Effects of COVID-19 Severity on Serum Calcium Levels

Background: The hypocalcaemia may be a unique biochemical feature of COVID -19 that has the potential to influence disease severity and represents a new potential therapeutic target worth testing in this clinical setting. Because COVID -19 testing has primarily focused on individuals with respiratory symptoms rather than calcium levels, Therefore the objective of current study was to determine the effect of e COVID-19 severity on Serum calcium levels. Methods: After the ethical approval, all the RT-PCR positive patients from the record of corona isolation wards of Ganga Ram hospital Lahore. Demographic details including name, age, gender, complete history & examination serum Calcium level was noted recorded al from hospital files on a predesigned proforma. To assess clinical severity of coronavirus disease, all the enrolled patients' disease category as mild, moderate, severe & critical was note. Data was analyzed using SPSS-26. Association between age and gender between disease severity was determined by using Chi-square test. Binary logistic regression was applied to find out the effect of disease severity on serum calcium levels. P-value less than 0.05 were considered to be significant. Results: 555 patients were enrolled in the current study. The mean ages of patients were 38.34+14.86. There were 300(54.1) male and 255(45.9) female, the severity of the disease shows that the majority 490(88.3%) of the patients had mild disease and 65(11.7%) had moderate disease. The mean serum calcium level was 8.7+0.34. The majority of patients had mild disease, of which 270 were female and 220 male and 230 among 31-50 years. The results of binary logistic regression show the effect of disease severity (Mild, Moderate) on calcium, age and gender. It was reported that only serum calcium, male gender and age category 30-50 years were a significant predictor of disease severity. Conclusion: It was concluded from current study that majority of patients have mild disease severity and patients have normal serum calcium. The disease severity has no significant impact on the calcium levels as the majority of patient has mild disease.

Evaluation Liver Function Test Abnormalities in Covid-19 Patient in Tertiary Care Hospital, A Cross Sectional Study

Since late December 2019, a novel coronavirus illness (COVID-19) outbreak has been detected in Wuhan, China, affecting 215 nations so far. Although respiratory symptoms are the most common symptom in COVID-19 patients, several extra pulmonary organ dysfunctions have also been observed. Previous investigations have found that individuals with COVID-19 had a high incidence of aberrant liver function parameters. The objective of current study will be to evaluate the effect of effects of covid-19 severity on liver function test and hypocalcaemia. Material and Methods: A cross-sectional study conducted at Corona Isolation Wards of Sir Gaga Ram Hospital Lahore from April to June 2019. Total 110 RT PCR Positive Covid-19 patients were enrolled in current study by consecutive sampling technique. The Demographic details, Disease severity, Laboratory Findings of Liver Function Test (LFTs) and outcome of every patient was recorded from on a predesigned proforma. Data was analyzed using SPSS-26. ANOVA was applied to find out the difference between disease severity LFTs level. P-value less than 0.05 considered as significant. Results: The patients' average age was 30.03+15.03. The average length of stay in the hospital was 14.76+2.77 days. There was predominance of Male in current study male [M=60(54.5%) vs. F=50(45.5%)]. There are 48 (43.6%) patients with mild disease, 28 (25.5%) patients with moderate disease, and 34 (30.9%) patients with severe disease. Only 2(1.8%) patients died, while 102(92.7%) patients recovered. The most common symptom experience by patients was Fever, followed by Cough (32), Fatigue (29), Diarrhea (17), sore throat (18). A significant increase was observed in ALT, AST, ALP, Serum Bilirubin, Total Protein, Albumin and Globulin according to disease severity (p-value<0.05) Conclusions: The abnormal liver function test was shown to be more common in moderate to severe cases. The severity of COVID-19 has a major impact on the liver's functional outcome.

Comparison of Clinical and Laboratory Features in RT-PCR Positive and RT-PCR Negative Covid-19 Patients Admitted in High Dependency Unit in a Tertiary Care Hospital, SGRH, Lahore

Introduction: Corona virus disease 2019 (COVID-19) is currently diagnosed mainly using reverse transcriptase polymerase chain reaction (RT-PCR). Yet a significant proportion of patients have negative RT-PCR result. A comparative study of RT-PCR negative patients with RT-PCR positive patients will help understand clinical characteristic and differences of this diseased population. Objective: To compare the clinical and laboratory features of RT-PCR Positive and RT-PCR negative patients admitted in high dependency unit. Patients and methods: In this retrospective cohort study, the data of 128 patients (59 patients with RT-PCR positive result and 69 patients with RT-PCR negative results) was obtained. These patients had been admitted in high dependency unit of a community hospital. Demographics, clinical characteristics and laboratory abnormalities were noted and a comparison was done using statistical analysis. Results: In our study-total 128 patients were enrolled out of which 68 (53.1%) were males and 60 (46.9%) were females. 59 (46.1%) patients were RT-PCR positive and 69 (53.9%) patients were RT-PCR negative. Median age was 55.34 years (18 to 95). No significant difference was noted in most of clinical symptoms (fever, sputum production, rhinorrhea, dyspnea, myalgia, nasal congestion, vomiting, diarrhea, urinary symptoms, altered level of consciousness), comorbidities (diabetes mellitus, hypertension, prior lung disease, prior ischemic heart disease, prior kidney disease), laboratory abnormalities (elevated creatinine, elevated liver enzymes, elevated ferritin, elevated C-reactive protein, elevated d-dimers, elevated procalcitonin, abnormal electrocardiogram). Cough was significantly found to be more prevalent in RT-PCR positive patients (p=0.042) and severe disease was also more prevalent in these patients significantly (p=0.000). Conclusion: Our study shows that patients admitted and diagnosed to be suffering from COVID-19 infection had remarkable similarities in clinical features and laboratory parameters regardless of RT-PCR status, however RT-PCR positive patients suffered from more severe pneumonia as compared to RT-PCR negative patients.

Parenting Practices during COVID-19 in Pakistan

Objective: The current study intends to look at how COVID-19 pandemic affected parenting practices during COVID-19 in Pakistan and if the children were exposed to more abuse and neglect at home. Study Design: A quantitative design survey. Place and Duration of the Study: Data was collected from parents visiting outpatient departments (OPDs) in four hospitals of Lahore, Peshawar, and Karachi in three months from July to September 2020. Material and Methods: A quantitative design survey was used, and data (N=923) were collected using a self-administered COVID-19 Parenting Response Scale (α = 0.74). Results: The primary responsibility of taking care of children rested with mothers in most of the cases. Ratio of severe disciplinary practices like shouting, yelling, cursing, and slapping children was increased significantly during the lock down as the anger and frustration in the parents also mounted. This effect was more pronounced in families from lower socioeconomic groups as well as for those who suffered income loss during COVID-19. Conclusion: Financial and emotional stress caused by COVID-19 exacerbated the already difficult parenting practices. Ultimately children suffered more violence at the hands of parents. In Pakistani society there is little awareness on building one‟s capacity on good parenting and little availability of such trainings. There is a need to understand implications for good parenting and create awareness of positive parenting methods.

Effect of COVID-19 on the Screen Time of the Children in Pakistan

Objectives: This study intended to look at how people were receiving information on COVID-19, how children spent time during the COVID-19 pandemic and if the screen time for children had increased during the pandemic. Study Design: The study was descriptive in nature and a quantitative Place and Duration of the Study: Data was collected from parents visiting OPDs in four hospitals of Lahore, Peshawar and Karachi in three months from July to September 2020. Material and Methods: Quantitative survey design was used, data (N=923) were collected using self-administered scale and checklist. Results: Most of the information about COVID-19 was received either through TV (50.8%) or through online social media (33.6%). Most children were spending their time either playing (32.2%) or watching cartoons/movies (19.6%). Screen time of children in the lockdown period was increased. 87.4% children used screens for at least 2 hours per day during the lock down whereas 69.1% used screen for more than 2 hours before COVID-19. Most often used devices were mobile/tablet/PC in 64.2% whereas TV was viewed 34.9% of the time. Conclusion: Most COVID-19 related information was gathered online, and a large proportion of children spent their time in front of screens. There is a need to understand the serious implications of increased screen time for children and to develop effective strategies to reduce screen time of the children.

Stabilising Critically Ill Children;improving confidence within the anaesthetics team at a small district general hospital

Background and Aims: Paediatric emergencies occur infrequently at our district general hospital in North West England. Debrief following one such case revealed low confidence was common amongst anaesthetists and operating department practitioners (ODPs) regarding their role in stabilising critically ill children. This project aimed to explore and address factors influencing confidence in responding to paediatric emergencies within our team. Methods: All anaesthetists and ODPs in our department were invited to respond to an online survey regarding their confidence and experience in the stabilisation of critically ill children. This survey also explored respondents' perceived training needs in this aspect of their clinical remit. In response to the findings of our initial survey, a multi-modal, multi disciplinary teaching package was designed and implemented. This included a (covid-secure) virtual pre-recorded lecture, interprofessional simulation and provision of credit-card sized 'quick reference' cards. Following its implementation, a further survey was undertaken to assess the effectiveness of this training intervention. Results: Respondents included all grades of anaesthetists and ODPs. 50% rated their confidence in paediatric emergencies at 5/10 or lower on a Likert scale. 65% had attended 5 or less paediatric emergencies in their current role. 85% expressed interest in attending training in stabilisation of critically ill children, tailored to their role. 100% of those who engaged with our new training initiative reported improved confidence following this intervention. Conclusions: Infrequent clinical exposure to paediatric emergencies resulted in low confidence amongst anaesthetists and ODPs within our department, in the stabilisation of critically ill children. Remedial action in the form of a specially designed training package was successful. To mitigate the longterm effects of infrequent clinical exposure to paediatric emergencies, periodic in-situ multidisciplinary simulation training in conjunction with continued access to our virtual seminar, may prove useful. [Figure Presented].

Mitigating surgical emergency practice during COVID-19 pandemic?

PURPOSE: To define the change in Emergency Surgical Unit (ESU) workload during the COVID-19 pandemic. METHODS: Patient data for a three-week period was prospectively collected for ESU patients during lockdown period and compared to the ESU workload for the same time period prior to lockdown. RESULTS: Surgical emergencies admissions reduced by 2.5 times during our study period (p value = 0.001). In this changed paradigm, the overall number of surgical emergencies were reduced. A high mortality (n = 4, 5.7%) was noted during lockdown period as compared to pre-lockdown period (n = 1, 0.58%, p value = 0.025). Almost half of surgical admissions were tested for COVID-19 based on their symptoms and more than third (n=14, 38.9%) of them were positive. Gastrointestinal symptoms were common in COVID-19 positive group (85.7%) and only a third (36%) of COVID-19 positive patients needed surgical attention. Chest x-ray findings were comparable to PCR testing in terms of sensitivity and specificity but CT chest was more sensitive. CONCLUSIONS: It remains unclear how COVID-19 reduced surgical emergencies. A significant proportion of COVID-19 presented with gastrointestinal symptoms. In a new outbreak all General Surgical patients should be tested with CRP and WCC used as a triage adjunct. KEY WORDS: Coronavirus, COVID-19, Emergency Surgery Pandemic, General Surgery. SCOPO DELLO STUDIO: È di definire la variazione del carico di lavoro dell’unità chirurgica di emergenza (ESU) durante la pandemia COVID-19 sono stati raccolti prospetticamente i dati dei pazienti per un periodo di tre settimane per i pazienti dell’unita di emergenza chirurgica durante il periodo di blocco e confrontati con il carico di lavoro della stessa Unità per lo stesso periodo di tempo prima del blocco. RISULTATI: I ricoveri per emergenze chirurgiche si sono ridotti di 2,5 volte durante il nostro periodo di studio (valore p = 0,001). In questo scenario cambiato, il numero complessivo di emergenze chirurgiche si è ridotto. Durante il periodo di blocco è stata osservata un’elevata mortalità (n = 4, 5,7%) rispetto al periodo di preblocco (n = 1, 0,58%, valore p = 0,025). Quasi la metà dei ricoveri chirurgici sono stati controllati per COVID- 19 in base ai loro sintomi e più di un terzo (n = 14, 38,9%) è risultato positivo. I sintomi gastrointestinali erano comuni nel gruppo positivo per COVID-19 (85,7%) e solo un terzo (36%) dei pazienti positivi per COVID-19 necessitava di cure chirurgiche. I risultati della radiografia del torace erano paragonabili al test PCR in termini di sensibilità e specificità, ma la TC del torace era più sensibile. CONCLUSIONI: Non è chiaro come COVID-19 abbia ridotto le emergenze chirurgiche. Una percentuale significativa di COVID-19 presentava sintomi gastrointestinali. In una nuova epidemia tutti i pazienti di chirurgia generale dovrebbero essere testati con CRP e WCC usati come coadiuvanti del triage.

Mitigating surgical emergency practice during COVID-19 pandemic?

PURPOSE: To define the change in Emergency Surgical Unit (ESU) workload during the COVID-19 pandemic. METHODS: Patient data for a three-week period was prospectively collected for ESU patients during lockdown period and compared to the ESU workload for the same time period prior to lockdown. RESULTS: Surgical emergencies admissions reduced by 2.5 times during our study period (p value = 0.001). In this changed paradigm, the overall number of surgical emergencies were reduced. A high mortality (n = 4, 5.7%) was noted during lockdown period as compared to pre-lockdown period (n = 1, 0.58%, p value = 0.025). Almost half of surgical admissions were tested for COVID-19 based on their symptoms and more than third (n=14, 38.9%) of them were positive. Gastrointestinal symptoms were common in COVID-19 positive group (85.7%) and only a third (36%) of COVID-19 positive patients needed surgical attention. Chest x-ray findings were comparable to PCR testing in terms of sensitivity and specificity but CT chest was more sensitive. CONCLUSIONS: It remains unclear how COVID-19 reduced surgical emergencies. A significant proportion of COVID-19 presented with gastrointestinal symptoms. In a new outbreak all General Surgical patients should be tested with CRP and WCC used as a triage adjunct. KEY WORDS: Coronavirus, COVID-19, Emergency Surgery Pandemic, General Surgery.

Can HbA1c levels be used as an independent marker of mortality and morbidity risk in patients with COVID-19 positive swabs?

Background: Diabetes mellitus has been considered a significant risk factor for morbidity and mortality for COVID-19.1 HbA1c levels are often used as a marker of poor glycaemic control and are one way of diagnosing pre-diabetes as well as diabetes.2,3 We tried to explore whether HbA1c levels could be an independent risk factor for mortality and morbidity in patients with positive coronavirus (SARS-COv-2) swabs. Methods: This was a retrospective multicentre study of coronavirus swab positive patients who had a recent HbA1c test. Their demographic data, medical history, COVID-19 swab and laboratory results, and final outcomes were analysed. Patients were divided into three groups;HbA1c in normal (group 1), pre-diabetic (group 2) and diabetic (group 3) ranges. Data were analysed using JASP and statistical computation using a χ2 test. Results: A total of 1,226 patients had SARS-CoV-2 RNA identification swabs between 10 February 2020 and 1 May 2020. A cohort of 120 of these patients had positive swab results and recent HbA1c results. Mortality rates for group 1 (normal HbA1c) and 3 (diabetic HbA1c) were relatively higher than group 2 (pre-diabetic HbA1c). Among group 2, female patients had greater mortality, perhaps because of fewer male patients, although overall co-morbidity was less (4/120 (3.33%) in group 2 compared with 18/120 (15%) in group 1 and 14/120 (11.66%) in group 3. Overall, 36/120 (30%) patients died and 84/120 (70%) survived. Survival curves after analysis of data showed that increasing HbA1c levels were associated with poorer outcomes across all groups. Analysis was significant with p=0.003. Conclusions: HbA1c levels in this study were an independent marker of increased risk of mortality in COVID-19 swab positive patients. The findings are statistically significant (p=0.003). Increased co-morbidities at normal HbA1c seem to have a contributing role in enhanced mortality.

Formally identifying COVID-19 patients for providing medical services using drones

The Internet of Things (IoT) is an emerging technology that allows connecting physical devices that are linked to the internet across the world to communicate and share information. Drones are flying objects without any human pilot. In many countries, drones are being used for the fast delivery of packages or products. Nowadays the whole world is fighting against the COVID-19 pandemic which is a viral disease that can be spread by the interaction of people. To fight against this pandemic, the drone's technology can be very effective to minimize the interaction of people. There exists little research work in this area because this virus has been introduced recently in 2019. In this paper, we have proposed an IoT-based model in which wearable sensors are used that will be able to identify COVID-19 patients by monitoring the temperature and respiratory system of the people. After confirmation of identification, the control room will send an alert message and sends medical kits to the residence of the patient through drones. The UML (Unified Modeling Language) is used for the representation and flow of the system. models of the proposed system is specified using Vienna Development Method-Specification language (VDM-SL). VDM-SL toolbox is used to ensure the correctness of the models. © 2021 IEEE.

Kidney damage by COVID-19 and rationale for extracorporeal therapies

Without doubt, there is some involvement of the kidney in novel coronavirus disease (COVID-19), which is responsible for multiple organ dysfunctions resulting in severe complications in the human body. This newly discovered COVID-19 has incited panic globally. However, the role of kidney involvement in the novel COVID-19 disease is still unclear. In this commentary, we discuss the various pathways involved in kidney damage by COVID-19, and the rationale for extracorporeal support with various blood purification strategies in critically ill people with COVID 19.

Probiotics: Helpful for the prevention of COVID-19?

Up to now, no vaccine has been developed for COVID-19 treatment. Although many scientists are working for the rapid development of a vaccine to control this pandemic, nonetheless, it will take time. If the vaccine will be developed soon, it will not be available to the entire world instantly since the mass production of the vaccine will take time. In this scenario, we will have to take alternative measures to control the COVID-19 pandemic. These alternative approaches include the stimulation of the immune system to fight against viral infections. Among the different approaches to strengthen the immune system, the use of probiotics is the best one. Probiotics can help the body to fight against COVID-19 directly and indirectly. In this review, we comprehensively discuss the use of probiotics for the prevention and control of COVID-19.

Policy brief on child protection during covid-19 crisis in pakistan

Children are not the face of the COVID-19 pandemic;however, they are considered its “biggest victims” and the ensuing crisis is likely to have a profound effect on their wellbeing. The “secondary pandemic” of economic depression is going to affect the children most because of its socio-economic fallout and at times, due to the measures being taken to mitigate the impact of the pandemic. Children in low and low-middle income countries like Pakistan are expected to be the worst affected in the post COVID-19 crisis. Lockdowns and school closures are adversely affecting the families, resulting in extreme poverty, learning crisis due to insufficient resources for online education, and lack of access to health care along with a plethora of child protection issues. This policy brief is prepared by Child Rights Committee of Pakistan Pediatric Association and PAHCHAAN (Protection and Help of Children Against Abuse and Neglect) and endorsed by Pakistan Pediatric Association. It provides an in-depth analysis of the challenges that the children are facing and likely to face as an aftermath of COVID-19 crisis, in terms of their health and nutrition, education, and protection. This policy brief identifies a series of recommendations and suggested immediate actions to be taken by the government and policymakers focusing attention to issues related to child rights and services in COVID-19 crisis. It suggests training and awareness programs for parents, teachers, social workers, other care givers, and duty bearers. It also suggests an easy access to online education facilities and support of COVID-19 prevention and response measures for children and their families. This policy brief urges the government to scale up social protection mechanisms. It urges the stakeholders to seek additional ways to protect children from violence in their homes as well as to help shield children from the psychological impact of the pandemic. Children are our future and we are obligated to provide them with all their rights as enshrined in the United Nation’s Convention on the Right of the Child. © 2020, Pakistan Pediatric Journal. All rights reserved.