Immunoinformatics design of B and T-cell epitope-based SARS-CoV-2 peptide vaccination.

SARS-COV-2 is a virulent respiratory virus, first identified in China (Wuhan) at the end of 2019. Scientists and researchers are trying to find any possible solution to this deadly viral disease. Different drug source agents have been identified, including western medicine, natural products, and traditional Chinese medicine. They have the potential to counteract COVID-19. This virus immediately affects the liver and causes a decrease in oxygen levels. In this study, multiple vacciome approaches were employed for designing a multi-epitope subunit vaccine for battling against SARS-COV-2. Vaccine designing, immunogenicity, allergenic, and physico-chemical assessment were performed by using the vacciome approach. The vaccine design is likely to be antigenic and produce potent interactions with ACE2 and NSP3 receptors. The developed vaccine has also been given to in-silico cloning models and immune response predictions. A total number of 12 CTL and 12 HTL antigenic epitopes were predicted from three selected covid-19 virulent proteins (spike protein, nucleocapsid protein, and membrane proteins, respectively) based on C-terminal cleavage and MHC binding scores. These predicted epitopes were amalgamated by AYY and GPGPG linkers, and a ß-defensins adjuvant was inserted into the N-terminus of this vaccine. This analysis shows that the recommended vaccine can produce immune responses against SARS-COV-2. Designing and developing of the mentioned vaccine will require further experimental validation.

Effect of physical activity and sedentary sitting time on psychological quality of life of people with and without disabilities, A survey from Saudi Arabia

Background Mental and psychological health issues are on the rise globally. People with disabilities are at greater risk of poor psychological quality of life especially after covid-19 pandemic. Along with other factors physical activity (PA) may have a significant effect on mental health. This study aims to analyze the difference of PA participation and sitting time among people with and without disabilities and their association with psychological quality of life. Methods A standard questionnaire was used to collect the data from disabled and non-disabled participants above 15 years of age. Bivariate and multivariate analysis was performed to yield statistical results. Results Total study sample consisted of 359 participants (67.7% without disability and 32.3% with disability). Participants without disabilities reported a significantly better psychological quality of life (QOL) (Mean score = 68) as compared to the ones with disabilities (Mean score = 61), (p < 0.01). There was significant difference between the sitting time of two groups with longer sitting time among people with disabilities (6.1 h/day) as compared to non-disabled (5.3 h). Optimum level of PA was strongly associated with better psychological quality of life among individuals without disabilities (p = 0.00). Younger age (p = 0.00) and being single (p = 0.01) were significant predictors of poor psychological health among non-disables. Increase in sedentary sitting time was significantly associated with poor psychological quality of life among both groups. Conclusions Tailored health policies to encourage PA and reduce sitting hours should be formulated to improve psychological health with special focus on individuals with disabilities. Future studies with large sample size are recommended to validate the current results and further explore the difference in association of PA and psychological wellbeing in people with and without disabilities.

Role of Environmental Quality of Life in Physical Activity Status of Individuals with and without Physical Disabilities in Saudi Arabia.

The promotion of physical activity (PA) in various subgroups of the population such as people with physical disabilities has been spotlighted in the revised guidelines of The World Health Organization (WHO), Geneva, Switzerland. In order to update public health interventions, there is a need to identify factors that may promote or prevent engagement in PA for special subgroups of the population. This study aims to calculate the PA levels of individuals with and without physical disabilities in Saudi Arabia, their assessment of the environmental (EQoL), and the predictive role of EQoL in PA. The International Physical Activity Questionnaire (IPAQ) and the EQoL domain in standardized WHOQoL Questionnaire were administered on both groups of the population. The study sample comprised 116 individuals with physical disabilities and 243 individuals without any form of disability as a control group. A regression analysis was performed to analyze the predictors of PA in both groups. Findings showed that among the individuals with disabilities, older people were more likely to engage in PA as compared to the younger age group (p < 0.05) and males were significantly less likely to meet the PA criteria. Some of the EQoL features such as safety increased the likelihood of PA up to 2.3 times (p < 0.05) in individuals with physical disabilities. In addition, opportunities for leisure activities were a significant predictor of PA among both groups of individuals with and without physical disabilities (p < 0.05). Our findings suggest that upcoming public health interventions should focus on improving various dimensions of EQoL for the promotion of physical activity among individuals with physical disabilities. Additional studies are needed to further explore various sociodemographic and environmental factors which can affect the PA status of disabled groups.

The establishment of a telemedicine center during the COVID-19 pandemic at a tertiary care hospital in Pakistan

Background Telemedicine involves the innovative application of technology to provide remote patient healthcare services especially those relating to emergency care and contagious disease spread. Telemedicine is less developed in low-and-middle-income countries like Pakistan and there is little published literature on its function and efficiency. Our institution was established to triage patients with COVID-19 symptoms to ease the load on emergency departments. Objective To conduct an analysis of the first month of function of a telemedicine/tele-triage center in Pakistan. To determine in which ways it was beneficial to hospital management during the COVID-19 pandemic. Methods This study was carried out at the newly established telemedicine/tele-triage center at the Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU) in Islamabad Pakistan between the 26th March and the 25th April 2020. Data were collected over telephone interview using a proforma to provide each caller with a C-Score (a C-score of <3 indicated observe at home 3-5- indicated home isolation with confirmatory testing and >5 indicated testing and transfer to hospital) representing their COVID-19 risk and informing the nature of the advice given to them. Data were presented using descriptive statistics. Results The center received total of 857 calls. Fever cough dyspnea and flu were present in 327(38.2%) 268(31.3%) 107(12.5%) and 124(14.5%) callers respectively. Based on the completion of the proforma 774(90.3%) callers had a C-Score of <3 75(8.8%) callers had a C-Score of 3-5 and 8 (0.9%) callers had a C-Score of >5. We recommended COVID-19 testing in 83 patients (9.68%) based on C-score. Out of these 83 patients 64 underwent testing and only 1 tested positive for COVID-19. Conclusion In a one-month period the center was able to support patients by providing a triage service thereby preventing numerous unnecessary hospital visits and helping to protect healthcare professionals during a global pandemic. Telemedicine has great potential to help patient populations in low-and-middle-income countries.

Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19: an international collaborative meta-analysis of randomized trials (preprint)

Background: Substantial COVID-19 research investment has been allocated to randomized clinical trials (RCTs) on hydroxychloroquine/chloroquine, which currently face recruitment challenges or early discontinuation. We aimed to estimate the effects of hydroxychloroquine and chloroquine on survival in COVID-19 from all currently available RCT evidence, published and unpublished. Methods: Rapid meta-analysis of ongoing, completed, or discontinued RCTs on hydroxychloroquine or chloroquine treatment for any COVID-19 patients (protocol: https://osf.io/QESV4/). We systematically identified published and unpublished RCTs by September 14, 2020 (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, PubMed, Cochrane COVID-19 registry). All-cause mortality was extracted (publications/preprints) or requested from investigators and combined in random-effects meta-analyses, calculating odds ratios (ORs) with 95% confidence intervals (CIs), separately for hydroxychloroquine/chloroquine. Prespecified subgroup analyses included patient setting, diagnostic confirmation, control type, and publication status. Results: Sixty-two trials were potentially eligible. We included 16 unpublished trials (1596 patients) and 10 publications/preprints (6317 patients). The combined summary OR on all-cause mortality for hydroxychloroquine was 1.08 (95%CI: 0.99, 1.18; I-square=0%; 24 trials; 7659 patients) and for chloroquine 1.77 (95%CI: 0.15, 21.13, I-square=0%; 4 trials; 307 patients). We identified no subgroup effects. Conclusions: We found no benefit of hydroxychloroquine or chloroquine on the survival of COVID-19 patients. For hydroxychloroquine, the confidence interval is compatible with increased mortality (OR 1.18) or negligibly reduced mortality (OR 0.99). Findings have unclear generalizability to outpatients, children, pregnant women, and people with comorbidities.