Aim To determine the efficacy of neutrophil/lymphocyte ratio (NLR) as a marker of the severity of COVID‐19 pneumonia in the South‐Asian population. Methods This was a prospective, cross‐sectional, analytic study conducted at HDU/ICU of District Headquarter Hospital, Faisalabad, Pakistan, from May through July 2020. Sixty‐three eligible patients, admitted to the HDU/ICU, were prospectively enrolled in the study. Their NLR, C‐reactive protein, serum albumin, and serum fibrinogen were measured. Patients’ demographic characteristics, comorbidities, clinical manifestations of COVID‐19 infection, medication use, and history of lung malignancy were retrieved from their medical history. Patients were categorized into either a general group (with mild COVID‐19) or a heavy group (with moderate to severe COVID‐19). Results There were significant differences between the two groups in diabetes prevalence, NLR, C‐reactive protein, and serum albumin. NLR and C‐reactive protein were positively correlated (P < 0.001, P = 0.04 respectively) whereas serum albumin was negatively correlated (P = 0.009) with severe COVID‐19. NLR was found to be an independent risk factor for severe COVID‐19 pneumonia in the heavy group (OR = 1.264, 95% CI: 1.046~1.526, P = 0.015). The calculated AUC using ROC for NLR was 0.831, with an optimal limit of 4.795, sensitivity of 0.83 and specificity of 0.75, which is highly suggestive of NLR being a marker for early detection of deteriorating severe COVID‐19 infection. Conclusion NLR can be used as an early warning signal for deteriorating severe COVID‐19 infection and can provide an objective basis for early identification and management of severe COVID‐19 pneumonia.

Introduction: The US Food and Drug Administration issued safety warnings about neuropathy in 2013 and dysglycemia in 2018 caused by fluoroquinolone use, mainly based on case reports and case series. We conducted this systematic review to evaluate the safety of fluoroquinolones in diabetic patients by investigating their dysglycemic and neuropathic effects. Methods: PubMed, Scopus, and Google Scholar were searched for randomized controlled trials and observational studies published from inception till September 2019 evaluating the safety of fluoroquinolones. Efficacy studies of fluoroquinolones reporting these adverse effects were also included. Primary outcomes were hypoglycemia, hyperglycemia, and neuropathy among patients with or without diabetes and treated with fluoroquinolones compared with placebo or other antibiotics. The Cochrane Collaboration tool for randomized controlled trials and modified Newcastle–Ottawa quality-assessment scale were used for assessment of the included studies. Results and Discussion: A total of 725 studies were identified in the initial search. After screening of titles and abstracts and full-text review, 16 articles fulfilled the inclusion criteria. The sampled patients were aged 30– 78 years. Hyperglycemia was reported in 1,588 patients that received fluoroquinolone among eight studies with 4,663 patients, and hypoglycemia was reported in 2,179 patients that received fluoroquinolones among eleven studies with 6,208 patients. Dysglycemia was not generally associated with diabetes mellitus per se. Nevertheless, patients with more comorbidities, especially those with chronic kidney disease, receiving antidiabetics and/or steroids had more glycemic events when treated with fluoroquinolones. Conclusion: Moxifloxacin was found to be associated the most and ciprofloxacin the least with dysglycemia. fluoroquinolones must be used with great caution among diabetic patients who have comorbidities and are receiving antidiabetics and/or steroids. Further evidence is required from studies on neuropathy caused by fluoroquinolones.

COVID-19 pandemic induced lockdown, suspending all on-campus educational activities in the Kingdom of Saudi Arabia (KSA), compelling to continue the education online. We explored pharmacy students’ perspective on its impact on their learning. A Twitter chat was organized on three consecutive days, after final examinations, inviting all pharmacy students in KSA to participate. Day 1 chat included 11 questions regarding learning and assessment, Day 2 chat included six questions about online examinations and six questions about technology use, Day 3 chat included six questions related to lessons learnt from the learning experiences during the lockdown. The questions were validated and piloted before the chat. The responses were copied, reviewed to remove any confidential information, and thematically analyzed by two teams of research students independently. During the three-day chat, 790 responses were received in total. Thematic analysis generated 944 codes which were categorized into 43 subthemes. These subthemes were further categorized into six main themes: ‘facilitators for online education’, ‘barriers for online education’, ‘online versus onsite education’, ‘role of technology in online education’, ‘suggestions for improving online education’ and ‘long-term impact of online education during lockdown’. Participants highlighted several facilitators and barriers which affected their education during the lockdown, compared online education with onsite education, and provided suggestions for improving online education based on their learning experiences during the lockdown. As COVID-19 pandemic and its repercussions are expected to last longer, pharmacy colleges and academic staff will find these findings useful to prepare for the coming years, ensuring pedagogical and accreditation standards.

The effect of anticoagulation control on overall Health-Related Quality of Life (HRQoL) in patients taking warfarin in Malaysia has not been explored yet. Therefore, this study aimed to evaluate HRQoL among patients on warfarin in Malaysia. HRQoL among patients on warfarin was measured using WHOQOL-BREF (World Health Organization Quality of life Assessment: Brief Version). Descriptive and inferential statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 22. Out of 319 patients, more female patients were observed than the males (n = 221, 69.3%, and n = 98, 30.7% respectively). Mean scores for the physical (61.14 ± 15.96), psychological (68.58 ± 16.11), social (63.55 ± 27.06) and environmental domains (62.78 ± 17.58) were observed. Statistically, a significant association was found between the comorbidities other than CVDs with health satisfaction (p = 0.002), physical (p = 0.001), psychological (p < 0.001), social (p = 0.003) and environmental domains of the WHOQOL-BREF. A weak positive correlation between overall health satisfaction and the social domain (r = 0.153) and a moderate positive correlation between the physical and environmental domains (r = 0.628) of the WHOQOL-BREF were observed. Patients had overall better perceived HRQoL scores in the psychological domain as compared with the rest of the domains of the WHOQOL-BREF. Age, gender, employment status, education level, the indication of use and duration of warfarin therapy associated with overall perceived HRQoL.

Timely, high-quality feedback is vital in medical education but increasingly difficult due to rising student numbers and limited faculty. Artificial intelligence (AI) tools offer scalable solutions, yet limited research compares their effectiveness with traditional tutor feedback. This study examined the comparative effectiveness of AI-generated feedback versus human tutor feedback within the medical curriculum. Second-year medical students (n = 108) received two sets of feedback on a written assignment, one from their tutor and one unedited response from ChatGPT. Students assessed each feedback using a structured online questionnaire focused on key feedback quality criteria. Eighty-five students (79%) completed the evaluation. Tutor feedback was rated significantly higher in clarity and understandability (p < 0.001), relevance (p < 0.001), actionability (p = 0.009), comprehensiveness (p = 0.001), accuracy and reliability (p = 0.003), and overall usefulness (p < 0.001). However, 62.3% of students indicated that both pieces of feedback complemented each other. Open-ended responses aligned with these quantitative findings. . Human tutors currently provide superior feedback in terms of clarity, relevance, and accuracy. Nonetheless, AI-generated feedback shows promise as a complementary tool. A hybrid feedback model integrating AI and human input could enhance the scalability and richness of feedback in medical education.