As the COVID-19 pandemic rages on, reports on disparities in vaccine roll out alongside COVID-19 reinfection have been emerging. We conducted a systematic review to assess the determinants and disease spectrum of COVID-19 reinfection. A comprehensive search covering relevant databases was conducted for observational studies reporting Polymerase Chain Reaction (PCR) confirmed infection and reinfection cases. A quality assessment tool developed by the National Institute of Health (NIH) for the assessment of case series was utilized. Meta-analyses were performed using RevMan 5.3 for pooled proportions of findings in first infection and reinfection with a 95% confidence interval (CI). Eighty-one studies reporting 577 cases were included from 22 countries. The mean age of patients was 46.2 ± 18.9 years and 179 (31.0%) cases of comorbidities were reported. The average time duration between first infection and reinfection was 63.6 ± 48.9 days. During first infection and reinfection, fever was the most common symptom (41.4% and 36.4%, respectively) whilst anti-viral therapy was the most common treatment regimen administered (44.5% and 43.0%, respectively). Comparable odds of symptomatic presentation and management were reported for the two infections. However, a higher Intensive Care Unit (ICU) admission rate was observed in reinfection compared to first infection (10 vs 3). Ten deaths were reported with respiratory failure being the most common cause of death (7/10 deaths). Our findings support immunization practices given increased ICU admissions and mortality in reinfections. Our cohort serves as a guide for clinicians and authorities in devising an optimal strategy for controlling the pandemic. (249 words)

Primary Myelofibrosis is a BCR-ABL negative myeloproliferative neoplasm with a variety of hematologicalpresentations, including thrombosis, bleeding diathesis and marrow fibrosis. It is estimated to have an incidence of1.5 per 100,000 people each year. Although JAK2 or MPL mutations are seen in PMF, several other mutations haverecently been documented, including mutations in CALR, epigenetic regulators like TET, ASXL1, and 13q deletions.The identification of these mutations has improved the ability to develop novel treatment options. These include JAKinhibitors like ruxolitinib, heat shock protein-90 inhibitors like ganetespib, histone deacetylase inhibitors includingpanobinostat, pracinostat, vorinostat and givinostat, hypomethylating agents like decitabine, hedgehog inhibitors likeglasdegib, PI3K, AKT and mTOR inhibitors like everolimus as well as telomerase inhibitors like imtelstat. Researchon novel therapeutic options is being actively pursued in order to expand treatment options for primary myelofibrosishowever currently, there is no curative therapy other than allogenic hematopoietic stem cell transplantation (ASCT)which is possible in select patients.

BACKGROUND Type 2 diabetes is a chronic medical condition that is associated with high morbidity and mortality. The prevalence of type 2 diabetes has been increasing over the past few decades. While most interventions are aimed at managing the symptoms of type 2 diabetes, few of these interventions have proven to be effective in preventing the progression of the disease. Weight loss is one of the few known interventions that has been proven to delay the progression to diabetes from the prediabetic state and results in an improvement in symptoms with a reduced dependence on pharmacological therapy. The methods commonly used to achieve weight loss are calorie restriction (CR) and time-restricted feeding (TRF). The purpose of this study was to determine whether CR, TRF, or CR with TRF is the most ideal method for treating patients with prediabetes and diabetes and to determine the effects of these interventions on body weight, blood sugar levels and the serum lipid profile. OBJECTIVE The objectives of our study are to determine the effects of TRF alone, TRF with CR, and CR alone on disease markers and clinical parameters of diabetes such as body weight, blood sugar levels and serum lipid profile. METHODS This will be a randomized controlled clinical trial. The subjects who met the inclusion criteria will be randomly divided into four of the following groups: 1) CR 2) TRF 3) TRF with CR and 4) Control. Patients will be asked to document their food intake with the assistance of MyFitnessPal application and to track their fasting hours using the Zero application. Body weight, BMI, vital signs, fasting plasma glucose, HbA1c and lipid profiles will be assessed at baseline and at weeks 4 and 12. RESULTS This study received approval from the Ethics Review Committee of the Aga Khan University in 2020. Enrollment of the clinical trial completed in May 2021. Full and final results of the trial will be published in a separate manuscript and shared with the broader medical community in a separate manuscript by the end of 2024 and through conference proceedings. Initial results indicate a statistically significant reduction in the TRF and combined (TRF+CR) cohorts as well as a statistically significant reduction in the fasting blood sugar levels of study participants. CONCLUSIONS The ultimate purpose of this study is to identify a patient-friendly, novel and therapeutic dietary intervention that will help limit the risk of type 2 diabetes. This study will help in introducing an effective lifestyle intervention to promote health, which will reduce the dependence on pharmacological therapies as well as the burden on the healthcare system in the long term. CLINICALTRIAL Registry: ClinicalTrials.gov ClinicalTrials.gov ID: NCT04463277 URL of Trial Registry Record: https://classic.clinicaltrials.gov/ct2/show/NCT04463277