Comparing effects of invasive versus non-invasive ventilation on P/F ratio, CRP and respiratory rate of COVID patients, a retrospective observational study

Introduction: Some of the COVID pneumonitis patients are happily hypoxic and not showing signs of severe respiratory distress despite being significantly hypoxic,1 leading to a delay to start a timely treatment and may worsen the prognosis.2 Studies have shown that non-invasive ventilation could be used in severe COVID pneumonitis and could avoid intubation in some of those patients.3 Effects of different modalities of ventilation on the oxygenation of COVID-19 patients and on the inflammatory process accompanying COVID-19 pneumonitis need thorough investigation in a trial to reach to an understanding of the pathophysiological process and may be a guide to formulate the optimum protocol to ventilate COVID-19 patients. Objective(s): Comparing the effects of invasive versus non-invasive ventilation on P/F ratio, CRP and respiratory rate of COVID-19 patients. Method(s): In this retrospective observational study, we compared the effect of NIV on the P/F ratio, CRP trends and Respiratory rates of COVID patients during their ITU admission in comparison with intubated ventilated patients. The study was carried out in a single center in England before introduction of the Tocilizumab in the guidelines of COVID treatment and included 74 COVID patients divided in to two groups, group A which included 15 patients who were non-invasively ventilated and avoided intubation during their ITU admission while group B included 59 patients who were intubated at certain point of their course of admission. Patients Respiratory rate, modality of ventilation, time of intubation (if any), modes of ventilation, FIO2, P/F ratio and CRP trends were followed during their admission. The collected data of 3 variable (CRP, RR and P/F ratio) has been blotted and a summative means were calculated. The least square means of the linear models of the ventilated and non-ventilated patients were used to compare both groups. Result(s): 36.4 % of intubations was done before or during the first 20 hours of the ITU admissions and 50% during the first 40 hours. The study also has shown the probabilities in the difference between slopes as following. Firstly, regarding P/F ratio the probability was 0.058 in favor of non-invasive ventilation. Secondly, RR probability was <0.0001 significantly in favor of non-invasive ventilation. Lastly, CRP probability was 0.024 significantly in favor of non-invasively ventilated patients. Conclusion(s): CRP and respiratory rate were significantly less in non-invasively ventilated COVID pneumonitis patients in comparison with ventilated patients while there was no significant difference in P/F ratio trends between both groups.

From Explaining to Engaging: A Seventy-Thirty Rule

At the beginning of the COVID-19 outbreak, universities worldwide quickly adapted to an online teaching setting as an emergency measure. During this rapid adaption, individual academics were given the challenge of teaching online [1]. Due to the vast discrepancies between the usual pedagogical approach to online teaching and to online teaching necessitated by the pandemic, the latter limited itself to instructor-centred knowledge transmission [2]. More recently, learning has moved back to the on-campus setting. This paper reports on one instructor's change to on-campus sessions based on experience in transforming pre-pandemic on-campus sessions, which were explanation centred, to pandemic online sessions, which were activity-centred and therefore more engaging for the students. The post-pandemic on-campus sessions comprised three parts: (1) Whiteboard Centring, (2) Case Study Introduction, and (3) Solution Envisioning. The sessions were strongly student-centred and incorporated a 15 to 20-min break. The material covered in the sessions was examined in the module's unseen 2-h examination. When compared with previous results, the students performed better overall, and inspection of the examination scripts suggested that more of the students had a better understanding of the material. The paper discusses the extent to which the improvement reflects the student-centred approach. In addition, a 70–30 rule is proposed as a way of both characterising the instructor's student-centred approach and offering one guide to instructors as to whether they themselves are adopting a student-centred approach. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

From Explaining to Engaging: A Seventy-Thirty Rule

At the beginning of the COVID-19 outbreak, universities worldwide quickly adapted to an online teaching setting as an emergency measure. During this rapid adaption, individual academics were given the challenge of teaching online [1]. Due to the vast discrepancies between the usual pedagogical approach to online teaching and to online teaching necessitated by the pandemic, the latter limited itself to instructor-centred knowledge transmission [2]. More recently, learning has moved back to the on-campus setting. This paper reports on one instructor's change to on-campus sessions based on experience in transforming pre-pandemic on-campus sessions, which were explanation centred, to pandemic online sessions, which were activity-centred and therefore more engaging for the students. The post-pandemic on-campus sessions comprised three parts: (1) Whiteboard Centring, (2) Case Study Introduction, and (3) Solution Envisioning. The sessions were strongly student-centred and incorporated a 15 to 20-min break. The material covered in the sessions was examined in the module's unseen 2-h examination. When compared with previous results, the students performed better overall, and inspection of the examination scripts suggested that more of the students had a better understanding of the material. The paper discusses the extent to which the improvement reflects the student-centred approach. In addition, a 70–30 rule is proposed as a way of both characterising the instructor's student-centred approach and offering one guide to instructors as to whether they themselves are adopting a student-centred approach. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Principals' digital transformational leadership, teachers' commitment, and school effectiveness

The knowledge about principals' digital transformational leadership in schools is scarce. This lacuna is problematic because recently many countries switched to remote schooling and online learning models during the COVID-19 pandemic. The new situation changed the principal's role to one of distant digital leadership, working with teachers and students remotely. The present study aims to investigate principals' digital transformational leadership and its outcomes. The research is based on data from 380 teachers in Bahrain. The findings and their implications for effective remote schooling are discussed. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Pokémon GO with Social Distancing: Social Media Analysis of Players' Experiences with Location-based Games

Pokémon GO is a popular location-based mobile game that seeks to inspire players to be more active, socialize physically and virtually, and spend more time outside. With the onset of the COVID-19 pandemic, several game mechanics of Pokémon GO were changed to accommodate socially-distanced play. This research aims to understand the impacts of the pandemic and subsequent game adjustments on user perceptions of the game. We used an exploratory mixed-method approach, a machine learning technique (Latent Dirichlet Allocation) for topic modeling, and thematic analysis for qualitative coding of top-level Reddit comments to identify whether and how the social distancing approach changes the players' behaviors. The results demonstrate that players were less physically active, less eager to discover, and more interested in remote social practices. We discuss which players leverage social distancing changes and reflect on key game features that provide a better gaming experience in the age of remote play. © 2022 Owner/Author.

Perception and prevalence of dietary supplements among gym users in nasiriyah city: A cross-sectional pilot study in thi-qar provence, southern iraq

Background: Dietary supplements (DSs) are widely used in gymnastics around the world to improve health, save energy and increase strength. However, consumers should be familiar with the required knowledge regarding the benefits and risks of these supplements. Objective: To assess the perception and prevalence of dietary supplements among Gymnastics users in the city of Nasiriyah. Material and methods: The study was a pilot descriptive cross-sectional survey of 150 Gymnastics both males (n = 75) and females (n = 75). The data were statistically analyzed and a “p value ≤ 0.05” was taken as statistically significant. Results: Participants Socio-demographic characteristics varied widely and were shown to be related to DSs information sources, purpose of use and beliefs. The coaches were the main source of information for males and the internet for females. Males generally use DSs for Bodybuilding, while females mostly use DSs for weight loss. Gymnastics consumed between 1-2 types of DSs with less consumption of three or more. Electrolyte drink, amino acids, vitamin D, calcium, Red Bull or similar, Omega-3, and slimming products were among the most common DSs. Weight gain, ephedra, and anabolic hormones were less often used. Conclusion: The majority of dietary supplement information was received from unreliable sources. The purpose of using DSs differed greatly between males and females and was related to social and demographic factors. The impact of Covid-19 has limited the size of our participants and more research is needed on wider sample of gymnastics after the pandemic to get a better understanding of the use of DSs and their potential impact on health. © 2021 by authors, all rights reserved.

Prediction of development of disease among contacts of COVID-19 patients

Objectives Coronavirus disease 2019 (COVID-19) is a very progressive disease that concerns everyone regarding its infection and spread. This study predicted infection among people who came in contact with COVID-19-infected patients. The authors observed many categories of patients to get the best results. The aim of this work was to study the contact status of patients with COVID-19 in Sharkia Governorate, Egypt, and to assess the criteria of contacts being infected. Patients and methods This is a retrospective cohort study that used the data of Zagazig University Hospitals in Sharkia Governorate, reviewing people who came in contact with COVID-19 cases for appearance of symptoms, so that the authors can predict (later on) the probability of contacts getting infected. Results Of the 101 contacts, 49 were positive according to symptoms, 27 were positive according to computed topography (CT), and 38 were positive according to laboratory investigations, so contacts who were getting infected were according to the definition of suspect and probable cases. Overall, the suspect and probable contacts were 61, and about 27 (of 68 contacts who did CT from our sample) were moderate and severe cases. Conclusion Contact cases with comorbidity and old age were more liable to get infected and to be more serious cases than young age with no comorbidity. Of all contacts (101), 42 had comorbidities and about 31 of them had the disease.

Treatment and comorbidities of patients with erectile dysfunction before and during COVID-19 in the United States: A real-world data analysis

Introduction Erectile dysfunction (ED) is usually a symptom of another medical condition. People with poor overall health are more likely to develop severe form of coronavirus disease 2019 (COVID-19) and may have unwanted symptoms such as ED. COVID-19-related stress, anxiety, and depression can also impact sexual health and possibly lead to ED. There are various treatment options for patients with ED. However, real-world evidence of the impact of COVID-19 on the treatment and comorbidities of patients with ED is limited. Objectives To estimate the impact of COVID-19 on the treatment and comorbidities of patients with ED in the United States. Methods This retrospective real-world data (RWD) analysis used the IQVIA PharMetrics® Plus claims database, which is a patient-Centric, closed claims database of fully adjudicated pharmacy, hospital and medical claims anonymized at the patient level, that captures the complete patient journey for all services billed to and covered by the patient's health plan. We compared the ED treatment and comorbidities in adult males aged 18+ years with ED in the same 3-month periods before (01March - 31May, 2019) and during (01March – 31May, 2020) the COVID-19 pandemic. ED treatment included any ED-related claims, prescriptions of any and individual phosphodiesterase-5 inhibitor (PDE5i) medications (avanafil, sildenafil, tadalafil and vardenafil). Results See the table below for number of patients having ED-related claims, having any and individual PDE5i prescriptions, number of patients with COVID-19 diagnosis, and percentage of patients with each of the top 10 comorbidities, in the 3-month periods before and during COVID-19. Conclusions RWD showed that ED-related claims significantly decreased during the COVID-19 pandemic, reflecting the pandemic's impact on ED patients’ health. However, the use of PDE5i medications remained stable during the pandemic. Key comorbidities including hypertension, hyperlipidemia, type 2 diabetes mellitus, benign prostatic hyperplasia with lower urinary tract symptoms, testicular hypofunction, and malignant neoplasm of the prostate, during the pandemic, compared with pre-pandemic period, highlighted the impact of the pandemic on ED patients’ health and need for managing their other comorbid chronic diseases. Disclosure Work supported by industry: yes, by Viatris. A consultant, employee (part time or full time) or shareholder is among the authors (Viatris).

A Global Update on COVID-19 Pandemic

As of October 10, 2021, the entire planet has reported 219 million COVID-19 cases, with 4.55 million fatalities. Lockdowns and softening measures have been thrown into turmoil throughout the world since the outbreak. Our social life will only return to normal once an appropriate vaccine is produced and proper authorized preventive techniques are implemented. To tackle this pandemic, governments and health experts all around the globe are experimenting with a range of measures and preventative strategies. So far, 22 vaccines have been approved. They are effective against immunocompromised people, pregnant women, and multiple sclerosis patients. Certain nations are considered to be more successful than others in terms of providing safety to their inhabitants and increasing their economic activities. A plethora of vaccinations have been produced, and a research anthology has been published. However, medical personnel are still searching for a viable treatment to limit this pandemic. © Pakistan Academy of Sciences.

Encouraging Student Engagement Through Storytelling

The COVID-19 pandemic has had a severe impact on higher education. Universities worldwide had to transition abruptly to online teaching, which was unexplored territory for most academics. The transition came bearing a new set of challenges: while on-campus lectures allow direct visual contact with students, enabling academics to use body language and eye contact to help encourage student engagement, these are absent in online sessions. As a result, lectures can become monotonic, with little interaction and indeed lacking the depth that engagement can motivate. This paper describes efforts by one academic to address these challenges, motivated by student feedback. The challenges were addressed by bringing in a more storified approach based on sketches, relegating the usual PowerPoint presentation to a supportive rather than a central role in the lecture sessions. An interesting change observed as a result of this approach was that the academic’s style changed from an expert teaching style to a facilitator teaching style. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

INTENSIVE CARE UNIT MANAGEMENT OF SARS-COV-2 PATIENTS: A NARRATIVE REVIEW

Y The 2019 Coronavirus disease is a public health emergency of international concern (PHEIC). COVID-19 causes acute respiratory distress syndrome (ARDS) in certain individuals. In such individuals, non-invasive and invasive ventilation methods are used to treat ARDS. Non-invasive ventilation approaches must be used initially before introducing intrusive mechanical ventilation techniques. Non-invasive methods used in the therapy of COVID-19 associated ARDS include high-flow nasal cannula, bi-level positive air pressure, and helmet ventilation. Before employing any of these non-invasive methods, the risk of viral aerosol transmission to healthcare and paramedical personnel must be considered. When non-invasive procedures are used, the load on hospital ventilatory equipment can be reduced. If at all possible, avoid intubating the patient too soon. The clinical appearance of the patient, as well as vital indicators such as oxygen saturation and respiratory rate must be evaluated on frequent basis in order to determine whether the patient requires ventilation. In COVID-19 patients, the judicious application of non-invasive and invasive breathing methods can minimize the risk of death from ARDS.

PAKISTAN'S PERSPECTIVE ON COVID-19 VACCINES

There has never been a pandemic of this magnitude in contemporary human history. In less than 16 months after the outbreak of the pandemic, almost 188 million confirmed COVID-19 cases and 2.5 million fatalities have been reported globally. In addition, a great deal of work has been done to discover vaccinations that are both safe and effective. In May 2021, 184 SARS-Cov-2 vaccine contestants were in pre-clinical trials, 105 were in clinical trials, and 18 vaccines had been licensed for emergency use by at least one national or international regulatory body. Till date, only 5 vaccines are given approval by WHO for emergency use that includes, Pfizer-BioNTech, Moderna, AstraZeneca, Sinopharm, Johnson & Johnson. These vaccines include entire virus inactivated or live attenuated, virus vector, protein-based, and nucleic acid vaccines. Currently, confusing information about the COVID-19 vaccination is being disseminated across the world. During health emergency, rumors spread and caused panic, insanity, and anxiety. SARS-CoV-2 strains, on the other hand, are constantly appearing over the world. This article provides a Pakistan's perspective towards COVID-19 vaccines with an updated review.

COVID-19-related Posterior Reversible Encephalopathy Syndrome in an Adult ICU Patient in Ireland

Radiologically confirmed, novel coronavirus disease 2019 (COVID-19)-related neurological manifestations are being reported with increasing frequency since the outbreak of the disease. We describe a 54-year-old male with COVID-19, who demonstrated radiological and clinical findings of posterior reversible encephalopathy syndrome(PRES). The proposed mechanism suggested for COVID-19-related PRES is a disease induced inflammatory storm, which causes endothelial injury, resulting in endothelialdysfunction (ED), interstitial fluid extravasation and cerebral edema. Key Words: COVID-19, Encephalopathy, Neurological complications, PRES.

Stroke etiologies in patients with COVID-19: the svin COVID-19 multinational registry

Background and purpose: Coronavirus disease 2019 (COVID-19) is associated with a small but clinically significant risk of stroke, the cause of which is frequently cryptogenic. In a large multinational cohort of consecutive COVID-19 patients with stroke, we evaluated clinical predictors of cryptogenic stroke, short-term functional outcomes and in-hospital mortality among patients according to stroke etiology. Methods: We explored clinical characteristics and short-term outcomes of consecutively evaluated patients 18 years of age or older with acute ischemic stroke (AIS) and laboratory-confirmed COVID- 19 from 31 hospitals in 4 countries (3/1/20-6/16/20). Results: Of the 14.483 laboratory-confirmed patients with COVID-19, 156 (1.1%) were diagnosed with AIS. Sixty-one (39.4%) were female, 84 (67.2%) white, and 88 (61.5%) were between 60-79 years of age. The most frequently reported etiology of AIS was cryptogenic (55/129, 42.6%), which was associated with significantly higher white blood cell count, c-reactive protein, and D-dimer levels than non-cryptogenic AIS patients (p</=0.05 for all comparisons). In a multivariable backward stepwise regression model estimating the odds of in-hospital mortality, cryptogenic stroke mechanism was associated with a fivefold greater odds in-hospital mortality than strokes due to any other mechanism (adjusted OR 5.16, 95%CI 1.41-18.87, p=0.01). In that model, older age (aOR2.05 per decade, 95%CI 1.35-3.11, p<0.01) and higher baseline NIHSS (aOR 1.12, 95%CI 1.02-1.21, p=0.01) were also independently predictive of mortality. Conclusions: Our findings suggest that cryptogenic stroke among COVID-19 patients may berelated to more severe disease and carries a significant risk of early mortality.