Personal protective equipment-derived pollution during Covid-19 era: A critical review of ecotoxicology impacts, intervention strategies, and future challenges.

During the COVID-19 pandemic, people used personal protective equipment (PPE) to lessen the spread of the virus. The release of microplastics (MPs) from discarded PPE is a new threat to the long-term health of the environment and poses challenges that are not yet clear. PPE-derived MPs have been found in multi-environmental compartments, e.g., water, sediments, air, and soil across the Bay of Bengal (BoB). As COVID-19 spreads, healthcare facilities use more plastic PPE, polluting aquatic ecosystems. Excessive PPE use releases MPs into the ecosystem, which aquatic organisms ingest, distressing the food chain and possibly causing ongoing health problems in humans. Thus, post-COVID-19 sustainability depends on proper intervention strategies for PPE waste, which have received scholarly interest. Although many studies have investigated PPE-induced MPs pollution in the BoB countries (e.g., India, Bangladesh, Sri Lanka, and Myanmar), the ecotoxicity impacts, intervention strategies, and future challenges of PPE-derived waste have largely gone unnoticed. Our study presents a critical literature review covering the ecotoxicity impacts, intervention strategies, and future challenges across the BoB countries (e.g., India (162,034.45 tons), Bangladesh (67,996 tons), Sri Lanka (35,707.95 tons), and Myanmar (22,593.5 tons). The ecotoxicity impacts of PPE-derived MPs on human health and other environmental compartments are critically addressed. The review's findings infer a gap in the 5R (Reduce, Reuse, Recycle, Redesign, and Restructure) Strategy's implementation in the BoB coastal regions, hindering the achievement of UN SDG-12. Despite widespread research advancements in the BoB, many questions about PPE-derived MPs pollution from the perspective of the COVID-19 era still need to be answered. In response to the post-COVID-19 environmental remediation concerns, this study highlights the present research gaps and suggests new research directions considering the current MPs' research advancements on COVID-related PPE waste. Finally, the review suggests a framework for proper intervention strategies for reducing and monitoring PPE-derived MPs pollution in the BoB countries.

Analysis of the Factors Influencing the Stability of Stored Grains: Implications for Agricultural Sustainability and Food Security

The recent unprecedented situations like the COVID-19 pandemic and the Russia-Ukraine war have severely impacted food security and grain production in emerging economies. These countries can try to import grains to enhance secure food security, but this will strain their dollar reserve and endanger their financial stability. Under such circumstances, the adoption of sustainable grain storage practices is essential to reducing the unusual gap between grain production and grain availability. This research, therefore, explores the key factors that may affect the stability of stored grains to promote agricultural sustainability and food security in emerging economies. First, the study identifies the significant factors that influence the stability of stored grains from an emerging economy perspective. Then, the study employs an integrated approach consisting of Pareto analysis, fuzzy-based Total Interpretive Structural Modeling (TISM), and Cross-Impact Matrix Multiplication Applied to Classification (MICMAC) analysis. Based on the literature review and expert feedback, nineteen factors were initially identified. After employing Pareto analysis, the top thirteen factors have been further analyzed using fuzzy TISM- fuzzy MICMAC to examine their interrelationships. The study findings indicate that "Proper training on advanced storage operations” is the most significant factor influencing sustainable grain storage operations. The study insights can help practitioners to focus more on the crucial aspects of the grain storage operation and can assist the policymakers and industry leaders of emerging economies in strategic decision-making to achieve agricultural sustainability and thus improve food security.

Acute Kidney Injury after Covid 19 Infection in Chronic Kidney Disease Patients of Bangladesh: Retrospective Study

Introduction: COVID 19 pandemic has caused unprecedented devastation worldwide. Spectrum of Covid 19 illness is wide and variable. Risk of mortality is increased in chronic kidney disease patients, during coronavirus disease. CKD is an independent risk factor for poor outcome. AKI is also common in COVID-19 patients who are hospitalized. This study was undertaken to see the outcome of Covid-19 infection in CKD patients. Method(s): This retrospective observational study was carried out in the Kidney Foundation Hospital and Research Institute, Bangladesh from January 2021 to July 2022. One hundred CKD patients who were on regular follow up in the outpatient department and developed COVID-19 as confirmed by reverse transcription polymerase chain reaction (RT-PCR) test underwent chart review after they consented to be part of the study. Their clinical parameters, treatment regiments and laboratory investigations were noted in a data collection sheet. Data was analyzed by Statistical Analysis Software. Result(s): The mean age of the patients was 55.2 years. Of them 43% were female. Diabetes mellitus was the most common comorbidity, seen in 65% of the patients. 24% were CKD stage 4 or 5 prior to the onset of COVID-19, rest were of earlier stage. Hospitalization was required in 65.3% patients;41.1% required oxygen, steroid given in 19.8% patients,8.4% required ICU transfer. 7 patients died, all of respiratory failure. Treatment with antiviral, biologics like Tocilizumab and plasma exchange was not commonly done. AKI developed in 28% of the patients during the course of the illness. Males were more prone to develop AKI (p = 0.23). People with longer duration of symptoms had higher incidence of AKI (p < 0.0001). AKI incidence did not vary according to baseline eGFR (p = 0.16). Among those who developed AKI, 17.9% required temporary dialysis and 7.1% went on to develop end stage kidney disease. Interim outcomes such as hospitalization, oxygen requirement, ICU transfer and death did not vary according to development of AKI. Conclusion(s): People with chronic kidney disease and other comorbid conditions are at higher risk for more serious COVID-19 illness. In our study it has been shown that a significant proportion of CKD patients developed AKI after COVID 19 infection of which a number of patients develop end stage kidney disease and required renal replacement therapy. No conflict of interestCopyright © 2023

Proximal Tubular Dysfunction as a Predictor of Aki in Hospitalized Covid-19 Patients

Introduction: Severe acute respiratory syndrome coronavirus 2 associated pneumonia (COVID-19) is a modern pandemic. Recent evidence suggests that kidney is an important target organ in COVID-19. High concentration of Angiotensin converting enzyme receptors in the proximal tubules make them an early target. Proximal tubular dysfunction (PTD) may act as an early predictor of acute kidney injury (AKI), need for renal replacement therapy (RRT), intensive care unit (ICU) transfer, mechanical ventilation, hospital length of stay (LOS) and death. Method(s): This prospective observational study was conducted in the COVID unit, Bangabandhu Sheikh Mujib Medical University. 87 COVID-19 patients without preexisting kidney disease were screened for markers of PTD on admission. Patients having at least 2 of the 4 defining markers of PTD (inappropriate uricosuria, renal phosphate leak, normoglycemic glycosuria and proteinuria) positive on admission were considered to have PTD. 35 patients with PTD and 35 without PTD were followed up throughout their hospital stay and compared. Result(s): 52.9% of the patients had at least 2 of the 4 defining markers of PTD positive on admission. The most prevalent markers were proteinuria (66.7%), followed by hyperuricosuria (42.5%), renal phosphate leak (28.7%) and normoglycemic glycosuria (20.7%). Also, 67% patients had renal sodium leak and 32.2% patients had renal potassium leak. Mean age was 55.7 years. 50% of the patients were diabetic. The PTD group had significantly lower oxygen saturation and higher parenchymal involvement on HRCT chest, CRP and LDH compared to the non PTD group on admission. 32.9% patients developed AKI during their hospital stay. PTD group had higher odds of developing AKI (odds ratio 17.5 for stage 1, 24.8 for stage 2 and 25.5 for stage 3;p<0.0001). The mean duration of hospital stay was 9 days higher in the PTD group (p<0.001). PTD group also had higher odds of transferring to ICU (OR=9.4, p=0.002), need for mechanical ventilation (OR=10.1, p=0.002) and death (OR=10.3, p=0.001). There was complete recovery of PTD in 32.6% and complete renal recovery in 47.8% of patients during their hospital stay. 26.1% of the patients who developed AKI required hemodialysis. 11.4% of all patients died. Conclusion(s): Proximal tubular dysfunction is highly prevalent in COVID-19 patients very early in the disease and may act as a predictor of AKI, ICU transfer, need for mechanical ventilation and death. No conflict of interestCopyright © 2023

Industry 5.0 challenges for post-pandemic supply chain sustainability in an emerging economy

To ensure business continuity in the post-COVID-19 era, decision-makers should reconfigure their traditional supply chain (SC) networks, assisted by the development and implementation of cutting-edge technologies. Recently, Industry 5.0 (I5.0) has gained increasing attention as a paradigm offering salient features for the creation of resilient and inclusive operations by ensuring long-standing SC sustainability. However, there has been insufficient analysis of the challenges of implementing I5.0 in SCs. Therefore, this study aims to understand the challenges of implementing I5.0 when managing the impact of SC disruptions due to the COVID-19 pandemic in an emerging economy. Both qualitative and quantitative methods were used for this research. First, the challenges to I5.0 implementation were identified through a literature review and experts' feedback. Those challenges were examined and prioritised using the Best-Worst Method (BWM). Second, the contextual relationships amongst these challenges were analysed using interpretive structural modelling (ISM) with cross-impact matrix multiplication applied to classification (MICMAC) analysis. Findings showed that to adopt I5.0 initiatives successfully in order to manage the post-COVID-19 impact on SC sustainability, the active involvement of senior managers is required in the execution process. Findings also showed that financial support and funding (e.g., tax reduction, short loans, etc.) from investors and the government play a pivotal role in enabling sustainability in SCs. Finally, the challenges were classified using MICMAC analysis to provide valuable insights for managing future disruptions. This study is expected to help managers and decision-makers successfully overcome the challenges of implementing I5.0 in SCs and thus improve SC sustainability.

Fungal osteomylitus in diabetic patients and COVID-19

Background: COVID-19 pandemic has become a big medical problem worldwide. In this era, COVID-19 along with diabetes mellitus are at an increased risk of developing opportunistic infections. This study demonstrate association of COVID-19 infection in patients having uncontrolled diabetes with the fungal osteomyelitis. Subjects and methods: This prospective cross-sectional study was done at a Nishter Institute of Dentistry, Multan. Patients diagnosed with fungal osteomyelitis of jaw bones presented during April to December 2021 were included in this study. Data was collected from the patients regarding history of the disease, clinical diagnosis, imaging findings by plain radiographs and CT scans, histopathology. Association of disease process with diabetes and COVID-19 was analyzed in SPSS. Results: Between the period April 2021 to December 2021, 23 cases presented in Nishter Institute of Dentistry Multan with fungal osteomylitus were diagnosed clinically and fungal organism was identified by immunohistochemical studies by PAS and GMA stains. 22/23 (95.6%) patients were with uncontrolled diabetes mellitus and 18/23(78.2%) gave the history of Covid 19 infection 2 to 3 months before with moderate to severe symptoms.11/23 (47.8%) gave the history of treatment with systemic steroid. Age range was 38-72 years of age with mean age 53.26. 12/23(52.1%) were males and 11/23 (47.8%) were females. 17/23 (73.9%) patients presented with pain in jaws with exposed bone and 6/23(23%) complained of pain and loose teeth in arch. In 22/23 (95.6%) involved jaw was maxilla. In one patient associated medical condition was hepatitis C virus infection also with diabetes. 2 patients were cardiac and 3 were hypertensive along with diabetes. One patient was previously treated with radiotherapy of mandible due to alveolar cancer. Only one (0.04%) patient was non diabetic. She was on chemotherapy for renal cancer. Conclusion: There is increased incidence of fungal osteomyelitis of jaws mostly maxilla in diabetic and COVID-19 infected patients. © 2022 Authors.

Assessing the challenges to medical waste management during the COVID-19 pandemic: Implications for the environmental sustainability in the emerging economies.

Emerging economies are struggling with proper and efficient management of waste due to their constrained resources and weak management. In recent days, this crisis has worsened due to the outbreak of the highly contagious COVID-19 pandemic. To avoid building up stockpiles and contaminating communities with potentially contagious medical waste (MW), and to ensure sustainability in the current and post-COVID-19 era, it is a dire need to develop and implement a safe and efficient medical waste management (MWM) system. This research, thereby, aims to identify, assess, and prioritize the key challenges to efficient and sustainable MWM to mitigate the impacts of the disruptions caused by situations like the pandemic in emerging economies. An integrated approach consisting of the Best-Worst Method (BWM), Interpretive Structural Modeling (ISM), and Cross-Impact Matrix Multiplication Applied to Classification (MICMAC) has been proposed to achieve the objectives. Based on the literature review and expert feedback, a total of seventeen challenges were identified and later prioritized by using BWM. The top twelve challenges have been further analyzed using ISM-MICMAC to examine their interrelationships. This study reveals that lack of proper law enforcement and insufficient financial support from investors and the government are two crucial challenges for efficient MWM implementation. The research insights can assist healthcare facility administrators, practitioners, and city managers in identifying the associated challenges and shaping strategic decisions for establishing and managing efficient MWM systems to ensure sustainable development in the post-COVID-19 era.

Production Profiling of a Long Dead Well - A Prime Case Study of Operational and Technical Excellence Using Simultaneous Lifting and Logging Services

Reservoir surveillance and production optimization will remain at the forefront of company strategies in the new post-COVID19 environment. We anticipate that companies will focus more on producing assets and go the route of production enhancement rather than exploration. Accordingly, production logging will remain an important surveillance method in evaluating and strategizing production-optimization schemes pertaining to flow-characterization from reservoir-to-wellbore. This work is culmination of operational and technical excellence that enabled the revival of a loaded-up well through simultaneous lifting-and-logging technique. Conventionally, wireline is the preferred mode of conveyance for production-logging;however, well must be continuously flowing throughout acquisition timeframe. Kicking-off the well using nitrogen-lift and then bringing in wireline-unit for production-logging in Well A-4 was not feasible as previous attempts confirmed well to load-up in few hours post-offloading. Therefore, success of this project was heavily dependent on initial planning stage, which accounted for all available data including production-history, well-events, intervention-details, fluid analysis and well load-up behavior. Next, a multi-domain approach was adopted while bringing-out each domain from its silos and strategize collectively to simultaneously kickoff the well with nitrogen and acquire real-time downhole production-logging data through smart-coiled-tubing (CT). This was first implementation of concurrent lifting and logging operation in Pakistan. By deploying the approach mentioned above through smart CT (using optical-telemetry-link inside the CT-string coupled with downhole-assembly), synchronized lifting-and-logging operation was carried-out successfully. Well was observed to swiftly go back to load-up conditions post-kickoff;however, continuous well dynamics monitoring downhole enabled us to log perforated interval across multiple time domains. Well was activated through CT nitrogen-injection but depicted continuous loading tendency, which was captured downhole in form of flow-transients. Real-time job optimization ensured vigilant monitoring and selection of right-time to acquire meaningful zonal-contribution data for evaluation and diagnostic solutions. Finally, operational excellence was complemented through technical data analysis and interpretation, integrating passes data with transients and stationary measurements. Ultimately, acquired data analyzed using an integrated lens involving fluid velocities, downhole density, temperature, and water hold up data. Consequently, enabling us to decipher gas and water-entries on a zonal-basis across perforated sandstone reservoir. Copyright © 2022, Society of Petroleum Engineers.

A grey decision-making trial and evaluation laboratory approach for evaluating the disruption risk factors in the Emergency Life-Saving Drugs supply chains

Emergency Life-Saving Drugs (ELSDs) are among the highest-priority healthcare necessities since they must be administered immediately to save patient lives and prevent complications in the most critical conditions. Due to this reason, it is vital to ensure a continuous and undisrupted supply chain (SC) network for ELSDs throughout the country. However, the SC network of ELSDs is very complex and unpredictable, requiring many stages and processes and involving many parties. The recent COVID-19 pandemic and the Russia-Ukraine war have increased these SC disruptions even to a greater extent. Due to the associated complexities and uncertainties, the efficient management of ELSDs SC is usually very challenging. Consequently, proper identification and evaluation of ELSDs SC disruption risks are crucial, of which few studies have concentrated yet, especially from an emerging economy perspective. This study aimed to identify and analyze the most impactful risk factors (RFs) that disrupt the ELSDs SC, particularly in a developing country context, to address this research gap. The study identified 14 key RFs to the ELSDs SC from relevant literature and expert feedback. Then, a combination of the Grey theory and the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method was utilized in this study to assess and prioritize the RFs and show the interrelationships among them. The findings suggested that financial and economic risk, non-availability of critical raw material, an influx of infectious disease, and sudden natural disasters pose the greatest threats to the ELSDs SC. A sensitivity analysis was also conducted afterward to evaluate the robustness of the proposed framework. This research is expected to aid the managers of ELSDs SC in maintaining a continuous and undisrupted availability of these essential medicines to save the lives of millions of patients under critical care.

Hybrid model of dermatology residency training in COVID-19 pandemic

Objective To plan and execute a teaching and assessment strategy to engage the residents in academics to minimize the potential loss in their training during COVID-19 pandemic. Methods At the start of COVID-19 pandemic in the country (from 4th week of March 2020), we started online academic activities for our 28 post graduate residents, by incorporating smart phone applications ("WhatsApp" and "Zoom") and during following one and half year, our teaching strategy evolved through following four stages. (i) Pure Online Learning, (ii) Online plus Physical Learning, (iii) Predominantly Physical Learning, (iv) Reengagement in a "new normal" environment.. Results All components of residency curriculum (theoretical knowledge, professional competencies, skills enhancement) were achieved through frequent MCQs tests, clinical slide sessions, patient-based real time teaching, case presentations, Mock viva and TOACS exams and hands on workshops. Conclusion Hybrid model using smart phones with WhatsApp and Zoom applications is a feasible, cost-effective, and appropriate alternate to traditional medical education during COVID-19 pandemic.

An Alternate Approach in the Management of COVID-19 in Unvaccinated / Vaccine Allergic Population-A Case Study

The COVID-19 vaccines offer protection against the severe acute respiratory syndrome Corona virus 2 (SARS-CoV-2) by developing an immune response to the same. Further, there are mass vaccination programs being conducted across the globe. India administered COVID - 19 vaccines for more than 90 crores of people as on October 2021. However, there are still a bunch of people yet to receive vaccination. Adding to this, very few are found to be allergic to COVID - 19 vaccines. Hence there is a need for an alternative approach till the whole population of the world gets vaccinated. One such approach is prescribing Nilavembu kudineer and Kabha sura kudineer, a polyherbal Siddha medicine formulation of Traditional Indian system of Medicine. This case study highlights the positive effects and importance of the above mentioned polyherbal formulations in the management of mild to moderate COVID-19 patients. Hence, the same can be advised to the individuals who are yet to receive COVID-19 vaccine and persons who are allergic to COVID-19 vaccines.

An extremely unusual case of covid-19 presenting with multiple extrapulmonary manifestations

Corona virus disease 2019 (COVID-19) pandemic has adversely affected the whole world. Health care professionals are continuously trying to understand and cope up with this rapidly mutating virus having variable manifestations and unpredictable outcomes. We report an unusual case of a young male who was admitted in dermatology ward with mucocutaneous rash but during hospitalization developed acute abdomen and acute chest pain. Evaluation of acute abdomen and chest pain did not reveal any underlying cause and meanwhile he turned out to be COVID-19 positive. He was managed accordingly and all his symptoms got settled on recovery from COVID-19 illness.

Association of elevated D-dimers with severity and outcome of COVID-19 infection in children

Background : COVID-19 caused by novel coronavirus (SARS-CoV-2) resulted in global pandemic. In Pakistan, the first case was reported on 26th February 2020. Out of total confirmed cases, children and adolescents ≤20 years of age represented 10.6%. Hypercoagulability has been reported in COVID-19 infection. Multiple adult studies have highlighted relation of elevated D-dimers with disease severity. Aims : To determine association of D-dimers with the disease severity and outcome of children with COVID-19 and MIS-C/KD presenting to The Children's hospital, Lahore, Pakistan. Methods : This cross-sectional study was done at The Children's Hospital, Lahore, from March 15 to December 31, 2020. We analyzed data of all laboratory-confirmed pediatric cases of severe acute respiratory syndrome coronavirus infection and post-COVID MIS-C/KD admitted to the Corona ward. Results : Of 110 children, 73.6% were COVID and 26.4% post-COVID MIS-C/KD. 63.6% had mild-moderate illness followed by severe disease 21.8%. In 41% there was a pre-existing comorbidity, the most common of which was congenital heart and chronic kidney disease. The mean age was 7.03 ± 4.42 years with a male preponderance 58.2%. Fever (74.5%), respiratory (46.4%), and gastrointestinal symptoms (14.5%) were the predominant symptoms. Ddimers were done in 67 patients with the mean of 3.68 ± 2.08 μg/ml and a higher D-dimer value was significantly associated with severe and critical disease ( P = 0.001). D-dimer levels were high in MIS-C (4.61 ± 4.0 μg/ml) as compared to COVID (3.05 ± 4.6) ( P = 0.030). There were six deaths, comorbid conditions were associated with a fatal outcome in five cases and one death was due to MIS-C. A high D-dimer value was significantly associated with poor outcome ( P = 0.009). Conclusions : COVID-19 in children is generally mild with good outcome. A significant proportion of children presented with post-COVID MIS-C/KD. A high D-dimer value is significantly associated with severe disease and poor outcome. The presence of a co-morbid condition was a risk factor for poor outcome.

Association of blood groups with severity and outcome of covid-19 infection in children

Objective: To find out the association of ABO blood groups with severity and outcome of Corona Virus Disease 2019 (COVID-19) infection in children presenting to a single tertiary care hospital. Study Design: Descriptive cross-sectional study. Place and Duration of Study: The study was conducted inThe Children's Hospital & ICH Lahore from March 2020 to September, 2020. Material and Methods: This study included all the laboratory-confirmed cases of COVID-19 and post-COVID (MIS-C)/Kawasaki like illness admitted to Corona Isolation ward. The blood groups were recorded and the disease course was followed. Results: Of a total of 74 admitted children, 66 children in which blood group was available were included. Of these, 45 (68%) were COVID-19 and 21(32%) MIS-C/ Kawasaki like illness temporally associated with SARS-C0V2. The mean age was 7.9 ± 4.1 years with a male preponderance 38/66 (57%). Majority 62 (94%) had Rh-positive blood, O blood group was the predominant group 25 (38%) followed by B in 23 (35%) and A in 17 (26%). Majority of children had mild to moderate illness 38 (58%), while 23 (35%) had severe or critical disease. Among all patients 24(36%) had some underlying comorbidity. Blood group A was significantly associated with severe and critical disease (p=0.030). Our case fatality rate was 7.6% and underlying comorbid conditions were significantly associated with a fatal outcome (p=0.035). Conclusion: COVID-19 in children has generally a good outcome but children with blood group A are more susceptible to severe/critical disease. The presence of an underlying comorbid conditions is also a risk factor for poor outcome. .

Is leukopenia and lymphopenia a characteristic feature of covid-19 in children?

Objective: To describe the blood picture of children with COVID-19. Study Design: Descriptive cross-sectional study. Place and Duration of Study: The study was conducted in The Children's Hospital & ICH, Lahore from March 2020 to October 2020. Material and Methods: All confirmed cases of COVID-19 infection and post-COVID (MIS-C)/Kawasaki Disease (KD) like illness diagnosed on the basis of RT-PCR from nasopharyngeal swab and Antibody test admitted were included. Complete blood (CBC) and differential counts was performed on the day of admission. Results: Out of a total of 83 patients 60 (72%) were diagnosed as COVID-19 and 23 (28%) as post COVID MIS-C/ KD. The mean age of children was 7.0 ± 4.3 years (95% CI: 6.07 -8.75) with a male preponderance 51 (61%). Twenty (24%) children had some underlying comorbidity and 7 (8%) were surgical cases. Our case fatality rate was 5 (6%) and all children who died had some underlying comorbid condition. In both group (COVID and MIS-C/KD) the mean leucocyte count was (14.0 ± 12.5 vs 13.6 ± 6.9) respectively (p=0.888). The mean lymphocyte count in children with COVID was 39.1 ± 21.4.Patients with MIS-C/KD showed significantly higher levels of neutrophil count (76.5 ± 15.0) as compared to children with COVID (52.0 ± 22.1) (p=<0.001). In 60 COVID-19 patients the mean NLR in mild-moderate and severe-critical group was 2.00 and 5.08 respectively (p=0.009). Conclusion: The blood picture of COVID-19 in children does not show leucopenia. NLR was a prognostic factor to assess the severity in COVID-19 patients. The presence of an underlying comorbid conditions is a significant risk factor for poor outcome.

Multisystem inflammatory syndrome associated with covid-19 in children: The spectrum of clinical presentation, myocardial involvement and treatment outcome

Objective: To determine the spectrum of clinical presentation, multisystem involvement and treatment outcome in children with MIS-C. Study Design: A descriptive cohort study Place and Duration of Study: Conducted at The Children's Hospital and Institute of Child Health, Lahore from May 15, 2020 to November 22, 2020. Material and Methods: Children (aged 0-16 years) with features of this new inflammatory syndrome who fulfilled the WHO criteria for MIS-C and required admission to hospital were prospectively identified. Demographic and clinical data were collected from patient records and entered on a predesigned proforma and results were analyzed on SPSS 20. Results: A total of 24 patients were enrolled in the study. Majority were males (17/24, 70%). Mean age of presentation was 7.3 years. Six patients (25%) had a positive PCR for SARS CoV-2 but none of the patients had been symptomatic with classic COVID-19 respiratory symptoms in the 6 weeks prior to admission. Comorbid conditions were present in only 2 patients (8%). SARS-CoV-2 antibodies were positive for 23/24 patients (96%). Despite being clinically unwell, with laboratory evidence of elevated C-reactive protein, ferritin, and D-dimers, no pathological organism was isolated in any of the 24 children. There were two major presentations: one as atypical or typical Kawasaki disease (18 of 24, 75%) and a more severe second one with shock or low cardiac output (6 of 24, 25%). Common presenting features were fever, body aches, and abdominal pain. Four out of 24 (16%) patients had sufficient criteria for typical Kawasaki disease, whereas 18 children (75%) presented more sub acutely with presentation resembling Kawasaki disease;all had at least two features of classic Kawasaki. Myocardial dysfunction seen in 3 patients (12%) and pericardial effusion was observed in 5 patients (20%). Coronary artery dilatation was seen in 12 (50%) patients. All 6 children with shock-like presentation had coronary artery involvement. Twenty children (83%) received intravenous immunoglobulin within the first 2 days of their stay. Thirteen (54%) patients received therapeutic anticoagulation (enoxaparin) on the basis of the high risk of thromboembolism and number of D-dimers. There was one death (4%). Conclusion: The SARS-COV 19 pandemic led to the identification of a new and potentially life-threating childhood disease, referred to as MIS-C. Prompt diagnosis and early treatment with IVIGs has shown a good early outcome. .

Comorbidity and covid-19 in children-a single center experience

Objectives: To describe the epidemiological characteristics, clinical presentation, severity of the disease, and early outcomes of children with COVID-19 in Pakistan with special reference to underlying comorbid conditions. Study Design: Descriptive cross-sectional study. Place and Duration of Study: The Children’s Hospital and The Institute of Child Health, Lahore, from March 15 to July 31, 2020. Material and Methods: We analyzed data on all laboratory-confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARC-COV-2) infection in children admitted to a single tertiary care center including patient characteristics, clinical course and hospital outcomes with special reference to underlying comorbidity. Results: Of 42 symptomatic children, 19 (45%) had a pre-existing comorbidity, the most common of which was chronic kidney disease (7/19-37%). The median age was 7.75 years (IQR: 1.3–11.2) with a slight female preponderance (55%). Fever (79%), respiratory symptoms (52%), and gastrointestinal symptoms (14%) were the most common symptoms. No direct or indirect contact with COVID-19 positive person was identified in 12 patients (29%). Patients with pre-existing comorbidity required mechanical ventilation and prolonged intensive care monitoring than those without. There were three fatalities in the groups of 42 (7%) patients, and underlying comorbid conditions were significantly associated with a fatal outcome (p=0.032). Conclusion: COVID-19 in children is generally mild with good outcome. Chronic kidney disease was the commonest co-morbidity and the presence of an underlying co-morbid condition is a risk factor for prolonged hospital stay and a poor outcome. © 2020, Pakistan Pediatric Journal. All rights reserved.

Current Scenario and Future Direction of Newborn Screening and Management Program for Phenylketonuria in Bangladesh

Phenylketonuria (PKU) is a correctable inborn error of metabolism which causes lethal intellectual delay and neurobehavioral anomalies. A screening package, especially for early recognition can support to regulate the PKU process of most patients. Newborn screening program in any country focuses at the earliest detection of inheritance deficiency disorders in order to avoid the most severe repercussion by appropriate medication. This screening program needs a concomitant diagnosis and involves additional clinical research. Strategies from developed countries recommend that new-born screening should be done as soon as possible after birth before hospital/clinic discharge because if detected later, it conveys to significantly increase in disability as well as morbidity. Although exact protocol differs among different countries, testing procedures for PKU should be followed universally recognized in the developed world. Unfortunately, new-born screening program in Bangladesh is in lying-in room or possibly in pilot study in particular hospital, because the health-care system is classically targeted mortality (like childbirth complications) and transmittable morbidities (such as COVID-19) but not inborn frailties. Although policies and management of childbirth complications have been successfully lowered infant and mother mortality rates, the number of disabled babies increased tremendously. The study aims to investigate the current status of new-born screening (NBS) program of PKU in the Rajshahi Division Bangladesh, and focus on future plans to manage with life-long treatment. The primary challenges such as financial support for newborn screening, publicity, should be identified and implemented for national PKU-NBS policy as a role model of Bangladesh for developing countries.