COVID-19- A Challenge for Urology Subspecialty in an overwhelmed public sector hospital: A Descriptive Review of Urology Department, Lady Reading Hospital

Background: COVID-19 has brought unprecedented changes in every aspect of life throughout the world including the healthcare delivery system. After a grinding halt in surgical practice due to this pandemic, the conventional protocols needed a thorough overhaul before kick-starting formal services. This study discusses ways and procedure changes adopted at the Urology department to navigate this crisis and extend adequate urological care to patients at the same time. Aim(s): To share our experience of patient management in the era of the COVID-19 pandemic. Method(s): It's a descriptive review article based on patient management protocols and clinical audit in the era of COVID-19 pandemic at the Departmentof Urology, MTI, Lady Reading Hospital from 20th Marchto 20th June 2020. Clinical implication the benefit of this study is how to organize things and continue health care provision in a deadly pandemic. Furthermore, it will set a precedence that how to cope with such a pandemic in the future. Conclusion(s): All surgical patients should be screened for COVID-19, with preference given to PCR tests. All elective surgeries should be put on hold as a result of the limited availability of ventilators, manpower, and hospital beds. Only semi-elective, lifesaving and oncologic surgeries that cannot be delayed should be done with full PPEs provided to every personnel frequenting operating theaters during the procedure. Furthermore, more efforts are needed to lift the infrastructure of hospitals and make them capable to face problems of such proportions in the future.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

INFLUENCE OF DEATH ANXIETY ON THE PREVENTIVE PRACTICES OF HEALTHCARE PROFESSIONALS DURING COVID-19 OUTBREAK

OBJECTIVES: To ascertain the degree of death anxiety in healthcare professionals and their preventive practices during the ongoing pandemic and to find correlations between these two variables. METHODS: This cross-sectional study was conducted on healthcare professionals working in Combined Military Hospital, Lahore, Pakistan, from July 2020 to February 2021. A descriptive online questionnaire was distributed to measure demography, death anxiety using Collette-Lester Fear of Death Scale Revised and preventive practices using the prevention section of WHO European Region COVID-19 survey tool and guidance. Data were analyzed using SPSS version 24. RESULTS: Out of 136 subjects, 65 (47.8%) were male and 71 (52.2%) were female. Median (IQR) age of the participants was 28 (26-40) years. Median total degree of death anxiety was 83 (66-107). The four subscales showed Median (IQR) scores as follows: your own death 18 (12-27), your own dying 20 (15-27), the death of others 23 (18-28), and the dying of others 22 (16-29). Death anxiety was mild in 55 (40.4%), moderate in 65 (47.8%) and high in 16 (11.8%) participants. Significant association of female gender (p=0.002), experience of death of a patient (p=0.001) or loved one (p=0.001) was found with death anxiety. Zero participants recorded a high preventive practice score. CONCLUSION: A significant proportion of healthcare professionals suffered from undiagnosed moderate levels of death anxiety. The level of preventive practices amongst healthcare professionals was moderate to low. Death anxiety had no correlation with preventive practices. Further study is required to investigate the reason behind these unconventional findings. © 2022, Khyber Medical University. All rights reserved.

Cybersecurity Attacks and Vulnerabilities During COVID-19

As a result of quick transformation to digitalization for providing the employees teleworking/home office services with the capabilities to access company resources from outside the company over Internet using remote desktop and virtual private network (VPN) applications and the increase in digital activity during COVID-19 such as the usage of audio/video conferencing applications, many businesses have been victims of cyber attacks. This paper investigates whether there was an increase in the frequency of cyber attacks during COVID-19. It also identifies the motivations for such attacks in light of software/hardware/system vulnerabilities. Following this research, we also categorize vulnerabilities and develop a taxonomy. Such a taxonomy helped to identify the type of attacks on their frequency and their impact. To do that, we developed a research methodology to collect attack and vulnerability information from the selected databases. Using relevant key words, we developed the taxonomy that led us to create insightful information to answer the research questions that are thoroughly analyzed and presented accordingly. This work also recommended a list of mitigation measures that can be considered in the future to prepare the industry for a similar pandemic including establishing and maintaining a Information Security Management System (ISMS) by following relevant standards (ISO/SAE 2700x, BSI-Standards 200-x, SMEs: CISIS12®). © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Pathogenesis, Clinical Manifestation, Diagnosis, Pathological Findings, Treatment Options, Preventive Measures, and Risk Factors of COVID-19

Background: COVID-19 is an infectious disease caused by SARS-CoV-2. The disease has hit hard around the globe and is now a pandemic. As of April 01, 2020, a total of 875,560 cases have been reported and the figures are increasing day by day. Currently, there is no treatment or vaccine available for curing COVID-19 and pharmaceutical companies are racing toward the common goal of achieving the cure. Method(s): Scientific databases, including Science direct, Pub med, Elsevier, Scopus, and Nature, were explored. Data has also been accessed from case reports, newspaper reports, internet data, World Health Organisation (WHO) reports, and Centre of Disease Control (CDCs) reports. The US National Library of Medicine, Clinicaltrials.gov, were accessed to get information about the ongoing clinical trials. The literature survey started in the first week of February 2020 and was completed in the first week of April 2020. Additional literature survey was done in the second week of June 2020. Result(s): The epicentre of COVID-19 is Wuhan City, Hubei Province, China. Coronavirus belongs to Order Nidovirale and is subdivided into four groups alpha, beta, gamma, and delta. Coronavirus 229E, NL63, HKU1, MERS-CoV and SARS-CoV are known to infect humans. It is an enveloped, non-segmented positive-sense RNA virus of size 30-32 kb with several structural and accessory proteins. The pathogenesis of COVID-19 involves attachment of Spike (S) protein of SARS-CoV-2 to the angio-tensin-converting enzyme 2(ACE2) receptor present on the host cell membrane. Clinical manifestation of COVID-19 include fever, cough, complicated dyspnoea, pneumonia, etc. Real-time-PCR is a sensi-tive test for the detection of SARS-CoV. Remdesivir, Bevacizumab, Darunavir and cobicistat, lopinavir-ritonavir, Oseltamavir, hydroxychloroquine, Sarilumab, mRNA-1273, Ad5-nCoV are some of the drugs under the clinical phase of the trial. People with A-positive blood group, with comorbidities like diabe-tes, hypertension, chronic pulmonary obstructive disease, substance abuse disorders, immunocom-promised individuals, health care workers, and older adults are at high risk of getting infected with SARS-CoV-2 Conclusion(s): This article gives insight into the occurrence of COVID-19, classification and structure of SARS-CoV-2, pathogenesis, pathological findings, clinical manifestation, diagnosis, potential treatment options and prevention, and people at risk of COVID-19.Copyright © 2021 Bentham Science Publishers.

The Cancer Hub Approach for Upper Gastrointestinal Surgery During COVID-19 Pandemic: Outcomes from a UK Cancer Centre.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic caused unprecedented disruption to global healthcare delivery. In England, the majority of elective surgery was postponed or cancelled to increase intensive care capacity. Our unit instituted the 'RM Partners Cancer Hub' at the Royal Marsden Hospital in London, to deliver ongoing cancer surgery in a 'COVID-lite' setting. This article describes the operational set-up and outcomes for upper gastrointestinal (UGI) cancer resections performed during this period. METHODS: From April 2020 to April 2021, the Royal Marsden Hospital formed the RM Partners Cancer Hub. This approach was designed to coordinate resources and provide as much oncological treatment as feasible for patients across the RM Partners West London Cancer Alliance. A UGI surgical case prioritisation strategy, along with strict infection control pathways and pre-operative screening protocols, was adopted. RESULTS: A total of 231 patients underwent surgery for confirmed or suspected UGI cancer during the RM Partners Cancer Hub, with 213 completed resections and combined 90-day mortality rate of 3.5%. Good short-term survival outcomes were demonstrated with 2-year disease free survival (DFS) and overall survival (OS) for oesophageal (70.8% and 72.9%), gastric (66.7% and 83.3%) and pancreatic cancer resections (68.0% and 88.0%). One patient who developed perioperative COVID-19 during the RM Partners Cancer Hub operation made a full recovery with no lasting clinical sequelae. CONCLUSION: Our experience demonstrates that the RM Partners Cancer Hub approach is a safe strategy for continuing upper gastrointestinal (GI) resectional surgery during future periods of healthcare service disruption.

Negligible peptidome diversity of SARS-CoV-2 and its higher taxonomic ranks (preprint)

The unprecedented increase in SARS-CoV-2 sequence data limits the application of alignment-dependent approaches to study viral diversity. Herein, we applied our recently published UNIQmin, an alignment-free tool to study the protein sequence diversity of SARS-CoV-2 (sub-species) and its higher taxonomic lineage ranks (species, genus, and family). Only less than 0.5% of the reported SARS-CoV-2 protein sequences are required to represent the inherent viral peptidome diversity, which only increases to a mere ~2% at the family rank. This is expected to remain relatively the same even with further increases in the sequence data. The findings have important implications in the design of vaccines, drugs, and diagnostics, whereby the number of sequences required for consideration of such studies is drastically reduced, short-circuiting the discovery process, while still providing for a systematic evaluation and coverage of the pathogen diversity.

EFFECT OF RISK PERCEPTIONS, FEAR AND MYTHS ABOUT COVID-19 INFECTION SUSCEPTIBILITY ON PROTECTIVE BEHAVIORS IN PAKISTAN

Adoption of protective behaviours is a significant intervention to deal with the current COVID-19 outbreak, even if we get a cure. This study aimed to investigate the effect of risk perceptions, fear and myths about COVID-19 infection susceptibility on protective behaviors in the Pakistani population. An online survey was conducted in Pakistan with a sample size of N=440. A questionnaire was administered in the Urdu language about people's perceptions of risk, fear, myths, and protective behaviors about COVID-19 infection. Results revealed that perceptions of risk about COVID-19 infection susceptibility had a significant positive effect on protective behaviours. Fear about COVID-19 was significantly correlated with protective behaviors but was not a significant predictor of protective behaviors. Myths about COVID-19 infection were not a significant correlate of protective behaviors. The present sample was found optimistically biased about the susceptibility for COVID-19 infection. Surprisingly, this study provided significant evidence about the adaptive nature of optimistic bias because optimistic estimates about COVID-19 infection susceptibility were significantly predicting protective behaviors. Further studies are suggested to investigate the adoptive nature of optimistic bias related to COVID-19 infection susceptibility.

Forecasting Time Series COVID-19 Statistical Data with Auto-Regressive Integrated Moving Average and Box-Jenkins' Models

The current epidemic situation due to COVID-19 is a public health disaster worldwide. Forecasting play's, a crucial role in determining the pandemic's hypothetical situation and economic situation. It provides the base for authorities, public health officials, management teams, and other stakeholders to plan for future preventive actions in their companies, citizens, and governments. This paper proposes Auto-Regressive Integrated Moving Average mathematical modeling in integration with Box-Jenkins' model-building approach examining the variation in pandemic severity through the Loess smoothed curves to forecast the COVID-19 pandemic situation. The time-plot and forecasting results show Chinese resilience to pact with pandemic situation effectively whereas India was severely affected by the pandemic. The future forecast for India shows the worst situation by the end of 2021. Pakistan and Bangladesh are the least affected among the specified countries while decline in weekly death cases has been observed in Iran till the end of 2021. We observed the Case Fatality Ratio (CFR) of 2.08% globally. © 2021 IEEE.

Energy Efficiency in the Post-COVID-19 Era: Exploring the Determinants of Energy-Saving Intentions and Behaviors

The COVID-19 pandemic has a long-lasting influence on global economies. Households are expected to consume more electricity for their usual routine activities due to mandatory stay-at-home restrictions, resulting in greater energy utilization. The proposed study seeks to investigate the most relevant energy consumption factors amid the COVID-19 pandemic. The study employs a structural equation modeling approach to evaluate the responses from 511 Pakistani residents. Empirical results report a positive and significant association among perceived behavioral control (PBC), perceived environmental concern (PEC), perceived monitory benefits (PMB), and intention to save energy (ISE). Positive anticipated emotions (PAE) is found to be a significant predictor of ISE and energy-saving behavior (ESB). As a step further, we extend the analysis to find the moderating effect of perceived COVID-19 disruptiveness (PCD) between the relationship of ISE and ESB. Results reveal that PCD positively moderates this relationship. Based on research findings, policy implications and future research directions are provided for practitioners, researchers, and academicians to fulfill the country’s energy needs on its way to a future of sustainable development. Copyright © 2022 Ahmad, Irfan, Salem and Asif.

Shoulder Injury Related to Vaccine Administration: Diagnosis and Management.

Shoulder injury related to vaccine administration (SIRVA) is a rare but potentially debilitating injury characterized by persistent shoulder pain, typically occurring within 48 hours of intramuscular deltoid vaccine administration. With over 150 million flu vaccines being administered in the United States each year, and the US Centers for Disease Control's goal of immunizing greater than 70% of the population for the coronavirus disease 2019 virus, cases of SIRVA can be expected to rise. A search of current literature was done to identify published material corresponding to incidence, diagnosis, and treatment of SIRVA. Most events have been associated with poor needle placement and/or a local reaction to the delivered serum during vaccine administration. Shoulder injury related to vaccine administration events can lead to persistent and possibly permanent injury. Clinical evaluation involves a thorough history, physical examination, and often diagnostic studies including radiographs, magnetic resonance imaging, and nerve studies. Treatment is individually directed and should initially consist of observation and local symptom management. Recalcitrant cases or infections may warrant surgical intervention. Published outcomes vary widely, and our understanding of SIRVA remains limited. Large-scale studies are necessary to better understand the pathophysiology of SIRVA, its treatment, and its outcomes. Overall, the initial priority in managing SIRVA should be awareness and prevention.

Stewardship in the pediatrician's office: Diagnostic certainty in acute otitis media

In 2013, the AAP revised its initial 2004 guidelines to include stringent diagnostic criteria and emphasized the need for accurate diagnosis of AOM and otitis media with effusion. Multifaceted interventions that aim to change provider behavior (education, anonymous internal reporting of antimicrobial stewardship practices by physicians), change workflow (tympanometry for patients with ear pain, increasing availability of pneumatic otoscopes), educate patients (handouts, posters) and leverage technology (electronic medical record alerts, templates, decision support) may be employed. When clinicians are not confident in using a no-antibiotic strategy, a delayed antibiotics approach may be an acceptable compromise in place of immediate prescribing to significantly reduce unnecessary antibiotic use for respiratory tract infections, and thereby reduce antibiotic resistance while maintaining patient safety and satisfaction levels.

The efficacy of plasma exchange in covid-19 patients with comorbid diabetes mellitus

Objective: To explore the use of therapeutic plasma exchange as adjunctive therapy in COVID-19 patients with and without diabetes mellitus. Study Design: Prospective, observational study. Place and Duration of Study: Pakistan Emirates Military Hospital Rawalpindi, from Jan to Feb 2021. Methodology: A total of 90 male patients with laboratory-confirmed coronavirus infection were selected based on our inclusion criteria and their management and outcomes were recorded. The data were analyzed using SPSS-22 and Microsoft Excel. Results: The mortality rate was lower in patients who received 1 or more sessions of plasma exchange compared to those who did not receive plasma exchange (7.5% vs 12%). A lower mortality rate was seen in patients without diabetes who received therapeutic plasma exchange in addition to standard therapy compared to patients who received standard therapy alone (0 vs 14.82%, p=0.112). In patients with diabetes, a higher mortality rate was found in the group that had received therapeutic plasma exchange in addition to standard therapy instead of standard therapy alone (20% vs 8.7%, p=0.365). Conclusion: Overall our study supports the use of therapeutic plasma exchange in COVID-19 patients. However, although statistically insignificant, there appears to be a higher mortality rate in patients with diabetes who received therapeutic plasma exchange in addition to standard therapy. As such, we recommend further investigation of this aspect. © 2021, Army Medical College. All rights reserved.

An Alignment-Independent Approach for the Study of Viral Sequence Diversity at Any Given Rank of Taxonomy Lineage.

The study of viral diversity is imperative in understanding sequence change and its implications for intervention strategies. The widely used alignment-dependent approaches to study viral diversity are limited in their utility as sequence dissimilarity increases, particularly when expanded to the genus or higher ranks of viral species lineage. Herein, we present an alignment-independent algorithm, implemented as a tool, UNIQmin, to determine the effective viral sequence diversity at any rank of the viral taxonomy lineage. This is done by performing an exhaustive search to generate the minimal set of sequences for a given viral non-redundant sequence dataset. The minimal set is comprised of the smallest possible number of unique sequences required to capture the diversity inherent in the complete set of overlapping k-mers encoded by all the unique sequences in the given dataset. Such dataset compression is possible through the removal of unique sequences, whose entire repertoire of overlapping k-mers can be represented by other sequences, thus rendering them redundant to the collective pool of sequence diversity. A significant reduction, namely ~44%, ~45%, and ~53%, was observed for all reported unique sequences of species Dengue virus, genus Flavivirus, and family Flaviviridae, respectively, while still capturing the entire repertoire of nonamer (9-mer) viral peptidome diversity present in the initial input dataset. The algorithm is scalable for big data as it was applied to ~2.2 million non-redundant sequences of all reported viruses. UNIQmin is open source and publicly available on GitHub. The concept of a minimal set is generic and, thus, potentially applicable to other pathogenic microorganisms of non-viral origin, such as bacteria.

Viral outbreaks: A real threat to the world

Global public health is facing significant challenges in terms of emerging and re-emerging pathogens. The world is facing a new public health crisis emergence and spread of Coronaviruses outbreaks especially COVID-19 after nine deadliest viral outbreaks including Marburg virus, Ebola virus, Rabies, HIV, Smallpox, Hantavirus, Influenza, Dengue and Rotavirus. Coronaviruses (enveloped non-segmented positive-sense RNA viruses) belong to the Coronaviridae family, broadly distributed in humans as well as in other mammals. In December 2019, the COVID-19 outbreak was reported in the Wuhan, Hubei province of China. WHO confirmed that COVID-19 is associated with Huanan seafood (Wuhan). COVID-19 virus outbreak is more dangerous than its ancestors MERS-CoV and SARS-CoV. Although the case fatality rate is lower, it has alarmed the world because of its rapid spread during this era of the modern world where the whole world is connected through different channels of trade. As the world is already facing economic challenges, underdeveloped countries are not capable of facing such challenges, and this outbreak may become worse than ever before. © Advancements in Life Sciences 2020.

Investigation of hrct chest severity in patients with covid-19: A study of tertiary care hospital in pakistan

Background: High-resolution computed tomography (HRCT) chest has a key role in diagnosis COVID-19, as it provides specific imaging features, i.e., bilateral, peripheral and sub-pleural, ground-glass opacity (GGO), consolidation and many associated findings. Aim: To provide the detailed chest HRCT findings along with clinical information in patients with COVID-19. Methods: A cross-sectional study was conducted in the Department of Radiology SZPGMI, Lahore. Information on clinical data, chest radiography appearance and comorbidities were recorded ona designed proforma. HRCT chest findings were recorded in terms of pattern, distribution, laterality, and other findings. HRCT chest severity was calculated using a 25 point CT severity score. Kendall's Tau test applied to investigate the correlation between the severity of HRCT chest with clinical severity levels of COVID-19. Results: Fever (74%) was the most reported presenting symptom, followed by dry cough (70%). The majority of patients had abnormal chest X-ray (57%) as well as abnormal HRCT chest (90%). The majority of patients were in mild clinical scoring levels of disease (61%) and mild category (49%) of HRCT chest severity. In majority of the patients (46%), all five pulmonary lobes were involved, whereas the right lower lobe was most frequently affected. The pattern of ground-glass opacity (GGO) was found in 82% of patients. Most common distribution was 'peripheral', reported in 90% patients. Multiple lobe involvement was found in 82% of patients. The unilateral pulmonary involvement was observed in 12% of patients, whereas, bilateral was found in 78% of patients. Reticulations were reported in 22% followed by atelectasis in 18% patients. Conclusion: COVID-19 patients usually present with abnormal HRCT chest, mostly with a benign course. Multiple pulmonary lobes are commonly involved, especially basal lobes with ground glass opacities. Clinical severity of the disease is reflected in HRCT findings.

Impact of online teaching on BDS students

Introduction: One goal of any teaching strategy is to help students become effective learners. Many persuasive educators have suggested that the time-honored lecture is not the most productive mode for many students to learn new material. Aims and objectives: The main objective of the study is to find the impact of online teaching on learning outcomes of BDS students in Pakistani dental colleges. Material and methods: This cross sectional study was conducted in Multan Medical & Dental College Multan during from June 2020 to Sep 2020. The data was collected for measuring the learning outcomes of online teaching method for BDS students. The data was collected through questionnaire which was prepared on Google form from both male and female students. This questionnaire consist of both open-ended and closed questionnaire. Results: The data was collected from 200 dental students. The response rate were approximately 54% from both male and female students. There is no significance difference between the views of male and female students. Out of 200 participants 145 students preferred online learning, 37 for face to face learning and only 18 students preferred both online and face to face learning. Conclusion: It is concluded that due to COVID-19 students are willing to participate in online learning system but they also face issues regarding the use of technology. Online learning is not the best way of communication especially in medical and dental studies.