A Rare Case of Paxlovid-Induced Pancreatitis.

Acute pancreatitis can result secondary to an inflammatory cascade due to an insult to the pancreatic parenchyma, whether it be from infections, medications, etc. We present a case of a 37-year-old male with acute pancreatitis after being started on Paxlovid, a combination drug containing Nirmatrelvir and Ritonavir, for COVID-19 treatment. Multiple reports in the literature have documented such an association between acute pancreatitis and the protease inhibitor Ritonavir. We suspect that similar results may have taken place that link the initiation of this medication with pancreatic inflammation.

Perspective on China's commitment to carbon neutrality under the innovation-energy-emissions nexus

The changing landscape in global geopolitics of energy security coupled with post-COVID slow economic recovery has raised concerns about China's carbon neutrality commitment. This study seeks to answer the role of China's green innovation, renewables, non-renewables, and GDP for CO2 emissions using the novel Quantile Auto-regressive Distributed Lag (QARDL) model over an extended period from 1990 to 2020. The results conclude that green innovation can reduce CO2 emissions by up to three times with a 1:3 ratio while renewable energy sources are able to cut CO2 emissions with a modest rate of return at a 1:0.8 ratio. Similarly, with a 1:3.5 ratio, fossil fuels which still account for more than 83% of total energy consumption are highly emission-intensive. GDP spurs CO2 emissions but at a decreasing rate. In addition, the results also conclude the validation of the EKC hypothesis, meaning that GDP has the potential to offset environmental degradation in both short- and long-run paths. In the current situation, the renewable energy sector is environmentally inefficient and needs policy reforms. Considering the current economic slowdown and potential future challenges to energy security, the country needs to take stringent policy measures to fulfill its existing commitments in self-interest.

Analysis of differential gene expression of pro-inflammatory cytokines in the nasopharyngeal milieu of mild & severe COVID-19 cases.

INTRODUCTION: A subset of individuals with COVID-19 can suffer from a severe form of the disease requiring breathing support for respiratory failure and even death due to disease complications. COVID-19 disease severity can be attributed to numerous factors, where several studies have associated changes in the expression of serum pro-inflammatory cytokines with disease severity. However, very few studies have associated the changes in expression of pro-inflammatory changes in the nasopharyngeal milieu with disease severity. Therefore, in the current study, we performed differential gene expression analysis of various pro-inflammatory cytokines in the nasopharyngeal milieu of mild & severe COVID-19 cases. MATERIAL AND METHOD: For this retrospective, cross-sectional study, a total of 118 nasopharyngeal swab samples, previously collected from mild and severe (based on the WHO criteria) COVID-19 patients were used. A real-time qPCR was performed to determine the viral loads and also evaluate the mRNA expression of eight cytokines (IL-1, IL-2, IL-4, IL-6, IL-10, IFN-γ, TGF-ß1, and TNF-α). Subsequently, an unpaired T-test was applied to compare the statistical difference in mean expression of viral loads and each cytokine between the mild and severe groups, while the Pearson correlation test was applied to establish a correlation between disease severity, viral load, and cytokines expression. Similarly, a multivariable logistic regression analysis was performed to assess the relationship between different variables from the data and disease severity. RESULTS: Out of 118 samples, 71 were mild, while 47 were severe. The mean viral load between the mild and severe groups was comparable (mild group: 27.07± 5.22; severe group: 26.37 ±7.89). The mRNA expression of cytokines IL-2, IL-6, IFN- γ, and TNF-α was significantly different in the two groups (p<0.05), where the Log2 normalized expression of IL-2, IL-6, IFN- γ, and TNF-α was found to be 2.2-, 16-, 2.3-, and 1.73-fold less in the severe group as compared to the mild group. Furthermore, we also observed a significant positive correlation between all the cytokines in the severe group. The multivariate analysis showed a significant relationship between age, IL-6, and disease severity. CONCLUSION: This decreased expression of certain cytokines (IL-2, IL-6, TNF-α, and IFN-γ) in the nasopharyngeal milieu may be considered early biomarkers for disease severity in COVID-19 patients.

Prevalence of acute kidney injury amongst Covid-19 admitted patients in Ribat Teaching Hospital isolation centre: A retrospective cross-sectional study.

Background: Covid-19 sequeale have been a cause of serious health concerns since the start of the Covid-19 pandemic. Studies regarding this are still lacking especially in relation to the prevalence of Covid-19 induced AKI. Therefore, we have aimed to determine the prevalence of AKI amongst Covid-19 hospitalised patients in Ribat isolation centre. Methodology: A cross-sectional retrospective study was conducted in the period from March 2020 to July 2021 in Ribat teaching hospital primary isolation centre which includes admitted Covid-19 induced AKI patients. A total of 333 confirmed Covid-19 patients were tested out of which we analyzed 183 files that fit the criteria of our research. The data was collected from the patients' record files using a checklist. Results: A total of 77 out of 183 patients (42%) of admitted patients were diagnosed with AKI, out of which 35 patients had stage 3 AKI (46%), followed by 28 (36%) and 14 (18%) regarding stage 1 and stage 2 respectively. Furthermore, 57 out of the total 77 (74%) aged 60 years and above. Conclusion: This study substantiates the theory that Covid-19 induces AKI regardless of its severity and the presence of co-morbidities. Additionally, older age (60 years and above) was the most important risk factor associated with it. Furthermore, most cases of Covid-19 induced AKI were stage 3.

Prevalence of acute kidney injury amongst Covid-19 admitted patients in Ribat Teaching Hospital isolation centre: A retrospective cross-sectional study

Background Covid-19 sequeale have been a cause of serious health concerns since the start of the Covid-19 pandemic. Studies regarding this are still lacking especially in relation to the prevalence of Covid-19 induced AKI. Therefore, we have aimed to determine the prevalence of AKI amongst Covid-19 hospitalised patients in Ribat isolation centre. Methodology A cross-sectional retrospective study was conducted in the period from March 2020 to July 2021 in Ribat teaching hospital primary isolation centre which includes admitted Covid-19 induced AKI patients. A total of 333 confirmed Covid-19 patients were tested out of which we analyzed 183 files that fit the criteria of our research. The data was collected from the patients’ record files using a checklist. Results A total of 77 out of 183 patients (42%) of admitted patients were diagnosed with AKI, out of which 35 patients had stage 3 AKI (46%), followed by 28 (36%) and 14 (18%) regarding stage 1 and stage 2 respectively. Furthermore, 57 out of the total 77 (74%) aged 60 years and above. Conclusion This study substantiates the theory that Covid-19 induces AKI regardless of its severity and the presence of co-morbidities. Additionally, older age (60 years and above) was the most important risk factor associated with it. Furthermore, most cases of Covid-19 induced AKI were stage 3

A Case Series of SARS-CoV-2 Omicron Variant in Patients With Acute Leukemia.

Coronavirus disease 2019 (COVID-19) is a respiratory viral illness caused by coronavirus 2 (SARS-CoV-2). The disease often presents with non-specific symptoms, including fever, and fatigue, usually associated with respiratory symptoms (eg., cough) and other systemic involvement. The primary strategy to prevent transmission and reduce the disease severity of the SARS-CoV-2 infection is through vaccination. However, the virus had shown significant changes and mutations that resulted in the emergence of different strains. Each strain varies in its virulence, disease severity, and the body's immune system response. Previous reports showed that the Omicron variant causes mild disease. Little is known about the effect of Omicron in patients with acute leukemia. We present three patients with acute leukemia who had an infection with the Omicron variant of the SARS-CoV-2 virus.

The Pre-Vaccination Donated Blood Is Free from Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) but Is Rich with Anti-SARS-CoV-2 Antibodies: A Cross-Section Saudi Study.

(1) Backgrounds and Objectives: Since its discovery, information about the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has spread rapidly. However, many issues remain unresolved. Coronaviruses are primarily transmitted through respiratory secretions. The possibility of transmission via donated blood transfusion deserves studying. This is the first study in Saudi Arabia to look at pre-vaccination donated blood anti-SARS-CoV-2 antibody content as a marker for virus transmission via viral RNA positive blood and/or the potential therapeutic value of convalescent plasma. (2) Methods: A total of 300 blood samples were sequentially collected from unvaccinated donors who donated blood to the blood bank of Prince Mutaib Bin Abdulaziz Hospital in Sakaka, Al-Jouf, Saudi Arabia. Specific ELISA was used to detect anti-SARS-CoV-2 IgG and IgM antibodies. SARS-CoV-2 was detected using specific real-time reverse-transcription PCR (rRT-PCR). (3) Results: The prevalence of anti-SARS-CoV-2 IgG was low (9%), whereas the prevalence of anti-SARS-CoV-2 IgM was high (65%). Relevant demographics, anthropometrics, and lifestyle factors revealed significant associations (p < 0.05) between IgM-positivity only vs. age (age group 21-30 years), postgraduate education, no history of international travel, IgG-negativity, and absence of experience with COVID-19-like symptoms. Furthermore, there are significant associations (p < 0.05) between IgG-positivity only vs. age (age group 21-30 years), postgraduate education, and being a non-healthcare worker. All donors in the anti-SARS-CoV-2 IgG-positive group (n = 27) had previously experienced symptoms similar to COVID-19 (p < 0.001) and most of them (n = 24) showed anti-SARS-CoV-2 IgM-positive test (p = 0.006). However, all the samples tested negative for SARS-CoV-2 RNA using rRT-PCR. (4) Conclusion: Our findings add to the growing body of evidence that donated blood is safe, with the added benefit of convalescent plasma rich in potentially neutralizing IgG and IgM against SARS-CoV-2.

Tumor Lysis Syndrome in the Chronic Phase of Chronic Myeloid Leukemia Following COVID-19 Infection: A Case Report.

Tumor lysis syndrome (TLS) is a hematological emergency. This syndrome is characterized by metabolic derangements such as hyperkalemia and hypocalcemia, which result from rapid lysis of cells, especially rapidly growing tumors, after the initiation of chemotherapy. It is rarely seen in chronic myeloid leukemia (CML) and has not been previously reported to be triggered by coronavirus disease 2019 (COVID-19) infection. We report a case of a 45-year-old male, a known case of CML in the chronic phase, who presented with fatigue and abdominal pain for four days. Initial laboratory results were consistent with leukocytosis and positive COVID-19 antigen. The patient was started on intravenous fluids and hydroxyurea; however, over the next few days, he deteriorated quickly and developed oliguric acute kidney injury (AKI) with electrolyte disturbance consistent with TLS. The patient was shifted to the intensive care unit and underwent one sustained low-efficiency dialysis (SLED) session and received rasburicase. Over the next few days, the patient started to improve and was discharged in good shape. Although CML rarely presents with TLS, physicians should monitor their patients closely, especially those who have concurrent COVID-19 infection, as this condition may result in lethal sequelae such as AKI, severe arrhythmias, and multiorgan failure. Additionally, early detection and treatment lead to a better prognosis.

Next level of Hospitalisation through Smart ICU

Automation technology is developing intelligent health applications to facilitate patients by providing smart health solution. However, plethora of research is required in the autonomous robotics industry to provide smart solutions to hospitals.Hence, the proposed study aims to develop an intelligent automated infrastructure for hospitals, capable of performing several smart tasks in an Intensive Care Unit (ICU). The developed system will make food and medicine approachable by using a robotic arm on an autonomous robot. Furthermore, robotic arm can be locally controlled by the patient paramedic’s staff. The proposed intelligent robot will monitor patient’s condition by automatically monitoring the vitals conditions such as sleeping, stress, discomfort etc. This proposed system is very useful for diseases where close proximity can spread the disease, such as the covid-19 situation. Moreover, the automation will aid ICU patients by controllable bed functionality supported with patient’s EEG signals or remotely by staff. This research proposed LSTM based neural network for EEG classification and compare the results with other machine learning algorithms. The proposed LSTM network achieve 94% accuracy on self generated dataset. The achieved results are also compared with other machine learning models like SVM and Multilayer Perceptron (MLP). The intelligent navigation feature is also introduced which enables the robot to move autonomously in ICU. In addition to this, it can also establish video conference set up between the patient, staff and family members. The robot can automatically alert the staff in an emergency and assist the patient through an intelligent chatbot.

SARS-CoV-2 Omicron Variant in Patients With Chronic Myeloid Leukemia: A Retrospective Study.

Background and aims Coronavirus disease 2019 (COVID-19) is caused by a virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the first pandemic wave, SARS-CoV-2 had developed significant changes and mutations that resulted in the emergence of different strains. Each strain varies in its virulence and disease severity. Most reports have shown that the Omicron variant causes mild illness. Little is known about the impact of Omicron in patients with chronic myeloid leukemia. We present patients with chronic myeloid leukemia who had infection with the Omicron variant of the SARS-CoV-2 and their outcomes. Materials and methods  Retrospective data from the records of the National Center for Cancer Care and Research from December 20, 2021, to January 30, 2022. Participants were adults over the age of 18 years with Omicron infection who had been diagnosed with chronic myeloid leukemia according to World Health Organization classifications from 2008 and 2016. Results Eleven patients with chronic myeloid leukemia had Omicron infection. All patients had a mild disease according to the World Health Organization classification of COVID-19 severity. The majority of patients were young males.  Conclusions In patients with chronic myeloid leukemia, infection with the Omicron variant of the SARS-CoV-2 usually results in mild disease not requiring hospitalization.

COVID-19 Perceptional Disparity Among Dental Healthcare Personnel at King Faisal University: Applying Health Belief Model.

OBJECTIVES: In Saudi Arabia, more than 100, 000 cases of COVID-19 have been reported, and more than 4,000 in Al Hofuf to date. Dental healthcare personnel are at a higher risk of COVID-19 due to their exposure to saliva, blood, and aerosol/droplet during their daily practice. Their perceptions of COVID-19 drive their behaviors. MATERIALS AND METHODS: A cross-sectional online survey to assess COVID-19 related perceptions and possible disparities between them. STATISTICAL ANALYSIS: Data were analyzed using the Statistical Package for the Social Science, version 23 (IBM SPSS). Descriptive analyses were performed using frequencies and percentages for categorical variables, mean and (± SD) for numerical variables. Bivariate analyses were assessed using t-test and one-way ANOVA, with a 95% confidence interval (CI). RESULTS: With a response of 75% (150), results showed that there were perceptional disparities: students and technical staff perceived more barriers to preventive measures compared to faculties with a mean difference of (-0.145 SD ± 0.580, p = 0.802, CI -1.29 / 1.00 and -2.433, SD ± 0.94, p = 0.010), respectively. This was also shown in threat perception with a mean difference of (2.525, SE ± 0.917, CI 0.71/4.34, p = 0. 0.007). Students perceived more threat than clerks did with a mean difference of (1.281, SE ± 0.569, CI - 0.16 / 2.41, p = 0.026), while clerks perceived less threat than the technical staff with a mean difference of (-2.790, SE ± 0.860, CI -4.49 /-1.09, p = 0.001). CONCLUSIONS: There was a clear disparity in the perceptions among the different categories of participants. More emphasis on the training and preparedness of the dental healthcare personnel is required.

Case Report: COVID-19-Related Pneumothorax-Case Series Highlighting a Significant Complication.

COVID-19 is a recent outbreak in China and rapidly spread worldwide. Lung consolidation is the most common radiologic finding of COVID-19 pneumonia. Pneumothorax has been rarely reported as a complication of severe COVID-19 pneumonia. Early recognition and management are detrimental to the outcome. We here report three cases of SARS-CoV-2 infection complicated by pneumothorax. In addition, we present a brief literature review.

Acute abdomen -like-presentation associated with SARS-CoV-2 infection.

As the cases of COVID-19 are flooding around the world, atypical presentations are being recognized, making the diagnosis challenging. Gastrointestinal symptoms and mild abdominal pain are common. However, severe abdominal pain associated with COVID-19 warranting surgical evaluation has been rarely described; recognizing such presentations and differentiating them from a surgical abdomen is critical to effectively and safely manage COVID-19 patients. Here we present a case of a middle-aged gentleman who developed features resembling secondary peritonitis. Eventually, he was found to have COVID-19 and was managed conservatively. In this report, we discuss his management course, and we explore pertinent relevant literature.

Case Report: COVID-19 Masquerading as an Acute Surgical Abdomen.

SARS-CoV-2 infection can present with various clinical features, among which gastrointestinal manifestations such as nausea, diarrhea, vomiting, and mild abdominal pain have been reported. Recognition of rare presentations of SARS-CoV-2 infection has increased over time. These atypical and rare presentations may lead to difficulties in establishing the diagnosis in a timely manner; furthermore, they may lead to unnecessary investigations, extended hospital stays, adverse outcomes, and more strain on healthcare resources. We present three cases admitted to our hospital with a picture that mimicked an acute abdomen, necessitating surgical assessment and evaluation. All cases turned out to be SARS-CoV-2 positive and did not require surgical management. We discuss the management course, highlight the importance of abdominal symptoms in the setting of COVID-19, and discuss the implications of this association for medical practice amid the current pandemic in both resource-rich and resource-limited settings.