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Ethnopharmacological Relevance: Prunella vulgaris L.(PV) and Tussilago farfara (TF) are perennial herbs rich in flavonoids and phenolic compounds with immense medicinal value. PV extract (PV-E) possesses potent antipyretic, anti-inflammtory, antioxidant, antiseptic, anti-cancer and immune stimulatory properties and have been traditionally known for the treatment of wounds, ulcers and sores. TF extract (TF-E) has been known for antibacterial, antioxidant, anti-inflammatory, anti-viral, anti-diabetic, anti-cancer, anti-obesity and wound healing effects. Additionally, TF-E infusions have been used for asthma, cough, and bronchopneumonia treatments., Aim of the Study: The therapeutic efficacy of transplanted human adipose stem cells (hASCs) is abrogated under the deteriorating effects of heat stress offered by burn wounds. Earlier researches has documented antioxidant priming as an effective strategy to enhance stem cell performance. As both PV-E and TF-E are known for their potent antioxidant effects. The present study aims to examine the cryoprotective effects of PV-E and TF-E priming on hASCs against in-vitro heat-induced thermal stress. Moreover, we determined the anti-inflammatory potential of both PV-E and TF-E on rabbits., Methods: Antioxidant capacity of both PV-E and TF-E is examined via DPPH assay and anti-inflammatory activity is assessed in rabbits using carrageen-induced paw edema model of inflammation. Next, we investigate the efficacy of different doses (1.25-100 μg/ml) of PV-E and TF-E on hASCs; MTT, LDH, calcein AM staining, and wound scratch assay were used to assess cell viability, cytotoxicity, proliferation ability and cell migration potential in the cells. Then, hASCs were pretreated for 24 h with optimum doses of PV-E and TF-E determined from MTT assay results and were subsequently exposed to in-vitro thermal injury (51 °C,10 min). The cytoprotective effects of both PV-E and TF-E priming under thermal stress were investigated via MTT, LDH, annexin-V staining and gene expression analysis., Results: Both PV-E and TF-E extracts demonstrated potent antioxidant and effective anti-inflammatory activities, with a clear reduction in inflammation. Study on hASCs exhibited improved cell viabilities, enhanced cell proliferation and migration abilities of both extracts. While heat stress data revealed that PV-E (2.5 μg/ml) and TF-E (5 μg/ml) pretreatment significantly ameliorated effects of thermal-injuries in hASCs as depicted by significantly enhanced cell viabilities, low LDH release profile, and lower annexin-V expression and regulated gene expression of the pretreated cells., Conclusion: PV-E and TF-E priming effectively enabled hASCs to combat thermal injury by significantly promoting cell survival than untreated cells. Hence, these findings suggest that PV-E and TF-E priming could be used to attain improved cellular responses and enhanced therapeutic efficacy in burnt tissue., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The establishment of empirical evidence in the Eastern Mediterranean Region necessitates the implementation of wide-scale studies to describe the demographic, clinical features, and severity profile of patients with COVID-19., Objective: This study aims to assess the patterns of COVID-19 severity and mortality in seven countries, and to determine the risk factors of COVID-19 severity and mortality., Methods: This multicountry study was based on a retrospective review of medical records of hospitalized patients confirmed to have COVID-19. This study includes data from Iraq, Pakistan, Sudan, Somalia, Morocco, Egypt, and Yemen. All demographic and clinical data were extracted from hospital records (paper files) by trained data collectors., Results: A total of 4141 patients were included in this study from seven countries. Comorbidities were reported by nearly half of the patients, with hypertension (n=1021, 24.7%) and diabetes (n=939, 22.7%) being the most common. Older age, diabetes mellitus, hypertension, and heart diseases were significantly associated with COVID-19 severity and mortality. Ever smoking and renal diseases were significantly associated with severity but not mortality, while male gender, respiratory diseases, and malignancy were significantly associated with mortality but not severity., Conclusions: The study confirms the role of comorbidities and demographic features on the severity and mortality of COVID-19. Understanding the contributing factors ensures attentive care and informs clinical management of patients with poorer prognoses in the early stages of diseases., (©Faris Lami, Maisa Elfadul, Hiba Rashak, Mohannad Al Nsour, Hashaam Akhtar, Yousef Khader, Ahmed M Hussein, Mariam Naciri, Sahar Samy, Yasser Ghaleb, Hana Taha, Alaa Hussein, Nameer A Ali, Raheem Hussein, Aamer Ikram, Fazal ur Rahman, Mohammad Mujeeb Khan, Reema Adam, Abdulrazaq Yusuf Ahmed, Salma Afifi. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 15.03.2022.)

Background: COVID-19 became a pandemic rapidly after its emergence in December 2019. It belongs to the coronavirus family of viruses, which have struck a few times before in history. Data based on previous research regarding etiology and epidemiology of other viruses from this family helped played a vital role in formulating prevention and precaution strategies during the initial stages of this pandemic. Data related to COVID-19 in Pakistan were not initially documented on a large scale. In addition, due to a weak health care system and low economic conditions, Pakistan's population, in general, already suffers from many comorbidities, which can severely affect the outcome of patients infected with COVID-19., Objective: COVID-19 infections are coupled with a manifestation of various notable outcomes that can be documented and characterized clinically. The aim of this study was to examine these clinical manifestations, which can serve as indicators for early detection as well as severity prognosis for COVID-19 infections, especially in high-risk groups., Methods: A retrospective observational study involving abstraction of demographic features, presenting symptoms, and adverse clinical outcomes for 1812 patients with COVID-19 was conducted. Patients were admitted to the four major hospitals in the Rawalpindi-Islamabad region of Pakistan, and the study was conducted from February to August 2020. Multivariate regression analysis was carried out to identify significant indicators of COVID-19 severity, intensive care unit (ICU) admission, ventilator aid, and mortality. The study not only relates COVID-19 infection with comorbidities, but also examines other related factors, such as age and gender., Results: This study identified fever (1592/1812, 87.9%), cough (1433/1812, 79.1%), and shortness of breath (998/1812, 55.1%) at the time of hospital admission as the most prevalent symptoms for patients with COVID-19. These symptoms were common but not conclusive of the outcome of infection. Out of 1812 patients, 24.4% (n=443) required ICU admission and 21.5% (n=390) required ventilator aid at some point of disease progression during their stay at the hospital; 25.9% (n=469) of the patients died. Further analysis revealed the relationship of the presented symptoms and comorbidities with the progression of disease severity in these patients. Older adult patients with comorbidities, such as hypertension, diabetes, chronic kidney disease, and asthma, were significantly affected in higher proportions, resulting in requirement of ICU admission and ventilator aid in some cases and, in many cases, even mortality., Conclusions: Older adult patients with comorbidities, such as hypertension, diabetes, asthma, chronic obstructive pulmonary disorder, and chronic kidney disease, are at increased risk of developing severe COVID-19 infections, with an increased likelihood of adverse clinical outcomes., (©Hashaam Akhtar, Sundas Khalid, Fazal ur Rahman, Muhammad Umar, Sabahat Ali, Maham Afridi, Faheem Hassan, Yousef Saleh Khader, Nasim Akhtar, Muhammad Mujeeb Khan, Aamer Ikram. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 14.12.2021.)

Background: Inadvertent delays in access to appropriate therapeutic interventions in high-risk group coronavirus disease 2019 (COVID-19) patients contribute to mortality in patients with severe/critical disease presentation., Objectives: The aim of this study was to determine the effect of timely admission to the hospital on mortality of patients with severe/critical COVID-19. Another secondary aspect of this study was to observe the efficacy of time-dependent use of corticosteroids on mortality of critical/severe COVID-19 patients., Methods: Clinical data of 659 patients with severe/critical COVID-19, admitted to four major tertiary care hospitals from the Islamabad-Rawalpindi region of Pakistan was retrospectively collected from a period February-August 2020. Multivariate logistic regression analysis was carried out to determine the predictors of mortality in severe/critical COVID-19 patients., Results: Out of a total of 659 patients, 469 (71.2%) patients died. Age > 60 years, presence of hypertension, heart disease and kidney disease along with late admission (>5 days) were significant predictors of mortality in patients with severe/critical COVID-19., Conclusions: The study highlights the importance of well-timed provision of appropriate medical interventions control COVID-19-associated mortality., (© The Author(s) 2021. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: This study aimed to compare knowledge, attitude and practice (KAP) regarding COVID-19 between public health workers (PHWs) attended field epidemiology training program (FETP-trained) and those who did not attend FETP (non-FETP trained)., Methods: Multi-country cross-sectional survey was conducted among PHWs who participated in COVID-19 pandemic in 10 countries at EMR. Online questionnaire that included demographic information, KAP regarding COVID-19 pandemic was distributed among HCWs. Scoring system was used to quantify the answers, bivariate and Multivariate analysis performed to compare FETP-trained with non-FETP trained PHWs., Results: Overall, 1337 PHWs participated, with 835 (62.4%) < 40 years of age, and 851 (63.6%) males. Of them, 423 (31.6%) had FETP, including that 189 (44.7%) had advanced level, 155 (36.6%) intermediate and 79 (18.7%) basic level training. Compared with non-FETP trained, FETP trained were older, having higher KAP scores. FETP participation was low in infection control, and PH laboratories. KAP mean scores for intermediate level attendees are comparable to advanced level., Conclusions: FETP-trained are having better KAP than non-FETP PHWs. Expanding the intermediate level, maintain the Rapid Response training and introduce the laboratory component are recommended to maximize the benefit from FETP. Infection control, antimicrobial resistance and coordination are areas where training should include., (© The Author(s) 2021. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background and objective Blood gas analysis plays a pivotal role in the management of various respiratory and metabolic disorders. Both arterial and venous samples can be used for blood gas analysis. Arterial blood sampling is technically difficult and is associated with more complications as compared to venous sampling. Many studies have shown the correlation of arterial and venous pH and bicarbonate levels in sepsis, diabetic ketoacidosis (DKA), chronic obstructive pulmonary disease (COPD), and circulatory failure. But, there is a paucity of data, pertaining specifically to the correlation of arterial blood gas (ABG) analysis and venous blood gas (VBG) analysis in patients with renal failure. The objective of this study was to look for any possible correlation between arterial and venous pH and bicarbonate values in patients with renal failure. Methods This cross-sectional study was carried out at a large tertiary care hospital in Rawalpindi, Pakistan. Over a period of eight months, 101 patients with renal failure were enrolled after obtaining informed consent. Arterial and venous samples from the patients were obtained, analyzed, and compared. Results Out of the total 101 patients, 53 (52.5%) were male while 48 (47.5%) were female. The mean age of the patients was 46.23 ±15.54 years. Mean arterial pH and venous pH were 7.35 and 7.28 respectively. The Pearson correlation coefficient between arterial and venous pH was found to be 0.857 (p<0.001). The mean arterial and venous bicarbonate values were 14.47 mEq/L and 15.51 mEq/L respectively. And the Pearson correlation coefficient between arterial and venous bicarbonate was found to be 0.842 (p<0.001).  Conclusion Venous pH and bicarbonate levels correlate strongly with arterial pH and bicarbonate levels, respectively, in patients with renal failure., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Ayaz et al.)

Background: Since the first reports of COVID-19 infection, the foremost requirement has been to identify a treatment regimen that not only fights the causative agent but also controls the associated complications of the infection. Due to the time-consuming process of drug discovery, physicians have used readily available drugs and therapies for treatment of infections to minimize the death toll., Objective: The aim of this study is to provide a snapshot analysis of the major drugs used in a cohort of 1562 Pakistani patients during the period from May to July 2020, when the first wave of COVID-19 peaked in Pakistan., Methods: A retrospective observational study was performed to provide an overview of the major drugs used in a cohort of 1562 patients with COVID-19 admitted to the four major tertiary-care hospitals in the Rawalpindi-Islamabad region of Pakistan during the peak of the first wave of COVID-19 in the country (May-July 2020)., Results: Antibiotics were the most common choice out of all the therapies employed, and they were used as first line of treatment for COVID-19. Azithromycin was the most prescribed drug for treatment. No monthly trend was observed in the choice of antibiotics, and these drugs appeared to be a random but favored choice throughout the months of the study. It was also noted that even antibiotics used for multidrug resistant infections were prescribed irrespective of the severity or progression of the infection. The results of the analysis are alarming, as this approach may lead to antibiotic resistance and complications in immunocompromised patients with COVID-19. A total of 1562 patients (1064 male, 68.1%, and 498 female, 31.9%) with a mean age of 47.35 years (SD 17.03) were included in the study. The highest frequency of patient hospitalizations occurred in June (846/1562, 54.2%)., Conclusions: Guidelines for a targeted treatment regime are needed to control related complications and to limit the misuse of antibiotics in the management of COVID-19., (©Hashaam Akhtar, Samar Akhtar, Fazal-Ul Rahman, Maham Afridi, Sundas Khalid, Sabahat Ali, Nasim Akhtar, Yousef S Khader, Hamaad Ahmad, Muhammad Mujeeb Khan. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 27.05.2021.)

This study aimed to investigate the suitability of Moringa oleifera oil and palm olein blends as vanaspati substitutes on the basis of physico-chemical and sensory characteristics. Blends were prepared either by blending Moringa oleifera oil or palm olein at 25:75, 50:50, 75:25, and 100 ratios, transesterified by Rhizopus miehei, compared with market vanaspati, designated as T1, T2, T3, T4 and T5, respectively. The blends were filled in 3-layer polyethylene pouch packs, stored at ambient temperature, sampled at every at 0, 90 and 180-days for the assessment of storage stability. The melting point and iodine value of T2 and control were 36.8, 37.2 °C and 62.2, 51.8, with no effect on free fatty acids content, peroxide, anisidine values and color of the deodorized stuffs. C18:1 content of T2 was 59.7 % with no trans fatty acids. Trans fatty acid content of the market vanaspati was 22.9 %. The addition of Moringa oleifera oil improved the induction period of the blends strongly inhibited the formation of primary and secondary oxidation products. The overall acceptability score of French fries prepared in T2 was 81 % of the total score (9). Blend containing 50 % palm olein and 50 % Moringa oleifera oil can be used in the formulation of a functional shelf stable fat that can be used as a vanaspati substitute.