Comparison of Different Antiviral Regimens in the Treatment of Patients with Severe COVID-19: A Retrospective Cohort.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes respiratory disorders, with disease severity ranging from asymptomatic to critical manifestations. The current retrospective study compared the efficacies of different antiviral regimens used in patients suffering from severe COVID-19 disease from 19 January 2020 to December 2021 in a single center in Saudi Arabia. In total, 188 patients were enrolled in the current study, including 158 patients treated with different antiviral regimens, and 30 who did not receive any antiviral treatment. Different antiviral regimens, including favipiravir, remdesivir, oseltamivir, favipiravir/remdesivir, and favipiravir/oseltamivir were adopted. The effects of using different antivirals and antibiotics on the survival rate were evaluated, as well as the presence of comorbidities. Among all severely affected patients, 39/188 (20.7%) survived. Both age and comorbidities, including diabetes and hypertension, were significantly correlated with high case fatality following SARS-CoV-2 infection. Remdesivir alone and the combination of favipiravir and remdesivir increased the survival rate. Surprisingly, both imipenem and linezolid helped in the deterioration of disease outcome in the patients. A negative correlation was detected between increased mortality and the use of favipiravir and the use of either imipenem or linezolid. Among the compared antiviral regimens used in the treatment of severe COVID-19, remdesivir was found to be an effective antiviral that reduces COVID-19 case fatality. Antibiotic treatment using imipenem and/or linezolid should be carefully re-evaluated.

The Challenges for Implementation of Policies Causing A Delay in Mass Immunization Against Covid-19: A Cross Sectional Qualitative Study

Objective: To investigate the policy barriers leading to hindrance in mass immunization of Covid-19 in Pakistan. Study design: A cross-sectional qualitative study was Duration of study: study was conducted from October 2021 to April 2022 Place of study: was conducted on 106 individuals at 4 vaccination centers of Lahore, including Expo center, Pakistan Kidney and Liver Institute and research center (PKLI), Lahore Developmental Authority (LDA) sports complex, Railway dispensary Model Town. Methodology: It covered interviews, focus group discussions and filling in of semi- structured questionnaires from the general public visiting the vaccination center. Individual interviews of hospital administrators and focused group interviews of general public visiting various hospitals of Lahore, including Jinnah Hospital, Services hospital, Lady Wallington hospital and University of Lahore Teaching Hospital were also included in this study. The data obtained was transcribed and analyzed by using SPSS software version 21. The theme we chose was Politically Informed Views and the subthemes were common hurdles, common myths, different vaccine brands, lack of awareness and conspiracy theories. Result(s): The results were significant (p<0.05) with the levels of different variables as: Common hurdles 41%;Common myth 25%;Religious Aspects 17%;Different brands 7% ;Lack of awareness 10% respectively. Each variable showed a remarkable difference from considered standard SOPs. Conclusion(s): To increase the vaccination drive, proper implementation of the already established government policies, with better surveillance and monitoring of the vaccine centers is required. Awareness among the general population should also be increased to debunk myths and motivate them. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

Synthesis and Characterization of Silica Coated Magnetite Nanoparticle Clusters for Viral RNA Extraction

Magnetite nanoparticles or iron oxide nanoparticles are the most explored magnetic nanoparticles till recent times, particularly due to their attractive properties for biomedical applications such as viral RNA extraction. The physical and chemical properties of magnetite nanoparticles and their clusters largely depend on the synthesis method and chemical structure. Co-precipitation method was used to synthesize magnetite nanoparticles at varying process parameters. The nanoparticles were coated with silicon-oxide using Stober method at different deposition durations. These particles were characterized by X-Ray Diffraction, Scanning Electron Microscopy, vibrating sample Magnetometer and PCR testing to study the phases formed, morphology, size, magnetic properties and RNA extraction efficiency. The synthesized magnetite nanoparticles were in the range of 10 to 100 nm;suitable for super-para-magnetic behavior. The maximum saturation magnetization achieved for synthesized paramagnetic beads was 56 emu and RNA extraction efficiency was more than 80% as compared to commercial beads. © 2022 Trans Tech Publications Ltd, Switzerland.

RHABDOMYOLYSIS AS A VARIANT OF COVID-19 MYOSITIS

SESSION TITLE: Management of COVID-19-Induced Complications SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Myalgias are one of the most common manifestations of a COVID infection. Myositis is much less reported with the spectrum of presentation ranging from asymptomatic elevation of creatinine kinase (CK) to rhabdomyolysis. Further understanding is required to formulate evidence based protocols for management and prognostication. CASE PRESENTATION: A 25-year-old male smoker, unvaccinated for COVID presented to the hospital with fever, weakness and myalgias and tested positive for COVID. Examination showed mild tenderness in the proximal muscles of the lower extremities. Labs were significant for metabolic acidosis, hypocalcemia, hyperkalemia, acute kidney injury, AST 6178, ALT 1340, CK > 36000 and CPK > 60000 and gross hematuria. Electrolyte abnormalities were corrected and he received aggressive hydration with intravenous fluids containing bicarbonate. Oxygen requirements increased and he received dexamethasone and Baricitinib for COVID. His creatinine continued to increase despite downtrending transaminases and CK. Ultrasound liver was normal. He developed bilateral pleural effusions and mild ascites suspected secondary to volume overload in the setting of acute renal failure. Hemodialysis was initiated and he received a total of 6 sessions of hemodialysis over the next week. Creatinine, BUN and GFR significantly improved. AntiJo1 Ab ordered to rule out polymyositis was negative. Transaminitis and raised CK levels downtrended alongside the COVID inflammatory markers and oxygen requirements as the patient was weaned to room air. DISCUSSION: The spectrum of COVID myositis reported thus far covers asymptomatic elevation of muscle enzymes, myasthenia, paraspinal myositis, dermatomyositis and rhabdomyolysis (1). The pathophysiology of COVID myositis has been hypothesized to be through ACE2 receptor mediated viral entry into muscle fibers leading to activation of innate and adaptive immunity. Other proposed mechanisms include the release of inflammatory cytokines and molecular mimicry with cross reaction of the antiviral antibodies. Myositis was most reported most commonly among males aged 33–87 (1). Symptoms when present include fevers, cough, shortness of breath, myalgias and proximal, lower limb–dominant, acute, and symmetric weakness. Peak CK values as high as 33,000 U/L have been reported (2). In general, patients diagnosed with rhabdomyolysis appear to have negative myositis-specific autoantibodies and higher CK levels than those without, highlighting the need for close monitoring of CK levels. Rhabdomyolysis associated fatality was reported to be as high as 45% (4 of 9 reported) over a short follow-up duration (1). Our case documents a recovery period in days-weeks with hydration and hemodialysis (3). CONCLUSIONS: Areas for exploration include factors predisposing patients to rhabdomyolysis, utility of checking enzyme levels and impact of vaccination on disease severity. Reference #1: Saud A, Naveen R, Aggarwal R, Gupta L. COVID-19 and Myositis: What We Know So Far. Curr Rheumatol Rep. 2021 Jul 3;23(8):63. doi: 10.1007/s11926-021-01023-9. PMID: 34216297;PMCID: PMC8254439. Reference #2: Husain R, Corcuera-Solano I, Dayan E, Jacobi AH, Huang M. Rhabdomyolysis as a manifestation of a severe case of COVID-19: A case report. Radiol Case Rep. 2020 Jul 7;15(9):1633-1637. doi: 10.1016/j.radcr.2020.07.003. PMID: 32690987;PMCID: PMC7340044. Reference #3: Byler J, Harrison R, Fell LL. Rhabdomyolysis Following Recovery from Severe COVID-19: A Case Report. Am J Case Rep. 2021 May 8;22:e931616. doi: 10.12659/AJCR.931616. PMID: 33963170;PMCID: PMC8127859. DISCLOSURES: No relevant relationships by Asim Amjad No relevant relationships by Sarasija Natarajan No relevant relationships by Pius Ochieng No relevant relationships by Yamini Patel

Comparison of Vitamin D, Interleukin-6, and Interleukin-8 Levels in Covid Positive patients with or without Cytokines Storm

Background: Currently world is within the clutches of the coronavirus disease (COVID-19), caused by the SARS-CoV-2 virus, COVID-19 virus has evolved to human-to-human spread . COVID-19 infection can cause fever, fatigue, dry cough, severe pneumonia, respiratory distress syndrome and in some instances death. Release of cytokine is the main process by which COVID-19 affects human system. High level of chemokines and pro-inflammatory cytokines has been observed among the patients with COVID-19. Methodology: 100 COVID-19 positive patients with cytokine storm and100 COVID-19 positive patients without cytokine storm with 18+ age and both gender were included after their formal consent. Interleukin-6, interleukin-8 and Vitamin-D were determined by their respective ELISA kits. SPSS software was applied for statistical analysis. Results: the results of current study showed the raised levels of interleukin-6 and interleukin 8 in case group as compared to controls. Levels of Vit D were compromised in case of Covid patients with cytokine storm than controls respectively. Conclusion: it was concluded that increased oxidative stress and lacking anti-oxidants may add to the development and advancement of cytokine storm in corona virus positive patients.

Efficacy of Prednisolone/Zn Metal Complex and Artemisinin Either Alone or in Combination on Lung Functions after Excessive Exposure to Electronic Cigarettes Aerosol with Assessment of Antibacterial Activity

The use of transition metal complexes as therapeutic compounds has become more and more pronounced. These complexes offer a great diversity of uses in their medicinal applications. Electronic cigarettes (ECs) are an electronic nicotine delivery system that contain aerosol (ECR). The ligation behavior of prednisolone, which is a synthetic steroid that is used to treat allergic diseases and asthma arthritis, and its Zn (II) metal complex were studied and characterized based on elemental analysis, molar conductance, Fourier-transform infrared (FT-IR) spectra, electronic spectra, XRD, scanning electron microscopy (SEM), energy dispersive x-ray (EDX), and transmission electron microscopy (TEM). The FT-IR spectral data revealed that PRD acts as a mono-dentate ligand via oxygen atoms of the carbonyl group. Electronic and FT-IR data revealed that the PRD/Zn (II) metal complexes have square planner geometry. Artemisinin (ART) is the active main constituent of Artemisia annua extract, and it has been demonstrated to exert an excellent antimalarial effect. The experiment was performed on 40 male mice that were divided into the following 7 groups: Control, EC group, PRD/Zn, ART, EC plus PRD/Zn, EC plus ART, and PRD plus combination of PRD/Zn and ART. Serum CRP, IL-6, and antioxidants biomarkers were determined. Pulmonary tissue histology was evaluated. When in combination with Zn administration, PRD showed potent protective effects against pulmonary biochemical alterations induced by ECR and suppressed severe oxidative stress and pulmonary structure alterations. Additionally, PRD/Zn combined with ART prevented any stress on the pulmonary tissues via antioxidant regulation, reducing inflammatory markers CRP and Il-6 and improving antioxidant enzymatic levels more than either PRD or ART alone. Therefore, PRD/Zn combined with ART produced a synergistic effect against any sort of oxidative stress and also improved the histological structure of the lung tissues. These findings are of great importance for saving pulmonary function, especially during pandemic diseases, such as during the COVID-19 pandemic.

Accuracy and perceptions of teledentistry in KSA during the COVID-19 pandemic: A single-centre randomised controlled trial.

Objective: Teledentistry conveniently delivers dental care when in-person visits are restricted, such as during the COVID-19 pandemic. This study aimed to assess Saudi Arabian patients' accuracy, perceptions, knowledge, attitudes, and challenges regarding teledentistry used for diagnosis during the COVID-19 pandemic, as well as its accuracy, versus traditional dental visits. Methods: A single-blind, parallel-group randomised controlled trial design was used. The 70 participants were randomised equally into study and control groups. While the control group waited, the study group received teledentistry diagnoses which were compared with baseline clinical examinations retrieved from the UQU dental hospital, Makkah, KSA. After the intervention was completed, all participants answered a questionnaire. Results: There were no significant differences between the groups in knowledge or attitudes regarding teledentistry. However, study group participants had more favourable experiences with teledentistry. They reported good accuracy with diagnosis and recording of their chief complaints (74.3%), number of missing teeth (74.3%), number of filled teeth (71.4%), and oral hygiene status (65.7%). Additionally, moderate accuracy was reported on recording of health complaints (51.4%) and number of decayed teeth (40.?%). The number of decayed teeth and the decayed, missing, and filled teeth (DMF) index scores reported using teledentistry were significantly (p < 0.05) higher than reported in the baseline examinations. Conclusion: Teledentistry is widely accepted by patients and can be efficient for preliminary examinations, particularly during pandemic lockdowns or in more frequently occurring situations such as severe weather conditions, but subsequent clinical examination is necessary for maximally accurate diagnoses.

Clinical Profile and Demographic Features of COVID-19 Patients in a Tertiary Care Hospital of Pakistan

Background and Objective: The COVID-19 pandemic is an ongoing health challenge for both developed and developing countries worldwide. The epidemiological and clinical features of COVID-19 should be analyzed in our country. The current study aims to evaluate the demographic features and clinical profile of COVID-19 patients ina Tertiary Care Hospital of Rahim Yar Khan, Pakistan. Materials and Methods: This observational, cross-sectional study was conducted on 85 patients with positive real-time reverse transcriptase-polymerase chain reaction (RT-PCR) verified by nasopharyngeal swabs and throat at Covid 19 setup in Sheikh Zayed Hopsital, Rahim Yar Khan, Pakistan for period of six months i.e from September 2020 to February 2021. Institutional consensus protocol and COVID-19 SOPs were followed to investigate each individual. Various parameters such as symptom presentation, demographics' details, ventilator therapy and oxygen required, and co-morbidities were studied. Results: The mean age of the patients was 37.6 +/- 5.7 years with an age range of 15 to 81 years. Of the total 104 patients enrolled, 60 (58%)were male and 44 (42%). The prevalence of COVID-19 caused by contact was 67 (65%).Symptomatic patients out of enrolled were 49 (47.1%). In this study, a significant association was found between severe COVID-19 and parameters such ashypertension and diabetes history, and patients having age above 65 years. Out of 104 COVID-19 positive patients, symptomatic complaints were as follows;Cough 29(27.9%), fever 63 (60.6%), and breathe shortness 12 (11.5%). Tachypnea (RR>24), hypoxia and comorbid illness were found 32 (31%), 27 (25.8%), and 45 (43.2%)respectively. About 19 (18.2%) patients needed intensive care unit admission with 5 (4.8%) required immediate ventilation assistance. Mortality was 3.8% (4 patients) observed in this study. Conclusion: The COVID-19 pandemic mortalityrate is higher among patients above 60 years of age and with comorbidities. The COVID-19 majority of patients presented in our hospital were of young or average age and asymptomatic. Respiratory symptoms were present in half and fever was recorded in more than half patients. Comorbidities patients were more venerableto the COVID_19 complications. Early admission and aggressive treatment must beprovided to COVID-19 patients to help reduce the mortality rate.

Analysing Public Sentiments Regarding COVID-19 Vaccines: A Sentiment Analysis Approach

The COVID-19 pandemic has signified the interconnected nature of our world demonstrating that no one is safe until everyone is safe. The social and economic turmoil caused by the pandemic is devastating and revealing a dramatic loss of human life worldwide and presents a prodigious challenge to food systems, public health, and work worldwide. The vaccination programs are of utmost priority for every institution but there is a clear divide among people on efficacies and application of the offered vaccines. Today, the world has access to high-performance wireless internet due to 5G technologies which can enable systems to fetch billions of records from social media within a blink of an eye. The internet revolution has opened a new door of opportunities. This study aims to come up with a system that can utilize 5G technologies to access the data from social media to create awareness, prevent and control the impact of the pandemic by assessing the people's sentiments towards the COVID vaccines. People's sentiments are classified from not afraid to afraid divulging a total of three classes. The dataset is extracted from Twitter. The study has three main objectives 1) data collection and preprocessing 2) analyzing public sentiments, 3) evaluating the performance of Machine Learning (ML) classifiers. The results show that majority of people belong to the neutral class which indicates that they are still doubtful if they should be vaccinated or not. There is an urgent need for vaccine awareness programs to prevent COVID. © 2021 IEEE.

Clinical outcomes of patients with cancer who tested positive for COVID-19 hospitalised in a UK district general hospital

Background: Individuals diagnosed with cancer have been particularly affected by the COVID-19 pandemic. Most of the relevant information so far has come from tertiary cancer centres and less is known of the outcomes of patients in District General Hospitals (DGH). In this audit, we aimed to investigate the clinical outcomes of patients with cancer who tested positive for COVID-19 and were admitted in a DGH. Methods: Electronic records of patients admitted at Tameside General Hospital (TGH) (>500 beds) between March 2020–March 2021 were reviewed retrospectively. Clinical outcomes of those who tested positive for COVID-19 and factors relating to death were analysed. Cox regression and Kaplan-Meier survival analyses were performed (SPSS v26.0). Results: Within the 12-month study period, there were 2417 inpatients who tested positive for COVID-19 at TGH. Of 235 individual patients with cancer admitted during this period, 14% (n=33) tested positive. Median age was 75 (68;81) years;majority female (67%). The most prevalent primary site of cancer were lung (21%) and breast (12%). Most were ECOG PS 1 (39%) or PS 2 (36%), and had high Charlson Comorbidity Index (median 5 (3;6), range 0-10). 24% of patients were on curative treatment, 39% palliative treatment, 18% best supportive care and 18% not on treatment. Types of treatment included chemotherapy (37%), hormonal treatment (26%), radiotherapy (21%) and immunotherapy (5%). On average, patients were admitted at least once (range 0-4) prior to positive test for COVID-19. At last follow-up, there were n=664/2417 (27%) and n=22/33 (67%) deaths in the non-cancer and cancer patient subgroups, respectively. The median time from diagnosis of COVID-19 to death/censor date was 44 (4;85) days. In univariate Cox regression analysis, only ECOG PS was significantly correlated with death, HR 1.523 (95% CI 1.064-2.181, p=0.022). Conclusions: The outcomes of our cohort of patients with cancer who tested positive for COVID-19 and hospitalised were poor. The high comorbidity burden and poor ECOG PS could potentially account for this rather than the recent oncological treatment. Acute oncology input to general medical teams treating cancer patients with COVID-19 is pivotal for best possible outcomes for patients. Legal entity responsible for the study: Konstantinos Kamposioras. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

The immediate impact of the associated COVID-19's lockdown campaign on the native vegetation recovery of Wadi Al Batin Tri-state desert.

Law enforcement and massive media awareness, limiting the anthropogenic disturbance, is the way to go for implementing successful desert native vegetation recovery plans. A lesson learned on the resiliency of desert ecosystems throughout studying the native vegetation coverage in the Wadi Al-Batin desert ecosystem during the COVID-19 pandemic. Wadi Al-Batin tri-state desert (89,315 km2) covers the South-western part of Iraq, State of Kuwait, and the North-eastern part of Saudi Arabia. In this study, the spatiotemporal changes in vegetation coverage was detected, by using Sentinel-2A imageries, during the period from 2017 to 2020. For better understanding the impact of associated law enforcement and media practices during COVID-19 pandemic, native vegetation coverage of years with relevant rainfall records were compared. The results revealed that despite receiving the least amount of rain of the three years (≤93 mm), the COVID-19 year (2020) had the highest native vegetation coverage at 28.5% compared with 6% in 2017, and 2% in 2018. These results prove that the main drivers of desert vegetation deterioration are anthropogenic activities, such as quarrying, overgrazing, distractive camping, and off-road vehicle movements. Moreover, the estimated 63% vegetation coverage in Wadi Al-Batin desert in 2019 assures the significant role of precipitation in desert vegetation recovery. This bulk increase in vegetation coverage detected during COVID-19 pandemic shows that the desert vegetation adapts to harsh environments (low rainfall) and rapidly recovers once the source of the disturbance was removed by enforcing the environmental rules. Thus, the protection of natural resources and ecosystems can be achieved through the synergy between governments and civil communities, including intensive awareness of environmental impacts via media, enforcing environmental regulations, and promoting regional collaboration.

Clinical, sinonasal, and long-term smell and taste outcomes in mildly symptomatic COVID-19 patients.

INTRODUCTION: Coronavirus 2019 disease (COVID-19) has variable clinical, sinonasal, and smell/taste outcomes. METHODS: Observational study was conducted at a tertiary hospital in Amman, Jordan. Demographic data, clinical presentation and smoking status were collected. Sinonasal symptoms, using Sino-Nasal Outcome Test (SNOT-22) Questionnaire, were evaluated. Smell/taste dysfunction was followed for three months. RESULTS: Ninety-Seven patients had satisfactory responses. Eighty-six patients were symptomatic (41 at presentation, and 45 during admission). Among those patients, 59.3% had cough, 52.3% sore throat and 48.8% fever. The most common initial symptom was sore throat. Shortness of breath and smell/taste dysfunction were significantly higher in females. Surprisingly, shortness of breath was more common in non-smokers. Smell/taste dysfunction affected 25.6% of patients, but was the first symptom in only one patient. Fourteen of 22 symptoms in SNOT-22 had significant increase. The overall average of symptoms scores increased from 0.472 to 1.034, with smell/taste dysfunction to have the most increment. The latter symptom recovered completely in 81% and dysgeusia developed in 9.5% at three months, and it recovered completely in all patients at six months. CONCLUSION: Although COVID-19 may produce severe lower airways disease, it has modest effect on nose and paranasal sinuses. Moreover, smell/taste dysfunction is a prominent symptom, but it usually recovers dramatically.