Predictors of non-invasive ventilation failure in adult patients with cardiac dysfunction presenting with community-acquired pneumonia: an Egyptian multicenter prospective study

Non-invasive ventilation (NIV) might be successful if carefully selected in adult patients with cardiac dysfunction presenting with community-acquired pneumonia. The main objective of this study was to identify the early predictors of NIV failure. Adult patients with left ventricle ejection fraction (LV EF) <50% admitted to the intensive care unit (ICU) with community-acquired pneumonia and acute respiratory failure were enrolled in this multicenter prospective study after obtaining informed consents (study registrationID: ISRCTN14641518). Non-invasive ventilation failure was defined as the requirement of intubation after initiation of NIV. All patients were assessed using the Acute Physiology and Chronic Health Evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores at admission, while their Heart rate Acidosis Consciousness Oxygenation and Respiratory rate (HACOR) and lung ultrasound (LUS) scores in addition to blood lactate were assessed at NIV initiation and 12 and 24 hours later. A total of 177 patients were prospectively enrolled from February 2019 to July 2020. Of them, 53 (29.9%) had failed NIV. The mean age of the study cohort was 64.1+or- 12.6 years, with a male predominance (73.4%) and a mean LV EF of 36.4 +or- 7.8%. Almost 55.9% of the studied patients had diabetes mellitus, 45.8% had chronic systemic hypertension, 73.4% had ischemic heart disease, 20.3% had chronic kidney disease, and 9.6% had liver cirrhosis. No significant differences were observed between the NIV success and NIV failure groups regarding underlying morbidities or inflammatory markers. Patients who failed NIV were significantly older and had higher mean SOFA and APACHE II scores than those with successful NIV. We also found that NIV failure was associated with longer ICU stay (p < 0.001), higher SOFA scores at 48 hours (p < 0.001) and higher mortality (p < 0.001) compared with the NIV success group. In addition, SOFA (Odds Ratio (OR): 4.52, 95% Confidence Interval (CI): 2.59-7.88, p < 0.001), HACOR (OR: 2.01, 95% CI: 0.97-4.18, p = 0.036) and LUS (OR: 1.33, 95% CI: 1.014-1.106, p = 0.027) scores and blood lactate levels (OR: 9.35, 95% CI: 5.32-43.26, p < 0.001) were independent factors for NIV failure. High initial HACOR and SOFA scores, persistent hyperlactatemia and non-decrementing LUS score were associated with early NIV failure in patients with cardiac dysfunction presenting with community-acquired pneumonia, and could be used as clinical and paraclinical variables for early decision making regarding invasive ventilation.

Association between echocardiographic features and inflammatory biomarkers with clinical outcomes in COVID-19 patients in Saudi Arabia.

Background: Respiratory infections are one of the most common comorbidities identified in hospitalized patients. The coronavirus disease 2019 (COVID-19) pandemic greatly impacted healthcare systems, including acute cardiac services. Aim: This study aimed to describe the echocardiographic findings of patients with COVID-19 infections and their correlations with inflammatory biomarkers, disease severity, and clinical outcomes. Methods: This observational study was conducted between June 2021 and July 2022. The analysis included all patients diagnosed with COVID-19 who had transthoracic echocardiographic (TTE) scans within 72 h of admission. Results: The enrolled patients had a mean age of 55.6 ± 14.7 years, and 66.1% were male. Of the 490 enrolled patients, 203 (41.4%) were admitted to the intensive care unit (ICU). Pre-ICU TTE findings showed significantly higher incidence right ventricular dysfunction (28 [13.8%] vs. 23 [8.0%]; P = 0.04) and left ventricular (LV) regional wall motion abnormalities (55 [27.1%] vs. 29 [10.1%]; p < 0.001) in ICU patients compared to non-ICU patients. In-hospital mortality was 11 (2.2%), all deaths of ICU patients. The most sensitive predictors of ICU admission (p < 0.05): cardiac troponin I level (area under the curve [AUC] = 0.733), followed by hs-CRP (AUC = 0.620), creatine kinase-MB (AUC = 0.617), D-dimer (AUC = 0.599), and lactate dehydrogenase (AUC = 0.567). Binary logistic regression showed that reduced LV ejection fraction (LVEF), elevated pulmonary artery systolic pressure, and dilated right ventricle were echocardiographic predictors of poor outcomes (p < 0.05). Conclusion: Echocardiography is a valuable tool in assessing admitted patients with COVID-19. Lower LVEF, pulmonary hypertension, higher D-dimer, C-reactive protein, and B-type natriuretic peptide levels were predictors of poor outcomes.

Nursing Students' Satisfaction with Online Learning Experiences During Covid-19 Pandemic at Albaha University, Saudi Arabia

Background: The teaching process in universities had faced several challenges during the COVID-19 pandemic. As most universities have shifted to online learning, this study aimed to assess nursing students' satisfaction with online learning during the pandemic. Methods: This is a descriptive cross-sectional study;it was conducted among nursing students during the COVID-19 pandemic. The authors used an adopted online questionnaire to assess students' satisfaction. The data were analyzed by SPSS software. Results: The study found that nursing students age was mainly between 22-24 years (78.9%), both male (46.1%) and female ( 53.9%) students. The nursing students' satisfaction with online learning during COVID-19 was moderate (23.68%) to high (64.47%). A significant relationship was observed between students age and sex with satisfaction levels in online learning with a p-value less than 0.05. Conclusions: The study showed that the nursing students were satisfied with an online learning experience. Female students and those who are between 22-24 years have significantly higher levels of satisfaction.

Characteristics and outcomes of COVID-19 patients with COPD from the United States, South Korea, and Europe

Background: Characterization studies of COVID-19 patients with chronic obstructive pulmonary disease (COPD) are limited in size and scope. The aim of the study is to provide a large-scale characterization of COVID-19 patients with COPD. Methods: We included thirteen databases contributing data from January-June 2020 from North America (US), Europe and Asia. We defined two cohorts of patients with COVID-19 namely a ‘diagnosed' and ‘hospitalized' cohort. We followed patients from COVID-19 index date to 30 days or death. We performed descriptive analysis and reported the frequency of characteristics and outcomes among COPD patients with COVID-19. Results: The study included 934,778 patients in the diagnosed COVID-19 cohort and 177,201 in the hospitalized COVID-19 cohort. Observed COPD prevalence in the diagnosed cohort ranged from 3.8% (95%CI 3.5-4.1%) in French data to 22.7% (95%CI 22.4-23.0) in US data, and from 1.9% (95%CI 1.6-2.2) in South Korean to 44.0% (95%CI 43.1-45.0) in US data, in the hospitalized cohorts. COPD patients in the hospitalized cohort had greater comorbidity than those in the diagnosed cohort, including hypertension, heart disease, diabetes and obesity. Mortality was higher in COPD patients in the hospitalized cohort and ranged from 7.6% (95%CI 6.9-8.4) to 32.2% (95%CI 28.0-36.7) across databases. ARDS, acute renal failure, cardiac arrhythmia and sepsis were the most common outcomes among hospitalized COPD patients. Conclusion: COPD patients with COVID-19 have high levels of COVID-19-associated comorbidities and poor COVID-19 outcomes. Further research is required to identify patients with COPD at high risk of worse outcomes. Copyright: © 2023 Moreno-Martos D et al.

INTRODUCTION: Development and environment in the 2020s

Environmental contradictions loom larger than ever across scales, from the global coronavirus pandemic reaching into households to accelerated global climate change melting ice caps, amplifying dramatic and devastating wildfires, and flooding coasts. Environmental economics treats the environment, often conceptualized as "natural capital” as a commodity to be "priced” and factored into cost-benefit or profit equations. The idea of balance and sustainability crystalized in the Brundtland Report in 1987, where the driving notion of development and environment was utilizing the earth's natural resources for the greatest number of people in current and future generations. Political ecologists contest foldings of development and environment together and often directly address who defines and controls notions of "growth”. Eco-Marxist, green Marxist, and other related schools of thought take a different ontological approach to the relationship between people and their environment. The chapter also presents an overview on the key concepts discussed in this book. © 2022 selection and editorial matter, Brent McCusker, Waquar Ahmed, Maano Ramutsindela, and Patricia Solís;individual chapters, the contributors.

E-Learning stress and coping strategies among nursing students at Albaha University during COVID-19 pandemic, Saudi Arabia

Background/Objective: Stress is one of the serious issues that affect university student's life, its effects could be reflected in student social, academical, and mental health, thus this study is to Assess E-learning stress and coping strategies among nursing students at Al-Baha university during Pandemic COVID-19. Method(s): A descriptive cross-sectional study has been utilized in this study. It was conducted at Nursing Department, Faculty of Applied Medical Sciences at Al-Baha University, Saudi Arabia. Data was collected from 15th February to 24th March using a convenience sampling technique to select participants. A Stress Likert Scale was adopted from Smith et al., (2014) [9]. It used (29) items questionnaire to gather information regarding stress and Stress-Coping Scale which was adopted from Malik and Javed (2021) [10], consisted of 8 items which scaled. The tools were validated before collecting the required data. The data was analyzed by Statistical Package for Social Science (SPSS) version 22. Result(s): Among 110 male and female nursing students at Albaha University, the study showed that nursing students have moderate stress (30%) to high stress (22%) related to contributing factors of E-learning (35% as very stressful and 21% quite stressful), psychosocial stressors related to E-learning (12% as very stressful and 30% quite stressful), physiological stressors related to E-learning (20.67% as very stressful and 29.11% quite stressful). The used coping strategies to face stressors were taking mind off by doing something (74%), getting help from lecturer (66%), getting help from friend (60%), physical activity (54%), taking action (50%) and giving up attempts and praying (48%). The findings also showed that female nursing students have significantly higher stress compared to male students (p-value 0.03) and rural residence significantly increase stress level compared to urban residence (p-value 0.04). Conclusion(s): Nursing students have moderate to high stress, the contributing factors related to E-learning are psychosocial stressors, and physiological stressors.The students took mind off by doing something getting help from lecturer or friend, physical activity, taking action or giving up attempts or praying as coping strategies. Copyright © 2022, Bahrain Medical Bulletin. All rights reserved.

Impact of deepfake technology on FinTech applications

The distribution of fabricated disinformation through deliberate manipulation of audio/video content by imposters with the intent to affect organization is deepfake. The "infodemic" that spread alongside the COVID-19 pandemic also increased cyber risk in financial technology (FinTech) applications. The continuous evolution of cybercrime has culminated with deepfakes which severely magnify the threats of traditional frauds. Recent evidence indicates that deepfake videos are mainly created with the help of artificial intelligence (AI) or machine learning (ML) techniques. This results in creation of fake videos by merging, superimposing, and replacing actual video clips and images with other videos. There are a lot of people who accept deepfake videos as actual videos without any doubt. The use of AL and ML techniques have made video/image forgery difficult to identify with the help of existing deepfake detection techniques. Deepfake technology is becoming more and more sophisticated, and detection of fake videos is relatively challenged for quite some time. © 2023, IGI Global.

Vaccine allocation policy optimization and budget sharing mechanism using reinforcement learning

The optimal allocation of vaccines to population subgroups over time is a challenging health care management problem. In the context of a pandemic, the interaction between vaccination policies adopted by multiple agents and the cooperation (or lack thereof) creates a complex environment that affects the global transmission dynamics of the disease. In this study, we take the perspective of decision-making agents that aim to minimize the size of their susceptible populations and must allocate vaccine under limited supply. We assume that vaccine efficiency rates are unknown to agents and we propose a reinforcement learning approach based on Thompson sampling to learn mean vaccine efficiency rates over time. Furthermore, we develop a budget-balanced resource sharing mechanism to promote cooperation among agents. We apply the proposed framework to the COVID-19 pandemic. We use a raster model of the world where agents represent the main countries worldwide and interact in a global mobility network to generate multiple problem instances. Our numerical results show that the proposed vaccine allocation policy achieves a larger reduction in the number of susceptible individuals, infections and deaths globally compared to a population-based policy. In addition, we show that, under a fixed global vaccine allocation budget, most countries can reduce their national number of infections and deaths by sharing their budget with countries with which they have a relatively high mobility exchange. The proposed framework can be used to improve policy-making in health care management by national and global health authorities.

The impact of COVID-19 pandemic on type A aortic dissection care

Funding Acknowledgements Type of funding sources: None. Introduction COVID-19 created a challenging situation for cardiac surgery and associated acute care programs around the world. While non-urgent cases might be postponed, operating on life-threatening conditions, including type A aortic dissection (TAAD), must be sustained despite the ongoing pandemic. Therefore, we investigated the impact of the COVID-19 pandemic on our urgent aortic program. Methods 36 individuals presenting with TAAD in a single centre were analysed from the pre-pandemic period (2019, n=16) and the pandemic era (2020, n=20). Retrospective data review was conducted on patient characteristics, TAAD presenting symptoms, operative techniques, postoperative outcomes and length of stay. A comparison was made between both eras applying appropriate testing methods, and a p-value <0.05 was considered statistically significant. Results A 25% increase in TAAD referrals occurred during the pandemic era. Patients were featured by younger age of presentation in contrast to Western data (pre-pandemic group: 47.6 ± 18.7, and the pandemic group: 50.6 ± 16.2 years, p=0.6) but showed similar male predominance (4:1) in both groups. There was no statistical difference in baseline comorbidities between the groups. Length of hospital and intensive care unit stays were comparable between both groups. Low rates of postoperative complications were registered in both groups with no significant between-group difference. Conclusion Emergent surgical management remains essential in patients with TAAD regardless of the pandemic. Furthermore, temporary structural departmental re-configuration and optimal personal protective equipment utilisation warrant maintained satisfactory outcomes in such critical healthcare scenarios.

Magnet-related foreign body aspiration in two children requiring thoracotomy: A concerning report

With the increase in use of smaller magnets in gadgets and toys at home, magnets pose a growing aspiration risk in children. We present two simultaneous cases of magnet-related foreign body aspiration (FBA) in two children, in two different cities: Karachi, and Lahore. They presented with similar signs and symptoms: tachypnea, tachycardia and asymmetric breath sounds on auscultation. They were initially diagnosed with the help of a chest X ray. Both the cases were complicated by failed bronchoscopy attempts due to the slippery texture of the magnet. Due to the failed bronchoscopy, both patients had a prolonged and complicated course including a 24–48 hour stay in the PICU prior to magnet removal. They eventually had to undergo thoracotomy for successful removal of the magnet. Both had an unremarkable post-operative course and were discharged in good health.

Barriers to employment for refugees seeking work in the Australian construction industry: an exploratory study

Purpose>In Australia, as in many other countries, refugees are over-represented in the ranks of the unemployed, under-employed and precariously employed and often become frustrated in their attempts to secure work. Despite the construction industry being a major potential source of employment for refugees, there has been a surprising lack of research into their experiences of securing work in the industry. Addressing this gap and also the general lack of voice for refugees in construction research, the aim of this paper is to explore the barriers refugees face in securing employment in the construction industry.Design/methodology/approach>This paper reports a survey of refugees who have worked or attempted to seek work in the Australian construction industry.Findings>Results show that the main barriers to securing employment in construction are: lack of local work experience;employer discrimination;employer failure to recognise previous qualifications, skills and experience and employers not understanding the challenges they face. Government employment agencies and systems are also perceived to be of limited value and overly complex, in contrast to the activities of not-for-profit support agencies.Research limitations/implications>While the research is limited to Australia, the findings contribute an important and missing refugee dimension to the emerging body of research on construction social procurement. They also contribute unique sector-specific insights into the broader debate about refugee resettlement and employment. Further research is needed in other national contexts.Practical implications>Recommendations are made to address the barriers to employment identified including: initiatives to provide refugees with work experience in the industry;education to break-down negative stereotypes of refugees among employers;greater support for not-for-profits supporting refugees and reform of government and employment agency systems and procedures.Social implications>By enhancing understanding of the barriers to employment for refugees in construction and proposing solutions to reduce those barriers, this research contributes new insights into a growing global challenge of how we better integrate growing numbers of refugees into harmonious and prosperous societies.Originality/value>The findings are important in facilitating the smoother integration of refugees into society. Beyond the moral imperative, there are significant social, cultural and economic benefits which successful refugee integration brings to host countries and industries like construction which in many countries are now being required to employ refugees in their workforce as a condition of public sector contracts.

In Situ Calibration of Passive Samplers for Viruses in Wastewater

Wastewater surveillance for SARS-CoV-2 RNAhas rapidly developed worldwide. In low-prevalence settings, sampling in sewage networks is proposed to monitor community transmission. Passive samplers are cost-effective and suitable for catchments where autosamplers cannot be operated. This resulted in their pioneering applications in some countries, even though their sampling kinetics for viruses remains unclear. We conducted in situ calibration of passive sampling materials (membranes, swabs, gauzes, and tampons) for the uptake of pepper mild mottle virus (PMMoV), enterovirus, and human adenovirus 40/41. Passive samplers were deployed in wastewater influent and retrieved sequentially over 48 h. Membranes performed continuous sampling over 48 h with estimated linear sampling rates of 1 mL h-1 for PMMoV, 0.3 mL h-1 for enterovirus, and 33.1 mL h-1 for adenovirus. Tampons and swabs showed a rapid initial uptake of viruses and reached equilibrium after 8 h, while gauze uptake rates were potentially confounded by either inhibitors or viral losses during extended exposure. Additionally, monitoring SARS-CoV-2 at 17 sewer manholes showed that the detection ratio of membranes (14 of 17) was higher than that of tampons (8 of 17). This study demonstrated the ability of passive samplers to retain viral fragments, making them a practical tool for wastewater surveillance for the detection of disease outbreaks in communities. © 2022 American Chemical Society. All Rights Reserved.

Twitter users' coping behaviors during the COVID-19 lockdown: an analysis of tweets using mixed methods

Purpose - Using data from Twitter, the purpose of this paper is to assess the coping behaviour and reactions of social media users in response to the initial days of the COVID-19-related lockdown in different parts of the world. Design/methodology/approach - This study follows the quasi-inductive approach which allows the development of pre-categories from other theories before the sampling and coding processes begin, for use in those processes. Data was extracted using relevant keywords from Twitter, and a sample was drawn from the Twitter data set to ensure the data is more manageable from a qualitative research standpoint and that meaningful interpretations can be drawn from the data analysis results. The data analysis is discussed in two parts: extraction and classification of data from Twitter using automated sentiment analysis;and qualitative data analysis of a smaller Twitter data sample. Findings - This study found that during the lockdown the majority of users on Twitter shared positive opinions towards the lockdown. The results also found that people are keeping themselves engaged and entertained. Governments around the world have also gained support from Twitter users. This is despite the hardships being faced by citizens. The authors also found a number of users expressing negative sentiments. The results also found that several users on Twitter were fence-sitters and their opinions and emotions could swing either way depending on how the pandemic progresses and what action is taken by governments around the world. Research limitations/implications - The authors add to the body of literature that has examined Twitter discussions around H1N1 using in-depth qualitative methods and conspiracy theories around COVID-19. In the long run, the government can help citizens develop routines that help the community adapt to a new dangerous environment - this has very effectively been shown in the context of wildfires in the context of disaster management. In the context of this research, the dominance of the positive themes within tweets is promising for policymakers and governments around the world. However, sentiments may wish to be monitored going forward as large-spikes in negative sentiment may highlight lockdown-fatigue. Social implications - The psychology of humans during a pandemic can have a profound impact on how COVID-19 shapes up, and this shall also include how people behave with other people and with the larger environment. Lockdowns are the opposite of what societies strive to achieve, i.e. socializing. Originality/value - This study is based on original Twitter data collected during the initial days of the COVID-19-induced lockdown. The topic of "lockdowns" and the "COVID-19" pandemic have not been studied together thus far. This study is highly topical.

TWITTER-BASED EDUCATIONAL ACTIVITIES #MONDAYNIGHTIBD AND #SCOPINGSUNDAYS ENHANCE ENGAGEMENT IN LEARNING, IMPROVE CLINICAL PRACTICE, AND FACILITATE NETWORKING AND COLLABORATION AMONG MEMBERS OF THE GASTROENTEROLOGY COMMUNITY

Introduction The use of social media (SM) as an educational and networking platform is rapidly growing among healthcare professionals (HCPs), with Twitter being a preferred media for gastroenterologists. This has led to the development of organized gastroenterology (GI)-focused weekly Twitter chats (GIT) to promote medical education while enhancing user engagement. Methods A survey instrument was designed to evaluate the use and effectiveness of GIT as an educational resource for HCPs and to ascertain its perceived value relative to more traditional sources of education. The survey was distributed via Twitter from the official accounts of #MondayNightIBD and #ScopingSundays. Questions regarding participant demographics, area of clinical practice, participation and effectiveness of GIT were included. Level of agreement was assessed using a 5-point Likert scale. Results Of the 237 respondents, 49.8% were GI attending physicians, and 32.5% were GI fellows/trainees;75.5% currently practice in an academic medical center/hospital and 21.9% in a community hospital/private practice. 61.4% of respondents reported actively participating in GIT while 21.2% reported leading a weekly discussion/s. Regarding the impact of GIT on practice, majority of the respondents (89.1%) agreed/strongly agreed that it has improved their understanding of evidence-based treatment strategies, and their comfort level in navigating complex cases (90.3%), managing clinical scenarios not discussed in guidelines or textbooks (91.9%), and interpreting the results of new and emerging data and their implications (86.3%;Table 1). Respondents agreed/strongly agreed that GIT enhances expertise (90.3%), promotes decision making based on others’ expertise (88.9%), while also facilitating community building and /collegiality (95.3%), and networking (92.8%). Respondents selected GI journals (61.6%), GIT (62.3%), and conferences/symposia (51.9%) as the most effective tools to help improve their practice (Table 2). They also reported increasing use of the following educational platforms during the COVID-19 pandemic: SM including GIT (84.8%), webinars (80%), virtual conferences (65.8%), journals (24.1%), and podcasts (21.5%). Conclusions Among gastroenterologists who use Twitter, organized educational Twitter chats #MondayNightIBD and #ScopingSundays, rank high or highest as compared to other educational resources for evidence-based learning and clinical practice impact, while providing opportunities for community building and networking. The success of these educational platforms is likely due in part to the interactive and open access format that facilitates effective learner engagement. The use of Twitter in medical education is an emerging field of scholarship that merits further study.(Image Presented)

Analysis of the socioeconomic barriers in implementing public health measures to contain COVID-19 transmission in Pakistan: a DELPHI-DEMATEL-based approach

Purpose The present study aims to identify and evaluate the socioeconomic barriers to effective COVID-19 pandemic transmission control in Pakistan. Design/methodology/approach The study identifies multiple socio-economic barriers through an extensive literature review. The preliminary analysis unveiled 15 socio-economic barriers. Nine experts were contacted to collect data and finalize the most prominent barriers to COVID-19 transmission control using the DELPHI method. The Decision-Making Trial and Evaluation Laboratory (DEMATEL) method was used to process and interpret the data collected and a cause-effect relationship was established among the barriers. Findings The finalized barriers to effective COVID-19 pandemic transmission control were evaluated using DEMATEL which grouped criteria into two grouped criteria - cause and effect. The DEMATEL analysis shows that poor safety culture, lack of strategy and goal setting, lack of resources, late realization and recognition of the pandemic problem and lack of expertise and capacity in disaster and risk management fall into the cause group. These factors are critical as they directly affect the remaining barriers identified in the study. Originality/value Despite the collective global efforts, the national economies have been struggling to completely control COVID-19 transmission control. Pakistan's economy has been facing the third wave of the pandemic. It is mandatory to identify the barriers and evaluate them to develop a comprehensive strategy ensuring that there would be no fourth wave. The study identifies and evaluates the barriers to COVID-19 transmission control in Pakistan using the integrated DELPHI-DEMATEL framework. The findings would help the government, experts and strategists to develop a comprehensive disaster and risk management strategy.

Social network analysis of Twitter data from Pakistan during COVID-19

Purpose The use of social media has increased during the COVID-19 pandemic. Social media platforms provide opportunities to share news, ideas and personal stories. Twitter is used by citizens in Pakistan to respond and comment on emerging news stories and events. However, it is not known whether Twitter played a positive or negative role in spreading updates and preventive messages during the COVID-19 pandemic. The purpose of this study is to analyse content from Twitter during the pandemic. Design/methodology/approach NodeXL was used to retrieve data using the keyword (written in Urdu and which translates to Coronavirus). The first data set (Case Study 1) was based on 10,284 Twitter users from the end of March. The second data set (Case Study 2) was based on 10,644 Twitter users from the start of April. The theoretical lens of effective message framing was used to classify the most retweeted content on Twitter. Findings Twitter was used for personal and professional projections and included certain tweets included political motives even during the unfolding health crisis. There appeared to be very few successful attempts to use Twitter as a tool for health awareness and risk communication. The empirical findings indicate that the most retweeted messages were gain-framed and can be classified as personal, informative and political in nature. Originality/value The present study provides insights likely to be of interest to researchers, health organizations, citizens, government and politicians that are interested in making more effective use of social media for the purposes of health promotion. The authors also provide novel insights into the key topics of discussions, websites and hashtags used by Pakistani Twitter users during the COVID-19 pandemic.