Relationship of clinical symptoms, comorbidities and treatment options along with disease outcomes in individuals tested for COVID-19 in Pakistan: a national survey

Background: This web-based survey is done to collect and assess data from people tested for COVID-19 with PCR in Pakistan. Methods: This 3-month study is a cross-sectional online survey, conducted by Pakistan Islamic Medical Association (PIMA), Health Research Advisory Board (HealthRAB) and National Institute of Health (NIH). Data collection was done using Google Forms. People who were tested for COVID-19 using Polymerase Chain Reaction (PCR) were included in the study. The sample size of the study was 1,537. SPSS version 22 was used for data analysis. Results: Majority of the respondents belonged to the age group 20 - 39 years. The most common symptoms found were fever 633 (41%), cough 534 (34%), generalized body aches 432 (28%) and sore throat 392 (25%). The mean COVID-19 mental health score was 3.59 (SD: 5.808, range: 0-18). Treatment with antibiotics and painkillers had a strong correlation (p-value < 0.05) with the disease outcomes. The disease outcomes had moderate correlation (p-value < 0.05) with anti-allergy, steroids, plasma and oxygen therapy, and weak correlation (p-value < 0.05) with Antiviral and Antimalarial therapy. Out of the total respondents, 561 (36.1%) were cured from COVID-19, 14 (0.9%) were expired during/after hospitalization, 15 (1%) were still infected and 962 (62%) were not infected. Conclusion: Pakistani population has a better cure rate than some of its neighboring countries. However, further research in this area is required to draw a definite conclusion.

Phages and SARS-CoV-2

The emerging human pathogenic viruses, including the recently emerged severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), have markedly affected the human health and have become a challenge for researchers worldwide. Antibiotic therapy and existing vaccines have reduced the pandemic burden to some extent. However, there is still need for efficient treatment, vaccination, and antiviral agents to control the pandemic. This chapter illustrates the role of bacteriophage in bacterial infections, SARS-COV-2 infected patients, biological activities of phages, phage display method, phages as potential inducers of antiviral immunity, phage-based vaccines, CRISPR and phage-based SARS-CoV-2 vaccines, and possible advantages of phage-based vaccines. It is concluded that phages have considerable breadth in the SARS-CoV-2 pandemic and offer many substantial advantages, such as clearing respiratory bacterial infections, which significantly reduce the burden of mortalities. Phage plays a vital role in triggering antiviral immunity by inducing cytokines such as IFN-α and IL-12. It suggests the role in driving antiviral immunity, triggering TLR3-dependent pattern recognition receptors, inhibiting TNF-driving type I IFN, inducing antiviral immunity through upregulation of the expression of defensin in IL-2, and encouraging a marked upregulation of gene hBD2 that induces virucidal effects, thus playing a key role in anti-SARS-COV-2 immunity. Moreover, phages have been presented as an alternative universal adjuvant-free nano-vaccine platform in which single-phage scaffolds are used to incorporate multiple targets. © 2023 Elsevier Inc. All rights reserved.

Natural products and SARS-CoV-2

Natural products have been proven to be the source of many antiviral drugs in the past. History has a bunch of natural products used as traditional medicine, therapies, mixtures, and oils. However, there are many bioactive natural products that need to be evaluated against severe acute respiratory syndrome (SARS-CoV-2) to curb the ongoing pandemic. Several plants and fungal-derived natural products are extensively reported with antiviral activities against SARS-CoV-2. In vitro, preliminary study assays and computational studies revealed several antiviral drugs from natural fungal compounds, including cordycepin isolated from Cordyceps militaris fungi. Polyphenolic compounds isolated from the Broussonetia papyrifera plant showed promising antiviral activity against SARS CoV-2 in in silico studies. Two alkaloid compounds, 10-hydroxyusambarensine and cryptoquindoline isolated from African medicinal plants, inhibited the main protease (Mpro) of SARS CoV-2. At the start of the COVID-19 pandemic, FDA approved the emergency use of chloroquine against SARS CoV-2;chloroquine is a derivative of alkaloid. The development of modern technologies has streamlined the discovery of new drugs from natural products. Gas chromatography–mass spectrometry, infrared radiation, nuclear magnetic resonance, high-performance thin-layer chromatography, and high-performance liquid chromatography and other high output technologies should be available for the structural interpretation and distinguishability of prudent lead molecules © 2023 Elsevier Inc. All rights reserved.

Detection of COVID-19 in High Resolution Computed Tomography Using Vision Transformer

In the current pandemic, precise and early diagnose of COVID-19 patient remained a crucial task for control of the spread of the COVID-19 virus in the healthcare sector. Due to the unexpected spike in COVID-19 cases, the majority of countries have experienced scarcity and poor testing rate. Chest X-rays and CT scans have been discussed in the literature as a viable source of testing for COVID-19 disease in patients. However, manually reviewing the CT and x-ray images is time-consuming and prone to error. Taking account into these constraints and the improvements in data science, this research proposed a Vision Transformer-based deep learning pipeline for COVID-19 diagnose from CT-based imaging. Due to the scarcity of large data sets, three open-source datasets of CT scans are pooled to generate 27370 images of covid and non- covid individuals. The proposed vision transformer-based model accurately diagnoses COVID-19 from normal chest CT images with an accuracy of 98 percent. This research would assist the practitioner, radiologist and doctors in early and accurate diagnose of COVID-19. © 2022 IEEE.

Mechanical power and 30-day mortality in mechanically ventilated, critically ill patients with and without Coronavirus Disease-2019: a hospital registry study.

BACKGROUND: Previous studies linked a high intensity of ventilation, measured as mechanical power, to mortality in patients suffering from "classic" ARDS. By contrast, mechanically ventilated patients with a diagnosis of COVID-19 may present with intact pulmonary mechanics while undergoing mechanical ventilation for longer periods of time. We investigated whether an association between higher mechanical power and mortality is modified by a diagnosis of COVID-19. METHODS: This retrospective study included critically ill, adult patients who were mechanically ventilated for at least 24 h between March 2020 and December 2021 at a tertiary healthcare facility in Boston, Massachusetts. The primary exposure was median mechanical power during the first 24 h of mechanical ventilation, calculated using a previously validated formula. The primary outcome was 30-day mortality. As co-primary analysis, we investigated whether a diagnosis of COVID-19 modified the primary association. We further investigated the association between mechanical power and days being alive and ventilator free and effect modification of this by a diagnosis of COVID-19. Multivariable logistic regression, effect modification and negative binomial regression analyses adjusted for baseline patient characteristics, severity of disease and in-hospital factors, were applied. RESULTS: 1,737 mechanically ventilated patients were included, 411 (23.7%) suffered from COVID-19. 509 (29.3%) died within 30 days. The median mechanical power during the first 24 h of ventilation was 19.3 [14.6-24.0] J/min in patients with and 13.2 [10.2-18.0] J/min in patients without COVID-19. A higher mechanical power was associated with 30-day mortality (ORadj 1.26 per 1-SD, 7.1J/min increase; 95% CI 1.09-1.46; p = 0.002). Effect modification and interaction analysis did not support that this association was modified by a diagnosis of COVID-19 (95% CI, 0.81-1.38; p-for-interaction = 0.68). A higher mechanical power was associated with a lower number of days alive and ventilator free until day 28 (IRRadj 0.83 per 7.1 J/min increase; 95% CI 0.75-0.91; p < 0.001, adjusted risk difference - 2.7 days per 7.1J/min increase; 95% CI - 4.1 to - 1.3). CONCLUSION: A higher mechanical power is associated with elevated 30-day mortality. While patients with COVID-19 received mechanical ventilation with higher mechanical power, this association was independent of a concomitant diagnosis of COVID-19.

Reference collection amidst COVID-19 pandemic: fish, crustacea, and mollusc of rumphius expeditions deposited in Ambon, Indonesia

Due to COVID-19, many scientists have to work remotely and have limited access to physical reference collections. This situation has highlighted that providing online digital content is considered one of the most effective solutions. To make materials of reference collection more accessible to scientists or researchers, we here report the Rumphius expeditions (1973 – 1980) materials to Indonesia that still remain at the Ambon Research Station or now become reference collection of Centre for Deep-Sea Research, LIPI-Ambon, Indonesia. The morphological analyses of fish, crustacea, and mollusc collected during the Rumphius expeditions revealed: 34 species from 23 different genera of fish;21 species from 19 different genera of crustacea;and 60 species from 42 different genera of mollusc. This study demonstrates the value of reference collections as a resource in marine biology science and the important role of archivists in this current pandemic situation.

Knowledge of COVID-19 and Perception Regarding Isolation, Quarantine, Social Distancing, and Community Containment During COVID-19 Pandemic Among People with Diabetes

Aim: The aim of this article is to determine knowledge level and perception about coronavirus disease 2019 (COVID-19) among people with diabetes. Materials and Methods: A cross-sectional study was conducted among 268 diabetic subjects from April 2020 to October 2020 at the outpatient department of Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan. A series of questions regarding knowledge and perception about COVID-19 were asked, and participants' demographic characteristics and source of information regarding COVID-19 were recorded and analyzed. Results: Among 268 participants, 59.7% had diabetes for more than 5 years. More than half of the subjects had heard about COVID-19 on television (63.8%). The majority of subjects had information about symptoms of COVID-19, including fever (92.2%), dry cough (79.9%), flu (78%), and shortness of breath (52.6%). Most of the participants had knowledge about preventive measures for COVID-19 such as wearing a face mask (77.6%), washing hands frequently with soap (72.8%), using hand sanitizer (72%), social distancing (47.4%), isolation and hygiene (38.8%), and quarantining (32.1%). However, less than half of the participants knew the correct meanings of social distancing (40.3%), isolation (29.1%), and quarantine (22.4%). Conclusion: Overall, most of the participants had information about common symptoms of COVID-19 including fever, dry cough, flu, and shortness of breath as they had heard about COVID-19 on television, at office, radio, and their living area. The government has taken effective measures in the prevention of COVID-19. Still, there remains a need for public awareness campaigns to combat the spread of disease.

The aftermath of COVID-19 pandemic period: barriers in implementation of social distancing at workplace

Purpose: The study aims to investigate the barriers in implementing social distancing at the workplace as an aftermath of the COVID-19 pandemic period. Design/methodology/approach: Study design consists of a review of literature, data collection and analysis. It encompasses identification, verification and analysis of the relationships among the barriers. Data have been collected from a panel of experts on matrix-type questionnaires from workplaces. Interpretive structural modeling (ISM) augmented with “Matrice d' Impacts Croise's Multiplication Appliquée a UN Classement (Cross Impact Matrix Multiplication Applied to Classification)” (MICMAC) for structural analysis. Findings: The literature has identified twenty major barriers to implementing social distancing at the workplace. The research findings reveal/show that the barrier “matter of disrespect” occupies the bottom level in the ISM model. Therefore, it is the most critical barrier;whereas, employees with disabilities and “herding culture” are crucial as they occupy the next lowest level, therefore, are crucial. Moreover, there are ten barriers positioned in the middle of the model having moderate-severe effects, and seven falls on the top level of the model having relatively less severe effects. Results of MICMAC affirm and avow the results of ISM. Research limitations/implications: The study will have profound theoretical and practical implications for stakeholders since it provides lot of new useful and valuable information, gives relational insights and determines priorities subject to usual limitations of survey research. Originality/value: It is an original attempt to make some sense of practicability of social distancing for stakeholders including policymakers, frontline health workers and public at large. © 2021, Emerald Publishing Limited.

Impact of covid-19 pandemic on well-being and mental health of business community

People around the world of developing countries have faced severe issues during this long pandemic outbreak, and harshly affected mentally, economically and socially. Financial pondering and worries have caused serious psychological and mental health problems among the people whatever is their income. Well-being and metal health of business community are the target constructs of this article to be discussed. The present study was aimed to investigate the demographical backgrounds in relationship to well-being, mental effects and financial causes. An online self-administered data was collected from a sample of population (n=100) in Timergara, Dir Lower, Khyber Pakhtunkhwa, Pakistan. We developed a study with psychometric properties of major scales included well-being, impact event on depression anxiety stress scale (DASS). The event impact was significantly, and negatively associated with wellbeing (r = -.43, p<.01), and positively associated with stress (r = .60, p<.01), anxiety (r = .60, p<.01) and depression (r = .58, p<.01). However, a negative event impact on wellbeing (B= -.23, p<.001), stress (B = .17, p<.001), anxiety (B = .16, p<.001), depression (B = .17, p<.001) was observed with a predictor (R-2) accounted on 43%, 36%, 36%, 36% of variance on outcome, respectively. The results were healthy and generalized to the population of Dir community, Pakistan, in relation to their income loss and effects on mental well-being. It could be assumed that not only ecological, climatic or any other features were the only effective responsible factors, in fact, the psychological and economic impacts seemed to be the major factors affected the most.

Impact of COVID 19 pandemic on psychological wellbeing of oncology clinicians in MENA (Middle East and North Africa) region

Background: Cancer care has been severely affected by covid 19 pandemic leading to medical, ethical and organizational issues. Oncology healthcare professionals face challenges due to reorganization of cancer services and increasing health care requirements resulting in uncertainty and psychological stress. Aim of this study is to evaluate the impact of covid 19 pandemic on psychological well being of oncology clinicians in the MENA region. Methods: We randomly invited 1500 oncology clinicians including medical oncologists, clinical oncologists, radiation oncologists and surgical oncologists from 17 countries in the MENA region to complete a web based survey to determine the level of psychological stress during covid 19 pandemic from October 2020 to January 2021. The questionnaire was based on Perceived Stress Scale (PSS), Generalized Anxiety Disorders Scale (GAD-7) and WHO Well-being Index (WHO-5). The data was analyzed using SPSS version 21 and difference between groups was measured by T-test and ANOVA. Results:Overall 520 (35%) oncology clinicians including 368 (71%) males and 152 (29%) females participated in the survey. Most of the participants were medical oncologists (38%) from teaching institutions (76%) and the public sector (84%). 46% (n = 242) participants were 35- 45 years of age. Majority of clinicians reported moderate (45.6%) to severe (42.3%) anxiety on GAD-7 scale. Females had statistically higher levels of anxiety (average score;15.46 ±4.87, p = 0.04). On PSS, the majority of participants reported higher stress with average scores (29.64 ±3.83) for males and (30.23 ±4.62) for females. Average score for WHO wellbeing index was 62.95 (±20.52) for males and 74.3 (±20.87) for females denoting a preservation of general well being, even in a higher stress and anxiety situation. Female gender was significantly associated with anxiety level on GAD- 7 scale (p = 0.04), but this difference in stress level and well being was not observed on PSS (p = 0.134) and WHO well being index (p = 0.709). Clinicians of ages 25-35 years had significantly higher anxiety levels on GAD-7 scale (p = 0.004) and higher stress on PSS (p = 0.000). Age over 55 years was associated with lower levels of anxiety and stress on GAD-7 and PSS. Oncology clinicians working in public sector experienced significantly lower stress as compared to private sector on PSS scale (p = 0.041) Conclusions: Covid 19 pandemic has significantly increased the anxiety and stress levels among oncology clinicians in the MENA region. Anxiety and stress were higher in females and young clinicians. Clinicians over 55 years of age and oncologists working in the public sector reported less stress and anxiety. General well being of clinicians was well preserved even in a highly stressful and anxious situation.

Covid-19 associated acute respiratory distress syndrome, treated with tissue plasminogen activator, as a compassionate salvage therapy

Introduction: The association of diffuse pulmonary micro and macro thrombi is well established in acute respiratory distress syndrome (ARDS). Similar pathological findings are observed in COVID-19 related pulmonary injury. Herein, we present a COVID-19 induced respiratory failure case, treated with unconventional tissue plasminogen activator (tPA) infusion therapy, which led to remarkable hypoxemia improvement. Case description: 53-year-old male, a former smoker, presented with fever, cough, and shortness of breath. He tested positive for COVID-19 and was found to have bilateral lower lobe consolidation on Chest CT and elevated inflammatory markers. The patient was started on therapeutic anticoagulation with enoxaparin. The patient was hypoxic, requiring 6 liters oxygen supplementation via nasal cannula initially, but on day 9, he developed worsening hypoxic respiratory failure requiring 100 % High-flow nasal cannula (HFNC) oxygen supplementation without significant change in radiological findings compared to prior imaging. A spike in D dimer levels was appreciated as well, from 2600 to 10,000 ng/mL. The decision was made to administer tPA 25 mg over 2 hours, followed by a 25 mg tPA infusion administered over the next 22 hours. Therapeutic enoxaparin was restarted afterwards. His oxygenation status improved after the bolus dose and required 50 % HFNC. On day 2 of administration, the patient's hypoxemia dramatically improved, and the patient was saturating 96% with 3 liters of oxygen supplementation. Discussion: Our patient developed refractory hypoxemia which couldn't be explained by radiographic findings and combined with a spike in D dimer, suggested a high thrombotic burden in the pulmonary circulation which prompted us to consider low dose tPA as a salvage therapy. Dramatic improvement of hypoxemia post tPA administration confirmed our suspicion. Multiple case series in mechanically ventilated and non-mechanically ventilated patients with COVID-19 associated ARDS, have shown mortality benefit after tPA infusion. However not commonly used in view of the potential adverse effect of life-threatening bleed. Our case highlights the fact that, in spite of absence of randomized evidence, tPA may be used as a compassionate salvage therapy, if no contraindications exist.

A Novel Ensemble Machine Learning Method to Detect Phishing Attack

Currently and particularly with remote working scenarios during COVID-19, phishing attack has become one of the most significant threats faced by internet users, organizations, and service providers. In a phishing attack, the attacker tries to steal client sensitive data (such as login, passwords, and credit card details) using spoofed emails and fake websites. Cybercriminals, hacktivists, and nation-state spy agencies have now got a fertilized ground to deploy their latest innovative phishing attacks. Timely detection of phishing attacks has become most crucial than ever. Machine learning algorithms can be used to accurately detect phishing attacks before a user is harmed. This paper presents a novel ensemble model to detect phishing attacks on the website. We select three machine learning classifiers: Artificial Neural Network (ANN), K-Nearest Neighbors (KNN), and Decision Tree (C4.5) to use in an ensemble method with Random Forest Classifier (RFC). This ensemble method effectively detects website phishing attacks with better accuracy than existing studies. Experimental results demonstrate that the ensemble of KNN and RFC detects phishing attacks with 97.33% accuracy. © 2020 IEEE.

A case of acute pancreatitis associated with the novel severe acute respiratory syndrome coronavirus-2

INTRODUCTION: Acute pancreatitis is a frequent cause of hospital admissions. The most common causes are gallstones and alcohol, while 10% are infectious. To our knowledge, we present the 4th case of acute pancreatitis caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV2). CASE DESCRIPTION/METHODS: A 60-year-old African American male with uncontrolled hypertension presented with weakness and nausea for one week. He denied alcohol use, herbal medications and reported non-compliance to his prescribed medications. Vitals: BP 188/98 mmHg, HR 110/min. Physical exam revealed epigastric tenderness. Labs were significant for positive SARS-CoV- 2, T bili:0.3mg/dl, IGG:1145mg/dl, IGM: 77mg/dl, calcium:8.3mg/dl, triglyceride:440mg/dl, Lipase 4800U/L and D-Dimer 2418 ng/ml. Ultrasound abdomen was negative for gallstones.CT abdomen revealed peripancreatic fat stranding. He was started on intravenous hydration and oxygen supplementation. His abdominal pain resolved and he tolerated a normal solid diet. He had a prolonged hospital course due to increasing oxygen requirements. Repeat imaging revealed possible pancreatic pseudocyst formation. He was diagnosed with SARS-CoV-2 pancreatitis as a diagnosis of exclusion. DISCUSSION: SARS-CoV-2 typically presents with respiratory symptoms. As more data emerges, gastrointestinal symptoms (GI) are being reported which is believed to be caused by feco-oral transmission route. Studies show that SARS-CoV-2, uses Angiotensin converting enzyme -2 (ACE2), a viral receptor found in the intestinal epithelia, to enter host cells downregulating the expression of ACE2 leading to intestinal inflammation. 10% of acute pancreatitis cases are infectious, although the exact incidence of viral pancreatitis is unknown. Studies show viral pancreatitis as a consequence of direct destruction of the pancreatic acinar cells and we hypothesize that SARS-CoV-2 via binding to ACE2, uses a similar mechanism. Also, it is associated with the formation of microthrombi, which may impair microcirculation causing inflammation and ischemia of the pancreas.Earlier, patients were admitted primarily based on respiratory-related symptoms. This case brings to our attention the incidence of GI symptoms and possible complications associated with the virus. It shows the challenges associated with treatment of both, in which fluid overload with subsequent acute respiratory distress syndrome is a concern. This case serves to increase awareness of a possible association of the novel SARS-CoV-2 with pancreatitis. (Figure Presented).

COVID-19: a challenge or opportunity for terrorist groups?

The Covid-19 contagion has emerged amid a rapidly changing geopolitical environment and technological transformations. These developments have created new opportunities and challenges for terrorist groups. Whereas terrorist groups are struggling to launch conventional attacks during the lockdown, they have a captive young audience on the internet to recruit and radicalise. Similarly, though travel restrictions have limited terrorists’ mobility, they are using the time to develop new skills. This article examines the opportunities and challenges for terrorists to provide an assessment of the evolving strategic landscape. The persistence of religious terrorism, despite the weakening of Al-Qaeda and the Islamic State, alongside the emergence of the far-right terrorism in the West, renders the existing terrorist landscape complex and chronic. While the internet and social media revolutionised terrorist recruitment and radicalisation, emerging technologies such as artificial intelligence, drone technology and 3D-printing can potentially change the face of future terrorist violence. © 2020 Department of Security Studies and Criminology.