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Background: A hypersensitivity condition called cytokine storm is the main cause of death in COVID-19 patients. A monoclonal antibody called tocilizumab may be able to suppress the Interleukin-6 receptors (IL-6R) and lessen the likelihood that the body would have a hypersensitive immune response. Aim(s): To evaluate the mortality advantages of tocilizumab in individuals with COVID-19. Study design: Retrospective study. Place and duration of study: Bahria Town International Hospital Lahore from 16th June 2020 to 17th September 2021. Methodology: Patients with 96 confirmed instances of COVID-19 were enrolled. Two groups of patients were created. A single dosage of tocilizumab was administered to 52 participants in the first group, referred to as the survivors, and 44 patients in the second group, who passed away within 14 days. From the patients' medical records, the demographic information, co-morbid conditions, and laboratory values were obtained. The hospital's institutional review board and ethics committee (IRBEC) gave its approval for this study. The permission was ignored because this was a retroactive analysis. Result(s): 54.24 16.58 was the average age, and 54 (56.25%) of the population were men. 52 (54.16%) patients were survivors, compared to 44(45.83%) patients in the non-survivor group. In non-survivors compared to survivors, the older age group was shown to be statistically significant (62.78+/-12.86 vs. 51.65+/-11.68, p=0.003). Additionally, non-survivors had a greater BMI (p=0.006). In our study, hypertension and diabetes were the two co-morbid conditions that were most frequently detected (35.24% and 28.94%, respectively). The mortality rates among patients with diabetes, asthma, COPD, and cancer were all considerably higher (P=0.01, 0.006, and 0.004, respectively). Cancer and type-2 diabetes patients had death rates that were considerably higher (p=0.05 and p=0.01, respectively). C-reactive protein (CRP), D. Dimer, procalcitonin (PCT), and IL-6 were discovered to be the significant predictors of mortality (p 0.0001, 0.05, 0.001, and 0.004 respectively). Conclusion(s): Even though tocilizumab is authorised and has been shown to have positive results, people with diabetes, COPD, and asthma are more likely to experience negative results even after getting a single dosage of the medication. Similar to CRP, D. Dimer levels are reliable indicators of death. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.
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Background: There is significant evidence to support that patients with the Coronavirus disease 2019 (COVID-19) have a higher propensity to develop thrombotic events. COVID-19 patients in intensive care units (ICU) have an increased rate of venous thromboembolism (VTE), ranging from 17% to 25%. Apart from acute respiratory failure, coagulopathy remains a common abnormality in these patients, within creased levels of both fibrinogen and D-dimers. Anticoagulation using subcutaneous heparin is known to reduce the incidence of thromboembolic events;although concern regarding over-anticoagulation resulting in excessive bleeding remains an impediment. Objective: Study Design: Retrospective study Place and Duration of Study: Bahria International Hospital Lahore from 1st May 2020 to 31st October 2020. Methodology: One hundred and eight patients admitted in the ICU were enrolled. The incidence of thrombotic and bleeding events in patients treated with subcutaneous heparin during their admission with moderate to severe COVID19 in the ICU. All patients were given therapeutic dosed anticoagulation universally unless contraindicated. Results: Thromboembolic events were seen in 10 patients while 98 patients did not have any such event. 3 patients had a bleeding event during their stay. Conclusions: Using prophylactic therapeutic dose anti-coagulation therapy is an effective and safe strategy in COVID-19 patients and it is associated with improved outcomes in terms of reducing morbidity and mortality.
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Background: The coronavirus disease 2019 (COVID-19) has quickly spread to become a pandemic. Most studies demonstrate that increased liver enzymes in COVID-19 have little clinical relevance. In severe COVID-19, lower albumin levels are seen. Aim: To see how hypoalbuminemia levels affect the COVID-19 patients. Study design: Retrospective cohort study. Place and duration of study: Services Institute of Medical Sciences Lahore and Bahria International Hospital, Lahore from 10th January 2021 to 17th September 2021. Methodology: Sixty-seven confirmed cases of COVID-19 on RT-PCR were recruited. They were further divided into two groups. Group N (normal albumin levels) had thirty-six participants whereas group HA (hypoalbuminemia) contained thirty-one participants. Both males and females of all age groups, having complete medical records were included. Biochemical variables were noted from the medical record within 48 to 72 hours after admission. Twenty eight days follow up was done to note the mortality. Patients having incomplete medical records who expired within 2 days after admission were excluded. Results: A significantly higher number of deaths, lymphopenia, hypertensive, diabetics, and asthmatic participants were found in Group HA as compared to Group N. Hypoalbuminemia is mostly seen in older age and biochemical variables such as total leukocyte count and, neutrophils were elevated, whereas lower levels of lymphocytes were found in group HA. Lower lymphocytes and higher creatinine levels are the most prevalent predictors of mortality. The Pearson’s correlation of albumin with lymphocytes showed a positive correlation and inverse correlation with TLC, Neutrophil counts, CRP levels Conclusion: The group HA is associated with higher mortality and increased levels of prognostic factors of mortality.
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Background: In individuals with coronavirus, a cytokine storm is an important cause of illness and demise. The purpose of the study was to assess whether pro-inflammatory cytokines had an impact on progression and risk of mortality in patients with COVID-19. Study Design: Retrospective study Place and Duration of Study: Intensive Care Unit (ICU) and Medical Wards, Bahria Town International Hospital from 21st August 2020 to 17th September 2021. Methodology: One hundred and thirty-six patients of confirmed cases of COVID-19 disease were enrolled. Their demographic, blood and biochemical parameters were collected within 48 hours after admission from the medical record of patients. Patients were divided into two groups according to the final outcome, the survivors and non survivors. The data were investigated to assess the prognostic importance of the blood marker and inflammatory variables for the prognostic importance. Results: The mean age and body mass index (BMI) were statistically higher in the non-survivors than in the survivors (p=0.017 and 0.03 respectively). For those with asthma and chronic obstructive pulmonary disease, the number was statistically higher in non-survivors (p = 0.002 and 0.04, respectively). The inflammatory markers concentrations of CPR, D. Dimer, serum ferritin, procalcitonin, and interleukin-6 were significantly higher within 48 hours of admission for non-survivors (p = 0.003, 0.007, <0.001, 0.015, and <0.001 respectively). Except ferritin levels, multi-variate logistic regression analysis exhibited that the CRP, D. Dimer, Procalcitonin and IL-6 were associated statistically significant higher risk of mortality (OR 1.235, p=0.007, 95% Cl 5.621-42.652, OR 1.906, p=0.003, 95% Cl 1.481-1.982, OR 3.967, p=<0.001, 95% Cl 4.256-23.981, and OR 7.589, p=0.009, 95% Cl 4.561-113.852 respectively). Conclusion: The inflammatory markers have the prognostic importance in patients suffering from covid-19 infection as we found higher levels of these markers were related with the poor prognosis.
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Background: Spontaneous pneumothorax is a rare complication seen in patients of COVID-19 pneumonia. The risk factors associated with this complication and its incidence remain unknown largely. We herein, review and present the incidence, clinical characteristics and outcomes of spontaneous pneumothorax in 1767 patients admitted in three COVID treatment tertiary care centers in Lahore. Study Design: Retrospective study Place and Duration of Study: Services Institute of Medical Sciences Lahore and Bahria International Hospital Lahore from 15th April 2020 to 15th May 2021. Methodology: One thousandseven hundred and sixty-seven patients who were diagnosed with a spontaneous pneumothorax were enrolled. Clinical characteristics of these cases were also reviewed and recorded. Results: One thousand and five hundred patients had positive RT PCR from nasopharyngeal swab. Eleven (.62%) cases of COVID-19 patients who developed spontaneous pneumothorax were identified. The initial HRCT imaging showed typical and diffuse bilateral ground-glass opacities and consolidations, mainly in their peripheral, posterior and basal lung regions. Three patients had pneumothorax late in the course of disease after they were discharged home. We had only one mortality among those (11) cases and that was also not related to the pneumothorax directly but to development of sepsis and multi-organ failure. Conclusion: Spontaneous pneumothorax is a rare complication seen in COVID-19 pneumonia.
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Background: Since the COVID-19 pandemic has started, glucocorticoids have been proved to be one of the most effective lifesaving treatments for respiratory complications associated with SARS CoV-2. Aim: To review the incidence of steroid induced diabetes and the associated risk factors in COVID-19 patients. Study Design: Retrospective cohort study Place and duration of the study: Bahria International Hospital Lahore from 15th April 2020 to 31st December 2020 Methodology: Two hundred and thirty patients of COVID-19 cases treated with glucocorticoids (Dexamethasone 4mg BID) were enrolled. All known cases of pre-existing diabetes mellitus and with initial (admission) random blood glucose levels of more than 200 mg/dl were excluded. Patients labelled as glucocorticoid induced diabetes mellitus (GI-DM)met the following criteria, fasting blood glucose level of more than 126 mg/dl or a random glucose level of more than200 mg/dlon two occasions after starting these patients on steroids. Results: The glucocorticoid induced diabetes mellitus was 36 (15.65%). Multivariate logistic regression analysis revealed that older age (odds ratio 1.19, 95% confidence interval (1.02-1.36) was found to be the most profound risk factor for GI-DM. Conclusion: Glucocorticoid induced diabetes mellitus found to be associated with glucocorticoid used among COVID-19 patients especially in older ages. So, it is recommended that the treating physicians should consider this side effect of steroids especially when dealing with geriatric cases.
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Aim: To focus on the frequency of ICU-acquired infections in Sars Co-V2 Corona Virus disease (COVID 19) patients. Method: A retrospective observational study carried out in two tertiary care hospitals treating COVID 19 cases, Services Institute of Medical Sciences and Bahria International Hospital, Lahore. Data was collected from the medical records of the COVID 19 ICUs of both hospitals from May 1, 2020 to April30, 2021. All charts were reviewed for the evidence of positive cultures. The treatment given prior to positive cultures, after the availability of culture results and outcomes were also recorded. Results: A total of 432 records were reviewed and 400 cases were included while 32 cases were excluded because of incomplete data. The frequency of infections per 1,000 days of ICU stay was calculated in 90 (22.5%) patients. Gram-negative bacteria accounted for 68 cases (75.5%) with Pseudomonas in 44 cases (48.8%), Acinetobacter in 23/90 (25.5%) while 17 cases (18.8%) had gram positive infection with Enterococcus in 14/18 (77.77%) or 14/90 (15.55%), MRSA in 4/18 (22.22%) 4/90 (4.44%), while 5/90 (5.5%) had more than 2 isolates at same time. Among these 3 had both pseudomonas and Acinetobacter while 2 patients had Pseudomonas and Stenotrophomonas Maltophilia. Conclusion: There seems to be an increase in the infection rate among critically sick COVID 19 patients admitted in ICU. Use of steroids and Tocilizumab seems to play a role through their immunomodulatory effects.
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Aim: To determine overall mortality, outcome and mortality of COVID 19 infection in solid organ transplant pts. Study design: Retrospective study. Place and duration of study: Department of Medicine, Bahria International Hospital, Lahore, Pakistan15thApril 2020 to 31stDecember 2020. Methodology: Twenty-three patients 18 out of which were kidney transplant recipients while 5 were liver transplant recipients. All the solid organ transplant patients who were admitted with Sars CoV2 (Corona virus) infection were recorded. Their charts were reviewed regarding clinical course, management, and outcome of COVID-19 infection in recipients of solid organ (liver and kidney) transplant. Results: Mean age was 44.8±10.9 years. Median time lapsed from transplant surgery to admission was 2.88 years (interquartile range 2.25, 7.33). Median hospital stay was 15 days (interquartile range 13, 28). All 23 patients were admitted and managed, with 17 (73.91%) admitted in ICU. Over half of the cases (58.2%) presented with raised serum creatinine due to acute kidney injury. 80% received azithromycin, Tocilizumab and 50% received Remdesivir. Antimetabolites with or without calcineurin inhibitors were held or reduced. A total of 5 patients had died while the others 18 patients (78.26%) were discharged home. Conclusion: There is a theoretical high risk of getting Sars CoV-2 infection in post-transplant patients but we did not find any increase in overall mortality in solid organ transplant recipients receiving immunosuppressive therapy who acquired Sars CoV2 infection as compared with mortality in the general patients with SARS-CoV-2. We had favorable outcome in solid organ transplant COVID 19 patients in our center.
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Aim: To evaluate the effectiveness of Ivermectin in COVID 19 infection in terms of virus clearance and symptomatic improvement. Study design: Prospective Quasi experimental study Place and duration of study: Study was carried out in COVID treatment units of Services Institute of Medical Sciences and Bahria International Hospital COVID treatment centre from April 15, 2020 to November 30, 2020 Methodology: One hundred COVID19 confirmed patients for this study and divided into 2 groups. Both groups were given standard treatment including Oxygen, therapeutic anticoagulation and hydroxychloroquine therapies. Group-1 was given Ivermectin for 6 days and group 2 didn't receive Ivermectin. Results: The significance value represented as p value (p=.825) was greater than the table value at 0.05 in all aspects, which shows that Ivermectin has no effect in improving PF ratio in COVID19 patients. Out of 50 only 4 patients who received Ivermectin got COVID19 PCR negative after 6 days but on the other hand 3 patients who did not receive Ivermectin also got their PCR negative after 6 days of treatment. Conclusion: Ivermectin does not seem to be effective in improvement of PF ratio and virus clearance in COVID19 patients.
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Objective: To evaluate the stress level among doctors and nurses during COVID-19 crises. Study design: Descriptive correlational study Place and duration of study: Department of Medicine &Critical Care, Services Hospital Lahore and Bahria International Hospital, Lahore from 1st May 2020 to 31st July 2020 Methodology: Descriptive correlational study design to evaluate the stress level among doctors and nurses. A couple of other factors were also identified like lack of personal protective equipment's (PPEs) and family pressure to quite job along with COVID-19 stress. Two groups were substituted one with exposure of COVID-19 and other without its exposure. The internal review board and ethical committee of Bahria International Hospital, Lahore, approved the study. Questionnaire was collected after proper informed consent from health professionals working at COVID management units at Services Hospital Lahore and Bahria International Hospital Lahore. Chi-Square test and Odd ratios were calculated among the stated groups of doctors and nurses. Results: Statistical analysis among the groups of doctors and nurses exposed and not exposed shows significant higher levels of anxiety in doctors and nurses who were involved in management of COVID-19 patients directly as compared to those who were not. Similarly, the level of risks increased almost double in the exposed healthcare workers. Availability of personal protective equipment and pressure from the families to quit the job also plays significant role in elevating of anxiety levels. Conclusion: Study concludes that anxiety increases in the health care professionals due to lack of robust systems to cope up with the COVID-19 pandemic. Factors like stress from family, lack of proper protective equipment leads to fear of being infected and taking the infection to their loved ones. It is responsibility of management of health care set ups to ensure the availability of PPEs and making a robust system of infection control to help combat the pandemic. © 2020 Lahore Medical And Dental College. All rights reserved.