Work stress, office clutter and employees' performance during COVID-19 waves

PurposeThe aim of the study is to test the integrated model involving work stress, office clutter and employee performance with the moderating roles of training and self-discipline (SD) after the re-opening of the banks after the COVID-19 wave.Design/methodology/approach The study used 333 respondents from banking industry, whose responses were recorded using a closed ended questionnaire. The authors used partial least square path anaysis to analyze the data.Findings Work stress significantly increases office clutter, which harms the employees' performance. Moreover, SD and training significantly improve employees' performance by reducing work stress and thereby office clutter. There are various mechanisms through which both these factors reduced stress and office clutter.Practical implications The employee's performance can be enhanced with lower levels of office clutter. The office clutter can be managed through having lower levels of stress and providing people with training and inculcating SD among them. A greater understanding of the factors that count toward office clutter might help bank managers and employees to address the issues related to their performance.Originality/value The authors have proposed a new framework involving conservation of resources theory for the employees' performance. They posit employees' performance is an organizational resource, which can be conserved as well as enriched both by employers and employees through their own contribution.

Humanistic teaching during the pandemic: Education beyond the lesson

During the COVID-I9 crisis, teaching and learning activities were largely conducted online through open and distance learning (ODL). As a result, educators and students lacked the personal warmth and emotional support usually found in face-to-face classes, which affected the quality of the teaching and learning process. Therefore, what could educators do to facilitate the teaching and learning process during the pandemic? This chapter features narratives on humanistic practices in teaching that were carried out during the pandemic by five university lecturers. The narratives shed light on how they embedded humanistic elements in either one or several of these aspects of teaching: delivery, content, consultation, and assessment. Their pedagogical approaches indicate that education is not a rigid domain, but it can be extended beyond the four walls of the classroom and executed from the sincere heart. © 2023 by IGI Global. All rights reserved.

COVID-19 and the Psychosocial Impact of Breast Health Delays

INTRODUCTION: Reallocation of resources during the COVID-19 pandemic resulted in delays for breast health care. Data are sparse regarding the impact of these delays on psychosocial outcomes. METHOD(S): Women seeking breast health care across a multi-site breast program in a large metropolitan area were assessed for psychosocial outcomes including depression, stress, and anxiety as it related to delays in care. Psychosocial outcomes were evaluated utilizing validated instruments (PROMIS, PHQ-9). Outcomes were stratified by treatment group (healthy, breast cancer, survivor) and Kaplan-Meier curves created for breast cancer patients to evaluate the relationship of time to treatment stratified by dichotomous psychosocial outcomes. Demographic and clinical data was ed from the electronic medical record. RESULT(S): 85 women enrolled in the study including 30 (35%) breast cancer patients, 24 (28%) healthy women, and 31 (36%) breast cancer survivors. Overall, 58% reported a delay in breast health care including surgery, radiation, chemotherapy, medical oncology treatments, clinical appointments, breast imaging and/or biopsies, survivorship follow-up, support groups, and/or screening. Compared to women in the no delay group, a greater proportion of women reporting a delay had high anxiety (78% vs. 58%;p = 0.06), high perceived stress (45% vs. 28%;p = 0.17), high loneliness (67% vs. 32%;p = 0.003), moderate or higher depression (16% vs. 8.3%;p = 0.34), and no or low emotional support (58% vs. 28%;p = 0.008). Among breast cancer patients, the first treatment modality was surgery in 73% and the median time to treatment was 33 days. The median time to treatment was 40 days for breast cancer patients reporting a delay compared to 28 days for patients reporting no delay. Longer time to treatment was observed among breast cancer patients with high versus low anxiety, perceived stress, loneliness, and depression and for patients with low versus high emotional support. CONCLUSION(S): Women with and without breast cancer reporting a delay had worse measures for anxiety, depression, perceived stress, loneliness, and emotional support. Longer time to treatment was experienced by breast cancer patients with worse psychosocial measures. Risk stratification of women seeking breast health care during the COVID-19 pandemic is needed to identify and support those at risk for adverse psychosocial outcomes. (Table Presented).

Inculcating Ethical and Moral Values amongst the E-Learners: Proposing a Model for E-Learning Platforms

Under the influence of neo-liberalism and marketization, education is increasingly becoming more content-focused than character one. Ignoring the fact that money, science, and technology may take a person to the moon, these are ethical and moral values that take him/her to the even loftier heights of humanity. Recent COVID-19-driven focus on information and communication technology (ICT) and digital learning have further added to these woes by focusing more on human-machine interaction than human-human ones. Traditional models for inculcating these values through education which heavily rely on the physical presence of teachers do not seem to work in these circumstances. This demands a model for inculcating these values in learning management systems/ e-learning platforms. This study contributes in this regard by first identifying key players and factors, and then proposing a model for it. Using the Delphi model, it gathers opinions from 59 experts in two rounds. Academic institutions, society and online community members, teachers, and e-contents were identified as key factors and players. It suggests a holistic approach-based model through which all of them play their role and collaborate through an e-learning platform. That platform can be used to disseminate information, create awareness, monitor, and report the e-learners. It uses pull and push strategies to help the e-learners to develop those values. © 2023 The Author(s).

Predicting the need for Continuous Positive Airway Pressure (CPAP) or High-flow nasal oxygen (HFNO) in COVID-19 and patient outcome

Background: Patients admitted with COVID-19 pneumonia often have severe hypoxemic respiratory failure which requires additional support with CPAP/HFNO. It is not known which clinical variable best predicts the need for CPAP/HFNO. Aim(s): We reviewed consecutive patients admitted with COVID-19 to an acute respiratory care unit (ARCU) to assess, if any clinical or demographic data could help predict the need for CPAP/HFNO in a high risk group of patients, and also assessed their outcome. Method(s): Data collected from patients admitted to our ARCU with COVID-19 pneumonia between 28th November 2020 and 16th February 2021 was retrospectively reviewed. Clinical and demographic data was collected. The 4C mortality score for COVID-19 and chest x-ray scoring was performed. Result(s): 271 people were included in the study, CPAP/HFNO was initiated in 187 (73%). A CRP >100 (OR: 3.12, CI:1.8-5.4), or a respiratory rate >=30 (OR: 9.54, CI:3.9-26) at admission were associated with requiring CPAP/HFNO. A severe degree of zonal involvement on chest x-ray (OR: 3.65, CI:1.8-7.6) predicted the need for CPAP/HFNO. The 4C mortality score showed a step wise increase in the odds of needing CPAP/HFNO. 144 patients were commenced on CPAP/HFNO who were for escalation to invasive ventilation, 45% required escalation to invasive ventilation. 43 patients underwent CPAP/HFNO as a ceiling of care, 35 of which died resulting in an 81% mortality. Discussion(s): It is possible to predict which patients may require CPAP/HFNO using easily available clinic data. CPAP/HFNO as a ceiling of care in severe COVID-19 can be associated with a very high risk of mortality and should be carefully considered.

Tocilizumab in severe COVID-19 – A randomized, double-blind, placebo-controlled trial

Background: The therapeutic effectiveness of interleukin-6 receptor inhibitor in critically ill hospitalized patients with coronavirus disease 2019 (COVID-19) is uncertain. Methods: To evaluate the efficacy and safety of the outcome as recovery or death of tocilizumab for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, we conducted a randomized, double-blinded, placebo-controlled phase 2 trial in critically ill COVID-19 adult patients. The patients were randomly assigned in a 4:1 ratio to receive standard medical treatment plus the recommended dose of either tocilizumab or the placebo drug. Randomization was stratified. The primary outcome was the recovery or death after administration of tocilizumab or a placebo drug. The secondary outcomes were clinical recovery or worsening of the patients' symptoms and inflammatory markers and discharge from the hospital. Results: Of 190 patients included in this study, 152 received tocilizumab, and 38 received a placebo. The duration of hospital stay of the interventional group was 12.9 ± 9.2, while the placebo group had a more extended hospital stay (15.6 ± 8.8). The mortality ratio for the primary outcome, ie, mortality or recovery in the tocilizumab group was 17.8%;p = 0.58 by log-rank test). The mortality ratio in the placebo group was 76.3%;p = 0.32 by log-rank test). The inflammatory markers in the tocilizumab group significantly declined by day 16 compared to the placebo group. Conclusions: The use of tocilizumab was associated with decreased mortality, earlier improvement of inflammatory markers, and reduced hospital stay in patients with severe COVID-19. © 2022 The Author(s)

Rate and spectrum of incidental findings on CT pulmonary angiogram of COVID-19 patients

Introduction: Patients admitted with COVID-19 infection and had suspected pulmonary embolism were investigated with CT pulmonary angiogram(CTPA). Apart from the features of COVID pneumonitis, other incidental findings can be reported on the scan. Aim(s): This study illustrates the rate and spectrum of incidental findings on CTPA performed on patients admitted with COVID-19 in a busy district general hospital. Method(s): Electronic patient record and CTPA report of patients admitted with COVID-19 confirmed from SARS-COV2 PCR test were retrospectively analysed using Allscripts Gateway and Sectra software respectively between March 2020 to March 2021. Descriptive and statistical data analysis were undertaken in Excel and GraphPad Prism software. Result(s): 874 patients with COVID-19 with median age of 69 yrs were studied and 218 patients had CTPA (25%). 219 Incidental findings were noted in 112 (51%) patients who had CTPA. Patients with incidental findings are older (68 yrs vs 59yrs, p value 0.0005). 35 patients(16%) were found to have pulmonary embolism in our cohort. Conclusion : This study illustrates that incidental findings are common when COVID-19 patients had CTPA scans, and these patients were older. These incidental findings were both varied and clinically significant. This would increase the pressure on respiratory and cardiology services to investigate these incidental findings, further management and subsequent follow up.

A Rare Case of Heart Failure in Third Trimester Pregnancy - Diagnostic and Therapeutic Dilemma

Background Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is an extremely rare disorder. Case A 20-year-old, 36-week pregnant female (G1P0) presented with acute shortness of breath, sharp chest pain and fever. She was COVID-19 positive and required BiPAP. Echocardiogram showed 40% EF, dilated LV with global hypokinesis and moderate mitral regurgitation (MR). She was hypotensive and on oxygen despite diuresis, emergent cesarean and COVID-19 treatment. Left heart catheterization showed anomalous takeoff of the left main coronary artery (LCA) from the dilated pulmonary artery (PA) with coronary steal (Figure 1). She had ALCAPA repair with LIMA to LAD bypass grafting. Decision-making Differential diagnoses included peripartum cardiomyopathy, Covid-myocarditis, pulmonary embolism, and spontaneous coronary artery dissection. LHC was performed only when symptoms failed to improve and troponin kept rising. ALCAPA has two major clinical subtypes - Infantile type and adult type. Adult type presents as dyspnea, chest pain, reduced exercise ability, and sudden cardiac death. Despite having good RCA to LCA collaterals, adult patients can still have ongoing ischemia of the LV myocardium, causing ischemic MR, malignant ventricular dysrhythmias. Diagnosis was delayed due to pregnancy and COVID-19 infection. Conclusion ALCAPA is a lethal coronary disorder. Elevated troponin and dilated cardiomyopathy with acute MR should raise suspicion of ALCAPA in young adults. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Acute Epiglottitis Due to COVID-19 Infection.

A 53-year-old man presented acutely to the Accident and Emergency department with a 2-day history of progressive odynophagia and shortness of breath. The patient had stridor at rest and acute epiglottitis was suspected. The patient was transferred urgently to theatre for intubation but due to a severely oedematous airway, this was unsuccessful and emergency tracheotomy was performed by the ENT team. Throughout admission the only positive microbiological sample was a nasopharyngeal swab for SARS-CoV-2 infection. In the absence of other positive microbiology, it is highly likely that COVID-19 was the aetiological cause of acute epiglottitis in this instance. LEARNING POINTS: COVID-19 infection is a novel disease with multiple presentations; it should be considered as a possible causative organism in patients presenting with acute epiglottitis.Due to the time delay in taking samples for microbiology and results being available, treatment should be commenced with antibiotics, nebulised adrenaline and steroids to cover bacterial infection.Presentation can occur following a delayed inflammatory response and treatment should target the organ system involved.

Factors associated with noncompliance of COVID-19 guidelines recommended by Government of Pakistan for international travelers arriving at Islamabad International Airport, 1st June to 30th July 2021

Introduction: Since the start of pandemic new variants have been evolving and moving from one country to another either by air travel or ground crossings. Objective: To find out factors associated with noncompliance of recommended guidelines by international passengers so that we can improve the arrangements at airports where required, improve future preparedness, and give recommendations to concerned authorities for improvement in enforcing guidelines. Methodology: A cross-sectional study was carried out at Islamabad International Airport during the months of June and July 2021. The study population included international arriving passengers aged 12 years and above. Questions were asked about following guidelines before boarding, on board, and after disembarkation. Twenty questions were asked to assess compliance level. A median cut off value was set for assessment of noncompliance. Results: The male to female ratio was 1:1. The age range was 12 – 75 years. The odds of noncompliance to guidelines were higher in females compared to males. The results revealed a significant association between region of arrival of respondents and noncompliance. Passengers arriving from Afghanistan, the UK and the USA were more likely to be noncompliant to guidelines (p-value = 0.00). There was a significant association between occupation of participants and noncompliance. Housewives and retired were more likely to be noncompliant (p-value = 0.00). A significant association was observed between vaccinated people and noncompliance. Conclusion: Travelers arriving from some specific countries were noncompliant to guidelines. Vaccinated were most noncompliant which indicates still we need to work on awareness and need legislations, fines, or travel restrictions for noncompliant travellers. © 2022 The Author(s).

Effect of Moderate Exercise Training on Vitals and Peak VO2 in Different Age Categories of Adults in COVID-19 Pandemic

Objective: To determine the effect of moderate exercise training on vitals i-e., Blood pressure (Systolic and diastolic), Pulse Rate (PR), Respiratory Rate (RR) and Peak VO2 in different age categories of adults during COVID-19 pandemic. Study Design: Descriptive cross-sectional study. Place and Duration of Study: This study was carried out at a tertiary cardiac care center from Feb 2021 to May 2021. Methodology: It was a descriptive cross sectional study conducted generally for 6 months in tertiary care center. A total of 104 participants were included and divided into three groups i-e., Young adults (17-30 years), Middle age adults (31-45 years) and Old age (>45 years) Participants were selected through non-probability convenient sampling technique and allocated in groups based on their age. Participant, after meeting inclusion criteria were supervised during moderate exercise training which includes walking for 23 minutes, cycling for 23 minutes and stepping for 5 minutes. Participants were assessed Pre and Post through Manual sphygmomanometer for BP, NMQ for muscle discomfort. Borg scale was used to assess exertional level and 6 Minute Walk test to assess Peak VO2. Results: Post intervention between the groups showed the significant effect on all three assessment factors of VO2, Borg Scale and SBP with Kruskal Wallis test (p<0.05). Post intervention within the group showed significant effect on all three assessment factors of SBP,DBP,PR,RR,VO2 and Borg RPE scale with Friedman test (p<0.05). Post assessment of muscle discomfort shows highest frequency i-e 13.8(4%) in shoulder, thigh, upper and lower back region. Conclusion: This study reported that disturbed vitals and reduced VO2 due to inactivity because of COVID-19 pandemic. Post COVID-19 affects can be recovered through 6 weeks of moderate training. Furthermore, this study reported that participants belonging to old age showed maximum improvement in vitals in response to training while showed maximum muscle discomfort frequency in shoulder, thigh, lower and upper back. © 2022, Army Medical College. All rights reserved.

Lecturers' perceptions of authentic assessment in times of COVID-19 pandemic: a case of Indonesian universities

PurposeThe present study aims to provide a better understanding of authentic assessment in the COVID-19 pandemic era by exploring how Indonesian lecturers perceive authentic assessment in terms of input, process and output. It also examines the issue through the theoretical lens of authentic assessment following the tenet of a five-dimensional framework (5DF) including assessment task, physical context, social context, assessment result and standard authentic criteria.Design/methodology/approachThe study employed an exploratory sequential mixed-methods design to garner data through qualitative interviews and authentic assessment questionnaires in which 48 lecturers from four universities were involved.FindingsThe study gleaned two important findings. The qualitative data showed that the university teachers enacted the cognitive assessment fruitfully. The study shows that lecturer participants experienced difficulties in integrating cognitive, psychomotor and affective domains into authentic assessment tasks during the teaching and learning process. Additionally, the results of quantitative data support the qualitative data that lecturer participants faced challenges (asking students to demonstrate or perform the tasks) in implementing both social and physical contexts in authentic assessment tasks of online learning during COVID-19 pandemic.Research limitations/implicationsThe present study addresses practical and conceptual implications. Practically, it suggests the need to facilitate the development of lecturers' technological skills to design online authentic assessment in higher education that responds to fully online assessment, such as the prevalence of COVID-19 pandemic. Meanwhile, the study suggests that lecturers need to build their understanding of 5DF theoretical lens which include assessment tasks, physical contexts, social contexts, assessment result and standard authentic criteria to enhance their literacy in enacting authentic assessment.Originality/valueAlthough many studies have investigated the implementation of authentic assessment in higher education, only a few have examined how lecturers perceived online authentic assessment during the COVID-19 pandemic. The present study contributes to developing conceptual and empirical evidence regarding lecturers' perception of the implementation of authentic assessment based on 5DF theoretical lens in higher education settings during the pandemic of COVID-19.

Analysis of Dynamic Resource Allocation in Digital Education Ecosystems

The use of technology enhanced learning in education institutions has been developing at a rapid pace. Higher education administration affirms the value of digitization in learning platforms, especially in view of the response to the COVID-19 pandemic. The conventional education system is not consistent with the changing demands of modern education concepts, which are the driving factors towards formation and development of the digital educational ecosystem. To digitally transform education systems within a cross organizational environment, educational institutions should be interconnected, and the learners are able to access the learning modules from anywhere in the world. The effective allocation of learning modules to the students is of crucial importance due to the scarceness of such resources. The main objective of this paper is to identify the methods for assigning digital learning modules from a set of existing solutions. Facilitated by optimal resource allocation, the digital ecosystem can provision learning instances via virtual machines or containers and allocate it based on demand. Through the optimal resource allocation, the overall cost and power consumption shall be decreased and the availability of the learning service shall be increased. In this paper, literature research of different scheduling and allocation policies are discussed under varying statistical processes, priority, and performance metrics to increase efficiency and reduce operating cost of servers with no allocated task. © 2022 IEEE.

Modified spectral conjugate gradient iterative scheme for unconstrained optimization problems with application on COVID-19 model

In this work, a new class of spectral conjugate gradient (CG) method is proposed for solving unconstrained optimization models. The search direction of the new method uses the ZPRP and JYJLL CG coefficients. The search direction satisfies the descent condition independent of the line search. The global convergence properties of the proposed method under the strong Wolfe line search are proved with some certain assumptions. Based on some test functions, numerical experiments are presented to show the proposed method's efficiency compared with other existing methods. The application of the proposed method for solving regression models of COVID-19 is provided. Mathematics subject classification: 65K10, 90C52, 90C26. Copyright © 2022 Novkaniza, Malik, Sulaiman and Aldila.

WHEN NOTHING HELPS: A RARE CASE OF COVID-19 EMPYEMA IN A YOUNG HEALTHY MALE

SESSION TITLE: Problems in the Pleura Case Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Severe COVID 19 has now been known to cause devastating damage to the lungs. The manifestations include severe pneumonia, acute respiratory distress syndrome, spontaneous pneumothorax, etc. As we were learning about the pathogenesis of the infection, we were also learning rapidly about the therapeutics targeted against it. A report a case of severe COVID 19 ARDS in a non-vaccinated young male, who later developed empyema during his hospital course. CASE PRESENTATION: A 29-year-old male with no past medical history presented to the emergency department complaining of chest pain and shortness of breath. He was not vaccinated against COVID-19. He was discharged from the hospital on 2 liters of supplemental oxygen two days ago after undergoing treatment for COVID-19 pneumonia with dexamethasone and remdesivir. Physical examination revealed bilateral diminished lung sounds on auscultation. His blood pressure was 112/75 mm Hg, heart rate (HR) 120 per minute, respiratory rate 25 per minute, the temperature of 38.5 Celsius and he was saturating 91% on 15 L of oxygen via a non-rebreather mask. Initial CT scan revealed bilateral ground-glass opacities (figure 1.). Due to high oxygen requirements and CRP of 10.5 MG/DL, the patient was started on Sarilumab. Given his escalating oxygen requirements and worsening respiratory distress, he was intubated and transferred to the intensive care unit. Despite intermittent prone positioning, he became progressively hypoxemic and eventually required Veno-venous Extracorporeal Membrane Oxygenation (VV-ECMO). One week later he developed intermittent fever spikes up to 39.5 C with HR of 120 per minute and leukocytosis of 40.8 K/µL. Bedside point of care ultrasound revealed new bilateral complex pleural effusions. Chest CT-scan showed moderate bilateral pleural effusions with new cystic changes and worsening consolidations (figure 2). Pleural fluid analysis showed lactate dehydrogenase of 2798, pH of 7.11, and cell count of 100 with 98% neutrophils. Despite aggressive therapy with chest tube placements and broad-spectrum antibiotics his condition continued to worsen over the next month with the development of hydropneumothoraxes and traction bronchiectasis (figure 3). Given the clinical deterioration despite aggressive care, his family decided to pursue a comfort-oriented treatment approach and he eventually passed away. DISCUSSION: COVID-19 related pleural effusion is a reported complication of COVID-19 pneumonia in up to 2-11% of the cases [1]. Most cases are associated with comorbid conditions, such as heart failure, superimposed bacterial infections, and pulmonary embolism [2]. CONCLUSIONS: Our case indicates that bacterial empyema may complicate COVID-19 pneumonia later in the disease course even in young immune-competent patients, it is unclear if empyema is directly related to the disease process itself r the therapeutic used to treat the COVID 19 infection. Reference #1: Chong WH, Saha BK, Conuel E, Chopra A. The incidence of pleural effusion in COVID-19 pneumonia: State-of-the-art review. Heart Lung. 2021;50(4):481-490. doi:10.1016/j.hrtlng.2021.02.015 Reference #2: Zhang L, Kong X, Li X, et al. CT imaging features of 34 patients infected with COVID-19. Clin Imaging. 2020;68:226-231. doi:10.1016/j.clinimag.2020.05.016 DISCLOSURES: No relevant relationships by Rimsha Ali No relevant relationships by Konstantin Golubykh No relevant relationships by Iuliia Kovalenko No relevant relationships by Maidah Malik No relevant relationships by Taaha Mirza No relevant relationships by Navitha Ramesh

THE ERA OF HIV-NEGATIVE PNEUMOCYSTIS PNEUMONIA

SESSION TITLE: Chest Infections in Immunocompromised Patients Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Pneumocystis pneumonia (PCP) is a life-threatening opportunistic infection caused by Pneumocystis jirovecii. HIV-negative patients with PCP are primarily individuals receiving immunosuppressive therapy for other disease processes. In rare instances, PCP could be an initial manifestation of underlying defected or suppressed cell-mediated immunity that needs to be diagnosed to prevent morbidity and mortality. CASE PRESENTATION: 75-year-old female with a history of hypertension and hypothyroidism presented to the emergency department for evaluation of cough, fever, and shortness of breath gradually worsening over the last few weeks. She received outpatient treatment with no improvement. She was vaccinated against covid-19. On presentation, the temperature was 103F, heart rate was 108 bpm, blood pressure was 163/93 mm Hg, and oxygen saturation was 86% on room air. Hemogram showed leukocytosis with left shift with elevated inflammatory markers. Chest X-ray revealed bilateral ground glass opacities. She was started on broad-spectrum antibiotics, but symptoms worsened over the next few days. CT chest showed diffuse bilateral ground glass opacities with prominent interstitial markings. BAL obtained from bilateral upper lobes was lymphocyte predominant with pneumocystis jirovecii diagnosed on Gomori methenamine silver (GMS) staining. She was started on PCP-directed antibiotics with intravenous glucocorticoids, and workup for an underlying immunodeficiency was started. Subsequent BATS biopsy revealed diffuse organizing alveolar damage, with possible associated acute interstitial pneumonia pattern. This could be a rare manifestation of PCP or a primary presentation in the appropriate clinical setting. Autoimmune panel, leukemia, and lymphoma panel came back negative. AFB smear, HIV, EBV, CMV, HTLV I/II also returned negative. The lymphocyte subset panel revealed a CD4 count of 205 and a subsequent count a few days later of 64 with decreased total IgG. The patient was treated with high dose steroids for an extended period along with treatment for PCP however continued to decline clinically. The patient and family eventually decided to pursue comfort care. DISCUSSION: The predisposition to PCP in patients is primarily due to a decrease in cell-mediated immunity regardless of HIV infection. In our patient, the etiology of idiopathic CD4+ T cell lymphocytopenia cannot be determined due to the lack of serial laboratory data measurement. One of the proposed etiologies of ICL is systemic persistent immune activation in the setting of exogenous mRNA, the current technology that is being widely used for vaccine development. CONCLUSIONS: In this era of biotechnology, with advancements in immunosuppressive therapy and mRNA-based vaccines, increased awareness around the potential immune system activation and potential downstream complications needs to be further highlighted to raise awareness among physicians. Reference #1: Li, Y., Ghannoum, M., Deng, C., Gao, Y., Zhu, H., Yu, X., & Lavergne, V. (2017). Pneumocystis pneumonia in patients with inflammatory or autoimmune diseases: usefulness of lymphocyte subtyping. International Journal of Infectious Diseases, 57, 108-115. Reference #2: Pardi, N., Hogan, M. J., Porter, F. W., & Weissman, D. (2018). mRNA vaccines - a new era in vaccinology. Nature reviews. Drug discovery, 17(4), 261–279. https://doi.org/10.1038/nrd.2017.243 Reference #3: Vijayakumar, S., Viswanathan, S., & Aghoram, R. (2020). Idiopathic CD4 Lymphocytopenia: Current Insights. ImmunoTargets and therapy, 9, 79–93. https://doi.org/10.2147/ITT.S214139 DISCLOSURES: No relevant relationships by Santhosh Gheevarghese John No relevant relationships by Konstantin Golubykh No relevant relationships by Iuliia Kovalenko No relevant relationships by Maidah Malik No relevant relationships by Hafiz Muhammad Siddique Qurashi No relevant relationships by Taj Rahman No rel vant relationships by Tabinda Saleem

SEQUELAE OF COVID-19 COUGH: A RARE LIFE-THREATENING PRESENTATION

SESSION TITLE: Management of COVID-19-Induced Complications SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Rib fractures are an infrequent consequence of severe cough. In some patients, undetected rib fractures can lead to life-threatening outcomes. We bring to light a case of uncontrolled cough associated with COVID-19 infection resulting in multiple rib fractures that were missed in 2 hospital visits and subsequently diagnosed when the patient presented in acute distress and at high risk of decompensation from a hemothorax and a diaphragmatic hernia that required expedited evaluation, ICU admission, and surgical intervention. CASE PRESENTATION: This is a case of a 73 years old male who presented with shortness of breath and worsening dry cough of 4 weeks duration. He was seen in the ED 3 weeks previously for severe right-sided chest pain that was evaluated by a CT chest that did not reveal any acute findings. He was discharged home on pain medications. He had a repeat admission in 2 days and was diagnosed with acute hypoxic respiratory failure secondary to COVID-19 infection. CT abdomen was done for continued right upper quadrant pain which showed an upper abdominal wall hernia. He was discharged with instructions to follow up with outpatient surgery for hernia repair. In the interim, the patient continued to have excessive dry cough, progressively worsening shortness of breath, and bruising over the right abdominal wall and back. He returned to the ED where he was found to be hypoxic, and hypotensive. Imaging studies revealed a large right pleural effusion, fracture of the right sixth rib and seventh rib, and herniation of the hepatic flexure of the colon into the chest. He was subsequently admitted to the cardiothoracic ICU and underwent flexible bronchoscopy, right VATS, evacuation of hemothorax, complete decortication, and repair of diaphragmatic hernia. DISCUSSION: This case is an unusual presentation of an amalgamation of complications resulting from an unrelenting cough that prompted rapid recognition and swift action. Cough-induced complications are rare but can be life-threatening. Various imaging studies can be pursued to avoid a delay in diagnosis. CONCLUSIONS: Persistent cough is a common complication of COVID-19 infection. A clinician should have a high index of suspicion for rib fractures, diaphragmatic hernia, and hemothorax in a patient with persistent or progressive symptoms. Reference #1: Camarillo-Reyes LA, Marquez-Córdova RI, Surani S, Varon J. Hemothorax induced by severe cough: An unusual presentation. SAGE Open Med Case Rep. 2019;7:2050313X19846043. Published 2019 Apr 26. doi:10.1177/2050313X19846043 Reference #2: Daccache A, Haddad J, Ghanem A, Feghali EJ, El Osta B. Cough-induced rib fracture in a smoker: a case report. J Med Case Rep. 2020;14(1):147. Published 2020 Sep 5. doi:10.1186/s13256-020-02497-4 DISCLOSURES: No relevant relationships by Navya Akula No relevant relationships by Sanjana Chetana Shanmukhappa No relevant relationships by Muhammad Ahmed Malik No relevant relationships by Aqsa Malik No relevant relationships by Fahd Shaukat

Monitoring Novel Corona Virus using Machine Learning

In this article, we are working on a new Pandemic Corona (COVID-19) virus. COVID-19 is an infectious disease that causes serious lung damage. COVID-19 causes a disease in humans and has killed many people around the world. However, the virus has been declared pandemic by the World Health Organization (WHO) and all countries are trying to control and block all locations. In particular, four standard forecasting models have been used: linear regression (LR), logistics regression (LOR) and polynomial regression. Many areas of application that require the identification and hierarchy of threats have long used automatic learning models. [1] Machine-based (ML) analysis methods have been shown to be useful in predicting preoperative outcomes and improving decision-making about future actions. Different forecasting methods are widely used to solve forecasting problems. The purpose of this study was to determine the function of COVID-19 research and machine learning applications and algorithms for various purposes [2]. © 2022 IEEE.

Combating COVID: Exploring Pakistani Universities' responses to COVID-19

This study investigates Pakistani universities' responses during COVID-19. Permanent faculty members from eight different universities were interviewed for data collection. The participants reported six different strategies that were employed to continue the teaching-learning process during COVID-19: from well-developed LMS to virtually no classes. They also pointed out five main issues and challenges during COVID-19 (i.e., infrastructure and internet-related issues, students' participation and engagement issues, teachers' training and attitudinal issues, quality assurance issues, and lack of uniform policy by HEC). They also feared increased educational disparities due to the digital divide. Although this pandemic has adversely affected the higher education sector in Pakistan, if the policymakers and institutions are willing to learn and innovate, this crisis can be turned into an opportunity. © 2022, IGI Global.

Comparative Research on Educational Policy Responses to the COVID-19 Pandemic: Eastern vs. Western Perspectives

The COVID-19 pandemic has caused unprecedented ripples throughout society, bringing many sectors and fields, including education, to a virtual halt or forcing them to change their working style abruptly. Based on technological advancements, e-learning preparedness, and human and financial resources, higher education systems and universities in Eastern and Western countries have responded differently to this crisis. Comparative Research on Educational Policy Responses to the COVID-19 Pandemic: Eastern vs. Western Perspectives presents global research on the response of higher education to the COVID-19 pandemic from both the East and the West. It sheds light on the relevant challenges, strategies, and effectiveness of the policies set in place in response to the pandemic. Covering topics such as international student-related policies, pedagogical adaptation, and student motivation, this premier reference source is an essential resource for policymakers, government officials, faculty of higher education, students and educators of higher education, libraries, researchers, and academicians. © 2022 by IGI Global. All rights reserved.