Background The medical community's understanding of the novel coronavirus disease (COVID-19) was limited initially, and many laboratory investigations were performed to observe effects of the virus on the body, its complications, and outcomes. We observed that some laboratory investigations provided redundant information regarding outcomes, and, therefore, were not necessary. Therefore, the extent of laboratory investigations may need to be pared down to not only avoid issues related to repeated blood sampling but also to minimize the financial burdens in poor socioeconomic countries. Objective This study aimed to observe trends of clinical and laboratory values in COVID-19 patients and their relationship to outcomes, including disease severity, length of hospital stay, and mortality. Methods We conducted an observational cohort study of COVID-19 patients treated as inpatients at the Shifa International Hospital (SIH) in Islamabad in April 2020. Patients were included if they were nonsurgical, adult inpatients of SIH diagnosed with COVID-19 via positive polymerase chain reaction test. We monitored study participants' clinical and laboratory values (including hypoxia) on admission and throughout the study period. We used IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY, USA) for data entry and analysis. Descriptive statistics were calculated for qualitative and quantitative data. We determined the effect of all variables on outcomes through chi-squared or Fisher's exact test, and p-values <0.05 with 95% confidence interval were considered statistically significant. Results A total of 51 patients with COVID-19 were enrolled. Most of the study participants were men older than age 50 with multiple comorbidities and resided in Khyber Pakhtunkhwa. Length of hospital stay ranged from eight to 14 days, and most patients had severe disease and survived. Factors such as patient age, gender, comorbid conditions, residence, and medication did not significantly affect outcomes. Hypotension during the height of symptoms and oxygen saturations <80% on admission was associated with prolonged hospital stays. Two complete blood count (CBC) parameters (platelet counts and mean corpuscular volume, MCV) were strongly associated with mortality and severity in our patients. Four non-CBC parameters (alanine transaminase, ALT; D-dimer; C-reactive protein, CRP; and lactate dehydrogenase, LDH) had strong statistical impact on disease severity, length of hospital stay, and mortality in our patients. Conclusion In a resource-limited country, laboratory testing must be chosen wisely and used appropriately. Patient age, gender, comorbid conditions, drugs, residence, and ferritin levels did not affect COVID-19 outcomes. Hemoglobin, platelet count, MCV, CRP, D-dimer, ALT, LDH, hypoxia, and hypotension were all correlated to disease outcomes. Therefore, these factors are useful laboratory examinations for COVID-19 patients, especially in poor countries. Categories: Internal Medicine, Infectious Disease Keywords: covid-19, tren...

Introduction: Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus (HIV) affect a significant proportion of the populace in developing countries. Pregnant women and deprived segments of the population are disproportionately affected. The aim of our study was to assess the awareness regarding the three blood-borne infections amongst pregnant Pakistani women belonging to low socioeconomic classes. Methodology: A cross-sectional survey was conducted among 297 pregnant women at two antenatal healthcare facilities in Islamabad, Pakistan between September and November 2019. A pretested structured questionnaire was employed for data collection and knowledge levels were classified into three categories i.e. “Good”, “Average”, and “Poor” according to pre-set criteria. Data were analyzed using Microsoft Excel 2016 and SPSS Version 21. Results: None of the study participants had “Good” knowledge regarding the three blood-borne infections. Around 52% of the women had “Poor” while 47% had “Average” knowledge. None of the study participants were aware that HIV can be transmitted during delivery. Women aged 30-35 years had significantly higher knowledge as compared to other age groups (p < 0.001). The difference in knowledge amongst women in association with education, income status, and previous pregnancies was not significant. Conclusions: Awareness regarding Hepatitis B, Hepatitis C, and HIV amongst pregnant Pakistani women of low socioeconomic status is insufficient which can lead to an increased risk of acquiring these infections, especially during childbirth. It is vital to impart health education regarding these diseases and monitor hygiene standards in health care facilities.

Background: Despite of our strong want, the datum is that the Covid-19 pandemic is still not over. Its physical and mental sufferings are well known. Mass vaccination is the true hope to eradicate this virus. Despite of large scale efforts, vaccination including boosters still needs optimization Aim: To see the effect of vaccination against covid-19 on general and covid-19 related anxiety so to endorse the continuation of vaccination until the virus is completely eradicated. Study Design: Observational, cross-sectional study Place and Duration of Study: Shifa International Hospital Islamabad from 1st October 2021 to 31st March 2022. Methodology: Three hundred and thirteen subjects with recent history of Covid-19 vaccination were enrolled and 281 subjects completed the survey, asked to fill out CAS (covid-19 anxiety scale) and GAD-7 (general anxiety disorder) scale based on the recall of their feelings before vaccination and then about after vaccination. Results:. Majority were females (61.1%), had education graduation and above (71.2%), belonged to non-medical profession (71.4%). 47.3% had Covid-19 cases in family while 13.2% had covid-19 related deaths in family. Means of CAS were higher than the means of GAD-7 (p<0.001). Drop in anxiety level was statistically significant for both Covid related anxiety and general anxiety after vaccination (p<0.05). Conclusion: Vaccination against covid-19 is crucial to manage Covid related and general anxieties because, future covid waves hence the anxiety waves are still expected. Bereaved families need further psychiatric support beyond vaccination to deal with their anxieties. Keywords: Anxiety in covid, Vaccination and anxiety, Mental health in covid, Covid related anxiety

Objective: To observe association of Melasma with serum Iron and complete blood count indices Study Design: Case-control cross-sectional study Place and Duration of Study: Department of Dermatology, HIT Hospital Taxila from 1st May 2021 to 1st October 2021 Methodology: Fifty seven females having melasma were taken as cases and 48 non-pregnant females without melasma as control between 12-50 years of age. Women with pregnancy, history of cardiac or thyroid disease and usage of hormone therapy, phototoxic drugs or anti-convulsant drugs were not included. History and examination was done by a dermatologist. Modified MASI (m Melasma Area and Severity Index) score was used for assessing severity of melasma. Blood samples were collected and send for serum Ferritin level, TIBC and Complete blood count in both groups. Results: The mean age of females were 35±7.4 years, and 48 female patients with no melasma were selected as controls with mean age of 25.7±8.4 years. We also analyzed the effect of different hematological and general factors on mMASI score within group of melasma patient but again found no statistically significant effect of any of these on MASI score. Conclusion: There is no direct association between melasma, serum iron levels and blood indices. Keywords: Melasma, Serum ferritin levels, Complete blood count

Background: Despite the advances in anesthesiology and surgical techniques, postoperative pain continues to be a global health-care issue. To increase the duration of analgesia during caesarian section under spinal anesthesia, adjuvants are frequently added to improve the quality of block. Aim: To determine the mean post-operative duration of analgesia produced by intrathecal dexmedetomidine with bupivacaine as compared to bupivacaine with placebo in patients undergoing elective caesarean section in spinal anesthesia. Study Design: Randomized control trial Place and Duration of Study: Department of Anaesthesiology and Gynaecology/Obstetrics Operation Theatre, Nishtar Medical University, Multan from 1st July 2020 to 31st December 2020. Methodology: Sixty patients admitted for elective caesarean section were randomized into two groups. Subarachnoid block was performed in all the patients. Group D received intrathecal Inj. Dexmedetomidine 10 mcg along with the standard bupivacaine dose while group C received 1 ml of 0.9% isotonic saline. Time for requirement of first rescue analgesia, which was provided by Inj. Ketoroloac 30 mg IV noted. Results: The mean post-operative analgesia of Group D and Group C was 270.25±23.81 minutes and 140.46±10.38 minutes, respectively in statistically significant difference( p=0.000). Post stratification was applied to control the effect modifiers like age, BMI, parity and ASA. It was found that in all strata of patients, Dexmedetomidine provided statistically significant difference in analgesia as compared to control group (p=0.000). Conclusion: Standard spinal anesthesia with Dexmedetomidine has a longer duration of post-operative analgesia as compared to standard spinal anesthesia alone. Keywords: Analgesia, Caesarean section, Intrathecal dexmedetomidine, Spinal anesthesia.