Acute encephalomyelitis in a 52-year-old male post messenger ribonucleic acid severe acute respiratory syndrome coronavirus 2 vaccination: a case report.

BACKGROUND: Acute disseminated encephalomyelitis is a well-known, but rare, side effect of some vaccines, or symptom following a febrile illness. CASE: A 69-year-old, otherwise healthy Hispanic male presented with acute fever, confusion, and later progressive weakness after receiving the first dose of the mRNA-1273 (Moderna) severe acute respiratory syndrome coronavirus 2 vaccine. Considering the progressive deterioration of the patient, despite being on multiple immunosuppressive agents, a brain biopsy was obtained, which revealed nonspecific meningoencephalitis. CONCLUSION: In this case, we highlight the need for a regulatory framework to assist clinicians and patients with coverage of treatment for acute disseminated encephalomyelitis. The use of intravenous immunoglobulin in conjunction with glucocorticoids seems to be an effective treatment option.

Honey and Nigella sativa against COVID-19 in Pakistan (HNS-COVID-PK): A multicenter placebo-controlled randomized clinical trial.

Until now, no specific and effective treatment exists for coronavirus disease 2019 (COVID-19). Since honey and Nigella sativa (HNS) have established antiviral, antibacterial, antiinflammatory, antioxidant, and immunomodulatory properties, we tested their efficacy for this disease in a multicenter, placebo-controlled, and randomized clinical trial at four medical care facilities in Pakistan. RT-PCR confirmed COVID-19 adults showing moderate or severe disease were enrolled in the trial. Patients were randomly assigned in a 1:1 ratio to receive either honey (1 g kg-1 day-1 ) and Nigella sativa seeds (80 mg kg-1 day-1 ) or a placebo for up to 13 days along with standard care. The outcomes included symptoms' alleviation, viral clearance, and 30-day mortality in the intention-to-treat population. Three hundred and thirteen patients, 210 with moderate and 103 with severe disease, underwent randomization from April 30 to July 29, 2020. Among the moderate cases, 107 were assigned to HNS, whereas 103 were assigned to the placebo group. Among the severe cases, 50 were given HNS, and 53 were given the placebo. HNS resulted in ~50% reduction in time taken to alleviate symptoms as compared to placebo (moderate cases: 4 vs. 7 days, Hazard Ratio [HR]: 6.11; 95% Confidence Interval [CI]: 4.23-8.84, p < 0.0001 and for severe cases: 6 vs. 13 days, HR: 4.04; 95% CI: 2.46-6.64; p < 0.0001). HNS also cleared the virus earlier than placebo in both moderate cases (6 vs. 10 days, HR: 5.53; 95% CI: 3.76-8.14, p < 0.0001) and severe cases (8.5 vs. 12 days, HR: 4.32; 95% CI: 2.62-7.13, p < 0.0001). HNS further led to a better clinical score on day 6 with normal activity resumption in 63.6% vs. 10.9% among moderate cases (OR: 0.07; 95% CI: 0.03-0.13, p < 0.0001) and hospital discharge in 50% versus 2.8% in severe cases (OR: 0.03; 95% CI: 0.01-0.09, p < 0.0001). In severe cases, the mortality rate was less than 1/4th in the HNS group than in placebo (4% vs. 18.87%, OR: 0.18; 95% CI: 0.02-0.92, p = 0.029). No HNS-related adverse effects were observed. HNS, compared with placebo, significantly improved symptoms, expedited viral load clearance, and reduced mortality in COVID-19 patients. This trial was registered on April 15, 2020 with ClinicalTrials.gov Identifier: NCT04347382.

Implementation of computationally efficient numerical approach to analyze a Covid-19 pandemic model

Corona virus disease (Covid-19) which has caused frustration in the human community remains the concern of the globe as every government struggles to defeat the pandemic. To deal with the situation, we have extensively studied a deadly Covid-19 model to provide a deep insight into the disease dynamics. A mathematical analysis of the model utilizing preventive measures is performed with the aim to reduce the disease burden. Some comprehensive mathematical techniques are employed to demonstrate several essential properties of solutions. To start with, we proved the existence and uniqueness of solutions. Equilibrium points are stated both in the absence and presence of the pandemic. Biologically important quantity known as threshold parameter is computed to handle the future disease dynamics and analyzed for its sensitivity. We proved the stability of the proposed model at equilibrium points by employing necessary conditions on threshold parameter. A reliable and competitive numerical analysis is conducted to observe the effectiveness of implemented strategies and to verify obtained analytical results. The most sensitive parameters are determined through sensitivity analysis. An important feature of this study is to employ Non-Standard Finite Difference (NSFD) numerical scheme to solve the system instead of other standard methods like Runge-Kutta method of order 4 (RK4). Finally, several numerical simulations are performed to validate our former theoretical analysis. Numerical results exhibiting dynamical behavior of Covid-19 system under the influence of involved parameters suggest that both the implemented strategies, especially quarantine of exposed individuals, are effective for the substantial reduction in the diseased population and to achieve the herd immunity.

Identifying How E-Service Quality Affects Perceived Usefulness of Online Reviews in Post-COVID-19 Context: A Sustainable Food Consumption Behavior Paradigm

In this study, the concept of online food purchasing is explored where consumers are not required to visit markets to purchase their foods, especially during the COVID-19 pandemic. Thus, the purpose of this study is to investigate the relationship between perceived e-service quality and related customer service outcomes in online shopping context. The influence of sustainable marketing practices in terms of perceived e-service quality (ESQ), perceived usefulness of online reviews (PUO), brand self-connection (BSC), personal innovativeness (PRI), and willingness to pay for online food services (WPO) has largely been neglected in the previous studies. The present study proposes a conceptual model to fill this gap and empirically examines how ESQ affects PUO, BSC, WPO, and e-word-of-mouth (e-WOM) of food delivery service brands. An online questionnaire survey was conducted with 423 customers utilizing the PLS-SEM-based approach to determine product indicators. Empirical results reveal that ESQ significantly influence BSC and PUO. In the same vein, PUO significantly influence BSC, while BSC significantly influence e-WOM and WPO. The results further indicate that PRI moderates the relationship between ESQ and BSC. In a post-pandemic context, our analysis indicates enormous implications for food service delivery brands in emerging economies. Online food service providers should consider reviewers' opinions about the products and services they offer and encourage their customers to write positive reviews of the products and services they offer.

Tourism supply chains: Issues and resilience strategies during the global pandemic

Having an extensive network structure, and the help of key government organisations like Tourism NZ (who shared information and created targeted marketing campaigns focused on attracting domestic tourists), enabled these supply chains to bounce back relatively quickly. While there has been some improvement to occupancy rates due to domestic travel, IATA (2020) predicted that global passenger numbers are not likely to top pre-Covid-19 levels until 2023 as airlines' capacity has significantly reduced, and the cost of travel has increased. [...]the management, coordination, and collaboration with different suppliers, customers, and third-party logistics service providers are also included in supply chain management (Frankel et al., 2008). The term tourism supply chains refers to a network of tourism related organisations engaged in range of different activities, from the supply of different tourism components (such as flights and accommodation), to the distribution and marketing of a specific tourism product (X. Zhang et al., 2009).

Optimal urban planning through the best–worst method: bicycle lanes in Palermo, Sicily

Since 2020, due to the Covid-19 pandemic, planners and designers have proposed numerous changes for urban spaces and mobility concepts to comply with governments' anti-contamination restrictions. Several European cities have implemented strategies for developing cycling, favouring the design of temporary (pop-up) or permanent cycle lanes and state incentives to purchase bicycles and electric micro-mobility vehicles. However, existing research suggests that design optimisation must pursue specific geometric, functional and safety standards for cyclists and space sharers (pedestrians/cars). It is thus necessary to analyse the perceptions of citizens and commuters for optimisation of the planning and design of these infrastructures. A multi-criteria evaluation was used to determine optimal infrastructure schemes (temporary and permanent) for the metropolis of Palermo in Sicily, Italy. First, three groups of cyclists (citizens, technicians and commuters) were selected. Then, applying the best-worst method, a series of design alternatives were evaluated by the target groups. The results showed a correlation between different types of users in terms of those who live in the city compared with commuters in the city for the first time. The results of this work lay the foundation for improved planning and design strategies in sustainable urban mobility plans and the Italian Biciplan guidelines.

Analysis of COVID-19 epidemic model with sumudu transform

In this paper, we develop a time-fractional order COVID-19 model with effects of disease during quarantine which consists of the system of fractional differential equations. Fractional order COVID-19 model is investigated with ABC technique using sumudu transform. Also, the deterministic mathematical model for the quarantine effect is investigated with different fractional parameters. The existence and uniqueness of the fractional-order model are derived using fixed point theory. The sumudu transform can keep the unity of the function, the parity of the function, and has many other properties that are more valuable. Solutions are derived to investigate the influence of fractional operator which shows the impact of the disease during quarantine on society.

COVID and World Stock Markets: A Comprehensive Discussion.

The COVID-19 outbreak has disturbed the victims' economic conditions and posed a significant threat to economies worldwide and their respective financial markets. The majority of the world stock markets have suffered losses in the trillions of dollars, and international financial institutions were forced to reduce their forecasted growth for 2020 and the years to come. The current research deals with the impact of the COVID-19 pandemic on the global stock markets. It has focused on the contingent effects of previous and current pandemics on the financial markets. It has also elaborated on the pandemic impact on diverse pillars of the economy. Irrespective of all these destructive effects of the pandemic, still hopes are there for a sharp rise and speedy improvement in global stock markets' performance.

Acute Neurological Manifestations of COVID-19 Patients From Three Tertiary Care Hospitals in Qatar.

Introduction Worldwide, there are more than 424 million confirmed cases of COVID-19. Most of the hospitalized critical COVID-19 patients manifested neurological signs and symptoms and higher mortality. The majority of COVID-19 fatalities occurred mostly in patients with advanced age and underlying medical comorbidities. This is the first local retrospective study in Qatar, which reported neurologic manifestations (48.5%) of hospitalized COVID-19 patients. The primary objective of this study is to evaluate acute neurological manifestations in COVID-19 hospitalized patients in the country. Methods This is a retrospective, observational study of 413 hospitalized COVID-19 patients. They were admitted to three different COVID-19 designated hospitals (Hazm Mebaireek, Ras Laffan, and Cuban tertiary care Hospitals) under the Hamad Medical Corporation, Qatar from 1st January 2020, to 31 January 2021. We evaluated electronic medical records of these patients and data were collected while their neurological manifestations were confirmed by two trained neurologists. These neurologic manifestations were categorized into three major groups: central nervous system (CNS), peripheral nervous system (PNS), and neuromuscular system. Results Of 413 patients, 94% (389) were male and 6% (24) were female; the mean age was 52 years. Among all different nationalities of COVID-19 patients, 20.3% (84) were Indian, 12.5% (52) were Bangladeshi, 10.1% (42) were Qatari and 9.2% (38) were Nepali. The most common symptoms at the onset of COVID-19 illness were as follows: 77.5% (321) had a fever, 67.4% (279) experienced cough, 58.7% (243) experienced shortness of breath and 26.1% (108) developed a sore throat. Overall 48.5% (201) patients developed different neurologic manifestations. The most common neurologic symptoms were myalgia (28%; 116), headache (10.4%; 43), dizziness (5.8%; 24) and hemiparesis due to strokes (5.3%; 22). In this study, the most common risk factors were hypertension (47.6%), diabetes (46.9%), obesity (21%), chronic kidney disease (10%), ischemic heart disease (9.7%), and smoking (6.8%). About 45.2% (187) patients were admitted to MICU and 8.5% (35) died due to COVID-19 complications. Significant other extrapulmonary multiorgan system involvement were skeletal muscle injury (39.4%), kidney injury (36.7%), liver injury (27.5%), myocardial injury (23.9%), rhabdomyolysis (15.7%) heart failure (11.4%) and acute pancreatitis (11.1%). Discussion The most common neurologic signs and symptoms were myalgia, headache, dizziness, and strokes, mainly due to large vessel thrombosis, lacunar, and posterior circulation strokes. Conclusions Patients with COVID-19 are at high risk of developing neurological manifestations. The most common COVID-19-related acute neurological manifestations were myalgia, headache, dizziness, and acute ischemic stroke. Prompt recognition, early diagnosis, and appropriate management of these manifestations could potentially lead to better patient outcomes in COVID-19 patients.

COVID and World Stock Markets: A Comprehensive Discussion

The COVID-19 outbreak has disturbed the victims' economic conditions and posed a significant threat to economies worldwide and their respective financial markets. The majority of the world stock markets have suffered losses in the trillions of dollars, and international financial institutions were forced to reduce their forecasted growth for 2020 and the years to come. The current research deals with the impact of the COVID-19 pandemic on the global stock markets. It has focused on the contingent effects of previous and current pandemics on the financial markets. It has also elaborated on the pandemic impact on diverse pillars of the economy. Irrespective of all these destructive effects of the pandemic, still hopes are there for a sharp rise and speedy improvement in global stock markets' performance.

Prevalence of Nomophobia and an Analysis of Its Contributing Factors in the Undergraduate Students of Pakistan.

Nomophobia (no-mobile-phone phobia) is a relatively new term that describes the growing fear and anxiety associated with being without a mobile phone. Our study aims to determine the prevalence of nomophobia among the undergraduate students of Pakistan, and to determine its correlation with age and gender. It also aims to determine the contributory factors of nomophobia. A cross-sectional study was conducted through an online survey from March 25 to April 25, 2021. The snowball sampling technique was used for data collection. The Nomophobia Questionnaire (NMP-Q) developed by Yildirim and Correia was circulated among the target population. It was a 7-point Likert Scale that was analyzed on the basis of age and gender using IBM SPSS version 22 and MS Excel 2007. The contributing factors were also analyzed. Of the 483 responses we received, 28 were discarded due to incompleteness and respondents being out of age under study that is, 15-25 years. Most of the respondents were women (n = 314, 69.01 percent). Men were less in number than women (n = 141, 31 percent). The ages of most of the respondents lied between 15 and 25 years. Twenty was the mode age. One hundred eighty-six (40.88 percent) had severe, 221 (48.57 percent) had moderate, and 48 (10.55 percent) had mild nomophobia. Average factor-wise scores and individual item scores were also added. Our findings reached a conclusion that the majority of the undergraduate students in Pakistan suffer from nomophobia ranging from its mild to severe form. Nomophobia can possibly be included as a recognized phobia in the DSM. Wider research on the subject to investigate it further and evaluate the clinical significance should be done.

A quadruple blinded placebo controlled randomised trial to evaluate the effectiveness of an Iodine complex for patients with mild to moderate COVID-19 in Pakistan (I-COVID-PK): A structured summary of a study protocol for a randomised controlled trial.

OBJECTIVES: The objective of the study is to measure the efficacy of ionic-iodine polymer complex [1] for clinical and radiological improvement in coronavirus disease 2019 (COVID-19) patients. TRIAL DESIGN: The trial will be closed label, randomized and placebo-controlled with a 1:1:1:1 allocation ratio and superiority framework. PARTICIPANTS: All PCR confirmed COVID-19 adult patients including non-pregnant females, with mild to moderate disease, will be enrolled from Shaikh Zayed Post-Graduate Medical Complex, Ali Clinic and Doctors Lounge in Lahore (Pakistan). Patients with any pre-existing chronic illness will be excluded from the study. INTERVENTION AND COMPARATOR: In this multi-armed study ionic-iodine polymer complex with 200 mg of elemental iodine will be given using three formulations to evaluate efficacy. Patients will be receiving either encapsulated iodine complex of 200 mg (arm A), iodine complex syrup form 40 ml (arm B), iodine complex throat spray of 2 puffs (arm C) or empty capsule (arm D) as placebo; all three times a day. All the 4 arms will be receiving standard care as per version 3.0 of the clinical management guidelines for COVID-19 established by the Ministry of National Health Services of Pakistan. MAIN OUTCOMES: Primary outcomes will be viral clearance with radiological and clinical improvement. SARS-CoV-2 RT-PCR and HRCT chest scans will be done on the admission day and then after every fourth day for 12 days or till the symptoms are resolved. RT-PCR will only be shown as positive or negative while HRCT chest scoring will be done depending on the area and severity of lung involvement [2]. Time taken for the alleviation of symptoms will be calculated by the number of days the patient remained symptomatic. 30-day mortality will be considered as a secondary outcome. RANDOMISATION: Stratification for initial COVID-19 status (or days from initial symptoms as a proxy), age groups, gender, baseline severity of symptoms and co-morbidities will be used to ensure that the study arms remain balanced in size for the 1:1:1:1 allocation ratio. Randomization will be done using the lottery method. As patients are being admitted at different times, they will be recruited after obtaining their voluntary written informed consent following all standard protocols of the infection, control and disinfection. BLINDING (MASKING): This is a quadruple (participants, care providers, investigators and outcomes assessors) blinded study where only the study's Primary Investigator will have information about the arms and their interventions. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): 200 patients will be randomized into four groups with three experimental and one placebo arm. TRIAL STATUS: Protocol Version Number is 2.3 and it is approved from IRB Shaikh Zayed Hospital with ID SZMC/IRB/Internal0056/2020 on July 14th, 2020. The recruitment is in progress. It was started on July 30, 2020, and the estimated end date for the trial is August 15, 2021. TRIAL REGISTRATION: Clinical Trial has been retrospectively registered on www.clinicaltrials.gov with registration ID NCT04473261 dated July 16, 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). With the intention of expediting dissemination of this trial, the conventional formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines.

Clinical efficacy of iodine complex in SARS-CoV-2-infected patients with mild to moderate symptoms: study protocol for a randomized controlled trial.

BACKGROUND: Coronavirus disease 2019 (COVID-19) caused by the novel coronavirus-infected millions globally. Despite a wide range of advised options for the treatment of COVID-19, a single strategy to tackle this pandemic remains elusive, thus far. That is why we are conducting a clinical trial to find out the efficacy of iodine complex to clear a viral load of severe respiratory syndrome coronavirus-2 (SARS-CoV-2) along with a reduction in time taken to alleviate symptoms. METHOD: The proposed study is a placebo-controlled, add-on, randomized trial using parallel group designs. This is a closed-label and adaptive with sample size reassessment, multi-centered design with a 1:1:1:1 allocation ratio and superiority framework. It will be conducted in Shaikh Zayed Post-Graduate Medical Complex, Ali Clinic, and Doctors Lounge, Lahore, Pakistan. This study will have three arms of mild to moderately symptomatic COVID-19 patients (50 patients in each) which will receive ionic-iodine polymer complex with 200 mg of elemental iodine: interventional arm A will have encapsulated, arm B will receive suspension syrup form, arm C will get throat spray, while arm X will be standard care with placebo. Data will be collected on self-constructed, close-ended questionnaires after obtaining written consent. Data will be analyzed using SAS version 9.4. COVID-19 patients will be monitored by RT-PCR and HRCT (high-resolution computed tomography) chest. In addition to these, the duration of the symptomatic phase and mortality benefits will be analyzed in both groups. DISCUSSION: The study is designed to measure the superior efficacy of the iodine complex as an add-on in treating COVID-19-positive patients with mild to moderate symptoms. This combination is hypothesized to improve various parameters like rapid viral load reduction, clinical and radiological improvement, lower mortality, and reduction in hospitalization. The trial will aid in devising a better strategy to cope with COVID-19 in a relatively inexpensive and accessible way. The implications are global, and this could prove itself to be the most manageable intervention against COVID-19 especially for patients from limited-resource countries with deprived socioeconomic status. TRIAL REGISTRATION: ClinicalTrials.gov NCT04473261 . Registered on July 16, 2020.

Biofortification of Diverse Basmati Rice Cultivars with Iodine, Selenium, and Zinc by Individual and Cocktail Spray of Micronutrients

Given that an effective combined foliar application of iodine (I), selenium (Se), and zinc (Zn) would be farmer friendly, compared to a separate spray of each micronutrient, for the simultaneous biofortification of grain crops, we compared effectiveness of foliar-applied potassium iodate (KIO3, 0.05%), sodium selenate (Na2SeO4, 0.0024%), and zinc sulfate (ZnSO4∙7H2O, 0.5%), separately and in their combination (as cocktail) for the micronutrient biofortification of four Basmati cultivars of rice (Oryza sativa L.). Foliar-applied, each micronutrient or their cocktail did not affect rice grain yield, but grain yield varied significantly among rice cultivars. Irrespective of foliar treatments, the brown rice of cv. Super Basmati and cv. Kisan Basmati had substantially higher concentration of micronutrients than cv. Basmati-515 and cv. Chenab Basmati. With foliar-applied KIO3, alone or in cocktail, the I concentration in brown rice increased from 12 to 186 µg kg−1. The average I concentration in brown rice with foliar-applied KIO3 or cocktail was 126 μg kg−1 in cv. Basmati-515, 160 μg kg−1 in cv. Chenab Basmati, 153 μg kg−1 in cv. Kisan Basmati, and 306 μg kg−1 in cv. Super Basmati. Selenium concentration in brown rice increased from 54 to 760 µg kg−1, with foliar-applied Na2SeO4 individually and in cocktail, respectively. The inherent Zn concentration in rice cultivars ranged between 14 and 19 mg kg−1 and increased by 5–6 mg Zn per kg grains by foliar application of ZnSO4∙7H2O and cocktail. The results also showed the existence of genotypic variation in response to foliar spray of micronutrients and demonstrated that a foliar-applied cocktail of I, Se, and Zn could be an effective strategy for the simultaneous biofortification of rice grains with these micronutrients to address the hidden hunger problem in human populations.

Clinical and epidemiological characteristics of pediatric and adolescent patients of COVID-19, an experience of a Divisional Corona Center, Bahawalpur from South Punjab, Pak

Objective: To assess various clinical and epidemiological characteristics of pediatric and adolescent patients of COVID-19 of Bahawalpur division, to improve their outcome and management. Study design: Descriptive Cohort study. Setting: Department of Pediatrics, Civil Hospital Bahawalpur. Period: 1st March to 30th July 2020. Material & Methods: Data of patients was recovered from hospital record. Data of variables like age, gender, rural or urban living area, symptomatology and need for hospitalization was collected from hospital record. Results: Out of total 516 diagnosed COVID-19 patients, 5.4% patients were of age less than 20 years, 32% from birth to 5 years, 20% from 6 to 10 years of age, 21.4% were 11 to 15 years of age, 28.5% were 16 to 20 years age group. 57.1% were male and 42.8% were female. 42.8% were asymptomatic, 32% patient had respiratory symptoms, 25% had Gastro-intestinal symptoms. 64.2% belonged to urban territory of living, 35.7% belonged to rural. 81.2% patients fall in mild category and 18.7% in moderate. Mortality was Null. Hospitalization was needed in 53.5%, while 46.5% were home quarantined. Mean duration of hospital stay was 14+1 days. Conclusion: Pediatric and adolescent patients have mild to moderate disease severity leading to better outcome of the disease. [ FROM AUTHOR] Copyright of Professional Medical Journal is the property of Professional Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

The pathogenesis of COVID-19-induced IgA nephropathy and IgA vasculitis: A systematic review.

OBJECTIVE: IgA nephropathy (IgAN) and IgA vasculitis (IgAV) are part of a similar clinical spectrum. Both clinical conditions occur with the coronavirus disease 2019 (COVID-19). This review aims to recognize the novel association of IgAN and IgAV with COVID-19 and describe its underlying pathogenesis. METHODS: We conducted a systematic literature search and data extraction from PubMed, Cochrane, ScienceDirect, and Google Scholar following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Our search identified 13 cases reporting IgAV and IgAN associated with COVID-19 infection and 4 cases of IgAN following COVID-19 vaccination. The mean, mode, and median ages of patients were 23.8, 4, and 8 years, respectively. Most cases associated with COVID-19 infection were reported in males (77%). Rash and purpura (85%) were the most common clinical features, followed by gastrointestinal symptoms (62%). In symptomatic cases, skin or renal biopsy and immunofluorescence confirmed the diagnosis of IgAN or IgAV. Most patients were treated with steroids and reported recovery or improvement; however, death was reported in two patients. CONCLUSION: There is a paucity of scientific evidence on the pathogenesis of the association of IgAN and IgAV with COVID-19, which thus needs further study. Current research suggests the role of IgA-mediated immune response, evidenced by early seroconversion to IgA in COVID-19 patients and the role of IgA in immune hyperactivation as the predominant mediator of the disease process. Clinicians, especially nephrologists and paediatricians, need to recognize this association, as this disease is usually self-limited and can lead to complete recovery if prompt diagnosis and treatment are provided.

Prophylactic potential of honey and Nigella sativa L. against hospital and community-based SARS-CoV-2 spread: a structured summary of a study protocol for a randomised controlled trial.

OBJECTIVES: Considering the therapeutic potential of honey and Nigella sativa (HNS) in coronavirus disease 2019 (COVID-19) patients, the objective of the study is defined to evaluate the prophylactic role of HNS. TRIAL DESIGN: The study is a randomized, placebo-controlled, adaptive clinical trial with parallel group design, superiority framework with an allocation ratio of 1:1 among experimental (HNS) and placebo group. An interim analysis will be done when half of the patients have been recruited to evaluate the need to adapt sample size, efficacy, and futility of the trial. PARTICIPANTS: All asymptomatic patients with hospital or community based COVID-19 exposure will be screened if they have had 4 days exposure to a confirmed case. Non-pregnant adults with significant exposure level will be enrolled in the study High-risk exposure (<6 feet distance for >10min without face protection) Moderate exposure (<6 feet distance for >10min with face protection) Subjects with acute or chronic infection, COVID-19 vaccinated, and allergy to HNS will be excluded from the study. Recruitment will be done at Shaikh Zayed Post-Graduate Medical Institute, Ali Clinic and Doctors Lounge in Lahore (Pakistan). INTERVENTION AND COMPARATOR: In this clinical study, patients will receive either raw natural honey (0.5 g) and encapsulated organic Nigella sativa seeds (40 mg) per kg body weight per day or empty capsule with and 30 ml of 5% dextrose water as a placebo for 14 days. Both the natural products will be certified for standardization by Government College University (Botany department). Furthermore, each patient will be given standard care therapy according to version 3.0 of the COVID-19 clinical management guidelines by the Ministry of National Health Services of Pakistan. MAIN OUTCOMES: Primary outcome will be Incidence of COVID-19 cases within 14 days of randomisation. Secondary endpoints include incidence of COVID-19-related symptoms, hospitalizations, and deaths along with the severity of COVID-19-related symptoms till 14th day of randomization. RANDOMISATION: Participants will be randomized into experimental and control groups (1:1 allocation ratio) via the lottery method. There will be stratification based on high risk and moderate risk exposure. BLINDING (MASKING): Quadruple blinding will be ensured for the participants, care providers and outcome accessors. Data analysts will also be blinded to avoid conflict of interest. Site principal investigator will be responsible for ensuring masking. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): 1000 participants will be enrolled in the study with 1:1 allocation. TRIAL STATUS: The final protocol version 1.4 was approved by institutional review board of Shaikh Zayed Post-Graduate Medical Complex on February 15, 2021. The trial recruitment was started on March 05, 2021, with a trial completion date of February 15, 2022. TRIAL REGISTRATION: Clinical trial was registered on February 23, 2021, www.clinicaltrials.gov with registration ID NCT04767087 . FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). With the intention of expediting dissemination of this trial, the conventional formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines.

Anti-COVID property of subcutaneous ivermectin in synergy with zinc among midlife moderately symptomatic patients: a structured summary of a study protocol for a randomised controlled trial.

OBJECTIVES: The study objective is to quantify the effectiveness of ivermectin (subcutaneous/oral IVM) in the presence or absence of zinc (Zn) for clinical and radiological improvement in coronavirus disease 2019 (COVID-19) patients with moderate severity. TRIAL DESIGN: This quadruple-blinded, placebo-controlled randomized clinical trial will be a multiarmed multi-centered study with superiority framework. PARTICIPANTS: Quinquagenarian and sexagenarian patients with moderate COVID-19 symptoms and positive severe respiratory syndrome coronavirus -2 (SARS-CoV-2) PCR will be included. Participants with co-morbidities and pregnant women will be excluded. Patient recruitment will be done in Shaikh Zayed Medical Complex, Doctors Lounge and Ali Clinic in Lahore (Pakistan). INTERVENTION AND COMPARATOR: The registered patients will be allocated in 6 groups (30 participants each). Patients will be taking subcutaneous IVM at 200 µg/kg/48 h (Arm A) or subcutaneous IVM at 200 µg/kg/48 h and oral Zn 20mg/8 h (Arm B) or oral IVM at 0.2 mg/kg/day (Arm C) or oral IVM at 0.2 mg/kg/day and oral Zn 20mg/8 h (Arm D) or alone oral Zn 20mg/8 h (Arm E) or placebo alone (Arm X). Patients in all arms will receive standard care and respective placebo (empty capsule 8 hourly and/or subcutaneous normal saline 2ml/48 h). MAIN OUTCOMES: Primary endpoints will be duration of symptomatic phase and SARS-CoV-2 clearance along with high resolution CT (HRCT) chest score and clinical grade scale (CGS) on day 6. 30-day mortality will be documented as a secondary endpoint. SARS-CoV-2 clearance will be calculated by second PCR on day 7. HRCT chest score will be measured by the percentage and lung lobes involvement on day 6 with a maximum score of 25. CGS will be recorded on a seven-point scale; grade 1 (not hospitalized, no evidence of infection and resumption of normal activities), grade 2 (not hospitalized, but unable to resume normal activities), grade 3 (hospitalized, not requiring supplemental oxygen), grade 4 (hospitalized, requiring supplemental oxygen), grade 5 (hospitalized, requiring nasal high-flow oxygen therapy and/or noninvasive mechanical ventilation), grade 6 (hospitalized, requiring ECMO and/or invasive mechanical ventilation) and grade 7 (death). RANDOMISATION: A simple lottery method will be used to randomly allocate scrutinized patients in 1:1:1:1:1:1 ratio in 6 groups. BLINDING (MASKING): Patients, primary care physicians, outcome assessors and the data collection team will be blinded. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): 180 participants will be randomized into six arms with five investigational and one placebo group. TRIAL STATUS: Institutional Review Board Shaikh Zayed Post-Graduate Medical Complex, Lahore, Pakistan has approved the protocol (version 2.3) with ID SZMC/IRB/Internal0056/2020. The trial was approved on July 14, 2020, and enrolment started on July 30, 2020. The estimated completion date is October 30, 2021. TRIAL REGISTRATION: Clinical Trial has been retrospectively registered on www.clinicaltrials.gov with registration ID NCT04472585 dated July 16, 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). With the intention of expediting dissemination of this trial, the conventional formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines.