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The study aims to assess and analyze the social outcomes of the COVID-19 pandemic. The study uses the discourse of comprehensive literature review to identify the outcomes, Interpretive Structural Modeling (ISM) for developing a structural model and Matrices' Impacts Cruise's Multiplication Appliquée a UN Classement (MICMAC) for analysis, classification of societal outcomes, and corroboration of results of ISM. Data from fifteen experts was collected through a survey questionnaire. As a result of the literature review, a list of sixteen outcomes was generated and verified by a panel of experts. Results of ISM revealed that the outcomes, namely, "emotional instability," "mental health self-harm," loneliness reduced recreational activities, obesity, and "increased screen time" come at the top of the model; therefore, they are less vital outcomes, whereas the most significant outcome which is at the bottom of the model is "employment instability"; hence it has a major impact on the society. The remaining outcomes fall in the middle of the model, so they have a moderate-severe impact. Results of MICMAC validate the findings of ISM. Overall findings of the study reveal that "employment instability" is the crucial social outcome of the COVID-19 pandemic. It is an original attempt based on real-time data, which is helpful for society at large, researchers, the international community, and policymakers because this study provides a lot of new information about the phenomenon. The study includes understanding society at large, policymakers, and researchers by illustrating the complex relations and simplifying the connections among a wide range of social outcomes of COVID-19., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The study aims to assess a sustainable green financial environment by exploring the underlying structure of monetary seismic aftershocks of the COVID-19 pandemic. This study is qualitative and uses a review of literature, primary data collection methods, and qualitative analysis techniques as the study's overall design. The data is collected by one-to-one interview using a matrix style questionnaire from a panel of experts based on the purposive sampling technique. Interpretive structural modeling (ISM) combined with Matrices' Impacts Cruise's Multiplication Appliquée a UN Classement (MICMAC) is used for assessment, modeling, and analysis of data. The monetary aftershocks, namely, "more cash in hand required," "decreased travel costs," "shift to more certain or fixed revenue streams," "lower rent costs," "more zealous monitoring of cash collection cycle," and "decreased entertainment costs," occupy level I (top of the model being least critical shocks), and "tedious regulations" occupy level VIII (bottom of the model being the most vital). Other aftershocks form the middle of the model being moderate critical. Analysis of MICMAC shows that monetary seismic aftershocks high fees for assistance regarding SOPs, tedious regulations, and more downtime due to pandemic alerts are independent. This study addresses the core issue from within the aftermath of the COVID-19 pandemic. It provides new important information regarding the structure of a sustainable green financial environment that is useful for economists, financial analysts, commercial and central bankers, accountants and finance managers from the organization's public/and private sectors, local and international community, and researchers of the domain. It provides an informative structural model and classification of critical aftershocks. There are specific data/methodological/resource-related limitations of the study. The study's data are collected from a focus group; the study's methodology is qualitative and indicates relations among variables that do not quantify the associations. The study is a typical initiative of academic researchers with limited financial/physical resources; therefore, the generalizability of the study results is accordingly limited. The study is based on original, essential data and innovatively and creatively approaches the problem. It provides a unique model of an unprecedented phenomenon for reverberating the sustainable green financial environment., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The COVID-19 pandemic created a significant economic decline and altered market behavior, forcing buyers and dealers online. The traditional local market merchants are not fully equipped with e-commerce business techniques and strategies, which is a barrier to their e-commerce behavior and success. The study aims to help small-medium firms adapt to an uncertain economic environment instead of reducing or shutting down business-like in Pakistan. From health to education, economy to domestic and social protection, various researches have been done since 2020. The researcher used primary data sources and did a Quantitative study after collecting the 240 samples size of data from the successful e-commerce players of Pakistan. The results confirm that customer satisfaction is essential for entrepreneurs to succeed, as customers were not satisfied with online shopping during COVID-19. Customer knowledge management (CKM) and job satisfaction (JS) are studied as potential and realized capacity variables. CKM act as a strategic asset to collect and assimilate the external customer knowledge. In contrast, satisfied employees act as a valuable asset that dynamically responds to changing customer needs and business environment by efficiently utilizing their knowledge and skills and reaching business success which is mirrored in customer satisfaction. Conclusive results enable practitioners to perceive the business success during economic crises in the organization's absorptive capacity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Khaliq, Ali, Chen, Kanwal, Khan, Niazi and Chen.)

This study aimed to analyze stressors to which medical staff is vulnerable due to the coronavirus disease 2019 (COVID-19) pandemic. It also imposes a hierarchy on complex relations among stressors for excavating underlying structure and builds a model of interrelationships contrasting reality. The design of this study comprises a literature survey, data collection from primary sources, and analysis. Stressors have been explored from within current published/unpublished literature and validated by experts through approval vote. Data were collected from the focus group (panel of experts), and interpretive structural modeling (ISM) was used as the research methodology. Findings of ISM are avowed through "cross-impact matrix multiplication applied to classification" (MICMAC) analysis. As a result of the literature survey, a list of stressors was generated, and a total of 19 stressors qualified as representative of the phenomenon. The results of ISM show that two stressors (i.e., "unavailability of proper personal protective equipment (PPE)" and "lack of proper communication") emerged as the most critical stressors since they occupy the bottom of the model, whereas, four stressors (i.e., "anxious about isolation/quarantine," "subject to violent crimes," "feeling frustrated and powerless," and "exhausting shifts/hours without clear end") are relatively less critical since they occupy the top of the model. The rest of the stressors occupy the middle of the model and therefore, have moderate-severe effects on frontline soldiers. The results of MICMAC show that the stressor "subject to violent crimes" is classified in the dependent cluster and the remaining fall in the linkage cluster but no stressor falls in independent and autonomous. Overall results indicate that all stressors are relevant to the phenomenon under this study, but they are currently not settled. This study is invaluable for policymakers, frontline soldiers, researchers, the international community, and society since it provides a lot of new information that is helpful in refining strategies and combating influential stressors., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Shaukat, Scholz, Qazi, Niazi, Basit and Mahmood.)

The study is aimed to analyze the determinants of the effectiveness of SOPs in mass gatherings for containing COVID-19. The overall design of the study involves a literature review, data collection by field survey, structural modeling, and analysis. The study is built on the experts' opinion of a focus group (representing people who recently participated in and are responsible for mass gatherings). The study uses the discussion of the literature review to identify the determinants, interpretive structural modeling (ISM) for developing and analyzing a structural model, and Matrice d'Impacts Croises Multiplication Appliquée a un Classement (MICMAC) for corroboration of results of the ISM/classification of determinants. From the literature review, a list of determinants is generated and verified by a panel of experts. The results of the ISM revealed that the determinants "legal environment of the country," "practicability of SOPs," "perceived benefit of adapting SOPs," and "possibilities of avoiding gathering" occupied the top of the model, therefore, they are less critical determinants, whereas "nature of gathering" occupied the bottom of the model, and is thus the most critical determinant. The remaining determinants form the middle of the model, and are therefore moderately severe. The results of MICMAC show that the determinant "perceived benefit of adapting SOPs" is dependent, "nature of gathering" is independent, and all others are linked. The results of MICMAC implicitly substantiate the findings of the ISM. The overall results of the study show that "nature of gathering" is the key determinant. This research does not require a priori theory since it is a theory-building study that uses an inductive approach. It is based on real data and it is useful for local authorities, organizers, participants (attendees/visitors) of mass gatherings, health officials/regulators, researchers, and the community at large. This study has fundamental importance for planning and preparing for such events while ensuring the minimum risk of COVID-19 transmission., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Basit, Scholz, Niazi, Qazi, Shaukat, Rao and Mahmood.)

The purpose of the study is to evaluate county-wide health systems using the data set of the first wave of the COVID-19 pandemic. The overall design of study comprises a literature review, secondary data, and a mathematical analysis. It is a cross-sectional quantitative study following a deductive approach. It uses the data of the first wave of the COVID-19 pandemic taken from the website of Worldometer as of April 8, 2020. The study uses a gray incidence analysis model (commonly known as Gray Relational Analysis, i.e., GRA) as its research methodology. On the basis of the results of GRA, a classification has been made under a predetermined scheme of ensigns: much better, better, somewhat better, fair, poor, somewhat worse, and worse health systems. There are a total 211 countries that have been divided into the seven aforementioned categories. Findings of the study show that Southern Africa Development Community (SADC) countries fall predominantly under the much better ensign, whereas Organization for Economic Co-operation and Development (OECD), Schengen Area (SA), and/or European Union (EU) countries fall under the worse ensign. Pakistan falls under the ensign of poor . It is an original attempt to evaluate the response of health systems based on real data using a scientific methodology. The study provides valuable information about the health systems of the countries for forming an informed opinion about the health systems herein. The study provides useful new information for stakeholders and a new framework for future research., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Qazi, Shaukat, Niazi and Basit.)

The aim of the study is to reveal the underlying structure of issues of university students taking online classes during the COVID-19 pandemic period. The overall design of the study includes a review of contemporary literature and field survey for data collection and analysis. Discourse of literature coupled with expert opinion has been employed for identification of issues. Interpretive Structural Modeling (ISM) is used for the determination of intra-issue relationships and analyzing the underlying structure. Cross impact matrix multiplication applied to classification (MICMAC analysis) is used as a technique for classifying issues on the basis of driving-dependence power. Results of the literature show that there are 21 major issues faced by the students taking online classes. ISM shows that lack of institutional guidelines, lack of regulators' guidelines, stress of pandemic situation, and abrupt (not planned) start of online classes are the most critical issues. MICMAC analysis reveals that there is no autonomous issue, 4 (i.e., connectivity issue, shy to use technology, lack of institutional guidelines, and stress of pandemic situation) are independent, 6 other issues are dependent, and the remaining 11 are linking. This is a valuable study having practical implications for regulators, students, parents, and society to understand the current problem. It is an original attempt that contributes toward literature in the form of a structural model and a diagram of classification of issues., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Shaukat, Niazi, Qazi and Basit.)

Preeclampsia (PE) is a leading cause of maternal mortality and morbidity worldwide. It occurs in women with first or multiple pregnancies and is characterized by new onset hypertension and proteinuria. Improper placentation is mainly responsible for the disease. If PE remains untreated, it moves towards more serious condition known as eclampsia. Hypertension, diabetes mellitus, proteinuria, obesity, family history, nulliparity, multiple pregnancies and thrombotic vascular disease contribute as the risk factors for PE. PE triggered metabolic stress causes vascular injury, thus contributing to the development of cardiovascular disease (CVD) and/or chronic kidney disease (CKD) in future. This risk appears to be increased especially in women with a history of recurrent PE and eclampsia. Clinically increased serum levels of sFlt-1 and decreased placental growth factor (PIGF) and vascular endothelial growth factor (VEGF) represent the severe condition of PE. The clinical findings of sever PE are assorted by the presence of systemic endothelial dysfunction, microangiopathy, the liver (hemolysis, elevated liver function tests and low platelet count, namely HELLP syndrome) and the kidney (proteinuria). The early detection of PE is one of the most important goals in obstetrics.

CYTOMEGALOVIRUS (CMV) AND THE HUMAN TUMOR CELL SHARE THE SAME OBJECTIVES: escape the recognition and destruction by the immune system and establish a state of immune tolerance conducive for their development. For early tumor development, the escape of the first lines of defense of the immune surveillance is a critical step which determines survival or destruction. The presence of CMV on the tumor site and its involvement in carcinogenesis as initiator or promoter is increasingly documented. In this article, we highlight the similarity between mechanisms used by tumors and CMV to circumvent the immune defenses and evade from immune surveillance. We suggest that CMV and tumors help one another for their common objective. CMV gets shelter in immunologically poor environment of the tumor cells. In return CMV, by acting directly on the cancer cell and/or on the tumor microenvironment, provides the tumor cell the ways to promote its immune escape and development of immune tolerance.

Primary Hyperparathyroidism (HPT) is an inappropriate hyper secretion of parathyroid hormone (PTH). Primary HPT is caused by parathyroid adenoma in 80-85% of patients. Clinical manifestations are kidney stones, abdominal groans, painful bones, psychic moans, and fatigue overtones. Ultrasonography is widely used in suspected cases for localization of parathyroid adenoma. There is considerable intra-observer variation and it is difficult for ultrasound alone to differentiate parathyroid lesion form that of thyroid. Dual phase Tc-99m MIBI scinitigraphy for detection of parathyroid adenomas has sensitivity and specificity values ranging from 82% to 100% and from 89% to 100%, respectively. Percutaneous ethanol injection for parathyroid glands can be applied effectively in selected cases when surgery is unadvisable either for technical reasons (e.g., recurrence ofhyperplastic glands in the neck after subtotal surgery or intrathyroideal parathyroid tumors or the poor clinical state of the patient.