COVID-19 Pandemic Disease Research Articles

ML-DTD: Machine Learning-Based Drug Target Discovery for the Potential Treatment of COVID-19.

Recent research has highlighted that a large section of druggable protein targets in the Human interactome remains unexplored for various diseases. It might lead to the drug repurposing study and help in the in-silico prediction of new drug-human protein target interactions. The same applies to the current pandemic of COVID-19 disease in global health issues. It is highly desirable to identify potential human drug targets for COVID-19 using a machine learning approach since it saves time and labor compared to traditional experimental methods. Structure-based drug discovery where druggability is determined by molecular docking is only appropriate for the protein whose three-dimensional structures are available. With machine learning algorithms, differentiating relevant features for predicting targets and non-targets can be used for the proteins whose 3-D structures are unavailable. In this research, a Machine Learning-based Drug Target Discovery (ML-DTD) approach is proposed where a machine learning model is initially built up and tested on the curated dataset consisting of COVID-19 human drug targets and non-targets formed by using the Therapeutic Target Database (TTD) and human interactome using several classifiers like XGBBoost Classifier, AdaBoost Classifier, Logistic Regression, Support Vector Classification, Decision Tree Classifier, Random Forest Classifier, Naive Bayes Classifier, and K-Nearest Neighbour Classifier (KNN). In this method, protein features include Gene Set Enrichment Analysis (GSEA) ranking, properties derived from the protein sequence, and encoded protein network centrality-based measures. Among all these, XGBBoost, KNN, and Random Forest models are satisfactory and consistent. This model is further used to predict novel COVID-19 human drug targets, which are further validated by target pathway analysis, the emergence of allied repurposed drugs, and their subsequent docking study.

To Compare the Outcome of Conservative Management Versus Open Appendicectomy in Early Presentation of Acute Appendicitis in Children during Covid-19 Pandemic

Objective: Aim was to compare the outcome of conservative management versus open appendicectomy in early presentation of Acute Appendicitis in children during Covid-19 pandemic. Study Design: Retrospective study Place and Duration: The Children’s Hospital PIMS. March 2020 to Sep 2020 Methods: This research comprised 80 children of both sexes who were diagnosed with acute appendicitis during the Covid-19 epidemic. Following the collection of written informed consent, complete demographic data, including age, sex, and sickness severity, was collected from all recruited patients. There were two sets of patients, and both were treated similarly. Forty individuals in Group I underwent for open appendicectomy, whereas the same number in Group II underwent conservative treatment (intravenously injection Tanzo, Flagyl, Amikacin). Complications after therapy and antibiotic resistance were analysed and compared between the two groups. All of the data was analyzed using SPSS 22.0. Results: There were majority males 47 (58.8%) and 33 (41.2%) females in this study. Mean age of the patients was 9.09±5.29 years. Disease severity was found in 67 (83.8%) cases. Although there was no statistically significant difference between the groups, the more conservatively treated group had a higher risk of complications. Between the two groups, there was no discernible difference in the average length of hospitalization. Surgery patients had significantly higher white cell counts (WCCs) and Alvarado scores (p=0.010 and p=0.018, respectively) at arrival. We found higher readmission and reoperation during Covid-19 pandemic among both groups. Conclusion: We concluded in this study that severity of acute appendicectomy was higher during pandemic wave of coronavirus. Both conservative and open appendicectomy was effective in terms of minimum complications and decrease hospital say while readmission and reoperation was higher among both groups because of pandemic disease Covid-19. Keywords: Acute Appendicitis, Conservative Management, Open Appendicectomy, Complications, Hospital Stay

Impact of COVID-19 on Employment in Tertiary Care Hospital of Karachi

A public health dispute regarding the pandemic disease COVID-19 has wrapped up the entire world. Based on statistics Pakistan lies as a low and middle-income country throughout the world and out of 189 countries it lies in the 152nd rank with an index value of 0.560 on the Health development scale. Objective: To evaluate the unemployment among health care workers working in rehabilitation departments in tertiary care hospitals. Methods: This was a cross-sectional survey of sample size 212 conducted on healthcare workers working in Ziauddin hospital department of rehabilitation sciences, Karachi, the research study is explanatory, whereas the method is quantitative. The initial research was done by gathering the literature linked to healthcare workers and being examined via validated questionnaires through emails and various statistical tools used to analyze the complete data. Results: The results showed that the mean age was found to be 28.75 ± 5.8. Male participants were found to be 20(9.4%) and females were 192(90.6%). Most of the participants were graduates 128(60.4%) followed by post-graduate 76(35.8%). There were 128(60.4%) participants who were single. Employment status was asked most of the respondents found out of work and looking for work there were 16 respondents in Taking care of the home and family and 80 unemployed and seeking a job with a significant P-value of <0.001. Conclusion: The conclusion of the study showed there is a significant effect of the COVID-19 pandemic disease on the employment status of workers of healthcare in tertiary care hospitals in Karachi

What Influence did the Lockdown 2020 have on the Use of a Central Emergency Room by Psychiatric Emergency Patients

The current coronavirus pandemic (Covid-19 disease) poses major challenges to healthcare systems worldwide. The aim of this work was to identify the impact on psychiatric emergency presentations in an ED during the implemented lockdown. A retrospective survey of all psychiatric emergency presentations in the ED during the lockdown was conducted. The same period in 2019 served as the reference year. There was a decrease in psychiatric patients. Changes were observed in the age and diagnoses. Some clear effects of the lockdown on psychiatric emergencies in an ED setting can be described. However, the changes were smaller than in other countries with other health care systems.

Evaluation of apigenin-based biflavonoid derivatives as potential therapeutic agents against viral protease (3CLpro) of SARS-CoV-2 via molecular docking, molecular dynamics and quantum mechanics studies

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the causative agent of the pandemic COVID-19 disease that affects human respiratory function. Despite the scientific progression made in the development of the vaccine, there is an urgent need for the discovery of antiviral drugs for better performance at different stages of SARS-CoV-2 reproduction. The main protease (Mpro or 3CLpro) plays a pivotal role in the life cycle of the virus, making it an attractive target for the development of antiviral agents effective against the new strains of coronaviruses (CoVs). In this study, a series of apigenin-based natural biflavonoid derivatives as potential inhibitors of coronaviruses 3CLpro was investigated by in silico approaches. For this purpose, the molecular docking was performed to analyze the interaction of the natural biflavonoids with SARS-Cov-2 main protease and for further investigation, docking to the 3CLpro of SARS-CoV and MERS-CoV. Based on docking scores and comparison with the reference inhibitors (ritonavir and lopinavir), more than half of the biflavonoids had strong interactions with the residues of the binding pocket of the coronaviruses 3CLpro and exhibited better binding affinities toward the main protease than ritonavir and lopinavir. The top biflavonoids were further explored through molecular dynamics simulation, binding free energy calculation and residual energy contributions estimated by the MM-PBSA. Also, drug likeness property investigation by Swiss ADME tools and density functional theory (DFT) calculations were performed. The results confirmed that the 3CLpro-amentoflavone, 3CLpro-bilobetin, 3CLpro-ginkgetin, and 3CLpro-sotetsuflavone complexes possess a large amount of dynamic properties such as high stability, significant binding energy and fewer conformation fluctuations. Also, the pharmacokinetics and drug-likeness studies and HOMO-LUMO and DFT descriptor values indicated a promising result of the selected natural biflavonoids. Overall findings indicate that the apigenin-based biflavonoids may inhibit COVID-19 by significant interactions in the binding pocket and those results can pave the way in drug discovery although the effectiveness of these bioactive compounds should be further validated by in-vitro and in-vivo investigations. Communicated by Ramaswamy H. Sarma

Does the plasma vitamin D level affect the severity of infection in COVID-19 patients of different age groups?

Purpose: SARS-CoV-2 has caused an on-going global pandemic of COVID-19 disease. Vitamin-D has an immunomodulatory effect on the disease by suppressing the adaptive immune system which can lead to a cytokine storm, and boosting the innate immune system. This study evaluated the relationship between both the clinical characteristics of COVID-19 patients and the severity of their infections, and their serum Vitamin D levels. Material and Methods: Forty COVID-19 patients from the period April to July, 2020, and 46 healthy subjects from a similar period in 2019, were included. Serum Vitamin-D level, Clinical findings, comorbidities, chest computed tomography findings, hematological and serum biochemistry analyzes of the patients were evaluated. Results: COVID-19 patients had a significantly lower mean serum 25(OH) Vitamin-D level (12·86 ± 6·27 ng/mL) than healthy subjects (25·4 ± 12·7 ng/mL) (p<<0·001). The prevalence of Vitamin D deficiency in COVID-19 patients was high, not only in the elderly, but also in middle age and young patients. Ground-glass opacification and paving stone sign were the most frequent patterns observed in chest-computed tomography (CT) images. There was a significant negative relationship between Vitamin-D deficiency and C-reactive protein (CRP) level (p=0·0243). In addition, a high CRP level was associated with abnormal CT findings (p=0·001). Conclusion: The authors conclude that determining the Vitamin-D level in COVID-19 patients and administering it at the appropriate dosage can reduce the severity and progression of COVID-19 disease by contributing to the regulation of the cytokine storm and pulmonary inflammatory response.

Analyze the Association of Depression and Anxiety in Patients with and without Pandemic Disease Covid-19

Objective: The purpose of this study is to compare the prevalence of depression and anxiety in people with and without COVID-19. Study Design: Cross-sectional Place and Duration: Sahara Medical College / Sughra Shafi Medical Complex Narowal. Feb-2021-Aug 2021 Methods: In this study, 178 cases of both sexes had age 15-55 years were presented. After obtaining written consent, the patient's complete demographic information—including age, sex, and BMI—was collected. Two groups of patients were split evenly. Group M contained 89 COVID-19 patients, while group N contained 89 cases but did not contain COVID-19. Both groups' rates of depression and anxiety were assessed. It was decided to use structural questionnaires. SPSS 18.0 was used to analyze all the data. Results: Among 178 cases, 104 (58.4%) were males and 74 (41.6%) were females. Majority of the cases 80 (44.9%) had age 18-30 years, 65 (36.5%) had age 31-40 years and 33 (18.5%) had age &gt;40 years. 120 (67.4%) had BMI &lt;25kg/m2 and 58 (33.6%) had BMI &gt;25kg/m2. We found significantly higher number of depression 48 (53.9%), anxiety 30 (33.7%) and stress 19 (21.3%) in patients of group M as compared to group N found in 24 (26.9%), 18 (16.9%) and 11 (12.4%) with p value &lt;0.005. Conclusion: In this study, we found that, in comparison to non-COVID 19 patients, COVID-19 patients typically experienced significant levels of anxiety and depression. Patients with medical conditions should learn methods for quick identification and treatment of depression and anxiety. Keywords: COVID-19, anxiety, depression, illness

Pharmacological activities of Curcumin: An update

In the past few years, multiple drugs have been produced from traditional raw materials and recent pandemic disease COVID-19 once again research on this matter is being conducted to determine potential therapeutic purposes of different Ayurvedic Indian medicines and herbs. One such medicinal herb is Curcuma longa. Curcumin is strong antioxidant, anti-inflammatory, antispasmodic, antiangiogenic, anti-carcinogenic, as shown by multiple in vitro and in vivo studies. The action of the growth factor receptors is inhibited by curcumin. The anti-inflammatory effect of curcumin is obtained on the cytokines, proteolytic enzymes, eicosanoids, and lipid mediators. The superoxide radicals, nitric oxide and hydrogen peroxide, are sifted by curcumin, while lipid peroxidation is inhibited. Such properties of the compound thus form the foundation for its various therapeutic and pharmacological effects could also hold antiviral properties including COVID-19. The aim of this research is to summarize the updated pharmacological activities of curcumin.

Fuzzy expert systems for prediction of ICU admission in patients with COVID-19

The pandemic COVID-19 disease has had a dramatic impact on almost all countries around the world so that many hospitals have been overwhelmed with COVID-19 cases. As medical resources are limited, deciding on the proper allocation of these resources is a very crucial issue. Besides, uncertainty is a major factor that can affect decisions, especially in medical fields. To cope with these issues, we use fuzzy logic (FL) as one of the most suitable methods in modeling systems with high uncertainty and complexity. We intend to make use of the advantages of FL in decisions on cases that need to treat in ICU. In this study, an interval type-2 fuzzy expert system is proposed for the prediction of ICU admission in COVID-19 patients. For this prediction task, we also developed an adaptive neuro-fuzzy inference system (ANFIS). Finally, the results of these fuzzy systems are compared to some well-known classification methods such as Naive Bayes (NB), Case-Based Reasoning (CBR), Decision Tree (DT), and K Nearest Neighbor (KNN). The results show that the type-2 fuzzy expert system and ANFIS models perform competitively in terms of accuracy and F-measure compared to the other diagnosis systems.

Analysis of the legislative proposals for amendments to the Penal Code Of Ukraine aimed to overcome the pandemic disease COVID-19, caused by Coronavirus Sars-Cov-2

Draft laws of Ukraine towards the amendments to the Penal Code of Ukraine aimed to overcome the pandemic disease COVID-19, caused by Coronavirus SARS-COV-2 are analyzed, namely: "On Amendments to the Penal Code (concerning the criminal liability for violation of the established procedure for vaccination of citizens against infectious diseases)" registration № 4647 26/01/2021 and "On Amendments to the Penal Code of Ukraine in terms of liability for forgery of documents about preventive vaccination" registration № 6084 23/09/21.&#x0D; Some disadvantages of the following drafts are identified: 1) importation into Ukraine of a vaccine not registered in the State Register of medicine products is currently considered as an illegal activity; 2) placing into turnover of an unregistered medical product is a falsification and entails criminal liability under the provisions of the current article 321-1 of the Penal Code of Ukraine. Therefore, it makes no sense to criminalize actions of this nature; 3) the level of public danger of the proposed criminal offense (Article 321-3 of the Criminal Code of Ukraine) is not sufficient for the existence of the sanction Part 1 – imprisonment and its classification as "minor crimes"; 5) establishment of separate (special) criminal liability for forgery of documents related to preventive vaccinations is an excessive criminalization; 6) introduction of the proposed criminal offense (Article 321-3 of the Penal Code of Ukraine) to Section XIII "Criminal offenses in the sphere of drugs, psychotropic substances, their analogues or precursors and other criminal offenses against public health" Special part of the PenalCode of Ukraine does not take into account principles of the existing criminal law doctrine on delimitation and definition of the object of criminal law protection.&#x0D; The inexpediency of detailing the forms of the objective side of the proposed criminal offense (Article 321-3 of the Penal Code of Ukraine) by introducing the concepts of "dissemination" and "implementation", as well as the introduction of a broader understanding of the term "use" as a «violation of a prohibition to use (sales and implementation ") is established;&#x0D; The ways to overcome the identified disadvantages and improve the norms of the analyzed bills are pointed out. It is concluded that it is impossible to adopt amendments in this form to the Penal Code of Ukraine.

Challenges in Heart Transplantation in COVID 19 Pandemic New Biopsy Protocol a Single Center Experience

PurposeOrthotopic heart transplantation remains the treatment of choice for endstage heart failure. In the face of the COVID19 pandemic, managing patients with advance HF before and after OHT has become an increasing challenge in both: in immunosuppression treatment and postoperative managements including biopsy protocolMethodsWe retrospectively evaluated the outcomes of all patients who underwent OTH from March 2020 to February 2021 at Silesian Heart Diseases Center, Zabrze, Poland. Due to global pandemic of COVID19 several challenges including reduced numbers of myocardial biopsies were doneResults88 patients (67 male, 21 female) underwent OHT. During this period of time the COVID-19 infections were at high level in Poland. Both donor and recipients were tested for SARSCOV2 within 48 hrs of the procedure and none tested positive. We employed strict protocol of hand hygiene, PPE usage, isolation and regular staff PCR testing. We elected to reduce the routine myocardial biopsy rate from 4to1 in first month in order to reduce exposure of the patients to the potential of COVID19 disease. All patients received a standard triple regimen of calcineurin inhibitor (tacrolimus), antimetabolite (mycophenolate mofetil) and methylprednisolone. The level of immunosuppressive medications was done every day. 20 of 88 patients underwent first biopsy at 7 - 10 days post-operatively, and 3 more biopsies at one-month interval. The first myocardial biopsies did not demonstrate acute cellular rejection. We observed acute cellular rejection (2R grade) among 3 patients (15%) in second myocardial biopsy and they were treated with methylprednisolone 1gram iv for 3 days and after we return to previous prednisone dose. Third myocardial biopsy did not demonstrated acute cellular rejection. All of patients were discharged from the hospital at day14 days, and followed up in OPD once a week till the next admission. Ultrasonography including strain echo parameters of left and right ventricle, lab tests and the level of immunosuppression were done during each OPD visit.ConclusionOHT recipients who underwent reduced numbers of myocardial biopsies appear to have reasonable outcomes (including adequate home support) compared to recipients with standard protocol. We have shown that successful heart transplantation could be performed during of COVID19 disease pandemic.

Role of the Microbiome in the Pathogenesis of COVID-19.

The ongoing pandemic coronavirus disease COVID-19 is caused by the highly contagious single-stranded RNA virus, SARS-coronavirus 2 (SARS-CoV-2), which has a high rate of evolution like other RNA viruses. The first genome sequences of SARS-CoV-2 were available in early 2020. Subsequent whole-genome sequencing revealed that the virus had accumulated several mutations in genes associated with viral replication and pathogenesis. These variants showed enhanced transmissibility and infectivity. Soon after the first outbreak due to the wild-type strain in December 2019, a genetic variant D614G emerged in late January to early February 2020 and became the dominant genotype worldwide. Thereafter, several variants emerged, which were found to harbor mutations in essential viral genes encoding proteins that could act as drug and vaccine targets. Numerous vaccines have been successfully developed to assuage the burden of COVID-19. These have different rates of efficacy, including, although rarely, a number of vaccinated individuals exhibiting side effects like thrombosis. However, the recent emergence of the Britain strain with 70% more transmissibility and South African variants with higher resistance to vaccines at a time when several countries have approved these for mass immunization has raised tremendous concern regarding the long-lasting impact of currently available prophylaxis. Apart from studies addressing the pathophysiology, pathogenesis, and therapeutic targets of SARS-CoV-2, analysis of the gut, oral, nasopharyngeal, and lung microbiome dysbiosis has also been undertaken to find a link between the microbiome and the pathogenesis of COVID-19. Therefore, in the current scenario of skepticism regarding vaccine efficacy and challenges over the direct effects of currently available drugs looming large, investigation of alternative therapeutic avenues based on the microbiome can be a rewarding finding. This review presents the currently available understanding of microbiome dysbiosis and its association with cause and consequence of COVID-19. Taking cues from other inflammatory diseases, we propose a hypothesis of how the microbiome may be influencing homeostasis, pro-inflammatory condition, and the onset of inflammation. This accentuates the importance of a healthy microbiome as a protective element to prevent the onset of COVID-19. Finally, the review attempts to identify areas where the application of microbiome research can help in reducing the burden of the disease.

3β-Acetoxy-21α-H-hop-22(29)ene, a novel multitargeted phytocompound against SARS-CoV-2: in silico screening

The present pandemic disease COVID-19 demands an urgent need for more efficient antiviral drugs against SARS-CoV-2. Computational drug designing and discovery enable us to explore ethnomedicinal plants as a source of various lead molecules that can be used against present and future pathogens. Adiantum latifolium Lam., a common fern, is resistant to pathogens mainly due to the presence of various phytochemicals having antimicrobial properties. In our previous study, 3β-acetoxy-21α-H-hop-22(29)ene, a terpenoid has been characterized from the methanol extract of leaves of A. latifolium. The manuscript evaluates the antiviral potency of the compound against SARS-CoV-2 through molecular docking method. Proteins essential for SARS-CoV-2 multiplication in host cells are the target sites. The study revealed strong binding affinity of the compound for all the ten proteins selected, including seven nonstructural proteins, two structural proteins and one receptor protein, with a binding energy of −4.67 to −8.76 kcal/mol. MDS and MMPBSA analysis of the best ranked complex further confirmed the results. The multitargeted compound can be considered as a natural lead molecule in drug designing against COVID-19, but requires wet-lab experimentation and clinical trials. Communicated by Ramaswamy H. Sarma

Investigation of SARS-CoV-2 RNAemia in the convalescent plasma of COVID-19 patients

PurposeThe novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for the ongoing global COVID-19 disease pandemic. Convalescent plasma therapy (CPT) is one of the promising therapies being tried for COVID-19 patients. However, the presence or disappearance of SARS-CoV-2 RNA (RNAemia) in convalescent plasma is unclear and the prognostic implication of viral RNA detection in these samples is not fully understood. Hence, we aimed to investigate SARS-CoV-2 RNAemia in the convalescent plasma of COVID-19 patients.Methods & MaterialsConvalescent plasma samples from donors with a previous laboratory-confirmed SARS-CoV-2 infection were included in the study. Samples were screened for the presence of Anti-SARS CoV-2 IgG antibodies using a commercially available enzyme-linked immunosorbent assay targeting the whole-cell antigen of SARS-CoV-2. Then plasma samples were pooled by the mixing of five samples. RNA extraction and real-time RT-PCR for SARS-CoV-2 specific gene targets was performed for pooled plasma samples.ResultsA total of 250 convalescent plasma samples of COVID-19 patients with different disease severity were included in the study; of these, 149 (59.6%) were found to have anti-SARS-CoV-2 antibodies using serological tests. SARS-CoV-2 RNA was not detected in any of the convalescent plasma samples.ConclusionSARS-CoV-2 RNAemia was not found in individuals with a previous laboratory-confirmed SARS-CoV-2 infection at least 28 days after the resolution of their symptoms. All RT-PCR positive COVID-19 patients subsequently may not develop antibodies. Our study showed that screening for neutralizing antibody titres is more important rather than SARS-CoV-2 RNA detection in convalescent plasma samples for therapeutic use.

Nanoparticle Delivery Platforms for RNAi Therapeutics Targeting COVID-19 Disease in the Respiratory Tract.

Since December 2019, a pandemic of COVID-19 disease, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread across the globe. At present, the Food and Drug Administration (FDA) has issued emergency approval for the use of some antiviral drugs. However, these drugs still have limitations in the specific treatment of COVID-19, and as such, new treatment strategies urgently need to be developed. RNA-interference-based gene therapy provides a tractable target for antiviral treatment. Ensuring cell-specific targeted delivery is important to the success of gene therapy. The use of nanoparticles (NPs) as carriers for the delivery of small interfering RNA (siRNAs) to specific tissues or organs of the human body could play a crucial role in the specific therapy of severe respiratory infections, such as COVID-19. In this review, we describe a variety of novel nanocarriers, such as lipid NPs, star polymer NPs, and glycogen NPs, and summarize the pre-clinical/clinical progress of these nanoparticle platforms in siRNA delivery. We also discuss the application of various NP-capsulated siRNA as therapeutics for SARS-CoV-2 infection, the challenges with targeting these therapeutics to local delivery in the lung, and various inhalation devices used for therapeutic administration. We also discuss currently available animal models that are used for preclinical assessment of RNA-interference-based gene therapy. Advances in this field have the potential for antiviral treatments of COVID-19 disease and could be adapted to treat a range of respiratory diseases.

Challenges faced by the Teachers and Students in online learning during COVID-19

Most of the educational institutions (Universities, Schools and Colleges) in Pakistan are based on traditional method of learning and teaching. Although various institutions are now converting the learning methods from traditional to technology based online learning. At the end of 2019, the sudden outbreak of Pandemic disease Covid-19 has totally changed the learning and teaching system. Many educational institutions that were based on traditional methods of learning and teaching have to shift entirely on online learning and teachings. A survey based research has been conducted to highlight the challenges faced by students and teachers during Covid-19 in learning and teachings at undergraduate and graduate levels. The results of the research indicated that the students and teachers faced a lot of problems during the online learning and teaching. The online learning system of Pakistan, problems during online learning and solutions to the online learning problems are also discussed. This research will give a direction for the solution of problems associated with online learning and teachings.

Developing inhibitors of the SARS-CoV-2 main protease

SARS-CoV-2 is the causative virus of the global pandemic disease COVID-19, causing a significant public health burden. With the continued spread of SARS-CoV-2 comes an urgent need for drugs to treat those infected. The main protease (Mpro, also known as 3CL) of SARS-CoV-2 is a validated drug target. We created a pipeline to computationally screen molecules on a variety of Mpro pockets and pocket sizes, identified with enhanced sampling molecular dynamics simulations before carrying the putative hits forward to in vitro and in vivo assays for hit validation and optimization.

Differences in Clinical Outcomes between Smokers and Non-Smokers infected with COVID-19.

Cigarette smoking is a risk factor associated with different diseases, claiming millions of lives annually. Smoking status has been studied for a long time and proved to be a major cause of smokers' decreased immunity. In the present pandemic COVID-19 disease, there was an unclear belief about the effect of smoking on patients with COVID-19. Therefore, the current cross-sectional study aimed to evaluate the effect of cigarette smoking on the sequelae of COVID-19. This cross-sectional study involved 200 COVID-19 patients (114 males and 86 females) aged 13-77 years. A number of 87 patients were smokers, and the rest of them were non-smokers. All patients underwent a comprehensive laboratory assessment and diagnosis by full medical history by the physicians. The results indicated a significant difference (P<0.001) between smokers and non-smokers in terms of hypertension, anticoagulant, steroid therapy, pulmonary lesion, oxygen saturation, and duration of disease. As an overall conclusion, it can be stated that COVID-19 is less severe in smokers and they require less intensive treatment.

Oboljenje kovid 19 - povreda na radu ili profesionalna bolest?

The COVID-19 disease pandemic has opened a number of legal issues, one of which is the need to define COVID-19 as a possible consequence of performing work. In that sense, the question arose whether it could be qualified as an injury at work or as an occupational disease. When it comes to the comparative law, this need to put COVID-19 in a professional context has already been answered in various ways, and the wandering in that process (due to the complexity of the issue) is probably best illustrated by the fact that in some systems it takes on the nature of a legal chameleon that is adjusting itself to a sector of work or to a period of exposure to the virus. In the Republic of Serbia, on the other hand, the controversy on this issue is still ongoing - which is also the reason why a review of comparative legal experiences is necessary. And while the qualification of COVID-19 as an injury at work is problematic due to the fact that it is hard to define an event that could be characterized as an accident at work that produced such a consequence, the qualification of COVID-19 as an occupational disease encounters other problems. Most of those problems in the Republic of Serbia, on the other hand, are systemic in nature and, therefore, require fixes of the existing legal gaps and systematic changes of the existing regulations by the Serbian lawmaker. Additionally, when it comes to COVID-19, the one question that arises is the question of causality - having in mind that in this day and age we are all in contact with the SARS-CoV-2 virus to a greater or to a lesser extent. In that sense, occupational medicine will be entrusted with the difficult task of determining the occupational origin of this disease - since it does not seem fair to recognize the status of an occupational disease to an employee if there are reasonable suspicions on the matter whether the infection took place during his performance of his work tasks.

Effects of Covid-19 Pandemic on First and Second Trimester Pregnancies

Objective: Main purpose of this study is to determine the effects of pandemic disease COVID-19 on first and second trimester pregnancies. Study Design: Cross-sectional/Descriptive study Place and Duration: Study was conducted at Gynae and Obs department of Jinnah International Hospital, Abbottabad for duration of 10 months from January to October, 2021. Methods: Total ninety pregnant women of ages 18- 35 years were presented in this study. All the presented women had pandemic disease COVID-19. Women had first and second trimester pregnancies. Patients’ age, body mass index, parity, education status, socio-economic status and residency were calculated after taking informed written consent. Chi square and t-test was performed to differentiate between symptomatic and asymptomatic cases. Outcomes were assessed in terms of stress, depression among mothers and low birth weight of infants, perinatal death, preterm delivery, and C-section. Data was analyzed by SPSS 23.0 version. Results: Among 90 pregnant women 40 (44.4%) patients had first trimester pregnancies and 50 (55.6%) females had second trimester pregnancies. Mean age of the patients was 29.16±6.34 years and had mean BMI 22.13±5.16 kg/m2. Majority of the patients 52 (57.8%) had parity primipara. 44 (48.9%) patients were educated and majority of the patients were financially weak 62 (68.9%). 55 (61.1%) females were from urban areas. 54 (60%) females were symptomatic and 36 (40%) were asymptomatic. Frequency of depression among females was 68 (75.6%) and depression was found in 61 (67.8%) cases. Low birth weight was found in 22 (24.4%) cases, prevalence of preterm delivery was among 38 (42.2%) cases, number of C-section among cases was 47 (52.2%). Perinatal death was found in 7 (7.8%) cases. Majority of the patients with infants were instantly discharged after delivery 75 (83.3%) and 8 patients were admitted because of severity of pandemic disease. Conclusion: We determined in this study that Covid-19 among females with trimester first and second pregnancies were highly affected and had severity of psychotic disorders at start of disease but had lower adverse outcomes with low perinatal mortality. Majority of the females were recovered and discharged safely after delivery. Keywords: Pregnancy, Trimester, C-section, Coronavirus, Outcomes