Case report: COVID-19 infection of a transplanted heart simulating cellular rejection

Contemporary reports showed that solid organ transplanted patients who contract severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have a high mortality rate. There are sparse data about recurrent cellular rejections and the immune response to SARS-CoV-2 virus in patients following heart transplantation. Herein, we report a case of a 61-year-old male post-heart transplant patient who tested positive for COVID-19 and developed mild symptoms four months after transplantation. Thereafter, a series of endomyocardial biopsies showed histological features of acute cellular rejection despite optimal immunosuppression, good cardiac functions and hemodynamic stability. Demonstration of SARS-CoV-2 viral particles by electron microscopy in the endomyocardial biopsy confirmed the presence of the virus in the foci of the cellular rejection, pointing to a possible immunologic reactions to the virus. To our knowledge, there is limited information regarding the pathology of COVID-19 infection in immunocompromised heart transplant patients, and there are no well-established guidelines for the treatment of such patients. Based on the demonstration of SARS-CoV-2 viral particles within the myocardium, we concluded that myocardial inflammation that can be seen on endomyocardial biopsy may be attributed to the host immune response to the virus which mimics acute cellular rejection in newly heart transplant patients. We report this case to increase the awareness of such events post-transplantation, and to gain more knowledge regarding the management of patients with ongoing SARS-CoV-2 infection which proved to be challenging.

Detection of Cyberbullying Patterns in Low Resource Colloquial Roman Urdu Microtext using Natural Language Processing, Machine Learning, and Ensemble Techniques

Social media platforms have become a substratum for people to enunciate their opinions and ideas across the globe. Due to anonymity preservation and freedom of expression, it is possible to humiliate individuals and groups, disregarding social etiquette online, inevitably proliferating and diversifying the incidents of cyberbullying and cyber hate speech. This intimidating problem has recently sought the attention of researchers and scholars worldwide. Still, the current practices to sift the online content and offset the hatred spread do not go far enough. One factor contributing to this is the recent prevalence of regional languages in social media, the dearth of language resources, and flexible detection approaches, specifically for low-resource languages. In this context, most existing studies are oriented towards traditional resource-rich languages and highlight a huge gap in recently embraced resource-poor languages. One such language currently adopted worldwide and more typically by South Asian users for textual communication on social networks is Roman Urdu. It is derived from Urdu and written using a Left-to-Right pattern and Roman scripting. This language elicits numerous computational challenges while performing natural language preprocessing tasks due to its inflections, derivations, lexical variations, and morphological richness. To alleviate this problem, this research proposes a cyberbullying detection approach for analyzing textual data in the Roman Urdu language based on advanced preprocessing methods, voting-based ensemble techniques, and machine learning algorithms. The study has extracted a vast number of features, including statistical features, word N-Grams, combined n-grams, and BOW model with TFIDF weighting in different experimental settings using GridSearchCV and cross-validation techniques. The detection approach has been designed to tackle users' textual input by considering user-specific writing styles on social media in a colloquial and non-standard form. The experimental results show that SVM with embedded hybrid N-gram features produced the highest average accuracy of around 83%. Among the ensemble voting-based techniques, XGboost achieved the optimal accuracy of 79%. Both implicit and explicit Roman Urdu instances were evaluated, and the categorization of severity based on prediction probabilities was performed. Time complexity is also analyzed in terms of execution time, indicating that LR, using different parameters and feature combinations, is the fastest algorithm. The results are promising with respect to standard assessment metrics and indicate the feasibility of the proposed approach in cyberbullying detection for the Roman Urdu language.

Assessment of the levels of antispike SARS-CoV-2 IgG antibodies and their association with clinical characteristics in cohort of patients in Saudi Arabia.

Background: Coronavirus disease 2019 (COVID-19) has caused a global public health crisis. The disease is known to be caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, but the detailed characteristics of the immune response to this novel virus have not been fully elucidated yet. In this study, we aimed to determine the level of immunoglobulin G (IgG) antibodies and their correlation with clinical features at three time points postinfection in a group of patients in Saudi Arabia. Method: In this prospective observational study, we collected the demographic and clinical data from 43 polymerase chain reaction (PCR)-confirmed patients and measured the COVID-19 antispike IgG levels at three different visits. Result: The seroconversion rate after COVID-19 infection was 88.4% in the study participants, with no significant changes in the IgG levels through the three visits. The duration of shortness of breath had a significant positive correlation with the IgG level of the patients. Using the logistic regression model, participants having coughs were found to be 12.48 times more likely to develop positive IgG. The IgG levels were less in smokers than nonsmokers [Odds ratio = 6.42 (95% CI 2.11-19.48); P = 0.001]. Conclusion: Positive IgG levels have been developed in most COVID-19 patients and did not significantly change over 3 months following the diagnosis. The level of IgG antibodies was found to be significantly associated with the presence of cough, duration of shortness of breath, and the smoking habit of the patients. These findings have clinical and public health significance and need to be validated in larger studies in different populations.

Raising Awareness of Hearing and Communication Disorders Among Emergency Medical Services Students: Are Knowledge Translation Workshops Useful?

OBJECTIVE: In numerous countries, emergency medical services (EMS) students receive curriculum training in effective patient-provider communication, but most of this training assumes patients have intact communication capabilities, leading to a lack of preparedness to interact with patients, who have communication disorders. In such cases, first responders could end up delivering suboptimal care or possibly wrong procedures that could harm the disabled person. METHOD: A quasi-experimental design (pretest-posttest) was used to assess the knowledge of EMS students both before and after a translation workshop on how to deal with patients who have hearing and communication disorders during emergencies. Comparisons between pretest and posttest scores were examined using the Wilcoxon signed rank test. The level of knowledge scores was compared before and after the workshop. RESULTS: The results indicated that EMS students' scores improved after the workshop. There was a 0.763 increase in the average score of knowledge level. The results of this study show that knowledge translation workshops are a useful intervention to enhance the level of knowledge among EMS students when interacting with hearing and communication patients. CONCLUSIONS: Our results show that such training workshops lead to better performance. Communication is a vital element in a medical encounter between health care providers and patients at all levels of health care but specifically in the prehospital arena. Insufficient or lack of communication with a vulnerable population, who may suffer from various disabilities, has a significant impact on the outcome of treatment or emergency management.

Mouth rinses efficacy on salivary SARS-CoV-2 viral load: A randomized clinical trial.

Considering the global trend to confine the COVID-19 pandemic by applying various preventive health measures, preprocedural mouth rinsing has been proposed to mitigate the transmission risk of SARS-CoV-2 in dental clinics. The study aimed to investigate the effect of different mouth rinses on salivary viral load in COVID-19 patients. This study was a single-center, randomized, double-blind, six-parallel-group, placebo-controlled clinical trial that investigated the effect of four mouth rinses (1% povidone-iodine, 1.5% hydrogen peroxide, 0.075% cetylpyridinium chloride, and 80 ppm hypochlorous acid) on salivary SARS-CoV-2 viral load relative to the distilled water and no-rinse control groups. The viral load was measured by quantitative reverse transcription PCR (RT-qPCR) at baseline and 5, 30, and 60 min post rinsing. The viral load pattern within each mouth rinse group showed a reduction overtime; however, this reduction was only statistically significant in the hydrogen peroxide group. Further, a significant reduction in the viral load was observed between povidone-iodine, hydrogen peroxide, and cetylpyridinium chloride compared to the no-rinse group at 60 min, indicating their late antiviral potential. Interestingly, a similar statistically significant reduction was also observed in the distilled water control group compared to the no-rinse group at 60 min, proposing mechanical washing of the viral particles through the rinsing procedure. Therefore, results suggest using preprocedural mouth rinses, particularly hydrogen peroxide, as a risk-mitigation step before dental procedures, along with strict adherence to other infection control measures.

The Effect of COVID-19 Lockdown on Cerebrovascular Accidents, Acute Coronary Syndrome, and Diabetic Ketoacidosis Visits the Emergency Department: A Retrospective Study.

Objective This study aims to assess the effect of the COVID-19 lockdown on acute coronary syndrome (ACS), cerebrovascular accident (CVA), and diabetic ketoacidosis (DKA) visits the emergency department (ED). Methods We compared two groups of patients attending King Abdulaziz University Hospital (KAUH) ED diagnosed with one of the following ACS, CVA, or DKA; patients presenting from 21 December 2019 to 23 March 2020 and patients presenting from 23 March 2020 to 21 June 2020, representing COVID-19 pre-lockdown and during-lockdown period, respectively. The variables we analyzed were age, nationality (Saudi/non-Saudi), and gender. Results Our total sample size was 285 patient visits, ACS (n=130), CVA (n=98), and DKA (n=57). Results showed a statistically significant relationship between the number of patients with ACS and the period of visitation to ED (45.24% reduction, p-value <0.001), while CVA (18.5% reduction, p-value 0.312) and DKA (16% reduction, p-value 0.508) showed no statistically significant relationship. Conclusion A lockdown may be necessary to control a pandemic. However, it may carry potential collateral damage, such as a decrease and delay in the presentation of life-threatening conditions, which may lead to worsening outcomes. A clinical presentation of these conditions should warrant comprehensive evaluation by healthcare workers regardless of an ongoing pandemic while implementing infection control guidelines.

Post-COVID-19 Syndrome: Incidence, Risk Factor, and the Most Common Persisting Symptoms.

INTRODUCTION: The pandemic of the coronavirus disease 2019 (COVID-19) has caused a significant burden worldwide. The most common presentation of coronavirus disease is acute, and most patients recover completely. However, now a substantial proportion of patients experience long-term health effects. Post-COVID-19 syndrome (PCS) is defined as "signs and symptoms that develop after an infection consistent with COVID-19 that persist for more than 12 weeks and have not been explained yet by an alternative diagnosis." We faced a lack of studies regarding PCS in the Gulf area. Therefore, this study aimed to assess the incidence, risk factors, and most common persisting symptoms of PCS in confirmed COVID-19 patients who presented to King Abdulaziz University Hospital (KAUH) in Jeddah between June 1, 2020 and December 31, 2020. METHODS: This retrospective cohort study was conducted via telephone survey, which took place in June 2022 at KAUH. PCS was defined as the presence of one or more symptoms beyond 12 weeks from the onset of the illness. The inclusion criteria were patients aged 18 or above with laboratory-confirmed SARS-CoV-2 infection through positive RT-PCR in KAUH from June 1, 2020 to December 31, 2020, and both genders were included. The exclusion criteria were inability to provide informed consent, death, currently active COVID-19 infection (PCR +ve), and if they did not complete the interview. Medical records were obtained from patients diagnosed with COVID-19 through positive RT-PCR tests from June 1, 2020 to December 31, 2020. RESULTS: Data of 504 patients were analyzed. The incidence of PCS was 45.0% (95%CI, 40.7% to 49.5%). PCS was associated with female gender (OR = 1.71, 95%CI, 1.13 to 2.59, p = 0.011), having three or more co-morbid conditions (OR = 2.37, 95%CI, 1.19 to 4.75, p = 0.014), receiving steroids (OR = 2.13, 95%CI, 1.16 to 3.98, p = 0.016), also patients who experienced congestion (OR = 1.68, 95%CI, 1.05 to 2.71, p = 0.032) and depression (OR = 1.80, 95%CI, 1.03 to 3.18, p = 0.039) during acute COVID-19 infection. The most commonly reported symptoms beyond 12 weeks included fatigue (19.6%), joint pain (14.1%), and decreased exercise tolerance (12.7%). CONCLUSION: In conclusion, the main risk factors to develop PCS are being female, having three or more co-morbidities, receiving steroids, or patients presenting with nasal congestion and/or depression.

Prevalence, Patterns, Prognosis, and Psychosocial Impact of Olfactory and Gustative Dysfunctions Among Saudi COVID-19 Patients.

Objective The objective of this study is to estimate the prevalence of olfactory and gustative dysfunctions (OGD) and analyze their pattern and psychosocial impact among COVID-19 patients. Method A cross-sectional study was conducted among 194 confirmed COVID-19 cases at Al-Noor Specialist Hospital between 1 September 2020 and 30 September 2021. A questionnaire was translated and modified from another study to collect the baseline demographic data and medical history; characterization of smell and taste loss separately, including timing, level, practices or treatment used to restore, recovery, and symptom duration; and the psychological impact of OGD using six items to explore the multidimensional impact, such as daily activity, job performance, and social life. A four-point Likert-type agreement scale was used, and an impact score was calculated. Result As high as 97.4% and 94.8% of the participants declared having experienced a certain level of olfactory and gustative dysfunction, respectively. In the majority of these cases, the dysfunction occurred after the acute phase of the disease and persisted less than one month after onset. Social life (78.4%), job performance (64.4%), and daily life activities (42.8%) were the most frequently impacted dimensions, and 32% of the participants were deemed to have experienced a high psychosocial impact. Younger participants, females, and certain job categories were significantly more impacted than their counterparts. Conclusion OGDs are highly frequent in COVID-19 patients. They are described to be relatively severe and have frequent psychosocial impacts, notably in females and the younger age category. Further research is warranted to determine efficacious preventive and management strategies in order to prevent their long-term impact on wellbeing.

COVID-19 and Sustainable Development Goals: A Bibliometric Analysis and SWOT Analysis in Malaysian Context

The COVID-19 crisis has been a core threat to the lives of billions of individuals over the world. The COVID-19 crisis has influenced governments' aims to meet UN Sustainable Development Goals (SDGs);leading to exceptional conditions of fragility, poverty, job loss, and hunger all over the world. This study aims to investigate the current studies that concentrate on the COVID-19 crisis and its implications on SDGs using a bibliometric analysis approach. The study also deployed the Strengths, Weaknesses, Opportunities, and Threats (SWOT) approach to perform a systematic analysis of the SDGs, with an emphasis on the COVID-19 crisis impact on Malaysia. The results of the study indicated the unprecedented obstacles faced by countries to meet the UN's SDGs in terms of implementation, coordination, trade-off decisions, and regional issues. The study also stressed the impact of COVID-19 on the implementation of the SDGs focusing on the income, education, and health aspects. The outcomes highlighted the emerging opportunities of the crisis that include an improvement in the health sector, the adoption of online modes in education, the swift digital transformation, and the global focus on environmental issues. Our study demonstrated that, in the post-crisis time, the ratio of citizens in poverty could grow up more than the current national stated values. We stressed the need to design an international agreement to reconsider the implementation of SDGs, among which, are strategic schemes to identify vital and appropriate policies.

COVID-19 and sustainable development goals: A bibliometric analysis and SWOT analysis in Malaysian context.

The COVID-19 crisis has been a core threat to the lives of billions of individuals over the world. The COVID-19 crisis has influenced governments' aims to meet UN Sustainable Development Goals (SDGs); leading to exceptional conditions of fragility, poverty, job loss, and hunger all over the world. This study aims to investigate the current studies that concentrate on the COVID-19 crisis and its implications on SDGs using a bibliometric analysis approach. The study also deployed the Strengths, Weaknesses, Opportunities, and Threats (SWOT) approach to perform a systematic analysis of the SDGs, with an emphasis on the COVID-19 crisis impact on Malaysia. The results of the study indicated the unprecedented obstacles faced by countries to meet the UN's SDGs in terms of implementation, coordination, trade-off decisions, and regional issues. The study also stressed the impact of COVID-19 on the implementation of the SDGs focusing on the income, education, and health aspects. The outcomes highlighted the emerging opportunities of the crisis that include an improvement in the health sector, the adoption of online modes in education, the swift digital transformation, and the global focus on environmental issues. Our study demonstrated that, in the post-crisis time, the ratio of citizens in poverty could grow up more than the current national stated values. We stressed the need to design an international agreement to reconsider the implementation of SDGs, among which, are strategic schemes to identify vital and appropriate policies.

Advancement of management information system for discovering fraud in master card based intelligent supervised machine learning and deep learning during SARS-CoV2.

During coronavirus (SARS-CoV2) the number of fraudulent transactions is expanding at a rate of alarming (7,352,421 online transaction records). Additionally, the Master Card (MC) usage is increasing. To avoid massive losses, companies of finance must constantly improve their management information systems for discovering fraud in MC. In this paper, an approach of advancement management information system for discovering of MC fraud was developed using sequential modeling of data depend on intelligent forecasting methods such as deep Learning and intelligent supervised machine learning (ISML). The Long Short-Term Memory Network (LSTM), Logistic Regression (LR), and Random Forest (RF) were used. The dataset is separated into two parts: the training and testing data, with a ratio of 8:2. Also, the advancement of management information system has been evaluated using 10-fold cross validation depend on recall, f1-score, precision, Mean Absolute Error (MAE), Receiver Operating Curve (ROC), and Root Mean Square Error (RMSE). Finally various techniques of resampling used to forecast if a transaction of MC is genuine/fraudulent. Performance for without re-sampling, with under-sampling, and with over-sampling is measured for each Algorithm. Highest performance of without re-sampling was 0.829 for RF algorithm-F score. While for under-sampling, it was 0.871 for LSTM algorithm-RMSE. Further, for over-sampling, it was 0.921 for both RF algorithm-Precision and LSTM algorithm-F score. The results from running advancement of management information system revealed that using resampling technique with deep learning LSTM generated the best results than intelligent supervised machine learning.

Prevalence and Risk Factors of Venous Thromboembolism in Critically Ill Patients with Severe COVID-19 and the Association between the Dose of Anticoagulants and Outcomes.

Introduction: COVID-19 is characterized by a procoagulant state that increases the risk of venous and arterial thrombosis. The dose of anticoagulants in patients with severe COVID-19 pneumonia without suspected or confirmed thrombosis has been debated. Aim of the study: We evaluated the prevalence, predictors, and outcomes of venous thromboembolism (VTE) in critically ill COVID-19 patients and assessed the association between the dose of anticoagulants and outcomes. Materials and methods: This retrospective cohort included patients with COVID-19 who were admitted to the ICU between March and July 2020. Patients with clinically suspected and confirmed VTE were compared to those not diagnosed to have VTE. Results: The study enrolled 310 consecutive patients with severe COVID-19 pneumonia: age 60.0±15.1 years, 67.1% required mechanical ventilation and 44.7% vasopressors. Most (97.1%) patients received anticoagulants during ICU stay: prophylactic unfractionated heparin (N=106), standard-dose enoxaparin (N=104) and intermediate-dose enoxaparin (N=57). Limb Doppler ultrasound was performed for 49 (15.8%) patients and chest computed tomographic angiography for 62 (20%). VTE was diagnosed in 41 (13.2%) patients; 20 patients had deep vein thrombosis and 23 had acute pulmonary embolism. Patients with VTE had significantly higher D-dimer on ICU admission. On multivariable Cox regression analysis, intermediate-dose enoxaparin versus standard-dose unfractionated heparin or enoxaparin was associated with lower VTE risk (hazard ratio, 0.06; 95% confidence interval, 0.01-0.74) and lower risk of the composite outcome of VTE or hospital mortality (hazard ratio, 0.42; 95% confidence interval, 0.23-0.78; p=0.006). Major bleeding was not different between the intermediate- and prophylactic-dose heparin groups. Conclusions: In our study, clinically suspected and confirmed VTE was diagnosed in 13.2% of critically ill patients with COVID-19. Intermediate-dose enoxaparin versus standard-dose unfractionated heparin or enoxaparin was associated with decreased risk of VTE or hospital mortality.

Social anxiety in E-Learning: Scale validation and socio-demographic correlation study.

During the ongoing coronavirus disease 2019 pandemic, over 1.5 billion students worldwide have been deprived of access to traditional learning. This situation has necessitated the use of social distancing-based educational methods; consequently, a tremendous shift towards e-learning has been observed. This study assesses medical students' social anxiety levels in e-learning environments. The study was conducted in two phases. In the first phase, the original Turkish Social Anxiety Scale for E-Learning Environments (SASE) was adapted in English and tested for validity and reliability. This instrument has two subscales: social anxiety in learner-learner interaction and in learner-instructor interaction. In the second stage, we explored the associations of gender, age, and perceived academic performance with medical students' social anxiety levels in e-learning environments. A total of 325 responses were analysed. Consistent with the original version, the adapted scale is a reliable and valid measure of social anxiety in e-learning. Social anxiety in e-learning was related to gender (p = 0.008) and age (p = 0.013). Social anxiety levels were higher in students with lower perceived performance during e-learning compared to students with enhanced performance, but the difference was not significant. The SASE is a useful instrument for evaluating social anxiety in e-learning environments across English educational frameworks. Considering the shift in social interaction environments, efforts are required to reduce medical students' social anxiety levels and enhance learning.

What is the impact of eWOM in social network sites on travel decision-making during the COVID-19 outbreak? A two-stage methodology.

Social media users share a variety of information and experiences and create Electronic Word of Mouth (eWOM) in the form of positive or negative opinions to communicate with others. In the context of the COVID-19 outbreak, eWOM has been an effective tool for knowledge sharing and decision making. This research aims to reveal what factors of eWOM can influence travelers' trust in their decision-making to travel during the COVID-19 outbreak. In addition, we aim to find the relationships between trust in eWOM and perceived risk, and perceived risk and the decision to travel. These relationships are investigated based on online customers' reviews in TripAdvisor's COVID-19 forums. We use a two-stage data analysis which includes cluster analysis and structural equation modeling. In the first stage, a questionnaire survey was designed and the data was collected from 1546 respondents by referring to the COVID-19 forums on TripAdvisor. Specifically, we use k-means to segment the users' data into different groups. In the second stage, Structural Equation Modeling (SEM) was performed to inspect the relations between the variables in the hypothesized research model using a subsample of 679 respondents. The results of the first stage of the analysis showed that three segments could be discovered from the collected data for trust based on eWOM source and eWOM message attributes. These segments clearly showed that there are significant relationships between trust and perceived risk, and between perceived risk and the decision to travel. The results in all segments showed that users with a low level of trust have a high level of perceived risk and a low level of intention to travel during the COVID-19 outbreak. In addition, it was found that users with a high level of e-trust have a low level of perceived risk and a high level of intention to travel. These results were confirmed in all segments and these relationships were confirmed by SEM. The results of SEM revealed that visual and external information moderated the relationship between eWOM length and trust, and experience moderated the relationship between trust and perceived risk. For the moderating role of gender, it was found that the perceived risk has a higher impact on the decision to travel in the female sample.

Medical image processing and COVID-19: A literature review and bibliometric analysis.

COVID-19 crisis has placed medical systems over the world under unprecedented and growing pressure. Medical imaging processing can help in the diagnosis, treatment, and early detection of diseases. It has been considered as one of the modern technologies applied to fight against the COVID-19 crisis. Although several artificial intelligence, machine learning, and deep learning techniques have been deployed in medical image processing in the context of COVID-19 disease, there is a lack of research considering systematic literature review and categorization of published studies in this field. A systematic review locates, assesses, and interprets research outcomes to address a predetermined research goal to present evidence-based practical and theoretical insights. The main goal of this study is to present a literature review of the deployed methods of medical image processing in the context of the COVID-19 crisis. With this in mind, the studies available in reliable databases were retrieved, studied, evaluated, and synthesized. Based on the in-depth review of literature, this study structured a conceptual map that outlined three multi-layered folds: data gathering and description, main steps of image processing, and evaluation metrics. The main research themes were elaborated in each fold, allowing the authors to recommend upcoming research paths for scholars. The outcomes of this review highlighted that several methods have been adopted to classify the images related to the diagnosis and detection of COVID-19. The adopted methods have presented promising outcomes in terms of accuracy, cost, and detection speed.

University students' behavioral intention and gender differences toward the acceptance of shifting regular field training courses to e-training courses.

During the COVID-19 lockdown, all the courses at Imam Abdulrahman Bin Faisal University (IAU) were delivered fully online, including field-training courses. Since there was no previous experience in offering field-training courses in a distance format, the current study aims to identify factors that could impact students' behavioral intention to accept the e-training approach in teaching field training courses at IAU. In order to gather the data, the researchers designed a questionnaire based on the UTAUT model and they ensured the face, content, and construct validity of the questionnaire by sending it to five experts in the relevant field and by using exploratory factor analysis. Also, all the questionnaire's items were reliable since the Cronbach's alpha values were above 0.77 for all the items. A total of 397 participants provided valid responses. The result of this study indicated that Effort Expectancy (EE), Facilitating Condition (FC), Performance Expectancy (PE), and Social Influence (SI), respectively were the primary predictors for students' intention to use e-training. These factors explained 32.1% of the variance in students' behavioral intentions. As far as students' gender is concerned, there were significant differences between students' PE, FC, and SI. Based on these results, policymakers at IAU will have a clear image of the most essential factors that colleges should target to increase students' acceptance of e-training.

What is the impact of service quality on customers' satisfaction during COVID-19 outbreak? New findings from online reviews analysis.

The COVID-19 pandemic has caused major global changes both in the areas of healthcare and economics. This pandemic has led, mainly due to conditions related to confinement, to major changes in consumer habits and behaviors. Although there have been several studies on the analysis of customers' satisfaction through survey-based and online customers' reviews, the impact of COVID-19 on customers' satisfaction has not been investigated so far. It is important to investigate dimensions of satisfaction from the online customers' reviews to reveal their preferences on the hotels' services during the COVID-19 outbreak. This study aims to reveal the travelers' satisfaction in Malaysian hotels during the COVID-19 outbreak through online customers' reviews. In addition, this study investigates whether service quality during COVID-19 has an impact on hotel performance criteria and consequently customers' satisfaction. Accordingly, we develop a new method through machine learning approaches. The method is developed using text mining, clustering, and prediction learning techniques. We use Latent Dirichlet Allocation (LDA) for big data analysis to identify the voice-of-the-customer, Expectation-Maximization (EM) for clustering, and ANFIS for satisfaction level prediction. In addition, we use Higher-Order Singular Value Decomposition (HOSVD) for missing value imputation. The data was collected from TripAdvisor regarding the travelers' concerns in the form of online reviews on the COVID-19 outbreak and numerical ratings on hotel services from different perspectives. The results from the analysis of online customers' reviews revealed that service quality during COVID-19 has an impact on hotel performance criteria and consequently customers' satisfaction. In addition, the results showed that although the customers are always seeking hotels with better performance, they are also concerned with the quality of related services in the COVID-19 outbreak.

Covid-19 pandemic outburst in Saudi Arabia: A glimpse.

Severe Acute Respiratory Syndrome Coronavirus2 (SARS-CoV2) provoked alertness globally. Existing pandemic eruption of infections with SARS-CoV2 has been phrased as coronavirus disease 2019 (covid-19). Worldwide pneumonia outburst attributable to new SARS-CoV2 alleged to be originated in Wuhan city of China and has affectation of enormous danger regarding civic wellbeing. As of 11 March 2020, international death toll owing to outburst of new coronavirus was approximately 3,800, and about 110,000 have been declared as confirmed cases. The novel SARS-CoV2 demonstrated competence with respect to human to human communication; therefore depicted exponential intensification of cases. As of March 23, there are 374,513 collective cases of global infections; more than 16,350 deaths and number of recovered cases is 101,554. Now Europe has turn out into new epicenter of lethal coronavirus. More than one third of the covid 19 cases are currently outside China. Presently Italy is one of worst hit countries followed by Spain. The rapid global widespread of novel covid-19 viruses lead to World Health Organization (WHO) to declare outbreak as pandemic. Given to seriousness of present scenario an accurate and rapid classification of noxious pathogenic virus is important which will lend a hand in opting for best fitting drugs. The screening program will aid saving people's lives and help to put off the pandemic situation. The scientists and researchers should collaborate nationally and internationally to win the battle against novel covid-19. We aimed to represent covid 19 outburst scenario in general and Saudi Arabia in particular. This short review report very briefly highlights covid-19 syndromes; propagation; Middle East outburst, natural products as cure for viral diseases, probable psychosomatic effects, protective measures and Islamic wisdom. SARS-CoV2 is subsequent coronavirus outburst that perturbs Middle East, after SARS-CoV and MERS-CoV which has been originated in kingdom of Saudi Arabia in year 2002 and 2012 respectively. The report covers information and developments till 23rd of March 2020 on basis of current published data and studies published on different scientific web-pages.

Cardiac Surgery Services During the COVID-19 Outbreak: Surgeons' Thoughts.

Cardiac surgeons during this pandemic crisis have a responsibility to ensure that essential elective cardiac operations are provided at their centers to the public, at the same time, they have to face administrative demands as well as the infection prevention guidelines and restrictions to protect themselves and their patients. Here, we describe the patient and procedures characteristics that we recommend to protect our patients and the healthcare workers.