ABSTRACT The clinical manifestations of coronavirus disease 2019 (COVID-19)-associated pneumonia show a wide range of variations. It ranges from mild hypoxemia without significant signs of respiratory distress, to rapid clinically deteriorating course with severe hypoxemia. Unexplained severe hypoxemia, associated with platypnea, triggers the possibility of ventilation-perfusion (V/Q) mismatch, ranging from intrapulmonary shunts (IPS) to alveolar dead space ventilation. In the literature, very few cases with COVID-19-pneumonia have been reported with IPS. Herein, we report a COVID-19 confirmed 45-year male patient, who developed IPS without apparent pulmonary perfusion defect on lung perfusion scintigraphy. The patient had no cardiovascular disease except chronic pulmonary hypertension secondary to interstitial lung disease. The clinical manifestations combined with nuclear imaging features enabled in making the ultimate diagnosis. The patient's clinical condition improved on appropriate clinical management, using high flow oxygen combined with intravenous steroids and anticoagulants. Key Words COVID-19, Adult respiratory distress syndrome, Right to left shunt, Lung perfusion scintigraphy, Platypnea.In this study, we report a familial cluster of cases which included five patients and two close contacts who were confirmed to have coronavirus disease 2019 (COVID-19). These participants had received real-time reverse transcription-polymerase chain reaction (RT-PCR) and chest X-rays (CXRs) before diagnosis. The follow-up CXRs of three patients in the family showed significant progression, with COVID-19 pneumonia, clinically worsening in a short period of time. Therefore, the results of follow-up CXRs in the short-term may be an adjunctive diagnostic method for COVID-19 disease diagnosis and its progression. Key Words Chest X-ray, COVID-19, RT-PCR, Familial clustering.The novel coronavirus disease 2019 (COVID-19) pandemic has not only challenged global health systems but also social, economic, and educational systems. In this short communication, our focus is on its impact on medical education in Pakistan. We discuss the structure of undergraduate medical education in Pakistan; and how it has evolved in the wake of COVID-19. We describe our role as teaching associates (TAs) at the Aga Khan University (AKU); and how it has enabled us to be a part of the transition to online medical education, with a specific focus on online examinations in medical schools. https://www.selleckchem.com/products/atezolizumab.html Key Words Medical education, Online examinations, COVID-19, Pandemic.The SARS-CoV-2 outbreak began in China in December 2019 and rapidly spread globally. Up to July 2020, the number of cases of coronavirus disease 2019 (COVID-19) had been increasing in the USA, Italy, England, Spain and numerous other countries. Patients with this disease in different countries present with different clinical manifestations and different prognosis. The present study aimed to analyse the clinical characteristics of patients infected with SARS-CoV-2 in different regions of the world and provide special advices for the different regions to prevent the spread and a second outbreak of COVID-19. Key Words COVID-19, SARS-CoV-2, Characteristics, Worldwide. To determine the effects of tocilizumab (TCZ) on inflammatory markers, laboratory indices; and short-term outcome in patients with severe COVID-19. Cross-sectional analytical study. Place and Duration of the Study Hayatabad Medical Complex, Peshawar, Pakistan from 10th June till 31st August 2020. Fifty-four patients with severe COVID-19 fulfilled the inclusion criteria and were included. All patients had received TCZ (4 mg/kg) in addition to standard treatment. Serum C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer levels, full blood count, and liver function tests (LFTs) were checked before and 24 hours after receiving TCZ. Short-term outcome, defined as survival at day 28, was determined from hospital record/telephonic contact. Paired t-test was employed to assess the statistical significance of mean differences between the pre- and post-TCZ variables, considering a p-value of <0.05 as significant. Overall, the mean pre- and post-TCZ CRP was 18.7 ± 10.7 and 10.2 ± 8.6 mg/dl (p <0ality. To compare the diagnostic accuracies of HRCT chest and RT-PCR results in diagnosis of coronavirus disease (COVID-19) in a tertiary care hospital in Lahore. Descriptive study. Department of Radiology and Central Research Lab, Lahore General Hospital, Lahore, from April to July, 2020. Patients aged 18 to 83 years, who had clinically suspected symptoms of COVID-19 (fever, cough/sore throat or shortness of breath) presenting in outpatient or emergency department, were included. These patients had their HRCT chest conducted from Radiology Department and RT-PCR performed at Central Research Lab. These data were retrieved from electronic system of PACS. Results were categorised into positive and negative findings for COVID-19. Diagnostic accuracies of HRCT chest and first RT-PCR along with 95% confidence interval were calculated. A total of 94 patients, 55 (58.5%) males and 39 (41.5%) were females. Out of them,83% patients had positive HRCT chest findings of COVID-19, 17% had negative HRCT chest findings; while 40.4% had positive and 59.6% had negative first PCR. Among the repeat second PCR, 19.6% had negative, 1.8% had positive PCR results; while 78.6% patients didn't undergo repeat PCR. The sensitivity, specificity, NPV, PPV and accuracy of HRCT chest was 92%, 23%, 81%, 45%, and 51%; while of first RT-PCR was 45%, 81%, 23%, 92% and 51%, respectively. The sensitivity of HRCT chest is higher (92%) as compared to first RT-PCR (45%). Key Words COVID-19, RT-PCR, HRCT chest, Sensitivity, Specificity. The sensitivity of HRCT chest is higher (92%) as compared to first RT-PCR (45%). Key Words COVID-19, RT-PCR, HRCT chest, Sensitivity, Specificity. To measure the outcomes of conservative treatment of acute appendicitis. Observational study. Fauji Foundation Hospital, Rawalpindi from April to July 2020. MethodologyAll 58 patients (n=58) presenting with acute appendicitis (AA) were included. Assessment was done with Alvarado score (AS) and ultrasound. Treatment was initiated according to the algorithm corresponding with AS. Those with AS score of 4 or less were started on outpatient oral antibiotics. Patients with AS score of 5 or more were admitted for IV antibiotics. If the symptoms and signs resolved, they were sent home on oral antibiotics to complete a course of 5 days. If their condition did not improve in 72 hours or deteriorated at any time, appendectomy was done. Outcomes were recorded and analysed on SPSS. Out of 58 patients, 16 were treated with oral, while 42 with IV antibiotics. This yielded a statistically significant difference on the course of disease (p=0.028). Resolution of symptoms was seen in 27.6% (n=16) with conservative management; whereas, 72.