Tick-Borne Illness Ticking Off the Heart: A Case of Cardiomyopathy Due to Anaplasmosis

Background Human granulocytic anaplasmosis (HGA) is a tick-borne disease caused by Anaplasma phagocytophilum. The most common presenting features are transaminitis, leukopenia, thrombocytopenia, fever, and malaise. HGA causing cardiomyopathy likely from myocarditis is uncommon but a serious complication. Case A 70 year-old male with a history of coronary artery disease presented with fever (38.3 C) and dyspnea on exertion. He was found to have hypoxic respiratory failure, pancytopenia, acute kidney injury and transaminitis. He was treated empirically with ceftriaxone and doxycline. Baseline electrocardiogram was unremarkable for ischemia. However, he had troponin elevation and was decompensated on exam. Bedside transthoracic echocardiogram (TTE) showed LVEF of 20-25% for which he was administered dobutamine and monitored in intensive care unit (ICU). Repeat TTE illustrated LVEF 30-35% with moderate diffuse hypokinesis of LV. Blood and urine cultures were negative. He tested positive for Anaplasma DNA-PCR with unremarkable rest of the tick borne, viral and parasitic panel. He was then continued with doxycycline for 14 days for sepsis due to Anaplasmosis. Follow up TTE in a month showed improved LVEF to 40% with resolution of his symptoms. Decision-making Our patient presented with common tick-borne illness symptoms and signs, which prompted initiation of empiric antibiotics. However, the significantly reduced LVEF and elevated troponins were concerning for which he was monitored in ICU. Cardiac magnetic resonance imaging was not pursued due to delay in transfer process to the higher center amidst COVID pandemic and ongoing sepsis due to Anaplasmosis. After the results of HGA PCR, he was continued on a 14-day course of doxycycline which eventually resolved his symptoms. Conclusion There must be a high level of suspicion for cardiomyopathy if the patient is being empirically treated for tick-borne illness and has decompensated heart failure symptoms. PCR is the most sensitive test for diagnosing HGA. However, the test results should not delay the treatment as tick-borne illness responds well to doxycycline which should alleviate the heart failure symptoms as seen in our case.Copyright © 2023 American College of Cardiology Foundation

Dynamic volatility spillover between oil and marine shipping industry

Oil consumption not only makes up a large percentage of the overall operating expenses for the marine shipping industry, besides that, the tanker sector is a major carrier of global oil supply, which magnifies the relevance of oil market for the shipping industry. In this backdrop, the following study examines the volatility transmission between marine shipping industry's tanker and dry cargo market and oil market using daily data from May 2006 to August 2021 by employing spillover index methodology. The empirical results suggest pronounced spillovers for the tanker market while lower spillovers are observed for dry cargo market, indicating the well-integrated tanker market in comparison to dry cargo sector and oil market. The volatility in oil prices contributed higher spillovers in the tanker market, and remained a net contributor. The volatility in oil prices is a significant source of the volatility transmission during periods of the sudden drop in oil prices coupled with the higher volatility in oil market, and is a net receiver during stable periods. The period of higher spillovers lasts longer for the tanker sector as compared to dry cargo sector. In the particular case of dry cargo market, the smaller (larger) the size of the vessels, the greater (lower) are the spillovers observed (From and To). Hedging turns out be irrelevant during turmoil periods, as the comovement between shipping and oil market becomes stronger. The spillovers are pronounced during the period of financial crisis, COVID-19 and 2014–2016, owing to the significant fluctuations in oil prices and a troubled period for marine shipping industry. © 2023 The Author(s)

Administration of sinopharm Covid-19 vaccine in cancer patients

For prevention against SARS-CoV-2, various vaccines have been approved globally including Pfizer, Sinopharam, Moderna, Johnson & Johnson etc which have proved quite effective. To evaluate the immunization and safety of Sinopharm vaccine in cancer patients. A prospective study was conducted in the Oncology Department of Nishtar Medical Hospital, Multan from March 2021-September 2021. A total of 150 cancer patients undergoing treatment were included in the study. All the patients were administered 0.5 ml Sinopharm vaccine with 28 day difference between the two doses. A two-month follow-up was done to test the immunization using ELISA kits. Among all the patients, 16 patients (10.7%) had a history of COVID-19 before the administration of the vaccine. At the time of vaccination, 23.3% of patients were seropositive. After the vaccination, 130 patients (86.7%) developed immunity against the infection. 30.6% of participants developed a fever and 20.9% had fatigue. Other side effects were also observed including pain, redness, swelling, itching, chills, anorexia, nausea, vomiting, myalgia and diarrhea. Sinopharm vaccine is effective and safe for patients with malignancies especially in patients receiving radiaton therapy but still recommended for older patients and patients receiving chemotherapy.

Effect of Covid on Gaster Intestinal Tract and its Signs and Symptoms

The aim of this descriptive case series was to determine the frequency of various gastrointestinal symptoms of the COVID-19 patients along with the respiratory symptoms. Secondary outcome was to determine the effect of various co-morbid conditions and various sign and symptoms on the length of hospital stay and outcome of disease Material: In this descriptive case series type study, carried out in the COVID ward in the Jinnah Hospital, Lahore, all patients diagnosed with COVID-19 by consultant physician in the out-patient department and ward were included. Written informed consent was taken from all the participants of the study after explaining the primary objective of the study. The study was carried out from 01-07-2019 to 31-12-2019. Primary objective of this study was to determine the various gastrointestinal symptoms of the COVID-19 patients along with the respiratory symptoms Results: Among the 386 patients enrolled in the study, 60% were male and 40% were female. Mean age of the patients was 54.14 SD 16.3 years, with around 71% cases of age above 45 years. Abdominal pain, anosmia and diarrhea were the most common GI complaints. Over all, 26% of the patients of COVID had GI symptoms. Conclusion(s): GI complaints such as anorexia, nausea, vomiting, diarrhea, and abdominal cramping have been documented in COVID-19 individuals even in the absence of respiratory problems. As a result, COVID-19 disease must be explored in individuals who have mostly GI complaints. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

To Determine the Effect of Diabetes Mellitus on the Clinical Course and Outcome of COVID-19 at Jinnah Hospital, Lahore, Pakistan

Background: Diabetes is a common disease known to cause morbidity and mortality. Individuals with diabetes are at greater risk of complications from coronavirus and have recently gains attention of researchers and practitioners. Aim: To assess the effect of diabetes mellitus on clinical course and outcome of coronavirus infection. Study design: Prospective cohort study Place and duration of study: Coronavirus Disease High Dependency Unit Jinnah Hospital, Lahore from 01-01-2021 to03-04-2021. Methodology: Three hundred and seventy six patients of either genders and age range of 15-75 years were enrolled. They were divided into diabetic or non-diabetic groups. The various attributes such as demographic data, medical history, COVID-19 exposure history, symptoms and signs, laboratory findings, chest radiograph findings, the treatment measures and complications of diabetes and in hospital outcome were compared for both the groups. Result: Statistically different from each other in terms of oxygen requirement, lymphocyte %, neutrophil to lymphocyte ratio (P=0.026), alanine aminotransferase (P=0.038), C-reactive protein (P=0.048), ferritin (P=0.031), lactic acid dehydrogenase (LDH) (P=0.011), Ddimer (P=0.024), Quick sequential organ failure assessment score (qSOFA score) (P=0.001) and Chest X-ray (P=0.049), blood sugar random (P=0.000), treatment during hospital stay (P=0.000), insulin dose increase (P=0.000), complications during hospital stay (P=0.042) and shifting to the intensive care unit (P=0.002). Conclusion: Diabetic coronavirus patients have poorer prognosis due to higher risk of severe pneumonia and related complications including mortality than their non-diabetic counterparts.

IMPACT OF THE ONLINE LEARNING TECHNIQUES ON STUDENTS' CUMULATIVE GRADE POINTS

When COVID-19 prevailed, the educational system was shifted to online rather than traditional to facilitate the learning process. This study aimed at exploring the impacts of online learning techniques on the students' Cumulative Grade Point Average (CGPA). A total of 155 randomly selected students currently studying M. Phill education at the University of Agriculture Faisalabad, Pakistan participated in this study. Data were collected through validated, pre-tested and reliable questionnaires. Collected data were analyzed using Statistical Package for Social Sciences (SPSS). Findings unveiled that online learning techniques improved the learning abilities, personality traits and teaching styles as perceived by the respondents which further improved the CGPA of students. Within the effects on learning abilities, enabling students to judicious use of technology, multimedia, observation and clearing the concepts were major improvements which helped students to attain an increase in CGPA. As for as effects on personality traits were concerned, social interaction enhanced communication skills and improvement in understanding, social skills and confidence led the students to get high CGPA. Moreover, online learning improved the teaching styles by integrating video lectures, immediate results assessment and easy access to the technology were key drivers of the increase in CGPA. This study suggested a hybrid educational system at the University of Agriculture Faisalabad for effective learning in students.

Knowledge, Awareness & Practice (KAP) for COVID-19 in the Pakistani Nation

Objectives: The study aimed to examine COVID-19 knowledge among the general public in Pakistan, to review their attitudes and views regarding the fast epidemic. Study Design: Descriptive cross-sectional study. Duration of Study: June-July 2020. Methodology: A total of 679 respondents included. The questionnaires comprised of the following basic themes: basic demography, general & basic clinical/medical knowledge, attitudes, awareness, perceptions as well as a sense of prevention regarding COVID-19. Results: The majority (75.5%) of the respondents were from Punjab province. Around half (54.5%) of the respondents had heard about the COVID-19 infection through different social media. The majority were 28.4% medical students. The majority of the respondents (80-95%) selected correct answers from the given choices for the questions related to some clinical knowledge. More than half of people (59-64%) think positively that COVID-19 will successfully be controlled and Pakistan will be successful in winning this battle of the pandemic. 61% were afraid of COVID-19 as it is highly contagious disease (37.7%). Around 60% always covered their noses and mouths while sneezing and coughing. Conclusion: The people must have a thorough understanding of COVID-19 to successfully execute COVID-19 prevention strategies. Although we found enough knowledge, favorable perspectives, and readiness to follow SOPs, we believe that additional preventative and cautious attitudes, as well as awareness, are needed.

Comparison of Motivation of Medical students: During Covid-19 Pandemic-A Cross-Sectional Study

Objective: Motivation is one of the most integral components of learning. It is influenced by the student's personality, capabilities, talent, capacities, aptitudes, interests, behaviour, knacks, teachers' behaviors, and environment. In our current we checked the potential of students by using the Motivated Strategies for Learning Questionnaire (MSLQ) from online learning during the Covid-19 Pandemic. Method: A modified pre-structured, valid, and reliable questionnaire MSLQ was used to access the intrinsic and extrinsic motivation, Task value, self-efficacy for learning and performance, test anxiety, rehearsal, elaboration, cognition, metacognition, different types of resources management, academic year, and gender. The Cronbach alpha of multiple strategies of MSLQ is, ranging from .52 to .93. Results: This Descriptive Cross-sectional study was conducted at CMH Lahore Medical College from June 2021 to July 2021. Out of 121 students, 38.8% were male and 61.2% were female. First-year students were responded 55% and seniors' students 45%. MSLQ motivation items evidenced mean scores between 4.79 +/- 1.39 and 5.47 +/- 1.39, while MSLQ learning strategy items, mean scores ranged between 4.51 +/- 1.66 and 5.45 +/- 1.55. Conclusion: These results are also dependent on intrinsic factors such as one's effort, as opposed to external factors such as the teacher.

BLOOD CULTURES IN PATIENTS WITH ACUTE COVID-19 PNEUMONITIS: CONTAMINATION OR BACTERIAL CO-INFECTION?

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: INTRODUCTION: Research shows that 90% of blood cultures show no growth and a third of the remainder who test positive are identified as false positives [Garcia RA et al. Am J Infect Control 2015]. Although blood culture contamination rates of <1% are achievable, historical rates at <3% are industry accepted standards[Wayne PA. Clinical and laboratory Standards Institute (CLSI) document M47-A;2007];contaminants from skin flora are the most common, but 20% are from microbes deep in the dermis layer which may be drawn into blood specimens. Evidence for early use of antibiotics managing patients with COVID-19 pneumonitis is lacking but there are anecdotal concerns that more blood cultures than usual have identified organisms usually considered contaminants in sampling. Objectives were to quantify our local findings and relate these to outcome at discharge and during follow up. METHODS: Computer based retrospective review of 228 patients, mean age 71.8 (SD 8.7, range 29-87) years admitted at this hospital between March-May 2020 during the UK COVID-19 (SARS-Cov-2 RNA) peak and surge. Blood cultures reported here correspond to initial presentation with COVID-19 following a sepsis protocol. Comparative analysis by chi square (X2). RESULTS: 137/228 (60%) of patients had blood cultures at admission. 21/137 (15.3%) identified organisms from either one (n=13) or both (n=8) aerobic and anaerobic blood culture bottles. 12/21 (57.1%) (8 died) were identified as coagulase negative staphylococci (CoNS), traditionally considered contaminants at sampling;others included coagulase positive staph aureus (2), Klebsiella (2), E coli (2), and one each for Diptheroids, Proteus Miribalis and Aerococcus Viridans. The remaining 116 reported no growth from initial samples but 3 had positive results later in the admission (2 with CoNS, 1 with E Coli). 7/21 (33.3%) of those with any growth had died during the admission and this was proportionately similar to the 38/116 (32.8%) with no growth on blood cultures [X20.0027, p=.9588, not significant]. At 6 month follow up however, 15/21 (71.4%) of those who had positive findings on original cultures had died compared with 48/116 (41.4%) that had shown no growth [X26.4639, p=.0110, statistically significant]. CONCLUSIONS: Although death rates during admission did not differ, comparing those with and without positive findings on initial blood cultures, a large percentage with positive initial findings then died during follow up. Despite several organisms traditionally considered contaminants, the higher (15.3%) reporting and potential false positive rates requires further study;this should address sampling errors but also revisit bacterial co-infection in COVID-19. CLINICAL IMPLICATIONS: Improving sampling for blood cultures, but research is also needed to make sure this is not a signal for underlying bacterial co-infection. DISCLOSURES: No relevant relationships by Nawaid Ahmad, source=Web Response No relevant relationships by Emma-Jane Crawford, source=Web Response No relevant relationships by Annabel Makan, source=Web Response No relevant relationships by Nikhita Moudgil, source=Web Response No relevant relationships by Harmesh Moudgil, source=Web Response No relevant relationships by Afrah Riaz, source=Web Response No relevant relationships by Koottalai Srinivasan, source=Web Response

Effect of COVID-19 Pandemic on Mental Wellbeing of Healthcare Workers in Tertiary Care Hospital

Objective: The corona virus (COVID-19) outbreak which started in China now has become a pandemic. This disease is affecting the health of general population and causing severe psychological distress in healthcare workers. This survey was planned to investigate the impact of pandemic on mental wellbeing of these workers. Methods: Medical staff members working in Services hospital, Lahore were recruited. The information regarding demographic data, insomnia, anxiety, depression and stress symptoms were obtained by questionnaire. Comparison of demographic data and these psychological variables were done between insomnia and non-insomnia groups. Results: Total 356 healthcare workers were included in the study. There were symptoms of depression in 222(62.35%), anxiety in 227 (64.76%), stress in 197 (55.33%) and insomnia in 190 (53.37%) of participants. Mild to severe symptoms of depression (91.65% vs. 28.9%), anxiety (83.1% vs. 41.6%) and stress (84.26% vs. 22.22%) were seen predominately in the insomnia group (p<0.001),Insomnia was more in participants with low education level (78.08%) vs post-graduate degree (30.9%). Paramedics, nurses and healthcare workers in isolation/intensive care units were more prone to insomnia (p<0.001). Conclusion: Mental wellbeing of health care workers is affected due to COVID-19 pandemic. Nurses, paramedics and those working in isolation unit have significant insomnia. Involvement of mental health professionals and online mental health services can be helpful.

Knowledge and attitude of pakistani dentists regarding COVID-19

Objective: The objective of the study was to examine the knowledge, and attitude of Pakistani dentists, regarding novel COVID-19 disease. Study Design: Descriptive, Cross sectional study. Place and Duration of Study: This study was conducted at the Department of Conservative Dental Sciences and Endodontics, College of Dentistry, Qassim University, Al-Qassim, Saudi Arabia and Department of Oral Pathology, Frontier Medical and Dental College Abbottabad from 15th to 31st March, 2020 in Pakistan. Materials and Methods: A self-designed e-questionnaire was administered through e-mail to 500 dentists. SPSS version 23 was used to analysis data. Descriptive statistics were presented as frequency and percentages. The association between the dependent and independent variables was determined by utilizing Chi-square test and the level of significance was set at p value <0.05. Moreover, the inferential statistics (Mann Whitney U and Kruskal Wallis tests, p-value<0.05) were used for determining the significance among study variables. The correlation between the attitude and knowledge scores was assessed by utilizing Spearman's rank correlation coefficient. Results: A total of 306 dentists responded. Participants' mean knowledge score was 10.69± 2.14, with 91.5 % participants having sufficient knowledge. 242 (79.1%) respondents showed positive attitude (>4) towards COVID- 19. The mean attitude score was 4.28±0.61. The results of current study showed a significant correlation of knowledge with both designation (p-value=0.002) and gender (p-value=0.04). Conclusion: Pakistani dentists have exhibited adequate awareness about general symptoms, transmission mode, cross-infection control and dental practice management in perspective of the COVID-19 outbreak. However, their understanding to protect dental professionals from this highly contagious disease during specialized dental procedures was unsatisfactory.