Introduction: Emergency department healthcare workers of Pakistan during COVID 19 pandemic are facing an acute rise of mental illnesses. In the present study, the authors aim to assess the frequency of anxiety and depression among healthcare workers in the emergency department. Methods: A cross-sectional online survey was conducted in the emergency department between July to August 2020 at Aga Khan University Hospital Karachi, Pakistan. The Hospital Anxiety and Depression (HAD) scale was used for mental illness assessment among emergency physicians and nurses. Descriptive analysis of grading as per Likert scale is done through frequencies, means and standard deviations. Categorical variables were expressed as frequency (%). Mann-Whitney U test was used to compare scores of various groups and sub-groups and Chi-square test was used to assess the association of depression and anxiety categories among the groups. Results: In the emergency department, 127 healthcare professionals (physicians and nurses) were included in this survey. Median depression score was 8 (IQR 6–10) with 21% (27) fall under depression and 39% (50) to borderline depression. Median anxiety score was 9 (IQR 7–12) with 33% (42) had abnormal, 38% (48) had borderline anxiety. Healthcare workers working for > 45 hours per week have odds of 3.62 [1.374–9.549] of developing depression compared to anxiety with a p-value of 0.009. Similarly, nurses and medical officers develop depression with odds of 2.18 [1.016–4.686] p-value 0.045 and 5.18 [0.197–1.02] p-value 0.002, respectively. Conclusion: In our study, we determined that healthcare workers working in the Emergency Department during COVID-19 pandemic suffered high levels of anxiety and depression, which is a matter of concern. Therefore, comprehensive support and training of emergency department healthcare providers are paramount to promote physical and mental wellbeing specifically through adequate provision and training on the use of personal protective equipment, strict infection control practices, shorter shift length, and provision of mental health and support services.

Acute pancreatitis (AP) refers to the acute inflammation of the pancreas; however, if there is concurrent necrosis, it is called necrotizing acute pancreatitis (NAP). The diagnosis is sometimes difficult because it might mimic acute coronary syndrome (ACS). We report a case of a 28-year-old male, who presented to the emergency department (ED) with severe epigastric pain, shortness of breath and diaphoresis for 4–5 h. The initial electrocardiogram (ECG) showed marked sinus bradycardia with an incomplete left bundle branch block. Considering the clinical presentation and ECG changes, he was managed as ACS and was rushed to catheterization laboratory for a coronary angiogram, which was reported normal. Subsequently, his serum pancreatic enzymes were elevated, and computed tomography of the abdomen showed NAP. In ED settings, it is difficult to differentiate between the two, particularly when AP presents with ECG manifestations masquerading as ACS.

Subclinical hyperthyroidism (SH) is a condition in which blood levels of Thyroxine (T4) and Triiodothyronine (T3) are normal in the presence of low levels of thyroid-stimulating hormone (TSH). Patients with SH have either no symptoms or mild nonspecific symptoms. Hypokalemic periodic paralysis (HPP) is one of the rare presentations of overt hyperthyroidism; however, only a few cases are reported to date to occur with SH. This case report presents a case of a young Asian male who was admitted to the emergency department (ED) with paralysis of the lower extremities that progressed to the upper extremities and neck muscles in 2 days. Clinically, he was euthyroid; however, his thyroid profile revealed normal levels of T3 and T4 with undetectable TSH levels. This case report aims to add to the limited literature on SH that presents with HPP in the ED.

Introduction Emergency department (ED) healthcare workers in Pakistan during the COVID-19 pandemic are facing an acute rise in mental illnesses. In this study, the authors aim to assess the frequency of anxiety and depression among healthcare workers in the ED. Methods A cross-sectional online google form-based survey was conducted in the ED of Aga Khan University Hospital, Karachi, Pakistan between July and August 2020. The Hospital Anxiety and Depression (HAD) scale was used for mental illness assessment among ED healthcare workers. Descriptive analysis of grading as per the Likert scale is done through frequencies, means, and standard deviations. Categorical variables were expressed as frequency (%). Mann–Whitney U test was used to compare scores of various groups and sub-groups and the Chi-square test was used to assess the association of depression and anxiety categories among the groups. Results In the ED, 127 healthcare workers (physicians and nurses) were included in this survey. The median depression score was 8 (IQR 6–10) with 21% (27) falling under depression and 39% (50) under borderline depression. The median anxiety score was 9 (IQR 7–12) with 33% (42) having abnormal, and 38% (48) having borderline anxiety. Healthcare workers working for > 45 h per week have odds of 3.62 [1.374–9.549] of developing depression compared to anxiety with a p-value of 0.009. Similarly, nurses and medical officers develop depression with odds of 2.18 [1.016–4.686] p-value 0.045 and 5.18 [0.197–1.02] p-value 0.002, respectively. Conclusion ED healthcare workers during the COVID-19 pandemic suffered high levels of anxiety and depression, which is a matter of concern. Comprehensive support and training of ED healthcare workers are needed to promote physical and mental well-being and to develop guidelines that should be used during situations that can affect the mental health of healthcare workers.