CriSPR as a novel technique for COVID-19 diagnosis: a review

To this moment, the human coronavirus disease COVID-19 that occurs as a result of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is still a critical case that provokes concern around the world. In January 2022, there were over 300 million infections and over 5 million fatalities from COVID-19. As a countermeasure against this rapid spread, there is a vital need for effective and low-cost diagnosis methods in order to control the danger of this pandemic. CRISPR technology has proved its ef-ficiency in detecting COVID-19 due to its simplicity, specificity and high sensitivity. This paper reviews the state-of-the-art of developing the CRISPR platforms for the purpose of COVID-19 diagnosis and treatment. Limitations and challenges of CRISPR in terms of nucleic acid analytical methods for viral infection diagnosis are discussed. © 2023, Palladin Institute of Biochemistry of the NASU. All rights reserved.

Oil Exports, Political Issues, and Stock Market Nexus

This study investigates the influence of oil export and political issues on Iraq's stock exchange using various Ordinary Least Square regression models. The empirical results show that the model's effect is not similar based on the explanatory variables included, such as the Covid-19 outbreak, financial crisis, parliament elections, and ISIS emergence are not significant. In contrast, the internal conflict, oil export, and oil prices are substantial effects on the index of the Iraq stock exchange from (2004 to 2021);researchers in the literature have neglected this market due to its novel establishment after (2003). Moreover, the market capitalization still considers very small compared to the regional financial markets. The study contributes to the existing knowledge because most studies on stock market determinants consider political, economic, democratic, or governmental factors. In contrast, here, most elements included using new measurements, such as the internal conflict by cutting off the financial share of the Kurdistan region from the central state budget. Finally, the analysis incorporates the conclusions with straightforward suggestions that policymakers can use, government, investors, and supervisors to control the stock market risk. © Econjournals.

Comparison of Different Treatment Strategies Combating COVID-19 in Pakistan

Objective: To compare different treatment strategies for patients of COVID-19 in Pakistan. Study Design: Retrospective longitudinal study. Place and Duration of Study: Abbas Medical Hospital, Muzaffarabad Pakistan, during Apr 2021. Methodology: One hundred and twenty, COVID-19-positive patients between 31-45 years of age were admitted to Abbas hospital after carrying out the rRT-PCR test. Group-A was administered Azithromycin, while Group-B was treated with Azithromycin in combination with Hydroxychloroquine. Group-C was given a combination of oral Ivermectin and Doxycy-cline, and Group-D was treated with Lopinavir. Diagnostic tests include rRT-PCR, blood parameters such as creatinine, random blood sugar, alanine aminotransferase, complete blood count, ECG, chest x-ray and blood biomarkers including procalcitonin, C-reactive protein, lactate dehydrogenase and ferritin were performed at Day 1, 5, 7, 14 and 30. Results: Patients treated with Azithromycin revealed the highest recovery of about (77.80%) among COVID-19 patients, followed by the combination of Azithromycin and Hydroxychloroquine which was (65.56%), the combination of Ivermectin and Doxycycline was (19.63%), and Lopinavir was (9.06%) displayed minimum potency in recovering the COVID-19 positive patients (p-value <0.001). Conclusions: Azithromycin was most effective in helping patients recover from COVID-19, followed by a combination of azithromycin and Hydroxychloroquine. Patients who recovered after treatment with Ivermectin Doxycycline were lower, followed by those who recovered with Lopinavir only. © 2022, Army Medical College. All rights reserved.

termination of xanthine, hypoxanthine and c- reactive protein in the serum of patients of coronavirus and patients vaccinated with fizer

Background: The coronavirus associated with severe acute respiratory syndrome type 2 causes Coronavirus disease 2019 (COVID-19) (SARS-CoV-2). Xanthine is a purine nucleotide that is found in the majority of human tissues and fluids, as well as other biota. Hypoxanthine is a purine derivative that occurs naturally. C-reactive protein (CRP) is an annular (ring-shaped) pentameric protein that is detected in blood plasma and whose circulating levels increase in response to inflammation. The aim of the current study is evaluation of serum (Xanthine, Hypoxanthine, and C-RP) patients of COVID-19 (vaccinated and unvaccinated) with P-fizer vaccine.Methods: The study was done in Babylon University/College of Science. Study continued five months from 3-1 to 3-5 - 2022.. 150 samples of blood were obtained from three groups.50 blood samples were obtained from healthy people (group I), 50 blood samples were drawn from COVID-19 patients unvaccinated (group II), and 50 samples were obtained from COVID-19 patients vaccinated with P-fizer (group III). The target parameters were (Xanthine, Hypoxanthine, and C-RP). (Xanthine and Hypoxanthine) were measured by HPLC instruments. C-RP was measured by the ichroma instrument.Results: The result showed age was shown to be not significant between groups. Xanthine showed a significant increase in the non-vaccinated group of patients compared to the rest of the groups, where it was 2.16 ± 0.02, While in the vaccinated group, it was 0.68 ± 0.01. Hypoxanthine also showed a significant increase in unvaccinated patients. CRP showed a significant increase in unvaccinated patients.Conclusion: The current study concluded that the Pfizer vaccine had an effect on (Xanthine, Hypoxanthine,C-reactive protein (CRP)) concentrations for the better in the vaccinated group of patients. © 2022, ResearchTrentz Academy Publishing Education Services. All rights reserved.

Social Support in the Times of Social Distancing: Learnings from the South Asian Context

This study will examine the relationship between social support from the work and family domains, referred to as multiple social network ties (MSNT), and employees' job and family-related performance outcomes during the COVID-19 crisis. The study also demonstrates the importance of employees' work-family balance (WFB) in moderating the association between MSNT and job and family-related performance. A two-wave design was used to collect data from 320 managerial level personnel in Pakistan's textile sector. The path analysis technique of structural equation modelling (SEM) was used to analyze the responses. In times of crisis, social support mechanisms could potentially replace organizational support mechanisms for employees dealing with work and family obligations, according to the study. The findings of this study show that work-family balance is a significant partial mediator between MSNT and employees' job and familyrelated outcomes during the COVID-19 pandemic, according to a best-fit model. This research supports the pragmatic view of MSNT's action mechanism in generating jobs for employees and family-related results, especially in uncertain situations. According to the findings, employees who have a positive work-life balance are happier and more productive in both work and personal life. It has major implications for human resource management (HRM) research and practice.

Risk factors for development of covid associated pulmonary aspergillosis in ICU population. An observational study from a large tertiary care hospital

Background: Covid associated pulmonary aspergillosis is a serious life-threatening infection which is increasingly being identified in severe covid pneumonia. There are multiple factors which predispose to this infection, still lot of research is needed to explore more about this infection Objective: Our aim of study was to find out risk factors associated with development of CAPA in severe covid pneumonia. Materials and methods: We prospectively enrolled 698 cases of severe covid pneumonia and aimed to identify risk factors associated with development of CAPA. We included only those who were PCR confirmed cases severe covid pneumonia requiring ICU admission with at least 48 hours of ICU stay. Infectious disease experts decided candidacy of Tocilizumab. CAPA cases were diagnosed according to ISHAM criteria for diagnosis of CAPA. Results: Out of 678 participants, 17.4% developed CAPA. Out of 17.4% cases of CAPA, 83.9% did not survive. Median ICU stay was 10 days. NUTRIC score and ICU days were identified as statistically significant risk factors for CAPA (OR: 2.1,1.2 p= 0.006, <0.001). Median NUTRIC score was 3. Tocilizumab prevents development of CAPA (OR: 0.09, p=< 0f.001). Conclusion: We concluded that NUTRIC score and ICU days are predisposing factors for CAPA in severe covid pneumonia. Tocilizumab has role in reducing CAPA infection in severe covid pneumonia.

Attention based Covid-19 Detection using Generative Adversarial Network

The novel Coronavirus Disease 2019 (nCOVID-19) pandemic is a global health challenge, that requires collaborative efforts from multiple research communities. Effective screening of infected patients is a significant step in the fight against COVID-19, as radiological examination being an important screening methods. Early findings reveal that anomalies in chest X-rays of COVID-19 patients exist. As a result, a number of deep learning methods have been developed, and studies have shown that the accuracy of COVID-19 patient recognition using chest X-rays is very high. In this paper, we propose an attention based deep neural network for classifying the COVID-19 images, and extracting useful clinical information. Generative adversarial network is used to generate the synthetic COVID-19 images, as well as a good latent representation of both COVID-19 and normal images. Experiment results on public datasets shows the effectiveness of the proposed approach. © 2021 IEEE.

Ischemic Priapism Progressing to Penile Gangrene in a Patient with COVID-19 Infection: A Case Report with Literature Review

Priapism is considered a rare disorder and even more rare when it occurs as a complication of COVID-19. To the best of our knowledge, only eight studies have reported priapism as a complication of COVID-19. Here, we report the case of a 66-year-old male with COVID-19 who presented with neglected priapism for three days. On local examination, penile erection was apparent in association with blackened areas on the glans penis extending to the midpenile shaft denoting penile gangrene. A clear line of demarcation was noticed at the midpenile shaft. Penile duplex was performed, showing no blood flow in both cavernosal arteries. Penile aspiration was performed, and the cavernosal blood sample showed evidence of ischemic priapism. Given the presence of penile gangrene extending to the midshaft of the penis and the poor general condition of the patient, the decision was made to perform partial penectomy and suprapubic tube placement. We recommend the establishment of a guideline for the diagnosis and prevention of thrombotic diseases in patients with COVID-19 infection as there is increasing evidence of COVID-19-related thrombotic manifestations.

Non-Invasive Ventilation versus Invasive Mechanical Ventilation: Results from a Tertiary Care Hospital

Objective: To compare the patient outcome in severe COVID-19 pneumonia between the non-invasive ventilation and invasive mechanical ventilation. Study design: Prospective, observational study Study Setting and Duration: Department of Pulmonology, Bahawal Victoria Hospital, Bahawalpur from January 2021 to June 2021. Methodology: We analyzed 660 patients of severe covid pneumonia. Conscious proning was done in those requiring ≥ 21 L oxygen and oxygen saturation < 90%. We defined typical ARDS according to Berlin criteria. Atypical ARDS did not fulfill set criteria. We divided ARDS into 2 types i-e H and L type. We managed ARDS with either NIV, invasive mechanical ventilation or both. We used multiple regression analysis to predict ICU stay. Results: Out of 660 patients, 285 (43.18%) developed biPAP failure and were subsequently intubated. We observed 273 (41.4%) overall mortality, 175 (64.1%) in IMV and 98 (35.9%) in the NIV group (p<0.0001). invasive mechanical ventilation had statistically significant correlation with mortality and also predicted ICU stay. (p=< 0.001, OR 3.2, p=0.001). Conclusion: NIV therapy is superior to invasive mechanical ventilation in terms of ICU stay and outcome.

Challenges Faced by University Students in Online Education During Covid-19

This study aims to identify the issues and challenges faced by university students in online education during COVID-19.It includes all the hurdles faced by the students during the lockdown of this pandemic. The major objectives of the study were, to identify the difficulties faced by higher education students because of converting from the traditional mode to an online system and to recognize the weaknesses and drawbacks of the limited internet and technology resources available in Pakistan for the online education system. This study was descriptive in nature, and a survey method was used for the purpose of data collection. A self-developed questionnaire was prepared for the students by using a convenient sampling technique, and the sample size was 414. Significant findings of study were, most of the students faced problems while attending online classes at home, such as: most students do not know how to operate Zoom LMS, the students find difficulty in contacting their teachers for clarification of their concepts, and they feel more disciplined in attending classes physically. The major recommendations of the study were that university teachers should teach the students about learning through digital media, should also use modern technology for delivering their lectures, and that the government should educate the teachers about different means of teaching effectively through online classes. © 2022, International Journal of Special Education. All rights reserved.

Integrated Safety Analysis of Abrocitinib for the Treatment of Moderate-to-Severe Atopic Dermatitis From the Phase II and Phase III Clinical Trial Program.

BACKGROUND: Pivotal phase III studies demonstrated that abrocitinib, an oral, once-daily, JAK1-selective inhibitor, is effective treatment for moderate-to-severe atopic dermatitis (AD) as monotherapy and in combination with topical therapy. OBJECTIVE: The aim of this study was to evaluate the long-term safety of abrocitinib 200 mg and 100 mg in an integrated analysis of a phase IIb study, four phase III studies, and one long-term extension study. METHODS: Two cohorts were analyzed: a placebo-controlled cohort from 12- to 16-week studies and an all-abrocitinib cohort including patients who received one or more abrocitinib doses. Adverse events (AEs) of interest and laboratory data are reported. RESULTS: Total exposure in the all-abrocitinib cohort (n = 2856) was 1614 patient-years (PY); exposure was ≥ 24 weeks in 1248 patients and ≥ 48 weeks in 606 (maximum 108 weeks). In the placebo-controlled cohort (n = 1540), dose-related AEs (200 mg, 100 mg, placebo) were nausea (14.6%, 6.1%, 2.0%), headache (7.8%, 5.9%, 3.5%), and acne (4.7%, 1.6%, 0%). Platelet count was reduced transiently in a dose-dependent manner; 2/2718 patients (200-mg group) had confirmed platelet counts of < 50 × 103/mm3 at week 4. Incidence rates (IRs) were 2.33/100PY and 2.65/100 PY for serious infection, 4.34/100PY and 2.04/100PY for herpes zoster, and 11.83/100PY and 8.73/100PY for herpes simplex in the 200-mg and 100-mg groups, respectively. IRs for nonmelanoma skin cancer, other malignancies, and major adverse cardiovascular events were < 0.5/100PY for both doses. Five venous thromboembolism events occurred (IR 0.30/100PY), all in the 200-mg group. There were three deaths due to gastric carcinoma (diagnosed at day 43), sudden death, and COVID-19. CONCLUSION: Abrocitinib, with proper patient and dose selection, has a manageable tolerability and longer-term safety profile appropriate for long-term use in patients with moderate-to-severe AD. TRIAL REGISTRIES: ClinicalTrials.gov: NCT02780167, NCT03349060, NCT03575871, NCT03720470, NCT03627767, NCT03422822.

Can disseminated intravascular coagulation scores predict mortality in COVID-19 patients?

OBJECTIVES: Complications related to coronavirus disease 2019 (COVID-19) may lead to disseminated intravascular coagulation (DIC), which has been reported to be among the known causes of mortality in such patients. This study aims to analyse the incidence of DIC in COVID-19 non-survivors and to assess the association between DIC and its comorbidities. METHODS: The medical records of 154 non-survivors of COVID-19, hospitalised between April 2020 and July 2020, were retrospectively analysed. The International Society on Thrombosis and Haemostasis (ISTH) criteria for DIC were applied to identify the occurrence of coagulopathy. The receiver-operating characteristic (ROC) analysis was used to assess the association between DIC and its comorbidities. RESULTS: Out of 154 non-survivors, non-overt DIC was observed in 94.8% of the patients, whereas only 5.2% fulfilled the overt criteria of DIC with a mean age 64.6 years. The mortality rate was 4.5 times higher among men than women. The D-dimer level was >250 ng/ml in 68.8% of the patients including 88.9% of the non-overt and 100% of the overt DIC patients. Prothrombin time (PT) in non-overt and overt DIC cases was 17.3 s and 24.4 s, respectively. Thrombotic event and chronic kidney disease were found to be the main predictors of DIC (p < 0.0001 and 0.03, respectively) followed by diabetes mellitus (DM) and hypertension (statistically insignificant). CONCLUSIONS: Our study concludes that the ISTH DIC score cannot predict mortality as the COVID-19 related DIC differs from the sepsis-induced DIC. Among the seriously ill, older patients with comorbidities, increased levels of D-dimer and prolonged PT are more reliable parameters among COVID-19 non-survivors.

Lung cancer referrals: The impact of the coronavirus pandemic

Introduction: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has been declared a global pandemic.1 A national lock-down was announced in the UK from 23rd March 2020, with a public health campaign encouraging patients to stay home. Healthcare services, including the NHS, had to urgently adapt to the demands of COVID-19, with changes in primary and secondary care. At our hospital trust we have reviewed the referrals to our lung cancer services during the pandemic. Suspected lung cancers in the community are referred using the cancer 2-week pathway. Survival estimates for lung cancer are poor compared to most other primary cancers and NICE advocates for quick referral to a specialist for patients whom lung cancer is suspected 2. We have looked at the impact of the pandemic on the referrals to our services. Method: We have reviewed the referrals to lung cancer services, via the lung cancer 2-week pathway at our hosptial trust, between the same periods in 2019 and 2020. Results: There has been a noticeable reduction in the number of referrals to the lung cancer services from the 23rd March, in comparison to same period in 2019 (see graph 1). Between weeks 13 and 19 of 2020 there was a 56.85% reduction in the number of referrals made compared to 2019. Conclusion: There are several likely reasons for the reduction in referral rate shown, including the nationwide advice to 'stay home to protect the NHS', changes to service provision and alterations to clinical set-ups. Timely referral of patients to lung cancer services and prompt diagnosis are essential, directly relating to lung cancer outcomes. We all, therfore, have a responsibility to ensure we learn from the COVID-19 pandemic, to help develop robust services, on top of appropriate clinical awareness, ensuring essential medical services can be provided irrespective of other pressures on the NHS.

Self-isolation during the COVID-19 pandemic is associated with increased risk of burnout among physician trainees: A cross sectional study

The COVID-19 pandemic emerged in late 2019. Previous research has shown a significant prevalence of burnout among physician trainees, with concern that the pandemic will increase burnout. We aimed to assess this risk among trainees at a large academic hospital. We performed a cross-sectional study during the pandemic using a survey that included the Maslach Burnout Inventory. The response rate was 94.7%. Among trainees, 58.5% changed their living arrangements to protect family. Psychological wellbeing was negatively affected in 81.7% and clinical performance in 64.3%;13.8% were at high risk of burnout. Emotional exhaustion (EE) scores were high in 50% and depersonalization (DP) scores in 28.8%;a sense of personal accomplishment was low in 41.9%. Increased risk of burnout was associated with male gender and increased exposure to suspected COVID-19 cases. Risk of high EE correlated with an increased number of children and risk of high DP with male gender. High EE and DP score correlated with increased exposure to suspected and confirmed COVID-19 patients. Trainees who self-isolated to protect family were more likely to experience high DP and burnout. Trainees in surgical specialties were more likely to feel their clinical performance was negatively affected. The results suggest that a significant percentage of trainees are at high risk of burnout during the pandemic especially those that attempted self-isolation. Training programs should incorporate methods to maintain well-being and coping, including adequate time off between shifts. Future research should evaluate other aspects of trainee well-being in relation to self-isolation and/or changed living arrangements.

Operating Facilities:- Suggested Guidelines to Cope COVID-19 in Third World Countries

The whole world is passing through an unprecedented time during the pandemic of COVID-19. COVID-19 has affected all of medical practices in relation to patient management, availability of resources, logistics, safety and protection of healthcare workers and off course emergency management of healthcare facilities. Although surgeons are not frontline workers but provision of emergency and urgent surgeries without knowing status of patient in relation to COVID-19 put the surgical team at risk. Moreover our operative healthcare settings are not designed to deal with paradigm of COVID 19. We are living in a 3rd world country. Our resources are scarce and our theater settings are not up to mark. This article deals with suggested changes in already existing theater facilities or creating new facilities to come up with new requirement of COVID-19.

Transfusion practices during the COVID-19 pandemic: An experience from a hematology daycare in India.

The Coronavirus disease-19 (COVID-19) pandemic has in multiple ways affected healthcare delivery to non-COVID patients throughout the world. Adequate transfusion services are fundamental in ongoing therapy of patients with hematological ailments. We present the transfusion services in the hematology daycare under the department of Hematology and supported by the Blood Bank at our institution for the period 12th April 2020-30th June 2020, which saw the stringent lockdown and unlocking Phase I in India, declared in lieu of the pandemic. A 56 % reduction in total transfusion sessions was observed in 2020 (588 sessions given to 176 patients) compared to 1336 sessions in 516 patients over the same period in 2019. The reductions were seen across the different blood components (packed red blood cells [PRBC]: 585 vs. 1840, platelet rich plasma: 372 vs. 1313, single donor platelet 18 vs. 16), with a significant reduction in the mean PRBC transfused per PRBC transfusion session (1.11 vs 1.99, p<0.001) in 2020, compared to 2019. There were however no major differences in the transfusion practices across the different phases of the lockdown. Our study highlights the detrimental reduction in transfusion services due to the COVID-19 pandemic and related lockdown and showcases the remedial strategies taken to maximize transfusion support to patients during this period. Our observations might help to provide insights to adequately combat possible similar adverse situations in the future.