Drug Repurposing in COVID-19 and Cancer: How Far Have We Come?

Drug repurposing is a strategy for ascertaining new implications for already approved drugs. Historically, this field started with the serendipitous and inadvertent findings of a drug that was found to have an effect other than its original indication that was previously unrecognized and that had potential application in an entirely different disease. The fact that the rate of failure associated with the development of new drugs is high and the funds needed are enormous, it has compelled the scientific fraternity to look for alternatives and thus the drug repurposing approach has gained traction in the scientific community. The havoc that COVID-19 wreaked is unprecedented and till date it has led to the death of around 5.7 million people worldwide. The scientific fraternity, the world over, has embarked on the journey of getting a sure shot treatment for this deadly disease and till date many studies have been published discussing the role of various repurposed drug candidates in COVID-19 treatment. A majority of these studies have been carried out using structural bioinformatics and have not been validated by in vitro experiments. There is a pressing need for the treatment of COVID-19 disease using repurposed drugs by experimental validation and clinical testing, and augmented by the modern Machine Learning (ML)-and Artificial Intelligence (AI)-based approaches. A number of drug candidates have been investigated for their potential applications in cancer therapy, however the conundrum about the utility of either repurposed drug candidates or only active anti-cancer drugs for cancer therapy is to be pursued thoroughly so that mankind gets the most out of whatever potential the drug candidates, whether old or new, have in store for us. This chapter discusses the utility of drug repurposing approach as an alternative strategy for drug discovery that is intended to find treatment for new and emerging infectious diseases, viz. COVID-19 and cancer. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023.

Medical Students' Perceptions Towards Online Teaching During the Covid-19 Pandemic: A Cross-Sectional Study from Saudi Arabia

Background The Covid-19 has made a huge impact on higher education. Online teaching and learning became essential to deliver educational activities in all areas including medical education. In this study, we aimed to investigate medical students' perceptions on the role of online teaching and learning in facilitating medical education. Material and Methods A cross-sectional study using a self-administered online questionnaire was conducted. Students eligible were medical students across all years at Imam Abdulrahman Bin Faisal University, Saudi Arabia. Perceptions analysis was conducted using SPSS software. Results A total of 563 students participated in the study (prominent category female 64%, n = 361). There was a significant increase in the number of hours devoted to online learning during the pandemic. Live lectures/tutorials platform via zoom showed the highest rate of interaction compared to pre-recorded lectures and learning materials uploaded on blackboard. 50% of the students disagreed that online teaching is as effective as face-to-face teaching. The greatest perceived enjoyable aspect included the online accessibility of materials. Whereas the most frequent perceived barrier to online learning included internet connection. 17% of students reflected a poor understanding of scientific materials through online PBL. More than 50% of students revealed that online theoretical lectures are as good as classroom or better. Whereas the majority (70%) were unable to learn clinical skills online. The results indicated high impact on students' physical activities (80%). Impacts were higher on pre-clinical students' health and social life than on clinical students. Conclusion Our findings reported that during emergency situations due to the pandemic, online teaching enables the continuity of medical education and provides adequate efficiency. The use of live online platforms showed high level of interaction. However, some barriers need to be addressed especially at the clinical skills development level to maximize the benefit of online teaching and learning.

Quality of sleep in Tunisian patients with Multiple Sclerosis during the COVID-19 pandemic

Introduction: COVID-19 pandemic has affected human communities around the world, and there is fear that people with chronic diseases such as Multiple sclerosis(MS) are more vulnerable to negative psychological effects. Objective(s): The aim of the present study was to assess the quality of sleep in patients with (MS) in comparison with healthy controls(HCs), during the COVID-19 pandemic and to identify its associated factors. Method(s): This was a cross-sectional survey study conducted with patients followed at the neurology department of Hbib bourguiba university hospital in sfax(Tunisia), during the month of november2020. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index(PSQI). The PSQI is a questionnaire assessing participants' sleep quality, sleep duration, and sleep disturbances and their severity during the past month.Participants with a PSQI <=5 are classified as 'good sleepers'. Result(s): Fifty two patients were included in the study. The mean age was 33.69 years(SD=9.21 years)and the sex ratio(F/H)was 4.77. Overall, our patients had higher scores of(PSQI)compared to HC and these differences were statistically significant(p < 0.05). The mean score of(PSQI)was 11.04(SD=3.003)and 11.53%were classified as 'good sleepers'. Unemployment was related to a poor sleep quality(p=0.0001). Patients with high EDSS(r=0.7;p=0.0001), high number of relapses(r=0.58 ;p=0.0001)were more likely to have sleep disturbance. There was a positive correlation between a poor sleep quality and the duration of disease(r=0.38;p=0.005). Conclusion(s): We identified that during the COVID-19pandemic patients with(MS)had a worse sleep quality. The COVID- 19pandemic poses a challenge to psychological resilience. More studies are warranted to better understand the long-term consequences of the pandemic on mental health of vulnerable people.

Neutrophil-to-lymphocyte ratio on admission to predict mortality of COVID-19 patients admitted to the emergency department

Introduction: COVID-19 is a pandemic declared in 2020, the gravity of which lies in the risk of developing a cascade of complications in 20% of cases, which can lead to death. These complications result from an inadequate immuno-inflammatory reaction. Several factors are predictive of severe forms and death. Taking into account these predictive markers will allow the classification of patients with COVID-19 and their optimal management. The aim of our study was to investigate the value of neutrophil-lymphocyte ratio (NLR) in predicting mortality of COVID-19 patients hospitalized in the emergency department of Mahdia. Methods: A retrospective cohort study including patients over 18 years old hospitalized in the emergency department with COVID 19 confirmed by either RT-PCR and or SARS-COV-2 Rapid Antigen Test, over a period of 9 months from September 2020 to May 2021. The parameters collected were: demographic, clinical, biological characteristics as well as patient outcome and hospital mortality. The NLR was calculated for all patients. Results: A total of 454 patients were included, the mean age of the patients was 67 years (SD ± 14), the sex ratio (M/W) was 1.11. In-hospital mortality was 34% (155 patients). On-admission NLR levels were significantly higher in the non-survivor group 14.4 (SD ± 15.0) compared to the survivor group 9.7 (SD ± 9.6) (p = 0.001). Although NLR differed significantly between the survivor and non-survivor groups, this ratio was not identified as a predictor of mortality in COVID-19 lung disease as the informational index study showed low sensitivity and specificity. Conclusions: Our study showed that on-admission neutrophil-lymphocyte ratio (NLR) was statistically higher in non-survivors patients, however we did not find a cut-off value that could discriminate between surviving and non-surviving patients with acceptable statistical significance.

Descriptive epidemiology of COVID-19 death cases reported at the emergency department Taher Sfar Mahdia

Introduction: The Coronavirus disease 2019 (COVID-19) is a pandemic responsible for 3 million deaths worldwide according to the World Health Organization (WHO) hence considered as a “ global health emergency”. The aim of the present study was to describe the demographic characteristics, clinical presentation, of COVID-19 death cases in the emergency department Taher Sfar Mahdia. Methods: We did a retrospective study over a period of 1 year, from August 2020 to August 2021, carried out at Taher Sfar Mahdia hospital, in the Emergency Department, on patients over 18 years old with COVID 19 confirmed by either RT-PCR and or SARS-COV-2 rapid antigen test and dead in emergency room. Results: A total of 976 cases were detected over the study period including 308 (29,9%) COVID-19 deaths among them dead in emergency department. The median age of those patients was 76 years [IQR 69-83]. The sex ratio (M / W) was 1.3. 57 (56%) patients had at least one comorbidity mainly arterial hypertension (57%) followed by diabetes (38%). The median time from symptoms onset to patient's admission was 5 days [IQR 4-10], they had a median SpO2 of 81% [IQR 75%-88. While their hospitalization, these patients required high flows of O2, mainly HCM: 148 (48%);NIV 49 (15%) and MV 101 (33%). The median length of stay was 4 days [IQR 2-7]. Conclusions: This descriptive retrospective study shows also a high mortality rate in the emergency department. These deaths could be avoided if the intensive care department accepted them, but the advanced age, several comorbidities, a severe clinical form were the reasons why the medical resuscitation department refused to take them in charge preferring to save the few places they have for patients with better prognosis.