Epidemiological Analysis of COVID-19 Patients detected by Real-Time Reverse Transcription - Polymerase Chain reaction in a Tertiary Care Biosafety Level III Laboratory, Rawalpindi

Introduction: Unexpected eruption and global dissemination of Coronavirus disease (COVID-19) has tested the healthcare systems of both developed and developing countries.Objective: To analyze the spectrum of novel coronavirus infection in a tertiary care setup.Materials and Methods: All oropharyngeal and nasopharyngeal samples (n=7057) were collected in a viral transport medium (VTM) for qualitative analysis by a real-time reverse transcription-polymerase chain reaction (RT-PCR) machine. Positive and negative controls were applied with each batch. Positive cases were stratified into mild, moderate, severe, and asymptomatic, according to the guidelines of the National Institute of Health, Pakistan. Descriptive statistical tests were applied including percentage, chi-square tests, mean, median, and mode. P < 0.05 was counted as statistically significant.Results: Average positive test rate was 18.97% (n=1339). The maximum positivity rate (26%) of COVID-19 infection was observed in June 2020. Most of the cases (60%) belonged to Rawalpindi District, were male (n=844, 63.03%), and belonged to age group (20-40 years) and mean of 36 and age range from 2-85 years. Forty-nine percent of COVID-19 infected patients were asymptomatic and only 9.8% progressed to severe disease. Overall, the mortality rate was 159(11.87%) in RT-PCR confirmed cases.Conclusion: Average positive test rate was 18.97%. The majority of the participants belonged to the young age group (20-40 yrs.) with a range from 2 to 85 years. Forty-nine percent positive COVID-19 infected patients were asymptomatic while 9.8% had severe disease

Predictive Efficacy of Haematological Biomarkers in COVID-19 infection

Introduction: The ongoing Corona Virus Pandemic is linked with high rates of morbidity and mortality globally. Early and effective predictors of clinical outcomes are urgently required to develop effective management protocols.Objective: To investigate the predictive efficacy of haematological biomarkers in Covid -19 infectionMethods: Blood samples were drawn from COVID‐19 infected pneumonia patients. Baseline clinical information was collected and quantification of hemostatic variable was done.  Laboratory data both groups expired and recovered were compared using t- test, Mann Whitney- U test, chi squared-test and Kruskal Wallis test. Multivariate regression analysis was performed to determine the independent contribution of haematological variable in Covid19 related mortality. Receiver operating characteristic curve were drawn to find the predictive efficacy of significantly related parameters.Results: Out of 191 patients 68.1%  were male. D‐dimer (median 800 ng/mL; IQR 200‐3200) and NLR (median 10.40; IQR 3.20-22.80) were found to be predominantly raised and significantly correlated with Covid mortality in multivariate regression analysis. The optimum cutoff value of D-dimer to predict in-hospital mortality was 450 ng/ml with a sensitivity of 71.6% and a specificity of 95.8%. The optimum cutoff value of NLR to predict in-hospital mortality was 5.450 with a sensitivity of 70.1% and a specificity of 71%.Conclusion: D-dimer and NLR could be used as the significant indicators in predicting the mortality of COVID-19

Online assessments during COVID-19 pandemic - A paradigm shift in educational strategy

Objectives: Covid-19 pandemic has instigated changes in the teaching and assessment practices of institutions in many parts of the world, resulting not only in online teaching but also online assessments. The present study analyzes the perceptions of students regarding the first online assessments conducted at a medical college in Pakistan. Methodology: This Mixed method cross-sectional study was conducted in Wah Medical College, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan from July to November 2020. The questionnaire was developed after collaboration of the authors and review of the pertinent literature on online examinations. Universal sampling was done and all students of WMC were invited to participate in the study. Data collection was done by google forms and analysis was performed on SPSS. Results: Students from all five years of the MBBS program participated almost equally in the study. Students of 1st, 3rd and 4th year were not contented with their performance in online exams whereas students of 2nd and 5th year were satisfied. Most students considered technological issues as a basis of their poor performance and proposed technical training before online exams. They also provided suggestions related to improvement of examination formats and tools. Conclusion: Majority of the students found the online assessment more effective and helpful in improving their performance in exams. Student perceptions provided valuable insights for improving the online examinations system at Wah Medical College. Key words: Online Assessments, Medical education, e-assessments, student perceptions, Higher Education institute

Ribavirin Induced Hemolytic Anemia In Patients Infected With Chronic Hepatitis C Virus

Objective: The objective of this study was to determine the ribavirin-induced hemolytic anemia in patients infected by chronic hepatitis c virus.Study Design: Descriptive Case series study.Place and Duration:  Gastroenterology Unit, Isra University Hospital, Hyderabad from 15-10-2014 to 15-04-2015.Methodology: Total 102 patients were included. Complete and relevant gastrointestinal and systemic examination was performed with special emphasis on anemia and its manifestations. Every patient was tested with hepatitis C antibodies, (HCV RNA PCR positive), pre-treatment hemoglobin levels, and at twelve weeks, twenty-four weeks, and at forty-eight weeks of ribavirin treatment and documented on structured questionnaire. The laboratory data were also collected by the researcher and pathologist. Hemoglobin levels were checked before and after start of ribavirin at 12 weeks 24, and 48 weeks.Results: The patient’s mean age was 41.68±11.91 years. 41.18% of patients diagnosed with hemolytic anemia. A significant proportion of hemolytic anemia was observed in middle-aged group (34–48years), P–value 0.033. Mean reduction of hemoglobin levels were observed after 12 weeks. No significant association of hemoglobin levels was observed, in those who received ribavirin for 12 and 48 weeks P value 0.295.Conclusion: Noticeable frequency of hemolytic anemia observed among HCV patients treated with ribavirin

Online assessments during COVID-19 pandemic - A paradigm shift in educational strategy

Objectives: Covid-19 pandemic has instigated changes in the teaching and assessment practices of institutions in many parts of the world, resulting not only in online teaching but also online assessments. The present study analyzes the perceptions of students regarding the first online assessments conducted at a medical college in Pakistan. Methodology: This Mixed method cross-sectional study was conducted in Wah Medical College, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan from July to November 2020. The questionnaire was developed after collaboration of the authors and review of the pertinent literature on online examinations. Universal sampling was done and all students of WMC were invited to participate in the study. Data collection was done by google forms and analysis was performed on SPSS. Results: Students from all five years of the MBBS program participated almost equally in the study. Students of 1st, 3rd and 4th year were not contented with their performance in online exams whereas students of 2nd and 5th year were satisfied. Most students considered technological issues as a basis of their poor performance and proposed technical training before online exams. They also provided suggestions related to improvement of examination formats and tools. Conclusion: Majority of the students found the online assessment more effective and helpful in improving their performance in exams. Student perceptions provided valuable insights for improving the online examinations system at Wah Medical College. Key words: Online Assessments, Medical education, e-assessments, student perceptions, Higher Education institute

Extensively Drug-Resistant Salmonella typhi XDR Infection at Rawalpindi Medical University and Allied Hospitals

Objective: To evaluate the prevalence of extensively drug-resistant Salmonella typhi (XDR) in RMU Allied Hospitals. Study Design: A descriptive cross-sectional study. Material and Methods: It is a cross-sectional, prospective study conducted at RMU Allied Hospitals from January 2019–December 2019. Blood culture samples were received in the pathology lab, they were collected by simple random sampling and processed by conventional incubation. Antibiotic susceptibility of the isolates was done on Muller Hinton agar using modified Kirby Bauer disk diffusion method and antibiotic zone diameters were measured according to CLSI guidelines. Results: Out of the total 8045 cultures, 911 (11%) showed growth, among which 179 (20%) were Salmonella typhi and 135 (15%) XDR Salmonella. Meropenem revealed the highest sensitivity, Chloramphenicol, and Augmentin revealed the highest resistance. Conclusion: Blood culture results revealed Salmonella typhi 20% with a significant number of XDR Salmonella 15%. Antibiotics susceptibility pattern exhibits Meropenem and Azithromycin as the only antibiotics for XDR Salmonella. Salmonella typhi infection has a significantly high prevalence among children as compared to adults. (p=0.0017) Injudicious use of antibiotics is one of the important aspects of the occurrence of antibiotic-resistant Salmonella

Epidemiologic Profile of Thyroid Disorders in a Tertiary Care Hospital, a Five Years Analysis

Background: Thyroid disorders are commonly encountered endocrine ailments in clinical practice.Objective: To determine the trends and frequency of thyroid disorders in patients presented for thyroid dysfunction at the department of Pathology Benazir Bhutto hospital RawalpindiStudy Design: Cross-sectional retrospective study. Materials and Methods: Patients who underwent thyroid function tests were enrolled in the study Thyroid function tests were performed on a fully automated Chemistry Analyzer. Graph Pad Prism version 7 and SPSS version 25 were used for statistical analysis of the data.Results: Out of 2856 patients, 81.9% were females and 18.1% were males. The mean age of the participants was 38.12 ± 14.51 years and the median was 35(13-96). Overall, 1951 (68.3%) of the subjects were euthyroid, 343(12.0%) had subclinical hyperthyroidism, 200 (7.0%) had subclinical hypothyroidism, 192(6.7%) had overt hyperthyroidism and 168 (5.9%) had overt hypothyroidism. Females have a significantly high percentage of thyroid disorders as compared to males(χ2 =0.976 p =0.027). The major age group 798(27.9 %) tested for thyroid dysfunction suspicion was 24 to 33 years followed by 34-43 (22.9%).Conclusions: The thyroid dysfunction prevalence was higher in females than males. An upward trend in the frequency of thyroid dysfunction was observed with increasing age. Subclinical hyperthyroidism was the commonest abnormality observed. A steep rise in subclinical hyperthyroidism may be attributed to the high intake of iodized salt