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.

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.

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.

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.

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.

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 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.

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.

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 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.

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.

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.

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.

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

OBJECTIVE

The "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)" disease has caused a worldwide challenging and threatening pandemic (COVID-19), with huge health and economic losses. The US Food and Drug Administration, (FDA) has granted emergency use authorization for treatment with the Pfizer/BioNTech and Moderna COVID-19 vaccines. Many people have a history of a significant allergic reaction to a specific food, medicine, or vaccine; hence, people all over the world have great concerns about these two authorized vaccines. This article compares the pharmacology, indications, contraindications, and adverse effects of the Pfizer/BioNTech and Moderna vaccines.

MATERIALS AND METHODS

The required documents and information were collected from the relevant databases, including Web of Science (Clarivate Analytics), PubMed, EMBASE, World Health Organization (WHO), Food and Drug Authorities (FDA) USA, Local Ministries, Health Institutes, and Google Scholar. The key terms used were: Coronavirus, SARS-COV-2, COVID-19 pandemic, vaccines, Pfizer/BioNTech vaccine, Moderna vaccine, pharmacology, benefits, allergic responses, indications, contraindications, and adverse effects. The descriptive information was recorded, and we eventually included 12 documents including research articles, clinical trials, and websites to record the required information.

RESULTS

Based on the currently available literature, both vaccines are beneficial to provide immunity against SARS-CoV-2 infection. Pfizer/BioNTech Vaccine has been recommended to people 16 years of age and older, with a dose of 30 μg (0.3 m) at a cost of $19.50. It provides immunogenicity for at least 119 days after the first vaccination and is 95% effective in preventing the SARS-COV-2 infection. However, Moderna Vaccine has been recommended to people 18 years of age and older, with a dose of 50 μg (0.5 mL) at a cost of $32-37. It provides immunogenicity for at least 119 days after the first vaccination and is 94.5% effective in preventing the SARS-CoV-2 infection. However, some associated allergic symptoms have been reported for both vaccines. The COVID-19 vaccines can cause mild adverse effects after the first or second doses, including pain, redness or swelling at the site of vaccine shot, fever, fatigue, headache, muscle pain, nausea, vomiting, itching, chills, and joint pain, and can also rarely cause anaphylactic shock. The occurrence of adverse effects is reported to be lower in the Pfizer/BioNTech vaccine compared to the Moderna vaccine; however, the Moderna vaccine compared to the Pfizer vaccine is easier to transport and store because it is less temperature sensitive.

CONCLUSIONS

The FDA has granted emergency use authorization for the Pfizer/BioNTech and Moderna COVID-19 vaccines. These vaccines can protect recipients from a SARS-CoV- 2 infection by formation of antibodies and provide immunity against a SARS-CoV-2 infection. Both vaccines can cause various adverse effects, but these reactions are reported to be less frequent in the Pfizer/BioNTech vaccine compared to the Moderna COVID-19 vaccine; however, the Moderna vaccine compared to the Pfizer vaccine is easier to transport and store because it is less temperature sensitive.

Magnetic Resonance Imaging (MRI) and neurological manifestations in SARS-CoV-2 patients

OBJECTIVE

The "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)" disease caused a challenging and threating pandemic (COVID-19) worldwide with a great loss to life and the global economy. SARS-CoV-2 mainly involves the respiratory system, however, with Magnetic Resonance Imaging (MRI), neurological and special senses clinical manifestations have been reported rarely. The present study aims to investigate the MRI findings, clinical manifestations of neurological and special senses involvement in SARS-CoV-2 patients.

MATERIALS AND METHODS

In this study, 284 articles from the databases "Pub-Med, Web of Science-Clarivate Analytics, Embase and Google Scholar" were identified. The keywords, coronavirus, SARS-CoV-2, COVID-19 pandemic, MRI, brain, special senses, neurological involvement were entered into the search engines and the concerned documents were selected and reviewed. The descriptive information was recorded from the particular studies; finally, we included 48 publications.

RESULTS

The common neurological manifestations in SARS-CoV-2 patients were headache, impaired consciousness, acute cerebrovascular disease, ataxia, tremors, meningitis, encephalitis, cerebral bleeding, subarachnoid hemorrhage, frontal lobe, temporal lobe and intracerebral hematoma, hemiparesis and seizures. However, common special senses manifestations in SARS-CoV-2 patients were olfactory, auditory and gustatory disorders including red eyes, painless monocular visual disturbance, anosmia, ageusia, dysgeusia, dysosmia and hypoacusis. Moreover, the MRI findings identified in SARS-CoV-2 patients were isolated oval-shaped lesion in the corpus callosum, bilateral basal ganglia hemorrhage, ischemic lesions involving the corpus callosum, basal ganglia, cerebellum and vasogenic edema extending to the cerebral peduncles, pons and ventricles.

CONCLUSIONS

The neurologic manifestations of SARS-CoV-2 patients are highly variable. The SARS-COV-2 exerts its damaging effects on the nervous system and special senses by developing determinant numerous neurological and special senses' clinical manifestations. Physicians with the help of MRI must rule out the neurological and special senses manifestations among SARS-CoV-2 patients.

Effect of motor vehicle pollution on lung function, fractional exhaled nitric oxide and cognitive function among school adolescents

OBJECTIVE

Motor vehicle emission is a major cause of environmental pollution, which threatens human health. This study aimed to investigate the effect of motor vehicle pollution on lung function, fractional exhaled nitric oxide (FeNO), and cognitive function among students studying in a school located in a traffic-polluted area.

SUBJECTS AND METHODS

In this cross-sectional study, students were recruited based on their apparent healthy status, same age, gender, height, weight, ethnicity, and homogenous educational, socio-economic status, and living backgrounds. Initially, 200 students, 100 from school-1 located in motor vehicle polluted area (exposed group) and 100 from school-2, located away from motor vehicle polluted area (control group) were recruited. After clinical history, 68 students were selected, 34 from school-1 and 34 from school-2. These students were exposed to motor vehicle pollution for 6 h a day, 5 days a week for a total period of 2 years. Lung function test parameters were recorded using a Spirometer, fractional exhaled nitric oxide (FeNO) was measured by Niox Mino, and cognitive function was recorded using the Cambridge Neuropsychological Test Automated Battery (CANTAB).

RESULTS

The lung function test parameters, Forced Vital Capacity (FVC) (p=0.03); Forced Expiratory Volume in First Second (FEV1) (p=0.02); and cognitive function parameter motor screening task (MOT) mean latency (p=0.04) were decreased among the students who were studying in school situated in traffic-polluted area compared to those students who were studying in school which was located away from the traffic-polluted area. However, no significant difference was noted in FeNO between the groups.

CONCLUSIONS

Motor vehicle pollution showed an association with decreased respiratory and cognitive functions among students studying in schools located in traffic-polluted areas. Environmental protection organizations must establish standards to minimize motor vehicle pollutants and develop strategies to control vehicle emission to reduce pollution and disease burden.

Wildfire and COVID-19 pandemic: effect of environmental pollution PM-2.5 and carbon monoxide on the dynamics of daily cases and deaths due to SARS-COV-2 infection in San-Francisco USA

OBJECTIVE

The wildfire allied environmental pollution is highly toxic and can cause significant wide-ranging damage to the regional environment, weather conditions, and it can facilitate the transmission of microorganisms and diseases. The present study aims to investigate the effect of wildfire allied pollutants, particulate matter (PM-2.5 μm), and carbon monoxide (CO) on the dynamics of daily cases and deaths due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in San Francisco, USA.

MATERIALS AND METHODS

For this study, we selected San Francisco, one of the regions affected by the wildfires allied pollution in California, USA. The data on the COVID-19 pandemic in San Francisco, including daily new cases and new deaths were recorded from Worldometer Web. The daily environmental pollutants particulate matter (PM-2.5 μm) and carbon monoxide (CO) were recorded from the metrological web "BAAQMD". The daily cases, deaths, particulate matter (PM-2.5 μm) and carbon monoxide were documented from the date of the occurrence of the first case of (SARS-CoV-2) in San Francisco, CA, USA, from March 20, 2020 to Sept 16, 2020.

RESULTS

The results revealed a significant positive correlation between the environmental pollutants particulate matter (PM2.5 μm) and the number of daily cases (r=0.203, p=0.007), cumulative cases (r=0.567, p<0.001) and cumulative deaths (r=0.562, p<0.001); whereas the PM2.5 μm and daily deaths had no relationship (r=-0.015, p=0.842). In addition, CO was also positively correlated with cumulative cases (r=0.423, p<0.001) and cumulative deaths (r=0.315, p<0.001), however, CO had no correlation with the number of daily cases (r=0.134, p=0.075) and daily deaths (r=0.030, p=0.693). In San Francisco, one micrometer (μg/m3) increase in PM2.5 caused an increase in the daily cases, cumulative cases and cumulative deaths of SARS-COV-2 by 0.5%, 0.9% and 0.6%, respectively. Moreover, with a 1 part per million (ppm) increase in carbon monoxide level, the daily number of cases, cumulative cases and cumulative deaths increased by 5%, 9.3% and 5.3%, respectively. On the other hand, CO and daily deaths had no significant relationship.

CONCLUSIONS

The wildfire allied pollutants, particulate matter PM-2.5μm and CO have a positive association with an increased number of SARS-COV-2 daily cases, cumulative cases and cumulative deaths in San Francisco. The metrological, disaster management and health officials must implement the necessary policies and assist in planning to minimize the wildfire incidences, environmental pollution and COVID-19 pandemic both at regional and international levels.

Impact of weather conditions on incidence and mortality of COVID-19 pandemic in Africa

OBJECTIVE

The weather-related conditions change the ecosystem and pose a threat to social, economic and environmental development. It creates unprecedented or unanticipated human health problems in various places or times of the year. Africa is the world's second largest and most populous continent and has relatively changeable weather conditions. The present study aims to investigate the impact of weather conditions, heat and humidity on the incidence and mortality of COVID-19 pandemic in various regions of Africa.

MATERIALS AND METHODS

In this study, 16 highly populated countries from North, South, East, West, and Central African regions were selected. The data on COVID-19 pandemic including daily new cases and new deaths were recorded from World Health Organization. The daily temperature and humidity figures were obtained from the weather web "Time and Date". The daily cases, deaths, temperature and humidity were recorded from the date of appearance of first case of "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)" in the African region, from Feb 14 to August 2, 2020.

RESULTS

In African countries, the daily basis mean temperature from Feb 14, 2020 to August 2, 2020 was 26.16±0.12°C, and humidity was 57.41±0.38%. The overall results revealed a significant inverse correlation between humidity and the number of cases (r= -0.192, p<0.001) and deaths (r= -0.213, p<0.001). Similarly, a significant inverse correlation was found between temperature and the number of cases (r= -0.25, p<0.001) and deaths (r=-0.18, p<0.001). Furthermore, the regression results showed that with 1% increase in humidity the number of cases and deaths was significantly reduced by 3.6% and 3.7% respectively. Congruently, with 1°C increase in temperature, the number of cases and deaths was also significantly reduced by 15.1% and 10.5%, respectively.

CONCLUSIONS

Increase in relative humidity and temperature was associated with a decrease in the number of daily cases and deaths due to COVID-19 pandemic in various African countries. The study findings on weather events and COVID-19 pandemic have an impact at African regional levels to project the incidence and mortality trends with regional weather events which will enhance public health readiness and assist in planning to fight against this pandemic.

Effect of heat and humidity on the incidence and mortality due to COVID-19 pandemic in European countries

OBJECTIVE

The weather allied conditions have an impact on air, water, soil, food, ecosystem, feelings, behaviors, and pattern of health and disease. The present study aims to investigate the impact of heat and humidity on the daily basis incidence and mortality due to COVID-19 pandemic in European countries.

MATERIALS AND METHODS

We selected 10 European countries, Russia, United Kingdom, Spain, Italy, Germany, Turkey, France, Belgium, Netherlands and Belarus. This region has a relatively low temperature and high humidity, and has homogenous European ethnicity with almost similar socioeconomic culture and health care system. The data on COVID-19 pandemic including daily new cases and new deaths were recorded from World Health Organization (WHO). The information on daily temperature and humidity was obtained from world climate web "Time and Date". The daily cases, deaths, temperature and humidity were recorded from the date of appearance of first case of "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)" in the European region, from Jan 27, 2020 to July 17, 2020.

RESULTS

In 10 European countries, (Russia, United Kingdom, Spain, Italy, Germany, Turkey, France, Belgium, Netherlands and Belarus), the daily basis mean temperature from Jan 27, 2020 to July 17, 2020 was 17.07±0.18°C, and humidity was 54.78±0.47%. The overall results revealed a significant inverse correlation between humidity and the number of cases (r= -0.134, p<0.001) and deaths (r= -0.126, p<0.001). Moreover, an increase in temperature was linked with an increase in the number of cases (r=0.062, p=0.013) and deaths (r=0.118, p<0.001). The regression analysis results further revealed that with an increase of 1% humidity the number of cases (β = -15.90, p<0.001) and deaths (β=-1.56, p<0.001) reduced significantly. Whereas, with an increase of 1°C in temperature the number of cases (β = 20.65, p<0.001) and deaths (β = 3.71, p<0.001) increased significantly.

CONCLUSIONS

Increase in relative humidity was associated with a decrease in the number of daily cases and deaths, however, a rise in temperature was allied with an upsurge in the number of daily cases and daily deaths due to COVID-19 pandemic in European countries. The study findings on weather events and COVID-19 pandemic have an impact at European regional levels to project the incidence and mortality trends with regional weather events to enhance public health readiness and assist in planning to fight against this pandemic situation.

Climate and COVID-19 pandemic: effect of heat and humidity on the incidence and mortality in world's top ten hottest and top ten coldest countries

OBJECTIVE

The COVID-19 pandemic has caused a global public health crisis with social, psychological and long-lasting economical damages. Weather-related dynamics have an impact on the pattern of human health and disease. The present study aimed to investigate the impact of heat and humidity on daily basis incidence and mortality due to COVID-19 pandemic in ten of the world's hottest countries compared to ten of the coldest ones.

MATERIALS AND METHODS

Worldwide, we selected 20 countries; 10 hottest countries with the highest temperatures and 10 coldest countries with the lowest temperature. The selection of the countries was based on the daily basis mean temperature from the date of appearance of the initial cases of COVID-19, Dec 29, 2019 to May 12, 2020. In the world's 10 hottest countries, the mean temperature was (26.31±1.51) and humidity (44.67±4.97). However, in the world's 10 coldest countries the mean temperature was (6.19±1.61) and humidity (57.26±2.35). The data on the global outbreak of COVID-19, daily new cases and deaths were recorded from World Health Organization, and daily information on temperature and humidity was obtained from metrological web "Time and Date".

RESULTS

In countries with high temperatures and low humidity, the mean daily cases incidence were (407.12±24.33); cumulative cases (9094.34±708.29); and cumulative deaths (452.84±43.30) were significantly low compared to countries with low temperatures and high humidity: daily cases (1876.72±207.37); cumulative cases (44232.38±5875.11); and cumulative deaths (2008.29±310.13). Moreover, COVID-19 cases and deaths per million population were significantly low in countries with high temperatures (cases 711.23, and deaths 16.27) compared to countries with low temperatures (cases 1685.99; and deaths 86.40). Furthermore, in hottest countries, a 1% increase in humidity reduced number of cases and deaths by (β = -5.40, p<0.001) and (β = -0.187, p=0.004) respectively. A similar trend was seen with a 1°C increase in temperature, reducing the number of deaths by (β = -1.35. p<0.001).

CONCLUSIONS

The results revealed a significant decrease in incidence of daily cases and deaths in countries with high temperatures and low humidity (warmest countries), compared to those countries with low temperatures and high humidity (coldest countries). The findings could be of interest to the policymakers and the health officials on the epidemiological trends of COVID-19 pandemic and weather changes.

Effect of temperature and humidity on the dynamics of daily new cases and deaths due to COVID-19 outbreak in Gulf countries in Middle East Region

OBJECTIVE

Weather-related dynamics have an impact on the pattern of health and disease. The present study aimed to investigate the effect of temperature and humidity on the daily new cases and daily new deaths due to COVID-19 in Gulf Cooperation Council (GCC) countries in the Middle East.

MATERIALS AND METHODS

We selected all the six GCC countries, including Saudi Arabia, United Arab Emirates, Bahrain, Kuwait, Qatar and Oman. This region has a relatively high temperature and humidity, and has homogenous Arab ethnicity with a similar socioeconomic culture. The data on the global outbreak of COVID-19, including daily new cases and deaths were recorded from World Health Organization. The information on daily temperature and humidity was obtained from world climate web "Time and Date". The daily basis, mean temperature and humidity were recorded from the date of appearance of first case of COVID-19 in the region, Jan 29, 2020 to May 15, 2020. We also evaluated the growth factor, "a ratio by which a quantity multiplies itself over time; it equals daily cases divided by cases on the previous day".

RESULTS

In GCC countries, the daily basis mean temperature from Jan 29, 2020 to May 15, 2020 was 29.20±0.30°C and humidity was 37.95±4.40%. The results revealed that there was a negative correlation and decrease in the number of daily cases and deaths from COVID-19 with increase in humidity in Oman, Kuwait, Qatar, Bahrain, United Arab Emirates and Saudi Arabia. The correlation coefficient between temperature with daily cases shows that an increase in temperature was associated with an increase in daily cases and deaths due to COVID-19, however, the temperature is still gradually rising in the region. The growth factor result for daily cases was 1.09±0.00 and daily deaths was 1.07±0.03 for COVID-19, and shows declining trends in GCC region.

CONCLUSIONS

An increase in relative humidity was associated with a decrease in the number of daily cases and deaths due to COVID-19 in GCC countries. The daily growth factor for patients and deaths shows a declining trend. However, the climate is swiftly changing in the region; further studies may be conducted during the peak of summer season. The findings have outcomes for policymakers and health officials about the impact of temperature and humidity on epidemiological trends of daily new cases and deaths due to COVID-19.

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

OBJECTIVE

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also called COVID-19, has caused a pandemic which has swiftly involved the entire world and raised great public health concerns. The scientific community is actively exploring treatments that would potentially be effective in combating COVID-19. Hydroxychloroquine has been demonstrated to limit the replication of SARS-CoV-2 virus in vitro. In malarial pandemic countries, chloroquine is widely used to treat malaria. In malarial non-pandemic nations, chloroquine is not widely used. Chloroquine and hydroxychloroquine share similar chemical structures and mechanisms of action. The aim of this study was to indirectly investigate the efficacy of chloroquine and hydroxychloroquine for the treatment of COVID-19 by determining the prevalence of COVID-19 in malaria pandemic and non-pandemic nations. We sought evidence to support or refute the hypothesis that these drugs could show efficacy in the treatment of COVID-19.

MATERIALS AND METHODS

We reviewed in vitro studies, in vivo studies, original studies, clinical trials, and consensus reports, that were conducted to evaluate the antiviral activities of chloroquine and hydroxychloroquine. The studies on "COVID-19 and its allied treatment were found from World Health Organization (WHO), ISI-Web of Science, PubMed, EMBASE, Scopus, Google Scholar, and clinical trial registries. The search was based on keywords: antiviral drugs, chloroquine, hydroxychloroquine, COVID-19, COVID-19 treatment modalities, and coronavirus. In addition, we analyzed the prevalence of COVID-19 in malaria pandemic and non-pandemic countries. The review and analyses were performed on March 28, 2020.

RESULTS

For this study, we identified a total of 09 published articles: 03 clinical trials with sample size 150; 03 in vitro studies and 03 expert consensus reports. These studies were all suggestive that chloroquine and hydroxychloroquine can successfully treat COVID-19 infections. We found that COVID-19 infections are highly pandemic in countries where malaria is least pandemic and are least pandemic in nations where malaria is highly pandemic.

CONCLUSIONS

Chloroquine and hydroxychloroquine have antiviral characteristics in vitro. The findings support the hypothesis that these drugs have efficacy in the treatment of COVID-19. People are currently using these drugs for malaria. It is reasonable, given the hypothetical benefit of these two drugs, that they are now being tested in clinical trials to assess their effectiveness to combat this global health crisis.

Novel coronavirus 2019-nCoV: prevalence, biological and clinical characteristics comparison with SARS-CoV and MERS-CoV

OBJECTIVE

Human infections with zoonotic coronavirus contain emerging and reemerging pathogenic characteristics which have raised great public health concern. This study aimed at investigating the global prevalence, biological and clinical characteristics of novel coronavirus, Wuhan China (2019-nCoV), Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV), and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection outbreaks.

MATERIALS AND METHODS

The data on the global outbreak of "2019-nCoV, SARS-CoV, and MERS-CoV" were obtained from World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), concerned ministries and research institutes. We also recorded the information from research documents published in global scientific journals indexed in ISI Web of Science and research centers on the prevalence, biological and clinical characteristics of 2019-nCoV, SARS-CoV, and MERS-CoV.

RESULTS

Worldwide, SARS-CoV involved 32 countries, with 8422 confirmed cases and 916 (10.87%) casualties from November 2002 to August 2003. MERS-CoV spread over 27 states, causing 2496 cases and 868 (34.77%) fatalities during the period April 2012 to December 2019. However, the novel coronavirus 2019-nCoV spread swiftly the global borders of 27 countries. It infected 34799 people and resulted in 724 (2.08%) casualties during the period December 29, 2019 to February 7, 2020. The fatality rate of coronavirus MERS-CoV was (34.77%) higher than SARS-CoV (10.87%) and 2019-nCoV (2.08%); however, the 2019-nCoV transmitted rapidly in comparison to SARS-CoV and MERS-CoV.

CONCLUSIONS

The novel coronavirus 2019-nCoV has diverse epidemiological and biological characteristics, making it more contagious than SARS-CoV and MERS-CoV. It has affected more people in a short time period compared to SARS-CoV and MERS-CoV, although the fatality rate of MERS-CoV was higher than SARS-CoV and 2019-nCoV. The major clinical manifestations in coronavirus infections 2019-nCoV, MERS-CoV, and SARS CoV are fever, chills, cough, shortness of breath, generalized myalgia, malaise, drowsy, diarrhea, confusion, dyspnea, and pneumonia. Global health authorities should take immediate measures to prevent the outbreaks of such emerging and reemerging pathogens across the globe to minimize the disease burden locally and globally.

CRISPR technology: new paradigm to target the infectious disease pathogens

OBJECTIVE

Infectious diseases are one of the prime causes of death worldwide. An innovative sequence specific editing technology "Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)" has been tested on a broad range of microorganisms to target and destroy invading foreign DNA to human cells or tissues. This study aimed to discuss the mechanism and therapeutic usage of CRISPR/Cas9 genome editing technology in the management of various infectious disease pathogens.

MATERIALS AND METHODS

We conducted a broad search of the English-language literature in "PubMed" using the search terms "CRISPR", "Cas-9", "Genome editing", "Gene therapy", "infectious disease pathogens". All the articles were reviewed and required information was recorded.

RESULTS

CRISPR technology is used to modify and modulate the gene expression in biomedical research and therapeutic development. This technology facilitates the understanding of fundamental biology and broadens the horizon of treatments of germ-laden conditions.

CONCLUSIONS

The applications of CRISPR technology are widely established in the diagnosis and treatment of various bacterial, viral, fungal and parasitic infectious diseases. CRISPR technology is a simple, efficient and tested on a broad range of microorganisms to rectify disease-associated genetic defects and destroy invading foreign DNA to human cells or tissues.

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: epidemiology, pathogenesis and clinical characteristics

OBJECTIVE

Middle East Respiratory Syndrome Coronavirus-(MERS-CoV) infection is an evolving worldwide health crisis. The early diagnosis and management of the disease remains a major challenge. This study designed to discuss the epidemiology, pathogenesis and clinical appearances of MERS-CoV infections.

MATERIALS AND METHODS

We conducted a broad search of the English-language literature in "PubMed" "Medline" "Web of knowledge", "EMBASE" and "Google Scholar" World Health Organization-WHO" using the key words "Middle East Respiratory Syndrome", "MERS", "MERS-CoV" "Epidemiology" "Transmission" "Pathogenesis" "Clinical Characteristics". We reviewed the literature on epidemiology, pathogenesis and clinical appearances of MERS-CoV infection and the required information was documented.

RESULTS

The global prevalence of MERS-CoV infection from June 2012 to April 2018 is 2206 people. The number of cases reported from Saudi Arabia is 1831 (83%) with mortality rate of 787 (35.67%). The main clinical manifestations are fever, chills, generalized myalgia, cough, shortness of breath, nausea, vomiting and diarrhea. The age-allied prevalence of MERS-CoV was highest amongst elderly people with chronic debilitating diseases such as pulmonary diseases, end-stage renal illness, diabetes mellitus and malignancy.

CONCLUSIONS

MERS-CoV infection is an emerging global health concern, affected people in 27 countries in the various continents. MERS-CoV infection has been identified mainly in the Middle East, Europe, Africa, Asia and North America. Early detection and management of MERS-CoV infection is of critical importance to minimize the burden of the disease.

Global seasonal occurrence of middle east respiratory syndrome coronavirus (MERS-CoV) infection

OBJECTIVE

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is an evolving global health crisis. Despite recent efforts, there are numerous notable gaps in the understanding of MERS-CoV seasonal diversity. We aimed at investigating the global seasonal occurrence of Middle East Respiratory Syndrome coronavirus (MERS-CoV) outbreaks.

MATERIALS AND METHODS

We obtained the data on the prevalence and occurrence of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection from the World Health Organization (WHO) for all the MERS cases reported from the various countries and their allied ministries. We also recorded the research documents published in various global scientific journals on the seasonal occurrence of MERS-CoV infection during the period 2012-2017.

RESULTS

Worldwide 2048 laboratory confirmed cases of MERS-CoV infection were reported from June 2012 to the Dec 2017. 1680 (82.03%) cases were from the Saudi Arabia and 368 (17.96%) cases were reported from the other countries of the world. The maximum number of cases reported in June was 474 (23.14%). 287 (14.01%) cases were reported from Saudi Arabia and remaining 187 (9.13%) cases were reported from all over the world. The number of cases reported from April to June was 396 (19.33%) while the cases encountered from October to December were 231 (11.27%).

CONCLUSIONS

The highest global seasonal occurrence of Middle East Respiratory Syndrome coronavirus-MERS-CoV outbreak cases were found in the month of June, while the lowest was found in the month of January during the period of 2012 to 2017. The pattern of MERS-CoV infections has been observed to have seasonal variations. It is suggested that the health officials should highlight the seasonal occurrence of MERS-CoV outbreak and take better preventive measures to minimize the disease burden nationally and globally.

Shisha smoking: impact on cognitive functions impairments in healthy adults

OBJECTIVE

Shisha smoking is becoming highly prevalent and is a predominant mode of tobacco use particularly amongst the young generation around the globe. This study aims to investigate whether or not shisha smoking impairs the cognitive functioning in adolescents.

SUBJECTS AND METHODS

We recruited 65 (32 control subjects and 33 shisha smokers) apparently healthy male volunteers. The first group consisted of 33 volunteer male shisha smoker subjects with mean age 24.45±2.93 (mean ± SD) years. The second group consists of 32 subjects with mean age 23.31±2.68 (mean ± SD) years who did not smoke shisha. Age, gender, weight, height, ethnicity, educational and socioeconomic status of a matched design was used to appraise the impact of shisha smoking on cognitive functions. The cognitive function's outcome variables were the response time (Attention Switching Task-AST), (Complex Reaction Time-CRT task) and the percentage of correct answers (Pattern Recognition Memory PRM-task). Cognitive functions were assessed by using Cambridge Neuropsychological Automated Battery (CANTAB).

RESULTS

Shisha smokers showed significant decline in cognitive performances AST-Latency (p=0.03); AST-Congruent (p=0.05); AST-Incongruent (p=0.05); mean CRT (p=0.001); CRT % (p=0.01); PRM (p=0.024) compared to their matched control.

CONCLUSIONS

Cognitive functions including attention, alertness, and memory were significantly impaired in healthy adult shisha smokers compared to non-shisha smokers.

CRISPR technology: new paradigm to target the infectious disease pathogens

OBJECTIVE

Infectious diseases are one of the prime causes of death worldwide. An innovative sequence specific editing technology "Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)" has been tested on a broad range of microorganisms to target and destroy invading foreign DNA to human cells or tissues. This study aimed to discuss the mechanism and therapeutic usage of CRISPR/Cas9 genome editing technology in the management of various infectious disease pathogens.

MATERIALS AND METHODS

We conducted a broad search of the English-language literature in "PubMed" using the search terms "CRISPR", "Cas-9", "Genome editing", "Gene therapy", "infectious disease pathogens". All the articles were reviewed and required information was recorded.

RESULTS

CRISPR technology is used to modify and modulate the gene expression in biomedical research and therapeutic development. This technology facilitates the understanding of fundamental biology and broadens the horizon of treatments of germ-laden conditions.

CONCLUSIONS

The applications of CRISPR technology are widely established in the diagnosis and treatment of various bacterial, viral, fungal and parasitic infectious diseases. CRISPR technology is a simple, efficient and tested on a broad range of microorganisms to rectify disease-associated genetic defects and destroy invading foreign DNA to human cells or tissues.

Prevalence of type 2 diabetes in the Arab world: impact of GDP and energy consumption

OBJECTIVE

Diabetes Mellitus (DM) is a rapidly growing and most challenging health issue of the 21st century. This study aimed to investigate the prevalence of type-2 DM and its association with Gross Domestic Product (GDP) and energy consumption in the Arab world countries.

MATERIALS AND METHODS

We identified 88 articles through systematic searches including Institute of Scientific Information (ISI) Web of Science, PubMed and EMBASE databases published between 1980-2015. The related literature was searched by using the keywords including diabetes mellitus, prevalence, incidence, epidemiology of type-2 diabetes mellitus (T2DM), and names of the individual Arab world countries. The articles were selected and investigated for the prevalence of T2DM. No limitations were imposed in the design of the study or publication language. Finally, 50 peer-reviewed publications were included and the rest were excluded.

RESULTS

Arab world countries with the highest prevalence of T2DM are: Kingdom of Saudi Arabia 31.6%, Oman 29%, Kuwait 25.4%, Bahrain 25.0% and United Arab Emirates 25.0%. The lowest prevalence was found in Mauritania (4.7%) and Somalia (3.9%). The highest prevalence was observed in Gulf Cooperation Council (GCC) countries (25.45%) whilst non-GCC countries had the lowest prevalence (12.69%). The combined mean prevalence of T2DM in both GCC and Non-GCC Arab countries was 16.17%. The prevalence of T2DM was found to be significantly associated with higher Gross Domestic Product (GDP) (p=0.020) and energy consumption (p=0.017).

CONCLUSIONS

In the Arab world, the countries with the highest prevalence of type 2 diabetes mellitus are: Saudi Arabia, Oman, Kuwait, Bahrain and UAE, whilst the countries with the lowest prevalence are Mauritania and Somalia. This prevalence was significantly associated with high GDP per capita and energy consumption. Arab states must incorporate diabetes preventive policies on a war-footing basis to minimize the burden of the disease.

Association of ABO and Rh blood groups with type 2 diabetes mellitus

OBJECTIVE

The phenotypic "ABO" blood groups are inherited antigenic substances which are found on the surface of red blood cells in addition to other tissues. Certain hypothesis advocates that genetic predisposition like "ABO" blood group would be associated with occurrence of diseases including type 2 diabetes. This study aimed to investigate the potential association between "ABO" and "Rhesus" blood groups with type 2 diabetes.

MATERIALS AND METHODS

We identified 47 research documents in a data based search including ISI-Web of Science, EMBASE and PubMed. Literature was explored using the key terms including "ABO blood groups" "type 2 diabetes". Studies in which "ABO" blood types and diabetes mellitus were discussed included without restrictions of research documents, types, status and language of the publications. Finally, 15 publications which matched our criteria were included, and remaining studies were excluded.

RESULTS

Blood group "B" was associated with high incidence of type 2 diabetes and blood group "O" has a minimum association with type 2 diabetes. Blood group "A" and "AB" were almost equally distributed in both diabetic and non-diabetic population. However, we were unable to find an association between "Rh+ve" and "Rh-ve" blood groups with type 2 diabetes.

CONCLUSIONS

Subjects with blood group "B" are at high risk while individuals with blood group "O" are at low peril of evolving type 2 diabetes. It is suggested that subjects with blood group "B" should be closely monitored by physicians as these subjects have an increased risk of type 2 diabetes.

Effect of environmental air pollution on cardiovascular diseases

OBJECTIVE

Environmental air pollution has become a leading health concern especially in the developing countries with more urbanization, industrialization and rapidly growing population. Prolonged exposure to air pollution is a risk factor for cardiovascular diseases. The present study aimed to investigate the effects of environmental air pollution on progression of cardiovascular problems.

METHODS

In this study, we identified 6880 published articles through a systematic database including ISI-Web of Science, PubMed and EMBASE. The allied literature was searched by using the key words such as environmental pollution, air pollution, particulate matter pollutants PM 2.5 μm-PM 10 μm. Literature in which environmental air pollution and cardiac diseases were discussed was included. Descriptive information was retrieved from the selected literature. Finally, we included 67 publications and remaining studies were excluded.

RESULTS

Environmental pollution can cause high blood pressure, arrhythmias, enhanced coagulation, thrombosis, acute arterial vasoconstriction, atherosclerosis, ischemic heart diseases, myocardial infarction and even heart failure.

CONCLUSIONS

Environmental air pollution is associated with increased risk of cardiovascular diseases. Environmental pollution exerts its detrimental effects on the heart by developing pulmonary inflammation, systemic inflammation, oxidative stress, endothelial dysfunction and prothrombotic changes. Environmental protection officials must take high priority steps to minimize the air pollution to decrease the prevalence of cardiovascular diseases.

Effect of exposure to silica in inducing autoimmune hepatitis: an experimental animal-controlled study

OBJECTIVE

The aim of this experimental study is to investigate the effect of subcutaneous and oral sodium silicate in inducing the autoimmune hepatitis.

MATERIALS AND METHODS

Twelve Brown Norway rats were studied, six rats were challenged with Sodium Silicate and the rest were challenged with normal saline as a control group. At 14th week post-sodium silicate or normal saline exposure, the rats were sacrificed. Histopathological studies were conducted in six positive autoantibodies responding silicate group rats and then compared with an equal number of negative autoantibodies responding control rats.

RESULTS

The liver findings from sodium silicate group of animals showed a histopathological reaction in 3/6 (50%) compared with 0/6 of the corresponding control saline group (p = 0.09). However, the absolute differences in the percentage between the two groups was 50%, the subcutaneous sodium silicate sub-group showed hepatic tissue response close to being statistically significant level (p = 0.05).

CONCLUSIONS

After correlating the results with autoantibodies including serum antinuclear antibodies and anti ribo-nucleoprotein response of the same rats, it is concluded that sodium silicate play a role in inducing the autoimmune hepatitis in a genetically susceptible rat model.

Effect of environmental air pollution on type 2 diabetes mellitus

OBJECTIVE

Air pollution is a novel risk factor for insulin resistance and occurrence of type 2 diabetes mellitus (T2DM), but the evidence is limited and diverse. Therefore, the aim of this study was to assess the effect of environmental air pollution on incidence of type 2 diabetes mellitus.

METHODS

In this study, we identified 102 published studies through a systematic data base search including ISI-Web of Science, EMBASE and PubMed. We searched the related literature by using the key terms including diabetes mellitus, air pollution, occupational and environmental pollution, gaseous, NO2, particulate matter pollutants PM2.5, and PM10. Studies in which diabetes mellitus, insulin resistance, air pollution, occupational and environmental pollution was discussed were included in the study. No confines on publication status, study design or language of publication were considered. Descriptive and quantitative information were extracted from the selected literature. Finally we included 21 publications and remaining studies were excluded.

RESULTS

Air pollution is a leading cause of insulin resistance and incidence of type 2 diabetes mellitus. The association between air pollution and diabetes is stronger for traffic associated pollutants, gaseous, nitrogen dioxide, tobacco smoke and particulate matter.

CONCLUSIONS

Exposure to air pollutants is significantly associated with increased risk of type 2 diabetes mellitus. It is suggested that, environmental protection officials must take high priority steps to minimize the air pollution, hence to decrease the incidence of type 2 diabetes mellitus.

Diabetes during Ramadan: underestimated, under-investigated, needs more attention

OBJECTIVE

In Ramadan, Muslims adults fast from sunrise to sunset for a period of a month. Due to paucity of data it seems that, diabetes mellitus during Ramadan is underestimated and the statistics are not a reflection of the actual reality. The aim this study is to highlight the staggering demographics in the diabetic Muslim population and emphasize its ramifications on fasting during Ramadan.

METHODS

In this study, we identified 37 published studies through a systematic database searches including ISI-Web of Science and PubMed. We searched the related literature by using the key words Diabetes Mellitus, Ramadan Fasting, Ramadan Fasting complications. Studies in which Diabetes Mellitus, Ramadan Fasting was discussed were included in the study. No limitations on publication status, study design or language of publication were obligatory. Finally we included 19 publications and remaining 18 were excluded.

RESULTS

Today's emerging diabetes hotspots in Muslim majority countries are the Middle East, Western Pacific, Sub-Saharan Africa and South-East Asia. Poverty, lack of education, poor healthcare, minimum available data and inappropriate guidance for the diabetic patients are the major risk factors resulting in serious complication during fasting in the month of Ramadan.

CONCLUSIONS

Still there are big gaps in the management of diabetic patients during Ramadan, the care of diabetic patients is fragmented and it is felt that diabetes during Ramadan is underestimated, under-investigated and needs more attention. It is vital to empower the healthcare workers and the patients in the frontlines with the appropriate information about Ramadan fasting in diabetic patients. Diabetic patients who fast during Ramadan should be adequately investigated and engaged in a structured Ramadan-focused diabetes education to undertake the fast safely.

Serum alanine aminotransferase has limited predictive value for liver disease in chronic hepatitis C

OBJECTIVES

Serum alanine aminotransferase (ALT) levels are sometimes used to identify patients with progressive liver disease in chronic hepatitis C. We assessed the predictive value of serum ALT at various cut-off levels, for the identification of liver disease severity.

PATIENTS AND METHODS

This cross sectional study was carried out at Ziauddin University and Pakistan Medical Research Council, Karachi. Liver biopsy specimens were staged and graded according to METAVIR scoring system. Identification of overall significant liver disease (F2 or A2 and above) was the primary outcome variable. Diagnostic value of ALT was assessed through receiver operating characteristic (ROC) curve analysis.

RESULTS

Out of 98 patients, 42 (43%) had significant fibrosis and 26 (27%) had significant inflammatory activity. Overall significant liver disease was present in 46 (47%) patients of which 13 had widespread fibrosis. Area under the ROC curve for overall significant disease was 0.727 (95% CI 0.627-0.826). A clinically acceptable cut off level to rule out presence of clinically significant disease was found to be ≤ 20 U/L. This low level of ALT was present in 13 (13%) patients. At this cut off, sensitivity was 96%, specificity was 19%, positive predictive value was 49% and negative predictive value was found to be 85%.

CONCLUSIONS

Serum ALT level of ≤ 20 U/L can reliably exclude significant liver disease. Values of ALT above 20 U/L do not reliably differentiate between minimal and significant disease.

Effect of exposure to cement dust on Fractional Exhaled Nitric Oxide (FeNO) in non-smoking cement mill workers

OBJECTIVES

This cross-sectional study aimed to determine the effects of exposure to cement dust on Fractional Exhaled Nitric Oxide (FeNO) in non-smoking cement mill workers.

SUBJECTS AND METHODS

We recruited 121 apparently healthy male volunteers, 90 of them were non-smoking cement mill workers and 31 non-smoking un-exposed subjects served as control. The mean age of cement mill workers was 36.62 ± 1.03 years and 36.65 ± 2.28 years of control subjects. Based on the duration of exposure, cement mill workers were divided into four groups, less than 5, 5-10, 10-15 and more than 15 years. All subjects were individually matched for age, ethnicity and socioeconomic status. Fractional Exhaled Nitric Oxide test was performed by using Niox Mino.

RESULTS

Significant increased level of Fractional Exhaled Nitric Oxide was observed in cement mill workers (31.71 ± 2.963 ppb) compared to their non-exposed counterparts (25.39 ± 2.46 ppb). The significance difference was further increased with long-term working exposure in cement industry.

CONCLUSIONS

Fractional Exhaled Nitric Oxide is significantly increased in cement mill workers and associated with duration of exposure to cement dust. The findings also show that cement mill workers have higher pulmonary inflammation.

Prevalence of erectile dysfunction among Saudi type 2 diabetic patients

OBJECTIVES

The present study aimed to determine the prevalence and etiology of erectile dysfunction in Saudi type 2 diabetic patients.

PATIENTS AND METHODS

429 Saudi type 2 diabetic male patients aged more than 30 years were recruited. Total and bio-available serum testosterone, sex hormone binding globulin and free testosterone levels were measured by ELISA-IBL GMBH Germany.

RESULTS

47 (12.6%) subjects had hypogonadism with total testosterone < 8 nmol/l and 109 (29.3%) had possible hypogonadism with a total testosterone between 8 and 12 nmol/l. Similarly, using bioavailable levels, 30 (8%) men had overt hypogonadism with bioavailable testosterone < 2.5 nmol/l and 89 (33.9%) men had possible hypogonadism with bioavailable testosterone between 2.5-4 nmol/l; while 266 (71.6%) patients with free testosterone < 0.255 nmol/l had hypogonadism. BMI and waist circumference were both significantly negatively correlated with testosterone levels in Saudi type 2 diabetic men.

CONCLUSIONS

Testosterone levels are frequently low in Saudi men with type 2 diabetes and majority of these patients have symptoms of hypogonadism. The prevalence of erectile dysfunction (ED) was 86.7% in diabetic men with low testosterone level of 8-12 nmol/L. Obesity is an associated factor with low testosterone levels and ED in Saudi type 2 diabetic patients.

Diabetes during Ramadan - PRE-approach model: presentation, risk stratification, education

OBJECTIVE

Fasting (Sawm) during Ramadan is one of the five pillars of Islam and mandatory for all Muslim healthy adults. Most of the Muslim diabetic patients insist on fasting in Ramadan despite their exemption. Due to paucity of literature, diabetes during Ramadan is underestimated and the statistics are not reflecting the actual reality. The aim of this study is to highlight the demographics in diabetic Muslim population and emphasize its ramifications on Ramadan fasting.

METHODS

In this study, we developed a 3 step PRE-approach model based on Presentation, Risk stratification, Education in diabetics who fast during Ramadan. For the establishment of this model we identified 40 published studies in database searches including ISI-web of science and pub-med. We searched the related literature by using the key words including diabetes mellitus, Ramadan fasting. All studies in which diabetes and fasting in Ramadan was investigated were included. There was no limitation on publication status, design or language. Finally, we included 35 publications and remaining 5 were excluded from the study.

RESULTS

The diabetic patients who fast are at risk of severe hypoglycemia, hyperglycemia, diabetic ketoacidosis, dehydration, thrombosis, strokes and retinal artery occlusion. Lack of education, poor healthcare and no structured guidance cause adeverse health consequences.

CONCLUSIONS

It is vital to empower the healthcare workers and the patients in the frontlines with appropriate information. To preempt and minimize the problems faced by the diabetic patients who fast, available resources should be mobilized to efficiently and effectively reach out these patients. Diabetic patient educational guidelines about Ramadan fasting should be disseminated and translated into major regional languages to minimize the complications. Diabetic patients who are stable, free of deteriorating complications and able to manage can be allowed to fast.

Effects of electronic cigarette smoking on human health

OBJECTIVE

Electronic cigarette smoking is gaining dramatic popularity and is steadily spreading among the adolescents, high income, urban population around the world. The aim of this study is to highlight the hazards of e-cigarette smoking on human health.

MATERIALS AND METHODS

In this study, we identified 38 published studies through a systematic database searches including ISI-web of science and pub-med. We searched the related literature by using the key words including Electronic cigarette, E-cigarette, E-vapers, incidence, hazards. Studies in which electronic cigarette smoking hazards was investigated were included in the study. No limitations on publication status, study design of publication were implemented. Finally we included 28 publications and remaining 10 were excluded.

RESULTS

E-smoking can cause, nausea, vomiting, headache, dizziness, choking, burn injuries, upper respiratory tract irritation, dry cough, dryness of the eyes and mucous membrane, release of cytokines and pro-inflammatory mediators, allergic airway inflammation, decreased exhaled nitric oxide (FeNO) synthesis in the lungs, change in bronchial gene expression and risk of lung cancer.

CONCLUSIONS

Electronic cigarettes are swiftly promoted as an alternative to conventional cigarette smoking, although its use is highly controversial. Electronic cigarettes are not a smoking cessation product. Non-scientific claims about e-cigarettes are creating confusion in public perception about e-cigarette and people believe that e-cigarettes are safe and less addictive, but its use is unsafe and hazardous to human health. E-cigarette smoking should be regulated in the same way as traditional cigarettes and must be prohibited to children and adolescents.

Impact of R&D expenditures on research publications, patents and high-tech exports among European countries

OBJECTIVES

This study aimed to compare the impact of Research&Development (R&D) expenditures on research publications, patents and high-tech exports among European countries.

MATERIALS AND METHODS

In this study, 47 European countries were included. The information regarding European countries, their per capita Gross Domestic Product (GDP), R&D spending, number of universities, indexed scientific journals, high technology exports and number of patents were collected. We recorded the total number of research documents in various science and social sciences subjects during the period 1996-2011. The main source for information was World Bank, Web of Science, Thomson Reuters and SCImago/Scopus.

RESULTS

The mean GDP per capita for all the European countries is 23372.64 ± 3588.42 US$, yearly per capita spending on R&D 1.14 ± 0.13 US$, number of universities 48.17 ± 10.26, mean number of Institute of Scientific Information (ISI) indexed journal per country 90.72 ± 38.47, high technology exports 12.86 ± 1.59 and number of patent applications 61504.23 ± 22961.85. The mean of research documents published in various science and social science subjects among all the European countries during the period 1996-2011 is 213405.70 ± 56493.04. Spending on R&D, number of universities, indexed journals, high technology exports and number of patents have a positive correlation with number of published documents in various science and social science subjects. We found a positive correlation between patent application and high-tech exports. However, there was no association between GDP per capita and research outcomes.

CONCLUSIONS

It is concluded that, the most important contributing factors towards a knowledge based economy are spending on R&D, number of universities, scientific indexed journals and research publications, which in turn give a boast to patents, high technology exports and ultimately GDP.

Research progress and prospects of Saudi Arabia in global medical sciences

OBJECTIVES

Since last decade, Saudi Arabia has been swiftly moving ahead to promote an education and research in the country. This study aimed to investigate the research outcome of Saudi Arabia in medical sciences during the period 1996-2012.

MATERIAL AND METHODS

In this study, the research papers published in various global science journals during the period 1996-2012 were accessed. We recorded the total number of research documents having an affiliation with Saudi Arabia. The main source for information was Institute of Scientific Information (ISI) Web of Science, Thomson Reuters and SCI-mago/Scopus.

RESULTS

In global science data base, Saudi Arabia contributed 103804 documents in all science and social sciences. In medicine the total number of research papers from Saudi Arabia are 16196, citable documents 14732, total citations 102827, citations per documents 6.36 and Hirsch index (h-index) is 92. However, in combined medical and allied health sciences the total number of research papers are 27246, citable documents 25416, total citations 181999, mean citations per documents 7.07 and mean h-index is 41.44. Furthermore, Saudi Arabia contributed 40797 research documents in ISI indexed journals only and also 151 research documents in highly reputable and towering science journals.

CONCLUSIONS

Saudi Arabia's research performance in global medical sciences has markedly increased during the period 2006-2012. The research publications are continuously on mounting path; however, the number of citations has decreased. The country improved its regional as well as international research rankings and graded 45 in the world in year 2012.

Research productivity of Pakistan in medical sciences during the period 1996-2012

OBJECTIVES

This study aimed to investigate the degree of research outcome in medical science subjects in Pakistan during the period 1996-2012.

MATERIALS AND METHODS

In this study, the research papers published in various global science journals during the period 1996-2012 were accessed. We recorded the total number of research documents having an affiliation with a Pakistan. The main source for information was Institute of Scientific Information (ISI) Web of Science, Thomson Reuters and SCI-mago/Scopus.

RESULTS

In global science, Pakistan contributed 58133 research papers in all science and social sciences both in ISI and non ISI indexed journals. However, in medical sciences the total number of research papers from Pakistan are 25604, citable documents 23874, citations 128061, mean citations per documents 6.45 and mean Hirsch index is 35.33. In Pakistan, the upward trend of articles published in global medical science was from the period 1996-2008. However, from 2008 the trend is markedly declined.

CONCLUSIONS

Pakistan significantly improved its international ranking positions in research during the period 2000-2008. However, the upward trend of research papers published in global medical science could not be retained and from the year 2008 the trend started declining. This trend of research papers further declined in year 2012 compared to year 2011. It is suggested that, Pakistan must take strategic steps to enhance the research culture and increase the research and development expenditure in the country.

Impact of GDP, spending on R&D, number of universities and scientific journals on research publications in pharmacological sciences in Middle East

OBJECTIVES

Research in pharmacological science is vital to support the health needs of human beings. Measuring the research output provides information that forms the basis of strategic decisions. This study aimed to investigate the impact of Gross Domestic Product (GDP), spending on Research and Development (R&D), number of universities and scientific journals on research documents (papers), citable documents, citations per document and H-index in pharmacological science among Middle East countries.

MATERIALS AND METHODS

All the 16 Middle East countries were included in the study. The information regarding GDP, spending on R&D, total number of universities and indexed scientific journals were collected. We recorded the total number of research documents, citable documents, citations per document and H-index in pharmacological science during the period 1996-2011. The main sources for information were World Bank, Web of Science, Journal Citation Reports (Thomson Reuters) and SCI-mago/Scopus.

RESULTS

The mean per capita GDP of all the Middle East countries is 18125.49±5386.28 US$, spending on R&D 0.63±0.28% of GDP in US$, number of universities 36.56±11.33 and mean ISI indexed journal are 8.25±3.93. The number of research documents published in pharmacological science among the Middle East countries during the period 1996-2011 is 1344.44±499.34; citable documents 1286.37±476.34; citations per document 7.62± 0.84; and H-index is 30.68±6.32. There was a positive correlation between spending on R&D and citations per documents (r = 0.56, p = 0.02), H-Index (r = 0.56, p = 0.02); number of universities and research documents (r = 0.72, p = 0.002), citable documents (r = 0.72, p = 0.001); ISI indexed journals and research documents (r = 0.88, p = 0.0001), citable documents (r = 0.88, p = 0.0001), H-Index (r = 0.67, p = 0.004). However, there was no correlation between the GDP per capita and research outcome in pharmacological science.

CONCLUSIONS

There is a positive association between spending on R&D, number of universities and indexed scientific journals on research outcome in pharmacological science in Middle East.

Gut modulator effects of Conyza bonariensis explain its traditional use in constipation and diarrhea

BACKGROUND AND OBJECTIVES

The current investigation was carried out to explore the pharmacological basis of the crude extract of Conyza bonariensis (Cb.Cr) for its use in constipation and diarrhea.

MATERIALS AND METHODS

The plant extract of Conyza bonariensis (C. bonariensis) was prepared, isolated guinea-pig ileum and rabbit jejunum preparations were used to evaluate its gut modulator effects.

RESULTS

The Cb.Cr (0.3-10 mg/mL) exhibited spasmogenic effect in isolated guinea-pig ileum preparation, which was about 19-84% of the acetylcholine maximum. Pretreatment of the tissues with atropine (0.1 µM) abolished the contractile effect, similar to acetylcholine. Among the fractions, only the butanol fraction exhibited atropine sensitive contractile effect. In isolated rabbit jejunum preparations, Cb.Cr produced appreciable atropine-sensitive spasmogenic effect at lower concentrations (0.03-0.3 mg/mL) followed by spasmolytic effect at next higher concentration (1.0 and 3.0 mg/mL). Cb.Cr caused an inhibition of the high K+ induced contraction in isolated rabbit jejunum preparation with EC50 value of 0.62 mg/mL. Similarly, verapamil, a standard calcium blocker, inhibited high K+ induced contraction in isolated rabbit jejunum preparations. Cb.Cr caused a right ward shift in the Ca++ concentration response curve, similar to verapamil. Among various fractions of C. bonariensis, only hexane and ethylacetate fractions showed spasmolytic effects.

CONCLUSIONS

The crude extract of C. bonariensis contains spasmogenic and spasmolytic constituents, which explains its medicinal use in constipation and diarrhea.

Induction of autoimmunity in Brown Norway rats by oral and parenteral administration of sodium silicate

Silica and silicate may disturb immune function such as autoimmunity and tumour immunity. The main objective of this study was to examine the relation between sodium silicate and induction of autoimmunity in genetically susceptible rats. In this study, thirty Brown Norway rats were randomised into four treatment groups, the first and second group receiving 3 mg of sodium silicate (NaSiO(4)) (equivalent to 2 mg silica) in 0.2 mL of normal saline either per oral or subcutaneously, and the third and fourth group (control) receiving 0.2 mL of normal saline (0.9%) through the same corresponding route. A significant number of rats (80%) (P < 0.05) which received sodium silicate by the subcutaneous route showed a high level of serum ANA compared with controls. In the oral, sodium silicate group showed high serum ANA in an insignificant number of rats. Other autoantibodies in both groups (anti-dsDNA, anti-Smith, anti-SSA, anti-SSB) showed gradual increased post exposure, but the numbers of rats with positive titres post exposure was statistically not significant. Silica exposure in rats appears to induce the development of autoimmunity. A longer duration post exposure to silicate seems to be associated with greater risks.