ROLE OF INTERLEUKIN--6 AND PROCALCITONIN AS INFLAMMATORY BIOMARKERS IN EVALUATING COVID--19 DISEASE SEVERITY ON HRCT CHEST-- AN EXPERIENCE AT CMH QUETTA

Objective: To explore the relation of Interleukin-6 and Procalcitonin with COVID-19 severity on high resolution computerized tomogram (HRCT) chest. Study Design: Randomized Control Trial (NCT04945811). Place and Duration of study: Pathology Department, Combined Military Hospital Quetta, from April 2020 to May 2021. Methodology: Serum Interleukin-6 and Procalcitonin of 100 consenting COVID-19 positive patients from April 2020 to May 2021 were assessed at Pathology department Combined Military Hospital Quetta and their levels were correlated with severity of lung involvement on HRCT Chest Results: Serum Interlukin-6 levels were significantly raised in 97 patients with mean levels of 20.43 ± 19.66 (pg/ml). Serum procalcitonin levels were also significantly raised in 95 patients with mean levels of 0.43 ± 0.24 (ng/ml). Conclusion: Interlukin-6 and procalcitonin are important biomarkers for diagnosis and predicting severity of COVID-19 pneumonia. © 2021, Army Medical College. All rights reserved.

Closed Formulas of Topological Properties for Remdesivir (C27H35N6O8P)

Coronavirus is able to cause illnesses ranging from the common flu to severe respiratory disease. Today there is great competition among researchers and physcisians to cure COVID-19. Remdesivir is being studied for the COVID-19 treatment In this article, we presented the topological analysis of remdesivir with the help of M-polynomial. Proofs of the closed form of some topological indices via M-polynomial are also included in this article. [GRAPHICS] .

Online Teaching in an Un-prepared Country during COVID-19: An Interview Study on Final Year Medical and Dental Students

Aims: To assess medical students' perception of online teaching to suggest transforming the future curriculum in low-economic countries. Study Design: Cross-sectional online interview study. Place and Duration of Study: A team of collaborators interviewed final year medical and dental students of Pakistan from 07/08/2020 till 17/09/2020. Methodology: A questionnaire was developed based on open and close-ended questions in Google forms;focusing on institutional preparedness, views on online education, the institute's closure and COVID-19, and long-term effects of closure of the institute. Independent fellow researchers systematically analyzed the unaltered transcripts of the responses, and themes were then identified and coded to conclude the results. SPSS version 23 used for analysis. As this study was based on final year students. Results: In response to an invitation email, 2442/2661 (91.77%) students voluntarily participate in this qualitative study. Most participants were females (1614, 66.10%). Closing down institutes was directly linked to a lack of motivation and feel of helplessness. As most showed dissatisfaction with online teaching compounded by psychological effects, students feared losing clinical skills and life during the pandemic. Conclusion: The psychological impact of the crisis led to resistance to accepting the change for a better outcome. Incorporating telemedicine, different interactive learning style to online teaching, and resilience training would result in fruitful outcomes. Developed countries may also guide build infrastructure in developing countries to develop a more robust online teaching methodology in the long-run.

Effectiveness of Noninvasive Positive Pressure Ventilation in COVID-19 Patients with Severe Acute Respiratory Distress Syndrome

Results of invasive positive pressure ventilation (IPPV) in COVID-19 patients with Severe Acute Respiratory Distress Syndrome are discouraging despite its prompt use. However noninvasive positive pressure ventilation (NIPPV) is yet not a common practice internationally because of lack of global evidence advocating its effective use in severe cases of ARDS as well as dreadful concern about aerosol generation especially in patients having COVID-19 infection. Objective: To determine whether, NIPPV application is effective and safe in COVID-19 Patients. Methods: One hundred and thirty hemodynamically stable patients with severe CARDS as per Berlin definition (PaO2/FiO2 ratio <= 100mm Hg), having GCS > 13, respiratory breathing index (RBI) < 105, and without any systemic complication were selected. They were managed with NIPPV in Corona Intensive Care Unit of Mayo Hospital/King Edward Medical University Lahore. A little innovation was done with the application of a specific orofacial interface, fitted with heat and moist exchanger (HME) at the interface and viral/bacterial filters at the expiratory limb of ventilatory circuit. Favorable outcome has been observed in 64% of treated cases in terms of improvement in PaO2/FiO2 ratio, thus abating severity of ARDS from severe to mild category, in an average time span of 6 days. Remaining 36% of patients progressed to IPPV with definitive airway. During study period, 4.2% of healthcare workers (HCW) got infected with COVID-19. Associated complications of NIPPV application were claustrophobia (13.8%), nasal crusting (6.9%), aspiration (6.1%) and barotrauma (0.7%). Conclusion: In carefully selected patients, use of noninvasive positive pressure ventilation with the application of HME and viral/bacterial filters is an effective, preferable and safe modality of choice to provide respiratory support, thus obviating the need for IPPV. However further larger studies are needed to confirm our recommendations.