Year 2020, Volume 36 - Issue 2S

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Since the outbreak of COVID-19 has emerged, 2022 is predicted by researchers as the year for the return of normalcy. With every domain of life at halt, the tardiest recovery will be in education and research where 1.5 billion learners have been affected globally by the Pandemic. With meticulous but strong concomitant situation analysis by the universities, robust measures need to be taken to ensure (1) optimal mental and physical health of all faculty, staff and students, (2) balancing the financial and managerial crises and (3) development and implementation of long-term policies to stand-up to the challenges of this situation

Consequent to the COVID-19 global recession, nearly all medical universities in Pakistan are coping with the changed circumstances, the best they can. Creating more opportunities for online learning and education system, introducing newer courses and Self Sufficiency Programs and making sustainable and balanced investment in potential research areas with local and international collaborators and funding agencies remain the mainstay of successful subsistence during this pandemic and afterwards.

After World Health Organization named COVID-19 pandemic as a “Pandemic of Misinformation”, a common man has to cope with superfluous advices, remedies and, most of all, conspiracy theories, that seem undermining even the genuine recommendations of experts and authorities. This is a high time that timely corrective action, preaching social responsibility, relying on science and technology, and using mass media as channels to communicate the truth, may be used as weapons by the government in the battle against COVID-19 infodemic.

The Coronavirus has changed the dynamics of human interaction around the globe. Medical Education in Pakistan is moving through a state of transition with introduction of the modular education in place of traditional methodologies. The development of Lecture bank can be the source of helpful educational transfusions for student centered self-directed learning in health professional education.

After global health catastrophe due to Coronavirus disease-2019 (COVID-19), a deep impact on the way we perceive our world and our everyday lives has been imprinted. Till now, no specific antiviral drug has been proven effective for curing patients. Ivermectin, the broad-spectrum macrocyclic lactone has proven to exert antiviral activity against human immunodeficiency virus (HIV), dengue virus and now capability to reduce viral RNA up to 5,000-fold after 48 h of infection with SARS-CoV-2.

Coronavirus disease-2019 (COVID-19) outbreak was first declared as emergency on January 30th2020 by World Health Organization (WHO). The Government of Pakistan presented a National action plan, which aimed to inhibit the spread of this Corona virus and to reinforce the effective reaction due to this COVID-19 epidemic. Lahore General Hospital (LGH) is the first public sector hospital that started COVID-19 real-time reverse transcription polymerase chain reaction (rRT-PCR) testing to serve community. COVID-19 has affected the mental health of public in general and health professional in particular. We need to support healthprofessionals to do theirjobs, be safe and stay alive. Future research should explore the fears and
coping strategies of health professionals during pandemics.

Worldwide, health, medical and dental professionals are at the front line of the COVID-19 outbreak and playing at hands with the hazards that put their lives at stake of getting infected. Hazards include pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence. Four specialties are further declared as highly susceptible to contamination with COVID-19 virus which include ENT, Ophthalmology, Dermatology and Dentistry that government was forced to stop their OPDs country wise. Dental practices are those hospital areas that are potentially affected with COVID-19, strict and effective infection control protocols are urgently needed, for this FDI World Dental Federation (FDI) played its role and brought few SOPs for the dental practice which are highlighted in this article. The aim of this manuscript is to help update information among dentist and lead them towards safer dental practice.

The only job which never gets a break is ‘house service’ and with more people living at home the work just adds on. There was a sudden rise of ‘reported’ domestic violence in many countries of the world. Media, social and print hold the key in disseminating awareness of household abuse and call upon neighbors, families and friends to report violence.

The world with COVID-19 is in greatly challenging circumstances that can lead to stress for many reasons including the feeling of uncertainty and the worry about family members and friends. Chronic stress affects both humoral and cellular immunity. The role of government and public support for the health teams is demanded to help the health professionals overcome these stressors and therefore defeat the infection.

Health care professionals (HCPs) remain the most vulnerable population while performing their duties they inadvertently put themselves at high risk for any pandemic. During COVID-19 outbreak, scarce supply of personal protective equipment (PPEs) and prolonged exposure of HCPs with large number of COVID-19 positive cases in healthcare settings, long stressful duty hours and insufficient infection prevention and control (IPC) training given to them has led to a large number of infected cases. Policies should be designed and implemented for more screening and better protection with provision of optimal resources to these valuable personnel of health care system.

The essential and critical role of laboratory medicine in the current Coronavirus disease of 2019 (COVID19) outbreak regarding diagnosis, therapeutics and prognostics cannot be overruled. No laboratory test is perfect and there is always a dilemma especially for respiratory diseases as in case of tuberculosis. Sensitivity, specificity, PPV and NPV are not always perfect for any one test. In case of COVID-19, we need to step ahead of PCR and also start supplementary serology testing. It will provide wide range of information, important for future thinking, planning and actions against COVID-19.

Current plight of COVID-19 in developing countries entails uncertain prognosis, impending severe shortages of resources for testing and treatment and inadequate safety measure for health care providers. The imposition of unfamiliar public health measures that may infringe on personal freedoms, large and growing financial losses, and conflicting messages from authorities are among the other major stressors that undoubtedly will contribute to widespread emotional distress and increased risk for mental fatigue associated with COVID-19.

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Over the past six months, the world has undergone drastic changes related to unprecedented emergence of deadly virus namely novel Coronavirus, COVID-19. Telemedicine service provides excellent platform for technology based remote patient care in the time of current pandemic crisis. It is emerging as an effective and sustainable solution if current pandemic continues for long time. Telemedicine is revolutionising patient care and help to support the health system of country by reducing the impact of pandemic. There is a need to create the multidisciplinary team of health professionals striving to serve the patients by provision of quality health care service delivery.

In the wake of COVID-19 pandemic, global trend for launching online courses and trainings regarding risk factors, acquisition, diagnosis, clinical presentation, management and prevention of COVID-19 is cresting. Department of Family Medicine at University of Health Sciences Lahore introduced a 2-hours online course where a total of 39993 health professionals from all over the world were enrolled and 32000 participants completed the course with encouraging feedback.

The use of technology to facilitate communication and care between patients and dental health care providers at different locations is referred as tele dentistry. It utilises different electronic modalities thus increasing the efficacy of dental clinics by converting traditional paper patient’s records to Electronic Health Records (EHR). These EHR can help in increasing inter-professional communication between clinicians and multidisciplinary management of complex cases. Tele dentistry is a unique way to overcome the geographical barriers by delivering long distance treatment, providing Continuing Education (CE) and training opportunities for dental and non-dental providers. It also has the potential to reduce or eliminate oral health care disparities between different communities. During current COVID-19 pandemic tele dentistry is an effective way to triage high risk patients needing urgent or emergency care thus mitigatingthe risk of the spread of the Coronavirus. Tele dentistry is yet to become integral part of Pakistan dental health care service but it is imperative that dental health care providers actively promote and support the use of tele dentistry

Coronavirus disease- 2019 (COVID-19) presented as case of viral pneumonia of unknown etiology is diagnosed by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test of the samples from upper and lower respiratory tract. It can present as a mild flu-like illness for healthy adults yet it may become a life-threatening disease for the immunocompromised, such as cancer patients, by predisposing them to respiratory pathogens which may manifest as life-endangering pneumonia. Physicians should carefully evaluate their patient’s disease process and tailor treatment for individual patients to ensure that before doing beneficence, no further harm is done. Whether this is a wrinkle in time or the new normal, time will tell, but in light of recent evidence, ‘extra’ caution is the way forward.

Civil hospital of Gujranwala District of Punjab is a teaching hospital where a huge number of patients visit every day. Obstetrics and gynecology department of the hospital is a much busy department, around 92,186 patients visited the department last year and 11,788 births were conducted. Since the first case of Coronavirus disease-2019 (COVID-19) was reported, country has witnessed a lot of phenomena due to Coronavirus pandemic. Therefore, it was much needed that department develops Standard Operating Procedures (SOPs) to respond to Coronavirus outbreak and sustain essential obstetric services at this institute. There are three important components to focus on for developing a policy for the department with aim of preventing COVID-19 infection transmission among patients and health care providers. These are Guarding (Protection), Gears (Equipment) & Grounding (Planning). These important elements need to be addressed for preventing spread of infection. Aim should be to continue smooth delivery of quality health services to gravid females and to keep a check on complications during pandemic.

The knowledge regarding diagnostic testing for SARS COV-2 is still at hit-and-trial phases, all over the world. Evolving day by day through ongoing research and extensive trials, use for SARS-COV-2 infectionsReverse Transcriptase-Polymerase Chain Reaction (RT-PCR) and IgM/ IgG serology by Enzyme Linked Immunosorbent Assay (ELISA) or Electro-Chemiluminescent Immunoassay remain the main stay of diagnosis. However, the time course for the PCR positivity and seroconversion seem to vary in children and adults both, which also includes a huge population of asymptomatic individuals who are potentially labelled negative hence posing a great threat to the surrounding community.

Coronavirus disease 19 (COVID-19) has been promptly spreading to different countries becoming a global pandemic, to the reports of the World Health Organization (WHO). Sufficient immune responses over whelming the virus in the first or second phase without immune over-reaction can be seen in patients with competent immune functions and no obvious risk factors like old age, co-morbidities, etc. There is high sensitivity and specificity of saliva specimens in detecting respiratory viruses by an automated multiplex molecular assay while comparing with those of nasopharyngeal aspirate. The beneficial role of saliva as a quick and non-invasive diagnostic bio sample has been established.

Ever since Coronavirus disease 2019 (COVID-19) has been declared a pandemic by World Health Organization (WHO) it has gradually become top cause of morbidity. Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) possesses the tendency to cause severe symptoms in patients with a weakened immune system. In the setting where a mother develops mild COVID-19 infection yet remains stable, responds to medical treatment and there is no fetal compromise; the pregnancy may be continued to term with close surveillance. What is important in the current scenario is that the patients of COVID-19 along with any other comorbidities or medical conditions are at more risk of having fatal disease then the ones with COVID-19 alone. The pregnancy is one physiological condition in which a patient can face drastic pathological complications with COVID-19 if not given the due care.

People have suffered both physically and mentally from threatening situation of the emerging cases of Coronavirus in Pakistan. The health professionals who are directly involved in performing various blood tests on the samples of COVID-19 patient are almost equally in danger zone to get infected as much as the health care workers who treat them. The environmental contamination is higher in the hospitals and working medical staff should practice strict protective measures to overcome this psychological stress or mental trauma as it sub-optimizes a person’s working capacity.

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Children of all ages have been reported to be susceptible to COVID-19 with no significant gender difference. Clinical manifestations of paediatric patients are generally less severe than those of adult patients except for the children with co-morbidities. We report a case of a COVID-19 positive child, 13 months old, with both parents positive and managed conservatively for symptoms of cough and loss of appetite. Continuous monitoring and close follow-up in intensive care is the key to successful recovery in patients with Coronavirus infection without co-morbidities.

Coronavirus disease COVID-19, caused by Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV2), is highly contagious and has been a pandemic since March 2020. The SARS-CoV-2 is an enveloped, single-stranded, positive-sense RNA viruswhich spreadsthrough air droplets by sneezing and coughing from affected person. The diagnosis of the COVID-19 remains a challenge to the scientists since the genome of the SARS-CoV-2 was novel and varying. Various studies have reported the validated procedures for sampling and the detection method of SARS-CoV-2. This mini-review provides a brief introduction of the SARS-CoV-2 features and the current knowledge for the recommended COVID19 detection methods including sampling procedures and real time SARS-CoV-2 genome detection.

The SARS pandemic produces new avenues to discover and anticipate the variations made in SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) and how human angiotensin converting enzyme 2 receptor ideally becomes congenial with “S” region of this virus and in consequence ofits spread in human species all over the globe. At the end of 2019, the earliest wave of SARS-CoV-2 transmission was notified from Wuhan-Hubei China and thereafter spread globally. COVID-19 infection got widespread and upto now, 2,776,224 active cases, 334,058 deceased and 2,078,505-recovered cases have been reported. Morbidity and mortality rate vary in every region which pondered the researcher to look into the linkage between a different variant of the SARS-CoV-2 with disease severity along with other determining factors like climatic changes, diagnostic techniques, hospitals and laboratory quality control measures.

Currently major challenge for scientists is to cope with Coronavirus infection that alters host immune response in different ways. There is variability in immune response in diverse populations against this infection and particularly immunity of a certain population against SARS-CoV-2is not clear. Many factors such as viral and host genetics that play crucial in this infection but immunological aspects are more important in infection and disease progression. Its different patterns of spread and severity needs timely focus to design strategies against this disease. This review sums up the concepts related to host immune response to SARS-CoV-2, cellular and humoral immunity, cytokines storm and immunization against COVID-19.

Since the COVID-19 outbreak has emerged, every nation and every government are trying its best to combat the disease and develop strategies for better prevention, diagnosis, treatment and management of this lethal virus. Though the mortality rate is far less than any other pandemic the world has experienced, still patients with co-morbid conditions and immune system disorders are at high risk of fatal outcome. There are no approved treatments for COVID-19; thus, people with COVID-19 should be referred to clinical trials. Several agents have been touted as treatments for COVID-19, but at this point, the data are insufficient to inform a recommendation for or against the use of these agents outside of clinical trials; well-conducted randomized trials will be critical in determining how COVID-19 should be treated.

Novel Coronavirus disease 2019 (nCOVID-19) a global pandemic is an ever-remaining threat for patients with Diabetic Mellites (DM). Herein, we have tried to provide brief insight to critically analyze the reasons causing the severity of Coronavirus disease (COVID-19) in patients diagnosed with DM. This, mini review highlights the key investigations starting from binding of COVID-19 at the cellular surface to create sever infection or even death in DM patients. The study further suggested to pay urgent attention towards stabilization of deadly immune response arises as a result of COVID-19. We hope the highlighted investigation will help the researchers to understand and develop a road map to deal DM patients infected with COVID-19 to minimize the severity rate.

The world is facing a severe and acute public health emergency due to the ongoing COVID-19 global pandemic. How individual countries respond in the coming weeks will be critical in influencing the trajectory of national epidemics. The mortality and morbidity rates reported so far and healthcare demands anticipated, are based on data from China and other high-income countries; marked variations in underlying health conditions of general public, capacity and strength of healthcare systems and vision of policy makers will likely result in different patterns in low income settings. This review is focusing on variations in pattern and outcome of SARS-COV-2 in Asian region in comparison with some neighboring countries. In conclusion, the aged population with co-morbidities has deadly outcome. As asymptomatic carriers are source of transmission of disease to vulnerable subjects, therefore, we need to continuously develop, monitor and implement prophylactic and therapeutic strategies to combat this deadly virus over the next months to years. A possible explanation of different outcome in different country can be ascribed by the presence of comorbidities, average age of population that are infected with virus and the use of some drugs that induce the cell expression of receptors for the virus.

In inference, this hazardous Corona virus has a wide-spread terror over the world. This drastic pandemic originates from china and prevailed darkly all over the world. It has damaged all spheres of life in developing and developed countries as well. In Pakistan, It severely has harmed all areas of a country but specifically it demolished the state of economy, health care professionals, education and employment. However, around the globe, Governments have taken serious actions but remain unable to control the situation completely. There is a dire need of proactive management to fight effectively with such unexpected far-reaching pandemic. Along with Governments it is the duty of a common man to cooperate and participate actively in stimulus actions taken by Government.

Background and Objective: There is a high suspicion that SARS-CoV-2 might be transmitted vertically from mother to fetus and causes clinically significant infection. This review evaluates the pathogenesis, risk factors, diagnosis and management strategies in pregnant women suspected or confirmed with COVID-19 infection. Methods: A literature review of published articles was carried out using keywords of corona virus (and its root derivatives), pregnancy, vertical transmission and childbirth in Medline, Cochrane, CINAHL and Web of Sciences. Clinical articles including case-control, case reports, case series and reviews published between 2019 and 2020, in English language were included. Editorials and Letter to Editors were not included. Two independent authors reviewed title and abstract and another set of two independent authors screened full text. A total of 22 articles were shortlisted for addition into the final manuscript. Results: A total of 403 pregnancies were considered in the study with most of the patients in the third trimester of pregnancy. There was no maternal mortality reported in the literature, however 1.49% fetal mortality has been reported. Conclusion: Extensive care should be taken to determine the timing and mode of delivery, preparation of a safe-to-deliver labor room and the choice of anesthesia with detailed newborn observation.

Background and Objective: A set of new studies is offering perspective and guidance on the differences between using Real Time Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) and chest Computerized tomography (CT) in terms of sensitivity and specificity. This review paper addresses the comparative diagnostic potential of CT chest and RT-PCR for COVID-19. Method: An online literature search was carried out from Jan. 2020 to Apr. 2020 from Google -Scholar, Web of Science, Science Direct and PubMed using the MeSH key words. Twenty-five articles were retrieved. Articles with incomplete information and covering other factors like ethnicity were excluded and only the articles with comparison between two clinical diagnostic methods were included. Avoiding the duplication of issues, 5 articles were finally selected for review. Result: This review observed 98% pooled sensitivity of CT-chest being much higher than that of RT-PCR (75%). Conclusion: Patients with suspicion of COVID-19 should be screened using CT scan chest as a more sensitive technique.

The infection caused by Severe Acute Respiratory Syndrome-Corona Virus 2 (SARS-CoV-2) has rapidly emerged as a serious pandemic, causing substantial morbidity and sometimes mortality with a significant healthcare burden. Unfortunately, Pakistan is among top twenty countries of the world affected by COVID19. The clinical spectrum in COVID-19 is diverse, ranging from mild disease having flu-like symptoms to potentially fatal ARDS, cytokine storm, multiple organ failure and death. Common risk factors associated with severe outcome in COVID-19 infection include male gender, older age and presence of comorbidities such as hypertension, diabetes and cardiovascular disease. Here we reviewed the available literature and report that the underlying mechanisms that account for a broad range of symptoms during respiratory viral infections, that have been well studied in the case of influenza viruses, adenoviruses, SARS-CoV and MERS-CoV, suggest that host genetic and epigenetic factors may also play a significant role in determining susceptibility and clinical outcome in COVID-19 infection. In this review we discuss the potential roles of host genetic factors including cellular receptors for COVID-19, HLA and inflammatory cytokine genes. Based on the SARS-CoV-2 genome and protein-protein interactions map between host and viral proteins we also describe the potential roles of several viral proteins in epigenetic modulation of host inflammatory innate immune response by targeting different cellular pathways particularly NF-κB activation, which may lead to the inflammatory cytokine storm and a severe COVID-19 disease. Investigations of these genetic and epigenetic mechanisms during COVID-19, especially in local settings, will be helpful in management of patients with higher risks and in the development of novel antiviral therapeutics.

Corona virus Disease-19 (COVID-19) is a global health pandemic that has affected life of every individual in the world. It is caused by a novel Corona virus strain that has caused seventh Corona virus infection that has affected human population, named as “COVID-19” virus by the World Health Organization. Previously, six Corona virus infections have affected humans but those caused by SARS-CoV and MERS-CoV have proved to be more lethal. Angiotensin Converting Enzyme 2 (ACE2) has been found as the receptor for COVID-19 through which cellular entry of the virus is mediated into the body. These receptors are abundantly present in the oral cavity especially on the epithelial cells of the tongue, oral mucosa and the gingiva. Saliva is an oral bio-fluid of the oral cavity in which high titres of the virus have been identified during early and later stages of infection. Saliva collection is a non-invasion method and can act as a diagnostic tool for COVID-19 disease. Common oral symptoms of the disease include transient loss of taste, smell and dryness of mouth. Precautionary measures must be taken by dentist before carrying out any dental procedure for safety of the health care professional, staff and also the patient. Dental community must think of the “new normal” regarding clinical dental care in light of post-COVID-19 situation.

A bat-borne disease is any infectious disease whose primary reservoir is any species of bat. It is not a coincidence that some of the deadly viral disease outbreaks in recent years like severe acute respiratory syndrome (SARS), Middle East respiratory disorder (MERS), Ebola, Marburg and the new 2019-nCoV virus are speculated to be originated in bats. Rarely some bacterial and fungal diseases are also related to certain species of bats. Such illnesses are part of Zoonosis, which refers to the human diseases of animal origin. In this review we highlight some of the bat-borne diseases with emphasis on the viral outbreaks as bats world-wide harbor a greater proportion of viruses than several other groups of mammals.

The outbreak of pneumonia that broke out in Wuhan, in December 2019, later rapidly spread to the rest of the world. This was identified as Coronavirus disease 2019 (COVID-19) [officially renamed severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2)] caused by a zoonotic beta Coronavirus entitled 2019 novel Coronavirus (2019-nCoV). The aim of this study was to summarize the biological features of SARSCoV-2, its clinical features and the possible antiviral effect of honey against SARS-CoV-2. For this purpose, recently published literature, official documents and selected up-to-date preprint studies were reviewed. The initial source of SARS-CoV-2 is still unknown but a possible animal-to-human transmission is indicated. Human spread of SARS-CoV-2 is due to droplet spread. The infected individual may present as symptomatic or asymptomatic, this varies from patient to patient mainly depending upon his/her immunity. To combat the current pandemic various modalities are under study, an important and harmless way of treatment might be the use of honey. Various studies have demonstrated antiviral effects of honey. Propolis and honey have shown promising anti-viral effect against SARS-CoV-2. Thus, the combined effect of honey and its products might open a door for developing a safe and highly efficient natural drug against COVID-19
infection.

Background and Objective: Infectious disease outbreak caused by novel Coronavirus is a global public health concern. In this pandemic, pregnant women are high risk population. Knowledge and data on the effect of this COVID-19 disease on pregnant females and their newborns is limited. Number of cases is increasing day by day. Aim of the current study was to provide evidence-based knowledge related to effects of Coronavirus on pregnancy to improve the understanding of the COVID-19 disease. Methods: This is a systematic review, carried out in the Department of Obstetrics & Gynecology at Shalamar Medical and Dental College, Lahore. The available published research data from January 1st 2020 to May 13th 2020, on the effects of Coronavirus in pregnancy was collected. On the basis of Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines the articles in English were selected from electronic databases PubMed and Goggle scholar. Results: The information gathered is organized in five main themes namely; Clinical manifestations of COVID-19 during pregnancy, risk of vertical transmission, issues related to breast feeding, care during antenatal period and labor and strategies for prevention. The main concern is to focus on best clinical practices for care of pregnant females. Conclusion: Clinical manifestations of Coronavirus infection in pregnant females are not different from general population. There is on strong evidence of risk of vertical transmission. Best antenatal care and care during labor is the right of all pregnant females whether suspected or infected and it must be according to the standardized guidelines. Breast feeding is encouraged either with full protection of transmission of droplet infection or my expressing milk manually. Vaginal delivery is safe and preventive strategies for the disease available for general population must be adapted by the pregnant women also to avoid getting the infection.

Rapid emergence and spread of current pandemic of COVID-19 has evoked the medical science community to investigate quick, accurate and reliable diagnostic and prognostic approaches. Early identification of causative agent SARS-CoV-2 in host and monitoring the blood biochemical parameters for the assessment of disease severity leads to devise proper management and care to minimize mortality rate. The research studies on biochemical markers in COVID-19 published till May 15, 2020, are retrieved by using keywords “biochemical markers, biomarkers, COVID-19, and SARS-CoV-2” at web search engines (Google scholar & PubMed). Selected articles are reviewed for the selected biomarkers that can be useful prognosticators of mild and severe patient outcomes to provide assistance in clinical management of the outbreak for frontline medical personnel. Biochemical tests include panels of liver and renal functioning, lactate dehydrogenase, C-reactive protein, and interleukin-6 that have abnormal and deteriorated values as compared to normal controls and mild cases. Patients having baseline comorbidities such as hepatitis or chronic kidney disorder might develop multiorgan injuries during hospitalization but in other patients’ biomarkers measure the status of inflammatory response and drug therapy outcomes

Background and Objective: The Coronavirus disease 2019 (COVID-19) pandemic has affected more than four million people in 213 countries. Health care workers (HCWs) who deal with COVID-19 patients have a high chance of getting infected. They have got valid concerns regarding their own health as well as the impact it can have on the wellbeing of their family and acquaintances. The current study aims to assess the prevalence of psychological problems among HCWs during the COVID-19 pandemic. Methods: A cross-sectional study was conducted among HCWs of Wah Medical College and Pakistan Ordnance Factories (POF) Hospital Wah Cantt from 1st May 2020 to 7th May 2020 after an ethical approval by ethical review board. A total of 340 HCWs participated by filling an online questionairre; questions on demographic profile and validated Depression, Anxiety and Stress Scale–21 (DASS-21) score were included. Frequency of depression, anxiety and stress and mean DASS-21 scores between house officers and all other healthcare workers and between Medicine and allied department and other departments was assessed. Data was analysed using Statistical Package for the Social Sciences (SPSS)-23. P-value ≤ 0.05 was considered statistically significant. Results: Among 340 HCWs majority i.e. 66.8% were less than 35 years of age and the mean age of participants was 40.65 ± 11.64 years. There was a female proponderance with a F:M ratio of 1.7:1. Most (55.3%) of the participants were single and there was a high percentage of house officers with 45% among all. The overall prevalence of depressiom, anxiety and stress among all HCWs was 32.9%, 25% and 23.5% respectively. The depression, anxiety and stress among house officers than other HCWs and higher prevalence in Medicine and Allied Departments than other departments. Conclusion: As the global threat of COVID-19 continues to emerge, it is important not to underestimate the psychological impact of this pandemic on HCWs. Interventions and support to especially vulnerable groups of HCWs will help improve psychological health, which in turn will help improve the quality of patient care.

Background and Objective: The pandemic caused by Coronavirus disease-2019 (COVID-19) is notably becoming similar to severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome viruses (MERS) for causing poor feto-maternal outcome. There is not much data available about COVID-19 during pregnancy in Pakistan therefore the objective of this study is to determine maternal and fetal outcome in pregnant women affected with COVID-19 and to find out frequency of vertical transmission. Methods: This descriptive case series was conducted from 1st April 2020 to 10th May 2020 at Department of Obstetrics and Gynecology, COVID ward, Sir Ganga Ram Hospital, Lahore. A total of 20 women were included in the study that were found positive for viral RNA by Real-Time Reverse TranscriptionPolymerase Chain Reaction (rRT-PCR) of nasopharyngeal specimens. Demographics, duration of gestation, fetomaternal outcome and vertical transmission were noted in the respected proformas. The data was analyzed using Statistical Package for Social Sciences version 20. Results: The mean age of these gravid females was 29.3 ± 4.17 years. The mean gravidity was 2.60 ± 1.14 and mean gestational age was 29 ± 9.53 weeks. Among 20 patients, 4(20%) were primigravida, 5(25%) females were gravida 2 and remaining 11(55%) cases were gravida 3 and 4. The most common presenting complaints were fever followed by dry cough, myalgia and shortness of breath. Nine patients were delivered by lower segment cesarean section in which fetal distress was observed in 5(55.6%) newborns and 1(10%) newborn was preterm. Among all newborns, 02 developed respiratory distress syndrome and were admitted in pediatric intensive care unit. All pharyngeal swabs of newborns were negative at 12 and 24 hours of life. Conclusion: COVID-19 in pregnant females is not different than in general population. The fetomaternal outcome is usually good and there is no evidence of vertical transmission in any newborn.

Background and Objective: Congestive Heart failure (CHF) is an increasing clinical syndrome with frequent exacerbation requiring a very close follow-up to prevent hospitalization. Due to current lockdown situation related to coronavirus disease 2019 (COVID-19) pandemic, CHF patients suffered by having limited access to their physicians and therefore are more vulnerable and at higher risk for CHF exacerbations requiring CCU admission. There is no data so far in Pakistan using telemedicine to manage CHF patients. The present study aimed to use telemedicine to manage CHF patients at home, keeping them safe from COVID-19 in order to prevent exacerbation of CHF. Methods: A descriptive study was carried out at Shalamar Hospital, Lahore. A total of 31 established CHF patients were enrolled to manage them at home via telemedicine after taking the approval from Institutional Review Board. Patients were followed via telemedicine every two weeks for a total period of 8 weeks. Data was analyzed in SPSS version 20. Mean with standard deviation was calculated for quantitative variables like age. Frequency and percentages were calculated for qualitative variables. For determining any significant difference between the stratified groups, the Chi-Square test was applied hence taking Pvalue ≤ 0.05 as significant. Results: Among 31 patients, mean age was 54.4 ± 11.121 years. A total of 60% were males. Average Left Ventricle Ejection Fraction (LVEF) of 26.9% was seen. Patients were followed on defined CHF monitoring parameters including weight changes, new or worsening ankle edema or breathing difficulty. Patients were trained to record and report their daily vitals. A total of 14 patients reported CHF symptoms and 11patients required adjustment of diuretic dose with successful management. Only two patients ended up being admitted in Coronary Care Unit (CCU) for CHF exacerbation and at 8 weeks there was no significant change in the weight gain or renal functions as a result of medicine adjustment due to telemedicine. Conclusion: Telemedicine during current lockdown related to COVID-19 pandemic is an effective strategy to manage CHF patients at home while keeping them safe from Corona virus infection.

Background and Objective: The COVID-19 pandemic to-date has no treatment or vaccine and protection from the viral illness is only possible by acting upon valid and reliable information. The dentists are considered to be the most vulnerable profession due to proximity with the patient, and this also puts dental patients at risk. Internet is one of the primary sources of information, therefore this study aimed to evaluate the accuracy of the online available information using validated instruments. Methods: The following terms were searched on google.com “Coronavirus and dentistry”, “COVID-19 and dentistry” and “SARS COV 2 and dentistry”. The first fifty results for each search term were evaluated. Eighteen of the websites did not meet inclusion criteria so 132 websites were critically analyzed by Health on the Net Foundation Code of Conduct (HON code) and the Journal of the American Medical Association (JAMA) benchmark. Also, the websites were categorized according to content type. Results: A total of 6 (4.54%) websites had the HON code seal, and the JAMA benchmark showed that 14 (10.6%) did not fulfill any of the requirements. Another 69 (52.3%) links had fulfilled all the requirements but 65 (94.2%) of these websites were either links to research journals or guidelines published by dental associations, universities or government organizations, and usually not accessed by the general public. Conclusion: The information available to the dentists is satisfactorily accurate and reliable, but the nonhealth personnel need to be aware of the quality of information they read. The dentists should provide information to the patients about accessing reliable online sources for information and the expected changes in dental practice. The government should regulate health information on the internet to curb apprehension associated with dental treatment and viral pandemic.

Background and Objective: Pakistan has been sternly affected by COVID-19 (Coronavirus Disease 2019) since March, 2020. This study was intended to evaluate the mental health among health care workers throughout the epidemic and to sight see the possible influence factors. Methods: A web-based cross-sectional survey composed of n = 237 self-selected health care workers was conducted. Their demographics, COVID-19 associated knowledge, Hospital Anxiety and Depression Scale (HADS) were noted. Results: This study received n = 237 responses. A total of (59%) of the participants belonged to age group 20-30 years. Females (56.3%) were more among all of them. Regarding marital status, (44.5%) were unmarried. Out of n = 237 participants, there were (62%) doctors, (34%) nurses and (4%) paramedical staff. Depression and anxiety prevailed in about (34.6%) and (42.2%) of participants respectively. Moderate depression was reported equally by doctors and nurses. Severe anxiety was found in (25%) while borderline anxiety in (17%) of all the participants. Nurses reported more severity in depression while comparing to doctors. Conclusion: Females were slightly more depressed than males and anxiety was more common than depression especially in health workers from Sahiwal. Depression was seen more commonly in married individuals while comparing to singles. Risk of transmission of COVID-19 to family was most stressful for the participants and more than half of them affirmed it.

Background and Objectives: Coronavirus disease 2019 (COVID-19) is a respiratory disease caused by a novel Coronavirus. The World Health Organization (WHO) officially declared it a health emergency on January 30, 2020. WHO also called for collaborative efforts from all countries to prevent its further spread. The success of the world’s battle against COVID-19 depends upon people’s adherence to the control measures which is affected by their Knowledge, Attitudes and Practices (KAP) towards the disease as suggested by KAP theory. In this study, the KAP of population from Punjab towards COVID-19 during the rapid rise period of the COVID-19 outbreak is investigated. Methods: This was a cross-sectional study based on Google forms-based survey regarding the Knowledge, Attitudes and Practices of participants towards COVID-19. A total of n = 500 participants completing their questionnaires were included. Online data was extracted and cross-checked for any discrepancy. Statistical analysis was done by using SPSS ver.22. Results: Participants with ≥ 22 years of age significantly practicing more social distancing (P<0.05). Knowledge of hand hygiene and proper discarding of mask were significantly more associated with the practices of social distancing. Knowledge of cough and sneezing etiquettes was significantly related to practice social distancing (P < 0.01). Attitude of hand hygiene protocols was significantly related to practicing hand washing, minimizing touching environment (P < 0.01) and disinfecting house and workplace (P < 0.05). Conclusion: The present study showed a good knowledge, positive attitudes and suitable practices in population of Punjab. The health awareness programs designed after pandemic declaration by WHO, played a vital role in improving all these things.

Background and Objective: COVID-19 has emerged as a serious threat to the public health. It has been declared as Public Health Emergency of International Concern (PHEIC) because of morbidity and mortality associated with it all over the world. The objective of the present study was to analyze COVID-19 related fatalities in terms of comorbidity, length of hospital stays and critical illness in Allied hospitals of Rawalpindi Medical University. Methods: A retrospective hospital data-based research was carried out on n = 25 fatalities registered in three Allied hospitals (Rawalpindi Institute of Urology & Transplantation, Benazir Bhutto Hospital and Holy Family Hospital) of Rawalpindi Medical University. The data included age, gender, date of admission and death, severity of illness, comorbidity, oxygen administration or ventilator support and was gathered through consecutive sampling. The data was analyzed by using SPSS version 25.0. Fisher’s Exact test was applied to determine statistical significance of association between comorbidity and need for ventilation. Statistical significance of association between length of hospital stay and comorbidity was verified by independent sample t-test. Results: Of the total n = 25 COVID-19 related fatalities in Allied hospitals, 76% were males. The mean age of study subjects was 55.9 ± 15.28 years. The greatest number of overall deaths was among 51 – 70 years old patients. About 44% fatalities had comorbid states with hypertension and diabetes constituting the highest (45.4%) proportion. Comorbidity had statistically significant association (P < 0.02) with need of ventilators in critically ill patients while length of hospital stays depicted insignificant association with comorbidity (P > 0.80). Conclusion: People above the age of 50 years are more likely to die due to COVID-19. Comorbid states of hypertension and diabetes should be carefully managed to avoid grave consequences.

Background and Objective: Coronavirus induced disease (COVID-19) is affecting people all around the world. The rising number of deaths due to COVID-19 is not only harassing people but also causing strong emotions in adults as well as in children due to anxiety, fear and stress. The objective of this study was to assess the fears, anxiety and stress due to COVID-19 pandemic and related issues among the apprentices at various levels in different parts of world. Methods: It was a cross sectional survey design to assess the students/trainee’s immediate psychological response during COVID-19 outbreak by using an anonymous online questionnaire. A snowball sampling technique was conducted focusing general public all around the world from 3rd April 2020 till 7th April 2020. A total of N=354 participants filled the form completely. The structured questionnaire collected information on demographic data and psychological aspect of this outbreak, including extreme fear and uncertainty. Results: A total of N = 354 participants completed the questionnaire; majority were from the age group of 21–30 years. Approximately 66.4% were females and 33.6% males. Participants from Asia were 83.6% while 9.9%, 3.4%, 2.8% and 1% from America/Canada, Europe, Africa and Australia respectively. Out of n = 354 participants 59.3% were relying on health professionals for authentic source of information regarding COVID-19 while 16.4%, 15% and 5.4% considered social media, television and World Health Organization (WHO) website respectively as their authentic guide. Out of the (n = 354) participants 80.5% were afraid about health status during COVID-19 most predominantly females (66.3%) (P = 0.000). A total of 65.8% participants felt agitated or irritated in this outbreak. Conclusion: COVID-19 lockdowns are affecting both physical and mental health of students and apprentices enrolled at different levels of education. Females are more affected and concerned to their loved ones and themselves. Working norms are being maintained and responsibilities are being fulfilled despite this grave situation.

Background and Objective: Coronavirus disease-2019 (COVID-19) pandemic starting from China has been spread internationally. This rapidly spreading and high mortality epidemic of Coronavirus caused significant anxiety and panic globally and affected more than 197 countries. This study aims to assess the anxiety level among health care professionals working on frontline against Coronavirus disease in teaching hospitals of Bahawalpur. Methods: A cross sectional analytical study was conducted in Bahawal Victoria Hospital and Civil Hospital Bahawalpur from February to April 2020 after taking ethical approval from institutional ethical review committee. A total of 343 physicians and nurses were surveyed through predesigned, pretested questionnaire after taking written informed consent from each respondent. Anxiety was assessed by using Hamilton Anxiety Rating Scale (HAM-A). The sociodemographic variables of the respondents were cross tabulated with anxiety levels and Chi-square test was applied to assess statistical analysis. P-value less than or equal to 0.05 was taken as significant. Results: Mean age of the participants was 37 ± 10.54 years. Majority of the study participants (39.6%) were in the age range of 31 to 40 years. More than two thirds (69.7%) respondents were working on Contract/Adhoc basis. Job experience of 270 (78.7%) participants was between 1 – 5 years. Statistically significant association was observed between severity of anxiety and job status (P < 0.001), marital status (P < 0.001) and job experience (P < 0.001). Conclusion: Job status, marital status and experience of health care professionals has significant association with severity of anxiety which suggest that hiring of healthcare professionals should be on permanent basis which will ensure their job security that may help to reduce their anxiety level and improvement in performance.

Background and Objective: The Coronavirus disease 2019 first appeared in the area of Wuhan, China. Dental professionals are at greater risk of getting infected by patients and certain dental procedures involving aerosol generation and proximity to the oropharyngeal region. Therefore, Personal Protective Equipment (PPE) is recommended to protect skin and mucosa from infected blood or saliva. American Dental Association (ADA) has published recommendations for dental treatment, yet most of the dentists are still hesitant in treating patients. The objective of this study was to assess the knowledge and practices of dentists in Pakistan regarding PPE during COVID-19 pandemic. Methods: Data collection was done using a well-structured web-based questionnaire (Google forms). The survey form was disseminated by sending the link via email, WhatsApp and other online forums. Results: A total of n = 1016 responses were collected. Approximately 91.6% of the participants were young dentists with years of experience 1 – 10 years. Majority of the participants 76.7% did not have easy access to PPE. A total of 60.8% claimed to be aware of the recent World Health Organizations, Centre for Disease Control and other international guidelines to screen COVID-19 patients at their clinic. Almost all the participants, 95.6%, had never undergone N95 fit-testing in their career. More than half of the participants, 64.4% were not aware of the differences between N95, N99, N100 masks. A positive trend was observed in 91.7% of the participants when asked about washing hands or uses an alcohol-based sanitizer before every patient encounter. More than three quarter (81%) of the participants was not performing aerosol producing procedures at their practices. Conclusion: Majority of dentists were found to have adequate knowledge and practice scores, which is important to combat COVID-19. However there still many gaps in their knowledge and practices which need to be highlighted to ensure safe dental practice for both patients and dentists.

Background and Objective: At the outset of outbreak of Coronavirus disease-19 (COVID-19) infection in Pakistan, there had been a lot of confusion regarding the preventive measures in general public. The objective of current study was to determine the knowledge, attitude and practices regarding the home preventive measures against COVID-19 infection amongst smart phone users at the outset of outbreak in Pakistan. Methods: It was a cross-sectional online survey to determine the knowledge, attitude and practice amongst the smart phone users regarding the preventive measures against Corona infection. Total 388 questionnaires were submitted in one week in first week of April 2020. The data was collected through online questionnaire which were disseminated through WhatsApp groups. The completed questionnaires were compiled and analysed by using SPSS software version 21. Frequencies of responses were calculated. Results: A total of 196 (50.5%) participant were in the age category of 17–25 years with female predominance. Three hundred and 66 (94.3%) preferred washing hands with soap and water for 20 or more seconds, two thirds of the participants also agreed on the role of sanitizers. Only 159 (41%) knew what social distancing meant. Regarding the disinfection of eatable and non-eatable, almost half of the participants agreed to use soap and water. Considering the most effective disinfectant, 225 (43.8%) preferred Dettol. Surgical mask and N-95 masks were considered the effective ways to avoid droplet infections. Regarding the survival of the virus in different media, majority of the responses were completely ignorant. Conclusion: There are still gaps in knowledge, attitude and practices regarding prevention against Coronavirus infection at the outset of this out-break in Pakistan.

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