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Aims Lockdown and restricted mobility due to the pandemic of corona virus disease  2019 (COVID-19) has severely affected the continuity of healthcare of patients with acute and chronic diseases. We evaluated the impact of COVID-19 on the adherence to gluten-free diet (GFD), symptom control, and quality of life (QOL) in patients with celiac disease (CeD). Methods A questionnaire, consisting of both ad-hoc and validated questions, was created after review of literature, group discussions, and expert meetings. Standardized questionnaires namely CeD adherence test (CDAT), celiac symptom index score, and CeD-related QOL were used. The web-based questionnaire was sent to 3130 patients via social media and 452 responses (14.4%) were received. Also, additional 68 patients (not available on any social media application) were interviewed telephonically by a trained dietitian. Results Overall, 505 patients (females: 318; mean age: 24.1±14.2 years) were included. While only 6.7% ( n = 34) had poor compliance to GFD (CDAT > 17) before COVID-19 pandemic, it almost doubled to 12.6% ( n = 64) during the COVID-19 pandemic times ( p = 0.02). Furthermore, 4.9% ( n = 25) of patients were diagnosed contacting  COVID-19. Interestingly, 73.2% ( n = 370) patients preferred online appointment than physical appointment. Most common difficulties faced during lockdown period were high delivery charges for getting gluten-free (GF) food at home (54.4%), increased prices of regular GF food (43.1%), and travelling long distance to arrange GF food (44.9%). Conclusions The COVID-19 pandemic has substantially affected the adherence, symptom control, and QOL in patients with CeD, attributable to unavailability, shortage of money, and heightened cost of GF food. The pandemic has offered an opportunity to practice teleconsultation approach for patients with CeD. Supplementary Information The online version contains supplementary material available at 10.1007/s12664-021-01213-4.

Abstract110 disabled and 110 normal healthy children with the age range from 3 to 14 were examined in this cross sectional study. The average number of decayed tooth found 5.6 in deciduous and 6.5 in mixed dentition in disabled children, and the numbers were 3.5 and 4.0 respectively in normal children. Average number of missing tooth was 1.3 in disabled and was 1.0 normal child. The oral hygiene index value was 3 in disabled and 2.47 were in healthy children. In the disabled children, 36% respondents had normal gingiva, 50% had mild gingivitis and 14% had marked gingivitis; but in the normal children, about 73% showed normal gingiva, 23% developed mild gingivitis and only 4.5% had marked gingivitis.

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IntroductionNeurological injuries because of trauma and accidents are common but rarely reported or examined in Pakistan. In this study, we will determine the frequency of neurological deficits reported in the emergency unit in patients presenting with acute trauma. MaterialThis study was conducted in an emergency unit of tertiary care setting in Karachi, Pakistan. One hundred patients presenting with mild to moderate trauma were enrolled in the study after informed consent. Patients with severe trauma requiring emergency intervention were excluded from the study. ResultsOut of the 100 patients enrolled in our study, 57% presented with neurological deficits after a road traffic accident (RTA), making RTA the most common cause of trauma. The most prominent site of injury was the lower limb (57%). Upper limb examination revealed that out of the 35% patients presenting with upper limb injuries, ten patients (28.6%) had a decreased biceps reflex, while six patients (10.5%) had tingling in their hands. Out of the 57% of patients presenting with lower limb injuries, ten patients (17.5%) had decreased ankle reflexes and six patients (10.5%) had tingling in their legs. ConclusionNeurological deficit is very common in patients presenting to emergency settings in Pakistan. Neurologists should be present in emergency centers to perform detail neurological examinations of patients coming to emergency centers, and follow-up visits should be arranged in Neurology clinics for patients suffering from any neurological deficits.