ABSTRACT
Introduction: Pulmonary embolism (PE) is a major cause of intensive care unit (ICU) mortality and morbidity [1]. Optimal venous thromboembolism preventive strategy in COVID-19 patients remains a controversial issue. Therapeutic anticoagulation in the context of severe COVID-19 without a formal indication does not appear to offer a survival advantage and was associated with increased risk of major bleeding episodes. Locally, we adopted an enhanced anticoagulation (enoxaparin twice a day) pathway guided by anti-Xa levels. Method(s): This is a retrospective cross-sectional single-center study between March 2020 and March 2021. All patients admitted to the intensive care unit at University Hospital Southampton with diagnosis of COVID-19 confirmed via a reverse-transcriptase-polymerase-chain reaction (RT-PCR) test were included in this study. Result(s): There were 292 admissions included in the study with a mean age of 60 (+/- 15). 67.1% received enhanced anticoagulation titrated according to anti-Xa levels. The median day 7 trough and peak anti-Xa levels were 0.33 (IQR 0.18-0.41) and 0.54 (IQR 0.33-0.68) respectively. 62 patients had CTPA for clinical suspicion of pulmonary embolism and 11 were positive. The overall incidence of PE was 3.8%. The distribution of PE was mostly bilateral segmental or unilateral segmental. There were no lobar or main pulmonary artery pulmonary embolism. There were 9 major bleeding episodes in those received enhanced anticoagulation. Conclusion(s): For critically ill COVID-19 patients, anti-Xa guided enhanced anticoagulation protocol proved to be associated with lower than anticipated incidence of PE with minimal clot burden. Randomised controlled trials are required to explore this concept further.
ABSTRACT
Still in many countries COVID19 virus is changing its structure and creating damages in terms of economy and education. In India during the period of January 2022 third wave is on its high peak. Many colleges and schools are still forced to teach online. This paper describes how cyber security actionable or practical fundamental were taught by school or college teachers. Various cyber security tools are used to explain the actionable insight of the subject. Main Topics or concepts covered are MITM (Man In the Middle Attack) using ethercap tool in Kali Linux, spoofing methods like ARP (Address Resolution Protocol) spoofing and DNS (Domain Name System) spoofing, network intrusion detection using snort , finding information about packets using wireshark tool and other tools like nmap and netcat for finding the vulnerability. Even brief details were given about how to crack password using wireshark. © 2022 IEEE.