoma. click here Further staging showed bone marrow involvement and extensive abdominal adenopathy. After two cycles of inpatient chemotherapy with dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab), the patient developed multifocal pneumonia complicated by respiratory failure. Following a prolonged ICU stay, after discussion with the family members, a decision of withdrawal of life-sustaining therapy was reached.

Persistent LA, without identifiable causes of tissue hypoxia, should prompt clinicians to suspect non-hypoxic etiologies, including occult high-grade malignancies. Hematological malignancies constitute an extremely rare cause of type-B LA, carrying a poor prognosis.

Persistent LA, without identifiable causes of tissue hypoxia, should prompt clinicians to suspect non-hypoxic etiologies, including occult high-grade malignancies. Hematological malignancies constitute an extremely rare cause of type-B LA, carrying a poor prognosis.In this article, three data-driven approaches were explored, including two artificial intelligence (AI) based models namely; Extreme Learning Machine (ELM) and Hammerstein-Weiner (HW) models and a trivial linear model namely; multilinear regression (MLR). In this context, the models were developed using the onset of diarrhoea, the total number of wet faeces, total number of faeces, weight of intestinal content (g) and length of the small intestine (cm) as the independent variables. In contrast, distance travelled by charcoal meal (C) and volume of intestinal content (I) were considered as the dependent variables for the prediction of the intestinal hypermotility and secretory inhibitory effects of the methanol leaf extract of Combretum hypopilinum (MECH). Three different performance indicators including; mean absolute percentage error (MAPE), Nash-Sutcliffe efficiency (NSE) and Root mean square error (RMSE) were employed in this research to calculate and determine the performance skills of the models. The obtained results indicated the reliable capability of ELM and HW over MLR model having NSE-values higher than 0.90 in both the calibration and verification stages. The results further demonstrated that, in terms of MAPE and RMSE, ELM and HW models showed higher performance efficiency than the MLR model. Even though HW outperformed the ELM and MLR models in the prediction of I. Whereas, ELM outperformed HW and MLR models in the prediction of C. Overall; the results proved the satisfactory ability of the AI-based models (HW and ELM) for modelling the Intestinal hypermotility and secretory inhibitory effects of MECH.PTP1B is identified as the insulin signaling pathway downregulator; involved in pancreatic β-cell apoptosis. Further, it associates in regulating multiple pathways in diabetes mellitus; kindled us to identify the binding affinity of bioactives from Cymbopogon citratus by targeting PTP1B and identify the probably associated with it; further identifying the probable pathways involved in diabetes mellitus. In this regard, ChEBI database was used to retrieve bio-actives from C. citrates and 3D structures for the same were obtained from the PubChem database. The energy of bioactives was minimized and converted into ligand and the docking was carried using autodock 4.0 against PTP1B. Further, multiple characters of bio-actives like drug-likeness score, ADMET profile, probable adverse effects, and boiled egg model for bioavailability were also studied. Swertiajaponin was predicted for the highest drug-likeness score i.e. 0.26. However, swertiajaponin was predicted with the highest probable side effect of nephrotoxicity with pharmacological activity of 0.478. Similarly, swertiajaponin was predicted for the highest binding affinity with PTP1B with the binding energy of – 8.3 kcal/mol. Likewise, KEGG identified 80 pathways associated with PTP1B modulation in which 7 pathways were involved in diabetes mellitus in which FoxO signaling pathway was predicted to have the least false discovery rate by modulating 7 genes. Swertiajaponin could act as the potent inhibitor of PTP1B; scored highest druglikeness score but possessed minimum GIT absorptivity; further, PTP1B was identified to be linked with multiple pathways that are concerned with diabetes mellitus.