IntroductionThe COVID-19 pandemic has challenged healthcare facilities and healthcare professionals' stamina and wellbeing. This study examines the psychological impact of COVID-19 on healthcare professionals. MethodsThis analytical cross-sectional study was conducted in July 2020 after institutional review board approval at a tertiary care institution in Lahore, Pakistan. A total of 175 healthcare workers participated following an online Depression, Anxiety and Stress Scale-21 (DASS-21) questionnaire invitation and 41 were excluded following pre-existing mental health conditions. Data was analysed using MS Excel and SPSS Amos 23. Chi-squared test and regression were applied for comparison and impact of confounding variables respectively (p<0.05 was considered significant). ResultsOut of 134, 66 (49%) were doctors, 24 (18%) were nurses and 44 (33%) were non-medical professionals. Ninety-five (70%) with age 21-30 years. Male to female ratio was 2:1. Overall mean depression score accounted for 6.89 ± 6.64; anxiety score was 7.28 ± 6.74 and stress score was 8.83 ± 6.93. Mild depression, anxiety and stress was noted in 21 (15.6%), eight (6%) and 27 (20.1%) healthcare workers, respectively. A statistically significant difference (p<0.05) was observed among healthcare workers for depression, anxiety and stress. ConclusionThis study demonstrated considerable impact of COVID-19 on mental health of healthcare workers. A well-structured targeted mental health support programme is needed urgently to support and reduce the long-term impact on healthcare workers' mental health and wellbeing.

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Undifferentiated connective tissue diseases usually present with arthralgias, sicca symptoms, Raynaud's phenomenon and leucopenia. This case presents the atypical presentation of an undifferentiated connective tissue disease with extensive cutaneous involvement of fingers and toes leading to gangrene with absence of typical rheumatological symptoms. The autoimmune profile showed positive ANA and anti-Ro/SS-A. Thromboembolism was ruled out on the basis of transthoracic and transesophageal echo. She was treated with I/V corticosteroids and cyclophosphamide that halted the disease progression.

SARS-COV-2 emerged as pneumonia of unknown etiology and transforming into global pandemic leading mass casualties globally. It leads to serious complications with a wide range of symptoms and laboratory and radiological abnormalities. Methodology: This retrospective study included 191 admitted patients was conducted between 15 April 2020 and 31 August 2020 at university of Lahore teaching hospital, Lahore, Pakistan. Baseline demographics, clinical, laboratory and radiological characteristics were compared amongst disease severity categories with One way ANOVA and comparison amongst recovered and non-recovered was carried out by independent t test, Fisher’s exact and chi-square test respectively. All data were analysed in SPSS 25 and p-value <0.05 was considered significant. Results: Out of 191 patients enrolled in this study, majority were male and above 50 year age. Fever (68%) was the most common symptom though dyspnea was statistically significant (p-value<0.05) and diabetes (41.4%) being the most common comorbidity. A statistical significant downtrend in eosinophil counts were observed in critical and severe disease from non-severe disease and similar trend was observed in non-recovered (died) patients than recovered. A significant rise in neutrophil to lymphocyte ratio, crp, ferritin and d-dimer were observed amongst critical and severe disease and non-recovered patients (p-value<0.05). Patients with eosinopenia had low survival proportion at day 5 and 10 than those with relatively normal eosinophil counts. Conclusion: Patients with advanced age, multiple comorbidities, elevated hematological, deranged coagulation markers presented with more severe disease and had poor outcome. In particular, eosinopenia can play key role in early diagnosis, disease severity recognition and disease surveillance as it is an independent risk factor for prognosis.

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