Risk factors predicting outcome in patients with pneumonia in Al-Ain, United Arab Emirates.

OBJECTIVE: To determine the predictive value of commonly used clinical and laboratory factors for mortality in patients with pneumonia in the Arab world. METHODS: We retrospectively analyze the data collected from all inpatients over the age of 16 years with a diagnosis of pneumonia in Tawam Hospital, Al-Ain, United Arab Emirates between the years 1997 and 2002. Patients were grouped into those who survived and those who died in the hospital. Clinical and laboratory factors on admission were used to predict outcome using simple, and multiple logistic regression analyses. RESULTS: Among the 236 patients admitted, 122 were females (age 56.9 +/- 23 years), and 114 males (age 58.5 +/- 23 years). The 30-day mortality rate was 10%. The most common comorbid risk factors were diabetes mellitus in 23.7% and chronic obstructive pulmonary disease in 19.5%. Of the 236 patients, 145 had sputum culture on admission. Simple logistic regression analysis showed increasing age, presence of comorbidity, low systolic blood pressure, confused mental status, low serum albumin, high serum creatinine, raised blood urea nitrogen and raised partial pressure of carbon dioxide at the time of admission were associated with higher mortality. On the Stepwise-multilogistic regression analysis, the most significant factors influencing mortality were: older age, altered mental status, low systolic blood pressure, low serum albumin and raised serum creatinine. Using a scoring system developed in the presence or absence of these risk factors, a score of >=100 predicted high risk for mortality. CONCLUSION: The in-hospital mortality rate for pneumonia was 10%. Older age, altered mental status, low systolic blood pressure, low serum albumin concentration and raised serum creatinine at admission were predictive of poor outcome in this cohort of patients.

Serum interleukin-5 levels are elevated in mild and moderate persistent asthma irrespective of regular inhaled glucocorticoid therapy.

BACKGROUND: Interleukin-5 (IL-5) is thought to play a pivotal role in the pathogenesis of asthma. High levels of circulating IL-5 have been documented in acute asthma. However, serum IL-5 levels in mild to moderate asthmatics and the influence of regular use of inhaled glucocorticoids, is not known. METHODS: Fifty-six asthmatics and 56 age and sex matched controls were recruited prospectively from an outpatient department. Information on asthma severity and treatment was gathered by a questionnaire. Serum IL-5, total IgE and specific IgE levels were measured in a blinded fashion. RESULTS: There were 32 atopic and 24 non-atopic mild-to-moderate asthmatics. The median serum IL-5 levels in atopic asthmatics (9.5 pg/ml) and in non-atopic asthmatics (8.1 pg/ml) were significantly higher than in normal controls (4.4 pg/ml, both p < 0.003). However, median serum IL-5 levels in atopic and non-atopic asthmatics were not significantly different. The median serum IL-5 level was insignificantly higher in fourteen moderate persistent asthmatics (10.6 pg/ml) compared to forty-two mild persistent asthmatics (7.3 pg/ml) (p = 0.13). The median serum IL-5 levels in asthmatics using regular inhaled steroids (7.8 pg/ml) was not significantly different from those not using inhaled steroids (10.2 pg/ml). Furthermore, serum total IgE levels and eosinophil counts were not significantly different in those using versus those not using inhaled glucocorticoids. CONCLUSION: Serum IL-5 levels are elevated in mild and moderate persistent atopic and non-atopic asthmatics. Regular use of inhaled glucocorticoids may not abrogate the systemic Th2 type of inflammatory response in mild-moderate persistent asthma.

Silicosis in a housewife.

Silicosis is an occupational respiratory disease caused by inhaling respirable crystalline silica dust. We report the case of silicosis in a 50-year-old woman that presented with pulmonary fibrosis and later developed pulmonary tuberculosis. Her condition is believed to be due to inhalation of dust produced by scrubbing a silica rich surface during usual daily housework.