Sequential early-life viral infections modulate the microbiota and adaptive immune responses to systemic and mucosal vaccination (preprint)

Increasing evidence points to the microbial exposome as a critical factor in maturing and shaping the host immune system, thereby influencing responses to immune challenges such as infections or vaccines. To investigate the effect of early-life viral exposures on immune development and vaccine responses, we inoculated mice with six distinct viral pathogens in sequence beginning in the neonatal period, and then evaluated their immune signatures before and after intramuscular or intranasal vaccination against SARS-CoV-2. Sequential viral infection drove profound changes in all aspects of the immune system, including increasing circulating leukocytes, altering innate and adaptive immune cell lineages in tissues, and markedly influencing serum cytokine and total antibody levels. Beyond these immune responses changes, these exposures also modulated the composition of the endogenous intestinal microbiota. Although sequentially-infected mice exhibited increased systemic immune activation and T cell responses after intramuscular and intranasal SARS-CoV-2 immunization, we observed decreased vaccine-induced antibody responses in these animals. These results suggest that early-life viral exposures are sufficient to diminish antibody responses to vaccination in mice, and highlight their potential importance of considering prior microbial exposures when investigating vaccine responses.

Influence of time factor and albuminuria on characteristics of patients with type 2 diabetes Mellitus before, during and 1 year after COVID-19 recovery.

BACKGROUND: The potential effects of time factor and albuminuria on the morbid alterations in patients with type 2 diabetes (T2D) and COVID-19 are still unclear. We aimed to address the morbid alterations and the potential effects of time factor and albuminuria on the patients' characteristics before, during, and 1 year after COVID-19 recovery. METHODS: 83 patients with T2D were included, at Mansoura University Hospital, Egypt (July 2021-December 2021). Data of detailed history, physical examination, laboratory tests were recruited from files of the patients. Diagnosis and resolution of COVID-19 were established by Real time polymerase chain reaction (RT-PCR) test of SARS-CoV2. Complete blood count (CBC), renal and hepatic function tests, multiple measures of morning spot urine albumin to creatinine ratio (urine ACR), glycosylated hemoglobin (HBA1c), lipid profile, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Ferritin, neutrophil to lymphocyte ratio (NLR), vitamin D3, intact parathyroid hormone (intact PTH), serum calcium were applied to all participants. RESULTS: Our participants had a mean age of 45 years, 60.2% male, 56.6% were hospitalized, and 25.3% were admitted to ICU for severe COVID-19. Albuminuria was prevalent in 71.1% before, 98.8% during, and 92.8% after COVID-19 recovery. Patients with albuminuria showed older age, longer duration of T2D, more frequent severe COVID-19 and hospitalization (p = 0.03, p < 0.001, p = 0.023& p = 0.025) respectively. Body mass index (BMI), mean arterial blood pressure, ESR, CRP, ferritin, NLR, HBA1c, triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) ratio, vitamin D3, serum calcium, alkaline phosphatase (ALP), hepatic aminotransferases, and urine ACR showed significant alterations throughout the study (p < 0.001 for all). Although the interaction between time and albuminuria showed non-significant effect on all studied parameters, we noticed relevant main effects of time factor on Body mass index (BMI), HBA1c, glomerular filtration rate (eGFR), TG/HDL ratio, NLR, vitamin D3, (p < 0.001 for all). Moreover, albuminuria showed main effects on BMI, serum creatinine, and intact PTH (p = 0.019, 0.005 & <0.001), respectively. CONCLUSION: The characteristics of patients with T2D significantly altered throughout the study. Time factor and albuminuria exerted relevant main effects on the patients' characteristics without significant effect of their interaction.

The effects of probiotic Lactobacillus acidophilus and colchicine on the control of symptoms, duration, and disease progression of mild and moderate cases of COVID-19: A randomized controlled clinical trial (preprint)

Background Coronavirus disease 2019 (COVID-19) is a newly emerging human disease caused by a novel coronavirus, causing a global pandemic crisis. Probiotics and/or colchicine may be considered as options for treatment since they have anti-viral, anti-inflammatory, and immunomodulatory effects.Objective To assess the effectiveness of probiotic supplements (Lactobacillus acidophilus) and colchicine on symptoms, duration, and progression of mild and moderate cases of COVID-19 infection.Methods A three-arm randomized controlled clinical trial was carried out in the triage clinic of the family medicine department at Ain Shams University Hospitals on 150 participants who had been diagnosed as COVID-19 patients with mild and moderate severity. Patients aged below 18 years or above 65 years with any co-morbidities, pregnant or lactating females, and severe COVID-19 confirmed cases were excluded. Randomization was done by using sealed envelopes containing codes for intervention or control. Patients are followed up for improvement of their symptoms with no development of new symptoms over the course of two weeks.Results A total of 150 patients with mild and moderate severity of COVID-19 were enrolled in the study, 50 patients in each arm; around one third (34.7%) of the participants were aged between 29 and 39 years; one-quarter (24.7%) were aged between 18 and 28 years and 40.6% were aged 40 years and above. The mean duration of symptoms improvement was 12, 11 and 12 in the colchicine, probiotic, and control groups, respectively. Improvement of inflammatory markers over time occurred in each of the three groups, with no statistically significant difference between them.Conclusion Probiotic Lactobacillus acidophilus and colchicine shows no significant effect on the symptoms, duration, and progression of mild and moderate cases of COVID-19.

The challenges of recruitment in clinical trials in developing countries: the Mycetoma Research Centre experience.

Mycetoma is a chronic disease caused either by fungi (eumycetoma) or bacteria (actinomycetoma). Treatment remains suboptimal and based on personal clinical experience. Recently, the Mycetoma Research Centre (MRC), a WHO Collaborating Centre on mycetoma, began the first-ever double-blind clinical trial. Here, we report the challenges and barriers faced in the recruitment and retention of patients in the MRC experience. Patient recruitment and retention are critical determinants of clinical trial success and yet a substantial number of trials fail to reach their recruitment goals. Recruitment challenges are identified throughout the different stages of the clinical trial, starting from planning, participant screening and intervention, through to retaining participants for the entire study duration. The MRC made efforts to address these challenges to ensure the constant flow of patients. The recruitment committee at the MRC conducted training workshops for the medical staff in the endemic areas, along with regular meetings with health authorities and local leaders. Moreover, telemedicine technology was used to examine patients in endemic areas. Challenges and barriers facing clinical trial conduct need to be examined thoroughly to ensure actionable, evidence-based recommendations for improving patient recruitment and retention. In conclusion, effective patient recruitment and retention are based on three pillars, which are proper clinical trial design and protocol development, realistic and feasible trial site selection, and objective communication with the trial stakeholders.

COVID-19's Psychological Impact on Chronic Disease Patients Seeking Medical Care.

BACKGROUND: The outbreak has harmed patients with multiple comorbidities and chronic conditions. The pandemic's psychological impact is thought to change their routine of seeking medical care. Research Question or Hypothesis: During COVID-19, patients with chronic conditions may experience anxiety, depression, and stress, and their pattern of seeking medical care may change. MATERIALS AND METHODS: In May 2021, a cross-sectional, web-based study of patients with chronic diseases was conducted. Eligible patients (1036) were assessed for psychological disorders, primarily depression, stress, and anxiety, using the DASS-21 scale, and their pattern of receiving medical care during COVID-19. RESULTS: During the pandemic, 52.5% of the patients with chronic diseases were depressed, 57.9% were anxious, and 35.6% were stressed. Patients with chronic diseases who had moderate to severe depression (34.9% versus 45.1%, p = 0.001), moderate to severe anxiety (43.6% versus 53.8%, p = 0.001), or moderate to severe stress (14.9% versus 34.8%, p = 0.001) were significantly more likely to have no follow-up for their chronic conditions. CONCLUSIONS: Patients with chronic conditions experienced significant anxiety, depression, and stress during COVID-19, which changed their pattern of seeking medical care, and the majority of them did not receive follow-up for their chronic conditions.

Roles and challenges of primary healthcare workers: lessons learned from COVID-19 pandemic.

Context: The COVID-19 pandemic has changed the structure of the healthcare system. As a response to the pandemic, the ministry of health applied many changes to the primary healthcare system. These changes created new challenges for healthcare workers (HCWs). Aims: To identify the roles and challenges of practitioners in primary healthcare (PHC) centers during COVID-19 in Al-Baha city, Saudi Arabia, in 2022. Methods and Materials: An analytical cross-sectional study was carried out in 2022 in Al-Baha city, Saudi Arabia. An electronic online questionnaire was distributed formally to HCWs in PHC centers. All primary HCWs during the COVID-19 pandemic in Al-Baha city, Saudi Arabia, were included. Results: A total of 424 responses were analyzed. Half (50.7%) of the participants had fieldwork roles during the pandemic. The two most commonly agreed-upon challenges were stress (78.7%) and worry about getting infected (79.8%). The majority (74.4%) of the participants' roles involved direct contact with suspected COVID-19 cases, whereas 50.9% involved direct contact with confirmed COVID-19 cases. Direct contact with confirmed cases showed a significant association with worrying about getting infected (P = 0.019). Conclusions: Workload, overtime, conflict ambiguity, fear of getting and transmitting the infection, stress, and lack of personal protective equipment were challenges faced by the primary HCWs, which negatively impacted the quality of delivered services and mental health. We recommend facilitating access of primary HCWs to psychiatric clinics to improve stress and help cope with new roles during the pandemics and changes in the healthcare system.

Clinical Consequences for Individuals Treated with Tocilizumab for Serious COVID-19 Infection.

There seem to currently be no therapeutic medications found for the severe coronavirus infection in 2019 (COVID-19). In light of this, it has been hypothesized that the immunomodulatory treatment known as tocilizumab can lessen the inflammatory response that occurs in the respiratory system, speed up the process of clinical benefit, lower the risk of death, and avert the need for ventilators. This randomized controlled trial (RCT) studied patients with a proven infection of SARS-CoV-2 and hyperinflammatory reactions. The inclusion criteria included fever (body temperature > 38 °C), pulmonary infiltrates, or supplemental oxygen. The patients received either conventional treatment with one dose of either tocilizumab (8 mg per kilogram of body weight) or conventional treatment only. The subjects were randomized to receive either treatment with a 1:1 ratio. A time-to-event test was conducted to determine the time to intubation or death. There was an insignificant difference between the investigated groups regarding the time to death, time to mechanical ventilation, and percentage of deaths. The conventional group's median (IQR) hospital length of stay was 4 (3-6) days, whereas the tocilizumab therapy group was 7 (4.75-10) days. There was a substantial difference in the mechanical ventilation rates in both groups, which were 17 (34%) and 28 (56%), respectively. In hospitalized patients with severe illness and COVID-19, tocilizumab was ineffective in preventing intubation or death. Trials must be larger, however, in order to exclude the potential benefits or harms.

Transformational Leadership, Employee Engagement, Job Satisfaction, and Psychological Well-Being among Hotel Employees after the Height of the COVID-19 Pandemic: A Serial Mediation Model.

Over the past few years, great attention has been given to the impacts of the COVID-19 pandemic and its consequences on employee psychological well-being (PWB), particularly in the hospitality industry. Like many aspects of human life, employee PWB is influenced by multiple factors. One of the factors that may affect employee PWB is transformational leadership (TLS). Accordingly, we aim through this study to empirically (1) examine the direct effect of transformational leadership on employee PWB and (2) investigate the potential independent and serial mediation effects of employee engagement (EEG) and job satisfaction (JS) on the TLS-PWB relationship after the height of the COVID-19 pandemic. Data were gathered using an online questionnaire from a convenience sample of 403 front-line employees from five-star hotels in Saudi Arabia. The partial least squares structural equation modeling (PLS-SEM) with the bootstrapping technique was utilized to test the study hypotheses. Based on the demands-resources (JD-R) theory, the findings of this study reveal a significant positive effect of TLS on hotel employees' PWB. Additionally, drawing on the stimulus-organism-response (S-O-R) model, the two main contributions of this study are: (1) EEG and JS serially and independently have a significant partial mediational effect on the TLS-PWB relationship among hotel employees, and (2) EEG has a greater impact on the TLS-PWB relationship as an intervening variable than the two other mediators (JS, as well as EEG and JS serially). Based on these findings, hotel management should mainly consider developing and encouraging TLS behavior among their managers to promote EEG and increase JS among their followers, which consequently enhances their PWB and alleviates negative psychological outcomes due to experiencing a disaster such as the COVID-19 pandemic.

The impact of Blackboard Collaborate breakout groups on the cognitive achievement of physical education teaching styles during the COVID-19 pandemic.

The rapid spread of COVID-19 has forced schools and universities to close. Globally, education systems face unprecedented challenges, and learning management systems (LMS) are the only solution. The current study aimed to investigate the effectiveness of a Blackboard collaborative breakout group on the cognitive achievement of physical education teaching styles. The quasi-experimental method involved creating two groups: one experimental and one control, with the experimental group using Blackboard collaborative breakout groups and the control group relying exclusively on online lectures and continuing with the same method without breakout groups. The study sample consisted of 40 students who were randomly assigned and divided equally into the two groups. Based on the research sample, homogeneity within the group and equivalence between groups in terms of age, Grade Point Average (GPA), and high intelligence test (IQ) were evaluated. The results showed that the experimental group's cognitive achievement was superior to that of the control group. Therefore, the design of the learning process enhances student collaboration, participation, and reinforcement. Additionally, the experimental group retained the learning outcomes for a month after the cessation of all teaching and learning processes. To conclude, giving a lecture using webinar tools such as Blackboard Collaborate Ultra does not necessarily mean achieving the intended educational goals. As a result, it is necessary to look for ways to integrate active learning strategies, such as collaborative learning, to enhance student involvement in distance learning.

Whole-blood Point-of-Care Activated Partial Thromboplastin Time Ratio (APR) is not Accurate Enough to Monitor Heparin Therapy in Patients with Severe Respiratory Failure Secondary to SARS-Cov-2 Infection Supported with Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO).

Support with VV-ECMO requires anticoagulation with unfractionated heparin to prevent thrombotic complications. This must be monitored due to bleeding risk. A point-of-care (POC) method of testing aPTT and APR was evaluated for agreement with laboratory methods. In a prospective observational study, patients supported on VV-ECMO as a result of severe respiratory failure secondary to Covid-19 infection were given heparin as part of standard therapy. The aPTT was measured (i) at the bedside using the Hemochron Signature Elite device and (ii) at the hospital laboratory. Duplicate results were compared. Agreement between the POC and laboratory tests was poor, as assessed using the Bland-Altman method. The maximum difference between POC and laboratory methods was 133% and the minimum was 0%. Overall bias was 7.3% and limits of agreement were between -43.8% and 58.5%. Correlation increased when results were normalised to platelet count and creatinine. This POC test is insufficiently accurate for use as the primary method of heparin monitoring in patients requiring VV-ECMO for Covid-19. Platelets and renal function may influence the result of this whole blood POC test.

Preschool teachers' practices of online learning during the pandemic: insights from Egypt

The purpose of this study was to examine preschool teachers' practices of online learning during the COVID-19 pandemic. A total of 389 preschool teachers from 48 preschools (governmental, experimental, private, and international) in greater Cairo, Egypt responded to a survey in the Fall semester of 2021/2022. The survey was comprised of seven subscales (45 items) that represented teachers' online practices during the pandemic. The multiple linear regression analysis showed that teachers' online learning practices in private and international schools outperformed those in other schools. Teachers who have a teaching experience (11-20 years) outperformed other teachers. Teachers who had training related to online learning showed better practices than other teachers who had not. The multivariate analysis of variance showed that there are statistically significant differences according to the type of school. The study results highlight the need to enhance teachers' online practices during the pandemic to maximise preschool students' learning gains.

SARS-CoV-2 and Animals: From a Mirror Image to a Storm Warning.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), emerged in Wuhan city (Hubei province, China) in December 2019, and the World Health Organization (WHO) declared an international public health emergency on 11 March 2020 [...].

Antibiotic consumption in hospitals during COVID-19 pandemic: a comparative study.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) results in similar clinical characteristics as bacterial respiratory tract infections and can potentially lead to antibiotic overuse. This study aimed to determine the changes in hospital antimicrobial usage before and during the COVID-19 pandemic. METHODOLOGY: We compared antimicrobial consumption data for 2019 and 2020. Inpatient antibiotic consumption was determined and expressed as a defined daily dose (DDD) per 100 occupied bed days, following the World Health Organization (WHO) methods. The WHO Access, Watch, and Reserve (AWaRe) classification was used. RESULTS: The total antimicrobial consumption in 2020 increased by 16.3% compared to consumption in 2019. In 2020, there was a reduction in fourth-generation cephalosporins (-30%), third-generation cephalosporins (-29%), and combinations of penicillins (-23%). In contrast, antibiotics that were consumed more during 2020 compared with 2019 included linezolid (374%), vancomycin (66.6%), and carbapenem (7%). Linezolid is the only antibiotic from the Reserve group on the hospital's formulary. Antibiotic usage from the Access group was reduced by 17%, while antibiotic usage from the Watch group and the Reserve group was increased by 3% and 374%, respectively. CONCLUSIONS: The findings show a significant shift in antibiotic usage from the Access group to the Watch and Reserve groups. The Watch and Reserve groups are known to be associated with increased resistance to antibiotics. Therefore, antimicrobial stewardship should be increased and maintained during the pandemic to ensure appropriate antibiotic use.

Religious Tourists' Satisfaction with Services and Their Impacts on Spirituality in the Post-COVID-19 Era

Islamic pilgrimage has social, political, and economic benefits, but there are major challenges in the management of large numbers of groups at one time. This spiritually healing journey is likely to be influenced by the overall experience and the quality of logistical services provided while performing the rituals. In the postpandemic period, challenges were more apparent in preventing the spread of infection while maintaining acceptable levels of spiritual atmosphere. Pilgrims' characteristics might mediate or moderate the changes in spirituality based on individuals' satisfaction with service quality. In the current study, we investigated the potential service quality predictors of spiritual satisfaction among Muslim pilgrims and investigated the potential mediators and/or moderators of such relationships. The results showed that higher spirituality satisfaction scores were independently associated with enhanced satisfaction with medical services, religious guidance, and the overall Hajj experience. These relationships were not mediated by any demographic characteristics. The Hajj experience significantly moderated the relationship between satisfaction with religious guidance and spirituality. It is recommended that the national authorities should ensure the highest levels of spiritual satisfaction via improving medical and guidance services to achieve the spiritual healing of pilgrims.

Modeling the relationship between perceived service quality, tourist satisfaction, and tourists' behavioral intentions amid COVID-19 pandemic: Evidence of yoga tourists' perspectives.

Purpose: This study aims to investigate the impact of perceived service quality (PSQ) on tourist satisfaction and behavioral intentions and explore the potential mediating role of tourist satisfaction in the relationship between service quality and behavioral intentions in the yoga tourism context during the COVID-19 pandemic. Further, this is to examine to what extent yoga tourist satisfaction directly affects their behavioral intentions. Design/methodology/approach: Based on a review of literature, the study proposes a conceptual model to test four hypothesized relationships among the constructs of perceived service quality, tourist satisfaction, and behavioral intentions. Data was collected by using a self-administrated questionnaire that was developed and directed to a convenience sample of yoga tourists (380 forms). Structural equation modeling (SEM) was employed to determine the relationship between study constructs. Findings: The results of SEM illustrated that all the hypothesized relationships are supported. The findings confirm that yoga tourists' behavioral intentions are significantly affected directly and indirectly (through tourist satisfaction) by perceived service quality. Additionally, tourist satisfaction significantly partially mediates the relationship between PSQ and tourists' behavioral intentions. Research limitations: The subject of this study was yoga tourists staying in yoga retreats/studios in Egyptian destinations (South Sinai Governorate). Future research may focus on other geographical destinations and other influential variables of yoga tourists' satisfaction and behavioral intentions should be investigated. Practical implications: For improving tourists' satisfaction and behavioral intentions, yoga service providers should take care by giving tourists personalized attention, and understanding, fulfilling their specific needs. Health and hygiene practices must be considered during the COVID-19 pandemic. Originality/value: This study is perhaps the first empirical study that examines the relationship between PSQ and tourists' satisfaction and behavioral intentions in the yoga tourism context. A new integrated conceptual model that combined three service quality dimensions, namely, tangibles, intangibles as well as health and hygiene was developed and validated.

Prevalence of physical activity using validated tools among adults during the COVID-19 pandemic in the Eastern Mediterranean region: A systematic review and meta-analysis.

Many interventions have been taken around the world to limit the spread of COVID-19. These interventions have affected people's lifestyles such as physical activity. The aim of this systematic review and meta-analysis was to determine the prevalence of physical activity using validated tools among adults during the COVID-19 pandemic in the Eastern Mediterranean region. A systematic literature review and meta-analysis were conducted in October 2021. We searched three electronic databases (Web of Science, Scopus, and PubMed) for English-language original articles of observational studies (cross-sectional, case-control, and cohort studies) with original data reporting the prevalence of physical activity among adults in 22 countries from EMR during the COVID-19 pandemic. Hoy's risk of Bias tool was applied to assess the biases in individual studies. The result was reported as a percentage for prevalence. A meta-analysis was conducted using the random-effect model with a 95% confidence interval. A total of 363 articles were retrieved. Finally, 15 articles were selected and included in the statistical analysis. The selected studies included 16,585 participants. The result of the meta-analysis showed that the overall physical activity was 51.6% (95% confidence interval: 42.1, 61: p = 0.745). The result of subgroup analysis based on different tools was 60.2%, 39.5%, 36.3%, 39.4%, and 55.2% for Global Physical Activity Questionnaire , The Godin-Shephard Leisure-Time Physical Activity Questionnaire, International Physical Activity Questionnaire, International Physical Activity Questionnaire-BREF, and International Physical Activity Questionnaire-short form, respectively. Our study highlights the urgent need for large-scale measurement and reporting of physical activity and the use of standard tools that can allow for the regular assessment and screening of the PA prevalence to support evidence-informed policy and programs development at both national and regional levels.

Perceived barriers to facemask adherence in the covid-19 pandemic in Pakistan-A cross-sectional survey.

OBJECTIVE: To explore perceived barriers associated with facemask adherence to prevent spread of COVID-19 spread in Pakistani population. METHODOLOGY: A cross sectional study was conducted from 25-July 2020 to 5-August 2020. Participants of both genders of age >17 years, currently residing in Pakistan, who had access to internet and understood English were included in the survey. The survey was designed on Google form and was distributed digitally across different areas of Pakistan via social media. Survey included questions regarding socio-demographics, facemask adherence and perceived barriers related to facemask adherence such as perceived risks, health concerns, comfort, social influences, religious/cultural norms and social protocols and health recommendations. SPSS version 23 was used to analyze data. Independent t-test/One-way ANOVA was applied to assess significant difference between perceived barriers to wear face mask and socio-demographic factors, p-value ≤0.05 was taken as statistically significant. Post-hoc LSD test was also applied where applicable. RESULTS: Only 20% of the participants reported non-adherence to facemask. Amongst these participants, majority agreed that comfort was the main barrier precluding them from wearing a mask, 89.4% subjects saying that it was too hot to wear it and 84.1% saying that a mask was too uncomfortable to wear. Whereas, 82.1% highly agreed that difficulty in breathing is perceived barrier related to facemask usage. Statistically significant difference was found between health concerns with gender (p = 0.031), locality (p = 0.001) and religion (p = 0.03); comfort with locality (p = 0.007); social influences with gender (p = 0.001), ethnicity (p = 0.001) and locality (p = 0.017); cultural/religious norms with religion (p = 0.001) and social protocols and health recommendations with age (p = 0.015). CONCLUSION: Despite of satisfactory facemask adherence, still there are perceived barriers to it. In order to increase utilization of face masks among the general population, strict health policies should be implemented and awareness regarding the importance of face masks should be enhanced by educational interventions.

Family promotion of children's healthy lifestyles during the COVID‐19 pandemic in light of Saudi Vision 2030

Objective This study aims to determine the role of the family in promoting an active and healthy lifestyle for children aged 3–12 years during the COVID‐19 pandemic in the Qassim region in light of Saudi Arabia's Vision 2030 program. Background This study is important in defining the role of the family in promoting an active lifestyle for children during the COVID‐19 pandemic because the family is primarily responsible for promoting a healthy lifestyle for children. Method We evaluated responses of 320 parents completing an online survey about their children's physical health during the pandemic. Results The results showed a low level of children's physical activity and excessive use of electronic devices. Late bedtimes were evident and defined as midnight or later. As well, however, families knew the necessary information about COVID‐19 and maintained the children's preventive measures. The families were aware of the child's consumption of a healthy diet. They helped the child complete studies through distance education. The families supported the child's psychological well‐being and helped them develop some entertainment plans. Conclusions Although the family plays an important role in promoting the active and healthy lifestyle of the child, there is still a need for more awareness regarding the child's practice of physical activity, healthy sleep habits, and correct use of electronic devices. Implications Programs should be established to increase family awareness of the guidelines of the World Health Organization and the Saudi Ministry of Health regarding the child's physical activity, sleep habits, and the use of electronic devices.

Clinical Study to Evaluate the Possible Efficacy and Safety of Antibodies Combination (casirivimab and imdevimab) versus standard antiviral therapy as antiviral agent against Corona virus 2 infection in hospitalized COVID-19 patients (preprint)

Introduction Corona Virus induced disease – 2019 (COVID-19) pandemic stimulates research works to find a solution to this crisis from starting 2020 year up to now. With ending of 2021 year, various advances in pharmacotherapy against COVID-19 have emerged. Regarding antiviral therapy, Casirivimab and imdevimab antibody combination is a type of new immunotherapy against COVID-19. Standard antiviral therapy against COVID-19 includes Remdesivir and Favipravir. Aim of Study 1- To compare the efficacy of antibodies cocktail (casirivimab and imdevimab), Remdesivir and Favipravir in reducing 28-day mortality in hospitalized patients with moderate, severe or critical COVID19 2- To compare safety of antibodies cocktail (casirivimab and imdevimab), Remdesivir and Favipravir by monitoring hypersensitivity and infusion related reactions or other significant adverse effects Patients and Population 265 COVID-19 Polymerase Chain Reaction (PCR) confirmed patients with indication for antiviral therapy is included in this study and will be divided into 3 groups (1:2:2): 1- Group A: REGN3048-3051(Antibodies cocktail (casirivimab and imdevimab)) 2- group B: Remdesivir 3- group C: Favipravir Methods Study design is single blind non-Randomized Controlled Trial (non-RCT). The drugs of the study are owned by Mansoura University Hospital (MUH), and prescribed by chest diseases lectures of faculty of medicine-Mansoura University. The duration of study is about 6 months after ethical approval. Results and discussion Casirivimab and imedivimab achieves less 28-day mortality rate, less mortality at hospital discharge, more negative swab cases, less need for O2 therapy and IMV, less duration of this need, less hospital and ICU stay, less case progression as presented by lower World Health Organization (WHO) scale and better multi-organ functions as presented by lower Sequential Organ Function Assessment (SOFA) score than Remdesivir and Favipravir. Conclusion From all of these results, it is concluded that Group A (Casirivimab & imedivimab) has more favorable clinical outcomes than B (remdesivir) & C (favipravir) intervention groups.