Pneumomediastinum and Pneumopericardium as Uncommon Complications of COVID-19 Infection: A Review Article.

There is an emerging body of literature describing an increasing incidence of pneumomediastinum and, to a lesser extent, pneumopericardium as a complication of COVID-19. However, the literature lacks information regarding patients' characteristics and a general view of this unusual condition. The purpose of this paper is to summarize the current literature on this phenomenon. In this study, we summarize the risk factors/etiology, imaging modalities, management, and prognosis of known cases in the literature. In total, 48 articles were included in the study, ranging from case reports to case series. Most patients were male (83.3%). The overall mortality rate was 27.1% and the recovery rate was 62.5%.

Post Covid-19 Complications of Symptomatic and Asymptomatic among Healthcare Professionals Working in Tertiary Care Hospital of Lahore Pakistan

Background: Growing evidence shows that a significant number of patients with COVID-19 experience prolonged symptoms, known as Long COVID. COVID-19, caused by SARS-CoV-2, can involve sequelae that last weeks to months after initial recovery. The objective of this study is to assessing the long-term effects of COVID-19 and estimate the prevalence of each symptom of patients at a post-COVID-19 stage. Aim(s): This study was conducted to determine the frequency of post COVID effects among symptomatic and asymptomatic patients at a tertiary hospital Lahore, Pakistan. Material(s) and Method(s): This cross-sectional study was conducted among the population (such as doctors, nurses, paramedical staff, students and faculty) at a tertiary hospital Lahore, Pakistan. This study included 30 participants and the collected data had been checked, coded, entered and exported at SPSS version 25 for analysis. Pearson chi square test was used for the statistical analysis of the data. Result(s): Among 30 participants, no one show symptoms of hypertension, diabetes mellitus and visual problems during COVID-19 and after recovery.8 patients were asymptomatic and 22patients were symptomatic which shows post COVID effects such as which include dyspnea (67.7%), mental confusion (26.7%), tiredness (93%), chest pain (16.7%), anorexia(26%), insomnia(26%), dyspepsia(67%), headache(66.7%), fatigue(50%), fever(10%), loss of smell(33%), weakness(40%), hypoxia on altitude(60%), breathlessness(70%), arthrgia(13.3%), mental confusion(26.7%), post-exertinal malasia(16.7%), sore throat(10%), joint pain(40%) Conclusion(s): Conclusion based on the study result that most common post-COVID long terms effects are dyspnea, weight loss, mental confusion, anorexia, arthrgia, post-exertinal malsiae, insomnia, fever, hypoxia, breathlessness, sore throat. Symptoms can be controlled by taking proper precautionary measure and strict following on PPE. The problem can only get worse with time if not followed PPE Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

Cerebral Venous Infarct After Recovery From COVID-19 Pneumonia.

The coronavirus disease 2019 (COVID-19) may have multisystem organ involvement. Thrombotic events are well-recognized complications of COVID-19. Such complications may include the pulmonary, renal, and other organs vasculature. The risk of coagulopathy is usually related to the severity of COVID-19 pneumonia. Few cases suggested that the coagulopathy risk may persist for some period after the recovery from COVID-19. We report the case of a middle-aged man with severe COVID-19 pneumonia that required seven days of endotracheal intubation and mechanical ventilation who presented with headache and left-sided weakness that occurred three days after his discharge. A computed tomography scan was performed to rule out intracranial hemorrhage before initiating the thrombolytic therapy. The scan demonstrated hemorrhage in the right temporal lobe with surrounding vasogenic edema along with density in the right transverse sinus. Subsequently, computed tomography venography was performed and demonstrated the filling defect representing right sigmoid venous sinus thrombosis. The patient received conservative measures in the form of intravenous hydration, anticoagulation, analgesics, and anticonvulsants. During the hospital stay, the patient had improvement in his symptom and mild neurological deficit persisted. The case highlighted that risk of thrombotic complications in COVID-19 pneumonia may persist for some period after the recovery from the disease. Hence, thromboprophylaxis may be indicated in selected patients with a risk of thrombotic events after their recovery from severe COVID-19.

A Case of Hepatotoxicity After Receiving a COVID-19 Vaccine.

The coronavirus disease 2019 (COVID-19) has led to a global health crisis. Its clinical manifestations are well-documented, and severe complications among patients who survived the infection are being continuously reported. Several vaccines with well-established efficacies and excellent safety profiles have also been approved. To date, few side effects of vaccines have been reported. Drug-induced hepatotoxicity is an extremely rare side effect of these vaccines, with few reported instances. In this case report, we describe a patient who experienced hepatotoxicity after receiving the COVID-19 vaccine from Pfizer BioNTech.

Snapshot of Pakistani children 18 years and less during the COVID-19 pandemic presenting to a tertiary care rheumatology clinic

Background/Purpose: Coronavirus disease 2019 (COVID-19) is a pandemic infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Children develop symptomatic COVID-19 less frequently than adults;they account for 1-8% of laboratory-confirmed cases. However, severe cases of COVID-19, including fatalities, have also been reported in children. Children with rheumatic diseases may be immunosuppressed due to underlying disease activity and/or immunosuppressive treatment and are at greater risk for severe disease. Methods: Participants in this survey were pediatric patients who came to a Rheumatology OPD between July and December of 2020 and whose parents/guardians consented to them being a part of this research. We collected data regarding current diagnosis, medications, as well as COVID symptoms, diagnosis and outcome in case of infection. Results: A total of 35 pediatric patients were included in the survey out of the clinic's database of 60. This represented a confidence interval of 90% with a 9% margin of error. had a confirmed diagnosis on PCR. Of these, one was an asymptomatic case with underlying JIA, on Methotrexate, while 2 had underlying SLE, on MMF, and developed severe symptoms requiring hospital admission. One recovered, sadly the second passed away due to a simultaneous Lupus flare and COVID pneumonia. Conclusion: The infectivity rate in our study was 8.5% which was lower than Pakistan's pediatric average viz >10. This supports the hypothesis that certain anti-rheumatic drugs may have protective properties against COVID-19. On the other hand, studies have found patients on MMF to be more susceptible to severe COVID-19, as also seen in our study, with higher mortality in patients with increased rheumatic disease activity, also echoed here with the patient who had a Lupus flare during COVID-19 infection and passed away.

Severe COVID-19 pneumonia treated with tocilizumab: Outcomes with associated variables

Background/Purpose: To look at outcomes (viz recovery or death) of patients with severe COVID-19 pneumonia treated with Tocilizumab, and to identify the demographic, clinical and laboratory variables impacting the outcome. Methodology: This was a single centre, retrospective, descriptive case series conducted at National Hospital & Medical Centre, Lahore, after approval from the Institutional Review Board. Data was collected from the hospital files and laboratory records of 49 ICU and HDU patients admitted with COVID pneumonia over the previous 4 months, all of whom had been given Tocilizumab. Data was analysed to identify significant differences between patients who expired and those who recovered. Results: The demographics of our patients are shown in Figure 1. LDH, D-Dimers and NLR were consistently higher in the expired group, and this difference is seen to be statistically significant (<0.05) as highlighted in Table 1. The last available WBC count prior to outcome viz., recovery or death, was found to be higher in the expired group and the odds of coinfection were 8.21 times higher in the latter. Conclusion: Raised LDH, D-Dimers and NLR were associated with poor prognosis in our COVID-19 patients. Interpretation, however, needs to be cautious as the specificity of these markers may be inconsistent;elevated values have also been reported in pre-existing conditions like heart failure and acute events such as DVT or stroke. This study did not look at their association with these confounders. It is important to note that while CRP was significantly higher at baseline in the patients who expired, there seemed to be no difference following treatment. Hence baseline CRP could be used to indicate the likelihood of survival but serial monitoring did not help determine prognosis. This requires further analysis.

Survey: Compliance of Pakistani rheumatology patients with COVID-19 prevention guidelines

Background/Purpose: Effectiveness of primary prevention of diseases is dependent on both the evidence presented and the compliance of people in the guidelines. Auditing the compliance would be able to guide improvements in the dissemination of information and primary prevention strategies in any pandemic. Methods: Patients in Arthritis Care Foundation's records were selected using random sampling. Data was obtained via phone by research assistants and entered into a web-based survey. Compliance of the patients' households with isolation and home care guidelines was determined in addition to ascertaining their beliefs regarding COVID-19. confirmed or suspected COVID-19 infection patient data was also collected. The relationships between the primary source of COVID information and compliance with prevention guidelines/outcomes was analysed. Results: We got 115 responses out of the 200 selected. 108 answered all questions. This represented a confidence interval of 95% with a 9% margin of error. There appeared to be a significant correlation between patients' primary source of information regarding COVID-19 and suspected COVID infection in the household (fever and at least one of: cough, sore throat, nasal congestion, dyspnea or anosmia). The source of information was also linked to the likelihood for household members to socially distance themselves from people outside their homes. Conclusions: Our survey found a significant correlation between a household's primary source of information and a household member being COVID positive. There was also an association of compliance with social distancing guidelines. The majority of our respondents' primary source of COVID related information was either social media or news channels. This is worrying as it has been shown through various studies that misinformation is very prevalent in these sources. The increased rate of exposure to misinformation has had a negative impact on adherence with prevention guidelines as well as trust in the medical community with regards to treatment and vaccination.

Laboratory trends in severe COVID-19 patients undergoing treatment with tocilizumab

Background/Purpose: To observe the changes over time in laboratory values of patients with severe and critical COVID infections who were being treated with Tocilizumab (TCZ). Methodology: This was a single centre, retrospective, observational study conducted in a single hospital. Data was collected over a 4 month period from the hospital files and laboratory records of 49 ICU and HDU patients with COVID pneumonia, all of whom had been given Tocilizumab. Lab values were recorded at various points in time: closest to the time of admission (Baseline), the latest values available as of the day Tocilizumab was administered (Day 1 of TCZ), Day 3 of TCZ and the last available labs (Discharge/Expiry). Data was entered into a spreadsheet and the Friedman test was used to assess which parameters varied significantly over time. These values were then plotted in the form of a line graph to observe the trends over time. Results: As per the Friedman test, White Cell Count (WCC), Neutrophil to Lymphocyte ratio (NLR), and C-Reactive Protein (CRP) changed significantly over time. There were no significant changes for the majority of the lab values. Conclusion: Following TCZ administration, both CRP and NLR decreased. CRP is a widely used indicator of inflammation whereas NLR has been used as an indicator of severity in COVID-19. Zhiling Zeng et al. found that CRP continued to decrease with time in severe cases but rose back up after 10 days in critical cases whereas it continued to decrease in all patients in our study group, suggesting that TCZ + standard of care may prove more effective in controlling CRP in critically ill patients versus standard of care alone. Case control studies can be done in the future to determine if this is indeed the case, and whether this has a mortality benefit in critically ill patients.

HRCT chest finding and clinical course of asymptomatic cases with COVID-19 pneumonia

Aim: To detect the early HRCT chest findings and clinical course in patients diagnosed as COVID-19 positive but are asymptomatic. Study design: A prospective study. Setting: All the confirmed COVID-19 patients encountered at Sir Ganga Ram Hospital Lahore corona desk, from 1st April 2020 to 30th April 2020 were studied in this survey. Methods: In our survey, we selected those asymptomatic patients who had positive contact history, diagnosed as COVID-19 positive by RT-PCR. Characteristic CT findings of each enrolled patient were collected and then interpreted. Results: 53 asymptomatic exposed patients with COVID-19 lung disease were enrolled and underwent HRCT Chest. All patients who had a contact history of COVID-19 patients were tested positive by RT-PCR. These patients had a history of contact with COVID-19 patients. 58.49% of patients had normal HRCT Chest while 41.5% patients had abnormal CT findings. The predominant feature on HRCT Chest was GGO in (100%) with peripheral distribution (72.2%), diffuse (27.27%), unilateral distribution (45.4%), and bilateral distribution (54.5%). After a short-term follow-up, 20 patients (37.7%) developed symptoms mainly including fever, SOB, cough, and lethargy. Follow-up HRCT showed progression of disease in (9.09%) patients. Conclusion: HRCT chest of patients having COVID-19 pneumonia that are asymptomatic has specific characteristics. As asymptomatic patients are silent carriers and some patients can worsen in a very short period. It is important to consider the importance of the detection and surveillance regarding asymptomatic patients having COVID-19. HRCT chest also has great value in screening and diagnosing patients with COVID-19 pneumonia, specifically in those who have a high suspicion, asymptomatic patients with negative PCR. © 2021 Lahore Medical And Dental College. All rights reserved.

Analysis and Dynamics of Fractional Order Mathematical Model of COVID-19 in Nigeria Using Atangana-Baleanu Operator

We propose a mathematical model of the coronavirus disease 2019 (COVID-19) to investigate the transmission and control mechanism of the disease in the community of Nigeria. Using stability theory of differential equations, the qualitative behavior of model is studied. The pandemic indicator represented by basic reproductive number R0 is obtained from the largest eigenvalue of the next-generation matrix. Local as well as global asymptotic stability conditions for the disease-free and pandemic equilibrium are obtained which determines the conditions to stabilize the exponential spread of the disease. Further, we examined this model by using Atangana–Baleanu fractional derivative operator and existence criteria of solution for the operator is established. We consider the data of reported infection cases from April 1, 2020, till April 30, 2020, and parameterized the model. We have used one of the reliable and efficient method known as iterative Laplace transform to obtain numerical simulations. The impacts of various biological parameters on transmission dynamics of COVID-19 is examined. These results are based on different values of the fractional parameter and serve as a control parameter to identify the significant strategies for the control of the disease. In the end, the obtained results are demonstrated graphically to justify our theoretical findings.

Analysis of the COVID-19 Pandemic Spreading in India by an Epidemiological Model and Fractional Differential Operator (preprint)

Fractional differential mathematical model unfolding the dynamics of the COVID-19 pandemic in India is presented and explored in this paper. The purpose of this study is to estimate the future outbreak of disease and potential control strategies using mathematical models in India as a whole country as well as in some of the states of the country. This model is calibrated based on reported cases of infections over the month of April 2020 in India. We have used iterative fractional complex transform method to find approximate solutions of the model having modified Riemann Liouville fractional differential operator. We have also carried out a comparative analysis between actual and estimated cumulative cases graphically, moreover, most sensitive parameters for basic reproduction number$(R_0)$ are computed and their effect on transmission dynamics of COVID-19 pandemic is investigated in detail.

A Mathematical Model of COVID-19 Using Fractional Derivative: Outbreak in India with Dynamics of Transmission and Control (preprint)

Since the first case of 2019 novel coronavirus disease (COVID-19) detected on Jan 30, 2020, in India, the number of cases rapidly increased to 3819 cases including 106 deaths as of 5 April 2020. Taking this into account, in the present work, we are studying a Bats-Hosts-Reservoir-People transmission fractional-order COVID-19 model for simulating the potential transmission with the thought of individual social response and control measures by the government. The real data available about infectious cases from $14^{th}$ March to $26^{th}$ March 2020 is analysed and accordingly various parameters of the model are estimated or fitted. The Picard successive approximation technique and Banach's fixed point theory have been used for verification of the existence and stability criteria of the model. Numerical computations are done utilizing the iterative Laplace transform method. In the end, we illustrate the obtained results graphically. The purpose of this study is to estimate the effectiveness of preventive measures, predicting future outbreaks and potential control strategies using the mathematical model.