Impact of viral co-infection on clinical outcomes and mortality of COVID-19 patients: a study from Saudi Arabia.

Background: In COVID-19 patients undetected co-infections may have severe clinical implications associated with prolonged hospitalization, ICU admission, and mortality. Therefore, we aimed to investigate the impact of viral coinfections on the outcomes of hospitalized patients with COVID-19 in a large tertiary Saudi Arabian Hospital. Methods: A total of 178 adult patients with confirmed SARS-CoV-2 who were hospitalized at the Armed Forces Hospital Southern Region (AFHSR), Saudi Arabia, from March 1st to June 30th 2022, were enrolled. Real-time PCR for the detection of viral co­infections was carried out. Cases (SARS-CoV-2 with viral coinfections) and control (SARS-CoV-2 mono-infection) groups were compared. Results: 12/178 (7%) of enrolled COVID-19 patients had viral coinfections. 82/178 (46%) of patients were males. 58% of patients had comorbidities. During the study period, 4/12 (33%) and 21/166 (13%) cases and control patients died, p=0.047, respectively. Duration of hospitalization was the only significant independent factor associated with SARS-CoV-2 coinfections, OR 1.140, 95% CI 1.020-1.274, p=0.021. Conclusions: The findings of this study from a large tertiary Saudi Arabian Center revealed a prevalence of 7% for SARS-CoV-2 viral coinfections. SARS-CoV-2 coinfected patients had a significantly prolonged duration of hospitalization and higher mortality than those with SARS-CoV-2 alone. Future studies are needed.

Prophylactic Inferior Vena Cava Filters for Venous Thromboembolism in Adults With Trauma: An Updated Systematic Review and Meta-Analysis.

Background: Trauma is an independent risk factor for venous thromboembolism (VTE). Due to contraindications or delay in starting pharmacological prophylaxis among trauma patients with a high risk of bleeding, the inferior vena cava (IVC) filter has been utilized as alternative prevention for pulmonary embolism (PE). Albeit, its clinical efficacy has remained uncertain. Therefore, we performed an updated systematic review and meta-analysis on the effectiveness and safety of prophylactic IVC filters in severely injured patients. Methods: Three databases (MEDLINE, EMBASE, and Cochrane) were searched from August 1, 2012, to October 27, 2021. Independent reviewers performed data extraction and quality assessment. Relative risk (RR) at 95% confidence interval (CI) pooled in a randomized meta-analysis. A parallel clinical practice guideline committee assessed the certainty of evidence using the GRADE approach. The outcomes of interest included VTE, PE, deep venous thrombosis, mortality, and IVC filter complications. Results: We included 10 controlled studies (47 140 patients), of which 3 studies (310 patients) were randomized controlled trials (RCTs) and 7 were observational studies (46 830 patients). IVC filters demonstrated no significant reduction in PE and fatal PE (RR, 0.27; 95% CI, 0.06-1.28 and RR, 0.32; 95% CI, 0.01-7.84, respectively) by pooling RCTs with low certainty. However, it demonstrated a significant reduction in the risk of PE and fatal PE (RR, 0.25; 95% CI, 0.12-0.55 and RR, 0.09; 95% CI, 0.011-0.81, respectively) by pooling observational studies with very low certainty. IVC filter did not improve mortality in both RCTs and observational studies (RR, 1.44; 95% CI, 0.86-2.43 and RR, 0.63; 95% CI, 0.3-1.31, respectively). Conclusion: In trauma patients, moderate risk reduction of PE and fatal PE was demonstrated among observational data but not RCTs. The desirable effect is not robust to outweigh the undesirable effects associated with IVC filter complications. Current evidence suggests against routinely using prophylactic IVC filters.

Consumer Profile Comparisons: Traditional food local entrepreneurs

The study aims to explore consumer profiles in Sabah and Selangor states. Twenty (20) informants from selected business categories are being identified and interviewed using a semi-structured question and online video and phone recording due to the Covid 19 pandemic. Two (2) themes have been identified: Food category and Business criteria. Under the food category: categories of food and type of food. While under the business criteria: experience, customer, and type of business. Entrepreneurs from both states must adapt to the changes due to the Covid-19 pandemic by implementing new methods to sustain their business life.

Examining Local Traditional Food Entrepreneurs in Selangor and Sabah States during Covid 19 Pandemic

The study aims to explore local entrepreneurs' profile criteria during covid 19 pandemic in Sabah and Selangor states. Two (2) themes have been identified for this study which are 1) Food category and 2) Business criteria. Twenty (20) informants from selected business categories are being identified and interviewed using a semi-structured question and online video and phone recording due to the Covid 19 pandemic. The finding shows that entrepreneurs from both states share similarities in food categories and customer backgrounds. They also implement technology such as online delivery applications to sustain their business during the Covid-19 pandemic.

Recent applications of microfluidic immunosensors

[Display omitted] • Materials have an important effect on the reliability of microfluidic systems. • Magnetic particles are widely used in the fabrication of microfluidics immunosensors. • Near field communication-integrated microfluidics will more use in the future studies. The fast diagnosis of diseases is vital in the early stages of the cure of illnesses. Although conventional procedures have been broadly employed in clinics, newly presented microfluidic microchips are becoming more attractive. The benefits of the new microfluidic system involve more fast diagnosis, the need for low patient samples and reagents, user-friendly application, and high repeatability in the quantification of biomolecules. The primary aim of this review is to offer a summary of the effect of the applied nanomaterials in the fabrication of novel immunosensor-based microfluidic sticks and to carefully explore different applications of microfluidic systems in the determination of bioagents. New kinds of immunosensor-based microfluidic systems for coronavirus disease and HIV are also explored. The next types of biomedical diagnosis will mainly rely on point-of-care (POC) methods, which propose rapid and sensitive detections. However, microfluidic systems propose a high potential to fabricate reliable POC devices. [ FROM AUTHOR] Copyright of Microchemical Journal is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Effets pervers de la COVID-19 sur les soins dans deux hopitaux de reference en Tunisie.

Contexte: Des multiples effets collateraux de la lutte contre la pandemie de COVID-19, sur les systemes de sante ont ete recemment reveles. L'objectif de cette etude est d'evaluer l'impact de la COVID-19 sur la performance des soins dans les hopitaux de 3e ligne, a Sousse (Tunisie). Methodes: Il s'agit d'une etude quasi-experimentale de type avant/apres, durant les trois mois de mars, avril et mai, en 2019 (avant) et en 2020 (apres) dans deux services traceurs de la pratique medicale de reference a Sousse (Tunisie): Chirurgie generale (CHU Sahloul) et Oncologie (CHU Hached). Les urgences abdominales et le cancer du sein ont ete les problemes de sante inclus dans l'audit clinique. L'impact de la COVID-19 a ete evalue a travers les indicateurs d'acces aux soins, de la gravite des maladies et de la flexibilite de l'offre des soins. Resultats: Au total, 196 patients en 2019 et 153 patients en 2020 ont ete inclus. En chirurgie generale, 68,9 % (n=71) des patients ont consulte apres un jour de l'apparition des symptomes en 2020, versus 52,3 % (n=68) en 2019 (p<0,05), avec plus de peritonites : 47,6 % (n=49) versus 30 % (n=39), p<10-2. Au service d'oncologie, le delai median entre le diagnostic et le traitement etait de 3 [2,75-6] mois en 2019 contre 4 [2.5-6] (p=0,61), sans changement des schemas therapeutiques et sans contextualisation. Discussion/Conclusion: La lutte contre la COVID-19 a ete accompagnee de difficultes a l'acces aux soins avec un retard de consultation entrainant des formes cliniquement compliquees. En plus, la faible flexibilite du systeme de soins a adapter l'offre avec les contraintes de la pandemie, a impacte negativement la performance globale de conservation des acquis et de riposte contre les pandemies. D'ou l'urgence de renforcement de la resilience des structures de sante face aux epidemies emergentes. Declaration de liens d'interets: Les auteurs declarent ne pas avoir de liens d'interets.Copyright © 2022

Medical misinformation: A primer and recommendations for pharmacists

Medical misinformation is more pervasive today because of widespread and near instantaneous dissemination of information via the internet and social media platforms. Consequences of medical misinformation may include decreased uptake of needed health care resources, delays in seeking care, vaccine hesitancy, medication non-compliance, increased disease outbreaks and/or burden, and increased hospitalization and mortality. It disproportionately impacts underserved populations, including Black patients, those who identify as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and more), and patients with reduced health literacy skills or who are digitally disadvantaged. Medical misinformation challenges health care professionals not only to provide the best care possible, but to assist patients in finding accurate information. Preprint publications, although potentially beneficial in rapidly disseminating new scientific discoveries, often have not undergone peer review and may contribute to the widespread propagation of inaccurate or overstated results, thereby perpetuating the spread of medical misinformation when it exists. The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of practicing evidence-based medicine and the need for cautious review of preprint publications and articles from predatory publishers in addition to usual and customary literature evaluation techniques. Everyone plays a role in preventing the spread of medical misinformation, with pharmacists uniquely positioned as trusted and highly accessible professionals who may help combat its spread. The goal of this article is to define medical misinformation and related terms, outline mechanisms by which it is spread, describe its clinical impact, highlight how it disproportionately impacts underserved populations, provide actionable strategies to prevent its spread, and give examples of practical tactics to help identify, correct, and alert individuals about the possible presence of medical misinformation.Copyright © 2023 Pharmacotherapy Publications, Inc.

Could biological disease modifying anti rheumatic drugs (bDMARDs) and small molecules have a key role in preventing COVID-19 infection?

Background: The clinical manifestations of COVID-19 infection are very heterogeneous. Rheumatic patients should be more susceptible to develop severe forms of COVID-19 pneumonia due to an unbalanced immune response and treatment immunodepressants (disease modifying anti rheumatic drugs-DMARDs). Aims and objectives: To investigate if the chronic use of biological DMARDs and small molecules may increase the susceptibility to COVID-19 and to developing severe disease. Method(s): We studied 43 consecutive patients on bDMARDs or small molecules from March 2020 to January 2022. Data collection included: rheumatic diagnosis, comorbidities, smoking history and COVID-19 clinical course according to MEWS (modifying early warning score) in 4 stages: 0=no symptoms at all;no hospitalization;1=not complicated disease with mild or non-specific symptoms;no hospitalization;2=mild pneumonia with clinical and/or radiological diagnosis, without any signs of severity;no hospitalization;3=severe pneumonia with respiratory failure with need of hospitalization;4=hospitalization in ICU or sub-ICU. Result(s): 30 patients (69.8%) got COVID infection: 26 were not hospitalized (MEWS 0=3.3%;1=70%;2=13.3%);of the four patients that required hospitalization, none was intubated. Hospitalized patients were obese and had hypertension, and 3 had a positive smoking history. Patients taking TNF-inhibitors compared to other treatment were not at major risk of COVID-19 infection (p=0.041). Conclusion(s): Rheumatic patients taking bDMARDs or small molecules appear more susceptible to contract SARSCoV-2 infection, but the development of severe forms appears to be rare.

Virtual Hands: Real Time Keyboard, Desktop & Application Navigation using Gestures

In computer system keyboard is the most prominent input medium of all time. But lately, human community is living in an era of global pandemic being afraid of suffering from Coronavirus (Covid-19) and hence each and every person avoids touching anything. This is because of the fear of contracting this contagious virus and their mutants. So, to mitigate this issue, we present a method "webcam based virtual keyboard interface"to interact with a computer system. The code of this method is written using pre-built modules like OpenCV, MediaPipe, PyVDA, Win32API, etc. and Python 3.9. This approach uses matching the index finger and middle finger on the specific key. After that the virtual desktop switching mechanism is done by PyVDA. The PyttSX3 library plays the sound whenever any key is pressed or when a desktop switch is initiated, corresponding to the key pressed or the desktop switched. In this approach no additional hardware device other than the webcam, that is already available in the system, is required. This approach is also useful for those persons who wants the access the system, even when their hands are dirty. © 2022 IEEE.

CPAP-associated changes in oxygenation and clinical outcomes in severe COVID-19 pneumonia

Background: Continuous positive airway pressure (CPAP) can improve oxygenation in severe COVID-19 pneumonia. Objective(s): To assess whether CPAP-associated improvements in oxygenation can inform clinical outcomes in patients with severe COVID-19 pneumonia. Method(s): Retrospective study in patients with severe COVID-19 pneumonia treated with CPAP in three academic respiratory units in Milan, Italy. Arterial gas analysis obtained before and 1 hour after starting CPAP. CPAP failure defined as either death in the respiratory units while on CPAP or need for intubation. Result(s): 211 patients (mean age 64 years, 74% males) were included. Baseline median PaO2was 68 (57-83) mmHg, PaO2/FiO2(P/F) ratio was 129 (91-179) mmHg and alveolar-arterial (A-a) O2 gradient was 310 (177-559) mmHg. On CPAP, PaO2and P/F increased to 100 (79-141) (p<0.001) and 195 (132-257;p<0.001) mmHg and A-a gradient decreased to 240 (188-308;p<0.001) mmHg. 42 (19.9%) patients died in the respiratory units while on CPAP and 51 (24.2%) required intubation. There was a substantial overlap of baseline and CPAP-associated values of PaO2, P/F ratio and A-a gradient in CPAP failures and successes (Figure). CPAP-associated changes in PaO2, P/F ratio and A-a gradient in both groups were similar. Conclusion(s): CPAP-associated improvements in oxygenation cannot be used to inform clinical outcomes of the individual patient with severe COVID-19 pneumonia.

Low Back Pain Prevalence among Distance Learning Students.

Background: Low back pain as a symptom affects many individuals around the globe regardless of their economic status or sociodemographic characteristics. During the 2019 COVID-19 pandemic, students found themselves obligated to sit down for long periods of time. The aim of this current study is to investigate the impact of these prolonged periods of sitting down in front of computers on developing a new episode of low back pain. Methods and Materials: This research adopted an observational cross-section study design. Students who are currently enrolled or had experienced distance learning classes in the last 6 months were eligible to participate. An online-based questionnaire was developed by the investigators through reviewing the literature with relevant objectives. McNemar's test was used to compare certain variables between two periods before and during online distance learning. We used paired t-tests to compare pain intensity before, during, and after online learning, while a chi-square test was used to investigate correlations between factors influencing low back pain. Results: A total of 84 students participated in the study­46 (54.8%) females and 38 (45.2%) males. Before online distance learning, only 42.9% of participants reported low back pain, while only 20% had a back injury. The mean pain scores before, during, and after online distance learning were (2.85 ± 2.16, 4.79 ± 2.6, and 4.76 ± 2.7), respectively. The pain scores before online learning were significantly lower than pain scores during and after online distance learning (p < 0.05), respectively. Conclusion: The study findings suggested that low back pain prevalence increased among students during the COVID-19 pandemic. Future research should study participants' behavior during the online learning and assess the long-run impact of distance learning among high-school and undergraduate students.

Development, validation and forced degradation studies of green liquid chromatographic method for determination of remdesivir in bulk drug and pharmaceutical formulation

Remdesivir was recently approved by Food and Drug Administration (FDA) to treat severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease. In this study, we report development of the green and reversed-phase liquid chromatographic method for quantitative determination of remdesivir in pharmaceutical formulations in forced degradation studies using mobile phase consisting of 0.4% trifluoroacetic acid: Acetonitrile with flow rate of 1.0mL min-1. High performance liquid chromatographic stability-indicating procedure was evaluated and impurities were profiled by subjecting the remdesivir under stress conditions i.e. acidic and alkaline hydrolysis, oxidative and thermal degradation. The developed method effectively separated the parent drug response from that of degradation products and it was validated following ICH guidelines within linearity range of 5-50 mu g mL-1 exhibiting correlation coefficient greater than 0.997. At all levels, the %RSD values were less than 2.0 indicating satisfactory precision. Green profile of developed method was evaluated by NEMI and AGREE tools. Comparison of proposed method with already existing chromatographic method was established using analytical eco-scale. The proposed method is eco-friendly and resulted in reliable quantification of remdesivir in dosage formulation and impurity profiling.

Monitoring the Trend of Energy Consumption during the Pandemic

The COVID-19 pandemic had a tremendous impact on socioeconomics and directly impacted the electrical system. In Malaysia, Grid System Operators (GSOs) were found to lack detailed information to differentiate the total energy demand before and during a pandemic. Working from home during the pandemic has changed the way of life and daily energy management methods for the domestic sector. This paper aims to study the national energy demand during the pandemic and then look into domestic energy management. The study included 3 phases. Phase 1 involved the analysis of data from the GSO to identify differences in energy demand before and during the pandemic. Next, in phase 2, a survey will be conducted on the energy management of the domestic sector. Finally, phase 3 involves household energy-saving proposals through examples of structural improvements. During the 2020 Movement Control Order (MCO) in Malaysia, the average total decrease in energy demand compared to 2019 was 15.82%. This high percentage is due to the closure of several economic sectors, such as trade and industry. From the survey, 88 110 respondents reported that domestic electricity bills increased during the MCO. Statistical analysis using ANOVA indicated no significant link between age range and behavior, knowledge, and total bills paid by respondents. Furthermore, this study also suggested structural upgrades incorporating 5-star air conditioning that can save RM389.47 per year, which will take 4.78 years to repay. This study concluded with suggestions on changes that can be implemented to aid homeowners with energy savings. © 2022 IEEE.

Correlation coefficients for T-spherical fuzzy sets and their applications in pattern analysis and multi-attribute decision-making

T-spherical fuzzy set is an effective tool to deal with vagueness and uncertainty in real-life problems, especially in a situation when there are more than two circumstances, like in casting a ballot. The correlation coefficient of T-spherical fuzzy sets is a tool to calculate the association of two T-spherical fuzzy sets. It has several applications in various disciplines like science, management, and engineering. The noticeable applications incorporate pattern analysis, decision-making, medical diagnosis, and clustering. The aim of this article is to introduce some correlation coefficients for T-spherical fuzzy sets with their applications in pattern recognition and decision-making. The under discussion correlation coefficients are far more advantageous than the existing and many other tools used for T-spherical fuzzy sets, because they are used completely and demonstrate the nature as well as the limit of association between two T-spherical fuzzy sets. Further, an application of proposed correlation coefficients in pattern analysis is discussed here. In addition to it, the proposed correlation coefficients are applied to a multi-attribute decision-making problem, in which the selection of a suitable COVID-19 mask is presented. A comparative analysis has also been made to check the effectiveness of the proposed work with the existing correlation coefficients.

Improving social presence in online higher education: Using live virtual classroom to confront learning challenges during COVID-19 pandemic.

The COVID-19 pandemic has compelled practically all higher education institutions to adopt online education tools over the previous 2 years. Online education has a huge potential to supplement or take the place of in-person instruction. However, there are certain drawbacks of online learning, such as the absence of classroom environment interaction and the difficulty in keeping track of students' engagement and participation. In this study, a live virtual classroom was developed to aid students in their learning activities. The effectiveness of these live video classes was reported from both students and instructors, as well as the variables promoting their implementation within higher education institutions. One of the more significant findings to emerge from this study is that the instructors found it convenient, as they could readily check course participants understanding by studying their live video lectures. The second major finding was that students felt satisfaction with online learning while asking questions without interfering with the instructor's presentation. Moreover, peers could also provide them with more expertise. However, the teaching process became dynamic, requiring the educator to pay close attention. The course participants also experienced anxiety when they were in front of other people. Additionally, both the instructor and the students need to be highly self-sufficient in technology.

Oxidative stress and viral Infections: rationale, experiences, and perspectives on N-acetylcysteine.

This article explores current evidence on the role of oxidative stress in viral infections, and on the use of antioxidant drugs as adjunctive treatment. MEDLINE/PubMed was searched for appropriate keywords, and preclinical and clinical studies with reviews were retrieved and examined by authors. Old and current evidence shows that GSH content reduction is the main mechanism of redox imbalance in viral-infected cells. Clinical studies found that GSH levels are depleted in patients with viral infections such as HIV and SARS-CoV. Viral infections activate inflammation through different pathways, and several of these mechanisms are related to oxidative stress. NAC is a precursor of GSH, and many of its intracellular effects are mediated by GSH replenishment, but it also activates some anti-inflammatory mechanisms. NAC has an excellent safety profile and better oral and topical bioavailability than GSH. These characteristics make NAC a suitable option as a repurposed drug. Adjunctive antioxidant treatment may improve the outcomes of antiviral therapies. Current evidence supports the rationale for this practice and some clinical experience showed encouraging results.

Impact of COVID-19 Pandemic Lockdown on the Prognosis, Morbidity, and Mortality of Patients Undergoing Elective and Emergency Abdominal Surgery: A Retrospective Cohort Study in a Tertiary Center, Saudi Arabia.

The SARS-CoV-2 pandemic's main concerns are limiting the spread of infectious diseases and upgrading the delivery of health services, infrastructure, and therapeutic provision. The goal of this retrospective cohort study was to evaluate the emergency experience and delay of elective abdominal surgical intervention at King Abdul-Aziz University Hospital from October 2019 to October 2020, with a focus on post-operative morbidity and mortality before and during the COVID-19 pandemic. This study compares two groups of patients with emergent and elective abdominal surgical procedures between two different periods; the population was divided into two groups: the control group, which included 403 surgical patients, and the lockdown group, which included 253 surgical patients. During the lockdown, surgical activity was reduced by 37.2% (p = 0.014), and patients were more likely to require reoperations and blood transfusions during or after surgery (p= 0.002, 0.021, and 0.018, respectively). During the lockdown period, the average length of stay increased from 3.43 to 5.83 days (p = 0.002), and the patients who developed complications (53.9%) were more than those in the control period (46.1%) (p = 0.001). Our tertiary teaching hospital observed a significant decline in the overall number of surgeries performed during the COVID-19 pandemic and lockdown period. During the lockdown, abdominal surgery was performed only on four patients; they were positive for COVID-19. Three of them underwent exploratory laparotomy; two of the three developed shock post-operative; one patient had colon cancer (ASA score 3), one had colon disease (ASA score 2), and two had perforated bowels (ASA scores 2 and 4, respectively). Two out of four deaths occurred after surgery. Our results showed the impact of the COVID-19 lockdown on surgical care as both 30-day mortality and total morbidity have risen considerably.