Nutritional assessment of Covid-19 patients admitted in intensive care units in Pakistan

Coronavirus disease 2019 (COVID-19) can be life threating if untreated. Early diagnosis and effective nutritional management can save life. To assess the nutritional status and predict possible outcomes of critical patients Sequential Organ Failure Assessment (SOFA), nutrition risk in critically ill patients (NUTRIC), and acute physiology and chronic health evaluation (APACHE) score has been used. This retrospective observational study was conducted on confirmed COVID-19 cases in Intensive Care Unit (ICU) of Shifa hospital between November 24, 2020 to May 31, 2021. The demographic, clinical and laboratory information was obtained from hospital records. Risk factors for COVID-19 were identified and compared using multivariate logistic regression analysis. The nutritional risk for each patient was assessed. In this study 162 COVID-19 patients with median age of 64 years (IQR: 56-74) were included. Hypertension (59.2%) was found to be the most common comorbidity and the most prevalent symptoms upon admission were fever (54.9%). The patients in critical condition were supplied nutrients through nasogastric route (61.7%) while 37.7% and 0.6 % were assisted through oral and total parenteral nutrition (TPN) route. The Glasgow comma score was found to be mild (72.2%) (GCS>12) with increased creatinine, white blood cell count, C-reactive protein (CRP C), and glycosylated haemoglobin HbA1c level were present. Interestingly based on SOFA, APACHE and NUTRIC score low insignificant malnutrition risk was observed. Our study found different demographic factors and comorbidities have a substantial impact on COVID19 patients, as evidenced by demographic, laboratory, clinical, and nutritional risk factors.

Generalized plithogenic whole hypersoft set, PFHSS-Matrix, operators and applications as COVID-19 data structures

This article is a preliminary draft for initiating and commencing a new pioneer dimension of expression. To deal with higher-dimensional data or information flowing in this modern era of information technology and artificial intelligence, some innovative super algebraic structures are essential to be formulated. In this paper, we have introduced such matrices that have multiple layers and clusters of layers to portray multi-dimensional data or massively dispersed information of the plithogenic universe made up of numerous subjects their attributes, and sub-attributes. For grasping that field of parallel information, events, and realities flowing from the micro to the macro level of universes, we have constructed hypersoft and hyper-super-soft matrices in a Plithogenic Fuzzy environment. These Matrices classify the non-physical attributes by accumulating the physical subjects and further sort the physical subjects by accumulating their non-physical attributes. We presented them as Plithogenic Attributive Subjectively Whole Hyper-Super-Soft-Matrix (PASWHSS-Matrix) and Plithogenic Subjective Attributively Whole-Hyper-Super-Soft-Matrix (PSAWHSS-Matrix). Several types of views and level-layers of these matrices are described. In addition, some local aggregation operators for Plithogenic Fuzzy Hypersoft Set (PPFHS-Set) are developed. Finally, few applications of these matrices and operators are used as numerical examples of COVID-19 data structures. [ABSTRACT FROM AUTHOR] Copyright of Journal of Intelligent & Fuzzy Systems is the property of IOS Press 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 abstract 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 abstract. (Copyright applies to all Abstracts.)

The severity of COVID-19 in hypertensive patients is associated with mirSNPs in the 3′ UTR of ACE2 that associate with miR-3658: In silico and in vitro studies

The SARS-CoV-2 virus targets the antigen converting enzyme 2 (ACE2) receptor, thus resulting in elevated morbidity and an increased risk of severe and fatal COVID-19 infection in individuals with hypertension and diabetes mellitus. Objectives This study aimed to identify the association between increased susceptibility and severity in order to evaluate their impact in hypertensive COVID-19 patients using in vitro and in silico models. Methods We identified 80 miRNA binding sites on ACE2 (for different miRNAs) as well as various 30 SNPs in the miRNA binding sites of the 3′ untranslated region (3′ UTR) in the ACE2 gene using different online software and tools. From August 2020 to August 2021, a total of 200 nasopharyngeal/mouth swabs samples were collected from Multan, Pakistan. In order to quantify the cDNA of ACE2 and miR-3658 genes, we used Rotor Gene qRT-PCR on hypertensive patients with COVID-19 as well as healthy controls. Results Interestingly, the binding site of miR-3658 corresponding to the 3′ UTR of ACE2 featured three SNPs (rs1457913029, C>T;rs960535757, A>C, G;rs1423809569, C>T), and its genomic sequence featured a single SNP (rs1024225815, C>T) with the same nucleotide variation (rs1457913029, C>T) which potentially increases the severity of COVID-19. Similarly, three other SNPs (rs1557852115, C>G;rs770335293, A>G;rs1024225815, C>T) were also found on the first binding site positions of miR-3658. Our in vitro study found that ACE2 gene expression had an effect on miR-3658 in COVID-19 patients who also had hypertension. In both cases, our analysis demonstrated that the in silico model captured the same biological mechanisms as the in vitro system. Conclusion The identified SNPs could represent potential informative signatures owing to their position in the splicing site of the ACE2 gene.

The severity of COVID-19 in hypertensive patients is associated with mirSNPs in the 3' UTR of ACE2 that associate with miR-3658: In silico and in vitro studies.

The SARS-CoV-2 virus targets the antigen converting enzyme 2 (ACE2) receptor, thus resulting in elevated morbidity and an increased risk of severe and fatal COVID-19 infection in individuals with hypertension and diabetes mellitus. Objectives: This study aimed to identify the association between increased susceptibility and severity in order to evaluate their impact in hypertensive COVID-19 patients using in vitro and in silico models. Methods: We identified 80 miRNA binding sites on ACE2 (for different miRNAs) as well as various 30 SNPs in the miRNA binding sites of the 3' untranslated region (3' UTR) in the ACE2 gene using different online software and tools. From August 2020 to August 2021, a total of 200 nasopharyngeal/mouth swabs samples were collected from Multan, Pakistan. In order to quantify the cDNA of ACE2 and miR-3658 genes, we used Rotor Gene qRT-PCR on hypertensive patients with COVID-19 as well as healthy controls. Results: Interestingly, the binding site of miR-3658 corresponding to the 3' UTR of ACE2 featured three SNPs (rs1457913029, C>T; rs960535757, A>C, G; rs1423809569, C>T), and its genomic sequence featured a single SNP (rs1024225815, C>T) with the same nucleotide variation (rs1457913029, C>T) which potentially increases the severity of COVID-19. Similarly, three other SNPs (rs1557852115, C>G; rs770335293, A>G; rs1024225815, C>T) were also found on the first binding site positions of miR-3658. Our in vitro study found that ACE2 gene expression had an effect on miR-3658 in COVID-19 patients who also had hypertension. In both cases, our analysis demonstrated that the in silico model captured the same biological mechanisms as the in vitro system. Conclusion: The identified SNPs could represent potential informative signatures owing to their position in the splicing site of the ACE2 gene.

The Assessment of Medication Effects in Omicron Patients through MADM Approach Based on Distance Measures of Interval-Valued Fuzzy Hypersoft Set.

Omicron, so-called COVID-2, is an emerging variant of COVID-19 which is proved to be the most fatal amongst the other variants such as alpha, beta and gamma variants (α, ß, γ variants) due to its stern and perilous nature. It has caused hazardous effects globally in a very short span of time. The diagnosis and medication of Omicron patients are both challenging undertakings for researchers (medical experts) due to the involvement of various uncertainties and the vagueness of its altering behavior. In this study, an algebraic approach, interval-valued fuzzy hypersoft set (iv-FHSS), is employed to assess the conditions of patients after the application of suitable medication. Firstly, the distance measures between two iv-FHSSs are formulated with a brief description some of its properties, then a multi-attribute decision-making framework is designed through the proposal of an algorithm. This framework consists of three phases of medication. In the first phase, the Omicron-diagnosed patients are shortlisted and an iv-FHSS is constructed for such patients and then they are medicated. Another iv-FHSS is constructed after their first medication. Similarly, the relevant iv-FHSSs are constructed after second and third medications in other phases. The distance measures of these post-medication-based iv-FHSSs are computed with pre-medication-based iv-FHSS and the monotone pattern of distance measures are analyzed. It is observed that a decreasing pattern of computed distance measures assures that the medication is working well and the patients are recovering. In case of an increasing pattern, the medication is changed and the same procedure is repeated for the assessment of its effects. This approach is reliable due to the consideration of parameters (symptoms) and sub parameters (sub symptoms) jointly as multi-argument approximations.

Time-Leveled Hypersoft Matrix, Level Cuts, Operators, and COVID-19 Collective Patient Health State Ranking Model

This article is the first step to formulate such higher dimensional mathematical structures in the extended fuzzy set theory that includes time as a fundamental source of variation. To deal with such higher dimensional information, some modern data processing structures had to be built. Classical matrices (connecting equations and variables through rows and columns) are a limited approach to organizing higher dimensional data, composed of scattered information in numerous forms and vague appearances that differ on time levels. To extend the approach of organizing and classifying the higher dimensional information in terms of specific time levels, this unique plithogenic crisp time-leveled hypersoft-matrix (PCTLHS matrix) model is introduced. This hypersoft matrix has multiple parallel layers that describe parallel universes/realities/information on some specific time levels as a combined view of events. Furthermore, a specific kind of view of the matrix is described as a top view. According to this view, i-level cuts, sublevel cuts, and sub-sublevel cuts are introduced. These level cuts sort the clusters of information initially, subject-wise then attribute-wise, and finally time-wise. These level cuts are such matrix layers that focus on one required piece of information while allowing the variation of others, which is like viewing higher dimensional images in lower dimensions as a single layer of the PCTLHS matrix. In addition, some local aggregation operators are designed to unify i-level cuts. These local operators serve the purpose of unifying the material bodies of the universe. This means that all elements of the universe are fused and represented as a single body of matter, reflecting multiple attributes on different time planes. This is how the concept of a unified global matter (something like dark matter) is visualized. Finally, to describe the model in detail, a numerical example is constructed to organize and classify the states of patients with COVID-19.

Evaluation of the potential of Rejuveinix plus dexamethasone against sepsis.

Aim: Our main objectives were to compare the effects of Rejuveinix (RJX), dexamethasone (DEX) and their combination on the severity of sepsis and survival outcome in an animal model of fatal sepsis. Methods: We used the LPS plus D-galactosamine mouse model of sepsis to compare the anti-inflammatory activities of RJX, dexamethasone and a combination of RJX plus DEX. Additionally, we examined the clinical feasibility and tolerability of combining RJX with DEX in COVID-19 patients in a clinical phase I study. Data were analyzed using standard methods. Results & conclusion: RJX exhibited potent anti-inflammatory activity in the murine sepsis model. The combination of RJX plus DEX was more effective than either agent alone, decreased the inflammatory cytokine responses and associated organ damage, and improved the survival outcome in mice. In the phase I clinical study, RJX plus DEX was well tolerated by COVID-19 patients.

Impact of the coronavirus pandemic on mental prosperity of medical care laborers in tertiary consideration hospital: A case report.

Since the outbreak of the Corona pandemic in December 2019, many people affected, especially medical care laborers, who deal with the treated cases. Coronavirus disease 2019 not only affects the body parts, but also extends to the psychological symptoms. The purpose of this research is to explore the impact of the pandemic on the mental prosperity of the laborers. Clinical staff members from the administration emergency clinic, Lahore, were enlisted. A poll was used to collect data on the segment information, a sleeping disorder, despondency and stress manifestations. Correlation of the segment information and the mental factors were done among the sleeping and non-sleeping disorder samples. All 356 medical service laborers were selected for this investigation. There were manifestations of misery in 222 (62.35%), nervousness in 227 (64.76%), stress in 197 (55.33%) and sleep deprivation in 190 (53.37%) of members. Gentle to extreme side effects of melancholy (91.65% vs 28.9%), nervousness (83.1% vs 41.6%) and stress (84.26% vs 22.22%) were seen predominately in the sleep deprivation gathering (P < .001). Insomnia was more pronounced in the members with low training levels (78.08%) versus post-advanced education (30.9%). Paramedics, attendants, and medical service laborers in confinement/serious consideration units were more inclined to the sleep deprivation (P < .001). Mental prosperity of medical care laborers was influenced because of Coronavirus pandemic. Attendants, paramedics, and those working in the detachment unit showed a critical sleeping disorder. The results and indicators have proven that there is a relationship between the infection with the Corona pandemic and occurrence of disorders in psychological behavior. Therefore, the psychological rehabilitation sessions must be conducted for those infected and those in contact with the Corona cases to relieve the burden of that patients to raise their psychological conditions and support the immune system such that resist against the infection.

An Optimized Decision Support Model for COVID-19 Diagnostics Based on Complex Fuzzy Hypersoft Mapping

COVID-19 has shaken the entire world economy and affected millions of people in a brief period. COVID-19 has numerous overlapping symptoms with other upper respiratory conditions, making it hard for diagnosticians to diagnose correctly. Several mathematical models have been presented for its diagnosis and treatment. This article delivers a mathematical framework based on a novel agile fuzzy-like arrangement, namely, the complex fuzzy hypersoft (CFHS) set, which is a formation of the complex fuzzy (CF) set and the hypersoft set (an extension of soft set). First, the elementary theory of CFHS is developed, which considers the amplitude term (A-term) and the phase term (P-term) of the complex numbers simultaneously to tackle uncertainty, ambivalence, and mediocrity of data. In two components, this new fuzzy-like hybrid theory is versatile. First, it provides access to a broad spectrum of membership function values by broadening them to the unit circle on an Argand plane and incorporating an additional term, the P-term, to accommodate the data's periodic nature. Second, it categorizes the distinct attribute into corresponding sub-valued sets for better understanding. The CFHS set and CFHS-mapping with its inverse mapping (INM) can manage such issues. Our proposed framework is validated by a study establishing a link between COVID-19 symptoms and medicines. For the COVID-19 types, a table is constructed relying on the fuzzy interval of [0,1]. The computation is based on CFHS-mapping, which identifies the disease and selects the optimum medication correctly. Furthermore, a generalized CFHS-mapping is provided, which can help a specialist extract the patient's health record and predict how long it will take to overcome the infection.

Evaluation of Bi-Lateral Co-Infections and Antibiotic Resistance Rates among COVID-19 Patients in Lahore, Pakistan.

Background and Objective: Bacterial infections are among the major complications of many viral respiratory tract illnesses, such as influenza and coronavirus disease-2019 (COVID-19). These bacterial co-infections are associated with an increase in morbidity and mortality rates. The current observational study was conducted at a tertiary care hospital in Lahore, Pakistan among COVID-19 patients with the status of oxygen dependency to see the prevalence of bacterial co-infections and their antibiotic susceptibility patterns. Materials and Methods: A total of 1251 clinical samples were collected from already diagnosed COVID-19 patients and tested for bacterial identification (cultures) and susceptibility testing (disk diffusion and minimum inhibitory concentration) using gold standard diagnostic methods. Results: From the total collected samples, 234 were found positive for different bacterial isolates. The most common isolated bacteria were Escherichia coli (E. coli) (n = 62) and Acinetobacter baumannii (A. baumannii) (n = 47). The E. coli isolates have shown the highest resistance to amoxicillin and ampicillin, while in the case of A. baumannii, the highest resistance was noted against tetracycline. The prevalence of methicillin resistant Staphylococcus aureus (MRSA) was 14.9%, carbapenem resistant Enterobacteriaceae (CRE) was 4.5%, and vancomycin resistant Enterococcus (VRE) was 3.96%. Conclusions: The results of the current study conclude that empiric antimicrobial treatment in critically ill COVID-19 patients may be considered if properly managed within institutional or national level antibiotic stewardship programs, because it may play a protective role in the case of bacterial co-infections, especially when a patient has other AMR risk factors, such as hospital admission within the previous six months.

An Intelligent Multiattribute Decision-Support Framework Based on Parameterization of Neutrosophic Hypersoft Set.

Hypersoft set is a novel area of interest which is able to tackle the real-world scenarios where classification of parameters into their respective sub-parametric values in the form of overlapping sets is mandatory. It employs a new approximate mapping which considers such sets in the form of sub-parametric tuples as its domain. The existing soft set-like structures are insufficient to tackle such kind of situations. This research intends to establish a novel concept of parameterization of fuzzy set under hypersoft set environment with uncertain components of intuitionistic fuzzy set and neutrosophic set. Two novel structures, i.e., fuzzy parameterized intuitionistic fuzzy hypersoft set (fpifhs-set) and fuzzy parameterized neutrosophic hypersoft set (fpnhs-set), are developed by employing algebraic techniques like theoretic, analytical, pictorial, and algorithmic techniques. After characterizing the elementary properties and set-theoretic operations of fpifhs-set and fpnhs-set, two novel algorithms are proposed to solve real-life decision-making COVID-19 problem. The results of both algorithms are compared with related already established models through certain evaluating features to judge the advantageous aspects of the proposed study. The generalization of the proposed models is discussed by describing some of their particular cases.

Demographic Characteristics and Digital Platforms for Physical Activity Among the Chinese Residents During the COVID-19 Pandemic: A Mediating Analysis

Background E-health apps play a vital role in the era of the COVID-19 pandemic. More people across the globe have started to use fitness and health apps to mitigate the COVID-19 negative impacts on the health-related quality of life. E-health treatments are becoming more common these days. Aim The present research aim was to explore the mediating role of digital platforms for physical activity and fitness with demographic characteristics among Chinese people during the pandemic. Methods The primary data was collected through an online survey across China under the snowball sampling technique. A total of 5351 respondents took part in the online questionnaire survey. After quantification and quality check of the data, a total of 5000 respondents’ responses were added in the final analysis. The collected data were analyzed by using SPSS-25 and SmartPLS 3.0 software. Results The structural equation model analysis H1 (β = 0.227, t = 18.725, p = < 0.000), H2 (β = 0.225, t = 17.892, p = < 0.000), H3 (β = 0.229, t = 17.845, p = < 0.000), H4 (β = 0.54, t = 60.928, p= < 0.000), H5 (β = 0.553, t = 57.291, p = < 0.000), H6 (β = 0.559, t = 56.956, p = < 0.000), H7 (β = 0.358, t = 24.779, p = < 0.000), H8 (β = 0.259, t = 19.617, p = < 0.000) and H9 (β = 0.288, t = 19.92, p = < 0.000) results confirm the proposed hypothesis of the study. Conclusion E-health apps are playing a vital role in maintaining an active lifestyle through physical activity. Fitness and health apps can promote physical activity and improve health-related quality of life. Results of the current study concluded that E-health apps are promising to promote physical activity and fitness during the COVID-19 preventive measures.

Global data analysis and risk factors associated with morbidity and mortality of COVID-19.

This review was focused on global data analysis and risk factors associated with morbidity and mortality of coronavirus disease 2019 from different countries, including Bangladesh, Brazil, China, Central Eastern Europe, Egypt, India, Iran, Pakistan, and South Asia, Africa, Turkey and UAE. Male showed higher confirmed and death cases compared to females in most of the countries. In addition, the case fatality ratio (CFR) for males was higher than for females. This gender variation in COVID-19 cases may be due to males' cultural activities, but similar variations in the number of COVID-19 affected males and females globally. Variations in the immune system can illustrate this divergent risk comparatively higher in males than females. The female immune system may have an edge to detect pathogens slightly earlier. In addition, women show comparatively higher innate and adaptive immune responses than men, which might be explained by the high density of immune-related genes in the X chromosome. Furthermore, SARS-CoV-2 viruses use angiotensin-converting enzyme 2 (ACE2) to enter the host cell, and men contain higher ACE2 than females. Therefore, males may be more vulnerable to COVID-19 than females. In addition, smoking habit also makes men susceptible to COVID-19. Considering the age-wise distribution, children and older adults were less infected than other age groups and the death rate. On the contrary, more death in the older group may be associated with less immune system function. In addition, most of these group have comorbidities like diabetes, high pressure, low lungs and kidney function, and other chronic diseases. Due to the substantial economic losses and the numerous infected people and deaths, research examining the features of the COVID-19 epidemic is essential to gain insight into mitigating its impact in the future and preparedness for any future epidemics.

A critical analysis of SARS-CoV-2 (COVID-19) complexities, emerging variants, and therapeutic interventions and vaccination strategies.

Coronavirus is a family of viruses that can cause diseases such as the common cold, severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS). The universal outbreak of coronavirus disease 2019 (COVID-19) caused by SARS coronaviruses 2 (SARS-CoV-2) has become a global pandemic. The ß-Coronaviruses, which caused SARS-CoV-2 (COVID-19), have spread in more than 213 countries, infected over 81 million people, and caused more than 1.79 million deaths. COVID-19 symptoms vary from mild fever, flu to severe pneumonia in severely ill patients. Difficult breathing, acute respiratory distress syndrome (ARDS), acute kidney disease, liver damage, and multi-organ failure ultimately lead to death. Researchers are working on different pre-clinical and clinical trials to prevent this deadly pandemic by developing new vaccines. Along with vaccines, therapeutic intervention is an integral part of healthcare response to address the ongoing threat posed by COVID-19. Despite the global efforts to understand and fight against COVID-19, many challenges need to be addressed. This article summarizes the current pandemic, different strains of SARS-CoV-2, etiology, complexities, surviving medications of COVID-19, and so far, vaccination for the treatment of COVID-19.

An Insight Into COVID-19: A 21st Century Disaster and Its Relation to Immunocompetence and Food Antioxidants.

Coronavirus Disease 2019 (COVID-19) ranks third in terms of fatal coronavirus diseases threatening public health, coming after SARS-CoV (severe acute respiratory syndrome coronavirus), and MERS-CoV (Middle East respiratory syndrome coronavirus). SARS-CoV-2 (severe acute respiratory syndrome coronavirus type 2) causes COVID-19. On January 30, 2020, the World Health Organization (WHO) announced that the current outbreak of COVID-19 is the sixth global health emergency. As of December 3, 2020, 64 million people worldwide have been affected by this malaise, and the global economy has experienced a loss of more than $1 trillion. SARS-CoV-2 is a positive-sense single-stranded RNA virus belonging to the Betacoronavirus genus. The high nucleotide sequence identity of SARS-CoV-2 with the BatCoV RaTG13 genome has indicated that bats could be the possible host of SARS-CoV-2. SARS-CoV-2 penetrates the host cell via binding its spike protein to the angiotensin-converting enzyme 2 (ACE2) receptor, which is similar to the mechanisms of SARS-CoV and MERS-CoV. COVID-19 can spread from person to person via respiratory droplets and airborne and contaminated fomites. Moreover, it poses a significant risk to smokers, the elderly, immunocompromised people, and those with preexisting comorbidities. Two main approaches are used to control viral infections, namely, vaccination, and biosecurity. Studies to analyze the antigenicity and immunogenicity of SARS-CoV-2 vaccine candidates are underway, and few vaccines may be available in the near future. In the current situation, the Human Biosecurity Emergency (HBE) may be the only way to cope effectively with the novel SARS-CoV-2 strain. Here, we summarize current knowledge on the origin of COVID-19 as well as its epidemiological relationship with humans and animals, genomic resemblance, immunopathogenesis, clinical-laboratory signs, diagnosis, control and prevention, and treatment. Moreover, we discuss the interventional effects of various nutrients on COVID-19 in detail. However, multiple possibilities are explored to fight COVID-19, and the greatest efforts targeted toward finding an effective vaccine in the near future. Furthermore, antioxidants, polyphenols, and flavonoids, both synthetic and natural, could play a crucial role in the fight against COVID-19.

Rheumatoid arthritis management in the APLAR region: Perspectives from an expert panel of rheumatologists, patients and community oriented program for control of rheumatic diseases.

Rheumatoid arthritis (RA) is a major health burden in Asia Pacific affecting the quality of life of patients and consuming healthcare resources. According to recent estimates from the World Health Organization-International League Against Rheumatism-Community Oriented Program for Control of Rheumatic Diseases, prevalence is around 0.3%-0.5%. Management guidelines have helped to improve treatment across this diverse region. To gain better insight into current real-world management applications in view of these guidelines, virtual meetings were conducted in mid-2020 to explore perspectives of rheumatologists and patients, as well as discuss the impact of coronavirus disease 2019 on RA management. Patients and rheumatologists from Hong Kong, Malaysia, Singapore, the Philippines, Thailand, India, Pakistan, and Taiwan were included, representing a diverse mix of healthcare systems, wealth, ethnicity and culture. Despite many countries having prospered in recent years, similar challenges in RA diagnosis and treatment were identified. The daily impact and patient experience of RA were also similar across countries, marked by "silent" pain and disability, and universal misunderstanding of the disease. Late diagnosis and treatment, and barriers to access to appropriate treatment, remain problematic. The experience shared by Taiwan offers a glimmer of hope, however, wherein patient advocacy groups have succeeded in being included in policy-making decisions and securing access to advanced treatment. Real-world solutions that pay heed to the unique local needs and diversity of Asia Pacific are required to improve RA management, which will take time. In the interim, help can be sought from the trained, non-rheumatologist community to reduce some of the disease burden.

Knowledge, attitudes and practices of patients with chronic illnesses during the COVID-19 pandemic: A cross-sectional survey from Pakistan.

OBJECTIVES: We studied the impact of the Covid-19 pandemic on the physical and mental health of patients with chronic illnesses and their behavioural responses. METHODS: We conducted a cross-sectional knowledge, attitudes and practices (KAP) survey among outpatients with chronic illnesses in Lahore, Pakistan. RESULTS: Four hundred and one participants were surveyed (84% above 50 years of age). One or two chronic illnesses were present in 130 (32%), three or four in 211 (53%) and more than four in 60 (15%). The majority correctly identified the sources of Covid-19 infection and higher risk patients. Of the respondents, 127 (32%) described feeling more vulnerable. Respondents reported a lack of trust in the community response (199; 49.6%) and hospital measures (167; 41.6%) to slow the spread of Covid-19 and 369 (92%) practiced some degree of social distancing. Respondents described negative impacts of lockdown measures on their physical and mental health (235; 58.6% and 262; 65.3%, respectively). Many reported difficulty in getting medical help during the pandemic (302; 75.2%). Half of the respondents (200; 49.8%) felt that delays in receiving care had adversely affected their health. CONCLUSIONS: Respondents with chronic illnesses frequently reported negative behavioural and health impacts during the Covid-19 pandemic.

SNPs at 3'UTR of APOL1 and miR-6741-3p target sites associated with kidney diseases more susceptible to SARS-COV-2 infection: in silco and in vitro studies.

Acute Kidney Injury (AKI) is a common manifestation of COVID-19 and several cases have been reported in the setting of the high-risk APOL1 genotype (common genetic variants). This increases the likelihood that African American people with the high-risk genotype APOL1 are at increased risk for kidney disease in the COVID-19 environment. Single-nucleotide polymorphisms (SNPs) are found in various microRNAs (miRNAs) and target genes change the miRNA activity that leads to different diseases. Evidence has shown that SNPs increase/decrease the effectiveness of the interaction between miRNAs and disease-related target genes. The aim of this study is not only to identify miRSNPs on the APOL1 gene and SNPs in miRNA genes targeting 3'UTR but also to evaluate the effect of these gene variations in kidney patients and their association with SARS-COV-2 infection. In 3'UTR of the APOL1 gene, we detected 96 miRNA binding sites and 35 different SNPs with 10 different online software in the binding sites of the miRNA (in silico). Also we studied gene expression of patients and control samples by using qRT-PCR (in vitro). In silico study, the binding site of miR-6741-3p on APOL1 has two SNPs (rs1288875001, G > C; rs1452517383, A > C) on APOL1 3'UTR, and its genomic sequence is the same nucleotide as rs1288875001. Similarly, two other SNPs (rs1142591, T > A; rs376326225, G > A) were identified in the binding sites of miR-6741-3p at the first position. Here, the miRSNP (rs1288875001) in APOL1 3'UTR and SNP (rs376326225) in the miR-6741-3p genomic sequence are cross-matched in the same binding region. In vitro study, the relative expression levels were calculated by the 2-ΔΔCt method & Mann-Whitney U test. The expression of APOL1 gene was different in chronic kidney patients along with COVID-19. By these results, APOL1 expression was found lower in patients than healthy (p < 0.05) in kidney patients along with COVID-19. In addition, miR-6741-3p targets many APOL1-related genes (TLR7, SLC6A19, IL-6,10,18, chemokine (C-C motif) ligand 5, SWT1, NFYB, BRF1, HES2, NFYB, MED12L, MAFG, GTF2H5, TRAF3, angiotensin II receptor-associated protein, PRSS23) by evaluating online software in the binding sites of the miR-6741-3p. miR-6741-3p has not previously shown any association with kidney diseases and SARS-COV-2 infection. It assures that APOL1 can have a significant consequence in kidney-associated diseases by different pathways. Henceforth, this study represents and demonstrates an effective association between miR-6741-3p and kidney diseases, i.e., collapsing glomerulopathy, chronic kidney disease (CKD), acute kidney injury (AKI), and tubulointerstitial lesions susceptibility to SARS-COV-2 infection via in silico and in vitro exploration and recommended to have better insight.

Inflammation, immunity and potential target therapy of SARS-COV-2: A total scale analysis review.

Coronavirus disease-19 (COVID-19) is a complex disease that causes illness ranging from mild to severe respiratory problems. It is caused by a novel coronavirus SARS-CoV-2 (Severe acute respiratory syndrome coronavirus-2) that is an enveloped positive-sense single-stranded RNA (+ssRNA) virus belongs to coronavirus CoV family. It has a fast-spreading potential worldwide, which leads to high mortality regardless of lows death rates. Now some vaccines or a specific drug are approved but not available for every country for disease prevention and/or treatment. Therefore, it is a high demand to identify the known drugs and test them as a possible therapeutic approach. In this critical situation, one or more of these drugs may represent the only option to treat or reduce the severity of the disease, until some specific drugs or vaccines will be developed and/or approved for everyone in this pandemic. In this updated review, the available repurpose immunotherapeutic treatment strategies are highlighted, elucidating the crosstalk between the immune system and SARS-CoV-2. Despite the reasonable data availability, the effectiveness and safety of these drugs against SARS-CoV-2 needs further studies and validations aiming for a better clinical outcome.