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The use of Chest radiograph (CXR) images in the examination and monitoring of different lung disorders like infiltration, tuberculosis, pneumonia, atelectasis, and hernia has long been known. The detection of COVID-19 can also be done with CXR images. COVID-19, a virus that results in an infection of the upper respiratory tract and lungs, was initially detected in late 2019 in China's Wuhan province and is considered to majorly damage the airway and, thus, the lungs of people afflicted. From that time, the virus has quickly spread over the world, with the number of mortalities and cases increasing daily. The COVID-19 effects on lung tissue can be monitored via CXR. As a result, This paper provides a comparison regarding k-nearest neighbors (KNN), Support-vector machine (SVM), and Extreme Gradient Boosting (XGboost) classification techniques depending on Harris Hawks optimization algorithm (HHO), Salp swarm optimization algorithm (SSA), Whale optimization algorithm (WOA), and Gray wolf optimizer (GWO) utilized in this domain and utilized for feature selection in the presented work. The dataset used in this analysis consists of 9000 2D X-ray images in Poster anterior chest view, which has been categorized by using valid tests into two categories: 5500 images of Normal lungs and 4044 images of COVID-19 patients. All of the image sizes were set to 200 × 200 pixels. this analysis used several quantitative evaluation metrics like precision, recall, and F1-score. © 2022 IEEE.
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The COVID-19 pandemic profoundly affected global patterns, and the period of the declared virus pandemic has had a negative influence on all aspects of life. This research focuses on categorizing and empirically investigating the role of digital platforms in learning and business processes during the COVID-19 pandemic outbreak. The main purpose of this paper is to investigate to what extent the use of electronic learning (EL) has been boosted by COVID-19's spread, and EL's effectiveness on the sustainable development of electronic commerce due to the demand for a variety of electronic devices. For this purpose, the information has been collected through an online questionnaire applied to 430 participants from the Kurdistan Region of Iraq (KRI). The results indicate that participant usage and skills with electronic devices and online software programs are increasing, as the ratio indicated a level of 68% for both genders. Thus, the significance of EL concerning electronic commercial enterprises has been openly acknowledged and influenced by numerous factors. In addition, several suggestions and steps to be undertaken by the government are highlighted. Finally, this research mentions the current limitations of EL and suggests future works to build sustainable online experiences. © 2023 by the authors.
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Feature selection can be defined as one of the pre-processing steps that decrease the dimensionality of a dataset by identifying the most significant attributes while also boosting the accuracy of classification. For solving feature selection problems, this study presents a hybrid binary version of the Harris Hawks Optimization algorithm (HHO) and Salp Swarm Optimization (SSA) (HHOSSA) for Covid-19 classification. The proposed (HHOSSA) presents a strategy for improving the basic HHO’s performance using the Salp algorithm’s power to select the best fitness values. The HHOSSA was tested against two well-known optimization algorithms, the Whale Optimization Algorithm (WOA) and the Grey wolf optimizer (GWO), utilizing a total of 800 chest X-ray images. A total of four performance metrics (Accuracy, Recall, Precision, F1) were employed in the studies using three classifiers (Support vector machines (SVMs), k-Nearest Neighbor (KNN), and Extreme Gradient Boosting (XGBoost)). The proposed algorithm (HHOSSA) achieved 96% accuracy with the SVM classifier, and 98% accuracy with two classifiers, XGboost and KNN © 2022, International journal of online and biomedical engineering.All Rights Reserved.
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Objective Making sure the right type of health workers are available in the right place is crucial to achieve universal health coverage. The Global Fund Strategic Initiative 2020- 2023 aims to improve the distribution of health workers at decentralized level in Chad, DRC, Mali, Niger and Nigeria. Within this project, technical support is provided to governments to strengthen priority setting processes for the selection of health workforce interventions. This study aims to share lessons learned on the contextualization of technical support across five different countries. Methods Between September 2021-February 2022, for each country, a document review was done to understand health worker issues and the policy context. An inventory was made of available health workforce data and evidence. About 15 stakeholder per country were interviewed on their roles, knowledge, interests and power related to health workforce issues. An institutional capacity assessment studied the capability of ministry of health to facilitate the priority setting process. The researchers collected lessons learned on the contextualization process using project update sheets. Results Contextual factors that played a role in the adaptation of technical support were decision space at decentralized level, covid-19 pandemic, travel security, fiscal space for health workforce interventions, stakeholders views on health workers issues, stakeholder's interest and political support for specific interventions, data and evidence base, timing of future policy processes, presence and potential synergy with other technical support projects and capacity of the government health workforce focal point in convening stakeholders. Discussion This is one of the first studies reporting on technical support for priority setting for health workforce interventions. In contextualizing technical support a broad range of factors need to be taken into account which may be relevant for other settings too. In contextualization a critical reflection is needed on the influence of the funder and provider of technical support.
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Background: Chronic cough management necessitates a clear integrated care pathway approach. Primary care physicians initially encounter the majority of chronic cough patients, yet their role in proper management can prove challenging due to limited access to advanced diagnostic testing. A multidisciplinary approach involving otolaryngologists and chest physicians, allergists, and gastroenterologists, among others, is central to the optimal diagnosis and treatment of conditions which underly or worsen cough. These include infectious and inflammatory, upper and lower airway pathologies, or gastro-esophageal reflux. Despite the wide armamentarium of ancillary testing conducted in cough multidisciplinary care, such management can improve cough but seldom resolves it completely. This can be due partly to the limited data on the role of tests (eg, spirometry, exhaled nitric oxide), as well as classical pharmacotherapy conducted in multidisciplinary specialties for chronic cough. Other important factors include presence of multiple concomitant cough trigger mechanisms and the central neuronal complexity of chronic cough. Subsequent management conducted by cough specialists aims at control of cough refractory to prior interventions and includes cough-specific behavioral counseling and pharmacotherapy with neuromodulators, among others. Preliminary data on the role of neuromodulators in a proof-of-concept manner are encouraging but lack strong evidence on efficacy and safety. Objectives: The World Allergy Organization (WAO)/Allergic Rhinitis and its Impact on Asthma (ARIA) Joint Committee on Chronic Cough reviewed the recent literature on management of chronic cough in primary, multidisciplinary, and cough-specialty care. Knowledge gaps in diagnostic testing, classical and neuromodulator pharmacotherapy, in addition to behavioral therapy of chronic cough were also analyzed. Outcomes: This third part of the WAO/ARIA consensus on chronic cough suggests a management algorithm of chronic cough in an integrated care pathway approach. Insights into the inherent limitations of multidisciplinary cough diagnostic testing, efficacy and safety of currently available antitussive pharmacotherapy, or the recently recognized behavioral therapy, can significantly improve the standards of care in patients with chronic cough.
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Background: SARS-Cov-2 infection (COVID-19) and associated gastrointestinal manifestations have been well documented during the pandemic. To date, several centers have reported isolated cases of COVID-19 and its effect on the pancreas. Here, we present a case series of 13 patients with acute pancreatitis (AP) due to COVID-19, which represents one of the larger case series to date. Methods: A retrospective review was performed from 3/1/2020 through 4/1/2020 at 4 NYC academic medical centers. Patients with a diagnosis of AP and COVID-19 were included. AP was diagnosed based on AGA criteria. COVID-19 infection was confirmed via nasopharyngeal viral PCR testing. All patients with a prior history of AP were excluded. Patients with apparent/suspected etiologies of AP (including gallstones, alcohol, hypertriglyceridemia, post ERCP, medication, and other viral etiologies) were excluded. 13 patients met our inclusion and exclusion criteria. Outcomes studied included mortality, ICU admission, length of stay, BISAP scores on admission and at 48 hours. Results: 7 of the 13 patients in this cohort were African American, 8 of 13 were men, and the median age was 51 years of age. The youngest patient was 18 years old and the oldest patient was 71 years old. Of the 13 patients, 5 patients died during their hospital course. Of those 5 who passed, 4 were African American, and all 5 were > 50 years of age. 6 of the 13 required ICU level of care. The mean length of stay for all patients was 23 days. On admission, 4 patients had BISAP scores > 3, at 48 hours 3 patients had BISAP scores > 3. Discussion: We report the characteristics of 13 patients with confirmed SARS-Cov-2 infection and AP without other common etiologies. We suspect that SARS-Cov-2 was a direct cause of AP in these patients. 5 patients died (38.5%) due to multiorgan failure from Acute Respiratory Distress Syndrome. Patients with COVID-19 and AP had a higher mortality rate than the overall mortality reported with COVID-19 during the same period. The mortality of patients in our series far exceeds the reported mortality in mild or moderate AP (less than 1%)1,2. Currently molecular theories suggest that viral attachment to ACE-2 receptors on pancreatic acinar cells leads to apoptosis, inhibition of nitric oxide production, and programmed cell death that ultimately leads to AP. Conclusion: This case series indicates a possible association between COVID-19 and AP and the increased mortality in this subset of patients. Further research is needed concerning the molecular mechanisms and clinical management of this entity. Larger studies are needed to confirm the worse outcomes with AP associated with COVID-19. Ref: 1. Russo MW et al. Digestive and liver diseases statistics, 2004. Gastroenterology. 2004;126:1448–53. 2. Triester SL et al. Prognostic factors in acute pancreatitis. J Clin Gastroenterol. 2002;34:167–76.
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Aims: The current climate brought forth by the COVID-19 pandemic has caused considerable changes in academic teaching at the undergraduate and postgraduate level. Online teaching and webinars over video conferencing platforms have become the new standard for delivery of material. Here we evaluate the efficacy of online webinars in the area of Neuroscience, Neurology and Neurosurgery. Methods: We delivered 10 online webinars across 10 weeks, with one or two speakers, covering a range of topics across the fields of Neuroscience, Neurology and Neurosurgery. Feedback was gathered anonymously using an online feedback form following the event. Results were statistically analysed and significance reported using the Wilcoxon signed-rank test. Results: Our results show a statistically significant increase in the attendees' self-reported knowledge on the subject, before and after the webinar (P<0.0001, n=117);this represents a 57.3% increase in selfreported knowledge. Our feedback indicated that of all attendees across the 10 webinars, 82.9% rated the event overall “Very Good”, 79.5% were “Very Satisfied” with the organisation of the event, 84.6% with the speaker(s), 76.9% with the content of the event and 82.9% with the format of the webinar. Conclusions: In summary, our analysis shows that delivering Neurological and Neurosurgical teaching via an online platform is a viable and effective method of delivering knowledge. This finding has significant implications not only in the current response to the COVID- 19 pandemic, but also in the future provision of medical education at the undergraduate and postgraduate level.
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BACKGROUND: Chronic cough can be triggered by respiratory and non-respiratory tract illnesses originating mainly from the upper and lower airways, and the GI tract (ie, reflux). Recent findings suggest it can also be a prominent feature in obstructive sleep apnea (OSA), laryngeal hyperresponsiveness, and COVID-19. The classification of chronic cough is constantly updated but lacks clear definition. Epidemiological data on the prevalence of chronic cough are informative but highly variable. The underlying mechanism of chronic cough is a neurogenic inflammation of the cough reflex which becomes hypersensitive, thus the term hypersensitive cough reflex (HCR). A current challenge is to decipher how various infectious and inflammatory airway diseases and esophageal reflux, among others, modulate HCR. OBJECTIVES: The World Allergy Organization/Allergic Rhinitis and its Impact on Asthma (WAO/ARIA) Joint Committee on Chronic Cough reviewed the current literature on classification, epidemiology, presenting features, and mechanistic pathways of chronic cough in airway- and reflux-related cough phenotypes, OSA, and COVID-19. The interplay of cough reflex sensitivity with other pathogenic mechanisms inherent to airway and reflux-related inflammatory conditions was also analyzed. OUTCOMES: Currently, it is difficult to clearly ascertain true prevalence rates in epidemiological studies of chronic cough phenotypes. This is likely due to lack of standardized objective measures needed for cough classification and frequent coexistence of multi-organ cough origins. Notwithstanding, we emphasize the important role of HCR as a mechanistic trigger in airway- and reflux-related cough phenotypes. Other concomitant mechanisms can also modulate HCR, including type2/Th1/Th2 inflammation, presence or absence of deep inspiration-bronchoprotective reflex (lower airways), tissue remodeling, and likely cough plasticity, among others.
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The COVID-19 pandemic has spread across the world and has become an international public health emergency. The outbreak of COVID-19 has focused attention on the use of quarantine and social distancing as the primary defense strategies against community infection. Arabic language, as one of the most spoken languages in the world, and the fastest-growing language on the Internet motivates us to provide reliable automated tools that can perform sentiment analysis to reveal users' opinions. This paper was proposed to utilize machine learning (ML) methods for Arabic Sentiment Analysis to understand the positive and negative opinions related to quarantine and social distancing during the outbreak of COVID-19. We provided a model of different essential and ensembles ML classifiers and compared their effectiveness in classifying the collected imbalanced dataset. Moreover, the application of a variety of SMOTe (Synthetic Minority Over-sampling Technique) for our imbalanced dataset was evaluated. The results demonstrated that SMOTe Edited Nearest Neighbor (SMOTEENN) outperformed other SMOTe techniques. Moreover, the results showed that ensemble classifiers are more robust with imbalanced datasets than single classifiers. On the other hand, the overall average of F1 score of single classifiers is more robust than ensemble classifiers when applying SMOTEENN. © 2021 IEEE.
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Purpose: The coronavirus disease 2019 (COVID-19) pandemic has subjected a considerable strain on the healthcare (HC) systems around the world. The most affected countries are developing countries because of their weak HC infrastructure and meagre resources. Hence, building the resilience of the HC system of such countries becomes essential. Therefore, this study aims to build a resilience-based model on the HC sector of Pakistan to combat the COVID-19 and future pandemics in the country. Design/methodology/approach: The study uses a novel hybrid approach to formulate a model based on resilient attributes (RAs) and resilient strategies (RSs). In the first step, the multi-criteria decision-making (MCDM) technique, i.e. full consistency method (FUCOM) is used to prioritize the RAs. Whereas, the fuzzy quality function deployment (QFD) is used to rank the RSs. Findings: The findings suggest “leadership and governance capacity” to be the topmost RA. Whereas “building the operational capacity of the management”, “resilience education” and “Strengthening laboratories and diagnostic systems” are ranked to be the top three RSs, respectively. Practical implications: The model developed in this study and the prioritization REs and RSs will help build resilience in the HC sector of Pakistan. The policymakers and the government can take help from the prioritized REs and RSs developed in this study to help make the current HC system more resilient towards the current COVID-19 and future pandemics in the country. Originality/value: A new model has been developed to present a sound mathematical model for building resilience in the HC sector consisting of FUCOM and fuzzy QFD methods. The main contribution of the paper is the presentation of a comprehensive and more robust model that will help to make the current HC system of Pakistan more resilient. © 2021, Emerald Publishing Limited.
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PURPOSE: To estimate dental students' self-perception of mental well-being (MWB) and its effects on their clinical psychomotor skills (CPS) once they (or their family members) get infected with COVID-19. MATERIALS AND METHODS: This is a cross-sectional (n =268) study from a public dental college in Riyadh. We collected data on MWB and CPS. An 18-item online survey was used to collect the responses from the participants. The inter-rater reliability for the finalised survey came out to be 0.86. RESULTS: The participants (54.3%) who were infected with COVID-19 recorded that their CPS were significantly affected (almost 4 times higher) as compared to others (OR= 4.02; P=0.0004). However, 42.2% reported infection control measures at clinics resulted in bringing significant (OR=2.22, P=0.04) psychological upsets, for those who were infected with COVID-19. Participants (45.1%) also reported that they have difficulty in recalling old memories or information due to the COVID-19 pandemic; among them, 46.7% were the ones who (and/or any family member) were exposed to COVID-19. CONCLUSION: The study spotlighted the extent of dental students' MWB and its significant effect on their CPS once (themselves or a family member) infected with COVID-19. Moreover, levels of infection control measures at clinics resulted in psychological upsets for dental students. CLINICAL SIGNIFICANCE: The issue is fundamental as participants enter the clinical workforce and face the ever-increasing demands of dental practice.
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The novel corona virus has infected thousands of individuals around the globe as worldwide pandemic, the objective of the study was to assess the knowledge attitude and practices of general population of Karachi. A cross sectional survey to assess the knowledge, attitude and perception of general population of Karachi was conducted for the period of 5 months, December 2019-April 2020. The questionnaire included demographic details and rest of was divided into 3 sections, Section A displayed knowledge, Section B displayed attitude, while Section C displayed practice regarding current pandemic of COVID-19. Out of total 425 participants, 310 were males, 115 were females, 12.7% were students, 78.4% were employees while 8.9% were not working currently i.e. either housewives' females, unemployed or retired. 793% (n = 337) had correct knowledge, 12.4% (n = 54) did not know about the infection, 24.1% (n = 102) agreed children are at higher risk to get infected, 67.2% (n = 286) agreed that individuals above 60 years of age are at higher risk. 89.1% (n = 379) individuals suggested N95 mask, 3.2% (n = 13) agreed local cloth mask was enough to prevent the infection, 7.5% (n = 32) suggested wearing surgical mask is good practice. 93.1% (n = 396) respondents agreed COVID-19 has disturbed the life routine, 6.8% (n = 29) remained unaffected, 76.9% (n = 327) were emotionally/psychologically affected by the current pandemic. 73.5% (n = 312) agreed they have limited their social life and avoiding social gatherings. 46.6% (n = 198) agreed to stay isolated at home to avoid the infection. 87.9% (n = 373) agreed that they are worried by media and news related to worldwide pandemic. The study concluded that the general population had knowledge regarding the viral infection by news, media counseling, nearly majority of population addressed their practices regarding preventive measures.
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INTRODUCTION: Cannabinoid Hyperemesis Syndrome (CHS) is increasingly encountered as cannabis use is on the rise. Several gastrointestinal syndromes have been associated with CHS. We present a rare case of CHS presenting with intramural gas in the stomach. CASE DESCRIPTION/METHODS: A 40 year old man with chronic daily marijuana use presented with acute epigastric pain and emesis. Prior episodes resolved after warm baths, yet this time, symptoms persisted. He denied any other medications, surgeries, or trauma. He was afebrile with stable vitals, and no constitutional symptoms. Exam revealed mild epigastric tenderness. Otherwise, he was well-appearing in no distress. However, he had leukocytosis of 17 k/uL and lactate of 9.1 mmol/L. Lipase, troponin and EKG were normal. There was no evidence of infection on chest X-ray, urinalysis, blood cultures, and COVID test. CT scan showed scattered pockets of air in the gastric wall, no perforation or free air (Image 1). Proton pump inhibitor (PPI) was started. Upper endoscopy showed mild esophagitis, non-bleeding Mallory-Weiss tear, prolapse gastropathy, and a small focus of bulging mucosa in the body (Image 2). With supportive care and close monitoring with concern for emphysematous gastritis, the patient remained stable with resolution of emesis and pain, while off antibiotics. He was discharged on a PPI and anti-emetics as needed. He was counseled extensively to avoid cannabis use. DISCUSSION: Gastric emphysema has been associated with both iatrogenic and non-iatrogenic injury such as complications from endoscopy, enteral tube placement, and mucosal injury from retching and vomiting with subsequent tracking of air into the gastric wall. Gastric emphysema typically carries a benign course that parallels the underlying etiology and tends to resolve with conservative management. Emphysematous gastritis caused by gas-forming bacteria, on the other hand, is associated with worse prognosis and often requires intensive care and surgical intervention. The distinction between the two entities is critical. In our case, the intractable and forceful vomiting led to the appearance of gas within the gastric wall, along with hyperlactatemia. When intramural gas in the stomach is detected, attention to a history of cannabis use is critical to manage this typically benign finding with supportive measures rather than unnecessary surgical intervention. Counseling the patient on cessation of cannabis use is key to preventing CHS and its complications including gastric emphysema.
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Introduction: Identifying patients with COVID19, at risk of having a severe clinical course during their hospitalization is important for appropriate allocation of clinical resources. We recently described the Kuwait Progression Indicator based on laboratory findings, in an initial training cohort derived from the first series of 1096 consecutive patients admitted to Jaber AlAhmad AlSabah Hospital in Kuwait. The aim of this study was to validate the KPI scoring system in an independent cohort of patients with COVID19. Methodology: Data was collected prospectively for consecutive patients admitted to Jaber AlAhmad AlSabah Hospital in Kuwait between 24th February till 28th April 2020. Patients were grouped according to the severity of their clinical course as their main outcome, based on clinical and radiological parameters, with ICU admission and death as secondary outcomes. Model discrimination was assessed through the area under the receiver operating characteristic curve (AUC) while model calibration was assessed through a calibration plot and measures of slope and calibration in the large (CITL). Results: Of 752 patients not used in model development previously, 414 met the criteria for inclusion in this validation study. The baseline characteristics for these 752 patients were similar to the patients that were included in our validation cohort. The area under the curve was equal to 0.904 (95% CI, between 0.867 to 0.942), indicating good model discrimination. The calibration plot and CITL confirmed reasonably good model calibration. Sensitivity and specificity were above 90% for the low and high risk levels respectively. Conclusions: We were able to validate our previously described laboratory based prognostic scoring system for COVID19 patients, to predict which patients progressed to a severe clinical course.