Multisystem Inflammatory Syndrome in Children

Multisystem inflammatory syndrome in children (MIS-C) is an uncommon but emerging syndrome related to SARS-CoV-2 infection. While the presentation of MIS-C is generally delayed after exposure to the virus that causes coronavirus 2019, both MIS-C and Kawasaki disease (KD) share similar clinical features. Multisystem inflammatory syndrome in children poses a diagnostic and therapeutic challenge given the lack of definitive diagnostic tests and a paucity of evidence regarding treatment modalities. We review the clinical presentation, diagnostic evaluations, and management of MIS-C and compare its clinical features to those of KD.

Genomics, metagenomics, and pan-genomics approaches in COVID-19

The coronavirus outbreak, which initially started in Wuhan China, has rapidly led to numerous morbidities and mortalities worldwide. Although potential antiviral and antiinflammatory medicines are available, several individuals are dying daily. In order to thoroughly tackle this deadly virus, the knowledge of genomics, metagenomics, and pan genomics is required, not only to devise new treatment regimens but also to improve the present approaches. Understanding the genomic organization, diversity and structural complexity of this virus can help to figure out several previously unanswered questions. SARS-CoV-2 corona virus comprises of four major structural proteins, namely, the spike surface glycoprotein, tiny envelope protein, matrix protein, and nucleocapsid protein along with accessory proteins that contribute to pathogenesis and persistence of the virus in one way or the other. This chapter covers genomics, metagenomics, and pan-genomics-based strategies that can facilitate to figure the possible mutational recombination and trace the phylogenetic background of the species. Sequencing has been performed and the hence derived viral sequences have been deposited into exclusive repositories to speed up research and explore targeted treatment options. Moreover, immunoinformatics approaches and reverse vaccinology have been applied to speed up the process of formulating reliable, safe, and specific therapeutic options, rapidly. © 2023 Elsevier Inc. All rights reserved.

Potential impact of combined influenza and pneumococcal vaccines on the severity of respiratory illness in COVID-19 infection among type 2 diabetic patients.

To retrospectively assess the impact of regular yearly administration of recombinant influenza and single administration of pneumococcal conjugate vaccines on the occurrence of serious respiratory infection including COVID-19 in patients with type 2 diabetes mellitus. Hundred patients with type 2 diabetes mellitus were given Vaxigrip and Prevnar13® vaccines and were evaluated by comprehensive clinical review, airflow screening questionnaire, and routine laboratory investigations with follow-up during the COVID-19 pandemic and compared to a control group of diabetic patients with the same inclusion criteria (n = 100). After Vaxigrip and Prevnar13, there is a significant improvement in respiratory symptoms and a decrease in the airflow screening questionnaire (p = 0.0001) with a significant improvement in inflammatory parameters as neutrophil-lymphocyte ratio, ESR, CRP, and platelet count. Four patients had mild COVID-19 (4%), mainly gastrointestinal with no complications. Twenty-one out of 32 (65.6%) patients in the control group had severe COVID-19. The hazard ratios of significant respiratory tract infection and death due to COVID-19 were 2.29 and 10.24 in the non-vaccinated control (p = 0.001).The severity of COVID-19 in diabetes correlated with HBA1C (p = 0.007), combined Vaxigrip and Prevnar13 vaccination (p = 0.0001), serum creatinine (p = 0.001), neutrophil-lymphocyte ratio (p = 0.001), and thrombocytopenia (p = 0.003). The present study suggested that the combination of Prevnar13 and Vaxigrip may be related to decreased occurrence of serious respiratory infections including COVID-19. Further randomized control trials may be needed to establish a direct causation between the two and clarify these associations.

Assessment of Predictors of Mortality in COVID-19 Patients Treated with Tocilizumab

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.

Pattern of chest X-ray findings in Covid-19 patients admitted in Covid-19 unit, Sahiwal, Pakistan

Objective: To assess the pattern of chest X-ray findings in Covid-19 patients admitted in Covid-19 unit. Methodology: This retrospective cross-sectional study included COVID-19 positive patients admitted in COVID isolation unit, Government Haji Abdul Qayyum Hospital, Sahiwal from 15th March to 15th September 2020. Data of 89 COVID-19 RT-PCR positive patients were included. Frequency distribution with percentages were calculated for different demographic variables and chest X-ray findings using SPSS version 24. Results: Most common finding in chest X-ray was ground glass opacities seen in 71 (79.8%) patients followed by consolidation in 41 (46.1%). Pleural effusion was found in 19 (21.3%) patients and pneumothorax in one (1.1%). We found 13 (14.6%) patients had unilateral and 68 (76.4%) bilateral lung disease. Conclusion: Consolidation and peripheral ground glass opacities with bilateral lower zone involvement were the commonest abnormalities in chest X-ray of COVID-19 patients.

Risk factors for development of covid associated pulmonary aspergillosis in ICU population. An observational study from a large tertiary care hospital

Background: Covid associated pulmonary aspergillosis is a serious life-threatening infection which is increasingly being identified in severe covid pneumonia. There are multiple factors which predispose to this infection, still lot of research is needed to explore more about this infection Objective: Our aim of study was to find out risk factors associated with development of CAPA in severe covid pneumonia. Materials and methods: We prospectively enrolled 698 cases of severe covid pneumonia and aimed to identify risk factors associated with development of CAPA. We included only those who were PCR confirmed cases severe covid pneumonia requiring ICU admission with at least 48 hours of ICU stay. Infectious disease experts decided candidacy of Tocilizumab. CAPA cases were diagnosed according to ISHAM criteria for diagnosis of CAPA. Results: Out of 678 participants, 17.4% developed CAPA. Out of 17.4% cases of CAPA, 83.9% did not survive. Median ICU stay was 10 days. NUTRIC score and ICU days were identified as statistically significant risk factors for CAPA (OR: 2.1,1.2 p= 0.006, <0.001). Median NUTRIC score was 3. Tocilizumab prevents development of CAPA (OR: 0.09, p=< 0f.001). Conclusion: We concluded that NUTRIC score and ICU days are predisposing factors for CAPA in severe covid pneumonia. Tocilizumab has role in reducing CAPA infection in severe covid pneumonia.

Mechanistic Episodes on SARS-CoV-2 Mediated Neurological Manifestations and Their Possible Therapeutic Interventions

Recently, the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been critically recognized and spread rapidly on this planet. Considerable recognition of SARS-CoV-2 has been known with a range of viruses that are more capable to cause diseases in avian and mammals including humans. The virus was found as a main culprit for major defects in respiratory system and thereby caused severe acute respiratory syndrome disease. This has led to depict the mortality in human population. Nevertheless, compromised reports on SARS-CoV-2 has also shown neurological complications in both central nervous system (CNS) and peripheral nervous system (PNS). This virus has notified with neurological defects as stroke, encephalopathy, cerebral edema, erythema, seizures, meningitis, ischemic, agcusia, loss of smell, myalgia and Guillain Barre Syndrome. In this review, we focused on COVID-19 mediated neurodegerieration and its mechanistic episodes on affected patients. We also discuss the possible available therapeutic interventions with clinically investigated drugs against COVID-19 mediated neurological impairment in patients and experimental in vitro and in vivo research models required for the development of drugs and/or vaccines against COVID-19 mediated neurological complications.

The Impact of a Community Tour on Incoming Residents During Orientation at an Inner-City Hospital

Study Objective: Healthcare providers at inner-city hospitals face the unique challenge of learning how to care for disproportionately impoverished patient populations. We investigate the impact of an institution-wide community tour on incoming residents’ sense of preparedness to provide care to impoverished patients and their knowledge of social determinants of health. Methods: A two-hour voluntary bus tour of an inner-city hospital’s catchment area was offered to incoming residents during orientations in June 2016 and 2017. Residents visited a local school, healthcare clinic, needle-exchange program, police precinct, homeless shelter, and community park, among other locations. Pre-tour surveys were collected from individuals present at orientation, and post-tour surveys were collected from those who attended. A 5-point Likert scale questionnaire was used to gauge preparedness to work with impoverished patients and subjective knowledge of social determinants of health. Numerical values of 1 to 5 were designated as strongly disagree, disagree, neutral, agree, and strongly agree, respectively. Numerical values of 4 and 5 were deemed as “high.” A 9-option multiple choice question assessed objective knowledge of the hospital’s catchment area poverty rate. Fisher’s exact test was used to determine statistical significance. Results: 219 incoming residents completed the pre-tour survey, 91 demonstrated interest in attending the tour (41.6%), and 76 completed the post-tour survey. Of the 219 residents who completed the pre-tour survey, majority specialized in internal medicine (89, 40.6%), pediatrics (32, 14.6%), OMFS (25, 11.4%), transitional year (25, 11.4%), and emergency medicine (19, 8.7%);the remainder were psychiatry, OB-GYN, and general surgery. The majority of participants endorsed previous experience working with underserved populations (196 of 219, 89.5%). A significantly larger percentage of participants rated their preparedness to work with impoverished patients as “high” after the tour (63/76, 82.9%) than before (157/219, 71.7%) (Fisher’s exact test p = 0.0021). Similarly, a large fraction rated their knowledge of social determinants of health as “high” after the tour (64/76, 84.2%) than before (85/219, 38.8%) (Fisher’s exact test p < 0.0001). The percent of participants reporting the correct poverty rate significantly increased from 13/219 (5.9%) to 19/76 (25%) (Fisher’s exact test p < 0.0001). Conclusion: This study demonstrates that a community bus-tour of an inner-city hospital’s catchment area augmented incoming residents’ preparedness to work with an impoverished population and their knowledge of social determinants of health. As most participants demonstrated similar levels of preparedness and knowledge prior to the tour, it is likely that new physicians would benefit from direct exposure to their hospitals’ surrounding communities at the start of residency. As COVID-19 health measures are mitigated, residency programs should strongly consider tours or other community immersion experiences to assist with new residents’ knowledge and preparedness to care for their respective patient communities.

NASOPHARYNGEAL SPECIMEN COLLECTION FROM SUSPECTED COVID-19 CASES, MAKING THE PROCEDURE SAFE

Objective: To comparison was made between standard (control group) nasopharyngeal sample collection technique for RT-PCR and modified technique and the outcome was compared in terms of the proportion of positive results of Rt-PCR tests. Study Design: Double blinded randomized clinical trial. Place and Duration of Study: Pakistan Naval Ship Shifa Hospital Karachi Pakistan, from June and July 2020. Methodology: This study was a newly developed modified technique for nasopharyngeal sampling for RT-PCR tests of COVID-19 suspects. Target population included all patients who developed COVID-19 related symptoms and/or also had history of recent travel or closed contact with Covid-19 patients. Total 1500 nasopharyngeal PCR tests were done by a team of trained technicians. Systemetic probability sampling technique was utilized. Subjects were divided into two groups by using even and odd serial numbers. Proportion of positive test results were compared between two groups by using chi square test. Results: Results were collected for 3000 nasopharyngeal swab sample for RT-PCR testing. Mean age was 31.68 ± 11.89 years. In study group with modified technique, 470 tests were found positive for a total of 1500 samples while only 297 out of 1500 samples were detected positive in control group with standard technique. Chi square test applied to assess the difference between this proportion and it proved that the difference was highly statistically significant (p-value <0.00). Conclusion: we interpret that modified samples collection technique is relatively safe for sample collector of Covid-19 PCR which has got potential benefits to get more genuine results of these samples. © 2021, Army Medical College. All rights reserved.

Non-Invasive Ventilation versus Invasive Mechanical Ventilation: Results from a Tertiary Care Hospital

Objective: To compare the patient outcome in severe COVID-19 pneumonia between the non-invasive ventilation and invasive mechanical ventilation. Study design: Prospective, observational study Study Setting and Duration: Department of Pulmonology, Bahawal Victoria Hospital, Bahawalpur from January 2021 to June 2021. Methodology: We analyzed 660 patients of severe covid pneumonia. Conscious proning was done in those requiring ≥ 21 L oxygen and oxygen saturation < 90%. We defined typical ARDS according to Berlin criteria. Atypical ARDS did not fulfill set criteria. We divided ARDS into 2 types i-e H and L type. We managed ARDS with either NIV, invasive mechanical ventilation or both. We used multiple regression analysis to predict ICU stay. Results: Out of 660 patients, 285 (43.18%) developed biPAP failure and were subsequently intubated. We observed 273 (41.4%) overall mortality, 175 (64.1%) in IMV and 98 (35.9%) in the NIV group (p<0.0001). invasive mechanical ventilation had statistically significant correlation with mortality and also predicted ICU stay. (p=< 0.001, OR 3.2, p=0.001). Conclusion: NIV therapy is superior to invasive mechanical ventilation in terms of ICU stay and outcome.

The Development of Robot Control via Virtual Reality for Safe Human-Robot Interaction

In Human-Robot Interaction (HRI) domain the prime focus is laid on the safety of the involved humans. High inertias, velocities and extensive work envelop, particularly of most of the currently used industrial robots, are reasons for the hazards associated with the interaction of humans with robots. Several strategies are being investigated for ensuring safety which includes lightweight robots (LWR), force-limiting control, start-stop monitoring, speed limiting mode, etc. These approaches often require a range of hardware peripherals to be incorporated within and around the robotic system. Alternatively, the use of Virtual Reality (VR) systems to interact with otherwise dangerous robots allows for contactless interaction. In this paper we present a Virtual Reality based arrangement that allows the interaction with the robot from distance, in a virtually created environment, to ensure human safety. Keeping in view the frequent requirements of changes in robot’s movement plan, the proposed scheme demonstrates the capability of programming these plans in the virtual environment as well. We have shown the results of controlling a real robot in VR and the root mean square error (RMSE) between the two joint angles of the real and the virtual robot is 2.61 degrees and 3.08 degrees. This leads to remote/tele-control of the robot which is one of the future demands considering the social impact of COVID-19. © 2021. Pakistan Journal of Engineering and Applied Sciences. All Rights Reserved.

Outcomes of patients undergoing emergency surgery during the first phase of national lockdown in the United Kingdomdue to COVID-19 pandemic: Experience at A District General Hospital

Introduction: This study aimed to assess the impact of the COVID-19 pandemic on emergency operations during the first phase of lockdown in the United Kingdom, compared to the equivalent population in the same calendar period in 2019 Method: We retrospectively reviewed patients undergoing surgery in emergency theatres at our district general hospital between March 23rd and May 11th in 2019 and 2020. Data collected included demographics National Confidential Enquiry into Patient Outcome and Death (NCEPOD) category and procedure. The primary outcome was 90-day post-operative mortality;secondary outcomes included time to intervention and length of inpatient stay Result: 132 patients (2020) versus 141 (2019) patients were included with no significant difference in age (P=0.676), sex (P=0.230), or overall 90-day postoperative mortality (P=0.196). Notably, time to intervention was faster for NCEPOD code 3 patients in 2020 than 2019 (P=0.027) Time to intervention in 2020 was longer for those dying within 90 days post-operatively compared to survivors (P=0.02). There was no difference in length of stay between years, both overall and when comparing subgroups by NCEPOD category or procedures (fractured neck of femur (P=0.776), laparoscopies (P=0.866), laparotomies (P=0.252)), except for upper limb trauma (P=0.007) Conclusion: This study is amongst the first describing the general case mix in emergency theatres in the UK. Patient pre-operative characteristics and demographics did not change. Our data confirms patient prioritisation according to NCEPOD recommendations and streamlining of surgical services, with no difference in overall mortality time to intervention or length of stay compared to 2019 Take-home Message: At this district general hospital, patients were appropriately prioritised, and our results show adaptation of hospital practice to emerging national guidelines during the first phase of lockdown A national validation audit assessing morbidity and mortality outcomes for all NCEPOD patients may be facilitate further understanding of risks posed to patients requiring urgent surgery during these unprecedented times .

Restrictions and Driving Forces for Renewable Energy Production Development and Electrical Energy Demand in General and During COVID-19

The adoption of green energy policies is paid regard to as a major driver for renewable energy production development (REPD) in terms of fossil fuel combustion and the reduction of gas emissions. However, besides several challenges including energy sustainability, global warming and environmental pollution, COVID-19 arose in 2019 has a considerable impact on the REPD, companies and supply chains and decelerated the transition to the sustainable energy world. The industrial and commercial electrical energy users are imposed to restrict their operation during the COVED-19 outbreak In this regard, this paper examines and investigates the impacts of restrictions and driving forces for the REPD and electrical energy demand in general and during COVID-19. The most critical factors for barriers and driving forces for the REPD have been examined and discussed in detail. Some important statistical data for investments in the energy sector and energy demand before and during COVID-19 have been addressed in detail.

Academic Impact on Emergency Medicine Training Programs During COVID-19 Pandemic

Background: Rapid spread of the Novel Coronavirus Disease (COVID-19) resulted in a global pandemic. As front-line health care workers, this crisis significantly affected emergency medicine residents and their respective programs. We sought to explore the impact of COVID-19 on the education and training of emergency medicine residents across the United States and Puerto Rico. Methods: A survey was sent out to Accreditation Council for Graduate Medical Education (ACGME) accredited United States and Puerto Rico emergency medicine residency programs (264 programs at the time) via email correspondence to the Program Directors and the Program Coordinators. The survey stratified program type (practice setting, length of training, institution type, moonlighting allowed) and impact of COVID-19 on residents (off-service rotations, weekly conferences, effect on research, and resident wellness initiatives). Comparison was made by United States and Puerto Rico regions divided by Northeast, South, Midwest, and West, as these closely correlated with the differences in areas of COVID-19 spread and saturation. REDCap was used as the platform for data capture. Results: A total of 134 emergency medicine residency programs completed the survey. Northeast (44%), South (26%), Midwest (17%) and West (13%) programs by regions were reviewed. Overall, the majority of programs were in an urban setting (70%), and academic practice comprised 58%, followed by community at 40% (p=NS). The curriculum was a 3-year format for 71% of the programs (p=0.002). Overall half of the programs stated their institution was declared a site of pandemic emergency status by the ACGME, with 70% in Northeast and 39% of the Midwest, followed by the West and South regions (p=0.011). The impact of COVID-19 on off-service rotations for the emergency medicine residencies was not significant;Northeast had a high impact in 34% of the programs, moderate impact for Midwest (35%) and minimal impact in the South (34%) and West (29%) programs. Weekly lectures were switched to virtual format and smaller groups. Of note, clinical research for prospective studies was negatively impacted throughout all the regions (p=0.034), however retrospective studies were not affected. Additionally, 88% of programs reported changes since the start of COVID-19 to assure residents with new initiatives and activities such as improving wellness and reducing burnout and stress. Conclusions: The COVID-19 pandemic impacted the training of emergency medicine residents in various aspects. Northeast programs were more affected compared to the other regions. Weekly didactic sessions largely transitioned to a virtual format and/or small group sessions. Off-service rotations overall were not significantly affected. Retrospective clinical research continued while there was a substantial disruption in prospective research projects. Finally, a positive outcome was the increased awareness to changes in improving resident well-being overall.

COVID-19 pandemic did not affect emergency theatre patient demographic and length of stay in the first phase of UK countrywide lockdown in a district general hospital.

INTRODUCTION: We aim to identify any changes in outcome for patients undergoing nonelective surgery at the start of the UK pandemic in our district general hospital. This was a single-centre retrospective cohort review of a UK district general hospital serving a population of over 250,000 people. METHODS: Participants were all patients undergoing a surgical procedure in the acute theatre list between 23 March to 11 May in both 2019 and 2020. Primary outcome was 90-day postoperative mortality. Secondary outcomes include time to surgical intervention and length of inpatient stay. RESULTS: A total of 132 patients (2020) versus 141 (2019) patients were included. Although overall 90-day postoperative mortality was higher in 2020 (9.8%) compared with 2019 (5.7%), this difference was not statistically significant (p=0.196). In 2020, eight patients tested positive for COVID-19 either as an inpatient or within 2 weeks of discharge, of whom five patients died. Time to surgical intervention was significantly faster for NCEPOD (National Confidential Enquiry into Patient Outcome and Death) code 3 patients in 2020 than in 2019 (p=0.027). There were no significant differences in mean length of inpatient stay. CONCLUSIONS: We found that patients were appropriately prioritised using NCEPOD classification, with no statistically significant differences in 90-day postoperative mortality and length of inpatient stay compared with the 2019 period. A study on a larger scale would further elucidate the profile and outcomes of patients requiring acute surgery to generate statistical significance.

Virtual visits during COVID-19 pandemic;a pediatrician'sperspective

Telehealth is an expanding eld and facilitates the ability to connect with the patients, when physicalencounters are not possible. However, its use in pediatric services remains limited. In light of the COVID-19pandemic, telehealth is the only available option to provide continuity of care. American Academy of Pediatricsalso has issued guidance in order to ensure continued care for children during this crisis. We assess thefeasibility of web-based platforms and explore the challenges and barriers to telehealth implementation in asmall primary care setting. Methods A video-conference using web-based applications is used for historytaking and visual examination to assess child activity in a pediatric practice serving over 400 children. Weasked parents to rate their experience and degree of satisfaction. Results We summarize our experienceintegrating telehealth technology into the practice of pediatrics: Limited Evaluation;Although telehealth maybe equivalent to face-to-face evaluation in many regards;it lacks the opportunity to perform a physicalexamination. This is particularly concerning in examining children with medical complexities. It is therefore important to pre-screen which children should be seen, in person. Time Management: The visits often exceedtime allotted particularly in infants and younger children. Initially it took signicant time to obtain andadequate history. We started pre-brieng regarding virtual visit and what to expect. Technical Challenges: Lackof familiarity with telehealth and the equipment is an important challenge, particularly in disadvantagedpopulation. Physicians also facing technical issues as there was insufficient time to prepare. Concern for Over-treatment: The treatment may simply be based on symptoms such as child touching the ears and attributed tootitis media;or a fever and cough may be treated as pneumonia. Also, because of the ambiguity of thesituation, many parents may simply prefer to obtain a prescription for an antibiotic, or other medications.Threat to Privacy: This issue is more relevant to the adolescent. We believe adolescents would be betterserved, if they were permitted to use their personal cell phone. Reimbursement: An inadequatereimbursement is a most important issue. For sustainability, a sincere effort is needed to establish adequatepayment mechanism for telehealth services. Liability Issues: Since telehealth mediated medical care is limitedregarding a physical examination, physicians are anxious whether they are missing certain importantdiagnosis. This raises a concern for medicolegal liability. There is a need to set clear guidelines for liabilityprotections. Conclusion Although telehealth is widely accepted by the parents, it is important to understandthe limitations of telehealth. The nature of such limitations should be conveyed to parents. Since the health ofchildren cannot wait for a normalization of health care delivery;we need to be able to modify, adapt and try todo what is feasible.

SARS - CoV-2, Pandemic COVID 19: A Brief Review

As a novel coronavirus now known as SARS-COV-2 first reported in Wuhan china in late December 2019, the severe corona respiratory syndrome (SARS-CoV) is responsible for an acute human respiratory syndrome and is linked to Wuhan wholesale sea food market. The virus spread rapidly involving whole country and with span of three months WHO had to declare it as pandemic. Although its origins are not entirely understood, these genomic analyses suggest that SARS-CoV-2 probably evolved from a strain found in bats. SARS-COV-2 is zoonotic but human-to-human transmission is also possible. Surveillance and phylogenetic researches indicate SARS-CoV-2 to be closely associated with bats' corona viruses, suggesting bats as reservoirs, although unconfirmed. With no vaccine currently available for SARS-COV-2 nor approved prophylactics, its global spread to over 150 countries with high virulence highlights its role as ongoing public health threat. An articulated action plan ought to be taken, preferably from a One Health perspective, for appropriately advanced counter measures against COVID 19.

Role of Social Media in Diagnosis and Management of COVID-19;An Experience of a Pulmonologist

COVID-19 is the recent and one of the severe pandemic faced by the whole world. No country was left without feeling its wrath. Due to blurred picture regarding the pathogenesis of this disease it posed a great (treatment) challenge for healthcare professionals all over the world and particularly the challenge was even greater in Pakistan, Such situation in Pakistan aroused mainly due to controversial isolation/quarantine and burial policy by Government, misconception and rumors among public about COVID-19 and social stigma attached with a COVID-19 positive case, As a result majority of patients with mild and moderate disease started avoiding Government and private hospitals. Only severe cases of COVID disease with respiratory insufficiency presented in emergency department. In order to prevent conversion of mild and moderate cases into severe ones, the Pulmonology team of Sahiwal Medical College Sahiwal utilized Social Media tools (Whatsapp and Facebook Messenger) for telemedicine to address medical issues of the vast majority. This methodology was also adopted to make timely diagnosis of severe cases for prompt medical attention and prevention of spread of disease by advocating social distancing and masking.