BACKGROUND & OBJECTIVES: Novel corona virus has claimed significant mortality and morbidity. Timeline of long-term complications and effects on humanity are yet to be explored. Current study aims to evaluate the spectrum of post Covid syndromes in our Covid survivors. METHODOLOGY: This observational study was conducted at Medicine Dept. RIHS Islamabad after ethical approval. 195 recovered COVID cases were selected and followed 3 monthly over a year. Inclusion criteria: Age >12 years, both genders, Covid PCR+ve >4 weeks earlier. Exclusion criteria: Malignancies, pregnancy, recurrent Covid and that lost follow-up. Patients were evaluated for new onset generalized symptoms, respiratory, cardiovascular, neurological, hematological, gastrointestinal, dermatological and genitourinary supported by relevant investigations. Data analyzed by SPSS-22 with significant p<0.05. RESULTS: Amongst 195 cases, 102(52.3%) males and 93(47.7%) females, mean age was 42.35+14.31 years, mean duration since Covid recovery 32+24.47 weeks. There was history of mild COVID in 89(45.6%), moderate 71(36.4%), severe 32(16.4%) and life threatening 02(01%) having significant association with increased mean age and female gender (p<0.05). ninety four (48.2%) cases had post COVID syndromes. persistent fatigue (58), fever (29), myalgia’s (27),  dyspnea (26), persistent cough (19), weight loss/gain (18), smear positive TB (2), bronchitis (7), asthma exacerbations (3) and pleural effusion (1). X-ray findings showed lung fibrosis in 12, ground glass appearance 10. Spirometry showed reduced exercise capacity in 11. Anemia in 11, leukopenia 02, thrombocytopenia 02, pancytopenia 01 case. In CVS, retrosternal chest pain in 11, orthopnea/PND 05, myocarditis/myocardial fibrosis 04, pericardial effusion 01, new onset hypertension 03, worsened hypertensive control 02, palpitations 10 and POTS 03. Regarding ENT, sinusitis in 12 and mucor-mycosis 03. Reduced GFR 05 and COVAN 01. New onset diabetes 05, worsened diabetic control 06, bone-demineralization 03 and thyroiditis 01. Persistent diarrhea 06, IBS 04, gastritis 08, esophagitis 06, GERD 11. Seven of 93 females reported menstrual irregularities. Hair loss 15, rash 07. headache in 23, anxiety 17, disturbed sleep 14, depression 09, peripheral neuropathy 03, CVA 03, amnesia and PTSD 03 each. 03 cases expired with cardiopulmonary arrest. CONCLUSION: Post COVID syndrome observed in half of Covid survivors. The respiratory, cardiovascular, dermatological, neuropsychiatric and generalized symptoms were frequent. Authors suggest follow-up of Covid survivors. The clinical evaluation and timely management may improve quality of life and morbidity amongst survivors. KEY WORDS:  COVID-19. Post Covid Syndromes. Long Covid syndrome. Covid complications. Persistent post-Covid syndrome (PPCS), Myocarditis. Lung Fibrosis.

Objective: To determine a score that best predicts the mortality of admitted patients within six weeks of Acute Variceal Hemorrhage (AVH).Study Design: Cross sectional study.Place and Duration of Study: The study was conducted at Inpatient Department of Gastroenterology Unit at Pakistan Institute of Medical Sciences (PIMS), Islamabad for six months.Materials and Methods: The number of patients with AVH enrolled in this study were 223. A pretested questionnaire was used to gather the required information; Model for End-stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) scores of each patient were recorded at the time of admission in the inpatient facility. The outcome was documented via a telephonic call at the end of six weeks. The primary outcome of the study was “mortality” at end of six weeks.Results: The total number of participants were 223, including 61% (n=136) males and 39% (n=87) females. The mean age was 52.4±13.96. The overall mean value of CTP score was 9.6±2.8 and mean value of MELD score was 19.3±6.7, while the mean values of CTP and MELD among non-survivors were 12.9±2.1 and 26.6±5.6, respectively. After six weeks, the number of deaths were 27% (n=60). The MELD had positive predictive value (PPV) of 83.3%, negative predictive value (NPV) of 96.8%, sensitivity: 91.7%, specificity: 93.3%, diagnostic accuracy: 92.82%, and positive likelihood ratio of 13.68. Similarly, CTP had PPV: 77.4%, NPV: 92.5%, sensitivity: 80%, specificity: 91.4%, diagnostic accuracy: 88.34% and positive likelihood ratio of 9.3. The area under the curve (AUC)for MELD was 0.91, while CTP was 0.90.Conclusion: The MELD score is better in its discriminative ability and more accurate in predicting six weeks mortality in patients with AVH than CTP score.