Paediatric Contacts of Adult COVID-19 Patients: Clinical Parameters, Risk Factors, and Outcome

Background. There is insufficient data in Pakistan and in South Asia regarding paediatric COVID-19 demographics and related parameters. The main aim of this study was to assess the paediatric population exposed to SARS-CoV-2 infection, their clinical parameters, risk factors, and outcome. Methods. This was a descriptive retrospective study conducted at the Pakistan Institute of Medical Sciences and Federal General Hospital Islamabad from 23rd July 2020 to 22nd August 2020. All paediatric contacts (≤13 years) of one hundred adult COVID-19 patients were included. Data of the index cases was taken from the medical records. Paediatric data was collected on the phone using a predesigned proforma. Results. There were 137 paediatric contacts of 100 adult COVID-19 index cases. The index cases were predominantly males (67%) and belonged to the middle socioeconomic class (89%), and 14% succumbed to the disease. Females had more paediatric contacts. The mean age of contacts was 6.6 years, and the majority (80%) developed no symptoms. Among the symptomatic contacts, fever and cough were the most common symptoms. None of the contacts developed dyspnoea or required hospitalization. Majority of the contacts had been vaccinated with the BCG vaccine. Testing for COVID-19 was done in only 77 (56%) contacts, 25 (32%) by the government team, and 52 (67%) privately. A higher number of symptomatic contacts were positive (15/17 (88%)) as compared to that of the asymptomatic contacts (6/60 (10%)) (p = 0:002). Development of symptoms in the contacts was associated with the history of respiratory illnesses, recurrent infections, use of hematinics, a positive COVID-test result, and health professionals being index cases (p ≤ 0:01). Parents with higher education and in the health profession and the families of symptomatic contacts reported better compliance with quarantine regulations. Conclusion. A significant number of children were exposed to adult COVID-19 patients. Most paediatric contacts remained asymptomatic. Children with preexisting medical conditions and with parents in health profession were susceptible to infection.publishedVersio

A Rare Case of Thiamine Responsive Megaloblastic Anemia Presenting with Seizures

Thiamine responsive megaloblastic anemia (TRMA) also known as Rogers syndrome is a rare entity inherited as an autosomal recessive disorder. It consists of a pentad of diabetes-mellitus, megaloblastic anemia, thrombocytopenia, leukopenia and sensory-neural hearing loss. The defect occurs due to mutations in SLC19A2 gene resulting in the deficiency of a thiamine transporter proteins which prevents the transport of thiamine in to the cells and tissues. Here we report a 13 year old boy with megaloblastic anemia, sensory-neural deafness and young onset diabetes mellitus who presented with generalized tonic-clonic seizures. Diagnosis was based on clinical features and a rapid response to thiamine replacement with adequate control of seizures. This clinical entity and its association with epilepsy is extremely rare and must be thought of amongst the differentials of megaloblastic anemia and epilepsy. This rare case emphasizes the unique association of TRMA with epilepsy. Early diagnosis and management with thiamine drastically improves anemia, seizure control and blood glucose levels. To the best of our knowledge, it is the first case report of TRMA with epilepsy from Pakistan

Hemichorea Associated with type 2 Diabetes: A Rare Neurological Complication

Diabetic hemichorea/hemiballism is a spectrum of hyper kinetic, involuntary, irregular, purposeless, non-rhythmic, rapid and unsustained movements flowing from one part of the body to another. It involves contra lateral basal-ganglia and often striatum of the brain. Here we are reporting an un-usual case of choreiform movement disorder which was sudden in onset. It was accompanied with abnormally high values of blood glucose. Our patient had a complete remission of symptoms after an adequate control of blood glucose was achieved. This case illustrates the importance and rarity of hyperglycemia as a rare cause of hemichorea. It recovers rapidly and has a good prognosis. Screening for hyperglycemia even in those patients without a prior history of diabetes is very important, once they present with an involuntary movement disorder. Recognition and early treatment is beneficial to prevent adverse outcomes. Today, in the medical literature it is often referred to as C-H-BG (chorea, hyperglycemia, basal ganglia) syndrome

Paediatric Contacts of Adult COVID-19 Patients: Clinical Parameters, Risk Factors, and Outcome

Background. There is insufficient data in Pakistan and in South Asia regarding paediatric COVID-19 demographics and related parameters. The main aim of this study was to assess the paediatric population exposed to SARS-CoV-2 infection, their clinical parameters, risk factors, and outcome. Methods. This was a descriptive retrospective study conducted at the Pakistan Institute of Medical Sciences and Federal General Hospital Islamabad from 23rd July 2020 to 22nd August 2020. All paediatric contacts (≤13 years) of one hundred adult COVID-19 patients were included. Data of the index cases was taken from the medical records. Paediatric data was collected on the phone using a predesigned proforma. Results. There were 137 paediatric contacts of 100 adult COVID-19 index cases. The index cases were predominantly males (67%) and belonged to the middle socioeconomic class (89%), and 14% succumbed to the disease. Females had more paediatric contacts. The mean age of contacts was 6.6 years, and the majority (80%) developed no symptoms. Among the symptomatic contacts, fever and cough were the most common symptoms. None of the contacts developed dyspnoea or required hospitalization. Majority of the contacts had been vaccinated with the BCG vaccine. Testing for COVID-19 was done in only 77 (56%) contacts, 25 (32%) by the government team, and 52 (67%) privately. A higher number of symptomatic contacts were positive (15/17 (88%)) as compared to that of the asymptomatic contacts (6/60 (10%)) (p = 0:002). Development of symptoms in the contacts was associated with the history of respiratory illnesses, recurrent infections, use of hematinics, a positive COVID-test result, and health professionals being index cases (p ≤ 0:01). Parents with higher education and in the health profession and the families of symptomatic contacts reported better compliance with quarantine regulations. Conclusion. A significant number of children were exposed to adult COVID-19 patients. Most paediatric contacts remained asymptomatic. Children with preexisting medical conditions and with parents in health profession were susceptible to infection

Wheat pill poisoning: complications and management

Wheat pill (zinc or aluminum phosphide) is used as rodenticide in wheat and rice storage reservoirs also known as rice pill. In developing countries like Pakistan there has been an increase in the number of aluminum phosphide (wheat-pill) poisoning with suicidal intent due to easy accessibility. It has high mortality rate, with no antidote available. A young female presented with wheat pill poisoning in June 2019, upon arrival she had classical signs and symptoms of wheat pill poisoning although during her stay she developed cardiac arrythmias leading to shock, Hematuria, Pleural effusion, and hyperglycemia due to acute pancreatitis. Due to the appropriate recognition and management of complications, patient was able to recuperate. felicitous transfer to Intensive Care Unit and prompt recognition of complications can lead to virtuous outcomes. We recommend that there should be nationwide cognizance campaign regarding the lethal consequences of wheat-pill consumption by humans and proper Continuous..

Comparison of efficacy of Moxifloxacin and Ceftriaxone in acute exacerbation of chronic obstructive pulmonary disease

Objective: The aim was to compare the efficacy of Moxifloxacin and Ceftriaxone in acute exacerbation of the chronic obstructive pulmonary disease. Methodology: This randomized trial was conducted in the Pulmonology Department, PIMS, Islamabad between August 2018 to February 2019. Ethical approval was granted by the hospital ethics committee and patients were enrolled after written informed consent. Patients were screened from the OPD department and before randomization their sputum was collected over a 24-h period in strong sterile plastic (60 mL) bottle at room temperature. They were randomized equally into two treatment groups using a lottery method. Group A received Moxifloxacin 400 mg orally once daily for five days and group B received Ceftriaxone 1 g (IV infusion) once daily for five days. All the measurements (dyspnea grading, sputum volume, and character) were taken after 5 days of antibiotics therapy.  Results: The mean age was 60.79 ± 13.34 years in Moxifloxacin and 59.86 ± 12.72 years in the Ceftriaxone group. In Moxifloxacin group, there were 49(68.06%) male and 23(31.94%) females and in the Ceftriaxone group, there were 49(68%) males and 23(31.94%) female cases. In Moxifloxacin a total of 68(94.4%) cases recovered while 4 (5.6%) cases did not achieve efficacy whereas in the Ceftriaxone group 54 (75.0%) cases achieved efficacy and 18 (25.0%) were therapy failures. The efficacy of the oral Moxifloxacin group was significantly better than the oral Ceftriaxone group (p-value, < 0.05). Conclusion: The efficacy of Moxifloxacin was better than Ceftriaxone in acute exacerbation of chronic obstructive pulmonary disease

DAR-GRACE: Diabetes and Ramadan: glycaemic control, physician counselling and patient practices –experience from a tertiary care hospital in Pakistan

Objective: To identify patient practices and knowledge pertaining to Ramadan fasting and to see whether physicians were providing adequate counselling and adjusting medications accordingly. Methods: The cross-sectional study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from June to August 2018, and comprised diabetic patients who fasted during Ramadan. A questionnaire was designed to assess patients’ knowledge, risk category, pre-Ramadan counselling, medication adjustment, lifestyle changes, pre- and post- Ramadan glycated haemoglobin levels, and complications during Ramadan. Data was analysed using SPSS 23. Results: Out of 272 diabetics, 176(64.7%) were females. Mean number of fasts kept were 22±10.61. Pre-Ramadan 120(44.1%) patients consulted their physicians and 105(87.5%) of them received relevant counselling. Medications were adjusted in only 30 (25%) such cases. Overall, 41(15.1%) patients were in the high-risk category, while 109(40.1%) and 122(44.9%) were in the moderate and low-risk categories. During the month, 17(6.25%) were hospitalised due to diabetes-related complications. Glycated haemoglobin levels fell significantly (p<0.0001). Conclusion: Anomalous patient behaviours and suboptimal physician practices were noticed. Keywords: Diabetes; Ramadan; Pakista

Assessment of sleep quality in severe covid-19 hospitalized patients

Objectives: To evaluate the quality of sleep in patients hospitalised with coronavirus disease-2019, and its impact on hospitalisation duration, need for intensive care unit admission and mortality. Methods: The cross-sectional study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from May 2, 2021 to April 30, 2022, and comprised hospitalised coronavirus disease-2019 patients. Data was gathered using the Pittsburgh Sleep Quality Index questionnaire, including demographics, comorbidities, length of hospital stay, need for intensive care unit admission, C-reactive protein and D-dimer values at admission, and the outcome. The patients were divided into group A having good sleep quality score >5 and group B having poor sleep quality score <5. Data was analysed using SPSS 25. Results: Of the 1,250 patients, 559(44.7%) were males and 691(55.3%) were females. There were 560(44.8%) patients in group A with mean age 53.80±14.85 years, and 690(55.2%) patients in group B with mean age 53.71±14.32 years. There were no significant intergroup differences in terms of age and high-resolution computed tomography scan (p>0.05). The difference was significant with respect to gender, comorbid conditions, education status as well C-reactive protein and D-dimer levels (p<0.001). Group B patients had a longer duration of hospitalisation (p<0.001) and a higher need for intensive care unit admission (p<0.001) compared to group A. The outcome was death in 166(13.28%) patients in group B compared to 40(3.2%) in group A (p<0.001). Conclusion: Poor sleep quality was found to be associated with longer hospital stay, increased need for mechanical ventilation, and higher mortality rate in coronavirus disease-2019 patients. Key Words: Sleep condition, Covid-19, PSQI

Effectiveness of Roflumilast in Treating Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

From PubMed via Jisc Publications RouterHistory: accepted 2022-03-03Publication status: epublishBackground Chronic obstructive pulmonary disease (COPD) is a chronic airflow obstructive condition. The mainstay of treatment is to avoid exacerbation and manage the symptoms. Roflumilast is being used as a part of treatment to reduce the inflammatory process in this disease. Method This systematic review and meta-analysis were conducted following the provided guidelines. PubMed, Cochrane Library, and Cinahl were considered for searching the desired studies selected until 19 June 2021. The eligibility criteria for inclusion and exclusion were set before selecting studies. Result Five hundred eighty (580) studies were identified at the beginning. Removal of duplicates was done using Endnote software. The eligibility criteria, including the randomized controlled trial study design and others, were applied for screening the title and abstracts. Six studies were selected for the qualitative analysis. After assessing the data from these studies, it was found that roflumilast is an effective drug to treat COPD. Roflumilast plays an essential role in improving quality of life, inflammatory process, and clinical improvement. The drug's mild to moderate adverse effects were observed, but no significant severe adverse events were reported, and the drug was well tolerated. Conclusion Roflumilast is a valuable drug that can be used for its beneficial effects on COPD exacerbation. The benefits of the drug outweigh its adverse effects. [Abstract copyright: Copyright © 2022, Naseem et al.