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Objectives: To study the effect of corona virus on blood hemoglobin and the changes this virus causes on hemoglobin in COVID-19 infected patients. Study Design: Observational study. Settings: Rawal institute of Health Sciences and Pakistan Institute of Medical Sciences, Islamabad. Period: Feb 2021 to April 2021. Material & Methods: Total 100 adult patients were included all were suffering from corona virus infection. COVID-19 infected patients belonging to both genders with no other cause of anemia were selected and all adult patients in which anemia was due to diseases other than corona infection were excluded. The blood samples of COVID-19 infected patients was taken in 5cc syringe and was send to the laboratory of Rawal Institute Of Health Sciences Islamabad for hemoglobin estimation. Blood heamoglobin (Hb) at the time of admission was recorded. Changes in their blood Hb was noted. Statistical Analysis: Data was be entered into SPSS version 23, normality of data was checked. For non-normally distributed data kruskal wallis and Mann whitney U test was applied and for normally distributed data Anova and post hoc was used. Spearsman correlation was used to correlate non distributed data and Pearson’s correlation was used for normally distributed data. Results: 100 adult patients were divided in two groups. Group I with mild symptoms of corona virus and group II with severe symptoms of corona virus. Patients with mild corona symptoms their blood hemoglobin level was 12.2 g/dl and those with severe corona symptoms their blood hemoglobin level was 10.0 g/dl. Conclusion: It was observed that patients suffering from severe disease of corona COVID-19 had reduced hemoglobin levels than those suffering from milder form of disease, thus confirming that corona virus effects the hemoglobin level and reduces its serum value causing anemia leading to complication of disease.

Objective: To assess the distractor efficiency of the multiple-choice questions and find out the structural flaws in the items that negatively impact the distractor efficiency. Study Design: Retrospective Observational study. Setting: Department of Pathology, Rawal Institute of Health Sciences (RIHS) SZAMBU, Islamabad. Period: April 2021 to June 2021. Material & Methods: This study was conducted at Rawal College of Medicine, RIHS Islamabad. The data was based on the item- analysis report from a sendup exam MCQ paper (2020) of 3rd year MBBS class. Distractor efficiency of total of 140 MCQs was analyzed. Distractor efficiency was categorized as low in MCQ with 3-4 non-functional distractors, medium with 1-2 nonfunctional distractors and high if there are no non-functional distractors. These MCQs were investigated with reference to item writing guidelines proposed by Haladyna et al. The flaws identified were grouped as, within option flaws, alignment flaws between options and stem/ lead-in and other flaws. Results: Out of 140 MCQs, distractor efficiency was high in 58 (41%), moderate in 75 (54%) and low in 7 (5%). The item writing flaws identified in moderate to low DE items were Alignment flaws between distractors and stem/ lead-in were linguistic cues 8(10%), logic cues 10 (12%) and irrelevant distractors 5(6%). Item flaws within the distractors were non homogenous length 2 (2.4%), non-homogenous content 5(6%) and distractors with true and false statements 3(4%). Flaws that were categorized in other than distractors were low cognitive level items 13 (16%) and un-necessarily complicated stems were 8(10 %). Conclusion:  This analysis found out distractor efficiency of multiple-choice items was moderate to high. The major flaws that negatively impact distractor efficiency include the distractors with low cognitive level, unnecessary complicated stems, logic cues, linguistic cues, irrelevant distractors and distractors with non-homogenous length and content.