L-Moments and calibration-based variance estimators under double stratified random sampling scheme: Application of Covid-19 pandemic

Extreme events gives rise to outrageous results in terms of population-related parameters and their estimates are usually done using traditional moments. Traditional moments are usually affected by extreme observations. This study aims to propose some new calibration estimators considering the L-Moments scheme for variance, which is one of the most important population parameters. a number of suitable calibration constraints under double stratified random sampling were defined for these estimators. The proposed estimators, which were based on L-Moments, were relatively more robust despite extreme values. The empirical efficiency of the proposed estimators was also assessed through simulation. Covid-19 pandemic data from January 22, 2020 to August 23, 2020 was taken into account in the simulation study. (c) 2023 Sharif University of Technology. All rights reserved.

The Integration of Digital Technologies into Practicum Classrooms by Smartphone-Savvy Pre-Service Teachers in Indonesia

The Indonesian government has declared a strong commitment to information and communication technology (ICT) education reform but has made meager progress due to inconsistent education policies, fragmentary technological infrastructure, and ill-prepared teachers. Despite these obstacles, young people in Indonesia have embraced smartphones and related technologies as important means of maintaining their socially integrated lifestyles. This project sought to measure the adoption of smartphone technologies among pre-service teachers as part of their broader ICT consciousness and teaching. We examined the ICT competencies of 220 pre-service teachers at two state universities in western Indonesia. A questionnaire was distributed to the participants toward the end of the students' final practicum during the COVID-19 closure of the schools. Results showed very high use of smartphones in private contexts, infrequent use of laptops and desktop computers, a strong rejection of institutionally available (or often unavailable) devices and services, and a skewing of ICT skills toward tools available on smartphones, especially those accessible through social media platforms. © 2023 The Author(s). Open Access - This article is under the CC BY license (https://creativecommons.org/licenses/by/4.0/).

Demographic features and outcomes in critically ill mechanically ventilated COVID-19 patients with respiratory failure in a resource limited ICU setting Report from a tertiary care center in Karachi

Background: Studies done on severe COVID-19 have revealed a wide heterogeneity in intensive care clinical outcomes across various countries. We aimed to identify the demographic features and outcomes of mechanically ventilated COVID-19 patients with respiratory failure in Pakistan in resource limited settings. Methods: This was a cross-sectional study conducted at the COVID-19 Intensive care unit (ICU) of Jinnah postgraduate medical center in Karachi, Pakistan. 86 patients who received mechanical ventilation in a period of five months from 1/2/2021 till 30/6/2021 were included in the study. Patient demographic characteristics, comorbidities, clinical manifestations of COVID-19 infection, laboratory values at the time of presentation (hemoglobin, Neutrophil lymphocyte ratio, platelets, glomerular filtration rate, C-reactive protein, D-dimers, Ferritin, liver function tests and electrolytes) and mode and duration of ventilation, final outcome (survivor vs. non-survivor) and cause of death in non-survivors were recorded. Data was analysed using SPSS 26. Patient characteristics were compared among those who died early before 7 days with those who survived for more than 7 days using P sample t-test. Results: 86 patients, who required mechanical ventilation because of severe respiratory distress not alleviated by non-invasive methods of ventilation, were included in the study. 66.3% (n=57) were males and 33.7% (n=29) were females. Mean age was 59 (SD 12). The most common comorbidities were diabetes mellitus and hypertension 44.2% (n=38) each. Only 3 (3.4%) of mechanically ventilated patients were extubated and 1 patient was eventually discharged home on room air. The mortality rate was 98.8% and only one patient survived. The most common causes of death were respiratory failure (86%, n=74), renal failure (48.8%, n=42) and sepsis (18.6%, n=16). Conclusion: Mortality in COVID-19 patients who require mechanical ventilation is very high in resource limited settings because of the lack of essential medications, specialized teams and established protocols of ICU management and is not related to the demographic characteristics and comorbidities of patients and severity of disease at presentation. © 2022 Authors.

Endog-Endogan games of fractional number ideas in ethnomathematics learning

This paper examines the creative mathematical abilities of grade 4 to grade 5 primary school students using face-to-face Sundanese ethnomathematics learning, which is limited due to the covid 19 pandemic. This quantitative research uses a quasi-experimental pretest-posttest one-sample test method. This research involved 17 students in grade 4 and 11 students in grade 5. The study results showed the t-test results that Sundanese ethnomathematical learning by using the Endog-Endogan game proved beneficial for students because it could develop mathematical creative thinking skills in fractional number material. The creative thinking ability test found that fluency is higher than flexibility. Traditional games help students easily understand mathematical ideas contextually by involving interesting games in learning fractions activities. © 2023 Author(s).

Medications safety for special population case studies: Pediatrics

Medication errors are among the most common medical errors, and studies have shown that the pediatric population is particularly vulnerable. Errors can occur at any stage of the medication process. We tried to build various cases, which highlighted different aspects of drug safety in pediatrics. The case studies focused on vancomycin infusion, supportive treatment in COVID-19-related multisystem inflammatory illness, side effect of antitubercular treatment drugs, management of respiratory failure, low cardiac functioning, acyclovir nephrotoxicity, stress ulcer, cyclophosphamide-induced hemorrhagic cystitis in rhabdomyosarcoma, blood pressure after aortic coarctation elective surgery, and use of paracetamol instead of NSAIDs in pediatrics. These cases would be useful in both as a diagnostic tool and as a way of monitoring certain conditions. © 2023 Elsevier Inc. All rights reserved.

Simulation in Urological Training: The Hybrid Model of Institute of Kidney Diseases Peshawar A Comparative Study

Background:"I fear the man who has practised one kick 10,000 times." Lee Bruce This aphorism highlights the growing importance of simulation in postgraduate urology training, especially during the COVID 19 pandemic, when all teaching and training activities were stopped, jeopardising postgraduate residents' education. Postgraduate residents must perform hours of surgical training to overcome urological learning curves. According to study, residents educated on simulators boost their summative scores. By introducing simulation to urology training in a way comparable to the well-known Halsted apprenticeship model, the current study emphasises the hybrid model of IKD. Objective(s): to compare the formative assessment results between residents taught on simulators and residents in the conventional apprenticeship model on factors of communication skills, technical competence, and overall capacity to conduct procedure on OSAT and DOPS. Material(s) and Method(s): from 2019 to 2021 this comparative study was conducted in the Department of Urology by Team C at the Institute of Kidney Diseases Peshawar. Group A (10 residents) and Group B (10 residents, 5 from the second and third years) received STEPS method OT instruction in the first phase. These simulators were used to impart knowledge to Group "B" Harvey for counseling and medical examinations Simulator for PCNL The second phase included a six-month training assignment swap between the two groups. A standard QSAT and DOPS proforma was used to evaluate each resident. Data analysis was done using SPSS 24.0. Result(s): Residents in Group A, who were originally exposed to the conventional technique, considerably outperformed Group B on Harvey (mean: 50.5;standard deviation: 2.21.1) in terms of communication skills, professionalism, and ethical concern during the first phase (p 0.001). However, the Group p0.05 shown considerably higher technical proficiency and overall process performance capacity. The mean technical skill and overall capacity to finish the process had a somewhat positive association in phase 1 in favour of group B (r=0.630, p 0.01). All QSAT and DOPS metrics significantly improved in the second phase. However, both groups did not vary significantly (p> 0.05). According to Pearson coefficient correlation, both groups considerably overcame their gaps in technical proficiency, communication skills, and procedural competence. (P= 0.001) Results are shown in Figures 1 through 06 and Tables 1 through 2. Conclusion(s): To improve the standard of urology residency in Pakistan, a hybrid paradigm that includes both simulation and actual performance is necessary. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

Machine learning approaches used to analyze auditory evoked responses from the human auditory brainstem: A systematic review.

BACKGROUND: The application of machine learning algorithms for assessing the auditory brainstem response has gained interest over recent years with a considerable number of publications in the literature. In this systematic review, we explore how machine learning has been used to develop algorithms to assess auditory brainstem responses. A clear and comprehensive overview is provided to allow clinicians and researchers to explore the domain and the potential translation to clinical care. METHODS: The systematic review was performed based on PRISMA guidelines. A search was conducted of PubMed, IEEE-Xplore, and Scopus databases focusing on human studies that have used machine learning to assess auditory brainstem responses. The duration of the search was from January 1, 1990, to April 3, 2021. The Covidence systematic review platform (www.covidence.org) was used throughout the process. RESULTS: A total of 5812 studies were found through the database search and 451 duplicates were removed. The title and abstract screening process further reduced the article count to 89 and in the proceeding full-text screening, 34 articles met our full inclusion criteria. CONCLUSION: Three categories of applications were found, namely neurologic diagnosis, hearing threshold estimation, and other (does not relate to neurologic or hearing threshold estimation). Neural networks and support vector machines were the most commonly used machine learning algorithms in all three categories. Only one study had conducted a clinical trial to evaluate the algorithm after development. Challenges remain in the amount of data required to train machine learning models. Suggestions for future research avenues are mentioned with recommended reporting methods for researchers.

FEVER-INDUCED BRUGADA SYNDROME

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Brugada syndrome (BrS) is a rare cause of sudden cardiac death in asymptomatic healthy adults. We present a case of BrS unmasked by fever secondary to COVID-19 infection. CASE PRESENTATION: 38-year-old male with no prior medical history presented with a two-day history of subjective fevers, chills, productive cough, dyspnea, and left-sided pleuritic chest pain. He was noted to be febrile, tachypneic, tachycardic and hypoxic to the low-90s on room air. Bloodwork revealed elevated inflammatory markers with leukocytosis. Imaging and bloodwork were consistent with severe bilateral multifocal pneumonia secondary to COVID-19 infection. EKG on admission showed evidence of sinus tachycardia and type I Brugada pattern in leads V1 and V2 without ischemic changes. He was admitted for treatment of COVID-19 pneumonia with intravenous (IV) Remdesivir, IV steroids, and oxygen supplementation. Despite this, patient continued to be febrile, and interestingly, serial EKGs showed persistent type 1 Brugada pattern, which transformed into type 2 Brugada pattern after day 2 of admission, to persist for the next seven days. Echocardiogram showed normal left ventricular systolic function (ejection fraction 65%) with no significant valvular abnormalities. The Brugada pattern was thought to be induced by the febrile episodes, therefore all fevers were aggressively treated, and patient was closely monitored for any ventricular arrhythmias. Patient was educated on avoiding tricyclic antidepressants and sodium channel blockers as they are contraindicated in BrS. He was discharged home with plans for outpatient electrophysiological study. DISCUSSION: BrS is a clinical entity that can lead to sudden cardiac death and is associated with ECG changes of a 2mm J-point elevation and 1mm ST-segment elevation in two or more of the right precordial leads;type 1 is characterized by coveted-ST elevation in V1 and V2 whereas type 2 involves a saddle-back appearance. Diagnosis is made after excluding all other known causes of ST-segment elevation in right precordial leads, known as phenocopies. Known triggers include fever, intoxication, vagal stimulation, electrolyte imbalances, and various medications. Fever-induced BrS is more common among men in an age group of 30 to 60 years [4], it can precipitate cardiac arrest due to increased arrhythmogenicity of cardiac sodium channels at higher temperatures. Thus, timely and aggressive control of fever is crucial in preventing fatal arrhythmias, with fever-induced BrS leading to cardiac arrest in 18-20% of patients [2,3]. CONCLUSIONS: Clinicians need to be aware of the circumstances that can induce BrS, including fevers and medications, as BrS can be fatal, leading to cardiac arrest in many patients. Early recognition can lead to early intervention, through placement of an implantable pacemaker for documented arrhythmia, to decrease morbidity and mortality. REFERENCE #1: 1. Bayés de Luna A, Brugada J, Baranchuk A, et al. Current electrocardiographic criteria for diagnosis of Brugada pattern: a consensus report. J Electrocardiol. 2012;45:433-442. [PubMed] [Google Scholar] REFERENCE #2: 2. Amin AS, Meregalli PG, Bardai A, Wilde AA, Tan HL. Fever increases the risk for cardiac arrest in the Brugada syndrome. Ann Intern Med. 2008;149:216-218. [PubMed] [Google Scholar] DISCLOSURES: No relevant relationships by Muhammad Hanif, source=Web Response No relevant relationships by Sudheer Konduru, source=Web Response No relevant relationships by Marino Leonardi, source=Web Response No relevant relationships by SANA MULLA, source=Web Response No relevant relationships by Ruqqiya Mustaqeem, source=Web Response No relevant relationships by Vihitha Thota, source=Web Response

Positive rate of COVID 19 in the setting of GGH Ghulam Muhammadabad

Background: The corona virus disease also known as COVID-19 has opened gates to a lot of research about detection, treatment and prevention in the last past year due to lack of information regarding the SARS-CoV-2 virus. PCR corona via nasopharyngeal swab is the standard method of detection in our set-up. Materials and methods: Nasopharyngeal swabs were taken by ENT department using precautions and following proper SOPs. Swabs were sent for rRT-PCR tests. Data was collected and analyzed. All the subjects meeting the inclusion criteria were included in study. Data was analyzed using SPSS version 20. Frequency and percentage was calculated for gender. Positivity rate was calculated using CDC formula. Study design: - Descriptive studies Place and Duration of Study: - Government General Hospital, Ghulam Muhammadabad, Faisalabad. 889 samples were taken from 7.1.2020 to 6.12.2020. Results: Standard PCR for corona test by nasopharyngeal route was taken of suspected corona patients and of patients with contact with corona positive patients. 894 samples were taken from 7.1.2020 to 6.12.2020. 263 were positive for corona. The calculated positive rate is 29.41%. Conclusions: Calculation of positive rates is a very easy metric to give us a quick overview of the spread of the virus.

Environmental impact analysis on the covid 19 pandemic to primary education learning process in madiun jawa timur Indonesia

This study aims to analyze the Covid-19 pandemic impact and influencing factors on primary education in Madiun City, Indonesia. The qualitative approach uses in-depth interviews, observation, and documentation as data resources and analyzed by using interactive techniques. The validity is source triangulation and observative perseverance. The results show a serious impact, classified into negative and positive. The negatives are;face-to-face is unreplaced by online learning, due to online system constraints, internet access, and teachers’ digital competence. The assessment cannot be objective and are severely constrained. The positives are to encourage parents' concern for the children learning and digital literacy. © 2020, Advanced Research Trentz. All rights reserved.

Laboratory diagnosis of novel corona virus (2019-nCoV)-present and the future.

BACKGROUND: In December 2019 a novel coronavirus SARS-CoV-2 emerged in the Hunan seafood market in Wuhan, China, and soon became a global health problem. Since its outbreak, SARS-CoV-2 has had a major impact on clinical diagnostic laboratories. The scientific community has quickly risen to the occasion and reports of new developments have arrived at an unprecedented scale. At present, there is a growing list of over 400 SARC-CoV-2 diagnostic tests either in development or approved for clinical use. This presentation reviews the current laboratory methods available for testing COVID- 19 in microbiology laboratories and also provides an insight into the future diagnostics approaches. METHODS: Proper respiratory specimen collected at the appropriate time and from the right anatomical site is critical in the accurate and timely diagnosis of SARSCoV2. While oropharyngeal and nasopharyngeal swabs are recommended for the detection of early infection, other lower respiratory tract specimens like the sputum and bronchoalveolar lavage are used for late detection and monitoring of patients with severe COVID-19 pneumonia. RESULTS AND CONCLUSION: Real-time RT-PCR based molecular assay remains the test of choice for the etiological diagnosis of SARS-CoV-2 while serological tests are being introduced as supplementary tools. Finally, there is an urgent need for scaling up the diagnostic capacity by the introduction of reliable and accurate point-of-care tests which will assist in effective control of this outbreak. These assays can be used in the local hospitals and clinics bearing the burden of identifying and treating patients.

Benefits and limitations of serological assays in COVID-19 infection.

Accurate and rapid diagnostic tests are critical for achieving control of coronavirus disease 2019 (covid-19), a pandemic illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Diagnostic tests for covid-19 fall into two main categories: molecular tests that detect viral RNA, and serological tests that detect anti-SARS-CoV-2 immunoglobulins. Reverse transcriptase polymerase chain reaction (RT-PCR), a molecular test, has become the gold standard for diagnosis of covid-19; however, this test has many limitations that include potential false negative results, changes in diagnostic accuracy over the disease course, and precarious availability of test materials. Serological tests have generated substantial interest as an alternative or complement to RT-PCR and other Nucleic acid tests in the diagnosis of acute infection, as some might be cheaper and easier to implement at the point of care. A clear advantage of these tests over RT-PCR is that they can identify individuals previously infected by SARS-CoV-2, even if they never underwent testing while acutely ill. Many serological tests for covid-19 have become available in a short period, including some marketed for use as rapid, point-of-care tests. The pace of development has, however, exceeded that of rigorous evaluation, and important uncertainty about test accuracy remains.

iWorksafe: Towards Healthy Workplaces During COVID-19 With an Intelligent Phealth App for Industrial Settings

The recent outbreak of the novel Coronavirus Disease (COVID-19) has given rise to diverse health issues due to its high transmission rate and limited treatment options. Almost the whole world, at some point of time, was placed in lock-down in an attempt to stop the spread of the virus, with resulting psychological and economic sequela. As countries start to ease lock-down measures and reopen industries, ensuring a healthy workplace for employees has become imperative. Thus, this paper presents a mobile app-based intelligent portable healthcare (pHealth) tool, called i WorkSafe, to assist industries in detecting possible suspects for COVID-19 infection among their employees who may need primary care. Developed mainly for low-end Android devices, the i WorkSafe app hosts a fuzzy neural network model that integrates data of employees' health status from the industry's database, proximity and contact tracing data from the mobile devices, and user-reported COVID-19 self-test data. Using the built-in Bluetooth low energy sensing technology and K Nearest Neighbor and K-means techniques, the app is capable of tracking users' proximity and trace contact with other employees. Additionally, it uses a logistic regression model to calculate the COVID-19 self-test score and a Bayesian Decision Tree model for checking real-time health condition from an intelligent e-health platform for further clinical attention of the employees. Rolled out in an apparel factory on 12 employees as a test case, the pHealth tool generates an alert to maintain social distancing among employees inside the industry. In addition, the app helps employees to estimate risk with possible COVID-19 infection based on the collected data and found that the score is effective in estimating personal health condition of the app user.

Frequency of electrolyte imbalances (sodium and potassium) in patients with Covid-19 disease

Objective: To examine the frequency of electrolyte imbalance such as sodium and potassium deficiency in patients with coronavirus disease. Study Design: Cross-sectional Place and Duration: Medical Unit-II Holy Family Hospital, Rawalpindi, During from April 2020 to June 2020. Methodology: Total 90 patients of both genders diagnosed to have severe covid-19 disease by real time PCR were enrolled in this study. Patients detailed demographics including age, sex, and were recorded after taking written consent. 5ml blood sample was taken from each patient and sent to laboratory to examine serum sodium and potassium level. Data was analyzed by SPSS 24.0. Results: There were 52 (57.78%) male and 38 (42.22%) females with mean age 52.48±8.37 years.Hyponatremia was found in 38 (42.22%) patients and hypokalemia was found in 24 (26.67%) patients. Mortality found in 10 (11.11%) patients and 80 (88.89%) patients were discharged. Mortality was significantly higher in patients with sodium and potassium abnormalities as compared to patients with no electrolyte imbalances (p-value <0.05). Conclusion: It is concluded that the frequency of electrolyte imbalances such as sodium and potassium deficiency was high in patients with severe covid-19 disease. © 2020 Lahore Medical And Dental College. All rights reserved.