Global, regional, and national incidence and mortality burden of non-COVID-19 lower respiratory infections and aetiologies, 1990-2021: a systematic analysis from the Global Burden of Disease Study 2021

BACKGROUND

Lower respiratory infections (LRIs) are a major global contributor to morbidity and mortality. In 2020-21, non-pharmaceutical interventions associated with the COVID-19 pandemic reduced not only the transmission of SARS-CoV-2, but also the transmission of other LRI pathogens. Tracking LRI incidence and mortality, as well as the pathogens responsible, can guide health-system responses and funding priorities to reduce future burden. We present estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 of the burden of non-COVID-19 LRIs and corresponding aetiologies from 1990 to 2021, inclusive of pandemic effects on the incidence and mortality of select respiratory viruses, globally, regionally, and for 204 countries and territories.

METHODS

We estimated mortality, incidence, and aetiology attribution for LRI, defined by the GBD as pneumonia or bronchiolitis, not inclusive of COVID-19. We analysed 26 259 site-years of mortality data using the Cause of Death Ensemble model to estimate LRI mortality rates. We analysed all available age-specific and sex-specific data sources, including published literature identified by a systematic review, as well as household surveys, hospital admissions, health insurance claims, and LRI mortality estimates, to generate internally consistent estimates of incidence and prevalence using DisMod-MR 2.1. For aetiology estimation, we analysed multiple causes of death, vital registration, hospital discharge, microbial laboratory, and literature data using a network analysis model to produce the proportion of LRI deaths and episodes attributable to the following pathogens: Acinetobacter baumannii, Chlamydia spp, Enterobacter spp, Escherichia coli, fungi, group B streptococcus, Haemophilus influenzae, influenza viruses, Klebsiella pneumoniae, Legionella spp, Mycoplasma spp, polymicrobial infections, Pseudomonas aeruginosa, respiratory syncytial virus (RSV), Staphylococcus aureus, Streptococcus pneumoniae, and other viruses (ie, the aggregate of all viruses studied except influenza and RSV), as well as a residual category of other bacterial pathogens.

FINDINGS

Globally, in 2021, we estimated 344 million (95% uncertainty interval [UI] 325-364) incident episodes of LRI, or 4350 episodes (4120-4610) per 100 000 population, and 2·18 million deaths (1·98-2·36), or 27·7 deaths (25·1-29·9) per 100 000. 502 000 deaths (406 000-611 000) were in children younger than 5 years, among which 254 000 deaths (197 000-320 000) occurred in countries with a low Socio-demographic Index. Of the 18 modelled pathogen categories in 2021, S pneumoniae was responsible for the highest proportions of LRI episodes and deaths, with an estimated 97·9 million (92·1-104·0) episodes and 505 000 deaths (454 000-555 000) globally. The pathogens responsible for the second and third highest episode counts globally were other viral aetiologies (46·4 million [43·6-49·3] episodes) and Mycoplasma spp (25·3 million [23·5-27·2]), while those responsible for the second and third highest death counts were S aureus (424 000 [380 000-459 000]) and K pneumoniae (176 000 [158 000-194 000]). From 1990 to 2019, the global all-age non-COVID-19 LRI mortality rate declined by 41·7% (35·9-46·9), from 56·5 deaths (51·3-61·9) to 32·9 deaths (29·9-35·4) per 100 000. From 2019 to 2021, during the COVID-19 pandemic and implementation of associated non-pharmaceutical interventions, we estimated a 16·0% (13·1-18·6) decline in the global all-age non-COVID-19 LRI mortality rate, largely accounted for by a 71·8% (63·8-78·9) decline in the number of influenza deaths and a 66·7% (56·6-75·3) decline in the number of RSV deaths.

INTERPRETATION

Substantial progress has been made in reducing LRI mortality, but the burden remains high, especially in low-income and middle-income countries. During the COVID-19 pandemic, with its associated non-pharmaceutical interventions, global incident LRI cases and mortality attributable to influenza and RSV declined substantially. Expanding access to health-care services and vaccines, including S pneumoniae, H influenzae type B, and novel RSV vaccines, along with new low-cost interventions against S aureus, could mitigate the LRI burden and prevent transmission of LRI-causing pathogens.

FUNDING

Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care (UK).

Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic.

METHODS

The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic.

FINDINGS

Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021.

INTERPRETATION

Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades.

FUNDING

Bill & Melinda Gates Foundation.

Existential anxiety about artificial intelligence (AI)- is it the end of humanity era or a new chapter in the human revolution: questionnaire-based observational study

Background

Existential anxiety can profoundly affect an individual, influencing their perceptions, behaviours, sense of well-being, academic performance, and decisions. Integrating artificial intelligence into society has elicited complex public reactions, marked by appreciation and concern, with its acceptance varying across demographics and influenced by factors such as age, gender, and prior AI experiences. This study aimed to investigate the existential anxiety about artificial intelligence (AI) in public in Saudi Arabia.

Methods

The present questionnaire-based observational, analytical cross-sectional study with a structured, self-administered survey was conducted via Google Forms, using a scale to assess the existential anxiety levels induced by the recent development of AI. The study encompassed a diverse population with a sample size of 300 participants.

Results

This study's findings revealed a high prevalence of existential anxieties related to the rapid advancements in AI. Key concerns included the fear of death (96% of participants), fate's unpredictability (86.3%), a sense of emptiness (79%), anxiety about meaninglessness (92.7%), guilt over potential AI-related catastrophes (87.7%), and fear of condemnation due to ethical dilemmas in AI (93%), highlighting widespread apprehensions about humanity's future in an AI-dominated era.

Conclusion

The public has concerns including unpredictability, a sense of emptiness, anxiety, guilt over potential AI-related catastrophes, and fear of condemnation due to ethical dilemmas in AI, highlighting widespread apprehensions about humanity's future in an AI-dominated era. The results indicate that there is a need for a multidisciplinary strategy to address the existential anxieties in the AI era. The strategic approach must blend technological advancements with psychological, philosophical, and ethical insights, underscoring the significance of human values in an increasingly technology-driven world.

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations.

METHODS

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds.

FINDINGS

The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles.

INTERPRETATION

Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere.

FUNDING

Bill & Melinda Gates Foundation.

The global impact of SARS-CoV-2 variant BA.2.86: a comprehensive analysis with the latest developments and transmission trends - an epidemiological study

OBJECTIVE

The variant BA.2.86 of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing concern globally. The virus contains a large number of mutations, and transmission trends are rapidly changing globally. This study investigates the global epidemiological and transmission trends of SARS-CoV-2 new variant BA.2.86 in various continents and countries.

MATERIALS AND METHODS

The data were recorded using key terms, including SARS-CoV-2, Omicron, BA.2.86, epidemiology, occurrence, incidence, prevalence, and transmission trends. The data on SARS-CoV-2 variant BA.2.86 were searched by the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), the Global Initiative on Sharing All Influenza Data (GSIAD), PubMed, and Web of Science. Initially, 40 documents were identified, and finally, 8 documents were included for the data analysis and discussion. The analysis of findings on transmission trends was based on the data from August 14, 2023, to February 28, 2024.

RESULTS

The SARS-CoV-2, novel variant BA.2.86, crossed the international borders of 6 continents and 89 countries and infected 19,532 people. In Europe, 32 countries are affected and involved 12,667 people (64.85%), North and South America 18 countries with 3,515 cases (17.99%), Asia 27 countries with 2,063 people (10.56%), Oceania 2 countries with 689 cases (3.52%), and Africa 10 countries with 598 (3.06%) cases. The BA.2.86 rapidly spread and mainly affected the people in the United Kingdom 3,228 (16.52%), Sweden 2,380 (12.18%), USA 1,929 (9.87%), Denmark 1,621 (8.29%), Canada 1,516 (7.67%), France 833 (4.26%), Japan 810 (4.14%), Netherlands 725 (3.71%), Germany 681 (3.48%), Spain 665 (3.40%), South Korea 556 (2.84%), and Australia 512 (2.62%).

CONCLUSIONS

The SARS-CoV-2, novel variant BA.2.86, spread over six continents and 89 countries and affected 19,532 people worldwide. The disease is more prevalent in the United Kingdom, United States of America, and European countries. The detection of the disease in multiple continents and countries suggests some degree of transmissibility. Global health authorities need to rethink their policies and implement strict strategies to eradicate emerging variants and minimize the global disease burden.

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020-21 COVID-19 pandemic period.

METHODS

22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution.

FINDINGS

Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5-65·1] decline), and increased during the COVID-19 pandemic period (2020-21; 5·1% [0·9-9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98-5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50-6·01) in 2019. An estimated 131 million (126-137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7-17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8-24·8), from 49·0 years (46·7-51·3) to 71·7 years (70·9-72·5). Global life expectancy at birth declined by 1·6 years (1·0-2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67-8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4-52·7]) and south Asia (26·3% [9·0-44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations.

INTERPRETATION

Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic.

FUNDING

Bill & Melinda Gates Foundation.

Environmental pollutants PM2.5, PM10, carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3) impair human cognitive functions

OBJECTIVE

Environmental pollution is an emerging global public health problem across the world and causes serious threats to ecosystems, human health, and the planet. This study is designed to explore the impact of environmental pollution particulate matter PM2.5, PM10, carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3) on cognitive functions in students from schools located in or away from air-polluted areas.

SUBJECTS AND METHODS

In this study, two schools were selected: one was located near a traffic-polluted area (school #1), and the second was in an area away from the traffic-polluted area (school #2). In this study, a total of 300 students were recruited: 150 (75 male and 75 female) students from school #1 located in a traffic-polluted area, and 150 students (75 male and 75 female) from school #2 located away from a traffic polluted area. The overall average age of students was 13.53±1.20 years. The students were selected based on age, gender, health status, height, weight, BMI, ethnicity, and homogenous socio-economic and educational status. The pollutants PM2.5, PM10, CO, NO2, O3, and SO2 were recorded in the surrounding environment. The overall mean concentration of environmental pollutants in school #1 was 35.00±0.65 and in school #2 was 29.95±0.32. The levels of airborne particles were measured, and the cognitive functions were recorded using the Cambridge Neuropsychological Test Automated Battery (CANTAB). The students performed the cognitive functions tasks, including the attention switching task (AST), choice reaction time (CRT), and motor screening task (MOT).

RESULTS

The results revealed that the AST-Mean 928.34±182.23 vs. 483.79±146.73 (p=0.001), AST-mean congruent 889.12±197.12 vs. 473.30±120.11 (p=0.001), AST-mean in-congruent 988.98±201.27  vs. 483.87±144.57 (p=0.001), CRT-Mean 721.36±251.72  vs. 418.17±89.71 (p=0.001), and MOT-Mean 995.07±394.37 vs. 526.03±57.83 (p=0.001) were significantly delayed among the students who studied in school located in the traffic polluted area compared to students who studied in school which was located away from the traffic-polluted area.

CONCLUSIONS

Environmental pollution was significantly higher in motor vehicle-congested areas. Cognitive functions were impaired among the students who were studying in a school located in a polluted area. The results further revealed that the students studying in schools located in environmentally polluted areas have attention, thinking, and decision-making abilities related to cognitive function impairment.

Lung functions pre- and post-endoscopic balloon dilation treatment among patients with subglottic stenosis

OBJECTIVE

Subglottic stenosis (SGS) is an unusual clinical condition of mucosal wounding, compromising the extra-thoracic part of the tracheal airway below the vocal folds. The diagnosis of SGS is established with a detailed clinical examination and a direct endoscopic examination, and the role of spirometry is also often acknowledged. This study aimed to investigate the impact of SGS on lung functions before and after the balloon dilation procedure.

PATIENTS AND METHODS

The respiratory functions were performed in the Department of Clinical Physiology and the Department of Otolaryngology College of Medicine, King Saud University, Riyadh, Saudi Arabia. In this study, 50 patients with SGS were referred from the Department of Otolaryngology, and lung functions before and after the balloon dilation procedure among patients with SGS were performed using an electronic spirometer.

RESULTS

The results revealed that the mean values for lung function test parameters VC (p=0.01), FVC (p=0.01), FEV1 (p=0.004), FEV1/FVC Ratio (p=0.01), PEFR (p=0.01), FEF-25% (p=0.01), FEF-50% (p=0.01), and FEF-75%, (p=0.01) were significantly improved in both male and female patients with SGS on one month after the balloon dilation procedure.

CONCLUSIONS

It is concluded that the lung function test parameters were increased after the balloon dilation procedure among patients with SGS. The findings showed the impact of SGS on lung function test parameters. Spirometry is a valuable test in patients with SGS and is an appropriate marker to reveal post-airway outcomes. Physicians must suggest lung function tests in patients with SGS before and after the balloon dilation procedure.

Perceptions about the Implementation and Education of Telemedicine among University Students in Riyadh, Saudi Arabia

Objectives

This study evaluated and compared the perceptions, awareness, and experiences of telemedicine among university students in Riyadh.

Methods

In this cross-sectional study, a questionnaire was distributed electronically to undergraduate university students in Riyadh. The study was conducted from September 2021 to March 2022. Five-point Likert scale data were reported as percent agreement, while open-text comments were reported as recurring themes. Besides, the perceptions of medical students were compared with students from other disciplines.

Results

Of 564 participants, 209 (37%) were medical students. Most respondents agreed that telemedicine could save patients' time (77.7%) and improve access to healthcare (73.4%). The agreement was low for the statements that doctors would effectively evaluate the clinical features (39.2%) and that patients would effectively communicate their illnesses (44.3%). The agreement of medical students compared to students from other disciplines was even lower for these statements (25% vs. 47%; p<0.001) and (37% vs. 48%; p=0.03), respectively. Most medical students reported that they never learned about telemedicine (65%) and its tools (69%). Lack of awareness, training of healthcare workers and perceived lower quality of healthcare emerged as the most relevant factors for the limited acceptance of telemedicine.

Conclusions

Most participants perceived that telemedicine could save patients' time and improve access to healthcare. The low agreement, especially of medical students, for the ability of physicians to evaluate clinical features and of patients to communicate illnesses effectively possibly represented suboptimal education of telemedicine in medical curricula. Thus, incorporating telemedicine into medical curricula and improving public awareness might expedite telemedicine implementation.

The Scientific Knowledge of Bard and ChatGPT in Endocrinology, Diabetes, and Diabetes Technology: Multiple-Choice Questions Examination-Based Performance

BACKGROUND

The present study aimed to investigate the knowledge level of Bard and ChatGPT in the areas of endocrinology, diabetes, and diabetes technology through a multiple-choice question (MCQ) examination format.

METHODS

Initially, a 100-MCQ bank was established based on MCQs in endocrinology, diabetes, and diabetes technology. The MCQs were created from physiology, medical textbooks, and academic examination pools in the areas of endocrinology, diabetes, and diabetes technology and academic examination pools. The study team members analyzed the MCQ contents to ensure that they were related to the endocrinology, diabetes, and diabetes technology. The number of MCQs from endocrinology was 50, and that from diabetes and science technology was also 50. The knowledge level of Google's Bard and ChatGPT was assessed with an MCQ-based examination.

RESULTS

In the endocrinology examination section, ChatGPT obtained 29 marks (correct responses) of 50 (58%), and Bard obtained a similar score of 29 of 50 (58%). However, in the diabetes technology examination section, ChatGPT obtained 23 marks of 50 (46%), and Bard obtained 20 marks of 50 (40%). Overall, in the entire three-part examination, ChatGPT obtained 52 marks of 100 (52%), and Bard obtained 49 marks of 100 (49%). ChatGPT obtained slightly more marks than Bard. However, both ChatGPT and Bard did not achieve satisfactory scores in endocrinology or diabetes/technology of at least 60%.

CONCLUSIONS

The overall MCQ-based performance of ChatGPT was slightly better than that of Google's Bard. However, both ChatGPT and Bard did not achieve appropriate scores in endocrinology and diabetes/diabetes technology. The study indicates that Bard and ChatGPT have the potential to facilitate medical students and faculty in academic medical education settings, but both artificial intelligence tools need more updated information in the fields of endocrinology, diabetes, and diabetes technology.

Efficacy of Oxford-AstraZeneca (ChAdOx1 CoV-19) vaccine against Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) cases, hospital admissions, type of variants, and deaths

OBJECTIVE

The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) epidemic has instigated enormous damage to the global healthcare system and economies. A large number of vaccines have been developed. However, confidence in any COVID-19 vaccine is essential for its sustainable success. The present study aimed to investigate the efficacy of the Oxford-AstraZeneca (ChAdOx1 CoV-19) vaccine against SARS-COV-2 cases, hospital admissions, type of variants and deaths.

MATERIALS AND METHODS

This study recorded data using electronic platforms PubMed, Web of Science, World Health Organization, US-Food and Drug Authorities-FDA, Facts sheets, and Pharmaceutical Websites. Initially, 278 articles and reports were identified, and after revising the abstracts, 39 studies, clinical trials and organizations, reports were selected for a detailed analysis.

RESULTS

The efficacy of the Oxford-AstraZeneca COVID-19 vaccine against symptomatic COVID-19 cases after the first dose was 60.59% (p=0.00001) and after the second dose was 66.84% (p=0.00001). The highest efficacy was against the Alpha variant 58.80% (p=0.00001) and the lowest efficacy was against the Beta variant 30.83% (p=0.00001). However, the overall efficacy against the SARS-CoV-2 variants after the first dose was 49.20%. The highest efficiency of SARS-CoV-2 variants after the second dose against the Beta (B.1.351) variant was 90.34% (p=0.00001), while the lowest efficacy was against the Omicron (B.1.1.529) variant 46.46% (p=0.00001), with overall efficacy against SARS-CoV-2-2 variants after the second dose 73.73%. The highest efficacy against emergency admission was 94.42% (p=0.00001), while the lowest efficacy was 86.57% (p=0.00001), with overall efficacy against ICU, hospital, and emergency admissions after the second dose was 87.74%. Furthermore, the efficacy of the Oxford-AstraZeneca vaccine against deaths after the second dose was 87.44% (p=0.00001).

CONCLUSIONS

The efficacy of the Oxford-AstraZeneca COVID-19 vaccine against symptomatic COVID-19 cases, various variants, ICU, and emergency admissions, and against deaths was high. The present study results provide valuable insights for healthcare workers, policymakers, and researchers about the precise efficacy levels against symptomatic cases, hospitalization, and mortality across the diverse populations and age groups.

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.

Implications of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infected Hospitalised Patients with Co-Infections and Clinical Outcomes

The clinical severity of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection may rise because of acquiring a co-infection during the hospital stay of the patients. The rate of hospital co-infection alongside COVID-19 infection remains low. However, the mortality rates and intensive care unit (ICU) admission remains ambiguous. The present study investigates the implications of COVID-19 hospitalised infected patients with co-infection and the clinical outcomes. In this study, 142 patients were included. The eligible patients who tested positive for COVID-19 infection were hospitalised for more than two days. Each patient's characteristics and laboratory results were collected, such as who was admitted to the intensive care unit and who was discharged or expired. The results revealed that out of the 142 hospitalised patients, 25 (17.6%) were co-infection positive, and 12 identified types of co-infection: two Gram-positive bacterial infections, one fungal infection and nine Gram-negative bacterial infections. In addition, 33 (23.2%) were ICU admitted, 21 were co-infection negative and 12 were co-infection positive. Among the 12 ICU admitted with co-infection, 33.4% were discharged. The death rate and ICU admission had a p-value < 0.05, indicating statistical significance for co-infected patients compared to non-co-infected patients. It was concluded that co-infection remains very low within hospitalised COVID-19-infected patients but can have severe outcomes with increased ICU admission and increased mortality rates. Thus, implementing infection preventive measures to minimize the spread of hospital-acquired infections among COVID-19 hospitalised patients.

ChatGPT Knowledge Evaluation in Basic and Clinical Medical Sciences: Multiple Choice Question Examination-Based Performance

The Chatbot Generative Pre-Trained Transformer (ChatGPT) has garnered great attention from the public, academicians and science communities. It responds with appropriate and articulate answers and explanations across various disciplines. For the use of ChatGPT in education, research and healthcare, different perspectives exist with some level of ambiguity around its acceptability and ideal uses. However, the literature is acutely lacking in establishing a link to assess the intellectual levels of ChatGPT in the medical sciences. Therefore, the present study aimed to investigate the knowledge level of ChatGPT in medical education both in basic and clinical medical sciences, multiple-choice question (MCQs) examination-based performance and its impact on the medical examination system. In this study, initially, a subject-wise question bank was established with a pool of multiple-choice questions (MCQs) from various medical textbooks and university examination pools. The research team members carefully reviewed the MCQ contents and ensured that the MCQs were relevant to the subject's contents. Each question was scenario-based with four sub-stems and had a single correct answer. In this study, 100 MCQs in various disciplines, including basic medical sciences (50 MCQs) and clinical medical sciences (50 MCQs), were randomly selected from the MCQ bank. The MCQs were manually entered one by one, and a fresh ChatGPT session was started for each entry to avoid memory retention bias. The task was given to ChatGPT to assess the response and knowledge level of ChatGPT. The first response obtained was taken as the final response. Based on a pre-determined answer key, scoring was made on a scale of 0 to 1, with zero representing incorrect and one representing the correct answer. The results revealed that out of 100 MCQs in various disciplines of basic and clinical medical sciences, ChatGPT attempted all the MCQs and obtained 37/50 (74%) marks in basic medical sciences and 35/50 (70%) marks in clinical medical sciences, with an overall score of 72/100 (72%) in both basic and clinical medical sciences. It is concluded that ChatGPT obtained a satisfactory score in both basic and clinical medical sciences subjects and demonstrated a degree of understanding and explanation. This study's findings suggest that ChatGPT may be able to assist medical students and faculty in medical education settings since it has potential as an innovation in the framework of medical sciences and education.

Brain drain of healthcare professionals from Pakistan from 1971 to 2022: Evidence-based analysis

Since the creation of Pakistan in August 1947, political instability has been a persistent issue in the country, causing a migration of highly qualified, skilled people, and healthcare professionals. From 1971 to 2022 the total number of highly qualified and skilled people including healthcare professionals who migrated from the country is 60,19,888. Among them, 251677 (4.18%), were highly qualified, 455097 (7.55%) were highly skilled, and 5313114 (88.27%) were skilled professionals. Moreover, 50110 (0.83%) were healthcare professionals including doctors 31418 (62.69%), nurses 12853 (25.64%), and pharmacists 5839 (11.65%). The unsustainable political environment, lack of advanced technology-based institutes, poor healthcare infrastructure, low job opportunities and salary benefits in Pakistan caused the brain drain of highly qualified people including healthcare professionals. It adversely affected the academic institutes, the healthcare system, socio-economic growth, research productivity, and the development of the nation. The government of Pakistan must establish sustainable policies to minimize the brain drain of highly qualified people, and healthcare professionals, and recuperate the prosperity of their academic institutes and healthcare system for better healthcare services, and the advancement and sustainable development of the nation.

Hospital-Acquired Infections Caused by Carbapenem-Resistant Enterobacteriaceae: An Observational Study

Worldwide, hospital-acquired infections (HAIs) are continuously rising within healthcare settings, leading to high mortality and morbidity rates. Many hospitals have reported the spread of carbapenemases globally, specifically within the E. coli and K. pneumoniae species. This study was aimed at analyzing the state of hospital-acquired, carbapenem-resistant E. coli and K. pneumoniae in the United Kingdom between 2009 and 2021. Moreover, the study analyzed the most efficacious approaches to patient management for controlling the carbapenem-resistant Enterobacteriaceae (CRE) spread. Initially, 1094 articles were identified as relevant for screening, and among them, 49 papers were eligible for full-text screening, with a total of 14 articles meeting the inclusion criteria. The information was recorded from published articles through PubMed, the Web of Science, Scopus, Science Direct, and the Cochrane library and was used to search for hospital-acquired carbapenem-resistant E. coli and K pneumoniae in the UK between 2009 and 2021, in order to evaluate the spread of CRE in hospitals. The total number of carbapenem-resistant E. coli was 1083 and this was 2053 for carbapenem-resistant K. pneumoniae in more than 63 UK hospitals. KPC was the dominant carbapenemase produced by K. pneumoniae. The results showed that the treatment options considered depended on the type of carbapenemase produced; K. pneumoniae showed more resistance to a treatment options, i.e., Colistin, than the other carbapenemase. The current state of the UK is at minimal risk for a CRE outbreak; however, appropriate treatment and infection control measures are highly required to prevent this CRE spread at the regional and global levels. The present study findings have an important message for physicians, healthcare workers, and policymakers about hospital-acquired carbapenem-resistant E. coli and K. pneumoniae spread and approaches to patient management.

Impact of traveling on transmission trends of human monkeypox disease: worldwide data based observational analysis

Background

Human monkeypox is an emerging viral zoonotic disease caused by a monkeypox virus (MPXV). This year since early May 2022, the virus swiftly spread involved 94 countries, and 41,358 people, and has developed a highly challenging and threatening situation worldwide. This study aimed to investigate the impact of traveling on the transmission of human monkeypox disease and comprehend the link between monkeypox exported cases in the context of the global outbreak.

Methods

In this study, we identified data from two leading health organizations, the World Health Organization (WHO), and the Centers for Disease Control Prevention (CDC), as well as 40 documents that were identified through the search engines Web of Science, Pub-Med, Medline, EMBASE, Scopus, and Google Scholar using the keywords "monkeypox," "human monkeypox," "imported"', "exportation" "travelers," and "prevalence." Finally, two international organizations WHO, and CDC, and out of 40 documents, 10 (25.0%) were included in the analysis, and the remaining 30 (75.0%) documents were excluded. The studies originated from the United Kingdom, the United States of America, Singapore, Israel, the Republic of Korea, Taiwan, and India. The data on transmission trends and human monkeypox was recorded and analyzed.

Results

The epidemiological data for exported monkeypox cases were analyzed jointly for understanding the transmission trends of exportations and the geographic context of the monkeypox outbreak. Ten people had a travel history, six had a travel history from Nigeria to the United Kingdom (2), Nigeria to the United States of America (2), Nigeria to Singapore (1) and Nigeria to Israel (1). Moreover, from Germany to Taiwan (1), Germany to the Republic of Korea (1) and the United Arab Emirates to India (2). Among these 10 people, all travelers were male (100%), with age ranges of 20-38 years, seven people (70%) developed clinical symptoms before the start of travel, three people (30%) developed symptoms 2-6 days after the travel, and one person (10%) developed clinical symptoms in the flight during the journey.

Conclusion

The study findings conclude that traveling can cause the spread of human monkeypox disease in various countries. The findings support the hypothesis that virus sources can travel and spread the disease from person to person and from region to region. The international health authorities must implement global preventive policies to control the burden of the disease both at regional and international levels.

Prevalence of Chemosensitive Neurological Disorders of Smell and Taste and Association with Blood Groups in SARS-CoV-2 Patients: Cross-Sectional Study

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused a highly challenging and threatening situation worldwide. SARS-CoV-2 patients develop various clinical symptoms. The olfactory and taste dysfunctions are potential neurological manifestations among SARS-CoV-2 patients; however, their relationship with blood groups has rarely been investigated. This study aimed to investigate the prevalence of chemosensitive neurological disorders of smell and taste and their association with blood groups in SARS-CoV-2 patients. The present cross-sectional study was performed in the Department of Pathology, and Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia. A well-structured, self-administered questionnaire was designed and distributed through social media platforms. A total of 922 Saudi and non-Saudi adults aged 18 years or older participated in the study. Out of 922 participants, the number of people who had anosmia was 309 (33.5%), 211 (22.9%) had hyposmia, and 45 (4.8%) had dysosmia. Moreover, 180 (19.52%) had ageusia, 47 (5.1%) and 293 (31.8%) had hypogeusia and dysgeusia, respectively. Among all the participants, 565 (61.27%) had smell-related disorders and 520 (56.39%) participants had taste-related clinical symptoms. The occurrence of anosmia and ageusia was relatively high among females compared to males (p = 0.024). The prevalence of smell-related disorders was 25.0% (230) and taste-related disorders was 23.21% (214) among the study participants with blood group O compared to all other blood group (A, B, and AB) participants who have smell allied disorders 30.69% (283), and taste allied disorders 27.98% (258). The prevalence of chemosensitive neurological disorders involving impaired smell and taste was higher in SARS-CoV-2 patients. These clinical symptoms were common among the participants with blood group type O compared to all other ABO blood group types. The role of certain demographic characteristics was consistent throughout multiple studies, notably with female gender and young adults.

The Risk Factors for Acute Cerebrovascular Accident (Stroke) in Patients with Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2)

Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) patients may experience an acute ischemic stroke; however, risk factors, in-hospital deaths, and outcomes have not been thoroughly investigated. This study investigates the risk factors, comorbidities, and outcomes in patients with SARS-VoV-2 infection and acute ischemic stroke compared to patients without these conditions. The present retrospective study was conducted in the King Abdullah International Medical Research Centre (KAIMRC), Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia, during the period from April 2020 to February 2022. This study investigates the risk variables among the individuals who were diagnosed with either SARS-CoV-2 with stroke or patients with stroke alone. A total of 42,688 COVID-19 patients were registered, 187 cases of strokes were listed in COVID-19 patients, however, 5395 cases with stroke without SARS-CoV-2 infection. The results revealed that factors including age, hypertension, deep vein thrombosis, and ischemic heart disease are associated with an increased risk of ischemic stroke. The results also displayed an elevated frequency of in-hospital deaths in COVID-19 patients with acute ischemic stroke. The results also showed that SARS-CoV-2 together predicts the probability of stroke and death in the study sample. The study findings conclude that ischemic strokes were infrequent in patients with SARS-CoV-2 and usually occur in the presence of other risk factors. The risk factors of ischemic strokes in patients with SARS-CoV-2 are old age, male gender, hypertension, hyperlipidaemia, DVT, ischemic heart disease, and diabetes mellitus. Furthermore, the results showed a higher frequency of in-hospital deaths in COVID-19 patients with stroke compared to COVID-19 patients without stroke.

Comparison of Biological, Pharmacological Characteristics, Indications, Contraindications, Efficacy, and Adverse Effects of Inactivated Whole-Virus COVID-19 Vaccines Sinopharm, CoronaVac, and Covaxin: An Observational Study

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging viral zoonotic illness that has developed a distinctive and threatening situation globally. Worldwide, many vaccines were introduced to fight against the COVID-19 pandemic. The present study aims to compare the bio-pharmacological characteristics, indications, contraindications, efficacy, and adverse effects of inactivated whole-virus COVID-19 vaccines, Sinopharm, CoronaVac, and Covaxin. Initially, 262 documents and 6 international organizations were selected. Finally, 41 articles, fact sheets, and international organizations were included. The data were recorded from the World Health Organization (WHO), Food and Drug Administration (FDA) USA, Web of Science, PubMed, EMBASE, and Scopus. The results demonstrated that these three inactivated whole-virus COVID-19 vaccines, Sinopharm, CoronaVac, and Covaxin, received emergency approval from the FDA/WHO, and all three of these vaccines are beneficial for the prevention of the COVID-19 pandemic. The Sinopharm vaccine has been recommended during pregnancy and for people of all age groups, and the CoronaVac and Covaxin vaccines are recommended for people over 18 years of age and older. These three vaccines have recommended intramuscular doses of 0.5 mL each, with a 3-4 week interval. These three vaccines can be stored in a refrigerator at +2 to +8 °C. The common adverse effects of these vaccines are pain at the injection site, redness, fatigue, headache, myalgias, general lethargy, body ache, arthralgia, nausea, chills, fever, and dizziness. The overall mean efficiency for the prevention of the COVID-19 disease is 73.78% for Sinopharm, 70.96% for CoronaVac, and 61.80% for Covaxin. In conclusion, all three inactivated whole-virus COVID-19 vaccines, Sinopharm, CoronaVac, and Covaxin, are beneficial for the prevention of the COVID-19 pandemic. However, evidence suggests that the overall impact of Sinopharm is slightly better than that of CoronaVac and Covaxin.

Author Correction: Impact of environmental pollutants Particulate Matter PM2.5, carbon monoxide, nitrogen dioxide and ozone on the incidence of Monkeypox cases in New York City

Correction to: European Review for Medical and Pharmacological Sciences 2022; 26 (21): 8197-8203. DOI: 10.26355/eurrev_202211_30173-PMID: 36394769-published online on November 15, 2022. After publication, the authors applied a correction to the title: Impact of environmental pollutants Particulate Matter PM2.5, carbon monoxide, nitrogen dioxide and ozone on the incidence of Monkeypox cases There are amendments to this paper. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/30173.

Adverse Effects of Sinopharm COVID-19 Vaccine among Vaccinated Medical Students and Health Care Workers

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease caused a highly problematic situation worldwide. Various vaccines were launched to combat the COVID-19 pandemic. This study aims to investigate the adverse effects of first and second doses of the Sinopharm vaccine among vaccinated medical and dental students and healthcare workers. A well-established questionnaire was distributed online, and 414 medical and dental students and healthcare workers (HCW) comprising 355 females (85.7%) and 59 males (14.3%) participated; all were vaccinated with two doses of Sinopharm. The most common side effect was pain at the injection site after dose one in 253 respondents (61.3%) and after dose two in 161 respondents (38.9%). Other symptoms included general lethargy in 168 (40.6%), myalgia/body pain in 99 (23.9%), low-grade fever in 93 (22.4%), and headache in 87 (21%) respondents. Common side effects reported after the second dose of the vaccine following pain at the injection site included general lethargy in 21.3% (88), headache in 10.4% (43), myalgia/body pain in 9.9% (41), and low-grade fever in 6.1% (25) of the respondents. In conclusion, common adverse effects of the Sinopharm vaccine were pain at the injection site, general lethargy, myalgia, body pain, low-grade fever, and headache. These adverse effects were mild in intensity for both doses but slightly more frequent and severe for the first dose than the second dose.

Public health in Global South: effect of environmental pollutant PM2.5 on the incidence and mortality of SARS-CoV-2 in Karachi, Lahore, and Islamabad

OBJECTIVE

Environmental pollution has undoubtedly been established as a planetary, intergenerational, and existential threat to global human health and safety. Environmental pollution is adversely affecting the world, mainly the countries where human health is not a priority aspect, and this has been exacerbated due to the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), and pandemic is known as "COVID pandemic". This study investigates the association of environmental pollutants, particulate matter (PM2.5), with SARS-CoV-2 daily cases and deaths in Karachi, Lahore, and Islamabad, Pakistan, presenting the perspectives from the Global South.

MATERIALS AND METHODS

The day-to-day PM2.5 levels were recorded from the metrological website, Real-Time Air Quality Index-AQI. The corresponding data on the COVID cases and deaths in Karachi, Lahore, and Islamabad were obtained from August 1, 2020, to September 30, 2021, from the Health Ministry and National Command Operations Centre Pakistan.

RESULTS

The mean values for PM2.5 in Karachi were 110.4±46.2; in Lahore 174.0±83.2; and in Islamabad 107.1±40.0. The COVID-19 mean daily cases in Karachi were 538.9±446.6; Lahore 398.3±403.1; and Islamabad 212.2±187.6; and mean daily deaths in Karachi were 9.2±8.3; Lahore 9.3±9.7; and Islamabad 1.8±1.8. The results further depicted that the SARS-CoV-2 cases were 2.86 times higher in Karachi and 1.4 times higher in Lahore than in Islamabad. Similarly, the SARS-CoV-2 deaths were 3.6 and 2.8 times higher in Karachi and Lahore, respectively, compared to Islamabad.

CONCLUSIONS

The findings claim that cases and deaths augmented significantly along with PM2.5 levels. These empirical estimates demonstrate an association between PM2.5 and SARS-CoV-2 daily cases and deaths in the cities of the Global South. These findings can contribute to policy-making decisions about addressing air pollutants and climate concerns in developing countries and create an urgency to develop a strategy for minimizing environmental pollution. This study can also steer the actions needed to address the environmental problems in developing countries to improve public health and safety.

Comparison of Biological, Pharmacological Characteristics, Indications, Contraindications and Adverse Effects of JYNNEOS and ACAM2000 Monkeypox Vaccines

Human monkeypox is an emerging viral zoonotic disease, that has caused highly distinctive, challenging and threatening problems worldwide. The US Food and Drug Administration (FDA) has given interim authorization for the JYNNEOS and ACAM2000 vaccines for the outbreak of monkeypox 2022. The present study aims to highlight the globally derived evidence about the biological and pharmacological features, indications, contraindications and adverse effects of JYNNEOS and ACAM2000 vaccines. Initially, 82 documents were selected and, finally, 14 fact sheets, documents and international organizations were included. The data were recorded from the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA) USA, ISI-Web of Science, PubMed, EMBASE and Scopus. The data revealed that the JYNNEOS vaccine has been recommended to children, adults, females during pregnancy and people of all age groups with a dose of 0.5 mL, and the complete vaccination cost per person is about USD 115. It provides immunogenicity, and the mean titer of neutralizing antibodies was 153.5. However, the ACAM2000 vaccine is contraindicated in infants and pregnant females, and recommended to people over 18 years of age and older, with a single dose of 0.0025 mL, and a cost of about USD 139. ACAM2000 provides immunogenicity, and the mean titer of neutralizing antibodies was 79.3. The JYNNEOS vaccine has mild adverse effects including pain, redness, swelling or itching at the site of the vaccine shot, fever, fatigue, headache, nausea and muscle pain. However, the ACAM2000 vaccine can cause pain, redness, edema, headache, fever, fatigue, muscle pain, body ache, nausea, vomiting, diarrhea, shortness of breath and increased risk of myopericarditis and cardiomyopathy. The evidence supports the view that both vaccines are beneficial, but the overall impact of JYNNEOS is better than that of ACAM2000.

Seasonal variations impact on SARS-CoV-2 incidence and mortality in southern and northern hemispheres: Two years pandemic period based study

Objectives

The Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) infection is a highly challenging problem in the world. The impact of weather conditions on the spread of SARS-CoV-2 has been hypothesized, but the level of understanding remains lacking. This study investigates the impact of seasonal variations on SARS-CoV-2 incidence and mortality in the Southern and Northern hemispheres.

Methods

We enlisted all the countries from both hemispheres and then randomly selected 20 countries, 10 countries from each hemisphere. After that, we recorded the SARS-CoV-2 daily cases and deaths in these selected countries from the Worldometer for the period of two years from December 31, 2019, to December 31, 2021.

Results

During the study period, in 10 selected countries of the Northern hemisphere, the number of SARS-CoV-2 cases was 18381.6 ± 419.7 and deaths 300.4 ± 6.4. However, the number of cases in the southern hemisphere is 6282.9 ± 205.8, and mortality was 210.0 ± 7.7. In the Northern hemisphere, the number of SARS-CoV-2 cases (p = 0.001) and deaths (p = 0.001) significantly increased compared to the southern hemisphere. The maximum number of cases and deaths occurred during the winter (18806.4 ± 785.3) and autumn (17034.1 ± 538.4) periods in both the hemisphere compared to spring and summer. Similarly, the number of deaths increased in winter (391.0 ± 13.4, p = 0.001) and autumn (308.6 ± 11.6) compared to spring and summer in both hemispheres.

Conclusions

The highest occurrence of SARS-CoV-2 cases and deaths was found during the winter and autumn seasons, while the lowest was found in the spring and summer during the study period of two years. The health officials inform the public about the seasonal occurrence of the SARS-CoV-2 outbreak and take priority preventive measures to minimize the disease burden.

Impact of environmental pollutants Particulate Matter PM2.5, carbon monoxide, nitrogen dioxide and ozone on the incidence of Monkeypox cases. [corrected]

OBJECTIVE

The human monkeypox disease (MPXD), is an emerging zoonotic disease caused by the monkeypox virus. The rapid spread of human monkeypox cases has developed an alarming situation worldwide. This study evaluated the impact of day-to-day air pollutants, particulate matter PM2.5, Carbon monoxide (CO), Nitrogen dioxide (NO2), and Ozone (O3) on the daily incidence of monkeypox cases in New York City, United States of America.

MATERIALS AND METHODS

The daily data on air pollutants and monkeypox cases were recorded from May 1, 2022, to August 16, 2022. The everyday concentrations of "PM2.5, CO, NO2, and O3 were recorded from the metrological website "Real-Time Air Quality Index-AQI" and human monkeypox cases were documented from the official website of "NVC Health". The mean values along with correlations were performed to investigate the impact of environmental pollutants on the occurrence of monkeypox cases in New York, city USA.

RESULTS

The mean value for the concentration of CO in the air was 25.61 ppm, NO2 38.16 ppm, O3 9.46 μg/m3 and PM2.5 was 1.82 ppm. The air pollutants, CO, and NO2 have a positive association (p=0.001) with daily monkeypox cases in New York, USA. The correlation analysis showed significant relationships between CO and NO2 and the number of monkeypox cases (r=0.298, p<0.002), (r=0.513, p<0.001), respectively. The linear regression analysis also showed that CO has a positive impact on monkeypox cases (β=0.298, p<0.001). With one unit increase in the CO levels in the air, the number of monkeypox cases increased by 0.298 units, and adjusted R-square shows a 0.08 or 8% variation in the number of monkeypox cases due to an increase in CO in the environment. Moreover, NO2 has a significant positive impact on monkeypox cases (β=0.513, p<0.001), with a one-unit increase in NO2 concentration in the air, the monkeypox cases increased by 0.513. The adjusted R-square shows that NO2 causes a 25.7% variation in the increase in monkeypox cases. However, Ozone (β=0.018. p>0.05) and PM2.5 (β=-0.122, p>0.05) does not have a significant correlation with monkeypox cases in the city of New York.

CONCLUSIONS

Environmental pollutants NO2 and CO have a positive relationship with the number of daily monkeypox cases in New York City, USA. The air pollutants which have a high concentration in the environment have a strong relationship with the occurrence of monkeypox cases. Environmental pollution may be a risk factor for the increasing occurrence of monkeypox cases. Health officials must take priority preventive measures to curtail environmental pollution to combat the monkeypox disease.

Human Monkeypox: Old virus with new Epidemiological and Transmission Trends

Human monkeypox is an emerging zoonotic disease caused by a monkeypox virus. The monkeypox virus history originated in 1958 after the occurrence of a pox-like illness in monkeys. In September 1970, the first case of human monkeypox was identified in the Democratic Republic of Congo, Africa. This year, from January 01, to September 30, 2022, the virus swiftly spread from endemic to non-endemic counties, involving 106 states, infecting 68,017 people; 689 cases from 07 endemic African countries and 67,328 cases in 99 non-endemic countries in Europe, America, Asia and Oceania continents. The disease caused 27 deaths in 13 countries worldwide. The human monkeypox disease significantly affects the population in South, North and Central America 34767 (51.11%), Europe 32047 (47.11%), Africa 707 (1.03%), Asia 351 (0.51%), and Oceania continent 145 (0.21%). The occurrence of the disease is high in males with age ranges of 21-55 years. The common clinical features in monkeypox patients are skin rashes (95%), fever (72%), malaise (69%), chills (67%), pruritis (64%), headache (64%), enlarged lymph nodes (63%) myalgia (60%) and nausea and vomiting (20%). The transmission trends of the disease are rapidly changing; the virus is not limited to close contact with humans. It can spread through body fluids, respiratory droplets, and sexual contact. The disease can transmit during travelling, contact with soiled materials, infected cloths, bed linen, objects, air pollutants, and in various workplace environments. The monkeypox virus has adopted multiple transmission routes, and swiftly spreading and developing challenging and threatening situations worldwide. doi: https://doi.org/10.12669/pjms.38.8.6978 How to cite this:Meo SA. Human Monkeypox: Old virus with new Epidemiological and Transmission Trends. Pak J Med Sci. 2022;38(8):---------. doi: https://doi.org/10.12669/pjms.38.8.6978 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Incense Burning Indoor Pollution: Impact on the prevalence of prediabetes and Type-2 Diabetes Mellitus

Objectives:

Incense burning is a well-known practice in Asian and Middle Eastern cultures for ceremonial and religious purposes. The excessive use of incense burning has become a critical environmental health concern. The incense sellers are more exposed to incense allied air pollution. This study examines the association between prediabetes and type 2 diabetes mellitus (T2DM) in incense sellers.

Methods:

This cross-sectional prevalence study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia” during the period July 2019 to January 2020. After medical history and examinations had been performed, a total of 265 non-smoking volunteers male incense sellers were selected. American Diabetes Association (ADA) criteria were followed, people with “HbA1c less than 5.7% were considered normal; HbA1c 5.7%-6.4% were pre-diabetics, and HbA1c > 6.4% were considered people with diabetes”. In shops, the incense sellers were exposed to incense-related pollution for 8 hours daily, seven days a week. The mean age for the participants was 25±5.5 years, and body mass index was 19±2.8 (kg/m)2.

Results:

In incense sellers, the pre-diabetic was 125 (47.2%), and diabetes was 75 (28.3%). However, 65 (24.5 %) incense sellers were without prediabetes and diabetes. There was an increase in HbA1c levels with increasing working exposure to incense shops.

Conclusions:

The prevalence of pre-diabetic and type-2 diabetes was increased in incense sellers. The prevalence of pre-diabetic and type-2 diabetes was further increased with the increasing working duration of incense sellers. The study findings call for safe practice and avoiding indoor burning incense. It is suggested that well-ventilated areas with proper masks for the workers may reduce the incense-related pollution effects.

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.

Human Monkeypox: Fifty-Two Years based analysis and Updates

The growing prevalence of human monkeypox infection has developed an alarming situation worldwide. Monkeypox virus was first time found in 1958 in monkeys and later spread to humans. The first case of human monkeypox was reported in September 1970 in the Democratic Republic of the Congo. Human monkeypox was found outside Africa in the year 2003 in United States. More recently, from May 7 2022 to June 29, 2022, the monkeypox cases are swiftly spread worldwide, involving over 50 countries, and affecting 5115 people in Europe, the United Kingdom, North America, and South America, Asia, Australia, and the Middle East. The confirmed monkeypox cases in the United Kingdom from May 7, 2022 to June 29, 2022, are 1076 (21.03%); Germany 874 (17.08%); Spain 800 (15.64%); France 440 (8.60%); Portugal 391 (7.64%); United States 350 (6.84); Canada 276 (5.39%); Netherlands 257 (5.02%); Italy 159 (3.10); Belgium 117 (2.28%); Switzerland 81 (1.58%); Israel 33 (0.64%), and Ireland 31 (0.60%). However, in about 35 countries, the cases are less than 20 in each country. The epidemiological trends of the human monkeypox infection are swiftly shifting from endemic regions to non-endemic countries. The global health authorities must take priority-based preventive measures to stop the outbreaks of monkeypox disease across the globe.

Medical Students and Faculty Perceptions About Online Learning During COVID-19 Pandemic: Alfaisal University Experience

Background and Objectives

Off-campus online learning methods abruptly increased and gained popularity during the COVID-19 pandemic. Previous studies have highlighted the limitations of online learning mode; however, further studies on the experiences of medical students are needed. This study aimed to investigate the preclinical medical students and faculty members' experiences with online education and learning.

Subjects and Methods

In this cross-sectional study, data were collected using convenience sampling. Two hundred nine students and 13 faculty members who participated in the online courses offered during the spring semester of 2019–2020 completed an online questionnaire. A 30-item questionnaire for the students and a 25-item questionnaire for the faculty were used in this cross-sectional study.

Results

Overall, 30% of the student sample was satisfied; importantly, high-achieving students (GPA > 3.5) were less satisfied (25 vs. 32%; p = 0.006). Satisfaction was also low (35%) for student-faculty interaction opportunities. About half of the student sample agreed that small-group interactive sessions would improve learning (53%). The most favored course format was the blended mode (43%), followed by traditional (40%) and online modes (17%). Six out of 13 (46%) faculty members were satisfied with their online experiences. Most of them found virtual teaching applications convenient (77%). Conversely, few faculty members agreed to interact effectively (54%), while 69% favored a blended format.

Conclusions

The level of satisfaction in fully online courses offered during the COVID-19 pandemic remained low, especially among high-achieving students. Both students and faculty favored the blended format for future purposes. Small group active-learning strategies and web-based interactive tools may facilitate engagement and student-faculty interactions.

Impact of the residential green space environment on the prevalence and mortality of Type 2 diabetes mellitus

OBJECTIVE

The residential green space environment plays a significant role in the progression of social, neuropsychological, behavioral, and public health. Green spaces are considered one of the most important components of healthy life events. This study investigated the impact of the green space environment on the prevalence and mortality of type 2 diabetes mellitus.

MATERIALS AND METHODS

In this study, 110 research articles were initially identified through search engines (Web of Science, Pub-Med, Medline, EMBASE, Scopus) using the keywords "green space, environment, prevalence, mortality, diabetes mellitus." Finally, out of 110, 16 (14.54%) original research publications were included in the analysis, and the remaining 94 (85.45%) articles were excluded. The sample size of these 16 studies was 4,615,359. These studies originated from China (4), Canada (3), the United States of America (2), Australia (2), and one study each from the United Kingdom, Hong Kong, Korea, Belgium, and Bangladesh. The data on prevalence and diabetes mellitus were recorded and analyzed.

RESULTS

Worldwide total of 16 studies met the selection criteria. The results showed that a high green space environment was significantly associated with a decreased prevalence of diabetes mellitus (13 studies; OR=0.875, 95% CI=0.859-0.891; p<0.001; I2=61.0%) and mortality (3 studies; HR=0.917, 95% CI=0.904-0.930; p<0.001; I2=75.4%). The findings support the hypothesis that a green space environment significantly reduces the prevalence and mortality of diabetes mellitus.

CONCLUSIONS

The residential green space environment significantly decreases the prevalence and mortality of type 2 diabetes mellitus. It is suggested to establish strategies to keep residential areas and living environment green and clean to minimize air pollution and fight diabetes mellitus.

Effects of transcranial magnetic stimulation on neurobiological changes in Alzheimer's disease (Review)

Alzheimer's disease (AD) is a neurodegenerative disorder characterized by cognitive decline and brain neuronal loss. A pioneering field of research in AD is brain stimulation via electromagnetic fields (EMFs), which may produce clinical benefits. Noninvasive brain stimulation techniques, such as transcranial magnetic stimulation (TMS), have been developed to treat neurological and psychiatric disorders. The purpose of the present review is to identify neurobiological changes, including inflammatory, neurodegenerative, apoptotic, neuroprotective and genetic changes, which are associated with repetitive TMS (rTMS) treatment in patients with AD. Furthermore, it aims to evaluate the effect of TMS treatment in patients with AD and to identify the associated mechanisms. The present review highlights the changes in inflammatory and apoptotic mechanisms, mitochondrial enzymatic activities, and modulation of gene expression (microRNA expression profiles) associated with rTMS or sham procedures. At the molecular level, it has been suggested that EMFs generated by TMS may affect the cell redox status and amyloidogenic processes. TMS may also modulate gene expression by acting on both transcriptional and post‑transcriptional regulatory mechanisms. TMS may increase brain cortical excitability, induce specific potentiation phenomena, and promote synaptic plasticity and recovery of impaired functions; thus, it may re‑establish cognitive performance in patients with AD.

Face Masks Use and Its Role in Restraining the Spread of COVID-19 Pandemic in Saudi Arabia: Knowledge, Attitude, and Practices Based Cross-Sectional Study

Face masks (FM) play a role in limiting the spread of viral infections; despite this, their role is influenced by the population's adherence to wearing the FM. However, the impact on the effectiveness of the FM is variable in various communities. This study aimed to investigate the knowledge, attitude, and practices toward FM use during COVID-19 in Saudi Arabia. This observational “cross-sectional questionnaire-based study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.” The data was collected using an online questionnaire survey from September 8–21, 2021, during the COVID-19 pandemic. The questionnaire was distributed via social media platforms to assess knowledge, attitude, and practices using single choice questions and a five-point Likert scale. Among 1,356, respondents' the rate was 678 (50%), 207 (30.5%) were males and 471 (69.5%) females. Among the participants, Saudi citizens were (649; 95.7%), with University education (502; 74%) and were mostly (368; 54.3%) between 16 and 24 years of age. The participants (384; 56.6%, p < 0.001) had good knowledge about face masks, and more than half of the respondents, 531 (78.3%) (p < 0.001), showed a positive attitude. Most of the respondents (477, 70.2%) believed that everyone could use the face mask to minimize the spread of the disease; however (111; 16.4%) reported that they would not wear a face mask if the government did not recommend wearing it in public places during the COVID-19 pandemic. Saudi citizens have above-average knowledge and optimistic attitudes toward using face masks during the COVID-19 pandemic. The community is convinced about the face masks and believes that face masks play a predominant role in limiting the spread of SARS-CoV-2.

National COVID-19 Vaccine Program and Parent's Perception to Vaccinate Their Children: A Cross-Sectional Study

Vaccinating children against COVID-19 is an essential public health strategy in order to reach herd immunity and prevent illness among children and adults. Parents are facing tremendous stress in relation to the COVID-19 pandemic and the effectiveness of the COVID-19 vaccination program for children. In this study, we aimed to investigate parents' perceptions and acceptance of the COVID-19 vaccine for their children in Saudi Arabia. A well-designed, pre-validated, Google questionnaire was distributed to parents through social media websites. The selection of the participants was based on the simple random sample technique. The study sample size was 1304 participants, with 342 males (26.2%), and 962 females (73.8%). The personal information, perception about COVID-19, and their children's vaccination status were obtained. Among the participants, 602 (46.1%) were willing to get the COVID-19 vaccination for their children, whereas 382 (29.3%) were hesitant to inoculate their children for COVID-19 and 320 (24.4%) were unsure. Age (p = 0.004), gender (p = 0.001), occupation (0.004), income (p = 0.030), and vaccination status (p = 0.001) had an influence on the parents' acceptance of COVID-19 vaccination of their children. On the other hand, education level, number of children, and having been previously infected with COVID-19 had no statistically significant effect on the parent acceptance. The correlation of parents' knowledge about COVID-19 and their agreement to the vaccination of their children was statistically significant, along with gender (males were more knowledgeable, with p < 0.001), occupation, income (higher income showed a statistical difference, with p < 0.001), and vaccination status (p < 0.001). There was a decrease in parents' acceptance toward the COVID-19 children vaccine in Saudi Arabia, which requires more attention and focus from health providers to eliminate fear and anxiety among the parents through additional educational programs and events to decrease the resistance toward the vaccination of children. More emphasis is required to increase the awareness of parents and convey the importance of the vaccine for children. In addition, more studies are needed to ensure the vaccine's safety.

Impact of COVID-19 pandemic on sleep quality among medical and general science students: King Saud University Experience

Objectives: Sleep is a vital component for overall health and well-being, and it plays an essential role in social, physical, psychological, and cognitive health. This study aimed to appraise the sleep quality in medical and science students during the COVID-19 pandemic. Methods: This questionnaire-based cross sectional study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia, during September-December 2020. In this study, a validated self-administered electronic questionnaire was distributed to 1000 students, 782 (78.2%) of whom completed the study. The selection of students was based on using the stratified random sampling. The Pittsburgh Sleep Quality Index (PSQI) instrument scale was used to assess the sleep quality among medical and general sciences students.  Results: Out of 782 respondents, 410 (52.4%) were medical students, and 372 (47.6%) were science students, including Physics, Chemistry, Mathematics, Statistics, Botany, and Zoology. Among the medical students, 143 (34.9%) were in pre-clinical years (1st and 2nd), while 266 (64.9%) of them were in clinical years (3rd, 4th, and 5th). Among all medical and general sciences students, it was found that 669 (85.5%) had poor sleep quality with a mean PSQI global score (mean 8.356) among them 336 (50.2%) were medical, and 333 (49.8%) were science students. Science students’ sleep quality was poorer (mean 8.78) than their medical counterparts (mean= 7.93). Conclusion: The COVID-19 pandemic has a significant negative impact on students’ mental health and sleep quality. Both medical and general science students showed alarming levels of sleep deprivation and concerning low sleep quality during the COVID-19 pandemic. The sleep deprivation among students may be due to the sudden change of pedagogy in education driven by the COVID-19 pandemic. Sleep quality is quite a critical issue to be evaluated and addressed nationally and globally. doi: https://doi.org/10.12669/pjms.38.3.5171 How to cite this:Meo SA, Alkhalifah JM, Alshammari NF, Alnufaie WS, Algoblan AF. Impact of COVID-19 pandemic on sleep quality among medical and general science students: King Saud University Experience. Pak J Med Sci. 2022;38(3):---------.  doi: https://doi.org/10.12669/pjms.38.3.5171 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Effect of environmental pollutants PM2.5, CO, O3 and NO2, on the incidence and mortality of SARS-COV-2 in largest metropolitan cities, Delhi, Mumbai and Kolkata, India

OBJECTIVES

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has developed a challenging situation worldwide. In India, the SARS-CoV-2 cases and deaths have markedly increased. This study aims to evaluate the impact of environmental pollutants "particulate matter (PM 2.5 μm), carbon monoxide (CO), Ozone (O3), and Nitrogen Dioxide (NO2) on daily cases and deaths due to SARS-CoV-2 infection" in Delhi, Mumbai, and Kolkata, India.

METHODS

The day-to-day air pollutants PM2.5, CO, O3, and NO2 were recorded from the metrological web "Real-time Air Quality Index (AQI)." SARS-COV-2 everyday cases and deaths were obtained from the "Coronavirus outbreak in India Web". The PM 2.5, CO, O3, NO2, and daily cases, deaths were documented for more than one year, from March 2, 2020, to March 15, 2021.

RESULTS

Environmental pollutants CO, O3, and NO2, were positively related to SARS-COV-2 cases and deaths. The findings further described that for each one-unit increase in CO, O3, and NO2 levels, the number of cases was significantly augmented by 0.77%, 0.45%, and 4.33%.

CONCLUSIONS

Environmental pollution is a risk factor to SARS-CoV-2 daily cases and deaths. The regional and international authorities must implement the policies to reduce air pollution and the COVID-19 pandemic. The findings can inform health policymakers' verdicts about battling the COVID-19 pandemic in India and globally by minimizing environmental pollution.

Effect of ambient air pollutants PM2.5 and PM10 on COVID-19 incidence and mortality: observational study

OBJECTIVE

Environmental pollution is a leading global challenge affecting weather conditions and causing severe environmental, social, and public health problems. This study explores the impact of ambient air pollutants, particular matter (PM), PM2.5 and PM10 on morbidity and mortality of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) globally.

MATERIALS AND METHODS

In this study, initially 492 research articles were identified through seven search engines containing Web of Science, Medline, PubMed, EMBASE, Scopus, WHO COVID-19 literature, and Ovid databases by consuming keywords "Environmental pollution, Ambient air pollutants, particulate matter, PM2.5, PM10, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), and COVID-19 pandemic". Finally, 26 original research publications were included for the analysis, and the remaining were excluded. These studies were originated from the United States of America (9), China (5), Italy (3), India (1), worldwide (1), and one study each from England, Spain, Canada, Saudi Arabia, Singapore, Japan, and Iran.

RESULTS

The analysis based on a worldwide dataset assembled the information from the global literature from December 2019 to September 30, 2021. The assessment for the various regions to a global extent was based on air pollutants and COVID-19 cases and deaths. Twenty- six studies met the selection criteria representing almost all over the world. Based on the synthesis of scientific studies, it was identified that PM2.5 and PM10 are associated with 15.08%, 11.44 increased COVID-19 cases, and 9.26% and 0.75% COVID-19 deaths, respectively.

CONCLUSIONS

The evidence indicates that PM2.5 and PM10 can affect COVID-19 epidemiology in various geographical regions. The findings established an association and a possible causal link between increasing ambient air pollutants, particulate matter PM2.5 and PM10 with increased incidence and mortality of COVID-19. The global health authorities must take strict preventive measures to minimize air pollution and combat such challenging and threatening COVID-19 pandemic globally.

Doctor of Science (D.Sc.): Time to move towards Higher Doctorate Degrees

The present most modern and highly advanced 21’st century is the era of science and technology. In human history, universities are the basic birthplace of higher education, research, and innovation and play a significant role in the countries’ performance, prosperity, and economic progress. Worldwide, there is a swift shift in the pattern of biological, environmental, economic, and educational systems. This broader change is rotating around the higher academia and its allied innovative research impact. The leading universities develop a culture and curricula as per need and demand and produce knowledge and skills-based professional graduates. The universities prepare graduates to keep in view their country’s requirements and compete with their peers at international levels.

Moreover, worldwide, universities are transforming towards higher doctorate degrees (D.Sc / S.Dc) to provide an elevated helipad to the applicant to compete in this modern and highly advanced era. The higher doctoral degree, D.Sc, is earned 6-8 years after the post Ph.D. The candidates with higher academic titles, professional skills, and innovative research could compete and achieve top-ranked positions worldwide. Many universities worldwide, including the United States of America, the United Kingdom, Australia, and New Zealand, promote D.Sc degree programs in various science disciplines, including medical sciences. This manuscript explores the dynamics of a higher doctorate and its significance, need, and demand in academia to compete globally.

Perceived effectiveness of learning methods among preclinical medical students - role of personality and changes over time

Background and Objectives:

Active learning methods are vital in inculcating skills of critical thinking, lifelong learning and effective communication. Personality may influence learning method preferences and academic performance. The aim of this cross sectional study was to examine the relationship between students’ personality and their predilection for learning methods and academic performance.

Methods:

Perceived effectiveness of learning methods was assessed over time. Second- and third-year medical students (n=112) completed a questionnaire consisting of Big Five Inventory to measure the personality dimensions, and evaluated lecture, problem-based learning (PBL) and team-based learning (TBL) for their helpfulness in learning. Grade point average (GPA), PBL and TBL grades were obtained. Correlation coefficients were calculated between personality traits and learning method effectiveness scores, and grades. Learning methods effectiveness was compared between second- and third-year students.

Results:

Positive correlations were identified between conscientiousness and lecture (r = 0.30), agreeableness and lecture (r = 0.20), and agreeableness and TBL (r = 0.23). Likewise, positive correlations were seen between extraversion and PBL grade (r=0.20), and conscientiousness and GPA (r = 0.23). In third year, significant decline in perceived effectiveness of lecture was seen (81% vs 57%; p = 0.006), while increased perceived effectiveness for PBL (38% vs. 50%) was not statistically significant (p = 0.22).

Conclusions:

The findings provide an evidence for modest correlations between personality and perceived effectiveness of learning methods. Remarkably, perceived effectiveness decreased for the lecture and increased for the PBL over time. The findings may help educators in better implementing active learning modalities. Besides, an earlier introduction may help students becoming acquainted with and getting the most out of PBL.

Effect of Green Space Environment on Air Pollutants PM2.5, PM10, CO, O3, and Incidence and Mortality of SARS-CoV-2 in Highly Green and Less-Green Countries

Worldwide, over half of the global population is living in urban areas. The metropolitan areas are highly populated and environmentally non-green regions on the planet. In green space regions, plants, grass, and green vegetation prevent soil erosion, absorb air pollutants, provide fresh and clean air, and minimize the burden of diseases. Presently, the entire world is facing a turmoil situation due to the COVID-19 pandemic. This study investigates the effect of the green space environment on air pollutants particulate matter PM2.5, PM10, carbon monoxide (CO), ozone (O₃), incidence and mortality of Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) in environmentally highly green and less-green countries. We randomly selected 17 countries based on the Environmental Performance Index (EPI) data. The 60% of the EPI score is based on seven categories: "biodiversity and habitat, ecosystem, fisheries, climate change, pollution emissions, agriculture, and water resources". However, 40% of the score is based on four categories: "air quality, sanitation and drinking water, heavy metals, and waste management". The air pollutants and SARS-CoV-2 cases and deaths were recorded from 25 January 2020, to 11 July 2021. The air pollutants "PM2.5, PM10, CO, and O₃" were recorded from the metrological websites, Air Quality Index-AQI, 2021. The COVID-19 daily cases and deaths were obtained from the World Health Organization. The result reveals that air pollutants mean values for PM2.5 110.73 ± 1.09 vs. 31.35 ± 0.29; PM10 80.43 ± 1.11 vs. 17.78 ± 0.15; CO 7.92 ± 0.14 vs. 2.35 ± 0.03 were significantly decreased (p < 0.0001) in environmentally highly green space countries compared to less-green countries. Moreover, SARS-CoV-2 cases 15,713.61 ± 702.42 vs. 3445.59 ± 108.09; and deaths 297.56 ± 11.27 vs. 72.54 ± 2.61 were also significantly decreased in highly green countries compared to less-green countries. The green environment positively impacts human wellbeing. The policymakers must implement policies to keep the living areas, surroundings, towns, and cities clean and green to minimize air pollution and combat the present pandemic of COVID-19.

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.

Sandstorm and its effect on particulate matter PM 2.5, carbon monoxide, nitrogen dioxide, ozone pollutants and SARS-CoV-2 cases and deaths

Sandstorms are a natural metrological phenomenon, frequently occurring in many arid and semi-arid regions of the world. The sandstorm dust contains environmental pollutants, microorganisms including bacteria, fungi, and viruses. These events are the primary sources of air pollution and its long-distance transport. Thus, sandstorms are becoming a greater concern during the COVID-19 pandemic. Therefore, this novel study aimed to investigate the effect of a sandstorm on "environmental pollutants particulate matter (PM2.5), carbon monoxide (CO), ozone (O3), nitrogen dioxide (NO2), and day-to-day new cases and deaths due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection" in Riyadh, Saudi Arabia. On March 12, 2021, a sandstorm occurred in the Riyadh region, the capital city of Saudi Arabia. The data on PM 2.5, CO, NO2, and O3 were recorded three weeks before and three weeks after the onset of the sandstorm, from February 20, 2021, to March 12, 2021, and from March 13 to April 2, 2021. The daily PM2.5, CO, NO2, and O3 levels were documented from the metrological websites, and Air Quality Index-AQI, COVID-19 daily cases, and deaths were obtained from Saudi Arabia's official coronavirus website. After sandstorm, the air pollutants, CO level increased by 84.25%; PM2.5: 76.71%; O3: 40.41%; NO2: 12.03%; and SARS-CoV-2 cases increased by 33.87%. However, the number of deaths decreased by 22.39%. The sandstorm event significantly increased the air pollutants, PM2.5, CO, and O3, which were temporally associated with increased SARS-COV-2 cases. However, no significant difference was noticed in NO2 and the number of deaths after the sandstorm. The findings have an important message to health authorities to timely provide information to the public about the sandstorm and its associated health problems, including SARS-CoV-2 cases and deaths.

Impact of Glycated Hemoglobin (HbA1c) on cognitive functions in Type 2 diabetic patients

OBJECTIVE

Diabetes mellitus is a highly challenging worldwide epidemic affecting the health of millions of people. This study investigates the impact of glycated hemoglobin (HbA1c) and duration of diabetes on cognitive functions in type 2 diabetic patients and evaluates whether high HbA1c or duration is more harmful to impair cognitive functions.

PATIENTS AND METHODS

In this study, 202 participants, 101 patients with type 2 diabetes mellitus (T2DM), and 101 age, gender, height, and weight-matched controlled subjects were enlisted. The HbA1c was determined using a clover analyzer, and cognitive functions were evaluated using "Cambridge Neuropsychological Test Automated Battery (CANTAB).

RESULTS

The results revealed that AST Mean correct latency, AST Mean correct latency (congruent), AST Mean correct latency (incongruent), CRT Mean correct latency, MOT Mean latency, SWM Between errors, SWM Strategy, PRM Percent correct responses were meaningly delayed in the diabetic group as compared to the control group (p < 0.0001).

CONCLUSIONS

High HbA1c or uncontrolled DM and duration of diabetes cause cognitive function impairment. Moreover, the cognitive functions declined were significantly linked with the duration of the disease and high HbA1c. While treating diabetic patients, physicians must monitor the HbA1c level as reasonable glycemic control is vital to curtail the complications of DM, including cognitive function impairment.

Effect of Glycated Hemoglobin (HbA1c) and Duration of Disease on Lung Functions in Type 2 Diabetic Patients

Diabetes mellitus is a highly challenging global health care problem. This study aimed to assess the effect of glycated hemoglobin (HbA1c) and duration of diabetes on lung function in type 2 diabetic patients and assess whether duration or high HbA1c is more noxious to damage the lung functions. A total of 202 participants, 101 patients with type 2 diabetes mellitus (T2DM), and 101 age-, gender-, height-, and weight-matched controlled subjects were recruited. The HbA1c was measured through a clover analyzer, and lung function test parameters were recorded by spirometry. The results revealed a significant inverse correlation between HbA1c and Vital Capacity (VC) (r = -0.221, p = 0.026), Forced Vital Capacity (FVC) (r = -0.261, p = 0.008), Forced Expiratory Volume in First Second (FEV1) (r = -0.272, p = 0.006), Forced Expiratory Flow 25% (FEF-25%) (r = -0.196, p = 0.050), Forced Expiratory Flow 50% (FEF-50%) (r = -0.223, p = 0.025), and Forced Expiratory Flow 75% (FEF-75%) (r = -0.169, p = 0.016). Moreover, FEV1 (p = 0.029), FEV1/FVC% (p = 0.006), FEF-50% (p = 0.001), and FEF-75% (p = 0.003) were significantly lower in the diabetic group with duration of disease 5-10 and >10 years compared to the control group. The overall results concluded that high HbA1c or uncontrolled diabetes mellitus has a more damaging effect on lung function impairment compared to the duration of diabetes mellitus. Physicians must regularly monitor the HbA1c level while treating diabetic patients, as good glycemic control is essential to minimize the complications of DM, including lung function impairment in patients with T2DM.

Automated detection of diabetic retinopathy using machine learning classifiers

OBJECTIVE

Diabetic Retinopathy (DR) is a highly threatening microvascular complication of diabetes mellitus. Diabetic patients must be screened annually for DR; however, it is practically not viable due to the high volume of patients, lack of resources, economic burden, and cost of the screening procedure. The use of machine learning (ML) classifiers in medical science is an emerging frontier and can help in assisted diagnosis. The few available proposed models perform best when used in similar population cohorts and their external validation has been questioned. Therefore, the purpose of our research is to classify the DR using different ML methods on Saudi diabetic data, propose the best method based on accuracy and identify the most discriminative interpretable features using the socio-demographic and clinical information.

PATIENTS AND METHODS

This cross-sectional study was conducted among 327 diabetic patients in Almajmaah, Saudi Arabia. Socio-demographic and clinical data were collected using a systematic random sampling technique. For DR classification, ML algorithm including, linear discriminant analysis, support vector machine, K nearest neighbor, random forest and its variate ranger random forest classifiers were used through cross-validation resampling procedure.

RESULTS

In classifying DR, ranger random forest outperforms the other methods by accurately classifying 86% of the DR patients on the test data. HbA1c (p<0.001) and duration of diabetes (p<0.001) were the most influential risk factor that best discriminated the DR patients. Other influential risk factors were the body mass index (p<0.001), age-onset (p<0.001), age (p<0.001), systolic blood pressure (p<0.05), and the use of medication (p<0.05) that significantly discriminated the DR patients.

CONCLUSIONS

Based on the present study findings, integrating ophthalmology and ML can transform diagnosing the disease pattern that can help generate a compelling clinical effect. ML can be used as an added tool for clinical decision-making and must not be the sole substitute for a clinician. We will work to examine the classification performance of multi-class data using more sophisticated ML methods.

Comparison of Generalized Anxiety and Sleep Disturbance among Frontline and Second-Line Healthcare Workers during the COVID-19 Pandemic

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection, also known as COVID-19, has developed into an alarming situation around the world. Healthcare workers are playing the role of frontline defense to safeguard the lives of everyone during the COVID-19 pandemic. The present study aimed to investigate the anxiety levels and sleep quality among frontline and second-line healthcare workers during the COVID-19 pandemic. In this cross-sectional study, a validated, self-administered, electronic questionnaire was distributed through email to healthcare workers. The selection of 1678 healthcare workers was based on a convenience sampling technique. The General Anxiety Disorder-7 (GAD-7) and Pittsburgh Sleep Quality Index (PSQI) instrument scales were used to assess healthcare workers' anxiety levels and sleep quality during the COVID-19 pandemic. Out of 1678 respondents, 1200 (71.5%) were frontline healthcare workers, while 478 (28.5%) were second-line healthcare workers. Among all the healthcare workers, 435 (25.92%) were experiencing moderate to severe anxiety. Among them, 713 (59.4%) frontline healthcare workers were experiencing anxiety in comparison with 277 (57.9%) second-line healthcare workers. Severe anxiety symptoms were seen in 137 (11.41%) frontline healthcare workers compared to 44 (9.20%) second-line healthcare workers. In total, 1376 (82.0%) healthcare workers were found to have poor sleep quality; 975 (58.10%) were frontline, and 407 (23.89%) were second-line healthcare workers. The highest poor sleep quality levels were found among 642 (84.6%) of the healthcare workers who work in frontline areas (emergency departments, intensive care units, and wards) compared to 734 (79.9%) of the healthcare workers who work in second-line areas. These findings provide a substantial contribution to the consolidation of evidence concerning the negative impact of the pandemic on the mental health of healthcare workers (HCWs). These results have established an association that the COVID-19 pandemic causes larger negative psychological symptoms in frontline healthcare workers, such as severe anxiety and poor sleep quality. Preventive measures to minimize anxiety levels and maintain sleep quality, addressing this issue nationally and globally, are essential to support the healthcare workers who are sacrificing their mental health for the future of our nations.

Effect of environmental pollution PM2.5, carbon monoxide, and ozone on the incidence and mortality due to SARS-CoV-2 infection in London, United Kingdom

OBJECTIVES

COVID-19 pandemic raised several queries on the relationship between the environment pollution and occurrence of new cases and deaths. This study aims to explore the effect of environmental pollution, particulate matter (PM 2.5 μm), carbon monoxide (CO) and Ozone (O₃) on daily cases and daily deaths due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in a largest metropolitan city London, United Kingdom.

METHODS

For this study, we selected London, one of the highly populated capitals, and markedly affected due to COVID-19 pandemic. The data on the SARS-CoV-2 daily new cases and deaths were recorded from UK-gov Web "Coronavirus COVId-19 in the UK, 2020". The daily environmental pollutants PM 2.5 μm, CO and O₃ were recorded from the metrological web "(London Air Pollution, Air Quality Index- AQI, 2020)". The daily cases, deaths, PM 2.5 μm, CO and O₃ were documented from the date of the occurrence of the first case of SARS-CoV-2 in London, February 24 to November 2, 2020.

RESULTS

The SARS-CoV-2 cases and deaths were positively related with environmental pollutants, PM2.5, O₃ and CO levels. Additionally, with 1 µm increase in PM2.5 the number of cases and deaths significantly increased by 1.1% and 2.3% respectively. A 1 unit increase in CO level significantly increased the number of cases and deaths by 21.3% and 21.8% respectively. A similar trend was observed in O₃, with 1-unit increase, the number of cases and deaths were significantly increased respectively by 0.8% and 4.4%.

CONCLUSIONS

Environmental pollutants, PM2.5, CO and O₃ have a positive association with an increased number of SARS-CoV-2 daily cases and daily deaths in London, UK. Environmental pollution management authorities must implement necessary policies and assist in planning to minimize the environmental pollution and COVID-19 pandemic.