The dynamic changes of psychosomatic symptoms in three waves of COVID-19 outbreak and fatigue caused by enduring pandemic in China.

BACKGROUND: Two years have passed since the 2019 novel coronavirus disease (COVID-19) was first reported. The persistent pandemic might lead to severe psychosomatic problems and fatigue. In addition, the recent rapid rising COVID-19 cases in China have become a trending issue. Therefore, this study aimed to investigate the dynamic changes in psychosomatic problems at the initial and current stages of the pandemic. METHODS: Three waves of cross-sectional online survey were conducted during the initial COVID outbreak in China. The psychosomatic symptom scale (PSSS), perceived stress scale (PSS), and pandemic fatigue scale (PFS) were used to assess the psychosomatic problems, stress, and fatigue. RESULTS: 4317, 1096, and 2172 participants completed the first, second, and third surveys. The prevalence of psychosomatic disorder was 22 %, 28 %, and 39 %, respectively. The network structure of PSSS symptoms has not significantly changed as the pandemic progresses. However, the global strength of the PSSS networks, indicating the overall connectivity, in the third wave was significantly higher than in the first wave (s = 0.54, P = 0.007). The most central symptoms in the first and third wave networks were depressed mood and tiredness. The PFS score was higher in the people concerned with indirect impact than those concerned with health (P < 0.001). PFS has positive relationships with PSSS and PSS score (R = 0.41, P < 0.001 and R = 0.35, P < 0.001, respectively). CONCLUSIONS: The persistence of the pandemic caused critical psychosomatic issues, stress, and indirect burden over time, leading to inevitable fatigue. People endured needing immediate attention to prevent or reduce psychosomatic disorders.

Mucociliary Clearance Augmenting Drugs Block SARS-Cov-2 Replication in Human Airway Epithelial Cells (preprint)

The coronavirus disease (COVID-19) pandemic, caused by SARS-CoV-2 coronavirus, is devastatingly impacting human health. A prominent component of COVID-19 is the infection and destruction of the ciliated respiratory cells, which perpetuates dissemination and disrupts protective mucociliary transport (MCT) function, an innate defense of the respiratory tract. Thus, drugs that augment MCT could improve barrier function of the airway epithelium, reduce viral replication and, ultimately, COVID-19 outcomes. We tested five agents known to increase MCT through distinct mechanisms for activity against SARS-CoV-2 infection using a model of human respiratory epithelial cells terminally differentiated in an air/liquid interphase. Three of the five mucoactive compounds tested showed significant inhibitory activity against SARS-CoV-2 replication. An archetype mucoactive agent, ARINA-1, blocked viral replication and therefore epithelial cell injury, thus, it was further studied using biochemical, genetic and biophysical methods to ascertain mechanism of action via improvement of MCT. ARINA-1 antiviral activity was dependent on enhancing the MCT cellular response, since terminal differentiation, intact ciliary expression and motion was required for ARINA-1-mediated anti-SARS-CoV2 protection. Ultimately, we showed that improvement of cilia movement was caused by ARINA-1-mediated regulation of the redox state of the intracellular environment, which benefited MCT. Our study indicates that Intact MCT reduces SARS-CoV-2 infection, and its pharmacologic activation may be effective as an anti-COVID-19 treatment.

Mucociliary transport deficiency and disease progression in Syrian hamsters with SARS-CoV-2 infection.

Substantial clinical evidence supports the notion that ciliary function in the airways is important in COVID-19 pathogenesis. Although ciliary damage has been observed in both in vitro and in vivo models, the extent or nature of impairment of mucociliary transport (MCT) in in vivo models remains unknown. We hypothesize that SARS-CoV-2 infection results in MCT deficiency in the airways of golden Syrian hamsters that precedes pathological injury in lung parenchyma. Micro-optical coherence tomography was used to quantitate functional changes in the MCT apparatus. Both genomic and subgenomic viral RNA pathological and physiological changes were monitored in parallel. We show that SARS-CoV-2 infection caused a 67% decrease in MCT rate as early as 2 days postinfection (dpi) in hamsters, principally due to 79% diminished airway coverage of motile cilia. Correlating quantitation of physiological, virological, and pathological changes reveals steadily descending infection from the upper airways to lower airways to lung parenchyma within 7 dpi. Our results indicate that functional deficits of the MCT apparatus are a key aspect of COVID-19 pathogenesis, may extend viral retention, and could pose a risk factor for secondary infection. Clinically, monitoring abnormal ciliated cell function may indicate disease progression. Therapies directed toward the MCT apparatus deserve further investigation.

Identifying and Examining Ethical Considerations Facing Data Monitoring Committees

The COVID-19 pandemic has exposed numerous unresolved research ethics challenges particularly for Data Monitoring Committees (DMCs). DMCs have worked to ensure the ongoing social value of research as rapid changes occur in health policy and epidemiology and there is substantial pressure to release early findings to the public. Unlike Institutional Review Boards, DMCs are charged with carefully monitoring ongoing research, but with limited ethical guidance and often without representation from all host countries. This article highlights ethical challenges for DMCs and lessons learned from the COVID-19 pandemic. DMCs have long faced high-stakes decisions in clinical trials including whether to continue, modify, or terminate a trial based on emerging trial data. Trial protocols, statistical analysis plans, and data monitoring charters establish principles for DMC decisionmaking;however, there has not been a great deal of systematic examination of the ethical issues faced by DMCs. For example, which ethical considerations should be addressed by DMCs as opposed to Institutional Review Boards or researchers is often unclear. Formal guidance rarely addresses whether DMCs should monitor the representativeness of trial participants as compared with the target population for the intervention. Furthermore, post-trial issues have received limited attention. Should DMCs ensure the accuracy of press releases and manuscripts detailing study findings? How should DMCs determine when to unblind participants after a study is over if it is relevant for their medical decision-making? In this presentation, we will report preliminary results of a qualitative study of DMC members (i.e. statisticians, clinicians, and ethicists). We will highlight persistent controversies, the range of roles DMCs are expected to play in monitoring clinical trials, and variation in formal guidance about the ethical obligations of DMCs. We will also examine the question of whether and when ethicists should serve on DMCs. We will conclude by identifying critical ethical issues facing DMCs that warrant further attention.

Remote vs Local Ex-Vivo Lung Perfusion, a Single Center Experience

Ex vivo lung perfusion (EVLP) could impact waitlist morbidity and mortality by increasing the number of transplantable allografts. Remote EVLP with a centralized lung evaluation system (CLES) at a dedicated facility has been shown to be feasible. There are no reports comparing the outcomes of remote vs local EVLP. Our institution has access to both modes of EVLP. Hereby, we describe the outcomes for remote EVLP (r-EVLP) and local EVLP (l-EVLP) at Mayo Clinic Florida. We did a retrospective analysis of the demographics, clinical characteristics, and outcomes of recipients of lungs that underwent EVLP as part of a r-EVLP clinical trial (NCT02234128) or at Lung Bioengineering Jacksonville (l-EVLP) with data obtained from the patient's electronic medical record. The r-EVLP cohort (n=10) tended to be younger than the l-RVLP cohort (n=12) (57.3 vs 61.6 years), and had a lower percentage of female recipients (20% vs 41.67% respectively). 80% of recipients were white in both cohorts. Most recipients were in the diagnosis group D (restrictive lung disease) in both cohorts. Three recipients in the l-EVLP group received a lung transplant due to complications from COVID-19. There were 5 single lung transplants (SLTx) in the r-EVLP (50%) and one in l-EVLP (8.33%). Lungs from donors after circulatory death (DCD) accounted for 40% of the allografts in the r-EVLP cohort and for 16.67% in the l-EVLP group. The median cold ischemia time (CIT) 1 was 5h:27min for the r-EVLP and 4h:35min for l-EVLP. The median CIT-2 time was 4h:16min for the r-EVLP and 3h:12min for the l-EVLP. EVLP time was similar for both groups. The median total preservation time was 13h:44min for the r-EVLP and 11h:38min for the l-EVLP cohorts. One (10%) in the r-EVLP and five (42%) in the l-EVLP groups were on ECMO at 72 hours post-transplant. Most of the remaining patients in both groups had a PGD-1 at 72 hours. All patients were alive at 30 days, and there was one death on each group at 1-year. At our center, survival at 1-year appeared similar in recipients of lungs assessed on r-EVLP or l-EVLP. Postoperative ECMO was used more frequently in the l-EVLP group. Median CIT-1 and CIT-2 were longer in the r-EVLP compared to the l-EVLP group by 52 and 64 minutes, respectively. Limitations of this study include single center retrospective experience, small sample size and lack of long-term outcomes. Future research comparing r-EVLP vs l-EVLP is warranted. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation 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.)

Solid organ graft-versus-host disease in a recipient of a COVID-19 positive liver graft

A 66-year-old male with end-stage liver disease (ESLD) secondary to non-alcoholic fatty liver disease (NAFLD), complicated by hepatocellular carcinoma (HCC), underwent deceased donor liver transplantation from a Coronavirus disease 2019 (COVID-19) positive donor. He presented a month later with fever, diarrhea and pancytopenia which led to hospitalization. The hospital course was notable for respiratory failure, attributed to invasive aspergillosis, as well as a diffuse rash. A bone marrow biopsy revealed hypocellular marrow without specific findings. In the following days, laboratory parameters raised concern for secondary hemophagocytic lymphohistiocytosis (HLH). Clinical concern also grew for solid organ transplant graft-versus-host-disease (SOT-GVHD) based on repeat marrow biopsy with elevated donor-derived CD3+ T cells on chimerism. After, a multidisciplinary discussion, the patient was started on ruxolitinib, in addition to high dose steroids, to address both SOT-GVHD and secondary HLH. Patient developed symptoms concerning for hemorrhagic stroke and was transitioned to comfort care. Although GVHD has been studied extensively in hematopoietic stem cell transplant (HSCT) patients, it is a rare entity in SOT with a lack of guidelines for management. Additionally, whether COVID-19 may play a role in development of SOT-GVDH has not been explored.Copyright © 2023 The Authors

Medications safety for special population case studies: Pediatrics

Medication errors are among the most common medical errors, and studies have shown that the pediatric population is particularly vulnerable. Errors can occur at any stage of the medication process. We tried to build various cases, which highlighted different aspects of drug safety in pediatrics. The case studies focused on vancomycin infusion, supportive treatment in COVID-19-related multisystem inflammatory illness, side effect of antitubercular treatment drugs, management of respiratory failure, low cardiac functioning, acyclovir nephrotoxicity, stress ulcer, cyclophosphamide-induced hemorrhagic cystitis in rhabdomyosarcoma, blood pressure after aortic coarctation elective surgery, and use of paracetamol instead of NSAIDs in pediatrics. These cases would be useful in both as a diagnostic tool and as a way of monitoring certain conditions. © 2023 Elsevier Inc. All rights reserved.

Synthesis and performance evaluation of copper and magnesium-based metal organic framework supported ionic liquid membrane for CO2/N2 separation

The CO2 emission is enhancing drastically because of the continuous emission from industries and transport sector. Although the CO2 emission had decreased in the first half of 2020 by 8.8% due to COVID-19 restrictions however, it is again on the rise and it might exceed the estimated level in 2030. The current methods used for CO2 separation have serious operational and environmental constraints. To overcome these problems we have devised a supported ionic liquid membrane (SILM) incorporated with the blend of bimetallic metal-organic framework (MOF) of copper and magnesium ions (CuxMgx) and Trihexyltetradecylphosphonium chloride [P66614] [Cl] ionic liquid (IL). CuxMgx MOF were synthesized and characterized using scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction analysis (XRD), and energy dispersive X-ray analysis (EDX). CuxMgx MOF with [P66614] [Cl] IL were immobilized on a flat sheet of polytetrafluoroethylene (PTFE) membrane. Single gas permeation tests of membranes loaded with 0.2/0.8 wt/wt% MOF/IL solution showed the highest CO2 permeability of 2937 Barrer and CO2/N2 selectivity of 33.26. The performance of SILM was also investigated with different water loadings of (30 wt % and 50 wt %) in addition to MOF/IL solution and at different feed pressure varying from 0.5 to 2 bars. Membranes showed enhancement in CO2 permeability to 3738 and 4628 Barrer whereas CO2/N2 selectivity decreased to 23.53 and 21.8 with membranes loaded with 30 and 50 wt % water, respectively, at a feed pressure of 2 bar. The gas permeation results show that the incorporation of CuxMgx MOF with IL in polymeric membrane enhances the CO2/N2 separation under humid conditions but slightly decreases CO2/N2 selectivity with an increase in feed pressure. The SILM synthesized in this research is highly viable for industrial flue gases because of the incorporation of phosphonium-based ILs that have high thermal stability. © 2022

An emerging natural antioxidant therapy for COVID-19 infection patients: Current and future directions

Objective: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) affects millions of people worldwide. The article aims to review the therapeutic perspective on natural antioxidants, their mechanism of action, pharmacokinetics in management and cure of COVID-19/ SARS-CoV-2 infection. Methods: We conducted a literature search including World Health Organization and National Institute of Health guidelines and clinical trials registered with ClinicalTrials.gov limited to antioxidants in COVID-19 management. Results: Elderly, immunocompromised patients, and others with underlying health conditions or multiple comorbidities have a high mortality rate. Disrupted redox homeostasis and oxidative stress seem to be biological pathways that may increase personal vulnerability to infection. Antioxidants like vitamins C, D, E, epigallocatechin-3 gallate, and morin have been reported to protect against COVID-19 disease. Reactive oxygen species are immunological regulatory elements of viral replication. Natural antioxidants exhibit potential action in preventing inflammation and organ dysfunction during viral infection. They also increase glutathione level, oxygenation rate, and immunological responses in the treatment of sepsis and acute respiratory distress syndrome. Conclusion: No wonder the selection of prevention, treatment, and cure of COVID-19 and SARS-CoV-2 mainly depends upon the antiviral and immunoregulatory activity which they possess. Yet, their efficacy against COVID-19 is of great concern and demands extensive study. © 2023 The Authors. Food Frontiers published by John Wiley & Sons Australia, Ltd and Nanchang University, Northwest University, Jiangsu University, Zhejiang University, Fujian Agriculture and Forestry University.

Comparing Student Learning in Face-to-Face Versus Online Sections of an Information Technology Course

Background: The recent COVID-19 pandemic forced most universities into online course delivery. As such, the rapid expansion of online learning and the prospect of its permanent increase for many institutions have sharpened the issue of the efficacy of remotely delivered courses. Literature review: Past studies have compared face-to-face (FTF) courses with online courses, with mixed results. However, the broad understanding is that efficacy differs based on the subject area. Educators frequently view theory-based courses as being better suited to online teaching than hands-on or experiential courses. Research question: Can information technology courses—especially those that are more experiential and technical—be supported through online learning given the extent of differences in efficacy between online and face-to-face experiential, technical courses?Research methodology: We compared multiple sections of an experiential IT Outsourcing class over several quarters in two course delivery modes. The two modes were FTF delivery and online synchronous delivery. Students in each course section responded to two surveys where they rated their knowledge of different topics at the start and end of the course. Results: Online students reported greater increases in learning on average across all measured items. Self-reported knowledge gains were significantly greater in five items, mostly in soft skills and project management knowledge. The only significantly improved technical IT skill was in using software for virtual meetings. Conclusions and implications for education: We conclude that universities should embrace teaching experiential IT-based courses virtually, as it is possible to obtain greater improvements in self-efficacy, counter to much existing research. This is especially the case as instructional technology improves. IEEE

The state of health in Pakistan and its provinces and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding health trends and estimating the burden of disease at the national and subnational levels helps policy makers track progress and identify disparities in overall health performance. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides comprehensive estimates for Pakistan. Comparison of health indicators since 1990 provides valuable insights about Pakistan's ability to strengthen its health-care system, reduce inequalities, improve female and child health outcomes, achieve universal health coverage, and meet the UN Sustainable Development Goals. We present estimates of the burden of disease, injuries, and risk factors for Pakistan provinces and territories from 1990 to 2019 based on GBD 2019 to improve health and health outcomes in the country. Methods We used methods and data inputs from GBD 2019 to estimate socio-demographic index, total fertility rate, cause-specific deaths, years of life lost, years lived with disability, disability-adjusted life-years, healthy life expectancy, and risk factors for 286 causes of death and 369 causes of non-fatal health loss in Pakistan and its four provinces and three territories from 1990 to 2019. To generate estimates for Pakistan at the national and subnational levels, we used 68 location-years of data to estimate Pakistan-specific demographic indicators, 316 location-years of data for Pakistan-specific causes of death, 579 location-years of data for Pakistan-specific non-fatal outcomes, 296 location-years of data for Pakistan-specific risk factors, and 3089 location-years of data for Pakistan-specific covariates. Findings Life expectancy for both sexes in Pakistan increased nationally from 61 center dot 1 (95% uncertainty interval [UI] 60 center dot 0-62 center dot 1) years in 1990 to 65 center dot 9 (63 center dot 8-67 center dot 8) years in 2019;however, these gains were not uniform across the provinces and federal territories. Pakistan saw a narrowing of the difference in healthy life expectancy between the sexes from 1990 to 2019, as health gains for women occurred at faster rates than for men. For women, life expectancy increased by 8 center dot 2% (95% UI 6middot3-13middot8) between 1990 and 2019, whereas the male life expectancy increased by 7 center dot 6% (3 center dot 5-11 center dot 8). Neonatal disorders, followed by ischaemic heart disease, stroke, diarrhoeal diseases, and lower respiratory infections were the leading causes of all-age premature mortality in 2019. Child and maternal malnutrition, air pollution, high systolic blood pressure, dietary risks, and tobacco consumption were the leading all-age risk factors for death and disability-adjusted life-years at the national level in 2019. Five non-communicable diseases-ischaemic heart disease, stroke, congenital defects, cirrhosis, and chronic kidney disease-were among the ten leading causes of years of life lost in Pakistan. Burden varied by socio-demographic index. Notably, Balochistan and Khyber Pakhtunkhwa had the lowest observed gains in life expectancy. Dietary iron deficiency was the leading cause of years lived with disability for both men and women in 1990 and 2019. Low birthweight and short gestation and particulate matter pollution were the leading contributors to overall disease burden in both 1990 and 2019 despite moderate improvements, with a 23 center dot 5% (95% UI 3 center dot 8-39 center dot 2) and 27 center dot 6% (14 center dot 3-38 center dot 6) reduction in age-standardised attributable DALY rates during the study period. Interpretation Our study shows that progress has been made on reducing Pakistan's disease burden since 1990, but geographical, age, and sex disparities persist. Equitable investment in the health system, as well as the prioritisation of high-impact policy interventions and programmes, are needed to save lives and improve health outcomes. Pakistan is facing several domestic and foreign challenges-the Taliban's return to power in Afghanistan, political turmoil, catastrophic flooding, the COVID-19 pandemic-that will shape the trajectory of the country's health and development. Pakistan must address the burden of infectious disease and curb rising rates of non-communicable diseases. Prioritising these three areas will enhance Pakistan's ability to achieve universal health coverage, meet its Sustainable Development Goals, and improve the overall health outcomes.

A master conceptual framework of research in Halal tourism

Halal tourism witnessed significant growth during the second half of the decade ended on December 2020 with the COVID-19 pandemic. This expansion can be witnessed equally in academic research and the Halal tourism industry. Keeping in view the phenomenal growth this research reviews the very high-quality research literature on Halal tourism to consolidate its findings and recommendations. It performs a thematic analysis of 74 articles published between the period 2009 to 2020 i.e., up to before the beginning of the COVID-19 pandemic, listed in the A* and A ranked journals of the Australian Business Deans Council (ABDC). It consolidates research methodologies, themes, dependent/independent and mediating/moderating variables, which ultimately lead to a master conceptual framework of research. It highlights that the research on Halal tourism is in its developing stages, with more themes emerging in recent years. It suggests that every country must reflect the blend of its own culture duly enveloped in the Shariah parameters. Finally, this review of the literature highlights a nexus between Social values, tourism services, and Islamic stipulations, as a way forward for research and developments in the Halal tourism research and industry.

ANALYZING DIGITAL DIVIDE AMONG UNIVERSITY STUDENTS OF PAKISTAN

An emergency shift to online education after Covid-19 brought many challenges for students and teachers, especially the university students living in the rural areas of Pakistan. So this study has focused on assessing the problems students faced while acquiring online education with special reference to the theoretical background of digital divide. It is a quantitative study which employed Heckman's treatment effect model to analyze the impact of digital divide on university students' performance. The results of the study indicate that online education further increases an already existing digital divide between have and have nots. Online education is a good alternate of face-to-face education in many cases however for ensuring maximum benefits of online education requires proper availability of gadgets and internet access along with training. Existing online education system in developing countries like Pakistan may be more suitable to teach theoretical subjects like social sciences which are subjective in nature however it is not much appropriate for teaching numerical subjects. The findings of the study direct a positive impact of digital divide due to the scarcity of necessary gadgets, internet access, family income, gender, field of study, age and location © 2023, Turkish Online Journal of Distance Education.All Rights Reserved.

Economic impact of COVID-19: Challenges and opportunities

The novel coronavirus (COVID-19)poses unprecedented challenges to global economy and international development and has become a humanitarian crisis affecting millions of lives and livelihoods throughout the world. It affects almost every economic activity and operation and at the same time poses a threat to every sector of the economy, people, places, and businesses. COVID-19 brought not only crisis, disruptions, and challenges but also bred fertile ground for opportunities, innovations, and digitalization of economic sectors. In this context, this chapter focuses keenly on the economic impacts of the COVID-19 crisis, including the economic challenges and opportunities it creates, and accordingly, recommendations have been presented. © 2023, IGI Global. All rights reserved.

Modifications in SARS-CoV-2 N Linker Region Regulate RNA Interactions and Phase Separation

The N protein of the SARS-CoV-2 virion is critical for viral genome packaging via RNA binding and regulation of viral transcription at the replication-transcription complex (RTC). The N protein can be divided into five main domains, and the central region is the linker, which is predicted to be primarily disordered and has not been heavily studied. The linker is Serine-Arginine Rich, which is phosphorylated at multiple sites by host kinases during infection, thereby promoting the N protein's role in viral transcription. Phosphorylation is a critical process for the regulation of many cellular processes and can provide recognition sites for binding complexes. In a study that examined the recognition of the SARS-CoV-2 N protein by the human 14-3-3 protein, the linker was found to contain critical phosphosites for 14-3-3 binding. The goals of this project are to determine the structure, dynamics, and RNA interactions of the Serine-Arginine Rich linker region. To accomplish this, we performed Nuclear Magnetic Resonance spectroscopy (NMR) experiments to analyze the structure of the linker region of the N protein and its ability to bind viral RNA. NMR confirms predictions that the linker is not entirely unstructured and it is able to bind RNA. The linker region of the N protein with phosphoserine incorporated at S188 was also examined via an NMR titration experiment with 1-1000 RNA. Compared to wild type, the incorporation of phosphorylation decreases binding. Other biophysical techniques such as Analytical Ultracentrifugation (AUC) and Multi-Angle Light Scattering (MALS) are used to identify the association state of the linker and the size of the resulting protein-RNA complex. We are currently working to biophysically characterize the structure, dynamics, and viral RNA binding ability of a mutation found in the Delta and Omicron variants: the R203M linker, which have been shown to enhance viral infectivity. This work was supported by the NSF EAGER grant NSF/ MCB 2034446 and URSA Engage. Support to facilities includes the Oregon State University NMR Facility funded in part by NIH, HEI Grant 1S10OD018518, and by the M. J. Murdock Charitable Trust grant # 2014162.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.

Key Levers to Reform Non-Motorized Transport: Lessons From the COVID-19 Pandemic

The objective of this research was to understand key levers that enabled city, regional, and national governments to improve non-motorized transport (NMT) infrastructure during the lockdowns necessitated by the COVID-19 pandemic. The research focused primarily on cycling and adopted a case study approach focusing on three cities: Bengaluru (India), Bogota (Colombia), and London (UK). The selected cities were chosen for diversity across geographies, country income levels, and the scale of interventions. Eight key levers were identified to understand how cycling interventions can be supported, implemented, sustained, and scaled up. These included institutional and organizational arrangements;technical capacity;financing;leadership;policy and regulatory framework;plans, strategies, and technical resources;role of civil society;and communications, messaging, and outreach. The research used secondary literature reviews and key informant interviews, which were validated through an online round table. Research revealed that certain levers were necessary in initiating and continuing successful NMT interventions. These included supportive leadership, participative civil society, and adequate financial and technical capacity. Communications and outreach helped bring behavioral change amongst residents while a coordinated institutional framework and plans and strategies were necessary to sustain momentum. This research contributes to urban mobility and public administration literature in understanding processes and enablers of sustainable mobility interventions. It is relevant for cities in low-and middle-income countries beginning to focus on NMT interventions to combat climate change and public health challenges. © National Academy of Sciences: Transportation Research Board 2021.

Investigation of Neolamarckia cadamba Phytoconstituents Against SARS-CoV-2 3CL Pro: An In-Silico Approach

In present study, the inhibitory potential of Neolamarckia cadamba phytoconstituents was investigated against SARS-CoV-2 3CL protease (3CL pro) (PDB ID: 6M2N). Molecular docking was analyzed using AutoDock Vina software by setting the grid parameter as X=-33.163, Y=-65.074 and Z= 41.434 with dimensions of the grid box 25 × 25 × 25 Å. Remdesivir was taken as the standard for comparative analysis along with inhibitor 5, 6, 7-trihydroxy-2-phenyl-4H-chromen-4-one. Furthermore, the exploration of 2 D Hydrogen-bond interactions was performed by Biovia Discovery Studio 4.5 program to identify the interactions between an amino acid of target and ligand followed by assessment of physicochemical properties using Lipinski's rule and Swiss ADME database. The decent bonding scores of secondary metabolites owing to hydrogen bonding with catalytic residues suggest the effectiveness of these phytochemicals towards 3CLpro. The results are further consolidated positively by Lipinski's rule and Swiss ADME prediction. Thus reasonably, observations with docking studies suggest possibility of phytochemicals from Neolamarckia cadamba to inhibit the 3CLpro and consequently would be explored further as agents for preventing COVID-19. © 2023, Universidade Federal de Mato Grosso do Sul, Departamento de Quimica. All rights reserved.

Association Between Severe SARS-CoV-2 Infection and De Novo HLA Donor Specific Antibody Production in Lung Transplant Recipients: Single-center study

Objectives: The COVID-19 pandemic has led to significant morbidity and mortality in lung transplant recipients (LTR). Respiratory viral infections may be associated with de-novo HLA donor-specific antibody (DSA) production and impact lung transplant outcome. Since one of the immunomodulation strategies post-SARS-CoV-2 infection in LTR include decreasing or holding anti-metabolites, concerns have been raised for higher incidence of de-novo DSA production in LTR. Method(s): We performed a retrospective chart review of 80 consecutive LTR diagnosed with COVID-19 to investigate this concern. COVID-19 disease severity was divided into 3 groups: mild, moderate, and severe. Mild disease was defined as patients with COVID-19 diagnosis who were stable enough to be treated as out-patients. Moderate disease was defined as patients who required admission to the hospital and were on less than 10 liters of oxygen at rest. Severe disease was identified as patients who required hospitalization and were on more than 10 liters of oxygen with or without mechanical ventilation or extra corporal membrane oxygenation (ECMO). Groups were compared using the Kruskal-Wallis test. Result(s): A total of 23, 47, and 10 LTR were diagnosed with mild, moderate, and severe COVID-19 respectively. De-novo HLA DSAwere detected in 0/23 (0%), 3/47 (6.3%), and 4/10 (40%) LTR with mild, moderate, and severe COVID-19 respectively (p = 0.0007) within 6 months post-COVID-19 diagnosis. Conclusion(s): Severe COVID-19 may be associated with increased risk of de novo HLA DSA production resulting in allograft dysfunction.Copyright © 2023 Elsevier Inc.

Etiology of Pancreatitis in Patients at a Tertiary Care Center

Objective: To compare etiological frequencies in patients of acute pancreatitis presenting to our setup with international data. Study Design: Cross-sectional study Place and Duration of Study: Department of Gastroenterology, Pakistan Emirates Military Hospital & Combined Military Hospital, Rawalpindi Pakistan, from Aug 2020 to Jan 2022. Methodology: Patients over 12 years suffering from pancreatitis were recruited using a convenience sampling technique based upon predefined criteria for diagnosis of pancreatitis on a questionnaire. Relevant basic lab tests, including chemistries and imaging, including Ultrasound abdomen and CECT abdomen, were analyzed to establish aetiology. Data were continuously uploaded into an electronic data sheet. International Consensus Diagnostic Criteria (ICDC) algorithms were applied to diagnose autoimmune pancreatitis. Results: Out of 120 patients, 74(61.7%) were males, and 46(38.3%) were females. Biliary pancreatitis was the most common aetiology 50(41.7%), followed in descending order by idiopathic 36(30%), drug-induced pancreatitis (DIP) 9(7.5%), Post ERCP Pancreatitis (PEP) 8(6.7%), tumours 5(4%), Autoimmune pancreatitis (AIP), Hypertriglyceridemia and alcohol-induced pancreatitis each 2(1.7%). Conclusion: Biliary pancreatitis has the highest frequency, followed by idiopathic and drug-induced pancreatitis. © 2023, Army Medical College. All rights reserved.

Clinical characteristics, complications, and outcomes of severe COVID-19 ARDS patients supported by ECMO and triaged for lung transplantations

Objectives: More than 200 patients have benefited from lung transplantation who failed to recover from COVID-19-induced acute respiratory distress (ARDS) with conventional ventilatory support and/ or extracorporeal membrane oxygenation support (ECMO) in USA. We aim to share our experience and lessons learned at our institute through this case series. Method(s): After IRB approval, we performed a retrospective chart review and identified 37 patients who received ECMO for COVID-19 induced ARDS between May 2020 through January 2022. Out of these, 12 received a formal consultation from the transplant team. We studied patient characteristics, interventions during ECMO support, and evaluation outcomes. Result(s): Most of our patients had single organ failure i.e., lung, except for two who required dialysis after ECMO initiation. Six out of the 12 patients received bilateral lung transplant. One patient received the transplant before ECMO initiation. However, the patient required two runs of ECMO after the transplant due to postop complications from suspected COVID19 reinfection and deceased on postoperative day 101. All the patients after transplant had an expedited recovery except one who required prolonged hospitalization before starting physical therapy. The median length of hospital stay for the transplant group was 148 (89- 194) days and for the non-transplant group was 114 (58-178) days. The 30-day survival rate was 100% for the transplant group. At a median follow-up of 207 (0- 456) days after discharge, 5(83.3%) patients in the transplant group and 3(50%) patients in the nontransplant group were alive. In the non-transplant group, 4 patients received ECMO support for more than 75 days and at last follow-up 2 were alive and functioning well without needing new lungs. This asks for an objective prospective study to define the timeline of irreversibility of the lung injury. Conclusion(s): Lung transplantation is a viable salvage option in patients with COVI-19 induced irreversible lung injury. However, the irreversibility of the lung injury and the timing of lung transplant remains to be determined case-by-case. (Figure Presented).