Matrix metalloproteinases in COVID-19: underlying significance

The role of matrix metalloproteinases (MMPs) in pathogenesis and severity of coronavirus disease 2019 (COVID-19) is under extensive exploration. MMPs are a family of extracellular proteases involved in a variety of physiological and pathological processes and conditions. The role of MMPs in COVID-19 stems from the pathogenesis resulting in the release of chemokines and pro-inflammatory markers which cause pulmonary oedema. In addition, the approaches to treatment of COVID-19 often are associated with some complications like acute lung injury due to extracellular matrix remodelling. In this respect, the aim of this review is to summarize, interpret and evaluate the significance of matrix metalloproteinases in SARS-CoV-2 infection in terms of the severity of the condition and delve into potential treatment from this perspective as well as highlighting the physiological and protective role of some MMPs. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

COVID-19 economic policy response, resilience and tourism recovery

This study investigates whether tourism sector recovery from the COVID-19 pandemic is influenced by only the size of the economic stimulus packages or whether a country's resilience plays a moderating influence in the underlying relationship. The results show that while economic stimulus packages help to enhance tourism recovery from the COVID-19 pandemic, it is contingent on the level of a country's resilience. For instance, amongst the less resilient countries, the impact of economic policy response on the tourism recovery is more pronounced, but the effect dissipates as countries become more resilient. These findings have important implications for policymakers, management teams, and relevant stakeholders in their effort to revive the tourism sector from the impact of the COVID-19 pandemic.

The Ments Criteria - Can We Apply It in Dialysis Access Surgery?

Introduction: Dialysis access surgery, in the UK, is almost always performed in NHS healthboard-run hospitals. During the height of the COVID-19 pandemic, in which access to elective operating theatres became limited, arrangements were made in our vascular access service, to perform some dialysis access surgery in a local private hospital. Patients were selected such that those deemed suitable as day-case and unlikely to require in-patient stay were chosen. A scoring system, 'Medically Necessary Time-Sensitive' (MeNTS) criteria, was proposed recently to assist in such decision-making processes by considering procedural, disease, and patient factors (Prachand et al, J Am Coll Surg.2020). The cumulative MeNTS score ranges from 21 to 105, with a score >65 signifying a 'too high risk to be justified' procedure. The aim of this study was to use MeNTS scores retrospectively to determine whether correct decisions were made in performing dialysis-access operations in the usual NHS university healthboard (UHB) setting vs local private hospital (Spire). Method(s): MeNTS scores were calculated for all patients who underwent dialysis access surgery at both sites between March 2020 - March 2021. Outcomes assessed included patient survival and COVID-19 infection Results: 213 Patients underwent dialysis access surgery at UHB and 76 at Spire. Mean cumulative MeNTS scores were 40.03(+/-0.30) and 39.97(+/-0.46) for the UHB and Spire groups, respectively (P=.922). COVID-19 infection occurred in four patients at UHB, and none in Spire (P=.576). Successful dialysis access was achieved in 76.06% and 69.74% in UHB and Spire patients, respectively (P=.287). At 30 days, one UHB patient had died whilst all Spire patients were alive (P>.999). Discussion and conclusion: Dialysis access surgery can take place safely during the COVID-19 pandemic, with necessary precautions. A modified version of the MeNTS score to make it more renal-specific would allow maximum benefit to be achieved from it in this field.

An Analysis of Serological Response and Infection Outcomes Following Oxford Astra-Zeneca (azd1222) and Pfizer-Biontech (mRNA BNT162b2) SARS-CoV-2 Vaccines in Kidney and Pancreas Transplant Patients

Purpose: SARS-CoV-2 is associated with high mortality among transplant recipients. This study aims to compare the humoral responses between the Oxford-Astra- Zeneca(AZ) and BNT162b2(Pfizer-BioNTech) vaccines in transplant recipients Methods: We recruited 920 kidney and SPK transplant patients receiving at least one dose of SARS-CoV-2 vaccine excluding patients with virus pre-exposure. Serological status was determined using the COVID-SeroKlir ELISA (Kantaro-EKF). Patients with corrected antibody level less than 0.7AU/mL were considered seronegative. Result(s): 495 AZ and 141 Pfizer patients had a sample post-first and 593 post-second dose (346 AZ vs 247 Pfizer) analysed. Following the 1st dose 25.7% of patients seroconverted (26.6% AZ and 22.8% Pfizer). Post-second dose 42.8% of AZ patients seroconverted (148/346) compared to 52.6% of Pfizer (130/247, p=0.02, HR 1.48, CI 1.07-2.06). When negative responders were excluded, Pfizer patients were shown to have a significantly higher response than AZ patients (median 2.6 vs 1.78AU/ mL, Mann-Whitney p=0.005), still lower than the one observed in general population. Patients on mycophenolate had a reduced seroconversion rate (42.2% vs 61.4%, p=0.001, HR 2.17) and reduced antibody levels (0.47 vs. 1.22 AU/mL, p=0.001) and this effect was dose dependent (p=0.05). Prednisolone reduced the seroconversion rate from 58.2% to 43.6% (p=0.03,HR 1.8) among Pfizer but not AZ recipients. This result was internally validated in two time points. Regression analysis has shown that antibody levels were reduced by older age (p=0.002), mycophenolate (p=0.001), AZ vaccine (vs Pfizer) (p=0.001) and male gender (p=0.02). There was no difference on infection rate post 2nd dose among the two vaccines but 14/15 serious post-vaccine infections leading to admission occurred to patients who did not seroconvert. Conclusion(s): Both seroconversion and antibody levels are lower following AZ compared to Pfizer vaccinated transplant patients following two vaccine doses. Mycophenolate, older age, male gender are also factors affecting the antibody response. Serious post vaccine infections are limited to patients without antibody response. Transplant patients remain at serious risk of SARS-CoV-2 infection.

Does the level of a country's resilience moderate the link between the tourism industry and the economic policy response to the COVID-19 pandemic? (Special Issue: COVID-19 and tourism.)

This study examines whether the level of a country's resilience to shocks moderates the link between the size of the tourism industry and the economic policy response to the COVID-19 pandemic using data from 113 countries. The findings suggest that countries with large tourism sectors responded more aggressively by using economic stimulus packages to mitigate the impact of the COVID-19 pandemic;however, the impact of the tourism sector is moderated by the country's resilience to shocks. The study also finds that both high level of economic resilience and high level of risk quality of a country moderate the link between the tourism sector and the economic policy response to the COVID-19 pandemic. The findings of the study suggest that tourism businesses in high resilient countries are better prepared to cope with the disruptive challenges posed by the COVID-19 pandemic and thus needed less assistance from governments. Improving a country's resilience to shocks is an important strategy to minimize the impact of future negative shocks in the tourism sector.

Conducting a nationwide brain tumor epidemiology study in an lmic: A multi-institutional experience

Very little research has been conducted on brain tumor epidemiology in Pakistan and a few studies that do exist provide regional data only. Conducting population based epidemiological studies in low-and-middle income countries (LMICs) like Pakistan can be particularly challenging due to limited resources, poor clinical and research infrastructure, unreliable or incomplete hospital records and a lack of standardization across the health care system. Population-wide studies and registries play an important role in cancer epidemiology and can help identify the current magnitude of cancer burden and its likely future evolution, allowing for better planning of prevention, diagnosis, management, and rehabilitation. This paper describes our experience in designing and conducting Pakistan Brain Tumor Epidemiology Study (PBTES), a first-ever nationwide study carried out to assess the distribution of brain tumors in Pakistan. In addition to the aforementioned obstacles, we were also faced with the global health crisis caused by the COVID-19 pandemic and had to promptly adjust our study accordingly. Other investigators conducting epidemiological studies in LMICs with similarly challenging and constricting settings could benefit from our experiences.

Gender-based implications of the COVID-19 pandemic on household diet diversity and nutritional security in Pakistan

Purpose: The COVID-19 pandemic has profound implications on the food and nutritional security of millions of households. The study assessed the impacts of the COVID-19 pandemic on diet diversity, calorie consumption and intake of essential nutrients based on the gender of the households. Design/methodology/approach: Mixed-design ANOVA and logistic regression were used to analyze the collected data from 260 female- and 463 male-headed households through an online survey in Pakistan. Findings: The outcomes revealed that the diet diversity of female households was affected more due to the COVID-19 compared to male households. The decline in daily nutrients' (protein, phosphorus, zinc, iron and iodine) intake during the COVID-19 was also greater for female-headed households than male-headed households. The share of all food groups in daily calorie and nutrient provision decreased significantly during the COVID-19 for both types of households. The share of meat and meat products declined more for female-headed households compared to male-headed households. The share of perishable commodities in calorie provision to female and male households decreased 2% during the COVID-19 compared to the normal period. Small- and medium-sized female and male households were less likely to experience worsened diet diversity than large-sized households during the COVID-19. Low-income compared to medium- and high-income female and male households were more likely to report declined food diversity during the COVID-19. Research limitations/implications: The data used in this study were collected through an online survey due to public health measures imposed in the country. Originality/value: Despite the emergence of literature on the implications of the pandemic on food security, the studies related to the gender-based impacts of COVID-19 on diet diversity and nutritional intakes of necessary nutrients are still non-existent. The current study will add to the literature by filling this gap. © 2021, Emerald Publishing Limited.