Evaluation of Currently Available Molecular Assays and Performance of Sampling Approaches for Detection of Sars-Cov-2 RNA

OBJECTIVES This study aims to identify the essential characteristics of diagnostic tests for SARS-CoV-2 and to discuss the limitations of currently available tests and their impact on the test selection process. METHODOLOGY The current study was conducted at Mardan Medical Complex (MMC). One hundred nasopharyngeal-positive samples were collected from February to March 2021. Oropharyngeal swab OPS, sputum, and blood samples were collected from the participants to detect SARS-CoV-2 RNA. RNA extraction of SARS-CoV-2 was done using a BigFish auto extractor. A Qiagen Thermal Cycler was used for genome amplification. Five different molecular assays, namely COVSIGN (N gene) Spain, BGI (ORF1ab gene) China, Maccura(ORF1ab, E and N gene) China, R-GENE (RdRp and N genes) France and Genuru (N gene, S gene and ORF ab/1) were used. RESULTS100 % positivity was recorded in the sputum of all individuals, followed by 91 % OPS and 21% blood. The highest positivity rate for different genes was observed. ROC (Receiver operating characteristic curve) was developed through SPPS version 26.00 to compare the sensitivity and specificity. CONCLUSION By comparing the results of different diagnostic kits, it was found that BGI and Maccura are the most sensitive and specific for diagnostic purposes against COVID-19

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Continual Learning Objective for Analyzing Complex Knowledge Representations

Human beings tend to incrementally learn from the rapidly changing environment without comprising or forgetting the already learned representations. Although deep learning also has the potential to mimic such human behaviors to some extent, it suffers from catastrophic forgetting due to which its performance on already learned tasks drastically decreases while learning about newer knowledge. Many researchers have proposed promising solutions to eliminate such catastrophic forgetting during the knowledge distillation process. However, to our best knowledge, there is no literature available to date that exploits the complex relationships between these solutions and utilizes them for the effective learning that spans over multiple datasets and even multiple domains. In this paper, we propose a continual learning objective that encompasses mutual distillation loss to understand such complex relationships and allows deep learning models to effectively retain the prior knowledge while adapting to the new classes, new datasets, and even new applications. The proposed objective was rigorously tested on nine publicly available, multi-vendor, and multimodal datasets that span over three applications, and it achieved the top-1 accuracy of 0.9863% and an F1-score of 0.9930