Norovirus outbreak amid COVID-19 in the United Kingdom; priorities for achieving control

Norovirus, an enteric virus primarily responsible for gastroenteritis outbreaks worldwide, is currently causing outbreaks around the United Kingdom during the COVID-19 pandemic. With an already exhausted health care system, the significant burden norovirus can have on the National Health Service, including economic and social burdens, is immense and cannot be tolerated. Primary challenges and priorities to be focused on due to the increase in norovirus outbreaks include a further depletion of health care services, increase cases in schools, nurseries, and care facilities, underreporting of the cases, and no effective vaccine being available. Therefore, it is essential to increase awareness about norovirus and its transmission in public, take necessary precautions, and increase reporting of cases. This article discusses the impact norovirus has during the COVID-19 pandemic, and the challenges, and recommendations to achieve control before it reaches epidemic levels.

Increased high-temperature extremes and associated population exposure in Africa by the mid-21st century

Previous studies warned that heat extremes are likely to intensify and frequently occur in the future due to climate change. Apart from changing climate, the population's size and distribution contribute to the total changes in the population exposed to heat extremes. The present study uses the ensemble mean of global climate models from the Coupled Model Inter-comparison Project Phase six (CMIP6) and population projection to assess the future changes in high-temperature extremes and exposure to the population by the middle of this century (2041-2060) in Africa compared to the recent climate taken from 1991 to 2010. Two Shared Socioeconomic Pathways (SSPs), namely SSP2-4.5 and SSP5-8.5, are used. Changes in population exposure and its contributors are quantified at continental and for various sub-regions. The intensity of high-temperature extremes is anticipated to escalate between 0.25 to 1.8 °C and 0.6 to 4 °C under SSP2-4.5 and SSP5-8.5, respectively, with Sahara and West Southern Africa projected to warm faster than the rest of the regions. On average, warm days' frequency is also expected to upsurge under SSP2-4.5 (26-59%) and SSP5-8.5 (30-69%) relative to the recent climate. By the mid-21st century, continental population exposure is expected to upsurge by ~25% (28%) of the reference period under SSP2-4.5|SSP2 (SSP5-8.5|SSP5). The highest increase in exposure is expected in most parts of West Africa (WAF), followed by East Africa. The projected changes in continental exposure (~353.6 million person-days under SSP2-4.5|SSP2 and ~401.4 million person-days under SSP5-8.5|SSP5) are mainly due to the interaction effect. However, the climate's influence is more than the population, especially for WAF, South-East Africa and East Southern Africa. The study findings are vital for climate change adaptation.

Diversity of the Anisoptera & Zygoptera (Odonata: Insecta) of Swat, Pakistan

Odonates are important biological control agents for the control of insect pests and insect disease vectors of medical and veterinary importance. The present study was conducted to evaluate the odonate fauna of Swat, Pakistan from March to October 2019. A total of 200 specimens of odonates were collected from diverse habitats. The collected specimens of the order Odonata belonged to 5 families, three families of suborder Anisoptera namely Libellulidae, Gomphidae and Aeshnidae while two families of suborder Zygoptera (Chlorocyphidae and Coenagrionidae). The specimens were categorized into 12 genera and 22 species. Libellulidae was the dominant family (n = 138) accounting for 69% of the odonate fauna. Orthetrum was the dominant genus (n = 73) of suborder Anisoptera accounting for 36.5% of the odonate fauna. The least dominant genera were Anax, Paragomphus and Rhyothemis (n = 5 each) accounting each for 2.5% of the odonate fauna. In Zygoptera, the dominant genus was Ceriagrion (12.5%) and the least dominant genus was Ischnura (6%). Pantala flavescens (Fabricius, 1798) was the most abundant odonate species in the study area recorded from all surveyed habitats. Shannon Diversity Index (H) was 2.988 and Simpson Diversity Index (D) was 0.95 for the collected odonate fauna. The highest abundance of Odonata was recorded in August, September and May while no odonate species were recorded in January, February, November and December. Lotic water bodies were the most suitable habitats with abundant odonate fauna. Anax immaculifrons (Rambur, 1842) was the largest sized odonate species having a wingspan of 53.2±1.63 mm and body length of 56.3 ± 0.4 mm. The present study shows the status of odonate fauna of Swat, Pakistan in diverse habitats and seasonsonal variation throughout the year. Further work is recommended to bridge the gaps in the existing literature.

COVID-19 suicide and its causative factors among the healthcare professionals: Case study evidence from press reports

PURPOSE

Recent research has demonstrated the psychological impact of the coronavirus disease 2019 (COVID-19) pandemic among the general population. However, COVID-19-related suicides among healthcare professionals (HCPs) have yet to be investigated.

FINDINGS

The present study utilized retrospective press media suicide reports and identified a total of 26 worldwide HCP COVID-19-related suicide cases (aged 22-60 years; 14 females; most of the cases from India). The cases comprised doctors (n = 11), nurses (n = 9), paramedics (n = 5), and one medical student. Being infected with the COVID-19 was the most common suicide reason, followed by work-related stress, and fear related to COVID-19 infection/transmission. Among the eight cases diagnosed with COVID-19, most were female (n = 6), and either doctors (n = 4) or nurses (n = 4).

PRACTICE IMPLICATIONS

The present findings will be helpful for human resources departments in healthcare workplaces in ensuring HCP's mental wellbeing.

Population preferences and attitudes towards COVID-19 vaccination: a cross-sectional study from Pakistan

BACKGROUND

While vaccine development is itself a challenge; ensuring optimal vaccine uptake at population level can present an even more significant challenge. Therefore, this study aimed to assess the Pakistani population's attitude and preferences towards the Coronavirus disease 2019 (COVID-19) vaccine.

METHOD

A cross-sectional study was carried out through an online self-administered questionnaire from 27 September 2020 to 11 October 2020. A total of 883 people responded to the survey. The questionnaire included the participants' socio-demographic variables, attitudes, beliefs towards the COVID-19 vaccine and acceptance and rejection of vaccination, and reasons for them. Logistic regression analysis was used to analyze the predictors for vaccine acceptance and willingness to pay for the vaccine.

RESULTS

A majority (70.8%) of respondents will accept the COVID-19vaccine if available, and 66.8% showed a positive attitude towards vaccination. Monthly family income, education level, self-diagnosis of COVID-19 or a friend, family member, or colleague are significant factors influencing the acceptance of COVID-19 vaccination. The dogma of being naturally immune to COVID-19 was a key reason for the refusal of the vaccine. Less than half (48%) of those who refuse will vaccinate themselves if government officials have made it compulsory. A third (33.9%) of participants were willing to pay up to (7 USD) 1000 Pkr (Pakistani Rupees) for the vaccine.

CONCLUSION

The population's positive attitude should be improved by increasing awareness and eradicating false myths about vaccines through large-scale campaigns.

Roles of N6-Methyladenosine Demethylase FTO in Malignant Tumors Progression

In 2007, the fat mass and obesity-associated (FTO) gene was discovered initially to regulate body mass index and obesity and was subsequently found to be the first mRNA N6-methyladenosine (m6A) demethylation enzyme, which can demethylate m6A. A growing body of evidence shows that m6A modification is involved in a variety of cell biological processes, including cell proliferation, apoptosis, and self-renewal through different regulatory mechanisms. In recent years, a large number of studies have found that m6A modification play key role in the occurrence and development of tumors, such as acute myeloid leukemia, breast cancer, lung cancer, etc. As a function of m6A demethylase, FTO has attracted more and more attention in cancer. There is evidence that specific FTO single nucleotide polymorphisms (SNPs) may be significantly associated with overweight and cancer susceptibility by regulating the expression of related genes. Besides, when the expression level of FTO is altered or dysfunctional, it may be involved in the occurrence and progression of a variety of tumors as a tumor suppressor gene or oncogene, usually in an m6A-dependent manner. Further research found that FTO is involved in the development of different kinds of malignant tumors, but the mechanism is unknown. According to this review, The FTO gene's research progress in tumors is reviewed, aiming to find new targets for molecular pathological diagnosis and molecular targeted therapy of tumors.

Honey as a bioindicator of environmental organochlorine insecticides contamination

Honey is a suitable matrix for the evaluation of environmental contaminants including organochlorine insecticides. The present study was conducted to evaluate residues of fifteen organochlorine insecticides in honey samples of unifloral and multifloral origins from Dir, Pakistan. Honey samples (5 g each) were extracted with GC grade organic solvents and then subjected to Rotary Evaporator till dryness. The extracts were then mixed with n-Hexane (5 ml) and purified through Column Chromatography. Purified extracts (1μl each) were processed through Gas Chromatograph coupled with Electron Capture Detector (GC-ECD) for identification and quantification of the insecticides. Of the 15 insecticides tested, 46.7% were detected while 53.3% were not detected in the honey samples. Heptachlor was the most prevalent insecticide with a mean level of 0.0018 mg/kg detected in 80% of the samples followed by β-HCH with a mean level of 0.0016 mg/kg detected in 71.4% of the honey samples. Honey samples from Acacia modesta Wall. were 100% positive for Heptachlor with a mean level of 0.0048 mg/kg followed by β-HCH with a mean level of 0.003 mg/kg and frequency of 83.3%. Minimum levels of the tested insecticides were detected in the unifloral honey from Ziziphus jujuba Mill. Methoxychlor, Endosulfan, Endrin and metabolites of DDT were not detected in the studied honey samples. Some of the tested insecticides are banned in Pakistan but are still detected in honey samples indicating their use in the study area. The detected levels of all insecticides were below the Maximum Residue Levels (MRLs) and safe for consumers. However, the levels detected can cause mortality in insect fauna. The use of banned insecticides is one of the main factors responsible for the declining populations of important insect pollinators including honeybees.

COVID-19 Associated Mucormycosis: A Systematic Review from Diagnostic Challenges to Management

The coronavirus disease 2019 (COVID-19) outbreak has caused significant destruction, claiming over three million lives worldwide. Post SARS-COV-2 invasion, immunosuppression with hyperglycemia and elevated ferritin levels along with steroidal treatment creates a perfect storm for opportunistic infections. There is increasing evidence of mucormycosis co-infection in COVID-19 patients, during or post-treatment. A worse prognosis, a late diagnosis, and limited guidelines of screening and management of COVID-19 associated mucormycosis have made healthcare professionals fear an epidemic alongside a pandemic. This review geographically reports cases of COVID-19 associated mucormycosis (CAM), evaluates characteristics, clinical manifestations, and outcomes of mucormycosis in COVID-19 active or recovered patients. It further describes preventive strategies and recommendations for optimal management therapy that can be adopted worldwide to curtail an impending threat to the healthcare system.

Trends in Incidence, and Mortality of Acute Exacerbation of Chronic Obstructive Pulmonary Disease in the United States Emergency Department (2010-2018)

Literature regarding trends of incidence, mortality, and complications of acute exacerbation of chronic obstructive pulmonary disease (COPD) in the emergency departments (ED) is limited. What are trends of COPD exacerbation in ED? Data were obtained from the Nationwide Emergency Department Sample (NEDS) that constitutes a 20% sample of hospital-owned EDs and inpatient sample in the US. All ED encounters were included in the analysis. Complications of AECOPD were obtained by using ICD codes. Out of 1.082 billion ED encounters, 5,295,408 (mean age 63.31 ± 12.63 years, females 55%) presented with COPD exacerbation. Among these patients, 353,563(6.7%) had AECOPD-plus (features of pulmonary embolism, acute heart failure and/or pneumonia) while 4,941,845 (93.3%) had exacerbation without associated features or precipitating factors which we grouped as AECOPD. The AECOPD-plus group was associated with statistically significantly higher proportion of cardiovascular complications including AF (5.6% vs 3.5%; p < 0.001), VT/VF (0.14% vs 0.06%; p < 0.001), STEMI (0.22% vs 0.11%; p < 0.001) and NSTEMI (0.65% vs 0.2%; p < 0.001). The in-hospital mortality rates were greater in the AECOPD-plus population (0.7% vs 0.1%; p < 0.001). The incidence of both AECOPD and AECOPD-plus had worsened (p-trend 0.004 and 0.0003) and the trend of mortality had improved (p-trend 0.0055 and 0.003, respectively). The prevalence of smoking for among all COPD patients had increased (p-value 0.004), however, the prevalence trend of smoking among AECOPD groups was static over the years 2010-2018. There was an increasing trend of COPD exacerbation in conjunction with smoking; however, mortality trends improved significantly. Moreover, the rising burden of AECOPD would suggest improvement in diagnostics and policy making regarding management.

Does tourism increase CO2 emissions and health spending in Mexico? New evidence from nonlinear ARDL approach

This study investigates the nexus between tourism, CO₂ emissions and health spending in Mexico. We applied a nonlinear ARDL approach for the empirical analysis for the time period 1996-2018. Mexico receives a large number of tourists each year, tourism improves foreign exchange earnings and contributes positively to the economic growth. However, tourist activities impose a serious environmental cost in terms of CO₂ emissions which increase health spending. The empirical findings suggest that tourism leads to CO₂ emissions which resultantly causes a high level of health spending in Mexico. Both short-run and long-run findings reported a significant positive association between tourism, CO₂ emissions, and health expenditures. Therefore, the government needs legislation to reduce CO₂ emissions, besides the use of renewable energy could also help to reduce the CO₂ emissions and health expenditures in society. This study does not support to reduce the health expenditure, rather it suggests optimal utilization of the funds allocated to the health sector.

Public Health Expenditures and Health Outcomes in Pakistan: Evidence from Quantile Autoregressive Distributed Lag Model

OBJECTIVE

The provision of healthcare facilities remains high on the manifesto of various political parties in Pakistan and healthcare spending has witnessed a significant surge in the last two decades that is expected to positively influence health outcomes in the country. Therefore, this research aims to explore the effects of healthcare expenditures on the actual health status of the masses in Pakistan for the period 1995Q1 to 2017Q1.

METHODS

We apply the Quantile Autoregressive Distributed Lag (QARDL) approach for estimation purposes. This is the most recent and emerging estimation technique in time series analysis.

RESULTS

Our findings confirm that public healthcare spending significantly impacts health outcomes in Pakistan both in the short-run and long-run. Public healthcare spending improves life expectancy and reduces death rate and infant mortality.

CONCLUSION

The study concludes that public healthcare is the main focus of the current regime. It is noticed that spending on healthcare significantly contributes to the health outcomes in Pakistan. These efforts by the government significantly promote life expectancy and drop down the mortality ratio in the country. Based on these notable facts, the government should allocate sufficient resources towards the latest healthcare technologies and equipment to optimize health outcomes in the country.

Live imaging of SARS-CoV-2 infection in mice reveals that neutralizing antibodies require Fc function for optimal efficacy

Neutralizing antibodies (NAbs) are effective in treating COVID-19, but the mechanism of immune protection is not fully understood. Here, we applied live bioluminescence imaging (BLI) to monitor the real-time effects of NAb treatment during prophylaxis and therapy of K18-hACE2 mice intranasally infected with SARS-CoV-2-nanoluciferase. Real-time imaging revealed that the virus spread sequentially from the nasal cavity to the lungs in mice and thereafter systemically to various organs including the brain, culminating in death. Highly potent NAbs from a COVID-19 convalescent subject prevented, and also effectively resolved, established infection when administered within three days. In addition to direct neutralization, depletion studies indicated that Fc effector interactions of NAbs with monocytes, neutrophils, and natural killer cells were required to effectively dampen inflammatory responses and limit immunopathology. Our study highlights that both Fab and Fc effector functions of NAbs are essential for optimal in vivo efficacy against SARS-CoV-2.

Loneliness may mediate the relationship between depression and the quality of life among elderly with mild cognitive impairment

BACKGROUND

Depression and mild cognitive impairment (MCI) are often comorbid mental health issues in older adults. The current study explored the prospective mediating role of loneliness in the relationship between depression and the quality of life in elderly with MCI. A second aim was to examine differences in depression, loneliness, and the quality of life in the elderly with MCI among gender groups, and type of residence groups.

METHODS

A cross-sectional survey with purposive sampling was used. Older adults with MCI (N = 170) from old age homes in Lahore and Rawalpindi (n = 82) and family residences in Sargodha (n = 88) in Pakistan completed UCLA Loneliness Scale, Depression Anxiety Stress Scale, and Mild Cognitive Impairment Scale.

RESULTS

Most of the participants had severe to extreme depression (98.2%), and moderate to moderately high levels of loneliness (85.3%). Depression was significantly associated with loneliness (b = 0.29, P < 0.05) and poor quality of life in MCI (b = 0.49, P < 0.001). The indirect effect of depression on the quality of life in MCI through loneliness was significant (95% confidence interval (CI) [0.002, 0.156]). However, the indirect effect of quality of life in MCI on depression through loneliness was not significant (95% CI [-0.001, 0.043]). The elderly with MCI living in old age homes had higher depression, loneliness, and poor quality of life. Elderly women had higher levels of depression and poor quality of life, whereas older men were lonelier.

CONCLUSION

The relationship between depression and quality of life in the elderly with MCI may be bidirectional, and loneliness partially mediates only one of these relationships.