BENEFICIAL EFFECTS OF TREATMENT WITH TOCILIZUMAB IN MODERATE TO CRITICALLY ILL COVID-19 PATIENTS

Introduction: COVID-19 virus initiates an inflammatory response in the body involving many cytokines. Interluukin-6 (IL-6) is one of them, elevated levels of which found to be directly related to morbidity and mortality of infected patients. The aim of the current study was to evaluate the clinical benefits of Tocilizumab, a monoclonal antibody against interleukin-6 receptor, as a therapeutic agent for the treatment of Coronavirus disease 2019. Methods: The current retrospective study was conducted at Bahria Town International hospital from rom May 1st to 5th July 2020. Total of one twenty (n=120) moderate to severely ill patients (94 males and 26 females), infected with SARS-CoV-2 virus, were included to assess the effect of TOCILIZUMAB in improvement of PF ratio and other biochemical variables of prognostic importance, including CRP, serum ferritin levels, D-dimers and LDH. These parameters were compared before and after the ten days of treatment with tocilizumab. Demographic, laboratory and clinical finding were recorded for the feather analyses. Statistical analysis was performed by using software SPSS version 21.0. The Wilcoxon signed‐rank test used to compare parameters whenever appropriate. A P‐value of less than .05 was considered statistically significant. Results: The results of our study showed statistically significant improvement in PF ratio and decrease in CRP levels. Other parameters such as D-Dimer, Serum ferritin levels and LDH showed no change before and after treatment with tocilizumab. Conclusion: In summary, TOCILIZUMAB improved the PF and CRP ratio in COVID-19 patients, but other markers did not improve in response to TOCILIZUMAB in critically ill COVID-19 patients.

INNOVATION OF AUDIO-VISUAL TRIAGE SYSTEM IN COMBATING THE SPREAD OF COVID-19 INFECTION AND ITS EFFICACY: A NOVEL STRATEGY

During the novel coronavirus pandemic, also known as SARS-CoV-2 or COVID-19 pandemic, frontline healthcare professionals suffered psychological as well as pathological trauma due to the lack of preparation to cope with this unforeseen situation. The protocols to prevent the spread of this disease proved to be less effective than anticipated. In these circumstances, improvement of the existing triage system was felt and an AUDIO-VISUAL TRIAGE (AVT) system was introduced to enhance confidence as well as increase the safety of frontline healthcare professionals. The current analysis was performed from March 21, 2020, to April 28, 2020, until the completion of sixty response forms, at Bahria Town International Hospital, Lahore. Thirty participants (Group A) deployed on visual triage and other thirty (Group B) on AVT for screening suspected cases of COVID-19 infection. Anxiety levels were measured by using the GAD-7 scoring system and the participants of both groups were periodically tested for COVID-19 infection by PCR. Independent t-test was used to evaluate the significance of different variables at a confidence level of 95%. The result of the current study revealed the effectiveness of AVT for the screening of COVID-19 patients. There was a statistically significant increase in anxiety levels and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rate in group A as compared to group B. Almost all participants in group A wanted to shift their place of work or ready to quit the job if they were forced to perform their duties at the same visual triage. AVT system for COVID-19 screening found to be more safe and less stressful than visual triage. It is not only a simple and effective way to prevent the spread of diseases but also boosted the confidence of frontline healthcare professionals to fight against coronavirus spread.

STRATEGIES TO ALLOW FAMILY VISITS TO ACUTE CARE UNITS DURING THE COVID-19 PANDEMIC

During pandemics, hospital administration does not allow family members to visit their loved ones. There is a need to develop standards and processes that may be followed when a family member enters an ICU or ward to prevent cross infection. These rules should also be put in place during epidemics to ensure that family have safe access to their patients.

GENE THERAPY FOR HAEMOPHILIA

The blood disorder, Hemophilia, has its roots embedded deep into the history of genetic disorders. The European royal family is one of the most prominent families to be affected by this disease thus, dubbing it 'the royal disease'. The types of Hemophilia are divided into two based on the type of coagulation factor mutation found in the patient. For treating haemophilia, gene therapy is done by using different vectors such as lentiviral and retroviral vectors but due to the production of limited expression different adeno associated virus (AAV) strains are used. Some engineerly modified vectors are currently used to get the best possible results. The clinical trials prove the efficacy of these vectors so through their obtained statistical consideration, patient experience and population study once can design vaccines and drugs for haemophilia patients but also due to pre-existing Nabs and pre-existing HCV or HBV infection, the general application of AAV gene therapy is currently limited. The possibility of gene editing for the repair of the mutation is on the horizon.

CULTURING, IDENTIFICATION AND DRUG RESISTANCE OF MYCOBACTERIUM TUBERCULOSIS IN SPUTUM SPECIMEN

The development of low-cost, fast, and reliable methods for detecting Mycobacterium tuberculosis (MTB) infection and drug susceptibility is critical for tuberculosis control. The new microscopic examination of liquid drug susceptibility assay (MODS) examines early MTB colonies in a liquid medium, which permits for more convenient diagnosis and testing of drug susceptibility. The sensitivity of MODS (91%) was superior as compared to the sensitivity of different culture methods (92%). The MGIT and MODS were used to monitor tuberculosis-positive sputum samples for isoniazid and rifampin susceptibility. Concordance between MODS and MGIT was found in 89 percent of cases. MODS are the fastest method used for diagnostic and susceptibility testing (median, 10.0 or 9 days). MODS is a fast, low-cost, responsive, and particular method for detecting and testing MTB susceptibility; it is specifically well-suited utilize in growing countries with high infection rates and a growing number of multidrug-resistant cases.

BENEFICIAL EFFECTS OF AWAKE PRONE POSITIONING IN COVID-19 PATIENTS WITH MODERATE TO SEVERE HYPOXEMIC RESPIRATORY FAILURE

Introduction: Coronavirus disease (COVID-19) is a leading cause of acute hypoxemic respiratory failure which can progress to acute respiratory distress syndrome (ARDS). These patients are deeply sedated, paralyzed and ventilated and prone positioning is known to help in these cases. Prone positioning has been known to help in ARDS cases, but they are ventilated deeply sedated and paralyzed. The aim of the current study was to assess the safety and potential benefits of awake prone positioning in COVID-19 patients with moderate to severe hypoxemic respiratory failure. Methods: This is a retrospective cohort study, performed at Bahira International Hospital Lahore. Record of confirmed COVID-19 patients with hypoxic respiratory failure was reviewed thoroughly to collect data. The duration, timing, frequency, tolerability, beneficial effects and adverse events during prone positioning were recorded from the medical records before and after self-prone positioning. Results: The current analysis showed that prone positioning is supportive to maintain good saturation (92%) as compared to keeping patients in spine position (82%). Conclusion: It can be concluded from the current study that prone position is helpful to maintain normal oxygen saturation even on low oxygen supply, helping in quick recovery and preventing oxygen induced damage to the lungs.

MORTALITY AND COVID-19: A SNAPSHOT OF A TERTIARY CARE FACILITY IN PAKISTAN

Background: Since SARS CoV-2 infection began in China and has evolved into a pandemic, mortality associated with this illness has been under discussion and hypercoagubility, severe acute respiratory syndrome and septicemia with multiple organ insufficiency have been cursed as potential causes of death in cases infected with the novel coronavirus. We did a retrospective analysis of cases admitted to our highly dependent and intensive care unit, and we tried to identify the leading cause of death in our cases. Methods: This is a single center retrospective study carried out at Bahria International Hospital Lahore over a 3-month period (May 10th to July 10th 2020) in which we analyzed the clinical and biochemical profiles of the COVID-19 patients who died during this period. Results: A total of 108 patients were admitted during this period out of which 11 patients died. 7 of them were men and 4 women. Majority of them had sudden cardiac arrest due to acute coronary syndrome followed by multiorgan dysfunction syndrome and acute respiratory distress syndrome. Conclusion: Acute coronary syndrome due to hypercoagubility was the leading cause of death in our patients.