Efficient Machine Learning Model For Covid-19 Spread Prediction

Machine learning models have shown great performance in prediction and detection of many diseases such as cancer, heart attack, liver infection, and kidney infection. COVID-19 emerged as one of the deadly disease. Its cases grownin unpredictable manner. Regression is the mathematical technique in machine learning that can used to find relation between outcome variable with independent variable. In the present manuscript, regression has been used to predict COVID-19 growth. It has been found that the model is highly accurate in the COVID case prediction. © 2023 IEEE.

Analysis of Attack Patterns and Cyber Threats in Healthcare Sector

Information Technology (IT) has become the integral part of majority of businesses. Healthcare sector is also one such sector where IT adoption is increased in recent times. This adoption of IT has increased the internet exposure and hence increased the attack surface of the organisations working in healthcare sector. During covid outbreak, we have observed various cyber-attack and threats on organisations operating in healthcare sector. This paper focuses on cyber threat pattern in healthcare sector during covid-19 outbreak and post-covid-19 period. This research paper also aims to generate basic cyber awareness through generic cyber sanity checks to secure healthcare sector from malicious threat actors. The adaptation of proactive measures required to enhance the cyber hygiene of organisations becomes very essential in this sector. © 2023 IEEE.

EVALUATION OF TELENURSING FOLLOW-UP IN A COHORT OF STABLE/LOW DISEASE ACTIVITY PATIENTS WITH INFLAMMATORY ARTHRITIDES: A FEASIBILITY STUDY

BackgroundPeriodic follow-up (FU) is necessary for patients with Rheumatic Diseases (RDs). In the case of a stable clinical condition or low disease activity, FU can be carried out also by rheumatology nurses (RNs). Recent studies focusing on FUs led by RNs either in Rheumatology Clinics and with Telenursing (TN), showed promising results in terms of outcomes, cost reduction and users' satisfaction.ObjectivesTo evaluate the feasibility of a Telenursing FU in a Rheumatology Centre in Florence, Italy.MethodsIn this pilot study, patients with stable inflammatory arthritis or low disease activity were contacted, after their first visit, through TN (T0) and then assessed during the following in-person visit (V12) by RNs for treatment adherence, for pain, for mental and physical health, for workability, for perception of disease activity and satisfaction concerning the TN service.ResultsOut of 27 interviewed patients, 59.3% (n=16/27) was affected by Rheumatoid Arthritis (RA), 18.5% (n=5/27) by Spondyloarthritis (AS), 14.8% (n=4/27) by Psoriatic Arthritis (PsA) and 7.4% (n=2/27) by Juvenile Idiopathic Arthritis. The mean age was 57.5±13.1 (M± DS) years and the treatment adherence level was optimal. 11.1% (n=3/27) of patients was referred for medical consultation because of the urgent clinical situation assessed by the RNs according to the clinical multidisciplinary checklist. After specialist consultation, 1 patient was revalued in presence for a transient ischemic attack;1 patient was contacted by the rheumatologist following independent discontinuation of methotrexate therapy;1 patient was redirected to urgent dermatology consultation because of a suspected cutaneous drug reaction.During the TN period (12 months), 33.3% (n=9/27) of the patients contracted SARS-CoV-2 infection and 11.1% (n=3/27) contracted urinary or upper respiratory tract infections.RA patients showed a mean Rheumatoid Arthritis Impact of Disease-RAID score of 2.4 at T0 and 2.5 at V12 (Range 0-10);AS patients showed a mean Assessment of Spondyloarthritis International Society-ASAS score of 0.3 in both periods and PsA showed a mean Psoriatic Arthritis Impact of Disease-PSAID score of 0.7 and 0.8 at T0 and V12, respectively. Among RA, AS and PsA patients, as a pain score of 3 was recorded in both periods.In order to attend the in-person FU visit, 68.4% (n=13/19) of the patients took work leave. 37% (n=10/27) of them waited 40.9±18.6 minutes at V12 control. The average distance between the Rheumatology Centre and patients' home was 29.3±25.6 km. 15.4% (n=5/13) of the respondents did not own a car and 23.1% (n=3/13) was accompanied to visit by their caregiver.All the included patients expressed high satisfaction for the TN service, corresponding to 5 point Likert scale.ConclusionThe data show that TN FU is a valuable model for maintaining an adequate level of therapeutic adherence, reducing the travel time and working day loss, intercepting remotely clinical issues, as well as registering a high level of user acceptance and satisfaction. Further studies on larger samples are needed to confirm our findings.References[1] Bech B et al (2020) 2018 update of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis. Annals of the Rheumatic Diseases;79:61-68. doi: 10.1136/annrheumdis-2019-215458.[2] Alcazar B, Ambrosio L. (2019) Tele-nursing in patients with chronic illness: a systematic review. An Sist Sanit Navar;42(2):187-197. doi: 10.23938/ASSN.0645.[3] Larsson I et al. (2013) Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy. Journal of Advanced Nursing;70(1), 164–175., 2013 doi:10.1111/jan.12183Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Fear the fear: the historical analogies of COVID-19 in US–China relations

The impacts of the novel coronavirus (hereafter COVID-19) pose one of the greatest crises of our generation. The policy decisions that the US and Chinese governments take will shape the current order of international relations, the global supply chain of medical supplies, and US–China relations. The COVID-19 crisis leads to the empirical puzzles: how do the two great world powers construct their narratives on the global pandemic and toward each other? What are the meanings, if any, of fear in US–China relations? This study explores the narrative of fear that is constituted in the US and China discourse. The historical analogies, such as the Boxer Indemnity, sick man of Asia, and Pearl Harbor attack, offer great examples to the political construction of the "fearful” other through specific representations amid the outbreak of COVID-19. Specifically, they have become the "cultural scripts” that define how they interact and who they are. The article proceeds as follows. First, this study examines the current literature of realism, constructivism, and discourse analysis. Second, it proposes a comparative framework for understanding the expressions of fear and threat perceptions for both countries. Specifically, the "Pearl Harbor Moment” from the US, and "the Boxer Indemnity” from the Chinese government substantially shape the landscape of US–China relations. Third, it highlights how the political elites appropriate these historical analogies in constructing their political identities and offers insights into the future of US–China relations. Finally, this article concludes with thoughts on the studies on the struggle of great powers and implications for pandemic politics.

Managing severe warm autoimmune haemolytic anaemia after the SARS-Cov- 2 vaccine with emergency splenectomy and eculizumab

Autoimmune haemolytic anaemia (AIHA) is rare but described after the SARS-CoV- 2 Pfizer-BioNTech vaccine. We present a case of severe refractory warm AIHA after this vaccine, managed with emergency splenectomy and complement inhibition with eculizumab. A male in his teens with a history of liver transplant for biliary atresia (aged 2 years) and AIHA (aged 6 years) presented to his district general hospital with jaundice, dark urine, fatigue and chest discomfort 48 h after the first dose of SARS-CoV- 2 Pfizer-BioNTech vaccine (BNT162b2 mRNA). Investigations revealed haemoglobin (Hb) of 70 g/L and bilirubin of 98 mumol/L, which was treated as AIHA. The patient initially responded to prednisolone (1 mg/kg, 60 mg) but subsequently deteriorated and failed to respond to second-line rituximab (375 mg/m2) and two units of packed red blood cells (PRBC). By day 29 the patient had developed life-threatening anaemia culminating in a Hb of 35 g/L (after transfusion), lactate dehydrogenase (LD) of 1293 units/L and bilirubin of 228 mumol/L. This necessitated an immediate transfer to our tertiary centre for specialist support. Further investigations revealed a haptoglobin <0.1 g/L and direct antiglobulin test (DAT) strongly positive for IgG (4+) and negative for C3d. The peripheral blood film showed severe anaemia, nucleated red cells, anisocytosis and spherocytes with no autoagglutination, schistocytes or platelet clumps. Thrombocytopaenia (platelets 49 +/- 109/L) was present. Differentials were ruled out, such as paroxysmal nocturnal haemoglobinuria and heparin-induced thrombocytopaenia. HIV and hepatitis serology were negative, as were adenovirus, cytomegalovirus and Epstein-Barr virus PCR assays. A CT showed splenomegaly of 15.5 cm. Urinalysis found urobilinogen and bilirubin at high concentrations and negative urinary haemosiderin. Together, the investigations were consistent with warm AIHA. On day 29, four units of PRBC were transfused alongside 100 mg methylprednisolone and 1 g/kg IVIG. On day 30 the patient deteriorated despite the escalated treatment: Hb had only increased to 54 g/L, bilirubin was 200 mumol/L and LD was rising. Considering this life-threatening fulminant haemolysis, an emergency splenectomy was performed. This slowed haemolysis but did not completely ameliorate it: by day 33 the patient had received 15 units of PRBC. Thus, eculizumab, a terminal complement pathway inhibitor, was trialled to arrest intravascular haemolysis, alongside rituximab, repeat IVIG 1 g/kg, prednisolone 40 mg and tacrolimus 2 mg. This showed a favourable response, requiring less frequent transfusions and settling haemolysis. This case highlights the rare complication of warm AIHA with the SARS-CoV- 2 Pfizer-BioNTech vaccine, the use of emergency splenectomy for disease control, and the potential of eculizumab for refractory cases.

Security Vulnerability in Face Mask Monitoring System

The COVID-19 pandemic has increased demand for face mask detection systems that utilize deep learning and machine learning algorithms. However, these systems are susceptible to adversarial attacks, where an attacker can manipulate the system to make incorrect predictions. This study aimed to test the vulnerability of a deep learning-based face mask detection model to a specific type of attack called a black box adversarial attack in which the attacker possesses only partial information about the target model. The study's findings showed that the attack successfully reduced the model's accuracy from 96.48% to 49.25%. This emphasizes the need for more robust defense mechanisms in face mask detection systems to ensure their reliability. © 2023 Bharati Vidyapeeth, New Delhi.

Household secondary attack rate in mild COVID-19.

Background: The coronavirus disease 2019 (COVID-19) pandemic has reached a staggering number of almost 280 million cases worldwide, with over 5.4 million deaths as of 29 December 2021. A further understanding of the factors related to the household spread of the infection might help to bring about specific protocols to curb such transmission. Objective: This study aims to find the secondary attack rate (SAR) and factors affecting SAR among the households of mild COVID-19 cases. Methods: An observational study was designed where data of patients admitted at All India Institute of Medical Sciences, New Delhi due to mild COVID-19 were collected, and outcome was noted after the discharge of the patient. Index cases who were the first in the household to have a positive infection only were included. Based on these data, the overall household SAR, factors related to the index case and contacts that affected transmissibility were noted. Results: A total of 60 index cases having contacts with 184 household members were included in the present study. The household SAR was measured to be 41.85%. At least one positive case was present in 51.67% households. Children below 18 years old had lower odds of getting a secondary infection compared to adults and elderly [odds ratio (OR) = 0.46, 95%CI = 0.22-0.94, p = 0.0383). An exposure period of more than a week was significantly associated with a higher risk of infection (p = 0.029). The rate of transmissibility drastically declined with effective quarantine measures adopted by the index case (OR = 0.13, 95%CI = 0.06-0.26, p < 0.00001). Symptomatic index cases contributed more to the SAR than asymptomatic primaries (OR = 4.74, 95%CI = 1.03-21.82, P = 0.045). Healthcare worker index cases had lower rates of spread (OR = 0.29, 95%CI = 0.15-0.58, P = 0.0003). Conclusion: The high SAR shows the household is a potential high-risk unit for transmissibility of COVID-19. Proper quarantine measures of all those exposed to the index case can mitigate such spread and lead to reduction of risk of COVID-19 within a household.

Recurrent/Subsequent Stroke and Associated Outcomes in Geriatric Patients with OSA and Prior Stroke Events: A Retrospective Study Using the 2019 National Inpatient Sample.

Background: Obstructive sleep apnea (OSA) increases the risk of stroke and cardiovascular diseases. However, its impact on geriatric patients with a prior history of stroke/transient ischemic attack (TIA) has not been adequately studied. Methods: We utilized the 2019 National Inpatient Sample in the US to identify geriatric patients with OSA (G-OSA) who had a prior history of stroke/TIA. We then compared subsequent stroke (SS) rates among sex and race subgroups. We also compared the demographics and comorbidities of SS+ and SS- groups and utilized logistic regression models to assess outcomes. Results: Out of 133,545 G-OSA patients admitted with a prior history of stroke/TIA, 4.9% (6520) had SS. Males had a higher prevalence of SS, while Asian-Pacific Islanders and Native Americans had the highest prevalence of SS, followed by Whites, Blacks, and Hispanics. The SS+ group had higher all-cause in-hospital mortality rates, with Hispanics showing the highest rate compared to Whites and Blacks (10.6% vs. 4.9% vs. 4.4%, p < 0.001), respectively. Adjusted analysis for covariates showed that complicated and uncomplicated hypertension (aOR 2.17 [95% CI 1.78-2.64]; 3.18 [95% CI 2.58-3.92]), diabetes with chronic complications (aOR 1.28 [95% CI 1.08-1.51]), hyperlipidemia (aOR 1.24 [95% CI 1.08-1.43]), and thyroid disorders (aOR 1.69 [95% CI 1.14-2.49]) were independent predictors of SS. The SS+ group had fewer routine discharges and higher healthcare costs. Conclusions: Our study shows that about 5% of G-OSA patients with a prior history of stroke/TIA are at risk of hospitalization due to SS, which is associated with higher mortality and healthcare utilization. Complicated and uncomplicated hypertension, diabetes with chronic complications, hyperlipidemia, thyroid disorders, and admission to rural hospitals predict subsequent stroke.

Paying Attention to cyber-attacks: A multi-layer perceptron with self-attention mechanism

Cyber-attacks cause huge monetary losses to the institutions that are victims of them. Cyber-attack is becoming increasingly sophisticated. Therefore, the protection system against cyber-attacks has become a highly requested resource by any type of state or private institution. During the pandemic caused by COVID-19, the number of cyber-attacks against both public and private health institutions has increased. Cybersecurity systems have become a necessity. Various protection systems have been proposed using different machine learning algorithms, but deep learning consistently provides the best results. In this work we develop a deep learning model for the detection of different kinds of cyber-attacks, a study is carried out on the relevance of the selection of features in this type of algorithm and the importance of attention mechanisms is analyzed to improve the assessment of features within the same model. We have carried out the experiments using two datasets that are benchmarks in the field of cybersecurity and we have carried out a comparative study with both.

Impact of Influenza in South-East Asia

Influenza infection is asymptomatic in up to 75% of cases, but outbreaks result in significant morbidity. Reports found that severe influenza complications tend to occur among the very young (<5 years) and very old (>65 years), especially those with underlying co-morbidities like diabetes mellitus and heart disease. Even with no co-morbidity, some older persons with severe influenza may require hospitalisation or intensive care, with increased risk of myocardial infarction and stroke. In South-East Asia, influenza was often seen as a mild problem and was not deemed notifiable until the appearance of the Influenza A(H1N1) pandemic in 2009. For decades the data made available were based on extrapolated estimates collected mainly from paediatric populations, resulting in inconsistent findings. Following expanded surveillance across the region using national surveillance systems for influenza-like illness (ILI) and severe acute respiratory illness (SARI), and better diagnostic methods, improved estimates of disease burden was achieved in South-East Asia. However, two studies conducted in 2008-2010 reported findings ranging from 2-3% to 11%. With regards to increased risk of complications, the estimated global annual attack rates for influenza were 5-10% in adults and 20-30% in children, resulting in 3-5 million cases of severe illness and 290,000-650,000 deaths. A study In Singapore reported that influenza is associated with annual excess mortality rates (EMR) of 11-14.8 per 100 000 person-years, especially affecting the elderly;these rates are comparable to that of the USA. As for hospitalisation rates of children under 5 years with seasonal influenza, the USA estimated a rate of 1.4 per 100,000. Comparable rates were reported in Singapore (0.7-0.9), Thailand (2.4), Viet Nam (3.9-4.7), and the Philippines (4.7). In 2018, an updated study reported a mean annual influenza-associated respiratory EMR of 4.0-8.8 per 100 000 individuals, with South-East Asia showing a high mortality rate of 3.5-9.2 per 100,000 individuals. It was already estimated in Thailand in 2004 that influenza resulted in USD23-63 million in economic costs, with the main contribution from lost productivity due to missed workdays. Thus, comparable to countries in temperate climate, the clinical and socioeconomic impact of influenza in South-East Asia appear to be just as substantial. With the emergence of the COVID-19 pandemic in 2020, global influenza incidence dropped dramatically. In South-East Asia, the trend in influenza detections was similar to the rest of the world, with numbers slightly higher than average in early 2020, followed by a quick drop-off by the end of April 2020. After April 2020, the detection rate remained low until late July 2020, when Influenza A(H3N2) predominated in Cambodia, Malaysia, the Philippines, Singapore, Thailand and Timor-Leste;influenza B in Lao People's Democratic Republic but with an upsurge in A(H3N2) activity. Following a two-year hiatus, influenza outbreaks began to re-emerge significantly since early 2022. From February through August 2022, influenza activity in the southern hemisphere remained lower than in pre-COVID-19 pandemic years, but was at the highest level compared to similar periods since the start of the COVID-19 pandemic. Reasons for the reduction during the COVID-19 pandemic include non-pharmaceutical interventions (NPIs), reduced population mixing and reduced travel, and possibly viral interference between SARS-CoV-2 and influenza virus in the same host. In general, the reduction in influenza detections however does not appear to be associated with lack of testing. The World Health Organisation (WHO) continues to recommend that vaccination is the most effective way to prevent infection and severe outcomes caused by influenza viruses. Although influenza vaccine is not commonly used in most countries in South-East Asia, its burden is similar in other parts of the world where influenza vaccine is now routinely used. Currently, the countries in South-East Asia that are providing free influenza vacc na ion for those at high risk include Thailand, Singapore, the Philippines and Lao People's Democratic Republic.Copyright © 2023

Comprehensive medication management services provided via telehealth or hybrid models: A scoping review

Comprehensive medication management (CMM) is increasingly provided by health care teams through telehealth or hybrid modalities. The purpose of this scoping literature review was to assess the published literature and examine the economic, clinical, and humanistic outcomes of CMM services provided by pharmacists via telehealth or hybrid modalities. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Randomized controlled trials (RCTs) and observational studies were included if they: reported on economic, clinical, or humanistic outcomes;were conducted via telehealth or hybrid modalities;included a pharmacist on their interprofessional team;and evaluated CMM services. The search was conducted between January 1, 2000, and September 28, 2021. The search strategy was adapted for use in Medline (PubMed);Embase;Cochrane;Cumulative Index to Nursing and Allied Health Literature;PsychINFO;International Pharmaceutical s;Scopus;and grey literature. Four reviewers extracted data using a screening tool developed for this study and reviewed for risk of bias. Authors screened 3500 articles, from which 11 studies met the inclusion criteria (9 observational studies, 2 RCTs). In seven studies, clinical outcomes improved with telehealth CMM interventions compared to either usual care, face-to-face CMM, or educational controls, as shown by the statistically significant changes in chronic disease clinical outcomes. Two studies evaluated and found increased patient and provider satisfaction. One study described a source of revenue for a telehealth CMM service. Overall, study results indicate that telehealth CMM services, in select cases, may be associated with improved clinical outcomes, but the methods of the included studies were not homogenous enough to conclude that telehealth or hybrid modalities were superior to in-person CMM. To understand the full impact on the Quadruple Aim, additional research is needed to investigate the financial outcomes of CMM conducted using telehealth or hybrid technologies.Copyright © 2022 Pharmacotherapy Publications, Inc.

Prevalence of Covid 19 among Returning Pilgrims at Islamabad International Airport, Pakistan, a Retrospective Cohort Study

Intro: Mass gathering events (MGEs) are associated with the transmission of COVID-19. The world's largest mass gathering hajj pilgrimage 2022 was held after two years of major disruption caused by the COVID pandemic, with one million pilgrims of different ages, health statuses, hygiene sophistication and close contact. This study aimed to estimate the Prevalence of COVID-19 among returning Pakistani pilgrims at Islamabad International Airport, its association with these MGEs and to quantify the potential risk factors associated. Method(s): A retrospective cohort study was carried out at Islamabad International Airport from 14th July to 13th August 2022. A representative sample of 1100 people with potential exposure at Hajj 2022 was surveyed by a questionnaire to obtain information about attendance at hajj and COVID-19 disease. In addition, Rapid antigen testing (RAT) against SARS-Cov-2 was implemented. Statistical analysis was done using Epi info version 7. Finding(s): A total of 1100 subjects participated in the questionnaire survey and underwent rapid antigen testing. The mean age was 49.7+/-10.4. Almost 17.9% of the respondents experienced Covid-like symptoms with sore throat and fever as the most frequent symptoms. Three cases were detected by RAT with an attack rate (AR) of 0.3%;79.7% were female. Considering MGE exposure, AR was 0.2 %. All participants were fully vaccinated with 86.5% boosted with one dose. A dose- response relationship was found between MGE attendance and the disease, (adjusted relative risk [ARR] = 3.4- 5% confidence interval [CI] 2.25-3.5). Associated risk factors with the incidence were co-morbidity (RR=5.2) and non- use of face masks (RR=9). Conclusion(s): The study highlights the significance of MGEs in COVID-19 transmission. Vaccination and booster shots significantly reduced the risk of Covid-19 transmission among the returning pilgrims. With surveillance, screening and Rapid antigen testing at Points of entry, risk of future pandemics is significantly reduced.Copyright © 2023

How Will Demographic Change Affect the Disease Burden of Future Epidemics?

Intro: The burden of infectious diseases is influenced by the structure of the population at risk. Population ageing may have implications for the disease burden of future epidemics. Moreover, changing household structures induced by population ageing may influence the dynamics of disease transmission and burden of infections transmitted via close contact interactions. We aim to investigate the impact of demographic change on the disease transmission dynamics and future disease burden and illustrate this for COVID-19 and influenza-like illness (ILI). Method(s): We simulate the Belgian population between 2020 and 2050 using an individual-based model with census data. The simulated population structures were used as input for an infectious disease model that distinguishes between exposure to infection in the household versus exposure in the community at large. We mimicked outbreaks of COVID-19 and ILI of varying total final size. Finding(s): The simulated population ages between 2020 and 2050, which also affects household size and composition. As the proportion of elderly people in the population increases, the overall attack rate slightly decreases because older age groups have fewer contacts and are therefore less likely to incur and transmit infections. Despite the lower per-person attack rate, the estimated disease burden increases as morbidity and mortality increases with the age at infection. Conclusion(s): The demographic changes induced by population ageing have an impact on the burden of future outbreaks of COVID-19 and ILI in Belgium. The shifting age distribution implies that the elderly, a population group with increased morbidity and mortality in case of infection, make up an increasing proportion of the total population. Population ageing also leads to an increasing proportion of single-person households and collective households (e.g. nursing homes) in the population. Since the household attack rate varies by household size and composition, the living arrangements of the elderly population influences the disease burden of future epidemics to some extent.Copyright © 2023

Role of SARS-CoV-2 in asthma exacerbations

Asthma is one of the most common chronic respiratory diseases in the world and there is great concern about the effect of COVID-19 infection on asthma severity and control. Although the link between asthma and COVID-19 infection remains to be determined, available data indicate that asthma does not seem to be a risk factor for severe COVID-19. This review aims to summarize the updated data about the association between viral infections and asthma exacerbations including COVID infection and management of asthma flare-ups during the COVID pandemic, based on the recommended asthma guidelines.Copyright © 2020 Bilimsel Tip Yayinevi. All rights reserved.

Asthma as a comorbid disease in COVID-19

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel coronavirus that causes coronavirus disease 2019 (COVID-19). In terms of asthma and COVID-19, there is also a risk of experiencing an asthma exacerbation triggered by coronavirus infection beyond the direct risk of the infection itself. As a comorbid disease, the prevalence of COVID-19 infection in asthma patients is not clear. In addition, the influence of asthma on the severity of COVID-19 has not been reported. The aim of this review was to summarize the reported worldwide data about the prevalence and the clinical characteristics of patients with asthma during COVID-19 infection.Copyright © 2020 Bilimsel Tip Yayinevi. All rights reserved.

The Coronavirus Double Threat: A Rare Presentation of Chest Pain in a Young Female.

Severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) led to global coronavirus disease 2019 (COVID-19) pandemic. The virus affects the respiratory system predominantly and has resulted in multiorgan complications. Myocarditis, acute coronary syndrome (ACS), cardiogenic shock, and sudden cardiac death were common cardiac manifestations of COVID-19. Spontaneous coronary artery dissection (SCAD) is a rare form of coronary artery disease that is previously reported in patients with COVID-19. SCAD usually occurs in a middle-aged woman with few or without any cardiovascular risk factors. The gold standard for its diagnosis is coronary angiography. The SCAD treatment recommendations depend on the hemodynamic status: conservative therapy in hemodynamically stable SCAD patients and urgent revascularization in hemodynamically unstable SCAD patients. The exact pathophysiology of COVID-19 associated with SCAD is unknown. It is considered a combination of systemic inflammatory response and localized vascular inflammation. The case reported is of COVID-19-associated SCAD in a patient with no history of cardiovascular disease later complicated by the transient ischemic attack (TIA) and left ventricular (LV) thrombus.

BFT-IoMT: A Blockchain-Based Trust Mechanism to Mitigate Sybil Attack Using Fuzzy Logic in the Internet of Medical Things.

Numerous sensitive applications, such as healthcare and medical services, need reliable transmission as a prerequisite for the success of the new age of communications technology. Unfortunately, these systems are highly vulnerable to attacks like Sybil, where many false nodes are created and spread with deceitful intentions. Therefore, these false nodes must be instantly identified and isolated from the network due to security concerns and the sensitivity of data utilized in healthcare applications. Especially for life-threatening diseases like COVID-19, it is crucial to have devices connected to the Internet of Medical Things (IoMT) that can be believed to respond with high reliability and accuracy. Thus, trust-based security offers a safe environment for IoMT applications. This study proposes a blockchain-based fuzzy trust management framework (BFT-IoMT) to detect and isolate Sybil nodes in IoMT networks. The results demonstrate that the proposed BFT-IoMT framework is 25.43% and 12.64%, 12.54% and 6.65%, 37.85% and 19.08%, 17.40% and 8.72%, and 13.04% and 5.05% more efficient and effective in terms of energy consumption, attack detection, trust computation reliability, packet delivery ratio, and throughput, respectively, as compared to the other state-of-the-art frameworks available in the literature.

Incidence of COVID-19 Infection in Nurses and their Families: A Prospective Cohort Study in Lahore

Background: Nurses, as frontline workers, are at a higher risk of contracting COVID19 and serve as a potential source of transmitting this infection to their family members. Estimating risk in this population is critical for controlling the rate of secondary attack rate among their families.Objective: To measure the incidence of COVID-19 in nurses and their families with associated risk factors for transmission of infection.Methods: A prospective cohort study was conducted in Akhtar Saeed Medical and Dental college, Lahore and associated three hospitals. A cohort of 176 nurses was identified in March 2020 by using non-probability convenience sampling technique and was followed till September 2021. During this tenure of one and a half year, incidence was observed by following the cohort and using a self-structured questionnaire. With SPSS 23, Chi square test was applied and p value of < 0.05 was considered significant.Results: In a cohort of 176 nurses, followed for one and a half year, incidence of COVID-19 was 37(21%). Secondary attack rate among household members of these nurses was 3%. A significant association was observed between the nursing staff and exposure to their family members (p = 0.002). Vaccination rate in nurses at the start of the study was only 26%. Nurses who worked directly with COVID-19 patients reported high incidence (p = 0.009). Nurses who used Personal protective equipment (PPE) were less affected (p = 0.003). Nurses with comorbidities showed higher incidence (p =0.02). Rate of psychological distress was high (p =0.007).Conclusion: Incidence of COVID-19 among nurses was 21% with secondary attack rate of 3% in families. Protective use of N 95 mask and comorbidities were associated with incidence.

Infection-Induced Immunity Is Associated With Protection Against Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Decreased Infectivity.

BACKGROUND: The impact of infection-induced immunity on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission has not been well established. Here we estimate the effects of prior infection induced immunity in adults and children on SARS-CoV-2 transmission in households. METHODS: We conducted a household cohort study from March 2020-November 2022 in Managua, Nicaragua; following a housheold SARS-CoV-2 infection, household members are closely monitored for infection. We estimate the association of time period, age, symptoms, and prior infection with secondary attack risk. RESULTS: Overall, transmission occurred in 70.2% of households, 40.9% of household contacts were infected, and the secondary attack risk ranged from 8.1% to 13.9% depending on the time period. Symptomatic infected individuals were more infectious (rate ratio [RR] 21.2, 95% confidence interval [CI]: 7.4-60.7) and participants with a prior infection were half as likely to be infected compared to naïve individuals (RR 0.52, 95% CI:.38-.70). In models stratified by age, prior infection was associated with decreased infectivity in adults and adolescents (secondary attack risk [SAR] 12.3, 95% CI: 10.3, 14.8 vs 17.5, 95% CI: 14.8, 20.7). However, although young children were less likely to transmit, neither prior infection nor symptom presentation was associated with infectivity. During the Omicron era, infection-induced immunity remained protective against infection. CONCLUSIONS: Infection-induced immunity is associated with decreased infectivity for adults and adolescents. Although young children are less infectious, prior infection and asymptomatic presentation did not reduce their infectivity as was seen in adults. As SARS-CoV-2 transitions to endemicity, children may become more important in transmission dynamics.

An Overview of Blockchain Technology and Its Adoption in Industry

The development of a cryptocurrency cannot occur without the use of a vital piece of technology known as blockchain. It is a distributed ledger that has progressed to the point where they are now even more applicable and beneficial. This is due to the passage of time and the development of many sectors. These days, blockchain technology is being employed in certain ways throughout all the industries. In this study, each and every significant attribute and weakness is discussed and analyzed. We have also conducted a literature analysis on blockchain-related topics and highlighted some of the most current sectors in which blockchain technology has found the greatest utility. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.