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Akhtar H, Khalid S, Rahman FU, Ali S, Afridi M, Khader YS, Hassan F, Akhtar N, Khan MM, Ikram A. Delayed admissions and efficacy of steroid use in patients with critical and severe COVID-19: an apprehensive approach. J Public Health (Oxf) 2021; 43:iii43-iii48. [PMID: 34580731 PMCID: PMC8500079 DOI: 10.1093/pubmed/fdab239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Inadvertent delays in access to appropriate therapeutic interventions in high-risk group coronavirus disease 2019 (COVID-19) patients contribute to mortality in patients with severe/critical disease presentation. OBJECTIVES The aim of this study was to determine the effect of timely admission to the hospital on mortality of patients with severe/critical COVID-19. Another secondary aspect of this study was to observe the efficacy of time-dependent use of corticosteroids on mortality of critical/severe COVID-19 patients. METHODS Clinical data of 659 patients with severe/critical COVID-19, admitted to four major tertiary care hospitals from the Islamabad-Rawalpindi region of Pakistan was retrospectively collected from a period February-August 2020. Multivariate logistic regression analysis was carried out to determine the predictors of mortality in severe/critical COVID-19 patients. RESULTS Out of a total of 659 patients, 469 (71.2%) patients died. Age > 60 years, presence of hypertension, heart disease and kidney disease along with late admission (>5 days) were significant predictors of mortality in patients with severe/critical COVID-19. CONCLUSIONS The study highlights the importance of well-timed provision of appropriate medical interventions control COVID-19-associated mortality.
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Affiliation(s)
- Hashaam Akhtar
- Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental College, Islamabad 44000, Pakistan
| | - Sundas Khalid
- Department of Materials Engineering, School of Chemical and Materials Engineering, National University of Science and Technology, Islamabad 44000, Pakistan
| | - Fazal-ur- Rahman
- Department of Medicine, Benazir Bhutto Hospital, Rawalpindi 44000, Pakistan
| | - Sabahat Ali
- Department of Gynecology and Obstetrics, Pakistan Air Force Hospital, Islamabad 44000, Pakistan
| | - Maham Afridi
- Department of Biotechnology, Quaid-i-Azam University, Islamabad 44000, Pakistan
| | - Yousef S Khader
- Department of Community Medicine, Public Health and Family Medicine/Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Faheem Hassan
- CT Angio Department, Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC/NIHD),, Rawalpindi 44000, Pakistan
| | - Nasim Akhtar
- Department of General Medicine, Pakistan Institute of Medical Sciences, Islamabad 44000, Pakistan
| | - Muhammad Mujeeb Khan
- Department of Infectious Diseases, Rawalpindi Medical University, Rawalpindi 44000, Pakistan
| | - Aamer Ikram
- National Institute of Health, Islamabad 44000, Pakistan
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Akhtar H, Khalid S, Ur Rahman F, Umar M, Ali S, Afridi M, Hassan F, Saleh Khader Y, Akhtar N, Mujeeb Khan M, Ikram A. Presenting characteristics, comorbidities, and outcomes among COVID-19 patients hospitalized in twin cities of Pakistan. JMIR Public Health Surveill 2021; 7:e32203. [PMID: 34710053 PMCID: PMC8673715 DOI: 10.2196/32203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/04/2021] [Accepted: 10/25/2021] [Indexed: 02/05/2023] Open
Abstract
Background COVID-19 became a pandemic rapidly after its emergence in December 2019. It belongs to the coronavirus family of viruses, which have struck a few times before in history. Data based on previous research regarding etiology and epidemiology of other viruses from this family helped played a vital role in formulating prevention and precaution strategies during the initial stages of this pandemic. Data related to COVID-19 in Pakistan were not initially documented on a large scale. In addition, due to a weak health care system and low economic conditions, Pakistan’s population, in general, already suffers from many comorbidities, which can severely affect the outcome of patients infected with COVID-19. Objective COVID-19 infections are coupled with a manifestation of various notable outcomes that can be documented and characterized clinically. The aim of this study was to examine these clinical manifestations, which can serve as indicators for early detection as well as severity prognosis for COVID-19 infections, especially in high-risk groups. Methods A retrospective observational study involving abstraction of demographic features, presenting symptoms, and adverse clinical outcomes for 1812 patients with COVID-19 was conducted. Patients were admitted to the four major hospitals in the Rawalpindi-Islamabad region of Pakistan, and the study was conducted from February to August 2020. Multivariate regression analysis was carried out to identify significant indicators of COVID-19 severity, intensive care unit (ICU) admission, ventilator aid, and mortality. The study not only relates COVID-19 infection with comorbidities, but also examines other related factors, such as age and gender. Results This study identified fever (1592/1812, 87.9%), cough (1433/1812, 79.1%), and shortness of breath (998/1812, 55.1%) at the time of hospital admission as the most prevalent symptoms for patients with COVID-19. These symptoms were common but not conclusive of the outcome of infection. Out of 1812 patients, 24.4% (n=443) required ICU admission and 21.5% (n=390) required ventilator aid at some point of disease progression during their stay at the hospital; 25.9% (n=469) of the patients died. Further analysis revealed the relationship of the presented symptoms and comorbidities with the progression of disease severity in these patients. Older adult patients with comorbidities, such as hypertension, diabetes, chronic kidney disease, and asthma, were significantly affected in higher proportions, resulting in requirement of ICU admission and ventilator aid in some cases and, in many cases, even mortality. Conclusions Older adult patients with comorbidities, such as hypertension, diabetes, asthma, chronic obstructive pulmonary disorder, and chronic kidney disease, are at increased risk of developing severe COVID-19 infections, with an increased likelihood of adverse clinical outcomes.
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Affiliation(s)
- Hashaam Akhtar
- Yusra Institute of Pharmaceutical Sciences (YIPs), Zaraj Housing Society, Opposite DHA Phase 2 Gate III, Main G.T. Road, Islamabad, PK
| | - Sundas Khalid
- School Of Chemical And Materials Engineering, National University Of Science And Technology, Islamabad, PK
| | - Fazal Ur Rahman
- HEAD OF DEPARTMENT OF MEDICINE BENAZIR BHUTTO HOSPITAL, Rawalpindi, PK
| | - Muhammad Umar
- Vice Chancellor, Rawalpindi Medical University (RMU), Rawalpindi, PK
| | - Sabahat Ali
- Department Of Gynecology And Obstetrics, Paf Hospital, Islamabad, PK
| | - Maham Afridi
- Department Of Biotechnology, Quaid I Azam University, Islamabad, PK
| | - Faheem Hassan
- CT Angio-Department, Armed Forces Institute of Cardiology (AFIC), Rawalpindi, PK
| | - Yousef Saleh Khader
- Medical Education And Biostatistics Department Of Community Medicine, Public Health And Family Medicine/ Faculty Of Medicine.Jordan University Of Science & Technology, Irbid, JO
| | - Nasim Akhtar
- Department of Infectious Diseases, Pakistan Institute Of Medical Sciences (PIMS), Islamabad, PK
| | - Muhammad Mujeeb Khan
- Department of Infectious Diseases, Rawalpindi Medical University (RMU), Rawalpindi, PK
| | - Aamer Ikram
- Executive Director, National Institute Of Health, Islamabad, PK
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Akhtar H, Akhtar S, Rahman FU, Afridi M, Khalid S, Ali S, Akhtar N, Khader YS, Ahmad H, Khan MM. An Overview of the Treatment Options Used for the Management of COVID-19 in Pakistan: Retrospective Observational Study. JMIR Public Health Surveill 2021; 7:e28594. [PMID: 33945498 PMCID: PMC8163494 DOI: 10.2196/28594] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/24/2021] [Accepted: 05/02/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Since the first reports of COVID-19 infection, the foremost requirement has been to identify a treatment regimen that not only fights the causative agent but also controls the associated complications of the infection. Due to the time-consuming process of drug discovery, physicians have used readily available drugs and therapies for treatment of infections to minimize the death toll. OBJECTIVE The aim of this study is to provide a snapshot analysis of the major drugs used in a cohort of 1562 Pakistani patients during the period from May to July 2020, when the first wave of COVID-19 peaked in Pakistan. METHODS A retrospective observational study was performed to provide an overview of the major drugs used in a cohort of 1562 patients with COVID-19 admitted to the four major tertiary-care hospitals in the Rawalpindi-Islamabad region of Pakistan during the peak of the first wave of COVID-19 in the country (May-July 2020). RESULTS Antibiotics were the most common choice out of all the therapies employed, and they were used as first line of treatment for COVID-19. Azithromycin was the most prescribed drug for treatment. No monthly trend was observed in the choice of antibiotics, and these drugs appeared to be a random but favored choice throughout the months of the study. It was also noted that even antibiotics used for multidrug resistant infections were prescribed irrespective of the severity or progression of the infection. The results of the analysis are alarming, as this approach may lead to antibiotic resistance and complications in immunocompromised patients with COVID-19. A total of 1562 patients (1064 male, 68.1%, and 498 female, 31.9%) with a mean age of 47.35 years (SD 17.03) were included in the study. The highest frequency of patient hospitalizations occurred in June (846/1562, 54.2%). CONCLUSIONS Guidelines for a targeted treatment regime are needed to control related complications and to limit the misuse of antibiotics in the management of COVID-19.
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Affiliation(s)
- Hashaam Akhtar
- Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental College, Islamabad, Pakistan
| | - Samar Akhtar
- Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental College, Islamabad, Pakistan
| | - Fazal-Ul Rahman
- Department of Medicine, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Maham Afridi
- Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Sundas Khalid
- School of Chemical and Materials Engineering, National University of Science and Technology, Islamabad, Pakistan
| | - Sabahat Ali
- Department of Gynecology and Obstetrics, Pakistan Air Force Hospital, Islamabad, Pakistan
| | - Nasim Akhtar
- Department of Infectious Diseases, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Yousef S Khader
- Medical Education and Biostatistics, Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Hamaad Ahmad
- Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental College, Islamabad, Pakistan
| | - Muhammad Mujeeb Khan
- Department of Infectious Diseases, Rawalpindi Medical University, Rawalpindi, Pakistan
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Akhtar H, Afridi M, Akhtar S, Ahmad H, Ali S, Khalid S, Awan SM, Jahangiri S, Khader YS. Pakistan's Response to COVID-19: Overcoming National and International Hypes to Fight the Pandemic. JMIR Public Health Surveill 2021; 7:e28517. [PMID: 33877048 PMCID: PMC8136406 DOI: 10.2196/28517] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 outbreak started as pneumonia in December 2019 in Wuhan, China. The subsequent pandemic was declared as the sixth public health emergency of international concern on January 30, 2020, by the World Health Organization. Pakistan could be a potential hotspot for COVID-19 owing to its high population of 204.65 million and its struggling health care and economic systems. Pakistan was able to tackle the challenge with relatively mild repercussions. The present analysis has been conducted to highlight the situation of the disease in Pakistan in 2020 and the measures taken by various stakeholders coupled with support from the community to abate the risk of catastrophic spread of the virus.
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Affiliation(s)
- Hashaam Akhtar
- Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental College, Islamabad, Pakistan
| | - Maham Afridi
- Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Samar Akhtar
- Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental College, Islamabad, Pakistan
| | - Hamaad Ahmad
- Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental College, Islamabad, Pakistan
| | - Sabahat Ali
- Department of Gynecology and Obstetrics, Paf Hospital, Islamabad, Pakistan
| | - Sundas Khalid
- School of Chemical and Materials Engineering, National University of Science and Technology, Islamabad, Pakistan
| | - Sajid Mahmood Awan
- Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental College, Islamabad, Pakistan
| | - Shahzaib Jahangiri
- Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental College, Islamabad, Pakistan
| | - Yousef Saleh Khader
- Medical Education and Biostatistics, Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Ali S, Khalid S, Afridi M, Akhtar S, Khader YS, Akhtar H. Notes From the Field: The Combined Effects of Tocilizumab and Remdesivir in a Patient With Severe COVID-19 and Cytokine Release Syndrome. JMIR Public Health Surveill 2021; 7:e27609. [PMID: 34009133 PMCID: PMC8136404 DOI: 10.2196/27609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 12/15/2022] Open
Abstract
SARS-CoV-2 is known to cause severe bilateral pneumonia and acute respiratory distress syndrome or COVID-19 in patients, which can be debilitating and even fatal. With no drugs or vaccines available yet, a wide range of treatment regimens used are being repurposed. The need of the hour is to analyze various currently available regimens and devise a treatment plan that is most effective for COVID-19. Here we describe the case of a 68-year-old man with hypertension and diabetes, exhibiting symptoms of cough and shortness of breath, who presented at the emergency department of our hospital. Chest computed tomography revealed bilateral ground glass opacities that were indicative of COVID-19, and a computed tomography score of 24 was indicative of severe pulmonary pneumonia. He tested positive for COVID-19. His treatment regimen included the use of convalescent plasma, oxygen therapy, steroids, high-dose antibiotics, broad-spectrum antiviral remdesivir, and anti–interleukin-6 monoclonal antibody (Tocilizumab) at various stages of the disease. Oxygen supplementation was required at the time of admission. The patient initially developed a cytokine release storm, and oxygen supplementation was initiated to manage his condition. Supportive care and multiple treatment regimens were used to successfully recover the patient’s health. With a rapid increase in number of confirmed cases worldwide, COVID-19 has become a major challenge to our health care system. With no available vaccines currently, the establishment of a combination of therapeutic drugs that effectively reduce disease progression is of utmost importance.
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Affiliation(s)
- Sabahat Ali
- Department Of Gynecology And Obstetrics, Pakistan Air Force Hospital, Islamabad, Pakistan
| | - Sundas Khalid
- School of Chemical and Materials Engineering, National University of Science and Technology, Islamabad, Pakistan
| | - Maham Afridi
- Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Samar Akhtar
- Yusra Institute of Pharmaceutical Sciences, Islamabad, Pakistan
| | - Yousef S Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Hashaam Akhtar
- Yusra Institute of Pharmaceutical Sciences, Islamabad, Pakistan
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Ganaie M, Bikmalla S, Afridi M, Khalil M, Hussain I, Haris M. P174 Utility Of Needle Aspiration In Patients With Primary Spontaneous Pneumothorax With Complete Lung Collapse: A Retrospective 5-year Study. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Afridi M, Montgomery C. Microhotplate Temperature Sensor Calibration and BIST. J Res Natl Inst Stand Technol 2011; 116:827-38. [PMID: 26989603 PMCID: PMC4551223 DOI: 10.6028/jres.116.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/01/2011] [Indexed: 05/04/2023]
Abstract
In this paper we describe a novel long-term microhotplate temperature sensor calibration technique suitable for Built-In Self Test (BIST). The microhotplate thermal resistance (thermal efficiency) and the thermal voltage from an integrated platinum-rhodium thermocouple were calibrated against a freshly calibrated four-wire polysilicon microhotplate-heater temperature sensor (heater) that is not stable over long periods of time when exposed to higher temperatures. To stress the microhotplate, its temperature was raised to around 400 °C and held there for days. The heater was then recalibrated as a temperature sensor, and microhotplate temperature measurements were made based on the fresh calibration of the heater, the first calibration of the heater, the microhotplate thermal resistance, and the thermocouple voltage. This procedure was repeated 10 times over a period of 80 days. The results show that the heater calibration drifted substantially during the period of the test while the microhotplate thermal resistance and the thermocouple-voltage remained stable to within about plus or minus 1 °C over the same period. Therefore, the combination of a microhotplate heater-temperature sensor and either the microhotplate thermal resistance or an integrated thin film platinum-rhodium thermocouple can be used to provide a stable, calibrated, microhotplate-temperature sensor, and the combination of the three sensor is suitable for implementing BIST functionality. Alternatively, if a stable microhotplate-heater temperature sensor is available, such as a properly annealed platinum heater-temperature sensor, then the thermal resistance of the microhotplate and the electrical resistance of the platinum heater will be sufficient to implement BIST. It is also shown that aluminum- and polysilicon-based temperature sensors, which are not stable enough for measuring high microhotplate temperatures (>220 °C) without impractically frequent recalibration, can be used to measure the silicon substrate temperature if never exposed to temperatures above about 220 °C.
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