Background: In the absence of a standard of treatment for COVID-19, the combined use of anti-inflammatory (corticosteroids and Enoxaparin) and antiviral drugs may be more effective than using either modality alone in the treatment of COVID-19. Methods: Patients hospitalized between April 10th, 2020, through May 10th, 2020, who had confirmed COVID-19 infection with clinical or radiographic evidence of pneumonia, in which 65 patients have moderate COVID-19 pneumonia, and 63 patients have severe COVID-19 pneumonia. All patients received early combination therapy of anti-inflammatory (corticosteroids and Enoxaparin) and antiviral drugs. They assessed for type and duration of treatment, and days need to wean from oxygen therapy, length of stay, virus clearance time, and complication or adverse events. All patients had more than 28 days follow up after discharge from the hospital. Results: Moderate COVID-19 pneumonia group were 65 patients who received Enoxaparin, antiviral drugs, empirical antibiotics for pneumonia, and standard treatment for comorbidity. Male patients were 50 (76.9%) and female patients were 15 (23.1%). 34 (52.3%) patients have comorbidity, 25 (38.5%) patients have Diabetes Mellitus and 2 (3.1%) pregnant ladies. 19 (29.2%) patients were on low flow oxygen therapy, 3L oxygen or less to maintain oxygen saturation more than 92%. All patients discharged home with no major or minor bleeding complications or significant complications. Severe COVID-19 pneumonia group were 63 patients who received methylprednisolone, enoxaparin, antiviral drugs, empirical antibiotics for pneumonia, and standard treatment for comorbidity. Male patients were 55 (87.3%) and female patients were 8 (12.7%). 37 (58.7%) patients have comorbidity, and 24 (38.1%) patients have Diabetes Mellitus. 32 (50.8%) patients were on low flow oxygen therapy, 4-9L oxygen, and 31 (49.2%) patients were on low flow oxygen therapy, 10L oxygen or more, including 12 patients on a non-rebreathing mask. Patients received methylprednisolone were 37 (58.7%) for 3 days, 16 (25.4%) for 5 days and 10 (15.9%) for more than 5 days. Sixty-two patients discharged home with one patient had a long stay, and the other two transferred to ICU. One long-stay patient transferred to ICU on low flow oxygen therapy. Conclusion: Early use of a combined anti-inflammatory (corticosteroids and Enoxaparin) and antiviral drugs treatment in patients with moderate to severe COVID-19 pneumonia prevent complications of the disease and improve clinical outcomes.

(SUMMARY) Objective: The study was conducted to determine the HBV vaccination status in health care workers of Muhammad Medical College Mirpurkhas. Study design, Setting & Duration of Study: This was a descriptive study carried out at Muhammad Medical College Mirpurkhas, from December 2007 to February 2008. Subjects & Methods: Total 480 health care workers were included; both male and female. Vaccination status & other data were filled on preformed Questionnaire proforma, if vaccinated or not. And if vaccinated either complete or incomplete. Results: Total 480 health care workers were studied, including 300 (62.5%) male and 180 (37.5%) females. The mean age was 34±8.7 and 36 ± 9.3 years in vaccinated and non-vaccinated subjects respectively. A total of 255 (53.15%) were vaccinated, including 215 males and 40 females. A 225 (44.875%) patients were non-vaccinated including 85 males and 140 females. The prevaccination HBsAg status was checked and found negative in all the subjects. The frequency of vaccination was highest among house officer 55 (91.66%) and lowest in the sanitary workers 3 (11.5%). The most common reason of not being vaccinated was non-affordability (high cost of vaccine). C o n c l u s i o n s : We conclude that a substantial number of health care workers are not vaccinated. So it demands a need for a more aggressive approach to be vaccinated and vaccine must be cost effective.

Background In the absence of a standard of treatment for COVID-19, the combined use of anti-inflammatory (corticosteroids and Enoxaparin) and antiviral drugs may be more effective than using either modality alone in the treatment of COVID-19. Methods Patients hospitalized between April 10th, 2020, through May 10th, 2020, who had confirmed COVID-19 infection with clinical or radiographic evidence of pneumonia, in which 65 patients have moderate COVID-19 pneumonia, and 63 patients have severe COVID-19 pneumonia. All patients received early combination therapy of anti-inflammatory (corticosteroids and Enoxaparin) and antiviral drugs. They assessed for type and duration of treatment, and days need to wean from oxygen therapy, length of stay, virus clearance time, and complication or adverse events. All patients had more than 28 days follow up after discharge from the hospital. Results Moderate COVID-19 pneumonia group were 65 patients who received Enoxaparin, antiviral drugs, empirical antibiotics for pneumonia, and standard treatment for comorbidity. Male patients were 50 (76.9 %) and female patients were 15 (23.1 %). 34 (52.3 %) patients have comorbidity, 25 (38.5%) patients have Diabetes Mellitus and 2 (3.1 %) pregnant ladies. 19 (29.2 %) patients were on low flow oxygen therapy, 3L oxygen or less to maintain oxygen saturation more than 92%. All patients discharged home with no major or minor bleeding complications or significant complications. Severe COVID-19 pneumonia group were 63 patients who received methylprednisolone, enoxaparin, antiviral drugs, empirical antibiotics for pneumonia, and standard treatment for comorbidity. Male patients were 55 (87.3 %) and female patients were 8 (12.7 %). 37 (58.7 %) patients have comorbidity, and 24 (38.1%) patients have Diabetes Mellitus. 32 (50.8 %) patients were on low flow oxygen therapy, 4-9L oxygen, and 31 (49.2 %) patients were on low flow oxygen therapy, 10L oxygen or more, including 12 patients on a non-rebreathing mask. Patients received methylprednisolone were 37 (58.7 %) for 3 days, 16 (25.4 %) for 5 days and 10 (15.9 %) for more than 5 days. Sixty-two patients discharged home with one patient had a long stay, and the other two transferred to ICU. One long-stay patient transferred to ICU on low flow oxygen therapy. Conclusion Early use of a combined anti-inflammatory (corticosteroids and Enoxaparin) and antiviral drugs treatment in patients with moderate to severe COVID-19 pneumonia prevent complications of the disease and improve clinical outcomes.

Objective: Evaluating circulating leukocytes in acute mental stress & relation with coronary artery disease. Design: Descriptive study Setting: Muhammad Medical College Mirpurkhas, Duration: from March 2007 to August 2007. Methods: Two hundred young healthy adults were studied for stress experiment. Venous blood samples were drawn before and after stress for estimation of leukocyte counts. Values were presented as mean ±standard error of mean (SEM). Results: The difference in Pre and during stress results of variables were TLC = - 4630.85 ± 140.65, N % = -11.8 ± 0.36, L% = 4.03 ± 0.14, M %= 5.48 ± 0.37, E % = 1.18 ± 0.07, B % = 1.11 ± 0.022. Highly significant p-values (≤ 0.001) were found among various parameters, in both groups of subjects. Conclusion: An increase in the number of circulating leukocytes was an important unexpected observation that was noted. We suggest that the real life stress induced leukocytes changes may warrant further investigation about its relation with the coronary artery disease (CAD).