Clinical features, diagnosis and management of COVID-19 patients in the outdoor setting

In a brief span of a few months, coronavirus disease (COVID-19) pandemic has brought a major paradigm shift in operation of clinical services around the world. Infection may be mild, moderate or severe; many remain asymptomatic. High burden of non-communicable and communicable diseases theoretically puts Pakistani population at increased risk of severe COVID-19 infection. Considering the universal risk of infection, the outpatient services in Pakistan need to be redesigned. Starting with risk assessment of the facility and provision of a dedicated telephone connection, structure and workflow need to be redesigned in order to minimise risk of exposure to healthcare professionals, staff and patients. Patients with COVID-19 patients should be identified before they arrive in the facility and should be served expeditiously, in an environment which prevents cross-transmission of infection. Tele-consultation is assuming an important role. Changes which are taking place in response to Covid-19 pandemic will have far reaching effects on clinical services in Pakistan

Dynamics of Particles Around a Schwarzschild-like Black Hole in the Presence of Quintessence and Magnetic Field

We investigate the dynamics of a neutral and a charged particle around a static and spherically symmetric black hole in the presence of quintessence matter and external magnetic field. We explore the conditions under which the particle moving around the black hole could escape to infinity after colliding with another particle. The innermost stable circular orbit (ISCO) for the particles are studied in detail. Mainly the dependence of ISCO on dark energy and on the presence of external magnetic field in the vicinity of black hole is discussed. By using the Lyapunov exponent, we compare the stabilities of the orbits of the particles in the presence and absence of dark energy and magnetic field. The expressions for the center of mass energies of the colliding particles near the horizon of the black hole are derived. The effective force on the particles due to dark energy and magnetic field in the vicinity of black hole is also discussed.Comment: 25 pages, 17 figures, accepted for publication in the European Physical Journal

Pneumonia caused by nocardia caviae in a healthy neonate

Nocardia infections have been associated with patients of Aids, chronic granulomatous disease, recipient of organ transplant and malignancy Pulmonary nocardiosis in neo­nates is an unusual infection. A case of neonatal pulmonary nocardiosis mimicking miliaiy tuberculosis has been reported in the past. We report another case of pulmonary nocardiosis in a neonate presenting as consolidation with pleural effusion and cavitation

Primary IgA and IgG subclass deficiency in a 17-year-old Pakistani girl: a case report

Primary immunodeficiency disorders pose a diagnostic dilemma for physicians in the developing countries such as Pakistan because of lack of adequate diagnostic facilities. We present here the case of a 17-year-old girl who had a history of recurrent respiratory tract infections since childhood and had been treated with anti-tuberculous medications thrice; for a total of 24 months. She had also received multiple courses of antibiotics. Her initial presentation to our hospital was with acute bronchopneumonia. Her past medical history of recurrent infections also alerted the treating physician to the possibility of bronchiectasis secondary to a variety of underlying potential pathologies such as post-infection, immunodeficiency syndromes or ciliary dyskinesia disorders. Cystic fibrosis was also an important consideration. Direct enquiry revealed that there was no history of consanguineous marriage in her parents. Her sweat chloride test was within normal range (<40 mmol/L). Blood analysis was performed which showed IgA, IgG2 and IgG4 deficiency. She has been following up at our hospital for the past few years. In that course of time, she has had multiple episodes of pneumonia, gastroenteritis and maxillary sinusitis. She was successfully treated with intravenous immunoglobulins on four occasions when she presented with systemic crisis secondary to severe systemic infection. She also developed biopsy proven intermediate grade non-Hodgkin’s lymphoma five years after the diagnosis of immunoglobulin deficiency was first made. This appeared to be a complication of her immunodeficient state. She has been receiving chemotherapy for the lymphoma. Physicians should be cognizant of the morbidity that primary immunodeficiency syndromes such as immunoglobulin deficiency can have in the form of multiple infections and increased risk of malignancies as seen in our patient