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 need of personal protective equipment to prevent the spread of COVID-19 in health care workers

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Social Media; its role in the infodemic of COVID-19

Introduction: A pandemic is defined as an outbreak of a disease that occurs over a wide geographic area and affects an exceptionally high proportion of the global population.Objective: This study aims to observe the discrepancies that social media provides users in terms of information regarding COVID-19 and how that information can affect practices for prevention against the virus.Methods: A cross-sectional study, with a non-probability convenience sampling technique, was conducted during April 2020. An online survey was created on Google Forms in the English language, and participants were invited to complete and submit the form. A total of 402 responses were received in one month. Citizens of age 18-60 partook in the study, and respondents tested positive for Covid-19 were excluded from the study as it could lead to bias.Results: A total of 375 responses were selected out of the 402 responses received. Six responses were excluded who tested positive for Covid-19, and 21 responses were rejected as they were filled incompletely. The mean age of respondents was 27.53 years (S.D 8.188), and there were more females, 52.53% (n=197) than male, 46.67%(175) participants. A Pearson correlation (r) of 0.383 between knowledge and practices of people who use social media as their primary source of information suggests a moderate linear correlation. People who did not use social media as their primary source of information had a stronger linear correlation (r=0.640) between knowledge and practices.Conclusion: According to the study, social media provided people with correct knowledge as well as encouraged efficient practices while also contributing to the spread of false news and malpractices.