Benazir Bhutto Hospital Research Articles

Frequency of Vitamin D Deficiency in Patient with Depression

Background: There has been some growing evidence that Vitamin D deficiency is also a causative factor in the etiology of depression, but there hasn’t been much work done on this topic and the evidence is inconsistent. The objective of this research is to find the association between blood 25-hydroxyvitamin D [25(OH)D] concentrations and depression among patients with depression in our local population. Objective: To determine frequency of vitamin D deficiency in patient with depression. Study design: Cross-sectional study Place and Duration of Study: Department of Psychiatry, Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi from 3rd August 2017 to 2nd February 2018. Methodology: One hundred and forty-two clinically diagnosed cases of depression gender between age 18 to 60 years were enrolled. Serum Vitamin D levels were estimated in each patient and frequency of vitamin D deficiency was determined. Results: 51 (35.9%) patients reported to have vitamin-D deficiency. Conclusions: We recommend effective screening tests for early detection vitamin D deficiency in clinically diagnosed patients of depression. Keywords: Depression, Vitamin D, Vitamin D deficiency

Effect of Parenting Style on Adolescent Depression

Background: Parenting style refers to the attitudes and behaviors of parents toward their children and an emotional environment in which the parents’ behaviors are expressed. Behavioral problems including externalizing and internalizing problems are amongst the most common mental health issues. Thus, to prevent the development of depression, it is necessary to understand the parenting styles. Objective: To determine the parenting style of parents of depressed adolescents. Study Design: Cross-sectional descriptive study. Place and Duration of Study: Child & Adolescent Unit, Institute of Psychiatry, Benazir Bhutto Hospital Rawalpindi from 31st January to 31st July 2020. Methodology: One hundred and fifty adolescents were enrolled. The presence of depression in adolescent patients was assessed by using the Hamilton Scale for Depression (HAM-D). For parenting style, the adolescent patients were asked to answer the Parental Authority Questionnaire. Results: Mean age was 15.90±2.82 years. 53 (35.3%) were male adolescents and 97 (64.7%) were female adolescents. Twenty two (14.7%), 75 (50%) and 53 (35.3%) patients had mild, moderate and severe depression. Eighty five (56.7%), 50 (33.3%) and 15 (10%) had authoritarian, permissive and authoritative parenting style respectively. Conclusion: The study reveals strong relation between depression and impaired parenting and emphasizes that parents should have warm and nurturing relationship with their children as it provides protection against the development of depression in adolescents. Keywords: Depression, Adolescents, Parenting style, Authoritarian, Permissive and authoritative parenting style

Comparative Analysis of Pattern of Dermatological Disorders Treated During 2019 and 2020 at Benazir Bhutto Hospital Rawalpindi and Hospital Statistics: A Rapid Review of Effect of Covid-19

Comparative Analysis of Pattern of Dermatological Disorders Treated During 2019 and 2020 at Benazir Bhutto Hospital Rawalpindi and Hospital Statistics: A Rapid Review of Effect of Covid-19

Kinesiophobia and its association with balance and mobility in knee osteoarthritis patients in Rawalpindi & Islamabad

Objective:
 The purpose of this study was to evaluate the relationship of fear avoidance belief or kinesiophobia with balance and mobility in knee osteoarthritis patients.
 Materials and methods:
 This cross-sectional correlational study was conducted in Fauji Foundation Hospital, Benazir Bhutto Hospital and Holy Family Hospital, Rawalpindi/Islamabad from January 2019 to June 2019. A total of 64 knee osteoarthritis patients (both male and female) between the ages of 40- 60 years were included in this study. They were selected using the Kallgren Lawrence Classification system (Grade I, II and III) and American College of Rheumatology criteria. Fear avoidance belief questionnaire was used to identify fear avoidance belief/kinesiophobia, Step-up test and Functional Reach test were used to measure balance and timed up and go test was used to measure mobility. Statistical analysis was carried out using SPSS version 21. Kolmogorov-Smirnov test was applied to find out the normal distribution. The relationship between fear avoidance belief and balance and mobility was examined using Spearman’s test of correlation.
 Results:
 Results showed a weak negative correlation between fear avoidance belief and functional reach test (r= -0.259, P= 0.039), and a weak positive correlation between fear avoidance belief and timed up and go test (r= 0.26, P= 0.841).
 Conclusion:
 Balance and mobility are negatively affected by fear avoidance beliefs in knee osteoarthritic patients. Thus, fear avoidance belief is an important psychological construct to be considered in the assessment and treatment of knee osteoarthritic patients to prevent balance impairments and fall risk.

Epidemiologic Profile of Thyroid Disorders in a Tertiary Care Hospital, a Five Years Analysis

Background: Thyroid disorders are commonly encountered endocrine ailments in clinical practice.Objective: To determine the trends and frequency of thyroid disorders in patients presented for thyroid dysfunction at the department of Pathology Benazir Bhutto hospital RawalpindiStudy Design: Cross-sectional retrospective study. Materials and Methods: Patients who underwent thyroid function tests were enrolled in the study Thyroid function tests were performed on a fully automated Chemistry Analyzer. Graph Pad Prism version 7 and SPSS version 25 were used for statistical analysis of the data.Results: Out of 2856 patients, 81.9% were females and 18.1% were males. The mean age of the participants was 38.12 ± 14.51 years and the median was 35(13-96). Overall, 1951 (68.3%) of the subjects were euthyroid, 343(12.0%) had subclinical hyperthyroidism, 200 (7.0%) had subclinical hypothyroidism, 192(6.7%) had overt hyperthyroidism and 168 (5.9%) had overt hypothyroidism. Females have a significantly high percentage of thyroid disorders as compared to males(χ2 =0.976 p =0.027). The major age group 798(27.9 %) tested for thyroid dysfunction suspicion was 24 to 33 years followed by 34-43 (22.9%).Conclusions: The thyroid dysfunction prevalence was higher in females than males. An upward trend in the frequency of thyroid dysfunction was observed with increasing age. Subclinical hyperthyroidism was the commonest abnormality observed. A steep rise in subclinical hyperthyroidism may be attributed to the high intake of iodized salt.

Blood groups and COVID-19: Exploring the link

The SARS COVID-19 pandemic took the whole world by storm due to its high and rapid infectivity. As it spread, its patterns became clear, and it became evident that a few individuals were more predisposed to it than others. Showing a massive inflammatory response by the body, and a negative coagulative affect, doctors and scientists began to perceive the role of blood cells, and hence blood types in the disease process. This lead to the main objective of this research: to assess the link between COVID19 infection and blood group types, and follow disease outcome according to it. The study comprises data collected from patients within 3 hospital setting of Northern Pakistan, viz Military Hospital Rawalpindi, Benazir Bhutto Hospital Rawalpindi, and Pakistan institute of medical sciences Islamabad. The study was conducted during a period of 1 month i-e from 15th June 2020 to 15th July 2020 after approval by the worthy Ethical review committee of PEMH. The study design was Analytical- Case series. Purposive Sampling technique was used. The sample size was 306 based on WHO sample calculator. Patients who were PCR positive and symptomatic for COVID-19 were included whereas PCR negative and asymptomatic patients were excluded. SPSS version 25 was used to process the data and Graphs and Charts were used to explain it. Among 306 patients of COVID 19 the most commonly affected blood group was A+ve followed by B+ve. The least affected blood group was O of which both positive and negative contributed to 17.71%. A blood group contributed 36%, while B 35% and AB 10.8%. The study substantiates that blood group A Rh positive has more susceptibility for SARS COVID-19 infection than other blood group types. Blood group O might have a protective effect against this infection.

Risk Factors Associated with Peritoneal Involvement in Acute appendicitis in Territory of Punjab, Pakistan

Aim: To study the frequency and factors associated with peritoneal involvement among patients operated for acute appendicitis in a tertiary care hospital. Place and duration of study: Department of Surgery, Benazir Bhutto Hospital Rawalpindi Pakistan from 1stJuly 2020 to 30thJune 2021. Methodology: This comparative cross-sectional study 500 patients diagnosed as acute appendicitis and operated by consultant surgeon were included. Peritoneal involvement was defined as signs of inflammation or infection on abdominal lining observed by operating surgeon during the time of surgery. Factors like age, gender, presence of comorbid illnesses and history of previous abdominal surgeries were associated with presence of peritoneal involvement. Results: There were 305 (61%) males while 195 (39%) were females with mean age was 32.331±4.544 years.Four hundred and forty two (88.4%) did not show any peritoneal involvement at the time of surgery while 58 (11.6%) had peritoneal involvement. Chi-square test revealed that history of previous abdominal surgeries and advancing age had statistically significant association with peritoneal involvement among the study participants (p-value<0.05). Conclusion: Peritoneal involvement was found in considerable number of patients operated as acute appendicitis by the treating surgeons. Patients with previous history of abdominal surgeries and advancing age were more at risk of having peritoneal involvement in our study. Keywords: Acuteappendicitis, Peritonitis, Risk factors, Frequency

Comparison of Chest X-rays findings in COVID-19 suspected and confirmed cases at a university teaching hospital: A retrospective comparative study.

ABSTRACTObjectives:To compare Chest X-rays findings in COVID -19 suspected and confirmed patients on RT-PCR, presented at corona filtration center, Benazir Bhutto hospital Rawalpindi.Methods:In this study, Chest radiographs of 100 COVID-19 RT-PCR positive confirmed patients were compared with 100 RT-PCR negative suspected COVID-19 patients screened at corona filtration center, Benazir Bhutto Hospital Rawalpindi from November 2020 to December 2020. Data on demographics, presenting complaints, co-morbid, lesion characteristic, distribution and attenuation, lobar involvement, pleural effusion and lymphadenopathy were collected. Associations between imaging characteristics and COVID-19 pneumonia were analyzed with univariate and multivariate logistic regression modals.Results:Chest X-rays findings revealed bilateral lung consolidation with peripheral and diffuse distribution, involving middle and lower lobe to be statistically significant (p<0.05) between RT-PCR positives and negative patients. Peripheral distribution was associated with an 11.08-fold risk in COVID-19 positive patients than diffuse distribution. Middle lobe involvement had four folds risk and lower lobe involvement had 11.04 folds risk in COVID-19 cases as compared to upper lobe involvement. Consolidation had 2.6 folds risk in COVID-19 positive cases.Conclusions:Bilateral, peripheral distribution of middle and lower lobes ground glass haze or consolidation with no pleural effusion is significantly related to COVID-19 pneumonia. Overlapping imaging features of the infectious and non-infectious COVID mimickers can be further excluded by detailed clinical evaluation and further radiological workup.

Frequency of Asymptomatic Bacteriuria in Pregnant Women

Objectives: To determine the frequency of asymptomatic bacteriuria in pregnantwomen. Study design: Descriptive, Cross sectional study Place and Duration: Department of Obstetrics &amp; Gynaecology, Benazir Bhutto Hospital, Rawalpindi. 26th December 2017 to 25th June 2018 Materials &amp; Methods: A total of 151 pregnant women of gestational age ≥28 weeks, 18 to 40 years of age were included. Patients with genital tract trauma, history of UTI in the past one year and urinary tract stones were excluded. Then clean-catch midstream urine was collected from each woman into a sterile universal container and sample was sent to the institutional laboratory for presenceor absence of asymptomatic bacteriuria. Results: Age range in this study was from 18 to 40 years with mean age of 28.78 ± 3.90 years. Majority of the patients 84 (55.63%) were between 18 to 30 years of age. Mean gestational age was 31.06 ± 1.67 weeks. Mean parity was 3.17 ± 0.99. Mean BMI was 27.44 ± 3.02 kg/m2. In our study, frequency of asymptomatic bacteriuria in pregnant women was found in 25 (16.56%) patients. Conclusion: This study concluded that frequency of asymptomatic bacteriuria in pregnant women is quite high. Keywords: Asymptomatic Bacteriuria, Pregnancy, Urinary Tract Infection.

Prevalence of Deep Vein Thrombosis in Cancer Patients in Hospitals of Rawalpindi

Background and Aim: Carcinoma/Cancer patients are more susceptible to venous thromboembolism compared to common disease patients. Regardless of chemotherapy, venous thromboembolism risk increases by 5-6 fold. The aim of the present study was to evaluate the prevalence of deep vein thrombosis in Fauji Foundation, Holy Family and Benazir Bhutto Hospital of Rawalpindi. Materials and Methods: This cross-sectional study was carried out on 434 carcinoma/cancer patients presented to the Department of Medical Oncology, Fauji Foundation, Holy Family and Benazir Bhutto Hospital of Rawalpindi from May 2020 to July 2021. Malignancy patients of age range from 5 years to 65 years with deep vein thrombosis clinical signs and symptoms were investigated. All patients had to have a biopsy to prove they had cancer. All patients underwent routine baseline investigations, which included a complete blood picture ECG, biochemistry, and X-rays. Results: Of the total 434 carcinoma/cancer patients, 23 (5.3%) malignant patients had deep vein thrombosis. The overall mean age of 23 patients was 34.56 ± 8.71 years with an age range from 5 years to 65 years. Out of 23 patients, 14 (60.9%) were male and 9 (39.1%) were females. The prevalence of primary cancer (tumors) and hematological malignancies were 11 (47.8%) and 12 (52.2%) respectively. Enoxaparin injections of 1mg/kg/day were prescribed to these patients for 5 days to 7 days duration followed by 6 months of warfarin. Conclusion: Our study found that the prevalence of deep vein thrombosis was 5.3%. Antithrombotic agents lower the risk of venous thromboembolism in cancer patients undergoing chemotherapy. Low dose warfarin and Low molecular weight heparins can both prevent and treat cancer-related thrombosis. Venous thromboembolism be treated with either unfractionated heparin (UFH) or low molecular weight heparin (LMWH) before starting Warfarin therapy as per guidelines. Keywords: Prevalence, Deep vein thrombosis, Warfarin

Effect of Neodymium: Yttrium-Aluminium-Garnet Laser Posterior capsulotomy on refractive status of the Eye

Objective: To assess the effect of Neodymium: Yttrium-Aluminium (Nd: YAG) laser posterior capsulotomy on the refractive status of the eye.Study Design: Quasi-experimental.Setting: Outpatient department of Benazir Bhutto Hospital, Rawalpindi.Duration: 1st January 2017 to 30th June 2017.Materials and Methods: A total of 95 eyes of 95 patients were included in this study. The patients were selected based on non - randomized convenient sampling. Among these patients 49 were females and 46 were males. The age range was 43 years to 85 years. These patients were those who had undergone uncomplicated cataract surgery with intraocular lens implantation 6 months or more than 6 months before presentation with posterior capsular opacification. Before Nd: YAG laser posterior capsulotomy, complete anterior and posterior segment examinations of these patients was performed and they were found to have no other associated anterior or posterior segment pathologies. Autorefractometre reading and best-corrected visual acuity were recorded and then after dilating the pupils, the procedure was performed. Post YAG capsulotomy, Autorefractometre readings were recorded again on the same day, at 1 week and the end of 4 weeks. Readings at the end of 4 weeks were considered for result purposes. These readings were converted into spherical equivalents for data analysis. Results: Data was analyzed through the SPSS version 18. The mean age was 60.14 years with a standard deviation of 9.241. Spherical equivalents were compared before and after YAG capsulotomy. Wilcoxon signed ranks test was applied. P-value (0.70) was found to be statistically insignificant which supported our hypothesis. Conclusion: Nd: YAG laser capsulotomy does not change the refractive status of the eye.

Comparison of Peri-tonsillar Injection of Tramadol with Adrenaline Vs Injection of Normal Saline (Placebo) Before Tonsillectomy in Reducing Per-operative Haemorrhage and Post-operative Pain

Introduction: Tonsillectomy is one of the most frequent surgical procedures performed in ENT. In the early postoperative period, pain and hemorrhage are considered to be the major cause of morbidity. Different methods of minimizing postoperative pain have been proposed including the use of oral analgesics, infiltration of local anesthetics, and analgesics like levobupivacaine, ketamine, and tramadol. To secure hemostasis during a tonsillectomy, several techniques including ligation, diathermy, and cauterization are used. To minimize these complications, preoperative preparation of the patient is mandatory. This study aimed to find out the efficacy of adrenaline and tramadol in controlling perioperative hemorrhage and postoperative pain respectively.&#x0D; Materials and Methods: A randomized controlled trial was conducted in the ENT department of Benazir Bhutto Hospital Rawalpindi for 6 months (21-11-2016 to 21-5-2017). The data was collected by operating surgeons. A total of 60 patients were included in the study with 1:1 randomization. Simple random sampling was used for the Selection of patients. Patients were divided into two groups. Group A was provided with the peri-tonsillar injection of tramadol with adrenaline while Group B was provided with normal saline injection (Placebo). Both groups were followed for 6 hours to measure mean pain scores and mean hemostasis time. After approval from the ethical review board, consent forms were distributed to patients. An Independent t-test was applied for the comparison of different variables.&#x0D; Results: Among all patients 60(100%), 25 (41%) males, and 35(59%) females. The mean age of patients was 12.2 years ± 4.49 SD. The mean time required for hemostasis was 4.9 minutes ± 1.92 SD. The mean pain scores were 1.3 (mild pain) ±1.12 SD. A statistically significant difference was found with time (p=0.01), mean pain (p=0.00), weight (p=0.00) and age (p=0.00) while insignificant with gender (p=0.06).&#x0D; Conclusion: Peri-tonsillar injection of tramadol with adrenaline during tonsillectomy leads to a significant reduction in per-operative hemorrhage and post-operative pain as compared to injection of normal saline.

Knowledge and Practices of Student Nurses towards Prevention and Management of Pressure ulcers in Allied Hospitals of Rawalpindi Medical University

Introduction: Pressure ulcer is a common preventable complication of prolonged hospitalisation. Although debilitating, but preventable through timely assessment and proper management. This study was conducted to access student nurse’s knowledge and practices towards the prevention and management of pressure ulcers. Materials and Methods: A cross-sectional study was conducted at Nursing Schools of Holy Family Hospital and Benazir Bhutto Hospital Allied with Rawalpindi Medical University. A pre-tested self-designed questionnaire was filled by 264 students selected through the non-probability convenient sampling technique. Data were analysed using SPSS 21. P-value &lt;0.01 was considered significant.&#x0D; Results: Mean percentage of Student nurse’s knowledge and practices were 58.7% 69.62% respectively. 21.7% of first-year students, 34.1% of second-year students, and 60.2% of third-year students had good knowledge. Correspondingly, 10.89% of first-year students, 32.9% of second-year students, and 56.2% of third-year students had good practice. There was a significant correlation between knowledge and practices i.e. r value is 0.92, the p-value is &lt;0.000.&#x0D; Conclusion: Knowledge and Practices of Student Nurses towards the prevention and management of pressure ulcers was found to be average. The practices of students gradually improved as their knowledge improved throughout their years of education.

Comparison between the outcome of proximal femoral locking compression plate and dynamic hip screw in intertrochanteric femoral fractures

Background: Inter-trochanteric femoral fractures are associated with a high complication rate and mortality. This study aims to compare the proximal femoral locking compression plate (PFLCP) with dynamic hip screws (DHS) for inter-trochanteric femoral fractures in terms of mean bone union time.Methods: It was a prospective randomized study conducted at the department of orthopedics, Benazir Bhutto Hospital, Rawalpindi, Pakistan from June 2015 to December 2015. Sixty patients with a diagnosis of inter-trochanteric fractures, requiring orthopedic surgery, were included in the study. After randomization thirty patients underwent PFLCP fixation and the other thirty patients underwent DHS fixation. Patient information, demographic data, and functional level were assessed. Mean bone union time and implant complications were compared for the two treatment groups.Results: Patients who underwent PFLCP fixation demonstrated shorter bone union time (2.8±0.2 months) than those who underwent DHS fixation (3.2±0.1 months) (p&lt;0.000). PFLCP group had 90% bone union whereas DHS group had 76.66% bone union at 12 weeks (p=0.16). Conclusions: PFLCP is better than DHS for intertrochanteric femoral fractures in terms of shorter mean bone union time and fewer complications.

The Effect of COVID-19 Pandemic on Hospital Visits and Admissions in Paediatric Department, Benazir Bhutto Hospital, Rawalpindi

Objectives: To assess the effect of the COVID-19 Pandemic on hospital visits and admissions of non-COVID-19 patients in 2020 compared to 2019.Material and Methods: This retrospective study was conducted in 2021 at the Department of Pediatrics, Benazir Bhutto Hospital, Rawalpindi comparing the data of non-COVID-19 patients visits and admissions from January to December 2019 with non-COVID-19 patients visits and admissions from January to December 2020. The relevant data was retrieved from the Pediatric Department record on a pre-designed study questionnaire. Data was entered and analyzed in SPSS version-24 for descriptive statistics and analysis. Results: The total OPD visits in 2019 were 112682 patients compared to 63859 patients in 2020 showing a 43.33% reduction. The total number of patients who visited pediatric emergency were 80274 in 2019 and 41182 in 2020, showing a decline of 48.65%. There were a total of 6151 admissions in the paediatric ward in 2019 compared to 2778 admissions in 2020 recording a decline of 54.84%. The admissions in the Neonatal Unit were 5544 in 2019 and 3528 in 2020 with a reduction of 36.36%. The admissions in PICU in 2019 were 2685 and in 2020 the admissions decline to 2011 which is a 25.1% reduction.Conclusion: There was a significant decline in both hospital visits and admissions in 2020 compared to those in 2019.

COVID-19 among Healthcare Workers of Teaching Hospitals Affiliated with Rawalpindi Medical University

Objectives: To overview COVID-19 scenario among healthcare workers in teaching hospitals of Rawalpindi Medical University&#x0D; Subjects &amp; Methods: A cross-sectional descriptive research was done among 482 coronavirus infected healthcare professionals from three teaching hospitals (Holy Family Hospital, Benazir Bhutto Hospital and District Head Quarters) that were affiliated with Rawalpindi Medical University during January 2021. Healthcare workers with COVID confirmation via RT-PCR testing reports were included in the study through consecutive sampling. Their demographic profile, workplace attributes, clinical manifestations, oxygen saturation, source of infection, re-infection, hospitalization, requirement for oxygen supply and disease severity according to COVID-19 adult cases categorization were inquired. Data analysis was done by means of SPSS version 25.0.&#x0D; Results: Mean age of 482 healthcare workers was 29.6 ± 5.7 years. Mainstream (69.1%) of our study participants was constituted by female healthcare staff. Majority (34%) were postgraduate trainees followed by 29% nurses and 20% house officers. Mean duration of sickness was 13.6 ± 6.4 days. About 63.1% of study subjects were COVID infected during July –December 2020. About 4.8% healthcare personnel were asymptomatic and 78% caught infection from their workplace. Approximately 82% suffered from fever while 71.4% and 55.8% went through bodyaches and cough respectively. Out of 39 hospitalized workers, 23 required oxygen supply for their vitality. Severe COVID infection was determined only among 5.4% healthcare professionals.&#x0D; Conclusion: Healthcare workers are more susceptible to acquire COVID infection from their workplace. In view of this vulnerability, firm compliance to preventive measures against coronaviurs infection by healthcare staff and general public is deemed necessary for their viability.

Impact of COVID Pandemic on the Mental Well-Being of Orthopaedic Patients – A Single Centre Study

Objectives:&#x0D; To assess the frequency of psychiatric diseases in orthopaedic patients during the COVID-19 pandemic.&#x0D; &#x0D; Material and methods:&#x0D; This study was conducted from 20th April 2020 to 20th September 2020 at the Department of Orthopaedics, Benazir Bhutto Hospital, Rawalpindi, Pakistan. Patients aged 18 years and above and belonging to either gender with Orthopaedic injuries were included. Gender, age, injury mechanism, associated trauma, site of fracture, use of tobacco and mental health disorder was recorded.&#x0D; Data was analyzed using SPSS version 23.&#x0D; &#x0D; Results:&#x0D; The study included 210 patients with Orthopaedic injuries. Mean age of patients in the study was 40.45±12.54 years. Falls were the most common mechanism of injury (50.4%) followed by motorcycle accidents (22.8%) and motor vehicle accidents (16.7%). 70.47% patients with Orthopaedic injuries were diagnosed with a mental health problem. There were notably higher rates of depression (33.1%) and anxiety (24.3%).&#x0D; &#x0D; Conclusion:&#x0D; There was a high frequency of psychiatric illnesses in Orthopaedic patients during the COVID-19 pandemic.&#x0D; &#x0D; Keywords:&#x0D; COVID-19, mental well-being, orthopaedic injuries, psychiatric illness.

Dermatological Manifestations of COVID-19: Data from a tertiary care hospital of Pakistan dedicated for COVID-19 Patients

Background: Cutaneous manifestations of COVID-19 disease are poorly characterized around the globe. Data from Pakistan is lacking.&#x0D; Objective: To describe the cutaneous manifestations of COVID-19 disease in Pakistani population.&#x0D; Introduction: SARS-CoV-2 virus has rapidly spread reaching the level of a pandemic disease. COVID-19 can affect different organ systems including the skin. There is a wide variety of descriptions of the cutaneous manifestations of COVID-19. However, cutaneous manifestations of COVID-19 disease are poorly characterized around the globe. The data from Pakistan is especially lacking. Our study was aimed at describing the cutaneous manifestations of COVID-19 disease in Pakistani population.&#x0D; Materials and Methods: This cross sectional study was carried out at Benazir Bhutto Hospital from March 2020 till December 2020. A total of 150 patients were screened by senior dermatology postgraduate trainees who were deployed for the care of COVID-19 patients. The demographics, rash if any along with its complete history and description and laboratory investigations were noted on a preformed performa. The pictures of the rash were taken after verbal consent of patient or surrogate. The pictures were then discussed with the consultant for appropriate categorization.&#x0D; Results: A total of 150 patients with the diagnosis of COVID-19 were screened. The mean age of the subjects was 51.9 ± 17.2 years. There were 94 (62.7%) males and 56 (37.3%) females. The mean duration of illness at the time of screening was 12.5 ± 9.7 days. Only 7 (4.7%) COVID-19 patients showed skin lesions. These included generalized bullous pemphigoid like (1 patient), urticarial lesions (1 patient), vesicular eruption (1 patient), skin necrosis (1 patient) and maculopapular rash (3 patients). The average duration of illness at the time of dermatological manifestation of COVID-19 was 6.31 ± 2.3 days. Skin necrosis was associated with severe disease.&#x0D; Conclusion: The skin manifestations of COVID-19 patients in Pakistan are less as compared to reports and data from western world. However, they are in accordance with the data reported from few Asian countries. Regardless of this, the type, distribution and association of skin lesions with COVID-19 appear to be universal. This difference of frequency can be attributed to the racial differences or the variety of COVID-19 viral strains predominant in different countries. However, further studies are required to prove this association. &#x0D; Key Words: COVID-19, Dermatology, Skin Manifestations, Cutaneous Manifestations

Predictors of Mortality of COVID-19 cases In Benazir Bhutto Hospital Rawalpindi

Background: There has been a global epidemic of COVID-19 caused by novel corona virus (SARS-2). Current research aims to study the demographic, clinical characteristics and co-morbidities in COVID-19 related deaths. Methodology: This observational (descriptive) study was conducted at BBH Rawalpindi based on data from 1st March-15th June 2020 after ethical approval. Inclusion criteria was the deceased COVID PCR positive cases (&gt;18 years age) of both the genders. Exclusion criteria was negative PCR, doubtful diagnosis and expiry outside the hospital setting. Data was collected from hospital record and family members. Demographic details, symptoms, duration of hospital stay, co-morbidities, type of ventilatory support were documented. Data analysed by SPSS, significant p&lt;0.05. Results: There were 54 expiries from1st March to 13th June, 42(78%) males &amp; 12(22%) females. Mean age was 54.24+12.78 years. 76% had various comorbidities, i.e., diabetes (57%), hypertension (54%), ischemic heart disease (20%); stroke, cancer, COPD and hypothyroidism (&lt;10% each). Most frequent cause of death was acute respiratory distress syndrome due to Covid-19. Two patients died of sepsis and multiorgan failure. 64% of patients received mechanical ventilation and 35% oxygen via non-rebreather mask. There was average 4 days on invasive mechanical ventilator. 51-60 years had longest duration of illness and hospitalization till death, while 20-30 years had the shortest. The average mortality climbed up (25% to 57%) from April to May 2020. Conclusion: COVID-19 claims significant mortality. The risk factors for mortality being age above 50 years, male gender, co-morbidities like diabetes, hypertension, ischemic heart disease, need for mechanical ventilation upon admission and longer duration of illness. There is need to intensify the vaccination and prevention in the community keeping in mind these high-risk groups. The high-risk cases, need to be aggressively managed to reduced mortality and improve outcome.&#x0D;

Role of HRCT for Rapid Triage of Patients with COVID-19 Pneumonia

Background: &#x0D; &#x0D; To assess the diagnostic performances of HRCT for COVID 19 pneumonia for efficient triage of patients, in comparison with RT-PCR reverse transcription polymerase chain reaction test.&#x0D; &#x0D; Method:&#x0D; &#x0D; It is retrospective comparative study conducted in Benazir Bhutto hospital affiliated with Rawalpindi medical university from March 25th to April 25th, 2021. HRCT of 500 patients were selected from central computer server and their RT-PCR results were also obtained from the HMS system of the hospital. HRCT were reported as “Definitely COVID positive”, “Possible COVID positive” or “COVID negative” by experienced radiologists. Sensitivity, Specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using the final RT-PCR test as standard of reference.&#x0D; Results: &#x0D; &#x0D; RT-PCR test of 207 patients was positive, whereas 293 were reported negative. HRCT was reported as “Definitely COVID positive” in 222 cases (44.4 %), “Possible COVID positive” in 24 cases (4.8%) and “COVID negative” in 254 cases (50.8%). Comparing only Definitely COVID positive category with RT-PCR results sensitivity, specificity. PPV and NPV were 90.3%, 88%,84.2% and 92.8%&#x0D; &#x0D; Conclusion:&#x0D; &#x0D; CT chest is the most reliable, sensitive and rapid tool for triaging of patients as COVID positive or negative in busy emergency departments as compared to RT-PCR which is time consuming and has limitations such as faulty sampling technique, limited kits and variable sensitivity