Relationship between the ABO blood group and Rhesus factors with COVID-19 susceptibility.

INTRODUCTION: The molecular research has raised copious hypotheses about different molecular effects on the variable expression of the current virus on the human body. The present prospective study aims to determine clinically as well as statistically, the relation between ABO blood groups and Rhesus (Rh) factor and the severity of the Covid-19 virus. RESEARCH DESIGN AND METHODS: We conducted a prospective, single-centered study at The Combined Military Hospital Lahore, Pakistan. Details of only those patients who exhibit COVID-19 symptoms were included. The odds ratios with a 95% confidence interval and the chi-square test of blood groups and Rhesus factor was also conducted individually with the severity of disease, outcomes, and respiratory symptoms. P-values less than 0.05 was considered significant. RESULTS: The chi-square test and odd ratio yielded no significant results when the covid-19 status was compared with the Rhesus factor (p-value > 0.05). However, the results were found to be significant when associations were run between Covid-19 status and all the blood groups (p-value < 0.05). CONCLUSION: According to the analytical results of the present study, protective nature of all the blood antigens (A, B, AB, none) was observed in patients presenting with Covid-19 symptoms of varying severity.

SARS-COV-2/COVID-19: scenario, epidemiology, adaptive mutations, and environmental factors.

The coronavirus pandemic of 2019 has already exerted an enormous impact. For over a year, the worldwide pandemic has ravaged the whole globe, with approximately 250 million verified human infection cases and a mortality rate surpassing 4 million. While the genetic makeup of the related pathogen (SARS-CoV-2) was identified, many unknown facets remain a mystery, comprising the virus's origin and evolutionary trend. There were many rumors that SARS-CoV-2 was human-borne and its evolution was predicted many years ago, but scientific investigation proved them wrong and concluded that bats might be the origin of SARS-CoV-2 and pangolins act as intermediary species to transmit the virus from bats to humans. Airborne droplets were found to be the leading cause of human-to-human transmission of this virus, but later studies showed that contaminated surfaces and other environmental factors are also involved in its transmission. The evolution of different SARS-CoV-2 variants worsens the condition and has become a challenge to overcome this pandemic. The emergence of COVID-19 is still a mystery, and scientists are unable to explain the exact origin of SARS-CoV-2. This review sheds light on the possible origin of SARS-CoV-2, its transmission, and the key factors that worsen the situation.

IMPACT OF COVID-19 PANDEMIC ON THE GASTROENTEROLOGY PRACTICES IN A TERTIARY CARE HOSPITAL IN LAHORE

ABSTRACT Objective: To assess the impact of COVID-19 pandemic on the gastroenterology practices in a tertiary care hospital. Study Design: A comparative cross-sectional study. Place and Duration of Study: The study was conducted at Gastroenterology Department, Combined Military Hospital, Lahore, from Jan 2020 to Jun 2020. Methodology: The departmental workload was recorded from before the pandemic was declared and during the pandemic. The number of procedures including upper GI endoscopies(OGD), Colonoscopies, and Endoscopic Retrograde Cholangiopancreato-graphy(ERCP) were recorded. The out-patient department and in-patient department patient load was also recorded for both time periods. Microsoft excel sheet and SPSS version 24 was used to perform data analysis. Results: We performed 34(11.07%) emergency and 273(88.93%) elective endoscopic procedures before the pandemic was declared in March 2020 whereas, afterwards, the load significantly reduced to only 25(32%) emergency and 53(67.95%) elective procedures(p<0.001). In our study, we reported that the frequency of indoor admissions was reduced by 26.8% during the COVID-19 pandemic whereas, the total number of outdoor patients was also substantially reduced from 2096(94.6%) in pre-pandemic period to a mere 350(82.35%) admissions. Conclusion: The patient load and frequency of procedures has both significantly reduced during the COVID-19 pandemic.

EFFECT OF COVID-19 ON LIVER FUNCTION TESTS;RESULT FROM A TERTIARY CARE HOSPITAL IN PAKISTAN

ABSTRACT Objective: To determine the changes in liver function tests if any in patients of COVID-19. Study Design: Cross sectional study. Place and Duration of Study: Combined Military Hospital Lahore, from Apr 2020 to Jun 2020. Methodology: A total of 209 confirmed cases of COVID-19 positive by RT-PCR patients presenting to Combined Military Hospital, Lahore were included in the study. Their demographic details were recorded. Patients were grouped into mild-moderate and severe disease groups according to the symptoms, complications and oxygen or ventilation requirements. Liver function tests of all these patients were advised. Results: Amongst confirmed COVID-19 patients, 187 (89.5%) had mild to moderate disease whereas 22 patients (10.5%) had severe disease. Liver test abnormalities were defined as the elevation of the following liver enzymes in serum: ALT 42 U/L, AST 45 U/L, GGT 49 U/L, ALP 300 U/L, albumin35g/L and total bilirubin (TBIL) 17.1. In LFTs, Bilirubin was increased in 20 (9.6%) patients), ALT in 32 (15.3%) patients, of which 8 had severe disease, 38 patients having high AST levels (45) 28 had mild-moderate disease and 10 had severe disease. ALP was raised in 24 (11.5%) patients with 8 being in severe disease and rest in mild moderate disease. Albumin was low in 35 (16.7%) patients of which 12 had severe disease and 23 had mild-moderate disease. Conclusion: About 15-20% of the confirmed cases of COVID-19 have deranged liver function tests and it correlates with severity of the disease.

UTILITY OF NEUTROPHIL-TO-LYMPHOCYTE RATIO, PLATELETS-TO-LYMPHOCYTE RATIO AND CALL SCORE FOR PROGNOSIS ASSESSMENT IN COVID-19 PATIENTS

ABSTRACT Objective: To validate if Neutrophil-to-Lymphocyte ratio (NLR), Platelet-to-Lymphocyte ratio (PLR) or CALL score (a novel scoring model) predict worse prognosis such as need for Intensive Care Unit (ICU) Admission and Mortality in COVID 19 patients. Study Design: Prospective observational cohort study. Place and Duration of Study: Combined Military Hospital Lahore, from Mar 2020 to May 2020. Methodology: Consecutive symptomatic patients with confirmed COVID-19 infection by RT-PCR were included. Patients' age, gender, comorbids and labs data including complete blood counts and serum LDH was recorded. neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and CALL Score were calculated. Main outcomes were need for Intensive Care Unit Admission/ventilator support and mortality. Results: A total of 125 patients were admitted with the diagnosis of COVID-19 infection. There were 35 (28%) Intensive Care Unit admissions, 17 (13.6%) required mechanical ventilation and 17 (13.6%) patients were deceased. Regression Analysis was done. For Intensive Care Unit Admission/ventilator support significant predictors were neutrophil-to-lymphocyte ratio (p=0.03), age greater than 50 (p=0.02), moderate CALL score (p=0.02) and high CALL Score (p=0.004). For hospital deaths, significant predictors included neutrophil-to-lymphocyte ratio (p=0.001) and age more than 50 years (p=0.01), CALL Score was not significant (p=0.3 and 0.9). Platelet-to-lymphocyte ratio (p=0.9 and 0.8) and Diabetes (p=0.1 and 0.6) were not significant. Conclusion: Neutrophil-to-lymphocyte ratio and age more than 50 years are significant predictors for need for Intensive Care Unit Admission or Ventilatory support and in-hospital mortality. High CALL Score is a significant predictor of Intensive Care Unit Admission or ventilator support but not for in hospital mortality.