A Robust Automated Framework for Classification of CT Covid-19 Images Using MSI-ResNet

Nowadays, the COVID-19 virus disease is spreading rampantly. There are some testing tools and kits available for diagnosing the virus, but it is in a limited count. To diagnose the presence of disease from radiological images, automated COVID-19 diagnosis techniques are needed. The enhancement of AI (Artificial Intelligence) has been focused in previous research, which uses X-ray images for detecting COVID-19. The most common symptoms of COVID-19 are fever, dry cough and sore throat. These symptoms may lead to an increase in the rigorous type of pneumonia with a severe barrier. Since medical imaging is not suggested recently in Canada for critical COVID-19 diagnosis, computer-aided systems are implemented for the early identification of COVID-19, which aids in noticing the disease progression and thus decreases the death rate. Here, a deep learning-based automated method for the extraction of features and classification is enhanced for the detection of COVID-19 from the images of computer tomography (CT). The suggested method functions on the basis of three main processes: data preprocessing, the extraction of features and classification. This approach integrates the union of deep features with the help of Inception 14 and VGG-16 models. At last, a classifier of Multi-scale Improved ResNet (MSI-ResNet) is developed to detect and classify the CT images into unique labels of class. With the support of available open-source COVID-CT datasets that consists of 760 CT pictures, the investigational validation of the suggested method is estimated. The experimental results reveal that the proposed approach offers greater performance with high specificity, accuracy and sensitivity. © 2023 CRL Publishing. All rights reserved.

Structural analysis of cotton stalk Puller and Shredder Machine

World scenario after pandemic COVID-19 has been drastically changing and researchers more focusing on, to minimize the post-pandemic effects on economy, energy sustainability and food security. Agriculture sector is playing pivotal role in world food security and energy sustain -ability. There is high need to optimize the mechanization technologies to increase the yield in limited energy inputs and operation time to fulfill the world growing food demand. This research is mainly focused on the design development and structural analysis aiding with Finite Element Analysis (FEA) approach for Cotton Stalk Puller and Shredder machine (CSPS) to cut the crop leftovers, soil conditioning (shredding the plant waste into soil) and sowing of next crop in single run by con-serving input resources. The experimental trials revealed that there is high pressure on cutting blades, chocking of shredder section and excessive pulling load on tractor hitches, which affected the machine's performance. To mitigate deficiencies and design optimization to improve the machine safety/reliability, the structure analysis carried out. Six core components of machine including baseplate, blade, gear system, root digger, pulley and shaft has investigated as per field conditions. The results revealed that the material of blade, root digger and teeth of gear system receiving the high stress under the operational conditions which results the edge wear and damage. The carbonization up to one-millimeter thickness can provide the extra strength to bear the exces-sive load on edge layers.(c) 2022 THE AUTHORS. Published by Elsevier BV on behalf of Faculty of Engineering, Alexandria University. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

Analysing the impact of COVID-19 pandemic on the psychological health of people using fuzzy MCDM methods

Recently, a large portion of the world's population has experienced an unprecedented devastating effect of the COVID-19 pandemic. At the time of its outbreak, not much was known about this disease and therefore, quarantine and social distancing were the only ways suggested to prevent its spread among humans. Although the current situation is much better than before however, strict social distancing norms as well as frequent long-lasting lockdowns with stringent guidelines and actions to control the spread in the early days have affected the physical and psychological health of the people. Consequently, this study was carried out to attain the following major objectives: (i) to identify the potential psychological problems/factors that might have been caused due to COVID-19 led social distancing and lockdowns, and (ii) to determine the ranks of the identified psychological factors to reflect their degree of criticality. The first objective was achieved by gathering information about the potential psychological factors from the experts. Data, in terms of linguistic variables, was collected from the experts and analyzed using two fuzzy-based multi-criteria decision-making (MCDM) methods i.e. Fuzzy Best Worst Method (F-BWM) and Fuzzy TOPSIS (F-TOPSIS) which led to the accomplishment of the second objective. The results of this study revealed that anxiety, stress, panic attacks, frustration, and insomnia were the top five critical psychological factors that might have affected people due to this pandemic. Consistency of the results was ensured by comparing the obtained ranks with the ranks found using the Fuzzy WSM and Fuzzy MABAC methods. In addition, the robustness of the results was ascertained by conducting the sensitivity analysis. Based on the findings of the study, the identified factors were categorized into most, average, and least critical psychological factors. This research might help the relevant authorities to understand the extent of the seriousness of the various psychological factors caused by this pandemic, so that an effective strategy may be developed for better management, control, and safety. © 2022 The Authors

Correction: Healthy lifestyle behaviors are major predictors of mental wellbeing during COVID-19 pandemic confinement: A study on adult Arabs in higher educational institutions.

[This corrects the article DOI: 10.1371/journal.pone.0243524.].

A comparison of three thromboprophylaxis regimens in critically ill COVID-19 patients: An analysis of real-world data.

Introduction: Thrombotic complications of coronavirus disease 2019 (COVID-19) have received considerable attention. Although numerous conflicting findings have compared escalated thromboprophylaxis doses with a standard dose to prevent thrombosis, there is a paucity of literature comparing clinical outcomes in three different anticoagulation dosing regimens. Thus, we investigated the effectiveness and safety profiles of standard, intermediate, and high-anti-coagulation dosing strategies in COVID-19 critically ill patients. Methodology: This retrospective multicenter cohort study of intensive care unit (ICU) patients from the period of April 2020 to August 2021 in four Saudi Arabian centers. Inclusion criteria were age ≥ 18 years, diagnosis with severe or critical COVID-19 infection, and receiving prophylactic anticoagulant dose within 24-48 h of ICU admission. The primary endpoint was a composite of thrombotic events, with mortality rate and minor or major bleeding serving as secondary endpoints. We applied survival analyses with a matching weights procedure to control for confounding variables in the three arms. Results: A total of 811 patient records were reviewed, with 551 (standard-dose = 192, intermediate-dose = 180, and high-dose = 179) included in the analysis. After using weights matching, we found that the standard-dose group was not associated with an increase in the composite thrombotic events endpoint when compared to the intermediate-dose group {19.8 vs. 25%; adjusted hazard ratio (aHR) =1.46, [95% confidence of interval (CI), 0.94-2.26]} or when compared to high-dose group [19.8 vs. 24%; aHR = 1.22 (95% CI, 0.88-1.72)]. Also, there were no statistically significant differences in overall in-hospital mortality between the standard-dose and the intermediate-dose group [51 vs. 53.4%; aHR = 1.4 (95% CI, 0.88-2.33)] or standard-dose and high-dose group [51 vs. 61.1%; aHR = 1.3 (95% CI, 0.83-2.20)]. Moreover, the risk of major bleeding was comparable in all three groups [standard vs. intermediate: 4.8 vs. 2.8%; aHR = 0.8 (95% CI, 0.23-2.74); standard vs. high: 4.8 vs. 9%; aHR = 2.1 (95% CI, 0.79-5.80)]. However, intermediate-dose and high-dose were both associated with an increase in minor bleeding incidence with aHR = 2.9 (95% CI, 1.26-6.80) and aHR = 3.9 (95% CI, 1.73-8.76), respectively. Conclusion: Among COVID-19 patients admitted to the ICU, the three dosing regimens did not significantly affect the composite of thrombotic events and mortality. Compared with the standard-dose regimen, intermediate and high-dosing thromboprophylaxis were associated with a higher risk of minor but not major bleeding. Thus, these data recommend a standard dose as the preferred regimen.

Contextual influence of the COVID-19 pandemic on pregnant women's emotional regulation abilities.

INTRODUCTION: Emotional regulation is a key factor that could determine the quality of becoming a parent. Since pregnancy is accompanied by changes in the emotional system, fluctuations in emotional regulation may also occur during this period. In 2020, the COVID-19 pandemic had major psychological repercussions on the general population which could have also affected emotional regulation capacities. OBJECTIVE: The objective of this study was to determine whether emotional regulation has characteristics during pregnancy and to evaluate the influence of the COVID-19 pandemic on the emotional regulation of pregnant women. METHOD: One hundred fifty-one women aged between 19 and 42 years old participated in this study. Their emotional regulation abilities were assessed using the Difficulties Emotion Regulation Scale before and during the pandemic. A two-factor multivariate analysis of covariance, "parental status" (pregnant vs. childless) and "time of data collection" (before vs. during COVID-19), was conducted to compare the emotional regulation abilities of pregnant women with those of childless women before and during the pandemic. RESULTS: (1) Prior to the pandemic, pregnant women exhibited better emotional regulation skills than childless women, characterized by greater acceptance and understanding of their emotions. (2) During the pandemic: (a) pregnant women's emotional regulation scores were comparable to those of women without children. (b) They also had more difficulty than pre-pandemic pregnant women in identifying their emotions. CONCLUSION: The lack of improvement in emotional regulation skills in pregnant women during the COVID-19 pandemic is a specific impact of COVID on this population. This could affect their mental health, as well as the emotional adjustment of the mother towards her baby.

The Influence of Workplace Factors on the Nursing Work Environment: A Study Before and After COVID-19.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has impacted the world and healthcare settings, particularly regarding onerous job responsibilities and changes in work culture for nurses. Nurses, known to provide skilled, compassionate, and humanitarian care to patients and families, require continual assistance and organization. Nurses must work in a good environment that encourages them to achieve their highest levels of performance and productivity to offer high-quality and safe care. Commitment to a nursing career necessitates professional dedication especially during times of crisis, as is in the case of the COVID-19 pandemic. OBJECTIVES: The study looked at the elements that influenced nursing work culture at Sultan bin Abdul Aziz Humanitarian City (SBAHC) Riyadh, Saudi Arabia during the COVID-19 epidemic. Leadership, satisfaction, teamwork, nurse behaviour in practice, and professional commitment were among these elements. The factors are interrelated together and help in shaping the nursing work culture considering the COVID-19 scenario. METHODS: A hospital-based cross-sectional study was conducted from January 2020 to December 2020, covering a period before the outbreak of COVID-19 and a period after. The study, conducted at SBAHC, Riyadh, Saudi Arabia, followed a quantitative, positivist approach undertaken in two phases utilizing an analytical survey design before and after the COVID-19 pandemic. An initial electronic survey was distributed to 439 nurses at SBAHC nursing units. Three hundred twenty-two nurses participated in the first survey and the second survey responses after COVID-19 were 205 nurses. RESULTS: There was a significant difference between the two groups in their responses (p<0.05). In all five scales used, the score of mean declined in the 'after' group, clearly showing the effect of all the five elements that influence nursing work culture due to the COVID-19 pandemic. Conclusion: The study concluded that the workplace factors influencing the nursing work environment were greatly affected due to the COVID-19 outbreak in Saudi Arabia. The findings of this study should be considered by nurse managers and leaders when drafting the policies and programs to reduce the negative impact of COVID-19 on nurse retention. It should also provide baseline information that will allow health authorities to prioritize training programs that will support nurses during difficult times.

Persistent Symptoms Post-COVID-19: An Observational Study at King Abdulaziz Medical City, Jeddah, Saudi Arabia.

Background As the prevalence of COVID-19 recovery cases increased, patients started to notice new symptoms after being cured of the acute infection. We aimed to study the type of persistent symptoms post-COVID-19 infection, their prevalence, and factors that play a role in developing the post-COVID-19 symptoms among COVID-19 patients at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Methods A cross-sectional study was conducted at King Abdulaziz Medical City, Jeddah, Saudi Arabia, from the period of September 2021 to December 2021. Participants were contacted via a phone interview. Statistical analysis was performed using IBM SPSS Statistics, and p-values of ≤0.05 were considered significant. Results A total of 327 participants completed the study, of which 169 (51.7%) were male. Nearly half of the patients, 161 (49.09%), had persistent symptoms. The most common symptoms were loss of smell, loss of taste, cough, and fatigue (22.6%, 19.2%, 11.6%, and 9.1% respectively). They were followed by an equal percentage of shortness of breath, headache, and hair loss (7.3%). Gender was found to be significant in loss of smell, loss of taste, and hair loss, with p-values of 0.016, 0.018, and <0.001, respectively. Conclusion A large proportion of patients with COVID-19 developed persistent symptoms. The most common symptoms were loss of smell and taste, cough, and fatigue. Some factors played a role in acquiring post-COVID-19 symptoms, including gender and place of treatment. Gender was significantly associated with hair loss. Follow-up after recovery is required to maintain individual well-being.

SARS-2 COVID-19-induced immunity response, a new prognostic marker for the pregnant population correlates inversely with neonatal Apgar score.

BACKGROUND: The COVID-19 infection has impacted pregnancy outcomes; however, few studies have assessed the association between haematological parameters and virus-related pregnancy and neonatal outcomes. We hypothesised differences in routine haematology indices in pregnant and non-pregnant COVID-19 patients as well as COVID-19-negative pregnant subjects and observed neonatal outcomes in all pregnant populations. Further, we tested if pattern identification in the COVID-19 pregnant population would facilitate prediction of neonates with a poor Apgar score. METHODS: We tested our hypothesis in 327 patients (111 COVID-19-positive pregnant females, 169 COVID-19-negative pregnant females and 47 COVID-19-positive non-pregnant females) in whom standard routine laboratory indices were collected on admission. RESULTS: Pregnant COVID-19-positive patients exhibited higher WBC, neutrophil, monocyte counts as well as neutrophil/lymphocyte and neutrophil/eosinophil ratio compared to non-pregnant COVID-19-positive patients (p = 0.00001, p = 0.0023, p = 0.00002, p = 0.0402, p = 0.0161, p = 0.0352, respectively). Preterm delivery was more prevalent in COVID-19-positive pregnant patients accompanied with a significantly lower birth weight (2894.37 (± 67.50) g compared with 3194.16 (± 50.61) g, p = 0.02) in COVID-19-negative pregnant patients. The COVID-19-Induced Immunity Response (CIIR) was defined as (WBC × neutrophil) / eosinophil; Apgar scores were significantly and inversely correlated with the CIIR index (r =-0.162). INTERPRETATION: Pregnancy appears to give rise to an increased immune response to COVID-19 which appears to protect the mother, however may give rise to complications during labour as well as neonatal concerns. CIIR is a simple metric that predicts neonatal distress to aid clinicians in determining the prognosis of COVID-19 and help provide early intensive intervention to reduce complications.

A quantitative analysis of the reactions of viewers with hearing impairment to the intralingual subtitling of Egyptian movies.

This study investigates how the viewers with hearing impairment reacted to the Modern Standard Arabic (MSA) subtitles added to some Vernacular Arabic movies during the COVID-19 stay-at-home period. A sample group of 106 deaf participants was asked to watch the MSA subtitled version of the Egyptian vernacular movie, Boushkash, and fill in an 18-item questionnaire of five constructs, namely, (1) movie watching habits, (2) technical aspects, (3) linguistic and paralinguistic information, (4) attitude, and (5) future actions and recommendations. The analysis showed that the intralingual subtitling of vernacular Arabic comedy movies was received positively by the participants. The technical specifications of the subtitles were satisfactory and adequate. The paralinguistic information was helpful as it offers a better understanding of the movie and creates a sense of reality in the movie's scenes. This indicates that intralingual subtitling is a step in the right direction that makes audiovisual materials accessible to people with hearing impairment and enhances their feeling of social inclusion. The study concludes that more governmental care in the Arab countries should be directed towards this minority group by urging national TV channels to add intralingual translation to their various programs.

Changes in the Management of Patients having Radical Radiotherapy for Lung Cancer during the First Wave of the COVID-19 Pandemic in the UK.

AIMS: In response to the COVID-19 pandemic, guidelines on reduced fractionation for patients treated with curative-intent radiotherapy were published, aimed at reducing the number of hospital attendances and potential exposure of vulnerable patients to minimise the risk of COVID-19 infection. We describe the changes that took place in the management of patients with stage I-III lung cancer from April to October 2020. MATERIALS AND METHODS: Lung Radiotherapy during the COVID-19 Pandemic (COVID-RT Lung) is a prospective multicentre UK cohort study. The inclusion criteria were: patients with stage I-III lung cancer referred for and/or treated with radical radiotherapy between 2nd April and 2nd October 2020. Patients who had had a change in their management and those who continued with standard management were included. Data on demographics, COVID-19 diagnosis, diagnostic work-up, radiotherapy and systemic treatment were collected and reported as counts and percentages. Patient characteristics associated with a change in treatment were analysed using multivariable binary logistic regression. RESULTS: In total, 1553 patients were included (median age 72 years, 49% female); 93 (12%) had a change to their diagnostic investigation and 528 (34%) had a change to their treatment from their centre's standard of care as a result of the COVID-19 pandemic. Age ≥70 years, male gender and stage III disease were associated with a change in treatment on multivariable analysis. Patients who had their treatment changed had a median of 15 fractions of radiotherapy compared with a median of 20 fractions in those who did not have their treatment changed. Low rates of COVID-19 infection were seen during or after radiotherapy, with only 21 patients (1.4%) developing the disease. CONCLUSIONS: The COVID-19 pandemic resulted in changes to patient treatment in line with national recommendations. The main change was an increase in hypofractionation. Further work is ongoing to analyse the impact of these changes on patient outcomes.

Lock-Down Effect on the Mental Health Status of Healthcare Workers During COVID-19 Pandemic.

Background: The psychological impact that outbreaks and pandemics could inflict on healthcare workers has been widely studied; yet, little is known about the impact of the lockdown measures. Objectives: To assess the magnitude of depression and anxiety among healthcare professionals before and after lifting of the lockdown restrictions in Saudi Arabia. Methods: Surveys targeting healthcare workers were circulated twice: during the lockdown, and 8 weeks after lifting of lockdown. Anxiety and depressive symptoms were assessed using Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scales. Results: A total of 947 healthcare workers, with the mean age of (37 ± 8.9) responded to the surveys. Among these, 23-27% respondents reported clinically significant levels of anxiety and depression. Whereas, easing of the lockdown restrictions was shown to be associated with decreasing mean scores of PHQ-9 and GAD-7. The noted burden fell heavily on female workers, those with a current or a history of psychiatric disorders, suffering from chronic diseases, being in workplaces with high exposure to COVID-19 or in contact with COVID-19 patients, nurses, as well as those who were living with elderly and perceived their physical and mental health as "much worse" compared to the time before the pandemic. Conclusion: Our findings identified several predictors for anxiety and depression at different time-points of the pandemic. Thus, priority to psychological support measures might be needed for these groups.

COVID-19 vaccine causing Guillain-Barre syndrome, a rare potential side effect.

Patients with neurological symptoms should be enquired about recent vaccination history. It is important after the COVID-19 mRNA vaccine, which is newly introduced as it might link to the development of a wider variety of neurological diseases.

Seroprevalence of SARS-CoV-2 among high-risk healthcare workers in a MERS-CoV endemic area.

INTRODUCTION: Healthcare workers (HCWs) in Saudi Arabia are a unique population who have had exposures to the Middle East Respiratory Syndrome coronavirus (MERS-CoV) and Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). It follows that HCWs from this country could have pre-existingMERS-CoV antibodies that may either protect from coronavirus disease 2019 (COVID-19) infection or cause false SARS-CoV-2 seropositive results. In this article, we report the seroprevalence of MERS-CoV and SARS-CoV-2 among high-risk healthcare workers in Riyadh city, Saudi Arabia. METHODS: This is a cross-sectional study enrolling 420 high-risk HCWs who are physically in contact with COVID-19 patients in three tertiary hospitals in Riyadh city. The participants were recruited between the 1st of July to the end of December 2020. A 3 ml of the venous blood samples were collected and tested for the presence of IgG antibodies against the spike proteins of SARS-CoV-2 and MERS-CoV using enzyme-linked immunosorbent assay (ELISA). RESULTS: The overall prevalence of SARS-CoV-2 in high-risk HCWs was 14.8% based on SARS-CoV-2 IgG testing while only 7.4% were positive by Polymerase Chain Reaction (PCR) for viral RNA. Most of the SARS-CoV-2 seropositive HCWs had symptoms and the most frequent symptoms were body aches, fever, cough, loss of smell and taste, and headache. The seroprevalence of MERS-CoV IgG was 1% (4 participants) and only one participant had dual seropositivity against MERS-CoV and SARS-CoV-2. Three MERS-CoV positive samples (75%) turned to be negative after using in-house ELISA and none of the MERS-CoV seropositive samples had detectable neutralization activity. CONCLUSION: Our SARS-CoV-2 seroprevalence results were higher than reported regional seroprevalence studies. This finding was expected and similar to other international findings that targeted high-risk HCWs. Our results provide evidence that the SARS-CoV-2- seropositivity in Saudi Arabia similar to other countries was due to exposure to SARS-CoV-2 rather than MERS-CoV antibody.

Management of proximal femur fractures in the elderly: current concepts and treatment options.

As one of the leading causes of elderly patients' hospitalisation, proximal femur fractures (PFFs) will present an increasing socioeconomic problem in the near future. This is a result of the demographic change that is expressed by the increasing proportion of elderly people in society. Peri-operative management must be handled attentively to avoid complications and decrease mortality rates. To deal with the exceptional needs of the elderly, the development of orthogeriatric centres to support orthogeriatric co-management is mandatory. Adequate pain medication, balanced fluid management, delirium prevention and the operative treatment choice based on comorbidities, individual demands and biological rather than chronological age, all deserve particular attention to improve patients' outcomes. The operative management of intertrochanteric and subtrochanteric fractures favours intramedullary nailing. For femoral neck fractures, the Garden classification is used to differentiate between non-displaced and displaced fractures. Osteosynthesis is suitable for biologically young patients with non-dislocated fractures, whereas total hip arthroplasty and hemiarthroplasty are the main options for biologically old patients and displaced fractures. In bedridden patients, osteosynthesis might be an option to establish transferability from bed to chair and the restroom. Postoperatively, the patients benefit from early mobilisation and early geriatric care. During the COVID-19 pandemic, prolonged time until surgery and thus an increased rate of complications took a toll on frail patients with PFFs. This review aims to offer surgical guidelines for the treatment of PFFs in the elderly with a focus on pitfalls and challenges particularly relevant to frail patients.

Flex Printed Circuit Board Implemented Graphene-Based DNA Sensor for Detection of SARS-CoV-2.

Since the COVID-19 outbreak was declared a pandemic by the World Health Organization (WHO) in March 2020, ongoing efforts have been made to develop sensitive diagnostic platforms. Detection of viral RNA provides the highest sensitivity and specificity for detection of early and asymptomatic infections. Thus, this work aimed at developing a label-free genosensor composed of graphene as a working electrode that could be embedded into a flex printed circuit board (FPCB) for the rapid, sensitive, amplification-free and label-free detection of SARS-CoV-2. To facilitate liquid handling and ease of use, the developed biosensor was embedded with a user-friendly reservoir chamber. As a proof-of-concept, detection of a synthetic DNA strand matching the sequence of ORF1ab was performed as a two-step strategy involving the immobilization of a biotinylated complementary sequence on a streptavidin-modified surface, followed by hybridization with the target sequence recorded by the differential pulse voltammetric (DPV) technique in the presence of a ferro/ferricyanide redox couple. The effective design of the sensing platform improved its selectivity and sensitivity and allowed DNA quantification ranging from 100 fg/mL to [Formula: see text]/mL. Combining the electrochemical technique with FPCB enabled rapid detection of the target sequence using a small volume of the sample (5-[Formula: see text]). We achieved a limit-of-detection of 100 fg/mL, whereas the predicted value was ~33 fg/mL, equivalent to approximately [Formula: see text] copies/mL and comparable to sensitivities provided by isothermal nucleic acid amplification tests. We believe that the developed approach proves the ability of an FPCB-implemented DNA sensor to act as a potentially simpler and more affordable diagnostic assay for viral infections in Point-Of-Care (POC) applications.

Elevated Expression Levels of Lung Complement Anaphylatoxin, Neutrophil Chemoattractant Chemokine IL-8, and RANTES in MERS-CoV-Infected Patients: Predictive Biomarkers for Disease Severity and Mortality.

The complement system, a network of highly-regulated proteins, represents a vital part of the innate immune response. Over-activation of the complement system plays an important role in inflammation, tissue damage, and infectious disease severity. The prevalence of MERS-CoV in Saudi Arabia remains significant and cases are still being reported. The role of complement in Middle East Respiratory Syndrome coronavirus (MERS-CoV) pathogenesis and complement-modulating treatment strategies has received limited attention, and studies involving MERS-CoV-infected patients have not been reported. This study offers the first insight into the pulmonary expression profile including seven complement proteins, complement regulatory factors, IL-8, and RANTES in MERS-CoV infected patients without underlying chronic medical conditions. Our results significantly indicate high expression levels of complement anaphylatoxins (C3a and C5a), IL-8, and RANTES in the lungs of MERS-CoV-infected patients. The upregulation of lung complement anaphylatoxins, C5a, and C3a was positively correlated with IL-8, RANTES, and the fatality rate. Our results also showed upregulation of the positive regulatory complement factor P, suggesting positive regulation of the complement during MERS-CoV infection. High levels of lung C5a, C3a, factor P, IL-8, and RANTES may contribute to the immunopathology, disease severity, ARDS development, and a higher fatality rate in MERS-CoV-infected patients. These findings highlight the potential prognostic utility of C5a, C3a, IL-8, and RANTES as biomarkers for MERS-CoV disease severity and mortality. To further explore the prediction of functional partners (proteins) of highly expressed proteins (C5a, C3a, factor P, IL-8, and RANTES), the computational protein-protein interaction (PPI) network was constructed, and six proteins (hub nodes) were identified.

Unusual Neurological Manifestation of Proton Pump Inhibitor: A Case Report of Acute Disseminated Encephalomyelitis and Severe Hyponatremia After Brief Use of Proton Pump Inhibitor.

Hyponatremia is commonly reported after the use of proton pump inhibitors (PPI). While omeprazole is most likely to cause hyponatremia, almost all the PPIs have been reported to cause hyponatremia. The underlying mechanism of PPI-induced hyponatremia is a syndrome of inappropriate antidiuretic hormone (SIADH) secretion which leads to hyponatremia. The hyponatremia can develop with only a few days of exposure to PPI. We present a case of a 56-year-old previously healthy female who was prescribed omeprazole for trivial acid reflux symptoms when she presented to the emergency room for evaluation of generalized weakness. She was discharged home from the emergency room after clinical evaluation as she had essentially normal lab work including a negative COVID PCR test. She subsequently developed progressive weakness of extremities and slurred speech over the next three days. She returned back to the emergency room and was found to have profound hyponatremia with MRI evidence of acute disseminated encephalomyelitis (ADEM). She was treated with hypertonic saline to correct hyponatremia and omeprazole was discontinued. The patient also received pulse dose steroids with improvement in her symptoms.

Perception of virtual clinics among Saudi adults with type 1 diabetes during the COVID-19 pandemic.

BACKGROUND AND AIMS: We aimed to assess patient perception toward the rapid implementation of virtual phone clinics among Saudi adult patients with type 1 diabetes mellitus (T1DM) during the coronavirus disease (COVID-19) pandemic. METHODS: This cross-sectional, web-based study included Saudi adult patients with T1DM who attended at least one virtual phone visit with the diabetes clinic at King Abdulaziz Medical City, Jeddah, Saudi Arabia, between August 1 and December 31, 2020. Patients anonymously answered a Google form-created Arabic questionnaire. Information about patient characteristics, outcome, and perception of the virtual phone visit were obtained. Data were presented using descriptive statistics, chi-square, one-way ANOVA, independent t-, and Welch's t-tests. RESULTS: The questionnaire was sent to 281 patients, of whom 201 completed it. 59.2% patients were satisfied with their overall virtual phone clinic experience, and 75.6% preferred to continue attending the virtual phone clinics in the future. The average perception value of patients toward virtual phone clinics was 67.76 ± 19.9, suggesting good perception among the majority. Negative or neutral views of current health, asking to be physically seen, and missing a virtual appointment were associated with significantly lower average patient perception value (p < 0.001). CONCLUSIONS: Most Saudi patients with T1DM have adapted to virtual phone consultations, exhibiting good satisfaction and perception, and high preference to continue using this system in the future. The utilization of the service to assist patients with diabetes is highly encouraged, especially during the COVID-19 pandemic. Strategies need to be developed to further enhance the patient experience.