Objective: To explore the relation of Interleukin-6 and Procalcitonin with COVID-19 severity on high resolution computerized tomogram (HRCT) chest. Study Design: Randomized Control Trial (NCT04945811). Place and Duration of study: Pathology Department, Combined Military Hospital Quetta, from April 2020 to May 2021. Methodology: Serum Interleukin-6 and Procalcitonin of 100 consenting COVID-19 positive patients from April 2020 to May 2021 were assessed at Pathology department Combined Military Hospital Quetta and their levels were correlated with severity of lung involvement on HRCT Chest Results: Serum Interlukin-6 levels were significantly raised in 97 patients with mean levels of 20.43 ± 19.66 (pg/ml). Serum procalcitonin levels were also significantly raised in 95 patients with mean levels of 0.43 ± 0.24 (ng/ml). Conclusion: Interlukin-6 and procalcitonin are important biomarkers for diagnosis and predicting severity of COVID-19 pneumonia.

Objective: To determine the effectiveness of Intratympanic Dexamethasone with Lidocaine in control of idiopathic tinnitus. Study Design: Randomized control trial (Clinical Trials. gov Identifier: NCT04798391). Place and Duration of Study: ENT Department, PAF Hospital, Sargodha Pakistan, from Apr 2017 to Jul 2019. Methodology: 264 consenting patients with idiopathic unilateral tinnitus presenting at ENT Department PAF Hospital Sargodha were assessed for tinnitus severity using the modified tinnitus handicap inventory. The scores were recorded and subsequently administered intra-tympanicaly 2.0ml (milli-liter) of Dexamethasone and Lidocaine (1.5 ml Dexamethasone ± 0.5 ml 1% Lidocaine). The dose was repeated twice at weekly intervals. All the patients were reassessed on the modified tinnitus handicap inventory two weeks after the third Intra-tympanic administration, with patients divided into responsive and noresponsive groups depending on ten points or more improvement in tinnitus score. Results: Mean modified tinnitus handicap inventory score pre-therapy was 29.6 ± 5.68, and post-therapy was 17.1 ± 7.45. Independent-sample T-test applied showed a p-value of <0.001. Conclusion: Intratympanic Dexamethasone with lidocaine has a definitively positive outcome on tinnitus improvement.

Results of invasive positive pressure ventilation (IPPV) in COVID-19 patients with Severe Acute Respiratory Distress Syndrome are discouraging despite its prompt use. However noninvasive positive pressure ventilation (NIPPV) is yet not a common practice internationally because of lack of global evidence advocating its effective use in severe cases of ARDS as well as dreadful concern about aerosol generation especially in patients having COVID-19 infection. Objective: To determine whether, NIPPV application is effective and safe in COVID-19 Patients. Methods: One hundred and thirty hemodynamically stable patients with severe CARDS as per Berlin definition (PaO2/FiO2 ratio ≤ 100mm Hg), having GCS > 13, respiratory breathing index (RBI) < 105, and without any systemic complication were selected. They were managed with NIPPV in Corona Intensive Care Unit of Mayo Hospital/King Edward Medical University Lahore. A little innovation was done with the application of a specific orofacial interface, fitted with heat and moist exchanger (HME) at the interface and viral/bacterial filters at the expiratory limb of ventilatory circuit. Favorable outcome has been observed in 64% of treated cases in terms of improvement in PaO2/FiO2 ratio, thus abating severity of ARDS from severe to mild category, in an average time span of 6 days. Remaining 36% of patients progressed to IPPV with definitive airway. During study period, 4.2% of healthcare workers (HCW) got infected with COVID-19. Associated complications of NIPPV application were claustrophobia (13.8%), nasal crusting (6.9%), aspiration (6.1%) and barotrauma (0.7%). Conclusion: In carefully selected patients, use of noninvasive positive pressure ventilation with the application of HME and viral/bacterial filters is an effective, preferable and safe modality of choice to provide respiratory support, thus obviating the need for IPPV. However further larger studies are needed to confirm our recommendations.