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.

Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P &lt; 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P &lt; 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P &lt; 0.001). Conclusion Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infection.

Infectious agents have been implicated in the pathogenesis of autoimmune disorders for decades. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is no exception. This became evident as the pandemic evolved. Once considered a respiratory pathogen only, SARS-CoV-2 is now linked to a variety of autoimmune rheumatic disorders such as rheumatoid arthritis, systemic lupus erythematosus, reactive arthritis, spondyloarthropathies, vasculitis, and inflammatory myopathy. Although the exact cause for muscle injury in the setting of coronavirus disease 2019 (COVID-19) is not established, autoimmune inflammatory damage is the most accepted mechanism. Moreover, SARS-CoV-2 can cause direct muscle damage and indirectly through a cytokine storm. Inflammatory polymyositis in relation to COVID-19 has seldom been reported in developing countries.Here, we report a unique case of inflammatory polymyositis in a 52-year-old lady. The patient presented with muscle weakness, generalized body aches, and fatigue occurring four months after recovering from mild COVID-19. She had muscle weakness of Medical Research Council (MRC) grade 3/5 involving the shoulders and pelvic girdle with elevated muscle enzymes. Electromyography revealed an active irritable myopathic process consistent with inflammatory polymyositis. She underwent magnetic resonance imagingguided muscle biopsy from the right thigh which revealed findings consistent with inflammatory myopathy. She was offered prednisolone and azathioprine. After four weeks of treatment, she had a remarkable improvement in her muscle strength to MRC grade 5/5.

Aims: The aims of this work undertaken to investigate and identify the prevalence of Enterococcus spp isolated from Chicken and pigeon meat and determine the using antibiotics sensitivity against isolates for human safety.

To determine the prevalence and the antibiotic resistant patterns of the multi-drug resistant Extended-Spectrum Β-Lactamase(ESBL) producing E. coli isolates from children urine samples, in Queen Rania Al-Abdullah Hospital for children.A total of 61 non-repetitive urine samples from various outpatient clinics and inpatient wards were collected retrospectively over a period of 5 months (May 2012 to September 2012). The resistant patterns, screening and confirmatory tests for phenotypic detection of ESBL-producers were studied using the VITEK 2 system against a set of antibiotics found on the antimicrobial susceptibility extend card AST-EXN8.Children were nearly equally infected by both types of E. coli isolates, ESBL-producers 31 (50.8%) and non ESBL-producers 30 (49.2%). ESBL-producing E. coli showed maximum rate resistance to Cefuroxime and Piperacillin (100%), Aztreonam, Cefixime, Ceftriaxone plus Levofloxacin (96.8%), Ampicillin/Sulbactam and Cefepime (93.5%), and Moxifloxacin (90.3%), while minimum resistance rate was seen with Tigecycline (12.9%), Colistin (3.2%) and meropenem (0%). ESBL-producing isolates were significantly more resistant than Non-ESBL-producers (p < 0.05) to the following antimicrobials (Ampicillin/Sulbactam, Aztreonam, Cefepime, Cefixime, Ceftriaxone, Levofloxacin, Moxifloxacin, Piperacillin and Tetracycline). Multi-drug resistance was found to be higher in ESBL-producing isolates, which were resistant to at least 9 antibiotics. To limit the spread of the multi-drug resistant ESBL-producers E. coli isolates, we should perform screening test for these isolates on daily basis, isolate the infected patients and choose the best therapeutic option.According to the resistant pattern and safety issue, Morepenem can be considered as first line treatment and colistin as last resort therapy.

Anti-tuberculosis therapy involves the combination of drugs to hamper the growth of Mycobacterium tuberculosis (MTB). The emergence of multidrug-resistant tuberculosis (MDR-TB) is a global concern. Pakistan has been ranked 5th position in terms of a high burden of MDR-TB in the world. The aim of the current study was to investigate the prevalence of drug resistance in MTB in Khyber Pakhtunkhwa. Random samples were collected from 25 districts using the simple random sampling formula. All samples were processed in a biosafety level 3 laboratory for culture and drug susceptibility testing. Among 5759 presumptive tuberculosis (TB) cases, 1969 (34%) were positive. The proportion of TB was higher in females (39%) than males (29%), thus it represents a significant association between gender and tuberculosis (p < 0.05). People ages between 25 to 34 years were more likely to be infected with MTB (40%). Drug-resistant profile showed 97 (4.9%) patients were infected with MDR-TB. Streptomycin resistance was the highest and was observed in 173 (9%) isolates followed by isoniazid in 119 (6%) isolates. The lowest resistance was observed to pyrazinamide (3%). The prevalence of MDR-TB (10.4%) among patients that previously received anti-tuberculosis treatment is seemingly high. A large-scale drug resistance survey is required to evaluate the drug resistance for better management of tuberculosis.

ABSTRAKUlkus dekubitus atau luka baring adalah tipe luka tekan, dan 7-8% dinyatakan sebagai penyebab kematian pada paraplegia yang sering terjadi pada pasien stroke, sehingga perlu dilakukan tindakan perawatan yang tepat. Penelitian ini bertujuan Untuk mengetahui pengaruh mobilisasi dan penggunaan VCO (Virgin Coconut Oil) terhadap luka dekubitus pada gangguan fungsi motorik pasca stroke di Rumah Sakit Islam Sultan Agung Semarang. Desain penelitian quasi experiment, rancangan penelitian dengan menggunakan time series design dengan kelompok intervensi dan kontrol. Jumlah sampel 8 orang. Teknik pengambilan sampel purposive sampling. kelompok intervensi dilakukan mobilisasi 2-3 jam sekali dengan memberikan VCO sedangkan kelompok kontrol dilakukan mobilisasi lebih dari 2-3 jam sekali dan tidak diberikan VCO. Hasil penelitian menunjukkan bahwa tidak terdapat perbedaan grade dekubitus pada kelompok intervensi dan kontrol yang dilakukan mobilisasi dan diberikan VCO dengan nilai p = 0,495. Perlunya tindakan yang tepat dilakukan pada pasien dengan gangguan fungsi motorik pasca stroke untuk mengurangi kejadian dekubitus.Kata kunci: mobilisasi, VCO, ulkus decubitus, pasca stroke, gangguan fungsi motorik