Introduction: Limited data exist on clinical characteristics and outcomes of hospitalized COVID-19 patients in low-middle income countries. We aimed to describe the clinical spectrum and outcomes of hospitalized COVID-19 patients at a tertiary-care center in Karachi, Pakistan. Methodology: We conducted an observational study of adult COVID-19 patients hospitalized between February-June 2020. Patients with a discharge diagnosis of COVID-19 and PCR positivity were included. We created logistic regression models to understand association of clinical characteristics with illness severity and in-hospital mortality. Results: The study population comprised 445 patients [67% males, median age 53 (IQR 40-64) years]. Majority of patients (N = 268; 60%) had ≥ 1 co-morbid [37.5% hypertension, 36.4% diabetes]. In-hospital mortality was 13%. Age ≥ 60 (aOR] =1.92; 95 %CI = 1.23-3.03), shortness of breath (aOR=4.43; 95% CI=2.73-7.22), CRP ≥150mg/L (aOR:1.77; 95% CI=1.09-2.85), LDH ≥ 500 I.U/L (aOR:1.98; 95% CI=1.25-3.16), Neutrophil-to-Lymphocyte ratio (NLR) ≥5 (aOR:2.80; 95%CI = 1.77-4.42) and increase in serum creatinine (aOR:1.32; 95%CI=1.07-1.61) were independently associated with disease severity. Septic shock (aOR: 13.27; 95% CI=3.78-46.65), age ≥ 60 (aOR: 3.26; 95% CI=1.07-9.89), Ferritin ≥ 1500ng/ml (aOR: 3.78; 95% CI=1.21-11.8), NLR ≥ 5 (aOR: 4.04; 95% CI=1.14-14.35) and acute kidney injury (aOR: 5.52; 95% CI=1.78-17.06) were independent predictors of in-hospital mortality. Conclusions: We found multiple predictors to be independently associated with in-hospital mortality, except diabetes and gender. Compared to reports from other countries, the in-hospital mortality among COVID-19 patients was lower, despite a high burden of co-morbidities. Further research is required to explore reasons behind this dichotomy.

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Objective COVID-19 mortality and outcomes differ significantly across the globe. Limited data exists from low-middle income countries (LMICs) on risk-factors for COVID-19 severity and mortality. We describe the clinical spectrum and predictors of mortality and severity of illness in COVID-19 from a single center in Karachi, Pakistan. Methods Retrospective cohort study of adults admitted with COVID-19 between February-June 2020 were reviewed and logistic regression applied on admission related risk-factors for severity and mortality. Results A total of 445 patients [66.97% males, mean age 51.6 (18-91) years] were admitted with PCR confirmed COVID-19 during the study period. Asymptomatic and severe/critical disease occurred in 55 (12.36%) and 137 (30.79%) patients, respectively. The proportion of severe disease increased with time and most ( 268, 60.22%) had [?] 1 co-morbid. Disease severity was associated with age [?] 60 (OR:1.92), shortness of breath (OR:4.43) , CRP [?]150mg/L (OR:1.77), LDH [?] 500 I.U/L (OR:1.98), Neutrophil to Lymphocyte ratio (NLR) [?]5 (OR:2.80) and unit increase in serum creatinine (OR:1.32). All-cause mortality was 13%. Mortality was associated with septic shock (AOR= 13.2), age [?] 60 (AOR: 3.25), Ferritin [?] 1500ng/ml (AOR: 3.78) and NLR [?] 5 (AOR: 4.04). Conclusion We describe the experience with COVID-19 from a tertiary-care hospital in a LMIC. Our study found a comparatively low inpatient mortality, high proportion of diabetics, and neutrophil to lymphocyte ratio of greater than 5 as a predictor of both severity of illness and as poor prognostic marker in COVID-19.

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The current study aims to determine the rate of surgical site infection, causal microorganism, and antibiotic sensitivity pattern in operated upper limb closed fractures at the Aga Khan University Hospital, Karachi. Cases presenting between June 2015 to October 2019, were selected from a single-centre, longitudinal, prospective orthopaedic trauma registry. Infection rate, causal microorganism, and antibiotic sensitivity pattern were determined up to six months after surgery. From among a total of 376 closed fractures, 12 encountered surgical site infection with some having late onset, giving an infection rate of 3% which is 1% higher than the international benchmark. Microorganism culture was performed on 5 (42%) patients out of which 2 (40%) were positive. Frequently used prophylactic antibiotics were first generation Cephalosporin and Co-amoxiclav in 9 (75%) patients, but all other the patients required other antibiotic categories. Five patients required implant removal with antibiotic coverage. K-wire insertion required prolonged antibiotic treatment. Most of the cultures were negative in spite of the presence of infection. Key words: Trauma registry, upper limb, closed fractures, wound infection.