IntroductionCOVID-19 has manifested a striking disarray in healthcare access and provision, particularly amongst patients presenting with life-threatening ischemic heart disease (IHD). The paucity of data from low-middle income countries has limited our understanding of the consequential burden in the developing world. We aim to compare volumes, presentations, management strategies, and outcomes of IHD amongst patients presenting in the same calendar months before and during the COVID-19 pandemic. MethodsWe conducted a retrospective cross-sectional analysis at the Aga Khan University Hospital, one of the premier tertiary care centres in Pakistan. Data were collected on all adult patients (>18 years) who were admitted with IHD (acute coronary syndrome (ACS) and stable angina) from March 1 to June 30, 2019 (pre-COVID) and March 1 to June 30, 2020 (during-COVID), respectively. Group differences for continuous variables were evaluated using student t-test or Mann-Whitney U test. The chi-squared test or Fisher test was used for categorical variables. Values of p less than 0.05 were considered statistically significant. Pvalue trend calculation and graphical visualization were done using STATA (StataCorp, College Station, TX). ResultsData were assimilated on 1019 patients, with 706 (69.3%) and 313 (30.7%) patients presenting in each respective group (pre-COVID and during-COVID). Current smoking status (p=0.019), admission source (p<0.001), month of admission (p<0.001), proportions ACS (p<0.001), non-ST-elevation-myocardialinfarction (NSTEMI; p<0.001), unstable angina (p=0.025) and medical management (p=0.002) showed significant differences between the two groups, with a sharp decline in the during-COVID group. Monthly trend analysis of ACS patients showed the most significant differences in admissions (p=0.001), geographic region (intra-district vs intracity vs outside city) (p<0.001), time of admission (p=0.038), NSTEMI (p=0.002) and medical management (p=0.001). ConclusionThese data showcase stark declines in ACS admissions, diagnostic procedures (angiography) and revascularization interventions (angioplasty and coronary artery bypass graft surgery, CABG) in a developing country where resources and research are already inadequate. This study paves the way for further investigations downstream on the short-and long-term consequences of untreated IHD and reluctance in health-seeking behaviour.

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Hospital acquired pneumonia (HAP) is a severe and dangerous complication in patients admitted with COVID-19, causing significant morbidity and mortality globally. However, the early detection and subsequent management of high-risk cases may prevent disease progression and improve clinical outcomes. This study was undertaken in order to identify predictors of mortality in COVID-19 associated HAP. A retrospective study was performed on all patients who were admitted to a tertiary care center with COVID-19 associated HAP from July 2020 till November 2020. Data was collected on relevant demographic, clinical and laboratory parameters to determine their association with in-hospital mortality. 1574 files were reviewed, out of which 162 were included in the final study. The mean age of subjects was 59.4 ± 13.8 and a majority were male (78.4%). There were 71 (48.3%) mortalities in the study sample. Klebsiella pneumoniae (31.5%) and Pseudomonas aeruginosa (30.2%) were the most common organisms overall. Clinically significant growth of Aspergillus sp. was observed in 41 (29.0%) of patients. On univariate analysis, several factors were found to be associated with mortality, including male gender (p=0.04), D-dimers >1.3mg/L (p<0.001), ferritin >1000ng/mL (p<0.001), LDH >500I.U/mL (p<0.001) and procalcitonin >2.0ng/mL (p<0.001). On multivariate analysis, ferritin >1000ng/mL, initial site of care in Special Care Units or Intensive Care Units, developing respiratory failure and developing acute kidney injury were factors independently associated with mortality in our patient sample. These results indicate that serum ferritin levels may be a potentially useful biomarker in the management of COVID-19 associated HAP.

Introduction: Undergraduate medical students have consistently been shown to have high prevalence of mental health disorders in comparison to their peers from non-medical backgrounds and sleep quality is a critical aspect for maintaining mental wellbeing. The aim of this study is to compile prevalence on poor sleep quality and analyze its potential risk factors. Methodology: A cross sectional study was conducted at the Aga Khan University. Undergraduate medical students asked to fill out a self-reported questionnaire that was sent via email which included the 14-point Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). 302 students responded and the data was analyzed using chi square and logistic regression to determine their association with Sex, BMI, Year of Study and Academic Score. Results: The mean age of study participants was 21.58 + 1.41 years and majority were males (58%). The mean PSQI, ESS and PSS scores were 6.35 + 3.28, 7.72 + 4.58 and 28.38 + 7.81 respectively. 11.3% of participants reported poor sleep quality, which was significantly associated with female sex and academic performance. 28.5% of students had excessive daytime sleepiness, which was significantly associated with female sex and academic year (first year). “Stress” and “Overthinking/Anxiety” were the two most common self-reported reasons for Poor Sleep Quality. 85.4% of students were stressed with an average PSS score of 28.38 + 7.81. Conclusion: This study therefore shows a high prevalence of stress with moderate sleep disturbance prevalence, which was associated with female sex and academic performance.

Problem: The COVID-19 pandemic has resulted in significant resource deficiencies, especially with regards to basic facilities required for the safety of Healthcare Professionals (HCPs) such as Personal Protective Equipment (PPE). Resource deficiency can be attributed both to inadequate production and to misdirected distribution due to deficits in the global supply chain, particularly in a time-sensitive situation like this. Low-Middle Income Countries (LMICs) face the added burden of economic constraints and underdeveloped health-care infrastructure. Lack of a centralized approach, ineffective rapid communication (especially amongst private and public entities), stockpiling and inefficient resource allocation further exacerbate this underlying issue.Approach: Project Alloy has worked on building a platform for “Logistical Triage” to strengthen the coordination of resource networks in crisis situations. We aim to facilitate supply chain optimization by tackling inequitable resource distribution through a centralized management approach. Through our portal, healthcare organizations in need of personal protective equipment, ventilators, and other key resources would be connected to non-governmental organizations, government agencies and manufacturers to enable time-sensitive and need-based optimization of resource allocation and distribution. Outcomes: We hope to facilitate near-real time tracking of resource consumption, to guide the efforts of rapidly emerging “pop-up” suppliers and manufacturers. This would ultimately feed into three key outcomes: a) to ensure immediate continuity of supplies to HCPs in the frontline against COVID-19; b) to track and preempt the trajectory of resource deficiencies and demands in order to mitigate the impact of the rapidly rising incidence of COVID-19 cases; and c) to establish a centralized network for healthcare specific e-commerce infrastructure in low-middle income countries to facilitate future crisis management. Future Steps: We plan to expand iteratively, to include e-commerce technology to build our supplier dashboard and to develop a crisis specific e-commerce marketplace for healthcare resources.