Clinical outcomes of hepato-pancreato-biliary surgical patients during COVID-19 pandemic.

OBJECTIVE: To determine the outcome of hepato-pancreato-biliary patients who were operated upon during the pandemic under a safety protocol devised to minimise the risk of coronavirus disease-2019 infection in patients and staff during the perioperative period. METHODS: The retrospective study was conducted at the Hepato-Pancreatico-Biliary (HPB) Unit of Bahria International Hospital Orchard, Lahore, Pakistan, in February 2021, and comprised data of all patients who were discussed in the multidisciplinary meeting of the Unit between May 1 and December 31, 2020. The coronavirus disease-2019 screening protocol was a negative polymerase chain reaction test just before admission and a second negative test 24-48 hours pre-surgery. All patients had computed tomography scan of chest to rule out atypical pneumonia due to coronavirus disease-2019 infection. Surgery was deferred for positive patients for at least 2 weeks until their test was negative. Surgeries were carried out with full personal protective equipment. Further testing was carried out if clinically indicated. Data was collected of 30-day coronavirus disease-2019-related morbidity and mortality. Data was analysed using SPSS 20. RESULTS: Of the 44 patients, 29(65.9%) were males and 15(34.1%) were females. Overall, 32(72.7%) patients were aged >40 years, 8(18.2%) were aged 20-40 years and 4(9%) were aged <20 years. Of the total, 7(15.09%) patients were found to be positive for coronavirus disease-2019 during preoperative screening. Among them, 5(71.4%) had successful surgery post-recovery, 1(14.3%) died without surgery due to pulmonary complications related to coronavirus disease-2019 and 1(14.3%) patient was lost to follow-up. Among the 42(95.5%) patients who underwent any procedure, 2(4.7%) patients turned positive for coronavirus disease-2019 in the postoperative period. There was 1(2.4%) mortality in the 30-day post-operative period which was not related to coronavirus disease-2019. Complications were seen in 5(11.90%) patients. Three (9.3%) out of 32 staff members were found to be asymptomatic carriers. CONCLUSIONS: Hepato-pancreatico-biliary surgery could be safely carried out during coronavirus disease-2019 pandemic if strict safety protocols were followed.

Does ivermectin reduce COVID-19 mortality and progression of disease severity? - A retrospective study

Objective: To investigate the efficacy of ivermectin in the treatment of mild, moderate, and severe COVID-19 infection. Study Design: Retrospective Cohort study. Setting: COVID-19 Treatment Centre, Dr. Ruth K M Pfau Civil Hospital Karachi. Period: July 2020 to December 2020. Material & Methods: Medical records of 423 patients during a selected duration of 6 months were reviewed. Patients were stratified into two groups based on whether or not they received a 6-day course of ivermectin in addition to the standard treatment for COVID-19. Primary outcome measures were rate of mortality, days from the start of treatment to negative SARS-CoV-2 PCR, and rate of step-up to the intensive care unit. Results: Patients who received ivermectin required a lesser number of days (8.39 days ± 2.04) to become COVID negative than the patients who didn't receive ivermectin (20.38 days ± 6.32), (p < 0.001). Multinomial logistic regression showed that the patients who were given ivermectin for COVID 19 infection were four times more likely to be discharged home than stepping up to ICU. The ICU step-up rate in the ivermectin group was found to be 3.7% compared to 13.04% in the non-ivermectin group. No significant differences in mortality were found. Conclusion: Treatment with ivermectin in COVID-19 infection is associated with improved outcomes in terms of reduction in duration of illness as well as the progression of disease severity. [ FROM AUTHOR] Copyright of Professional Medical Journal is the property of Professional Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Burden of Depression, Anxiety and Stress;The Psychiatric Burden in COVID-19 Patients at a Tertiary Care Hospital in Pakistan

Objective: To assess the levels of depression, anxiety and stress in patients diagnosed with COVID-19. Study Design: Cross-sectional study. Place and Duration of Study: COVID isolation ward of PNS Shifa Hospital, Karachi Pakistan, from May to Jun 2020. Methodology: A total of 110 patients whose COVID-19 PCR tests were positive were selected. They had a history of at least one-week admission to the hospital, and all of them were stable or had mild symptoms. Depression, Anxiety and Stress scale (DASS 21) was administered to all the patients through a video call. Results: The study revealed that 30 (27.3%) of the COVID-19 patients had depressive features, whereas 37 (33.6%) were found to be anxious, and 13 (11.8%) were under stress during this time. Depressive features were more common in the female gender affecting 9 (56.2%) out of 16 females (p=0.011) and unemployed patients affecting 12 (54.5%) out of 22 unemployed patients (p=0.006). Anxiety was more common in the female gender affecting 11 (68.7%) out of 16 females and married patients, affecting 26 (27.6%) out of 94 married patients (p=0.01). Stress was found to be more in females, affecting 8 (50%) out of 16 females (p=0.01). Conclusion: This study showed that the diagnosis of COVID-19 can lead to psychological effects, and patients should be monitored for depression, anxiety and stress.

Disparities in critical care resources across Pakistan – findings from a national survey (preprint)

Background: In response to the COVID-19 pandemic, concerted efforts were made by provincial and federal governments to invest in critical care infrastructure and medical equipment to bridge the gap of resource-limitation in Intensive Care Units (ICUs) across Pakistan. An initial step in creating a plan towards strengthening Pakistan’s baseline critical care capacity was to carry out a needs-assessment within the country to assess gaps and devise strategies for improving the quality of critical care facilities.  Methods: To assess the baseline critical care capacity of Pakistan, we conducted a series of cross-sectional surveys of hospitals providing COVID-19 care across the country. These hospitals were pre-identified by the Health Services Academy (HSA), Pakistan. Surveys were administered via telephonic and on-site interviews and based on a unique checklist for assessing critical care units which was adapted from the Partners in Health 4S Framework, which is: Space, Staff, Stuff, and Systems. These components were scored, weighted equally, and then ranked into quartiles.  Results: A total of 106 hospitals were surveyed, with the majority being in the public sector (71.7%) and in the metropolitan setting (56.6%).  We found infrastructure, staffing, and systems lacking as only 19.8% of hospitals had negative pressure rooms and 44.4% had quarantine facilities for staff. Merely 36.8% of hospitals employed accredited intensivists and 54.8% of hospitals maintained an ideal nurse-to-patient ratio. 31.1% of hospitals did not have a staffing model while 37.7% of hospitals did not have surge policies. On chi-square analysis, statistically significant differences (p<0.05) were noted between public and private sectors along with metropolitan versus rural settings in various elements. Almost all ranks showed significant disparity between public-private and metropolitan-rural settings, with private and metropolitan hospitals having a greater proportion in the 1st rank, while public and rural hospitals had a greater proportion in the lower ranks. Conclusion: Pakistan has an underdeveloped critical care network with significant inequity between   public-private and metropolitan-rural strata. We hope for future resource allocation and capacity development projects for critical care in order to reduce these disparities.

Synthesis, antioxidant, antimicrobial and antiviral docking studies of ethyl 2-(2-(arylidene)hydrazinyl)thiazole-4-carboxylates.

A series of ethyl 2-(2-(arylidene)hydrazinyl)thiazole-4-carboxylates (2a-r) was synthesized in two steps from thiosemicarbazones (1a-r), which were cyclized with ethyl bromopyruvate to ethyl 2-(2-(arylidene)hydrazinyl)thiazole-4-carboxylates (2a-r). The structures of compounds (2a-r) were established by FT-IR, 1H- and 13C-NMR. The structure of compound 2a was confirmed by HRMS. The compounds (2a-r) were then evaluated for their antimicrobial and antioxidant assays. The antioxidant studies revealed, ethyl 2-(2-(4-hydroxy-3-methoxybenzylidene)hydrazinyl)thiazole-4-carboxylate (2g) and ethyl 2-(2-(1-phenylethylidene)hydrazinyl)thiazole-4-carboxylate (2h) as promising antioxidant agents with %FRSA: 84.46 ± 0.13 and 74.50 ± 0.37, TAC: 269.08 ± 0.92 and 269.11 ± 0.61 and TRP: 272.34 ± 0.87 and 231.11 ± 0.67 µg AAE/mg dry weight of compound. Beside bioactivities, density functional theory (DFT) methods were used to study the electronic structure and properties of synthesized compounds (2a-m). The potential of synthesized compounds for possible antiviral targets is also predicted through molecular docking methods. The compounds 2e and 2h showed good binding affinities and inhibition constants to be considered as therapeutic target for Mpro protein of SARS-CoV-2 (COVID-19). The present in-depth analysis of synthesized compounds will put them under the spot light for practical applications as antioxidants and the modification in structural motif may open the way for COVID-19 drug.