Omicron new variant BA.2.86 (Pirola): Epidemiological, biological, and clinical characteristics - a global data-based analysis.

OBJECTIVE: Since December 2019, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused a threatening situation worldwide. The new variant of SARS-CoV-2, BA.2.86, also known as Pirola, is an Omicron subvariant that causes great concern because it has been found to contain a large number of mutations. This study aims to investigate and identify the biological and clinical characteristics of this threatening new variant of SARS-CoV-2, which is BA.2.86. MATERIALS AND METHODS: This observational study was performed in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia. The literature was searched using the key terms including "SARS-CoV-2, Omicron, BA.2.86, Pirola, epidemiology, clinical characteristics". The data on Omicron BA.2.86 were obtained from the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), the Global Initiative on Sharing All Influenza Data (GSIAD), PubMed, Web of Science, regional ministries, research institutes, and international print media. Initially, 26 documents were identified and 10 documents were included for the data analysis. The information on the prevalence and the biological characteristics of the new variant of SARS-CoV-2, Omicron BA.2.86, was recorded and synthesized for analysis. RESULTS: The Omicron BA.2.86 has been identified in 23 countries with 264 confirmed cases as of September 28, 2023. The number and distribution of these cases encompass the United Kingdom 66 (25.0%), USA 34 (12.87%), Denmark 31 (11.74%), Sweden 25 (9.46%), South Africa 20 (7.57%), Spain 20 (7.57%), France 15 (5.68%), Portugal 7 (2.65%), Japan 6 (2.27%), Canada 5 (1.89%), Thailand 5 (1.89%), Israel 5 (1.89%), Greece 5 (1.89%), Germany 3 (1.13%), Belgium 3 (1.13%), Luxembourg 3 (1.13%), Netherlands 3 (1.13%), South Korea 3 (1.13%). However, one case in each country has been reported in Australia, Italy, Iceland, Switzerland, and China. The disease has been reported more frequently in females (71.0%) than males (29.0%). To date, no deaths have been reported. The novel variant has spread more swiftly than other variants of SARS-CoV-2 and has crossed many international borders. CONCLUSIONS: The new Omicron variant BA.2.86 has affected 264 people in 23 countries. The disease is more common in females than males and mainly affects old age people (over 60 years of age). However, no deaths have been reported. The variant is spreading swiftly and transmitted more rapidly. The clinical manifestations in patients with Omicron BA.2.86 variant are not well documented and may be similar to earlier strains of COVID-19 by presenting with mild infectious symptoms, including headache, body ache, cough, fever, generalized myalgia, and severe fatigue. The global health authorities must take preventive measures to stop the outbreak of this emerging variant across the globe to minimize the disease burden.

Human monkeypox outbreak: global prevalence and biological, epidemiological and clinical characteristics - observational analysis between 1970-2022.

OBJECTIVE: The human monkeypox infection has become the prevalent orthopoxviral disease in humans, and has developed challenging and threatening situations worldwide. This study is aimed at exploring the global epidemiological, biological and clinical characteristics of monkeypox from 1970 to July 1, 2022. MATERIALS AND METHODS: Information about the monkeypox outbreak and its epidemiological and biological characteristics was obtained from the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC) reports, Pub-Med, and Web of Science. Initially, these two leading international health organizations, and 10 documents were identified; after reviewing, we included WHO and CDC, and six documents in the analysis. RESULTS: Worldwide, from 1970 to July 1, 2022, the total number of confirmed and suspected cases of human monkeypox disease in endemic and non-endemic nations was 46,915. In endemic regions, the number of confirmed cases has been 2,805 and suspected cases have been 38,327, with a total number of 41,132. However, from May 7, 2022, to July 1, 2022, 5,783 monkeypox cases have been found in 52 non-endemic nations in Europe, the UK, the USA, Australia and the Middle East. The majority of cases have been found in the United Kingdom (1,235), Germany (1,054), Spain (800), France (498), United States (459), Portugal (402), Netherlands (288), Canada (287), Italy (192), Belgium (117), Switzerland (91), Israel (42), Ireland (39), Austria (37), Sweden (28), Brazil (21), and Denmark (20). The clinical presentation of monkeypox disease is mild symptoms, including headache, lymphadenopathy, body aches, severe weakness, and acute onset of fever above 38.5°C. A skin rash initiates as macules or papules, progresses to pustules and vesicles, ulcers, and ultimately transitions to crusted scabs. In a short period of about two months, the monkeypox cases swiftly spread in 52 non-endemic countries with an increased percentage worldwide. CONCLUSIONS: The geographic pattern of monkeypox disease spread is rapidly shifting from endemic to non-endemic regions. It now involves not only Africa but also Europe, the USA, the UK, Australia and the Middle East. The clinical characteristics of monkeypox infection are mostly mild symptoms, including headache, lymphadenopathy, body aches, severe weakness, and acute onset of fever above 38.5 degrees Centigrade. A skin rash originates as macules or papules, progresses to pustules and vesicles, ulcers, and eventually to crusted scabs. The regional and international health establishments must take priority preventive procedures to break the outbreaks of monkeypox disease across the globe. The physicians, healthcare workers, patients, and public education is of utmost importance to eradicate the disease.

Effect of Pfizer/BioNTech and Oxford/AstraZeneca vaccines against COVID-19 morbidity and mortality in real-world settings at countrywide vaccination campaign in Saudi Arabia.

OBJECTIVE: Vaccinations are highly essential to control infectious diseases and epidemics. Presently, the entire world faces a challenging crisis of "Severe Acute Respiratory Diseases Coronavirus 2 (SARS-CoV-2), also known as the COVID-19 pandemic". The impact of vaccines at national levels to reduce the SARS-CoV-2 cases and deaths are unclear, and people have concerns about the effectiveness of vaccines in real-world settings. This study's objective was to examine the effect of the "Pfizer/BioNTech and Oxford/AstraZeneca" vaccines to prevent SARS-CoV-2 cases and deaths in Saudi Arabia. MATERIALS AND METHODS: In this retrospective cohort study, we collected data on SARS-CoV-2 cases and deaths from the date of the first case of SARS-CoV-2 in Saudi Arabia March 2, 2020, to the date of launching the vaccination campaign on December 14, 2020; and from December 15, 2020, to September 8, 2021. We recorded the World Health Organization data and Ministry of Health of Saudi Arabia to evaluate the impact of the "Pfizer/BioNTech, (BNT162b2 mRNA) and Oxford/AstraZeneca (AZD1222)" vaccine against SARS-CoV-2 cases and deaths before and after the vaccination campaign in Saudi Arabia. RESULTS: Saudi Arabia launched the "Pfizer/BioNTech and Oxford/AstraZeneca" vaccination campaign against SARS-CoV-2 on December 14, 2020. In Saudi Arabia, before the vaccination campaign from March 2, 2020, to December 14, 2020, the mean daily SARS-CoV-2 cases were 1235.60, daily deaths were 22.70, that significantly reduced (p=0.0001) compared to the period after the vaccination campaign from December 15, 2020, to September 8, 2021, in which the daily cases fell to 692.08, and daily deaths fell to 9.48 (p=0.0001). CONCLUSIONS: In Saudi Arabia, Pfizer/BioNTech and Oxford/AstraZeneca vaccinations significantly reduced the number of SARS-CoV-2 cases and deaths after the vaccination compared to the period before the vaccination campaign at country levels. The study findings demonstrate that vaccination and adherence to nonpharmaceutical intervention can better control the COVID-19 pandemic.

COVID-19 vaccines: comparison of biological, pharmacological characteristics and adverse effects of Pfizer/BioNTech and Moderna Vaccines.

OBJECTIVE: The "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)" disease has caused a worldwide challenging and threatening pandemic (COVID-19), with huge health and economic losses. The US Food and Drug Administration, (FDA) has granted emergency use authorization for treatment with the Pfizer/BioNTech and Moderna COVID-19 vaccines. Many people have a history of a significant allergic reaction to a specific food, medicine, or vaccine; hence, people all over the world have great concerns about these two authorized vaccines. This article compares the pharmacology, indications, contraindications, and adverse effects of the Pfizer/BioNTech and Moderna vaccines. MATERIALS AND METHODS: The required documents and information were collected from the relevant databases, including Web of Science (Clarivate Analytics), PubMed, EMBASE, World Health Organization (WHO), Food and Drug Authorities (FDA) USA, Local Ministries, Health Institutes, and Google Scholar. The key terms used were: Coronavirus, SARS-COV-2, COVID-19 pandemic, vaccines, Pfizer/BioNTech vaccine, Moderna vaccine, pharmacology, benefits, allergic responses, indications, contraindications, and adverse effects. The descriptive information was recorded, and we eventually included 12 documents including research articles, clinical trials, and websites to record the required information. RESULTS: Based on the currently available literature, both vaccines are beneficial to provide immunity against SARS-CoV-2 infection. Pfizer/BioNTech Vaccine has been recommended to people 16 years of age and older, with a dose of 30 µg (0.3 m) at a cost of $19.50. It provides immunogenicity for at least 119 days after the first vaccination and is 95% effective in preventing the SARS-COV-2 infection. However, Moderna Vaccine has been recommended to people 18 years of age and older, with a dose of 50 µg (0.5 mL) at a cost of $32-37. It provides immunogenicity for at least 119 days after the first vaccination and is 94.5% effective in preventing the SARS-CoV-2 infection. However, some associated allergic symptoms have been reported for both vaccines. The COVID-19 vaccines can cause mild adverse effects after the first or second doses, including pain, redness or swelling at the site of vaccine shot, fever, fatigue, headache, muscle pain, nausea, vomiting, itching, chills, and joint pain, and can also rarely cause anaphylactic shock. The occurrence of adverse effects is reported to be lower in the Pfizer/BioNTech vaccine compared to the Moderna vaccine; however, the Moderna vaccine compared to the Pfizer vaccine is easier to transport and store because it is less temperature sensitive. CONCLUSIONS: The FDA has granted emergency use authorization for the Pfizer/BioNTech and Moderna COVID-19 vaccines. These vaccines can protect recipients from a SARS-CoV- 2 infection by formation of antibodies and provide immunity against a SARS-CoV-2 infection. Both vaccines can cause various adverse effects, but these reactions are reported to be less frequent in the Pfizer/BioNTech vaccine compared to the Moderna COVID-19 vaccine; however, the Moderna vaccine compared to the Pfizer vaccine is easier to transport and store because it is less temperature sensitive.

Omicron SARS-CoV-2 new variant: global prevalence and biological and clinical characteristics.

OBJECTIVE: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has created a challenging and threatening situation worldwide. The SARS-CoV-2 embodies diverse epidemiological trends, alongside emerging and reemerging pathogenic characteristics, which have raised great public health concerns. This study aims to investigate the global prevalence, biological and clinical characteristics of Omicron, a new variant of SARS-CoV-2 that is causing concern and fear internationally. MATERIALS AND METHODS: The data on the outbreak of the new variant "Omicron" was obtained from the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), European Centre for Disease Prevention and Control (ECDC), research institutes, and global international print media. We recorded information on the prevalence, the biological and clinical characteristics of the Omicron Variant of SARS-CoV-2 from November 24 to December 9, 2021. RESULTS: Worldwide, the new variant of SARS-CoV-2, Omicron, has been identified in 57 countries with 2152 confirmed cases reported on December 9, 2021, ever since the emergence of the first case of this variant dated November 24, 2021. The number of confirmed Omicron variant cases has significantly increased globally. The novel variant is spreading swiftly and has crossed many borders all around the world. This new variant has been observed to be transmitted far more rapidly than other variants of SARS-CoV-2. CONCLUSIONS: The new variant of SARS-CoV-2 has novel epidemiological and biological characteristics, making it more contagious than other variants of SARS-CoV-2. It has affected 2152 people in 57 countries in a short period of two weeks. However, the fatality rate of the SARS-CoV-2 Omicron variant has not yet been reported. The major clinical manifestations in this new variant are those of a "mild infection", including headache, body ache, muscles ache, cough, fever, generalized myalgia, and severe fatigue. It is infecting younger and middle-aged people more than previous variants. Worldwide health establishments should take immediate preventive measures to stop outbreaks of this emerging and reemerging pathogenic variant across the globe to minimize the disease burden on humanity.

Efficacy of chloroquine and hydroxychloroquine in the treatment of COVID-19.

OBJECTIVE: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also called COVID-19, has caused a pandemic which has swiftly involved the entire world and raised great public health concerns. The scientific community is actively exploring treatments that would potentially be effective in combating COVID-19. Hydroxychloroquine has been demonstrated to limit the replication of SARS-CoV-2 virus in vitro. In malarial pandemic countries, chloroquine is widely used to treat malaria. In malarial non-pandemic nations, chloroquine is not widely used. Chloroquine and hydroxychloroquine share similar chemical structures and mechanisms of action. The aim of this study was to indirectly investigate the efficacy of chloroquine and hydroxychloroquine for the treatment of COVID-19 by determining the prevalence of COVID-19 in malaria pandemic and non-pandemic nations. We sought evidence to support or refute the hypothesis that these drugs could show efficacy in the treatment of COVID-19. MATERIALS AND METHODS: We reviewed in vitro studies, in vivo studies, original studies, clinical trials, and consensus reports, that were conducted to evaluate the antiviral activities of chloroquine and hydroxychloroquine. The studies on "COVID-19 and its allied treatment were found from World Health Organization (WHO), ISI-Web of Science, PubMed, EMBASE, Scopus, Google Scholar, and clinical trial registries. The search was based on keywords: antiviral drugs, chloroquine, hydroxychloroquine, COVID-19, COVID-19 treatment modalities, and coronavirus. In addition, we analyzed the prevalence of COVID-19 in malaria pandemic and non-pandemic countries. The review and analyses were performed on March 28, 2020. RESULTS: For this study, we identified a total of 09 published articles: 03 clinical trials with sample size 150; 03 in vitro studies and 03 expert consensus reports. These studies were all suggestive that chloroquine and hydroxychloroquine can successfully treat COVID-19 infections. We found that COVID-19 infections are highly pandemic in countries where malaria is least pandemic and are least pandemic in nations where malaria is highly pandemic. CONCLUSIONS: Chloroquine and hydroxychloroquine have antiviral characteristics in vitro. The findings support the hypothesis that these drugs have efficacy in the treatment of COVID-19. People are currently using these drugs for malaria. It is reasonable, given the hypothetical benefit of these two drugs, that they are now being tested in clinical trials to assess their effectiveness to combat this global health crisis.

Diabetes and technology in 2030: a utopian or dystopian future?

The ability of an individual living with diabetes to have human-to-human contact with their healthcare provider is not keeping pace with the number of people developing diabetes. From a futurist perspective, however, this dichotomy of diabetes care represents an opportunity for digital healthcare. The focus of technological innovation is unlikely to be the replacement of the multidisciplinary diabetes team but rather the provision of meaningful individual and family support between clinic visits and, on a larger scale, the facilitation of population health management for diabetes. We can also expect to see new therapies, including implantable drug delivery systems, automated closed-loop systems and miniaturized non-invasive glucose monitoring systems. New digital health technologies will create a 'digital diabetes ecosystem' to enhance rather than devolve care from humans. Concerns related to data privacy and ownership will inevitably rise, thus a future for diabetes care relying heavily on technology is not inevitably utopian. Nevertheless, revolutions in the development of novel sensors, accumulation of 'big data', and use of artificial intelligence will provide exciting opportunities for preventing, monitoring and treating diabetes in the near future.

Euglycemic ketosis in patients with type 2 diabetes on SGLT2-inhibitor therapy-an emerging problem and solutions offered by diabetes technology.

Diabetic ketoacidosis is an infrequent but life-threatening acute complication of diabetes, affecting predominantly patients with type 1 diabetes, children, and pregnant women, where ketosis is usually associated with marked hyperglycemia. Recently, an increasing number of cases have been reported of euglycemic diabetic ketoacidosis in patients with type 2 diabetes receiving sodium-glucose cotransporter 2 inhibitor treatment in routine practice. There is a minor, but not negligible diabetic ketoacidosis risk associated with this drug class, which was not seen in randomized clinical trials. However, sodium-glucose cotransporter2 inhibitors increase the risk of ketosis by increasing glucagon secretion in the pancreas and decreasing the renal excretion of 3-hydroxybutyrate and acetoacetate. When used in addition to insulin, any insulin dose reduction required to avoid hypoglycemia may lead to insufficient suppression of lipolysis and ketogenesis. sodium-glucose cotransporter2 inhibitor-induced loss of urinary glucose encourages euglycemia. Normo-glycemic or near-normoglycemic diabetic ketoacidosis represents a major threat to the health and well-being of a patient, because it may occur undetected and without any indicative hyperglycemia. In consequence, patients on sodium-glucose cotransporter2 inhibitors are recommended to perform regular blood ketone tests since they are not alerted to incipient diabetic ketoacidosis by glucose testing alone. This option is offered by several blood glucose meters that can also measure ketones with a separate ketone strip or in one case by an automatic parallel ketone assessment from the same strip. The need for extra testing and the associated costs may be a barrier to patient acceptance of this risk mitigation procedure. However, patients who are at risk for euglycemic diabetic ketoacidosis when being treated with sodium-glucose cotransporter2 inhibitors should be specially advised to monitor blood ketone levels on a regular basis.

An economic analysis of interventions for diabetes.

The objective of this article is to stratify interventions for diabetes according to their economic impact. We conducted a review of the literature to select articles that performed a cost-benefit analysis for 17 widely practiced interventions for diabetes. A scale for categorizing interventions according to their economic impact was defined. The 17 interventions were classified as follows: 1) clearly cost-saving, 2) clearly cost-effective, 3) possibly cost-effective, 4) non-cost-effective, or 5) unclear. Clearly cost-saving interventions included eye care and pre-conception care. Clearly cost-effective interventions included nephropathy prevention in type 1 diabetes and improved glycemic control. Possibly cost-effective interventions included nephropathy prevention in type 2 diabetes and self-management training. Non-cost-effective interventions were not identified. Interventions with unclear economic impact included case management, medical nutrition therapy, self-monitoring of blood glucose, foot care, blood pressure control, blood lipid control, smoking cessation, exercise, weight loss, HbA1c measurement, influenza vaccination, and pneumococcus vaccination. Widely practiced interventions for patients with diabetes can be clearly cost-saving and clearly cost-effective. These practices are attractive from both a medical and an economic perspective.