ABSTRACT
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.
ABSTRACT
The psychological and socioeconomic impact of the COVID-19 pandemic is significant and has changed the global order. Strict confinement has changed our everyday life and our buying behaviour. The purpose of this paper is to examine the impact of COVID-19 on the behaviour of digital payments in the Indian context. The cluster analysis technique is used to classify the types of customers according to their payment behaviour. The first group of clients may be described as ‘late majority’ and the second group of clients as ‘early majority’. The results suggest that fear of COVID-19 has contributed to digital initiatives by banks. The findings of this paper can be used by private and public sector banks or other small banks to understand the future implications of it in their payment operations and future policy to optimise the operational cost. © 2021 Inderscience Enterprises Ltd.
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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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Objective: To evaluate the radiographic patterns in COVID associated pneumonia in a tertiary care hospital of Karachi. Study Design: Analytic study Place and Duration of Study: This study was conducted in specifically designed COVID wards and HDU in Dow University Hospital, Karachi between 1st June 2020 to 15th July 2020, by reviewing the admission records of COVID diagnosed patients. Materials and Methods: A total of 150 patients presented with pulmonary symptoms were evaluated for chest radiographs. Results: Out of 150 COVID detected patients, 80 were males (53.33%) and 70(46.66%) were females with a mean age of 51.14±15.96 years. Frequent radiographic patterns were diffuse infiltrates occupying more than half lung field 56(37.33%), diffuse infiltrates less than half of lung field 45 patients (30%), lobar pneumonia in 9(6%) and cardiomegaly with basal infiltrates were observed in 7 patients (4.6%). Dominant symptoms were shortness of breath on exertion 105 patients (70%), fever 60(40%). The most common signs observed were hyperventilation 105(70%) and crepitation’s 30(20%). The most common comorbidities observed in the study were Uncontrolled Diabetes 114(74%), Hypertension 76(50.6%), and ischemic heart disease 52(34.66%). Conclusion: The majority of COVID detected with pneumonia were male, common radiographic patterns were pulmonary infiltrates. Lobar pneumonia and pleural effusion were rare findings and typically seen in severe disease where patients need mechanical ventilation. © 2021 Medical Forum Monthly. All rights reserved.
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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.