Exploring Australian pharmacists' views toward reducing the risk of medicines-related harm in aged care residents.

Medicines-related harm is common in older people living in residential aged care facilities (RACFs). Pharmacists offering services in the aged care sector may play a key role in reducing medicines-related injury. This study aimed to explore Australian pharmacists' views toward reducing the risk of medicines-related harm in older residents. Qualitative, semi-structured interviews were conducted with 15 Pharmacists across Australia providing services (e.g., through the provision of medication reviews, supplying medications, or being an embedded pharmacist) to RACFs identified via convenience sampling. Data were analyzed by thematic analysis using an inductive approach. Medicines-related harm was thought to occur due to polypharmacy, inappropriate medicines, anticholinergic activity, sedative load, and lack of reconciliation of medicines. Pharmacists reported that strong relationships, education of all stakeholders, and funding for pharmacists were facilitators in reducing medicines-related harm. Pharmacists stated that renal impairment, frailty, staff non-engagement, staff burnout, family pressure, and underfunding were barriers to reducing medicines-related harm. Additionally, the participants suggested pharmacist education, experience, and mentoring improve aged care interactions. Pharmacists believed that the irrational use of medicines increases harm in aged care residents, and medicines-specific (e.g., sedative load) and patient-specific risk factors (e.g., renal impairment) are associated with injuries in residents. To reduce medicines-related harm, the participants highlighted the need for increased funding for pharmacists, improving all stakeholders' awareness about medicines-associated harms through education, and ensuring collaboration between healthcare professionals caring for older residents.

Healthcare adjustments and concerns: a qualitative study exploring the perspectives of healthcare providers and administrative staff during the COVID-19 pandemic in Saudi Arabia.

Background: Healthcare systems have modified their strategies to manage their staff, supplies, and space to deal systematically with the COVID-19 pandemic. This research aimed to explore the nature of hospital adjustments and the concerns of healthcare providers and administrative staff working in Governmental and private hospitals throughout the Qassim Region of the Kingdom of Saudi Arabia (KSA) during the pandemic. Methods: A qualitative phenomenological study using semi-structured in-depth interviews were conducted with 75 purposively selected healthcare providers and administrative staff working at three main hospitals in the Qassim Region, KSA. The maximum variation sampling technique was utilized. Recruitment of participants was continued until data saturation was reached. All interviews were audiotaped, transcribed verbatim, and analyzed thematically. Results: Four core themes were identified in this paper: (1) changes in hospital policy and procedures, (2) workforce management, (3) the well-being of the workforce, and (4) apprehensions and expectations of the workforce. The participants showed satisfaction with timely administrative decisions and new policies during the COVID-19 pandemic. Furthermore, the psychological health of healthcare professionals was affected more than their physical state. Finally, the providers perceived the emergence of multiple concerns in the coming months. Conclusion: Although healthcare providers were initially overwhelmed, they gradually accepted new administrative policies. Numerous innovative interventions effectively reduced their physical workload and increased their productivity, but they remained significantly affected by a wide range of psychological disorders, with a high prevalence of obsessive-compulsive disorder. There were some concerns about the new SARS-CoV-2 variant, but the majority were optimistic.

cGAS-STING PATHWAY LIMITS SARS-CoV-2 REPLICATION IN ACE2+ AIRWAY CELL LINES

Background: We previously screened 10 human lung and upper airway cell lines expressing variable levels of endogenous ACE2/TMPRSS2. We found that H522 human lung adenocarcinoma cells supported SARS-CoV-2 replication independent of ACE2, whereas the ACE2 positive cell lines were not permissive to infection. Type I/III interferons (IFNs) potently restrict SARS-CoV-2 replication through the actions of hundreds of interferon-stimulated genes (ISGs) that are upregulated upon IFN signaling. Here we report that a number of ACE2 positive airway cell lines are unable to support SARS-CoV-2 replication due to basal activation of the cGAS-STING DNA sensing pathway and subsequent upregulation of IFNs and ISGs which restrict SARS-CoV-2 replication. Method(s): SARS-CoV-2 WT strain 2019-nCoV/USA-WA1/2020 viral replication was detected through analysis of cell associated RNA. RNA sequencing was used to study the basal level of genes in the type-I IFN pathway in the 10 cell lines, which was further validated by western blotting and qRT-PCR. A panel of 5 cell lines, with varying expression levels of ACE2 and TMPRSS2, were pre-treated with Ruxolitinib, a JAK1/2 inhibitor. A siRNA-mediated screen was used to determine the molecular basis of basally high expression of ISGs in cell lines. CRISPR knockout of IFN-alpha receptor and cGAS-STING pathway components was conducted in parallel Results: Here we show that higher basal levels of IFN pathway activity underlie the inability of ACE2+ cell lines to support virus replication. Importantly, this IFN-induced block can be overcome by chemical inhibition and genetic disruption of the IFN signaling pathway or by ACE2 overexpression, suggesting that one or more saturable ISGs underlie the lack of permissivity of these cells. Ruxolitinib treatment increased SARS-CoV-2 RNA levels by nearly 3 logs in OE21 and SCC25. Furthermore, the baseline activation of the STING-cGAS pathway accounts for the high ISG levels and genetic disruption of the cGAS-STING pathway enhances levels by nearly 2 and 3 logs of virus replication in the two separate ACE2+ cell line models respectively. Conclusion(s): Our findings demonstrate that cGAS-STING-dependent activation of IFN-mediated innate immunity underlies the inability of ACE2+ airway cell lines to support SARS-CoV-2 replication. Our study highlights that in addition to ACE2, basal activation of cGAS-STING pathway, IFNs and ISGs may play a key role in defining SARS-CoV-2 cellular tropism and may explain the complex SARS-CoV- 2 pathogenesis in vivo.

When viral RNA met the cell: a story of protein-RNA interactions

RNA is a central molecule for the RNA virus life cycle as it functions not only as messenger for the synthesis of proteins, but also as storage of genetic information as genome. Given the central role of viral RNA in infection, it is expected that it must function as a hub for critical host-virus interactions. To test this, my laboratory has developed new approaches that have been applied to several viruses such as Sindbis virus, SARS-CoV-2 and human immunodeficiency virus (HIV).We have discovered a new universe of host-virus interactions with central regulatory roles in infection. Interestingly, these viruses, despite having different sequences and infection cycles, engage with a largely shared pool of cellular RNA-binding proteins. My laboratory is currently focused on understanding the regulatory mechanisms underpinning these master regulators with molecular detail. We envision that these central host-virus interactions are promising targets for broad-spectrum antiviral strategies. I am funded by an ERC Consolidator grant (vRNP-capture 101001634) and an MRC research grant (MR/R021562/1).Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.

Prophylactic Inferior Vena Cava Filters for Venous Thromboembolism in Adults With Trauma: An Updated Systematic Review and Meta-Analysis.

Background: Trauma is an independent risk factor for venous thromboembolism (VTE). Due to contraindications or delay in starting pharmacological prophylaxis among trauma patients with a high risk of bleeding, the inferior vena cava (IVC) filter has been utilized as alternative prevention for pulmonary embolism (PE). Albeit, its clinical efficacy has remained uncertain. Therefore, we performed an updated systematic review and meta-analysis on the effectiveness and safety of prophylactic IVC filters in severely injured patients. Methods: Three databases (MEDLINE, EMBASE, and Cochrane) were searched from August 1, 2012, to October 27, 2021. Independent reviewers performed data extraction and quality assessment. Relative risk (RR) at 95% confidence interval (CI) pooled in a randomized meta-analysis. A parallel clinical practice guideline committee assessed the certainty of evidence using the GRADE approach. The outcomes of interest included VTE, PE, deep venous thrombosis, mortality, and IVC filter complications. Results: We included 10 controlled studies (47 140 patients), of which 3 studies (310 patients) were randomized controlled trials (RCTs) and 7 were observational studies (46 830 patients). IVC filters demonstrated no significant reduction in PE and fatal PE (RR, 0.27; 95% CI, 0.06-1.28 and RR, 0.32; 95% CI, 0.01-7.84, respectively) by pooling RCTs with low certainty. However, it demonstrated a significant reduction in the risk of PE and fatal PE (RR, 0.25; 95% CI, 0.12-0.55 and RR, 0.09; 95% CI, 0.011-0.81, respectively) by pooling observational studies with very low certainty. IVC filter did not improve mortality in both RCTs and observational studies (RR, 1.44; 95% CI, 0.86-2.43 and RR, 0.63; 95% CI, 0.3-1.31, respectively). Conclusion: In trauma patients, moderate risk reduction of PE and fatal PE was demonstrated among observational data but not RCTs. The desirable effect is not robust to outweigh the undesirable effects associated with IVC filter complications. Current evidence suggests against routinely using prophylactic IVC filters.

Consequences of COVID-19 Among Adult HIV Patients Versus Non-HIV Patients: Two-Year Data From the Primary Isolation Centre in Sudan.

Background The COVID-19 pandemic remains to have a global impact despite the great efforts in prevention. Controversy persists regarding the outcomes of SARS-CoV-2 among HIV patients versus non-HIV individuals. Objective This study aimed to assess the impact of COVID-19 among adult patients with HIV versus non-HIV in the chief isolation centre in Khartoum state, Sudan. Methods This is an analytical cross-sectional, comparative single-centre study conducted at the Chief Sudanese Coronavirus Isolation Centre in Khartoum from March 2020 to July 2022. Data were analysed using SPSS V.26 (IBM Corp., Armonk, USA). Results This study included 99 participants. The overall age mean was 50±1 years old, with a male predominance of 66.7% (n=66). 9.1% (n=9) of the participants were HIV cases, 33.3% of whom were newly diagnosed. The majority, 77.8%, reported poor adherence to anti-retroviral therapy. The most common complications included acute respiratory failure (ARF) and multiple organ failure, 20.2% and 17.2%, respectively. The overall complications were higher among HIV cases than non-HIV cases; however, statistically insignificant (p>0.05 ), except for acute respiratory failure (p<0.05). 48.5% of participants were admitted to the intensive care unit (ICU), with slightly higher rates among HIV cases; however, this was statistically insignificant (p=0.656). Regarding the outcome, 36.4% (n=36) recovered and were discharged. Although a higher mortality rate was reported among HIV cases compared to non-HIV cases (55% vs 40%), it was statistically insignificant (p=0.238). Conclusion The mortality and morbidity percent proportion among HIV patients with superimposed COVID-19 infection was higher than in non-HIV patients but statistically insignificant aside from ARF. Consequently, this category of patients, to a large extent, should not be considered highly susceptible to adverse outcomes when infected with COVID-19; however, ARF should be closely monitored for.

Relation of COVID-19 infection to outcomes of pregnancy during the pandemic in Kirkuk city

Based on what is known at this time, pregnant women are at an increased risk for severe illness from COVID-19 compared to non-pregnant women. Additionally, pregnant women with COVID-19 might have an increased risk of adverse pregnancy outcomes, such as preterm birth. The study was conducted in the city of Kirkuk city during the period between February 1, 2020, and September 1, 2020, at Gynecology and children hospital. Through the study, 100 pregnant women were received, complaining of Covid-19 infections, which were diagnosed in Kirkuk, and now Real Time PCR was confirmed through nasopharyngeal swabs that were taken from the Hospital. The study also included measuring the level of blood pressure, sugar and IL-6 in those women during the fifth to eight week, where we were infected, and then in the 12th week of pregnancy took place, where communication was made, and a level was measured, and as a result, these women who completed the period with a pre-term labor, miscarriage before the 24th week of pregnancy or those completed the period with successful pregnancyThe study showed that were asymptomatic, 45% of cases of COVID-19 patients were with mild infection and 10% were with severe infection (P<0.001) In this study, 10 % of COVID-19 pregnant women suffer from hypertension, 13% were with Diabetes, 35% with UTI while 70% were suffered from fever. When reaching 24th week of pregnancy, and as shown in Table 3. The study showed that 40% COVID-19 pregnant women experienced completed the period with a preterm labor, 10% was with miscarriage before the 24th week of pregnancy, while 50% of them completed the period continued the pregnancy. In this study, 82.5 % of COVID-19 pregnant women with preterm labor were suffered previously from fever comparing with 55% of COVID-19 pregnant women without preterm labor.The study showed that the highest mean of serum IL-6 was found in women infected with COVID-19 comparing with healthy control (12.8+/-3.6 v.s. 29.3+/-3.1 ng/ml) (P: <0.001). Conclusion(s):The study showed a significant relation of COVID-19 infection with pregnant women who pre-term labor especially who have high body temperature.Copyright © 2020 Ubiquity Press. All rights reserved.

Spinopelvic In Situ Fixation and Early Mobilization: A Case Report and Literature Review.

Pelvic fractures with sacroiliac extension are significant and complicated orthopedic injuries that pose a challenge in management and favorable outcomes. A 50-year-old obese female presented after a motor vehicle accident with pelvic fracture lateral compression. The patient underwent anterior external fixation with a left sacroiliac screw (SIS) on the next day of admission and was kept in a non-weight-bearing state. During her hospital stay, she developed deep vein thrombosis (DVT) and was treated. During the follow-up on the sixth week, the patient was not complying with her immobilization instructions and was exposing the left lower limb to weight bearing. The radiologic evaluation demonstrated a pulled-out SIS with a stable fracture. Considering that the patient was obese, had a history of DVT and COVID-19 infection, and the fracture was minimally displaced, it was decided to perform a spinopelvic in-situ fixation from L4 to S2 and augment it with a left SIS. The patient tolerated the surgery well and was referred to physiotherapy for early mobilization with full weight bearing. During her six-month and two-year follow-ups, she was well mobilized with no active complaints, and radiographic studies showed good healing, no displacement, no signs of instability, and a stable construct. Our case report presents a very rare and difficult but successful management of a fracture displacement in a non-compliant patient with one pulled-out screw through fast-tracked in situ spinopelvic fixation with early mobilization and full weight bearing. To our knowledge, this is one of the rare reports detailing a patient undergoing in situ spinopelvic fixation due to minimally displaced fracture with comorbidities such as obesity and DVT. Our report demonstrates the viability of accepting pulled-out screws, with respect to the patient's health, the fracture's geometry, a quick follow-up in situ spinopelvic fixation, early mobilization, full weight-bearing outcomes, and a lower risk for complications.

Diagnosis of COVID-19 Infection via Association Rules of Cough Encoding

COVID-19 has roused the scientific community, prompting calls for immediate solutions to avoid the infection or at least reduce the virus's spread. Despite the availability of several licensed vaccinations to boost human immunity against the disease, various mutated strains of the virus continue to emerge, posing a danger to the vaccine's efficacy against new mutations. As a result, the importance of the early detection of COVID-19 infection becomes evident. Cough is a prevalent symptom in all COVID-19 mutations. Unfortunately, coughing can be a symptom of various of diseases, including pneumonia and infiuenza. Thus, identifying the coughing behavior might help clinicians diagnose the COVID-19 infection earlier and distinguish coronavirus-induced from non-coronavirus-induced coughs. From this perspective, this research proposes a novel approach for diagnosing COVID-19 infection based on cough sound. The main contributions of this study are the encoding of cough behavior, the investigation of its unique characteristics, and the representation of these traits as association rules. These rules are generated and distinguished with the help of data mining and machine learning techniques. Experiments on the Virufy COVID-19 open cough dataset reveal that cough encoding can provide the desired accuracy (100%). © 2023, ECTI Association. All rights reserved.

Cluster analysis of biochemical markers as predictor of COVID-19 severity

Numerous blood biomarkers are altered in COVID-19 patients;however, no early biochemical markers are currently being used in clinical practice to predict COVID-19 severity. COVID-19, the most recent pandemic, is caused by the SRS-CoV-2 coronavirus. The study was aimed to identify patient groups with a high and low risk of developing COVID-19 using a cluster analysis of several biomarkers. 137 women with confirmed SARS CoV-2 RNA testing were collected and analyzed for biochemical profiles. Two-dimensional automated hierarchy clustering of all biomarkers was applied, and patients were sorted into classes. Biochemistry marker variations (Ferritin, lactate dehydrogenase LDH, D-dimer, and C- reactive protein CRP) have split COVID-19 patients into two groups(severe cases and non-severe cases groups). Ferritin, lactate dehydrogenase LDH, D-dimer and CRP were markedly increased in COVID-19 patients in the first group (severe cases). Our findings imply that early measured levels of (Ferritin, lactate dehydrogenase LDH, D-dimer, and C- reactive protein CRP) are linked to a decreased probability of COVID-19 severity. Elevated levels of this biomarker may predict COVID severity development.

High SARS CoV2 antibody-prevalence among health care workers with variable exposure to COVID-19 patients: A cross-sectional university hospital study

Background: During the COVID-19 pandemic, the pattern of medical services changed to minimize transmission to health care workers (HCWs) or hospitalized patients. Despite the care of COVID-19 patients in a special ward, new cases are accidentally discovered. This study aimed at determining the antibody seroprevalence among asymptomatic HCWs and the associated risks. Methods: The study involved 190 participants, including physicians, nurses, technicians, and administrative staff. All were inquired for sociodemographic, specialty, previous isolation, and previous infection, and their blood was tested for SARS-CoV2 antibody. Results: Of 190 HCWs;72,1% were females, the mean age was 32.6±7.9 years, 10.5% were smokers, and 15.8% reported co-morbid illness. SARS CoV2 antibodies were found in 68 (35.8%);being IgG, IgM and both IgM and IgG in 47 (69.1%), 10 (14.7%) and 11 (16.2%) participants respectively. The prevalence was higher (47.6%) among HCWs of the COVID unit, [OR=1.7 (95% CI: 0.69-4.3)] and HCWs with previous COVID-19, OR:1.61 (95% CI:0.88-2.94). The prevalence was significantly lower among smokers (p=0.049), OR:0.29 (95% CI:0.08-1.01), and significantly higher in HCWs who recalled cough (p=0.036) OR: 1.97 (95% CI: 1.05-3.69). The likelihood of antibody seropositivity increased in technicians [OR:2.02 (95% CI: 0.92-4.44)], followed by physicians [OR:1.7 (95% CI: 0.7-4.33)] while the odds ratio was low among nurses [OR:0.58 (95% CI: 0.32-1.07). Conclusion: A considerable proportion of antibody positive HCWs had evidence of past SARS CoV2. Provision of adequate personal protective equipment and periodic screening of HCWs are urgently needed to lessen the transmission within the health care settings. © 2020 The author (s).

Tocilizumab Outcomes in Critically Ill COVID-19 Patients Admitted to the ICU and the Role of Non-Tocilizumab COVID-19-Specific Medical Therapeutics.

BACKGROUND: Tocilizumab is a monoclonal antibody proposed to manage cytokine release syndrome (CRS) associated with severe COVID-19. Previously published reports have shown that tocilizumab may improve the clinical outcomes of critically ill patients admitted to the ICU. However, no precise data about the role of other medical therapeutics concurrently used for COVID-19 on this outcome have been published. OBJECTIVES: We aimed to compare the overall outcome of critically ill COVID-19 patients admitted to the ICU who received tocilizumab with the outcome of matched patients who did not receive tocilizumab while controlling for other confounders, including medical therapeutics for critically ill patients admitted to ICUs. METHODS: A prospective, observational, multicenter cohort study was conducted among critically ill COVID-19 patients admitted to the ICU of 14 hospitals in Saudi Arabia between 1 March 2020, and October 31, 2020. Propensity-score matching was utilized to compare patients who received tocilizumab to patients who did not. In addition, the log-rank test was used to compare the 28 day hospital survival of patients who received tocilizumab with those who did not. Then, a multivariate logistic regression analysis of the matched groups was performed to evaluate the impact of the remaining concurrent medical therapeutics that could not be excluded via matching 28 day hospital survival rates. The primary outcome measure was patients' overall 28 day hospital survival, and the secondary outcomes were ICU length of stay and ICU survival to hospital discharge. RESULTS: A total of 1470 unmatched patients were included, of whom 426 received tocilizumab. The total number of propensity-matched patients was 1278. Overall, 28 day hospital survival revealed a significant difference between the unmatched non-tocilizumab group (586; 56.1%) and the tocilizumab group (269; 63.1%) (p-value = 0.016), and this difference increased even more in the propensity-matched analysis between the non-tocilizumab group (466.7; 54.6%) and the tocilizumab group (269; 63.1%) (p-value = 0.005). The matching model successfully matched the two groups' common medical therapeutics used to treat COVID-19. Two medical therapeutics remained significantly different, favoring the tocilizumab group. A multivariate logistic regression was performed for the 28 day hospital survival in the propensity-matched patients. It showed that neither steroids (OR: 1.07 (95% CI: 0.75-1.53)) (p = 0.697) nor favipiravir (OR: 1.08 (95% CI: 0.61-1.9)) (p = 0.799) remained as a predictor for an increase in 28 day survival. CONCLUSION: The tocilizumab treatment in critically ill COVID-19 patients admitted to the ICU improved the overall 28 day hospital survival, which might not be influenced by the concurrent use of other COVID-19 medical therapeutics, although further research is needed to confirm this.

An Overview of Fluvoxamine and its Use in SARS-CoV-2 Treatment.

Fluvoxamine (FLV) is a well-tolerated, widely accessible antidepressant of the selective serotonin reuptake inhibitor (SSRI) category. It was formerly used to reduce anxiety, obsessive-compulsive disorder, panic attacks, and depression. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an enclosed ribonucleic acid (RNA) virus with a positive-sense RNA genome that belongs to the Coronaviridae family. Infection with SARS-CoV-2 causes clinical deterioration, increased hospitalization, morbidity, and death. As a result, the purpose of this research was to review FLV and its use in the treatment of SARS-CoV-2. FLV is a potent sigma-1 receptor (S1R) agonist that modulates inflammation by reducing mast cell downregulation, cytokine production, platelet aggregation, interfering with endolysosomal viral transport, and delaying clinical deterioration. FLV treatment reduced the requirement for hospitalization in high-risk outpatients with early identified coronavirus disease 2019 (COVID-19), defined by detention in a COVID-19 emergency department or transfer to a tertiary hospital. In addition, FLV may reduce mortality and risk of hospital admission or death in patients with SARS-CoV-2. The most common adverse effect is nausea; other gastrointestinal symptoms, neurologic consequences, and suicidal thoughts may also occur. There is no evidence that FLV can treat children with SARS-CoV-2. Although FLV is not expected to increase the frequency of congenital abnormalities during pregnancy, this risk must be balanced with the potential benefit. More research is required to determine the effectiveness, dose, and mechanisms of action of FLV; however, FLV appears to offer significant promise as a safe and widely accessible drug that can be repurposed to reduce substantial morbidity and mortality due to SARS-CoV-2.

Long-term outcomes of patients with COVID-19 treated with helmet noninvasive ventilation or usual respiratory support: follow-up study of the Helmet-COVID randomized clinical trial.

PURPOSE: To evaluate whether helmet noninvasive ventilation compared to usual respiratory support reduces 180-day mortality and improves health-related quality of life (HRQoL) in patients with acute hypoxemic respiratory failure due to COVID-19 pneumonia. METHODS: This is a pre-planned follow-up study of the Helmet-COVID trial. In this multicenter, randomized clinical trial, adults with acute hypoxemic respiratory failure (n = 320) due to coronavirus disease 2019 (COVID-19) were randomized to receive helmet noninvasive ventilation or usual respiratory support. The modified intention-to-treat population consisted of all enrolled patients except three who were lost at follow-up. The study outcomes were 180-day mortality, EuroQoL (EQ)-5D-5L index values, and EQ-visual analog scale (EQ-VAS). In the modified intention-to-treat analysis, non-survivors were assigned a value of 0 for EQ-5D-5L and EQ-VAS. RESULTS: Within 180 days, 63/159 patients (39.6%) died in the helmet noninvasive ventilation group compared to 65/158 patients (41.1%) in the usual respiratory support group (risk difference - 1.5% (95% confidence interval [CI] - 12.3, 9.3, p = 0.78). In the modified intention-to-treat analysis, patients in the helmet noninvasive ventilation and the usual respiratory support groups did not differ in EQ-5D-5L index values (median 0.68 [IQR 0.00, 1.00], compared to 0.67 [IQR 0.00, 1.00], median difference 0.00 [95% CI - 0.32, 0.32; p = 0.91]) or EQ-VAS scores (median 70 [IQR 0, 93], compared to 70 [IQR 0, 90], median difference 0.00 (95% CI - 31.92, 31.92; p = 0.55). CONCLUSIONS: Helmet noninvasive ventilation did not reduce 180-day mortality or improve HRQoL compared to usual respiratory support among patients with acute hypoxemic respiratory failure due to COVID-19 pneumonia.

Analyzing the impact of COVID-19 on the performance of listed firms in Saudi market.

The COVID-19 outbreak has hit enterprises all around the world, affecting virtually every business area and industry. Consequently, the purpose of this paper is to investigate how COVID-19 has affected the performance of listed companies in the Saudi market. The study uses financial data from 2009 to 2019 to examine the performance of the listed Saudi firms. The study gathers data from the years 2009 to 2019 to investigate the performance of the firms before the pandemic. The result of the study indicates that the COVID-19 pandemic had a detrimental effect on the enterprises' performance. The analysis indicates that the COVID-19 pandemic significantly harmed the enterprises' performance by reducing both their total investment and their overall income, respectively. The findings of the study remain unique and new with respect to the outbreak and performance of the firm.

Association between inflammatory cytokines/chemokines, clinical laboratory parameters, disease severity and in-hospital mortality in critical and mild COVID-19 patients without comorbidities or immune-mediated diseases.

There are limited data on inflammatory cytokines and chemokines; the humoral immune response; and main clinical laboratory parameters as indicators for disease severity and mortality in patients with critical and mild COVID-19 without comorbidities or immune-mediated diseases in Saudi Arabia. We determined the expression levels of major proinflammatory cytokines and chemokines; C-reactive protein (CRP); procalcitonin; SARS-CoV-2 IgM antibody and twenty-two clinical laboratory parameters and assessed their usefulness as indicators of disease severity and in-hospital death. Our results showed a significant increase in the expression levels of SARS-CoV-2 IgM antibody; IL1-ß; IL-6; IL-8; TNF-α and CRP in critical COVID-19 patients; neutrophil count; urea; creatinine and troponin were also increased. The elevation of these biomarkers was significantly associated and positively correlated with in-hospital death in critical COVID-19 patients. Our results suggest that the levels of IL1-ß; IL-6; IL-8; TNF-α; and CRP; neutrophil count; urea; creatinine; and troponin could be used to predict disease severity in COVID-19 patients without comorbidities or immune-mediated diseases. These inflammatory mediators could be used as predictive early biomarkers of COVID-19 disease deterioration; shock and death among COVID-19 patients without comorbidities or immune-mediated diseases.

Studying of COVID-19 fractional model: Stability analysis.

This article focuses on the recent epidemic caused by COVID-19 and takes into account several measures that have been taken by governments, including complete closure, media coverage, and attention to public hygiene. It is well known that mathematical models in epidemiology have helped determine the best strategies for disease control. This motivates us to construct a fractional mathematical model that includes quarantine categories as well as government sanctions. In this article, we prove the existence and uniqueness of positive bounded solutions for the suggested model. Also, we investigate the stability of the disease-free and endemic equilibriums by using the basic reproduction number (BRN). Moreover, we investigate the stability of the considering model in the sense of Ulam-Hyers criteria. To underpin and demonstrate this study, we provide a numerical simulation, whose results are consistent with the analysis presented in this article.

Systematic review of MCDM approach applied to the medical case studies of COVID-19: trends, bibliographic analysis, challenges, motivations, recommendations, and future directions

When COVID-19 spread in China in December 2019, thousands of studies have focused on this pandemic. Each presents a unique perspective that reflects the pandemic's main scientific disciplines. For example, social scientists are concerned with reducing the psychological impact on the human mental state especially during lockdown periods. Computer scientists focus on establishing fast and accurate computerized tools to assist in diagnosing, preventing, and recovering from the disease. Medical scientists and doctors, or the frontliners, are the main heroes who received, treated, and worked with the millions of cases at the expense of their own health. Some of them have continued to work even at the expense of their lives. All these studies enforce the multidisciplinary work where scientists from different academic disciplines (social, environmental, technological, etc.) join forces to produce research for beneficial outcomes during the crisis. One of the many branches is computer science along with its various technologies, including artificial intelligence, Internet of Things, big data, decision support systems (DSS), and many more. Among the most notable DSS utilization is those related to multicriterion decision making (MCDM), which is applied in various applications and across many contexts, including business, social, technological and medical. Owing to its importance in developing proper decision regimens and prevention strategies with precise judgment, it is deemed a noteworthy topic of extensive exploration, especially in the context of COVID-19-related medical applications. The present study is a comprehensive review of COVID-19-related medical case studies with MCDM using a systematic review protocol. PRISMA methodology is utilized to obtain a final set of (n = 35) articles from four major scientific databases (ScienceDirect, IEEE Xplore, Scopus, and Web of Science). The final set of articles is categorized into taxonomy comprising five groups: (1) diagnosis (n = 6), (2) safety (n = 11), (3) hospital (n = 8), (4) treatment (n = 4), and (5) review (n = 3). A bibliographic analysis is also presented on the basis of annual scientific production, country scientific production, co-occurrence, and co-authorship. A comprehensive discussion is also presented to discuss the main challenges, motivations, and recommendations in using MCDM research in COVID‐19-related medial case studies. Lastly, we identify critical research gaps with their corresponding solutions and detailed methodologies to serve as a guide for future directions. In conclusion, MCDM can be utilized in the medical field effectively to optimize the resources and make the best choices particularly during pandemics and natural disasters.

Cluster Analysis of Biochemical Markers as Predictor of COVID-19 Severity

Numerous blood biomarkers are altered in COVID-19 patients;however, no early biochemical markers are currently being used in clinical practice to predict COVID-19 severity. COVID-19, the most recent pandemic, is caused by the SRS-CoV-2 coronavirus. The study was aimed to identify patient groups with a high and low risk of developing COVID-19 using a cluster analysis of several biomarkers. 137 women with confirmed SARS CoV-2 RNA testing were collected and analyzed for biochemical profiles. Two-dimensional automated hierarchy clustering of all biomarkers was applied, and patients were sorted into classes. Biochemistry marker variations (Ferritin, lactate dehydrogenase LDH, D-dimer, and C- reactive protein CRP) have split COVID-19 patients into two groups(severe cases and non-severe cases groups). Ferritin, lactate dehydrogenase LDH, D-dimer and CRP were markedly increased in COVID-19 patients in the first group (severe cases). Our findings imply that early measured levels of (Ferritin, lactate dehydrogenase LDH, D-dimer, and C- reactive protein CRP) are linked to a decreased probability of COVID-19 severity. Elevated levels of this biomarker may predict COVID severity development. © 2022 University of Baghdad. All rights reserved.

Ebola outbreak in Guinea, 2021: Clinical care of patients with Ebola virus disease.

Background: Experience from the Zaire Ebolavirus epidemic in the eastern Democratic Republic of the Congo (2018-2020) demonstrates that early initiation of essential critical care and administration of Zaire Ebolavirus specific monoclonal antibodies may be associated with improved outcomes among patients with Ebola virus disease (EVD). Objectives: This series describes 13 EVD patients and 276 patients with suspected EVD treated during a Zaire Ebolavirus outbreak in Guinea in 2021. Method: Patients with confirmed or suspected EVD were treated in two Ebola treatment centres (ETC) in the region of N'zérékoré. Data were reviewed from all patients with suspected or confirmed EVD hospitalised in these two ETCs during the outbreak (14 February 2021 - 19 June 2021). Ebola-specific monoclonal antibodies, were available 2 weeks after onset of the outbreak. Results: Nine of the 13 EVD patients (age range: 22-70 years) survived. The four EVD patients who died, including one pregnant woman, presented with multi-organ dysfunction and died within 48 h of admission. All eight patients who received Ebola-specific monoclonal antibodies survived. Four of the 13 EVD patients were health workers. Improvement of ETC design facilitated implementation of WHO-recommended 'optimized supportive care for EVD'. In this context, pragmatic clinical training was integrated in routine ETC activities. Initial clinical manifestations of 13 confirmed EVD patients were similar to those of 276 patients with suspected, but subsequently non confirmed EVD. These patients suffered from other acute infections (e.g. malaria in 183 of 276 patients; 66%). Five of the 276 patients with suspected EVD died. One of these five patients had Lassa virus disease and a coronavirus disease 2019 (COVID-19) co-infection. Conclusion: Multidisciplinary outbreak response teams can rapidly optimise ETC design. Trained clinical teams can provide WHO-recommended optimised supportive care, including safe administration of Ebola-specific monoclonal antibodies. Pragmatic training in essential critical care can be integrated in routine ETC activities. Contribution: This article describes clinical realities associated with implementation of WHO-recommended standards of 'optimized supportive care' and administration of Ebola virus specific treatments. In this context, the importance of essential design principles of ETCs is underlined, which allow continuous visual contact and verbal interaction of health workers and families with their patients. Elements that may contribute to further quality of care improvements for patients with confirmed or suspected EVD are discussed.