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INTRODUCTION: Mathematical modelling is a rapidly expanding field that offers new and interesting opportunities for both mathematicians and biologists. Concerning COVID-19, this powerful tool may help humans to prevent the spread of this disease, which has affected the livelihood of all people badly. OBJECTIVES: The main objective of this research is to explore an efficient mathematical model for the investigation of COVID-19 dynamics in a generalized fractional framework. METHODS: The new model in this paper is formulated in the Caputo sense, employs a nonlinear time-varying transmission rate, and consists of ten population classes including susceptible, infected, diagnosed, ailing, recognized, infected real, threatened, diagnosed recovered, healed, and extinct people. The existence of a unique solution is explored for the new model, and the associated dynamical behaviours are discussed in terms of equilibrium points, invariant region, local and global stability, and basic reproduction number. To implement the proposed model numerically, an efficient approximation scheme is employed by the combination of Laplace transform and a successive substitution approach; besides, the corresponding convergence analysis is also investigated. RESULTS: Numerical simulations are reported for various fractional orders, and simulation results are compared with a real case of COVID-19 pandemic in Italy. By using these comparisons between the simulated and measured data, we find the best value of the fractional order with minimum absolute and relative errors. Also, the impact of different parameters on the spread of viral infection is analyzed and studied. CONCLUSION: According to the comparative results with real data, we justify the use of fractional concepts in the mathematical modelling, for the new non-integer formalism simulates the reality more precisely than the classical framework.
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Background: COVID-19 is essentially an illness brought about by corona virus. COVID-19 is transmitted primarily by close contact between infected individuals. COVID-19 has been related to myalgia and general weakness in one-quarter to one-portion of suggestive patients. Aim(s): To recognize the number of Covid-19 recovered patients who at present complain of musculoskeletal impairments. Method(s): This was an observational study in which 181 covid-19 recovered patients were surveyed. Data was collected from different hospitals of Pakistan, throughself-made questionnaire and analyzed by SPSS version 21. Result(s): After the collection of data, gender differences exist in musculoskeletal disorders after comparison of both genders with age group 20 to 50 years with 48% are males 58% are females and pie chart shows prevalence of musculoskeletal disorders among covid-19 recovered patients. According to the findings, around 35% of 181 healed patients (with pain in their body parts) have seen a doctor in the last 6 months, while 65% have not visited a hospital to consult a doctor for MSK disease Practical Implication: Musculoskeletal impairments are leading cause of pain and disability that canlead to deformity if remain untreated or left without prior notice. As Covid-19 infection rate is getting higher day by day and till date vaccinationis not available to everyone here. We must ensure that anyone getting infected by the novel Corona can have least negative effects even after patients get cured. Conclusion(s): Gender differences exist in musculoskeletal problems. We have to compare it with Covid. Here we may say that it may be due to more stress among females, there are more chances of MSK issue among females as compared to males.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.
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The COVID-19 is a contagious viral disease, was first emerged in Wuhan, China in December 2019 and became the whole world on alert. The mortality rate in top most countries in Asia with special reference to Pakistan has been focused. Since February 26 to September 2020 the total confirmed cases and mortality rate was measured through Wikipedia and the notable journals. Iran is the only country having highest number of deaths (5.73%) followed by Indonesia (3.77%) while Saudi Arabia shows the lowest number of deaths as 1.39%. In Pakistan the first case was confirmed in 26th February, 2020. The nCov-19 has closely related to severe acute respiratory syndrome (SARS) hence SARS COV-2 was named. This virus is responsible for more than 33.9 million deaths in over all the world as of 20th September, 2020. The number of new cases is increasing time to time. Sindh province of Pakistan has reported the highest number of cases till September, 20, 2020 as compared to other parts of the country and has the highest number of death followed by Khyber Pakhtunkhwa. Because of the person to person contact the disease is spreading rapidly. The individuals who has already infected with other diseases like cancer or diabetic etc. are vulnerable. The nCOV-19 is the most contagious due to its mode of transmission. There is still no vaccine is available for the treatment of disease caused by nCoV-2019. It is therefore the only option to control this pandemic is to adopt effective preventive measures.
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COVID-19 , Pandemics , China , Humans , Pakistan/epidemiology , SARS-CoV-2ABSTRACT
In this work, a four compartmental SEIR model is constructed for the transmission of the Novel Coronavirus infectious disease using Caputo fractional derivative. The disease-free equilibrium and endemic equilibrium are investigated with the stability analysis correspondingly. The solution at different fractional orders is obtained using the Laplace Adomian Decomposition method. Furthermore, the dynamics of the proposed fractional order model are interpreted graphically to observe the behaviour of the spread of disease by altering the values of initially exposed individuals and transmission rate. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Telemedicine refers to providing healthcare from one site to another remote site, through information technologies, and has been advocated by the World Health Organisation. Telemedicine has been found to be cost-effective, reducing travel and improving satisfaction as compared to face-to-face appointments. Methods. We assessed patient satisfaction with a new Telemedicine in Addictions service as part of a feasibility randomised controlled trial of telemedicine versus face-to-face consultations (ISRCTN36756455), with addiction specialist prescribers, pre-COVID19. Opioid dependent patients prescribed opioid replacement treatment attending an outreach clinic were recruited. Telemedicine participants completed the NHS Friends and Family Test (FFT) after each consultation. We completed qualitative analysis of the free text responses. Results. Thirty Friends and Family Tests were completed, of which all participants were ‘extremely likely’ (n=19;67%) or ‘likely’ (n=11;37%) to recommend Telemedicine. Qualitative analysis themes for recommending telemedicine were ‘convenience’, ‘less travel’, ‘supportive staff’ and ‘listened to’. Patients said that everything went well, including communication. Conclusions. Our study found that patients recommend telemedicine because of convenience, less travel, good communication and supportive staff, showing this is acceptable to patients. Due to the COVID-19 pandemic, this technology will be essential for continued access to addiction services.
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Background. Nursing home residents, a vulnerable population, experienced an extraordinary surge of COVID-19 cases and deaths at the beginning of the pandemic. Multidisciplinary collaboration from the Detroit Health Department (DHD), academic centers, along with interim guidance from the CDC provided a structured approach to control SARS-CoV-2 in Detroit skilled nursing facilities (SNF). We aim to describe this model. Methods. There were 26 SNF prioritized by the DHD over a 13-month period from 3/2020 - 4/2021. Testing for SARS-CoV-2 occurred biweekly, on average, at each facility for staff and residents. Any staff or resident cases were investigated by a specialized investigations team to determine outbreak status. Any resident that was identified as positive for SARS-CoV-2 was moved to a designated in-house quarantine unit or specific COVID-19 designated nursing homes within the City of Detroit, and cohorting guidance was provided. Facilities were evaluated for environmental controls, PPE provided as needed and infection prevention guidance was provided. COVID-19 vaccination was conducted by pharmaceutical chains or the DHD and vaccine education sessions were conducted for nursing home staff and residents. Results. On average, SNF facilities served a total of 2,262 residents (2031-2367 range) and employed a total of 2,965 staff (1034-3124 range) during the period from 7/2020 - 4/2021. SARS-CoV-2 cases overall for Michigan and Detroit are shown in Figure 1. In SNF facilities, cases ranged from zero to 279 cases in residents and zero to 115 cases per week in staff (Figure 1). Beginning 3/2020, the majority of cases were residents, whereas after 10/2020, staff cases exceeded resident cases. Immunization rates were 63% (partial) and 58% (complete) for residents, and 26% and 23% for staff, respectively. Measures to reduce vaccine hesitancy included organized education sessions, messaging from trusted leaders and organized mass vaccination schedules. Conclusion. We describe the effectiveness of multidisciplinary interventions to control dissemination, morbidity and mortality of SARS-CoV-2 amongst SNF residents in Detroit. We emphasize the continued need to address vaccine hesitancy and importance of this model as successful interventions to decrease infection rates.
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Objective: The aim of this study is to compare the ICU stay and mortality in vaccinated and non-vaccinated covid-19 patients. Study Design: A Retrospective/ Comparative study Place and Duration: The study was conducted in Medicine department of Fauji Foundation Hospital Rawalpindi, duration of six months from October 2020 to March 2021. Methods: Total 120 patients of both genders had coronavirus disease were presented in this study. Patients were aged between 22-80 years. Demographical details of patients including age, sex, body mass index, residency and socio-economic status were recorded after taking informed written consent. Patients were admitted in COVID 19 ward. Chest X-rays of both groups were taken. There were 50 vaccinated patients in group I and 70 non-vaccinated patients in group II. Co-morbidities among both groups were assessed. Recovery and outcomes among both groups were calculated in terms of mortality and reduction in severity of disease. Complete data was analyzed by SPSS 24.0 version. Results: There were 80 (66.7%) patients were males (35 in group I and 45 in group II) and 40 (33.3%) were females (15 in group I and 25 in group II). Mean age of the vaccinated patients was 46.21 ±9.67 years with mean BMI 32.12 ±6.33 kg/m2 and in group II mean age was 45.13 ±21.54 years with mean BMI 33.11±11.37 kg/m2. 34 (68%) were educated in group I and in group II 35 (50%) patients were literate. Severity of disease among non-vaccinated patients was high found in 55 (78.6%) cases as compared to vaccinated cases 17 (34%). Co-morbidities were diabetes mellitus, hypertension, ischaemic heart and chronic lung disease. Most of the patients 90 (75%) had bilateral lung involvement and interstitial infiltrates 105 (87.5%). Fever, cough and dyspnea were the most common symptom found in both groups. Recovery among patients of group I was greater 40 (80%) as compared to non-vaccinated 27 (38.6%). Frequency of poor outcomes hospitalization 9 (12.9%), ICU admission 11 (15.8%) and mortality 23 (32.9%) among non-vaccinated patients were significantly higher as compared to vaccinated patients in which hospitalization 2 (4%), ICU admission 3 (6%) and mortality was found in 5 (10%) cases. Conclusion: According to the findings of this study, vaccination against coronavirus disease is both efficacious and beneficial in reducing disease severity. Except for this, immunization can reduce the frequency of poor outcomes (hospitalization, ICU admission, and mortality), and individuals should be made aware of the importance of becoming vaccinated as soon as possible.
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Objectives: Participants will review the DSM-5 Cultural Formulation Interview (CFI) and CFI Supplementary Modules to obtain a culturally informed history, including religious identification. Participants will consider the intersectional cultural identity of these youth. Participants will learn techniques to navigate culturally informed conversations about suicidality with Muslim youth and their families. Methods: A literature review was conducted to examine suicidality in Muslim youth. In addition, Sarah Arshad, MD, will share specific cases of Muslim youth from different cultural backgrounds with acute suicidality. Results: American Muslim youth come from different cultural backgrounds. Understanding their intersectional cultural identities is critical in specifically navigating their religious identity. This can then be used to understand their presentation to mental health care and how their religious identity affects their symptoms such as suicidality. For many American Muslim youth, their religious identity may be different from their families, in part due to differences in other cultural factors, such as a desire to assimilate into American cultural norms, or result in barriers to communication with families. Therefore, culturally conceptualizing the youth’s identity and navigating familial expectations can help providers consider the unique circumstances that Muslim youth face and can help providers guide culturally sensitive conversations between Muslim youth and their families. In addition, some youth can find resilience in their Muslim identity, and providers can build upon these in safety planning. Conclusions: Suicide is a leading cause of mortality in teenagers, and there have been increased rates of suicidal youth during the COVID-19 pandemic. And although religious identity in general is thought to be a protective factor, this may be more nuanced in Muslim youth. As healthcare providers, it is imperative to be able to obtain and critically use culturally informed information in evaluation and treatment planning with these youth and families. ADOL, CUL, SP
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DNA methylation (DNAm) patterns over time at 1146 CpGs on coronavirus-related genes were assessed to understand whether the varying differences in susceptibility, symptoms, and the outcomes of the SARS-CoV-2 infection in children and young adults could be explained through epigenetic alterations in a host cell's transcriptional apparatus to coronaviruses. DNAm data from the Isle of Wight birth cohort (IOWBC) at birth, 10, 18, and 26 years of age were included. Linear mixed models with repeated measurements stratified by sex were used to examine temporal patterns, and cluster analysis was performed to identify CpGs following similar patterns. CpGs on autosomes and sex chromosomes were analyzed separately. The association of identified CpGs and expression of their genes were evaluated. Pathway enrichment analyses of the genes was conducted at FDR = 0.05. DNAm at 635 of the 1146 CpGs on autosomes showed statistically significant time effects (FDR = 0.05). The 635 CpGs were classified into five clusters with each representing a unique temporal pattern of DNAm. Of the 29 CpGs on sex chromosomes, DNAm at seven CpGs in males and eight CpGs in females showed time effects (FDR = 0.05). Sex-specific and non-specific associations of DNAm with gene expression were found at 24 and 93 CpGs, respectively. Genes which mapped the 643 CpGs represent 460 biological processes. We suggest that the observed variability in DNAm with advancing age may partially explain differing susceptibility, disease severity, and mortality of coronavirus infections among different age groups.
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COVID-19/genetics , DNA Methylation , Adolescent , Adult , Child , CpG Islands , Epigenome , Female , Humans , MaleABSTRACT
Aim: To assess and compare the knowledge and attitude of medical and dental undergraduates towards COVID-19 in current setup Study Design: Cross-sectional Place and Duration of Study: Study was done at Ziauddin university Karachi during the period of October 2020 to December 2020 Methodology: Medical and dental students from 1st year to final year were enrolled in the study. Cronbach's alpha was 0.71. The questionnaire was consisting of demographic variables, questions regarding the knowledge towards COVID-19 and the attitude of medical and dental students. Analysis was done by using SPSS version-20. Frequency and percentages was used to present the categorical data. Comparison between demographic variables and knowledge score was done by using the independent t-test and one-way ANOVA test as appropriate. p-value less than 0.05 was considered as significant. Results: About 56% of participants were female and from 3rd year (25.2%). Comparing with socioeconomic status, the upper class of medical students were having higher score. As the year of study upgraded the students reported higher knowledge score with significant p-values among both medical and dental students. Medical students were having higher knowledge about COVID-19 than the dental students but dental students were having more knowledge about the safety measures. Looking over the attitude, majority of medical students were interested in gaining information about COVID-19. Conclusion: It can be concluded that medical students are having more knowledge about the COVID-19 but the dental students were more aware of the protective measure which should be taken. Both groups of medical and dental students having positive attitude towards limiting the spread of COVID-19.
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Objective: The aim of this study was to evaluate the behavior of the pharmacists and patients' satisfaction in coronavirus disease-19 pandemic in Pakistan. Materials and Methods: A total of 314 participants participated in the study by cross-sectional study design and convenient sampling technique. Data were analyzed using Statistical Package for the Social Sciences. Results: Results revealed that significant number of respondents was not fully satisfied with behavior of the pharmacists. Around half of the respondents were agreed that pharmacists dispensed the same medication as prescribed by the prescribers. Around 38.9% of respondents noticed that pharmacists were not taking keen interest in resolving their health issues. Statistically, significant association (P < 0.05) was observed among patients' overall satisfaction with pharmacists' behavior and services, and precise dispensing of medications, medications counseling, interest in resolving patients' health problems, and general attention given by the pharmacists toward patients. Conclusion: The study concluded that pharmacists should pay more attention to deal with their patients, especially during such pandemics when there is a more need of empathy and good behavior to increase patients' satisfaction and decrease health-related problems.
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Background: The clinical spectrum of the novel corona virus disease 2019 (COVID-19) ranges from mild to severe disease and death. We aim to construct a simple and novel scoring model that will predict mortality events in hospitalized COVID-19 patients. Methods: We established a retrospective cohort of 2541 patients admitted with COVID-19 from February 19, 2020 to April 28, 2020 to Henry Ford Health System, MI. Sociodemographic data, comorbidities, and clinical data were collected. Our novel SAS score was constructed using 3 easily available parameters, namely Sex, Age, and Oxygen Saturation at presentation (Table 1 and 2). Primary endpoint was mortality. Multivariate analysis with logistic regression was done and the model was assessed using receiver operating characteristic (ROC) with area under ROC (AUROC) to determine the optimal cutoff for sensitivity, specificity, and positive and negative predictive values. Results: The mean age of survivors was 61 compared to 75 years for non-survivors (standard deviation 16 vs 13.8, p< 0.0001), and 1298 (51.1%) were men. Multivariateanalysis of the SAS score adjusted for modified SOFA [Sequential organ failure assessment] score (mSOFA) showed that age (odds ratio [OR] 2.4, 95% confidence interval {CI} 2.04-2.72, p< 0.0001) and oxygen saturation (OR 1.6, 95% CI 1.27-1.98) were the most significant predictors of mortality in the model. The SAS score had an AUROC of 0.78 (95% CI 0.77-0.81) (Figure 1). A cutoff score of 3 offered the most sensitivity for predicting mortality while maintaining a negative predictive value of 95% (Table 3). Comparison of AUROC shows that SAS score adjusted to mSOFA has better diagnostic information compared to either SAS score or mSOFA alone (Figure 2). Conclusion: The easy to use SAS score at time of presentation identified hospitalized COVID-19 patients at high risk for mortality. Application of the SAS score in the emergency department may help triage patients to inpatient versus outpatient care. (Figure Presented).
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Background: During the coronavirus disease 2019 (COVID-19) surge, there was a sharp increase of blood cultures (BC) performed at Henry Ford Health System (HFHS). However, the epidemiology and outcomes of bloodstream infections (BSI) in COVID-19 patients (pts) remains undefined. We report the utilization of blood cultures, risk factors and mortality associated with BSI in a large cohort of COVID-19 pts. Methods: A retrospective analysis was performed of all COVID-19 pts that had BC performed during hospitalization at HFHS, a 5-hospital system in southeast Michigan. BSI was defined using NHSN criteria. Demographics, comorbidities, severity of illness, and outcome of pts with and without BSI were compared. Results: From 3/10/2020 to 4/28/2020, 2541 pts were hospitalized with lab-confirmed COVID-19. 1393 (55%) of these pts had BC performed and 80 (5.74%) met criteria for BSI. Of the 84 pathogens identified, Staphylococcus aureus was most common (Figure 1). As compared to 1313 COVID-19 pts without BSI, those with BSI were older (70.1 vs 64.5 years, P = 0.0024). Other factors significantly associated with BSI included chronic kidney disease, higher mSOFA score, ICU stay and mechanical ventilation (all P < 0.0001) (Table 1). Multivariate analysis revealed age (OR, 1.07 CI [1.06-1.08]), ICU stay (OR, 7.91 [CI: 5.75-10.87]) and mSOFA score (OR, 1.29 [CI: 1.13-1.47]) were independent risk factors associated with mortality. BSI was not associated with increased mortality (Table 3). Conclusion: Although more than half of hospitalized COVID-19 pts had BC done, the number of BSI were low suggesting overutilization of BC. BSI was associated with older age and disease severity. Mortality was not affected by BSI but was primarily driven by age and severity of illness. (Table Presented).
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Background: The surge of COVID-19 cases overwhelms hospital systems necessitating rapid learning of the disease process and management. During the course of a novel pandemic, multiple interventions are rapidly implemented to improve patient outcomes. When evaluating efficacy of individual interventions, one should account for the simultaneous improvements in knowledge and experience of healthcare providers (HCP), known as the maturation effect. We hypothesized that multiple processes rapidly implemented, along with the maturation effect would result in improved survival of COVID-19 patients hospitalized over the course of the pandemic. Methods: This retrospective study was done at Henry Ford Hospital (HFH), a 900-bed tertiary care facility in Detroit, Michigan. The first COVID-19 patient was hospitalized on March 10, 2020 followed by a rapid surge of cases. We evaluated the trends of in-hospital case fatality rate of COVID-19 PCR positive patients through April 28, 2020. Time-points of sequential implementation of key measures for the management of COVID-19 patients were recorded. Results: A total of 1023 COVID-19 patients were hospitalized during the study period with 165 deaths (16 %). Case fatality rate during week one was 42% and down trended over time (Figure 1). Key measures were sequentially implemented over the course of the study period as shown in Figure 1. These included development and implementation of in-house PCR testing, dedicated infectious diseases COVID-19 rounding teams, treatment guidelines and algorithms, and early steroid use in hypoxic patients. Figure 2 demonstrates that despite the surge of COVID-19 admissions, mortality continued to improve over time. Conclusion: Maturation effect takes into consideration that regardless of individual interventions, HCP improve their knowledge of the disease process and treatment over time leading to better outcomes. Our study shows the possibility of the maturation effect leading to improved survival in hospitalized COVID-19 patients. The maturation effect should be accounted for when evaluating the effect of specific interventions for COVID-19. (Table Presented).
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Objective: to determine the level of blood markers of cellular Human Cluster of Differentiation 147 (CD147) by ELISA assay. Immunological system, establishing the profile in patientsSARS-CoV-2 invades host cells via a novel route: CD147-spike protein. Methods: a case-control study including 30 patients (10 female) with SARS-CoV-2 repertory disorder whose follow-up was carried out at the outpatient clinic of the intensive care unit Service at Al Hussain Hospital, southern of Iraq, Patients were divided into three subgroups based on the onset of symptoms within the first 6 days of the acute phase of disease: subgroup A, subgroup B, and C. according to the type of drugs. Main systemic subgroup. Treatment group included 60 outpatients (25 female) being submitted to follow-up at the same hospital for non-inflammatory diseases. For determined the plasmatic levels of Human Cluster of Differentiation 147 (CD147), groups of S proteins Results: To start with, in vitro antiviral tests showed Meplazumab, infliximab and Etrolizumab an foe of CD147 adapted neutralizer, essentially hindered the infections from attacking host cells in comparison to controls, patients with presented concentrations of CD147 products (determined by plasmatic levels of S protein circulating in blood. Conclusion: our results indicate the presence of molecular SARS-CoV-2 invades respiratory cells determined by assay in patients which confirm a decrease in the defense capacity of the cellular system against toxicity induced by drugs in these patients. © 2020, Advanced Scientific Research. All rights reserved.
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Background: Verify the differences in the values of lung function test parameters in patients with COVID19 and the control subject also to demonstrate the relationship between the inflammatory values and the respiratory function test parameters in patients. Distinguishing CD4 + / CD8 + T-lymphocyte in SARS CoV-2 disease as immune cells relative with levels of alpha-tumor necrosis factor (TNF-α) are critical to the formation of granuloma and TNF-alpha inhibitors compact on a third-line dealing alternative for COVID19 patients who do not respond to conventional treatment and usage. In responders with the acute phase of respirational tract syndrome. Objective: To assess the impacts of treatment with the utilization of Infliximab as inhibitor and anti-TNF-α on respiratory tracts, insusceptible cellular, and experimental attributes of patients. Strategies: Seventeen patients with CoV-2 SARS were assessed from conventional treatment with purification bronchial test, spirometer, and CT scan can rapidly to checks initiate infliximab usage. These examinations were rehashed three weeks after each drug dose. Results: Treatment infliximab inhibitor of cytokines storm, especially activity TNF-α, was very much endured without antagonistic techniques, aside from one patient who set up a possibly unsafe occasion with liver poisonousness. Thirteen patients were named respondents, TNF-α focus kicked with high lists, diminished CD4/CD8 proportion deviation, decline CD4+ T cells interconnecting the CD38, CD69, and CD147 initiation markers, and the quantity of monocytes, ESR, neutrophil, lymphocytes, and platelets (p ≤0.05 for each parameter). The extent of T administrative cells (T-regs), characterized by FoxP3 with CD4+/CD+8 T-cells, diminished in near responders. End: a period in three weeks of treatment in with SARS-CoV-2 patients by a dose of Infliximab brought about indications of diminished CD4+ /T-cell in the respiratory tract and diminished in count monocytosis in the respondents' pulmonary system. © 2020, Advanced Scientific Research. All rights reserved.