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Aim: To determine the intraoperative Ramsay sedation score after dexmedetomidine infusion in patients undergoing perineal surgery. Study design: Descriptive study. Place and duration of study: Department of Anaesthesia, JPMC, Karachi from 13th February 2021 to 13th August 2021. Methodology: One hundred and seventy four patients who met the diagnostic criteria were enrolled. Result(s): The mean age was 46.51 years with the standard deviation of +/-10.87. 66 (37.9%) were male and 108 (62.1%) were female. Whereas, mean duration of surgery, Ramsay sedation score at 5 minutes, 15 minutes, 30 minutes, height, weight and BMI in our study was 1.41+/-0.40 hours, 1.72+/-0.44, 3.51+/-0.60, 4.57+/-0.62, 165.62+/-8.23 cm, 68.34+/-8.23 kg and 24.85+/-3.34 kg/m2 respectively. Conclusion(s): Intraoperative dexmedetomidine proved beneficial in perineal surgeries and could be served as a potent sedative drug.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.
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Background: COVID-19 is still going on with lots of uncertainties. There is a need for early and effective marker for prognostication of COVID-19 patients. Coagulation dysfunction and increased D-dimer levels are seen in this disease. Thus, present study was aimed to compare D-dimer value in relation to disease severity and disease mortality, and to evaluate prognostic significance of D-dimer. Method(s): All symptomatic SARS-CoV-2 RT-PCR confirmed COVID-19 patients admitted in Hospital from March 31, 2021, to May 31, 2021 were evaluated and clinical, demographical and laboratory findings were collected and analysed. According to disease severity patients were grouped and death events and D-dimer value were assessed. Optimal D-dimer cut off point in all groups were evaluated. Result(s): 388 patients were included in the study out of which 142 (36.5%) died during hospital stay. Mean D-dimer value in mild disease was 1.17+/-0.21, moderate disease was 1.47+/-0.17 and in severe disease was 2.92+/-0.23 FEUmicrog/ml. Mean D-dimer value in non-survivors were significantly (P<0.001) different and higher (59.3%) as compared to survivors. ROC curve analysis showed a prognostic value of D-dimer in mild (AUC=0.755, Z=3.30, P=0.001), moderate (AUC=0.762, Z=4.65, P<0.001) and severe (AUC=0.694, Z=5.08, P<0.001) patients. Optimal cut off of D-dimer between survivor and non survivors was >0.78 in mild cases, >1.05 in moderate patients and >2.11 in severe cases. Conclusion(s): Mean D-dimer value showing increasing trend with increase disease severity and prognostic significance was found highest in moderate patients followed by mild patients and least in severe patients in terms of mortality.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.
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The COVID-19 pandemic has impacted the world in an unpredictable way, affecting economic, socio-cultural, political, environmental statuses and billions regardless of privilege and wealth. Vaccines were developed quickly, for protection against the Coronavirus, as well as to curb the pandemic. This study aimed to (1) compare awareness about risks and benefits of getting vaccinated against COVID-19, (2) compare the confidence in usage of vaccines for protection against the COVID-19 (3) determine the association between awareness about risks and benefits of the COVID-19 vaccine and confidence in getting it among selected undergraduate students in the Faculty of Health Sciences in Malaysia, Pakistan and UAE. A quantitative cross-sectional study was carried out using an online validated questionnaire with a 3-point Likert scale, which consisted of three domains, namely sociodemographic, awareness on risks and benefits of the vaccine, and confidence in getting the vaccine. Subjects were Faculty of Health Sciences' undergraduate students from three institutions;one each in Malaysia, Pakistan and UAE, that were recruited through non-probability sampling techniques;convenience and snowball sampling. The subjects' obtained scores on awareness and confidence from each country were averaged, and then compared between the countries using One-Way-ANOVA. Pearson's correlation was used to determine the association between awareness and confidence of the students. All data were analyzed using SPSS version 27.0. A number of 405 students from the three countries;Malaysia (142), Pakistan (124) and UAE (139) participated in this study. One-Way-ANOVA showed that students in Pakistan scored the highest mean awareness with a 1.55 ± 0.23 score, followed by UAE (1.53 ± 0.29) and Malaysia (1.49 ± 0.19). For confidence, students in Malaysia scored the highest mean confidence with a 1.25 ± 0.25 score, followed by Pakistan (1.24 ± 0.31) and UAE (1.20 ± 0.23). Pearson's correlation showed that there was a statistically significant association (p < 0.001, r = 0.442) between the students' awareness (1.52 ± 0.24) and confidence (1.23 ± 0.26) of getting COVID-19 vaccines. The study found that students in Pakistan had the highest awareness, followed by UAE and Malaysia. Whereas students in Malaysia had the highest confidence followed by Pakistan and UAE. There was a significant association found between the students' awareness regarding the benefits and risks of COVID-19 vaccines and their confidence in getting it. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Since its sudden outbreak in December 2019 in Wuhan, A pandemic of SARS-CoV-2 has been announced. Vitamin C is a water-soluble vitamin with anti-oxidant and immunity-boosting properties. Vitamin C acts as a nutritional supplement profoundly impacting the immune response to the second or third wave of the coronavirus disease (COVID-19). Vitamin C efficacy as an adjuvant treatment for inflammation and symptoms associated with COVID-19 infection should be investigated further. This report sheds light on the available information on the current clinical trials and pharmacotherapy related to COVID-19. Information available on Pubmed, EMBASE, Scopus, Web of Science databases and EU clinical trials regarding the use of therapeutic agents in patients with COVID-19 was used to perform analysis. Data was taken from 18 clinical trials available in the U.S. National Library of Medicine. All trials that are active, completed, or in the process of recruiting are included in data. Because of majority of clinical trials are still ongoing, specific results and high-quality clinical evidence are lacking. Before being standardised for use, the protocol must undergo large randomised clinical studies using a variety of existing medications and potential therapies. The pivotal role played by vitamins C in maintaining our immune system, is quite apparent. This review is an attempt to summarize the available information regarding the use of vitamin C as an adjuvant therapy in Covid -19 patients.
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Objective: To determine the frequency of myocarditis in patients recovered from COVID-19 infection. Study Design: Analytical Cross-sectional study. Place and Duration of Study: Cardiac Magnetic Resonance Imaging Department, Armed Forces Institute of Cardiology/ National Institute of Heart Disease (AFIC/NIHD), Rawalpindi Pakistan, from Jul 2020 till Apr 2022. Methodology: All patients who underwent Cardiac Magnetic Resonance Imaging after recovery from COVID-19 were enrolled. Non-probability consecutive sampling technique was used for sample selection and was calculated on the basis of G-power. Data of patients fulfilling the inclusion criteria was selected. All PCR positive cases of COVID-19 who recovered from COVID-19 and completed their 12 days of isolation not exceeding 60 days of 1st Polymerase chain reaction positive, and who have any symptoms of shortness of breath, fatigue and chest pain with reduced left ventricular ejection fraction (LVEF) on 2D-echocardiogram were included in the study. Data was recorded, stored, and analyzed by using SPSS version-21. Quantitative data was reported as Mean±SD. Categorical variables were reported as frequency and percentage. To determine the association between different variables Chi square test was used. Results: A total 83 patients were included in this study who recovered from COVID-19 and underwent Cardiovascular magnetic resonance. Mean age of the patients was 39.17±12.9 years. 67(80.72%) were male while 16(19.28%) were females. 50(60%) had myocarditis after recovery from COVID-19. This study showed statistically significant association of all the Cardiovascular magnetic resonance imaging findings with Myocarditis (p<0.05) at 95% confidence interval and 5% margin of error. Conclusion: Early detection of COVID-19 related myocarditis will help in better management of patient. In such patients, cardiac Magnetic Resonance Imaging is the modality of choice, since it allows for noninvasive assessment of myocardial edema and fibrosis, as well as therapeutic guidance and improved patient outcomes. © 2022, Army Medical College. All rights reserved.
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COVID-19 pandemic hit the world bringing socio-economic and cultural shutdown of activities. The curse was a blessing to the environment in terms of significant air quality improvements. The study uses geospatial technology for assessing the reduction in nitrogen dioxide (NO2) levels and aerosol optical depth (AOD) levels using satellite-based (Sentinel-5P TROPOMI and MODIS data, respectively) and ground-based (Central Pollution Control Board, etc.) observations of 2019 and 2020. The study examines the lockdown period-wise reductions in ambient air pollution in the Delhi Region- the capital of India. It was investigated that satellite observations recorded a reduction of 51% in NO2 during lockdown phase-1 as compared to the pre-lockdown phase in 2020. When compared with 2019, the maximum reduction of 66.5% was seen in the lockdown phase-1, with p < 0.001. The ground-based stations also showed a 61% reduction in daily NO2 during lockdown phase-1 and phase-2 as compared to 2019. There is a drop in AOD by 55, 24 and 30% in lockdown phase-1, lockdown phase-2 and lockdown phase-3 w.r.t. pre-lockdown phases. However, an increase of 30% is observed during the post-lockdown phase of 2020 w.r.t. pre-lockdown phase. Ground-based stations ascertained that the reduction of 66, 60, 53 and 14% was observed in 2020 in the lockdown phases 1, 2 and 3 and post-lockdown phase w.r.t. pre-lockdown phase of 2020. Additionally, there is a 14, 56, 41, 39 and 3% reduction during the pre-lockdown, lockdown 1, lockdown 2, lockdown 3 and post-lockdown phase of 2020 w.r.t. similar periods of 2019. It was highlighted that environmental degradation can be mitigated with such stringent measures by policymakers from time to time to protect the deteriorating environment. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Objective The objective of this study was to assess the attitude and hesitancy toward vaccine against COVID-19 in a Pakistani Population. Materials and methods A mix-method, prospective study was conducted and adults (aged ≥18 years) residing in Pakistan were invited to participate. The questionnaire was prepared, hosted in Google Forms and circulated through electronic platforms and was also available to be done in in-person. Data was compiled from 15th September to 30th November 2020. Results The response rate was 80%. A total of 1003 participants were included in the final analysis. Of them, 75% completed survey questionnaire online, while remaining 25% responded in-person. The mean age of the participants was 29.62 ± 10.47 years. The majority of participants were females;60.9% (n = 611). 57.02% (n = 572) of the participants were employed at the time of survey. Overall, 70.68% (n = 709) of the participants had previous experience of vaccines such as the flu vaccine Only 4.9% (n = 49) participants thought that they will be seriously ill from COVID-19 within six months and 39% (n = 392) participants were confident that they will get COVID-19. A total of 71.29% of the participants reported they would consider getting vaccinated once available. There was statistical association between gender and getting vaccinated (P < 0.001). Conclusion This study demonstrated that majority of the participants showed positive attitude toward considering COVID-19 vaccine. However awareness with informed knowledge of efficacy, possible adverse effects and cost would be of added great value to increase the real response of Pakistani population toward COVID-19 vaccination.
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Background The mechanisms and outcomes in COVID-19- associated stroke are unique from those of non-COVID-19 stroke. Objectives The purpose of this study is to describe the efficacy and outcomes of acute revascularization of large vessel occlusion (LVO) in the setting of COVID-19 in an international cohort. Methods We conducted an international multicenter retrospective study of consecutively admitted COVID-19 patients with concomitant acute large vessel occlusion (LVO) across 50 comprehensive stroke centers. Our control group constituted historical controls of patients presenting with LVO and receiving a MT between January 2018 to December 2020.Results: The total cohort was 575 patients with acute LVO, 194 had COVID-19 while 381 patients did not. Patients in the COVID-19 group were younger (62.5 vs. 71.2;p<0.001), and lacked vascular risk factors (49, 25.3% vs. 54, 14.2%;p =0.001). mTICI 3 revascularization was less common in the COVID-19 group (74, 39.2% vs. 252, 67.2%;p < 0.001). Poor functional outcome at discharge (defined as mRS 3-6) was more common in the COVID-19 group (150, 79.8% vs.132, 66.7%;p =0.004). COVID-19 was independently associated with a lower likelihood of achieving mTICI 3 (OR: 0.4, 95% CI: 0.2 -0.7;p<0.001), and unfavorable outcomes (OR: 2.5, 95% CI: 1.4 - 4.5;p=0.002). Conclusion COVID-19 was an independent predictor of incomplete revascularization and poor outcomes in patients with stroke due to LVO. COVID-19 patients with LVO patients were younger, had fewer cerebrovascular risk factors, and suffered from higher morbidity/mortality rates. (Figure Presented).
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Objective: To evaluate the prevalence and diagnostic significance of anosmia and ageusia among COVID-19 positive patients of Karachi, Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Dr Ruth K. M. Pfau Civil Hospital, (Dow University of Health Sciences), Karachi Pakistan, from Jan 2021 to Feb 2021. Methodology: The data were collected prospectively from 265 COVID-19 positive patients. Some patients were interviewed over the telephone, while for patient's ease, an online Google form was also formed, facilitating the online data collection. The patient's demographics, comorbidities, allergies, and COVID-19 associated characteristics were inquired. The statistical analysis was performed on SPSS version 23. Results: The observed frequency of anosmia and ageusia in COVID-19 patients was 49.1% & 43.8% respectively. The median time to recovery was 8-8.5 days (median) for both symptoms. We found no significant difference for gender, BMI, marital status, residential area, comorbidities and reason for long-standing breathing difficulties between patients with or without both anosmia and ageusia (p>0.05). Furthermore, most of the cigarette smokers reported none of the two symptoms (anosmia and ageusia), 24% and 25.2% of COVID-19 positive cases with smoking history were presented without anosmia and ageusia, respectively (p<0.05). Conclusion: Loss of sense of smell and taste was reported in almost half of the studied population infected by the SARS-CoV-2 virus. Therefore, screening for anosmia and ageusia must be considered while COVID-19 suspicion as an important diagnostic clue. © 2021, Army Medical College. All rights reserved.
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Objective: To evaluate and compare the impact of COVID-19 pandemic on admission rates and mortality in patients presenting with ST elevation myocardial infarction (STEMI) to a tertiary care cardiac setup in Pakistan. Study Design: Comparative cross-sectional study Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD) Rawalpindi, from Apr to May 2020. Methodology: All ST elevation myocardial infarction patients presenting to our hospital for two months (April, May) during COVID-19 pandemic were studied. Similar patients were also analyzed from pre-COVID era for an equivalent period. Para-meters compared include total number of ST elevation myocardial infarction patients, age, gender, door to balloon (DTB) time, MI type (anterior versus non-anterior) and prognosis in terms of mortality. Categorical variables are presented as absolute numbers and percentages and compared by chi-square test. Odds ratio was determined to study the impact of COVID-19 pandemic on ST elevation myocardial infarction mortality. SPSS-23 was used for all the analysis. Results: We observed a significant 43% reduction in the total numbers of ST elevation myocardial infarction admissions compared to equivalent time before pandemic. There was a decrease in patients >75 years of age (4.1%, p-value 0.007), decrease in female patients (21.7%, p-value 0.001), mild improvement in door to balloon (1.3%, p-value 0.4), increase in anterior MI (1.2%, p-value 0.7). The ST elevation myocardial infarction case fatality rate during the pandemic increased from 4-7.1% (Odds ratio 1.81, confidence interval 1.01 to 3.24, p-value 0.04). Conclusion: Although ST elevation myocardial infarction admissions decreased after COVID-19 but there was a paradoxical increase in mortality. Late presentation to hospital due to contagion fear, various lockdown measures, unavailability of public transport, economic instability may be some of the contributing factors, in addition to the COVID-19 infection itself, that need to be studied further. © 2021, Army Medical College. All rights reserved.
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Objective: To determine frequency of myocarditis in COVID-19 patients. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology-National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi and Pak Emirates Military Hospital (PEMH), Rawalpindi, from Dec 2020 to May 2021. Methodology: A total of 143 hospitalized patients who had tested positive for COVID-19 infection via RT-PCR were included in the study. Patients with pre-existing cardiac conditions were excluded. All patients underwent transthoracic echocardiography and their ejection fractions were recorded. Meticulous testing for the inflammatory markers including CRP, serum ferritin, procalcitonin and interleukin-6 (IL-6) and cardiac biomarker (NT-pro-BNP) was carried out. The data was recorded on a specially designed questionnaire and later transferred to SPSS-23 for analysis. Myocarditis was diagnosed on the basis of reduced Ejection Fraction or raised NT pro BNP or both in a person without any known cardiac pathologies before getting COVID-19. Results: Out of total 143 COVID-19 patients included in the study, 24 patients (16.8%) developed myocarditis. The frequency of myocarditis in COVID-19 positive male population was 14.6% (10.5% of all myocarditis cases) and that of female population was 22.5% (6.3% of all myocarditis cases). The raised pro-inflammatory markers IL-6 and CRP were significantly associated with development of myocarditis while ferritin was not significantly associated. Only 28% of the study population recovered and got discharged from the hospital, however, there were no survivors among those who developed myocarditis. Conclusion: Myocarditis is a serious complication of COVID-19 and directly linked to increased mortality risk. There is an increasing need to perform serial assays for the inflammatory as well as cardiac biomarkers including IL-6, Trop-I and NT-pro-BNP for early detection and prompt treatment of this not so uncommon complication. © 2021, Army Medical College. All rights reserved.
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The novel Coronavirus Disease 2019 (nCOVID-19) pandemic is a global health challenge, that requires collaborative efforts from multiple research communities. Effective screening of infected patients is a significant step in the fight against COVID-19, as radiological examination being an important screening methods. Early findings reveal that anomalies in chest X-rays of COVID-19 patients exist. As a result, a number of deep learning methods have been developed, and studies have shown that the accuracy of COVID-19 patient recognition using chest X-rays is very high. In this paper, we propose an attention based deep neural network for classifying the COVID-19 images, and extracting useful clinical information. Generative adversarial network is used to generate the synthetic COVID-19 images, as well as a good latent representation of both COVID-19 and normal images. Experiment results on public datasets shows the effectiveness of the proposed approach. © 2021 IEEE.
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Objective: To evaluate the radiographic patterns in COVID associated pneumonia in a tertiary care hospital of Karachi. Study Design: Analytic study Place and Duration of Study: This study was conducted in specifically designed COVID wards and HDU in Dow University Hospital, Karachi between 1st June 2020 to 15th July 2020, by reviewing the admission records of COVID diagnosed patients. Materials and Methods: A total of 150 patients presented with pulmonary symptoms were evaluated for chest radiographs. Results: Out of 150 COVID detected patients, 80 were males (53.33%) and 70(46.66%) were females with a mean age of 51.14±15.96 years. Frequent radiographic patterns were diffuse infiltrates occupying more than half lung field 56(37.33%), diffuse infiltrates less than half of lung field 45 patients (30%), lobar pneumonia in 9(6%) and cardiomegaly with basal infiltrates were observed in 7 patients (4.6%). Dominant symptoms were shortness of breath on exertion 105 patients (70%), fever 60(40%). The most common signs observed were hyperventilation 105(70%) and crepitation’s 30(20%). The most common comorbidities observed in the study were Uncontrolled Diabetes 114(74%), Hypertension 76(50.6%), and ischemic heart disease 52(34.66%). Conclusion: The majority of COVID detected with pneumonia were male, common radiographic patterns were pulmonary infiltrates. Lobar pneumonia and pleural effusion were rare findings and typically seen in severe disease where patients need mechanical ventilation. © 2021 Medical Forum Monthly. All rights reserved.
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Objective: The objective of this study was to assess the attitude and hesitancy toward vaccine against COVID-19 in a Pakistani Population. Materials and methods: A mix-method, prospective study was conducted and adults (aged ≥18 years) residing in Pakistan were invited to participate. The questionnaire was prepared, hosted in Google Forms and circulated through electronic platforms and was also available to be done in in-person. Data was compiled from 15th September to 30th November 2020. Results: The response rate was 80%. A total of 1003 participants were included in the final analysis. Of them, 75% completed survey questionnaire online, while remaining 25% responded in-person. The mean age of the participants was 29.62 ± 10.47 years. The majority of participants were females; 60.9% (n = 611). 57.02% (n = 572) of the participants were employed at the time of survey. Overall, 70.68% (n = 709) of the participants had previous experience of vaccines such as the flu vaccine Only 4.9% (n = 49) participants thought that they will be seriously ill from COVID-19 within six months and 39% (n = 392) participants were confident that they will get COVID-19. A total of 71.29% of the participants reported they would consider getting vaccinated once available. There was statistical association between gender and getting vaccinated (P < 0.001). Conclusion: This study demonstrated that majority of the participants showed positive attitude toward considering COVID-19 vaccine. However awareness with informed knowledge of efficacy, possible adverse effects and cost would be of added great value to increase the real response of Pakistani population toward COVID-19 vaccination.
Objetivo: El objetivo de este estudio fue evaluar la actitud y la renuencia hacia la vacuna frente a la COVID-19 en una población paquistaní. Materiales y métodos: Se realizó un estudio prospectivo de método mixto, invitándose a participar a personas adultas (edad ≥18 años) residentes en Paquistán. Se preparó el cuestionario, que se alojó en Google Forms y se hizo circular a través de plataformas electrónicas, pudiendo realizarse también de manera personal. Los datos se recopilaron desde el 15 de septiembre al 30 de noviembre de 2020. Resultados: La tasa de respuesta fue del 80%. El análisis final incluyó un total de 1.003 participantes, de los cuales el 75% completó el cuestionario-encuesta online, mientras que el 25% respondió en persona. La edad media de los participantes fue de 29,62 ± 10,47 años. La mayoría de los participantes eran mujeres: el 60,9% (n = 611). El 57,02% (n = 572) de los participantes tenía empleo en el momento de la encuesta. En general, el 70,68% (n = 709) de los participantes tenía experiencia previa sobre vacunas tales como la vacuna frente a la gripe. Solo el 4,9% (n = 49) de los participantes pensaba que padecerían la COVID-19 de forma grave en el plazo de seis meses, y el 39% (n = 392) de los participantes estaba seguro de que se contagiaría de dicha enfermedad. El 71,29% de los participantes reportó que consideraría recibir la vacuna una vez que se dispusiera de la misma. Existió una asociación estadística entre el sexo y el ser vacunado (P< 0,001). Conclusión: Este estudio demostró que la mayoría de los participantes mostró una actitud positiva hacia la consideración de la vacuna frente a la COVID-19. Sin embargo, la concienciación sobre el conocimiento informado de la vacuna, los posibles efectos adversos y el coste supondrían un gran valor añadido al incremento de la respuesta real de la población paquistaní hacia la vacuna frente a la COVID-19.
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Purpose: This study aimed to find the factors that affected the usage of OFD platforms during the emergent situation of the COVID-19 pandemic. Design/Methodology/Approach: The extended valence framework and UTUAT2 model were integrated to develop a parsimonious model comprising trust, perceived risk, performance expectancy, habit, and buying intention. The model was tested by employing structural equation modeling with a sample of 362 respondents from India. Findings: The relationship between trust and buying intention was found to be the strongest amongst all factors. All modeled predictors of trust were found to impact trust significantly, while perceived risk was found to have an inverse relation with trust. Research Limitations/Implications: The constructs presented in the model successfully explained the factors that impacted OFD platforms during the COVID-19 pandemic. The understanding of consumers’ responses developed in the study is a useful addition to the literature. Practical Implications: The study provides direction to promoters and marketers of OFD platforms to identify specific factors that can help boost the buyers’ intention to purchase during emergency situations. Originality/Value: The integration of two theoretical models: The extended valence framework and UTUAT2 is unique in the context of OFD platforms. The COVID-19 situation and circumstances therein provide a unique research situation for an improved understanding on the subject. © 2021, Associated Management Consultants Pvt. Ltd.. All rights reserved.
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BACKGROUND: We aim to study the utility of Google Trends search history data for demonstrating if a correlation may exist between web-based information and actual coronavirus disease 2019 (COVID-19) cases, as well as if such data can be used to forecast patterns of disease spikes. PATIENTS & METHODS: Weekly data of COVID-19 cases in Pakistan was retrieved from online COVID-19 data banks for a period of 60 weeks. Search history related to COVID-19, coronavirus and the most common symptoms of disease was retrieved from Google Trends during the same period. Statistical analysis was performed to analyze the correlation between the two data sets. Search terms were adjusted for time-lag over weeks, to find the highest cross-correlation for each of the search terms. RESULTS: Search terms of 'fever' and 'cough' were the most commonly searched online, followed by coronavirus and COVID. The highest peak correlations with the weekly case series, with a 1-week backlog, was noted for loss of smell and loss of taste. The combined model yielded a modest performance for forecasting positive cases. The linear regression model revealed loss of smell (adjusted R(2) of 0.7) with significant 1-week, 2-week and 3-week lagged time series, as the best predictor of weekly positive case counts. CONCLUSIONS: Our local analysis of Pakistan-based data seemingly confirms that Google trends can be used as an important tool for anticipating and predicting pandemic patterns and pre-hand preparedness in such unprecedented pandemic crisis.
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Objectives: MMA embolization has emerged in recent years as a safe and minimally invasive treatment for a chronic subdural haematoma. We report the first UK series of endovascular treatments of chronic subdural haematomas. Design: Prospective case series. Subjects: All adult patients referred with minimal midline shift (≤8 mm) and GCS ≥14/15 were considered. Patients had to be mobile with a standard origin of Middle Meningeal and Ophthalmic arteries. Patients with GCS ≤13 or profound weakness (MRC grade ≤3) were treated with Burr hole drainage and placement of subdural drains. Methods: Patients were recruited over a 7-month period from 25/10/2020 to 25/05/2021 through our electronic referral system. Patients' demographics, pre-morbid modified Rankin Score (mRS), symptoms, anticoagulation, and co-morbidities were prospectively collected. Suitability for endovascular treatment was discussed with the Neurovascular radiologist and neurosurgeon. SQUID-12 embolic material was used for all MMA embolizations which were performed under General Anaesthetic. Baseline CT/MRI characteristics were collected. Further imaging was obtained at 7, 21, 90, and 180 days. Clinical assessment and mRS were completed at three months. Results: Ten patients underwent endovascular embolization of MMA in the study period. Of these eight were male, the median age was 79 years. The median length of stay was 3 days. Follow-up CT at 3 weeks, obtained for 6/10 patients, has demonstrated significant reduction in both midline shift (μ = 3.3 mm, p = 0.0019) and maximum thickness of haematoma (μ = 5.8 mm, p = 0.0055). At the time of submission, five patients had reached the three months' follow-up period, of which, three had a complete radiological resolution, with a further patient observed to have >50% improvement in CT parameters. We report one mortality due to COVID-19. Conclusions: For select patients, MMA embolization is a safe, minimally invasive, and effective treatment for a chronic subdural haematoma. As we gain more experience, the procedure could be performed under local anaesthetic.