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Background: X-Linked Moesin-Associated Immune Deficiency (X-MAID) is a rare severe combined immunodeficiency (SCID) subtype that can present at any age due to its variability. Depending on severity, patients demonstrate failure to thrive, recurrent bacterial and viral infections, and increased susceptibility to varicella zoster. It has been characterized by marked lymphopenia with hypogammaglobulinemia and impaired T-cell migration and proliferation. Case Presentation: This is a report of a Cuban 7-year-old male with poor weight gain and facial dysmorphia. He had a history of recurrent bacterial gastrointestinal infections and pneumonia beginning at 4 months of age. He additionally had 4-6 upper respiratory tract and ear infections annually. While still living in Cuba, he was admitted for a profound EBV infection in the setting of significant leukopenia. A bone marrow biopsy confirmed no malignancy. After he moved to the United States, his laboratory work-up revealed marked leukopenia with low absolute neutrophil and lymphocyte count with low T and B cells, very low immunoglobulin levels IgG, IgA, and IgM, and poor vaccination responses to streptococcus pneumonia, varicella zoster, and SARS-CoV-2. Genetic testing revealed a missense pathogenic variant c.511C>T (p.Arg171Trp) in the moesin (MSN) gene associated with X-MAID. He was managed with Bactrim and acyclovir prophylaxis, and immunoglobulin replacement therapy, and considered for hematopoietic stem cell transplantation. Discussion(s): Diagnosis of X-MAID should be considered in patients with recurrent infections and profound lymphopenia. As with SCID, early diagnosis and intervention is of utmost importance to prevent morbidity and mortality. This case demonstrates the importance of genetic testing in identifying this disease as it may prompt an immunologist to consider HSCT if conservative management is suboptimal. In the current literature, HSCT appears promising, but the long-term outcomes have yet to be described.Copyright © 2023 Elsevier Inc.
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The COVID-19 epidemic has strained healthcare systems, causing stress among personnel and facing significant economic and social issues. COVID-19 patients have significant symptoms, necessitating prompt treatment. It is a global urgency to develop effective vaccinations against COVID-19. Quick immunization of the whole world population against an ever-changing, extremely deadly virus is alarming, and various vaccine techniques are being researched. Bacteriophages are helpful in the treatment of multidrug-resistant bacterial infections. But, their clinical efficacy may go far beyond. One of the most significant bioproducts in medicine is thought to be vaccines. Vaccines for a variety of diseases have been made. However, certain vaccinations have disadvantages, such as high prices and immunological responses. In this regard, the use of bacteriophages has been suggested as an exciting alternative for making more inexpensive vaccines. Bacteriophage-displayed vaccines are based on the antigens being expressed on the phage surface. This tactic uses the inherent advantages of these particles, including their high stability, inexpensive production, and adjuvant capacity. Phage-displayed, phages DNA and hybrid phage-DNA vaccines are the three phage-based vaccines that are currently offered. The traditional method for finding novel barrier protection epitopes, antigens, and mimotopes is phage display. In this frame of reference, phage particles serve as a versatile, effective, and promising strategy for making vaccine delivery systems that are more effective and should be widely applied in the future. The phage-vaccine technique can potentially address the growing demand for innovative vaccinations against emerging diseases. This short communication addresses bacteriophage uses in vaccine development and discusses recent developments in bacteriophage-based vaccinations. It also focuses on and describes bacteriophages as a novel vaccine candidate for COVID-19. © Pakistan Academy of Sciences.
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The objective of this research paper is to investigate the impact of COVID-19 on the factors influencing on-time software project delivery in different Software Development Life Cycle (SDLC) models such as Agile, Incremental, Waterfall, and Prototype models. Also to identify the change of crucial factors with respect to different demographic information that influences on-time software project delivery. This study has been conducted using a quantitative approach. We surveyed Software Developers, Project Managers, Software Architect, QA Engineer and other roles using a Google form. Python has been used for data analysis purposes. We received 72 responses from 11 different software companies of Bangladesh, based on that we find that Attentional Focus, Team Stability, Communication, Team Maturity, and User Involvement are the most important factors for on-time software project delivery in different SDLC models during COVID-19. On the contrary, before COVID-19 Team Capabilities, Infrastructure, Team Commitment, Team Stability and Team Maturity are found as the most crucial factors. Team Maturity and Team Stability are found as common important factors for both before and during the COVID-19 scenario. We also identified the change in the impact level of factors with respect to demographic information such as experience, company size, and different SDLC models used by participants. Attentional focus is the most important factor for experienced developers while for freshers all factors are almost equally important. This study finds that there is a significant change among factors for on-time software project delivery before and during the COVID-19 scenario. Copyright © 2023 by SCITEPRESS - Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)
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Introduction: During the COVID-19 pandemic, virtual interviews for resident and fellowship applicants became the standard. However, studies evaluating the experience of virtual interviews format are lacking. Accordingly, we sought to survey both gastroenterology fellowship applicants and interviewing faculty members about their experiences with the virtual interview process. Method(s): Interviewees and faculty at 13 different gastroenterology fellowship programs at academic medical centers across the United States completed a post-interview survey. The online survey was conducted during the 2020 ERAS fellowship interview season via Google Forms. The survey responses were anonymously collected and reported. Result(s): A total of 177 gastroenterology fellowship applicants and 83 faculty members completed the electronic surveys. Most participants reported a positive experience with 91% and 84% of applicants and faculty respectively, scoring at least 4 points on a 5-point scale. Eighty-8 percent and 85% of applicants and faculty respectively, reported that they had enough insight about the applicant or the fellowship program during the interview. Over 67% of applicants reported cost-savings of greater than $1,000 per interview. Thirty-6 percent of applicants reported that they missed the personal interaction with the current gastroenterology fellows in the respective programs and the experience of physically touring the facility. Twenty-7 percent and 25% of applicants and faculty experienced technical difficulties during the interview process, respectively. Thirty-one percent and 22% of applicants and faculty would like for the virtual interviews to be the standard of future fellowship interviews, while 35% and 42% of applicants and faculty would consider it in the future, respectively. Figure 1 shows the ranking process for both applicants and faculty. Conclusion(s): Virtual interviews were perceived as effective and cost-saving by both gastroenterology fellowship applicants and faculty members. The virtual experience was widely accepted by most applicants and faculty, with high potential to become the standard of fellowship interview process in the future. However, a substantial portion experienced technical difficulty. Further improvements in technology are needed to optimize the process and increase the acceptance of the virtual interview experience. (Figure Presented).
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Introduction: COVID-19 pneumonia can result in significant morbidity and mortality in affected individuals. Our audit aims to study the respiratory outcomes of patients with COVID-19 pneumonia following the use of HFNC and NIV during the second wave of the pandemic. Method(s): We analysed the outcomes of 94 patients admitted to a tertiary combined HDU/ICU with severe COVID-19 pneumonia requiring non-invasive support between July and December 2021. Result(s): 94 patients were admitted during the study period. ICU mortality rate was 22% (21/94), total in-hospital mortality was 38% (36/94). HFNC was used as first line respiratory support in 58/94 cases, of which 39.6% required intubation. Of those patients who failed HFNC, time to intubation was significantly higher in those patients who passed away than those who were intubated and survived (mean 6.08 days vs 2.86 days, p < 0.05 one sided T-test). In all patients, very late intubation defined as intubation > 5d post admission to ICU, occurred in 6/41 patients, of which the mortality rate was 100%. ROX score performed at 12 h post intubation was unable to discriminate those who succeeded with HFNC and those who required intubation (mean ROX 7.24 vs 7.9, p > 0.05). NIV was used in combination with HFNC pre-intubation in 5/23 HFNC cases with 100% mortality rate. Extubation failure rates were low (5/94) and use of tracheostomy was uncommon (4/94;all 4 survived ICU stay, 3 eventually died in hospital). Conclusion(s): HFNC failure with prolonged use of HFNC and use of multiple non-invasive device strategies before intubation was associated with a high risk of mortality. Conventional measurements of HFNC failure in the form of a 12 h ROX score could not assist the clinician in predicting those patients at risk of HFNC failure.
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Background: Health care workers (HCW) assume a significant part in teaching the overall population about the origin of the immunization and its implications and subsequently, vaccination hesitancy among them presents existential dangers to the stoppage and control of this pandemic. It will likewise impede endeavours to reduce COVID-19 pandemic. Objective(s):To comprehend coronavirus vaccine acceptance and specific attitudes toward vaccine hesitancy among HCWs and medical students at Jinnah hospital, Lahore. Method(s):200 HCWs employed by Jinnah Hospital, Lahore and 200 asymptomatic medical students to access attitudes toward vaccine acceptance and hesitancy. A cross-sectional survey was designed and the questionnaire was administered during May, 2022 while it was completed online throughout the month of May, 2022. Vaccination hesitancy was defined as procrastination or denial of vaccination although the services and the doses are available. Tabulated form was given to the descriptive statistics and the reported attitudes towards COVID-19 vaccine of the participants. Data was entered and analysed statistically by using SPSS software, IBM version 27. Qualitative data was shown as frequencies and percentages. For data analysis a chi-square test was used with P < .05 as statistical significance. Result(s):In total, 400 enrolees, completed the questionnaire, a majority of participants were doctors (98.5%), were vaccinated by choice (90.5%), had Chinese vaccination (80.5%), and had booster dose (34%). Almost all respondents were aware of COVID-19 vaccination (100%).Vaccination hesitancy was shown by health care workers right away due to fear of vaccine (1%). Conclusion(s):Vaccine intake was adequate among health care workers and satisfactory among medical students. Awareness regarding vaccination was good among both groups with low level of hesitancy.Copyright © 2022, Anka Publishers. All rights reserved.
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With recent advancements in IT, internet systems and and the need for IT-driven society, particularly during Covid-19, online education (online learning, or e-leaming) has become inevitable to achieve the multiple objectives (such as cost-effective, time-efficient, quality enhancement, etc.) both for educator and learner. Keeping in view the importance of online education, the current study focuses on pedagogy of how to increase the efficiency of a learner. Therefore, this study is aiming to explore how these two dimensions of online learning style are used to measure new learners' satisfaction with online education, for which this study focuses on identifying the role of a student-teacher-contact (STC) in exploring the degree of learners' satisfaction with online education, and also applying the moderating effect of student-student contact (SSC). A total of 340 target respondents were surveyed in three phases. The results showed that STC interaction was insignificant during phase – I, whereas both interactions were found significant during phase – II & III. The research emphasizes that SSC in the presence of moderators has a significant determinant of the degree of new learners' satisfaction with online education. In addition, the management of online learning institutions will realize that SSC is essential for achieving new learners' satisfaction with online education. Since there is no sufficient literature on the moderating role of STC, this study is a valuable contribution to the existing body of knowledge © 2023, Turkish Online Journal of Distance Education.All Rights Reserved.
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Introduction & Objectives: Holmium laser enucleation of the prostate (HoLEP) has the strongest evidence base for bladder outlet surgery, despite its steep learning curve. Rapid enucleation rates can be achieved in established hands with day-case surgery being the norm in service delivery. We have previously shown the validity of such a model. With the post Covid surgical backlog we have developed a tool to support theatre utilization based on established surgeon specific operating room (OR) times for a given prostate volume in our unit based on almost 1100 cases. Material(s) and Method(s): Four HoLEP naive surgeons completed 1096 HoLEPs over 7.5 years using a 50 Watt (W) Holmium laser (Auriga XL, Boston Scientific Inc., Piranha morcellator, Richard Wolf). Pre and post-operative data including TRUS/MRI volume, flow rate, residual volume, international prostate symptom score, quality of life, stop-clock enucleation, morcellation and total operating room (OR) times, hospital stay, histology, haemoglobin, creatinine, sodium and catheter times were prospectively recorded. Mentorship was provided by a senior 100W HoLEP surgeon from an adjoining hospital. Result(s): The data was independently analysed by a bio-statistician (IN). Statistical regression analysis of unit and surgeon specific OR times vs prostate volume were used to produce predictive linear graphs of OR times (mins) for a given prostate volume for individual surgeons and the unit. [Figure presented] Conclusion(s): Use of surgeon-specific and unit specific OR times allows the opportunity to maximize theatre operating schedules to help tackle the post Covid surgical backlog. We encourage this process for index specialist procedures across units.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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Background: In India, the first case of COVID-19 was reported on January 30, 2020. The case reporting is based on the testing of individuals by Real-time Reverse Transcription- Polymerase Chain Reaction (RT-qPCR). The present study was conducted to evaluatedifferent parameters, Haematological and Biomarker variations in patients with SARS-CoV2 Infection to assess the prognostic significance. Material & Methods: The present prospective study was conducted among 70 patients who were diagnosed with COVID-19 infection. Relavant physical examination and clinical data of the patient and routine blood investigations including, CBC, serum biochemistry, coagulation function and measurement of inflammatory markers were performed. The results were analyzed by using a SPSS Statistics software version 25.0. Results: In the present study total patients were 70 out of which 58.6% were males and 41.4% were females. Maximum subjects belong to age group 61-80 yrs (47.1%). Mean haemoglobin was 12.89g/l, mean platelet was 9.96x103/l. Mean neutrophil were 88.21%, mean lymphocyte were 8.84%, mean eosinophil were 1.47%, mean monocyte was 1.59%, mean TLC was 12007.14/l. Mean random blood sugar was 148.09 mg/dl. Mean D-dimer was 0.56. Mean CRP levels were 65.5 mg/l. Mean LDH was 516.03 IU/L, mean IL-6 was 282.6pg/ml, and mean procalcitonin was 0.8 ng/ml. Mean SGOT was 62.36u/l, mean ALP was 171.87IU/L, mean urea levels were 57.10 mg/dl and mean INR was 1.22. Outcome mortality was present in total 14 subjects (5 were male and 9 were female) out of all 70 subjects. Conclusion: The present study concluded that Mean values of neutrophil, eosinophil, TLC, random blood sugar, IL6, SGOT, ALP, urea levels and INR were increased in patients with SARS-CoV2 Infection.
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Background: Coronavirus disease 2019 (COVID-19) is currently spreading fast around the world. The rate of acute kidney damage (AKI) in patients hospitalized with Covid-19, as well as the outcomes related with it, are unknown. The goal of this study was to see if having acute kidney damage (AKI) increased the risk of severe infection and death in COVID-19 patients. It also described the symptoms, risk factors, and outcomes of AKI in Covid-19 patients. Material(s) and Method(s): We undertook a retrospective cohort from June 2020 and March 2021 to examine the connection between AKI and patient outcomes COVID-19. Result(s): The most common comorbid condition was hypertension and diabetes followed by chronic kidney disease and ischemic heart disease. Most of the patients who required low dose oxygen with nasal prongs, face masks, or rebreathing masks were in control groups (76.2% vs. 50.6%;p <.001). More patients in AKI group needed non-invasive ventilation and invasive mechanical ventilation compared to control group (33.8% vs. 19.9%;p .001, 15.6% vs. 3.9%;p <.001 respectively. Patients in the AKI group had higher levels of C-reactive protein, lactate dehydrogenase, D-dimer, and serum. Of 145 patients who developed AKI, 29 (20%) needed hemodialysis. Of 29 patients who needed hemodialysis, 18 (62%) expired. A higher number of patients in the control group were discharged than patients in the AKI group (82.1% vs. 56.9%;p <.001). One hundred five patients were expired, with higher mortality in the AKI group (41.7% vs. 12.4%;p <.001). Conclusion(s): COVID-19 patients admitted to the hospital, AKI is associated with a shockingly high fatality rate.Copyright © 2022 Lahore Medical And Dental College. All rights reserved.
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Introduction: Numerous studies have shown both hyponatremia and hypernatremia to be independently associated with mortality. Patients infected with Covid-19 infection can develop severe life threatening pneumonia and the mortality in these patients can be as high as 20.3% to 27.9%. While respiratory tract involvement is one of the main manifestation of Covid -19 infection, many patients also have associated dysnatremias. The reported prevalence of hyponatremia and hypernatremia in Covid -19 patients has been 25%-45% and 3% to 7% respectively. Recently, it has also been observed that patients with covid-19 infection develop severe treatment resistant hypernatremia > 150 mEq/L, which is difficult to correct. In patients with Covid-19 infection, dysnatremia is a frequent occurrence, although its relationship with mortality needs to be established. We aimed to study the frequency of dysnatremia in patients with Covid -19 infection at different stages of admission. Method(s): This retrospective analysis was conducted at Aga Khan University Hospital, Karachi, Pakistan over a period of twelve weeks. All admitted adult patients with covid -19 were included. Three levels of serum sodium were recorded: on admission, maximum level anytime during hospital stay and at the time of discharge or death (+/- 48 hours). Based on the serum level of sodium, three definitions were used: hyponatremia, hypernatremia and normonatremia. Hypernatremia was further categorized into mild, moderate and severe. Patients developing acute kidney injury (AKI) was also recorded. The main outcome measure was inpatient mortality. Result(s): The study included 574 patients;median age was 55.6 +/-14.4 years. On admission, the mean sodium was 135.9 +/- 6.4 mEq/L, 39% patients had hyponatremia and 4.7% had hypernatremia. During hospital admission, the percentage of hypernatremia increased to 18.8%: 12.7% had mild, 4.5% had moderate and 1.6% had severe hypernatremia. The mean serum sodium, during hospital stay, in patients who survived was around 140.6 +/- 5 as compared to 151 +/- 9.9 mEq/L in those who died with p value <0.001. The last mean serum sodium checked before death or discharge (+/- 48 hours) was 145.4 +/- 9.4 mEq/L as opposed to 137.7 +/- 3.7 mEq/L with p value of <0.001 in patients who died and survived respectively. The mean serum creatinine on admission was 1.3 +/-1.3 mg/dl;200 (34.8%) patients developed AKI;100 (50%) patients developed stage 1 AKI, 49 (24.5%) had stage 2 and 50 (25%) had stage 3 AKI. Around 36 (6.3%) required renal replacement therapy. The predictors of AKI included severity of Covid-19 [p = 0.001], age [p = <0.001], hypertension [p = 0.04] and invasive ventilation [p = 0.01]. Overall, mortality was 10.97%. Conclusion(s): Hyponatremia on admission is commonly seen in patients admitted with Covid -19 infection, whereas hypernatremia is a frequent finding in patients who could not survive, however their association with mortality needs to be established. No conflict of interestCopyright © 2023
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Objective: To find the trend of seropositivity of antiSARS-CoV-2 antibodies in registered patients for COVID-19 in Dow Diagnostic Reference and Research laboratory Methodology: A total of 5247 patients were enrolled for SARS CoV2 antibodies analysis from 01 August to 31 December, 2020. Patient consent was attained and questionnaire forms were filled. Samples were tested for anti-SARS-CoV-2 antibodies on (Roche Cobase 601). Result(s): In 5247 patient's samples, seropositivity of SARS CoV2 was found in 2425 (46.2%) samples. Seroprevalence in males was 28.4% (n;1491) as compared to females, who showed 17% (n;934). The age group G3 (> 46 to 60 years) showed higher seropositivity (n = 604/1118, 54%) as related to other age groups. Out of total reactive patients, only 30% (n;727) reported recent symptoms while 70% (n;1697) were asymptomatic. Fever was observed to be the most common symptom followed by dry cough. The most commonly affected areas were East 2353 (44%), South 855 (16.01%), Malir 793 (14.85%), Center zone 589 (11.03%) and Korangi area 378 (7.08%). The frequency of seropositivity showed an increasing pattern in the six months from August 2020 to December 2020. It was found to be 11.5% in August, 13.6% in September, 13.9% in October, and 42.5% in December 2020. Conclusion(s): The trend of seropositivity revealed a gradual upward course in the duration of study period. Nearly, two thirds of the patients were asymptomatic indicating the fact that many individuals were silently exposed to the infection and developed antibodies through their natural defense mechanism.Copyright © 2023, Pakistan Medical Association. All rights reserved.
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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.
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Purpose: Marketing is all about understanding your consumers and giving them what they want. However, this process becomes more complicated in times of economic crisis and national slowdown. Consumers can become scattered and unpredictable in their behaviour, making it hard to understand what they want or need. At times like these, it is more important than ever to rely on qualitative market research to understand the views of consumers and managers. Thus, this study aims to look at the significant consumer challenges that arise during times of crisis and the marketing strategies that managers prefer to counter the crisis. Design/methodology/approach: The data collected for this study involves an extensive literature review followed by personal interviews with industry experts. This study presents two separate models, indicating hierarchical relationships among consumer challenges during crisis and marketing strategies using the total interpretive structural modelling approach. Further MICMAC analysis (popularly known as cross-impact matrix multiplication) was also performed to assess each variable's driving and dependence power. Findings: "Price sensitiveness” and "adaptive buying” result as driving factors with the highest driving and lowest dependence power, which further gives rise to other consumer behaviour challenges. Likewise, the most critical strategies are "information systems” and the formation of "crisis management teams” during a crisis. At the same time, other strategies have resulted as linkage and dependent factors and none as the autonomous factor. Originality/value: This paper provides a systematic understanding of how a manager can understand the challenges consumers face during a crisis and suggests a powerful summary of strategies companies can implement to sail through a crisis. © 2023, Emerald Publishing Limited.
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Introduction: A novel coronavirus disease (COVID-19) was initially reported in China in December 2019. In a few months, the virus spread rapidly across the globe, and on 30 January 2020 the World Health Organization (WHO) declared the outbreak to be a Public Health Emergency of International Concern. Objective(s): The main objective of the study is to find the frustration intolerance, self-efficacy and sleep quality in medical students during pandemic of COVID-19. Material(s) and Method(s): This cross sectional study was conducted in University of Lahore during 2021-2022. The data was collected through questionnaire. The questionnaire covered sleep conditions, stores of infection control supplies, mood and stress, usage of social media and sources of acquiring COVID-19 information, risk perception, and sociodemographic data. Result(s): The data was collected from 200 patients. About half of them were young-aged (55.0%) and married (49.1%). In terms of social media use, 57.8% spent more than 2 h per day. With regard to sleep deterioration after the COVID-19 outbreak, the weighted proportions of those who reported worsening sleep quality, worsening sleep initiation, and shortened sleep duration were 38.3%, 29.8%, and 29.1%, respectively. The weighted prevalence of current clinical insomnia was estimated at 29.9%. Practical implication: This study will help to find out the effect of COVID-19 on sleep quality, sleep initiation and duration among Pakistani population. Conclusion(s): It is concluded that COVID-19 is widely spreading in Pakistan and it effects on their sleep quality, sleep initiation, and sleep duration had worsened since the outbreak of COVID-19. This study identified high prevalence of frustration intolerance and poor sleep quality in medical students during pandemic of Covid-19.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.
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Introduction: SARS-CoV-2 infection has profound effects on endothelial and immune cell function and coagulation, and better understanding of these events in COVID-19 would allow for targeted cardiovascular treatment and followup. Method(s): Longitudinal observational study of patients with PCR-confirmed SARS-CoV-2 infection admitted to hospital at two UK sites. Patients were enrolled within 96 hours of admission, with sampling up to day 29. RNAstabilised whole blood was processed for mRNA sequencing. Gene expression levels were compared between patients who did and did not suffer a major cardiac event (MACE) from admission to 1-year post-hospitalization. Result(s): At day 1, in acute COVID-19, no differences in gene expression were observed between those with (n=23) and without (n=140) a MACE. However, 93 significant differentially expressed genes (DEGs;adjusted pvalue<0.05;Wald test with Benjamini-Hochberg correction) were identified at day 29 between patients who suffered a MACE (n=16) or not (n=85) post-hospitalization. Neutrophil elastase (ELANE), tissue factor pathways inhibitor (TFPI) and integrin subunit alpha-2 (ITGA2B) were significantly elevated in patients who suffered a MACE. Significantly enriched pathways associated with cardiovascular events included type I interferon signalling and neutrophil chemotaxis. Conclusion(s): COVID-19 patients who experienced a MACE demonstrated significant changes in peripheral blood transcriptome 29 days after hospital admission. Significant DEGs were related to neutrophil activity, coagulation and interferon signalling, suggesting a relationship between these pathways and increased cardiovascular risk.
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Rhinocerebral mucormycosis is an uncommon, rapidly advancing, catastrophic, opportunistic fungal infection that predominantly affects metabolic and/or immunologically challenged individuals. Its frequency has increased dramatically since the SARS-COV-19 epidemic. The disease has been described as having distinct clinical categories, namely: rhinocerebral, pulmonary, cutaneous, gastrointestinal and disseminated. Extranasal dissemination has been invariably linked with an increased risk of death. Though an aggressive disease with a substantial rate of mortality, seeking timely help, prompt investigations and diagnosis, treatment with higher antibiotics, oral or intravenous antifungals, rigorous surgical excision, and control of underlying comorbidities has resulted in effective disease management and control with a gratifying outcome and lower morbidity when compared to the pre COVID era. We present a case of sinonasal mucormycosis with ocular, oral, pulmonary, and intracranial involvement in a young post COVID-19 immunocompromised male patient who was optimally treated with a comprehensive endoscopic surgical approach and combined with oral and systemic liposomal amphotericin B therapy. © 2023 Personal non-commercial use only EJENTAS. All rights reserved.
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Analyzing the emotions about the vaccines and vaccination will help to successfully carry forward the vaccination trials and government policies towards epidemic control. The tweets featured information on the most common immunizations has recently been available all around the world. The method of natural language processing is the successful tool to investigate the reactions of the people to various immunizations. This paper proposes a ensemble learning model making use of the VADER lexicon, logistic regression, and random forest algorithm for sentiment analysis to understand and interpret the people's sentiments through the tweets. We utilize a collection of tweets in April to May 2021 to extract inferences about public views on vaccinations as they become more widely available during the COVID-19 pandemic. The classification output of the VADER algorithm is used as one more feature that helps to achieve better accuracy using the random forest algorithm. One more feature is added with the available features using logistic regression. Hence, the classification outputs of VADER and logistic regression improve the classification accuracy to 88% for positive-negative outputs and 84% for positive, neutral, and negative outputs. © 2022 IEEE.
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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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The COVID-19 lockdown has severed many families, where they found themselves having a limited period to decide who would live where and with whom. In other instances, it cemented the divide which already existed for the non-custodial parent. Parents found themselves in a tug-of war over the children and with courts being temporarily closed during this time, travel restrictions and lockdown regulations, it became harder to enforce custody agreements. This worked out somewhat perfectly for the parent who tried to alienate their children from the other parent. Parental alienation is a recurring problem that affects many families who are experiencing high conflict, separation and divorce. Parental alienation can be defined as a process whereby one parent undermines the child's previously intact relationship with the other parent. It creates a situation where the alienating parent teaches the child to reject the other parent, to fear the parent and to avoid having contact with that parent. Although not much has been done to officially recognise parental alienation in South African courts, the law advocates for the best interests of the child in terms of the Children's Act 38 of 2005. Although parental alienation has been described in the psychiatric literature for at least 60 years, it has never been considered for the inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Nonetheless there have been various proposals and opinions that parental alienation be included in the definition. In addition, parental alienation does have emotional consequences to an alienated parent. When an alienator parent's conduct leads a child to reject the other parent, the alienated parent's emotional response usually includes a "sense of powerlessness and frustration", stress, loss, grief, anger, fear and feelings of pain, anxiety, deficiency, humiliation and being unloved. Ultimately, the alienated parent experiences the anguish of the loss of a child, which in turn causes that parent immense mental pain and suffering. This is similar to loss and is combined with the continuing concern for the child. The long-time existence of parental alienation and its lack of appropriate legislative consequences is a cause for concern. Unless effective deterrents to parental alienation are implemented, it is a fair prediction that alienation will continue. This paper will focus and discuss the civil remedies that are available for an affected parent. The paper will further propose that the additional delictual remedy for emotional distress and harm be utilised by an alienated parent against the alienator if their case warrants it.