Assessment and comparison of APACHE II (Acute Physiology and Chronic Health Evaluation), SOFA (Sequential Organ Failure Assessment) score and CURB 65 (Confusion; Urea; Respiratory Rate; Blood Pressure), for prediction of inpatient mortality in Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

OBJECTIVE: To assess and compare the role of Acute Physiology and Chronic Health Evaluation, Sequential Organ Failure Assessment, and Confusion Urea Respiratory Rate Blood Pressure scores in predicting inpatient mortality for patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease.. DESIGN: The retrospective study was conducted at the Jinnah Post-graduate Medical Centre, Karachi, and comprised data of all consecutive Acute Exacerbation of Chronic Obstructive Pulmonary Disease patients from December 1, 2013, to December 31, 2014. Logistic regression model and non-parametric tests were employed using SPSS 22.. RESULTS: There were 95 patients whose medical records were studied. The overall mean age was 60.79±12.39 years. Mortality rate was of 26(27.6%). Median hospital stay was 11.5 days (interquartile range: 9-17 days) in survivors and 4 days (2-8 days) in non-survivors. Out of the three scales used, Confusion Urea Respiratory Rate Blood Pressure-65 score showed the greatest difference between survivors and non-survivors (p <0.05). Significant higher scores were observed in non survivors with Type 2 than Type 1 respiratory failure (p<0.05). There was significant association of mortality with baseline partial pressure of oxygen and oxygen saturation (p<0.05 each). CONCLUSIONS: Confusion Urea Respiratory Rate Blood Pressure-65score determined at the time of admission had significant ability to predict inpatient mortality..

Knowledge of female doctors about smoking risks and their attitude toward cessation in antenatal clinics - perspective from tertiary care hospitals in Karachi.

OBJECTIVE: To assess the knowledge and attitude of doctors with regard to smoking risks and cessation, and to identify factors associated with self- reported assessment of smoking. METHODS: This cross-sectional survey was performed in 5 hospitals of Karachi from February to April 2014, and comprised doctors providing antenatal care. Data was collected using a questionnaire. SPSS 21 was used for data analysis. RESULTS: Of the 164 respondents,150(91.5%) considered the assessment of smoking an integral part of their medical responsibilities, but only 53(32.4%) reported that they asked regarding smoking habit in 100% of patients and 77(47.3%) inquired about passive smoking. The mean knowledge score for risks and cessation was 2.57±0.278 and 2.12±0.457, respectively. A few misconceptions were also found, such as 94(57.3%) doctors were against the use of nicotine replacement therapy in pregnant females and 114(69.4%) falsely believed that smoking was associated with pre-eclampsia. Factors independently associated with good baseline knowledge were: formal training (p=0.01) and hospital's smoke-free policy (p=0.004). Doctors with formal training more frequently assessed smoking habit of their patients and were more confident while counselling patients for smoking cessation (p=0.05). CONCLUSIONS: Basic misconceptions showed inadequate knowledge among doctors working in antenatal clinics.

Prognostic factors in tuberculosis related mortalities in hospitalized patients.

Setting. The study was undertaken at the Department of Pulmonology at a public, tertiary care centre in Karachi, Pakistan. Objectives. To evaluate factors concerned with in-hospital deaths in patients admitted with pulmonary tuberculosis (TB). Design. A retrospective case-control audit was performed for 120 patients hospitalised with pulmonary TB. Sixty of those discharged after treatment were compared to sixty who did not survive. Radiological findings, clinical indicators, and laboratory values were compared between the two groups to identify factors related to poor prognosis. Results. Factors concerned with in-hospital mortality listed late presentation of disease (P < 0.01), noncompliance to antituberculosis therapy (P < 0.01), smoking (P < 0.01), longer duration of illness prior to treatment (P < 0.01), and low body weight (P < 0.01). Most deaths occurred during the first week of admission (P < 0.01) indicating late referrals as significant. Immunocompromised status and multi-drug resistance were not implicated in higher mortality. Conclusions. Poor prognosis was associated with noncompliance to therapy resulting in longer duration of illness, late patient referrals to care centres, and development of complications. Early diagnosis, timely referrals, and monitored compliance may help reduce mortality. Adherence to a more radically effective treatment regimen is required to eliminate TB early during disease onset.

Risk factors predicting mortality in patients with lung abscess in a public tertiary care center in Karachi, Pakistan.

INTRODUCTION: Lung abscess is a commonly encountered entity in South-East Asia but not much data regarding its outcome is available. The objective of this study was to identify the factors associated with increased mortality in patients diagnosed with lung abscess in a tertiary care center of Karachi, Pakistan. METHODS: A retrospective case analysis was performed via hospital records, on patients admitted with lung abscess between January 2009 and January 2011 at the largest state-owned tertiary care centre in Karachi, Pakistan. Out of the 41 patients hospitalized, 17 could not survive and were evaluated for clinical, radiological and microbiological factors to determine association with heightened mortality. RESULTS: Mortality due to lung abscess stood at 41.4% (17 of 41 cases). Adult male patients were found to have higher mortality with 13 out of 17 (43%) dead patients being male. A majority (21/41, 51.2%) of the cases belonged to the 41-60 year old age group. Highest mortality was seen in patients<20 years of age (3/4, 75%). Patients with blood sugar levels of >200 mg/dL (56%) succumb to disease. Patients with a positive history of smoking, diabetes mellitus, and alcohol intake expressed mortality rates of 44%, 56%, and 50% respectively; while 29.4% of the mortalities were positive for Pseudomonas aeruginosa on sputum culture. A significant association was found with elevated mortality and low haemoglobin levels at time of admission; mortality was 58% (p=0.005) in patients with Hb less than or equal to 10 mg/dL. CONCLUSIONS: The risk factors involved with heightened mortality included male gender and history of smoking, diabetes and alcohol intake. High blood sugar levels and detection of Pseudomonas aeruginosa on sputum cultures were also implicated. Anemia (Hb level less than or equal to 10 mg/dl) was statistically significant predictive factor for increased mortality.

Assessment of risk factors against severity of COPD in non-smokers.

INTRODUCTION: Chronic obstructive pulmonary disease in non-smokers has been an important concern in past decade. We studied the risk factors responsible for more severe Chronic obstructive pulmonary disease. Identifying them would help to work against progression to more severe disease as well as prevention. METHODS: A prospective cross sectional study was done in outpatient clinic of Jinnah postgraduate medical center from December 2010 to December 2011. All patients fulfilling the criteria for Chronic obstructive pulmonary disease were taken in study. Patients with less than five pack years smoking with other risk factors for Chronic obstructive pulmonary disease were evaluated. RESULTS: Out of total 90 patients, 74 (82.2%) had mild chronic obstructive pulmonary disease and 16 (17.7%) had moderate to severe chronic obstructive pulmonary disease. Patients with single biomass exposure were found to have mild chronic obstructive pulmonary disease except those having mosquito coil exposure. Patients with mosquito coil and wood smoke exposure were observed to have moderate to severe chronic obstructive pulmonary disease (p-value 0.009). CONCLUSIONS: Wood smoke with mosquito coil smoke exposure is responsible for more severe chronic obstructive pulmonary disease.