The influence of the COVID-19 pandemic on the psychological well-being of college students: a cross-sectional study.

OBJECTIVE: Even before the outbreak of the COVID-19 pandemic, concerns regarding college students' mental health were on the rise due to the increasing number of students afflicted with mental health issues. Exposure to numerous pandemic-related measures exacerbated existing issues with anxiety, depression, and stress. This study aimed to assess depression, anxiety, and stress levels among university students in the Aseer region in Saudi Arabia. SUBJECTS AND METHODS: Data were collected from eligible individuals using a web-based, self-administered DASS-21 questionnaire. This questionnaire consists of 21 questions with a rating scale of 0-3. Each of the psychological factors of depression, anxiety, and stress was categorized as normal, mild, moderate, severe, and extremely severe. Results were expressed using descriptive statistics as proportions, and the Mann-Whitney/Kruskal-Wallis' test was used to evaluate the presence of a significant difference between each of the socio-demographic factors of the respondents and the psychological outcomes. RESULTS: Respondents aged between 18-24 years reported higher rates of extremely severe depression than other age groups. Females had higher rates of depression, especially severe and extremely severe forms. Extremely severe anxiety had a relatively high prevalence across all age groups. Extremely severe stress was more common among respondents aged between 18-24 years, while respondents older than 34 years reported the highest prevalence of severe stress. The Mann-Whitney/Kruskal-Wallis' tests showed statistically significant differences between participants in the different groups. CONCLUSIONS: The COVID-19 pandemic had a high psychological impact on university students, which indicates that a psychological support program should be implemented to reduce this impact.

A Case of Sars-Cov-2 Omicron Variant Associated Acute Encephalomyelitis

With the ongoing pandemic of SARS-CoV-2 many neurological complications in relation to COVID-19 infection as well as immune-mediated and vaccine-associated phenomena have been described. To our knowledge, there has been no publication of a case of SARS-CoV-2 Omicron variant associated acute encephalomyelitis. We present a case of a 73-year-old woman with no relevant Background history who is otherwise fit and well and fully vaccinated. She suffered from mild COVID symptoms and had a positive PCR test with presumptive Omicron variant on day 2. Five days into her respiratory illness she developed in quick suc- cession sensory disturbances of hands and feet, bilateral asymmetric flaccid leg weakness, and mild arm weakness. She had absent deep tendon reflexes in the legs and diminished deep tendon reflexes in the right arm. MRI of brain and spine showed signal changes in the brainstem, cervical and low thoracic cord in keeping with acute encephalomyelitis. Her CSF showed an inflammatory picture with raised protein of 1.27g/L and no cells. At the time of submission, the patient received treatment with five days of intravenous steroids followed by ongoing plasma exchange and no comment on treatment response can be made at this stage.

Characteristics and risk factors for persistent breathlessness after hospitalisation for COVID-19

Background: Persisting breathlessness after COVID-19 infection is common and debilitating. We aimed to characterise and identify risk factors for patients with persistent breathlessness following COVID-19 hospitalisation. Method(s): PHOSP-COVID is a multi-centre prospective cohort study of UK adults hospitalised for COVID-19. Clinical data were collected during hospitalisation and at a research visit. Breathlessness was measured by a numeric rating scale of 0-10. We defined post-COVID breathlessness as an increase in score of 1 or more compared to the preCOVID-19 level. Multivariable logistic regression was used to identify risk factors. Result(s): We included 1,226 participants (37% female, median age 59 years, 22% mechanically ventilated). At a median five months after discharge, 50% reported post-COVID breathlessness. Risk factors for post-COVID breathlessness were socio-economic deprivation (adjusted odds ratio, 1.67;95% confidence interval, 1.14-2.44), pre-existing depression/anxiety (1.58;1.06-2.35), female sex (1.56;1.21-2.00) and admission duration (1.01;1.00- 1.02). Black ethnicity (0.56;0.35-0.89) and older age groups (0.31;0.14-0.66) were less likely to report post-COVID breathlessness. Post-COVID breathlessness was associated with worse performance on the shuttle walk test and forced vital capacity, but not with obstructive airflow limitation. Conclusion(s): Half of this national cohort of patients hospitalised for COVID-19 experienced persistent breathlessness at follow up. The risk factors identified for post-COVID breathlessness should inform mechanistic work to understand causal processes and develop future interventions to improve outcomes in this growing population.

Technostress: A catalyst to leave the teaching profession - A survey designed to measure technostress among teachers in Pakistan during COVID-19 pandemic

The world has changed drastically in terms of telecommunication, running online businesses and daily life activities to keep social distancing and to perform the regular everyday tasks since the pandemic COVID-19. Governments have several times declared smart, partial or full lockdowns to deal with the health crisis situation, that has impacted the social activities, gatherings and has impacted the functionality of several professions, including education that are directly or indirectly impacted by the lockdowns. In the education environment the students in large numbers are expected to gather for lectures, labs and meet folks from industry and/or other sectors. The lockdown required the teachers to come up with alternative to meeting in person to online meetings and adapting to online-synchronous and asynchronous teaching styles. To meet the targets set for an academic year, a distinctive rise in e-learning has been observed where teaching and learning is undertaken remotely using digital platforms. This study aims to reveal the impact of computer-assisted teaching on the development of technostress among Pakistani teachers during the pandemic COVID-19. In addition, the role of teachers' self-efficacy is evaluated and motivation to leave the teaching profession is investigated in the coming endemic climate. The researchers have opted to a quantitative approach with a cross-sectional survey to generalize the statistically obtained results and test hypotheses. A total of 242 teachers at different levels of education voluntarily participated in the research during the lockdown from March to April 2020, where all regular educational activities were suspended and online classes were introduced as an alternative way to meet educational goals. The findings revealed that Learning Teaching Process Oriented and Technical Issues Oriented are the main contributing factors towards the development of technology stress and motivation to leave the teaching profession. Moreover, teachers' perception of self-efficacy in using computers is negatively associated with technology stress. It is recommended that computer-based instructional coaching be designed for teachers prior to engaging them in digitally oriented online courses to improve their self-efficacy in using computers and to promote a well-developed digital infrastructure to avoid the development of technology stress and discouragement for tutelage. © The Author(s) 2022.

Fusion Based Self Diagnosis Expert System Empowered with Leven-berg Marquardt Algorithm

COVID-19 coronavirus disease is the latest virus in the new century. The World Health Organization- WHO organization announced that COVID-19 disease is a pandemic that leads to thousands of death in short time of spam. A quick and accurate diagnosis of COVID-19 shows an important role in its prevention. This study is based on a fusion-based Self-Diagnosis Expert System Empowered by the Leven-berg Marquardt Algorithm for the diagnosis of diseases. Leven-berg Marquardt has been implemented for the classification of different symptoms of the diseases and relates the results for their diagnosis. The MatLab software was used for the simulation purpose. The proposed fusion-based LB increased the accuracy in the training and validation process to be 10 times more efficient than the existing. The fusion technique achieved an overall accuracy of 98.86%, and 99.09% in all performance metrics which included TNR, precision, and FPR statistical parameters. © 2022 IEEE.

Vaccine hesitancy and distrust: concerns of healthcare workers of Pakistani origin-a survey

Background: Vaccine acceptance can play a pivotal role towards control of COVID-19. Many healthcare workers (HCWs) have articulated safety and effectiveness concerns despite being the frontline takers of vaccination. This survey was aimed to investigate the causes of COVID-19 vaccine hesitancy and distrust among HCWs of Pakistani origin. Methodology: This internet-based survey was conducted on 138 HCWs of Pakistani origin from January 2021 to April 2021. Result(s): Out of a total of 138 subjects, 137 (99.3%) HCWs responded to the survey. COVID-19 vaccinations had already been administered to 101 (74%) of the respondents. Out of 36 (26.2%) unvaccinated individuals, 19 (14%) completely declined the vaccination. The prevalence of participants who distrust vaccination effectiveness and safety was 110 (80.3%), while 94 (68.6%) believed vaccine safety was compromised due to rapid development. The prevalence of HCWs who believed long-term adverse effects and that the manufacturers falsified the data was 36 (26.3%) and 22 (16%) respectively. Conclusion(s): Our survey found that fears and concerns about the efficacy of the vaccine can impasse struggles to disease transmission and vaccine distribution. Healthcare workers in Pakistan had a higher prevalence of vaccine acceptance compared to other surveys. Copyright © 2022 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.

Online working amid COVID-19 pandemic. The role of emotional intelligence as aggression de-escalator: research reported from Islamic Republic of Pakistan

World has transformed to a new era after the outbreak of a virus named COVID-19 in late 2019, a virus that consequently spread worldwide, forced the governments to declare smart, partial, or complete lockdowns. The constant and prolonged lockdowns resulted in the uncertainty over disease status, inadequate information, food supplies and boredom that led to anger and confusion, emotional breakdowns, and development of aggressive behaviors. During the pandemic and constant lockdown, one of the major differences in day-to-day activities was the transformation of the working and learning environment from the physical to the online realm. The prime objective of the study is to highlight that during pandemic how transferring towards online working helped people to stabilize their emotions, anxieties, aggressions, anger and frustration. The study is designed to find out how online working has negatively connected with the development of aggression and how emotional intelligence has mediated this effect. The study design is non-experimental, correlational and comparative, followed by quantitative research analysis. The survey technique used in the data collection process where validated and reliable questionnaire were used for data collection and hypothesis testing. A sample size of 233 (144 females, 88 males, 1 participant did not disclose gender) participants from the metropolis city of Karachi participated in an online survey. Results have indicated that engaging people in online working improved mental and emotional stability as well as the suppressed level of direct, indirect and displaced aggression. Moreover, emotional intelligence has acted as a negative influencing mediator towards different forms of aggression, where an expansion in online working, positively impacted emotional intelligence and negatively co-related with direct, indirect and displaced aggression. No gender difference is found in terms of emotional intelligence, however, a distinctive difference in terms of indirect and direct form of aggression is reported. It is concluded that emotional intelligence is acting as a mediator between online working and direct, indirect and displaced aggression. It means that engaging people in online working helped to stabilize themselves in terms of emotions and helped them to control their anxieties during isolation. © Italian e-Learning Association.

Drivers of Professional Fulfilment and Burnout in Intensivists during the Covid-19 Omicron Surge

INTRODUCTION: We assessed professional fulfilment and burnout and their relationship to personnel demographics, ICU call structure and work stress among anesthesiology intensivists during the COVID-19 Omicron variant surge. METHOD(S): Observational cross-sectional survey of 606 SOCCA members in January and February 2022 using the Stanford Professional Fulfilment Index (PFI) to grade levels of professional fulfilment and burnout (work exhaustion and interpersonal disengagement). Statistical analysis included the Mann-Whitney U (2-groups) and Kruskal-Wallis (>2-groups) Tests. RESULT(S): 175 intensivists (29%) responded of whom 65% were male and 49% between 36-45 years old. There was a wide range of subjective response and no direct relationship between level of professional fulfilment and symptoms of burnout. Factors associated with higher median professional fulfilment scores were age >45 years (p=0.005), call supervision of in-house ICU fellows from home (p=0.01), <=15 weeks full-time ICU coverage in 2020 (p=0.023) and role as Medical Director (p=0.019). Call supervision of in-house ICU fellows from home and >15 weeks full-time ICU coverage in 2020 were associated with lower median exhaustion scores (p=0.012) and higher median disengagement scores (p=0.047) respectively, but otherwise there was no correlation between symptoms of burnout and personnel demographics, ICU call structure and COVID-19 work stress. CONCLUSION(S): Our observations indicate that during the Omicron surge professional fulfilment was higher in intensivists who were older, had at home call, fewer ICU weeks of coverage or were Medical Directors. In contrast, the demographics we measured largely failed to predict symptoms of burnout. The wide range of responses suggests that institutional wellness initiatives to identify and alleviate burnout should be personalized rather than aggregated.

Scaling up of mental health services in the digital age: The rise of technology and its application to low- and middle-income countries

This chapter describes the rapid spread of digital mental health technologies across the world and further explores specific case studies in low-income and middle-income countries (LMICs). We are increasingly seeing rapid rates of technological innovation and adaptation in low-resource settings including the widespread use of smartphone mobile devices, apps and web-based platforms. Health-care settings have taken advantage of this growth and are maximizing its potential by introducing these technologies in their service delivery. These technologies have been applied to various settings such as training of health workers, screening patients, and care delivery. This chapter explores five major areas benefitting from these emerging technologies: (1) community outreach, challenging stigma, and spreading awareness, (2) youth mental health, (3) mental health in humanitarian settings, (4) clinical care and frontline health workers, and (5) technology for severe mental disorders. We close the chapter with a discussion of broad ethical considerations in LMICs, highlighting risks pertaining to misinformation, victimization, and widening health inequities. Finally, we emphasize the role of digital technologies during the COVID-19 pandemic in addressing the potential rise and exacerbation of mental health problems, and how these technologies can potentially be leveraged to alleviate this burden through the remote provision of essential mental health services. © 2022 Elsevier Inc. All rights reserved.

Smart Quarantine Environment Privacy through IoT Gadgets Using Blockchain

The coronavirus, formerly known as COVID-19, has caused massive global disasters. As a precaution, most governments imposed quarantine periods ranging from months to years and postponed significant financial obligations. Furthermore, governments around the world have used cutting-edge technologies to track citizens’ activity. Thousands of sensors were connected to IoT (Internet of Things) devices to monitor the catastrophic eruption with billions of connected devices that use these novel tools and apps, privacy and security issues regarding data transmission and memory space abound. In this study, we suggest a block-chain-based methodology for safeguarding data in the billions of devices and sensors connected over the internet. Various trial secrecy and safety qualities are based on cutting-edge cryptography. To evaluate the proposed model, we recom-mend using an application of the system, a Raspberry Pi single-board computer in an IoT system, a laptop, a computer, cell phones and the Ethereum smart contract platform. The models ability to ensure safety, effectiveness and a suitable budget is proved by the Gowalla dataset results. © 2023, Tech Science Press. All rights reserved.

Analysing and Identifying COVID-19 Risk Factors Using Machine Learning Algorithm with Smartphone Application

This study is divided into risk factor analysis (RFA) and proposed system architecture (PSA). The light gradient boosting machine (LightGBM) algorithm in the RFA will work with the PSA to predict the risk factors. The results, efficacy, and performance will be validated via a ROC-AUC curve. Therefore, a system usability scale (SUS) procedure will be implemented to increase the performance. If the SUS score reaches 85–99 and 100 thresholds, it will be classified as appropriate for use and robust. The prediction score thresholds will be 0–100. If the score is below 25, it will be classified as normal, 26–50 as moderate, 51–70 risk, and 71–100 as severe. Due to a shortage of experienced staff and intelligent technology, it is becoming progressively difficult to reduce COVID-19 fatality rates. In this research, a lightweight mobile application has been suggested from which the significant patterns and factors can be recognised. Furthermore, it will assist both doctors and patients become aware of COVID-19 risk factors and take the required steps to mitigate them. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Coronavirus-2019 Disease with Pancytopenia with Leptospirosis and Herpes Simplex Virus Co-infection

Aim and background: COVID-19 pandemic has affected the whole world. Besides COVID, many infections may emerge during the course of the disease. Lymphopenia, use of immunosuppressants underlying comorbidities, and immune dysregulation secondary to SARS-CoV-2 could be the likely cause of the emergence such infections. We hereby describe a case of COVID-19 disease which presented with pancytopenia and was found to have Leptospirosis and Herpes Simplex Virus co-infection. Case summary: A 23-yearold postpartum female with no comorbidities and uneventful obstetric history was referred to our hospital 2 weeks after a full-term normal vaginal delivery. She developed generalized convulsive status epilepticus on the 10th day of her delivery, which was managed elsewhere with anti-epileptic drugs (AEDs). During her hospital stay, RTPCR for COVID-19 turned out to be positive but she remained asymptomatic throughout the course of her illness and seizures remained well-controlled on AEDs. On admission to our hospital, she was fully conscious, alert with no focal neurological deficits. Notable findings on evaluation were pancytopenia with megaloblastic features, bilateral pedal edema, and hepatosplenomegaly. NCCT brain was done which was suggestive of subarachnoid hemorrhage (SAH) along bilateral parietooccipital region for which conservative management was planned. 2D echocardiography was normal. Ultrasonography of abdomen revealed gross splenomegaly and mild hepatomegaly with mesenteric lymphadenopathy. NCCT thorax and abdomen were unremarkable apart from hepatosplenomegaly. In the panel sent for pancytopenia workup, IgM anti-HSV 1 antibodies turned out to be positive in blood. In addition, tropical workup was suggestive of Leptospirosis (IgM antibodies were positive). Workup for tuberculosis was negative. Bone marrow workup revealed features of trilineage hematopoiesis with micronormoblastic maturation consistent with iron deficiency anemia with no evidence of hemophagocytosis. Subsequently, IV acyclovir, IV doxycycline, and iron replacement were added. She improved clinically after these therapies and was subsequently discharged in a stable condition. MRI brain with MR angiography and venography done before discharge showed T1 sulcal hyperintensities along bilateral parietooccipital regions suggestive of SAH which was not progressing (as compared to NCCT brain scan done at admission). On day 60 of telephonic follow-up, patient was doing well and leading normal life without any persistence or emergence of symptoms.

Role of High Flow Nasal Cannula for Respiratory Support During Oral Feeding for COVID-19 Patients on Non-invasive Ventilation: A Case Series

Aims and objectives: To establish that non-invasive ventilation (NIV) can be substituted by high flow nasal cannula (HFNC) for respiratory support during oral feeding of a patient with COVID-19 patients. Materials and methods: This prospective case series was conducted after taking informed and written consent from the patients. Ten patients with severe COVID-19 disease requiring NIV with inspiratory pressure of <10 cm H2O, positive end-expiratory pressure of <6 cm H2O and FiO2 <0.6 were included in this study. Patients with altered consciousness, circulatory failure, or worsening acidosis were not included in the study. Patients underwent HFNC trial for 10 minutes and were screened for risk of dysphagia and aspiration using a 3-ounce water swallowing test. The patients were given a trial of HFNC for 10 minutes with a flow of 60 L/minute and FiO2 of 0.1 more than their requirement on NIV. The patients were observed for hypoxemia (SpO2 <88%) or signs of respiratory distress, e.g., increase in respiratory rate (>35/minute), laboured breathing pattern, use of accessory muscle of respiration, heart rate (>20% change), blood pressure (>20% change), perspiration, and anxiety. Then, HFNC was used for supporting respiration during oral feeding for up to 20 minutes. Feeding was started with a hypocaloric target on starting day and was increased progressively as per European Society for Clinical Nutrition and Metabolism guidelines to the target estimated caloric requirement. Results: The HFNC support for oral feeding was successful with adequate diet intake in eight patients without desaturation/respiratory distress during oral feeding. Other than COVID-19, co-morbidities in these eight patients included diabetes mellitus, obesity, chronic obstructive pulmonary disease, coronary artery disease, and dilated cardiomyopathy. Six patients, previously on enteral nutrition using the nasogastric tube, were successfully switched to oral feeding with help of HFNC. Four patients were directly started on the oral diet with help of HFNC support. HFNC could not support respiration adequately in two of these four patients. The initial trial was successful for one of the patients and HFNC support for oral feeding was used for 3 days, but a progressive increase in ventilatory requirements resulted in failure of HFNC trial subsequent days and the patient was switched to nasogastric feeding. In another patient, the initial trial of HFNC failed due to rapid desaturation within a few minutes of the trial. The eight patients in whom HFNC was used successfully for feeding were switched to HFNC completely and discharged from the hospital after weaning off from oxygen support. The patients who failed the HFNC support for feeding required higher ventilatory requirements and needed endotracheal intubation. Conclusion: Based on our case series, using daily screening trial of oral feeds with HFNC support in selected patients of severe COVID-19 pneumonia on NIV seems thought-provoking and should be explored for its potential in improving patient's nutrition with a positive impact on the outcome.

A Case Report of Novel Coronavirus-2019 (COVID-19) Disease and Cytomegalovirus (CMV) Co-Infection: A Lethal Combination

Aim and background: The novel coronavirus-2019 (COVID-19) pandemic is raging all across the world. As we are delving more into the management of COVID-19, many new challenges are emerging, which may pose additional threats. One of these is the emergence or re-activation of concomitant viral infections owing to lymphopenia, use of immunosuppressants, underlying comorbidities, and immune dysregulation. Although we have come across the threat of fungal infections and resistant bacterial infections, experience regarding reactivation or co-infection with other viral infections is still limited. We hereby describe a case of COVID-19 disease with cytomegalovirus (CMV) co-infection. Case summary: COVID-19 with Cytomegalovirus (CMV) Co-infection. A 55-year-old male, COVID unvaccinated, chronic smoker, overweight, and hypertensive patient was admitted to our ICU with a 1-week history of fever, cough, and breathlessness. SARSCoV- 2 reverse transcriptase-polymerase chain reaction (RT-PCR) test was positive. At admission, he had hypoxaemia (SpO2 86% on room air), respiratory rate (RR) 35-40/minute, and ground-glass opacities in chest X-ray involving 50% of bilateral lung parenchyma suggestive of severe COVID-19 pneumonia. He was managed with lung-protective invasive mechanical ventilation, restrictive fluid strategy, 16-18 hour/day proning sessions (4-5), intravenous (IV) remdesivir, IV dexamethasone 6 mg 12 hourly, and enoxaparin thromboprophylaxis. After 2 weeks of ICU stay, weaning was attempted but the weaning attempts failed due to underlying neuromuscular weakness. On examination, bilateral (B/L) cranial nerve palsies, areflexia, and motor power 0/5 in bilateral upper and lower limbs were noticed. A possibility of Guillain-Barre Syndrome (GBS) was kept and IV immunoglobulin therapy was empirically administered for 5 days with some improvement in power up to 1/5 in upper limbs. On day 35 of hospitalization, he developed pancytopenia along with features of deranged liver function and gut dysfunction (in the form of paralytic ileus and abdominal distension). In evaluation, polymerase chain reaction (PCR) for CMV turned out to be positive in blood with a very high viral load.Bone marrow aspiration and biopsy showed hemopoiesis with viral inclusion bodies and haemophagocytosis (HLH). Histological evidence of CMV inclusion bodies was present in the bone marrow besides viremia (detected by PCR for CMV), which confirmed the diagnosis of CMV co-infection. IV ganciclovir was initiated along with steroids in view of HLH. There was a decrease in CMV viral load after initiation of IV gancyclovir with subtle clinical recovery. However, the patient continued to deteriorate and succumbed to his illness in the 8th week of the ICU stay.

A Case Report of Coronavirus (COVID-19) Disease and Herpesviridae Viral Co-Infections: A Lethal Combination? ABS0138)

Introduction: COVID-19 pandemic has affected the whole world. Besides COVID, other viral infections may emerge during the course of the disease owing to lymphopenia, use of immunosuppressants, underlying comorbidities, and immune dysregulation, which may pose additional threats.1 We hereby describe two cases of COVID- 19 with viral co-infections belonging to the Herpesviridae family with undulating clinical course. Case 1: Cytomegalovirus (CMV) Co-infection: A 55-year-old male, COVID unvaccinated, chronic smoker, overweight and hypertensive was admitted to our ICU with a 1-week history of fever, cough, and breathlessness. SARSCoV- 2 reverse transcriptase-polymerase chain reaction (RT-PCR) test was positive. At admission, he had hypoxaemia (SpO2 86%on room air), respiratory rate 35-40/minute, and ground-glass opacities in chest X-ray involving 50% of bilateral lung parenchyma suggestive of severe COVID-19 pneumonia. He was managed with lung-protective invasive mechanical ventilation, restrictive fluid strategy, 16-18 hour/day proning sessions (4-5), intravenous (IV) remdesivir, IV dexamethasone 6 mg 12 hourly, and enoxaparin thromboprophylaxis. After 2 weeks of ICU stay, weaning was attempted but the weaning attempts failed due to underlying neuromuscular weakness. On examination, bilateral (B/L) cranial nerve palsies, areflexia, and motor power 0/5 in bilateral upper and lower limbs were noticed. possibility of Guillain-Barre syndrome (GBS) was kept and IV immunoglobulin therapy was empirically administered for 5 days with some improvement in power up to 1/5 in upper limbs. On day 35 of hospitalization, he developed pancytopenia along with features of deranged liver function and gut dysfunction. In evaluation, PCR for CMV turned out to be positive in blood. Bone marrow aspiration and biopsy showed hemopoiesis with viral inclusion bodies and hemophagocytosis (HLH) [Figs 1 and 2]. A diagnosis of secondary HLH related to CMV was contemplated and IV ganciclovir was initiated along with steroids. Histological evidence of CMV co-infection was present and moreover, the quantitative viral load of CMV showed a decreasing trend after initiating IV gancyclovir. However, the patient continued to deteriorate and succumbed to his illness in the 8th week of the ICU stay. Case 2: Herpes Simplex Virus (HSV) Co-infection: Twenty-three years postpartum female with no comorbidities and uneventful obstetric history was referred to our hospital two weeks after a full-term normal vaginal delivery. She developed generalized status epilepticus on the 10th day of delivery, which was managed with anti-epileptic drugs (AEDs). During the hospital stay, RTPCR for COVID-19 turned out to be positive but she remained asymptomatic and seizures were well-controlled on AEDs. On admission to our hospital, she was fully conscious and alert with no neurological deficits. Notable findings were pancytopenia with megaloblastic features, B/L pedal edema, and hepatosplenomegaly. NCCT brain revealed mild subarachnoid hemorrhage (SAH) along the bilateral parietooccipital region for which conservative management was planned. 2D echocardiography was normal. Ultrasonography of the abdomen showed gross splenomegaly and mild hepatomegaly with mesenteric lymphadenopathy. NCCT thorax and abdomen were unremarkable apart from hepatosplenomegaly. In pancytopenia workup, IgM anti-HSV-1 antibodies turned out to be positive in blood. In addition, tropical workup was suggestive of Leptospirosis (IgM antibodies positive). Serological evidence was suggestive of acute HSV-1 infection (based on antibody titers). Bone marrow workup had features of trilineage hematopoiesis with micronormoblastic maturation consistent with iron deficiency anemia without any evidence of hemophagocytosis. IV acyclovir, IV doxycycline, and iron replacement were added, after which she improved clinically and was discharged in stable condition. Tables 1 and 2 show a detailed description of these cases. Discussion: Herpesviridae family is the most important group of viruses responsible for persistent vi al infections in humans, of which CMV contributes to 60-90% of infections in adults, especially in developing countries.2 In healthy individuals, these viruses are kept dormant by the body's immune mechanisms but in an immunocompromised population, reactivation from the latent state can occur. SARS-CoV-2 infection predisposes patients to concomitant viral co-infections, owing to T-cell lymphopenia, decreased NK cell number, and use of immunosuppressive medications.3,4 The first case of CMV co-infection was first reported by D'Ardes and co-workers in 2020.5 Since then, many studies have been emerging in this area. In an observational study from France, 38 COVID-19 patients on >7 days of MV were studied for HSV and CMV pulmonary co-infections (by quantitative real-time PCR in tracheal samples) out of which 47% of patients had one of these infections (24% HSV, 5% CMV, 18% both).6 Another study looking for HSV-1 in patients on invasive MV found HSV-1 reactivation between days 11 and 40, which correlated with immunological markers of decreased innate immunity.7 A case series looking for CMV infection (by PCR in plasma or BAL) in COVID-19, also found CMV reactivation between day 7 and 45 of illness. Most of these patients were above 60 years of age and immunosuppressed (HIV, diabetes mellitus, medications).8 Although immunocompromised individuals are more vulnerable, healthy immunocompetent adults who are critically ill or on prolonged MV may also be susceptible to these infections.9-12 This may be explained by a state of immunoparalysis inherent to prolonged critical illness. In case 1, an ICU stay of around 9 weeks complicated with recurrent nosocomial infections, multiple blood product transfusions, and steroid usage could have the likely triggers. Whether viral co-infections are merely bystanders or truly pathogenic is difficult to comment but timely management is essential to avoid end-organ damage (EOD) which may occur directly (by enhanced viral load secondary to compromised host immunity) or indirectly (by inflammatory changes consequent to prolonged cell-mediated immunity required to maintain viral dormancy).2-4,13 It also seems imperative to study if a viral co-infection has a proclivity to develop more severe hematological anomalies (besides the inherent risk of HLH with COVID) as was seen in case 1, in which the patient had a downward spiral of illness with multiorgan dysfunction.14-15 Limitations: Dynamics of PCR trends and virology studies of samples from trachea, gut, and urine could not be analysed in our patients. Conclusion: Viral co-infections can occur in COVID-19 disease as these patients are often immunocompromised and critically ill. A high index of suspicion and prompt management is needed to improve the outcome of patients. Patients with organ dysfunctions especially hematologic abnormalities with bone marrow involvement should be worked up in detail to look for concomitant viral co-infections. In the future, large-scale research is needed to better elucidate the relationship between SARS-CoV-2 and other viral co-infections.

Association of Dietary Behavior with Psychological Distress among House Officers in Karachi during Coronavirus Disease Pandemic

Objective: To observe the association between the officers' dietary behavior and psychological distress during the pandemic. Study Design: Cross-sectional study Place and Duration of Study: This study was conducted Department of Community Health Sciences Bahria University Medical and Dental College, Karachi at the June 2020 to July 2020. Materials and Methods: The convenience sampling was used to collect data. A Chi-square test and bivariate Pearson correlation were conducted, and SPSS version 23 was used to analyze the data. Results: A total of 161 house officers participated in the study, of which, most (73.9%) house officers were females, with a mean age of 24.7± 2.2 years. An association between the officers’ junk food consumption and psychological distress was found to be statistically significant, p < 0.05. Similarly, a significant positive correlation was observed between dietary behavior and distress, p < 0.05. Conclusion: COVID-19 pandemic has increased the burden on healthcare professionals globally and to cope with the situation the house officers are resorting to harmful behaviors such as consuming an unhealthy diet in Karachi. If not addressed, these behaviors will last and deteriorate their overall health and wellbeing in the long run.

COVID-19 Pandemic and its Impact on Blood Transfusion Services at A Tertiary Care Hospital Blood Bank in Northern India

Introduction: COVID-19 was a public health emergency and declared it as a pandemic by WHO. During this pandemic every branch of health care delivery system was negatively affected including Blood Transfusion Services (BTS). The main objective of this study is to compare the blood donations, issued and wasted units of blood and their components during pre-COVID and COVID period. Materials and Methods: It was a retrospective cross-sectional study and data of all voluntary and replacement donations, issue and wastage of blood and blood components were collected from 1st April 2019 to 31st March 2021. This duration was divided into pre COVID period from April 2019 to March 2020 and COVID period from April 2020 to March 2021 for this study purpose. Results: During the study period total 2818 blood donation were observed. Out of this 1818 donations were in pre COVID and 1000 donation occurred in COVID period. The mean with SD of collected blood units per month in pre COVID was 151.5±73.46, while during COVID 19 it was 83.33±36.79 (p value 0.0088). A total 4036 units of blood and blood products were issued during study period. In pre COVID period 2592 units (mean/month 216±108.46) were issued, and 1444 units (mean/month 120.33±57.97) were issued during COVID period (p value 0.0132). Conclusion: To maintain stable reserve and ensure availability of safe blood to the patients an emergency preparedness plan is necessary and blood banks must follow the guidelines given by national and international authorities.