Predictive factors and outcomes of severe community acquired pneumonia in patients with respiratory failure.

Objectives: To explore the risk factors, pathogens and outcomes of severe community-acquired pneumonia (SCAP) in patients with respiratory failure. Methods: A prospective observational study was conducted at Northwest General Hospital & Research Centre, Peshawar, Pakistan from February 2016 to October 2018. All patients with Community-acquired pneumonia (CAP) who fulfilled the inclusion criteria were recorded consecutively. Diagnosis of SCAP was made following the criteria established by the IDSA/ATS in the consensus guidelines on the management of CAP in adults published in 2007. In-hospital mortality was the main outcome. Results: The final analysis comprised a total of 100 patients with SCAP. The mean age was 60.0±18.01 years, and 54.0% were female patients. Afghani patients represented 22.0% of the total patients. The most common comorbidity associated with SCAP was hypertension (42.0%). The most commonly isolated etiological agents were Acinetobacter baumannii, followed by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. In-hospital mortality was 45%. On multivariate analysis, factors associated with in-hospital mortality were age (OR 1.054; 95%Cl 1.01-1.10; p=0.021), presence of two or more complications (OR 4.51; 95%Cl 1.18-17.28; p=0.028), septic shock (OR 6.44; 95%Cl 1.55-26.803; p=0.010), length of mechanical ventilation (OR 1.17; 95%Cl 1.01-1.40; p=0.043), and paO2 (OR 4.51; 95%Cl 1.18-17.28; p=0.004). Conclusion: A high mortality rate was observed in our study. Age, presence of two or more complications, septic shock, length of mechanical ventilation, and low paO2 were identified to be independent predictors of mortality for patients with SCAP.

Prevalence of depression and anxiety among general population in Pakistan during COVID-19 lockdown: An online-survey.

The present study's aim is to find the prevalence of two of the common indicators of mental health - depression and anxiety - and any correlation with socio-demographic indicators in the Pakistani population during the lockdown from 5 May to 25 July 2020. A cross-sectional survey was conducted using an online questionnaire sent to volunteer participants. A total of 1047 participants over 18 were recruited through convenience sampling. The survey targeted depression and anxiety levels, which were measured using a 14 item self-reporting Hospital Anxiety and Depression Scale (HADS). Out of the total sample population (N=354), 39.9% suffered from depression and 57.7% from anxiety. Binary logistical regressions indicated significant predictive associations of gender (OR=1.410), education (OR=9.311), residence (OR=0.370), household income (OR=0.579), previous psychiatric problems (OR=1.671), and previous psychiatric medication (OR=2.641). These were the key factors e associated with a significant increase in depression. Increases in anxiety levels were significantly linked to gender (OR=2.427), residence (OR=0.619), previous psychiatric problems (OR=1.166), and previous psychiatric medication (OR=7.330). These results suggest depression and anxiety were prevalent among the Pakistani population during the lockdown. Along with other measures to contain the spread of COVID-19, citizens' mental health needs the Pakistani government's urgent attention as well as that of mental health experts. Further large-scale, such as healthcare practitioners, should be undertaken to identify other mental health indicators that need to be monitored.

Knowledge, Attitude, and Barriers Toward ADRs Reporting Among Health-Care Professionals at Tertiary Care Health Settings in Peshawar, Pakistan: A Web Based Study.

Background: Underreporting of adverse drug reactions (ADRs) is considered a major determinant of poor ADR signal detection in Pakistan. Considering this, the study was proposed to evaluate healthcare professionals' (HCPs) knowledge attitude toward and the barriers that discourse ADRs reporting. Methods: A cross-sectional survey was distributed among HCPs in 3 major tertiary care facilities of Peshawar. A self-administered, 31 items questionnaire was circulated online to collect the required information. Relative index ranking was used to identify the top barriers to the ADR reporting process. Results: HCPs (n = 322) were requested, and over one-third (n = 122) responded. Of the total, 97 (79.5%) were males, and by designation, 59(48.4%) were resident medical officers. About 45% of the HCPs did not identify the appropriate pharmacovigilance (PV) definition. More than half of the HCPs (52.2%) distinguished the appropriate PV purpose. Nearly 80% HCPs did not know the acceptable reporting time frame, while 22.1% HCPs knew that regulatory body for ADRs does not exist in Pakistan. The majority (95.08%) of the HCPs either strongly agreed or agreed that reporting an ADRs is a professional obligation and all the HCPs were of the opinion that PV should be taught in detail to HCPs. Exploring the barriers, it was identified that the key barriers to ADRs reporting were "unavailability of professional environment to discuss ADRs," Relative Importance Index (RII) = 0.813, "lack of incentives for reporting" (RII = 0.774), "lack of knowledge regarding reporting" (RII = 0.693), and "insufficient knowledge of pharmacotherapy in detecting ADRs" (RII = 0.662). In addition to these, "complicated reporting forms" (RII = 0.616), "lack of motivation for reporting ADRs" (RII = 0.610), and "absence of professional confidence" were seen as major hindrances in effective reporting of ADRs (RII = 0.598). Conclusion: Concerning PV and ADR reporting poor knowledge was noted. However, the majority of the HCPs showed an explicit attitude regarding ADRs reporting. The majority of the HCPs disclosed unavailability of professional environment to discuss about ADRs, lack of incentives, and how to report the main factors hindering the ADRs reporting. It is emphasized that health authorities carve out a niche for a well purposeful PV center and pledge educational activities and trainings for increasing understanding and approaches regarding reporting of ADR.

A prospective observational study assessing the outcome of Sepsis in intensive care unit of a tertiary care hospital, Peshawar.

OBJECTIVE: The current study aims to explore the factors associated with outcome among patients with severe sepsis and septic shock admitted to the intensive care unit, Northwest General Hospital and Research Centre, Peshawar, Pakistan. METHODS: A prospective observational study was carried out at intensive care unit of our hospital from February 2014 to October 2015. Data was collected using a structured format and statistical analysis was done using SPSS version 20®. Regression model was applied to identify the factors contributing to the outcome of severe sepsis and septic shock. P-value less than 0.05 was considered statistically significant. RESULTS: Majority of the patients meeting the criteria of this study were male 147 (54.9%) with a mean age of 54.8. The most common source of sepsis was lung infections (42.2%) followed by urinary tract infections (18.7%), soft tissue infections (6.3%) abdominal infections (6%) and in 6.3% patients the source remained unknown. Further analysis has revealed that increase in number of days of hospitalization was observed to be slightly associated with the outcome of the treatment (1.086 [1.002 - 1.178], 0.046). Moreover, the risk of mortality was the higher among the patients with septic shock 22.161[10.055 - 48.840], and having respiratory, kidney and central nervous system complications. Overall it is seen that septic shock alone was found responsible to cause death among 32.0% of the patients (Model 1: R(2) 0.32, p=0.000), and upon involvement of the organ complications the risk of mortality was observed to 42.0%. CONCLUSION: Chances of recovery were poor among the patients with septic shock. Moreover, those patients having respiratory and urinary tract infection are least likely to survive.

Acute Kidney Injury In Hospitalized Covid-19 Patients: A Retrospective Observational Study.

Background: Published studies have reported that acute kidney injury (AKI) and other kidney related manifestations are associated with COVID-19 and linked with poor outcome. This study aimed to determine the incidence, risk factors and outcomes of AKI in hospitalized COVID-19 patients. Methods: This retrospective study of 154 patients involved retrieving data from hospital records confirm COVID-19 infection admitted to the Northwest General Hospital & Research Center, Peshawar from 1st April to 31st July 2020. AKI was defined using kidney disease. Improving Global Outcomes (KDIGO)" guidelines. Results: Incidence of AKI was 37.01%. Age, gender, intensive care (ICU) requirement, number of comorbid, diabetes mellitus, coronary artery disease, chronic kidney disease, chronic obstructive airway disease (COAD), arrhythmias among comorbid and fever and shortness of breath among symptoms were found to be significantly differed between AKI and non-AKI patients. Numerous differences of laboratory results such as serum sodium, potassium, total leukocyte count, absolute lymphocyte count and platelets between both groups were observed (p<0.05). Inflammatory markers including lactate dehydrogenase (LDH), ferritin, d-dimer and C-reactive protein (CRP) were significantly raised in AKI group. Overall mortality was observed to be 38 (24.7%). Moreover, age, ICU requirement; COAD, creatinine, serum sodium, inflammatory markers (LDH, ferritin, d-dimers and CRP), total leukocyte count, absolute lymphocyte count, platelets and support requirement were significantly differed between survivors and non-survivors. Mortality was significantly higher among AKI group, i.e., 52.6% compared to 8.2% in non-AKI group (p<0.001). Conclusion: AKI is common among hospitalized COVID-19 patients and is associated with mortality. In all, AKI patients less than half of the patients survived.

Depression and anxiety among Pakistani healthcare workers amid COVID-19 pandemic: A qualitative study.

Objectives: The sudden COVID-19 crisis required a determined effort on the part of the healthcare workers (HCWs) and excessive workload increased the risk of depressive and anxious symptoms in frontliners. The aim of the study was to assess anxiety and depression levels among HCWs during times of pandemic and its potential aggravating factors. Materials and methods: A web-based survey was conducted to assess the mental health outcomes of healthcare workers and related factors during the COVID-19 pandemic. For assessing depression and anxiety, the Hospital Anxiety and Depression Scale (HADS) comprised of 14 items with seven items for depression and seven for anxiety were used. Results: Of all 436 participants, 158 (36.2%) showed noticeable symptoms of depression and 220 (50.4%) showed substantial anxiety symptoms. The majority of them were females. It has been observed in the study that female gender, young, and unmarried marital status are associated with higher scores. HCWs working in urban regions show more depressive symptoms. Mild depression and anxiety ratio are very common among participants (21.3%). Factors found to be associated with higher anxiety and depression are the increased number of deceased patients with lower family support. Conclusions: Altogether, the present study findings present concerns about the psychological well-being of all HCWs during the acute COVID-19 outbreak. Therefore, steps should be taken to protect them from mental exhaustion, so they may fight with more zeal against the infectious pandemic that has caused significant impacts worldwide.

Cigarette Smoking and Its Hazards in Kidney Transplantation.

Cigarette smoking affects many organs. It causes vasoconstriction through activation of sympathetic nervous system which leads to elevation of blood pressure and reduction in glomerular filtration rate and filtration pressure. It also causes thickening of renal arterioles. Cigarette smoking increases the risk of microalbuminuria and accelerates progression of microalbuminuria to macroalbuminuria. Furthermore, it causes rapid loss of glomerular filtration rate in chronic kidney disease patients. After kidney donation, these factors may be injurious to the solitary kidney. Kidney donors with history of cigarette smoking are prone to develop perioperative complications, pneumonia, and wound infection. Postkidney transplantation various stressors including warm and cold ischemia time, delayed graft function, and exposure to calcineurin inhibitors may result in poor graft function. Continuation of cigarette smoking in kidney transplant recipients will add further risk. In this review, we will specifically discuss the effects of cigarette smoking on normal kidneys, live kidney donors, and kidney transplant recipients. This will include adverse effects of cigarette smoking on graft and patient survival, cardiovascular events, rejection, infections, and cancers in kidney transplant recipients. Lastly, the impact of kidney transplantation on behavior and smoking cessation will also be discussed.