\documentclass[twocolumn,twoside]{article}
\makeatletter\if@twocolumn\PassOptionsToPackage{switch}{lineno}\else\fi\makeatother

\usepackage{amsfonts,amssymb,amsbsy,latexsym,amsmath,tabulary,graphicx,times,xcolor}

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
% Following additional macros are required to function some 
% functions which are not available in the class used.
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
\usepackage{url,multirow,morefloats,floatflt,cancel,tfrupee}
\makeatletter


\AtBeginDocument{\@ifpackageloaded{textcomp}{}{\usepackage{textcomp}}}
\makeatother
\usepackage{colortbl}
\usepackage{xcolor}
\usepackage{pifont}
\usepackage[nointegrals]{wasysym}
\urlstyle{rm}
\makeatletter

%%%For Table column width calculation.
\def\mcWidth#1{\csname TY@F#1\endcsname+\tabcolsep}

%%Hacking center and right align for table
\def\cAlignHack{\rightskip\@flushglue\leftskip\@flushglue\parindent\z@\parfillskip\z@skip}
\def\rAlignHack{\rightskip\z@skip\leftskip\@flushglue \parindent\z@\parfillskip\z@skip}

%Etal definition in references
\@ifundefined{etal}{\def\etal{\textit{et~al}}}{}


%\if@twocolumn\usepackage{dblfloatfix}\fi
\usepackage{ifxetex}
\ifxetex\else\if@twocolumn\@ifpackageloaded{stfloats}{}{\usepackage{dblfloatfix}}\fi\fi

\AtBeginDocument{
\expandafter\ifx\csname eqalign\endcsname\relax
\def\eqalign#1{\null\vcenter{\def\\{\cr}\openup\jot\m@th
  \ialign{\strut$\displaystyle{##}$\hfil&$\displaystyle{{}##}$\hfil
      \crcr#1\crcr}}\,}
\fi
}

%For fixing hardfail when unicode letters appear inside table with endfloat
\AtBeginDocument{%
  \@ifpackageloaded{endfloat}%
   {\renewcommand\efloat@iwrite[1]{\immediate\expandafter\protected@write\csname efloat@post#1\endcsname{}}}{\newif\ifefloat@tables}%
}%

\def\BreakURLText#1{\@tfor\brk@tempa:=#1\do{\brk@tempa\hskip0pt}}
\let\lt=<
\let\gt=>
\def\processVert{\ifmmode|\else\textbar\fi}
\let\processvert\processVert

\@ifundefined{subparagraph}{
\def\subparagraph{\@startsection{paragraph}{5}{2\parindent}{0ex plus 0.1ex minus 0.1ex}%
{0ex}{\normalfont\small\itshape}}%
}{}

% These are now gobbled, so won't appear in the PDF.
\newcommand\role[1]{\unskip}
\newcommand\aucollab[1]{\unskip}
  
\@ifundefined{tsGraphicsScaleX}{\gdef\tsGraphicsScaleX{1}}{}
\@ifundefined{tsGraphicsScaleY}{\gdef\tsGraphicsScaleY{.9}}{}
% To automatically resize figures to fit inside the text area
\def\checkGraphicsWidth{\ifdim\Gin@nat@width>\linewidth
	\tsGraphicsScaleX\linewidth\else\Gin@nat@width\fi}

\def\checkGraphicsHeight{\ifdim\Gin@nat@height>.9\textheight
	\tsGraphicsScaleY\textheight\else\Gin@nat@height\fi}

\def\fixFloatSize#1{}%\@ifundefined{processdelayedfloats}{\setbox0=\hbox{\includegraphics{#1}}\ifnum\wd0<\columnwidth\relax\renewenvironment{figure*}{\begin{figure}}{\end{figure}}\fi}{}}
\let\ts@includegraphics\includegraphics

\def\inlinegraphic[#1]#2{{\edef\@tempa{#1}\edef\baseline@shift{\ifx\@tempa\@empty0\else#1\fi}\edef\tempZ{\the\numexpr(\numexpr(\baseline@shift*\f@size/100))}\protect\raisebox{\tempZ pt}{\ts@includegraphics{#2}}}}

%\renewcommand{\includegraphics}[1]{\ts@includegraphics[width=\checkGraphicsWidth]{#1}}
\AtBeginDocument{\def\includegraphics{\@ifnextchar[{\ts@includegraphics}{\ts@includegraphics[width=\checkGraphicsWidth,height=\checkGraphicsHeight,keepaspectratio]}}}

\DeclareMathAlphabet{\mathpzc}{OT1}{pzc}{m}{it}

\def\URL#1#2{\@ifundefined{href}{#2}{\href{#1}{#2}}}

%%For url break
\def\UrlOrds{\do\*\do\-\do\~\do\'\do\"\do\-}%
\g@addto@macro{\UrlBreaks}{\UrlOrds}



\edef\fntEncoding{\f@encoding}
\def\EUoneEnc{EU1}
\makeatother
\def\floatpagefraction{0.8} 
\def\dblfloatpagefraction{0.8}
\def\style#1#2{#2}
\def\xxxguillemotleft{\fontencoding{T1}\selectfont\guillemotleft}
\def\xxxguillemotright{\fontencoding{T1}\selectfont\guillemotright}

\newif\ifmultipleabstract\multipleabstractfalse%
\newenvironment{typesetAbstractGroup}{}{}%

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

\usepackage[authoryear]{natbib}



\newif\ifnokeywords\nokeywordsfalse

\makeatletter\input{size10-pointfive.clo}\makeatother%
\definecolor{kwdboxcolor}{RGB}{242,242,242}
\usepackage[hidelinks,colorlinks=true,allcolors=blue]{hyperref}
\linespread{1}                 
\def\floatpagefraction{0.8}

\usepackage[paperheight=11.69in,paperwidth=8.26in,top=1in,bottom=1in,left=1in,right=.75in,headsep=24pt]{geometry}

\usepackage{multirow-custom}

\makeatletter

\def\hlinewd#1{%
  \noalign{\ifnum0=`}\fi\hrule \@height #1%
  \futurelet\reserved@a\@xhline}
\def\tbltoprule{\hlinewd{1pt}\\[-14pt]}
\def\tblbottomrule{\noalign{\vspace*{6pt}}\hline\noalign{\vspace*{2pt}}}
\def\tblmidrule{\hline\noalign{\vspace*{2pt}}}



\let\@articleType\@empty
\let\@journalDoi\@empty
\let\@journalVolume\@empty
\let\@journalIssue\@empty
\let\@crossMarkLink\@empty
\let\@receivedDate\@empty
\let\@acceptedDate\@empty
\let\@revisedDate\@empty
\let\@publishedDate\@empty
\let\@copyrightYear\@empty
\let\@firstPage\@empty
\def\articleType#1{\gdef\@articleType{#1}}
\def\journalDoi#1{\gdef\@journalDoi{#1}}
\def\crossMarkLink#1{\gdef\@crossMarkLink{#1}}
\def\receivedDate#1{\gdef\@receivedDate{#1}}
\def\acceptedDate#1{\gdef\@acceptedDate{#1}}
\def\revisedDate#1{\gdef\@revisedDate{#1}}
\def\publishedDate#1{\gdef\@publishedDate{#1}}
\def\copyrightYear#1{\gdef\@copyrightYear{#1}}
\def\journalVolume#1{\gdef\@journalVolume{#1}}
\def\journalIssue#1{\gdef\@journalIssue{#1}}
\def\firstPage#1{\gdef\@firstPage{#1}}
\let\@issuelogo\@empty%
\let\@issuelogoex\@empty%
\def\issuelogo#1{\gdef\@issuelogo{#1}}
\def\issuelogoex#1{\gdef\@issuelogoex{#1}}


\def\author#1{%
  \gdef\@author{%
    \hskip-\dimexpr(\tabcolsep)\hskip5pt%
    \parbox{\dimexpr\textwidth-1pt}%
    {\fontsize{11}{13}\selectfont\raggedright #1}%
  }%
}


\usepackage{pharmascope-abs}
\usepackage{caption}
\usepackage{lastpage}
\usepackage{fancyhdr}
\usepackage[noindentafter,explicit]{titlesec}
\usepackage{fontspec}

\setmainfont[%
BoldFont=cambriab.ttf,%
ItalicFont=CAMBRIAI.TTF,%
BoldItalicFont=CAMBRIAZ.TTF]{Cambria.ttf}
\lefthyphenmin = 3

\def\title#1{%
  \gdef\@title{%
      \vspace*{-40pt}%
       \ifx\@articleType\@empty\else{\fontsize{10}{12}\scshape\selectfont\hspace{8pt}\@articleType\hfill\mbox{}\par\vspace{2pt}}\fi%
       \minipage{\linewidth}
         \hrulefill\\[-0.7pt]%%{\includegraphics[width=75pt,height=50pt]{ijrps_logo.png}}\hfill
         \mbox{~}\hspace{5pt}\parbox{.1\linewidth}{\IfFileExists{images/\@issuelogo.\@issuelogoex}{\includegraphics[width=79pt,height=61pt]{images/\@issuelogo.\@issuelogoex}}{\includegraphics[width=75pt,height=50pt]{ijrps_logo.png}}}\hfill
         \fcolorbox{kwdboxcolor}{kwdboxcolor}{\parbox{.792\linewidth}{%
          \begin{center}\fontsize{17}{17}\selectfont\scshape\vskip-7pt International Journal of Research in Pharmaceutical Sciences\hfill\end{center}%
          \vspace*{-10pt}\hspace*{4pt}{\fontsize{8}{9}\selectfont Published by JK Welfare \& Pharmascope Foundation\hfill  Journal Home Page: \href{www.ijrps.com}{\color{blue}\underline{\smash{www.ijrps.com}}}}\hspace*{4pt}\mbox{}}}%
       \par\vspace*{-1pt}\rule{\linewidth}{1.3pt}%
       \endminipage%
    \par\vspace*{9.2pt}\parbox{.98\linewidth}{\linespread{.9}\raggedright\fontsize{14}{17}\selectfont #1}%
    \vspace*{-8pt}%
  }
}


\setlength{\parindent}{0pt}
\setlength{\parskip}{0.4pc plus 1pt minus 1pt}

\def\abbrvJournalTitle{Int. J. Res. Pharm. Sci.}

\fancypagestyle{headings}{%
  \renewcommand{\headrulewidth}{0pt}%
  \renewcommand{\footrulewidth}{0.3pt}
  \fancyhf{}%
  \fancyhead[R]{%
    \fontsize{9.12}{11}\selectfont\RunningAuthor,\ \abbrvJournalTitle,\ \ifx\@journalVolume\@empty X\else\@journalVolume\fi%
    \ifx\@journalIssue\@empty\else(\@journalIssue)\fi%
    ,\ \ifx\@firstPage\@empty 1\else\@firstPage\fi-\pageref*{LastPage}%
  }%
  \fancyfoot[LO,RE]{\fontsize{9.12}{11}\selectfont\textcopyright\ International Journal of Research in Pharmaceutical Sciences}%
  \fancyfoot[RO,LE]{\fontsize{9.12}{11}\selectfont\thepage}
}\pagestyle{headings}

                                                         
\fancypagestyle{plain}{%
  \renewcommand{\headrulewidth}{0pt}%
  \renewcommand{\footrulewidth}{0.3pt}%
  \fancyhf{}%
  \fancyhead[R]{%
    \fontsize{9.12}{11}\selectfont\RunningAuthor,\ \abbrvJournalTitle,\ \ifx\@journalVolume\@empty X\else\@journalVolume\fi%
    \ifx\@journalIssue\@empty\else(\@journalIssue)\fi%
    ,\ \ifx\@firstPage\@empty 1\else\@firstPage\fi-\pageref*{LastPage}%
  }%
  \fancyfoot[LO,RE]{\fontsize{9.12}{11}\selectfont\textcopyright\ International Journal of Research in Pharmaceutical Sciences}%
  \fancyfoot[RO,LE]{\fontsize{9.12}{11}\selectfont\thepage}
  \ifx\@firstPage\@empty\else\setcounter{page}{\@firstPage}\fi
}


\def\NormalBaseline{\def\baselinestretch{1.1}}
\usepackage{textcase}
\setcounter{secnumdepth}{0}

\titleformat{\section}[block]{\bfseries\boldmath\NormalBaseline\filright\fontsize{10.5}{13}\selectfont}
{\thesection}
{6pt}
{\MakeTextUppercase{#1}}
[]
\titleformat{\subsection}[block]{\bfseries\boldmath\NormalBaseline\filright\fontsize{10.5}{12}\selectfont}
{\thesubsection}
{6pt}
{#1}
[]
\titleformat{\subsubsection}[block]{\NormalBaseline\filright\fontsize{10.5}{12}\selectfont}
{\thesubsubsection}
{6pt}
{#1}
[]
\titleformat{\paragraph}[block]{\NormalBaseline\filright\fontsize{10.5}{10}\selectfont}
{\theparagraph}
{6pt}
{#1}
[]
\titleformat{\subparagraph}[block]{\NormalBaseline\filright\fontsize{10.5}{12}\selectfont}
{\thesubparagraph}
{6pt}
{#1}
[]

\titlespacing{\section}{0pt}{.5\baselineskip}{.5\baselineskip}  
\titlespacing{\subsection}{0pt}{.5\baselineskip}{.5\baselineskip}  
\titlespacing{\subsubsection}{0pt}{.5\baselineskip}{.5\baselineskip}  
\titlespacing{\paragraph}{0pt}{.5\baselineskip}{.5\baselineskip}  
\titlespacing{\subparagraph}{0pt}{.5\baselineskip}{.5\baselineskip}

\captionsetup[figure]{skip=1.4pt,font=bf,labelsep=colon,justification=raggedright,singlelinecheck=false}
\captionsetup[table]{skip=1.4pt,font=bf,labelsep=colon,justification=raggedright,singlelinecheck=false}

\def\bibyear#1{#1}
%\def\bibjtitle#1{#1}   %%Publisher request
\def\bibauand{}
\setlength\bibsep{3pt}
\setlength\bibhang{8pt}

\makeatother
\date{}


\usepackage{float}

\begin{document}


\def\RunningAuthor{Pooja Agrawal and Anendd Jadhav}
\firstPage{1773}
\articleType{Review Article}
\receivedDate{10 Nov 2020}
\acceptedDate{16 Dec 2020}
\revisedDate{12 Dec 2020}
\journalVolume{2020, 11 (SPL)}
\journalIssue{1}
\journalDoi{ijrps.v11iSPL1.4221}
\copyrightYear{2020}
\def\authorCount{2}
\def\affCount{1}

\def\journalTitle{International Journal of Research in Pharmaceutical Sciences}

\title{Liver Damage in COVID-19}
\author{Pooja~Agrawal\textsuperscript{*}, 
            Anendd~Jadhav~\\[5pt]{Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe) Wardha, Maharashtra, India}}

\begin{abstract}
In the current era, COVID-19 emerges as a pandemic which is caused by a coronavirus. Every corner of this world has now witnessed ``COVID-19'' cases and the positive cases have crossed almost 50 mn till now. Patients who are suffering from novel coronavirus disease (COVID-19) had experienced lots of abnormalities in multiple internal organs such as abnormal pulmonary function, liver injury, kidney damage. Liver dysfunction requires dedicated works-up and surveillance should be done in a continuous manner. It depends upon multiple factors and is heterogeneous in nature. In the theme of COVID-19, physicians now have to decide that, the damages in the liver is relatable to any previous liver disorder or medications used to treat COVID-19 or maybe the virology effect. Further studies suggest various hypothesis on the potential mechanisms of liver damage in such kind of patients. The literature summarizes recent theory based on the evidence in relation to the liver complications in novel coronavirus disease 2019, allocates a gross scenario of the available case series and proposes recommendations for clinicians.
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Covid- 19,\newline Liver dysfunction,\newline Pandemic
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Pooja~Agrawal~\\ Phone:\ ~\\  Email:\ dragrawal47@gmail.com
        \par}\vspace*{-11pt}\hrulefill\par{\fontsize{12}{14}\selectfont ISSN: 0975-7538}\par% 
        \textsc{DOI:}\ \href{https://doi.org/10.26452/\@journalDoi}{\textcolor{blue}{\underline{\smash{https://doi.org/10.26452/\@journalDoi}}}}\par%
        \vspace*{-11pt}\hrulefill\\{\fontsize{9.12}{10.12}\selectfont Production and Hosted by}\par{IJRPS |~\href{www.ijrps.com}{www.ijrps.com}}\par%
        \vspace*{-2pt}{\fontsize{9.12}{10.12}\selectfont\textcopyright\ \@copyrightYear\ $|$ All rights reserved.}\par%
        \vspace*{-11pt}\rule{\linewidth}{1.2pt}
        \makeatother
        
    
\section{Introduction}
On 31\ensuremath{^{st}} December 2019, ``Wuhan Municipal Health Commission'', China recorded a cluster of patients who are suffering from pneumonia in Hubei Province. Eventually SARSCoV2 is identified \unskip~\citep{1001369:21388641}. COVID-19 was declared as a pandemic disease on 11\ensuremath{^{th}} March 2020, by the ``World Health Organization'' (WHO) and requested respective Governments, health care officials, scientific teams and all denizens should organize ourselves to slow-down the spreading of COVID-19, take remedies, restrict the negative effects and search more accurate cure.

In 2012 MARS ``Middle East Respiratory Syndrome'' was also seen which is caused by a coronavirus. According to ``International Taxonomy Group'', this pandemic COVID-19 has been identified as SARSCoV2 ``Severe Acute Respiratory Distress Syndrome'' \unskip~\citep{1001369:21388642}.

Recent virology researches done by Zhou and colleagues have presented up to 80\% similarity between SARS-CoV (in 2003 the virus got spread to 26 countries where more than 8000 population got affected) and the recent novel coronavirus.

Almost 60\% of patients who suffered from SARS epidemic 2003 had developed various degrees of liver damages \unskip~\citep{1001369:21388642}. As it COVID19 virus resembles the SARS phylogenitically; this is believed that novel coronavirus can also cause hepatobilliary damage. With the uses of antiviral and quinoline the chances of risk of liver injury may be there. 

\textbf{Transmission} \textbf{\space }

The primary route of SARS CoV-2 is a contact of mucous with respiratory droplets. It evolved as a zoonotic infection; howsoever, these viruses transmit in a flash from one person to another and become a pandemic. The novel coronavirus is resilient and may remain potent for up to 14 days, depending on the viral carrier and the immunity of the affected person \unskip~\citep{1001369:21388644}. Also, ACE2, the receptor protein of both SARS-CoV and 2019-nCoV, is abundantly present in humans in the epithelia of the lung and small intestine, and coronaviruses can infect the upper respiratory and gastrointestinal tract \unskip~\citep{1001369:21388646}. In a community, the transmission potential of infection is based on its basic reproduction rate which is usually indicated as ``Disease Transmission Ratio'' (R0). It determines the number of secondary cases occurred from an index case in a susceptible population. In SARS CoV 2003 R0 was reduced to 0.4 and COVID-19 is 2.2. The evidence collected from various sources indicates that COVID-19 extensively spreads in confined settings like hospitals, prisons, cruise ships and religious places. Pandemic outbreaks in restricted settings require investigation of the changes in the active reproduction number occurring as a consequence of interventional strategies such as quarantine and self-isolation of the travellers and crew members on board \unskip~\citep{1001369:21388648}. 

\textbf{Clinical Feature} \textbf{\space }

The clinical feature of COVID19 as similar to that of viral pneumonia and having most common symptoms as


  
  \begin{enumerate}
  \item \relax Feverish Condition
  \item \relax Cough
  \item \relax Sore throat
  \item \relax Impaired taste and smell
  \end{enumerate}
  Some of the less common symptoms such as 


  
  \begin{enumerate}
  \item \relax Aches and pains
  \item \relax Tiredness 
  \item \relax Skin rashes
  \item \relax Discoloration of fingers or toes
  \item \relax Diarrhoea 
  \end{enumerate}
  

\begin{itemize}
  \item \relax Because of the predominant distribution of the main viral entry receptor, such as angiotensin-converting enzyme2 (ACE2), COVID-19 causes many systemic disorder, having relatable involvement of vital organs such as lungs, heart, kidneys, liver additionally determines alterations of the circulating white blood cells and the immune system \unskip~\citep{1001369:21388645}\ensuremath{^{.\ensuremath{^{}}}}
\end{itemize}
  \textbf{Hepatic Dysfunction In Covid-19}

SARSCoV2 associated hepatic dysfunction is determined as any liver injury occurred during the onset of the disease, progression and treatment of COVID-19 patients with or without having a previous history of liver abnormalities. The gross incidence of increased serum level in indoor patients infected with novel coronavirus primarily elevated Aspartate Aminotransferase (AST) and Alanine transminase (ALT) and with little increased bilirubin level (i.e. from 14.0\% to 53.0\%). Elevated levels of Liver enzymes are seen more frequently in men and most of the serious cases \unskip~\citep{1001369:21388642}.

Albumin act as a marker: low albumin stands for a severe infectious condition with poor prognosis. Till now, 2-11\% of patients with COVID19 had underlying hepatic dysfunction.

\textbf{Viral Effect On Liver}

The liver receives both the portal and systemic circulation: hence it is involved in most systematic infections. Its a vital organ for host defence and immunity \unskip~\citep{1001369:21388645}. Some of the viruses exhibit a direct cytotoxic effect on hepatocytes and cholangiocytes; however, in maximum cases, the pathogenesis based on the multiple factors.

Hepatocellular necrosis, fatty degeneration and cellular infiltration are the usual pathological outcome of a liver biopsy specimen of SARS patients. Some of the current autopsy-records of hepatic tissue of COVID-19 patients show mild infectious nature in the lobular and portal area \unskip~\citep{1001369:21388644}.\ensuremath{^{}}

However, these patterns of histological damages have multi etiological factors. But they can also be seen during infectious condition or ``Drug-Induced Liver Injury'' (DILI).

\textbf{Mechanism Of Liver Injury} \textbf{\space }


  
  \begin{enumerate}
  \item \relax Immune mediated injuries as an outcome of the severe inflammatory responses following SARSCoV2 infection
  \end{enumerate}
  It shows increased the inflammation bio-markers that includes C-Reactive protein (CRP), Lactate Dehdrogenase, D-dimer, Interleukin-6, Interleukin-2 and serum ferritin \unskip~\citep{1001369:21388647}.

2. Direct cyto-toxicity as a result of active viral replication in liver cells

Novel coronavirus attaches to target cells through ACE2. As it is expressed more in the liver and mainly on biliary epithelial cells, the hepatic cell is a potential target for direct inflammation.

3. Anoxia 

 Hypoxic hepatitis is seen frequently in several cases.

4. Drug-induced liver injury (DILI)

Initially, WHO recommends the clinicians to use antiviral drugs such as remdesivir, hydroquinilones, chloroquine, flavipiravir. These are being potentially hepatotoxic in some patients \unskip~\citep{1001369:21388645}.

5. Pre-existing liver disease reactivation

A person having pre-existing chronic hepatic disorder, are more susceptible to hepatic injuries from COVID-19. Agents such as tocilizumab and baricitinib may cause HBV re-activation and often leads to hepatic degeneration \unskip~\citep{1001369:21388649}. Various mechanisms are indicated as below [Figure~\ref{f-d72ebb2b15a5}].


\bgroup
\fixFloatSize{images/f40f189a-c242-4c40-9b66-2557ab36179d-upicture1.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/f40f189a-c242-4c40-9b66-2557ab36179d-upicture1.png}{\includegraphics{images/f40f189a-c242-4c40-9b66-2557ab36179d-upicture1.png}}{}
\makeatother 
\caption{\boldmath {Mechanism of liver injury}}
\label{f-d72ebb2b15a5}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/efd6bb4c-c1fc-4453-9677-faf493c27c98-upicture2.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/efd6bb4c-c1fc-4453-9677-faf493c27c98-upicture2.png}{\includegraphics{images/efd6bb4c-c1fc-4453-9677-faf493c27c98-upicture2.png}}{}
\makeatother 
\caption{\boldmath {Management of liver diseases}}
\label{f-0a611fde6ead}
\end{figure}
\egroup
\textbf{Clinical Implication} \textbf{\space }

1. Continuous tracking of liver biochemical parameters should be done in every of the COVID-19 patients.

2. Serologic testing for Hepatitis B and C should be done

3. Assessment of elevated hepatic biochemistries should be noted. 

4. All approaches towards the safety of the medicines used for the cure of COVID-19 patients with liver injuries are empirical.

5. Severe liver injury is rare, but the efficiency of the liver is compromised.

\textbf{Management Of Liver Diseases }

The various process of managing liver diseases are [Figure~\ref{f-0a611fde6ead}].

\textbf{Prevention}

Currently, we are lacking medicinal aids to manage the pandemic. The tools to combat COVID-19 are mainly quarantine and social distancing \unskip~\citep{1001369:21388650}. Other method includes
  
  \begin{enumerate}
  \item \relax Use soap hand-wash or an alcohol-based hand rub to clean the hands.
  \item \relax Wearing a face mask.
  \item \relax Avoid gatherings.
  \item \relax Maintain a physical distance of 2 meters
  \item \relax Avoid touching eyes, nose or mouth frequently.
  \item \relax Stay home as much as possible.
  \item \relax If you have a high temperature, cough and difficulty breathing, ask for medical attention.
  \item \relax Govt. need to modify their strategies to contain the spreading of COVID19, testing methods and treatment protocols in accordance to the WHO Guidelines.
  \end{enumerate}
  
    
\section{Conclusion}
COVID-19 caused by novel coronavirus "SARS-CoV-2'' is a pandemic condition. The fatality rate is nearly 3\% but higher in patients with older age and co-morbidities. Symptoms are more relatable to pneumonia, but hepatobilliary dysfunction may be seen in some of the serious cases and may associate with fatal results. Prolong studies with follow-ups are necessary for assessment of the intensity of hepatic damages done due to COVID-19. The effects of COVID-19 related drugs and Novel Corona Virus on underlying chronic liver disorder needs a detailed evaluation; so that the hepato-toxicity can be reduced. 

\textbf{Funding Support}

The authors declare that they have no funding support for this study.

\textbf{Conflict of Interest }

The authors declare that they have no conflict of interest for this study.
    

\bibliographystyle{pharmascope_apa-custom}

\bibliography{\jobname}
\end{document}
