Assessing the impact of COVID-19 and related interventions on poverty and economic growth in Pakistan: A structural path analysis

This study uses social accounting matrix multipliers and structural path analyses to estimate effects of COVID-19 and related fiscal stimuli on five household groups. The COVID-19 lockdown increased poverty in Pakistan by 15%, which was addressed using a $1.5 billion, digitally implemented Ehsaas Emergency Cash (EEC) program that reached 14.8 million poor households. The study's models show that the largest multipliers from Ehsaas program finance were in agriculture, as a 1 Rupee shock adds 0.225 Rupee income to households. About 30% of that gain was estimated to go to poor farm families. In contrast, our models find that construction and trade growth added three times as much income to poor nonfarm and urban households as to farm households. However, those sectors added only one third as much total income as agriculture. From the structural path analysis, the importance of capital assets in generating income was seen, as was the possibility of greater poverty reduction from sectors with proportionally fewer intermediate inputs and more value added. © 2023 The Authors. Applied Economic Perspectives and Policy published by Wiley Periodicals LLC on behalf of Agricultural & Applied Economics Association.

COVID-19 related risk factors and their association with non-syndromic orofacial clefts in five Arab countries: a case-control study.

BACKGROUND: The environmental etiology of non-syndromic orofacial clefts (NSOFCs) is still under research. The aim of this case-control study is to assess COVID-19 associated factors that may be related to the risk of NSOFC in five Arab countries. These factors include COVID-19 infection, COVID-19 symptoms, family member or friends infected with COVID-19, stress, smoking, socioeconomic status and fear of COVID-19. METHODS: The study took place in governmental hospitals in five Arab countries from November 2020 to November 2021. Controls are matched in the month of delivery and site of recruitment. A clinical examination was carried out using LASHAL classification. Maternal exposure to medication, illnesses, supplementation, COVID-19 infection during their pregestation and 1st trimester periods were evaluated using a validated questionnaire. Maternal exposure to stress was assessed using the Life Events scale, fear of covid-19 scale, family member or friend affected with covid-19 infection, pregnancy planning and threatened abortion. RESULTS: The study recruited 1135 infants (386 NSOFC and 749 controls). Living in urban areas, maternal exposure to medications 3-months pregestation, maternal exposure to any of the prenatal life events and maternal fear of COVID-19 significantly increased the risk of having a child with NSOFC. On the other hand, mothers exposed to supplementation 3-months pregestation, mothers suspected of having COVID-19 infection, family members or friends testing positive with COVID-19 significantly decreased the risk of having a child with NSOFC. CONCLUSIONS: This study suggests that NSOFC may be associated with maternal exposure to lifetime stress and COVID-19 fear in particular, with no direct effect of the COVID-19 infection itself. This highlights the importance of providing psychological support for expecting mothers during stressful events that affect populations such as the COVID-19 pandemic, in addition to the usual antenatal care.

Prenatal maternal stress and the severity of autism spectrum disorder: A cross-sectional study.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder linked to several genetic and environmental factors including antenatal stress. Hence, we aimed to examine whether a mother's stress during pregnancy is associated with the severity of autism spectrum disorder in children. The study was conducted with 459 mothers of children with autism (aged 2-14 years) who were attending rehabilitation and educational centers in the two major cities of Makkah and Jeddah in Saudi Arabia. Environmental factors, consanguinity, and ASD family history were assessed using a validated questionnaire. The Prenatal Life Events Scale questionnaire was used to assess whether the mothers were exposed to stress during pregnancy. Two models of ordinal regression analysis were conducted including gender, child age maternal age, parental age, maternal education, parental education, income nicotine exposure, mother taking medication during pregnancy, family history of ASD, gestation, consanguinity, exposure of prenatal life events (in model 1), and severity of prenatal life events (in model 2). Family history of ASD showed a statistically significant association with the severity of ASD in both regression models (p = .015, odds ratio [OR]: 4.261 in Model 1, and p = .014, OR: 4.901 in model 2). In model 2, the moderate severity prenatal life events showed higher statistically significant adjusted odds ratio for ASD severity compared to no stress (p = .031; OR: 3.82). Within the limitations of this study, prenatal stressors showed some potential contribution to ASD severity. Family history of ASD was the only factor that showed a persistent association with ASD severity. A study that assesses the effect of COVID-19 stress on ASD prevalence and severity is recommended.

Spectrum of common and uncommon neurovascular and neurological manifestations of COVID-19 on cross-sectional imaging

COVID-19 is an emerging and re-emerging disease that is caused by SARS CoV-2, a neurotropic virus that frequently involves the central nervous system in ad-dition to the lungs. Findings on neuroimaging can be observed in a significant percentage of active COVID-19 and post-COVID patients, especially those who are/ have been critically ill. Accurate diagnosis of such cases on imaging aids in appropriate patient management and prevention of permanent neurological deficits. The features of CNS involvement in COVID-19 can be broadly categorized as the more common neurovas-cular and relatively uncommon neurological manifes-tations. Several pathophysiological mechanisms have been proposed for the patterns of CNS involvement and corresponding neuroimaging features in COVID-19. We have outlined the pathophysiology and indications for neuroimaging in COVID-19 and extensively discussed the neuroimaging features of the entire spectrum of neurovascular and neurological manifestations, in-cluding the rare and diagnostically challenging ones, through case-based illustrations. As new strains of COVID-19 continue to emerge, radiologists need to be aware of the imaging features of various neurological and neurovascular manifestations of CNS involvement in COVID-19 as timely diagnosis is vital in preventing or limiting permanent neurological deficits in such cases. © 2022, Zita Medical Managent. All rights reserved.

Covid-19 Disease Detection using Chest X-Ray Images by Means of CNN

Covid is a respiratory disease that ultimately results in death. It is of the utmost importance to determine whether or not a person has covid. Since it first appeared in December 2019, the COVID-19 pandemic has been a problem all across the world. For individuals who may have COVID-19, getting a timely and accurate diagnosis is absolutely necessary in order to receive medical treatment. In order to put a stop to the COVID-19 epidemic, chest X-rays will need to be capable of making an independent diagnosis of the virus using Machine Learning. This study provides evidence that the use of ensemble deep transfer learning for the early diagnosis of COVID-19 patients is both effective and efficient. If you follow these instructions, you will be able to report suspected COVID-19 activity and receive responses as they become available. With the help of medical sensors and the deep ensemble model of a cloud server, chest X-ray modalities can identify the presence of an infection. The authors of this study educated a Convolutional Neural Network system to reliably predict Covid-19 by using chest X-ray images as their training data. The researchers were the ones who developed the CNN algorithm. During the model's creation and training, they encountered difficulties, which they addressed and developed solutions for. © 2022 IEEE.

Identification of Comorbidities, Genomic Associations, and Molecular Mechanisms for COVID-19 Using Bioinformatics Approaches.

Several studies have been done to identify comorbidities of COVID-19. In this work, we developed an analytical bioinformatics framework to reveal COVID-19 comorbidities, their genomic associations, and molecular mechanisms accomplishing transcriptomic analyses of the RNA-seq datasets provided by the Gene Expression Omnibus (GEO) database, where normal and infected tissues were evaluated. Using the framework, we identified 27 COVID-19 correlated diseases out of 7,092 collected diseases. Analyzing clinical and epidemiological research, we noticed that our identified 27 diseases are associated with COVID-19, where hypertension, diabetes, obesity, and lung cancer are observed several times in COVID-19 patients. Therefore, we selected the above four diseases and performed assorted analyses to demonstrate the association between COVID-19 and hypertension, diabetes, obesity, and lung cancer as comorbidities. We investigated genomic associations with the cross-comparative analysis and Jaccard's similarity index, identifying shared differentially expressed genes (DEGs) and linking DEGs of COVID-19 and the comorbidities, in which we identified hypertension as the most associated illness. We also revealed molecular mechanisms by identifying statistically significant ten pathways and ten ontologies. Moreover, to understand cellular physiology, we did protein-protein interaction (PPI) analyses among the comorbidities and COVID-19. We also used the degree centrality method and identified ten biomarker hub proteins (IL1B, CXCL8, FN1, MMP9, CXCL10, IL1A, IRF7, VWF, CXCL9, and ISG15) that associate COVID-19 with the comorbidities. Finally, we validated our findings by searching the published literature. Thus, our analytical approach elicited interconnections between COVID-19 and the aforementioned comorbidities in terms of remarkable DEGs, pathways, ontologies, PPI, and biomarker hub proteins.

Aftermath of COVID-19 Pandemic-A Comparative Retrospective Single Center Study during the First, Second and Third Wave of COVID-19 in Tertiary Care Institute in North India

Background: At the onset of Covid-19 pandemic, it was an unknown entity in terms of risk status of the pregnant women for fetomaternal outcome. Both fetus and pregnant women were considered as groups under special concern due to their unique physiological characteristics. Method(s): A retrospective study was conducted in department of Obstetrics & Gynaecology along with Paediatrics department in Maharishi Markandeshwar Medical College and Hospital, Solan on pregnant females admitted to the Covid-19 Ward/ ICU over a period from August 2020 till 31st March 2022. Participants were included into 3 waves of pandemic based upon time of presentation and these 3 groups were further studied for the various fetomaternal parameters such as maternal age, symptom status, need for respiratory support, maternal mortality, abortions, still births, gestational age and weight of newborn and other morbidity and mortality in newborns. Result(s): A total of 171 pregnant were included in the study, of whom 47, 64 and 60 were seen in 1st, 2nd and 3rd waves respectively. Majority of subjects were asymptomatic in 1st, 2nd & 3rd wave, (p=0.30). Age wise distribution of the patients showed majority subjects in the age group of 20-30 years (p= 0.94). LSCS rates in 3 waves were not different significantly (p = 0.67). Maternal mortality rates and need for respiratory support were in similar proportions in all 3 waves (p=0.71) and (p=0.73) respectively. No significant difference was seen in maternal morbidity and neonatal outcome. Conclusion(s): The study showed no significant difference between the waves of Covid-19 pandemic in terms of fetomaternal outcome except no maternal mortality in 3rd wave. Copyright © 2022 Ubiquity Press. All rights reserved.

T Cells Immunophenotyping and CD38 Overexpression as Hallmarks of the Severity of COVID-19 and Predictors of Patients' Outcomes.

BACKGROUND: By the end of 2019, the COVID-19 pandemic spread all around the world with a wide spectrum of clinical presentations ranging from mild to moderate to severe or critical cases. T cell subtype dysregulation is mostly involved in the immunopathogenic mechanism. The present study aimed to highlight the role of monitoring T cell subtypes and their activation (expression of CD38) in COVID-19 patients compared to healthy subjects and their role in predicting severity and patients' outcomes. MATERIALS: The study involved 70 adult COVID-19 confirmed cases stratified into three groups: a mild/asymptomatic group, a clinically moderate group, and a clinically severe/critical group. Flow cytometry analysis was used for the assessment of CD3+ cells for total T cell count, CD4+ cells for helper T cells (Th), CD8+ cells for cytotoxic T cells (Tc), CD4+CD25+ cells for regulatory T cells (T reg), and CD38 expression in CD4+ T cells and CD8+ T cells for T cell activation. RESULTS: A statistically significant difference was found between COVID-19 cases and healthy controls as regards low counts of all the targeted T cell subtypes, with the lowest counts detected among patients of the severe/critical group. Furthermore, CD38 overexpression was observed in both CD4+ and CD8+ T cells. CONCLUSION: Decreased T cell count, specifically CD8+ T cell (Tc), with T cell overactivation which was indicated by CD38 overexpression on CD4+ and CD8+ T cells had a substantial prognostic role in predicting severity and mortality among COVID-19 patients. These findings can provide a preliminary tool for clinicians to identify high-risk patients requiring vigilant monitoring, customized supportive therapy, or ICU admission. Studies on larger patient groups are needed.

Evaluating Risk: Benefit Ratio of Fat-Soluble Vitamin Supplementation to SARS-CoV-2-Infected Autoimmune and Cancer Patients: Do Vitamin-Drug Interactions Exist?

COVID-19 is a recent pandemic that mandated the scientific society to provide effective evidence-based therapeutic approaches for the prevention and treatment for such a global threat, especially to those patients who hold a higher risk of infection and complications, such as patients with autoimmune diseases and cancer. Recent research has examined the role of various fat-soluble vitamins (vitamins A, D, E, and K) in reducing the severity of COVID-19 infection. Studies showed that deficiency in fat-soluble vitamins abrogates the immune system, thus rendering individuals more susceptible to COVID-19 infection. Moreover, another line of evidence showed that supplementation of fat-soluble vitamins during the course of infection enhances the viral clearance episode by promoting an adequate immune response. However, more thorough research is needed to define the adequate use of vitamin supplements in cancer and autoimmune patients infected with COVID-19. Moreover, it is crucial to highlight the vitamin-drug interactions of the COVID-19 therapeutic modalities and fat-soluble vitamins. With an emphasis on cancer and autoimmune patients, the current review aims to clarify the role of fat-soluble vitamins in SARS-CoV-2 infection and to estimate the risk-to-benefit ratio of a fat-soluble supplement administered to patients taking FDA-approved COVID-19 medications such as antivirals, anti-inflammatory, receptor blockers, and monoclonal antibodies.

Ultrawide Band Antenna for Wireless Communications: Applications and Challenges

Due to worldwide spread of COVID, there is an increase in demand of wireless body area networks (WBANs). Wearable antennas are integral part of WBANs in Internet of Things (IoT) technology. To increase the bandwidth, ultrawideband (UWB) technology has been used. UWB offers many advantages such as small-range, large-bandwidth communications with very low power requirements. These advantages of UWB make it suitable for WBAN applications. But UWB antennas use partial ground planes to increase the bandwidth, which means UWB antennas provide poor isolation from the human body. This chapter reviews wearable antennas focusing on different designs based on substrate-integrated cavities, electromagnetic band gap structures, and UWB antennas. UWB antennas with band stop characteristics are also discussed. UWB covers frequency ranges from 3.1–10.6 GHz. Also WiMAX, WLAN, and X band come under this range. So, UWB receives interference from these channels. To avoid such unwanted signals, band stop filters are required. External filters can lead to a heavy size. So research has been presented in this chapter for integrated band stop filters to enhance the quality of UWB antennas. This depends on the application for which the antenna is to be used. © 2022 selection and editorial matter, Arun Kumar Rana, Nitin Goyal, Sharad Sharma, Suman Lata Tripathi.

Lung Transplantation for COVID Acute Respiratory Distress Syndrome: A Pediatric and Adult Case Series

Purpose: Lung transplantation (LTx) has been shown to be a viable treatment for irreversible lung disease caused by COVID-19. Given the limited data on the subject, our purpose was to examine the process and outcomes of LTx for COVID Acute Respiratory Distress Syndrome (ARDS) in a retrospective single center cohort study which includes one pediatric patient. Method(s): This case series is a retrospective review of our patients diagnosed with COVID ARDS who underwent LTx for that diagnosis. All LTx in this cohort occurred between September 9, 2020 and August 26, 2021. We report on candidate selection, pre-LTx patient care, intra-operative procedure, and post-transplant recovery. Result(s): A total of ten patients that underwent LTx for COVID ARDS were identified. The average age of the cohort was 44.9 years (range of 16-60 years) and the mean Lung Allocation Score (LAS) 85.4 +/- 9.65. LTx occurred on average 96.5 +/- 32.9 days following onset of COVID symptoms. Seven patients (70%) in the cohort were bridged to LTx on extracorporeal membrane oxygenation (ECMO) for an average of 72.1 +/- 25.9 days. Six patients (60%) required mechanical ventilation prior to LTx. Intra-operatively, seven patients received life support via ECMO, 2 via off-pump, and 1 via cardio-pulmonary bypass (CPB). Seven patients required intraoperative packed red blood cells (mean 5.4 +/- 2.5). Following transplant, 60% of patients received ECMO for a mean duration of 2.0 +/- 0.9 days;90% of the cohort received ventilatory support. At 72 hours following surgery, cohort graft viability surpassed in center averages for non COVID LTx recipients;50% of patients had no primary graft dysfunction (PGD) (grade 0) and 50% had PDG grade 1. Discharges occurred 29.0 +/- 11.7 days following LTx and no episodes of acute rejection were noted in this time frame. As of publication there is 100% patient and allograft survival. Conclusion(s): While substantial center resources and expertise are required, LTx for COVID ARDS can be safely performed with a high rate of success. Careful candidate selection, donor selection, and institutional support were all critical elements that contributed to the 100% success rate observed in this cohort, which includes the youngest reported patient to undergo LTx for COVID ARDS.

ARE ABO INCOMPATIBLE KIDNEY TRANSPLANT RECIPIENTS AT HIGHER RISK OF INFECTIONS?-A SINGLE CENTER EXPERIENCE

Introduction: Because of the limited donor pool, transplants are being done across the blood group and even HLA incompatibility barriers. But this comes at the cost of increased immunosuppression and the side effects. Effect of this intensified immunosuppression on the incidence of post transplant infections and the type of infection has not been studied extensively. Methods: We retrospectively analysed the incidence of infection in ABO incompatible transplants (ABOi) and compared it with propensity matched cohort of ABO compatible transplants(ABOc) over the same timeframe i.e. 2011 to April 2019. using hospital eHIS record system. Patients were matched with 1:2 ratio (ABOi: ABOc) for age (<60yr, >60yrs),sex, number of previous transplants, pretransplant infections, history of prior immunosuppression, diabetic status, NODAT, and induction agent used. Desensitization protocol for ABO incompatible transplant includes rituximab with double filtration plasmapheresis, plasmapharesis or immunoadsorption to target anti blood group titre of 8. Patient with high immunological risk (e.g.second transplant, HLA incompatible) receive ATG induction while others receive basiliximab induction. Valganciclovir prophylaxis was given only in patients with ATG induction. Results: [Formula presented] [Formula presented] During the study period 89 patients underwent ABOi transplants which were compared with 178 ABOc transplants. (Table1)Mean follow up duration was 50.45months (SD 26.8) in ABOi group and 49.47months (SD28.7) in ABOc group. 17% patients lost to follow up with their last follow up being more than 2 years before. Incidence of overall infections was similar in both the groups (59% (43/89) Vs 44.3% (79/178);p=0.6). (Table2) Incidence of urinary tract infections(UTI)was significantly more in ABOi group vs ABOc group.(23.5% (21/89) vs 11.79% (21/178);p=0.019). Cytomegalovirus infections (CMV) were significantly more in ABOi group 12.3% (11/89) as compared to ABOc group 5% (9/187) (p=0.04). All the patients with CMV infection were CMV IgG positive pretransplant except 2, one from ABOc group who was CMV IgG negative and another from ABOi group who’s pretransplant CMV serology was unavailable. There was no significant difference in incidence of fungal infection, pneumocystis infection, diarrheal infections (other than CMV),pneumonia (other than CMV, PCP, fungal), Herpes, BKV infection. Incidence of post-transplant tuberculosis (3.3% (3/89) Vs 2.8% (5/178);p=1.0) and SARS COV2 infections (12.3% (11/89) vs 9% (16/178);p=0.39 was similar in both the groups. Patient survival was similar in both the groups i.e.95.5% but death censored graft loss was significantly more in ABOi group 0.9% (8/89) as compared ABOc group 0.3% (5/178) p=0.03. Reason of graft loss in all the patients was immunological and not infection. Infection was cause for death in three ABOi patients and four ABOc patients. Conclusions: Overall incidence of infections in ABOi transplants was similar to Abo compatible transplant. Incidence of UTIs and CMV infections were significantly higher in ABOi group. No conflict of interest

The Adverse Reactions of Pfizer BioNTech COVID-19 Vaccine Booster Dose are Mild and Similar to the Second Dose Responses: A Retrospective Cross-Sectional Study.

Background: Like other vaccines, Pfizer BioNTech's COVID-19 vaccine efficacy against SARS-CoV-2 virus infections begins to decline within a few months after the 2nd dose. On August 12, 2021, the FDA allowed additional Pfizer BioNTch's COVID-19 vaccine dose (3rd or booster dose) for individuals with weakened immunity. This study aimed to evaluate the short-term adverse reactions (ADRs) of the 2nd and the 3rd doses of the Pfizer BioNTech COVID-19 vaccine. Methods: Information for this study was collected by Google Form questionnaire (online survey). The results included responses from 442 people, the majority from Saudi Arabia. Results: The most common local ADRs following the 3rd dose were injection site pain, injection site hypersensitivity, and axillary lymph node swelling. The most common systemic ADRs were fatigue, muscle pain, bone pain, headache, and fever less than 38ºC. Less common systemic ADRs were shivering, fever more than 38ºC, nasal congestion and rhinorrhea, arrhythmia, cough, abdominal pain, chest tightness, nausea, diarrhea, vomiting, and tachypnea. Rare systemic ADRs were constipation, dizziness and vertigo, lack of concentration, sore throat, excessive hair loss, dysmenorrhea and heavy menstruation, and Bell's palsy. Severe allergic reactions were reported by 2.6% of participants after the 2nd dose, compared with none after the 3rd dose. Nasal congestion and runny nose are more frequent after the 3rd dose. The ADRs of the 2nd and 3rd doses were significantly more prevalent in females. 12% of participants reported ADRs lasting more than one week after the 3rd dose compared to 5% after the 2nd dose. People ≤ 60 years were more affected by the vaccine ADRs. Conclusion: Most of the ADRs reported after the 3rd vaccine dose were consistent with the Pfizer vaccine information sheet and similar to the 2nd dose ADRs.

Lung biopsy in coronavirus-19 pneumonia: a case report and review of literature

Pneumonia is one of the major manifestations of infection by the novel coronavirus (COVID-19) virus. CT scans are used as first line investigation in suspected cases. Biopsies are almost never done. The gross and microscopic pathology has been studied mostly on autopsy specimens in fatal cases. We present a case of a mildly symptomatic adult male, who was a chronic liver disease patient awaiting liver transplant. His lung biopsy was done for diagnosis of a lesion, suspected to be a fungal infection. He was tested for COVID-19 and was PCR-negative at the time. His biopsy showed patchy changes of viral pneumonia. One week later, he tested positive for COVID-19 on PCR. He became asymptomatic soon and the ground glass lung opacities cleared up within another week without any treatment in spite of having a serious comorbid condition.

LONGITUDINAL ASSESSMENT OF SEROLOGICAL RESPONSE AFTER THREE DOSES OF SARS-COV-2 MRNA VACCINE IN LIVER TRANSPLANT RECIPIENTS

Introduction We sought to evaluate the longitudinal serological response from the second to third dose of SARS-CoV-2 vaccine in liver transplant recipients at our institution. This study is ongoing and the total N will increase. Methods We prospectively enrolled 54 LT patients who received Pfizer-BioNTech or Moderna vaccine in two doses 3-4 weeks apart at our institution and an additional third dose after CDC approval in August 2021. 6 patients were excluded because of a positive nucleocapsid Ab after the third dose that indicated prior COVID infection. Recipients had semi-quantitative spike IgG and nucleocapsid IgG titers tested between 30 and 75 days after receiving a second vaccine dose. Serological responses to both spike and nucleocapsid antigens indicated COVID-19 infection. All recipients had spike and nucleocapsid Ab titers checked at least 14 days after receiving the third dose. Recipients who had a positive spike Ab titer and negative nucleocapsid titer after a second vaccine dose had repeat spike and nucleocapsid Ab testing within 1 week prior to receiving their third vaccine dose. Results Among 48 LT recipients that met inclusion criteria, seropositivity for spike Ab increased from 47.9% after the second dose to 81.3% after the third dose. 9 patients who were seronegative after a third dose had failed to develop detectable spike Ab after their second dose. The median interval between the second and third doses was 5.9 months. After the third dose, 69% of seropositive recipients had a high spike Ab titer. In 25 recipients who were seronegative after a second dose, 64% produced spike Abs after their third dose. Recipients who remained seronegative after 3 vaccine doses had significantly higher mean tacrolimus trough concentrations. To assess whether spike Ab titers waned after the second vaccine dose, we retested spike Ab titers within one week prior to the third dose in 14 out of 23 recipients who were seropositive after their second dose. All 14 patients had a decline in their spike Ab titers after their second dose. Previously detectable spike Ab titers became undetectable in 5 recipients. However, all five of these patients regained detectable spike Ab after the third vaccine. Discussion We demonstrate that a third dose of mRNA SARS-CoV-2 vaccine in LT recipients was effective. Minimizing immunosuppression by lowering tacrolimus trough thresholds is one potential strategy to improve immune responses. Our results also provide useful information about the optimal interval between the second and third vaccine doses in SOT recipients. Our cohort received the third vaccine dose after a longer delay of 6 months. With this delay, we demonstrated higher seropositivity and seroconversion rates than those reported after shorter interval dosing. A shorter delay between doses is a practical approach to help mitigate the immediate risk in this population. (Table Presented)

UTILIZATION OF DRUG OVERDOSE DONORS FOR LIVER TRANSPLANTATION DURING COVID-19 PANDEMIC

Background: The increasing number of deceased drug overdose donors (DOD) has paralleled the recent rise in the opioid epidemic, which has been further exacerbated by the COVID- 19 pandemic. While the transplant community has seen a rise in allografts donated by victims of drug overdose, we aim to characterize the recent shifts in DOD utilization during the pre-COVID and COVID eras. Methods: Using the United Network for Organ Sharing (UNOS) registry, we analyzed all adult recipients that underwent solid organ transplantation (SOT) including liver transplant (LT) in the United States from January 1, 2017 through June 30, 2021. The pre-COVID era was defined from January 1, 2019 to February 29, 2020 and the COVID era was defined from May 1, 2020 to June 30, 2021 (14 months each). We excluded March and April 2020 because transplant volume was adversely affected due to diversion of resources. DOD were identified using the UNOS variable that characterizes the mechanism of death of the donor. Tests of proportions and unpaired T-tests were performed to compare demographic information and clinical characteristics of DOD from the pre-COVID and COVID eras. Results: The number of donors for all SOT remained stable in the pre-COVID and COVID eras (14,029 vs 15,547). Likewise, the number of LTs remained stable (9,687 vs 10,096), reflected by a rise in DOD utilization. From the pre- COVID to the COVID eras, the utilization of DOD for SOT increased by 33% from 13.7% (n=1924) to 16.4% (n=2553) as shown in Table 1. This increase in DOD utilization during the pandemic was seen across all organ types with a significant rise for LT (pre-COVID n= 1465, 15.1% vs COVID n=1846, 18.3%;P<0.001). Among DOD, the percentage of young adult donors < 30 declined (31.2% vs 28.0%;P=0.022) in the COVID era. Similarly, the percentage of DOD with HCV seropositivity and HCV viremia decreased by 5.2% (34.3% vs 29.1%;P<0.001) and 4.3% (22.1% vs 17.8%;P<0.001) respectively. Regionally, there was a significant increase in DOD utilization in the South and Midwest (Table 1). Conclusion: The continued rise in the opioid epidemic has led to increased utilization of otherwise healthy DOD. This increase in DOD utilization has contributed to the steady transplant volume during the pandemic for all organ types, including LT. Fewer DOD with HCV during the pandemic reflects recent national trends. Unlike the early phases of the opioid epidemic, there is less of a regional distribution of utilization of allografts from DOD. (Table Presented)

Prospective Medicinal Plants and Their Phytochemicals Shielding Autoimmune and Cancer Patients Against the SARS-CoV-2 Pandemic: A Special Focus on Matcha.

Background: Being "positive" has been one of the most frustrating words anyone could hear since the end of 2019. This word had been overused globally due to the high infectious nature of SARS-CoV-2. All citizens are at risk of being infected with SARS-CoV-2, but a red warning sign has been directed towards cancer and immune-compromised patients in particular. These groups of patients are not only more prone to catch the virus but also more predisposed to its deadly consequences, something that urged the research community to seek other effective and safe solutions that could be used as a protective measurement for cancer and autoimmune patients during the pandemic. Aim: The authors aimed to turn the spotlight on specific herbal remedies that showed potential anticancer activity, immuno-modulatory roles, and promising anti-SARS-CoV-2 actions. Methodology: To attain the purpose of the review, the research was conducted at the States National Library of Medicine (PubMed). To search databases, the descriptors used were as follows: "COVID-19"/"SARS-CoV-2", "Herbal Drugs", "Autoimmune diseases", "Rheumatoid Arthritis", "Asthma", "Multiple Sclerosis", "Systemic Lupus Erythematosus" "Nutraceuticals", "Matcha", "EGCG", "Quercetin", "Cancer", and key molecular pathways. Results: This manuscript reviewed most of the herbal drugs that showed a triple action concerning anticancer, immunomodulation, and anti-SARS-CoV-2 activities. Special attention was directed towards "matcha" as a novel potential protective and therapeutic agent for cancer and immunocompromised patients during the SARS-CoV-2 pandemic. Conclusion: This review sheds light on the pivotal role of "matcha" as a tri-acting herbal tea having a potent antitumorigenic effect, immunomodulatory role, and proven anti-SARS-CoV-2 activity, thus providing a powerful shield for high-risk patients such as cancer and autoimmune patients during the pandemic.

Functional and psychosocial impact of COVID-19 pandemic on rheumatic patients' quality of life in Saudi Arabia.

PURPOSE: The COVID-19 pandemic might add to the stressors experienced by people living with rheumatic diseases. This study aimed to examine rheumatic patients' functional and psychosocial states during the pandemic and assess its impact on their quality of life. METHODS: Our time-series study included a patient-centered electronic survey, sampling adult rheumatic patients living in Saudi Arabia at different time points from March to August 2020. Patient-reported outcomes included physical function, anxiety, depression, fatigue, sleep disturbance, ability to participate in social roles, and pain interference domains were measured using the Patient-Reported Outcomes Measurement Information System (PROMIS-29 Profile v2.1). RESULTS: A total of 1278 respondents were enrolled. Results showed significant variation in patients' experiences. Our analyses revealed that the physical well-being of rheumatic patients was significantly impacted, and such effect was persistent over time irrespective of public health measures to control the COVID-19 outbreak. CONCLUSION: Our findings consistently demonstrated the need for psychological and social consideration to improve rheumatic patients' quality of life. Nevertheless, there is still a lot to be learned about the extent of COVID-19 impact on rheumatic patients and the implications it has on long-term disease outcomes.

Swami Ramdev: An International Prominent Human Figure for Promoting Yoga and Herbals Use in the World

Yoga is a multimodal practice that strengthens muscles, improves balance, and promotes flexibility. It has long been used against hypertension, obesity, anxiety, insomnia, aging, and other ailments. Several yog gurus have promoted the yoga legacy, but it has gained worldwide social popularity after the initiation of Swami Ramdev. Swami Ramdev is a spiritual leader best recognized for popularizing yoga and Ayurveda throughout India and the world. He had vowed to become a “Sanyasi” since childhood and achieved his goal with dedication, self-discipline and meditation. Initially, he began teaching yoga at Gurukuls but later laid the foundations for yoga and the herbal empire with his intellectual partner Acharya Balkrishna, a renowned Ayurvedacharya. He established The Divya Yog Mandir Trust in 1995, followed by Patanjali Yogpeeth in Haridwar, India to promote yoga and Ayurveda. These foundations have significantly expanded yoga, spiritualism, and Ayurveda research and treatment centers, including the world’s largest residential naturopathy facility at Haridwar. Swami Ramdev is known for his significant contributions to yoga and Ayurveda by saving millions of people’s life suffering from fatal diseases. Many individuals usually benefit daily from his live programming of yoga and herbal medication on television channels. As a research visionary, during the COVID-19 pandemic along with infrastructure and monetary assistance, his team developed an anti-SARS-CoV-2 remedy, Coronil, which was quite effective and popular among society. Yoga has the potential to improve public health, it is safe, inexpensive, and promotes self-sufficiency. Subsequently, Ayurveda provides comprehensive insights into the treatment and management of various illnesses.