COVID-19 independently predicts poor outcomes in Acute Ischemic Stroke- Insights from a multicenter study from Pakistan and United Arab Emirates.

BACKGROUND: Ischemic stroke associated with coronavirus 2019 (COVID-19) has been well recognized by now. Few studies have compared COVID related versus unrelated strokes. We intend to report on a large group of Asian patients from two countries and compare COVID with non-COVID strokes admitted during the same time period. METHODS: Consecutive cases of acute ischemic stroke either presenting or developing, between March 2020 and December 2021 in four tertiary care hospitals (1 in Dubai, UAE and 3 in Karachi, Pakistan) and testing positive for COVID-19 were included in the study. Patients admitted with ischemic stroke during the same time period and who tested negative for COVID-19 were also randomly selected from the four hospitals. All data was collected from the medical records of the patients and recorded on a standard questionnaire before it was entered in SPSS version 21 for analysis. RESULTS: There were 139 COVID positive and 271 COVID negative patients with acute ischemic stroke included in the current study. There were significantly more males (80.6% vs 64.9%, p=0.001) and more large vessel strokes in the COVID positive group (41% vs 21.8%, p<0.001). Being COVID positive was an independent predictor of poor outcome at discharge, defined as a modified Rankin score of 3-6 (OR 3.87, 95% CI 2.21-6.77) after adjusting for country, age, sex, vascular comorbid conditions and stroke subtype. CONCLUSIONS: In this largest series of patients with COVID related strokes from Asia, COVID-19 was an independent predictor of poor outcomes at discharge after adjusting for other variables.

Emergence of high colistin resistance in carbapenem resistant Acinetobacter baumannii in Pakistan and its potential management through immunomodulatory effect of an extract from Saussurea lappa.

Carbapenem resistant Acinetobacter baumannii has emerged as one of the most difficult to treat nosocomial bacterial infections in recent years. It was one of the major causes of secondary infections in Covid-19 patients in developing countries. The polycationic polypeptide antibiotic colistin is used as a last resort drug to treat carbapenem resistant A. baumannii infections. Therefore, resistance to colistin is considered as a serious medical threat. The purpose of this study was to assess the current status of colistin resistance in Pakistan, a country where carbapenem resistant A. bumannii infections are endemic, to understand the impact of colistin resistance on virulence in mice and to assess alternative strategies to treat such infections. Out of 150 isolates collected from five hospitals in Pakistan during 2019-20, 84% were carbapenem resistant and 7.3% were additionally resistant to colistin. There were two isolates resistant to all tested antibiotics and 83% of colistin resistant isolates were susceptible to only tetracycline family drugs doxycycline and minocycline. Doxycycline exhibited a synergetic bactericidal effect with colistin even in colistin resistant isolates. Exposure of A. baumannii 17978 to sub inhibitory concentrations of colistin identified novel point mutations associated with colistin resistance. Colistin tolerance acquired independent of mutations in lpxA, lpxB, lpxC, lpxD, and pmrAB supressed the proinflammatory immune response in epithelial cells and the virulence in a mouse infection model. Moreover, the oral administration of water extract of Saussuria lappa, although not showing antimicrobial activity against A. baumannii in vitro, lowered the number of colonizing bacteria in liver, spleen and lung of the mouse model and also lowered the levels of neutrophils and interleukin 8 in mice. Our findings suggest that the S. lappa extract exhibits an immunomodulatory effect with potential to reduce and cure systemic infections by both opaque and translucent colony variants of A. baumannii.

Emergence of high colistin resistance in carbapenem resistant Acinetobacter baumannii in Pakistan and its potential management through immunomodulatory effect of an extract from Saussurea lappa

Carbapenem resistant Acinetobacter baumannii has emerged as one of the most difficult to treat nosocomial bacterial infections in recent years. It was one of the major causes of secondary infections in Covid-19 patients in developing countries. The polycationic polypeptide antibiotic colistin is used as a last resort drug to treat carbapenem resistant A. baumannii infections. Therefore, resistance to colistin is considered as a serious medical threat. The purpose of this study was to assess the current status of colistin resistance in Pakistan, a country where carbapenem resistant A. bumannii infections are endemic, to understand the impact of colistin resistance on virulence in mice and to assess alternative strategies to treat such infections. Out of 150 isolates collected from five hospitals in Pakistan during 2019–20, 84% were carbapenem resistant and 7.3% were additionally resistant to colistin. There were two isolates resistant to all tested antibiotics and 83% of colistin resistant isolates were susceptible to only tetracycline family drugs doxycycline and minocycline. Doxycycline exhibited a synergetic bactericidal effect with colistin even in colistin resistant isolates. Exposure of A. baumannii 17978 to sub inhibitory concentrations of colistin identified novel point mutations associated with colistin resistance. Colistin tolerance acquired independent of mutations in lpxA, lpxB, lpxC, lpxD, and pmrAB supressed the proinflammatory immune response in epithelial cells and the virulence in a mouse infection model. Moreover, the oral administration of water extract of Saussuria lappa, although not showing antimicrobial activity against A. baumannii in vitro, lowered the number of colonizing bacteria in liver, spleen and lung of the mouse model and also lowered the levels of neutrophils and interleukin 8 in mice. Our findings suggest that the S. lappa extract exhibits an immunomodulatory effect with potential to reduce and cure systemic infections by both opaque and translucent colony variants of A. baumannii.

A comprehensive genomic study, mutation screening, phylogenetic and statistical analysis of SARS-CoV-2 and its variant omicron among different countries.

BACKGROUND: With the rapid development of the genomic sequence data for the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its variants Delta (B.1.617.2) and Omicron (B.1.1.529), it is vital to successfully identify mutations within the genome. OBJECTIVE: The main objective of the study is to investigate the full-length genome mutation analysis of 157 SARS-CoV-2 and its variant Delta and Omicron isolates. This study also provides possible effects at the structural level to understand the role of mutations and new insights into the evolution of COVID-19 and evaluates the differential level analysis in viral genome sequence among different nations. We have also tried to offer a mutation snapshot for these differences that could help in vaccine formulation. This study utilizes a unique and efficient method of targeting the stable genes for the drug discovery approach. METHODS: Complete genome sequence information of SARS-CoV-2, Delta, and Omicron from online resources were used to predict structure domain identification, data mining, and screening; employing different bioinformatics tools. BioEdit software was used to perform their genomic alignments across countries and a phylogenetic tree as per the confidence of 500 bootstrapping values was constructed. Heterozygosity ratios were determined in-silico. A minimum spanning network (MSN) of selected populations was determined by Bruvo's distance role-based framework. RESULTS: Out of all 157 different strains of SARS-CoV-2 and its variants, and their complete genome sequences from different countries, Corona nucleoca and DUF5515 were observed to be the most conserved domains. All genomes obtained changes in comparison to the Wuhan-Hu-1 strain, mainly in the TRS region (CUAAAC or ACGAAC). We discovered 596 mutations in all genes, with the highest number (321) found in ORF1ab (QHD43415.1), or TRS site mutations found only in ORF7a (1) and ORF10 (2). The Omicron variant has 30 mutations in the Spike protein and has a higher alpha-helix shape (23.46%) than the Delta version (22.03%). T478 was also discovered to be a prevalent polymorphism in Delta and Omicron variations, as well as genomic gaps ranging from 45 to 65aa. All 157 sequences contained variations and conformed to Nei's Genetic distance. We discovered heterozygosity (Hs) 0.01, mean anticipated Hs 0.32, the genetic diversity index (GDI) 0.01943989, and GD within population 0.01266951. The Hedrick value was 0.52324978, the GD coefficient was 0.52324978, the average Hs was 0.01371452, and the GD coefficient was 0.52324978. Among other countries, Brazil has the highest standard error (SE) rate (1.398), whereas Japan has the highest ratio of Nei's gene diversity (0.01). CONCLUSIONS: The study's findings will assist in comprehending the shape and kind of complete genome, their streaming genomic sequences, and mutations in various additions of SARS-CoV-2, as well as its different variant strains like Omicron. These results will provide a scientific basis to design the vaccines and understand the genomic study of these viruses.

Compliance to health protocols in the implementation of the 2020 regional elections

The regional elections (Pilkada) of 2020 have been concluded and could be considered a success. Yet its implementation cannot be said to be entirely successful considering the lack of concern of political parties in helping the Government handle the COVID-19 pandemic through their political campaigns.  This study intends to discuss political communication carried out by political parties in an effort to raise awareness of preventing the spread of COVID-19 to the public during the 2020 Pilkada in Indonesia. The approach taken is qualitative collecting data through in-depth interviews with the subjects comprising of representatives of political parties and political communication experts.  The study finds that the bulk of the political campaigns carried out by political parties is focused on winning the elections rather than on efforts to help deal with COVID-19. Community involvement also tends to be low in the 2020 elections due to a lack of understanding of digital literacy and reluctance to vote due to a lack of understanding of health protocols. Keywords: health protocols;regional elections;community involvement.

Perceptions of students regarding E-learning during Covid-19 at a private medical college.

OBJECTIVE: The purpose of this study was to determine the perceptions of students towards e-learning during the lock down. METHODS: A descriptive cross-sectional study was conducted at Liaquat College of Medicine and Dentistry. MBBS and BDS students of all levels participated in the study with a sample size calculated as 377. A self-administered questionnaire was developed. After validation from the Medical Education Experts, pilot test was run on 30 participants before the administration of the questionnaire. The questionnaire was emailed to the participants for data collection. Reliability of the questionnaire was determined. Independent T-test was applied for determining the perceptions of students towards e-learning. Frequencies and percentages were also computed for demographics. RESULTS: Total 382 responses were received.137 males and 245 females participated in the study. 0.851 was calculated as Cronbach's alpha of the questionnaire. Overall, 77% students have negative perceptions towards e-learning. 76% of the students use mobile device for their e-learning. CONCLUSION: Students did not prefer e-teaching over face-to-face teaching during the lock down situation. Administration and faculty members should take necessary measures for improving e-teaching for better learning during lock down.

Sensitivity Analysis of COVID-19 with Quarantine and Vaccination: A Fractal-Fractional Model

To eradicate most infectious diseases, mathematical modelling of contagious diseases has revealed that a combination of quarantine, vaccination, and cure is frequently required. However, eradicating the disease will remain a difficult task if they aren't provided at the appropriate time and in the right quantity. Control analysis has been shown to be an effective way for discovering the best approaches to preventing the spread of contagious diseases through the development of disease preventive interventions. The method comprises reducing the cost of infection, implementing control measures, or both. In order to gain a better understanding of COVID-19's future dynamics, this study presents a compartmental mathematical model. The problem is modelled as a highly nonlinear coupled system of classical order ODEs, which is then generalised using the Mittag-Leffler kernel's fractal-fractional derivative. The uniqueness of the fractional model under discussion has also been demonstrated. The boundedness and non-negativity of the considered model are also established. The next generation technique is used to examine basic reproduction, anddisease free and endemic equilibrium. We used reported cases from Australia in this investigation due to the high risk of infection. The reported cases are considered between 1st July 2021 and 20th August 2021. On the basis of previous data, the spread of infection is predicted for the next 600 days which is shown through different graphs. The graphical solution of the considered nonlinear model is obtained via numerical scheme by implementing the MATLAB software. Based on the fitted values of parameters, the basic reproduction number R0 is calculated as R0≈1.58276. Furthermore, the impact of fractional and fractal parameter on the disease spread among different classes is demonstrated. In addition, the impact of quarantine and vaccination on infected people is dramatically depicted. It's been argued that public awareness of the quarantine and effective vaccination can drastically reduce infection rates in the population.

The enormity of the Zinc deficiency problem and available solutions;an overview

The societal cost of micronutrient deficiency (MND) or the “hidden hunger” is in millions of dollars/year, reducing the GDP of some countries by as much as 11%. Zn is an important micronutrient for both plants and animals. An estimated 17% of the world population, or around 1.1 billion people, are at the risk of zinc (Zn) deficiency. The deficiency has been related to adverse pregnancy outcomes, stunted growth, premature deaths, immune system dysfunctions, neuro-behavioral disorders, and recently with the failure to recover from COVID-19. These health risks associated with Zn deficiency have compelled FAO and WHO to recommend Zn fortification of diet. Correcting Zn deficiency is a challenge due to several reasons. Close to half of the agricultural soils are Zn deficient, and chemical Zn fertilizers are costly and ineffective. Developing Zn-rich crops through plant breeding and genetic engineering is challenging. Zn-dense diet is costly and cannot be implemented in the low-income region most affected by Zn deficiency. Lack of consensus among regulatory bodies on defining and diagnosing Zn deficiency in plants and Humans. Awareness and other sociocultural issues. Among the most important available solutions are zinc biofortification of the cereal crops, use of zinc biofertilizers, development of Zn-efficient crops with reduced phytate content. The use of Zn supplements, dietary modification, and diversification, especially with fish, are proposed as the most accessible and affordable solutions. Awareness programs in areas suffering the most from Zn deficiency are required. Despite the suggestions from FAO and WHO, global efforts to combat Zn deficiency matching those for combating diseases like HIV are not in place. Coordinated efforts of the international community, especially policy-makers, agricultural scientists, dieticians, physicians, and others, are required to address the issue of hidden hunger.

Preparedness and impact of COVID 19 infection at tertiary care neurology centers in Pakistan.

OBJECTIVE: We aimed to assess the response and impact of covid 19 pandemic at tertiary care centers in Pakistan especially pertaining to neurological care, facilities and training. METHODS: A pre-tested survey form was sent to 40 neurology tertiary care centers in all the provinces in the country in the first week of July 2020. 33 filled forms were received, out of which 18 were public (government) and 15 were private hospitals. RESULTS: Estimated 1300 HCW (faculty, medical officers, trainees and nurses) work at these 33 participating centers. There were 17 deaths among HCW (1.3%) at ten centers. Sufficient personal protective equipment (PPE) were provided to 158 HCW (12%). 129 (10%)HCW tested positive for COVID 19 at 31 centers including trainees/medical officers (39), consultants (29) and nursing and other staff (61). Due to low neurology admissions, 23/33 hospitals (70%) posted neurology trainees in COVID 19 units to contribute to covid care. Less than 50% hospitals did covid screening PCR before admission to neurology wards. Only 10% hospitals provide training and regular update to HCW. Neurology tele-health services were started for clinically stable patients at 15 (45%) centers. Only 60% neurology training programs were able to start online training. Ongoing research studies and trials focusing neurological manifestations of COVID-19 were done at 10 (30%) centers. Modification of facilities for COVID patients showed that 24(72%) hospitals strictly reduced the number of attendants accompanying patients. Only 10 (30%) centers had neurophysiological tests being conducted on COVID-19 patients. Mental health support services to HCW were provided at 12 (36%) centers. CONCLUSIONS: Among HCW 10% tested positive for covid and 1.3% died. Mental health support services offered for HCW were available in 36% institutions. Neurology training was substantially affected due to low admissions, limited ward rounds and limited availability of online training.