Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the reason for the global pandemic that started from Wuhan, China, in December 2019, known as coronavirus diseases 2019 (COVID-19). Acute respiratory distress syndrome happened in COVID-19 not just because of uncontrolled viral replication but also because of an uncontrolled immune reaction from the host. That's why antiviral and anti-inflammatory treatments have become an increasing concern for clinicians. Methods A retrospective quasi-experimental study design was used to assess the effectiveness of methylprednisolone and dexamethasone in the improvement of PaO 2 /FiO 2 (P/F) ratio in COVID-19 patients. We included 60 participants for this study by using a convenient sampling technique and divided them into two groups with 30 patients in each group. Group 1 was given dexamethasone 8 mg twice daily, and group 1 given methylprednisolone 40 mg twice daily for eight days. We recorded C-reactive protein (CRP), serum ferritin level, and P/F ratio before administration of both drugs and after administration of drugs for eight days. We used the paired t-test to assess the effect of both drugs on the P/F ratio of participants. Results The initial mean CRP in group 1 was 110.34, which reduced to 19.45 after administration of dexamethasone; similarly, the CRP in group 2 was 108.65, which reduced to 43.82 after administering methylprednisolone for eight days. In P/F ratio improvement, the calculated significance value for dexamethasone (p=0.000) was less than the table value at 0.05 in all sections, p-value for methylprednisolone (p=0.009) was also less than the table value at 0.05, which shows that both dexamethasone and methylprednisolone were effective in improving P/F ratio. Calculated p-value for dexamethasone (p=0.000) was lower than the calculated p-value for methylprednisolone (p=0.009), which shows that dexamethasone is more effective as compare to methylprednisolone. Conclusions Steroid therapy is effective in controlling inflammation markers, and especially dexamethasone is significantly effective in improving the P/F ratio in COVID-19 patients.

Introduction: Ever since Sars CoV-2 infection has started from China and has taken the shape of pandemic the mortality associated with this disease has been under discussion and hypercoagubility, acute severe respiratory syndrome and sepsis with multi organ failure have been accursed as possible reasons of deaths in cases infected with novel Corona virus. We conducted a retrospective analysis of the cases admitted in our high dependency and Intensive care unit and tried to pinpoint the major cause of mortality in our cases. Methods: This is a single center retrospective study carried out at Bahria International Hospital Lahore over a 3 month period (May 10th to July 10th 2020) in which we analyzed the clinical and biochemical profiles of the COVID-19 patients who died during this period. Results: A total of 108 patients were admitted during this period out of which 11 patients died. 7 of them were men and 4 women. Majority of them had sudden cardiac arrest due to acute coronary syndrome followed by multiorgan dysfunction syndrome and acute respiratory distress syndrome. Conclusion: Acute coronary syndrome due to hypercoagubility was the leading cause of death in our patients.

Introduction: COVID-19 virus initiates an inflammatory response in the body involving many cytokines. Interluukin-6 (IL-6) is one of them, elevated levels of which found to be directly related to morbidity and mortality of infected patients. The aim of the current study was to evaluate the clinical benefits of Tocilizumab, a monoclonal antibody against interleukin-6 receptor, as a therapeutic agent for the treatment of Coronavirus disease 2019. Methods: The current retrospective study was conducted at Bahria Town International hospital from rom May 1st to 5th July 2020. Total of one twenty (n=120) moderate to severely ill patients (94 males and 26 females), infected with SARS-CoV-2 virus, were included to assess the effect of TOCILIZUMAB in improvement of PF ratio and other biochemical variables of prognostic importance, including CRP, serum ferritin levels, D-dimers and LDH. These parameters were compared before and after the ten days of treatment with tocilizumab. Demographic, laboratory and clinical finding were recorded for the feather analyses.  Statistical analysis was performed by using software SPSS version 21.0. The Wilcoxon signed‐rank test used to compare parameters whenever appropriate. A P‐value of less than .05 was considered statistically significant. Results: The results of our study showed statistically significant improvement in PF ratio and decrease in CRP levels. Other parameters such as D-Dimer, Serum ferritin levels and LDH showed no change before and after treatment with tocilizumab. Conclusion: In summary, TOCILIZUMAB improved the PF and CRP ratio in COVID-19 patients, but other markers did not improve in response to TOCILIZUMAB in critically ill COVID-19 patients.

Introduction: Coronavirus disease (COVID-19) is a leading cause of acute hypoxemic respiratory failure which can progress to acute respiratory distress syndrome (ARDS). These patients are deeply sedated, paralyzed and ventilated and prone positioning is known to help in these cases. Prone positioning has been known to help in ARDS cases, but they are ventilated deeply sedated and paralyzed. The aim of the current study was to assess the safety and potential benefits of awake prone positioning in COVID-19 patients with moderate to severe hypoxemic respiratory failure. Methods: This is a retrospective cohort study, performed at Bahira International Hospital Lahore. Record of confirmed COVID-19 patients with hypoxic respiratory failure was reviewed thoroughly to collect data. The duration, timing, frequency, tolerability, beneficial effects and adverse events during prone positioning were recorded from the medical records before and after self-prone positioning. Results: The current analysis showed that prone positioning is supportive to maintain good saturation (92%) as compared to keeping patients in spine position (82%). Conclusion: It can be concluded from the current study that prone position is helpful to maintain normal oxygen saturation even on low oxygen supply, helping in quick recovery and preventing oxygen induced damage to the lungs.

Severe acute respiratory coronavirus 2 (SARS-CoV-2), COVID-19, caused a pandemic that took millions of lives worldwide. The main reason is a lack of preparedness and knowledge about the treatment options. With the advancement in the understanding of the SARS-CoV-2 virus, many treatment options have been analyzed that helped effectively to decrease the mortality caused by this virus. Vitamin C is known to boost immunity and slow down the progression of viral infection. The current study was designed to assess the effectiveness of a high dose of intravenous (IV) vitamin C in COVID-19 infection.  The clinical trial registered on 23/12/2020 at ClinicalTrials.gov (NCT04682574) was conducted in Bahria Town International Hospital, Lahore (BTIHL), Fatima Memorial Hospital, Lahore (FMH), and Evercare Hospital Lahore from 28/12/2020 to 10/4/2022. Two hundred seventy-eight critically ill patients with COVID-19 were categorized into two groups. One hundred thirty-nine patients were randomized in group VC (vitamin C), which was given a high dose (30 grams) of intravenous (IV) vitamin C for four days, whereas distilled water as a placebo was given to the control group (n=139) along with standard treatment protocols. All the patients were analyzed for primary outcomes in partial pressure of arterial oxygen (PaO2) to Fraction inspired oxygen (P/F) ratio and survival analysis. At the same time, levels of inflammatory and biochemical markers needed for intubation and length of hospital stay in both groups were compared as the study's secondary endpoint. Among the two groups, we did not find any differences in 28-day mortality (Log Rank P= 0.11). Similarly, no difference in the P/F ratio on the fourth day after the start of IV vitamin C treatment was noted (p=0.24). The median values of biochemical and inflammatory variables improved significantly in group VC on day 4. However, only hemoglobin levels remained non-significant between the groups. Mean days of hospital stay were slightly longer in group C. However, no statistical significance (p=0.941) was found. Although Group VC needed fewer intubations than Group C, results remained statistically insignificant (p= 0.273). This trial did not find any mortality benefit or improvement of the P/F ratio in critically ill patients. However, the VC group showed improvement in biochemical variables of prognostic importance, which seems to lower the chance of intubation and LOS in group VC. A further clinical trial with a large sample size is needed to reach the final conclusion.