Amid the coronavirus disease 2019 (COVID-19) pandemic, there is an unprecedented increase in public avoidance of hospitals predominantly driven by fear of contracting the virus. Recent publications highlight a re-emergence of rare post–myocardial infarction complications. While mechanical complications are infrequent in the era of primary percutaneous coronary intervention, they are associated with high mortality rates. The concurrent occurrence of mechanical complications such as left ventricular aneurysm and ventricular septal rupture is an extremely rare entity. We hereby delineate a unique case of a 53-year-old Caucasian male who underwent successful concomitant closure of a ventricular septal rupture, left ventricular aneurysmectomy, and 3-vessel coronary artery bypass grafting. Due to a delayed initial presentation owing to the patient’s fear of contracting COVID-19, the surgery was carried out 3 months after the myocardial infarction. His postoperative evaluation confirmed normal contractility of the left ventricle and complete closure of the ventricular septal rupture. Six months postoperatively, the patient continues to do well. We also present a literature review of the mechanical complications following delayed presentation of myocardial infarction amid the COVID-19 pandemic. This article illustrates that clinicians should remain cognizant of these extremely rare but potentially lethal collateral effects during the ongoing global public-health challenge. Furthermore, it highlights a significant concern regarding the delay in first medical contact due to the reluctance of patients to visit the hospital during the COVID-19 pandemic.

Background December 2019 marked the inception of a global pandemic, with cases being reported worldwide. In the developing nations with scarce healthcare resources, the reliance on healthcare workers who are amply prepared to withstand the prevailing scenario is indispensable. Our study aimed to assess the level of preparedness of doctors working in various hospitals across Pakistan to combat coronavirus disease 2019 (COVID-19). Methods We conducted an online questionnaire-based survey in May 2020 to estimate the level of preparedness of doctors working in various departments of various private and public hospitals across Pakistan. The survey comprised 36 questions, with items evaluating the provision of adequate protective equipment, training, mental health resources, and sound collaboration between healthcare workers and the hospital management during the COVID-19 crisis. Results A total of 346 doctors responded to the survey, among whom 56.4% were working in public sector hospitals and 46.5% were working more than five days per week. Of those included, 87.6% were being provided with disposable gloves, but 72.8% and 43.4% of respondents professed to having no access to eye protective equipment and gowns, respectively. Only 35.3% of respondents claimed to be trained regarding the use of personal protective equipment and 28.95% were being tested. Of the physicians, 43.4% claimed to have no proper triage system for the suspected patients and 98.3% were concerned about transmitting the disease to their family members. Of the doctors, 53.5% reported that there was sound collaboration between the hospital management and healthcare staff. Conclusion The survey provided evidence of inadequate delivery of personal protective equipment and training to doctors working in various hospitals across Pakistan. A sound collaboration between the hospital management and departments needs to be addressed.

IntroductionWhile tetanus has largely been eradicated with the advent of the tetanus vaccine, its prevalence in Pakistan remains alarmingly high due to insufficient uptake of the vaccination program. The clinical presentations that the disease elicits range from mere opisthotonos to more sinister complications, including respiratory failure and death, often posing an insurmountable challenge for hospitals. MethodsA retrospective cross-sectional study was conducted and analyzed the medical charts of 43 patients with a confirmed diagnosis of tetanus infection. The charts were perused for the patients' demographics, clinical characteristics, and disease outcomes. The prevalence of various clinical symptoms and complications were reported in terms of frequencies and percentages. ResultsThe mean age of the patients hovered at 29.53 ± 16.53 years, with a range of 12 to 65 years. Of those affected, 83.7% were males while 16.3% were females. Notably, none of the infected patients had a prior history of vaccination against tetanus. Trismus was noted to be the most prevalent clinical manifestation and was found in 90.70% of the patients while paraesthesia at the site of infection, found in 6.98%, was the least prevalent. The overall mortality was noted to hover at 46.5%. ConclusionWhile tetanus has largely been eradicated, its prevalence in Pakistan remains alarmingly high. The complications noted in the study have implications for the country's public health system and aims to better inform the current state of the national vaccination program.

BackgroundNecrotizing enterocolitis (NEC) is a debilitating disease that predominantly afflicts premature neonates, although it can also affect term neonates. The clinical features of the ailment vary widely and range from transient feed intolerance to life-threatening complications such as septicemia and disseminated intravascular coagulation. While surgery is usually only reserved for severe cases, such as those presenting with intestinal perforation, the role of surgical management in cases of NEC without perforation remains elusive. MethodsA retrospective chart review of patients, three years in duration, was conducted and studied confirmed cases of NEC. The clinical presentations studied included cases of NEC with pneumatosis intestinalis, fixed bowel loop, pneumoperitoneum, and abdominal wall erythema. The patients were divided with regards to their intestinal perforation status and with pertinence to the treatment modality employed (medical or surgical). The results in either group were eventually analyzed in terms of the overall survival rate. ResultsA total of 48 patients were included in the study, of which 79.16% presented without perforation and 20.83% with perforation. Of the study participants included, 26 were females and 22 were males. Pertinently, no gender predominance was appreciated. In patients without perforation, medical management was noted to boast a lower mortality rate when compared with surgical intervention (15.6% vs 50.0%, respectively). In patients with perforation, the overall mortality was noted to hover at 50.0%, which was higher than that encountered in the non-perforation group. ConclusionIn patients with NEC without perforation, surgical treatment confers no comparative therapeutic advantage when compared with medical management alone. Conservative management with broad-spectrum antibiotics including metronidazole yields equally favorable outcomes in such cases.

Coronavirus disease 2019 (COVID-19) has proliferated rapidly in Pakistan, adversely affecting every province. The grave repercussions that the pandemic has elicited in Pakistan have evoked a dire need for drastic measures to be employed at both the governmental and provincial levels. Due to the inequitable appropriation of healthcare resources with respect to the various provinces, however, a stark contrast in terms of morbidity and mortality persists. Furthermore, considering that Pakistani citizens constitute a noteworthy proportion of expatriates residing in the United Arab Emirates (UAE) and the close proximity of the two countries, due consideration of the situation in the UAE is also warranted. We present a transnational review to delineate the current state-of-the-art in Pakistan and the United Arab Emirates and evaluate pragmatic management protocols that remain at the epicenter of a national healthcare conundrum.