Rare Case of Immune-Mediated Necrotizing Myopathy With Isolated Dysphagia as Presenting Symptom

Introduction: Immune mediated necrotizing myopathy (IMNM) is a rare, but progressive disease that accounts for about 19% of all inflammatory myopathies. Dysphagia occurs in 20-30% of IMNM patients. It often follows proximal muscle weakness and ensues in the later stages of the disease. We report a rare case of IMNM, presenting with dysphagia as the initial symptom, followed by proximal muscle weakness. Case Description/Methods: A 74-year-old male with a past medical history of coronary artery disease, hypertension, and hyperlipidemia presented to the ED with 2-3 weeks of intractable nausea, vomiting, and dysphagia for solids and liquids. Vital signs were stable, and initial labs displayed an AST of 188 U/L and ALT of 64 U/L with a normal bilirubin. Computed tomogram of the chest, abdomen, and pelvis were negative. An esophagram showed moderate to severe tertiary contraction, no mass or stricture, and a 13 mm barium tablet passed without difficulty. Esophagogastroduodenoscopy exhibited a spastic lower esophageal sphincter. Botox injections provided no significant relief. He then developed symmetrical proximal motor weakness and repeat labs demonstrated an elevated creatine kinase (CK) level of 6,357 U/L and aldolase of 43.4 U/L. Serology revealed positive PL-7 autoxantibodies, but negative JO-1, PL-12, KU, MI-2, EJ, SRP, anti-smooth muscle, and anti-mitochondrial antibodies. Muscle biopsy did not unveil endomysial inflammation or MHC-1 sarcolemmal upregulation. The diagnosis of IMNM was suspected. A percutaneous endoscopic gastrostomy feeding tube was placed as a mean of an alternative route of nutrition. He was started on steroids and recommended to follow up with outpatient rheumatology. He expired a month later after complications from an unrelated COVID-19 infection. Discussion(s): The typical presentation of IMNM includes painful proximal muscle weakness, elevated CK, presence of myositis-associated autoantibodies, and necrotic muscle fibers without mononuclear cell infiltrates on histology. Dysphagia occurs due to immune-mediated inflammation occurring in the skeletal muscle of the esophagus, resulting in incoordination of swallowing. Immunotherapy and intravenous immunoglobulin are often the mainstay of treatment. Our patient was unique in presentation with dysphagia as an initial presenting symptom of IMNM, as well as elevated enzymes from muscle breakdown. It is critical as clinicians to have a high degree of suspicion for IMNM due to the aggressive nature of the disease and refractoriness to treatment.

Review on Design and Performance of the Medical Ventilators

Ventilators we are available with have several drawbacks such as difficult to port, expensive and meant to be operated by professionals which create hardness in fighting with medical care. Thus, it creates suffering for people in the pandemic like COVID19. So, it is required to develop a ventilator that can be affordable, easy to port and install. We aimed to design a IoT based ventilator system using various electronic devices such as microcontroller and sensors that could monitor patient's body status. People suffering from COVID19 or any lung disease find difficulty in breathing so in such condition of emergency this smart ventilator system can be used. Ambu bag is used to provide certain volume of air that is pressed by using motor mechanism. A portable low-cost ventilator with computerized controlling and feedback system is installed. Ventilator designed can be connected to an interface for smart functioning. This paper provides us with different methods to monitor the patient's health condition by measurement of pressure, level of breathing to know whether the condition is healthy or unhealthy. The designing and developing of low-cost portable ventilator deliver breaths to patients when Ambu bag is compressed by using a piston connected to servo motor whose speed can be varied. Input of the designed system is patient's heart beat and breathing rate and the volume of oxygen provided to patient's lung with required beathing rate is the output of the system. PID (proportional Integral Derivative) and Full state feedback H2 controllers are used for the performance analysis of the system. Result of this review paper is found that a low-cost ventilator is developed removing all the possible shortcomings of existing conventional ventilator. Ventilator designed is portable and smart by using Arduino, servo motor and ambu bag preferred for emergency uses and available for clinical application. © 2023 IEEE.

Current understanding of an Emerging Coronavirus using in silico approach: Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2).

Novel coronavirus (nCoV) namely "SARS-CoV-2" is being found responsible for current PANDEMIC commenced from Wuhan (China) since December 2019 and has been described with epidemiological linkage to China in about 221 countries and territories until now. In this study we have characterized the genetic lineage of SARS-CoV-2 and report the recombination within the genus and subgenus of coronaviruses. Phylogenetic relationship of thirty nine coronaviruses belonging to its four genera and five subgenera was analyzed by using the Neighbor-joining method using MEGA 6.0. Phylogenetic trees of full length genome, various proteins (spike, envelope, membrane and nucleocapsid) nucleotide sequences were constructed separately. Putative recombination was probed via RDP4. Our analysis describes that the "SARS-CoV-2" although shows great similarity to Bat-SARS-CoVs sequences through whole genome (giving sequence similarity 89%), exhibits conflicting grouping with the Bat-SARS-like coronavirus sequences (MG772933 and MG772934). Furthermore, seven recombination events were observed in SARS-CoV-2 (NC_045512) by RDP4. But not a single recombination event fulfills the high level of certainty. Recombination mostly housed in spike protein genes than rest of the genome indicating breakpoint cluster arises beyond the 95% and 99% breakpoint density intervals. Genetic similarity levels observed among "SARS-CoV-2" and Bat-SARS-CoVs advocated that the latter did not exhibit the specific variant that cause outbreak in humans, proposing a suggestion that "SARS-CoV-2" has originated possibly from bats. These genomic features and their probable association with virus characteristics along with virulence in humans require further consideration.

Uncovering risk transmission between socially responsible investments, alternative energy investments and the implied volatility of major commodities

The interconnectedness and high integration among the global markets have reduced the portfolio diversification opportunities of international investors. In view of this, considering the rise of Socially Responsible Investments (SRI) and the Clean-Renewable energy & Clean-Technology energy (C&RTE) asset classes, the objective of this research is to examine risk transmission and the portfolio diversification prospects across the SRI, C&RTE, and the implied volatility indices (VIX) of major commodities (oil, silver, and the gold). To uncover the spillover and the risk transmission, we employ the approach of Dynamic conditional correlation (DCC-GARCH) along with the Asymmetric DCC-GARCH and VAR-GARCH. The findings exhibit a strong ability of volatility indices to hedge risks associated with SRIs and C&RTE investments as asymmetric-GARCH confirms that volatility indices have a negative correlation with most of the socially responsible and clean energy and technology equity indices. The findings confirm that the implied volatility indices of gold and silver exhibit the best hedging tool against SRIs while oil is the best hedging tool for C&RTE. During Covid-19, generally oil price volatility index is positively correlated with SRI indices whereas the silver and the gold volatility indices are negatively correlated with the C&RTE. More importantly, we find that hedging effectiveness and risk diversification are facilitated by the adaptive behavior of commodities, confirmed by the Adaptive Market Hypothesis (AMH) through the Generalized Spectral (GS) test. Moreover, we also find some evidence of a time-varying pattern in the hedging ratio and the hedging effectiveness. Finally, we show utility gains from hedging to be positive irrespective of whether we consider transaction costs or not. The findings of the study could be helpful for portfolio managers, brokers, and market participants to draw the role of implied volatilities of commodities in hedging the risk associated with SRIs and C&RTE investments. © 2023 Elsevier B.V.

A Longitudinal Study on COVID-19 Confinement and Impact on Physical Activity of Medical Students of Rawalpindi

Objective: To assess the impact of COVID-19 confinement on different aspects of physical activity and sedentary time of medical students with special emphasis on gender. Study Design: This was a longitudinal study in which two samples were taken, one during the confinement period and one after it, to assess the differences between the time spent on physical activity and sedentary time. Place and During of Study: This study was conducted on a total of 300 medical students from two medical colleges of Rawalpindi. The study extended from Apr till Jun 2021 over a period of two months. Methodology: Modified International Physical Activity Questionnaire (IPAQ) was used as a data collection tool. The respondents filled the questionnaire twice. First during COVID-19 confinement and the second, after the confinement ended. Results: A total of 300 individuals were selected to fill in the questionnaire, 200 of them filled in the first questionnaire. The second questionnaire was, however, filled by only 146 individuals and the rest were lost to follow-up. The 146 participants in our study were all students in medical schools in Rawalpindi/Islamabad Pakistan. Out of the total 43.2%(63) were male, while 56.8%(83) were female. The mean age was 20.18±1.72. Post confinement, the amount of time spent on moderate and vigorous activities by all the individuals increased by 26.7% and 82.5%, respectively. In addition, walking time was increased by 82%, sedentary time was also reduced by 36.4%. Conclusion: Physical activity of both men and women was found to be reduced during COVID-19 confinement along with increased sedentary time as compared to their normal routine. © 2022, Army Medical College. All rights reserved.

Co-Relation Between Androgenetic Alopecia and Severity of COVID-19 Disease-A Cross-Sectional Study

Objective: To find the correlation between the degree of androgenetic alopecia and the severity of COVID-19 disease. Study Design: Cross-sectional study. Place and Duration of the Study: Dermatology department, PEMH, Rawalpindi Pakistan from Feb to Aug 2021. Methodology: A total of 227 patients (male and female) of COVID-19 admitted in a Corona ward of Pak Emirates Military Hospital, Rawalpindi, Pakistan were selected randomly. The degree of androgenetic alopecia was assessed with the help of using the Hamilton-Norwood Scale (HNS) for men and the Ludwig Scale (LS) for women, and the severity of COVID-19 was graded based on CT severity score (CTSS). Results: Out of the total, 161 (71%) were male, and 66 (29%) were female. Out of 161 males, 31 (19.2%) had no alopecia, and 130 (80.7%) had some degree of alopecia. Out of patients with alopecia, 33 had moderate alopecia, and 97 had severe alopecia. Out of 66 females, 32 (48.5%) had no alopecia, while 34 (51.5%) had some degree of alopecia. Conclusion: High frequency of androgenetic alopecia in severely ill-hospitalized patients of COVID-19 suggests that androgen has a vital role in the disease severity of COVID-19. © 2022, Army Medical College. All rights reserved.

Time-Varying Return Predictability and Adaptive Behavior in The U.S. Commodity Markets During COVID-19

The study investigates the time-varying efficiency of the four most commonly traded international commodities from the U.S. Chicago Board of Options Exchange (CBOE) over a more extended period as well as during COVID-19. The study also explores how adaptive behavior of returns induces profitable opportunities in the commodity markets. Daily returns of commodity indices (gold, silver, oil, metal) are divided into subsamples of six years, to apply a battery of linear/nonlinear tests. The study uncovers the linear and nonlinear serial dependence in returns from commodities and finds evidence of time-varying volatility, thus consistent with the Adaptive Market Hypothesis over the full sample period. Moreover, returns from all the commodities are highly volatile and predictable during COVID-19. JEL Classification: G4, G41 © International Journal of Economics and Management. ISSN 1823-836X. e-ISSN 2600-9390.

Effect of Covid on Gaster Intestinal Tract and its Signs and Symptoms

The aim of this descriptive case series was to determine the frequency of various gastrointestinal symptoms of the COVID-19 patients along with the respiratory symptoms. Secondary outcome was to determine the effect of various co-morbid conditions and various sign and symptoms on the length of hospital stay and outcome of disease Material: In this descriptive case series type study, carried out in the COVID ward in the Jinnah Hospital, Lahore, all patients diagnosed with COVID-19 by consultant physician in the out-patient department and ward were included. Written informed consent was taken from all the participants of the study after explaining the primary objective of the study. The study was carried out from 01-07-2019 to 31-12-2019. Primary objective of this study was to determine the various gastrointestinal symptoms of the COVID-19 patients along with the respiratory symptoms Results: Among the 386 patients enrolled in the study, 60% were male and 40% were female. Mean age of the patients was 54.14 SD 16.3 years, with around 71% cases of age above 45 years. Abdominal pain, anosmia and diarrhea were the most common GI complaints. Over all, 26% of the patients of COVID had GI symptoms. Conclusion(s): GI complaints such as anorexia, nausea, vomiting, diarrhea, and abdominal cramping have been documented in COVID-19 individuals even in the absence of respiratory problems. As a result, COVID-19 disease must be explored in individuals who have mostly GI complaints. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

Detection of Omicron Caused Pneumonia from Radiology Images Using Convolution Neural Network (CNN)

COVID-19 disease caused by the SARS-CoV-2 virus has created social and economic disruption across the world. The ability of the COVID-19 virus to quickly mutate and transfer has created serious concerns across the world. It is essential to detect COVID-19 infection caused by different variants to take preventive measures accordingly. The existing method of detection of infections caused by COVID-19 and its variants is costly and time-consuming. The impacts of the COVID-19 pandemic in developing countries are very drastic due to the unavailability of medical facilities and infrastructure to handle the pandemic. Pneumonia is the major symptom of COVID-19 infection. The radiology of the lungs in varies in the case of bacterial pneumonia as compared to COVID-19-caused pneumonia. The pattern of pneumonia in lungs in radiology images can also be used to identify the cause associated with pneumonia. In this paper, we propose the methodology of identifying the cause (either due to COVID-19 or other types of infections) of pneumonia from radiology images. Furthermore, because different variants of COVID-19 lead to different patterns of pneumonia, the proposed methodology identifies pneumonia, the COVID-19 caused pneumonia, and Omicron caused pneumonia from the radiology images. To fulfill the above-mentioned tasks, we have used three Convolution Neural Networks (CNNs) at each stage of the proposed methodology. The results unveil that the proposed step-by-step solution enhances the accuracy of pneumonia detection along with finding its cause, despite having a limited dataset. © 2023 Tech Science Press. All rights reserved.

Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study.

BACKGROUND: The mechanisms and outcomes in coronavirus disease (COVID-19)-associated stroke are unique from those of non-COVID-19 stroke. OBJECTIVE: To describe the efficacy and outcomes of acute revascularization of large vessel occlusion (LVO) in the setting of COVID-19 in an international cohort. METHODS: We conducted an international multicenter retrospective study of consecutively admitted patients with COVID-19 with concomitant acute LVO across 50 comprehensive stroke centers. Our control group constituted historical controls of patients presenting with LVO and receiving a mechanical thrombectomy between January 2018 and December 2020. RESULTS: The total cohort was 575 patients with acute LVO; 194 patients had COVID-19 while 381 patients did not. Patients in the COVID-19 group were younger (62.5 vs 71.2; P < .001) and lacked vascular risk factors (49, 25.3% vs 54, 14.2%; P = .001). Modified thrombolysis in cerebral infarction 3 revascularization was less common in the COVID-19 group (74, 39.2% vs 252, 67.2%; P < .001). Poor functional outcome at discharge (defined as modified Ranklin Scale 3-6) was more common in the COVID-19 group (150, 79.8% vs 132, 66.7%; P = .004). COVID-19 was independently associated with a lower likelihood of achieving modified thrombolysis in cerebral infarction 3 (odds ratio [OR]: 0.4, 95% CI: 0.2-0.7; P < .001) and unfavorable outcomes (OR: 2.5, 95% CI: 1.4-4.5; P = .002). CONCLUSION: COVID-19 was an independent predictor of incomplete revascularization and poor outcomes in patients with stroke due to LVO. Patients with COVID-19 with LVO were younger, had fewer cerebrovascular risk factors, and suffered from higher morbidity/mortality rates.

Global overview of SARS-CoV-2 induced COVID-19 in 2020: biological characterization, epidemiology with social, economic and environmental implications

Background: COVID-19 is a global pandemic initiated in January 2020 that caused 79 million cases and more than 1.7 million deaths worldwide. The causative agent of COVID-19 is Severe Acute Respiratory Syndrome Coronavirus-2, a member of Betacoronvirus. COVID-19 patients are classified into asymptomatic, mild symptomatic, and severe symptomatic cases. Objectives: To review the prevalence, therapeutic interventions for the treatment, vaccination, and containment of COVID-19 in four quarters of 2020, emphasizing the advancements in biological studies, and the social, economic, and environmental impact of the pandemic. Methodology: Data of COVID-19 spread, identification, prevention, and control measures was analyzed. The impacts of pandemic on society, economy, and the environment were assessed.

Evaluating the utility of interleukin-6, c -reactive protein (CRP) and procalcitonin in predicting disease severity and prognosis in hospitalized SARS-CoV-2 patients: a north Indian retrospective study. (Special issue.)

Background: Coronavirus disease 2019 (COVID-19) associated inflammatory cytokine storm that worsens COVID-19, relies heavily on the inflammatory response. IL-6, a TH1 cytokine, PCT and CRP have been linked to serious illness and a higher mortality rate. We further tried to evaluate the role of these indicators and their association with clinical severity in COVID-19 patients. Material and Methods: Eighty-three consecutive patients with age 18 years with RT-PCR test positive for SARS-CoV-2 were included in the study. Demographic characteristics (age and sex), underlying co-morbidities, symptoms, physical findings, and laboratory tests of the patients were recorded. All patients were categorized as having mild, moderate, and severe COVID-19 disease, according to the Indian Council of Medical Research (ICMR). The levels of IL-6 and PCT were estimated by electrochemiluminescence immunoassay (ECLIA) using Cobas-e411 Immunoassay System, and Quantitative CRP was done by Unicorn-230 automated biochemistry analyzer to find out their correlation with disease severity and outcome. Multiple Regression was performed to find out factors associated with the adverse outcome of the disease. Result: Mean age of patients was 51 years. IL-6, CRP, and PCT levels increased in 73%, 68.0%, and 8.2% patients on admission, respectively. The most common co-morbidity associated with the disease was hypertension (25%), followed by diabetes (24%) and respiratory disease (15%). Increased IL-6, CRP, and PCT levels were found in 77 percent, 79 percent, and 20 percent of patients, respectively. We found that IL-6 (P0.05), CRP (P0.05), and PCT (P0.05) were significantly raised in COVID-19 patients with increasing severity of the disease. The Area under the receiver operating characteristic (AUROC) of these parameters ranged between 0.65 and 0.8 (IL-6, 0.828;CRP, 0.809;and PCT, 0.658), indicating a reliable biomarker to assess clinical severity.

International controlled study of revascularization and outcomes following COVID-positive mechanical thrombectomy.

BACKGROUND AND PURPOSE: Previous studies suggest that mechanisms and outcomes in patients with COVID-19-associated stroke differ from those in patients with non-COVID-19-associated strokes, but there is limited comparative evidence focusing on these populations. The aim of this study, therefore, was to determine if a significant association exists between COVID-19 status with revascularization and functional outcomes following thrombectomy for large vessel occlusion (LVO), after adjustment for potential confounding factors. METHODS: A cross-sectional, international multicenter retrospective study was conducted in consecutively admitted COVID-19 patients with concomitant acute LVO, compared to a control group without COVID-19. Data collected included age, gender, comorbidities, clinical characteristics, details of the involved vessels, procedural technique, and various outcomes. A multivariable-adjusted analysis was conducted. RESULTS: In this cohort of 697 patients with acute LVO, 302 had COVID-19 while 395 patients did not. There was a significant difference (p < 0.001) in the mean age (in years) and gender of patients, with younger patients and more males in the COVID-19 group. In terms of favorable revascularization (modified Thrombolysis in Cerebral Infarction [mTICI] grade 3), COVID-19 was associated with lower odds of complete revascularization (odds ratio 0.33, 95% confidence interval [CI] 0.23-0.48; p < 0.001), which persisted on multivariable modeling with adjustment for other predictors (adjusted odds ratio 0.30, 95% CI 0.12-0.77; p = 0.012). Moreover, endovascular complications, in-hospital mortality, and length of hospital stay were significantly higher among COVID-19 patients (p < 0.001). CONCLUSION: COVID-19 was an independent predictor of incomplete revascularization and poor functional outcome in patients with stroke due to LVO. Furthermore, COVID-19 patients with LVO were more often younger and had higher morbidity/mortality rates.

A Pilot study screening bank currency in community circulation for potential carriage of SARS-CoV-2: how safe handling the currency is?

Purpose: Currency seems to represent an important vehicle for transmission of pathogenic microorganisms, thus a potential in affecting the public health. Digital transactions are more common in developed countries;however, handling cash currency is still very common in many countries including Bahrain. A recent study from Australia reported that SARS-CoV-2 may survive for 28 days on smooth surfaces (including banknotes), however the study was purely experimental and done in controlled laboratory environment. There were worldwide speculations suggesting the possible transmission of SARS-CoV-2 infection through currency notes. A recent study from Bangladesh reported presence of SARS-CoV-2 in approximately 7% of currency samples collected from the community. No such study has been performed on Bahraini currency, so the present study was proposed to screen the cash currency in circulation in Bahrain for the possible presence of SARS-CoV-2. Method: We collected notes and coins of Bahraini currency and a few of Saudi riyals from different public sources of currency exchange. Two time points were selected for collection when percentage of tested positive cases was on its peak. All the samples were tested for the presence of SARS-CoV-2 antigen with rapid antigen detection kit and qRT-PCR method. For initial validation, 5 samples each of potential SARS-CoV-2 RNAs extracted from known positive cases and 5 samples of extracted RNA from known negative persons were tested by rapid antigen detection kit and qRT-PCR. The results of qRT-PCR were interpreted as per the interpretation chart provided by the supplier. Results: During the study period, a total of 250 currency samples were collected including different denominations of currency notes and coins. Majority of the currency samples were collected from grocery stores followed by food outlets. Following validation, the currency samples were tested, and all turned negative for SARS-CoV-2 by rapid antigen detection test as well as by RT-PCR. Conclusion: This study predicts on Bahraini currency posing no threat of SARS-CoV-2 transmission via currency exchange. © 2021, Arabian Gulf University. All rights reserved.

Caspase-4/11 exacerbates disease severity in SARS-CoV-2 infection by promoting inflammation and immunothrombosis.

Severe acute respiratory syndrome coronavirus 2 (SARS­CoV-2) is a worldwide health concern, and new treatment strategies are needed. Targeting inflammatory innate immunity pathways holds therapeutic promise, but effective molecular targets remain elusive. Here, we show that human caspase-4 (CASP4) and its mouse homolog, caspase-11 (CASP11), are up-regulated in SARS­CoV-2 infections and that CASP4 expression correlates with severity of SARS­CoV-2 infection in humans. SARS­CoV-2­infected Casp11−/− mice were protected from severe weight loss and lung pathology, including blood vessel damage, compared to wild-type (WT) mice and mice lacking the caspase downstream effector gasdermin-D (Gsdmd−/−). Notably, viral titers were similar regardless of CASP11 knockout. Global transcriptomics of SARS­CoV-2­infected WT, Casp11−/−, and Gsdmd−/− lungs identified restrained expression of inflammatory molecules and altered neutrophil gene signatures in Casp11−/− mice. We confirmed that protein levels of inflammatory mediators interleukin (IL)-1ß, IL-6, and CXCL1, as well as neutrophil functions, were reduced in Casp11−/− lungs. Additionally, Casp11−/− lungs accumulated less von Willebrand factor, a marker for endothelial damage, but expressed more Kruppel-Like Factor 2, a transcription factor that maintains vascular integrity. Overall, our results demonstrate that CASP4/11 promotes detrimental SARS­CoV-2­induced inflammation and coagulopathy, largely independently of GSDMD, identifying CASP4/11 as a promising drug target for treatment and prevention of severe COVID-19.

Perceptions of Medical Students towards Online Learning during COVID 19

Objective: To determine the perceptions of medical students towards online learning during COVID 19 Study Design: Cross sectional online survey Place and Duration of Study: The Department of Pediatrics, Post Graduate Medical Institute/Ameer-ud-Din Medical College, Lahore General Hospital, Lahore, Punjab, Pakistan from November 2020 to March 2021. Materials and Methods: Undergraduate medical students of fourth and final year MBBS were included in the study after approval from Institutional Review Board. They had to answer a questionnaire sent to them as Google Forms TM. Responses from 171 students were received and analyzed using SPSS version 24. Results: Among 171 students, 56 (32.7%) were male and 115 (67.3%) were female. Smart phone (56.7%) was the most common gadget used for online learning. Ability to stay home (69%) was the most frequent advantage recorded followed by access to online materials (68.4%),. while lack of patient interaction was the most common disadvantage (73.7%) followed by technical problems with IT equipment (52.6%). Online learning was considered to be less effective than traditional learning in terms of ability to increase knowledge, clinical skills and social competences. Students were less active during online classes as compared to traditional face to face teaching and majority (66%) rated online learning as unenjoyable. Conclusion: Undergraduate medical students rated online learning less effective and less enjoyable than traditional learning. Necessary measures should be taken to improve quality of online learning of undergraduate medical students during COVID 19 pandemic.

Prediction and Analysis of Covid-19 Positive Cases Using Deep Learning Model

At the end of December 2019, the COVID-19 virus was the initial report case in China Wuhan City. On March 11, 2020. The Department of Health (WHO) announced COVID-19, a global pandemic. The COVID-19 spread rapidly out all over the world within a few weeks. We will propose to develop a forecasting model of COV-19 positive case predict outbreak in Pakistan using Deep Learning (DL) models. We assessed the main features to forecast patterns and indicated The new COVID-19 disease pattern in Pakistan and other countries of the world. This research will use the deep learning model to measure several COVID-19 positive case reports in Pakistan. LSTM cell to process time-series data forecasts is very efficient. Recurrent neural network processes to handle time-dependent and involve hidden layers are confirmed and predict positive cases and weekly cases reported in the future. Bidirectional LSTM (Bi-LSTM) processes data and information in one direction to predict and analyze the weekly 6-9 days readily forecast the number of positive cases of COVID-19 © 2021 IEEE.

Maintaining recruitment to surgical trials during the pandemic

Aims: Recruitment to Randomised Controlled Trials (RCTs) has traditionally been the domain of Research Nurses. Due to the unprecedented pressures of the COVID pandemic, the majority of Research Nurses have been redeployed to other clinical roles, or those still working within research have had to focus on COVID-related projects. This has left existing surgical trials struggling to recruit. We report on our experience of engaging Specialist Nurses without a research background as well as Consultants and Trainees to support surgical research in these challenging circumstances. Method: The Sunflower RCT was first opened to recruitment in August 2019 at our trust. The recruitment was led by single Research Nurse, but the delegation log included a range of Consultants, Trainees, and Specialist Nurses. Due to the COVID pandemic, recruitment was paused from March 2020 and restarted in July 2020. Data were collected on recruitment until January 2021. Results: In the seven months before the recruitment pause, 80 patients were recruited (average 11 per month), with the highest proportion of recruits by the sole Research Nurse. Following the recruitment pause, a further 45 patients were recruited (average 7.5 per month). These patients were recruited by Consultants (20, 44%), Specialist Nurses (12, 27%), Trainees (7, 16%), Research Nurse (3, 7%) and postal consents (3, 7%). Conclusions: We have demonstrated that surgical research activity can be maintained even with minimal Research Nurse recruitment by engaging all members of the surgical team, especially utilising Specialist Nurses, who may not commonly be approached for such a role.

Online Teaching in an Un-prepared Country during COVID-19: An Interview Study on Final Year Medical and Dental Students

Aims: To assess medical students' perception of online teaching to suggest transforming the future curriculum in low-economic countries. Study Design: Cross-sectional online interview study. Place and Duration of Study: A team of collaborators interviewed final year medical and dental students of Pakistan from 07/08/2020 till 17/09/2020. Methodology: A questionnaire was developed based on open and close-ended questions in Google forms;focusing on institutional preparedness, views on online education, the institute's closure and COVID-19, and long-term effects of closure of the institute. Independent fellow researchers systematically analyzed the unaltered transcripts of the responses, and themes were then identified and coded to conclude the results. SPSS version 23 used for analysis. As this study was based on final year students. Results: In response to an invitation email, 2442/2661 (91.77%) students voluntarily participate in this qualitative study. Most participants were females (1614, 66.10%). Closing down institutes was directly linked to a lack of motivation and feel of helplessness. As most showed dissatisfaction with online teaching compounded by psychological effects, students feared losing clinical skills and life during the pandemic. Conclusion: The psychological impact of the crisis led to resistance to accepting the change for a better outcome. Incorporating telemedicine, different interactive learning style to online teaching, and resilience training would result in fruitful outcomes. Developed countries may also guide build infrastructure in developing countries to develop a more robust online teaching methodology in the long-run.

Entrepreneurial leadership and employees’ proactive behaviour: Fortifying self determination theory

The prevailing pandemic (COVID-19) has increased socioeconomic problems and caused psychological distress due to work uncertainty, specifically in emerging economies. Small and medium enterprises (SMEs) in emerging economies have been severely affected. Particularly, work uncertainty is becoming a hindrance towards proactive work behaviour (PWB) that can be improved by an effective entrepreneurial leadership role and proactive personality attribute. Based on fortifying self-determination theory, this research answered the question to what extent proactive personality moderates the relationship between work uncertainty and PWB and strengthens the relationship between entrepreneurial leadership and PWB. To empirically examine the study’s underlying theoretical framework, respondents were selected from SMEs working in Pakistan from the high-tech industry. Multisource data were accumulated from 420 workers and their leaders utilizing a two-wave, time-lagged research design. Conclusions revealed that entrepreneurial leadership first reduced individuals’ work uncertainty, which in turn, led to enhanced proactive work behaviour of employees. Furthermore, the results revealed that work uncertainty mediates the relationship between entrepreneurial leadership and proactive work behaviour. Moreover, proactive personality moderates the link concerning work uncertainty and proactive work behaviour, such that this association is significant only when proactive personality is low. Additionally, the moderated mediation analysis indicated that less proactive people, compared with their extraordinarily proactive colleagues, trusted entrepreneurial leadership to be more proactive in the workplace. These findings have important implications to induce PWB among employees. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.