SARS-CoV-2 infection disrupts trophoblast function and placental syncytial barrier integrity via its accessory protein, ORF3a

Problem: Although it is rare for a SARS-CoV-2 infection to transmit vertically to the fetus during pregnancy, there is a significantly increased risk of adverse pregnancy outcomes due to maternalCOVID- 19. However, there is a poor understanding of such risks because mechanistic studies on how SARS-CoV-2 infection disrupts placental homeostasis are significantly lacking. The SARS-CoV-2 proteome includes multiple structural and non-structural proteins, including the non-structural accessory proteinORF3a. The roles of these proteins in mediating placental infection remain undefined. We and others have shown that autophagy activity in placental syncytium is essential for barrier function and integrity. Here, we have used clinical samples and cultured trophoblast cells to evaluate syncytial integrity of placenta exposed to SARS-CoV-2. The objective of our study was to investigate potential mechanisms through which SARS-CoV-2 impairs placental homeostasis and causes adverse pregnancy outcomes. We tested the central hypothesis that an essential SARS-CoV-2 non-structural and accessory protein, ORF3a, uniquely (amongst multiple viral proteins tested) with a novel three-dimensional structure andwith no homology to any other proteins is a key modulator of placental trophoblast cell dynamics via autophagy and intracellular trafficking of a tight junction protein (TJP), ZO-1. Method(s): We used clinical samples and cultured trophoblast cells to evaluate syncytial integrity of placentas exposed to SARS-CoV- 2. Autophagic flux was measured in placental villous biopsies from SARS-CoV-2-exposed and unexposed pregnant women by quantifying the expression of autophagy markers, LC3 and P62. Trophoblast cells (JEG-3, Forskolin-treated JEG-3, HTR8/SVneo, or primary human trophoblasts (PHTs)) were transfected with expression plasmids encoding SARS-CoV-2 proteins including ORF3a. Using western blotting, multi-label immunofluorescence, and confocal imaging, we analyzed the effect of ORF3a on the autophagy, differentiation, invasion, and intracellular trafficking of ZO-1 in trophoblasts. Using coimmunoprecipitation assays, we tested ORF3a interactions with host proteins. t-tests and one-way analyses of variance (ANOVAs) with post hoc tests were used to assess the data, with significance set at P < .05. Result(s): We discovered :1) increased activation of autophagy, but incomplete processing of autophagosome-lysosomal degradation;2) accumulation of protein aggregates in placentas exposed to SARS-CoV- 2. Mechanistically, we showed that the SARS-CoV-2 ORF3a protein, uniquely 3) blocks the autophagy-lysosomal degradation process;4) inhibits maturation of cytotrophoblasts into syncytiotrophoblasts (STBs);5) reduces production ofHCG-beta, a key pregnancy hormone that is also essential for STB maturation;and 6) inhibits trophoblast invasive capacity. Furthermore, ORF3a harbors an intrinsically disordered C-terminus withPDZ-bindingmotifs.We show for the first time that, 7) ORF3a binds to and co-localizes with the PDZ domain of ZO-1, a junctional protein that is essential for STB maturation and the integrity of the placental barrier. Conclusion(s): Our work outlines a new molecular and cellular mechanism involving the SARS-CoV-2 accessory protein ORF3a that may drive the virus's ability to infect the placenta and damage placental syncytial integrity. This implies that the mechanisms facilitating viral maturation, such as the interaction of ORF3a with host factors, can be investigated for additional functionality and even targeted for developing new intervention strategies for treatment or prevention of SARS-CoV-2 infection at the maternal-fetal interface.

Automated flood inundation mapping over Ganga basin

The worldwide appearance of COVID-19 halted all activity and caused the longest statewide lockdown. These wreaked havoc on people's livelihoods. The July 2020 floods also caused severe challenges. It adds anguish to the lives of those seeking to regulate COVID-19. It reduces catastrophe risk in other industries. Real-time information from space-based sensors is needed for a quick response. Using a cloud-based platform like Google earth engine (GEE), SAR pictures are analyzed automatically. This research shows the possibilities of automated procedures and algorithms on cloud-based systems. The findings provide flood extent maps for the lower Ganga basin, in India. Severe floods affected a large population in Bihar and West Bengal. This research provides a rapid and exact estimate of flooded regions to aid in risk assessment, notably during COVID-19. © 2023 Elsevier Inc. All rights reserved.

Spectrum and Trends of Intestinal Parasitic Infections at a Tertiary Care Hospital during Pandemic Times: A Laboratory-Based Retrospective Study

Background Intestinal parasitic infections continue to loom in developing countries with low sanitation and socioeconomic conditions. Pandemic times are especially important to study the prevalence of these pathogens since the focus of all healthcare services was coronavirus disease 2019 (COVID-19). This study aimed to evaluate the prevalence and time-trend of intestinal parasitic infections in the capital region of India during the pandemic times.Methods In this cross-sectional study, a retrospective review based on data from the past 2 years in the post-COVID-19 pandemic was used. Descriptive and time-trend analyses were applied to the data. Time series analysis was analyzed using the best fit autoregressive integrated moving average (ARIMA) model to look for seasonality in trends and forecasting.Results A total of 7267 patients' stool samples over a 2-year pandemic period were included in the study. Intestinal parasites were detected in 11.18% (813/7276) patients. Giardia lamblia (2.28%) and Blastocystis hominis (3.78%) were the predominant ones. Time-trend analysis from 2020 to 2021 using ARIMA model predicted an increasing trend with waning of pandemic. The most prevalent infection was found in the monsoon and autumn months.Conclusion Rates of infection with Giardia lamblia and Blastocystis hominis have increased in comparison to other protozoan infections like Entamoeba histolytica when compared with prepandemic hospital-based studies. With fading of the pandemic, further increasing trends are predicted.

Acceptance of COVID-19 Vaccination Among Health Care Workers in India

Background: The coronavirus disease 2019 has been spread almost all over the world in the last two years, including in India. Vaccines are a critical tool in the battle against COVID-19, and India has flagged the largest vaccination drive on 16 January 2021. Although public acceptance was varying, which can lead to non-acceptance. Aim & Objective: To estimate an acceptance of the COVID-19 vaccine and its associated factors. Settings and Design: An analytical cross-sectional study among health care workers in India Methods & Material: It was conducted using a validated, self-administrated online survey questionnaire, and data were analyzed using SPSS 23 version. The outcome variable was healthcare workers' acceptance of a COVID-19 vaccine. Results: A total of 450 HCWs participated, including 205(45.6%) women and 245(54.4%) men. A total of 270 (60%) subjects will accept vaccines, while 33.3% were unwilling to accept and wait for vaccines. Male gender (OR=3.14), being married and experienced (OR=11.49), vaccine effectiveness (OR=6.4), vaccine safety (OR=3.4), and past history (OR=2.28) were significantly associated. On applying logistic regression for associated factors, gender (B= -1.145, S.E.= 0.200, Wald 32.748), being married (B= -1.482, S.E.= 0.216, Wald 46.937), for experienced (B= -0.865, S.E.= 0.200, effectiveness (B= -1.856, S.E.= 0.245, Wald 57.431), Safety (B= -1.224, S.E.= 0.202, Wald 36.633) and past history (B= -0.357, S.E.= 0.248, Wald 2.071) found significant. Recommendation: Proper information is crucial and healthcare workers' attitudes about vaccines are an important factor for acceptance and recommendation of the vaccine to the public for population-wide coverage.

Expect the Unexpected: Invasive Central Nervous System (Cns) Aspergillosis in Non-Neutropenic Patients - a Case Series of 15 Patients from India

Intro: Invasive aspergillosis of CNS is a severe form of aspergillosis & is associated with high mortality. Most of these cases are suspected & diagnosed in neutropenic patients. We hereby describe a series of 15 patients with CNS aspergillosis in non-neutropenic patients from a tertiary care hospital in India. Method(s): All patients with clinical & radiological features suggestive of CNS aspergillosis were screened for microbiological evidence of invasive aspergillosis, either by demonstration of hyphae by microscopy or histology, culture or galactomannan assay. Patients demographic details, clinical features, risk factors, diagnosis, management & outcome details were documented. Finding(s): A total of 15 patients were found to have CNS aspergillosis, 5 isolated CNS infections & 10 showing concomitant CNS & pulmonary aspergillosis in one between January 2021 to July 2022. The average age was 41.46+/-14.6y, with majority being male. Among the risk factors, most common ones were fungal sinusitis (46.6%), steroid use (40%), COVID-19 (33.3%). One patient had history of endoscopic sinus repair, another had h/o lung abscess. Most common symptoms of CNS aspergillosis were headache (73.3%), fever (60%), altered sensorium (53.3%) & seizures (47.6%). Radiologically, the common findings included ring enhancing lesion, s/o cerebral abscesses were observed in four patients. Direct microscopy s/o fungal hyphae were reported in 5 patients, with 4 culture positives. Average serum galactomannan was 1, while CSF galactomannan showed better sensitivity with mean CSF galactomannan being 2.53. Almost all patients were treated with Voriconazole based on weight, but showed high mortality of 60% even after initiation of therapy. Complete resolution were seen in only two patients, while 4 patients remaining static in improvement during 6 months follow up. Conclusion(s): Invasive CNS aspergillosis must be suspected even with nonneutropenic patients with newer emerging risk factors like steroid use, COVID-19 & h/o fungal sinusitis presenting with clinical & radiological manifestations.Copyright © 2023

Screening for COVID-19 among Workers Attending Medical Examinations Under Occupational Health Service of an Open Cast Iron Ore Mine in Jharkhand: A Cross-Sectional Study

Introduction: The world is going through an unprecedented phase of COVID-19. Safe and healthy workplace are integral part of Occupational Health. Unsafe work practices anywhere are a constant threat, both for our health and sustainable business of an organization. Screening involves testing asymptomatic individuals who do not have known or suspected exposure to COVID-19. There is no screening strategy to exclude anyone contagious entering workplace. Objective(s): Workplace-based testing for COVID-19 and thus help to prevent or reduce further transmission. Methodology: A cross-sectional study was conducted through screening for COVID-19 by Rapid Antigen Test (RAT) or RTPCR test (TrueNat) of 860 workers who appeared for initial and periodical medical examinations (IME / PME) under Occupational Health Service of a mine hospital in Jharkhand. Study period: December 2020 to April 2021. Chi-Square test was used for statistical analysis. Result(s): Study revealed, mean age of employees 32.09+/-8.42 years. Total 28 (3%) workers were tested COVID-19 positive, mostly asymptomatic (64%). Among COVID positive cases, 16 (57%) were in age group of 21-30 years and 25 (89%) were male. Among the symptomatic cases (n=10), 50% presented with generalized weakness. 20% workers presented with fever, 20% with cough and 10% workers had sore throat. Generalized weakness was significantly associated (p< 0.05) with COVID positive cases (x2=8.944, p=0.003). Conclusion(s): Screening is important part of health check-up to maintain safety in workplace, especially in time of pandemic. Most of the affected persons were asymptomatic and would have been caused of more positive cases at workplace, community at large. Our study emphasized the need for implementation of population-based screening programs at shop floors to prevent spread of COVID-19 among the mining workers.

Emerging Trends of ICT in Airborne Disease Prevention

Information and Communication Technologies (ICT) are becoming indispensable nowadays for the healthcare industry. The utilization of ICT in healthcare services has accelerated even faster after the commencement of the COVID-19 outbreak. This study aims to perform a scientometric analysis of scholarly literature on airborne diseases in the discipline of science and technology. It explores the recent advancement of internet technologies in healthcare to control the prevalence of deadly airborne illnesses by applying analytical approaches. It presents publication trends, citation structure, influential sources, co-citation, and cooccurrence network analysis using the CiteSpace tool. It identifies the important research topics, current research hotspots, most active research areas, and leading technologies in this scientific knowledge domain. It inferred significant results fromanalyses thatwill benefit researchers and the academic fraternity across the globe to understand the evolving paths and recent scientific progress of ICT in airborne disease management.

The systemic risk in Thailand: the role of tourism industry

The study analyses the contribution of the tourism, banking, property fund and real estate, and finance and securities industries to the systemic risk of Thailand. Using quantile regression, the study estimates the measures of systemic risk (conditional Value-at-Risk (CoVaR) and delta conditional Value-at-Risk ( increment CoVaR)) and examines the relevance of various industries in increasing the systemic risk of Thailand using Kolmogorov - Smirnov test. The findings support the relevance of the tourism industry in significantly contributing to the systemic risk in Thailand. The study also highlights the systemic relevance of the tourism industry during the COVID-19 period in Thailand, when the industry was severely impacted, which adversely affected its systemic risk.

Emerging Trends of ICT in Airborne Disease Prevention

Information and Communication Technologies (ICT) are becoming indispensable nowadays for the healthcare industry. The utilization of ICT in healthcare services has accelerated even faster after the commencement of the COVID-19 outbreak. This study aims to perform a scientometric analysis of scholarly literature on airborne diseases in the discipline of science and technology. It explores the recent advancement of internet technologies in healthcare to control the prevalence of deadly airborne illnesses by applying analytical approaches. It presents publication trends, citation structure, influential sources, co-citation, and co-occurrence network analysis using the CiteSpace tool. It identifies the important research topics, current research hotspots, most active research areas, and leading technologies in this scientific knowledge domain. It inferred significant results from analyses that will benefit researchers and the academic fraternity across the globe to understand the evolving paths and recent scientific progress of ICT in airborne disease management. © 2022 Association for Computing Machinery.

The impact of perceived risk of COVID-19 from smoking on the change in number of cigarettes smoked

Introduction: Smoking increases the risk of severe illness and mortality from COVID-19. However, the impact of risk perception on smoking over time is unknown. Method(s): Participants (n = 487) who reported having smoked daily or nondaily in February 2020 were recruited through Reddit and completed a cross-sectional survey. Linear regression models examined the impact of perception that smoking increases the risk of COVID-19 on changes in cigarettes per day (CPD). Result(s): The greater perceived risk of smoking on COVID-19 predicted greater decreases in CPD from before the pandemic (December 2019-February 2020) to March-May 2020, but no change was observed from March-May 2020 to June-August 2020. However, greater perceived risk predicted increases in CPD from June-August 2020 to November 2020-January 2021. Participants with high levels of perceived risk (>75th percentile) were more likely to reduce their CPD in the beginning of the pandemic compared to those with low perceived risk (<=25th percentile), but more likely to increase their CPD between June-August 2020 to November 2020-January 2021, even though perceived risk remained stable over time. Conclusion(s): Perceived risk is associated with a reduction in CPD, but participants returned to their pre-COVID smoking behavior within less than a year.Copyright © 2023 Taylor & Francis Group, LLC.

A novel COVID-19 herd immunity-based optimizer for optimal accommodation of solar PV with battery energy storage systems including variation in load and generation

The world has now looked towards installing more renewable energy sources type distributed generation (DG), such as solar photovoltaic DG (SPVDG), because of its advantages to the environment and the quality of power supply it produces. However, these sources' optimal placement and size are determined before their accommodation in the power distribution system (PDS). This is to avoid an increase in power loss and deviations in the voltage profile. Furthermore, in this article, solar PV is integrated with battery energy storage systems (BESS) to compensate for the shortcomings of SPVDG as well as the reduction in peak demand. This paper presented a novel coronavirus herd immunity optimizer algorithm for the optimal accommodation of SPVDG with BESS in the PDS. The proposed algorithm is centered on the herd immunity approach to combat the COVID-19 virus. The problem formulation is focused on the optimal accommodation of SPVDG and BESS to reduce the power loss and enhance the voltage profile of the PDS. Moreover, voltage limits, maximum current limits, and BESS charge-discharge constraints are validated during the optimization. Moreover, the hourly variation of SPVDG generation and load profile with seasonal impact is examined in this study. IEEE 33 and 69 bus PDSs are tested for the development of the presented work. The suggested algorithm showed its effectiveness and accuracy compared to different optimization techniques. © 2023 TÜBÍTAK.

Conductive Ink-Coated Paper-Based Supersandwich DNA Biosensor for Ultrasensitive Detection of Neisseria gonorrhoeae.

Herein, we report results of the studies relating to the development of an impedimetric, magnetic bead-assisted supersandwich DNA hybridization assay for ultrasensitive detection of Neisseria gonorrhoeae, the causative agent of a sexually transmitted infection (STI), gonorrhea. First, a conductive ink was formulated by homogenously dispersing carboxylated multiwalled carbon nanotubes (cMWCNTs) in a stable emulsion of terpineol and an aqueous suspension of carboxymethyl cellulose (CMC). The ink, labeled C5, was coated onto paper substrates to fabricate C5@paper conductive electrodes. Thereafter, a magnetic bead (MB)-assisted supersandwich DNA hybridization assay was optimized against the porA pseudogene of N. gonorrhoeae. For this purpose, a pair of specific 5' aminated capture probes (SCP) and supersandwich detector probes (SDP) was designed, which allowed the enrichment of target gonorrheal DNA sequence from a milieu of substances. The SD probe was designed such that instead of 1:1 binding, it allowed the binding of more than one T strand, leading to a 'ladder-like' DNA supersandwich structure. The MB-assisted supersandwich assay was integrated into the C5@paper electrodes for electrochemical analysis. The C5@paper electrodes were found to be highly conductive by a four-probe conductivity method (maximum conductivity of 10.1 S·cm-1). Further, the biosensing assay displayed a wide linear range of 100 aM-100 nM (109 orders of magnitude) with an excellent sensitivity of 22.6 kΩ·(log[concentration])-1. The clinical applicability of the biosensing assay was assessed by detecting genomic DNA extracted from N. gonorrhoeae in the presence of DNA from different non-gonorrheal bacterial species. In conclusion, this study demonstrates a highly sensitive, cost-effective, and label-free paper-based device for STI diagnostics. The ink formulation prepared for the study was found to be highly thixotropic, which indicates that the paper electrodes can be screen-printed in a reproducible and scalable manner.

Understanding the Molecular Mechanism(s) of SARS-CoV2 Infection and Propagation in Human to Discover Potential Preventive and Therapeutic Approach

Exported across the world might create a serious controversy. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection into the host undergoes a huge number of complex repli-cative machineries which remains unclear. Understanding the mechanism (s) of replication and mode of infection of SARS-CoV2 to human cells will help us in the development of novel vaccines or drugs for the eradication and prevention of the disease. This review compiles the knowledge of SARS-CoV2 rep-licative machinery, mode of infection to the human cells and the development of drugs and vaccines which are currently under clinical trials.Copyright © 2020 Bentham Science Publishers.

Bibliometric Analysis of Online Food Delivery: A Study on Pre (COVID-19) and Current Scenario

Increasing disposable income of society and the individual., time-saving attitude., health safety (during COVID-19)., and innovation have increased consumer inclination from offline to online food delivery (OFD). Before COVID-19., eating out the home was the fashion and hangout., but after COVID-19., consumers feel safe while sitting at home. This study aims to explore the pre and current publications on online food delivery., find out the most studied country in OFD., find out the top-cited research publications in OFD., and find out the most dominant research terms in OFD. The present study reviews previous research published during the last 11 years (2012-March 2022) extracted from the www.dimensions.ai free web app. A drastic increase in publications since 2020 explains researchers' inclination toward the OFD. Two hundred twenty research articles were published during the pandemic out of 253 published in the last 11 years. The maximum researched country in OFD is the United States., followed by India and the United Kingdom. The most cited research publication has 255 citations. The most visible keywords in the present study were 'Zomato.,' followed by 'SEM' and 'OFD.' The present study has some limitations., like the database used in the study (dimensions) may not be as good as Scopus or WoS., which may give a better result. More study is required to understand the OFD topic and its survival. It is recommended that the catering industry take OFD as an opportunity along with the regular business generated through steady footfall of the customer/guest. It can be improved through proper logistics., software support., and merging with artificial intelligence. © 2022 IEEE.

Potential of Hesperidin in the Medicinal Field

Hesperidin has gained major interest recently due to the outbreak of COVID-19. The traction has led to more research being conducted on the compound hesperidin. Recent studies have shown its anti-inflammatory and anti-viral attributes, which have beneficial effects on severe acute respiratory syndrome (SARS-CoV-2). Hesperidin has also shown unique effects on the protein of SARS-CoV-2, which lead to a good preventative measure for SARS-CoV-2. Hesperidin also causes a suppression of appetite, which helps to combat obesity through the release of cholecystokinin. Furthermore, hesperidin has shown cardioprotective properties, which cause an increase in plasma high-density lipoprotein levels and a decrease in plasma low-density lipoprotein levels. Hesperidin is also used in combination with the Japanese herb Rikkunshito, which has shown potential in a discovery of a new drug for gastrointestinal motility as hesperidin can depolarize pacemaker potential in interstitial cells of Cajal (ICC). The chemo-preventive effects of hesperidin are caused by its antioxidant effect, which may prevent tissue necrosis due to oxidative stress. The photo-protective effect of hesperidin can reduce the damage to the skin caused by UV rays. Hesperidin also possesses wound-healing properties.Copyright © 2023 Bentham Science Publishers.

Symptoms, Transmission, Prevention and Treatment of Pandemic Corona Virus: A Review

Coronaviruses belong to the largest group of viruses that elicit acute respiratory, enteric and systemic infections in an extensive range of hosts. A few coronaviruses from animals can progress into a new human coronavirus that can spread from person to person. On February 12, 2020, WHO officially termed the disease as Corona Virus Disease 2019 (COVID-19) and declared it a pandemic on March 11, 2020. COVID-19 is a newly emerging viral disease that has an effect on the lower respiratory tract and shows as pneumonia. Despite laborious efforts for worldwide lockdown and quarantine, the occurrence of COVID-19 continues to increase. Proper and well-designed strategies are needed to reduce social and economic consequences arisen due to this pandemic disease. Presently, there is no effective specific vaccine and anti-viral drug supported by great-level confirmation, but dexamethasone is approved in the UK for treatment of critically ill COVID-19 patients (patients on ventilators and patients requiring only oxygen) on June 16, 2020. Further research is required to clarify the factors that affect virus pathogene-sis and lethal infections.Copyright © 2021 Bentham Science Publishers.

Potential Drug Options for Treatment of COVID-19: A Revie

A virus known as novel corona (SARS-CoV-2) which causes COVID-19 pandemic disease is an invisible enemy, appeared for the first time in the world's most populous country, China, and became a reason for causing death of many people all over the world. As a result of this, a remarkable investigation and clinical trials are ongoing to discover the treatment for this devastating pandemic disease. Effective vaccines and anti-viral treatments are immediately required in order to control and eradicate the disease. But still, neither vaccine nor any drug is approved for prevention and control of COVID-19 pandemic. Proper and well-designed strategies are needed to reduce social and economic consequences arisen due to this pandemic disease. There are some drugs that are used for other diseases which are showing valuable outcomes to elicit the virus causing COVID-19. However, there are no approved drugs full of clinical evidence. A systematic review literature search was carried out from different electronic databases to identify available articles on the effectiveness of drugs against COVID-19.Four therapies suggested recently via World Health Organization (abbreviated "WHO") that were later incorporated for under taking efficient clinical trial of the newly established project (European Discovery), comprise remdesivir, combination of anti-viral drugs (lopinavir and ritonavir), lopinavir plus ritonavir with beta interferon, and anti-malarial drugs like hydroxyl chloroquine and chloroquine. On May 25 2020, hy-droxychloroquine and chloroquine were suspended by WHO from Solidarity trial because of their safety and efficacy concerns. However, there were neither effective specific antivirals nor drug combinations approved which were supported by great-level of clinical evidence.Copyright © 2020 Bentham Science Publishers.

Perception and factors affecting compliance to intravesical bacillus calmette - guerin therapy in carcinoma bladder patients: An in-depth analysis in a tertiary care-a mix method study design

Introduction and Objective: Intravesical Bacillus Calmette-Guerin (iBCG) therapy for urinary bladder cancer (UBC) is associated with poor compliance due to various psycho-social issues unique to its treatment. The objective of this study was to identify and analyse the patient's perception and the factors that affected its adherence. Method(s): This mixed-method study was conducted on UBC patients who received/received iBCG. Following purposive sampling, patients who received at least one induction and one maintenance dose were assigned to a compliant group, and who did not were assigned to the non-compliant group. The patient's quality of life was assessed using the World Health Organization Quality of Life Instrument (WHOQOL-BREF). Semi-structured, in-depth interviews (IDI) of 35-40 minutes were conducted. The transcribed verbatim was analysed by deductive coding and content analysis. The appropriate codes, domains and themes were identified and analysed. Result(s): Demographic and socio-economic characteristics were comparable in both groups. The mean treatment expenditure was higher in the non-compliant group (1.87+/-0.75 vs 3.87+/-1.31;p=0.04). The quality of life measured was similar in both groups. IDI analysis noted that the primary reasons for non-compliance were frequent hospital commute, COVID travel restrictions, lack of knowledge, loss of daily wage, paucity at various levels in government hospitals and expensive corporate healthcare. Treatment-related severe frequency and dysuria also significantly contributed to non-compliance. Conclusion(s): Compliance can be achieved if the patients cope with the initial phase of treatment with positivity and optimism. Good symptomatic relief with proper knowledge and guidance could address the non-compliance.

Analysis of Strategies to Tackle the Environmental Impact of the Vaccine Supply Chain: A Fuzzy DEMATEL Approach

To combat the COVID-19 pandemic, the scientific community has progressed from discovering antivirals to the large-scale production of vaccines. Mass vaccination programs to curb the COVID-19 pandemic started in many parts of the world at the beginning of 2021. Mass vaccination aims to exit from health emergencies by vaccinating all the population with the required dose in the shortest possible time. The production rate has been boosted, and many new production facilities have been opened to fulfill worldwide demand. The objective of the vaccination program is to maximize the medical benefit with the lowest cost and equitable distribution of vaccines worldwide. However, the environmental impact of this long-run immunization program has received very little attention. This study explores the environmental impact of the vaccine supply chain (VSC) and analyzes the mitigation strategies to minimize it without affecting the medical, economic, and social benefits of vaccination. The fuzzy DEMATEL technique has been used to prioritize the mitigation techniques and find cause and effect relations among them. The finding of studies shows that the "optimal vial design” is most important, and "vaccine awareness and education” is the most impactful strategy to tackle the environmental impact of VSC. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Knowledge and attitude towards COVID 19 vaccine among health care workers;a cross sectional study from Karachi, Pakistan

Objective: To assess the knowledge and attitude towards COVID 19 vaccine among health care workers in ongoing Pandemic. Methodology: This cross-sectional study was conducted at Dr. Ruth KM Pfau Civil Hospital and services hospital, Karachi. Comparison was done regarding knowledge and attitude towards covid-19 vaccine between three groups of health care workers i.e., doctors, nursing and supporting staff. Result(s): We found statistically significant difference in all aspects of knowledge between three groups (p < 0.05). Conclusion(s): Despite awareness among peoples regarding infection and its complications, still there is hesitancy regarding use of vaccines and its increasing in different individuals.Copyright © 2023, Pakistan Medical Association. All rights reserved.