Beyond laughter and smiles: analytical paradigms in social media COVID-19 humour studies

Amid the deluge of serious social media posts regarding the COVID-19 pandemic, humorous posts brought users much-needed respite. This article reviews studies on social media-based COVID-19 humour in 42 research articles that were selected from four databases, viz. Science Direct, Scopus, Taylor & Francis, and Web of Science. After the classification and analysis of the articles on the basis of some key features, a detailed description and discussion of the findings have been carried out. The results concerning the characteristics and functions of COVID-19 humour reveal that most studies investigated image-text memes;the most important feature found was ‘humour', in addition to others like sarcasm, irony, satire, criticism, juxtaposition, and locality. Intertextuality played a significant role in the structure of humorous posts, especially those related to specific countries. Additionally, it shows that although research on COVID-19 humour on social media is still in an early phase, several findings appear stable across various studies included in this review. Moreover, most humour studied is not only about the virus or the disease itself, but also focuses on absurd situations individuals found themselves in due to the pandemic and the lockdown that followed. © 2023,European Journal of Humour Research. All Rights Reserved.

Tocilizumab in severe COVID-19 – A randomized, double-blind, placebo-controlled trial

Background: The therapeutic effectiveness of interleukin-6 receptor inhibitor in critically ill hospitalized patients with coronavirus disease 2019 (COVID-19) is uncertain. Methods: To evaluate the efficacy and safety of the outcome as recovery or death of tocilizumab for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, we conducted a randomized, double-blinded, placebo-controlled phase 2 trial in critically ill COVID-19 adult patients. The patients were randomly assigned in a 4:1 ratio to receive standard medical treatment plus the recommended dose of either tocilizumab or the placebo drug. Randomization was stratified. The primary outcome was the recovery or death after administration of tocilizumab or a placebo drug. The secondary outcomes were clinical recovery or worsening of the patients' symptoms and inflammatory markers and discharge from the hospital. Results: Of 190 patients included in this study, 152 received tocilizumab, and 38 received a placebo. The duration of hospital stay of the interventional group was 12.9 ± 9.2, while the placebo group had a more extended hospital stay (15.6 ± 8.8). The mortality ratio for the primary outcome, ie, mortality or recovery in the tocilizumab group was 17.8%;p = 0.58 by log-rank test). The mortality ratio in the placebo group was 76.3%;p = 0.32 by log-rank test). The inflammatory markers in the tocilizumab group significantly declined by day 16 compared to the placebo group. Conclusions: The use of tocilizumab was associated with decreased mortality, earlier improvement of inflammatory markers, and reduced hospital stay in patients with severe COVID-19. © 2022 The Author(s)

Medicinal plants as COVID-19 remedy

COVID-19 (coronavirus) is an infectious disease which disturbs the modern world socially and economically. SARS-CoV-2, a causative agent of COVID-19, is a global pandemic. It is a fast-spreading disease which is largest ever pandemic in human history. The origin of this disease is still not known, and vaccine or medicine for the cure of infection has not been discovered so far. But various medicinal plants are used in different countries as a therapeutic treatment for COVID infection to help the immune system fight against COVID-19 disease. Various plant products contain high amount of vitamin C, boost up human immune system, and help to cure the disease. The medicinal and herbal plants act as effective therapeutic agents against coronavirus infection. The SARS-CoV-2 infection can also be relieved by a combined therapy of medicinal plants based on their properties. As COVID-19 can cause multiple organ disease, the use of natural products and medicinal plants may inhibit the SARS-CoV-2 life cycle linked proteins, i.e., papain-like or chymotrypsin-like proteases. In this article, different medicinal plants and herbs and their bioactive components that help in enhancing our immune system and play a role in fighting microbial infections as well as COVID-19 infection are discussed. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021.

Drug Repurposing for CoVID-19 Spike Protein through Molecular Docking

Drug repurposing is the technique of finding new uses for currently used or under-researched drugs. Because this strategy requires less time and money, it is thought to be a particularly effective drug development strategy. Due to current technological breakthroughs, the accessibility of vast and reliable database resources, as well as data accessibility from genomes, proteomics, transcriptomics, etc., there are numerous opportunities to identify drugs by drug repurposing. The recent SARS-COV-2 epidemic, which has so far claimed 6,245,750 lives, has significantly increased the use of bioinformatics techniques in deciphering the characteristics of viral diseases. Using FDA-approved antiviral drugs that target the COVID-19 spike protein, we have used a bioinformatics approach to drug repurposing to find possible effective inhibitors against the Coronavirus (COVID-19). We used a variety of bioinformatics tools in this study, including AutoDock-Vina, PyMol, and Discovery Studio, to identify a promising drug called Cepharanthine (CEP), which demonstrates successful outcomes and efficacy compared to recently used antiviral drug candidates like arbidol, talampicillin, bromhexine, chloroquine, lycorine, bruceine A, reserpine, indinavir, galidesiver, doxycycline, methisazone, flupentixol, trifluoperazine and fluoxetine. The potential therapeutic value of cepharanthine as a drug for treating COVID-19 has been investigated in this study. It is expected that the proposed study will help medical professionals and researchers cure disorders linked to Severe acute respiratory and variations of it. © 2022 IEEE.

An assessment of pregnant women's COVID-19 knowledge, practice, and obstacles to adopting preventative Interventions

S Introduction: Covid 19 has given birth to toils and troubles all around the globe. It has raised havocs in Pakistan as well. All the strata of the society have bear the brunt brought by pandemic. Pregnant females in Pakistan are already suffering various health issues where invasion of Covid 19 has added insult to the injury. Objective(s): This study is aimed at investing the level of knowledge among pregnant females in Pakistan about the signs and symptoms, transmission and prevention measures needed to decrease dissemination of the disease. This study also tries to elaborate the existing level of compliance in pregnant females to preventive interventions as well as major obstacles that are disturbing their compliance. Methodology: This is a cross sectional study in which 729 females visiting tehsil headquarters hospitals of Pakistan were taken as a sample. A research questionnaire was designed investigation 4 variables including demography of the sample, disease knowledge, preventive practices and obstacles in following preventive practices. Result(s): this study has revealed that 63% of the pregnant females in Pakistan have an adequate knowledge about Covid 19 disease while there is variability in frequency of compliance to Covid 19 preventive measures. This study has also revealed that cultural hesitancy has emerged as a main obstacle in promoting compliance to safety measures along with positive correlation between disease knowledge and compliance to safety measures. Copyright © 2022, Anka Publishers. All rights reserved.

Non-Compliance with Universal Masking Policy by Patients during Covid-19 Pandemic: A Major Threat to Health Care Worker in Pakistan

Objective: To determine the frequency of patient compliance with universal face mask policy during COVID-19 pandemic using simple observable criteria. Study Design: Cross sectional study Place and Duration of Study: Pakistan Railway Hospital, Rawalpindi during the third wave of COVID-19 pandemic over a period of one month from 15 March 2021 to 15 April 2021. Materials and Methods: A total of 266 patients were recruited from the general population of patients visiting our hospital after undergoing screening for COVID-19 at the filter clinic. Face mask compliance was defined as the wearing of a disposable surgical mask while employing correct techniques as per the World Health Organization and National Institute of Health guidelines for hospital settings. Results: Majority of the patients (79.9%) wore a surgical face mask as recommended for hospital settings. However, only 41% employed the correct mask wearing technique. Patients under strict supervision in outdoor clinics were more likely to wear mask as compared to their indoor counterparts (76.79% vs 51.76%). Correlation was significant at a level of 0.492. One third (34.2%) of the patients did not cover their face, nose, and chin completely. An overwhelming majority (129/183 or 70.49%) admitted reusing the mask multiple times. Conclusion: The study findings indicate that while majority of the general population of patients visiting our hospital wore a face mask, compliance with correct mask wearing technique as per recommended guidelines was poor. Our results support strict implementation of universal masking policies for hospitals in Pakistan as part of a multifaceted strategy to minimize transmission of infection in health care settings. © 2022 Journal of Islamic International Medical College. All rights reserved.

Prediction of Complications and Death in Covid-19 Patients with Deranged Liver Function Tests at Time of Admission and Hospitalization

COVID-19 pandemic has affected millions of individuals globally over the last three years and is spreading continuously. In view of different studies and clinical findings, patients suffering with COVID-19 frequently have deranged liver function tests (LFTs), but the clinical significance of this finding is debatable. Objective(s): The present study was aimed to estimate the prevalence, features, and clinical significance of deranged LFTs in COVID-19 infected individuals, who were hospitalized but were not critically ill. Method(s): We conducted a cross sectional from May 2021 to December 2021 at The Akbar Niazi Teaching Hospital Islamabd. A total of 250 COVID-19 patients were included in the current study. The patient's blood samples were collected to get laboratory results, which included LFTs. LFTs were performed at the time of admission and every 5 +/- 2 day throughout the stay. The outcome measure was either death or transfer of the patients to an intensive care unit. Result(s): At the time of admission, 160 patients (64%) showed deranged LFTs. Individuals with deranged LFTs experienced more severe inflammation, swelling, and organ damage than those who didn't. Patients with deranged LFTs had a greater proportion of transfer to the ICU (81 vs 17), hospital stay (17 vs 7 days), and death (17 vs 5) than those with normal LFTs. Conclusion(s): The results of the current investigation demonstrated that LFTs data might forecast the degree of illness in patients with COVID-19 infections at the time of admission and during their hospital stay. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

Delivery of Neurocritical Care Servicesto Critically Ill Patients with Altered Mental Status Before and During the COVID-19 Pandemic: A Single Center Study

Objective: Compare neurocritical care delivery and outcomes in patients with altered mental status before and during the COVID-19 pandemic. Background: Reduced utilization of inpatient radiology and routine diagnostic procedures has been reported during the COVID-19 pandemic. We hypothesized there was a reduction in the use of neurologic diagnostic procedures for patients with altered mental status. Design/Methods: Single-center retrospective study of critically-ill patients (age ≥18 years) at a large academic center in the United States. ICD-10 codes for altered mental status were used to identify eligible patients: 339 in pre COVID-19 period (June-December 2019);145 in the first wave (April-July 2020);279 in the second wave (April-July 2020). CPT codes were used to quantify neurocritical care procedures: head CTs, brain MRIs, lumbar punctures, and long-term monitoring EEGs. Results: There were no significant differences in gender, race, Comorbidity Index, or length of stay comparing the pre-COVID-19 period to each COVID-19 wave. Patients in the pre-COVID period were older (median age 64 years vs 60 years in each COVID phase;p=0.0001). There was no significant change in the frequency of head CT or MRIs, and long-term EEGs performed in patients with altered mental status across the three periods. The frequency of LPs decreased;8% in the pre-COVID period vs 6% and 4% (p=0.025) in the respective COVID periods. There was no significant difference in in-hospital mortality for patients with altered mental status across the three periods (OR 0.95 [0.78-1.08] p=0.31).Conclusions: In a large academic center the frequency of neurocritical care radiologic procedures and continuous EEG were not significantly impacted by the pandemic. Additional analysis is indicated to determine if the reduction in diagnostic LPs can be explained by differences in etiology of altered mental status across the three periods. Larger studies can determine whether the pandemic has differentially impacted neurocritical care delivery across varying resource settings.

A Cross-Sectional Online Study in Context of Knowledge, Attitude and Practices of the General Public of Karachi, Pakistan on COVID-19 Pandemic

The COVID-19 pandemic has badly affected the human health and exerted a negative impact on national and global economies. The understanding, observations and responses of the general public during COVID pandemic may help in discussion about healthiness risk and encourage acquiescence with standard guiding principles. Therefore, the study was aimed to measure the Knowledge, Attitude and Practice (KAP) of an individual regarding the COVID-19. However, the present learning was in the setting of a web based cross sectional study conducted to evaluate the KAP among the general public via the dissemination of online Performa. In this context, a questionnaire was designed that was comprised into various scoring divisions to calculate the KAP. The KAP response was achieved from 842 persons and of this strength, 344 were male and 498 responses were attained from females. The Percentages and the frequencies were reported and calculated for each of the response and the chi-square test was applied to find the association (considering pvalue >0.05 as significant). The questionnaire was executed to the age of 22 years and above. On the basis of revealed knowledge (K1-7), the result of K3 and K7 were found highly significant (p-0.001), whilst the K4 response was significant (P≥0.05). The rest Ks were reported non-significant. Likewise, attitude (A1-5) was reported with high percentage in females and overall it was revealed highly significant (p- 0.002) in A5 response. In general, attitudes among genders were found comparatively encouraging and meaningful. Moreover, practices (P1-4) regarding COVID-19 showed week response to the sub divisions of P1-4 but, P2 and P3 were showed highly significant i.e. p-0.00 in both cases. Hence, majority of the general public presented good response against KAP regarding the COVID-19 pandemic. Additionally, incorporation of good practices and knowledge in life can enhance and maintain the population health. In this respect, the policymakers of government organizations have performed well in pointing the grass root populations having no education and un-aware workers via health promotional activities. © 2022

Efficient Automated Disease Diagnosis Using Machine Learning Models

A.I. (ML) is a part of computerized reasoning and software engineering that spotlights the utilization of information and calculations to duplicate the way that people learn, bit by bit working on its precision. A.I. is a significant part of the creating field of data science. Utilizing simple strategies, computations are ready to make plans or figures, revealing critical encounters inside data mining projects. These pieces of information drive dynamic inside applications and organizations, ideally influencing critical advancement estimations. As enormous information continues to expand and create the market revenue for data analysts will augment, anticipating that they should help the I.D. of the most applied-link business questions and subsequently the data to react to them. By utilizing a machine learning (ML) calculation, the proposed work will recognize COVID-19 and disease patients in danger of creating cardiovascular breakdown. Proof has shown that COVID-19 and Cancer can contrarily affect the heart framework, leaving patients in peril for chances like cardiovascular assault, upheld surprising heartbeats, coronary disappointments, and death [2]. As a result of the expanded danger for these inconveniences, there is a critical need to distinguish COVID-19 patients at danger for heart problems, yet these prescient capacities don’t presently exist. The proposed work will give early signs and guarantee that assets are given to the patients at early need. Right away, we wanted to gather information from COVID-19 and disease patients. Likewise, we wanted cardiovascular explicit research facility tests, constantly acquired crucial signs, and imaging information like C.T. filters, Pet Scan, ECG (echocardiography). © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Zanubrutinib in patients with B-cell malignancies intolerant to ibrutinib and/or acalabrutinib

Introduction: Bruton tyrosine kinase inhibitor (BTKi) therapy is remarkably effective in a number of B-cell malignancies;however, its continuous use is limited by adverse events (AE) leading to discontinuation. Zanubrutinib is a potent and selective BTKi with the potential to be a safe and effective therapy after intolerance to previous BTKi therapy. Here, we report preliminary results of a phase 2 study of zanubrutinib in patients with B-cell malignancies intolerant to ibrutinib and/or acalabrutinib based on a median follow-up of 6 months. Methods: Patients meeting protocol criteria for intolerance to ibrutinib, acalabrutinib, or both (without documented progressive disease on ibrutinib or acalabrutinib) were given zanubrutinib monotherapy (160mg twice daily or 320mg once daily at investigator's discretion). Recurrence of adverse events that led to intolerance to prior BTKi and additional safety measures were assessed based on the Common Terminology Criteria for AEs v5.0. Investigators determined responses using disease status at study entry as baseline and standard established disease response criteria. Results: As of 1 March 2021 (cutoff), 64 patients (n=48 chronic lymphocytic leukemia/small lymphocytic lymphoma, n=10 Waldenström macroglobulinemia, n=3 mantle cell lymphoma, n=3 marginal zone lymphoma) were enrolled, received ≥1 dose of zanubrutinib, and were analyzed for safety. The median age was 71 y (range, 49-91);the median duration of treatment was 5.9 months (range, 0.6-16.6). The median number of prior regimens was 2 (range, 1-12). Regarding prior BTKi, 55 patients had received ibrutinib monotherapy, eight had received ibrutinib combination therapy, and seven had received acalabrutinib monotherapy. The median number of ibrutinib- or acalabrutinib-intolerant adverse events per patient was 2 (range, 1-5). Most ibrutinib- (75%) and acalabrutinib-intolerant events (75%) did not recur with zanubrutinib (Table 1). A majority (90%) of the recurrent ibrutinib-intolerant events were less severe with zanubrutinib than with ibrutinib. Ibrutinib intolerance events present in >1 patient that did not recur on zanubrutinib were alanine aminotransferase increased, aspartate transaminase increased, neutropenia, and pain in extremity. The ibrutinib-intolerant events that recurred were diarrhea, dizziness, insomnia, nausea, constipation, myalgia, stomatitis, arthralgia, headache, muscle spasm, rash, atrial fibrillation, fatigue, hemorrhage, and hypertension. One-third of the recurrent acalabrutinibintolerant events were less severe with zanubrutinib than with acalabrutinib. The acalabrutinib-intolerant events that recurred were myalgia and arthralgia. Two events of arthralgia that induced acalabrutinib intolerance did not recur with zanubrutinib. No ibrutinib- or acalabrutinib-intolerant events recurred at a higher severity while patients were on zanubrutinib. At cutoff, 57 patients remained on treatment;one withdrew consent due to zanubrutinib-unrelated grade 3 syncope. Grade ≥3 adverse events were reported in 14 patients (21.9%), serious adverse events in five patients (7.8%;pain in jaw;COVID-19 pneumonia;anemia;febrile neutropenia and salmonella infection [occurred in the same patient]), adverse events requiring dose interruptions in 15 patients (23.4%), and adverse events leading to dose reduction in three patients (4.7%). Adverse events led to zanubrutinib discontinuation for three patients (4.7%). One death was reported (COVID-19 pneumonia). Among efficacy evaluable patients (n=48), the disease control rate was 89.6% and the overall response rate was 50.0%. Conclusions: In patients with B-cell malignancies intolerant to ibrutinib and/or acalabrutinib, zanubrutinib therapy was effective and controlled patient's disease or induced responses to therapy, and was well-tolerated;most adverse events that led to discontinuation of previous BTKi therapy did not recur while patients were on zanubrutinib.

Assessment of the Level of Stress among Dental Students During Covid-19 in Teaching Hospital of Sialkot, Pakistan

Objective: The check the level of stress due to COVID-19 in dental students. Study Design: Descriptive cross-sectional study Place and Duration of Study: This study was conducted at the Department of Oral Biology, Islam Dental College, Sialkot for a period of 06 months from June to November 2020. Materials and Methods: The sample size has calculated with the help of Rao software. The total number of samples were 319 and recruited based on purposive sampling method. The data had analyzed descriptively. Results: Out of 319 students, 123 were male and 196 of female. The average age of the students are 21.7 years. Maximum number of responders were having severe stress i.e. 186. Four different doubts were asked from the students. Out of 319 responders, 281 were replied no in response of "will you feel comfortable after COVID-19 pandemic" and 38 said yes. Five different questions were asked from the students i.e. Handwashing, using sanitizers, surgical masks, avoid social gathering and hand shaking. 271 replied yes in response of "Handwashing" and 48 said no. While the level of stress was also measured among the responses. 162 students who had severe stress were categorized in yes response, 62 students who had moderate level of stress were categorized in yes response and 47 students who had mild level of stress were categorized in yes response. Conclusion: The present study explored the levels of stress among the dental students. The finding of the study indicated that the student in a teaching hospital needs the appropriate counselling and professional knowledge regarding the pandemic to deal with the current scenario of COVID-19. © 2021 Medical Forum Monthly. All rights reserved.

Radiological Assistance In Managing Workflow In Medical And Surgical Indications At Shifa International Hospital In COVID-19 Pandemic

BACKGROUND: Novel Corona Virus took the world by storm under the name of COVID-19, metamorphosing the whole health care structure and alienating what we the medical community considered normalcy. The sudden unexpected need for social distancing resulted in dire dependency on imaging for expert diagnosis and management. The purpose of the present study is to describe in-depth strategies that were taken by radiology department at our hospital as a part of a coordinated hospital system-wide response in managing workflow of patients presenting to our hospital for various medical and surgical semi-urgent/urgent indications requiring hospital admission. This article may assist and provide guidance for preparation and management for other radiology departments in the early stages or in dire need of providing services in a secure environment, especially in low-income countries such as ours, while maintaining the quality of radiological reports, dealing with increased workloads. It was a descriptive qualitative study, conducted at Shifa international hospital, Radiology Department, from 28 March to 5 June 2020. METHODS: After approval from IRB, a descriptive qualitative study was carried out, which included all patients regardless of age or gender who underwent radiological imaging including CT and radiograph chest, at our department from 28 March to 5 June, 2020. RESULTS: Overall, on a yearly basis, the number of CT scans decreased 30% (total), 53.4% (OPD), and 0.61% (IPD), respectively, in 2020 when compared with figures in 2019. However, no. of HRCTs performed were significantly increased compared to 2019, in same months 568 (0.09%), compared to 2020 where a majority of total CTs performed were HRCTs for COVID alone. CONCLUSION: The radiology department plays a central role in streamlining the patient inflow admitted for surgical or medical indications and thus needs to be prepared for patient surges and increased volumes, with large influxes of patients to the emergency department that will require diagnostic imaging and interventional services.

Global Oil Prices and Exchange Rate: Evidence from the Monetary Model

The study empirically examines the impact of monetary fundamentals along with global oil prices on the Pak-rupee exchange rate using the monthly data over 2001-2020. Employing the cointegrating vector autoregressive with exogenous variables (VARX) and vector error correction model with exogenous variables (VECMX), the study analyzes the impact of domestic monetary fundamentals while considering the foreign variables as weakly exogenous. In order to account for the structural breaks in the data, the Lagrange multiplier (LM) unit root test with two structural breaks has been used (Lee & Strazicich, 2003). The empirical results reveal that the domestic and foreign monetary variables significantly explain the exchange rate movements in Pakistan both in the long run and in the short run. The dynamic properties of the monetary model of exchange rate have been analyzed using the persistence profile analysis and generalized impulse response functions (GIRFs). The results reveal that the responses of shocks to domestic monetary fundamentals are consistent with the predictions of the monetary model of the exchange rate. Furthermore, being a net oil importer, a rise in global oil prices significantly depreciated the Pak-rupee exchange rate over the period of study. The global financial crisis (GFC) and pandemic (COVID-19) were also found to cause the Pak-rupee exchange rate depreciation.

Phase 2 Study of Zanubrutinib in BTK Inhibitor-Intolerant Patients (Pts) with Relapsed/Refractory B-Cell Malignancies

Background: Bruton tyrosine kinase inhibitors (BTKis) are important tools to treat B-cell malignancies. However, duration of treatment may be limited by adverse events (AEs). Zanubrutinib (zanu) is a BTKi approved for mantle cell lymphoma (MCL) and is in development for other hematologic malignancies. Data from phase 3 head-to-head trials of zanu vs ibrutinib (ibr) in pts with Waldenström macroglobulinemia (WM) or chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) demonstrated that pts treated with zanu showed lower rates of AEs leading to discontinuation (Blood 2020;136(18):2038-50;EHA 2021 LB1900). Preliminary results from BGB-3111-215 (NCT04116437) show that zanu was well-tolerated in pts who discontinued ibr and/or acalabrutinib (acala) treatment due to AEs (EHA 2021 EP642). Here, we report updated results from the BGB-3111-215 study with a median follow-up of 9 months. Methods: This study is an ongoing US, phase 2, multicenter, single-arm, open-label study. The safety and efficacy of zanu monotherapy (160 mg twice daily or 320 mg once daily) were evaluated in pts with B-cell malignancies who met criteria for continued treatment after having become intolerant to prior BTKi therapy. Pts were divided into cohort 1 (pts who were intolerant to ibr only) and cohort 2 (pts who were intolerant to acala alone/and ibr). Pts with documented progressive disease (PD) on prior BTKi therapy were excluded. Efficacy and safety, including recurrence of intolerant AEs to the prior BTKi, were evaluated. AEs were assessed for severity, seriousness, and relation to zanu;as well as dose reductions, holds, or discontinuations. Response was assessed by investigators based on response criteria for their respective indications (Blood 2008;131:2745;J Clin Oncol 2012;30:2820;J Clin Oncol 2014;32:3059;Br J Haemtol 2013;160:171). Disease parameters from study entry were the baseline for response assessment. Mutational analysis was performed on pts who discontinued treatment, and data will be shared once available. To support clinical findings, kinase selectivity was assessed using Kinome profiling at 100X IC50 (against BTK) for zanu, ibr, acala and its major metabolite, M27 (Reaction Biology Corp). Results: As of 7 June 2021 (data cutoff), 57 pts (n=44 CLL/SLL;n=9 WM;n=2 MCL;n=2 marginal zone lymphoma [MZL]) were enrolled in cohort 1, and 7 pts were enrolled in cohort 2 (n=4 CLL;n=1 WM;n=1 MCL;n=1 MZL). All received ≥1 dose of zanu and were analyzed for safety. The median age was 71 years (range, 49-91) in cohort 1 and 71 years (range, 65-76) in cohort 2;median duration of treatment was 8.7 months (range, 0.6-17.9) in cohort 1 and 8.2 months (range, 6.4-11.4) in cohort 2;median number of prior regimens was 1 (range, 1-12) in cohort 1 and 3 (range, 2-5) in cohort 2. Within cohort 2, 5 pts were intolerant to both ibr and acala. Median number of intolerant events per pt for both cohorts 1 and 2 was 2 (range, 1-5). Overall, 73% of pts did not experience recurrence of their ibr or acala intolerant events and 79% of recurrent events recurred at a lower severity (Figure 1). At cutoff, 54 pts remained on treatment. Reasons for treatment discontinuation were AEs (n=4), PD (n=4), physician's decision (n=1), and consent withdrawal (n=1). Grade ≥3 AEs were reported in 18 pts (28%), and serious AEs occurred in 7 pts (11%). AEs requiring dose interruptions occurred in 17 pts (27%), and AEs leading to dose reduction occurred in 3 pts (5%). One death, due to COVID-19, was reported. Pts demonstrated maintained (41%) and improved (53%) response with zanu treatment from their reported best overall response on prior BTKis for a total disease control rate of 94% (including a 42% partial response rate in pts with CLL/SLL, 30% in pts with WM, and a 20% very good partial response rate in pts with WM). Zanu also demonstrated good selectivity by kinase profiling. It showed >50% inhibition on 7/370 kinases, while ibr, acala, and M27 had more off-target binding (17, 15 and 23 kinases, respectively) at their respective 100X IC50 (BTK) c ncentrations (Figure 2). Conclusion: In pts with B-cell malignancies intolerant to ibr and/or acala, zanu treatment resulted in continued disease control or improved response. Zanu was well-tolerated, and most AEs that led to discontinuation of previous BTKi therapy did not recur or recurred at a lower grade. In support of clinical findings, differentiation between BTKi selectivity profiles favor zanu over ibr and acala. [Formula presented] Disclosures: Shadman: Abbvie, Genentech, AstraZeneca, Sound Biologics, Pharmacyclics, Beigene, Bristol Myers Squibb, Morphosys, TG Therapeutics, Innate Pharma, Kite Pharma, Adaptive Biotechnologies, Epizyme, Eli Lilly, and Atara Biotherapeutics, Adaptimmune: Consultancy;Mustang Bio, Celgene, Bristol Myers Squibb, Pharmacyclics, Gilead, Genentech, Abbvie, TG Therapeutics, Beigene, AstraZeneca, Sunesis, Atara Biotherapeutics, GenMab: Research Funding;Abbvie, Genentech, AstraZeneca, Sound Biologics, Pharmacyclics, Beigene, Bristol Myers Squibb, Morphosys, TG Therapeutics, Innate Pharma, Kite Pharma, Adaptive Biotechnologies, Epizyme, Eli Lilly, and Atara Biotherapeutics, Adaptimmune: Membership on an entity's Board of Directors or advisory committees. Flinn: Nurix Therapeutics: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute;Seagen: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding;MorphoSys: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding;Forty Seven: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding;Calithera Biosciences: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding;Verastem: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding;Curis: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding;Takeda: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding;Yingli Pharmaceuticals: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute;IGM Biosciences: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding;AbbVie: Consultancy, Other: All Consultancy and Research Funding payments made to Sarah Cannon Research Institute, Research Funding;Portola Pharmaceuticals: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding;Trillium Therapeutics: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding;Rhizen Pharmaceuticals: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding;Incyte: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding;Acerta Pharma: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding;Agios: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding;Kite, a Gilead Company: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding;Gilead Sciences: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding;Pharmacyclics LLC, an AbbVie Company: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding;Karyopharm Therapeutics: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding;Forma Therapeutics: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding;Genentech: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding;ArQule: Other: All research funding payments mad to Sarah Cannon Research Institute, Research Funding;Triphase Research & Development Corp.: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding;Roche: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding;Pfizer: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding;Teva: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding;Infinity Pharmaceuticals: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding;Unum Therapeutics: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding;Celgene: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding;Constellation Pharmaceuticals: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding;Juno Therapeutics: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding;AstraZeneca: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding;Iksuda Therapeutics: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute;Loxo: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding;Merck: Other: All research funding payments made to Sarah Cannon Research Institute, Research Funding;Novartis: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding;Great Point Partners: Consultancy, Other: All consultancy payments made toSarah Cannon Research Institute;BeiGene: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding;Janssen: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding;TG Therapeutics: Consultancy, Other: All consultancy and research funding payments made to Sarah Cannon Research Institute, Research Funding;Century Therapeutics: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute;Hutchison MediPharma: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute;Vincerx Pharma: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute;Sarah Cannon Research Institute: Current Employment;Servier Pharmaceuticals: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute;Yingli Pharmaceuticals: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute;Seagen: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute;Servier Pharmaceuticals: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute;Unum Therapeutics: Consultancy, Other: All consultancy payments made to Sarah Cannon Research Institute, Research Funding;Johnson & Johnson: Current holder of individual stocks in a privately-held company;Seattle Genetics: Research Funding. Levy: Epizyme: Consultancy, Other: Promotional speaker;Amgen Inc.: Consultancy, Honoraria, Other: Promotional speaker, Speakers Bureau;Gilead Sciences, Inc.: Consultancy, Honoraria, Speakers Bureau;GSK: Consultancy, Other: Promotional speaker;Morphosys: Consultancy, Honoraria, Other: Promotional speaker, Speakers Bureau;AbbVie: Consultancy, Honoraria, Other: Promotional speaker, Speakers Bureau;Beigene: Consultancy, Honoraria, Speakers Bureau;Karyopharm: Consultancy, Honoraria, Other: Promotional speaker, Speakers Bureau;AstraZeneca: Consultancy, Honoraria, Speakers Bureau;Takeda: Consultancy, Honoraria, Other: Promotional speaker, Speakers Bureau;Novartis: Consultancy, Other: Promotional speaker;Dova: Consultancy, Other: Promotional speaker;TG Therapeutics: Co sultancy, Honoraria, Speakers Bureau;Bristol Myers Squibb: Consultancy, Honoraria, Other: Promotional speaker, Speakers Bureau;Seattle Genetics: Consultancy, Honoraria, Other: Promotional speaker, Speakers Bureau;Jazz Pharmaceuticals: Consultancy, Honoraria, Speakers Bureau;Janssen Pharmaceuticals: Consultancy, Honoraria, Other: Promotional speaker, Speakers Bureau. Burke: SeaGen: Consultancy, Speakers Bureau;Beigene: Consultancy, Speakers Bureau;MorphoSys: Consultancy;Bristol Myers Squibb: Consultancy;AstraZeneca: Consultancy;Epizyme: Consultancy;Verastem: Consultancy;Kura: Consultancy;Kymera: Consultancy;AbbVie: Consultancy;Adaptive Biotechnologies: Consultancy;Roche/Genentech: Consultancy;X4 Pharmaceuticals: Consultancy. Cultrera: Beigene: Research Funding. Yimer: Astrazeneca: Speakers Bureau;Karyopharm: Current equity holder in publicly-traded company, Speakers Bureau;Janssen: Speakers Bureau;Beigene: Speakers Bureau;GSK: Speakers Bureau;Sanofi: Speakers Bureau;Amgen: Speakers Bureau;Pharmacyclics: Speakers Bureau;Texas Oncology: Current Employment. Chaudhry: Medical Oncology Associates, PS (dba Summit Cancer Centers): Current Employment;Novartis, Immunomedics: Current holder of individual stocks in a privately-held company. Gandhi: TG Therapeutics: Honoraria;Karyopharm Therapeutics: Honoraria;GlaxoSmithKline: Honoraria. Kingsley: Comprehensive Cancer Centers of Nevada: Current Employment. Tumula: Texas Oncology: Current Employment. Manda: Morphosys: Honoraria;Genmab: Current equity holder in publicly-traded company. Chen: BeiGene: Current Employment, Divested equity in a private or publicly-traded company in the past 24 months. Cohen: BeiGene: Current Employment, Current equity holder in publicly-traded company, Other: Travel, Accommodations, Expenses. By: BeiGene, Ltd: Current Employment. Xu: Beigene: Current Employment;AstraZeneca: Ended employment in the past 24 months. Liu: BeiGene Co., Ltd: Current Employment, Current equity holder in publicly-traded company. Sharman: TG Therapeutics: Consultancy;Centessa: Current holder of stock options in a privately-held company, Membership on an entity's Board of Directors or advisory committees;Pharmacyclics LLC, an AbbVie Company: Consultancy;BMS: Consultancy;AbbVie: Consultancy;BeiGene: Consultancy;AstraZeneca: Consultancy;Lilly: Consultancy.

Prevalence of smoking among surgical patients and their knowledge about abstinence from smoking before surgery in tertiary care hospitals in the largest city of Pakistan: A cross sectional study

Smoking is a known risk factor for a wide range of potential perioperative complications. Mehar R. et al. 2002 estimated a prevalence of smoking in general population of Karachi, it was reported 32.7%. The prevalence of smoking among surgical patient was around 20% in a systematic review by Wong J. et al. 2012. The aims of our study were to estimate the prevalence of smoking among surgical patients in the tertiary care hospitals of Karachi and to evaluate the knowledge of the patient about the need of smoking abstinence. The data was collected from the anaesthesia and surgery clinics of two public sector (i.e. Abbasi Shaheed hospital &Civil Hospital) and one private tertiary care hospital (i.e. Aga khan University hospital) of Karachi, Pakistan. A total of 811 patients were enrolled from July 30th 2019 to March 17th 2020. With the emergence of COVID pandemic in March 2020, elective surgical lists were halted in the selected hospitals so, we stopped our recruitment and concluded the study. Overall prevalence of smoking among surgical patients in all three hospitals during the above mentioned period came out to be 20.2%, with highest proportion in Civil hospital Karachi (i.e. 27.6%) and lowest in Abbasi Shaheed Hospital Karachi (i.e. 17%). The prevalence of smoking in Aga Khan University Hospital Karachi was came out to be 19.3%. Educational status was also cross tabulated with smoking status which came out that 23.0% of illiterate patients, 19.7% undergraduates, 20.6% graduates and 14.7% with postgraduate education were smokers. In conclusion, burden of smoking in surgical patients in Karachi was quiet significant and the knowledge about the preoperative smoking abstinence and potential perioperative complication were relatively more among the educated patients. Role of Anaesthesiologist and surgeon in educating patients was quiet insignificant (11% Vs 9% respectively).

Physical activity and emotional status of college students and working sector on 1 month lockdown

Introduction: Due to COVID-19 pandemic outbreak, a lot of countries are under lockdown for more than 30 days. The study is about the physical activity and emotional status of college students and the working sector for 1 month lockdown. Aim: To check the physical and emotional status of college students and in the working sector, while the response is either positive or negative towards the health concern. Method: A web survey was used which is based on IPAQ and PERS scales by 150 candidates. Result: IPAQ show the physical activity perform by the 150 candidates where the maximum candidate was of low activity and PERS shows the positive and negative reactivity of the candidates where the negative reactivity was high than positive reactivity. Conclusion: The low physical activity stimulates the negative reactivity.

DDoS attacks impact on data transfer in IOT-MANET-based e-healthcare for tackling COVID-19

The Covid-19, a pandemic situation, effects the economy of the whole world severely and is gaining much huge attention in the field of research currently across the globe. The Internet of things (IoT) technology is playing a great role for taking care of the patients by monitoring and controlling the symptoms and is very much essential for the developing countries, where monitoring of health of huge population has its own challenges. So the IoT and its amalgamation with mobile ad hoc network (MANET) acts as base of networks where devices send information among each other wirelessly thus also named as wireless mesh networks (WMN), in which various nodes are either stationary or allied with static position. Sensors and different other devices involved in e-healthcare sector used in WMN converse wirelessly and hence become the main gate to a numerous susceptibilities. The main aim of this research study is to evaluate the performance of reactive, secured and hybrid routing protocols for throughput as one of the important quality of service (QoS) parameters in absence as well as in presence of distributed denial of service (DDoS). The NS-2(network simulator) is used to simulate AODV (ad hoc on-demand vector, SAODV (secured AODV) and hybrid wireless mesh protocol) in scenario of changing nodes. The comparative analysis concludes the HWMP as most suitable protocol among the other two routing protocols with impact on throughput for handling DDoS attacks. This research study aids in providing implications to enhance existing protocols and alleviate the consequence of DDoS instigated by such attacks. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2021.