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To determine the mortality of patients with severe COVID-19 in the intensive care unit (ICU) in relation to age, gender, co-morbidities, ventilatory status, and length of stay (LOS). Methods This was a cross-sectional study based on data retrieved for 204 patients admitted to the ICU of Hayatabad Medical Complex, Peshawar, Pakistan, from April to August 2020. Study variables were age, gender, comorbid conditions, ventilatory status, and length of stay (LOS). The data were analyzed using SPSS version 21 (IBM Corp., Armonk, NY). The independent t-test and the chi-square test were used to compare the means and frequencies of variables. Multivariate regression analysis was used to predict the likelihood of mortality. Results The overall mortality was 77%. Non-invasive ventilation (NIV) was administered to 61.8% of patients. Mortality was higher for invasive mechanical ventilation (IMV) (93.6% vs 66.7%, p<0.001) and for over 60 years (87.3% vs 72.3%, p=0.019). Mortality without co-morbidities was 75.2%. Comparative mortality rates for at least one co-morbidity (79.7%), diabetes mellitus (80.0%), hypertension (100%), diabetes mellitus and hypertension both (87.1%), and chronic obstructive pulmonary disease (75%) were insignificant. The LOS for survivors was longer (8.9±8.9 versus 5.4±5.2 days, p=0.017). The LOS < 24h was associated with higher mortality (85.9% vs 72.9%, p=0.040). On multivariable regression, the likelihood of mortality was high for IMV (7.330, 95% CI 2.667-20.143, p<0.001) and elderly (>60 years) patients (2.607, 95%CI 1.063-6.394, p=0.036). Mortality decreased with LOS longer than 24h (0.412, 95%CI 0.173-0.982, p=0.045). Comorbidities did not have any effect on mortality. Conclusions Age more than 60 years and IMV were independent risk factors for higher mortality. Longer ICU stay, specifically more than 24 hours, was associated with lower mortality but LOS less than 24 hours might not have a causal relationship with mortality. The odds of survival were not affected by co-morbidities.

Objectives: To determine the association between ABO/Rh-D blood types and susceptibility to SARS-CoV-2 infection in Pakistan. Methods: In this cross-sectional study, 1935 confirmed cases of COVID-19 were included using consecutive sampling. Age and gender-matched sample of 1935 blood donors was used as a comparison group. Chi-square test and binary logistic regression were used for inferential statistics. Results: Significantly higher proportion of blood type-B was observed in COVID-19 group (35.9% vs 31.9%, p=0.009). Blood type-AB was found more frequently (14.2% vs 11.8%, p=0.03) in the comparison group. The Rh-D Positive blood types were 93.3% in COVID-19 group and 94.9% in comparison group (p=0.03). The odds of blood type-B, AB and Rh-D positive to test positive for SARS-CoV-2 were 1.195 (95% CI 1.04 – 1.36, p=0.009), 0.80 (95% CI 0.66 – 0.97, p=0.03) and 0.75 (95% CI 0.57- 0.98, p = 0.03), respectively. Blood types A and O did not have significant association with SARS-CoV-2 PCR result (p = 0.22 and 0.88, respectively). Conclusions: There is significant association between blood types B & AB and susceptibility to COVID-19. There is no association between blood types A and O with COVID-19. Rh- D positive blood types are less susceptible to COVID-19. doi: https://doi.org/10.12669/pjms.37.1.3655 How to cite this:Rahim F, Amin S, Bahadur S, Noor M, Mahmood A, Gul H. ABO / Rh-D Blood types and susceptibility to Corona Virus Disease-19 in Peshawar, Pakistan. Pak J Med Sci. 2021;37(1):4-8. doi: https://doi.org/10.12669/pjms.37.1.3655 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A severe earthquake occurred in Kashmir in 2005. The epicentre was close to Muzzafarabad. We collected data on over 1,100 children 18 months after the earthquake to look at symptoms of PTSD and behavioural and emotional problems using well established questionnaires. We found that 64.8% of children had significant symptoms of PTSD. Girls were more likely to suffer from these symptoms. The proportion of children suffering from emotional and behaviour difficulties was 34.6%. This percentage was not different from other studies of children from Pakistan within areas which were not affected by the earthquake. The rate of emotional symptoms was higher in girls while hyperactivity was more frequent in boys. This pattern is similar to other studies from across the world.

The objective is to determine the frequency of different congenital heart diseases and their association in children with Down syndrome (DS). MethodologyThis cross-sectional observational study was conducted in the pediatric department of Peshawar Institute of Cardiology, Peshawar, Pakistan from August 2021 to July 2022. A total of 123 children with DS and congenital heart disease (CHD) were included in this cross-sectional study. Detailed history and examination were performed, and findings were documented on performed pro forma. Diagnosis of CHD was confirmed through two-dimensional (2D) and Doppler echocardiography performed by a pediatric cardiologist. Patients were managed according to standard protocols and guidelines. The data including age, gender, mother's age at the time of birth, type of CHD and growth failure were documented and analyzed. Percentages were used to express frequencies. ResultsThe mean age was 2.2 years ± 3.4 years (interquartile range (IQR): 10 days to 14 years). There were 65 (52.8%) male and 58 (47.1%) female patients. Out of 123 patients, 101 (82.1%) had acyanotic CHD and 22 (17.8%) had cyanotic CHD. Among acyanotic CHD, isolated ventricular septal defect (VSD) was the most common observation in 23 (22.3%) and among cyanotic CHD, tetralogy of Fallot (TOF) in seven (31.8%) patients. The most common associations of CHD were VSD+ patent ductus arteriosus (PDA) in 11 (9%) patients and atrial septal defect (ASD)+PDA in nine (7.3%) patients. The median age of the mother at delivery was 31 years (interquartile range (IQR): 20 years to 45 years). Growth failure was seen in 70 (56.9%) patients. ConclusionBased on our data, VSD is the most common CHD followed by a complete atrio-VSD (CAVSD) in children with DS. The most common association of CHD in DS is VSD with PDA. Growth failure is seen in most of the patients with DS having a CHD.

Objective: To determine the effects of tocilizumab (TCZ) on inflammatory markers, laboratory indices; and short-term outcome in patients with severe COVID-19.

BackgroundAvailable research compared serum biomarkers such as lymphocyte count, C-reactive protein, ferritin, Lactate Dehydrogenase and D-dimers to predict survival in patients with mild, moderate and severe COVID-19. This study aims to compare these biomarkers among survivors and non-survivors of severe COVID-19. MethodsThis was a cross-sectional study based on patient’s data retrieved from Hospital Information System. Sixty-nine patients for whom a record of the biomarkers and survival status was available, were included in the study. For every patient, baseline and peak values were selected for CRP level, serum ferritin level, serum LDH level and serum D-Dimer level. Similarly, baseline and trough levels were selected for lymphocytes. Data were analyzed using SPSS version 21. Mean and standard deviation was used to compare the biomarkers with paired t-test. P value less than 0.05 was taken as significant. ResultsThe mean age of the study population was 55.5±9.1 years and 72.5% were male. Among survivors, the increase in CRP level was not significant (from 15.80±9.8 mg/dl to 17.87 ±8.4 mg/dl, p=0.45) while among the non-survivor, the increase in CRP level was significant (from 16.68± 10.90 mg/dl to 20.77±12.69 mg/dl, p=0.04). There was no significant rise in serum LDH levels in survivors (from 829.59±499 U/L to 1018.6±468 U/L, p=0.20) while there was a statistically significant increase in serum LDH level in non-survivors (from 816.2±443.08 U/L to 1056.61±480.54 U/L, p=0.003). Lymphocyte count decreased significantly in both survivors (p=0.001) and non-survivors (p=0.001). There was no statistically significant elevation in serum ferritin among the survivors and non-survivors (p > 0.05). The D-Dimer level increased significantly in both survivors (p=0.01) and non-survivors (p=0.001).Conclusions In severe COVID-19 patients, serum CRP and LDH can be used for risk stratification and predicting survival. Lymphopenia, increase in serum ferritin and D-dimers may not predict survival.Trial Registration Not applicable