Can Airflow Manipulation Disrupt the Transmission of COVID-19 Variants and Highly Infectious Droplets? (preprint)

In the ongoing battle against new variants of COVID-19 and airborne-transmitted diseases, the focus on indoor air quality, particularly in enclosed spaces, has intensified. This study utilizes computational fluid dynamics (CFD) modelling to investigate how different air distribution setups can impact the spread of airborne COVID-19 particles. Air distribution systems are at the forefront of this research, specifically examining supply and exhaust diffuser placements and their effects on droplet dispersion dynamics. Results reveal a promising reduction (10–21%) in residual droplet mass over a 10-second period when exhaust diffusers are strategically located above cough sources. This underscores the pivotal role of ventilation design in curbing airborne transmission. Furthermore, the analysis sheds light on variations (2.7–8.9%) in droplet Sauter mean diameter across different configurations, underscoring the significance of airflow patterns in dictating droplet size distribution and infection control efficacy. The study also emphasizes the importance of maintaining social distancing measures, showcasing a substantial decrease (82–89%) in viral concentration at a 2-meter distance, despite ventilation imperfections. In summary, this study highlights the critical role of ventilation design in combating airborne COVID-19 transmission within office environments. These findings offer valuable insights into optimizing airflow patterns, enhancing overall safety measures, and informing effective strategies to tackle the pandemic.

Characteristics, Treatment, Outcomes, and Cause of Death of Invasively Ventilated Patients with COVID-19 ARDS in Asir Central Hospital: A Retrospective Single Center Experience (preprint)

Introduction: COVID-19's emergence caused devastating consequences worldwide, with high morbidity and mortality rates. Critically ill patients face challenges like acute respiratory failure requiring intensive measures, including mechanical ventilation. Mortality rates in ARDS are influenced by various factors. This paper focuses on describing characteristics, management, and survival factors of mechanically ventilated ICU patients in Saudi Arabia. Methods: a retrospective, noninterventional approach, we reviewed charts and data of all COVID-19-infected patients who were admitted to the ICU, particularly those requiring ventilation support at Aseer Central Hospital (ACH) in the southern region of Saudi Arabia. Results: The study enrolled 594 COVID patients, mean age 60.5 ± 17.3 years, with 67% males. Approximately half had O negative blood group. Common chronic health issues: diabetes mellitus (35.5%). Positive culture findings in almost 340 (57.2%), with Klebsiella pneumoniae being the most isolated microorganism (45.5%). Significant correlations found with mortality: age, blood culture, Rh positive group (P<0.05). Conclusion: this study provides critical insights into the clinical and epidemiological aspects of COVID-19 patients admitted to the ICU in a Saudi Arabian hospital. The research underscores the impact of age, comorbidities, laboratory markers, and treatment interventions on patient out-comes, emphasizing the significance of tailored management strategies in this context.

The Impact of Extended E-Learning on Emotional Well-Being of Students during the COVID-19 Pandemic in Saudi Arabia.

Educational institutions in Saudi Arabia extended e-learning until the third semester of the academic calendar to prevent the spread of COVID-19 infection and to achieve 70% inoculation for the Saudi population. This study assesses the impact of extended e-learning and other associated stressors on the emotional health of university students in Saudi Arabia. An online cross-sectional survey collected data between the months of January-March 2021. The emotional signs of stress were measured by using a subset of items from the COVID-19 Adolescent Symptom and Psychological Experience Questionnaire (CASPE). Data about demographic variables, educational characteristics and academic performance were also collected. A regression analysis was performed to determine predictors of emotional health. A total of 434 university students including females (63%) and males (37%) provided responses. One-third of students (33%) indicated that the COVID-19 pandemic and its resulting changes including online distance studies greatly influenced their daily lives in a negative way. The regression analysis demonstrated that female students and students with average academic performance had increased vulnerability to experience emotional signs of stress (p < 0.05). The factors 'Not going to university' and 'Not having a routine life' were significant predictors of stress responses (p < 0.01) and (p < 0.001) respectively. E-learning during the COVID-19 pandemic made it possible for students to complete their studies as per academic calendar; simultaneously, it increased the vulnerability to experience stress, particularly for female students and students with average academic performance. These findings imply that academic advising and counseling services should be more readily available during digital studies to support at risk students.

'Who is telling the truth?' Migrants' experiences with COVID-19 related information in Norway: a qualitative study.

AIMS: The over-representation of migrants among those infected by COVID-19 in high-income countries has spurred questions about insufficient distribution of health information to society's subgroups. Our study aimed to shed light on migrants' experiences with information relating to COVID-19 in Norway. METHODS: We conducted 55 semi-structured interviews with migrants from five different countries living in Norway: Somalia (10), Syria (15), Sri Lanka (10), Chile (10), and Poland (10). The interviews were performed by bilingual researchers with a migrant background, audio-recorded, transcribed and thematically analysed. RESULTS: We identified the four key themes of multiple and contradictory information sources, language barriers, conspiracy theories/speculations, strategies for information provision and ways ahead. Participants accessed and combined several often transnational sources of information. Information was perceived as confusing and contradictory and there was a wish for more translated information. CONCLUSIONS: It is important to recognise the specific factors affecting migrants' ability to receive, trust and use health-related information during pandemics and other health crises.

Myasthenia gravis with achalasia secondary to thymoma: a case report and literature review.

Background: Myasthenia gravis is an autoimmune neuromuscular junction disorder characterized by fatigable muscle weakness and autoantibodies. Frequent associations exist between myasthenia gravis and thymic abnormalities, including hyperplasia and thymoma. Several autoimmune illnesses have been identified to be associated with thymoma; however, a few case reports have linked thymoma and achalasia, and the underlying mechanism is unknown. Case report: A 43-year-old man with thymoma-associated myasthenia gravis presented with dysphagia that was refractory to conventional treatment of myasthenia gravis. This dysphagia was challenging to diagnose even after multiple gastroenterology consults and upper endoscopy. The diagnosis of achalasia type II was established after a comprehensive evaluation, including upper endoscopy, barium swallow, and high-resolution esophageal manometry. The patient underwent elective pneumatic balloon dilatation, which successfully alleviated his dysphagia. Conclusion: This case confirmed the association between myasthenia gravis secondary to thymoma and achalasia and showed how the diagnosis of achalasia was challenging. Awareness of this association is crucial for early diagnosis and treatment, improving affected patients' quality of life.

Association of SARS-CoV-2 Nucleocapsid Protein Mutations with Patient Demographic and Clinical Characteristics during the Delta and Omicron Waves.

SARS-CoV-2 genomic mutations outside the spike protein that may increase transmissibility and disease severity have not been well characterized. This study identified mutations in the nucleocapsid protein and their possible association with patient characteristics. We analyzed 695 samples from patients with confirmed COVID-19 in Saudi Arabia between 1 April 2021, and 30 April 2022. Nucleocapsid protein mutations were identified through whole genome sequencing. 𝜒2 tests and t tests assessed associations between mutations and patient characteristics. Logistic regression estimated the risk of intensive care unit (ICU) admission or death. Of the 60 mutations identified, R203K was the most common, followed by G204R, P13L, E31del, R32del, and S33del. These mutations were associated with reduced risk of ICU admission. P13L, E31del, R32del, and S33del were also associated with reduced risk of death. By contrast, D63G, R203M, and D377Y were associated with increased risk of ICU admission. Most mutations were detected in the SR-rich region, which was associated with low risk of death. The C-tail and central linker regions were associated with increased risk of ICU admission, whereas the N-arm region was associated with reduced ICU admission risk. Consequently, mutations in the N protein must be observed, as they may exacerbate viral infection and disease severity. Additional research is needed to validate the mutations' associations with clinical outcomes.

Impact of the COVID-19 Lockdown on Children's Psychosocial Well-Being: A Cross-Sectional Study in Saudi Arabia.

Background The impact of COVID-19 on children is a vital topic to cover since the quarantine lasted for months, and limited research explored this effect locally in Arab countries. We studied the impact of the COVID-19 lockdown on the psychosocial well-being of children aged 1-18 years who were living in Saudi Arabia during the time of the pandemic. Method A total of 387 participants' responses were collected using online questionnaires (valid and reliable) composed of three sections with open and close-ended questions by the child's legal guardians. This cross-sectional study was conducted in Saudi Arabia and targeted children aged 1-18 years of both genders using a convenience sampling technique. One questionnaire assessed the child's behavior and sleep pattern, while the other evaluated child's activity and social skills. We analyzed the data using Statistical Package for Social Sciences (SPSS) version 20.0 (IBM Corp., Armonk, NY). Results Half of the children were 1-6 years (196; 50.6%), and the caregivers of more than half (225; 58.2%) were mothers. Two-thirds (234; 60.5%) of the children were male. Apart from a poor appetite for food and eating (non-nutritional) junk food, which was not significant (p-value > 0.05), all other factors, behavior, sleep patterns, activity, and social skills, all other factors were significantly affected by COVID-19 (p<0.05). Conclusion This study found that the COVID-19 pandemic had a negative impact on children's psychosocial well-being. It is recommended to implement actions that aim to enhance the ability of children to cope with challenges.

How helpful were molecular dynamics simulations in shaping our understanding of SARS-CoV-2 spike protein dynamics?

The SARS-CoV-2 spike protein (S) represents an important viral component that is required for successful viral infection in humans owing to its essential role in recognition of and entry to host cells. The spike is also an appealing target for drug designers who develop vaccines and antivirals. This article is important as it summarizes how molecular simulations successfully shaped our understanding of spike conformational behavior and its role in viral infection. MD simulations found that the higher affinity of SARS-CoV-2-S to ACE2 is linked to its unique residues that add extra electrostatic and van der Waal interactions in comparison to the SARS-CoV S. This illustrates the spread potential of the pandemic SARS-CoV-2 relative to the epidemic SARS-CoV. Different mutations at the S-ACE2 interface, which is believed to increase the transmission of the new variants, affected the behavior and binding interactions in different simulations. The contributions of glycans to the opening of S were revealed via simulations. The immune evasion of S was linked to the spatial distribution of glycans. This help the virus to escape the immune system recognition. This article is important as it summarizes how molecular simulations successfully shaped our understanding of spike conformational behavior and its role in viral infection. This will pave the way to us preparing for the next pandemic as the computational tools are tailored to help fight new challenges.

Covid-19 Detection Using Deep Correlation-Grey Wolf Optimizer

The immediate and quick spread of the coronavirus has become a life-threatening disease around the globe. The widespread illness has dramatically changed almost all sectors, moving from offline to online, resulting in a new normal lifestyle for people. The impact of coronavirus is tremendous in the healthcare sector, which has experienced a decline in the first quarter of 2020. This pandemic has created an urge to use computer-aided diagnosis techniques for classifying the Covid-19 dataset to reduce the burden of clinical results. The current situation motivated me to choose correlationbased development called correlation-based grey wolf optimizer to perform accurate classification. A proposed multistage model helps to identify Covid from Computed Tomography (CT) scan image. The first process uses a convolutional neural network (CNN) for extracting the feature from the CT scans. The Pearson coefficient filter method is applied to remove redundant and irrelevant features. Finally, theGrey wolf optimizer is used to choose optimal features. Experimental analysis proves that this determines the optimal characteristics to detect the deadly disease. The proposed model's accuracy is 14% higher than the krill herd and bacterial foraging optimization for severe accurate respiratory syndrome image (SARS-CoV-2 CT) dataset. The COVID CT image dataset is 22% higher than the existing krill herd and bacterial foraging optimization techniques. The proposed techniques help to increase the classification accuracy of the algorithm in most cases, which marks the stability of the stated result. Comparative analysis reveals that the proposed classification technique to predict COVID-19 withmaximumaccuracy of 98% outperforms other competitive approaches. © 2023 CRL Publishing. All rights reserved.

Nitazoxanide and azithromycin for the early treatment of COVID-19: A multi-spectroscopic, biochemical and computational drug–drug interaction study

Herein, we present an experimental and theoretical drug–drug interaction study between nitazoxanide (NTZ) and azithromycin (AZT) in an aqueous solution. Interaction was studied by using UV/Vis, fluorescence, attenuated total reflectance-fourier transform infrared (ATR-FTIR), and circular dichroism (CD) spectroscopy, while molecular docking studies were performed to establish the interaction computationally. A bright yellow color was observed when the two drugs interacted, giving a hyperchromic band at 420 nm. The rate of absorbance was linearly increased by increasing drug concentrations and in a time-dependent manner. Stability of the interaction complex (i.e., NTZ: AZT) was measured at variable temperatures (25–80°C), pH (5.0–10.0) and ionic strength (0.05–2.0 M NaCl), and not only proved stable but also retained antimicrobial potential with reduced cellular toxicity. Mole ratio and Job's method of continuous variations were used to establish the binding stoichiometry and found to be 2:1. The calculated binding constant (kb = 8,400 M−1) and Gibb's free energy (ΔG° = −22.4 KJ/mol) also suggested an energetically favorable interaction. FTIR spectra of NTZ: AZT complex in comparison with two drugs alone revealed significant interaction which was nicely complemented by molecular docking studies. Interaction was also successfully demonstrated in presence of carrier protein HSA and by spiking the two drugs in real samples of human plasma and urine. © 2023 The Chemical Society Located in Taipei & Wiley-VCH GmbH.

Deep Learning Convolutional Neural Network for SARS-CoV-2 Detection Using Chest X-Ray Images

The COVID-19 coronavirus illness is caused by a newly discovered species of coronavirus known as SARS-CoV-2. Since COVID-19 has now expanded across many nations, the World Health Organization (WHO) has designated it a pandemic. Reverse transcription-polymerase chain reaction (RT-PCR) is often used to screen samples of patients showing signs of COVID-19;however, this method is more expensive and takes at least 24 hours to get a positive or negative response. Thus, an immediate and precise method of diagnosis is needed. In this paper, chest X-rays will be utilized through a deep neural network (DNN), based on a convolutional neural network (CNN), to detect COVID-19 infection. Based on their X-rays, those with COVID-19 indications may be categorized as clean, infected with COVID-19 or suffering from pneumonia, according to the suggested CNN network. Sample pieces from every group are used in experiments, and categorization is performed by a CNN. While experimenting, the CNN-derived features were able to generate the maximum training accuracy of 94.82% and validation accuracy of 94.87%. The F1-scores were 97%, 90% and 96%, in clearly categorizing patients afflicted by COVID-19, normal and having pneumonia, respectively. Meanwhile, the recalls are 95%, 91% and 96% for COVID-19, normal and pneumonia, respectively. © 2023 by the author(s). Licensee Prague University of Economics and Business, Czech Republic.

Shoulder Weakness Following Intramuscular COVID- 19 Vaccine

History: Transient and generalized adverse effects are common following COVID-19 vaccination;among other adverse effects, shoulder injuries related to vaccine administration (SIRVA) have been known to occur. In this case, a previously healthy right-hand dominant 62-year-old male presented with left shoulder pain and weakness 3 months after receiving a COVID-19 intramuscular vaccine in the left deltoid. Approximately 2 weeks after the injection, he started experiencing pain and numbness around the injection site along with ipsilateral shoulder weakness. Despite conservative management with Motrin, Medrol Dosepak, gabapentin and physical therapy (PT), the pain and weakness persisted. Physical Exam: Left Shoulder-No calor or erythema;significant atrophy of the anterior and middle deltoid muscle relative to right side;abduction 4/5;external rotation with shoulder adducted 4/5;range of motion for active forward flexion was 150 degrees and passive was 170 degrees;passive range of motion for external rotation was 70 degrees;internal rotation to the level of L5;sensation to light touch was intact. Right Shoulder-Range of motion, strength, and sensation were intact. Cervical Spine-Full ROM;no cervical paraspinal tenderness noted. Negative Spurling's and Lhermitte's tests. Differential Diagnosis: 161. Axillary Nerve Palsy 2/2 Chemical Neurotoxicity 162. Brachial Neuritis 163. Mechanical Axillary Nerve Palsy 2/2 Vaccination 164. Partial-Tear of Left Supraspinatus Tendon 165. Acromioclavicular Osteoarthritis Test Results: Left Shoulder-XR:Mild pseudo-subluxation;MRI w/o contrast: 8x9mmpartial-thickness articular surface tear of the distal supraspinatus tendon (<50%fiber thickness). Minimal subacromial bursitis. Mild acromioclavicular joint osteoarthritis. EMG/NCV: Left and Right Axillary Motor Nerves: prolonged distal onset latency;Left Deltoid: increased insertion activity, moderately increased spontaneous activity, reduced recruitment;Remaining LUE muscles without evidence of electrical instability Final Diagnosis: Axillary Nerve Palsy Secondary To Chemical Neurotoxicity from Intramuscular COVID-19 Vaccine. Discussion(s): We postulate that the neurologic deficits presented in our case may be attributed to chemical neurotoxicity to the axillary nerve following vaccination as the delayed onset of pain and weakness are most consistent with this differential. There are several cases of brachial neuritis following vaccination for the prevention of COVID- 19, however, EMG/NCV results in our patient were not consistent with brachial plexopathy. Additionally, while there have been a handful of reported cases of bursitis following COVID-19 vaccines falling under the SIRVA classification of injuries, this is the first case of reported axillary nerve neurapraxia. Outcome(s): The patient's left shoulder numbness and pain improved with PT and medical management. While mild improvement in strength was noted, weakness and atrophy persisted even on the third follow up visit 6 months after the initial appointment. He was counseled on his injury and was recommended to undergo repeat EMG testing to document recovery after his 6-month follow-up appointment. Follow-Up: The patient did not follow-up for a repeatEMG after his 6-month follow-up appointment. At that time, the patient was clinically stable, tolerating PT, and expecting recovery of his deltoid function.

Private transfers, public transfers, and food insecurity during the time of COVID-19: Evidence from Bangladesh

In the aftermath of the COVID-19 pandemic, interest has grown in what kinds of assistance protect household food security during shocks. We study rural and urban Bangladesh from 2018 to 2019 to late 2021, assessing how pre-pandemic access to social safety net programs and private remittances relate to household food insecurity during the pandemic. Using longitudinal data and estimating differences-in-differences models with household fixed effects, we find that pre-pandemic access to social protection is associated with significant reductions in food insecurity in all rounds collected during the pandemic, particularly in our urban sample. However, pre-pandemic access to remittances shows no similar protective effect.

Expert consensus statement on venovenous extracorporeal membrane oxygenation ECMO for COVID-19 severe ARDS: an international Delphi study.

BACKGROUND: The high-quality evidence on managing COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO) support is insufficient. Furthermore, there is little consensus on allocating ECMO resources when scarce. The paucity of evidence and the need for guidance on controversial topics required an international expert consensus statement to understand the role of ECMO in COVID-19 better. Twenty-two international ECMO experts worldwide work together to interpret the most recent findings of the evolving published research, statement formulation, and voting to achieve consensus. OBJECTIVES: To guide the next generation of ECMO practitioners during future pandemics on tackling controversial topics pertaining to using ECMO for patients with COVID-19-related severe ARDS. METHODS: The scientific committee was assembled of five chairpersons with more than 5 years of ECMO experience and a critical care background. Their roles were modifying and restructuring the panel's questions and, assisting with statement formulation in addition to expert composition and literature review. Experts are identified based on their clinical experience with ECMO (minimum of 5 years) and previous academic activity on a global scale, with a focus on diversity in gender, geography, area of expertise, and level of seniority. We used the modified Delphi technique rounds and the nominal group technique (NGT) through three face-to-face meetings and the voting on the statement was conducted anonymously. The entire process was planned to be carried out in five phases: identifying the gap of knowledge, validation, statement formulation, voting, and drafting, respectively. RESULTS: In phase I, the scientific committee obtained 52 questions on controversial topics in ECMO for COVID-19, further reviewed for duplication and redundancy in phase II, resulting in nine domains with 32 questions with a validation rate exceeding 75% (Fig. 1). In phase III, 25 questions were used to formulate 14 statements, and six questions achieved no consensus on the statements. In phase IV, two voting rounds resulted in 14 statements that reached a consensus are included in four domains which are: patient selection, ECMO clinical management, operational and logistics management, and ethics. CONCLUSION: Three years after the onset of COVID-19, our understanding of the role of ECMO has evolved. However, it is incomplete. Tota14 statements achieved consensus; included in four domains discussing patient selection, clinical ECMO management, operational and logistic ECMO management and ethics to guide next-generation ECMO providers during future pandemic situations.

Evaluation of circulating insulin-like growth factor-1, heart-type fatty acid-binding protein, and endotrophin levels as prognostic markers of COVID-19 infection severity.

BACKGROUND: Coronavirus Disease 2019 (COVID-19) is a worldwide pandemic challenge spreading enormously within a few months. COVID-19 is characterized by the over-activation of the immune system causing cytokine storm. Insulin-like growth factor-1 (IGF-1) pathway can regulate the immune response via interaction with various implicated cytokines. Heart-type fatty acid-binding protein (H-FABP) has been shown to promote inflammation. Given the fact that coronavirus infections induce cytokines secretion leading to inflammatory lung injury, it has been suggested that H-FABP levels are affected by COVID-19 severity. Moreover, endotrophin (ETP), the cleavage product of collagen VI, may be an indicator of an overactive repair process and fibrosis, considering that viral infection may predispose or exacerbate existing respiratory conditions, including pulmonary fibrosis. This study aims to assess the prognostic capacity of circulating IGF-1, HFABP, and ETP, levels for COVID-19 severity progression in Egyptian patients. METHODS: The study cohort included 107 viral RNA-positive patients and an equivalent number of control individuals with no clinical signs of infection. Clinical assessments included profiling of CBC; serum iron; liver and kidney functions; inflammatory markers. Circulating levels of IGF-1; H-FABP, and ETP were estimated using the corresponding ELISA kits. RESULTS: No statistical difference in the body mass index was detected between the healthy and control groups, while the mean age of infected patients was significantly higher (P = 0.0162) than the control. Patients generally showed elevated levels of inflammatory markers including CRP and ESR concomitant with elevated serum ferritin; D dimer and procalcitonin levels, besides the COVID-19 characteristic lymphopenia and hypoxemia were also frequent. Logistic regression analysis revealed that oxygen saturation; serum IGF-1, and H-FABP can significantly predict the infection progression (P < 0.001 each). Both serum IGF-1 and H-FABP as well as O2 saturation showed remarkable prognostic potentials in terms of large AUC values, high sensitivity/specificity values, and wide confidence interval. The calculated threshold for severity prognosis was 25.5 ng/mL; 19.5 ng/mL, 94.5, % and for IGF-1, H-FABP, and O2 saturation; respectively. The calculated thresholds of serum IGF-1; H-FABP, and O2 saturation showed positive and negative value ranges of 79-91% and 72-97%; respectively, with 66-95%, 83-94% sensitivity, and specificity; respectively. CONCLUSION: The calculated cut-off values of serum IGF-1 and H-FABP represent a promising non-invasive prognostic tool that would facilitate the risk stratification in COVID-19 patients, and control the morbidity/mortality associated with progressive infection.

Evaluating the ability of some natural phenolic acids to target the main protease and AAK1 in SARS COV-2.

Researchers are constantly searching for drugs to combat the coronavirus pandemic caused by SARS-CoV-2, which has lasted for over two years. Natural compounds such as phenolic acids are being tested against Mpro and AAK1, which are key players in the SARS-CoV-2 life cycle. This research work aims to study the ability of a panel of natural phenolic acids to inhibit the virus's multiplication directly through Mpro and indirectly by affecting the adaptor-associated protein kinase-1 (AAK1). Pharmacophore mapping, molecular docking, and dynamic studies were conducted over 50 ns and 100 ns on a panel of 39 natural phenolic acids. Rosmarinic acid (16) on the Mpro receptor (- 16.33 kcal/mol) and tannic acid (17) on the AAK1 receptor (- 17.15 kcal/mol) exhibited the best docking energy against both receptors. These favourable docking score values were found to be superior to those of the co-crystallized ligands. Preclinical and clinical research is required before using them simultaneously to halt the COVID-19 life cycle in a synergistic manner.

Intelligent Healthcare Provided by Nano-Enhanced Biosensing Systems: Progress in COVID-19 Management via the Artificial Neural Network Approach

Biosensors using opto electronics mechanisms are evolving as efficient (sensitive and selective) and low-cost analytical diagnostic devices for early-stage disease diagnosis, which is crucial for person-centered health and wellness management. Due to advancements in nanotechnology in the areas of sensing unit fabrication, device integration, interfacing, packaging, and sensing performance at the point-of-care (POC), personalized diagnostics are now possible, allowing doctors to tailor tests to each patient's unique disease profile and management requirements. Innovative biosensing technology is being pushed as the diagnostic tool of the future because of its potential to provide accurate results without requiring intrusive procedures. Because of this, this visionary piece of writing explores analytical methods for managing personalised health care that IP 203.8 109.10 On: Th , 16 F b 2023 14 53 21 can enhance the health of the general population. The end goal is to take control of a healthier tomorrow as Copyright: Ame can Scientific Pub shers soon as possible. Right now, the most crucial part of controllig the COVID-19 pandemic, a potentially fatal Delive ed by Ingenta respiratory viral disease, is the rapid, specific, and sensitive detection of human beta severe acute respiratory system coronavirus (SARS-CoV-2) protein.

The state of health in Pakistan and its provinces and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding health trends and estimating the burden of disease at the national and subnational levels helps policy makers track progress and identify disparities in overall health performance. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides comprehensive estimates for Pakistan. Comparison of health indicators since 1990 provides valuable insights about Pakistan's ability to strengthen its health-care system, reduce inequalities, improve female and child health outcomes, achieve universal health coverage, and meet the UN Sustainable Development Goals. We present estimates of the burden of disease, injuries, and risk factors for Pakistan provinces and territories from 1990 to 2019 based on GBD 2019 to improve health and health outcomes in the country. Methods We used methods and data inputs from GBD 2019 to estimate socio-demographic index, total fertility rate, cause-specific deaths, years of life lost, years lived with disability, disability-adjusted life-years, healthy life expectancy, and risk factors for 286 causes of death and 369 causes of non-fatal health loss in Pakistan and its four provinces and three territories from 1990 to 2019. To generate estimates for Pakistan at the national and subnational levels, we used 68 location-years of data to estimate Pakistan-specific demographic indicators, 316 location-years of data for Pakistan-specific causes of death, 579 location-years of data for Pakistan-specific non-fatal outcomes, 296 location-years of data for Pakistan-specific risk factors, and 3089 location-years of data for Pakistan-specific covariates. Findings Life expectancy for both sexes in Pakistan increased nationally from 61 center dot 1 (95% uncertainty interval [UI] 60 center dot 0-62 center dot 1) years in 1990 to 65 center dot 9 (63 center dot 8-67 center dot 8) years in 2019;however, these gains were not uniform across the provinces and federal territories. Pakistan saw a narrowing of the difference in healthy life expectancy between the sexes from 1990 to 2019, as health gains for women occurred at faster rates than for men. For women, life expectancy increased by 8 center dot 2% (95% UI 6middot3-13middot8) between 1990 and 2019, whereas the male life expectancy increased by 7 center dot 6% (3 center dot 5-11 center dot 8). Neonatal disorders, followed by ischaemic heart disease, stroke, diarrhoeal diseases, and lower respiratory infections were the leading causes of all-age premature mortality in 2019. Child and maternal malnutrition, air pollution, high systolic blood pressure, dietary risks, and tobacco consumption were the leading all-age risk factors for death and disability-adjusted life-years at the national level in 2019. Five non-communicable diseases-ischaemic heart disease, stroke, congenital defects, cirrhosis, and chronic kidney disease-were among the ten leading causes of years of life lost in Pakistan. Burden varied by socio-demographic index. Notably, Balochistan and Khyber Pakhtunkhwa had the lowest observed gains in life expectancy. Dietary iron deficiency was the leading cause of years lived with disability for both men and women in 1990 and 2019. Low birthweight and short gestation and particulate matter pollution were the leading contributors to overall disease burden in both 1990 and 2019 despite moderate improvements, with a 23 center dot 5% (95% UI 3 center dot 8-39 center dot 2) and 27 center dot 6% (14 center dot 3-38 center dot 6) reduction in age-standardised attributable DALY rates during the study period. Interpretation Our study shows that progress has been made on reducing Pakistan's disease burden since 1990, but geographical, age, and sex disparities persist. Equitable investment in the health system, as well as the prioritisation of high-impact policy interventions and programmes, are needed to save lives and improve health outcomes. Pakistan is facing several domestic and foreign challenges-the Taliban's return to power in Afghanistan, political turmoil, catastrophic flooding, the COVID-19 pandemic-that will shape the trajectory of the country's health and development. Pakistan must address the burden of infectious disease and curb rising rates of non-communicable diseases. Prioritising these three areas will enhance Pakistan's ability to achieve universal health coverage, meet its Sustainable Development Goals, and improve the overall health outcomes.

A rare case of Guillain barre syndrome with overlapping cerebral sinus venous thrombosis masquerading as acute psychosis following COVID-19 vaccination

Guillain barre syndrome (GBS) is a rare autoimmune condition that has a prevalence of 1-2 per 100,000 people each year. Cerebral sinus venous thrombosis (CSVT) occurs at a rate of three to four cases per one million individuals annually. Both have variable clinical presentation with significant morbidity. The therapeutic management of CSVT and GBS presents unique challenges due to peculiar relationship and overlap in presentation. Reports suggest that psychosis may result from autoimmune encephalitis after receiving the COVID-19 vaccination. Hereby the reported case is of a female who is 18 years of age presenting with acute psychotic and catatonic symptoms following covid 19 vaccination with weakening of limbs which suspected an underlying organic pathology. Magnetic resonance imaging was normal but magnetic resonance venogram showed transverse and sigmoid sinus thrombosis and later GBS with CSVT after Covid-19 vaccination was diagnosed. The case was chosen to report a rare condition with an atypical

Intention to Participate in MOOCs: Case of University Students in Northwestern Nigeria During COVID-19 Pandemic

Massive open online courses (MOOCs) have been introduced over the past few decades to account for the twenty-first-era education and recent COVID-19 pandemic trials driven by the spread of internet-based technology on the internet. This research seeks to give an extended model investigating the intention to use MOOCs based on students at public universities in northwestern Nigeria. The extended TAM model was tested via PLS structural equation modelling using data collected from 451 students at public universities in northwestern Nigeria. The research findings indicated that the proposed extended model delivers a 72.0% descriptive effect. The creative technology acceptance TAM model establishes a strong signal for the effects of PU, PR, PEOU, SN, and TA on intentions to practice MOOCs technology among students in Nigerian public universities during the COVID-19 pandemic. The outcomes present practical and theoretical implications that MOOC developers can use to justify why MOOCs are not high within public universities in Northern-western Nigeria. The findings also indicated that PU, PEOU, PR SN, and TA significantly impact students' intention to use MOOCs. The research has provided insight into extended TAM in Nigerian learning environments to discover the issues influencing students' intention to use MOOCs. Dissimilar to preceding empirical reviews, this research broadly investigated the intention to participate in MOOCs of public University students in northwestern Nigeria during the COVID-19 pandemic, delivering crucial discoveries and commendations for impending research openings. The findings could practically enlighten administrators, instructors, developers, and policymakers in making informed decisions © 2023, International Journal of Interactive Mobile Technologies.All Rights Reserved.