A Study on Students' Online Learning Performance and Satisfaction During the Pandemic: The Case for TVET Education Institution in Borneo Malaysia

In the new norm, traditional face-to-face learning system has been inapplicable as the entire globe has to obey the movement order resulting the COVID-19 pandemic. Given today's uncertainties, Higher Education (HE) in most countries endorsed online learning to ensure the continuity of the education sector during the pandemic. This study was conducted during the pandemic period of COVID-19 to investigate the students' online learning challenges and discuss the readiness of students in aspects such as personal behavior, technological, resource, and environment. The study is quantitative in nature, taking 123 respondents through an online survey via Google Form who are majoring in Diploma of Electrical Engineering, Diploma of Accountancy and Diploma of Secretarial Science. This study is focused on Technical and Vocational Education and Training (TVET) Education Institution since limited information is available in another research. The findings revealed that the online learning challenges of TVET students was the learning environment at home, x=3.06 with social media as their main distractions. The findings further revealed that TVET institution challenges are akin to universities and the outcome can be further raised to HE in closing the loop. © 2022 IEEE.

BNT162B2 MRNA BOOSTER VACCINE-RELATED PERICARDITIS: A CASE COMPLICATED BY PERICARDIAL AND PLEURAL EFFUSIONS

SESSION TITLE: Issues After COVID-19 Vaccination Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Immune mediated vaccine related pericarditis reports have been well documented;albeit rare and generally well tolerated, it remains a real complication with possible devastating impacts. The incidence has increased even more with the covid vaccine.3 Here we describe a 72 year old female that received her 4th BNT162b2 dose, 5 months after the 3rd dose, and subsequently developed pericarditis. CASE PRESENTATION: 72 year old female, previously well, who presented with a 3 day history of central, sticking chest pain associated with exertional dyspnea, cough, palpitations and malaise. She denied any coryzal symptoms. On presentation she was hemodynamically stable but hypoxic and tachycardic. Laboratory investigations revealed leucocytosis and troponinemia of 0.13ng/ml. ECG showed diffuse ST elevations. A transthoracic echo showed a small pericardial effusion with normal LV and RV function, EF 60-65% and a CT Pulmonary Angiogram revealed a small sub-segmental pulmonary embolism with atelectasis and trace effusions. On further questioning she revealed that the symptoms started 3 days after she received her 2nd booster dose of the Pfizer covid vaccine. She was started on colchicine and apixaban and was discharged home with follow-up. Two days after discharge the patient represented to the hospital with worsening chest pain. Investigations revealed worsening leucocytosis and increased inflammatory markers (CRP 303mg/L, ESR 62mm/h). A new finding of a small pericardial effusion and bilateral pleural effusions with consolidations were noted on a repeat CT scan. Decision was made to continue colchicine and commence prednisone. Other infectious and inflammatory causes of pericarditis were ruled out. The COVID spike IgG was negative and the NAAT Cov 2 IgG showed titres >250 (<50). DISCUSSION: The exact pathogenesis of the COVID-19 vaccine-induced pericarditis remains unknown. It is thought that mRNA vaccines produce a large number of antibodies which elicit a multi-system inflammatory response1;despite this, steroid therapy remains controversial given the risk of recurrent pericarditis.2 A shorter vaccine interval has been associated with adverse outcomes. CDC extended the dosing interval in young persons to reduce the risk of severe myocarditis;however the interval for persons 65 years or more and immunocompromised remained unchanged. Our case and the identical case described by Singh et al1 reinforces the need to determine the best time interval for administration of the covid booster vaccines;especially in patients more than 65 years. CONCLUSIONS: More research needs to be done as to the most appropriate interval between booster doses to reduce the inflammatory complications related to the vaccine. A consideration should also be made to determine if the measurement of SARS COV-2 IgG spike titres have any role in determining the timing of subsequent booster doses. Reference #1: Singh A, Nguyen L, Everest S, et al. (February 12, 2022) Acute Pericarditis Post mRNA-1273 COVID Vaccine Booster. Cureus 14(2): e22148. DOI 10.7759/cureus.22148 Reference #2: Hajjo R., Sabbah D.A., Bardaweel S.K., Tropsha A. Shedding the Light on Post-Vaccine Myocarditis and Pericarditis in COVID-19 and Non-COVID-19 Vaccine Recipients. Vaccines. 2021;9:1186. doi: 10.3390/vaccines9101186. Reference #3: Diaz GA, Parsons GT, Gering SK, Meier AR, Hutchinson IV, Robicsek A. Myocarditis and Pericarditis After Vaccination for COVID-19. JAMA. 2021 Sep 28;326(12):1210-1212. doi: 10.1001/jama.2021.13443. PMID: 34347001;PMCID: PMC8340007. DISCLOSURES: No relevant relationships by Zachary Banbury No relevant relationships by Michael Basir No relevant relationships by Alexandra Gottdiener No relevant relationships by Janeen Grant-Sittol No relevant relationships by Srikant Kondapaneni No relevant relationships by Ross Lavine No relevant relationships by Anesha White

PHENOBARBITAL-INDUCED ACUTE LIVER INJURY

SESSION TITLE: Drug-Induced and Associated Critical Care Cases Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Drug-induced hepatotoxicity is a well-known occurrence from a variety of different medications. However, phenobarbital (PHB) induced hepatotoxicity has not been well studied, and acute liver injury from PHB even less so. In this case, although our patient had many reasons to develop acute liver failure, including alcohol and toluene exposure, timing and investigations seem to point to PHB being responsible. CASE PRESENTATION: Patient is a 39 y.o male with past medical history significant for hepatitis A and B, hyperlipidemia and alcohol abuse who was found unresponsive by EMS after friends reported witnessing patient drinking alcohol and sniffing paint thinner. Patient remained unresponsive on arrival and was intubated and transferred to the MICU. Patient was afebrile with BP 100/55 and otherwise normal vital signs. Significant labs on presentation included a WBC of 8.15, CO2 of 16, lactic acid of 3.6 and mildly elevated transaminases (ALT: 59, AST: 48). Urine toxicology was positive for marijuana. EKG, chest x-ray and CT Head without contrast unremarkable. COVID negative. Video EEG was negative except for generalized slowing. On hospital day 3, patient was increasingly agitated, at which point phenobarbital was started due to concerns for alcohol withdrawal. Hepatic function panel the following mornings showed significant increases in transaminases (ALT: 972 and 5,746, AST: 790 and 4,805) and total bilirubin (6.8 and 11.4), and mild increase in alkaline phosphatase (112 and 125), respectively. Hepatitis panel, acetaminophen level and salicylate level were unremarkable. RUQ ultrasound was also negative for pathology. Gastroenterology was consulted, who recommended starting NAC protocol. Phenobarbital was discontinued. Hepatic function panel the following morning showed significant improvement. Liver transplant was considered, however LFTs continued to downtrend and remainder of hospital course was unremarkable. DISCUSSION: PHB is an anticonvulsant developed primarily for seizure management. However its use has expanded to alcohol withdrawal and even sedative withdrawal. Studies have demonstrated in vitro liver toxicity as well as idiosyncratic reactions and acute liver failure in children (1) (2), with minimal documentation in adults. And while there has even been histological analysis with linkage of chronic phenobarbital use to hepatic necrosis and granulomatous formation (3), there has been minimal documentation regarding acute liver failure in an adults taking phenobarbital. CONCLUSIONS: In conclusion, it is clear that phenobarbital played a significant role in this patient's liver injury and may need to be considered in future episodes of acute liver injury with unclear etiology. Reference #1: Li AM, Nelson EA, Hon EK, Cheng FW, Chan DF, Sin NC, Ma KC, Cheung KL, Fok TF. Hepatic failure in a child with anti-epileptic hypersensitivity syndrome. J Paediatr Child Health. 2005 Apr;41(4):218-20. doi: 10.1111/j.1440-1754.2005.00591.x. PMID: 15813878;PMCID: PMC7166358. Reference #2: Roberts EA, Spielberg SP, Goldbach M, Phillips MJ. Phenobarbital hepatotoxicity in an 8-month-old infant. J Hepatol. 1990 Mar;10(2):235-9. doi: 10.1016/0168-8278(90)90058-y. PMID: 2332596. Reference #3: Di Mizio Di Mizio, G., Gambardella, A., Labate, A., Perna, A., Ricci, P., & Quattrone, (2007). Hepatonecrosis and cholangitis related to long-term phenobarbital therapy: An autopsy report of two patients. Seizure, 16(7), 653–656. https://doi.org/10.1016/j.seizure.2007.05.008 DISCLOSURES: No relevant relationships by Zachary Banbury No relevant relationships by Michael Basir No relevant relationships by Inessa Bronshteyn No relevant relationships by Kyle Foster No relevant relationships by Anna-Belle Robertson

Clinical characteristics and outcomes of patients presenting with acute myocardial infarction and cardiogenic shock during coronavirus disease 2019: An analysis from the national cardiogenic shock initiative

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has created challenges in the delivery of acute cardiovascular care. Here, we evaluate the clinical characteristics and outcomes of patients presenting with acute myocardial infarction and cardiogenic shock (AMICS) during the COVID-19 pandemic. Hypothesis: COVID-19 time period will associate with longer door to intervention times, and increased all-cause mortality among patients presenting with AMICS. Methods: Using the National Cardiogenic Shock Initiative database, we identified 406 patients who presented with AMICS. This group was divided into those who presented prior to COVID-19 (N=346, 5/9/2016-2/29/20) and those who presented during the pandemic (N=60, 3/1/20- 11/10/20). Clinical characteristics, treatment patterns, and outcomes were compared between the two groups. Results: The median age (25 -75 percentile) of the cohort was 64 (55-72) years, and 23.7% of the group was female. There were no significant differences in age, sex, and medical comorbidities between the two groups. Patients presenting during the pandemic were less likely to be of Black race, and more likely to be of Hispanic and White race than patients presenting prior to COVID-19. Median door to balloon (89.5 vs. 88 mins, p=0.38), door to support (88 vs. 78 mins, p=0.13), and onset of shock to support (73.5 vs. 62 mins, p=0.15) times were not significantly different when comparing those who presented prior to with those who presented during the pandemic. Rates of transfer from another hospital, and cardiac arrest prior to arrival in the cardiac catheterization lab were similar between the two groups. ST-Elevation Myocardial Infarction presentations were increased during the COVID-19 period (95% vs 80%, p=0.01). In adjusted logistic regression models, time period (during vs pre-COVID-19) did not significantly associate with survival to discharge (OR 1.17, 95% CI 0.59-2.35, p=0.65) or with one month survival (OR 0.82, 95% CI 0.42-1.61, p=0.56). Conclusions: Care of patients presenting with AMICS has remained robust among hospitals participating in the National Cardiogenic Shock Initiative during the COVID-19 pandemic. th th .

Validating learner-based e-learning barriers: developing an instrument to aid e-learning implementation management and leadership

Purpose Coronavirus disease 2019 (COVID-19) has had global repercussions on use of e-learning solutions. In order to maximise the promise of e-learning, it is necessary for managers to understand, control and avoid barriers that impact learner continuance of e-learning systems. The technology, individual, pedagogy and enabling conditions (TIPEC) framework identified theoretical barriers to e-learning implementation, i.e. grouped into four theoretical concepts (7 technology, 26 individual, 28 pedagogy and 7 enabling conditions). This study validates the 26 theoretical individual barriers. Appreciating individual barriers will help the e-learning implementation team to better scope system requirements and help achieve better student engagement, continuation and ultimately success. Design/methodology/approach Data were collected from 344 e-learning students and corporate trainees, across a range of degree programs. Exploratory and confirmatory factor analysis was used to define and validate barrier themes. Comparison of results against the findings of Ali et al. (2018) allows comparison of theoretical and validated compound factors. Findings Results of exploratory and confirmatory factor analysis combined several factors and defined 16 significant categories of barriers instead of the 26 mentioned in the TIPEC framework. Originality/value Individual learner barriers, unlike technology and pedagogy barriers which can be directly identified and managed, appear abstract and unmanageable. This paper, considering implementation from the learner perspective, not only suggests a more simplified ontology of individual barriers but presents empirically validated questionnaire items (see Appendix) that can be used by implementation managers and practitioners as an instrument to highlight the barriers that impact individuals using e-learning factors. Awareness of individual barriers can help the content provider to adapt system design and/or use conditions to maximize the benefits of e-learning users.

JOINT PAINS AND A RACING HEART- VENTRICULAR TACHYCARDIA AS AN INITIAL PRESENTATION OF UNDERLYING SCLERODERMA RELATED AUTOIMMUNE MYOCARDITIS

Background Myocardial involvement, especially with ventricular tachycardia as an initial presentation, is uncommon in scleroderma. Case A 56 year-old male presented with exertional dyspnea, palpitations and bilateral hand arthralgias. Physical examination showed regular tachycardia, no jugular venous distension, clear lungs, no cardiac murmurs and skin thickening of digits of both hands. Electrocardiogram showed sinus tachycardia. CXR showed bibasilar interstitial prominence. Laboratory studies showed troponin 0.15 ng/mL, normal BNP, WBC 2.27 K/uL and negative SARS-CoV2 PCR. 24 hours after admission, he developed sustained monomorphic ventricular tachycardia and hypotension, responding to amiodarone, lidocaine and IV fluids. Cardiac catheterization showed no CAD. CT chest showed no pulmonary embolism but lower lobe reticular, ground-glass opacities. Echocardiogram revealed moderate LV systolic dysfunction and inferolateral hypokinesis. Cardiac MRI showed similar wall motion abnormalities and diffuse sub-epicardial myocardial scar. Decision-making The patient was arrhythmia free on sotalol and carvedilol. Transbronchial lung biopsy was negative for sarcoidosis. Corticosteroids were started empirically. A defibrillator was placed for secondary prevention. Rheumatoid factor was negative, anti-CCP weakly positive (25 u), ANA >1:320, ACE levels normal, ESR 69 mm/h, CRP 15.2. He was diagnosed with scleroderma and started on Cellcept. Three months after hospitalization, he is free of ventricular arrhythmias and arthralgias are improved Conclusion Cardiac involvement in autoimmune disease can lead to rhythm abnormalities and sudden cardiac death (1);it is often missed in scleroderma and if found, diagnosis is usually made more than one year after rheumatologic diagnosis (2). Autoimmune myocarditis (AM) is associated with poor prognosis (3). Early initiation of anti-arrhythmic agents, medical optimization for LV dysfunction, ICD placement and corticosteroids/immunosuppressants have benefited our patient. Early recognition of AM and multidisciplinary approach are imperative for successful outcome.