Ivermectin is an antiparasitic drug being investigated for repurposing to SARS-CoV-2. In-vitro, ivermectin showed limited antiviral activity and a COVID-19 animal model demonstrated pathological benefits but no effect on viral RNA. This meta-analysis investigated ivermectin in 18 randomized clinical trials (2282 patients) identified through systematic searches of PUBMED, EMBASE, MedRxiv and trial registries. Ivermectin was associated with reduced inflammatory markers (C-Reactive Protein, d-dimer and ferritin) and faster viral clearance by PCR. Viral clearance was treatment dose- and duration-dependent. In six randomized trials of moderate or severe infection, there was a 75% reduction in mortality (Relative Risk=0.25 [95%CI 0.12-0.52]; p=0.0002); 14/650 (2.1%) deaths on ivermectin; 57/597 (9.5%) deaths in controls) with favorable clinical recovery and reduced hospitalization. Many studies included were not peer reviewed and meta-analyses are prone to confounding issues. Ivermectin should be validated in larger, appropriately controlled randomized trials before the results are sufficient for review by regulatory authorities.

Background:The first case of Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were diagnosed in Wuhan, China in 2019. In the first half of 2020 this disease has already converted into a global pandemic. Objectives: To assess the efficacy of Ivermectin in mild cases of COVID-19 patients on the basis of predefined assessment criteria. Study Settings: Fatima Memorial Hospital, Lahore Study Design: Open label randomized control trial. Duration of Study: From 1 st May, 2020 to 30 th June, 2020.Patients & Methods: Sample size and technique: Sample size was 50 patients; 25 patients were kept in control group and 25 patients were kept in experimental group. Results: There were total 50 patients, divided into two groups case and control group.The mean age of the participants was 40.60 ± 17 and out of those 31 (62%) were male and 19 (38%) were females. Cough was observed more in case group (p= 0.049). Fever, myalgias and dyspnea were the commonest symptoms in both the groups (p= 1.000). Diarrhea and vomiting were more common in control group (p=0.0001, p= 0.042 respectively). On follow up at day 7, patients were stratified as asymptomatic and symptomatic. Amongst the case group, out of 25 patients, 16(64%) patients were asymptomatic and rest of the 9(36%) patients was asymptomatic. In control group, out of 25 patients, 15(60%) patients were asymptomatic and rest of the 10(40%) patients was asymptomatic. p-value (0.500). Statistically there was no significant difference between case group who were given ivermectin along with symptomatic treatment and control group who were only given symptomatic treatment without ivermectin, being asymptomatic on day 7 at follow up. p-value (0.500

Background The first case of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was diagnosed in Wuhan, China, in 2019. By the first half of 2020, coronavirus disease 2019 (COVID-19) turned into a global pandemic. Objectives The aim of this study is to describe the clinical and demographic characteristics including comorbidities and their outcomes among patients hospitalized with COVID-19 in four tertiary care hospitals across Lahore . This retrospective study was conducted at Fatima Memorial Hospital, Sir Ganga Ram Hospital, Lahore General Hospital, and Jinnah Hospital, all in Lahore, Pakistan, from May 1, 2020, to June 30, 2020. The sample size was 445, which was derived using the convenient sampling method. Clinical outcomes during hospitalization included the requirement of invasive positive pressure ventilation, need for renal replacement therapy (RRT), and death. Data regarding demographics, baseline comorbidities, important vital signs on reporting, and initial workup with results were also collected. Results A total of 445 patients’ data were studied, of whom 291 (65.4%) were male patients and 154 (34.6%) female patients. The median age was 54 years (interquartile range [IQR]: 24). The most common comorbidities were hypertension (HTN) (195; 43.8%) followed by diabetes mellitus (DM) (168; 37.8%) and cardiovascular disease (CVD) (61; 13.7%). The median length of hospital stay was eight days (IQR: 3). Of the total patients, 137 (30.7%) were treated in intensive care unit settings, 40 (9%) received invasive mechanical ventilation, 40 (9%) patients had acute kidney injury, 38 (8.5%) received RRT, and 37 (8.3%) died. It was seen that more patients who were either diabetic or hypertensive received invasive mechanical ventilation as compared to those who did not have these comorbidities. The most common radiological finding on chest X-ray was the classical ground-glass appearance of COVID-19, which was found in 318 (71.4%) patients. Conclusions Patients with one or more underlying comorbidities had poor clinical outcomes compared to those with no comorbidities, with the most vulnerable group being patients with chronic kidney disease, DM, HTN, and CVD in descending order.

ABSTRACT… Background: Asians compared to Europeans are known to be at an increased risk of cardiovascular disease (CVD) risk factors. Obesity is a global cardio metabolic health and cancer risk. There is paucity of data regarding obesity in our local population. Aims & Objectives: To evaluate Body Mass Index (BMI). Visceral fat content and body fat percentage using Bio-impedance body composition monitor. Thus to identify overweight and obese individuals with high visceral and body fat content the risk factors for cardio metabolic syndrome. Study Design: Cross sectional survey. Setting: Outpatient Department of Medicine, Fatima Memorial Hospital Lahore, Pakistan. Period: 15 th January to 20 th March 2016. Material and Method: 250 patients above 18 years of age who reported in outdoor department were enrolled after informed consent in local language according to enrollment criteria. Approved by ethical review committee reference number FMS-2-2016-IRB-M-111. Their height and weight were measured and BMI, visceral fat content and body fat percentage was calculated using bioimpedance body composition monitor. They were asked questions for pertinent co-morbidities. The statistical analysis was done using SPSS 22.0 version. Results: Out of 250 patients enrolled 144 (58 %) were females and 106 (42 %) were males. Mean age was 45 ±13 years. Mean BMI was 29kg/m 2 . Above normal BMI was seen in 170 (68%), 98(39%) were obese (BMI>30kg/ m2) and 80 (32%) overweight ). Above normal visceral fat content and body fat percentage was seen in 110(44 %) and 191(76%) respectively. In the later group 100(67%) were females. Diabetes and hypertension were present in 63(64%) obese patients among 30(73%) with high visceral fat and in 90(60%) with high body fat percentage. Conclusion: A significant number of patients were overweight or obese with above normal visceral fat content and body fat percentage with female dominance in later group. They also had higher prevalence of diabetes and hypertension. Bio-impedance technique is useful simple inexpensive tool for initial assessment of visceral and body fat content in outdoor facility. Key words:Pakistan, Obesity, Visceral fat, Body fat percentage, Bio-impedance monitor, Hypertension, Diabetes Article Citation: Kitchlew R, Chachar AZK, Latif S. Body Mass Index; Visceral fat and total body fat distribution and its relation to body mass index in clinical setting using bioimpedance body composition monitor. Professional Med J 2017;24(2):326-334.

Granulomatosis with polyangiitis (GPA) previously known as Wegner’s granulomatosis, is a small vessel vasculitis that preferentially involves capillaries, arterioles and venules, presenting as multisystemic disease classically with alveolar haemorrhage and renal insufficiency. We report a case of GPA diagnosed on history, clinical findings and supported by imaging and very high levels of C-ANCA. Renal biopsy confirmed the typical histopathological findings. We discuss herein the management of the case and review of literature.