Effect of Anticoagulant Administration in patients Hospitalized with COVID-19 - A study from Lahore, Pakistan

Background: The recognition of the relationship between thromboembolism in COVID-19 and poor clinical outcomes led to the use of anticoagulants in patients diagnosed with COVID-19. Aim(s): To determine the effects of anticoagulants in COVID-19 patients and to compare the effect of oral, subcutaneous, and combined anticoagulants on patient outcomes. Study design: Retrospective cohort study Place and duration: A private tertiary care hospital, in Lahore, from 1st April 2020 to 30 Sep 2020 Methodology: Data were collected from electronic and paper records of admitted patients with a confirmed diagnosis of COVID-19 on PCR or with a radiological diagnosis of COVID-19. A total of 179 patients were included in the study, 172 were given anticoagulation, out of these, 74 were given oral anticoagulation, 73 were given subcutaneous and 24 were given combination of oral and subcutaneous anticoagulants. Result(s): Among 172 patients on anticoagulants, 41(23.8%) expired while 131(76.2%) recovered. Among 7(100%) patients on no anticoagulation, 1(14.3%) patient expired while 6(85.7%) recovered. 19(11%) patients on anticoagulation progressed towards the need for invasive ventilation while 152(89%) patients did not need invasive ventilation. Among patients on subcutaneous anticoagulants, 27(37%) expired while 46(63%) recovered. 8(33.3%) patients on combined anticoagulants expired while 16(66.7%) recovered. 6(8.1%) patients on oral anticoagulants expired while 68(91.9%) recovered. Conclusion(s): Anticoagulation improves the outcome of COVID-19 patients and oral anticoagulation is better than subcutaneous and combined anticoagulation.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

The Experience of Testing for Coronavirus Disease (COVID-19) at a Single Diagnostic Center in Paraguay before the Introduction of Vaccination.

Soon after the declaration of the COVID-19 pandemic, the Institute for Health Sciences Research (IICS) of the National University of Asunción, Paraguay became a testing laboratory (COVID-Lab) for SARS-CoV-2. The COVID-Lab testing performance was assessed from 1 April 2020 to 12 May 2021. The effect of the pandemic on the IICS and how the COVID-Lab contributed to the academic and research activities of the institute were also assessed. IICS researchers and staff adjusted their work schedules to support the COVID-Lab. Of the 13,082 nasopharyngeal/oropharyngeal swabs processed, 2704 (20.7%) tested positive for SARS-CoV-2 by RT-PCR. Of the individuals testing positive, 55.4% were female and 48.3% were aged 21-40 years. Challenges faced by the COVID-Lab were unstable reagent access and insufficient staff; shifting obligations regarding research, academic instruction, and grantsmanship; and the continuous demands from the public for information on COVID-19. The IICS provided essential testing and reported on the progress of the pandemic. IICS researchers gained better laboratory equipment and expertise in molecular SARS-CoV-2 testing but struggled to manage their conflicting educational and additional research obligations during the pandemic, which affected their productivity. Therefore, policies protecting the time and resources of the faculty and staff engaged in pandemic-related work or research are necessary components of healthcare emergency preparedness.

Methylprednisolone Versus Dexamethasone for Treatment of Severe or Critical Covid-19: A Quasi-Experimental Study (Md Treat)

Intro: Dexamethasone, a corticosteroid, was recently demonstrated to be the only medication capable of reducing mortality in severe COVID disease in the UK's Recovery Trial. There is a need to compare different steroids because it is well recognised that different corticosteroids have varied pharmacodynamic properties. The aim of our study was to compare outcomes in severe or critical COVID-19 when treated with Dexamethasone versus Methyl prednisolone. Method(s): We conducted a retrospective quasi-experimental, non-randomized study to determine whether intravenous or oral dexamethasone reduces mortality compared with intravenous methylprednisolone in patients with severe or critical COVID-19.The study was conducted on all patients aged 18 and over admitted at a 700-bedded academic medical center.The primary outcome was the mortality. The secondary outcome included length of stay. Finding(s): A total of 706 hospitalized patients with moderate to severe COVID- 19 were included in the study. There were n=217 patients in Dexamethasone group, n= 393 patients in Methylprednisolone group and n=96 patients who did not receive steroids.Among the baseline characteristics between the groups, there was no significant difference in median age (55 years in dexamethsone group vs 57 years in methyl prednisolone group p=0.09). There was male predominance in methylprednisolone group (74% versus 54% p<0.001) and a greater proportion of patients who required invasive mechanical ventilation (13.7% versus 3.2% p<0.001). Mortality was found to be significantly higher in methylprednisolone group compared to dexamethasone group on univariate logistic regression analysis (13.7% versus 3.2% p<0.001) and longer length of stay (7 days versus 4 days p<0.001). In multivariable model, dexamethsone was found to be associated with lower risk of mortality (aOR: 0.24;95% CI: (0.09- 0.62)(p=0.003) and lesser length of stay (aOR: 0.87;95% CI: (0.82-0.92) (p<0.001). Conclusion(s): Dexamethasone was associated with lower mortality and lesser length of stay when compared to Methyl prednisolone in moderate to critical COVID-19.Copyright © 2023

Silent Thyroiditis as a Complication of Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine

Introduction: Silent autoimmune thyroiditis, a type of chronic autoimmune thyroiditis, as an adverse effect of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination is infrequently reported in the literature. We hereby describe a case of silent thyroiditis followed by Grave's orbitopathy after vaccination against SARS-CoV2. Case Description: An 84-year-old male presented to clinic with a 10-pound weight loss with no other symptoms of hyperthyroidism, no personal history of thyroid illnesses, or recent viral infections. He had normal thyroid function 3 months prior to presentation. He had received 3 doses of SARS-CoV2 Pfizer-BioNTech vaccine with the last dose 5 months prior to presentation. Thyroid exam was normal. Laboratory testing revealed thyroid stimulating hormone (TSH) level of 0.005 IU/ml (0.45-4.5 IU/ml), total T4 14.4 g/dl (4.5-12.1 g/dl), and total T3 1.22 nmol/l (0.6-1.81 nmol/l). Thyroid Ultrasound revealed a heterogeneous atrophic thyroid gland with no nodules or hypervascularity. He was started on Methimazole by primary care provider. Four months later, he was seen in the Endocrinology clinic and reported no hyperthyroidism symptoms. His TSH level at that time was 65.9 IU/ml, free T4 0.47 ng/dl (normal: 0.82-1.77 ng/dl), total T3 level 75 ng/dl (normal: 71-180 ng/dl), thyroid stimulating immunoglobulin 2.05 IU/l (0-0.55 IU/L), thyrotropin receptor antibody level 2.8 (0-1.75). Methimazole was discontinued. At 6 months after initial presentation laboratory testing showed TSH 5.010 IU/ml, free T4 1.2 ng/dl, thyroid peroxidase antibody of 148 IU/ml (normal 0-34 IU/ml), thyroglobulin antibody 131.6 IU/ml (normal 0.0-0.9 IU/ml). He was diagnosed with silent autoimmune thyroiditis. A few weeks later, the patient presented to an ophthalmologist with bilateral eye bulging and impaired vision. He was diagnosed with acute Graves' orbitopathy and started on pulse-dose of intravenous Methylprednisolone 250 mg twice daily and urgently referred to a tertiary ophthalmology center for teprotumumab infusion. His thyroid function tests were normal at that time on no thyroid medications. Discussion(s): The underlying mechanisms of thyroid impairment following SARS-CoV2 vaccination are not completely understood. There is a role of molecular mimicry between SARS-CoV2 antigens and thyroid antigens that may help to hasten the emergence of autoimmunity in vulnerable individuals. Our patient developed multiple thyroid-related antibodies following vaccination. Silent painless thyroiditis is a self-limiting condition, characterized by temporary thyrotoxicosis, followed by a brief period of hypothyroidism and then a complete return to normal thyroid function. A radioactive iodine uptake scan can help differentiate between the different causes of thyrotoxicosis in the acute thyrotoxic phase. Development of severe Graves orbitopathy following silent autoimmune thyroiditis after SARS COV2 vaccination has not been previously reported.Copyright © 2023

New Onset of Type 1 Diabetes After Severe Acute Respiratory Syndrome Coronavirus 2 Vaccination

Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) poses the greatest threat of our times. SARS-CoV-2 vaccines are one of the most effective strategies against this infection. Diabetic ketoacidosis, hyperglycemic hyperosmolar syndrome, and new-onset diabetes as adverse effects of SARS-CoV-2 vaccination have been infrequently described in the literature. We hereby report a rare case of new-onset type 1 diabetes after SARS-CoV-2 vaccination. Case Description: An 18-year-old male presented to the outpatient office for evaluation of breast pain. On routine laboratory tests, he was noted to have fasting blood glucose of 200 mg/dL. On further questioning, he reported some polyuria, nocturia, and a 10-pound weight loss over the preceding month. He received the initial dose of Pfizer-BioNTech SARS-CoV-2 vaccine in May 2022 and the second dose in June 2022, approximately one month before the onset of symptoms. He denied any earlier viral infections and had no personal or family history of autoimmune conditions. On evaluation, his body mass index was 20 kg/m2, but otherwise, he had a normal physical exam, including a breast exam. Over the next few days, his blood glucose progressively increased to over 300 mg/dl. HbA1c was noted to be elevated at 8.6%, glutamic acid decarboxylase-65 (GAD-65) antibodies were remarkably high >250 IU/ml (normal 5 IU/ml), C-peptide was 1.51 ng/ml (normal 0.80 - 3.85 ng/ml), blood glucose 156 mg/dl, islet-cell antibody titer was 320 (< 1.25 JDF units) and insulin autoantibodies were negative. He was diagnosed with autoimmune Type 1 diabetes and a basal-bolus insulin regimen was initiated to improve glycemic control. On a one-month follow-up, his insulin requirements remained low but persistent and his glycemic control was acceptable. Discussion(s): Various viruses are known to play a fundamental role in the onset of type 1 diabetes via a variety of effects on pancreatic beta-cells because of either the direct lytic effects of viral replication or the inflammatory response to the virus, which is mediated by autoreactive T cells. The limited release of islet cell antigens induces molecular mimicry and paves the way for long-term autoimmunity and the development of type 1 diabetes mellitus. Our patient did not report any viral illnesses before the onset of his symptoms. He also did not have a family or personal history of autoimmune diseases. His onset of diabetic symptoms coincided temporally with receiving the SARS-CoV-2 vaccine. The detection of a considerable titer of GAD-65 antibodies proved autoimmunity. Clinicians must stay vigilant about this potential side effect of SARS-CoV2 vaccine so that a timely diagnosis can be made.Copyright © 2023

'We delivered at home out of fear': Maternity Care in Rural Nigeria During the COVID-19 Pandemic.

Background and Objective: The COVID-19 pandemic response overwhelmed health systems, disrupting other services, including maternal health services. The disruptive effects on the utilization of maternal health services in low-resource settings, including Nigeria have not been well documented. We assessed maternal health service utilization, predictors, and childbirth experiences amidst COVID-19 restrictions in a rural community of Kumbotso, Kano State, in northern Nigeria. Methods: Using an explanatory mixed methods design, 389 mothers were surveyed in January 2022 using validated interviewer-administered questionnaires, followed by in-depth interviews with a sub-sample (n=20). Data were analyzed using logistic regression models and the framework approach. Results: Less than one-half (n=165, 42.4%) of women utilized maternal health services during the period of COVID-19 restrictions compared with nearly two-thirds (n=237, 65.8%) prior to the period (p<0.05). Non-utilization was mainly due to fear of contracting COVID-19 (n=122, 54.5%), clinic overcrowding (n=43, 19.2%), transportation challenges (n=34, 15.2%), and harassment by security personnel (n=24, 10.7%). The utilization of maternal health services was associated with participant's post-secondary education (aOR=2.06, 95% CI:1.14- 11.40) (p=0.02), and employment type (civil service, aOR=4.60, 95% CI: 1.17-19.74) (p<0.001), business aOR=1.94, 95% CI:1.19- 4.12) (p=0.032) and trading aOR=1.62, 95% CI:1.19-2.94) (p=0.04)). Women with higher household monthly income (≥ N30,000, equivalent to 60 US Dollars) (aOR=1.53, 95% CI:1.13-2.65) (p=0.037), who adhered to COVID-19 preventive measures and utilized maternal health services before the COVID-19 pandemic were more likely to utilize those services during the COVID-19 restrictions. In contrast, mothers of higher parity (≥5 births) were less likely to use maternal health services during the lockdown (aOR=0.30, 95% CI:0.10-0.86) (p=0.03). Utilization of maternal services was also associated with partner education and employment type. Conclusion and Global Health Implications: The utilization of maternal health services declined during the COVID-19 restrictions. Utilization was hindered by fear of contracting COVID-19, transport challenges, and harassment by security personnel. Maternal and partner characteristics, adherence to COVID-19 preventive measures, and pre-COVID maternity service utilization influenced attendance. There is a need to build resilient health systems and contingent alternative service delivery models for future pandemics.

Importance of food quality analysis in relation to food safety and human health and COVID-19 in particular

Food quality analysts, scientists, and technologists have significantly focused on compositional analysis of food products to provide authenticated nutritional facts around the world. Nowadays, individuals have become greatly concerned about their eating habits and want healthy food in their homes with proper composition and nutrition labels. Overall, consumers, the food industry, and government have become more concerned about food quality and safety. Therefore, to analyze individual ingredients, composition analysis of specific products has become significant for critical product characterization. This chapter presents information regarding the rules and regulation of food quality analysis and importance of compositional analysis and techniques utilized for food products. It discusses different types of samples analyzed and the protocol for selecting food quality analysis methods. Food compositional analysis has become essential because it is the right of consumers to know about health facts about their purchasable products. Therefore, analysis of compositional parameters of food like moisture, fat, protein, carbohydrate, vitamin, and mineral analysis protocols are discussed herein with suitable techniques. Moreover, the analysis of chemical properties, for example, pH, enzyme, and contaminant analysis, is also done to monitor the quality of food products. If the quality analysis method goes wrong, then consumption of food ingredients above tolerance level by consumers may cause several health issues. This chapter also focuses on analytical techniques used to detect SARS-CoV-2 on the food surface and packaging material. According to the research, this virus is more active in cold places, as they enhance the virus survival time as compared to room temperature. © 2023 Elsevier Inc. All rights reserved.

AKI and Its Relation with Outcome in Patients with COVID-19

Background: Coronavirus disease 2019 (COVID-19) is currently spreading fast around the world. The rate of acute kidney damage (AKI) in patients hospitalized with Covid-19, as well as the outcomes related with it, are unknown. The goal of this study was to see if having acute kidney damage (AKI) increased the risk of severe infection and death in COVID-19 patients. It also described the symptoms, risk factors, and outcomes of AKI in Covid-19 patients. Material(s) and Method(s): We undertook a retrospective cohort from June 2020 and March 2021 to examine the connection between AKI and patient outcomes COVID-19. Result(s): The most common comorbid condition was hypertension and diabetes followed by chronic kidney disease and ischemic heart disease. Most of the patients who required low dose oxygen with nasal prongs, face masks, or rebreathing masks were in control groups (76.2% vs. 50.6%;p <.001). More patients in AKI group needed non-invasive ventilation and invasive mechanical ventilation compared to control group (33.8% vs. 19.9%;p .001, 15.6% vs. 3.9%;p <.001 respectively. Patients in the AKI group had higher levels of C-reactive protein, lactate dehydrogenase, D-dimer, and serum. Of 145 patients who developed AKI, 29 (20%) needed hemodialysis. Of 29 patients who needed hemodialysis, 18 (62%) expired. A higher number of patients in the control group were discharged than patients in the AKI group (82.1% vs. 56.9%;p <.001). One hundred five patients were expired, with higher mortality in the AKI group (41.7% vs. 12.4%;p <.001). Conclusion(s): COVID-19 patients admitted to the hospital, AKI is associated with a shockingly high fatality rate.Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

Mental health trainees: Experience of online classes during COVID-19 pandemic

Objective: To determine experiences of mental health trainees with their online classes. Methodology: It was an online cross-sectional study carried out during month of June, 2020. The sample comprised of 231 mental health trainees of BS (n = 114) and MS (n = 117) programs of a private university of Lahore. A google doc. consisting of 15 statements was prepared to for online delivery of their classes. Result(s): 45% students responded on "to some extent to no difficulty" experience of smooth running of online lectures. On the item of overall satisfaction with delivery of online lectures, 50% students (out of 114) from BS program and 51% students (out of 117) from MS program rated on "not at all" Although satisfaction was high on the online availability of teacher for the counselling of students however, on understand lectures Only 14% students showed highest level of satisfaction. Conclusion(s): Online classes remained a big challenge for trainees and it was associated with lack of satisfaction in terms of their own learning, evaluation comprehension and health issues.Copyright © 2023, Pakistan Medical Association. All rights reserved.

Cytopenias in Hospitalized Patients of Covid-19 during First and Other Waves

Introduction: COVID -19 emerged in December 2019 in china and till date this virus has mutated into different strains which are somewhat different in their presentation and severity. Pakistan has faced five waves of COVID-19 till date. This study was aimed to compare Haematological parameters and outcomes of hospitalized patients during First and other waves (second and third) of COVID-19. Method(s): Demographic, Clinical and laboratory data as well as outcome of total 202 COVID-19 PCR positive patients admitted in Fatima memorial Hospital, Lahore, Pakistan was collected during first and other waves. Data of First wave is from May 2020 to July 2020, second wave from early November to Mid December 2020 and third wave from Mid march to June 2021. We compared the data on basis of SII as well hematological parameters of First Wave were compared with other waves (second & third) of COVID-19. Result(s): There were 54(26.7%) patients with SII< 600 and 148(73.2%) patients with SII>600. Neutrophilia (p-< 0.001), leukocytosis (p-< 0.001), lymphocytopenia(p-< 0.001), Raised NLR(p-< 0.001), PLR(p-< 0.001) and MLR(p-< 0.001) had direct association with SII. Raised SII was directly related to increased requirement of ventilator support (p-0.2) and Mortality (p-0.001). There were total 90(44.5%) patients in first wave and 112(55.4%) patients in other waves of COVID-19. More Females (33.3% Vs 57.1%) than Males (66.7% Vs 42.9%) were infected during other waves (p- 0.001). Anemia (27.8% vs 37.5%) (p-0.09), leucopenia (1.1% vs 8.9%) (p-< 0.001), Lymphocytopenia (20% Vs 39.3%) (p-0.003) and thrombocytopenia (3.3% Vs 25%) (p-< 0.001) were more prevalent in other waves of COVID-19 when compared to first wave. Requirement of Ventilator Support (7.7% vs 22%) and mortality (10% vs 33.9%) were also increased in other waves of COVID-19 Conclusion(s): Systemic immune Inflammation Index (SII) is a good predicting tool in COVID -19 patients for prognosis and is directly associated with severity of disease as well as outcome. Patients with cytopenias like anemia, leucopenia, lymphocytopenia thrombocytopenia, requirement of Ventilator Support and mortality were noted to be more in other waves of COVID-19. Haematological parameters like ANC, AMC NLR, PLR, MLR and SII show no significant difference between first and subsequent waves of COVID-19.

Assessment of Clinical and Echocardiographic Findings of Pregnant Women with Dyspnea

Objective: To measure the frequency of dyspnea in pregnant patients and to evaluate the clinical and echocardiographic findings of pregnant women had dyspnea. Study Design: Analytical descriptive cross-sectional. Place and duration of study: Gynae and Obstetric Department of Tertiary Care Facility from Feb 2022 to Apr 2022. Methodology: It was an analytical cross-sectional study conducted during three months. Consecutive pregnant females through non-probability consecutive sampling were included in the study. Patients who had diagnosed history of cardiac disease, respiratory illness, anemic and had covid-19 infection history of 3 months were excluded. The calculated sample size was 323. The pregnant females were assessed for dyspnea (shortness of breath) during pregnancy. Those patients who had dyspnea were referred to cardiac facility for 2D-ECHO (Echocardiography) to determine the cause of dyspnea. Frequency & percentage and Mean±SD were calculated for qualitative and quantitative data respectively. Chi square test was applied to find association between categorical variables. Student t-test was applied for continuous data. Results: A total of 323 pregnant females of age more than 18 years were included in the study. Out of 87(26.9%) pregnant females who had dyspnea during their pregnancy, 2(2.1%) females were from 1st trimester, 26(23.2%) of 2nd trimester and 59(50.8%) of 3rd trimester. ECHO showed that mean left ventricle end-diastolic diameter (LVEDd) was 46±8mm, LVEF 58.8±7%, sPAP 25.40±3.5mmHg and LVESd 29.33±8.8mm. As compared to the normal range sPAP, LVESd were in lower range, while LVEDd value was higher than the normal range (27.2 mm). Study population who had dyspnea and hypertension (HTN) were (n=13)15.4% (p=1.000) and (n=7) 7.7% were had Diabetes (DM) (p=1.000). Cardiac disease was found to be higher in females who had dyspnea i.e., (n=67) 76.9% (p=<0.0001) Conclusion: The left ventricular end-diastolic diameter (LVEDd), left ventricle end-systolic diameter (LVESd), and systolic pulmonary artery pressure (sPAP) of pregnant women with dyspnea were all outside of the normal range. So that the cardiac causes of dyspnea can be clinically identified, we advise ladies with dyspnea to visit a cardiologist and have an echocardiography test. © 2022, Army Medical College. All rights reserved.

Frequency of Dry Eye Diseases among Children During the COVID-19 Pandemic in Pakistan

Objective: To assess the frequency of dry eye among children during the COVID-19 pandemic. Study Design: Cross-sectional study. Place and Duration of Study: Pakistan Naval Ship Hafeez Hospital, Islamabad Pakistan, from Mar to Aug 2021. Methodology: Children aged 7-15 years reporting to the PNS Hafeez Hospital, OPD were included in the study. A proforma was used to record the demographics and screen time of the children. In addition, an ophthalmic examination was conducted to assess the dry eye status of the children using the Schirmer-II test. Results: Seventy-three children participated in the study. Their mean age was 11.08±2.42 years. There were 40(54.8%) boys and 33 (45.2%) girls. These children had a mean daily screen time of 7.23±2.77hours. Children with dry eye had a greater amount of screen time (8.75±2.11hours) as compared to those with normal tear function (6.05±2.66 hours;p<0.001). In addition, the screen time of children with dry eyes was significantly greater than those with normal tear functions (p=0.001). Conclusion: Children with dry eyes were reported to have more screen time and more online classes than their counterparts with normal tear functions. Authorities should consider resuming face-to-face sessions for all school children. © 2022, Army Medical College. All rights reserved.

Etiology of Post-Covid Fungal Infections among Various Age Groups at Teritiary Care Hospital

Background: In patients with comorbid illnesses, COVID 19 disease is a severe acute respiratory syndrome that is linked to a variety of opportunistic bacterial and fungal infections. Finding the cause of fungal infections among post-covid patients in tertiary care hospitals is the aim of the study. Objective(s): To study the etiology of post-covid fungal infections among various age groups Methods: Out of 578 samples (pus/tissue/biopsy) collected from patients attending Koti ENT hospital with complaints of pain in eye, cheek swelling, headache. All samples were subjected to direct KOH mount and inoculated on SDA, incubated for 1 week at 25degreeC. Result(s): Out of 578 samples 214 are KOH positive and 291 are culture positive with fungi isolated - Mucor species, Aspergillus species and Candida species. Conclusion(s): As post covid fungal infections are rapidly progressive and devascularised disease, timely diagnosis helps in effective management and treatment of patients. Copyright © 2023, Institute of Medico-legal Publication. All rights reserved.

Timely PCI Shows Beneficial Long-Term Outcomes in Late Presentation With STEMI: A Systematic Review and Meta-Analysis Between 2012 and 2022

Introduction: Approximately 8-40% of ST-elevation Myocardial Infarction (STEMI) present later than 12 hours after symptom onset. Current ACC/AHA guidelines recommend primary percutaneous coronary intervention (PCI) for STEMI after 12 hours of symptom onset only in the setting of cardiogenic shock or severe acute heart failure, (Class Ia, LOE B) or persistent ischemic symptoms (Class IIa, LOE B). There are limited data comparing long-term outcomes among patients with a late STEMI presentation managed with PCI versus medical therapy (MT). Objective(s): To compare long-term outcomes among patients treated with PCI versus MT who have late presentation of STEMI Methods: We followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to extract data from PubMed/Medline, Cochrane, Embase, and Clinicaltrials.gov databases by using the search terms "late" or "delayed" or ">12 hours" presentation with STEMI from 01/2012 through 12/2022. Included studies reported at least one of the following outcomes: all-cause mortality, reinfarction, heart failure, major adverse cardiac events (MACE), and stroke. Studies reporting delays in PCI due to COVID-19 positive status or COVID-19 enforced protocols were excluded to prevent the impact of pragmatic barriers on treatment. Relative risk (RR) was calculated using random effects model if heterogeneity was >50%, otherwise, fixed effects model was used Results: Seven studies (n=11,576, delayed PCI n=6,248, and medical therapy n=5,319) were included in our analysis. The median follow-up was 12 months (1-60 months). Overall, among patients with STEMI and PCI >12 hour after presentation had lower incidence of MACE (27% vs. 30%, RR 0.85, 95% CI 0.76-0.69, I2=30%, p=0.007) compared to MT alone, which was driven by a significantly reduced all-cause mortality with PCI (4.4% vs. 17%, RR 0.38, 95% CI 0.17-0.85, I2=95%, p=0.01). No significant differences were observed in the incidence of recurrent MI and heart failure hospitalizations. Conclusion(s): Our study suggests favorable outcomes of PCI in STEMI with presentation >12 hours compared with medical therapy. Further prospective studies are needed to validate our findings.

Covid Icu Bed Occupancy Inversely Related to the States' Booster Rates: A Myth or a Reality

INTRODUCTION: The current CDC guidelines recommend COVID-19 vaccine boosters for all eligible individuals to enhance protection. Resources have been allocated to research done regarding the COVID-19 vaccine, and we speculate that there is a correlation between COVID booster rates and number of COVID patients in the ICU. We hypothesize that the states with a higher percentage of the population that received the booster shot will have decreased COVID ICU bed utilization and vice versa. METHOD(S): The percentage of people who received the COVID-19 booster vaccine and the number of ICU beds occupied by patients with COVID-19 per 10,000 population, both stratified by states, were reviewed to determine the pattern of correlation. The data for both the variables was sourced from Becker's Healthcare as it used information from the CDC's data tracker to rank states by their booster rates. The rankings were last updated based on data from July 20th, 2022. The state of Idaho was excluded because the data was not available. Limitations of the study included reporting lags between the states and CDC, the emergence of numerous variants of the virus, and a lack of a standardized timeline across the states. RESULT(S): Pearson Correlation Coefficient was used to determine the pattern of correlation between COVID booster rates and the number of COVID patients in the ICU for all US states. Booster rates was set as x and ICU patients was set as y. The data was analyzed while using the formula r = SIGMA((X - My)(Y - Mx)) / ((SSx)(SSy)). X Values were calculated with SIGMA = 2407.7, Mean = 48.154 and SIGMA(X - Mx)2 = SSx = 2308.544. Y Values were calculated with SIGMA = 5112, Mean = 102.24 and SIGMA(Y - My)2 = SSy = 835103.12. The coefficient of determination, R2, was 0.0611. Our obtained R was -0.25 which means no strong correlation was found. The data was analyzed independently by two statisticians and the same results were obtained. The results failed to confirm our hypothesis and suggested that there was no correlation between COVID booster rates and the number of COVID patients in the ICU. CONCLUSION(S): Based on our results, no correlation was found between the states' COVID booster rates and ICU bed occupancy. Further studies are needed to quantify this association if any as highly virulent COVID strains pose a threat to humanity.

Risk Factors for Covid-19 Mortality in Paediatric Populations: A Scoping Review

Aims Paediatric populations are generally considered to be at a lower risk of mortality from COVID-19 infection compared with adult populations. Regardless, a notable number of deaths from COVID-19 have been reported in paediatric populations. Therefore, the purpose of our work was to conduct a scoping review of the literature to assess the risk factors for COVID-19 mortality among paediatric populations. Methods Our review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Searches were performed in PubMed, Scopus, medRxiv, and WHO Coronavirus Database. There were no restrictions placed for searches based on date. Papers that were written in English, included at least one paediatric death from COVID-19, and described at least one risk factor for the death and/or clinical presentation of the child(ren) were eligible for inclusion. The paediatric population was defined as children aged 18 years and younger. Results Searches generated a total of 5828 papers and, of those, 75 were eligible for inclusion. There was a pooled total of 876 paediatric deaths. Significant risk factors for paediatric mortality included having co-infection of other pathogens, and at least one comorbidity;the comorbidities most frequently associated with mortality were malignancies, heart conditions, kidney disease, and genetic disorders such as Down Syndrome. The development of Paediatric Multisystem Inflammatory Syndrome (PMIS) was also consistently demonstrated to be a risk factor. Common clinical complications associated with paediatric COVID-19 infection resulting in mortality were sepsis, acute respiratory distress syndrome (ARDS), and acute kidney injury (AKI). Conclusion Our review has highlighted prominent risk factors for mortality from COVID-19 amongst paediatric populations. It is vital to consider the risk factors in order to assist prognostication and clinical decisions for severe paediatric infections of COVID-19. Our findings also highlight the importance of COVID-19 vaccination in paediatric populations.

"TRANSFER FOR HIGHER LEVEL OF CARE": AN EXCUSE TO GET RID OF UNINSURED PATIENTS?

SESSION TITLE: Actionable Improvements in Safety and Quality SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: The overall mortality rate for patients ‘transfered’ to the medical intensive care units is thought to be significantly higher than the mortality rate amongst those admitted directly. (1) It has also been suggested that uninsured critically ill patients have a higher probability of being ‘transferred’ to other hospitals as well as a higher mortality rate. (2, 3) We aim to determine whether insurance coverage impacts the transfer of critically ill patients. METHODS: This study was conducted at a quaternary care hospital which is also a regional transfer center. We accessed the public data for the year 2020 through our institutions Transfer Center Dashboard, System Analytics. The two aspects of transferred patients we focused upon were: 1) Hospital service (subspecialty care required) and 2) Financial class. Major subspecialties included in the study were: Pulmonology, Internal Medicine, Neurosurgery, Cardiology, and Neurology. Our study was a patient safety project, hence it qualified for IRB exemption. We classified the percentage of transfers as ‘Accepted’, ‘Declined’, or ‘Canceled’;and determined the insurance status of the patient. RESULTS: We found a total of 3552 patients transfers were initiated. 31.9% (1136) transfer patients were accepted, 46.79% (1662) transfers were declined, and 21.23% (754) were canceled due to reasons including unsafe transfer, acceptance at other institutions, or death prior to transfer. Major categories for transfers were Pulmonology (16.1%), other Internal Medicine related diseases (15.3%), and Neurosurgery (11.8%) were the subspecialties with the highest rate of transfers. In terms of financial class, we determined that 44.81% (n=509) of the ICU transfers had no insurance, 27.81% (n=316) had Medicare support, and 17.81% (n=202) had managed care through a health maintenance organization (HMO);the remaining 9.59% had other insurance plans. We used a binomial test to determine the probability of a transfer under no insurance (p) with the formula p + q=1, across the total number of transfer requests (n). K was the number of actual transfers that occurred. Total transfer requests were n=3552, actual transfers were k=1136 and transfers without insurance were 509/44.8%, converted into p=0.45 with a resulting q of 0.55.For z-test, we used the formula z = ((K - np) +- 0.5) / √npq = 15.58. Our one-tailed probability of exactly, or fewer than, 1136(K) out of 3552(n) was p <.000001. Our study was limited because of the COVID-19 pandemic occurring in the same year. CONCLUSIONS: Based on our results, we conclude that the ‘uninsured’ patients are more susceptible to getting transferred to other institutions. CLINICAL IMPLICATIONS: Critically ill ‘uninsured’ patients are selctively subjected to be transfered to other hospitals for higher level of care. These transfers may have significant health implications thereby resulting in higher morbidity and mortality in unisured populations. DISCLOSURES: No relevant relationships by Joodi Akhtar No relevant relationships by Sahar Fatima Advisory Committee Member relationship with Astra Zeneca Please note: 24 months Added 03/16/2022 by FAISAL MASUD, value=Honoraria Advisory Committee Member relationship with Teleflex Please note: 12 months Added 03/16/2022 by FAISAL MASUD, value=Consulting fee Advisory Committee Member relationship with La Jolla Please note: 12 months Added 03/16/2022 by FAISAL MASUD, value=Consulting fee No relevant relationships by Iqbal Ratnani No relevant relationships by Salim Surani No relevant relationships by Anza Zahid

Coagulation profile in COVID-19

Objective: To evaluate the coagulation profile in COVID-19 patients and to correlate disease severity with the coagulation parameters. Methodology: This retrospective study was conducted at Pathology and medicine departments, FMH College of Medicine and Dentistry. It included 101 confirmed cases of COVID-19 disease of both genders between 17 and 75-year age. Coagulation profile was compared between survivor and non-survivor groups. Results: Out of 101 patients, 93 (92.1%) patients were in the survivor group and eight (7.8%) in the non-survivor group. Mean APTT (p = 0.02) in non-survivor group showed relatively higher values than survivor group. Mean D-Dimers (p = 0.007) in non-survivors showed a significantly raised values. However other parameters of coagulation like Platelets, MPV, PT and INR showed no significant association statistically. Conclusion: High D-dimers and prolonged APTT were associated with mortality in COVID-19 Patients.

Khamira Banafsha for the symptomatic treatment of Covid-19 Disease

Respiratory illness is one of the most important public health problems in many countries worldwide. Even though most of the ailments are treatable with normal care, respiratory-related mortality continues to increase year after year. The global situation is deteriorating as a result of the COVID-19 epidemic. Numerous Unani formulations are beneficial against a variety of respiratory disorders, but they must be clinically researched before they can obtain widespread acceptance in the modern world. At the moment, no antiviral medication is either available for each respiratory disease or is costly and not easy to use in pandemics like COVID-19 on large scale, although Unani medicines may be considered an option. Khamira Banafsha (KB) is a semi-solid blend of three dried flowers, Viola odorata L., Borago officinalis L., and Rosa damascena Mill and the distillate of Rosa damascena, and sugar. The components in this formulation are well-known and frequently utilized in the treatment of respiratory problems.The formulation has been used to treat a wide range of illnesses for decades. This review will discuss the pharmacology, ethnopharmacology, and repurposing of KB as an adjuvant or symptomatic treatment for Covid-19 illness.The chemical composition of the ingredients may be evaluated In-silico to identify their eligibility for Covid-19 disease symptomatic management.

Impact of COVID-19 Pandemic on Surgical Education and Training: A Resident Survey in a Low-Income Country

Aim: The COVID-19 pandemic has adversely affected medical education and training programmes worldwide. This study aims to assess the impact of COVID-19 pandemic on surgical education and training in a low-income country. Method: This cross-sectional study was conducted in Allied hospitals of Rawalpindi Medical University, Rawalpindi, Pakistan, from June 2021 to July 2021. A structured questionnaire designed by the researchers was distributed to all surgery departments, and surgical residents who consented to participate in this study were included. Data was analyzed using IBM SPSS v25. Results: A total of 152 residents participated in this study, of which 53 (34.9%) were in general surgery and 99 (65.1%) in various surgical allied specialties. A large number of respondents reported a severe to complete reduction of elective surgical procedures (78, 51.3%), outpatient clinical activity (54, 35.6%) and academic sessions (86, 56.6%). A significantly higher number of general surgery residents (52.8%) reported increase in emergency surgical procedures as compared to surgical allied specialties (35.4%) (P=0.037). Majority of the respondents believed that loss of surgical training opportunities had a negative impact on their training and job performance (127, 83.6% and 130, 85.5%, respectively) with 43 (28.3%) residents suggesting an extension in training program. 137 (90.1%) residents reported increased stress and anxiety levels with the number of surgical allied residents significantly higher than general surgery residents (P=0.031). 125 (82.2%) respondents claimed that fear of contracting the virus affected proper patient evaluation. Conclusions: COVID-19 pandemic has severely impacted the training and psychological wellbeing of surgical residents and drastically affected patient evaluation.