Background Cancer patients particularly those on active anti-cancer treatment have been reported to be at a high risk of severe COVID-19 infection and deaths. This study aimed to describe the clinical characteristics and outcomes of patients diagnosed with COVID-19 whilst on anti-cancer treatment in a developing country. Methods This is a retrospective observational study of all adult cancer patients at SKMCH & RC Pakistan, from 15th March - 10th July,2020 diagnosed with COVID-19 within 4 weeks of receiving anti-cancer treatment, where a purposive sampling was carried out. Cancer Patients who did not receive anti-cancer treatment and clinical or radiological diagnosis of COVID-19 without a positive RT-PCR test were excluded. The primary endpoint was all-cause mortality after 30 days of COVID‐19 test. Data was analyzed through SPSS version 23. Categorical parameters were computed using Chi-Square test, keeping p-value <0.05 as significant. Results A total of 201 cancer patients with COVID‐19 were analyzed. The median age of patients was 45 (18-78) years. Mild symptoms were present in 162(80.6%) patients and 39(19.4%) had severe symptoms. The risk of death was statistically significant (p-value <0.05) amongst patients above 50 years of age, with metastatic disease and on palliative anti-cancer treatment. Anti-cancer treatment (chemotherapy, radiotherapy, hormonal therapy, targeted therapy and surgery) recieved within preceding 4 weeks, had no statistically significant (p-value >0.05) impact on mortality. Conclusion In cancer patients with COVID-19, mortality appears to be principally driven by age, advanced stage of the disease and palliative intent of cancer treatment. We did not identify evidence that cancer patients on chemotherapy are at significant risk of mortality from COVID-19 correlating to those not on chemotherapy.

Metastatic disease is one of the few rare causes which can present with clinical and radiological features of acute appendicitis. In this article, we present a case of a 33-years-old man with known primary gastric malignancy undergoing adjuvant treatment, who presented with clinical peritonitis. Imaging findings revealed acute appendicitis and a sealed-off appendiceal perforation. Diagnosis of metastatic adenocarcinoma to the appendix was confirmed on histopathology. Sound knowledge among clinicians and radiologists regarding clinical presentation and radiological findings of acute abdomen in patients with known primary malignancy can aid in rapid diagnosis and management.

Background: Palliative radiotherapy in patients with metastatic spinal cord compression is a well-known treatment modality but little is known whether it improves quality of life and performance status. Our study focusses on analyzing the impact of palliative radiotherapy on these two parameters in patients with metastatic spinal cord compression. Methods: We performed a prospective observational study from August 2020 to April 2021 to assess consecutive patients presenting to emergency department with suspected MSCC. We enrolled 24 patients in the study, and they were evaluated for their performance status and quality of life using ECOG and FACIT-PAL 14 scores respectively. Palliative radiotherapy was administered, and the patients were followed up four to six weeks later. Their ECOG and FACIT-PAL 14 scores before and after receiving palliative radiotherapy were analyzed. Results: The mean age of the patients was 48 (IQR 35–62), with 14 (58%) being male. 1 patient died soon after admission. Median dose fractionation was 2000 cGy. Median (IQR) of ECOG performance status score on admission and follow up was 2.5 (1.0–3.7) and 1.5 (1.0–3.7), p=0.719, respectively. Median (IQR) FACIT-PAL 14 score on admission and follow up were 35.5 (34.0–37.6) and 36.5 (30.2-44.7), p=0.277, respectively. Our results indicate that there was no statistically significant difference in the median ECOG performance status and FACIT PAL 14 scores before and after the administration of palliative radiotherapy. Conclusion: Our study indicates that palliative radiotherapy in patients with metastatic spinal cord compression had little benefit in objectively improving quality of life and performance status using the well-known and widely used scores. This lack of response could be due to delayed presentation of the patients. Earlier involvement of palliative care team could have improved both these parameters. Further research with larger population of patients over a longer period is needed to further assess these outcomes.

Background: Medication therapy management (MTM) continues to offer pharmacists the opportunity to use their knowledge, assist patients and caregiver in improving therapeutic outcomes, however the change is slow. Health information technology has been noted as an important driver in the success of MTM and has a potential role in improving therapeutic outcomes and reducing medication errors. Objective: This research aimed to design an integrated clinical pharmacist menu (CPM) software along with clinical decision support tools, optimizing MTM services and reducing medication errors. Methods: The integrated CPM software was designed abridged with decision support tools. A comparative study was conducted in a setting of integrated CPM software versus paper-based clinical pharmacy services (P-CPS) for the evaluation of MTM services. Clinical decision support systems (CDSS) and automated significant laboratory and medication alerts were analyzed for the improvement of MTM and impact on the identification and resolution of medication errors. Results: MTM improved after the application of the CPM software with a difference of 100% in “medication history generation” and “patient care plan,” with a reduction in medication errors by 39.8%. The identification of medication errors and verification of medication order significantly improved from 49% to 82% (p = 0.00) and from 4.5% to 7.0% (p = 0.00), respectively, in the CPM setting. The CDSS tool in the CPM software generated 730, 1802, and 198 auto alerts for “drug–drug interaction,” “inappropriate dose,” and “dose adjustment in an abnormal clinical laboratory test,” respectively, which improved the resolution and identification of medication errors. Conclusion: The CPM is user-friendly, which improved the MTM services. Medication error identification and resolution were significantly improved by the CPM software.