Role of awake prone positioning in patients with moderate-to-severe COVID-19: an experience from a developing country.

There is limited evidence on the efficacy of awake prone positioning (PP) in non-ventilated patients with COVID-19 who have hypoxemia. We, therefore, aim to describe our experience with the use of early proning in awake, non-intubated patients with confirmed COVID-19. In our retrospective observational study, 23 patients with confirmed positive PCR test results for Severe Acute respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and hypoxemia that required oxygen therapy with or without non-invasive ventilation were treated with PP. Patients were classified into mild, moderate and severe COVID-19 disease. There were no targeted number of hours for proning per day and patients were kept in prone position according to their tolerance. The primary outcome measure was the avoidance of intubation and secondary outcomes were in-hospital mortality, length of hospital stays and complications related to PP. The mean (standard deviation) age of our cohort was 54.5 (11.7) years, and the majority were males (21/23, 91.3%). Sixty-one per cent (14/23) of the patients were suffering from severe disease and 82.6% (19/23) had bilateral lung involvement with interstitial infiltrates. Majority of the patients were prone positioned for a median of 6 days (IQR 4 - 8). Only one patient required transfer to ICU for mechanical ventilation and subsequently died due to severe ARDS. All 22 patients showed progressive improvement in oxygen requirement and PF ratio, mostly after 3-5 days of proning. The mean length of hospital stay was 12 days. All patients, except one, were discharged in stable conditions, on room air or on a minimal oxygen requirement of 1-2 liters. No major complication of PP was recorded. Awake prone positioning is a valuable and safe therapeutic adjunct that can be applied in patients with moderate-to-severe COVID-19. It can also be included in the home-based management protocols of COVID-19 to improve patient outcomes and mitigate the burden on health care facilities.

COVID-19 Associated Interstitial Lung Disease - An Emerging Entity (preprint)

Background: COVID-19 disease associated pulmonary sequalae has been increasingly reported after recovery from acute infection. Therefore, we aim to explore the charactersitics of interstitial lung disease in patients with COVID-19.Methods: An observational study was conducted in patients with COVID-19 associated ILD from April 2020 till September 2020. Patients ≥18 years of age with COVID-19 who were diagnosed with ILD based on respiratory symptoms and HRCT chest imaging after the recovery phase of COVID-19 infection were recruited. Data was recorded on a structured proforma, and descriptive analysis was performed using Stata version 12.1.Results: A total of 30 patients with COVID-associated ILD were identified. The mean age of patients was 59.14 (SD 12.60) and 27 (90%) were males. Four HRCT patterns of interstitial lung disease were seen; organizing pneumonia in 10 (33.33%), non-specific interstitial pneumonitis in 17 (56.67%), usual interstitial pneumonitis in 12 (40%) and probable usual interstitial pneumonitis in 14 (46.67%). Diffuse involvement was found in 15 (50%) patients, while peripheral predominance in 15 (50%) and other significant findings were seen in 8 (26.67%) patients. All patients were treated with corticosteroids. The case fatality rate was 16.67%. Amongst the survivors, 8 (32%) recovered completely, 9 (36%) improved, while 8 (32%) patients had static or progressive disease.Conclusions: This is the first study from Southeast Asia that identified COVID-associated interstitial lung disease in patients who had no pre-existing lung disease, highlighting the importance of timely recognition and treatment of an entity that might lead to fatal outcome.

Awareness of COVID-19: What do Pakistanis perceive? A Large Survey of 1200 Residents (preprint)

Background: The Novel Coronavirus Disease (COVID-19) has created havoc globally as countries worldwide struggle to combat this pandemic. Since prevention and social isolation are known to be the only ways to prevent the spread of COVID-19, this has created challenges among the lower-middle income countries (LMIC) including Pakistan, as it battles between an under-resourced healthcare, an economic shutdown, and widespread myths and misconceptions. Therefore, we conducted a study to evaluate the knowledge, attitude and perceptions regarding COVID-19 as public understanding is vital to help facilitate the control of this outbreak. Methods: : A pre-validated online questionnaire was distributed among the general population of Pakistan from 1 st to 12 th June 2020. Descriptive statistics were analyzed using SPSS v25. Adequate knowledge was assigned as a score of >4 (range: 0-8) and good perception as a score of >3 (range: 0-5). Chi‑square test was used to determine the significance of difference in knowledge and perception of COVID-19 among socio-demographics. Logistic regression analysis was run to identify factors associated with adequate knowledge and perception. P < 0.05 was considered as significant. Results: : A total of 1200 respondents participated in this study with a wide range of age groups and education. Majority of the respondents had adequate knowledge (93.3%) with a mean score of 6.59 ± 1.35, and good perception (85.6%) with a mean score of 4.29 ± 0.82. Significant differences in knowledge and perception were observed among genders, age groups, education and between students and employees in the healthcare and non-healthcare department. A multivariable analysis revealed an advanced degree and a female gender to be significant predictors of adequate knowledge and perception. Conclusions: : Albeit the surge of COVID-19 cases in Pakistan, the participants demonstrated an overall adequate knowledge and good perception towards COVID-19. Perhaps, a potential hint towards noncompliance practices in following preventive protocols requires further educational interventions that target safe health practices and complications of this infection.