Learners' Perspective towards E-Exams during COVID-19 Outbreak: Evidence from Higher Educational Institutions of India and Saudi Arabia.

Online examinations, commonly referred to as e-exams (electronic examinations), underwent a considerable progression, getting adapted ubiquitously among higher education institutions worldwide. Their preferment was rapid due to the emergence of the COVID-19 pandemic. The process of conducting exams online is being opted as the appropriate way of assessment, ensuring the students' safety and well-being. According to Warts et al., this form of examination has been pretty effective in the past when blended with the conventional assessment. However, at present, implemented as the singular way of assessment, e-exams have shown a more significant promise in being beneficial to the learners. As a matter of fact, a comprehensive analysis on understanding the learners' perception towards the e-exams was not done earlier, particularly in the developing nations. Thus, it was pertinent to examine the pre-requisites of e-exams to promote it as a useful tool for the smooth conduct of exams in the aforesaid nations. Against such a backdrop, this study was conducted during January to March 2021 on 207 students enrolled in four universities, three situated in the National Capital Territory (NCT) of Delhi, India: Delhi University (DU), Jamia Millia Islamia (JMI), and Jawaharlal Nehru University (JNU), and one situated in Saudi Arabia, namely Saudi Electronic University (SEU). A quantitative approach was employed for the study, with the responses recorded via web questionnaires. Confirmatory -factor analysis (CFA) was applied in the study to examine whether the process of conducting online examinations is being chosen as the appropriate form of assessment, ensuring the safety and well-being of students through AMOS (version 24) software. For determining the reliability of the two latent constructs, namely "Perceptions of students towards E-exams (PSE)" and "Pre-requisites of E-exams (POE)," Cronbach's alpha was used through SPSS (version 25) software in the study, and the results reveal that the strong internal consistency exists between all the measured variables. In addition, the mean and standard deviation were used by the researchers to find out the pre-requisites of the online examination system. The participants expressed their insights on the relative benefits of online examination. Their perception was based on pedagogy, validity and reliability, affective factors, practicality, and security. From their insights, it was concluded that online examination is more advantageous than conventional paper-based exams. The outcome also applies to the authenticity of grading and the overall efficiency concerning the time, effort, and expenditure on conducting the examination. Contrarily, the participating students also recognized numerous hurdles in implementing e-exams concerning security, validity, and impartiality. The conclusion further revealed that online examination is especially relevant for formative assessment of learning instead of summative assessment, provided authenticity, security, and flexibility are used as fundamental tenants in the proper implementation of e-exams. The outcome of the present study will facilitate higher education institutions and policymakers in taking the electronic examination system to the next level.

Statins and Abnormal Liver Function Tests: Is There a Correlation?

Background Statins or 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors are one of the most commonly prescribed medications in cardiac patients. Just like any other class of drugs, they have the potential to cause liver injury over time even with judicious use. This drug-induced liver injury (DILI) can be either direct (hepatocellular) or idiosyncratic. As with multiple other hepatic pathologies, DILI may be asymptomatic or clinically silent. Therefore, it is prudent to carry out liver function tests (LFTs) from time to time. LFTs are an inexpensive, noninvasive, and quick first-line investigation to monitor liver status. However, the pattern of liver injury with statin use is not specific and a correlation over time may not be apparent. Aims To evaluate derangement in LFTs over time with respect to statin use and determine if a correlation exists. Methods This was a retrospective observational cohort. All data were collected from the online database of the National Institute of Cardiovascular Diseases (NICVD), Karachi. Patients admitted to the NICVD from July 1, 2018, to December 31, 2018, were eligible for inclusion in the study. Only patients already taking a statin (in any dose) were considered for inclusion. LFTs were recorded from the database at inclusion, post-induction at six and 12 months. Extensive workup was done and great care taken to rule out other diseases that may have affected the LFTs. Results Two hundred and four patients were eventually inducted into the study after a meticulous exclusion process. The male to female ratio was 4:1. The mean duration of statin use before induction into the study was 19.92±14.34 months. Patients were predominantly using only one of two statins, i.e., rosuvastatin 20mg/day or atorvastatin 40 mg/day. Elevations of LFTs were seen with both drugs throughout the study period. These elevations were almost always <2x the upper limit of normal (ULN); greater elevations were seen with atorvastatin 40 mg/day. The derangement in LFTs persisted and improvement was not seen. Conclusions Statins cause dose-dependent borderline elevations of liver function tests over time. These elevations are clinically and statistically insignificant and should not deter physicians from prescribing or continuing statins.

An Overview of First 100 Cardiac Surgery Cases at a Newly Developed Satellite Center in Sukkur, Pakistan.

Introduction The aim of this research is to evaluate the in-hospital and early outcomes of the first 100 adult cardiac surgeries performed at a newly developed satellite center in Sukkur, Pakistan. Methods This is an audit of the first 100 adult cardiac surgeries performed at a newly developed satellite center of the National Institute of Cardiovascular Diseases (NICVD) at Sukkur, Pakistan, from March 2018 to November 2018 with 12 months of post-operative follow-up. Patients were offered off-pump coronary artery bypass (OPCAB), on-pump coronary artery bypass (ONCAB), mitral valve replacement (MVR), aortic valve replacement (AVR), minimally invasive cardiac surgery (MICS), and congenital adult congenital heart disease (ACHD) procedures by expert faculty of NICVD with a minimum of five years of post-fellowship experience. Results The mean age was 47.11 ± 14.6 years, with a male predominance of 77%. Hypertension and smoking were the most common risk factors that were observed in 32% and 33%, respectively, followed by diabetes and dyslipidemia with a frequency of 20% and 9%, respectively. The mean EuroSCORE (European System for Cardiac Operative Risk Evaluation) II for this patient cohort was 1.165 ± 0.50, with a maximum score of 2.3 in one patient. Out of 100 procedures, 51 were ONCAB, 19 were OPCAB, 16 were MVR, three were AVR, nine were ACHD, and two were MICS. Survival status post-operative as well as after one year was 100%. The frequency of post-operative bleeding was 7%, mean post-operative mechanical ventilation time was 213 ± 273 hours, and in-hospital stay was 5.41 ± 0.165 days. Lost to follow-up at one year was 4% (four). During the follow-up assessment, 39.5% of the patients had complained of mild-to-moderate intensity retrosternal pain and 4.2% had superficial surgical site infection of the sternal wound. A significant improvement in functional class was observed in 38.5% of patients, whereas 4.2% (four) had a significant drop in functional class post-operatively. Conclusion Providing tertiary care and early cardiac surgical facility to the people of Sukkur at their doorstep, in a newly developed satellite center, has resulted in improved outcomes, early quality treatment facility, and avoidance of long travel time.

Common Predisposing Factors in Mortality of Patients After Undergoing Mitral Valve Surgery at a Tertiary Care Hospital in Karachi.

Background Isolated mitral valve replacement is a routinely performed procedure at our institute due to higher prevalence of rheumatic heart disease in every age category. Hardly any researches are available that dictate the predictors of surgical mortality in isolated mitral valve procedure. The aim of this study was to identify the most prevailing pre-operative factors in patients who had mortality after isolated mitral valve surgery. Methodology A retrospective observational study of two years was performed from January 2018 to December 2019 at the Adult Cardiac Surgery Department of a tertiary care cardiac center in Karachi, Pakistan. Patients of either gender of age ranging from 16 to 65 years who had mortality within 30 days after isolated mitral valve surgery were included in the study. Variables assessed from records were anemia, New York Heart Association (NYHA) functional classification, prolonged symptoms, poor nutritional status, degree of left ventricular (LV) dysfunction, valve pathology, pulmonary artery hypertension, and cardiac arrhythmias. Results We report our isolated mitral valve mortality rate of 5.5% (38/697) in the two-year duration. The most commonly encountered pre-operative factors were severe mitral regurgitation and pulmonary artery hypertension, which were observed in 32 (84.2%) and 23 (60.5%) patients, respectively. Other factors that were common to these patients were higher NYHA functional class (class III in 23 [60.5%] and class IV in 9 [23.7%]), prolonged duration of symptoms (20 [52.6%]), and right ventricular dysfunction (moderate in 21 [55.3%] and severe in 7 [18.4%]). Conclusions The outcome of our study suggests that severe mitral regurgitation, pulmonary artery hypertension, high NYHA functional class, LV dysfunction, and prolonged symptoms were the common predisposing factor in patients with peri-operative mortality after isolated MVR.