ABSTRACT
Pakistan is one of the two endemic countries for polio, reporting co-circulation of WPV1 and cVDPV2. Pakistan is classified by the International Health Regulations (IHR) as a state infected with Wild Poliovirus type 1 (WPV1) and circulating Vaccine derived poliovirus type 2 (cVDPV2) with potential risk of international spread. We describe an ongoing outbreak of WPV1 in North Waziristan district of southern Khyber Pakhtunkhwa (KP) province in Pakistan and the last documented outbreak of cVDPV2. The first case of the WPV1 outbreak was documented in the month of April 2022, after more than a year of polio free status. Since then, 20 cases in total have been reported, of which 87 percent had never received OPV through essential immunization. Major reasons which might be responsible for Pakistan's failure in the eradication of polio including governance issues, lack of health facilities, low routine immunization, or refusal of immunization, security threat to immunization staff, extensive public movement, and presence of polio reservoirs/zones in border regions with Afghanistan. Pakistan's struggle against polio eradication was further fuelled by the COVID-19 pandemic which brought a standstill to the routine immunizations. The threat to the Global Polio Eradication stems from reintroduction of the poliovirus and emergence of circulating vaccine derived poliovirus (cVDPV) in the polio-free countries. Hence, control of the WPV1 and cVDPV2 transmission in Pakistan is an international concern. © Global Biosecurity. All Rights Reserved.
ABSTRACT
Background and Aims: The hypercoagulability occurring in COVID-19 patients is detected only by Rotational thromboelastometry (ROTEM). However, the benefit of performing ROTEM in the management of disease and predicting the outcome of COVID-19 patients is yet to be established. Material and Methods: The data of 23 critically ill and 11 stable COVID-19 adult patients were extracted from the hospital information system admitted between July and August 2020 and patient charts and analyzed retrospectively. The critically ill patients were divided as a survivor and non-survivor groups. The Intrinsic pathway part of ROTEM (INTEM) and Fibrinogen part of ROTEM (FIBTEM) were performed on day 0 for both critically ill and stable patients, and on day 10 for critically ill patients. The statistical package for social science (SPSS) version 26 was used for statistical analysis. Results: The median FIBTEM amplitude at 5 min (A5) and maximum clot firmness (MCF) were elevated in both stable and critically ill patients (24 vs 27 mm, P = 0.46 and 27.5 vs 40 mm, P = 0.011) with a significant difference in FIBTEM MCF. But there was no significant difference between number of survivors and non-survivors with FIBTEM MCF >25 at day 0 and day 10. Conclusion: The Hypercoagulability state as detected by ROTEM parameters at day 0 and day 10 had no association with the outcome (mortality) of critically ill COVID-19 patients. Hence it cannot be used as a prognostic test. The increasing age, comorbidities and D-dimer values were associated with a poor prognosis in COVID-19 patients.
ABSTRACT
Introduction and Aim: Prone positioning has been reported to facilitate oxygenation in patients suffering from COVID-19, and improvement has been observed in cardiorespiratory functions following practice of asanas and pranayamas. We investigated the effects of prone asanas and slow pranayama on recovery from COVID-19 illness. Methods: A study was conducted on six COVID-19 patients of varied age with different pre-existing comorbidities such as asthma, diabetes and hypertension, admitted to COVID-hospital. In addition to routine medical treatment, all the patients practiced the prone asanas and slow pranayamic breathing for a period of four weeks (2 weeks of hospital stay during the illness and two weeks of home quarantine following discharge from the hospital). The intensity of illness, days to recover, level of stress assessed by Perceived Stress Scale (PSS-10), degree of depression assessed by Patient Health Questionnaire (PHQ-9), myocardial work stress determined by rate-pressure product, and complications if any, were recorded. They were advised to continue the asana-pranayama practice for another four weeks during the entire recovery period. Results: All the patients recovered smoothly from COVID-19 illness, their hospital stay was eventless, and the psychological stress, levels of depression and myocardial work stress due to COVID illness were reduced significantly by four-weeks practice of asana-pranayama schedule. Multiple regression demonstrated the association of decreased depression to decreased level of stress following asana-pranayama practice. There were no post-recovery complications during the one-month follow-up in the recovery period. Conclusion: Practice of prone asanas and slow pranayama for four weeks facilitated the healing from COVID-19 illness, alleviated psycho-physical stress and depression, and prevented development of post-recovery complications in all the patients. The reduction in depression could be linked to the reduced stress level following asana-pranayama practice in COVID-19 patients.
ABSTRACT
Introduction: •COVID-19 is a thrombotic state (hypercoagulable) •Incidence of thromboembolic complications: •DVT: 25%. •Combined DVT, PE, and arterial thrombosis: 31%. •Anticoagulation therapy is recommended to prevent thrombotic complications. •Rare case of extensive thrombosis of abdominal arteries - multiorgan infarct being reported first time even after giving anticoagulation prophylaxis. Materials and methods: Case •A 60-year-old male, k/c/o hypertension on medication, diagnosed to have COVID-19 pneumonia, with SpO2 of 85% on 15 L/minute O2 through a face mask. •Fully conscious, with normal vitals admitted in ICU. Results: Treatment given: •Azithromycin 500 mg od •Dexamethasone 6 mg IV od •Remdesivir 100 mg IV od •LMWH 0.4 mL SC bd COURSE IN ICU: DAY 5: Developed severe, constant abdominal pain. •P/A: Soft, tender in umbilical, hypogastric area •CECT Abdomen: Superior mesentric artery (SMA) thrombus, edematous wall bowel loops, caecum, colon. •Thrombolysis with streptokinase done, Heparin therapeutic bolus dose followed by infusion given, aPTT targeted for 3 times normal. DAY 6,7 : Abdominal pain improved, passed stools. Oral liquid started DAY and: Pain increased, whole abdomen tender, gaurding. Emergency laparotomy done and bowels excised. CECT Abdomen: Massive infarct in spleen, Multiple Massive infarct in both kidneys, ischaemic bowel loops. Celieac artery, bilateral renal artery, splenic artery occluded Emergency Laparotomy and ischaemic bowel loops excised. POD1: He developed refractory hypoxemia, shock and cardiac arrest and died on POD 1. Course in ICU: Day 5: Developed severe, constant abdominal pain. •P/A: Soft, tender in umbilical, hypogastric area. •CECT Abdomen: Discussions: Pathophysiology of COVID-19 Induced Hypercoagulopathy: •Multifactorial. •Acute inflammatory response: cytokine stromea activation of platelet, endothelial cells, tissue factor, changes in levels of thrombomodulin, proteins C and S. •Binding of SARS-CoV-2 to angiotensin-converting enzyme a endothelial activation. •Bedridden. •Presence of large vascular catheters. Conclusion: •COVID-19 patients can develop thromboembolism even after adequate thromboprophylaxis. •Thromboprophylaxis to be started either with LMWH, heparin. •Point of care ultrasound (POCUS) screening should be done for early diagnosis of any thrombotic complication. •PT/INR, aPTT, D-dimer to be monitored every 48 hours.