Online ISSN: 2515-8260

Keywords : Covid-19


Rakhimov R.A.; Ibadullaeva N.S.; Khikmatullaeva A.S.; Abdukadirova M.A.; Sadirova Sh. S.; Lokteva L.M.; Rakhimov R.R.; Bayjanov A.K.; Samatova I.R.

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 574-581

6 months after the start of the COVID-19 epidemic in Uzbekistan, a comparative analysis of the reported incidence of COVID-19 and the level of herd immunity to SARS-CoV-2 was carried out. The registration of patients with
COVID-19 in the country was carried out on the basis of the positive results of the examination for the presence of SARS-CoV-2 RNA, using the PCR method. To study herd immunity, the WanTai SARS-CoV-2 Ab Rapid test (China) was used to detect total antibodies (IgM and IgG) in blood. In the period from August 27, 2020 to September 11,   020, in all 14 administrative-territorial regions of Uzbekistan, blood samples of 86879 people who sought medical help at an outpatient clinic at their place of residence were tested for the presence of total antibodies to SARS-CoV-2. According to official figures, 0.14% of the population were infected with COVID-19. The proportion of the population with the presence of specific protective antibodies to the SARS-CoV-2 virus was 23.1%. This proves that the actual incidence of COVID-19, on the national average, was at least 165 times higher than officially reported. An uneven territorial distribution of the level of herd immunity was revealed. All regions were conditionally divided into 3 zones: 1) regions with a high level of herd immunity ˃ 20% (8 regions), 2) regions with an average level of herd immunity ˂ 20% and ˃ 10% (3 regions), 3) regions with a low the level of herd immunity ˂ 10% (3 regions). The degree of population affected in different regions of the county did not depend on the population density in the region, its age and gender composition. It was shown that the factors that influenced the intensity of the epidemic process and the formation of the level of herd immunity were the degree of external and internal migration.

Maternal and perinatal outcomes of pandemic Covid-19 in pregnancy in Basrah

Maysoon Sharief, C.A.B.O.G.; Gufran Jaafar, C.A.B.O.G.,; Alla Hussan, M. B. Ch. B., D.O.G

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 517-529

To evaluate the maternal, fetal and neonatal complications in pregnant women with Covid-19 infection. Setting and design: A prospective descriptive study was carried out in Basrah Teaching Hospital, Iraq during the period 15/3/2020 till 1/11/2020. There were 135 infected pregnant women with Covid-19. The maternal information's were obtained included Age, parity, residence, travel history, gestational age at time of diagnosis. The pregnancy measures of interest were evaluated according to the severity of the disease, medical disease, history of antepartum hemorrhage, mode of delivery, type of delivery, post-natal complication and admission to
intensive care unit and maternal death. The neonatal outcomes of interest were fetal weight, neonatal Apgar
score, admission to neonatal intensive care unit and neonatal death. Results: The mild type of the disease was common (41.48%) in comparison to severe conditions (17.77%).

The Impact of COVID-19 in the Procedure of Religious-Worship and Social Life, In Islamic View

Muhammad Fuad Zain; Hasanudin .

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 272-278

This article discusses the effects of a coronavirus pandemic in social life. Coronavirus is a global problem that has yet to be resolved until now, it has changed behavior in life, especially in the procedure of religious-worship and social life. The author find that the differences in understanding and attitude related to COVID-19 was caused by knowledge and mental readiness. So the case of COVID-19 corpse will not occur if they have understood and readiness even though it is clear that the coronavirus has changed the way of worship and social life.

Eminent role of Nanotechnology in Detection, Diagnosis and treatment to Combat COVID-19

Sanjeev Kumar; Sapna Jain; Bhawna Lamba

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 468-484

Today world is facing huge challenge to combat spread and death cause due to novel corona virus (COVID-19). This infectious disease cause tremendous amount of damage to human population medically as well as economically. COVID -19 also affected badly on education worldwide. Until date, no evident treatment or vaccine has been suggested for the treatment of COVID-19. Doctors are using different combination of antiviral medicines. They also using plasma therapy. The only way to prevent oneself is to maintain social distancing, proper hygiene and wear mask. Nanotechnology can play very important role in combating COVID- 19. Nanoparticle can be used in Nanomedicine. It can also coat or spray on mask or PPE kit for protection. It has also used for early detection of Covid 19 patients. The present paper aim to present comprehensive role of nanotechnology in curbing menace of SARS-CoV-2. The paper will also present different chemical route for synthesis of nanoparticles, which is being or would be used for limiting the risk of Covid 19.


Ilxamdjan Karimdjanov Asamovich; Nozima Sаdiqova Baxadirovna; Botir Tadjiev Mirkhashimovich; NurlanDinmukhammadiev Aktamovich; Bobir MirkhashimovBotirovich; Yaxyayeva Komola Zokirovna; Anvar Tursunbayev Karimberdiyevich; Fatima Xoltayeva Fayziyevna

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 1, Pages 1341-1351

The role of vitamin C in the prevention and treatment of pneumonia andsepsis has been investigated for past decades. This reviewaimsto translatethese findings into patients with severe coronavirus disease (COVID-19). It has indicatedthat patients with pneumonia and sepsis have low vitamin C status and elevated oxidative stress.Additional oral or intravenous (IV) vitamin C administered patients with pneumonia can mitigate the severity and course ofthe disease. Severely ill patients with sepsis need for intravenous administration of amounts counted in grams ofthe vitamin to achieve adequate plasma levels, an intervention that some studies suggest reduces mortality.The vitamin has physiological functions like pleiotropic, many of which are closely connected to COVID-19.These are its antioxidant, antiinflammatory, antithrombotic and immunomodulatory functions.Previous observational studies found out low vitamin C status in critically ill patients with COVID-19.A number of randomized controlled trials (RCTs) conductedworldwideevaluate intravenous vitamin C as monotherapy in patients with COVID-19. Optimization of the intervention protocolsin future trials, e.g., earlier and continuously administration, is justified to potentially improve itsefficacy. In order to the excellent safety profile, low cost, and potential for rapid enlargement of production,administration of vitamin C to patients, especially with hypovitaminosis C and severe respiratory infections,e.g., COVID-19, appears warranted. In addition, there are few new ways of concurrent using vitamin C and other manipulations or medications.

Oral Health Condition and Dental Care in Children with Congenital Heart Disease during the COVID-19 Pandemic: A Systematic Review

Harun Achmad; Sasmita M. Arief

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 2, Pages 1233-1247

Congenital heart disease (CHD) is one of the most common congenital defects, present at birth, it can affect the walls, valves or the great vessels of the heart. CHD considered to be among the most common malformations in newborn infants with an incidence of 8 out of 1000 live births worldwide. Children with congenital disease certainly need special health care. Healthy teeth and gums are important for everyone, especially for children with heart conditions. Providing children with dental care during the COVID-19 pandemic, and in particular during the increased social restrictions, can be a challenging task. The purpose of writing this systematic review is to examine about oral health condition and dental care in children with congenital heart disease during the COVID-19 pandemic. Data source of Pubmed, published from 2011-2021. After eliminating duplicated articles, the titles and abstracts of each article were analyzed across 119 articles resulting in 86 articles being excluded. The full-text articles in the remaining 33 articles were re-analyzed and excluded 23 articles and produced 10 articles which were then entered into the analysis. Based on this systematic review shows that children with congenital heart disease (CHD) have poor oral health. Education and disease awareness about and prevention of dental illnesses have to be guided and steered by the parents. The role of dentists and pediatricians is very important in this case. Providing children with dental care during the COVID-19 pandemic, and in particular during the increased social restrictions, can be a challenging task.

A Study Of Covid-19 Spread And Death Contributing Factors In America Using Multi- Layer Perception (MLP) And Radial Basis Function (RBF)

Shafaf IBRAHIM; Saadi Ahmad KAMARUDDIN; Nur Nabilah ABU MANGSHOR; Ahmad Firdaus AHMAD FADZIL

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 2, Pages 144-158

In recent years, Artificial Neural Networks (ANN) was widely implemented for
developing predictive and estimation models to estimate the needed parameters. As the
Coronavirus disease 2019 (COVID-19) case numbers are rising internationally as
uncontrolled outbreaks, it is important to better understand what factors promote the super
spreading events. In this paper, the use of Multi-Layer Perceptron (MLP) and Radial Basis
Function (RBF) of ANN for COVID-19 spread and death contributing factors in America
was described. A comparison was made by using a dataset of COVID-19 cases and deaths
reported from 49 states in America during April 2020. Seven covariates used in the network
which are High Temperature, Low Temperature, Average Temperature, Population,
Percentage of Cases over Population, Percentage of Death over Population, and Total
Cases. However, the performance of MLP and RBF networks may be evaluated relatively
similar. It was found that both MLP and RBF proved that the Population, Percentage of
cases over population, and Total cases are the most contributing factors towards COVID-19
spread and death in America particularly.


Reshmi B; Dhanraj Ganapathy

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 1, Pages 521-530

Coronavirus disease caused by SARS-COV2, a potentially fatal disease has become a global public health concern. As the understanding of this novel disease is evolving, dental students and professionals should have an in-depth knowledge and understanding and should be updated with the practices that have to be adapted to identify a possible COVID-19 infection .Not only knowledge but also an update on diagnostics, treatment ,variant ,side effects will be required to survive the infection on the upper hand .Knowledge of diagnostic tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still evolving, and a clear understanding of the nature of the tests and interpretation of their findings is important.The aim of the study was to assess the awareness of diagnostic tests for COVID-19 among dental students.This questionnaire containing 10 questions regarding awareness about the diagnostic test were given to 100 students including interns , final year students ,and third year students through google forms and responses were collected and results were tabulated using SPSS software.In this survey 79.8% were females and 20.2% were males. 16.2% were third years, 12.2% were final years , 34.3 % were interns and 37.4% were post graduates. 66.6% of the students know PCR is used for diagnosing and detecting viruses responsible for COVID 19 and 33.4% don't know that PCR is a key test for diagnosing COVID and detecting viruses.7-11 The study concluded the respondents had moderate awareness about the diagnostic tests for COVID-19.

Health Care in Prisons and Detention Homes During COVID-19 Pandemic in India

M.Z.M. Nomani; Zafar Hussain

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 1, Pages 1488-1492

The paper deals with the legal framework for the health care in prisons and detention homes during COVID-19 pandemic in India. The World Health Organization has issued Guidance on COVID-19 for Prisons and Detention, 2020 for the health care system to deal with challenges of contagion in the arena of criminal justice system. The National Crime Record Bureau and the Prison Statistics India, 2020 revealed overcrowding and occupancy in jails as formidable threat of infection and transmission. Though the health and human rights envisages highest attainable standard of health among prisoners and detainees, ripple effect on community infection through detainees in detention homes and jails cannot be ruled out. The global outbreak of the COVID-19 has cascading effect on the health of inmates and convicts living in enclosed environments during the pandemic.

Real-Time Measurement Of Psychological Impact Due To E- Learning; Among The Undergraduate Dental Students During Covid-19

H.M. Owais Nasim; Azeem Ul Yaqin Syed; Laraib Qamar; Saba Saleem; Zainab Javaid; Ayesha Khalid; Muhammad Sohail Zafar; Nausheen Aga

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 1, Pages 1242-1251

Objectives: To assess the psychological factors in undergraduate dental students towards elearning
in clinical skills education compared to traditional teaching methods and their
relationship with performance during the COVID-19 pandemic.
Methods: In this study, survey conducted among 494undergraduate dental students of all four
sessions from different dental universities within the Pakistan. Total 494 undergraduate
dental students responded to a 28-question online survey to identify e- learning is more
convenient and practical than traditional learning and to measure it 5- point Likert Scale used.
To measure level of psychological impact, Hamilton Anxiety Scale used due to e-learning
among undergraduate dental students.
Results: The majority of undergraduate dental student’s responded e-learning is not
convenient and practical than traditional learning system. The majority of undergraduate
dental students reported very severe level of psychological impact due to e-learning and closing
of institutions during COVID-19 pandemic. Results are statistically significant and analyzed
on IBM SPSS version 23. There are 82% students responded having problem with e-learning
system and among them 58 % have very severe anxiety and 24% have severe anxiety. So the
results shows increased percentage of anxiety due e-learning.
Conclusion: Dental students expressed a higher level of comfort and effective learning in a
recognizable, conventional classroom circumstance. Teaching with traditional system
improves student’s critical thinking skills and formulates opinions or arguments by engaging in
live discussions. This study reveals that students face challenges in using the e-learning
resources because of incompetency in the IT skills, lack of motivation and access to proper
internet. The most important issue identified by this study is maintaining an effective
interaction with dental students in e-learning system of teaching to fill the gap between the
teacher and students. There should be further flexibility workload and learning time tostudents to reduce the level of anxiety among the dental students.


D.Lakshmi Padmaja; Medisetty Sujith; Sai Sruthi Bejagam; Manish Reddy Morapally

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 2, Pages 2047-2052

The main aim of this paper is to know whether the temperature have any impact on the increase of corona virus. Covid-19, this name has brought a drastic change in our day-to-day life. People of Telangana have lived through 10 months of the Covid-19 pandemic and there might be more to come. Till date 2.8lakh official cases of covid-19 have been registered in Telangana and there may be many more which have gone unnoticed. In our busy life, we are neglecting our health and no one is maintaining a proper hygiene. And we have been more addicted to junk foods rather than nutrition, because of this reason covid-19 became a threat to our life. So proper precautions and awareness must be spread among people to avoid spread of virus. Fever, cough, breathing problems etc are the
symptoms of this covid-19. If we neglect these symptoms it leads to a severe problem like pneumonia, kidney failure and eventually leads to death of that person. At this moment we don’t have any vaccine to cure this disease, the only prevention or avoiding corona is to boost our immune system. To overcome this pandemic situation, firstly we need to know the important factors that increases in covid-19 cases. In this paper, machine learning techniques are used to identify how temperature varies with the increase of covid-19. Which means we find how the effect of temperature depends on the number of covid-19 cases in Telangana

Neurological disorders in patients underwent COVID-19

Nargiza Nasriddinovna Ergasheva; Dilbar Nabievna Khidoyatova; Yakutkxon Nabievna Madjidova; Yuldasheva Manzura Muchammad Tofik kizi; Zulfiya Amalgeldievna Xodjaeva

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 2, Pages 256-262

Introduction: COVID-19 is the current global coronavirus pandemic caused by the SARS-CoV-2 coronavirus. The first reports of the disease outbreaks appeared in China on December 31, 2019 and the first clinical manifestations occurred earlier on December 8, 2019. On January 30, 2020, the World Health Organization declared the outbreak as a public health emergency of international concern. On March 11 it was declared a pandemic. Common symptoms include fever, cough, fatigue, shortness of breath, and anosmia (loss of smell).Complications can cause acute respiratory distress syndrome (ARDS) and pneumonia. The incubation period is usually around five days, but can range from two to fourteen days.
Aim of the research isto study of clinical and diagnostic criteria for neurological disorders and changes of laboratory parameters in patients with COVID-19.
Material and methods: We examined 31 patients who had undergone COVID-19 and were hospitalized at the private clinic "Neuromed-Service" named after academician N.M. Madjidov. There were 19 males and 14 females. The age of the patients varied from 18 to 75 years (the mean age made up 41 years).
Results: Patients with inflammatory diseases of the peripheral nervous system (neuropathy, facial nerve, trigeminal neuralgia), considering an increase of C-reactive protein were performed anti-inflammatory therapy with NSAIDs and steroids (Dexamethasone intramuscularly). In patients with convulsive syndrome EEG was monitored using the "Neuron - range 2" (Russia). Diffusechangesinthebioelectricalactivityofthecerebralcortexwererevealedinthestudiedpatients.Epiactivityinthefronto-parietalregionofthebrain (against the background of taking anticonvulsants)was also recorded. The dose of anticonvulsants was increased for these patients and decongestants were prescribed. An increase in fibrinogen was also noted in the blood of these patients. Conclusion: Thereby, in patients after suffering COVID-19, the blood tests showed an increase of fibrinogen by more than 2 times and an increase of C-reactive protein. All this testifies the fact that in these patients after treatment, at the alleged improvement of their condition, the blood continued the process of thrombosis strengthening and inflammation persisted in tissues and organs. In patients who prematurely stopped taking antiplatelet agents and anti-inflammatory drugs after illness, neurological and other complications were developed

Neurological manifestations of COVID-19.

Madjidova Yakuthon Nabievna; Mansurova Nargiza Asrarovna; Ziyakhadjaeva Latofat Uchkunovna; Azimova Nodira Mirvositovna; Nurmukhamedova Mukhlisa Anvarovna

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 2, Pages 1906-1912

Objective of the article is to provide more comprehensive data of the prevalence of
neurological comorbid disorders and preexisting neurological disorders in patients with
Method. We systematically searched the literature through Pubmed, based on the search of
combination of keywords: Covid 19, coronavirus, neurological disorders, stroke,
complications, neurorehabilitation.
Results. The increased biomedical interest in the problem of COVID-19 is due to its high
contagiousness, variable symptomatology, severe course and multiple organ failure in a
pandemic, the critical importance of the state of the nervous system. The manifestations can
be considered as direct effects of the virus on the nervous system, para-infectious or postinfectious
immune-mediated disease, and neurological complications of the systemic effects of
Conclusion. The article deals with brief aspects of some factors contributing to the
development of neurological disorders in COVID-19 patients. The study results of coronavirus
infection of foreign researchers are summarized

Implementation of Deep Learning for Automatic Classification of Covid-19 X-Ray Images

Muhammad Shofi Fuad; Choirul Anam; Kusworo Adi; Muhammad Ardhi Khalif; Geoff Dougherty

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 2, Pages 1650-1662

Background:Reading radiographic images for Covid-19 identification by an expert radiologist requires significant time, therefore the development of an automated analysis system to assisting and saving time in diagnosing Covid-19 is important.
Objective: The purpose of this study is to implement the GoogleNet architecture with various epochs in hope achieving higher level of accuracy in Covid-19 detection.
Methods: We retrospectively used 813 images, i.e. 409 images indicating Covid-19 and 404 normal images. The deep TL model with GoogleNet architecture was implemented.The training was carried out several times to get the best acquisition value with a learning rate of 0.0001 for all levels. The network training was carried out with different epochs, i.e. 12, 18, and 24 epochs, and each epoch with 65 iterations.
Results: It was found that accuracy was determined by changes in the number of epochs. The classification accuracy was 96.9% in epoch 12, 98.2% in epoch 18, and 99.4% in epoch 24.
Conclusion: An increase in the number epochs increases the accuracy in the detection of Covid-19. In this study, the accuracy of the method reached 99.4%. These results are promising for the automation of Covid-19 detection from radiographic images.


Reshmi B; Dhanraj Ganapathy

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 1, Pages 570-578

COVID-19 is the disease supported by SARS-CoV-2 infection, which causes a severe form of pneumonia. Due to the pathophysiological characteristics of the COVID-19 the particular transmissibility of SARS-CoV-2, and the high globalization of our era, the epidemic emergency has spread rapidly all over the world. Human-to-human transmission seems to occur mainly through close contact with symptomatic people affected by COVID-19, and the main way of contagion is only through the inhalation of respiratory droplets, for example when patients talk, sneeze or cough.The dental practitioners are particularly exposed to a high risk of SARS-CoV-2 infection because they cannot always respect the interpersonal distance of more than a meter and are exposed to saliva, blood, and other body fluids during surgical procedures. Moreover, many dental surgeries can generate aerosol, and the risk of airborne infection is to be considered higher. The questionnaire was shared among students pursuing dentistry which contained a set of 10 questions . The questions were about duration , practice on PPE and how aware and protected the students are during treating the patients.88% of them agreed that the gloves they wear protect them from viral pathogens and 5% did not agree and 7% of them were not sure about it .90% of them were trained on personal protective equipment whereas 10% of them were not trained before.This study observed good awareness regarding the practice of using protective equipment during dental treatment among the respondents.

Liriodenine: The Prospect For Covid-19

Ade Zuhrotun

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 2, Pages 1381-1399

Until December 13, 2020, the total Covid-19 cases worldwide is 70,476,836 cases and counted 1,599,922 deaths globally since the start of the pandemic. The best medicine for Covid-19 has not been found yet, so this review intended to reveal potency of Liriodenine to overcome and help care for those affected. Liriodenine (C17H9NO3) along with Quinine and its derivate Chloroquine and hydroxychloroquine are include in the compound of nitrogen-containing group or alkaloid. The main mechanism of its activity of Liriodenine is DNA Topoisomerase I and II inhibitors that have cytotoxic effect on several human cell lines such as A549, NCI-H226, SPC-A-1, NPC-TW01, ECV2 and 7111, KB, HEp‑ 2, and against gram (+) and (-) bacteria. Review results showed that Topoisomerase Inhibitor posses dual activity that works on both DNA and RNA, so does Liriodenine predict may affect to RNA virus include SARS-CoV-2 strain or 2019-nCoV. The potency of Liriodenine as new agents for Covid-19 diseases is supported by its other activity antifungal, antiplasmodial (such as Plasmodium falciparum), antidiabetic, antioxidant, and anti-inflammatory (Immunomodulatory) activity. Plants-containing Liriodenine in the world is abundant, not limited to Annonaceae, Magnoliaceae, Lauraceae, Menispermaceae, and Rutaceae. So Liriodenine prospective for developing as herbal therapy or single
compound for Covid-19 diseases

Redesigning Dentistry To A New Reality In The Era Of COVID-19- A Review Article

Aayushi Aggarwal; Vinisha Pandey; Neha Awasthi; Subhra Dey

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 2, Pages 28-44

The epidemic of coronavirus disease 2019 (COVID-19) led to unprecedented outbreak in Wuhan, China; has become a major public health challenge for not only China but also countries around the world. The severe global quarantine efforts and social distancing were taken worldwide in response to this global outbreak. This has challenged the health professions and systems evoking heightened reactions around the globe as response to Covid-19. While most heavily impacted, the role of the dental professionals in preventing the transmission and responding to its long-term impacts on dentistry is crucially important. This review article, while outlining the essential knowledge about COVID-19 and nosocomial infection in dental settings, provides recommended strategies for dental practitioners to redesign dentistry to a new reality in a way to combat dental crisis to bridge the gaps in dental settings to overcome this emergency.

Attitudes and Behavior Practices Against Covid-19 During the Rapid Rise Period Among University Students In Indonesia

Fransiskus Xaverius Widiantoro; Yosi Maria Wijaya; Florentina Dian Maharina; Chi-Jane Wang

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 10, Pages 2393-2404

Despite strict measures taken, the attitudes and behavior practices of university students against infectious viruses remains the most important factor in limiting the widespread of COVID-19 diseases. This study examined attitude and behaviors practice against COVID 19 among university students during the rapid rise period. A university-based cross-sectional study was conducted among university students by the authors’ networks with university or students union in Indonesia. After consenting, participants completed an online survey to assess socio-demographic, health’s habit, family-history of chronic diseases, attitude, and behavior practice against COVID-19. Multivariable analysis was done using linear regression after checking collinearity, and a p-value of less than 0.05 was considered significant. Totally 543 participants, most of them (78.3%) were female and bachelor students (73.3%). Majority participants showed positive attitude (97.2%) and behavior practice (82,0%) with mean score 2.05 and 2.91, respectively. Education level and smoking habits were significantly different with attitude. The behavior practices were significantly different with age, religion, and exercise. Multiple linear regression showed that younger people were more likely to believe in successful control, and confidence against COVID-19. Being younger, diploma level, and inactive were among the significantly associated factors of poor behavior practices against COVID-19. Our results found that university students had positive attitudes and better behavior practice against COVID-19. Therefore, their attitude and behavior practice must be improved to be prepared for epidemic and pandemic situations. Development comprehensive health education programs are important to increase awareness and to reach sufficient knowledge.

Phbs Implementation And Personal Factors Of Medical Students During The Covid-19 Pandemic Period

Agustina Arundina Triharja Tejoyuwono; Rangga Putra Nugraha; Faisal Kholid Fahdi

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 10, Pages 1499-1510

The recommendation to prevent the coronavirus disease in Indonesia is to implement a clean and healthy lifestyle (PHBS). The good implementation of PHBS during the pandemic period is also the responsibility of medical students as part of the community and prospective health workers in the future. The purpose of this study is to describe the behavior in implementing PHBS and the conditions of student personal factors during the COVID-19 pandemic. This descriptive research was conducted by distributing online questionnaires in July 2020, involving 361 students from six study programs at the Faculty of Medicine Tanjungpura University. The good behavior of implementing PHBS has been carried out by medical students, such as washing their hands in 6 steps, under running water, using soap, providing hand sanitizers, not shaking hands, maintaining distance and carrying out coughing / sneezing etiquette properly. Social media, audio-visual media, and journals are sources of information used by students to obtain information about COVID-19. The impact of the pandemic on the health conditions of families and themselves, education and the family economy is a worrying factor for medical students. Medical education institutions need to provide support for the implementation of PHBS and prevent physical and mental health problems of medical students.

Convalescent Plasma Therapy Against Covid-19: A Comprehensive Review

Dr Suchitra Shenoy M, MD; Dr Pooja Rao, MD; Dr Deepa Adiga S A; Dr Nikhil Victor Dsouza, MD; Dr Basavaprabhu Achappa MD

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 10, Pages 3374-3384

The pandemic COVID-19, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) continues to create havoc all over the world having caused more than 40 million cases and more than 11,32.528 deaths worldwide as of October 21, 2020. The treatment of COVID-19 is proving to be a challenge to the medical fraternity worldwide with no specific drug therapy or vaccine available in sight. The use of Convalescent plasma (CP) therapy, a form of passive immunization, in the treatment of COVID-19 has been gaining ground all over the world including India as convalescent plasma therapy has been used previously in virus infections like MERS-CoV, SARS-CoV, H1N1 and other viral infection with some success, when the situation was similar as in any infectious outbreak situations. This review looks at CP therapy as a possible treatment option for COVID-19 in terms of: type of antibodies in the convalescent plasma, mechanism of action, possible adverse effects, current approval status and its limitations in the management of COVID-19.

Validity And Reliability Test For Research Instruments Regarding Health Professional Student Satisfaction Towards Online Learning During The Covid-19 Pandemic

Kulsum Kulsum; Taufik Suryadi

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 10, Pages 2802-2817

In the conditions of the COVID-19 pandemic, the strategies carried out to break the chain of transmission, one of which is by limiting social activities. A physical distancing policy has also been created which causes the face-to-face teaching and learning process to be transformed into an online learning system. Research is needed on the factors that can affect the satisfaction of health professional students related to online learning which requires valid instruments to answer research problems. The aim of study is determining the content validity of the questionnaire as a research instrument on the factors that influence health professional student satisfaction with online learning during the COVID-19 pandemic. The content validity of the instrument was carried out on 52 statement items by 7 experts. The validated instrument is an online questionnaire which refers to and adopts and modifies the questionnaire used by Pei-Chen Sun. The results of the validation of the 52 statement items obtained S-CVI/Ave by 7 experts of 0,953, S-CVI/Ave based on I-CVI of 0,945, S-CVI/UA of 0,731. Initial CVI of 0.890, but 4 items were eliminated, there were 48 statement items used as a research instrument with a final CVI of 0.935. The reliability test results obtained a Cronbach’s alpha coefficient value is 0.912. Calculating CVR, CVI and Cronbach’s alpha coefficient ensures that the questionnaire used as a research instrument is valid and reliable to assess the factors that influence health professional student satisfaction with online learning during the COVID-19 pandemic.

Psychosocial impact of COVID-19 Quarantine in South India: A online cross-sectional survey

Narrain shree S; Jagannathan K; Vinod N P

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 10, Pages 1530-1545

COVID-19 has been recognized as a pandemic by the World Health Organization. originated from China and has rapidly crossed borders, infecting people throughout the whole world. The present study sought to determine knowledge, attitude and behavior (KAB) of South Indian population toward COVID-19 Quarantine.
Methods: An online cross sectional, semi-structured questionnaire was undertaken through google forms among South Indian population (SIPs). SIPs aged 18 years and above constituted the study population. Data was analyzed using SPSS Software
Results: Totally 280 responses were received. The responders had a moderate level of knowledge about the COVID-19 infection and adequate knowledge about its preventive aspects. The attitude towards COVID-19 showed peoples' willingness to follow government guidelines on quarantine and social distancing. 32% of Participants have felt stressed during quarantine and 32.4% of participant had sleep disturbance. Alarmingly 32% are not anxious and feel free to roam around in public places without protective measures like mask and gloves. In this study, panic about acquiring COVID-19 infection during purchase and travel were reported in 29.5% and 11% participants respectively. The perceived Physical healthcare need was seen in more than 69% of participants.
Conclusions: COVID-19 Quarantine knowledge is gained mainly through media channels, Newspaper, which have strengths and weaknesses. Although the government has taken major steps to educate the public and limit the spread of the disease, there is a need to intensify the alertness of people during this COVID-19 Quarantine.

COVID-19- Vaccines: Trends & Future: Systematic Review & Meta Analysis

Dr. Nausheen Aga; Dr. Sachin Durkar; Dr. Heena Tiwari; Dr. Sourabh Ramesh Joshi; Dr. Mohammed Mustafa; Dr. Ali Robaian AlQahtani; Dr. Sharnjot Kaur

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 11, Pages 5922-5935

Background:Vaccination is essential and advised to prevent the spread of the pandemic COVID-19. There has been a difference of intention to take vaccination among people with a fear from the various misinformation.
Methods: Studies with a national representative samples of size greater than bthousand were considered for the study, meta-analysis was conducted among those anticipating to get vaccinated, unsure, or planning to refuse a COVID-19 vaccine when available were considered for the study. Generic inverse meta-analysis and meta-regression were used to group estimates and examine time trends. Scopus, PubMed were searched from March-November, 2020.

Survival analysis to assess the length of stay of novel coronavirus (COVID-19) patients under Integrated Medicine - Zinc, Vitamin C & Kabasura Kudineer (ZVcKK)

D. Jamuna; P. Sathiyarajeswaran; M. S. Shree Devi; K. Kanakavalli; N. P. Vinod; A. Nirmala; T. Ravikumar; P. Pathiban; K. Babu; C. Dhanam

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 10, Pages 1375-1387

COVID19 pandemic out of all odds has created an opportunity to offer treatment in an integrative manner. This study measures the Length of stay (LS) of patients in an integrative way as done earlier in China and Vietnam. Length of stay,
Clinical presentations, and Comorbidities were analyzed among COVID19 patients in ESI Hospital, Coimbatore, Tamil Nadu, India.
Method: Retrospective cross-sectional data on 251 Positive COVID19 patients of both sexes irrespective of age admitted from 27 March 2020 and 26 April 2020 cases were included in the study. The final discharge date is taken as 5th May 2020. Kaplan Meier survival analysis was adopted.
Results: Male, female ratio were 141(56.2%): 83(33.1%), 12 (4.8%) Male Child and 15 (6.0%) were Female child. 5.2% of the patients were in the age group greater than 60, 75.3% were in the age group 20-60, and the remaining 19.5% were 0-20 age group. 84.9% of patients were Asymptomatic, while fever and cough were the main symptoms recorded in the remaining cases. CT scan was done for 7 patients. No mortality and no serious adverse events were reported. Comorbidity is 15% and does not influence hospital length of stay. The overall median length of stay is 12 days for those who were under ZVcKK (Median ST CI- 11.59-12.41).
Conclusion: This study recorded a median of 12 days in the Length of stay and 13.5 days in the Length of stay average. Comparing earlier studies, patients taking ZVcKK have savings of 7 days. i.e., the relief speed is higher while using ZVcKK.

Qurban Innovation Due to The Covid-19: Experiences from Indonesia

Abdul Syatar; Arif Rahman; M. Ilham; Chaerul Mundzir; Muhammad Arif; Hasanuddin Hasim; Muhammad Majdy Amiruddin

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 10, Pages 1600-1614

This article aims to elaborate the innovations on the Qurban procession during the Covid-19 pandemic by following health protocols. The approach employed is normative-empirical by looking at the texts of revelation, the views of scholars, fatwa products, government policies and relevant journals, online news and the realities that occur in society. The result of the study found that the innovation of of Qurban procession consists of 3 parts. First, the payment system is done by collaborating with online payment services. Second, the process of slaughtering specificied to certain locations that meet health protocols. third, distribution of qurban products is in collaboration with online transportation providers. These innovations are a response to the Government's policy through the relevant ministries to issue a circular to continue to carry out the slaughter of sacrificial animals in a safe location and able to break the chain of the spread of Covid-19. MUI and Muhammadiyah also issued fatwa products in which there was no significant difference. Government policies and existing fatwa products continue to comply with one of the religious teachings every year by implementing the slaughter of sacrificial animals with strict provisions in accordance with health protocols.


Sree Jyothsna Beesetti; Nagendra Kumar Turaga; Girish Salaka; Mohana Turaga

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 9, Pages 2341-2349

A new, universally attractive and applicable paradigm that welcomes and encourages people to take responsibility for themselves and explore their true selves in search of health, especially in sickness and adversity is spirituality and psychological beliefs. In COVID-19 pandemic situation, how people react and will be in a healthy condition is a crucial aspect in India and even in other countries. To investigate the solution, we had aimed to study the impact of two factors like spiritual well-being and psychological well-being on attack of COVID-19 in India. To study the same a sample of 650 respondents were taken through online survey where 285 questionnaires were only selected for further analysis. A well-designed questionnaire was prepared by testing validating through experts for collecting the responses. Factor analysis and multiple regression tools were used to analyse the data for achieving objective of study. The results notified that spiritual well-being and psychological well-being were having less impact on attack of COVID-19 in people, but the relation exhibits significant. Which implies even there is less impact they are having some relation in prevention of attack of COVID-19. The paper continued with the future research of the study.

Challenges of COVID-19 Vaccine Delivery Management in India

Dr Sandeep Bhardwaj

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 10, Pages 2509-2515

Corona Virus or SARS-CoV-2 or Covid-19 virus has disrupted the world like nothing else humanity has seen. It has brought about an unprecedented health crises that we only heard about in books. Every country was found wanting in preparation to fight the attack. With no treatment in sight, the only solution scientists started working on was to make a vaccine to prevent infection. Vaccine development history shows at best 10 years in the making. In a rare worldwide cooperation of best minds of the world, this feat was achieved in 10 months. Humanity will never forget the year 2020 which brought a crises and the human spirit to find solution to it.
The main objective of this study is to look at the scenario post vaccine discovery and approval. The disease being so contagious, has to be curbed by vaccinating the entire population. This is not an easy task as it involves mind boggling efforts on part of government authorities who are directly concerned with public health. For a vast and highly populated country, it is even more complicated. The study examines the major challenges in vaccinating the billion plus Indian population. Availability of skilled manpower, a weak healthcare infrastructure, delivery logistics, cost of the vaccine, and spread of misinformation are some of the most important challenges that have emerged out of this study.

Coronavirus (COVID-19): preventive measures and potential interventions

Marwan M Merkhan; Ghayth M Abdulrazzaq; Hiyam A Al-Taii

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 10, Pages 1388-1399

Novel viral eruption originating in Wuhan city (Hubei, China) has spread internationally reaching all continents in an unexpectedly very short time, posing a great burden on global transportation, health, and economy. This mini-review article aimed at focusing on the available preventive measures and therapeutic interventions taking into account that there is a limited scientific resource of information and lack of specific established vaccination yet We searched Iraq Virtual Science Library (IVSL), PubMed, Cochrane Library MEDLINE, EMBASE, and the Chinese Biomedical Database (CBM), for the 3 target words ‘COVID-19, coronavirus, 2019-CoV’ and we included only articles in English in the study. The outcome of this study is important nationally and globally providing information about general measures and possible interventions relevant to public and health professionals. This review concludes that the nutritional status of the patient together with proper diagnosis should be the priority of the management plan provided that the loci is within the outbreak area and available flu vaccines should be used by unaffected health-care providers and children.

Automatic Classification of the Severity of COVID-19 Patients Based on CT Scans and X-rays Using Deep Learning

Sara Bhatti; Dr. Asif Aziz; Dr. Naila Nadeem; Irfan Usmani; Prof. Dr. Muhammad Aamir; Dr. Irum Khan

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 10, Pages 1436-1455

The 2019 novel coronavirus (COVID-19), which originated from China, has been declared a pandemic by the World Health Organization (WHO) as it has surpassed over eighty three million cases worldwide, with nearly two million deaths. The unexpected exponential increase in positive cases and the limited number of ventilators, personal safety equipment and COVID-19 test kits, especially in Low to Middle Income Countries (LMIC), had put undue pressure on medical staff, first responders as well as the overall health care systems. The Real-Time Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) test is the decisive test for the diagnosis of COVID-19, but a significant percentage of positive tests return a false negative result. For patients in LMICs, the availability and affordability of routine Computerized Tomography (CT) scanning and chest X-rays is better compared to an RT-PCR test, especially in rural areas. Chest X-rays and CT scans can aid in the prognosis and management of COVID-19 positive patients, but are not recommended for diagnostic purposes. Using Deep Convolutional Neural Networks (CNN), three network based pre-trained models (AlexNet, GoogleNet and Resnet50) were used for the automatic classification of positive COVID-19 chest X-Rays and CT scans based on their severity into three classes- normal, mild/moderate, severe. This classification can aid health care workers in performing expeditious analysis of large numbers of thoracic CT scans and chest X-rays of COVID-19 positive patients, and aid in their prognosis and management. The images were obtained from public repositories, and were verified and classified by trained and highly experienced radiologist from Agha Khan University Hospital prior to simulations. The images were augmented and trained, and ResNet50 was concluded to achieve the highest accuracy. This research can be used for other lung infections, and can aid the authorities in the preparations of future pandemics.

E-Learning In Undergraduates: New Insights In Medical Education

Haritha G; Benjamin M Sagayaraj; Nidhi Sharma

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 10, Pages 1708-1718

Aims & objectives: Covid-19 pandemic lead to the close of many real university campuses and initiation of online classes in MBBS curricula. The primary objective of the study is to analyze the conceptual flow and efficacy of online lectures in clinical disciplines and also to assess the medical undergraduate student satisfaction after 6 months of Online Clinical Phase III e-Campus. The secondary objective is to detect the student perspective and difficulties faced by final year medical students while attending online teaching in MBBS.Materials and methodsPhase III MBBS Students underwent Online Curricular activities like PPT lectures, QUIZ, buzz sessions, Case Based Discussions and Short Answer type assignments, on line Video presentation for Six months from April 2020-September 2020. Post test and Feedback was collected after six months as Google forms.
Results:Students felt that there was a longer screen time and there was an inability to focus due to the eyestrain. There were concerns in times of poor Internet accessibility too.
Conclusion:In Medical schools Online –learning is the necessity of the hour during this COVID pandemic especially with teaching hospitals having a high load of COVID -19 cases. Although it is user easy and freely accessible, E–learning cannot completely be used in lieu of in-campus learning. There are numerous effects on student life like eyestrain, easy tiredness due to more screen time and inability to concentrate

The Impact of LSSR Policy on the Anxiety Level of Undergraduate Students during COVID-19

Xindy Imey Pratiwi; Jayanti Dian Eka Sari; Bela Yuli Selfia; Ianatul Ulya Dewi

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 10, Pages 2178-2186

Coronavirus Disease (Covid-19) is an infectious disease caused by the new corona virus and causes most sufferers to experience respiratory disease. The current situation of Covid-19 until December 15, 2020 is known to be 623,309 people in Indonesia who have been confirmed as infected Covid-19. As a result of the continuous increase in the number of confirmed Covid-19 cases, the government implemented a LSSR policy to prevent the spread of Covid-19. However, this policy is felt to have a negative impact on the education sector, especially for undergraduate students. This research was an observational analytic study using a cross-sectional method located in cities and districts in East Java Province and was conducted from August to November 2020. The population in this study were all final semester students domiciled in East Java in 2020 with the number a sample of 385 people. This study was conducted to determine the effect of LSSR policy on the level of anxiety of final semester students in East Java. This study found that there was a significant influence between the implementation of the LSSR policy and the level of student anxiety in the final semester in East Java that was positive. This means that if there is an increase in the effect of the implementation of the LSSR policy on respondents, the level of anxiety will also increase.

Use Of Chloroquine And Hydroxychloroquine In COVID-19 Patients- A Dilemma

Archana Bhatia; Sandeep K Bains; Ruchika Gupta; Tajinder Bansal; Kuldeep S Sandhu; Jaideepa .

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 7, Pages 6558-6565

The terror of COVID-19 is present universally. The number of cases is on rise. There is always debate about use of chloroquine and hydroxychloroquine as a prophylaxis. Healthcare workers being the front line soldiers need additional protection as compared to general population. This review article highlighted the mechanism of action of both drugs and their role in COVID- 19 patients.

Child Neglect And Its Repercussions In Covid Era

Nagalakshmi Chowdhary; B Suba Ranjana; Subhathira Rajasekaran; V Rajashekar Reddy; Nisha Gupta; A Thirumagal Anuraaga

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 8, Pages 4805-4813

Neglect is one of the most common forms of child abuse, yet is different from other forms of abuse as it refers to omission or negligence in meeting the basic needs of the child. “Neglect of Neglect” is a universal problem that needs one step more attention than the ever soaring physical and sexual abuse. The wellbeing and security of children makes a fundamental part in developing a prosperous nation. Healthcare professionals and teachers play a key role in identifying the child abuse and neglect, and thereby provide an immediate and a long term support to the children. A search was done from pubmed and google scholar with key terms “child” “child neglect” “Covid” “child rights”. The purpose of the present article is to provide an overview of the child neglect from a medical to socio-legal perspective in India and its negligence amidst the Covid pandemic and to ensure a prompt comprehensive multidisciplinary approach to protect the neglected child.

Awareness And Practice Of Infection Control Protocol Amidst Covid-19 Pandemic In Private Dental Clinics In North India: An Original Research

Dr. Yash Pal Singh; Dr. Brajesh Gupta; Dr. Heena Tiwari; Dr. Akshay M. Dhewale; Dr. Monika Saini; Dr. Shraddha Joshi; Dr. Rahul VC Tiwari

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 7, Pages 6521-6526

Aim: The purpose of our research was to assess the knowledge and awareness regarding infection control practice against coronavirus infection in various dental clinics in North India.
Methodology: A descriptive survey was conducted amongst 200 dentists. A questionnaire consisting of 11 questions was distributed, based upon knowledge of COVID-19, transmission as well as prevention strategies that can be implemented in dental clinics for stopping the chain of outbreak of this pandemic. The data was analysed with the help of descriptive statistics.
Results: 71% of study participants felt the need for using N-95 masks routinely during patient treatment. An astounding number of participants (92%), believed that there have been significant changes in infection control after COVID-19 pandemic. 65% of participants believed that HVE suction devices as well as HEPA filters need to be used to control aerosol spread so as to prevent COVID-19 infection.
Conclusion: Dentists in North India showed satisfactory knowledge and positive attitude towards COVID-19. Improving dentists’ level of knowledge could be achieved through increasing their accessibility to materials provided by dental health care authorities, which specifies the best and safest approaches for dealing with patients during and after the outbreak.

Relation of COVID-19 infection to outcomes of pregnancy during the pandemic in Kirkuk city

Ebaa Ghassan Akram; Safaa Ibrahim Mohammed; Jaklen Zaea Khoshaba

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 1, Pages 4314-4318

Based on what is known at this time, pregnant women are at an increased risk for severe illness from COVID-19 compared to non-pregnant women. Additionally, pregnant women with COVID-19 might have an increased risk of adverse pregnancy outcomes, such as preterm birth. The study was conducted in the city of Kirkuk city during the period between February 1, 2020, and September 1, 2020, at Gynecology and children hospital. Through the study, 100 pregnant women were received, complaining of Covid-19 infections, which were diagnosed in Kirkuk, and now Real Time PCR was confirmed through nasopharyngeal swabs that were taken from the Hospital. The study also included measuring the level of blood pressure, sugar and IL-6 in those women during the fifth to eight week, where we were infected, and then in the 12th week of pregnancy took place, where communication was made, and a level was measured, and as a result, these women who completed the period with a pre-term labor, miscarriage before the 24th week of pregnancy or those completed the period with successful pregnancyThe study showed that were asymptomatic, 45% of cases of COVID-19 patients were with mild infection and 10% were with severe infection (P<0.001) In this study, 10 % of COVID-19 pregnant women suffer from hypertension, 13% were with Diabetes, 35% with UTI while 70% were suffered from fever. When reaching 24th week of pregnancy, and as shown in Table 3. The study showed that 40% COVID-19 pregnant women experienced completed the period with a preterm labor, 10% was with miscarriage before the 24th week of pregnancy, while 50% of them completed the period continued the pregnancy. In this study, 82.5 % of COVID-19 pregnant women with preterm labor were suffered previously from fever comparing with 55% of COVID-19 pregnant women without preterm labor.The study showed that the highest mean of serum IL-6 was found in women infected with COVID-19 comparing with healthy control (12.8±3.6 v.s. 29.3±3.1 ng/ml) (P: <0.001). Conclusions:The study showed a significant relation of COVID-19 infection with pregnant women who pre-term labor especially who have high body temperature.

Epidemiological study of COVID-19 pneumonia in pregnant woman and their neonates; report of thirteen confirmed COVID-19 pregnant women

Alireza Kamali; Behnam Mahmodiyeh; Amir Almasi-Hashiani; Morteza Mousavi Hasanzadeh; Maryam Shokrpour

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 1, Pages 4455-4461

Background: In new pandemic, the probable effects of COVID-19 pneumonia on pregnant woman and their infant is one of new critical challenge for health care. Here we presented clinical symptoms, laboratory findings and outcome of COVID-19 pneumonia in pregnant woman. Methods: In a case series study, from 15 Feb to 15 June 2020, all women with RT-PCR COVID-19 who referred to two hospitals (Taleghani and Qods Hospital) affiliated to Arak University of Medical Sciences were selected. The epidemiological and demographic variables, laboratory test and outcomes obtained from patient’s medical records. Results: In this case series, we presented thirteen confirmed COVID-19 pregnant women. Their mean age was 34.6 (S.D.: 5.9) years and the mean gestational age was 32.4 (S.D.: 7.3) weeks. Most of patient didn’t show any maternal complication and intrauterine vertical transmission. The large number of pregnant women had normal HRCT and also in terms of laboratory most of the patients had normal laboratory tests. Amniotic fluids, cord blood, the throat swab of neonate in our pregnant woman with delivery were tested for COVID-19 and all of them were negative. Conclusion: The COVID-19 mothers and their infant didn’t have higher risk for morbidity and mortality and this virus didn’t associate with intrauterine vertical transmission.