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Objective: To highlight the effect of COVID-19 and DM on each other by studying glycemic control and risk factors for mortality. Study Design: Retrospective Observational Review. Setting: Sindh Institute of Urology and Transplantation Karachi Pakistan. Period: March 2020 till March 2021. Methods: Covid-19 diagnosed patients admitted were enrolled. They were divided into DM and non-DM. Demographics, clinical variables and outcome were compared. Glycemic control during hospitalization was noted. Fasting glucose level >120 mg/dl, and random >200 mg/dl were considered as poor glycemic control. Survivors and non- survivors among DM patients were compared. Results: A total of 366 patients were included, 113(30.87%) DM and 253(69.12%) non-DM. Mean age was higher in DM group (58yrs vs 49.6yrs p <0.001). Significantly more patients with hypertension (p <0.001) and ischemic heart disease (p=0.001) developed Covid-19 in DM group. There was no difference in mortality (p = 0.295). In DM patients, the significant risk factors for mortality were age >60years, hypertension and chronic kidney disease. The mean high fasting and pre-dinner blood glucose levels at admission and day 5 were significantly associated with mortality. Conclusion: Diabetic patients with advanced age, hypertension and chronic kidney disease were associated with increased risk of death. More attention should be focused on dynamic monitoring and strict glycemic control as uncontrolled diabetes is associated with severe infection and mortality. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus disease-19 (COVID-19) is known to cause severe disease in chronic kidney disease and maintenance dialysis patients. We aim to report the outcome of COVID-19 and the adverse effects of Remdesivir (RDV) in patients with renal failure. Methodology: A retrospective observational study included all admitted patients with COVID-19 who received Remdesivir. Clinical characteristics and outcomes were compared in patients with renal failure (RF) and non-renal failure (NRF). We also evaluated RDV-associated nephrotoxicity and observed renal functions during antiviral treatment. Results: A total of 142 patients received RDV, 38 (26.76%) in RF and 104 (73.23%) in the non-RF group. The median absolute lymphocyte count was low while C-reactive protein, ferritin, and D-dimer were significantly high on admission in the RF group. A significant number of patients in the RF group required ICU admission (58% vs. 35% p = 0.01) and expired (29% vs. 12.5 p = 0.02). Among survivors and nonsurvivors in the RF group, raised inflammatory markers and low platelet count on presentation were significantly associated with high mortality. Median serum creatinine (mg/dL) was 0.88 on admission, remained at 0.85 in the NRF group, and improved from 4.59 to 3.87 (mg/dL) after receiving five days of RDV in the RF group. Conclusions: COVID-19 in renal failure has a high risk for ICU admissions leading to increased mortality. Multiple comorbidities and raised inflammatory markers are predictors of poor outcomes. We observed no significant drug-related adverse effects, and none of our patients required discontinuation of RDV due to worsening renal function. [ABSTRACT FROM AUTHOR]

Background: Carbapenem-resistant Gram-negative (CRGN) bacteraemia has high mortality and limited therapeutic options. We assessed the risk factors and outcome of CRGN bacteraemia treated with limited options., Methods: A prospective cohort study done at a tertiary care hospital in Pakistan, from October 2021 to August 2022. All patients >18 years with CRGN bacteraemia were assessed for demographics, source, risk factors and treatment received. Outcome was assessed as bacterial clearance and all-cause mortality at Day 14 of bacteraemia., Results: We included 175 patients. Median age was 45 years (IQR 30-58) and the majority of our patients were on haemodialysis (75%). We found 14 day mortality in 26.8% of our patients; in addition, microbiological clearance was achieved in 95%. The central line (49.7%) was the most common source and Klebsiella spp. (47%) the most common organism. On multivariate analysis, risk factors for mortality were Foley's catheter [aOR 2.7 (95% CI 1.1-6.5)], mechanical ventilation [aOR 5.1 (95% CI 1.6-15.8)] and Pitt bacteraemia score >4 [aOR 3.48 (95% CI 1.1-10.5)]. Source control was a significant protective factor [aOR 0.251 (95% CI 0.09-0.6)]. The majority received a colistin-based regimen with no difference in mortality between monotherapy and combination therapy., Conclusions: Our cohort of CRGN bacteraemia is unique, comprising younger patients mostly on haemodialysis with a central line as the source of bacteraemia and we have found 14 day mortality of 27%. Colistin with various combinations can be an effective option in patients with renal failure having prompt source control., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)

Ebola Virus Disease (EVD), also known as Ebola Hemorrhagic Fever (EHF), initially emerged over 40 years ago in the Democratic Republic of Congo. Endemic to Africa, outbreaks have been recorded in six African countries since its detection in 1976. Fruit bats are believed to be the natural hosts of Ebola viruses (EBoV), with humans and other mammals serving as accidental hosts. Transmission of EBoV has been reported in various ways, including human to human transmission through close contact with blood and bodily fluids. The virus has an incubation period ranging from two to twenty-one days, followed by a multitude of clinical manifestations such as the sudden onset of high fever, chills and myalgia depicting a flu-like syndrome. It is usually diagnosed based on several clinical symptoms such as the sudden onset of illness, high fevers for less than three weeks, and at least two hemorrhagic symptoms despite no predisposing factors. This generally provides enough evidence for clinicians to consider EHF and begin supportive treatment until the virus is confirmed through laboratory findings. Management of patients involves supportive care such as maintaining fluid along with electrolyte balance, blood pressure and oxygen saturation. This also includes treating complications arising from secondary infections. The main options include: prophylactic strategies, anti-viral therapy for EVD, immunotherapies, vaccines, and ZMapp. Finally, the key to managing EBoV epidemics is to stop the transmission of disease in the most severely affected population, as prevention has become of utmost importance to alleviate the significant physical and economic burden.

Human Immunodeficiency Virus associated neurocognitive dysfunction can present as a case of movement disorder in a patient with prolonged antiretroviral therapy. Diagnosis was made after ruling out space occupying lesions, nutritional deficiencies and infectious causes through brain imaging and cerebrospinal fluid analysis. With multidisciplinary care and change of antiretroviral therapy to drugs with higher cerebrospinal fluid penetration, symptoms of the patient improved over a span of six months. Delayed neurological damage due to Human Immunodeficiency Virus can present with isolated cerebellar symptoms.

Objective: To determine HBV suppression in patients with dual HBV and HDV infection after 48 weeks with 10.0 MIU of interferon-a 2b., Design: Quasi experimental study., Place and Duration of Study: Civil Hospital, Karachi and Lyari General Hospital, Karachi, from July 2003 to June 2005., Patients and Methods: All HBsAg positive patients were screened for anti-HDV, all positives were included. Baseline investigations, liver chemistries and HBsAg; HBeAg; anti-HBcore IgM; HBV DNA quantitative PCR were done. Patients with hepatocellular carcinoma and decompensated cirrhosis were excluded. Patients were treated with Interferon-alpha 10.0 MIU sc t.i.w. for 48 weeks. HBeAg and quantitative HBV DNA was done at week 0, 24 and 48 while CBC and SGPT were done monthly. HBV suppression was defined as levels < 400 copies/ml., Results: Fifty-two patients were selected for intervention, including 34 males and 18 females. At the end of therapy after 48 weeks, HBV DNA suppression was achieved in 51.9% and HBeAg became undetectable in 53.8% of patients. Twenty-one patients with HBV suppression still had raised SGPT., Conclusion: HDV should be screened in all patients eligible for HBV treatment.