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Objective: To determine the mode of e-learning preferred by the students regarding pre-recorded lectures (asynchronous) or online zoom lectures (online synchronous learning). Methodology: This cross-sectional study was conducted at CMH Lahore Medical College and Institute of Dentistry from 21st May to 21st June 2020. An online self-administered questionnaire was shared with the students via WhatsApp. The reliability was checked after conducting a pilot study and Cronbach's alpha was 0.711. Data were analyzed using SPSS version 20. Result(s): A total of 282 responses were obtained. Most respondents were female (69.9%), while about 83.7% of responses were from MBBS students. Students who were currently not in the country strongly agreed that time zone differences made online zoom lectures harder to attend. Most students (65.2%) preferred pre-recorded lectures over online zoom lectures. The major factors influencing their choice included pre-recorded lectures being less time-consuming (72.4%) with students being able to re-watch them during the exam preparation (87.6%) and better manage their daily activities (78.8%). Approximately 70.9% of the students wanted instructors to continue uploading recorded lectures after resumption of traditional lectures. Conclusion(s): Students preferred pre-recorded lectures over online zoom lectures. An online curriculum should be developed with predominantly asynchronous learning along with reliable methods of assessment to ensure that the students achieve their academic goals.Copyright © 2023, Pakistan Medical Association. All rights reserved.
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Objective: To determine the barriers to the maintenance of COVID 19 cross infection control protocols among medical and dental practitioners Methodology: A cross sectional study was conducted in College of Dentistry, Sharif Medical and Dental College, Lahore from July 2021 to July 2022 on medical and dental practitioners. The sampling technique employed was convenient sampling. Medical and dental practitioners irrespective of their age, gender and specialty of practice were included in the study. Data was collected using a pre-validated questionnaire with a Cronbach alpha value of 0.7. Result(s): There was s statistically significant difference in the scores of barriers to maintenance of COVID 19 cross infection control protocols of overcrowding in the hospital (p= <=0.001), limitation of infection control material (p=<=0.001), insufficient training in infection control (p=0.05), lack of handwashing (p=0.022), not wearing a mask while examining the patient (p=<=0.001) and lack of knowledge about mode of transmission of COVID 19 (P=0.036) Conclusion(s): The barriers faced to maintenance of cross infection control protocols pertaining to the hospital administration were reported to be higher for medical practitioners in comparison to the dental practitioners. The barriers faced to maintenance of cross infection control protocols pertaining to the attitude and practices of health care workers were also higher for medical practitioners in comparison to the dental practitioners. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.
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Aim: To investigate the prevalence and variations in precipitating causes of diabetes-related ketoacidosis (DKA) across hospitals and types of diabetes across the West Midlands. Methods: All people admitted with DKA from 1 January 2021 and 30 September 2021 in six hospitals in West Midlands as part of DEKODE database were included in this study. Precipitating causes were categorised as: excess alcohol-associated, covid-19 related, drug-induced, inter-current illness, new diagnosis of diabetes, sepsis, SGLT2 inhibitor related, suboptimal compliance to treatment, surgical, and unknown. Results from each of the participating hospitals are reported as frequencies and proportion anonymously. The differences in frequencies of precipitating causes by hospitals and type of diabetes were analysed by Kruskal-Wallis and Mann-Whitney U test respectively. Results: A total of 377 episodes were identified. Overall, inter-current illness (37.4%, n = 141) and suboptimal compliance to treatment (26.8%, n = 101) were the main precipitating causes of DKA. covid-19 contributed to 7.4% of episodes. While there were no significant differences between precipitating causes of DKA in people with type 1 (n = 210) and type 2 (n = 113) diabetes (p = 0.173), we noticed a variation across hospitals (p = 0.035). For example, hospital A had a higher prevalence of inter-current illness (44.4% vs 23.3%) and lower frequency of suboptimal compliance to treatment (18.8% vs 34.3%) compared to hospital B. Conclusion: Intercurrent illness and sub-optimal compliance remain common causes of DKA regardless of diabetes type. The DEKODE database allows rapid analysis of regional DKA data for both research and clinical care.
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Early and rapid detection of SARS-CoV-2 in an infected person is one fundamental part of the strategy against the spread of this virus. As of now, the usual practice is to carry out polymerase chain reaction (PCR) test which provides results in 24-48 hours. Hence, there exists a crucial need for rapid and immediate screening of people suspected to be infected. Presence of volatile organic compounds (VOCs) in the exhaled breath can be one such prospect for detection of virus. In this paper, we have designed chromophoric adducts of VOC's in the exhaled breath that can be formed for colorimetric detection of SARS-CoV-2. We noted the bathochromic shift in λ (nm) of VOC molecules upon chromophore formation for colorimetric detection. If adapted, this research work will result in low cost solution to the requirement of immediate detection of SARS-CoV-2, hence cost and time of testing will be reduced, compared to PCR and antibodies tests. Also VOC's detection in early stage of infection where symptoms are not visible can be advantageous. © 2022 Pakistan Journal of Pharmaceutical Sciences. All rights reserved.
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Background: The current study aimed to determine the effectiveness of E-learning in Pakistan among the higher education students (both medical and non-medical) during the global pandemic. Methodology: A cross-sectional study was conducted at a government university in Karachi, Pakistan between April 2020 to September 2021. All participants living in a region where COVID-19 is prevalent, having higher education status, who had access to the internet and were above 18 years of age were included in the study. All those who were younger than 18 years, those who were in primary and secondary education, and students who were already taking any online module before the Covid-19 pandemic were excluded. All findings were recorded in the semi - structured Proforma consisting of closed ended questions. Demographics of the study participant's such as age, gender and occupation were recorded. Furthermore, information to assess the satisfaction towards the online learning were included. Results: Mean age of study participants was 21 years with female dominance. Overall mean scores for learning environment, face-to-face learning, and E-learning were 18.1 ± 4.6, 23.1 ± 6.5, and 15.4 ± 7.1, respectively. The scores for the learning environment were significantly higher for female students as compared to male counterparts (p<0.008). However, no statistical difference was observed between gender and scores on face-to face learning and E-learning. It was further indicated that face-to-face learning was significantly higher in medical students (p=0.0001) while non-medical students score significantly higher in E-learning with a p-value of 0.0002. Conclusion: The present study presented a comparison between modes of teaching (face-to-face learning versus E-learning) from the perspective of the students. The study indicated that medical students preferred faceto- face learning while other non-medical students preferred E-learning. If interactive classes are an option for students in which they can easily interact with the teacher and postulate questions, then E-learning could be as effective as face-to-face learning. However, this should be further explored using a larger sample population including remote areas of Pakistan as well.
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Public health measures to reduce COVID-19 transmission include masking in public places, physical distancing, staying home when ill, avoiding high-risk locations, using a contact tracing app, and being willing to take a COVID-19 vaccine. However, adoption of these measures varies greatly. We aimed to improve health messaging to increase adherence to public health behaviours to reduce COVID-19 transmission by: (1) determining attitudes towards public health measures and current behaviours;(2) identifying barriers to following public health measures;and, (3) identifying public health communication strategies. We recruited participants from a random panel of 3000 phone numbers across Alberta to fill a predetermined quota: age (18-29;30-59;60+ years), geographic location (urban;rural), and whether they had school-age children. Two researchers coded and themed all transcripts. We performed content analysis and in-depth thematic analysis. Nine focus groups were conducted with 2-8 participants/group in August-September, 2020. Several themes were identified: (1) importance of public health measures;(2) compliance with public health measures;(3) critiques of public health messaging;and (4) suggestions for improving public health messaging. Physical distancing and masking were seen as more important than using a contact tracing app. There were mixed views around willingness to take COVID-19 vaccine. Current public health messaging was perceived as conflicting. Participants felt that consistent messaging and using social media to reach younger people would be helpful. In conclusion, these findings provide insights that can be used to inform targeted (e.g., by age, current behaviour) public health communications to encourage behaviors that reduce COVID-19 transmission.
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Purpose: This paper is aimed to fulfil two purposes. First, this paper aims to review the literature and examine step by step evolution of the Equality Act 2010. Second, this paper will reflect on the guidelines issued for employers by the Equality and Human Rights Commission to address how to manage the risks arising during the current crisis and as organisations continue with planning for eventual return to the workplace and for those who are currently working remotely. Design/methodology/approach: This paper has incorporated an integrative literature review reviews approach that aimed to synthesises secondary data about the literature to serve the aims of the paper in an integrated way. Findings: The introduction of the Equality Act (2010) has made it much more difficult to discriminate against individuals as its coverage is much wider in comparison to any previous legislation. At that point, there were still many exceptions, which permitted discrimination and unequal treatment towards others. Over time, however, the law has become much more strict and developed to counter any discrimination in its attempt to try and eliminate it. Originality/value: This paper has reflected on both pre- and post-covid developments of The Equality Act (2010) – and discrimination issues for employers. © 2021, Emerald Publishing Limited.
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Herein, molecular structure of SARS-CoV-2 main protease (Mpro) was used for docking or binding energy analysis with medicinally known anti-HIV protease inhibitor drug molecules at changing pH (4-8). Variance analysis performed on binding energies between pH 4-8 confirmed that the binding energy and mode of interaction of some ligands were variable with pH. Among the selected repurposed protease inhibitors, indinavir and saquinavir showed to have the highest differential binding energy with the changing pH. Using the variance analysis, we also proposed novel structural derivative of saquinavir as a pH sensitive specific protease inhibitor with higher pH related selectivity. Hence, the most pH selective protease inhibitors for treatment of SARS-CoV-2 were identified.
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Background: Social isolation from COVID-19 has been shown to affect the mental health of all socioeconomic, ethnic and age groups. One of the most affected populations is long-term care (LTC) residents. This increased separation from their families and society has created an additive effect to their baseline physical and mental ailments. We investigated the change in depression and anxiety over time in residents of one LTC facility during this crisis. Aim: The aim of the intervention was to reduce the impact of social isolation by modifying recreational activities to include faceto-face visits, music therapy, and similar activities. Methods: Staff collected PHQ-9 and NPIQ (Neuropsychiatric inventory questionnaire) scores of all residents in the facility before implementing modified activities. Between 8/10 and 10/3/2020 we had a modified event calendar. Following the 8-week intervention, PHQ-9 and NPIQ scores were re-recorded. All LTC residents were eligible. Short-term residents, hospice patients, and those who did not participate in the intervention were excluded from analysis. Our primary outcome was change in depression and anxiety. Our secondary outcomes were change in weight, ulcers, and falls (MDS quality metrics). We hypothesized there would be a positive change in PHQ9 and NPIQ scores over time. We analyzed our data using paired sample t-tests. Analyses were conducted using SPSS v. 26. Results: 97 residents participated this intervention with an age range of 63-103 (mean = 86;SD 8). Participants' mean PHQ-9 scores improved significantly after participation in activities (9.1 vs 6.3) with a mean difference of 2.804 (CI 1.924-3.684, p<.001). Similarly, mean NPIQ scored showed a similar trend (18.74 vs 14.94) with a mean difference of 3.804 (CI 3.098-4.510, p <.001). There were no significant differences in falls, weight, or ulcers. Conclusions: This study highlights how COVID-19 has impacted LTC residents' mental health and suggests implementing modified recreational activities can improve the mental health of LTC residents. This is especially important as the pandemic, and associated restrictions, have lasted longer than anticipated. Therefore, LTC facilities should slowly and safely increase social interaction for residents whenever possible.
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Introduction: SARS-COV-2 or Covid-19 has become a major contributor of significant morbidity and mortality around the world. Patients with cancer constitute a high risk group. Furthermore, presence of lung cancer, advanced stage and active immune-suppressive treatment has been associated with poor outcomes. We sought to evaluate the outcomes of lung cancer patients with PCR confirmed Covid-19 infection at a large tertiary care referral cancer center. Methods: We identified all the patients with histologically confirmed diagnosis of lung carcinoma that tested positive for Covid-19 by RT-PCR at Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan. We used our electronic medical records to retrospectively retrieve and analyze the data. Results: Of the 7 patients identified that met our study criteria, 71.4% were males and 28.6% were females. 42.9% had metastatic disease. Age ranged from 26-67 years. Most patients did not have any co-morbidity except diabetes mellitus in 14.3% and essential hypertension in 28.6%. 42.9% of the patients were on active IV cytotoxic chemotherapy, 28.6% were on surveillance post treatment and 28.6% were on palliative care. Nil patient had received immunotherapy. Cough was the leading presenting complaint (71.4%) followed by fever (57.1%), and shortness of breath (42.9%). One patient (14.3%) was asymptomatic at the time of presentation. None of our patients reported contact exposure or recent travel history. After testing positive for COVID-19 by PCR, 28.6% of patients met the criteria for home isolation while 71.4% required hospitalization. Of those who were hospitlaized 80% were managed in the isolation COVID-ward. One patient required admission in the Intensive Care Unit (ICU). Mean length of hospital stay was 8 days. Of the 7 patients, three (42.9%) had hemoglobin less than 11gm/dl, and TLC greater than 11(x10ˆ9/l). Ferritin level was found to be raised in all the four (57.1%) patients who were tested. D-Dimers were normal in 14.3%, high in 28.6% and not done in 57.1% patients. On radiographic imaging, 42.8% patients had consolidation and airspace disease while 28.6% showed no changes. Imaging was not performed in 1 patient. Those who were home isolated were given symptomatic treatment only. Of those who were hospitalized, all 5(100%) received symptomatic treatment and antibiotics in addition to therapeutic anticoagulation (2 patients, 40%), non-invasive ventilation (3 patients, 60%) and steroids (4 patients, 80%). Overall, four (57.1%) patients fully recovered while three patients (42.9%) died. Fatality rate for the hospitalized was 60% and nil for those who were home-isolated. 2/3rd of the patients on active chemotherapy and 1/3rd of patients with advanced stage of the lung cancer died of Covid-19 infection. Conclusion: Our limited data suggests that covid-19 infection in lung cancer patients is a significant cause of morbidity and mortality. While overall infection rate in our lung cancer population is unknown, almost 2/3rd of confirmed cases required hospitalization and more than half of them died of complication of covid-19 infection. Patients on active chemotherapy particularly had a high mortality rate. Further studies are needed to elucidate the effects of covid-19 infection in lung cancer patients. Keywords: COVID-19, Lung Cancer, Pakistan