Cardiac surgery was severely affected by the COVID‐19 pandemic. Reallocation of resources, conversion of surgical intensive care units and wards to COVID‐19 facilities, increased risk of nosocomial transmission to cardiac surgery patients, lead to reduced accessibility, quality, and affordability of health care facilities to cardiac surgery patients. Increasing the mortality and morbidity rate among such patients. Cardiac patients are at an increased risk to develop a severe illness if infected by COVID‐19 and are associated with a high mortality rate. Therefore, measures had to be taken to reduce the spread of the virus. Various approaches such as the hubs and the spokes centers, or parallel system were enforced. Elective surgeries were postponed while urgent surgeries were prioritized. Use of personal protective equipments and surgeries performed by only senior surgeons became necessary. Surgical trainees were also affected as limited training opportunities deprived them of the experience required to complete their fellowship. Some of the trainees were reallocated to COVID‐19 wards, while others invested their time in research opportunities. Online platforms were used for teaching, meetings, and workshops across the globe. Although some efforts have been made to reduce the impact of the pandemic, more research and innovation is required.
Purpose Increase susceptibility towards Anorexia nervosa (AN) was reported with reduced levels of NNAT gene. We sought to investigate the most pathogenic rare-coding missense mutations (nsSNPs) of NNAT and their potential damaging impact on protein function through transcript level sequence and structure based in silico approaches. Methods Gene sequence, SNPs of NNAT was retrieved from public databases and the putative post-translational modi cation (PTM) sites were analyzed. Distinctive in silico algorithms were recruited for transcript level SNPs analyses and to characterized high risk rare-coding nsSNPs along with their impact on protein stability function. Ab initio 3D-modeling of wild-type, alternate model prediction for most deleterious nsSNP, validation and recognition of druggable binding pockets were also performed. AN 3D therapeutic compounds followed rule of drug-likeness were docked with most pathogenic variant of NNAT to estimate the drugs' binding free energies.Results Conclusively, 10 transcripts (201-205) based nsSNPs from 3 rare-coding missense variants i.e., rs539681368, rs542858994, rs560845323 out of 840 exonic SNPs were identi ed. Transcript based functional impact analyses predicted rs539681368 (C30Y) from NNAT-204 as the high risk rare-coding pathogenic nsSNP, deviating protein functions. The 3D-modeling analysis of AN drugs' binding energies indicated lowest binding free energy (ΔG) and signi cant inhibition constant (K i ) with mutant models C30Y.Conclusions Mutant model (C30Y) exhibiting signi cant drug binding a nity and the commonest interaction observed at the acetylation site K59. Thus, based on these ndings, we concluded that the identi ed nsSNP may serve as potential targets for various studies, diagnosis and therapeutic interventions. Level of evidence No level of evidenceWhat Is Already Know On The Subject? Lombardi et al., 2019 and Ceccarrini et al in 2021 reported the role of con rmation of the involvement of the NNAT gene in the pathogenesis of AN. Further, its role in energy metabolic homeostasis has been clearly established through a vast spectrum of literature. What your study adds?Transcript level predictions of rare-coding high risk pathogenic human NNAT gene's SNPs by different in silico ML algorithms and their functional impact on protein stability. Characterizing the structural inference of rare-coding deleterious missense mutations and computing the molecular binding energies of most pathogenic 3D model of NNAT variant with therapeutic compounds of AN.
Madam, Since the beginning of 2021, massive vaccination programmes have been initiated, aiming to curb the COVID-19 pandemic, yet certain groups remain vulnerable, especially pregnant women (1). A recent study has emphasized the implications of COVID-19 in pregnant females; evaluating statistics from various countries, the authors reported maternal mortality to be 22 times higher in pregnant women with COVID-19 diagnosis than those without (2). Compared with those without COVID-19, infected females giving birth showed significantly higher rates of ICU admission, respiratory intubation, mechanical ventilation, and a greater risk of having a preterm birth of fewer than 37 weeks (2). In Pakistan, Covid-19 is speculated to cause multiple complications among unvaccinated pregnant women. When local data was collected and presented at a webinar “Pregnancy in Covid-19 and importance of vaccine” held by a public medical university in association with the American Society of Microbiology, it was highlighted that Covid-19 caused a death rate of 8% in pregnant women. Each year, approximately 14% of pregnant women are susceptible to have medical complications. (3) These adverse outcomes during pregnancy accentuate the need for vaccination of pregnant individuals. Recent studies have started assessing the outcome of Covid-19 vaccination on the pregnant women population and demonstrated positive results. Blakeway et al reported that women who received at least one dose of COVID-19 vaccine in pregnancy versus unvaccinated females had similar rates of all adverse pregnancy outcomes and concluded that vaccines do not affect perinatal outcomes (4). Guidelines recommending urgent vaccination for pregnant people have also been released, stressing that the benefits of the vaccine supercede any potential risks (1). However, several factors have hindered the process of vaccination of pregnant women such as the exclusion of pregnant women from clinical trials that have caused difficulty in establishing confidence of pregnant women in the vaccines In addition, the prevailing conspiracy theories in Pakistan about vaccination programmes, being a Western agenda to induce sterility in Muslim women has further hindered the success of vaccination programme for pregnant women. (5) Physicians must implement the past positive findings of vaccination among pregnant women when counseling patients who are pregnant, planning a pregnancy, breastfeeding, or planning to breastfeed, and facilitate them in opting for government authorized vaccines for clinical use. At the same time, pregnant women who wish to wait for more data to make an informed decision must be supported and updated by their doctor regularly. ---continue
BackgroundThe current research focused on studying the pattern of catheter-related bloodstream infections (CRBSI) with femoral central access versus internal jugular access in patients admitted to the medical intensive care unit (ICU).
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