Aim To determine the efficacy of neutrophil/lymphocyte ratio (NLR) as a marker of the severity of COVID‐19 pneumonia in the South‐Asian population. Methods This was a prospective, cross‐sectional, analytic study conducted at HDU/ICU of District Headquarter Hospital, Faisalabad, Pakistan, from May through July 2020. Sixty‐three eligible patients, admitted to the HDU/ICU, were prospectively enrolled in the study. Their NLR, C‐reactive protein, serum albumin and serum fibrinogen were measured. Patients’ demographic characteristics, comorbidities, clinical manifestations of COVID‐19 infection, medication use and history of lung malignancy were retrieved from their medical history. Patients were categorised into either a general group (with mild COVID‐19) or a heavy group (with moderate to severe COVID‐19). Results There were significant differences between the two groups in diabetes prevalence, NLR, C‐reactive protein and serum albumin. NLR and C‐reactive protein were positively correlated (P < .001, P = .04, respectively) whereas serum albumin was negatively correlated (P = .009) with severe COVID‐19. NLR was found to be an independent risk factor for severe COVID‐19 pneumonia in the heavy group (OR = 1.264, 95% CI: 1.046~1.526, P = .015). The calculated AUC using ROC for NLR was 0.831, with an optimal limit of 4.795, sensitivity of 0.83 and specificity of 0.75, which is highly suggestive of NLR being a marker for the early detection of deteriorating severe COVID‐19 infection. Conclusion NLR can be used as an early warning signal for deteriorating severe COVID‐19 infection and can provide an objective basis for early identification and management of severe COVID‐19 pneumonia.

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Aim: To describe the clinical characteristics and outcomes of severe COVID-19 adult patients, with the exploration of risk factors for mortality in the hospital. Methods: This study included 20 adult patients diagnosed with COVID-19 in the ICU of DHQ Hospital Faisalabad (Pakistan) and were categorized into the survival group and death group according to the outcome. We retrieved demographics, clinical manifestations and signs, laboratory indicators, treatment measures, and clinical outcomes from the medical record, and summarized the clinical characteristics and outcomes of these patients. Results: The average age of patients was 70 ± 12 years, of which 40% were male. They were admitted to the ICU 11 days after the onset of symptoms. The most common symptoms on admission were cough (19 cases, 95%), fatigue or myalgia (18 cases, 90%), fever (17 cases, 85%), and dyspnea (16 cases, 80%). Eleven (55%) patients had underlying diseases, of which hypertension was the most common (11 cases, 55%), followed by cardiovascular disease (4 cases, 20%), and diabetes (3 cases, 15%). Six patients (30%) received invasive mechanical ventilation and continuous renal replacement therapy and eventually died. Acute heart injury was the most common complication (19 cases, 95%). Ten (50%) patients died between 2 and 19 days after admission to the ICU. Compared to dead patients, the average body weight of surviving patients was lower (61.70± 2.36 vs 68.60±7.15, P = 0.01), Glasgow Coma Scale score was higher (14.69±0.70 vs 12.70±2.45, P = 0.03), with fewer concurrent shocks (2 vs 10, P = 0.001) and acute respiratory distress syndrome (2 vs 10, P = 0.001). Conclusion: The mortality rate is high in patients with critical COVID-19 disease. Lower Glasgow Coma Scale, higher body weight, and decreased lymphocyte count appear to be potential risk factors for the death of COVID-19 patients in the ICU.What is already known about this subject?• Mortality rate is higher in critically ill COVID-19 patients, in Japanese, European, and American populations. • Hypertension is the most commonly associated comorbidity in these patients.What does this study contribute to the literature?• Mortality rate is higher in critically ill COVID-19 patients and hypertension is the most commonly associated comorbidity, in South-Asian population also. • Lower GCS score, higher body weight, and lymphocytopenia appear to be potential risk factors for the death of COVID-19 patients in the ICU.

Aim To describe the clinical characteristics and outcomes of adult patients with severe COVID‐19, with the exploration of risk factors for mortality in the hospital. Methods This study included 20 adult patients diagnosed with COVID‐19 admitted to the ICU of DHQ Hospital, Faisalabad (Pakistan). Patients were categorised into the survival group and the death group according to the outcome. We retrieved demographics, clinical manifestations and signs, laboratory indicators, treatment measures and clinical outcomes from the medical record, and summarised the clinical characteristics and outcomes of these patients. Results The average age of patients was 70 ± 12 years, of which 40% were male. They were admitted to the ICU 11 days after the onset of symptoms. The most common symptoms on admission were cough (19 cases, 95%), fatigue or myalgia (18 cases, 90%), fever (17 cases, 85%) and dyspnoea (16 cases, 80%). Eleven (55%) patients had underlying diseases, of which hypertension was the most common (11 cases, 55%), followed by cardiovascular disease (4 cases, 20%) and diabetes (3 cases, 15%). Six patients (30%) received invasive mechanical ventilation and continuous renal replacement therapy and eventually died. Acute heart injury was the most common complication (19 cases, 95%). Ten (50%) patients died between 2 and 19 days after admission to the ICU. Compared with dead patients, the average body weight of surviving patients was lower (61.70 ± 2.36 vs 68.60 ± 7.15, P = .01), Glasgow Coma Scale score was higher (14.69 ± 0.70 vs 12.70 ± 2.45, P = .03), with fewer concurrent shocks (2 vs 10, P = .001) and acute respiratory distress syndrome (2 vs 10, P = .001). Conclusion The mortality rate is high in critically ill patients with COVID‐19. Lower Glasgow Coma Scale, higher body weight and decreased lymphocyte count appear to be potential risk factors for the death of patients with COVID‐19 in the ICU.

Inflammatory bowel disease is a systemic disorder with intestinal and extra-intestinal features. Arthritis is a well recognized extra intestinal manifestation. Spondylitis, sacroiliiatis are the common involvement with IBD. NSAIDs are generally recommended in the treatment with caution due to its potential of flaring up the gastrointestinal symptoms. Sulphasalazine, methotraxate, aziothioprine and anti TNF alpha agents are licensed for treatment of arthritis in IBD. This is a Review Article