Construction and standardization of toolkit of numeracy skills

India is facing learning crisis as close to 5 crore children in elementary school, lacks numeracy and literacy skills mentioned in draft NEP, 2019.ASER (2021) reported that COVID 2019 has worsen the situation, as only 10 per cent of the kids studying grade III to V in government schools can solve a subtraction problem. National Curriculum Frameworks, time to time has expressed the need to bring changes in the areas of teaching, learning and assessment for qualitative improvement in the school education system in India.If we want to bridge the learning gap, we need to provide the suitable interventions. For that purpose, we need to know where students are on the skill continuum and specifically the learning areas which need attention. Traditional pen paper test or examination is designed to test their knowledge on the bases of content, not on competence. This paper endeavors to construct standardized a simple, cost effective and easy to administer screening assessment toolkit to check the competence based numeracy skills for grade three. Final draft of the toolkit is comprised of 9 items. Reliability of the toolkit was found by test re-test method and it was .89. Content validity and construct validity of the toolkit was also established.

A paediatric case series of COVID-19-associated chilblain-like acral lesions

Chilblain-like acral skin lesions are a phenomenon that has been reported during the COVID-19 pandemic, particularly in younger, asymptomatic patients. We report four paediatric cases with this phenomenon. A 9-year-old boy had coryzal symptoms and was SARS-CoV-2-polymerase chain reaction (PCR) negative. He presented after 2 weeks with itchy, violaceous discolouration of all toes. Two months on, the toes remained intermittently tender and itchy despite the use of antihistamines and prednisolone. A 12-year-old girl presented with 3-day-old bilateral, painful, violaceous blistering toes. Her SARS-CoV-2-PCR was negative, but she had been exposed to a positive case 2 months earlier. No treatments were given. Two weeks later, the blisters had healed and were less painful but with persistent discolouration. The changes were still present 6 weeks later. A 10-year-old boy developed an erythematous rash affecting the fingertips, which were itchy, painful, and sensitive to temperature changes. A few weeks later, the eruption had settled on the fingers but was noted on the toes. There was discomfort and movement restriction. He was otherwise well, except for experiencing COVID-like symptoms three months prior. He was SARS-CoV-2-PCR negative and - antibody positive. A 4-year-old girl developed puffy, discoloured changes on all distal finger tips. She had no respiratory symptoms, but had COVID-19 exposure at school. It was unusual as there was no associated pain or discomfort, as usually reported with chilblains. Our cases highlight this evolving clinical entity post-COVID-19 in healthy children. In our series, what is quite striking is the delayed presentation and persistence of clinical symptoms.

Perinatally Acquired COVID-19 Requiring ECMO with Severe Hematologic Complications

Case Report: Perinatal acquisition of COVID-19 in neonates is uncommon and development of severe pulmonary disease remains extremely rare. Thus far, there have been no reports of otherwise healthy neonates requiring extracorporeal life support (ECLS) for ARDS secondary to COVID-19. Further, little is known about the hematologic implications of COVID-19 in the neonatal population. We report the first perinatally acquired case of COVID-19 requiring ECLS and describe associated hematologic complications. The patient was a 35-week gestational age twin infant, born to an asymptomatic COVID-19 positive mother. The infant was COVID-19 PCR positive just after birth, though asymptomatic. She presented on day of life 9 with respiratory distress and hypoxia. She had progressive respiratory failure and at 2 weeks of life was placed on veno-venous (VV) extracorporeal life support (ECLS). On post-operative day 1 there was development of a bi-atrial clot requiring open thrombectomy and conversion to veno-arterial (VA) ECLS with an open chest. Three days post-thrombectomy, despite therapeutic anticoagulation with heparin, the circuit oxygenator developed significant clot burden leading to oxygenator failure and requiring circuit change. Five days post-thrombectomy, patient developed severe, persistent hemorrhage after chest closure despite discontinuation of heparin anti-coagulation therapy and was transitioned to comfort care per parental request. Whole exome sequencing was negative with no evidence of innate hematologic disease. Conclusion: This case highlights the rare, though significant, risk COVID-19 infection can potentially impose on pulmonary and hematologic systems of an infected neonate.

Recent myocardial infarction and femoral neck surgery-a case report

Background: Hip fracture is a common injury in elder population. Generally, this condition requires urgent diagnosis and prompt surgical treatment, to reduce postoperative mortality, morbidity, and improve functional outcome. Outcome of surgical treatment by better techniques and improved anesthesia methods has changed the prognosis of the geriatric injury. Case report: A 79 Y/F with history of CAD, HTN and DM admitted with history of fall. Radiograph suggested right # N/F and left radius. History of CABG 7 years back, taking oral drugs;ecospirin, carvedilol, cidmus, eplerenone, nitroglycerin and atorvastatin. Investigation, RBS was 180mgm/dl, Hb1Ac was 7.12% and CRP was 131.48mgm/l. ECG showed LVH, complete LBB and sinus rhythm. 2D Echo - IHD, RWMA and akinetic basal infero-septum, post wall and mid basal segments of inferior wall. Paradoxical movement of the septum due to LBB. Concentric LVH and EF of 40%. Patient tested negative for COVID-19 (RT-PCR). NT pro BNP was 957 pg/ml. Preoperatively, LMWH was started. Patient was given G.A. Standard monitoring included - 5 lead ECG, SpO2, ETCO2, NIBP, urine output and gas monitoring. Anaesthesia was given with i/v fentanyl, i/v etomidate and cisatracurium. After endotracheal intubation, anaesthesia was maintained with oxygen, nitrous oxide and sevoflurane, DHS screw fixation with closed reduction of radius was done. Anaesthesia was reversed with i/v myopyrollate and extubated. Patient was haemodynamically stable throughout the procedure and tolerated anaesthesia well. Post-operatively, the patient recovery was good. Conclusion: The femoral neck fracture in a patient with recent myocardial infarction involves a difficult decision and a multidisciplinary collaboration. Although rare, this combined pathology is difficult to manage and still has no consensus on when to wait, how long to wait until surgery and whether to operate or to treat functionally these particular patients.

COVID-19 and Clinic Workflow Optimization Using Lean Six Sigma

Objectives: The COVID-19 pandemic has fundamentally changed the workflow of clinics. We applied Lean Six Sigma processes to optimize clinic workflow to reduce patient wait timesand improve the patient experience. Study Design: Prospective cohort study. Methods: We implemented (1) pushing most extended wait times to the end of the workfl owby rooming the patient directly and (2) using distractions during the waiting process by usingeducational videos and a timer for physician arrival in the patient exam room. We comparedthe patient wait times and subcomponents of Press Ganey scores as a surrogate forchanges in patient experience and satisfaction from the preimplementation period (n = 277)to the 3-month (September 1, 2020, to November 30, 2020) postimplementation period (n = 218). Results: There was a signifi cant reduction in overall throughput time (38 vs 35 minutes) andwait before rooming (11 vs 8 minutes), and increased physician time with patients (15 vs 17minutes) ( P < .0001 for all). These results corresponded with a signifi cant improvement inPress Ganey subcomponents of (1) waiting time in the exam room before being seen by thecare provider, (2) degree to which you were informed about any delays, (3) wait time at clinic(from arriving to leaving), and (4) length of wait before going to an exam room ( P < .001 forall). Conclusions: Simple, inexpensive measures can improve patient engagement and provide asafe setting for patients for clinic visits in the wake of COVID-19. In the future, clinics'common wait areas could be reappropriated to increase the number of clinic exam rooms.