Factors Associated with Psychiatric Morbidity among Patients who tested Positive and Isolated for COVID-19

Objective: To look for the psychiatric morbidity and associated socio-demographic factors among patients who tested positive and isolated for COVID-19. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Malir Pakistan, from Mar to May 2020. Methodology: All patients who tested positive for COVID-19 and were admitted to the COVID-19 Ward without complications were included in the study. General Health Questionnaire-12 (GHQ-12) was administered to look for the presence of psychiatric morbidity. Results: Out of 61 patients included in the study, 45(73.7%) showed the presence of psychiatric morbidity, while 16(26.3%) did not show psychiatric morbidity when screened with GHQ-12. 43(70.4%) were male, while 18(29.6%) were female. The mean age of the patients was 35.21±2.355 years. The advanced age and female gender have a statistically significant relationship (pvalue<0.05) with the presence of psychiatric morbidity among patients of COVID-19. Conclusion: Many patients had psychiatric morbidity after being tested positive for COVID-19 and were isolated in the health facility. Female patients and patients aged more than 40 years were found to be more at risk of developing psychiatric morbidity among the patients admitted to COVID-19 ward. © 2022, Army Medical College. All rights reserved.

Getting Negative for COVID-19: Role of Ethnicity and Demographic Factors

Objective: To explore the relationship between ethnicity and demographic factors with the time taken by patients to get negative on PCR for COVID-19. Study Design: Prospective Comparative Study. Place and Duration of Study: Combined Military Hospital, Malir Pakistan, from Mar to May 2020. Methodology: All patients who tested positive for COVID-19 with less than one week of exposure time and were admitted to the COVID-19 ward of Combined Military Hospital, Malir without any complications were included in the study. They were tested after every seven days with PCR. Time taken to get two consecutive negative tests were noted for each patient. Results: Out of 84 patients included in the study, 12(14.3%) tested negative on the 7th day, 34(40.4%) on the 14th day and 38(45.3%) tested negative after 14 days. 17(20.2%) were Sindhi, 13(15.5%) were Muhajir, 19(22.6%) were Punjabi, 25(29.7%) were Pathan, and 10(11.9%) were Kashmiris. Chi-square revealed that ethnicity and advancing age have a statistically significant relationship (p-value<0.05) with the time taken by patients to get negative on PCR for COVID-19. Conclusion: Ethnicity emerged as a significant factor in getting negative for COVID-19. Punjabis and Kashmiris required a shorter period to get negative than Sindhis and Pathans. Older age emerged as a factor requiring a longer period to get negative. © 2022, Army Medical College. All rights reserved.

The effect of caspase-8 as an apoptotic marker in relation to COVID-19 patients severity (preprint)

Objective: In Iraq, the COVID-19 pandemic was catastrophic, leading to mortality and morbidity. One of the leading causes of mortality was cell apoptosis that leads to organ failure. Aim: To diagnose the cell apoptosis of COVID-19 patients at an early stage so we can predict earlier organ failure. Methods: The research was conducted in the medicinal chemistry department of Al-Nahrain University/College of Medicine in Baghdad, Iraq. One hundred patients of different stages proved COVID-19 and compared with 100 persons in the control group, measure caspase-8 enzyme and acute inflammatory markers, procalcitonin (PCT), and IL-6 with COVID-19 immunoglobulins IgG, IgM in the blood of two groups. We're done—statical studies with clinical analysis results. Results: The marker of cell apoptosis was caspase-8 enzymes, which showed vertical elevation with the increase in severity of COVID-19 patients. There was a strong relationship between the caspase-8 enzyme and acute inflammatory markers. Moreover, there is a relationship between the caspase-8 enzyme and COVID-19 immunoglobulins. Conclusion: The caspase-8 enzyme is a strong marker of severity in COVID-19 patients and indicates a life-threatening condition.

Investigation of Antibiotic Resistome in Hospital Wastewater during the COVID-19 Pandemic: Is the Initial Phase of the Pandemic Contributing to Antimicrobial Resistance?

Since the COVID-19 pandemic started, there has been much speculation about how COVID-19 and antimicrobial resistance may be interconnected. In this study, untreated wastewater was sampled from Hospital A designated to treat COVID-19 patients during the first wave of the COVID-19 pandemic alongside Hospital B that did not receive any COVID-19 patients. Metagenomics was used to determine the relative abundance and mobile potential of antibiotic resistant genes (ARGs), prior to determining the correlation of ARGs with time/incidence of COVID-19. Our findings showed that ARGs resistant to macrolides, sulfonamides, and tetracyclines were positively correlated with time in Hospital A but not in Hospital B. Likewise, minor extended spectrum beta-lactamases (ESBLs) and carbapenemases of classes B and D were positively correlated with time, suggesting the selection of rare and/or carbapenem-resistant genes in Hospital A. Non-carbapenemase blaVEB also positively correlated with both time and intI1 and was copresent with other ARGs including carbapenem-resistant genes in 6 metagenome-assembled genomes (MAGs). This study highlighted concerns related to the dissemination of antimicrobial resistance (AMR) during the COVID-19 pandemic that may arise from antibiotic use and untreated hospital wastewater.

The Capabilities, Challenges, and Resilience of Digital Learning as a Tool for Education During the COVID-19

The current study’s objective examines contemporary advancements in learning utilizing digital technology for educational purposes during the recent pandemic outbreak. The study analysed the challenges, capabilities, and resilience of these digital learning environments and the future of digital learning. The PRISM statement is used to select records and assess the final 37 studies for the current investigation. According to the findings, the COVID-19 pandemic posed a significant challenge to educational institutions, and online learning was a challenging work for students and teachers. The availability of a large number of digital learning platforms, on the other hand, considerably mitigates the problem. Students’ and teachers’ skills and capacities have grown as a result of the learning process utilising digital platforms. The current study’s findings show that education in the post-COVID-19 era is heavily reliant on digital sources, and that new technologies greatly enhance the learning process. © 2022. International Journal of Interactive Mobile Technologies. All Rights Reserved.

Epidemiology of SARS--CoV--2 with Implications of Reinfection Update After 01 Year of Ongoing Pandemic:: Cross Sectional Study From Tertiary Care Hospital From Southern Region of Pakistan

Objective: To share the epidemiological, clinical and laboratory -based evidence of severe acute respiratory syndrome Corona Virus-2 with focus on the cases of re-infection;an update after one year of the ongoing pandemic. Study Design: Prospective observational study. Place and Duration of Study: Department of Pathology, in collaboration with Department of Medicine, Combined Military Hospital, Malir, from Mar 2020 to Feb 2021. Methodology: Total 5190 nasopharyngeal swabs were collected and transported to the laboratory in viral transport media for severe acute respiratory syndrome Corona Virus-2, from all symptomatic patients with a history of exposure/traveling from endemic areas and those requiring admission in hospital and were screened for COVID-19 as per hospital standing protocols. Results: 561(10.8%) patients were PCR positive for severe acute respiratory syndrome Corona Virus-2. The mean age of patients was 39.45±31.9 years and a majority of patients were males 426 (76%). The most common symptoms were fever and dry cough followed by myalgia and shortness of breath. 37 (9%) patients died due to the severity of the illness. Total 6 (1.46%) cases of laboratory-confirmed reinfection of severe acute respiratory syndrome Corona Virus-2 were reported. 2(33%) cases of reinfection were observed in health care workers, mortality was seen in a single patient associated with old age and comorbidities. Conclusion: In our study, the severity of the disease was directly related to the age of patients and underlying comorbidities. Reinfection was associated with increased viral load and exposure to the infected environment. © 2022, Army Medical College. All rights reserved.

Time-varying herding spillover for emerging countries: evidence from BRIC countries and Turkey

Purpose This study aims to investigate herding spillover in BRIC (Brazil, Russia, India and China) countries and Turkey under different regimes by using a time-varying approach. Design/methodology/approach The authors used the structural change model of Bai and Perron (1998). Findings The results indicate that there is an evidence of herding behaviour in the Chinese stock market in two different regimes. These regimes cover the recent global financial crisis and the period of Hong Kong protests. We also report the evidence of herding behaviour in the Turkish stock market in the regime covering the COVID-19 period. Findings of herding spillover show that there is a two-way herding among Russia and China during crises and high volatile regimes. Similarly, there exists a cross-country herding among Brazil and India during crisis regimes. Also, there is herding spillover from Turkey to Russia, China and Brazil during the global financial crisis, post-European debt crisis and COVID-19 periods respectively. Furthermore, it is also evident that there is a herding spillover from Russia and China to India during the period covering COVID-19. Originality/value To the best of the authors' knowledge, this is the first study that uses structural change approach to identify herding behaviour spillovers from the US stock market to BRIC countries and Turkey and to investigate the cross-country herding behaviour among BRIC countries and Turkey.

Safety and effectiveness of the BNT162B2 mRNA COVID-19 vaccine in a nationwide cohort of patients with inflammatory bowel disease

BACKGROUND & AIMS: The effectiveness of currently available SARS-CoV-2 vaccines in patients with inflammatory bowel disease (IBD) remains unknown. We aimed to determine the effectiveness of the Pfizer-BNT162b2 mRNA vaccine in a nationwide cohort of patients with IBD in Qatar. METHODS: Using a cohort design, we compared 476 IBD patients vaccinated identified between January 1, 2021, and March 31, 2021, with 476 matched unvaccinated controls (matched on age and date of SARS-CoV-2 testing). Study outcomes included documented SARS-CoV-2 infection, symptomatic COVID-19, and COVID-19 related hospitalization. We also studied the side effects of the vaccination, including the effect on IBD exacerbation and hospitalizations related to adverse events. RESULTS: Total follow-up was 23,289 person-days for the vaccinated and 23,653 person-days for the unvaccinated group. Vaccine effectiveness >14 days [AAB1] after the second dose was 85.1% (95% CI: 65.2, 93.6) for confirmed infection, and 87.1% (95% CI: 63.6, 95.4)[AAB2] for symptomatic infection. No patient required hospitalization >14 days after the second vaccine dose. Estimated vaccine effectiveness between 22 to 35 days after the first dose was 14.8% (95% CI: -151.5, 71.2) [AAB3] for any documented infection, and 59.8% (95% CI: -106.1, 92.2) for symptomatic COVID-19 disease. For patients taking biologics with or without immunomodulators, vaccine effectiveness >14 days after the second dose was 94% (95% CI: 53.1, 99.2), and 92.7% (95% CI: 45.1, 99.0) for any documented infection and symptomatic COVID-19 respectively. Vaccine effectiveness was 87.4% (95% CI: 46.0, 97.1) for any documented infection and 91.7% (95% CI: 37.2, 98.9) for symptomatic COVID-19 during the same period for patients taking immunomodulators alone. None of the vaccinated patients required intensive care unit admission or died. No patient had IBD exacerbation or required hospitalization for vaccinationrelated adverse events. CONCLUSION: In a nationwide cohort of IBD patients, the BNT162b2 mRNA vaccine was safe and highly effective.

Environmental Performance of Budget Hotels in Pakistan. Nexus of Environmental Orientation, Eco-innovation and Competitive Intensity

The current study aims to investigate the influence of budget-hotels' environmental orientation (EO) on their eco-innovation (EI) and environmental performance (EP). Besides empirically testing the said direct relationship, mediating role of EI in the relationship between EO and EP has also been investigated. Moderating effect of competitive intensity (CI) of the firm has also been examined on the link between EI and EP. The requisite data for this study was collected from 422 individuals, working on various managerial positions in the budget-hotels in Pakistan. Correlation, path analysis, structural equation modelling and hierarchical regression were used for the purpose of data analysis. Data analysis using SPSS and AMOS reveals a direct effect of EO on EI and EP. Moreover, the results substantiated that EI mediates between EO and EP. Moderating effect of CI on the link between EI and EP has also been confirmed. The study advocates new mechanisms which would be helpful in protecting natural environment. In the context of budget hotel segment of hospitality industry of Pakistan, the present study makes significant contribution to the literature through knowledge addition regarding the positive association of EO and EI © 2021,Pakistan Journal of Commerce and Social Sciences.All Rights Reserved

Impact of age on outcome of COVID-19 patients at a tertiary care hospital

Objective: To assess the impact of age on outcome of COVID-19 patients at a tertiary care hospital. Study Design: Cross sectional study. Place and Duration of Study: Combined Military Hospital Malir, Karachi, from Apr to Jun 2020. Methodology: This was a retrospective cross sectional study conducted at Combined Military Hospital Malir Karachi. About 120 positive cases of SARS COV-2 were studied, including males and females. Age range was 21-85 years. Patients were divided into groups according to age, group A (21-40 years), group B (41-55 years), group C (56-85 years). Presenting complaints and associated co morbidities were also analyzed. Mild cases were managed conservatively. Moderate to severe oxygen dependent cases were managed in intensive care units. Results: The mean age of patients was 40.24 years with 16.25 ± SD. Co-morbidities were noted in 67 (55.83%) patients, highest in group C, hypertension being the most common. Ten patients could not survive, due respiratory failure complicated by adult respiratory distress syndrome (ARDS). Bilateral infiltrates >50% observed in (14%) out of (n=120) patients. One hundred and ten patients were discharged with uneventful recovery. Conclusion: Mortality was highest among elderly patients with comorbidities. Therefore, international standing operative measures (SOPs) to be followed. Meticulous monitoring of vital signs and oxygen saturation in mild cases is the bare mini-mum requirement and timely appropriate treatment escalation of moderate to severe cases in intensive care units is the key to success. © 2021, Army Medical College. All rights reserved.

Assessment of perceived stress among resident trainees of a tertiary care hospital in saudi arabia during covid 19 pandemic a cross-sectional study

Background & Objective: The massive burden of COVID-19 disease is believed to be associated with significant psychological disturbances on healthcare professionals. Increasing levels of stress may lead to anxiety, depression, burnout syndrome, and in severe cases, post-Traumatic stress disorder. The objective of this study was to examine the presence of stress among resident trainee doctors working in a tertiary care hospital in Saudi Arabia in the context of the corona pandemic. Methodology: This was a cross-sectional study conducted in Security Forces Hospital, Riyadh, Saudi Arabia. We included the resident trainee doctors from different specialties of our hospital including medical, surgical, anesthesia, emergency room (ER), and critical care units. We used convenience sampling to select study respondents. Perceived Stress Scale (PSS) was used for assessing the stress levels among trainees. Trainees were requested to fill the questionnaire either online survey monkey or in paper form. All data were entered and analyzed using SPSS version 26. We calculated mean, standard deviation, frequency count, and percentages for the perceived stress. Results: A total of 60 trainees were included in this study. Mean PSS-10 score was 20 5.51, with a range between 6 and 34. Four (6.7 %) trainees had low stress and 50 (83.3 %) trainees had moderate stress while 6 (10 %) trainees had high stress Conclusion: The majority of resident trainees in our study experienced a moderate level of anxiety during this COVID pandemic.

COVID-19: Understanding pathology and management in Unani medical perspective

The whole world is facing a big challenge to fight against COVID-19 as it is a novel disease, highly infectious and having no treatment yet. Traditional Unani medicine is reviewed with an aim to find some solution for this disease prevention, control and management. Unani medical literature is extensively reviewed and it is found that there are some presentations similar to this disease and management of those clinical syndromes could be applied in present scenario. Major symptoms like fever, cough, fatigue, shortness of breath and rhinorrhoea are reviewed from Unani medical text having similar aetiology and interlinked pathology. It is demonstrated that in cold & humid atmospheric conditions in persons having Fuzlat (waste) in their body, Nazla (fall) of Balghami Rutubaat (phlegmatic fluids) from head comes towards lungs, infected there resulting in Zatur Riya (pneumonia/pneumonitis) and Humma Mawazba (fever caused by abnormal humour Balgham) and /or Humma Mutbiqa (fever caused by abnormal humour Dam). The bad atmospheric condition favours spread of this infection to other people who come in contact with such patient. The detailed description of these Unani concepts & interpretation is given below.

Estimating the minimum number of SARS-CoV-2 infected cases needed to detect viral RNA in wastewater: To what extent of the outbreak can surveillance of wastewater tell us?

There is increasing interest in wastewater-based epidemiology (WBE) of SARS-CoV-2 RNA to serve as an early warning system for a community. Despite successful detection of SARS-CoV-2 RNA in wastewaters sampled from multiple locations, there is still no clear idea on the minimal number of cases in a community that are associated with a positive detection of the virus in wastewater. To address this knowledge gap, we sampled wastewaters from a septic tank (n = 57) and biological activated sludge tank (n = 52) located on-site of a hospital. The hospital is providing treatment for SARS-CoV-2 infected patients, with the number of hospitalized patients per day known. It was observed that depending on which nucleocapsid gene is targeted by means of RT-qPCR, a range of 253-409 positive cases out of 10,000 persons are required prior to detecting RNA SARS-CoV-2 in wastewater. There was a weak correlation between N1 and N2 gene abundances in wastewater with the number of hospitalized cases. This correlation was however not observed for N3 gene. The frequency of detecting N1 and N2 gene in wastewater was also higher than that for N3 gene. Furthermore, nucleocapsid genes of SARS-CoV-2 were detected at lower frequency in the partially treated wastewater than in the septic tank. In particular, N1 gene abundance was associated with water quality parameters such as total organic carbon and pH. In instances of positive detection, the average abundance of N1 and N3 genes in the activated sludge tank were reduced by 50 and 70% of the levels detected in septic tank, suggesting degradation of the SARS-CoV-2 gene fragments already occurring in the early stages of the wastewater treatment process.

How early into the outbreak can surveillance of SARS-CoV-2 in wastewater tell us? (preprint)

There is increasing interest to use wastewater-based surveillance of SARS-CoV-2 as an early warning of the outbreak within a community. Despite successful detection of SARS-CoV-2 in wastewaters sampled from multiple locations, there is still no clear idea on the minimal number of cases needed in a community to result in a positive detection of the virus in wastewaters. To address this knowledge gap, we sampled wastewaters from a septic tank and biological activated sludge tank located on-site of a hospital. The hospital is providing treatment for SARS-CoV-2 infected patients, with the number of hospitalized patients per day known. It was observed that > 253 positive cases out of 10,000 persons are required prior to detecting SARS-CoV-2 in wastewater. There was a weak correlation between N1 and N2 gene abundances in wastewater with the number of hospitalized cases. This correlation was however not observed for N3 gene. The occurrence frequency of SARS-CoV-2 is at least 5 times lower in the partially treated wastewater than in the septic tank. Furthermore, abundance of N1 and N3 genes in the activated sludge tank were 50 and 70% of the levels detected in septic tank, suggesting poor persistence of the SARS-CoV-2 gene fragments in wastewater.