The maximal covering location problem with accessibility indicators and mobile units

We study the Maximal Covering Location Problem with Accessibility Indicators and Mobile Units that maximizes the facilities coverage, the accessibility of the zones to the open facilities, and the spatial disaggregation. The main characteristic of our problem is that mobile units can be deployed from open facilities to extend the coverage, accessibility, and opportunities for the inhabitants of the different demand zones. We formulate the Maximal Covering Location Problem with Accessibility Indicators and Mobile Units as a mixed-integer linear programming model. To solve larger instances, we propose a matheuristic (combination of exact and heuristic methods) composed of an Estimation of Distribution Algorithm and a parameterized Maximal Covering Location Problem with Accessibility Indicators and Mobile Units integer model. To test our methodology, we consider the Maximal Covering Location Problem with Accessibility Indicators and Mobile Units model to cover the low-income zones with Severe Acute Respiratory Syndrome Coronavirus 2 patients. Using official databases, we made a set of instances where we considered the poverty index, number of population, locations of hospitals, and Severe Acute Respiratory Syndrome Coronavirus 2 patients. The experimental results show the efficiency of our methodologies. Compared to the case without mobile units, we drastically improve the coverage and accessibility for the inhabitants of the demand zones.

Green synthesized nanomaterials as antiviral substances

Viruses are obligate intracellular parasites, and infections may lead to mortalities. The outbreaks of several viral infections during the twentieth century increased the demand for both conventional and nonconventional types of antiviral treatments. The recent lethal impact of the coronavirus has increased the scientific investigations into the quest for potent antiviral therapeutics. Many new antiviral drugs approved by FDA have been exploited for the treatment of viral infections. However, owing to the limitations of synthetic antiviral drugs, new technologies have paved the way in an attempt to discover antiviral drugs that can overcome the drug resistance and low bioavailability issues. Green nanoscience offers the potential advantage of designing novel, biocompatible and viral-targeted specific antiviral drugs. Plants, algae, fungi, and bacteria are the preferable greener choices for the synthesis of green antiviral nanomaterials. This chapter summarizes the green antiviral nanomaterials synthesized over the past 5years (2016-21) and surprisingly has found very limited information on the green nanomaterials screened as antiviral agents and their specific modes of the antiviral mechanism. Scientific investigations available regarding green antiviral nanomaterials are restricted to in vitro systems, which demands the translation of these active antiviral nanomaterials into in vivo clinical practice. © 2023 Elsevier Inc. All rights reserved.

THERAPEUTIC TARGET AND CLINICAL IMPACT OF DAY-TO-DAY BLOOD PRESSURE VARIABILITY IN HYPERTENSIVE PATIENTS WITH COVID-19

Objectives: Blood pressure variability (BPV) plays an important role in hypertensive patients, and frequently associated with organ damage. Although hypertension is the most common comorbidity in COVID-19, the impact of BPV and therapeutic target of BPV to outcome in COVID-19 patients with hypertension remain unclear. The aim of this study is to investigate the relationship between BPV and severity of COVID-19, in-hospital mortality, hypertensive status,, and efficacy of antihypertensives in suppress hypertensive covid-19 patient's BPV. Design and method: This was a cohort retrospective study that enrolled 351 patients hospitalized with COVID-19. Subjects were classified according to the presence of hypertension, the severity of COVID-19, and BPV status. Mean Arterial Pressure (MAP) was measured at 6 a.m. and 6 p.m. during hospitalization, and BPV was calculated as the coefficient of variation of MAP (MAPCV). MAPCV values above the median were defined as high BPV. We compared the hypertensive status, COVID-19 severity, in-hospital mortality and antihypertensive agents between the BPV groups. Results: The mean age was 53.85 ± 18.84 years-old. Subjects with high BPV were significantly associated with hypertension status (PR = 1.38;95%CI = 1.13- 1.70;p = 0.003) or severe COVID-19 (PR = 1.39;95%CI = 1.09-1.76;p = 0.005). In laboratory findings, high BPV group had higher CRP (55.15 ± 50.80 vs 97.79 ± 77.17), higher creatinine cerum (1.80 ± 3.15 vs 0.91 ± 0.14) and high BPV status also significantly increased risk of mortality (HR = 2.30;95%CI = 1.73-3,86;p = <0.001). Patients with combination of severe COVID-19 status, hypertension (+) and high BPV status had the highest risk of in-hospital mortality (HR = 3.51;95%CI = 2.32-4,97;p < 0.001) compared to other combination status of groups. In COVID-19 patients with hypertension, combination teraphy with CCB as well as CCB monoteraphy significantly decreased BPV (PR = 0.50;95%CI = 0.27-0.93;p = 0.004) and mortality (HR = 0.17;95%CI = 0.05-0.56;p = 0.004). Conclusions: High BPV was associated with hypertensive status and severe COVID-19, and these factors together increased in-hospital mortality. CCB are antihypertensive agents that were potentially effective in suppressing BPV and mortality in COVID-19 patients.

Assessment of neonatal intensive care unit nurses' compliance with standard precautions of infection control and identification of enabling factors.

Background: Rigorous implementation of infection prevention and control practices by healthcare workers in different healthcare settings is of utmost importance. Neonates, particularly preterm babies in neonatal intensive care units, are a vulnerable population at high risk for developing nosocomial infections. Nurses have the greatest risk of spreading healthcare-associated infections among patients and healthcare workers. This study was conducted to assess the compliance of neonatal intensive care unit nurses with standard precautions of infection control and to identify the potential influencing factors. Results: This was a cross-sectional study, whereby the compliance of a total of 58 neonatal intensive care unit nurses with standard precautions of infection control was assessed using the Arabic version of the Compliance with Standard Precautions Scale (CSPS-A). Student's t test, ANOVA test, and post hoc test were used for analysis.A suboptimal compliance rate (66.7%) was detected, with the highest for disposal of sharp articles into sharps boxes (86.2%) and the lowest for disposal of sharps box not only when full (27.6%). Significant differences were observed when participants were grouped according to their clinical experience and qualifications, where participants with longer clinical experience displayed higher mean scores for the use of protective devices score (P = 0.024), disposal of sharps score (P = 0.003), and total CSPS score (P = 0.006). Conclusions: Clinical experience and educational qualifications are key factors that impact nurses' compliance with infection control practices. Nurses should receive up-to-date evidence-based educational and practical sessions that link theory to clinical practice and elucidate the importance of accurate implementation of proper infection prevention and control practices.

Therapeutic target and clinical impact of day-to-day blood pressure variability in hypertensive patients with covid-19.

Blood pressure variability (BPV) is essential in hypertensive patients and is frequently associated with organ damage. As of today, hypertension is still the most common comorbidity in COVID-19, but the impact of BPV and the therapeutic target of BPV on outcomes in COVID-19 patients with hypertension remain unclear. Therefore, this study investigated the relationship between BPV and severity of COVID-19, in-hospital mortality, hypertensive status, and efficacy of antihypertensives in suppressing hypertensive covid-19 patient BPV. This cohort retrospective study enrolled 351 patients hospitalized with COVID-19. Subjects were classified according to the severity of COVID-19, the presence of hypertension, and their BPV status. During hospitalization, mean arterial pressure (MAP) was measured at 6 a.m. and 6 p.m., and BPV was calculated as the coefficient of variation of MAP (MAPCV). MAPCV values above the median were defined as high BPV. In addition, we compared the hypertensive status, COVID-19 severity, in-hospital mortality, and antihypertensive agents between the BPV groups. The mean age was 53.85 ± 18.84 years old. Hypertension was significantly associated with high BPV with prevalence ratio (PR) = 1.38 (95% CI = 1.13-1.70; p = 0.003) or severe COVID-19 (PR = 1.39; 95% CI = 1.09-1.76; p = 0.005). In laboratory findings, high BPV group had lower Albumin, higher WBC, serum Cr, CRP, and creatinine to albumin ratio. High BPV status also significantly increased risk of mortality (HR = 2.30; 95% CI = 1.73-3.86; p < 0.001). Patients with a combination of severe COVID-19 status, hypertension, and high BPV status had the highest risk of in-hospital mortality (HR = 3.51; 95% CI = 2.32-4.97; p < 0.001) compared to other combination status groups. In COVID-19 patients with hypertension, combination therapy with calcium channel blockers (CCB) as well as CCB monotherapy significantly develop low BPV (PR = 2.002; 95 CI% = 1.33-3.07; p = 0.004) and low mortality (HR = 0.17; 95% CI = 0.05-0.56; p = 0.004). Hypertensive status and severe COVID-19 were significantly associated with high BPV, and these factors increased in-hospital mortality. CCBs might be antihypertensive agents that potentially effectively suppressing BPV and mortality in COVID-19 patients.

Computation-guided inhibitor screening against the nucelocapsid of SARS-CoV-2

Nucleocapsid phosphoprotein sheaths the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA (positive strand) and assists in virion assembly. This occurs via an interaction with membrane protein and genomic elements involved in transcription and replication. It is important to study these interactions and infer details of the mechanisms behind the connection. Virtual screening for inhibitor mining is also a swift approach for repurposing drugs as well as finding new leads. In this chapter, we describe a swift computational approach in guiding us to interaction, inhibition, and drug-like phytocompound screening against pathogenic agents, especially in pandemics when difficulty in commuting and smooth availability of resources is reduced, leading to plummeted experimental work. We present a case study on virtual screening of phytochemicals against nucleocapsid using a docking approach, followed by ADMET profiling of top compounds. © 2022 Elsevier Inc. All rights reserved.

Effect of Sun Drying on Phytoconstituents and Antiviral Activity of Ginger against Low-Pathogenic Human Coronavirus

Rhizomes of ginger are commonly used as a spice and for home remedies in either fresh or dry form. This study aimed to assess the effect of sun drying on the volatile constituents, total phenolic and flavonoid content, and the antiviral activity of ginger against low-pathogenic human coronavirus. The antiviral effect of the major volatile compounds was predicted through molecular docking. GC/MS was employed for profiling the volatile constituents of both fresh and dry ginger oils. Moreover, chemometric analysis was applied to discriminate between fresh and dry ginger and to investigate the correlation between their volatile constituents and the antiviral activity using principal component analysis (PCA) and partial least-squares regression (PLS-R). GC/MS analysis revealed that the major effects of the drying process were an increase in α-curcumene and β-sesquiphellandrene. Moreover, total phenolic and flavonoid contents of dried ginger decreased considerably. A PCA score plot revealed significant discrimination between fresh and dry ginger, with α-curcumene and 4-thujanol identified as the main discriminating markers. These findings were validated by in silico molecular docking studies, which revealed that the compounds under consideration had good drug-like characteristics. Thus, ginger is rich in valuable phytoconstituents which showed promising therapy in viral infections such as COVID-19.

Glycyrrhizin and boswellic acids, the golden nutraceuticals: multitargeting for treatment of mild-moderate COVID-19 and prevention of post-COVID cognitive impairment.

Breakthrough infections have been reported in fully vaccinated persons. Furthermore, rebound symptoms have been reported following the new FDA granted emergency use to combat SARS-CoV-2. Glycyrrhizin (GR) and boswellic acids (BAs) combination has been shown to have highly successful actions against COVID-19 in our recent clinical trial. However, the study is limited by the small sample size, and therefore, the aim of this article is to comprehensively evaluate recent evidence on the efficacy of GR and BAs in preventing the development of COVID-19 in patients with mild and moderate infections and in preventing post-COVID-19 cognitive impairment, which is the most important symptom after recovery from Covid-19 disease. We have reviewed and discussed information published since the outbreak of the COVID-19 pandemic until July 2022 on preclinical (in vivo, in vivo and bioinformatics) and clinical studies related to the antiviral, anti-inflammatory and immunomodulatory activity of Gr and BAs. Sixteen studies were performed to determine the efficacy of GR against SARS-CoV-2. Ten studies were used primarily for in vitro and in vivo assays and six used molecular docking studies. However, the antiviral activity of BAs against SARS-CoV-2 was determined in only five studies using molecular modeling and bioinformatics. All these studies confirmed that GR n and BAs have strong antiviral activity and can be used as a therapeutic agent for COVID-19 and as a protective agent against SARS-CoV-2. They may act by inhibiting the main protease SARS-CoV-2 (Mpro) responsible for replication and blocking spike protein-mediated cell entry. Only seven rigorously designed clinical trials regarding the usefulness of GR, BAs or their combinations in the treatment of COVID-19 have been published as of July 2022. Although there is no clinical study regarding the treatment of cognitive impairment after COVID-19 that has been published so far, several preclinical and clinical studies have demonstrated the potential effect of GR and BAs in the prevention and treatment of cognitive impairment by inhibiting the activity of several molecules that activate inflammatory signaling pathway. In conclusion, the findings of our study documented the beneficial use of GR and BAs to treat SARS-CoV-2 and its variants and prevent post-COVID cognitive impairment. However, it warrants further studies with a larger randomized sample size to ensure that the studies have sufficient evidence of benefits against COVID-19 and post-COVID-19 symptoms.

Work and Family Disadvantage: Determinants of Gender Gaps in Paid Work During the COVID-19 Pandemic.

This article provides a comprehensive analysis of the increase in gender inequality in paid work during the pandemic to unpack the relative relevance of labor market and work-family conflict processes. Using panel data from the United States Current Population Survey, we examine four mechanisms in an integrated analysis that explicitly includes single-parent households and assesses the moderating role of women's economic position relative to their partners. The results indicate that increases in gender inequality during the pandemic were heavily concentrated in households with children but also partly connected to gender differences in prepandemic labor market positions and to the higher prevalence of women in lower earner position relative to their partners. Single parents were more negatively impacted than partnered parents, but the disproportionate concentration of this impact on women does not contribute much to increases in overall gender inequality due to the relatively smaller size of this group.

Application of human RNase P normalization for the realistic estimation of SARS-CoV-2 viral load in wastewater: A perspective from Qatar wastewater surveillance.

The apparent uncertainty associated with shedding patterns, environmental impacts, and sample processing strategies have greatly influenced the variability of SARS-CoV-2 concentrations in wastewater. This study evaluates the use of a new normalization approach using human RNase P for the logic estimation of SARS-CoV-2 viral load in wastewater. SARS-CoV-2 variants outbreak was monitored during the circulating wave between February and August 2021. Sewage samples were collected from five major wastewater treatment plants and subsequently analyzed to determine the viral loads in the wastewater. SARS-CoV-2 was detected in all the samples where the wastewater Ct values exhibited a similar trend as the reported number of new daily positive cases in the country. The infected population number was estimated using a mathematical model that compensated for RNA decay due to wastewater temperature and sewer residence time, and which indicated that the number of positive cases circulating in the population declined from 765,729 ± 142,080 to 2,303 ± 464 during the sampling period. Genomic analyses of SARS-CoV-2 of thirty wastewater samples collected between March 2021 and April 2021 revealed that alpha (B.1.1.7) and beta (B.1.351) were among the dominant variants of concern (VOC) in Qatar. The findings of this study imply that the normalization of data allows a more realistic assessment of incidence trends within the population.

Introduction and expansion of the SARS-CoV-2 B.1.1.7 variant and reinfections in Qatar: A nationally representative cohort study.

BACKGROUND: The epidemiology of the SARS-CoV-2 B.1.1.7 (or Alpha) variant is insufficiently understood. This study's objective was to describe the introduction and expansion of this variant in Qatar and to estimate the efficacy of natural infection against reinfection with this variant. METHODS AND FINDINGS: Reinfections with the B.1.1.7 variant and variants of unknown status were investigated in a national cohort of 158,608 individuals with prior PCR-confirmed infections and a national cohort of 42,848 antibody-positive individuals. Infections with B.1.1.7 and variants of unknown status were also investigated in a national comparator cohort of 132,701 antibody-negative individuals. B.1.1.7 was first identified in Qatar on 25 December 2020. Sudden, large B.1.1.7 epidemic expansion was observed starting on 18 January 2021, triggering the onset of epidemic's second wave, 7 months after the first wave. B.1.1.7 was about 60% more infectious than the original (wild-type) circulating variants. Among persons with a prior PCR-confirmed infection, the efficacy of natural infection against reinfection was estimated to be 97.5% (95% CI: 95.7% to 98.6%) for B.1.1.7 and 92.2% (95% CI: 90.6% to 93.5%) for variants of unknown status. Among antibody-positive persons, the efficacy of natural infection against reinfection was estimated to be 97.0% (95% CI: 92.5% to 98.7%) for B.1.1.7 and 94.2% (95% CI: 91.8% to 96.0%) for variants of unknown status. A main limitation of this study is assessment of reinfections based on documented PCR-confirmed reinfections, but other reinfections could have occurred and gone undocumented. CONCLUSIONS: In this study, we observed that introduction of B.1.1.7 into a naïve population can create a major epidemic wave, but natural immunity in those previously infected was strongly associated with limited incidence of reinfection by B.1.1.7 or other variants.

One Year of SARS-CoV-2: Genomic Characterization of COVID-19 Outbreak in Qatar.

Qatar, a country with a strong health system and a diverse population consisting mainly of expatriate residents, has experienced two large waves of COVID-19 outbreak. In this study, we report on 2634 SARS-CoV-2 whole-genome sequences from infected patients in Qatar between March-2020 and March-2021, representing 1.5% of all positive cases in this period. Despite the restrictions on international travel, the viruses sampled from the populace of Qatar mirrored nearly the entire global population's genomic diversity with nine predominant viral lineages that were sustained by local transmission chains and the emergence of mutations that are likely to have originated in Qatar. We reported an increased number of mutations and deletions in B.1.1.7 and B.1.351 lineages in a short period. These findings raise the imperative need to continue the ongoing genomic surveillance that has been an integral part of the national response to monitor the SARS-CoV-2 profile and re-emergence in Qatar.

Assessment of the Risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Reinfection in an Intense Reexposure Setting.

BACKGROUND: Risk of reinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unknown. We assessed the risk and incidence rate of documented SARS-CoV-2 reinfection in a cohort of laboratory-confirmed cases in Qatar. METHODS: All SARS-CoV-2 laboratory-confirmed cases with at least 1 polymerase chain reaction-positive swab that was ≥45 days after a first positive swab were individually investigated for evidence of reinfection. Viral genome sequencing of the paired first positive and reinfection viral specimens was conducted to confirm reinfection. RESULTS: Out of 133 266 laboratory-confirmed SARS-CoV-2 cases, 243 persons (0.18%) had at least 1 subsequent positive swab ≥45 days after the first positive swab. Of these, 54 cases (22.2%) had strong or good evidence for reinfection. Median time between the first swab and reinfection swab was 64.5 days (range, 45-129). Twenty-three of the 54 cases (42.6%) were diagnosed at a health facility, suggesting presence of symptoms, while 31 (57.4%) were identified incidentally through random testing campaigns/surveys or contact tracing. Only 1 person was hospitalized at the time of reinfection but was discharged the next day. No deaths were recorded. Viral genome sequencing confirmed 4 reinfections of 12 cases with available genetic evidence. Reinfection risk was estimated at 0.02% (95% confidence interval [CI], .01%-.02%), and reinfection incidence rate was 0.36 (95% CI, .28-.47) per 10 000 person-weeks. CONCLUSIONS: SARS-CoV-2 reinfection can occur but is a rare phenomenon suggestive of protective immunity against reinfection that lasts for at least a few months post primary infection.

Difficulty Breathing or Just a Case of the Nerves? Incidental Finding of Primary Pleural Schwannoma in a COVID-19 Survivor.

Schwannoma is a rare tumor that arises from the Schwann cells, which are specialized, myelin-producing cells of the peripheral nerve sheaths. As anatomic logic would dictate, these masses commonly occur in the skull base, cerebellopontine angle, and posterior spinal roots. Of this already rare entity, rarer still are the pleural schwannomas, representing approximately 1-2% of thoracic tumors. These tumors commonly affect adults with a propensity for the third and sixth decades of life and a comparative male predilection. Schwannomas are benign, indolent, and follow an asymptomatic course. As such, they often come to light incidentally. Here we report a case of primary pleural schwannomas in a 68-year-old female, found incidentally on a CT scan of the chest. To the best of our knowledge and literature review, no other similar case has been reported in our country, Pakistan. Around three weeks before her presentation, she was diagnosed with COVID-19. Her infection had run a mild course with quick recovery without the need for any hospitalization. Therefore, the manifestation of shortness of breath after resolution of all other symptoms prompted a further workup. Radiographic chest x-ray revealed an incidental finding of a large right upper lobe lung mass, slightly impinging on the trachea. This was followed by a chest CT scan at our radiological imaging facility, which showed a large, well-encapsulated, right upper lobe lung mass in the paraspinal apical location. She then underwent an image-guided biopsy of the aforementioned mass, pathological analysis of which was suggestive of a benign peripheral nerve sheath tumor (PNST) arising from the pleura (pleural schwannoma). She underwent right posterolateral thoracotomy with uneventful complete surgical removal of the pleural-based lung mass. Postoperative investigations included a chest x-ray that showed interval complete resection of the mass. Currently, she is asymptomatic and her clinical condition has improved with the successful resumption of her daily routine. Physicians thus need to keep pleural schwannomas in mind as a probable diagnosis of intrathoracic tumors. Indolent and asymptomatic, they are very amenable to surgical resection with little to no chances of recurrence in the long term. However, these patients should be closely followed with repeat imaging studies when symptomatic.

Blood pressure control among hypertensive patients in sanglah general hospital during covid-19 pandemic

Background: The COVID-19 pandemic presents a challenge to control patients with chronic disease and conditions, because many people have postponed regular visit for chronic health condition such as hypertension. To make things worse, hypertension is the most important comorbidities and predictor of poor outcomes from COVID-19. Blood pressure control become more crucial to be top priority during this pandemic and beyond. Objective: The aim of this study is to determine the blood pressure control status among hypertensive patient in outpatient settings during the pandemic, as compared to before the pandemic of COVID-19. Methods: This retrospective, comparative cross-sectional study included 108 medical records of patients with hypertension diagnosis in outpatient cardiology clinic, at Sanglah General Hospital in January 2021. The data obtained were blood pressure during pandemic in January 2021, compared to blood pressure in the same patient before the pandemic (before March 2020). Result: The proportion of controlled hypertension before pandemic era was 49.1%, and has decreased during the pandemic to 39.8% (p value=0.123). Wilcoxon signed rank test showed that there was increased systolic blood pressure level between before pandemic compared to during pandemic of COVID-19 (p value=0.041). Conclusion: The optimal management of hypertension become a very important issue during pandemic of COVID-19, since patients with this pre-existing condition could experience severe complications when infected with SARS-CoV-2. The alternatives to hospital and community-based care, such as mobile phone consultation or telemedicine can be developed by the multidiscipline collaboration to increase control status of hypertension.

Characteristics and comorbidities of hypertensive patients in sanglah general hospital during covid-19 pandemic

Background: Recent evidences suggest that hypertension is the most common underlying comorbid among COVID-19 patients, which often occurs in adults who are at higher risk of being infected with the SARS-CoV-2 virus and experiencing severe symptoms. Hypertension is also commonly accompanied by many comorbidities that will further compromised the clinical presentation of COVID-19 patients. Determination and appropriate management of hypertension and its comorbidities would be an important aspect during the pandemic Objective: The aims of this study is to defi ne the characteristics and comorbidities among hypertensive patients in outpatient settings during pandemic era. Methods: This descriptive cross-sectional study included 108 medical records of patients with hypertension diagnosis in outpatient cardiology clinic, at Sanglah General Hospital in January 2021. Result: Among 108 subjects, there was male predominance (57.4%) with mean of age 54.07 years old. About 23.1% subjects were active smokers and 61.1% were overweight/obese. The most common comorbidities that was found on subjects was Coronary Artery Disease (50%), which was followed by heart failure (27.8%) and Diabetes Melitus (14.8%). Blood pressure was controlled only in 39.8% patients. The patients most commonly took combination therapy (74.1%), with calcium channel blocker (CCB) was the most used pharmacotheraphy (81.5%). Conclusion: Hypertension and its comorbidities were important predictors of poor outcome among COVID-19 patients. Therefore, optimal therapy and control for all risk factors during this pandemic are mandatory, regarding the benefi t for morbidity and mortality.