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BACKGROUND: As on March 12, 2020, the WHO declared COVID-19 as a global pandemic. Its rapid spread has posed major challenges to the management of health-care systems. Patients with hematological disorders, being immunocompromised in more ways than one, face a lot of challenges. Most of these patients require frequent visits to health-care facilities for transfusion support, infusions, surveillance, and follow-ups, which increase the risk of exposure and hence infection with severe acute respiratory syndrome coronavirus 2. AIM: We assessed the impact of the pandemic on the decisions of hematologists in Saudi Arabia. Method(s): An online survey was done through questionnaires, to understand the decisions and course of clinical treatments taken. 45 hematologist answered 20-questions structured questionnaires through online link. RESULT(S): The majority of hematologist have used virtual clinics in managing patients and have delayed or canceled well visits. Although some hematologist delayed treatment in stable patients like autologous stem cell transplantation for myeloma patients, the majority did not delay induction or consolidation therapies for patients with leukemia with curative intent plans. CONCLUSION(S): The crisis brought along with it challenges and opportunities to improve patient care through research and clinical practice. Telemedicine was sought for supporting outpatients. Malignancies were taken care of, with due precautions. Observations of decisions of hematologists resulted in the patients still being closely followed up and urgent treatments being attended to. The hematologists expressed satisfaction with the use of telemedicine. Online consultations and monitoring of patients could probably be taken as an alternative resource in such situations.Copyright © 2023 Journal of Applied Hematology Published by Wolters Kluwer - Medknow.
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Education was one of the worst affected sectors globally due to the pandemic which has caused more than 220 million students who have got displaced from their regular classroom teaching. According to the reports by UNESCO, the COVID pandemic impact on teaching and learning was felt on the shift towards online education to all age groups. After this effect, more than 90% higher educational institutions have started to accept teaching and learning through an online mode using different virtual educational platforms as a mechanism to provide an uninterrupted learning experience. Prior to pandemic, globally most of the formal education was classroom based while the percent of those under online education are typically delivered through non-formal educational such as distance education, correspondence learning, E-learning etc. Besides, education system prior to pandemic were more focused and oriented towards formal education adopting traditional classroom and face to face teaching and learning. Nevertheless, before the pandemic there was also significant progress made towards online education especially in education technology adoption, usage of online learning apps, and software, which opens the scope for evaluating the implication of online education before and during the pandemic. This chapter has examined the role of online education especially during the pandemic and summarized the different trends, technologies applications in E-learning that are employed in the current online education system. © 2023 selection and editorial matter, Joanna Rosak Szyrocka, Justyna Zywiolek, Anand Nayyar and Mohd Naved;individual chapters, the contributors.
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In the present times talking about distance education would be incomplete without mentioning the online education. Online education can be broadly classified as asynchronous and synchronous learning. The online platforms like MS Teams, zoom, google meet, CISCO Webex etc are widely accepted tools for the synchronous learning, where the learner can attend a live session, and can interact with the instructor or the resource person. Covid 19 has led to a quick adoption of technology, however, a major share of the population still seems to be struggling with the use of technology and might be having an anxiety termed as new technology anxiety with regards to online platform. In this study MS Teams has been analysed from the viewpoint of users through Technology Acceptance Model (TAM). Descriptive statistics have been used via SPSS-21 on the data administered from 409 respondents from 15 nations who participated in the international workshop series organised in Oman. The study reveals that despite the popularity of MS teams, the participants had high level of new technology anxiety in using it. The results can be used as user feedback for MS teams, and can be utilised by Educational Institution, and other agencies that are facilitating the online education directly or indirectly. © 2023 selection and editorial matter, Joanna Rosak Szyrocka, Justyna Zywiolek, Anand Nayyar and Mohd Naved;individual chapters, the contributors.
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Since the first coronavirus disease-19 (COVID-19) outbreak, variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have continued to dominate the global population. The repeated waves of emerging variants, each replacing the previous one with a greater rate of transmissibility and mutations, are the primary cause of the global pandemic. Public health concerns dramatically rose when a highly mutated variant, omicron (B.1.1.529) emerged in late 2021. Omicron has more than 50 mutations, and over 30 mutations are in their spike protein that contributes to the virologic characteristics of the variant. Omicron is more contagious than previously reported SARS-CoV-2 strains and can re-infect people who have already contracted other SARS-CoV-2 infections. The variant has acquired a unique immune escape mechanism against monoclonal antibodies and vaccines. Currently, there are no specific therapeutic drugs or vaccines available to prevent omicron infection and sub lineages emergence. The review was designed to search the recent research or literature papers and compile the most pertinent data on the virologic characteristics of the variant of concern. The study reviewed and discussed the present prevalence, infectivity, dominance, immune evasion, therapeutic options, vaccine efficacy, and the future prospect of the omicron variant. Omicron variant has become a global public health concern due to the emergence of highly mutated sub lineages. Developing variant-specific therapeutic drugs or vaccines is desirable to prevent the spread of these contagious variants globally. © 2022, The Running Line. All rights reserved.
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Early detection of the COVID-19 infection is the key to avoiding fatalities. Chest radiography has proven to be an effective and low-cost solution for detecting the virus. It is important to evaluate the potential of deep learning models for COVID-19 detection from the x-ray images for quick and early detection of COVID-19 with high accuracy. We conducted a study that evaluates the potential and performance of various Convolutional Neural Networks (CNN) architectures for detecting the COVID-19 on a dataset consisting of 5902 chest X-ray images having 2276 instances of X-ray images of COVID-19 patients and 3626 images of healthy and non-COVID-19 pneumonia X-rays. The performance of the models is assessed using metrics like accuracy, specificity, sensitivity, F1 Score, ROC curve, etc. The results suggest that the DenseNet-121 model proved to be the better choice among evaluated architectures for COVID-19 detection from X-ray images in terms of overall performance with an accuracy of 98.2%, sensitivity of 97.6%, and specificity of 98.4%. We conclude that there is a need for further evaluation of the CNN architectures on large, real-world, and diverse datasets for obtaining generalizable results for a reliable diagnosis.Copyright © 2022 Informa UK Limited, trading as Taylor & Francis Group.
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Communication is an important tool in the education sector to ensure its effectiveness. During the Covid19 pandemic, the communication process across the globe undergone a major shift, i.e., from conventional (face-to-face) teaching to online/remote teaching. The communication effectiveness of online teaching has been the talk of the town since its adoption in Oman, major share of the users, adopted it as there was no alternative available. As higher education institutions (HEIs) in Oman are preparing for the post covid era, reflecting on the effectiveness of online teaching would be an area of study so that the HEIs can deliberate on the format of effective communication regarding its teaching learning process. On these lines, the present study is conducted on the faculty and administrative staff of the HEIs who are involved in the decision making of their respective institutions. This study is based on qualitative analysis of the responses based on open ended questions. The findings revealed that the online teaching in Oman suffered many deadlocks like network connectivity in remote areas, low motivation to use among users, students' participation, peer learning among students, lack of proper training to use online platforms etc. In light of these challenges the online teaching was found to be moderately effective and requires attention to improve its effectiveness as a communication tool. This study has an implication of HEIs of the middle east region, governing and accreditation bodies, education allied agencies and policy makers. © 2022,Journal of Content, Community and Communication.All Rights Reserved.
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INTRODUCTION: The Mayo Clinic, Mankato Intensive Care Unit (ICU) has seen a steady increase in central line utilization, known to increase risk for central line-associated bloodstream infections (CLABSI). The "central line" or "device utilization rate" (DUR) for quarter 4 (Q4) 2021 was at 63%, increased from a pre-covid baseline of 45% in 2019. The CLABSI rate in Q4 of 2021 rose to 5.67, the highest in the past 5 years. The aim of this project was to decrease the ICU DUR by 36.5% from a baseline of 63% to 40% by 09/2022 without adversely impacting staff satisfaction. This effort was anticipated to positively impact patient outcomes, patient safety and the patient experience. METHOD(S): A multidisciplinary team conducted a review of current practices and potential contributors to the increased DUR were identified. The root causes of increased central line usage were determined to be lack of awareness on appropriate central line indication and gaps in communication. Interventions were implemented to address the key barriers: (a) Process: A vascular access algorithm was created to suggest the type of access needed based on duration of line and medication infusions. A rounding checklist included indications for central line placement and alternatives for vascular access. (b) Communication: Enhancement of daily interdisciplinary rounds and implementation of evening rounds to discuss central line indication and barriers to removal (c) Education: Central line education was provided during daily nurse huddles and weekly newsletters. An educational poster was created and displayed in the ICU, and (d) Closed Loop Feedback: The result of the post-intervention numeric improvement measure and sample size were monitored. Quarterly data will be reviewed for discussion. Key project milestones were recorded throughout the project. RESULT(S): The pandemic saw a surge in ICU patients, and it caused an uptick in central line placement. The project brought awareness of our DUR. Discussions of appropriate placement and early removal of central lines helped decrease our DUR. By June 2022, our DUR rate has decreased to less than 40%. CONCLUSION(S): Through a defined process we have been able to decrease central line utilization in our ICU. We will continue to monitor to ensure that our improvements are sustained.
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INTRODUCTION: During the COVID-19 pandemic, the burden on the healthcare system makes it critical to examine readmission patterns. In this study, we evaluated the readmission rates and risk factors associated with COVID-19 from the large SCCM Discovery VIRUS: COVID-19 Registry. METHOD(S): This was a retrospective, cohort study including hospitalized adult patients from 181 hospitals in 24 countries within the VIRUS: COVID-19 Registry. Demographic, clinical, and outcome data were extracted and divided into two groups: Patients with readmission with COVID-19 in 30 days from discharge and those who were not. A univariate analysis is done using chi-square and t-test as appropriate. Multivariable logistic regression was used to measure risk factor associations with 30-day readmission. RESULT(S): Among 20,283 patients, 1,195 (5.9%) were readmitted within 30 days from discharge. The median (IQR) age of readmitted patients was 66 (55-78) years and 45.2% were female, 60.2% were white, and 78.9% non-Hispanic. Higher odds of readmission were observed in patients aged >60 vs 18-40 years (OR 2.76;95% CI, 2.23-3.41), moderate COVID-19 disease (WHO Ordinal scale 4-5) vs Severe COVID-19 (WHO Ordinal scale 6-9) (OR 1.23;95% CI, 1.10-1.39), no ICU admission at index hospitalization (OR 1.70;95% CI, 1.32-1.80), and Hospital length of stay <=14 vs >14 days (OR 1.53;95% CI, 1.32-1.80) vs those not readmitted (p= < 0.001). Comorbidities including coronary artery disease (OR 2.14;95% CI 1.84-2.48), hypertension (OR 1.58;95% CI 1.40-1.78), congestive Heart Failure (OR 2.54;95% CI 2.16-2.98), chronic pulmonary disease (OR 2.26;95% CI 1.94-2.63), diabetes (OR 1.32;95% CI 1.17-1.49) or chronic kidney disease (CKD) (OR 2.41;95% CI 1.2.09-2.78) were associated with higher odds of readmission. In multivariate logistic regression adjusted for age group, hospital length of stay <=14 days and, highest WHO COVID-19 ordinal scale and index ICU admission coronary artery disease, congestive heart failure, chronic pulmonary disease, chronic kidney disease, hospital length of stay <=14 days and age >60 years remained independent risk factors for readmission within 30 days. CONCLUSION(S): Among hospitalized patients with COVID-19, those readmitted had a higher burden of comorbidities compared to those non-readmitted.
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In March 2020, an infection caused by SARS-CoV-2 termed COVID-19, was declared by WHO, as a world pandemic having affected 54.1 crores individuals across 230 countries to date (23rd June 2022). The infection is caused due to a fast-mutating virus that can best be controlled through one's immune system and strengthening the same is a challenge currently. Enriching immunity has persistently been a matter of study and conclusive results depict that nutritional status has a tremendous impact on strengthening immunity. Both macro-and micronutrients play a significant role in developing a strong immune response. Most of the mediators of immune response like cytokines, interferons, and antibodies along with surface markers such as MHC, toll-like receptors, membrane transporters, etc., are all proteinaceous, and hence an adequate protein intake is vital for ideal immune response. The fermentation of dietary fiber by the microflora in the gut leads to the generation of short-chain fatty acids known to be anti-inflammatory. Poor status of nutrients such as vitamin A and zinc have been reported to be related to not only the increased rate of infection risk but also higher levels of oxidative stress as well as inflammation. Both these factors down regulate the immunity and thereby lower the recovery rate. These nutrients mediate the immune signalling pathways including the transcription of factors as NFkB and Nrf-2 and reduce the generation of cytokines as IL-6 which are associated with reducing inflammation. Nutrients like vitamin D besides working on immunity also play a substantial contribution in preventing infection as they modulate the surface receptors, thereby hindering the entry of viruses into the host cells. This article is aimed at emphasising the vital significance of nutritional status in enhancing the immune system and preventing infection during the current pandemic.
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Objective: The aim of this study is to analyze the perception of Dentists in Pakistan towards Tele-Dentistry and its usefulness during Covid-19 pandemic. Material(s) and Method(s): The study was conducted among general dentists of Lahore after taking approval from the Ethics and Research Committee of the institution. This descriptive cross-sectional study was completed over the period of three months. Non-probability snowball sampling technique was used. Result(s): The results revealed that most of the dentists (89.5%) perceived that Tele-Dentistry can be of help during COVID 19 Pandemic in Pakistan. Conclusion(s): Most of the dentists were aware of teledentistry, and its uses, advantages and disadvantages in Covid-19 pandemic. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.
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INTRODUCTION: During the COVID-19 pandemic, many hospitals employed neoadjuvant chemotherapy (NAC) to delay oncologic resections to mitigate resource strain. But the role of neoadjuvant chemotherapy in ampullary carcinoma is unclear. This study aimed to compare outcomes of NAC and adjuvant chemotherapy (AC) for surgically treated patients with ampullary carcinoma. METHOD(S): The National Cancer Database was queried for patients with stage I to III ampullary carcinoma diagnosed between 2004 and 2017 and treated with both chemotherapy and surgery. Factors associated with receiving NAC were identified. Patients in the NAC group were propensity matched in a 1:5 ratio with patients in the AC group by using the nearest neighbor method. Odds of negative resection margin and overall survival for the matched groups were compared using Fisher's Exact test and Cox hazards regressions, respectively. RESULT(S): Of 3,930 patients included in the study, 137 (3.5%) received NAC. Patients were more likely to receive NAC if they had stage I disease (odds ratio [OR] 3.12, 1.87 to 5.22 vs stage III), were treated in the Midwest (OR 2.25, 1.10 to 4.58 vs the West) or were age 65 or older (OR 1.98, 1.13 to 3.46). There were no differences between the matched NAC and AC groups for any stage in rate of negative surgical margins or overall survival (Table) CONCLUSION(S): We found that NAC is rarely used in the treatment of ampullary carcinoma. However, it is associated with outcomes similar to AC for this disease. Delay of surgical resection through utilization of NAC may be reasonable for this population when necessary.
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The coronavirus pandemic has caused unprecedented supply chain disruptions globally, resulting in a heightened need for supply chain resilience. Particularly in the case of semiconductor chips, a commodity already in high demand, the existing challenges in supply chains have been aggravated by the pandemic. This global shortage is resulting in manufacturing disruptions across multiple sectors from automobiles to electronics. The global automobile industry alone is said to suffer a $210 billion loss in revenue from chip shortages. This highlights the cruciality of scientifically analyzing and building solutions that addresses the issue of resiliency of global semiconductor supply chains. While several news articles and white papers have reported this issue, there has been a lack of scientific literature on this topic. The objective of this paper is to identify the factors causing semiconductor shortage, analyze, and quantify their impact on the supply chain. This paper identifies 20 factors under 4 major categories from pre-and post-pandemic era, in the period ranging from 2018 to 2021, that have contributed to this disruption. The categories are: geopolitical tensions, natural disasters, logistics challenges and COVID-19 pandemic. The factors are ranked using the Analytical Hierarchy Process (AHP) methodology. The scientific value of this study lies in its contribution of quantifying and ranking the impact of the individual factors leading to the recent disruption in semiconductor supply chains. The results of this study will provide supply chain managers with the analytical information necessary for enabling resilient semiconductor supply chains as they navigate through these current challenges. © Proceedings of ASME 2022 17th International Manufacturing Science and Engineering Conference, MSEC 2022.
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Across 218 countries, since March 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been a reason for concern. Doctors as well as researchers. stand together to find a treatment for this pandemic. The virus attaches to the host cells via transmembrane spike glycoprotein. The glycoprotein has affinity for human angiotensin-converting enzyme 2 and is dimeric. Thus, the virus attaches to the ACE receptors through the receptor-binding domain (SARS-CoV-2 RBD Spro). Further, the main protease (Mpro), a chymotrypsin-like protease (3CLpro), plays a critical role in post-translational modifications, thereby affecting viral survival. Thus, targeting these viral markers can not only block the fusion with host cells, but also affect replication of the virus. Ancient civilizations have been using plants, herbs as well as spices for their medicinal values as antiviral, antiinflammatory, antipyretic, antimicrobial and many more. The rich array of phytochemicals in these spices endows them with these beneficial properties, and hence they are largely being looked as agents for therapeutic use. However, the journey from laboratory for drug development is a time-consuming process as it starts from trying to identify the major therapeutic component to its pre-clinical studies, clinical and then its marketing as a drug. In the current pandemic where loss of human life has been in millions, a faster and more efficient modality like in silico studies can help escalate this search for a therapy thereby saving mankind. This study is a comprehensive review on results of in silico approaches conducted in near future in an attempt to evolve an ideal therapeutic candidate for ending the pandemic. Results of research conducted on phytochemicals from medicinal and aromatic plants as potential therapeutic candidates using tools of bioinformatics and computational modelling are hereby discussed.
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Paxlovid™ is a combination of Nirmatrelvir and Ritonavir antiviral pills with good oral bioavailability. In clinical studies, treatment of the patients infected with SARS-CoV-2 with Paxlovid™ within three to five days of the appearance of symptoms significantly reduced the hospitalization rate as well as mortality. It is the first oral antiviral treatment for the COVID-19 which received USFDA approval for EUA on 22nd December, 2021. Nirmatrelvir inhibits the replication of SARS-CoV-2 while another antiviral drug, Ritonavir, is given in combination to enhance the bioavailability of Nirmatrelvir. Molecular interaction studies have shown that Nirmatrelvir binds covalently with the catalytic triad of the active site of the viral protease enzyme (3CLPRO). It, therefore, acts by stopping the SARS-CoV-2 replication by its ability to block the translation of the viral genetic materials. Research studies conducted have proven the efficacy of this oral anti-viral drug in mild to moderate COVID-19 patients beside its ease of oral administration and good oral bioavailability. Alternative synthetic methods to scale up the synthesis of this potent molecule are needed to reduce the treatment cost of the COVID-19. Extensive clinical research on a larger group population is also underway for ensuring the safety and efficacy of this medication in the battle against the COVID-19 pandemic.
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Objectives: To determine patient satisfaction and factors affecting patient satisfaction with laboratory services in Azad Jammu & Kashmir (AJK). Study Design: Cross-sectional study. Place and Duration of Study: Seven District Headquarter Hospitals, DHQ Neelum, DHQ Hattian Bala, DHQ Pallandari, DHQ Bagh, DHQ Kotli, DHQ Bhimber and DHQ Mirpur, Kashmir Pakistan from Dec 2019 to Feb 2020. Methodology: The patients who were referred from the Outdoor Patient Department of the hospital for undergoing investigative tests were included, and patients of age less than 18 and critically ill patients were excluded. Results: The total number of respondents included in the study was 400, with the median score of patient satisfaction with laboratory services being 59 (19), ranging from 32 to 100. Statistically significant disparities in client satisfaction were observed in different DHQ hospitals (p-value=0.01) with Mirpur (63) and Pallandri (40) showing the extreme variation. Residential area, age, and education level were also identified as statistically significant determinants of patient satisfaction (p-value <0.05). Conclusion: patient satisfaction with laboratory services in public hospitals of AJK was very low, and targeted strategies are needed to improve the overall quality of these services. © 2022, Army Medical College. All rights reserved.
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Various international initiatives have been launched in 2021 to generate digital vaccination certificates to address challenges faced by travellers exposed during COVID19. While COVID19 has impacted multiple industries where alternate solutions have emerged at competing rates, airline industry in particular have been hit hard due to highly regulated protocol. Owing to its unique characteristics of transparency and decentralization, block chain technology provides an opportunity to create smart solutions for travel industry. We present a solution that describes a scaled, blockchain-based infrastructure for exchanging COVID-19 pandemic travellers’ history and vaccination status in a secure manner. The proposed approach ensures the travellers are coronavirus-free and check their COVID 19 history and vaccination status across the borders and immigration in particular. The framework employs a permission blockchain and Proof of Authority to check vaccination status on airports using the smart contract. It provides a distributed infrastructure for national and international healthcare systems, to check digital vaccination certificate and individual vaccination history and their verification by relevant stakeholders, such as airport securities, health authorities, governments, border control authorities and airlines. © 2022, Springer Nature Switzerland AG.
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In this comparative cross-sectional study, we compare the physical performance among post-COVID and non-COVID subjects. A sample of 64 subjects recovered from COVID-19 and 64 subjects who were not infected with COVID-19 were recruited for the study. Both groups were tested for physical performance by 30-s sit-to-stand test, 6-min walk test, and HUMAC balance system. The findings of the present study reveal that there was a significant difference in physical performance between both the groups. In conclusion, this study demonstrated that physical performance is impaired in the post-COVID subjects as compared to the matched non-COVID subjects. Therefore, physical therapy exercise program/regimen should be a part of recovery from COVID-19.
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E-commerce (EC) is a popular term also occasionally known as Internet Commerce which has grown drastically in the past few decades. Covid 19 has made most of the firms to consider EC as a necessity. At one place EC has started to grow and Business to Business Electronic Commerce (B2BEC) too has been implemented by many businesses. The process includes the transaction of goods and services, the transfer of funds and the exchange of data virtually. B2BEC opens up new possibilities of trade and for new business partners from around the globe can be found, their offers can be compared, even complex negotiations can be conducted electronically, and a contract can be drawn up and fulfilled via an electronic marketplace. However, sophisticated data management is required to provide such facilities. On the other hand the contribution of the researchers cannot be ignored in the present context, as they bring on surface many pertinent issues and potential solutions with regard to the daily problems faced by the society. The researchers also are responsible for unearthing issues that might become a point of concern in the future. The researchers’ works need to be reviewed in a systematic way so as to identify the gaps where the future research can be conducted and the gaps can be filled. As the database management is increasingly having relevance in the arena of B2BEC, it is crucial to check the holistic retrospective in this study in light of literature available. As there are no review papers till date in the arena of database management in B2BEC, the present paper is dedicated to explore for the same and propose gaps identified in this area. For this purpose, the paper adopts bibliometric analysis of SCOPUS database i.e., the largest database for scientific studies. © 2022 by Nova Science Publishers, Inc.
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OBJECTIVES: To assess the patient satisfaction with telepsychiatry consultations, and whether time and money was saved by patients availing the service. METHODS: Anonymous internet survey using Google Form method, was conducted between April 2020 and September 2020 to collect data from patients using teleconsultation in out-patients psychiatry clinic. The google form consisted of patient satisfaction questionnaire, demographic details, and additional questions about the money and time saved by patients using the service. RESULTS: Out of 260 participants, 152, (58.5%) were males, 148 (58.3%) were married and majority (n=157: 60.4%) of patients were <40 years of age. About 62.7% (n=163) were highly educated. Majority (n=108;41.5%) of the survey participants were from Khyber Pakhtunkhwa province. The average cost saving was Pakistani Rupees 3000 for the consultation whereas the average time saved was 1.5 days. Patients were happy during communication with doctor including seeing doctor on screen (85.7%), hearing to doctor (90.4%), talking to doctor (84.6%) and discussion of their care plan (81.6%). Majority (79.2%) of the survey participants were happy with the meeting of care needs and 86.5% were happy to avail the service in future. CONCLUSION: The study underscores the importance of telepsychiatry as mode of service delivery during the pandemics. The findings demonstrated a high level of patient satisfaction, considerable amount of time and money saving indicates the effectiveness of telepsychiatry consultation. It needs to expand the telepsychiatry service both in public and private hospitals and also test this model on a representative sample of patients in Pakistan.