Search

Introduction Upper crossed syndrome (UCS) is a common musculoskeletal issue that includes the dysfunctional tone of the muscles in the shoulder girdle or cervicothoracic region. The objective of the current study is to compare the effects of muscle energy techniques with the National Academy of Sports Medicine-based exercise protocol on pain, range of motion, and disability in patients with UCS. Methods It was a single-blinded randomised clinical trial carried out in the Physiotherapy Department of the University of Lahore Teaching Hospital, Pakistan. Fifty patients with upper cross syndrome aged between 20 to 35 years were randomly allocated into two groups: group A (routine physical therapy combined with muscle energy techniques) and group B (routine physical therapy combined with the National Academy of Sports Medicine-based exercise protocol) for three sessions per week for total 8 weeks. Data were collected at baseline, 4 th , 8 th , and 12 th week for assessing the long-term effects of the treatment protocol as well. The Visual Analogue Scale, Neck Disability Index, and an inclinometer were used to measure the pain, disability, and range of motion of the cervical region, respectively. The data was analysed using SPSS version 23.0 (IBM, New York, USA). Results Out of 50 participants, 30 were male and 20 were female. The mean age of all the participants in experimental group A was 29.76 ± 2.89 and that in experimental group B was 30.56 ± 2.48. At the 4 th , 8 th , and 12 th week, pain and disability were significantly ( p -value < 0.05) reduced and cervical range of motion was significantly ( p -value < 0.05) improved within both groups. After 8 weeks of treatment, a significant between-group difference was seen in favour of group A in terms of cervical range of motions (flexion, extension, rotation, and side bending) with p -values of less than 0.05 and in favour of group B in terms of pain ( p -value 0.03) and disability ( p -value 0.04) was seen. These differences were maintained at the 12 th week follow-up as well. Conclusions This study concluded that both NASM (National Academy of Sports Medicine-based exercise protocol) and METs (muscle energy techniques) are effective treatment options for people with upper cross syndrome. It was also concluded that METs are more effective in improving Range of motion (ROM), while the NASM-based exercise protocol is more effective in improving symptoms of pain and neck-related disability.

Abstract Background Innovations in cancer treatment have contributed to the improved survival rate of cancer patients. The cancer survival rates have been growing and nearly two third of those survivors have been exposed to clinical radiation during their treatment. The study of long-term radiation effects, especially secondary cancer induction, has become increasingly important. An accurate assessment of out-of-field/peripheral dose (PDs) is necessary to estimate the risk of second cancer after radiotherapy and the damage to the organs at risk surrounding the planning target volume. This study was designed to measure the PDs as a function of dose, distances, and depths from Telecobalt-60 (Co-60) beam in water phantom using thermoluminescent dosimeter-100 (TLD-100). Methods The PDs were measured for Co-60 beam at specified depths of 0 cm (surface), 5 cm, 10 cm, and 15 cm outside the radiation beam at distances of 5, 10, and 13 cm away from the radiation field edge using TLD-100 (G1 cards) as detectors. These calibrated cards were placed on the acrylic disc in circular tracks. The radiation dose of 2000 mGy of Co-60 beam was applied inside 10 × 10 cm2 field size at constant source to surface distance (SSD) of 80 cm. Results The results showed maximum and minimum PDs at surface and 5 cm depth respectively at all distances from the radiation field edge. Dose distributions out of the field edge with respect to distance were isotropic. The decrease in PDs at 5 cm depth was due to dominant forward scattering of Co-60 gamma rays. The increase in PDs beyond 5 cm depth was due to increase in the irradiated volume, increase in penumbra, increase in source to axis distance (SAD), and increase in field size due to inverse square factor. Conclusion It is concluded that the PDs depends upon depth and distance from the radiation field edge. All the measurements show PDs in the homogenous medium (water); therefore, it estimates absorbed dose to the organ at risk (OAR) adjacent to cancer tissues/planning target volume (PTV). It is suggested that PDs can be minimized by using the SAD technique, as this technique controls sources of scattered radiation like inverse square factor and effect of penumbra up-to some extent.

Introduction: Irritable Bowel Syndrome (IBS) is a common functional bowel disorder which remains a clinical challenge with limited therapeutic options. The diagnosis of IBS is made by the Rome IV criteria. Patients suffering from IBS often have impaired poor quality of life. Distinguishing IBS from Inflammatory Bowel Diseases (IBD) can be difficult, especially with mild disease activity. Both conditions share a symptom complex with abdominal pain and altered bowel habits but potentially have different treatments for each disorder. Aim: To evaluate Faecal Calprotectin S100A8/S100A9 Levels (FCL) in IBS patients and compare those levels with patients suffering from the IBD group. Materials and Methods: This was a cross-sectional study conducted for a period of one year from June 2022 to May 2023 at the Department of Pathology in collaboration with the Department of Medicine, Khaja Bandanawaz (KBN) University-Faculty of Medical Sciences, Kalaburagi Karnataka, India. The study included 130 patients aged between 18 and 65 years with chronic diarrhoea, consisting of 90 cases in the IBS group and 40 cases in the IBD group for comparison. After obtaining clinical details, FCL were analysed by Fluorescence Immunoassay (FIA). Patients were subjected to colonoscopic evaluation, and biopsies were taken for processing. FCL, colonoscopic, and histopathological findings were evaluated in IBS patients and IBD patients, respectively. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 24.0 software package. Quantitative data were expressed as mean±Standard Deviation (SD). Qualitative data were expressed using U-test Fisher’s-exact and Chi-square test, where a p-value

Background: Measles has been a significant public health concern in Pakistan, especially in the Khyber Pakhtunkhwa (KPK) province, where sporadic and silent epidemics continue to challenge existing control measures. This study aimed to estimate the prevalence and investigate the molecular epidemiology of the measles virus (MeV) in KPK and explore the vaccination status among the suspected individuals. Methods: A cross-sectional study was conducted between February and October 2021. A total of 336 suspected measles cases from the study population were analyzed for IgM antibodies using Enzyme-Linked Immunosorbent Assay (ELISA). Throat swabs were randomly collected from a subset of positive cases for molecular analysis. Phylogenetic analysis of MeV isolates was performed using the neighbor-joining method. The vaccination status of individuals was also recorded. Results: Among the suspected participants, 61.0% (205/336) were ELISA positive for IgM antibodies, with a higher prevalence in males (64.17%) compared to females (57.04%). The majority of cases (36.0%) were observed in infants and toddlers, consistent with previous reports. The majority of IgM-positive cases (71.7%) had not received any dose of measles vaccine, highlighting gaps in vaccine coverage and the need for improved immunization programs. Genetic analysis revealed that all MeV isolates belonged to the B3 genotype, with minor genetic variations from previously reported variants in the region. Conclusion: This study provides valuable insights into the genetic epidemiology of the MeV in KPK, Pakistan. The high incidence of measles infection among unvaccinated individuals highlights the urgency of raising awareness about vaccine importance and strengthening routine immunization programs.

Abstract Human adenoviruses (HAdVs) are a diverse group of viruses associated with respiratory infections in humans worldwide. However, there is a lack of research on the genetic diversity and epidemiology of HAdVs in Pakistan. This study characterized HAdVs in pediatric patients with respiratory tract infections in Karachi, Pakistan, between 2022 and 2023. We analyzed 762 nasopharyngeal samples of children ≤ 5 years. DNA extraction, followed by PCR targeting E2B and hexon genes, was carried out. Data analysis was performed on SPSS 25.0, and phylogenetic analysis of hexon gene was performed on MEGA 11. HAdV was detected in 7.34% (56/762) of patients round the year, but at a significantly higher rate during the winter season. Age was insignificantly associated with HAdV incidence (p = 0.662), but more than 62.5% (35/56) of positive cases were younger than 10 months. The circulating HAdVs were identified as six different types from species B (78.57%) and C (21.42%), with the majority of isolates found to be like B3. HAdV was found to be co-infected with bocavirus (5.4%) and measles (7.14%). These findings revealed a high frequency and genetic diversity of respiratory HAdVs in Karachi, Pakistan. We conclude that periodic and continuous surveillance of adenoviruses and other respiratory pathogens is necessary to improve the prognosis and management of respiratory diseases, thereby reducing the child mortality rate in Pakistan.

Abstract Background Advance care planning (ACP) describes the process of supporting individuals at any age or stage of health to consider and share their personal values, life goals, and preferences regarding future health care. Engaging in ACP is associated with better-quality of care in which people receive care in lines with their wishes, values and preferences. Direct translations of ACP guides and resources do not attend to the considerable inter- and intra-ethnic variations in cultural and religious or spiritual beliefs that shape preferences among people from culturally and linguistically diverse (CALD) backgrounds. ICanCarePlan is a three-year project that aims to determine the prevalence of ACP documentation among people from CALD backgrounds with cancer, identify resources available and their use to support ACP among CALD communities, identify barriers and facilitators of person-centred ACP, and to develop, through co-design with consumers and clinicians, approaches that enhance the process ACP for people from CALD backgrounds. Method A mixed-method sequential approach will be used comprising of four studies. Study one is retrospective medical record review of approximately 1500 medical records to establish the prevalence of ACP documentation among CALD patient records in cancer services. Study two is a document analysis synthesising the resources available in the Australian health system to support ACP. Study three is a qualitative study with healthcare staff and consumers to explore barriers and enablers of person-centred ACP. Evidence generated from studies one to three will inform the conduct of co-design with stakeholders to develop approaches to improve ACP processes among CALD communities. Language, technical and financial support for meaningful involvement with consumers from CALD backgrounds throughout this project is outlined. A plan for distress management is also made due to sensitive nature of the topic. The research project has also established a project steering group consisting of three consumer members who are from CALD backgrounds. Discussion The project will address a national priority issue for a growing population of CALD communities in Australia. The project will provide novel evidence of ACP among CALD communities and novel strategies developed with stakeholders to enhance uptake and experiences of ACP.

In recent years, there has been an increase in the adventive establishment and spread of parasitoid wasps outside of their native range. However, lack of taxonomic tools can hinder the efficient screening of field-collected samples to document the establishment and range expansion of parasitoids on continent-wide geographic scales. Here we report that Leptopilina japonica (Hymenoptera, Figitidae), a parasitoid of the globally invasive fruit pest Drosophila suzukii (Diptera, Drosophilidae), is now widespread in much of North America despite not having been intentionally introduced. Surveys in 2022 using a variety of methods detected L. japonica in 10 of 11 surveyed USA States and one Canadian Province where it was not previously known to occur. In most surveys, L. japonica was the most common species of D. suzukii parasitoid found. The surveys also resulted in the detection of Ganaspis cf. brasiliensis (Hymenoptera, Figitidae), the recently-released biological control agent of D. suzukii, in six USA States where it had not previously been found. These new detections are likely a result of intentional biological control introductions rather than spread of adventive populations. A species-specific multiplex PCR assay was developed as a rapid, accurate and cost-effective method to distinguish L. japonica, G. cf. brasiliensis, the closely-related cosmopolitan parasitoid Leptopilina heterotoma (Hymenoptera, Figitidae) and other native parasitoid species. This dataset and the associated molecular tools will facilitate future studies of the spread and ecological impacts of these introduced parasitoids on multiple continents.

Abstract Global biodiversity gradients are generally expected to reflect greater species replacement closer to the equator. However, empirical validation of global biodiversity gradients largely relies on vertebrates, plants, and other less diverse taxa. Here we assess the temporal and spatial dynamics of global arthropod biodiversity dynamics using a beta-diversity framework. Sampling includes 129 sampling sites whereby malaise traps are deployed to monitor temporal changes in arthropod communities. Overall, we encountered more than 150,000 unique barcode index numbers (BINs) (i.e. species proxies). We assess between site differences in community diversity using beta-diversity and the partitioned components of species replacement and richness difference. Global total beta-diversity (dissimilarity) increases with decreasing latitude, greater spatial distance and greater temporal distance. Species replacement and richness difference patterns vary across biogeographic regions. Our findings support long-standing, general expectations of global biodiversity patterns. However, we also show that the underlying processes driving patterns may be regionally linked.

Basal cell carcinoma (BCC) is a slow-growing, locally aggressive, rarely metastasizing, low-grade cutaneous neoplasm that arises from the epidermal basal layer and invades the adjoining tissues. It is the most common skin cancer. It is fairly common in fair Caucasians and quite uncommon in dark-skinned populations. It contributes to 65–75% of cutaneous malignancies in whites and 20–30% in Asian Indians. The most important causal factors appear to be radiation exposure and genetic predisposition. It may present as a nonhealing lesion that occasionally bleeds or as a pruritic lesion with no symptoms. Tumours rarely spread to regional lymph nodes. The clinical appearances and morphology of BCC are diverse. Clinical types include nodular, cystic, superficial, pigmented, morphoeaform, (sclerosing), keratotic and fibroepithelioma of Pinkus. Most of the lesions appear on the head and neck, usually above the line joining the tragus and the angle of the mouth. A biopsy should be performed on all lesions suspected of BCC. The primary aim of treatment is the complete excision of the tumour tissue. Other treatment modalities include cryotherapy, immunomodulatory drugs, laser treatment or locally applicable chemotherapeutic agents. Prevention consists of lifestyle changes such as avoiding sunburn, tanning beds and prolonged direct sun exposure, shade seeking, sunscreen application on the skin, and physical barrier methods such as protective clothing, hats and sunglasses. Regular sunscreen use in childhood and adolescence seems more beneficial than in adulthood.

Background: Pleomorphic adenoma (PA) is a benign tumor, with a high recurrence rate. This study aimed to compare the Mucin-2 (MUC2) expression in primary and recurrent cases of PA in tertiary care hospitals of Peshawar. Methods: In this study, there were 60 PA cases, 51 being primary lesions and 9 recurrent lesions. Formalin-fixed and paraffin-embedded (FFPE) blocks of the two groups were examined for the immunohistochemical expression of MUC2. The clinicopathological parameters were also examined. This study was conducted at the Pathology Department, Pakistan Institute of Medical Sciences (PIMS), Peshawar, between January 2019 to January 2021. A nonprobability sampling technique was used while collecting the samples. SPSS version 21 was used and p-value

Abstract The concept of interval-valued intuitionistic fuzzy sets is intellectually stimulating and holds significant utility in the representation and analysis of real-world problems. The development of similarity measures within the class of interval-valued intuitionistic fuzzy sets possesses significant importance across various academic disciplines, particularly in the fields of decision-making and pattern recognition. The utilization of similarity measures is of utmost importance in the decision-making process when implementing interval-valued intuitionistic fuzzy sets. This is due to its inherent capability to quantitatively assess the level of resemblance or similarity between two interval-valued intuitionistic fuzzy sets. In this article, the drawbacks of the existing similarity measures in the context of an interval-valued intuitionistic fuzzy environment are addressed, and a novel similarity measure is presented. Many fundamental properties of this new interval-valued intuitionistic fuzzy similarity measure are also established, and the effectiveness of this similarity measure is illustrated by presenting a useful example. Moreover, a comparison is given to demonstrate the validity of the newly proposed similarity measure within the existing knowledge of similarity measures in the interval-valued intuitionistic fuzzy environment. In addition, an algorithm is designed to solve multi-criteria decision making problems by means of the proposed measure in the interval-valued intuitionistic fuzzy setting. Furthermore, this newly defined similarity measure is successfully applied to select an optimal renewable energy source to reduce energy crises. Finally, we conduct a comparative study to showcase the authenticity of the recently defined technique within the existing knowledge of similarity measures in the interval-valued intuitionistic fuzzy environment.

Abstract In this paper, a wideband polarization conversion metasurface is designed. Additionally, coding and chessboard metasurfaces are specifically tailored for radar cross-section reduction (RCS). Initially, a compact unit cell demonstrating exceptional polarization conversion performance is introduced, achieving a polarization conversion ratio (PCR) exceeding 90 $$\%$$ % across frequencies ranging from 7.9 to 22.7 GHz. The PCR remains effective even when oblique incidence angles of up to 30 $$^\circ$$ ∘ are utilized across this frequency band. Roger RT5880, with a thickness of 0.254 mm, serves as the substrate. An airgap is introduced between the substrate and the ground plane to enhance the polarization conversion bandwidth. This unit cell serves as the fundamental building block for subsequent metasurface configurations. To assess the scalability and effectiveness, a 36 $$\times$$ × 36 unit array is assembled, confirming efficient polarization conversion capabilities extending to larger structures. Moreover, a 1-bit coding unit “0” and “1” are formed by the Pancharatnam-Berry phase based on the same-sized meta-atom with 90 $$^\circ$$ ∘ orientations. The robustness and practicality of the design are demonstrated by creating 12 $$\times$$ × 12 lattices and evaluating their RCS reduction potential under two distinct scenarios: a chessboard pattern and a coding-based scheme. Notably, its results indicate substantial RCS reduction across a broad frequency spectrum (7.9 to 22.7 GHz) for both configurations. This study demonstrates the wide-ranging applicability of metasurface design, making it a valuable contribution to the fields of microwave engineering, polarization control, and radar stealth technology. Owing to its simplicity, bandwidth, and versatility, this approach offers innovative solutions for diverse real-world applications.

Abstract The current study was conducted on the inhabitants living in the area adjacent to the Hudiara drain using bore water and vegetables adjacent to the Hudiara drain. Toxic heavy metals badly affect human health because of industrial environmental contamination. Particularly hundreds of millions of individuals globally have faced the consequences of consuming water and food tainted with pollutants. Concentrations of heavy metals in human blood were elevated in Hudiara drainings in Lahore city, Pakistan, due to highly polluted industrial effluents. The study determined the health effects of high levels of heavy metals (Cd, Cu, Zn, Fe, Pb, Ni, Hg, Cr) on residents of the Hudiara draining area, including serum MDA, 8-Isoprostane, 8-hydroxyguanosine, and creatinine levels. An absorption spectrophotometer was used to determine heavy metals in wate water, drinking water, soil, plants and human beings blood sampleas and ELISA kits were used to assess the level of 8-hydroxyguanosine, MDA, 8-Isoprostane in plasma serum creatinine level. Waste water samples, irrigation water samples, drinking water samples, Soil samples, Plants samples and blood specimens of adult of different weights and ages were collected from the polluted area of the Hudiara drain (Laloo and Mohanwal), and control samples were obtained from the unpolluted site Sheiikhpura, 60 km away from the site. Toxic heavy metals in blood damage the cell membrane and DNA structures, increasing the 8-hydroxyguanosine, MDA, creatinine, and 8-Isoprostane. Toxic metals contaminated bore water and vegetables, resulting in increased levels of creatinine, MDA, Isoprostane, and 8-hydroxy-2-guanosine in the blood of inhabitants from the adjacent area Hudiara drain compared to the control group. In addition,. This study also investigated heavy metal concentrations in meat and milk samples from buffaloes, cows, and goats. In meat, cow samples showed the highest Cd, Cu, Fe and Mn concentrations. In milk also, cows exhibited elevated Cu and Fe levels compared to goats. The results highlight species-specific variations in heavy metal accumulation, emphasizing the need for targeted monitoring to address potential health risks. The significant difference between the two groups i.e., the control group and the affected group, in all traits of the respondents (weight, age, heavy metal values MDA, 8-Isoprostane, 8-hydroxyguaniosine, and serum creatinine level). Pearson’s correlation coefficient was calculated. The study has shown that the level of serum MDA, 8-Isoprostane, 8-hydroxyguaniosine, or creatinine has not significantly correlated with age, so it is independent of age. This study has proved that in Pakistan, the selected area of Lahore in the villages of Laloo and Mohanwal, excess of heavy metals in the human body damages the DNA and increases the level of 8-Isoprostane, MDA, creatinine, and 8-hydroxyguaniosine. As a result, National and international cooperation must take major steps to control exposure to heavy metals.

ABSTRACTChange in land use land cover (LULC) is driven by human activities and drives changes that limit the accessibility of services and products for livestock and humans. This study aimed to develop the spatio-temporal changes in LULC, vegetation cover, and moisture index using multi-temporal satellite data in Southern Punjab, Pakistan. Analysis of satellite data was accomplished using ArcGIS 10.4 software. Based on ground-truthing, the supervised classification technique (maximum likelihood algorithm) was used to achieve the LULC classification. The LULC change analysis revealed that vegetation area converted to the build-up area by 7.17 % and bare soil converted to urban areas by 1.68 % from 2000 to 2021. Average NDVI values were calculated at 0.23, 0.17, 0.19, and 0.14 for 2000, 2007, 2014, and 2021, respectively. In the study area, average NDMI values were observed at 0.28, 0.25, 0.2, and 0.15 for 2000, 2007, 2014, and 2021, respectively. Based on our study, the general trend in Southern Punjab is a decrease in vegetation cover, moisture index, and forest area due to an increase in build-up areas. Assessments of LULC and NDMI changes, as well as estimates of the effect on the environment, are necessary for many policy decisions and planning.

Abstract Diabetes Mellitus is a metabolic disease characterized by elevated blood sugar levels caused by inadequate insulin production, which subsequently leads to hyperglycemia. This study was aimed to investigate the antidiabetic potential of pyrazolobenzothiazine derivatives in silico, in vitro, and in vivo. Molecular docking of pyrazolobenzothiazine derivatives was performed against α-glucosidase and α-amylase and compounds were selected based on docking score, bonding interactions and low root mean square deviation (RMSD). Enzyme inhibition assay against α-glucosidase and α-amylase was performed in vitro using p-nitrophenyl-α-D-glucopyranoside (PNPG) and starch substrate. Synthetic compound pyrazolobenzothiazine (S1) exhibited minimal conformational changes during the 100 ns MD simulation run. S1 also revealed effective IC50 values for α-glucosidase (3.91 µM) and α-amylase (8.89 µM) and an enzyme kinetic study showed low ki (− 0.186 µM, − 1.267 µM) and ki′ (− 0.691 µM, − 1.78 µM) values with the competitive type of inhibition for both enzymes α-glucosidase and α-amylase, respectively. Moreover, studies were conducted to check the effect of the synthetic compound in a mouse model. A low necrosis rate was observed in the liver, kidney, and pancreas through histology analysis performed on mice. Compound S1 also exhibited a good biochemical profile with lower sugar level (110–115 mg/dL), increased insulin level (25–30 μM/L), and low level of cholesterol (85 mg/dL) and creatinine (0.6 mg/dL) in blood. The treated mice group also exhibited a low % of glycated haemoglobin (3%). This study concludes that S1 is a new antidiabetic-agent that helps lower blood glucose levels and minimizes the complications associated with type-II diabetes.

BackgroundProtein-protein interactions (PPIs) are intriguing targets for designing novel small-molecule inhibitors. The role of PPIs in various infectious and neurodegenerative disorders makes them potential therapeutic targets . Despite being portrayed as undruggable targets, due to their flat surfaces, disorderedness, and lack of grooves. Recent progresses in computational biology have led researchers to reconsider PPIs in drug discovery.Areas coveredIn this review, we introduce in-silico methods used to identify PPI interfaces and present an in-depth overview of various computational methodologies that are successfully applied to annotate the PPIs. We also discuss several successful case studies that use computational tools to understand PPIs modulation and their key roles in various physiological processes.Expert opinionComputational methods face challenges due to the inherent flexibility of proteins, which makes them expensive, and result in the use of rigid models. This problem becomes more significant in PPIs due to their flexible and flat interfaces. Computational methods like molecular dynamics (MD) simulation and machine learning can integrate the chemical structure data into biochemical and can be used for target identification and modulation. These computational methodologies have been crucial in understanding the structure of PPIs, designing PPI modulators, discovering new drug targets, and predicting treatment outcomes.

ObjectivesThis double-blind randomized controlled trial investigated raising serum 25-hydroxyvitamin D (25D) with extended-release calcifediol (ERC) on time to symptom resolution in patients with mild to moderate COVID-19.MethodsCOVID-19 outpatients received oral ERC (300 mcg on days 1-3 and 60 mcg on days 4-27) or placebo (NCT04551911). Symptoms were self-reported daily. Primary end points were raising 25D to ≥50 ng/mL and decreasing resolution time for five aggregated symptoms (three respiratory).ResultsIn all, 171 patients were randomized, 160 treated and 134 (65 ERC, 69 placebo) retained. The average age was 43 y (range 18-71), 59% were women. The mean baseline 25D was 37 ± 1 (SE) ng/mL. In the full analysis set (FAS), 81% of patients in the ERC group achieved 25D levels of ≥50 ng/mL versus 15% in the placebo group (P < 0.0001). In the per-protocol (PP) population, mean 25D increased with ERC to 82 ± 4 (SE) ng/mL (P < 0.0001) by day 7; the placebo group trended lower. Symptom resolution time was unchanged in the FAS by ERC (hazard ratio [HR], 0.983; 95% confidence interval [CI], 0.695-1.390; P = 0.922). In the PP population, respiratory symptoms resolved 4 d faster when 25D was elevated above baseline level at both days 7 and 14 (median 6.5 versus 10.5 d; HR, 1.372; 95% CI, 0.945-1.991; P = 0.0962; Wilcoxon P = 0.0386). Symptoms resolved in both treatment groups to a similar extent by study end. Safety concerns including hypercalcemia were absent with ERC treatment.ConclusionERC safely raised serum 25D to ≥50 ng/mL in outpatients with COVID-19, possibly accelerating resolution of respiratory symptoms and mitigating the risk for pneumonia. These findings warrant further study.