Objective: To provide an insight on the disruption of multiple facets of residency programs in a multi-centre study. Methods: This cross-sectional survey was carried out by enrolling the available residents from three teaching hospitals of the country by sending a questionnaire through email. The questionnaire comprised of three parts; 1) basic demographics, 2) effect on multiple facets of training and 3) the use of smart learning with the support provided by the hospitals. Data collection was started during the first week of June 2020 after acquiring ethical approval from the concerned department and the total duration of the study was one month. Data was analysed using SPSS v. 19.0. Results: A hundred-and-five completed responses were obtained with a response rate of 42%. Fifty-nine percent of the participants were female residents. Majority of the residents (69%) belonged to the age group 25-30 years. Fourth year residents (38%) showed maximum participation and the mean number of work days per month were 22±5.4. All of the aspects of training suffered complete or severe reduction except for the multi-disciplinary team (MDT) meetings, elective rotations and e-log book entries. Sixty seven to sixty-nine percent of the residents felt complete clinical, educational and psychological desertion in their departments, 59% used telemedicine and 90% reported non-availability of smart learning facilities. Conclusion: Overall, our study confirmed that the COVID-19 pandemic has substantially affected the clinical skills, teaching and personal growth of many trainees. There is a decrease in exposure to almost all of the aspects of training with no alternative in the form of smart learning provided to many. Clinical, educational and psychological support, although an extremely important part of healthcare staffing and management, has been largely neglected as well. doi: https://doi.org/10.12669/pjms.37.2.3496 How to cite this:Alam L, Alam M, Kazmi SKH, Kazmi SAH. Impact of COVID-19 pandemic on the residency programs of the country: A multicentre study. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.3496 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objectives: 1) To explore the possible impact of the pandemic on the health seeking behavior of the patients, 2) To explore the relation of socio-demographics on the utility of health-care facilities. Methods: This cross-sectional study was conducted by enrolling all patients ≥15 years of age presenting to the Out-Patient-Department of three main public-hospitals after obtaining ethical committee approval. A questionnaire with validated Urdu translation was filled by each participant that included socio-demographic data, pre-Covid and Covid-19 era health seeking behaviors and the impact of the pandemic on the utilization of healthcare facilities. Data was analyzed using SPSS V.19. Results: A total of 393 patients were enrolled with a male preponderance (72%) and a median age range of 31-45 years. Fifty-eight percent of the study population was unemployed and 47.3% were seeking follow up care. The frequency of ER and multiple (>4 times) OPD visits were significantly decreased in the Covid-19 times whereas, the laboratory and radiology services were largely unaffected. A significant number of patients were not satisfied with the current healthcare facilities that was seen irrespective of the socio-demographic status. Emergency Room and radiology services were largely unaffected whereas, elective procedures and laboratory facilities were reported to be severely affected or delayed in relation to socio-demographic variables. Conclusions: Healthcare inequalities have widened and depression has shown a sharp rise during this pandemic. The over-burdened healthcare facilities at the verge of collapse may miss out on the chronic non-Covid patients which would ultimately lead to increased morbidity and mortality. doi: https://doi.org/10.12669/pjms.37.2.3536 How to cite this:Alam L, Kazmi SKH, Alam M, Faraid V. Amid COVID-19 pandemic, are non-COVID patients left in the lurch? Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.3536 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: To analyze the management of severe necrotizing pancreatitis in a specialized center of a lower middle-income country, Pakistan using multiple outcome measures. Methods: All the patients in this prospective observational study with severe necrotizing pancreatitis being referred to Pak Emirates Military Hospital from January 2017 to December 2019 were followed over the course of their admission. Demographic data and disease outcomes were duly noted. Cox regression analysis was used to predict fatality outcome. Results: A total of 57 patients with 48 (84.6%) infected necrotizing pancreatitis were managed in our set up. The most common etiology reported was gall-stones (37%) with male preponderance (72%) and a mean age of 50±11.3 years. The most common complications were acute-kidney-injury (63%), splenic-vein-thrombosis (21%) and ascites (21%). Fourteen patients required mechanical-ventilation with a mean duration of 7±1.4 days on respiratory support. Eight (14%) patients required Endoscopic-Ultra-Sound guided drainage and six (10.5%) underwent surgical-necrosectomy depending upon the patients’ condition and collections characteristics. Mortality, as one of the main outcome measures, was reported to be 12.3% and was statistically related to mechanical-ventilation, organ failure and surgical-necrosectomy while 22 (38.6%) patients were discharged on pancreatic enzymes supplements and 7% required insulin. Conclusion: Survival outcomes with acute severe necrotizing pancreatitis are improving in a dedicated hepato-biliary unit internationally in lieu with a multidisciplinary team approach. Percutaneous and EUS guided drainage of pancreatic collections have turned out to be an important procedure to manage infected pancreatic necrosis that helps to avoid a morbid procedure in the form of necrosectomy. doi: https://doi.org/10.12669/pjms.37.3.3440 How to cite this:Alam L, Khan RSA, Kazmi SKH, Rafi ud Din. Outcome of patients with acute severe necrotizing pancreatitis in a dedicated hepato-biliary unit of Pakistan. Pak J Med Sci. 2021;37(3):---------.   doi: https://doi.org/10.12669/pjms.37.3.3440 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.