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Purpose: With the COVID-19 pandemic, in-person fellowship interviews were curtailed, leading candidates to seek information from other resources. Our main purposes were (1) to determine what information recent participants in the match needed to evaluate programs and (2) to assess which of these were available online. Methods: A focus group of ten recent graduates/applicants identified information that was important in choosing a fellowship program. In August 2020 and December 2021, websites belonging to the American Pediatric Surgical Association (APSA) and individual programs were assessed. Results: Recent applicants identified 55 pieces of information considered important to their decision making. Of 57 pediatric surgery fellowships, 98% were listed on APSA's website. Program descriptions on APSA's website listed on average 60% of program information desired by applicants. All listed fellowship director, accreditation status, faculty list, and current fellow(s). Other descriptors frequently noted were alumni (95%), graduate's board performance (83%), ECMO exposure (77%), and curriculum (70%). Information desired but less frequently available were fellow case logs (63%), trauma center designation (53%), burn center designation (40%), research opportunities (30%), candidate interview assistance (25%), and supplemental fellowships (12%). There were 7% of program descriptions that were not updated for at least a year. Conclusions: APSA and individual program websites were complimentary. Websites often lacked data that applicants sought to inform their rank list. To best adapt to the evolving virtual interview paradigm, we suggest reporting key information on a central APSA website with more nuanced information available via links to program specific websites. Supplementary Information: The online version contains supplementary material available at 10.1007/s44186-023-00104-w.
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Covid-19 is a highly infectious disease that spreads extremely fast and is transmitted through indirect or direct contact. The scientists have categorized the Covid-19 cases into five different types: severe, critical, asymptomatic, moderate, and mild. Up to May 2021 more than 133.2 million peoples have been infected and almost 2.9 million people have lost their lives from Covid-19. To diagnose Covid-19, practitioners use RT-PCR tests that suffer from many False Positive (FP) and False Negative (FN) results while they take a long time. One solution to this is the conduction of a greater number of tests simultaneously to improve the True Positive (TP) ratio. However, CT-scan and X-ray images can also be used for early detection of Covid-19 related pneumonia. By the use of modern deep learning techniques, accuracy of more than 95% can be achieved. We used eight CNN (CovNet)-based deep learning models, namely ResNet 152 v2, InceptionResNet v2, Xception, Inception v3, ResNet 50, NASNetLarge, DenseNet 201, and VGG 16 for both X-rays and CT-scans to diagnose pneumonia. The achieved comparative results show that the proposed models are able to differentiate the Covid-19 positive cases.
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Purpose: This research investigates the relationship between e-learning service quality dimensions, student e-learning satisfaction, commitment and behaviour towards finance courses in higher education institutes of Pakistan. Design/methodology/approach: Due to specific study objectives, the authors gathered sample data of 359 university students who were enrolled in the traditional learning system and shifted to the e-learning environment. The study employed partial least squares-structural equation modelling (PLS-SEM) based approach using Smart PLS version 3.0. Findings: The results indicated that out of four e-learning service quality dimensions, three dimensions (system quality, course material and instructor quality, information technology (IT) and support service quality) positively impacted student e-learning satisfaction. The other dimension of e-learning service quality (course website quality) showed a positive but insignificant effect on e-learning satisfaction. Additionally, e-learning satisfaction was positively related to e-learning commitment, which, in turn, has a positive and significant influence on student e-learning behaviour towards finance courses. Originality/value: Overall, the study’s findings provide useful policy implications for higher education institutes, particularly in the coronavirus disease 2019 (COVID-19) pandemic. © 2022, Emerald Publishing Limited.
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α-Ketoamides have been found to be an important functional group in a broad spectrum of inhibitors such as the Corona virus and other viruses. Here we report an unprecedented gold-catalyzed 2-fold reaction of a bromoalkyne with anthranils. Hydrolysis of the initial product then directly leads to α-ketoamides. Water addition to the intermediate α-iminoimidoyl halides delivered α-ketoamides from a broad range of bromoalkynes.
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Gold , Methane , Catalysis , Methane/analogs & derivativesABSTRACT
Objective: The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods. Background: The COVID-19 pandemic led to widespread repercussions on the delivery of health care worldwide. Design/Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by ICD-10 codes and/or classifications in stroke center databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI,-11.7 to-11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI,-13.8 to-12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI,-13.7 to-10.3, p=0.001). There were greater declines in primary compared to comprehensive stroke centers (CSC) for stroke hospitalizations (-17.3% vs-10.3%, p<0.0001) and IVT (-15.5% vs-12.6%, p=0.0001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) months of the pandemic, with greater recovery in hospitals with lower COVID-19 hospitalization volume, high volume stroke center, and CSC. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months, with greater recovery in hospitals with lower COVID-19 hospitalizations, high volume stroke centers, and CSCs.
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Coronaviruses are a family of related viruses that cause diseases in mammals. Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV) are pandemics the world has already faced. It’s a contagious virus that originating in Wuhan, spreading across the World, and was later declared a Pandemic by WHO. It has led to a total of 75 million+ cases and 1.4 million+ deaths across the globe. It has become necessary to understand its spread. There is no doubt that this epidemic has become a disaster for all mankind. This paper is an effort to analyze the cumulative number of deaths, active cases, and recovered cases since its inception. Intuitive visualizations and inferences are made. Time series forecasting models are developed to predict the number of active cases in India. © 2021, Springer Nature Singapore Pte Ltd.
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At the end of 2019, in December, the Huanan Seafood Wholesale Market appeared to be linked with the massive outbreak of pneumonia in Wuhan. It was identified that a virus later called the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was responsible for this condition. The disease was named COVID-19 and declared a pandemic as it affected the entire world and claimed many lives. News pertaining to the spread of COVID-19 became the hot talk in all forms of media ranging from print and television to social media platforms. This study aims to provide an analysis of the role of all types of media in the crisis and emergency that has arisen worldwide due to the outbreak of COVID-19. The role of media in disseminating information, particularly within Pakistan, is discussed in detail regarding the spread of coronavirus and the media's active part in sensationalizing or controlling the situation.
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Objective: The aim of this study is to determine the demographics, comorbidities, presenting complaints, laboratory parameters, and factors associated with patients outcomes of the hospitalized patients with COVID-19 from one of the largest teaching institute of Karachi. Methodology: This was single center retrospective study conducted in Liaquat National Hospital Karachi, Pakistan. Records of all the COVID-19 positive patients who were hospitalized during April, 2020 to June, 2020 were studied. The diagnosis of COVID-19 was confirmed based on guidelines issued by WHO and standard laboratory test of real time PCR on a nasopharyngeal swab. Results: Total 208 records were completely retrieved and analyzed. Overall age of study participants was 54.60 13.77 years. Most of the admitted patients were males (68.3%). Majority of the patients were symptomatic (94.2%) and frequent symptoms were fever(75%), shortness of breath (58.7%) and cough (54.3%). Out of 252 patients, In-hospital mortality was observed on approximately quarter of the analyzed sample (26%) patients. Disease severity, presence of comorbid, higher hospital stay, NLR ratio and CRP levels were associated with significantly higher odds of mortality. On multivariable analysis, increasing age (aOR=1.18, 95% CI: 1.08-1.29), ICU admission (aOR=43.44, 95% CI: 5.49 343.8) and increasing creatinine (aOR=1.55, 95% CI: 1.00 2.39) were also independent predictors of mortality. Conclusion: The current study provides evidence that increasing age and ICU admission and increasing age were chief predictors of mortality in our settings. Presence of comorbidity and initial diseases severity are also important factors to triage patients.
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Purpose: COVID-19 remains a global health crisis and continues to greatly impact health care systems. Our study highlights the role of interventional radiology (IR) during the initial phases of COVID-19 in a large health care system based in the Midwest. Materials and Methods: IR procedural volumes were compiled and stratified by service location from January 1, 2020 to April 30, 2020 for a large health care system in the Midwest. Seven-day rolling aggregate values were calculated and comparisons were made to diagnostic radiology (DR) imaging volumes during the same time frame. Percentage change in volume was calculated in relation to a state-mandated order to halt all nonessential medical care on March 17, 2020. IR procedures were stratified by category with interventional oncology (IO), dialysis interventions, and aspiration/drainage interventions comprising a majority of procedures. A Z-test for proportions was performed to assess for change in each following the state-mandated shutdown. Results: IR demonstrated a 34.9% decrease in total procedural volume following the shutdown of nonessential medical care, compared to a 45.4% decrease in DR volume. There was a 25.4% decrease in inpatient IR volume and a 41.0% decrease in outpatient volume, DR volume showed 22.2% and 57.3% decrease, respectively. Weekly outpatient volume analysis revealed the largest decrease in week 2 for IR at 49.3% and week 4 for DR at 67.0%. IO, dialysis and aspiration/drainage procedures comprised 29.1%, 13.8% and 20.4% of procedures prior to the state mandated shutdown and 31.7%, 16.2% and 26.3% afterwards. The proportion of IO and dialysis procedures were not statistically significant (P = 0.16 and 0.08 respectively) while aspiration/drainage procedures comprised a significantly higher proportion (P < 0.05) after the shutdown. Conclusions: IR volumes during the initial phase of COVID-19 were relatively less affected than total DR volumes. Specific attention to outpatient IR volumes demonstrates the valuable care provided following the state-mandated shutdown of nonessential procedures. There was no significant change in oncology or dialysis interventions provided with a significant increase aspiration/drainage procedures.
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Purpose: COVID-19 has had a large impact on health care systems during the initial surge phase. Early state mandated guidelines limited non-essential medical care to help curb transmission, preserve medical resources, and ease the burden on health care systems. Our study evaluates the impact on interventional radiology (IR) and surgical procedural volumes following a state mandate to halt non-essential care in March 2020. Materials and Methods: Total IR volume and procedural volume for other surgical specialties, including vascular surgery, urology, general surgery, gynecology, and GI surgery were compiled for March 2020 and April 2020 for a large health care system based in the Midwest. Procedural volumes were compared to monthly baseline volumes calculated as an average of 6 months (January 2019 through April 2019 as well as January and February 2020). Percent change in volume for each specialty was calculated. Results: A total of 919 and 708 procedures were performed by IR during March and April 2020, respectively. The aforementioned specialties performed a total of 2,467 and 1,041 procedures in March and April 2020. IR demonstrated a 3.5% decrease in volume during March and 25.7% decrease in volume during April 2020. Vascular surgery, general surgery, urology, gynecology and GI surgery demonstrated 11.2%, 20.2%, 25.4%, 30.6%, 38% decrease in March and 25.7%, 47.4%, 63.3%, 68.0%, 72.9% and 78.7% reduction in volume in April 2020, respectively. Conclusions: Procedural volumes during the initial phase of the COVID-19 health crisis were decreased compared to baseline values. Analysis following a state mandated halt on all non-essential care yielded large resultant reductions in volumes for multiple specialties. IR volumes were relatively less impacted, suggesting a larger proportion of essential procedures during this time frame.
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BACKGROUND: Elderly patients with COVID-19 disease are at increased risk for adverse outcomes. Current data regarding disease characteristics and outcomes in this population are limited. AIM: To delineate the adverse factors associated with outcomes of COVID-19 patients ≥75 years of age. DESIGN: Retrospective cohort study. METHODS: Patients were classified into mild/moderate, severe/very severe and critical disease (intubated) based on oxygen requirements. The primary outcome was in-hospital mortality. RESULTS: A total of 355 patients aged ≥75 years hospitalized with COVID-19 between 19 March and 25 April 2020 were included.Mean age was 84.3 years. One-third of the patients developed critical disease. Mean length of stay was 7.10 days. Vasopressors were required in 27%, with the highest frequency in the critical disease group (74.1%). Overall mortality was 57.2%, with a significant difference between severity groups (mild/moderate disease: 17.4%, severe/very severe disease: 71.3%, critical disease: 94.9%, P < 0.001).Increased age, dementia, and severe/very severe and critical disease groups were independently associated with increased odds for mortality while diarrhea was associated with decreased odds for mortality (OR: 0.12, 95% CI: 0.02-0.60, P < 0.05). None of the cardiovascular comorbidities were significantly associated with mortality. CONCLUSION: Age and dementia are associated with increased odds for mortality in patients ≥75 years of age hospitalized with COVID-19. Those who require intubation have the greatest odds for mortality. Diarrhea as a presenting symptom was associated with lower odds for mortality.
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COVID-19/therapy , Decision Making , Pneumonia, Viral/therapy , Respiration, Artificial , Age Factors , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/mortality , Female , Hospital Mortality , Humans , Male , New York City/epidemiology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Retrospective Studies , Risk Factors , SARS-CoV-2 , Severity of Illness IndexABSTRACT
A panel of stroke experts from the Gulf and Iran region convened a consensus meeting to discuss how the Covid-19 pandemic has affected stroke care in the region. Lower stroke admissions were observed locally, but acute stroke care has largely been maintained in their centres despite the challenges of staff and resource shortages, and public fear of the virus. This article provides a snapshot of the pandemic in the region, its impact on local stroke care, highlights the approaches and practices shared between panellists in order to protect stroke care pathways during this uncertain period, and provides a guideline that is simple and easily adaptable to different locations. The intent is to protect stroke care pathways through Covid-19 risk stratification, infection control measures, and ensuring that all stroke patients have a full Covid-19 diagnostic assessment. Opportunities for increasing the use of telemedicine to reduce physical contact between patients and healthcare workers is also discussed.
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Remdesivir is an investigational antiviral agent available for COVID-19 therapy. Even though its efficacy has been proven through various clinical trials, the evidence is still scarce. The side effects of remdesivir are highlighted in this paper and should be kept in mind during its use. Moreover, the availability of this drug is limited, and we fear an impending shortage of the said medicine in the near future. Thus through this letter we hope to increase awareness regarding this potentially lifesaving medicine.
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Study Objectives: Older patients frequently utilize Emergency Departments (ED). Multiple comorbidities, polypharmacy, impaired mobility (falls), changes in mentation (delirium, dementia) and poor social support often contribute to ED visits. Traditional assessment tools, such as ISAR, to identify high-risk geriatric patients can be difficult to implement in a high volume, high acuity ED setting. We examined the impact of an electronic medical record (EMR) best-practice alert (BPA), on recognition and referral of high-risk older patients in the Emergency Department (ED) who could potentially benefit from geriatric evaluation. Methods: Retrospective case control study in a busy academic ED with 67,000 total annual visits, and 24% geriatric (age ≥ 65 y) visits, from October 1, 2019 to May 31, 2020. In the initial program (10/1/19-3/30/20), ED providers were educated about high-risk geriatric conditions and an EMR BPA alerted ED providers to a positive (+) triage delirium screen. Starting 3/31/20, an enhanced BPA used EMR-automated recognition that also included age ≥80y, fall complaint, documented dementia history, polypharmacy (≥ 10 medications recorded), or high ED utilization (>5 visits in 1 year) in addition to the (+) delirium screen. A modified Delphi method was used to select these additional high-risk geriatric characteristics. Frequency of BPA notification and ED or ED-observation unit geriatric consultation (summed as comprehensive geriatric assessment, CGA) are reported for initial and enhanced BPA cohorts. Data was abstracted from the electronic medical record. The difference between initial and enhanced BPA encounters is reported. Analysis used SAS studio (v9.4, Cary, NC). 95% CI and p-values are reported. Results: 7,718 geriatric patients were seen during the initial program;1,836 were seen during the enhanced BPA program. Mean age in the initial cohort was 74.9 years (95% CI, 74.7, 75.0) and 75.6 years (95% CI, 75.1, 76.0) in the enhanced BPA cohort (p=0.002). % Female was 53.0% and 52.9%, respectively (p= 0.95). Unenhanced BPA alerts in the initial program averaged 53/month (range 45-67). BPA alerts in the enhanced program averaged 699/month. In the initial cohort, 318 (4.1%) BPA alerts led to 30 CGA. 303 (4.1%) patients for whom the initial BPA did not fire were also referred for CGA. Overall, during the initial period, 333 (4.3%) patients had CGA. The enhanced BPA resulted in 1398 (76.1%) alerts and 82 (5.9%) CGA. 14 (3.2%) BPA-negative patients were also referred for CGA. Overall, during the enhanced-BPA, 96 (5.2%) patients had a CGA. After the BPA enhancement, the proportion of geriatric evaluations increased a relative 21% (4.3% to 5.2%, p=0.09). Overall CGA referrals averaged 56/month during initial BPA and 48/month in the enhanced period. Of note, due to COVID-19 impact, overall ED volume declined 29% and geriatric ED visits declined 30% during the enhanced BPA period. Conclusion: This single-site study demonstrates that the EMR can be used to identify high-risk elders. An enhanced automated EMR BPA increased both ED provider alerts and, more importantly, geriatric evaluations in high-risk older ED patients. An EMR-based automated alert can be a useful adjunct to increase referrals and geriatric evaluations in the ED setting for this at-risk population.
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The world is facing a new pandemic called COVID-19. It started in December 2019 in Wuhan, China and in a few months it spread to almost every country of the world. Caused by a new streak of Coronavirus, it develops into an acute respiratory syndrome that becomes fatal particularly in the elderly. Since two similar Coronavirus epidemics happened in the past i.e. in 2002 and 2012, there are certain rumors and myths that gradually seeped in cultural discourse. As a result, many people, discrediting scientific knowledge and verified precautionary measures, continue to believe in the rumors and myths and are spreading them on social media. These myths range from identifying the causes of pandemic to offering solutions. In this review we discuss some of prevailing myths on the current pandemic from different parts of the world.
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BACKGROUND: COVID-19 is an ongoing threat to society. Patients who develop the most severe forms of the disease have high mortality. The interleukin-6 inhibitor tocilizumab has the potential to improve outcomes in these patients by preventing the development of cytokine release storm. AIMS: To evaluate the outcomes of patients with severe COVID-19 disease treated with the interleukin-6 inhibitor tocilizumab. METHODS: We conducted a retrospective, case-control, single-center study in patients with severe to critical COVID-19 disease treated with tocilizumab. Disease severity was defined based on the amount of oxygen supplementation required. The primary endpoint was the overall mortality. Secondary endpoints were mortality in non-intubated patients and mortality in intubated patients. RESULTS: A total of 193 patients were included in the study. Ninety-six patients received tocilizumab, while 97 served as the control group. The mean age was 60 years. Patients over 65 years represented 43% of the population. More patients in the tocilizumab group reported fever, cough and shortness of breath (83%, 80% and 96% vs. 73%, 69% and 71%, respectively). There was a non-statistically significant lower mortality in the treatment group (52% vs. 62.1%, P = 0.09). When excluding intubated patients, there was statistically significant lower mortality in patients treated with tocilizumab (6% vs. 27%, P = 0.024). Bacteremia was more common in the control group (24% vs. 13%, P = 0.43), while fungemia was similar for both (3% vs. 4%, P = 0.72). CONCLUSION: Our study showed a non-statistically significant lower mortality in patients with severe to critical COVID-19 disease who received tocilizumab. When intubated patients were excluded, the use of tocilizumab was associated with lower mortality.