Oil and grease, nutrient and fecal coliform contents in port dickson coastal waters improved during the year of COVID-19 pandemic

Anthropogenic activities are among major contributors to the deterioration of coastal environmental quality. Reduction of these activities could improve the status. Hence, this study was carried out to investigate temporal variations of water quality parameters of Lukut and Port Dickson coastal waters during the first year of the COVID-19 pandemic. Three sampling events were carried out between February to March 2020 (Before COVID-19 pandemic movement control order - MCO), followed by September 2020 and from March to April 2021 (After one year of the first MCO). The parameters monitored were oil and grease (OG), nitrate (NO3-N), ammoniacal nitrogen (NH3-N), unionized ammonia (NH3), phosphate (PO4-P), and fecal coliform (Escherichia coli). The OG content was reduced to more than 99%, followed by ammonia, E. coli, ammoniacal nitrogen, and nitrates which decreased by 94.65%, 91.87%, 83.64%, and 80.58%, respectively, in the third sampling. Phosphate was the only element found to increase at specific sites during the third sampling, and this was expected to be influenced by other water parameters. The improvement of water quality, especially OG, ammonia, ammoniacal nitrogen, nitrates, and E. coli concentrations in the study area, was related to the restrictive human movement associated with the COVID-19 pandemic. © 2023 Author(s).

Hybrid deep neural network for automatic detection of COVID-19 using chest x-ray images

The 2019 coronavirus (COVID-19), started in China, spreads rapidly around the entire world. In automated medical imagery diagnostic technique, due to presence of noise in medical images and use of single pre-trained model on low quality images, the existing deep network models cannot provide the optimal results with better accuracy. Hence, hybrid deep learning model of Xception model & Resnet50V2 model is proposed in this paper. This study suggests classifying X-ray images into three categories namely, normal, bacterial/viral infections and Covid positive. It utilizes CLAHE & BM3D techniques to improve visual clarity and reduce noise. Transfer learning method with variety of pre-trained models such as ResNet-50, Inception V3, VGG-16, VGG-19, ResNet50V2, and Xception are used for better feature extraction and Chest X-ray image classification. The overfitting issue were resolved using K-fold cross validation. The proposed hybrid deep learning model results high accuracy of 97.8% which is better than existing techniques.

An intelligent framework to measure the effects of COVID-19 on the mental health of medical staff.

The mental and physical well-being of healthcare workers is being affected by global COVID-19. The pandemic has impacted the mental health of medical staff in numerous ways. However, most studies have examined sleep disorders, depression, anxiety, and post-traumatic problems in healthcare workers during and after the outbreak. The study's objective is to evaluate COVID-19's psychological effects on healthcare professionals of Saudi Arabia. Healthcare professionals from tertiary teaching hospitals were invited to participate in the survey. Almost 610 people participated in the survey, of whom 74.3% were female, and 25.7% were male. The survey included the ratio of Saudi and non-Saudi participants. The study has utilized multiple machine learning algorithms and techniques such as Decision Tree (DT), Random Forest (RF), K Nearest Neighbor (KNN), Gradient Boosting (GB), Extreme Gradient Boosting (XGBoost), and Light Gradient Boosting Machine (LightGBM). The machine learning models offer 99% accuracy for the credentials added to the dataset. The dataset covers several aspects of medical workers, such as profession, working area, years of experience, nationalities, and sleeping patterns. The study concluded that most of the participants who belonged to the medical department faced varying degrees of anxiety and depression. The results reveal considerable rates of anxiety and depression in Saudi frontline workers.

Perception, views, and barriers of primary care doctors regarding screening of depression among elderly patients attending public healthcare clinics in Kuching district: a qualitative study.

INTRODUCTION: Depression in the elderly constitutes 7.3% of the total Malaysian national prevalence of depression. However, depression is commonly underdiagnosed by primary care physicians, which may impact coexisting comorbid conditions and general well-being. As depression in the elderly increases with age, its prevalence is expected to become even more significant due to the increased life expectancy and isolation during the pandemic. This study aims to determine the perceptions, views and barriers encountered among primary care physicians on screening for depression among the elderly. MATERIALS AND METHODS: This qualitative study involved five public healthcare clinics in the Kuching district with indepth interviews (IDI) conducted on 14 primary care doctors (PCDs). Semi-structured interviews and in-depth discussions were conducted via videoconferencing. One representative was selected from each clinic at initiation, followed by snowball method for subsequent subject selection until saturation of themes. Interviews were transcribed verbatim, and analysis based on framework analysis principles via NVivo software. Themes were analysed deductively according to study objectives and evidence from literature. RESULTS: Three main themes emerged from the IDI: (1) The perception of depression in elderly patients, (2) The perceived barriers to screening, and (3) The screening processes. Majority of the PCDs perceived depression as part of ageing process. Time constraints, lack of privacy in consultation rooms, dominant caregivers and failure to recognise recurrent somatic symptoms as part of depression influenced PCDs decision to screen. Screening was technically challenging for PCDs to use the DASS-21, which was not socio-culturally validated for local native population. Only 21.4% of respondents (3/14) reported screening at least three out 10 elderly patients seen over 1- month period. During the covid pandemic, due to the same human resource support and practices, most participants thought their screening for depression in elderlies had not changed. CONCLUSION: Awareness of depression among PCDs needs to be re-enforced via continuous medical education programs to use appropriate screening tools, address infrastructure related barriers to optimise screening practices. The use of appropriate locally validated and socio-culturally adapted tool is vital to correctly interpret the screening test for patients.

Knowledge and attitudes toward COVID-19 vaccination in Sudan: A cross-sectional study.

Background: Vaccines are an essential part of public health interventions to mitigate the devastating health and non-health impacts of COVID-19 pandemic. Despite the fact that Sudan launched the COVID-19 vaccination program in March 2021, only 10% of the population received their two primary doses of vaccines by the end of May 2022. This delayed uptake of vaccines obviously warrants investigation. Therefore, we have conducted this study to evaluate the knowledge, attitude and acceptance of the general population in Sudan toward COVID-19 vaccines. Methodology: A descriptive cross-sectional community-based study. The data were collected using an electronic questionnaire from 403 individuals living in Khartoum, Sudan. The data were processed using the Statistical Package for Social Sciences (SPSS), and data analysis was performed using appropriate tests. Results: 51% of the participants were found to have sufficient knowledge about the COVID-19 vaccine, and the knowledge level is higher among those educated beyond the secondary school and those who were employed. Among those unvaccinated, only 47% of the participants expressed their intention to take the vaccine when offered to them. The major reason for not trusting the vaccine is safety concerns expressed by 65.5% of the unvaccinated. Conclusion: Higher education levels and employment were associated with an increase in sufficient knowledge about the vaccine in around half of the participants. However, most of participants had not taken the vaccine at the time of the study, and the trust in vaccines is not high. Effective interventions by the health authorities are needed to address these issues in order to accelerate the COVID-19 vaccination program in Sudan.

Does COVID-19 pandemic spur digital business transformation? Evidence from selected MENA countries

PurposeIn the light of high reliance on digital technology to mitigate the consequences of the coronavirus disease 2019 (COVID-19) pandemic and its containment measures, this study investigates the factors influencing firms' decision to adopt digital technologies during COVID-19 in four Middle East and Northern African (MENA) countries, namely, Egypt, Jordan, Morocco and Tunisia.Design/methodology/approachThe study used the International Labour Organization (ILO)/Economic Research Forum (ERF) COVID-19 - MENA Monitor Enterprise Survey (CMMENT), comprising 5,480 firms, surveyed during 2020-2021. The empirical model is estimated using the linear probability model (LPM) to address the problem of unobserved heterogeneity between firms, countries, and time.FindingsThe results revealed that firm characteristics, such as firm size and foreign ownership, encourage digital transformation in the business sector. Moreover, firms that face challenges during the pandemic, comply with the containment measures, and receive government assistance are more likely to adopt digital solutions. Furthermore, the results indicated that firms operating in services sector have a higher likelihood to adopt digital technology. Disaggregating the total sample into several sub-samples, the results are robust across countries and technology types, supporting the initial hypothesis that COVID-19 encourages digital transformation in the MENA region.Originality/valueThe study has numerous contributions. First, to the best of the authors' knowledge, this is the sole study that uses micro data collected during the COVID-19 to examine the factors influencing firms' decision to adopt and invest in digital solutions in the MENA countries. Second, the paper employs the LPM estimator to address the issue of unobserved heterogeneity between firms, countries and time. Finally, the paper offers some practical recommendations for accelerating digital transformation in MENA region.

A novel precision-serology assay for SARS-CoV-2 infection based on linear B-cell epitopes of Spike protein.

Introduction: The COVID-19 pandemic illustrates the need for serology diagnostics with improved accuracy. While conventional serology based on recognition of entire proteins or subunits thereof has made significant contribution to the antibody assessment space, it often suffers from sub-optimal specificity. Epitope-based, high-precision, serology assays hold potential to capture the high specificity and diversity of the immune system, hence circumventing the cross-reactivity with closely related microbial antigens. Methods: We herein report mapping of linear IgG and IgA antibody epitopes of the SARS-CoV-2 Spike (S) protein in samples from SARS-CoV-2 exposed individuals along with certified SARS-CoV-2 verification plasma samples using peptide arrays. Results: We identified 21 distinct linear epitopes. Importantly, we showed that pre-pandemic serum samples contain IgG antibodies reacting to the majority of protein S epitopes, most likely as a result of prior infection with seasonal coronaviruses. Only 4 of the identified SARS-CoV-2 protein S linear epitopes were specific for SARS-CoV-2 infection. These epitopes are located at positions 278-298 and 550-586, just proximal and distal to the RBD, as well as at position 1134-1156 in the HR2 subdomain and at 1248-1271 in the C-terminal subdomain of protein S. To substantiate the applicability of our findings, we tested three of the high-accuracy protein S epitopes in a Luminex assay, using a certified validation plasma sample set from SARS-CoV-2 infected individuals. The Luminex results were well aligned with the peptide array results, and correlated very well with in-house and commercial immune assays for RBD, S1 and S1/S2 domains of protein S. Conclusion: We present a comprehensive mapping of linear B-cell epitopes of SARS-CoV-2 protein S, that identifies peptides suitable for a precision serology assay devoid of cross-reactivity. These results have implications for development of highly specific serology test for exposure to SARS-CoV-2 and other members of the coronaviridae family, as well as for rapid development of serology tests for future emerging pandemic threats.

A Stress-Strength Model for Measuring the Role of Gender in Covid-19 Mortality

As COVID-19 continues to spread out globally, one of the concerns in the scientific community is whether men are more likely to die from COVID-19 than women. In this paper, we try to answer this question using a copula-based stress-strength model. An application on a global dataset is given.

Examining a Moderated Serial Mediation Model of the Relationship between Phoenix Leadership Characteristics and Organizational Change

Drawing on the social exchange approach and an accompanying sub-theory pertaining to upper echelons theory, which are the most influential theories for describing the behavior of workers in the workplace, this study empirically investigates some corresponding moderated serial mediation variables, such as affective commitment, work meaningfulness, and perceived organizational support, which impact the relationship between Phoenix leadership and organizational change. A total of 150 employees working in the Sudanese Electricity Company participated in the questionnaire survey. The response rate was 88%. The results revealed that Phoenix leadership significantly influences organizational change and affective commitment. Affective commitment significantly influences work meaningfulness. Affective commitment and work meaningfulness mediate the relationship between Phoenix leadership and organizational change. Affective commitment mediates the relationship between Phoenix leadership and work meaningfulness. Work meaningfulness mediates the relationship between affective commitment and organizational change, but perceived organizational support does not moderate the relationship between work meaningfulness and organizational change. By testing the mediated moderation effects on the relationship between Phoenix leadership and organizational change, this research proposes a new framework for assessing the impact of mediators and moderators on teams of employees during the COVID-19 pandemic.(c) CIKD Publishing

Negative and positive antecedents of intention to resume hotel consumption in new normal settings in Malaysia: insight from three psychological theories

PurposeApplying three psychological theories, this study aims to attempt to investigate the role of consumer psychology, specifically the factors of trust in vaccination, threat severity, fear, anxiety, risk and hygiene, and safety, on intention to resume hotel consumption. The authors also tested the mediation effect of anxiety among psychological constructs: perceived threat, fear and risk with the intention to resume hotel consumption.Design/methodology/approachUsing purposive sampling, data were collected from 470 respondents from four cities in Malaysia and analysed by applying analysis of moment structures (AMOS) structural equation model technique. The respondents for this study were frequent travellers meaning the leisure tourists who at least travel twice a year or travel when getting the occasion to explore new things. In this study, an online survey was employed to ensure easy accessibility and to enhance the number of replies.FindingsThe results of this study confirmed that perceived severity, risk and fear influence travellers' anxiety. This study further confirms that trust in vaccination and hygiene & safety provided by the hotelier reduces anxiety levels. Anxiety is found one of the most important predictors of intention to resume hotel consumption, which further mediates the relationship between other psychological variables: perceived severity, risk, fear and intention to resume hotel consumption. Anxiety mediates the relationship between perceived severity, fear and intention to resume hotel consumption and partially mediates the association between risk and intention to resume hotel consumption.Originality/valueThis study examined three psychological theories and extended them by including the trust in vaccination and the hygiene and safety constructs. Anxiety was investigated as a mediator.

A Case Series of Kodamaea Ohmeri Infection: The Hidden Threat Unleashed

Intro: Kodamaea ohmeri, previously known as Pichia ohmeri, is an ascomycetous yeast that has emerged as an important cause of fungemia in immunocompromised patients. During the anamorphic stage this organism is also known as Candida guillermondii var. membranaefaciens. Method(s): We report five cases of Kodamaea ohmeri encountered from multicenter in Malaysia. Antifungal agent of choice will be discussed based on literature review. Finding(s): The cases were: (1) a contaminated peritoneal fluid in an adult patient on peritoneal dialysis;(2) a 60-year-old man with infected diabetic foot isolated K. ohmeri from a bone sample. Both cases discharged well without active antifungal fungal therapy. We observed fatality cases involving (3) an old man with underlying gastric adenocarcinoma who complicated with catheter- related bloodstream infection caused by K. ohmeri;(4) a patient with ventilator- associated pneumonia and septicaemic shock secondary to perforated terminal ileum;(5) and a severely ill COVID-19 stage 5b patient who passed away due to systemic fungaemia caused by K. ohmeri. Discussion(s): All three fatal cases received either amphotericin B or caspofungin as active antifungal agent. Literature evidence has shown that 40% of patient met demise despite on active antifungal agent, suggesting that currently no definitive antifungal agent proven to be a superior treatment option for K. ohmeri infection. Removal of indwelling medical device combined with antifungal therapy has favorable clinical outcome. Conclusion(s): Therefore, K. ohmeri infection in severely ill patients should be considered as a critical condition. Potential of alternative antifungal combinations need to be explored for an effective treatment option.Copyright © 2023

Detection of Leptospira DNA among Post-Mortem Specimens during Covid-19 Pandemic

Intro: Leptospirosis is an emerging zoonosis with a global health concern. In Malaysia, leptospirosis incidence remains significant, since its first gazettement as a compulsorily notifiable disease in 2010. However, the prevalence of this disease among local forensic cases is unknown. Therefore, the present study aimed to determine the frequency of human leptospirosis among post-mortem specimens. Method(s): Archived forensic specimens referred to the Institute for Medical Research (IMR), Malaysia between January 2020 and December 2021 were retrieved. DNA from the specimens were extracted using an automated MagNA Pure 96 instrument and subjected to in-house qPCR targeting LipL32 gene and 16S rRNA gene of the pathogenic group of Leptospira spp. Amplification of RNaseP gene was included as internal amplification control (IAC). Finding(s): A total of 408 forensic specimens from 365 patients were received during the study period. Majority of the specimens were blood (n = 195, 47.8%), followed by tissue (n = 136, 33.3%) and liver (n = 59, 14.5%). Of the tested specimens, 2.2% (n = 9) were positive for leptospiral DNA. These positive specimens belonged to 9 different patients, of which the vast majority were male (n = 8, 88.9%), with an average age of 37.5 years. Conclusion(s): Albeit low detection of leptospiral DNA among forensic specimens in Malaysia, this study highlighted that majority of the positive patients were males of productive age.Copyright © 2023

The Attitude of Mobile Apps and It Impact in Health and Life Services Through Pandemic (Covid-19) In Iraq National Survey

Through and after the quarantine period of the COVID-19 epidemic, Mobile Applications developed for different purposes and goals, such as contacts and patient tracing, digital services, monitoring and testing, epidemiological research, and quarantine compliance. The main aim of this study is to highlight the effect of mobile pandemic applications in Iraqi society and the trustworthiness of developers and distributors of apps. To this end, we explored differences in the attitudes of smartphone users toward pandemic apps and shared the data to conduct research. The method adopted to achieve the Survey in this study is an Email and telephone-based Survey of (318) participants adults over 18 years old in Iraq. We used a total of (315) for Statistical Analysis. This 9-item Survey examined the current use of epidemic applications, motivations for using them, trust in app distributors, data handling, willingness to share coded data with researchers using a pandemic app, attitudes toward app use among people, demographics, and personal characteristics. The results of this study showed that most participants stated they were using smartphones (307/315, 97.5), but only (77/307, 24.4) were using pandemic apps on their smartphones. Intriguingly, in this Survey, when participants asked for the preferable organizations for storing data and application division, trust in federal or state government, regional health office, public-appointed such as statutory health insurance, or government-funded organizations (research institutes) was much higher than in private organizations (private research institutions, clinics, health insurances, information technology companies). © University of Garmian. All Rights Reserved.

Production of Sars-Cov-2 Membrane Protein as Better Target Protein for Diagnostic Application

Intro: The COVID-19 pandemic is caused by the SARS-CoV-2 virus, an enveloped RNA of the coronavirus family. The advancement in molecular technology and biochemistry has accelerated the development of diagnostic reagents and assays. Much attention has been focused on the S protein, but the high mutation rate in this region could lead to false negative results. Thus, a better target protein for diagnostic application is needed for accurate detection. Method(s): Nucleotide sequences encoded for membrane (M) glycoprotein gene region of SARS-CoV-2 from Malaysian isolates were extracted from GISAID, aligned, and selected accordingly. The DNA plasmid was commercially synthesized with codon optimization for Escherichia coli (E. coli), and the presence of the M gene was confirmed by PCR. The plasmid was then transformed into E. coli. Later, the expression of M glycoprotein was induced, separated on an SDS-PAGE gel, and transferred onto a nitrocellulose membrane, followed by immunostaining. Finding(s): The analysis of the M glycoprotein against the Omicron strains demonstrated that the amino acid is conserved (99.5%). The M glycoprotein was successfully expressed and detected with antibodies from SARS-CoV-2 infected patients at ~26 kDa. The protein is currently upscale for the generation of monoclonal Ab (Mab). Discussion(s): The M protein of SARS-CoV-2 is more conserved among the virus and also has been reported to confer antigenic properties. Selection of M protein perhaps a better option compared to current detection assays that use spike (S) protein, which could lead to false negative results, as this gene region particularly the ribosome-binding domain (RBD) rapidly undergoes mutations. The utilization of M protein potentially improves negative predictive value (NPV) of the diagnostic test. Conclusion(s): Further development of diagnostic reagents is needed to improve the assay's specificity. The newly developed M protein and the MAb can be used to generate a more accurate viral detection assay.Copyright © 2023

Detoxified synthetic bacterial membrane vesicles as a vaccine platform against bacteria and SARS-CoV-2.

The development of vaccines based on outer membrane vesicles (OMV) that naturally bud off from bacteria is an evolving field in infectious diseases. However, the inherent inflammatory nature of OMV limits their use as human vaccines. This study employed an engineered vesicle technology to develop synthetic bacterial vesicles (SyBV) that activate the immune system without the severe immunotoxicity of OMV. SyBV were generated from bacterial membranes through treatment with detergent and ionic stress. SyBV induced less inflammatory responses in macrophages and in mice compared to natural OMV. Immunization with SyBV or OMV induced comparable antigen-specific adaptive immunity. Specifically, immunization with Pseudomonas aeruginosa-derived SyBV protected mice against bacterial challenge, and this was accompanied by significant reduction in lung cell infiltration and inflammatory cytokines. Further, immunization with Escherichia coli-derived SyBV protected mice against E. coli sepsis, comparable to OMV-immunized group. The protective activity of SyBV was driven by the stimulation of B-cell and T-cell immunity. Also, SyBV were engineered to display the SARS-CoV-2 S1 protein on their surface, and these vesicles induced specific S1 protein antibody and T-cell responses. Collectively, these results demonstrate that SyBV may be a safe and efficient vaccine platform for the prevention of bacterial and viral infections.

A randomized controlled trial examining the impact of low vs. moderate-intensity aerobic training in post-discharge COVID-19 older subjects.

OBJECTIVE: Post-COVID-19 patients complained of pain, fatigue, breathlessness, and reduction in quality of life which required planned intervention. This study aimed to compare the impact of 10 weeks of low vs. moderate-intensity aerobic training on physical fitness, psychological status, and quality of life in post-COVID-19 older subjects. PATIENTS AND METHODS: 72 patients were randomized into 3 equal groups, moderate-intensity exercise (MIG, n = 24), low-intensity exercise (LIG, n = 24), and control group (CG, n = 24). The exercise was done 40 min/4 times per week for 10 weeks. We measured exercise capacity using the six-minute walking test, 1 min sit-to-stand test, post-COVID-19 functional scale (PCFS), and quality of life using the SF-36 questionnaire and HAMILTON Anxiety and Depression Scale (HADS). RESULTS: There was no difference between groups regarding the demographic and most clinical characteristics of the subjects. Compared with CG there were statistically significant improvements in studying groups (MIG and LIG) with (p < 0.05) in most outcomes and the improvement was higher in MIG than in LIG in most outcomes. CONCLUSIONS: 10-week moderate-intensity and low-intensity aerobic training programs are effective with superior effect to moderate-intensity. Moderate-intensity aerobic exercise is more effective and feasible in post-discharge COVID-19 older subjects regarding exercise capacity, quality of life, and psychological status than low-intensity aerobic exercise.

Evaluation of Anxiety of Medical Personnel during the Coronavirus Outbreak in Tasikmalaya, Indonesia

Background: Coronaviruses are a large family of viruses that can cause respiratory infections. A factor that has recently caused a great deal of anxiety is anxiety associated with the coronavirus. The purpose of this study was to evaluate the level of anxiety among medical personnel exposed to the new coronavirus pandemic. Methods: This descriptive, cross-sectional research was conducted on 210 medical personnel working in hospitals and health centers in Tasikmalaya, Indonesia. Medical personnel, who were exposed to or not exposed to this disease, were included in the study through census sampling in 2021. The data collection tools used include a demographic information questionnaire and the Corona disease anxiety scale (CDAS). Data analysis was performed using ANCOVA in Excel software. Results: The mean score of anxiety of the medical personnel during the new coronavirus pandemic in Tasikmalaya was 30.02%. Furthermore, in the medical personnel, the mean score of mental symptoms (47.22%) was higher than physical symptoms (13.15%). The anxiety, and psychological, and physical symptoms scores for women was higher than for men personnel, and there was a significant difference between them (P ˂ 0.05). The demographic variables of gender (P = 0.001), work experience (P = 0.023), and number of family members (P = 0.004) had a statistically significant relationship with anxiety (P < 0.05). Conclusion: According to the results of the study, the level of anxiety among female personnel was higher than male personnel. As a result, holding training classes and stress management courses among all personnel, especially female personnel, should be considered. © 2023, Vesnu Publications. All rights reserved.

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

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

Does COVID-19 provoke aggressive form of acute mesenteric thrombosis? A comparative study

Background Coronavirus disease 2019 (COVID-19) elicits thrombotic events, among which acute mesenteric thrombosis (AMT) might be very serious. Patients and methods Eligible patients with AMT who presented to Sohag University Hospital (January 2020-August 2021) were retrospectively studied. Patients were classified into group A (without) versus group B (with) COVID-19. Group B was subdivided into B-1 with mild symptoms and B-2 with peritonitis, all received treatment according to ;damage-control' protocol. Results Fifteen patients were eligible (nine males and six females) with median age of 66 (range: 38-81) years. Group B patients (10) were admitted during the last 35% of the study period (7 months) and exhibited delayed presentation compared with group A (five patients), P value less than 0.05. In group A, three patients with arterial thrombosis underwent laparotomy during which ischemic bowel segments were resected. Two patients had venous thrombosis and recovered under therapeutic anticoagulation. All group B patients suffered from mixed pattern of AMT (arterial and venous). Group B-1 (five patients) received initially anticoagulation, which was successful in two. Peritonitis developed in three, who required either repair of small-bowel perforations or resection of gangrenous segments. All five patients in group B-2 underwent upfront laparotomy due to peritonitis, gangrenous small bowel and colon of variable lengths were found and resected. The overall mortality rate was 33.3% (five patients died). However, death rate was significantly higher in group B (40%) compared with group A (20%), P value less than 0.05. Conclusions COVID-19 triggers aggressive variety of AMT with worse clinical outcome.

Vision Transformers in medical computer vision-A contemplative retrospection

Vision Transformers (ViTs), with the magnificent potential to unravel the information contained within images, have evolved as one of the most contemporary and dominant architectures that are being used in the field of computer vision. These are immensely utilized by plenty of researchers to perform new as well as former experiments. Here, in this article, we investigate the intersection of vision transformers and medical images. We proffered an overview of various ViT based frameworks that are being used by different researchers to decipher the obstacles in medical computer vision. We surveyed the applications of Vision Transformers in different areas of medical computer vision such as image-based disease classification, anatomical structure segmentation, registration, region-based lesion detection, captioning, report generation, and reconstruction using multiple medical imaging modalities that greatly assist in medical diagnosis and hence treatment process. Along with this, we also demystify several imaging modalities used in medical computer vision. Moreover, to get more insight and deeper understanding, the self-attention mechanism of transformers is also explained briefly. Conclusively, the ViT based solutions for each image analytics task are critically analyzed, open challenges are discussed and the pointers to possible solutions for future direction are deliberated. We hope this review article will open future research directions for medical computer vision researchers.