ABSTRACT
Background: The study focuses on the challenges faced by government officials in implementing public health interventions to control the spread of COVID-19 in the Lahore District, Pakistan. Material(s) and Method(s): This qualitative study used in-depth interviews to collect data from 45 government officials involved in implementing COVID-19 control measures in Lahore District. Result(s): The study identified several themes related to the challenges faced by government officials, including contact tracing and coordination, disease management and vaccination, public perception and engagement, international travellers management, and implementation strategies. Strategies implemented to address the challenges posed by the pandemic included the utilization of technology, provision of training to staff, coordination with other organizations, identification of high transmission areas, and targeting specific communities or populations at higher risk of infection. Conclusion(s): The effective management of the COVID-19 pandemic requires a coordinated and multi-faceted response that incorporates various strategies and practices aimed at controlling the spread of the disease and mitigating its impact on communities. The authors recommend prioritizing clear and consistent communication, community engagement, and capacity building in pandemic management strategies.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.
ABSTRACT
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. .
ABSTRACT
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. .
ABSTRACT
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.