ABSTRACT
Background: Limited evidence exists on the pandemic's role in limiting access and use of prenatal care services and the quality of care for pregnant women. We aimed to investigate the impact of the pandemic restrictions on in-person prenatal care visits (PNCV) and the quality of prenatal care. Method(s): Using the mother-infant-linked administrative health databases in Manitoba, Canada, we conducted a province-wide population-based cohort study among independent pregnancies. We examined the quarterly rates of PNCV before (October 2016-March 2020) and during (April 2020-March 2021) the pandemic. Quality of prenatal care was categorized using the Revised Graduated Prenatal Care Utilization Index (R-GINDEX) into inadequate (<50% visits), intermediate (50%-80% visits), adequate (>80% visits), intensive (high-risk), and no care. Interrupted time series analyses were conducted to assess the immediate and lagged changes in PNCV and quality of care after the implementation of pandemic restrictions. Result(s): Amongst 70,931 pregnancies, we observed no significant mean difference in the overall numbers of PNCV during the pandemic compared to prepandemic (8.2 vs. 8.6,p=0.0837). Prenatal care utilization was 3.4% inadequate and 34.7% adequate before the pandemic and 4.8% and 26.6% during the pandemic, respectively. Restrictions were associated with an abrupt decline in adequate and intermediate care during the first trimester by 11.3% (p<0.001) and 11.98%, respectively, followed by non-significant change throughout the pandemic (beta3=-0.25,p=0.694 and beta3=-0.96,p=0.192, respectively). Moreover, restrictions were associated with an increased rate of inadequate care during the first (beta2=1.52,p=0.007) and second trimesters (beta2=0.78,p=0.208), and not among third trimesters (beta2=-0.44,p=0.094). During the pandemic, we found no significant differences in the rates of intensive prenatal care during the first (p=0.478), second (p=0.614), and third (p=0.608) trimesters compared to pre-pandemic. Conclusion(s): Our findings suggest a decline in adequacy levels of prenatal care services after COVID-19 restrictions were enacted, with a higher impact on pregnancies during their first and second trimesters. Although the overall adequacy of care decreased, there were no changes to the rates of intensive visits. This study will further investigate the impact of the pandemic on virtual PNCV and assess the association between the quality of prenatal care and adverse maternal and neonatal outcomes.
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Background: Provision of health information and delivery of health care services by means of electronic information and communications technology (ICT) to distant patients, separated by geography, time, social and cultural barriers is termed as telehealth. Objective: To evaluate the provision of telehealth services for Gynae and Obstetrics in relation to satisfaction of patients and fetal outcomes. Methods: An analytical cross-sectional study was conducted between 18-5-21 to 31-12-21 in Gynae and obstetrics unit of Farooq Hospital Westwood branch. A sample of 108 respondents was collected through simple random sampling technique. In order to analyze the data, SPSS version 23 was utilized, and chi square test was used to determine the associations between variables fixing p value at less than 0.05. Results: Most common device used for appointment of telehealth services was smartphone (87%) (p=0.02) and most important barrier in telehealth services was network issues reported by (55.5%) (p=0.01) of respondents. Majority of the respondents (84.1%) were satisfied with telehealth service utilization (p=0.00). Strong association was seen between utilization of services and easing of appointment (p=0.00), understandability of language (p=0.00), need based services (p=0.00), convenience (p=0.00), comfort (p=0.00), cost effectiveness (p=0.01), better standard of care (p=0.01), careful response of physicians (p=0.02) and sympathetic attitude (p=0.00). Conclusion: High satisfaction rate was observed with provision of telehealth services in Pakistan and most important barrier was network issues.
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Objective: To determine the examination stress and anxiety score during COVID-19 pandemic and to identify coping mechanisms adapted by medical students. Study Design: Cross-sectional study. Place and Duration of Study: Sir Syed College of Medical Sciences for Girls, Karachi, from Apr-May 2021. Methodology: A total of 250 students were recruited in the study and validated questionnaire was used for data collection. Test anxiety scores were calculated from a previous study scale by Nist and Diehl (1990). Data was analyzed by using SPSS-23. Results: The mean age of students was 20.1 ± 0.6 years. 74 (29.6%) students felt stress sometimes, 40 (16.0%) students felt always and 30 (12.0%) students never felt stressed before examination. Students who reported improved performance during the examination due to stress were 121 (48.4%). 76 (30.4%) students reported decrease in performance and 53 (21.2%) reported that their stress did not affect their performance. Students were inquired regarding the methods to cope the stress. 78 (31.2%) students reported that they took study break, 66 (26.4%) students spent time with family and friends, 49 (19.6%) found solace in sleep, 30 (12.0%) students listened to music, 13 (5.2%) used beverages (tea, coffee), 11 (4.4%) used numerous combinations of methods, and only 3 (1.2%) students exercised. It was found that 158 (77%) students experienced healthy anxiety, 68 (27.2%) unhealthy anxiety, and 22 (8.8%) students were anxiety-free. Conclusion: Examination stress among medical students has increased during COVID-19 and various coping methods are used by the students to prevent anxiety. College administration must address stressors to improve the learning and mental health of the students. © 2022, Army Medical College. All rights reserved.
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Background: In December 2019, a group of cases of pneumonia of unknown cause was found in Wuhan, China, now known as coronavirus disease 2019, and the coronavirus was named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). High-resolution computed1tomography (HRCT) is currently regarded as a significant imaging technique for aiding in the diagnosis & management of COVID-19 patients. Objective: To find the different patterns of1manifestation in HRCT chest in COVID-19 patients. Study Design: Descriptive Cross-Sectional Setting: University of Lahore Teaching Hospital, Lahore Methodology: A descriptive, cross-sectional study was conducted in Radiology Department in University of teaching hospital, Lahore. 240 participants' medical histories were thoroughly reviewed, both directly from them and on case sheets. All patients with confirmed cases of COVID-19 pneumonia were admitted to the hospital and received a chest HRCT. Three follow-up HRCT chest scans were performed on one patient. The distribution and patterns of lung involvement were studied. Each of the five lung lobes was evaluated visually for degree of involvement and categorized as mild (26-50 percent), moderate (51-75 percent), or severe (75 percent) (76-100 percent). Data was analyzing in SPSS. Age was presented as mean + SD. Gender and other HRCT patterns were presented as frequency & percentage. Result: Total 240 COVID-19 patients included. There were 142(59.4%) male and 97(40.6%) female. The mean age was 54.0+15.71 with age range of 4 to 84 years. Large number of patients 114(47.7%) were in the age group 45-64 years. Ground glass opacity was the most common CT abnormality, with 236(99.2%) cases. Among them 49(20.5%) cases had GGO plus consolidations. Crazy paving pattern was seen in 136(56.9%) cases. Only 10(4.2%) patients with GGO pulmonary nodules and pleural effusion were involved. The majority of the patients had a fever 114(47.5%), while the least frequent symptom was a runny nose (7(2.9%). Conclusion: Pure GGO pneumonia is the most prevalent pattern of COVID-19 pneumonia seen on HRCT scans, GGO consolidation, with crazy paving with prominent distribution in the lung posterior & peripheral area.
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Aim: To compare the high resolution computed tomography features in Covid and other viral pneumonia presented in recent literature. Methodology: For this study, total 25 studies were included which follow the Preferred Reporting Items guideline for conducting this systematic review analysis (PRISMA). Electronic articles of Covid from January 2020 to April 2020 were searched on PUB Med, online Willey library, and Science Direct site by using keywords related to CT imaging and Corona virus. For pneumonia related studies articles from year 2010 to year 2017 were included for better comparison. Results: After pooling data, it was observed that bilateral involvement was found in 76.8% of studies, 68.4% GGO, and 62.2% ratio was occupied by peripheral distribution in different studies. Total 48.7% of studies were concerned about the ground glass opacity (GGO) consolidation, 33.2% observed consolidation, 27.7% look for crazy paving pattern, and 25% of studies observed mixed central and peripheral distribution. Conclusion: Study concludes that the chest CT finding results of selected studies for Covid and pneumonia cases were overlapping. Only high prevalence related to upper and lower lobe involvement and peripheral distribution was relatively high in Covid studies.
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The novel coronavirus (COVID-19) pandemic has spread globally to more than 200 countries with more than 5 million confirmed cases. World Health Organization and other global public health organizations have issued guidelines to prevent the community spread of virus. These include basic measures like repeated hand washing, social distancing, and cough etiquettes. Advice regarding disinfection of surfaces have also bee circulated. Due to the infodemic and misinformation public and even institutions particularly in the developing world have adopted certain unproven measure which have the potential to do more harm than good. We describe one such measure being commonly used called Sanitization walk through gate or anti-viral gate. We discuss how this tool is totally ineffective in protecting against the spread of COVID-I9 and only offers a false sense of security. There are concerns that such measure may discourage public to forgo the established and recommended practices in favor of these strategies.
ABSTRACT
Background: Severe acute respiratory syndrome coronavirus (SARS-CoV-2) also known as COVID19, is a newly discovered virus that has been recently isolated from humans. A number of researches with special emphasis on its clinical and epidemiological parameters are being carried out in various parts of the world. Aim: To analyze and evaluate the clinical, laboratory and chest x ray findings of Covid-19 cases, admitted at a recently established Corona Unit of Farooq Hospital West Wood Lahore, Pakistan. Study Design: Retrospective study Methods: The current study included a total of 105 COVID-19 positive cases from 9th April to 27th May 2020. 94 cases were confirmed on the basis of laboratory values whereas 11 were diagnosed based on their clinical characteristics. Results: Of all 105 patients admitted, 94(89.50%) were detected as laboratory-confirmed COVID-19 pneumonia with nasopharyngeal swab samples that were positive for SARS-CoV-2, whereas 11 (10.50%) were confirmed on clinical grounds. The mean age was 48.18 that ranged from 12 to 78 years. Majority were male patients (78.1%). Only 3 (2.9%) patients had recent travel history of abroad. The most common comorbidities were Hypertension (49.39%) and Diabetes Mellitus (43.37%). The most common symptoms (fever, dry cough, and tiredness) were observed in 29.5%, serious symptoms (shortness of breath, chest pain or pressure, and loss of speech or movement) in 40% and only few cases with acute respiratory distress syndrome. The mean systolic blood pressure recorded was 122.8 +/- 12.85 mm Hg and mean diastolic blood pressure 79.29 +/- 9.96. The mean oxygen saturation levels were 94.30 +/- 5.063. The mean value for chest x ray scoring was 7,50 +/- 5.6. The laboratory values were taken into account and elevated levels of C-reactive protein (CRP) were reported in 65.75% and procalcitonin levels in 58% of the patients. Higher polymorph leukocytes count was observed in 34 (33%) whereas 40 cases (38.83%) of COVID-19 patients had lymphopenia. D-dimers, AST, ALT levels were raised in 79.68%, 47.2% and 58.3% of patients, respectively. Higher levels of serum ferritin were seen in 61.4% of cases. Conclusion: The clinical, laboratory and radiological findings may play pivotal role in early detection of positive COVID-19 cases and thus help in timely therapeutics management.