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This innovative practice full paper presents a case of teaching modeling, simulation, and performance evaluation course online during the COVID-19 pandemic for graduate students. The course includes theoretical and practical sessions with varying complexity. Students should have a good background in math, statistics, and probability. Students must also have good experience in one of the computer programming languages to solve the homework and work on the term project. The challenge is how to teach these topics online and engage the students in the course as they learn in face-to-face classes. Delivering the course using PowerPoint slides and a whiteboard is not suitable for teaching the class online. Therefore, there must be an alternative way to deliver the course online. We noticed a growing interest in using Jupyter Notebook in teaching, which motivated us to apply it to the mentioned course with some innovations. Jupyter Notebook is an open-source web application that allows us to create and share documents that contain live code, equations, visualizations, and narrative text. We want to share our experience teaching this course online using Jupyter Notebook in this innovative practice. We will share the course development plan, delivery mode, lessons learned, and student feedback. I will also highlight maximizing the benefits of the Jupyter Notebook using add-ins and tools useful for teaching, such as converting the Jupyter Notebook to a slide show. Developing courses in Jupyter Notebook could be time-consuming and frustrating, especially if there are a lot of math equations, tables, and drawings. This effort pays off in terms of the quality of the instruction and learning, and it gives students a tool to help them practice and engage with the course material. © 2022 IEEE.
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Background: Thrombotic events are frequent in COVID-19 patients. The use of DOACs to treatment or extended prophylaxis is not clear in these population. Aim(s): To know the prevalence of PE associated with COVID-19 pneumonia in our population. To describe the use of DOACs for ambulatory prophylaxis after COVID-19 pneumonia patients. To describe the use of DOACs for ambulatory treatment in PE COVID-19 patients. Method(s): Retrospective registry of patients admitted for COVID-19 pneumonia from May 2020 to December 2021. Internists evaluated thrombosis risk after discharge according to IMPROVE score and body mass index (BMI) >=30 following a local guideline. Exclusion criteria: Treatment with other anticoagulants, no follow-up, death. Statistics: Quantitative data through parametric analysis of variance and categorical data according to contingency tables Results: 345 patients were admitted;279 were evaluable (Table 1). 37.5% patients received extended prophylaxis (87/232: 54 Apixaban, 33 Rivaroxaban). Mean prophylaxis time 14.27 days (7-28). There was no consensus among internists regarding prescribing ambulatory prophylaxis. 16.8% of COVID-19 pneumonias had PE (47/279). 70% were incidental (imaging studies due to underlying disease) and 30% were symptomatic. 38 were on Apixaban, 9 on Rivaroxaban. The mean days on anticoagulation treatment was 92 days (20-80). We had 4 thrombosis after discharge (Table 2). We have not recurrent thrombosis in the PE group. Bleeding events occurred in 3 cases on therapeutic doses. Only one was a major bleeding (hematuria). Conclusion(s): Our prevalence of PE in COVID-19 pneumonia was 16.8%. With respect to DOACs treatment we have not bleeding at prophylaxis doses and one mayor bleeding at therapeutic doses. We have four thrombosis after discharge. No recurrent thrombosis was seen in PE patients. The use of DOACs in extended prophylaxis or treatment after COVID-19 pneumonia seems to be safe, with no differences with the non-COVID- 19 population. (Table Presented).
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Background: Coronavirus disease-19 (COVID-19) is associated with disturbed hemostasis balance. Little is known about COVID-19- associated hemostasis alterations in pregnancy and their associations with the clinical course. Aim(s): We aimed to test hemostasis alterations in COVID-19- positive pregnant women as compared to non-infected pregnancies and to correlate results with maternal and perinatal outcomes. Method(s): In this single-center observational case-control study, 80 women with acute COVID-19 infection at 24-40 gestational weeks (COVID-19+ group) and 80 healthy age-and gestational week-matched pregnant women (COVID-19- group) were enrolled. All women were outpatients with mild/no symptoms at admission. Acute infection was confirmed/ruled out using SARS-CoV- 2 RT-PCR and/or antigen test. Blood taken on admission was analyzed for markers of inflammation (CRP, ferritin, IL-6), D-dimer, fibrinogen, von Willebrand factor antigen, factor VIII (FVIII) and factor XIII (FXIII) activity, clot-lysis assay, thrombin generation, ACE1, ACE2 activity, and anti-SARS- CoV- 2 antibody levels. Detailed clinical parameters of pregnancy, labor and post-partum period were registered. Pregnancies were followed for 6 weeks after childbirth. Result(s): In the COVID-19+ group, APTT was significantly prolonged, while PT, fibrinogen, and D-dimer levels did not significantly differ from the non-infected group. FVIII activity was significantly lower in the COVID-19+ group as compared to COVID-19- group (183.7 +/- 55.9% vs. 201.7 +/- 49.2%, p = 0.03). Similarly, FXIII activity was significantly reduced in COVID-19+ pregnant women (80.6 +/- 23.5% vs. COVID-19- group: 91.6 +/- 22.5%, p = 0.04). Pregnancy-associated complications were observed in 5 COVID-19+ cases, with marked alterations of coagulation screening tests, clot-lysis assay, and increased D-dimer. Perinatal complications were observed in 6 cases and one newborn tested positive for SARS-CoV- 2. Two cases of severe post-partum hemorrhage were observed in the COVID-19+ group. No post-partum thrombotic events occurred. Conclusion(s): In this cohort, third-trimester COVID-19+ pregnancies were associated with reduced levels of FVIII and FXIII activity. In a few cases, marked alterations of hemostasis and fibrinolysis balance occurred, which were accompanied by pregnancy complications.
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ABSTRACT
The new coronavirus infection (COVID-19) is associated with significant changes in hemostasis parameters, however, little is known about COVID-19-associated coagulopathy in pregnancy. In this observational case-control study, 39 women with acute COVID-19 infection at 36-40 gestational weeks of their pregnancy (COVID-19+ group) and 21 healthy age-and gestational week-matched pregnant women were enrolled (COVID-19-group). All women were outpatients and acute infection was confirmed or ruled out using SARS-CoV-2 RT-PCR or antigen test. In addition to screening tests of coagulation, D-dimer, fibrinogen, von Willebrand factor antigen, chromogenic factor VIII (FVIII) activity, factor XIII (FXIII) activity, in vitro clot-lysis, angiotensin convertase enzyme (ACE) activity, and anti-SARS-CoV-2 antibody levels were measured. In the COVID-19+ group, APTT was significantly increased, while PT, TT, fibrinogen and D-dimer were not significantly different as compared to the COVID-19-group. FVIII activity was significantly lower in the COVID-19+ group (183.7±47.7%) as compared to COVID-19-group (226.7±62.5%, p=0.01). Similarly, FXIII activity was reduced in the COVID-19+ group (82.3±23.5% vs. COVID-19-group: 96.2±26.6%, p=0.04). Pregnancy-associated complications including HELLP syndrome were observed in 2 cases of COVID-19+ group, with marked alterations of coagulation screening tests, clot-lysis and D-dimer levels. Conclusion: Pregnancy associated with SARS-CoV-2 infection in the third trimester leads to reduced levels of FVIII and FXIII activity, most likely as a result of increased coagulation activation and consumption.