COVID-19: Pakistan’s Preparedness and response

At the end of December 2019 in the Wuhan City of China, a novel coronavirus (Covid-19) outbreak has been proclaimed. Several cases have arisen in other cities of China. It spread simultaneously worldwide in 209 countries of Europe, Australia, America, Asia, and Pakistan. Mortality is high; millions of people have been affected while cases are rapidly increasing in the world. Different controlling strategies have been adopted for COVID-19. Pakistan took rigorous measures like the hospital, specific laboratories for testing, centres for quarantine, awareness campaign, Ehsaas Emergency Cash Programme and lockdown for controlling this virus. There is no antiviral and vaccine based treatment only preventive measures are taken.

Tailored Online Neurosurgical Evaluation in the Outpatient Setting during COVID-19 Pandemic—The Maldives Experience

Introduction: The recent COVID-19 pandemic has revealed important obstacles in our health care systems, including online specialist consultations. Amidst mass lockdowns and social distancing, we observed the importance of developing a consistent method of performing effective neurological examinations that yield accurate results in a time efficient manner. Objectives: To describe our experience in the Maldives of performing effective online neurological examination. Methodology: We designed and implemented a platform for patients to register for online consultation, collected a comprehensive neurological history, including pictures/scroll-videos of past radiological reports, and guided the patient and their aide through neurological examination methods- both verbally through online video consultation and informative pictorials that depict exactly how-to perform said examinations. Conclusions: Neurological examinations are time consuming, detailed and require skill and expertise to be performed appropriately. Yet, can be customized and adapted to be performed remotely. Proper guidance by examiner and assistance by family or friend with use of pictorials can conclude a thorough online examination.

Gastrointestinal manifestations of COVID-19 and possibility of feco-oral route of transmission

Covid-19 is a global health emergency originating from a small cluster of pneumonia like cases which spread to an extent to be regarded as a pandemic by WHO.in this review we discuss specifically the gastrointestinal manifestations of SARS CoV-2 positive patients in the published literature along with recent detection of SARS CoV-2 RNA in stool specimens and investigate the possible of feco oral route of viral transmission .

An audit of death due to poisoning: a retrospective study

Background: Poisoning is being more frequently encountered nowadays, both globally and locally. Knowing what poisons are involved more commonly and what kind of victims present with this condition, helps the clinicians to manage and treat the patients in a better manner and lessens the mortality rates. Objectives: To determine the age group and gender most vulnerable to fatal poisoning. To identify the agent used for poisoning. Material & Methods: The descriptive retrospective study was carried out King Edward Medical University, Lahore and reviewed the autopsy records of victims of fatal poisoning from January 2018 to December 2019. The data was analyzed using the SPSS software. Results: In the total 67 cases of poisoning that were studied, majority of the victims were males (85.07%).Most of the cases fell in the 21-30 years age group (53.73%), followed by the 31-40 years age group (23.88%).The overall mean age of the victims was calculated to be 32.597 years. Morphine was found to be the toxic agent in most cases (32 cases; 47.76%), followed by Dextromethorphan (26 cases; 38.80%) and codeine (19 cases; 28.35%). Conclusions: Poisoning is a serious issue that is more frequently encountered in our young adult and male population. Since narcotics were found in major share of the cases, measures should be taken for more strict control. Keywords: poisoning, autopsy, mortality, drug toxicity

Frequency of restrictive pulmonary function tests in patients with chronic Hepatitis C

Hepatis C infection is a common health problem world wide and is the major cause of chronic liver disease in Pakistan. Common complications of chronic hepatitis c infection are cirrhosis, ascities and hepatocellular carcinoma. Also HCV infection is associated with several extra hepatic manifestations including interstitial lung fibrosis. It has been found that frequency of pulmonary fibrosis is increased in patients with cirrhosis of liver as the stage of cirrhosis advances.This lung fibrosis can cause restrictive pattern of pulmonary function tests. This study was conducted to determine frequency of restrictive pulmonary function in patients with different stages of chronic hepatitis C infection, based on child pough classification. Study design This is descriptive case study Method 99 patients of age range 20 to 80 year, both males and females having chronic hepatitis C infection and interferon based treatment naïve patients were included from outpatient and inpatient department were selected. Patients were divided into three groups according to child’s criteria i.e. group A, group B, and group C. Pulmonary function tests were performed on patients in all three groups to look for FEV1/FVC ratio in all patients. FEV1/FVC ratio more than 80 was considered as restrictive pulmonary function. Results Out of 99 patients 32(35%) were found to have restrictive pattern of pulmonary functions Conclusion Chronic hepatitis C infection is associated with restrictive pattern of pulmonary function, suggestive of pulmonary fibrosis.

Rapid transmission of SARS-2 among Individuals - A Mini Review

The coronavirus disease emerged at the end of 2019 from Wuhan, China, and ultimately resulted in pandemic. It is a single positive-sense RNA virus spreading from person to person through contact in any form. Bats are the natural hosts of the SARS-CoV-2 virus. SARS-CoV-2 has the largest genome as compared to all RNA virus present so far. Spike proteins are responsible for their entrance into the human body. Social distancing and quarantine resulted in the best possible prevention for the less transmission of coronavirus. We performed a narrative review to describe its origin, transmission, pathogenesis, clinical manifestation, social implications, future possibilities, treatment, and vaccination.

Intima Media Thickness of Carotid and Femoral Artery as predictor of Cardiovascular Events

Objective: To establish the correlation between IMT (presence and severity) of carotid and femoral artery detected on Doppler study and presence of subclinical CAD in asymptomatic patients for early detection of CAD and risk stratification by a non-invasive method. Methodology: This cross-sectional analytic study was conducted in the Cardiology department of Mayo Hospital Lahore for a period of 1 year. One hundred and twenty asymptomatic subjects with and without conventional risk factors for CAD were included The thickness of the intima-media of carotid and the femoral artery was assessed by high-resolution B mode Ultrasonography. The patients enrolled in our study underwent coronary angiography. Data was entered and analyzed through SPSS (Statistical package for social science) version 16. Results: There were a total of 120 patients with a male-to-female ratio of 1.8:1 The mean age of patients was 32.40 ± 10.74 years, minimum age of patients was 20years while the maximum age was 40 years. Most of our patients were overweight, smokers, and had established family history of heart disease. Most of the patients had a single-vessel disease and had severe CAD at the time of presentation. There were 93 patients whose IMT was >0.8 mm. There were 16 patients whose CMIT was <0.8 mm. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of B-mode USG (using CIMT and FA-IMT) were calculated as 85.32%, 72.73%, 96.88%, 33.33% and 84.17% respectively for CMIT. For FA-IMT sensitivity, specify, PPV, NPV and Diagnostic accuracy of B-mode USG was 84.4%, 54.55%, 94.85%, 26.09% and 81.67% respectively. Conclusion: The increased IMT is a predictor of coronary vascular disease, measured non-invasively with B-mode ultrasound. It can be used to predict future cardiovascular events and risk stratification. If patients are diagnosed in the earlier stages then timely treatment can prevent or regress the progression of the disease.

The ‘Real’ Wolf of Wall Street- COVID-19’s Impact on Healthcare Systems & Global Economies

Background: Globally, over 7.8 million people have contracted COVID-19 and > 430,000 have died. The outbreak has strangled the world economy and has tested the resilience of all health systems —robust or fragile. Main Text: A thorough literature review of published articles in Medline, Web of Science, Google Scholar, renowned business analysis blogs, and indexed economic journals using keywords: novel coronavirus, economy, and healthcare systems was carried out with particular emphasis on United States (U.S.) healthcare systems, National Health Service (NHS) in United Kingdome (U.K.), China, Singapore and Pakistan. While all categories of the economy have been affected, pandemic has directly affected people and possession processing services the most. For all countries analyzed, an average economic impact of -4.5% of GDP is expected. Despite its success, the China model cannot be the go-to paradigm everywhere as level of compliance to local authorities, harsh lockdown measures, and ability to quickly complete labor-intensive projects may not be replicable in other countries. Conclusions: COVID-19 pandemic has exposed multiple fault lines in health systems in term of accessibility, adaptability, and preparedness. It has also become clear that a global economy centered on the principle of capital accumulation and not societal uplift is not sustainable through times of crises.

Cytokine Storm Syndrome, a potential cause of death in COVID-19 patients

COVID-19 pandemic caused by SARS-CoV-2 has infected more than two million people worldwide accounting for more than 130,000 mortalities. [1] Its mortality rate of 3.4% is driven by lower respiratory tract infections such as pneumonia, septic shock, multiorgan failure and acute respiratory distress syndrome (ARDS), the latter being the leading cause of mortality. [2] With constantly evolving research regarding the virus’s pathophysiology, possible treatment regimens and trials for potential vaccines having been undergone, the field of medicine is subjected to new data concerning the cause and cure of the current global crisis. Cytokine storm syndrome (CSS) is a hyperinflammatory state characterized by a fulminant and fatal hypercytokinemia with multiorgan failure. CSS occurs due to the virus’s ability to activate an uncontrolled immune response leading to local and systemic crisis. [3] Hyper-inflammation in COVID-19 illustrates elevated levels of pro-inflammatory cytokines including interleukin (IL)-6, IL-8, tumor necrosis factor-?, and granulocyte-macrophage colony-stimulating factor (GM-CSF). [5] Similar, fulminant cytokine production by lung macrophages and pneumocytes was observed in previous SARS-CoV and MERS-CoV epidemics. [4] Clinical features of CSS include unremitting fever, hyperferritinemia and elevated cytokine levels as well as pulmonary involvement (including ARDS). Data from a retrospective, multicenter study from China indicated hyperferritinemia and hypercytokinemia in COVID-19 patients suggestive of mortalities due to virus related hyperinflammation. [4] Proportionally increased cytokine levels with the severity of COVID-19 sheds light through a different perspective on the management and treatment of the disease. A multicentre, randomized controlled trial of tocilizumab (IL-6 receptor blocker, used for CSS), has been approved in patients with COVID-19 pneumonia and elevated IL-6 in China (ChiCTR2000029765), reporting significantly reduced fever and improved respiratory function. [5] Moreover, surge in cytokines is in turn mediated by catecholamines. The latter enhances IL-6 production through alpha-1 adrenergic receptor (?1-AR) signaling. It was concluded that ARDS patients with prior use of ?1-AR antagonists like prazosin in the year before their diagnosis were about less likely to need to be placed on a ventilator after their diagnosis.[4] This encourages its use as a prophylactic inhibitor for COVID-19. We believe that critically ill patients of COVID-19 should be tested for hyperinflammation using laboratory trends (hyperferritinemia, low platelet count, low erythrocyte sedimentation rate) and the HScore (used to diagnose CSS) to distinguish the subgroup of patients for whom immunosuppressive drug therapy could help improve mortality. [5]