Assessing the impact of COVID-19 and related interventions on poverty and economic growth in Pakistan: A structural path analysis

This study uses social accounting matrix multipliers and structural path analyses to estimate effects of COVID-19 and related fiscal stimuli on five household groups. The COVID-19 lockdown increased poverty in Pakistan by 15%, which was addressed using a $1.5 billion, digitally implemented Ehsaas Emergency Cash (EEC) program that reached 14.8 million poor households. The study's models show that the largest multipliers from Ehsaas program finance were in agriculture, as a 1 Rupee shock adds 0.225 Rupee income to households. About 30% of that gain was estimated to go to poor farm families. In contrast, our models find that construction and trade growth added three times as much income to poor nonfarm and urban households as to farm households. However, those sectors added only one third as much total income as agriculture. From the structural path analysis, the importance of capital assets in generating income was seen, as was the possibility of greater poverty reduction from sectors with proportionally fewer intermediate inputs and more value added. © 2023 The Authors. Applied Economic Perspectives and Policy published by Wiley Periodicals LLC on behalf of Agricultural & Applied Economics Association.

An Emerging Marker Predicting the Severity of Covid-19: Neutrophil-Lymphocyte Count Ratio

Objective: To assess the efficacy of neutrophil-lymphocyte count ratio in predicting the severity of covid-19 Materials and Methods: The patients with positive results for COVID-19 were shifted to COVID ITC, CMH, Multan. The clinical histories of confirmed patients of COVID-19 during February 2020 to May 2021 were reviewed. The patients were divided into 4 classes, mild, common, severe, and fatal, according to guidelines of COVID-19 i.e., trial version 7. Data was collected regarding age, sex, smoking history, temperature, epidemiological history, clinical symptoms, and laboratory findings of all included patients including NLCR. Results: The mean NLCR of Mild and Severe Group was 2.77±1.23 and 20.31±4.45, respectively, (p=0.000). (Table. II). The area under the curves of NLCR was larger than neut, suggesting the optimal performance of NLCR with cut-off value 5.89. The sensitivity and specificity of NLCR was 85% and 95%, respectively. (Table. III). Conclusion: It can be concluded that an increase in NLCR levels can indicate that the covid-19 disease is moving towards exacerbation. NLCR can be recommended as a novel and highly sensitive and specific indicator for severity prediction in Covid-19 patients.

Therapeutic plasma exchange (TPE);A management strategy for critically ill Covid-19 patients

Objective: To determine the effectiveness of therapeutic plasma exchange (TPE) in management of critically ill Covid-19 patients Materials and Methods: In this study non-randomized controlled trial, a total of 47 patients were included after thorough screening of the admitted patients in Covid ITC CMH, Multan from July-2020 to May-2021.Single administration of TPE was done to determine the results. The parameters assessed in this study included the efficacy of TPE in terms of improvement of critical end points such as Norepinephrine dose to maintain MAP of more than 65mmHg, 6-hour balance of fluid, MAP, CRP (C reactive protein), WBC count (white blood cell), platelets, INR (international normalized ratio), IL-6. Results: The variations before and after TPE in clinical and biochemical parameters shown in table. II. In clinical parameters and in gas exchange parameters no significant difference was found. Inflammatory biomarkers, before and after TPE, the parameters had not significant different, (p>0.005). The differences before and after TPE between acid base balance, cytokines and vasoactive substances were also statistically insignificant, (p>0.005). Conclusion: Even though there is evidence of slight improvement in clinical endpoints of Covid-19 patients with TPE, overall efficacy of TPE is still a question that needs an answer as no significant improvement could be seen in outcome values after TPE.

Teledermatology in the West Midlands during the COVID-19 pandemic

The COVID-19 pandemic has brought about rapid changes to dermatology service delivery. Guidance has been issued by the British Association of Dermatologists, which has set out key principles and advice for adaptation and restructuring of current services. We aimed to examine and analyse the use of teledermatology in the West Midlands during the pandemic. The West Midlands covers a population of almost six million, and it is ethnically and socioeconomically diverse. Geographically, the region covers sparsely populated rural areas to densely populated urban centres. To gather data, an online survey was sent to all past and present dermatology clinicians in the region. We collected responses from 41 clinicians from the region. The majority of respondents were consultants (73%). Prior to the pandemic, 89% of respondents were not using any teledermatology as part of their routine practice. As a direct result of the COVID-19 pandemic, all respondents were now making use of telephone consultations and 67% were using store-and-forward (SAF) images to triage patients on 2-week-wait (2WW) clinics. For 2WW clinics, the technical quality of the photographs was an important factor when making clinical decisions. Sixty-one per cent of photos received using SAF to triage 2WW patients were taken by patients or their relatives, 34% were taken by a medical photographer and 5% by a general practitioner (GP). Respondents indicated that photos taken by patients and GPs had a wide range of technical accuracy (averaging 47% and 54%, respectively). By contrast, photos from medical photographers scored higher, with 86% being technically accurate. Telephone consults were largely deemed satisfactory (56% of respondents expressed neutral views), but video consultation proved to be less favourable (64% of respondents who had access to this technology did not deem it a useful consultation tool). Overall, experiences of teledermatology use during the pandemic were positive, as 58% of respondents reported a positive impact;conversely, 8% of respondents felt that their experiences were negative. Only 37% of respondents were actively auditing their service and only 22% were carrying out patient surveys. There is no doubt that increased use of teledermatology is here to stay, and the pandemic has expedited its uptake. Encouraging learning, auditing and improving teledermatology services will lead to better understanding and development of precise and robust pathways. Shared learning of experiences and outcomes will be the cornerstone for achieving teledermatology services that can ultimately lead to better outcomes for our patients.

In-silico pharmacophoric and molecular docking-based drug discovery against the Main Protease (Mpro) of SARS-CoV-2, a causative agent COVID-19

COVID-19 (Coronavirus Disease 2019) caused by a novel 'SARS-CoV-2' virus resulted in public health emergencies across the world. An effective vaccine to cure this virus is not yet available, thus requires concerted efforts at various scales. In this study, we employed Computer-Aided Drug Design (CADD) based approach to identify the drug-like compounds - inhibiting the replication of the main protease (Mpro) of SARS-CoV-2. Our database search using an online tool "ZINC pharmer" retrieved ~1500 compounds based on pharmacophore features. Lipinski's rule was applied to further evaluate the drug-like compounds, followed by molecular docking-based screening, and the selection of screening ligand complex with Mprobased on S-score (higher than reference inhibitor) and root-mean-square deviation (RMSD) value (less than reference inhibitor) using AutoDock 4.2. Resultantly, ~200 compounds were identified having strong interaction with Mpro of SARS-CoV-2. After evaluating their binding energy using the AutoDock 4.2 software, three compounds (ZINC20291569, ZINC90403206, ZINC95480156) were identified that showed highest binding energy with Mproof SARS-CoV-2 and strong inhibition effect than the N3 (reference inhibitor). A good binding energy, drug likeness and effective pharmacokinetic parameters suggest that these candidates have greater potential to stop the replication of SARS-CoV-2, hence might lead to the cure of COVID-19.