Factors affecting asthma control in pregnancy: A cross-sectional study.

Background and Objective: Asthma control in pregnant women remains of utmost importance; suboptimal control can have adverse repercussions on both fetal and maternal health. The objective was to identify the factors that affect asthma control in pregnant Pakistani women presenting to a tertiary care hospital. Methods: This descriptive, cross-sectional research was conducted at KRL General Hospital between 1st November 2022 to 30th April 2023. Non-probability technique was used to sample one hundred and forty-five pregnant women with confirmed bronchial asthma irrespective of their trimester presented. Data regarding demographics and factors affecting asthma control was collected. Results: The mean age was 30.39 ± 4.33 years, with two-thirds (65%) being multiparous. Approximately 48% of participants were non-compliant with treatment, and less than 40% achieved adequate asthma control. A chi-squared test applied showed that multiparity (p = 0.003), treatment compliance (p < 0.001), BMI (p < 0.001), and proper inhaler technique (p < 0.001) were statistically significant factors affecting asthma control in pregnant women while, the level of education and household income did not exhibit a significant association. Multiple regression analysis qualified higher BMI, multiparity, treatment compliance, and inhaler technique as significant predictors of asthma control amongst pregnant women. Conclusion: Ensuring asthma control during pregnancy is important. This study identified BMI, multiparity, inhaler technique, and treatment compliance as factors that affect asthma control in pregnant women. Addressing these factors through regular antenatal check-ups can significantly mitigate risks and promote the optimal health of both maternal and fetal lives.

Clinical severity and high-resolution CT severity score in COVID-19: Is there an association.

Objectives: To identify a correlation between the clinical parameters and CT chest severity score in COVID-19. Methods: A total of 205 RT-PCR positive patients were included in this descriptive cross-sectional study with convenience sampling from November 2020 to June 2021 in KRL Hospital. The study population was stratified in disease severity as per the WHO's guidelines. Clinical and radiological characteristics were compared in survivors and non survivors to draw conclusion. Results: The mean age was 57 years and the majority of the patients 57% were male. Overall mortality was 22% and the mean CT severity score was 18. Non survivors were more tachypneic, hypoxic, had a higher CT chest severity score, higher clinical severity, more comorbid condition and higher TLC, D-Dimers, LDH, CRP, NLR. Raised CT severity score showed a conclusive correlation with greater disease severity. One way ANOVA showed a significant difference between mean CT severity score amongst different disease categories. Conclusion: Higher CT severity score corresponds to a higher clinical severity and higher chances of mortality.

Predictors of Mortality in COVID-19 patients: An observational study.

Objectives: To identify the factors that affect outcome in COVID-19 patients in the Pakistani population. Methods: A total of 225 patients of COVID-19 RT-PCR proven were included during November, 2020 to June, 2021 in this cross-sectional study. They were stratified into different disease severity categories as per WHO guidelines. The characteristics of survivors and non survivors were recorded and then compared to draw conclusions. Results: Mean age was 59 years. Majority of the patients were male (68%) and the overall mortality rate was 30.1%. The non survivors were more likely to be female, had a greater number of comorbidities, had a higher respiratory rate and lower oxygen saturations at presentation and had a greater frequency of invasive mechanical ventilation. Non survivors had higher values of TLC, CRP, D-dimers and lower values of Hemoglobin and Platelets. The non survivors had higher incidence of ARDS, Septic shock and Multiorgan involvement. A higher CURB-65 score was observed in non survivors as compared to those who survived. Multivariate analysis showed that female gender, presence of and higher number of comorbid conditions and a higher CURB-65 score was linked with mortality. Conclusion: Results are compatible with international studies; increasing age, number of comorbid conditions and high inflammatory markers are associated with increased mortality. Our study had an exception that female gender had higher mortality as compared to men.

Time to negative PCR in various disease categories of COVID-19 infection in Pakistani population.

OBJECTIVES: To identify association of epidemiological characteristics, presence of underlying pre-morbidities and disease severity with time to first negative PCR in Corona virus disease 2019. METHODS: Total 842 Corona Virus Real Time Polymerase-Chain-Reaction positive patients were included in this cross-sectional study. Patients were admitted to Department of Medicine at KRL Hospital Islamabad from April to August 2020. Age, gender, symptoms, pre-morbidities and disease severity were recorded. Outcome (recovered versus died) was documented. World Health Organization categories to classify disease severity (asymptomatic, mild, moderate and severe) were used. Time to negative PCR was documented as time between first positive PCR to first negative PCR. RESULTS: The mean age of patients was 39.04 ± 11.32 years with 99.8 % being males. Majority of patients (78.4%) were asymptomatic. Amongst symptoms, fever was the most common symptom. Diabetes mellitus and hypertension were the most commonly recorded co-morbidity. Mean time to negative PCR was 8.8 ± 3.1 days. A large proportion of patients recovered (99.9%). Significant positive correlation (p value < 0.05) was found between age, gender, presence of underlying pre-morbidities and disease severity categories with time to first negative PCR. CONCLUSION: The underlying epidemiological factors, pre-morbidities and disease severity are associated with time to negative PCR and hence affect frequency of recovery samples.

Pre-morbidity and COVID-19 disease outcomes in Pakistani population: A cross-sectional study.

OBJECTIVES: To identify association of underlying pre-morbidities with disease severity and mortality in hospitalized patients with Corona virus disease 2019. METHODS: Total 884 COVID RT-PCR positive patients admitted to KRL Hospital Islamabad from April 2020 to August 2020 were included in this cross-sectional study. Pre-morbidities recorded were hypertension, diabetes mellitus, ischemic heart disease, chronic respiratory disease, chronic kidney disease, chronic liver disease, chronic neuro-psychiatric conditions (stroke and depression) and malignancy. Oxygen requirement, requirement of invasive ventilation, and outcome (recovered versus died) was documented. WHO categories for disease severity were used. Demographic profile and symptoms were also noted. SPSS 22 was used for data analysis. Pearson's Chi square test was used to see association between pre-morbidities and disease severity categories, oxygen requirement, invasive ventilation and outcome. Pearson's correlation was applied to analyze the correlation between individual pre-morbidities and disease severity categories. P-value < 0.05 was considered statistically significant. RESULTS: The mean age was 40 ± 12.21 years with 98.5 % being males. Majority patients (74.8%) were asymptomatic. Fever was the most common symptom. Diabetes mellitus and hypertension were the most commonly recorded co-morbidity. Significant correlation (p value < 0.05) was found between the presence of underlying pre-morbidities and disease severity as well as oxygen requirement, requirement of invasive ventilation and mortality. CONCLUSION: Results are compatible with worldwide studies and underlying pre-morbidities are convincing risk factors for disease severity and mortality.

Lymphopenia: A useful predictor of COVID-19 disease severity and mortality.

OBJECTIVE: To detect association of lymphopenia with disease severity and mortality. METHODS: Total 874 COVID RT-PCR positive patients admitted to KRL Hospital Islamabad from April 2020 to August 2020 were included in this cross-sectional study. Lymphopenia was defined as <1100 cells/micro-L. WHO categories for disease severity were used. Demographic profile, absolute lymphocyte counts and co-morbidities were recorded. Pearson's Chi Square test was used to see association between lymphopenia and disease severity as well as disease outcome. Regression analysis was used to see whether lymphopenia would predict disease severity. Comparison of means of absolute lymphocyte count in different disease categories was done by ANOVA. Tukey's test range was then used to find the means different from each other. P-value ≤ 0.05 was considered statistically significant. RESULTS: The mean age of patients was 40 ± 12.3 years. Majority patients (73.9%) were asymptomatic. Lymphopenia was present in 6.9% of total patients. Significant association was found between lymphopenia and disease severity as well as lymphopenia and mortality (< 0.001). Lymphopenia was found to be a predictor of disease severity using regression analysis (< 0.001). Comparison of mean absolute lymphocyte count was significant among disease severity categories (< 0.001). On post-hoc analysis, difference in absolute lymphocyte count was significant moving from asymptomatic to mild and then moderate disease category. However no significant difference was seen in absolute lymphocyte count between moderate and severe categories. CONCLUSION: Results are compatible with worldwide studies and lymphopenia is valid as a marker of disease severity and mortality.

Neutrophil to lymphocyte ratio (NLR) in COVID-19: A cheap prognostic marker in a resource constraint setting.

OBJECTIVES: To identify association of neutrophil to lymphocyte ratio with disease severity and mortality. METHODS: Total 720 Corona Virus RT-PCR positive patients were included in this cross-sectional study. Patients were admitted to KRL Hospital Islamabad from April 2020 to August 2020. Neutrophil to lymphocyte ratio (NLR) was recorded on admission and then serially. NLR cut-off was 3.0. WHO categories for disease severity (asymptomatic, mild, moderate and severe) were used. Demographic profile, symptoms and co-morbidities were recorded. RESULTS: The mean age of patients was 40 ± 12.4 years with 96% being males. Majority patients (76.5%) were asymptomatic. Amongst symptoms, fever was the most common symptom. Diabetes mellitus was most common recorded co-morbidity. The mean NLR 2.5 ± 2.78. Significant association was found between NLR and disease severity as well as mortality. Difference in mean NLR amongst disease severity categories was also significant. CONCLUSION: Results are compatible with worldwide studies and NLR is a cheap and easily available marker of disease severity and mortality.

Characteristics of Chronic Cough in adults in Pakistani population: A cross sectional study.

BACKGROUND AND OBJECTIVE: Data about causes of chronic cough are lacking in our part of world. The aim of our study was to look for spectrum of causes in our setup and to determine a correlation between causes of cough and baseline factors of age, gender, and BMI and compare it to other populations. METHODS: Total 236 chronic cough patients who attended chest clinic at KRL Hospital Islamabad from January 2018 to June 2019 were included in this cross-sectional study. Chronic cough was defined as cough greater than eight weeks. Main causes of chronic cough taken were cough variant asthma, allergic rhinitis, interstitial lung disease, Gastro-esophageal reflux disease, bronchial hyper-reactivity, ACE-I induced cough and others'. Other demographic and clinical data were also recorded. RESULTS: The mean age was 45.16± 16.50 years and BMI was 26.23 ± 4.68kg/m2. Major cause of chronic cough was cough variant asthma in 111(47%). Age had significant positive correlations with ILD, ACE-I induced cough and CCF, while significant negative correlations with CVA and AR. On gender correlation, ILD and ACE-I cough were significantly found more in females. BMI had significant correlation with ACE-I cough only. CONCLUSION: Variability of epidemiology of cough variant asthma, allergic rhinitis and ACE-I induced cough is comparable to worldwide data while differences exist with epidemiology of interstitial lung disease. Further research is needed in the field to delineate the local trends in this regard and compare to other population groups.

To determine correlation between biochemical parameters of nutritional status with disease severity in HCV related liver cirrhosis.

OBJECTIVE: To identify correlation between biochemical parameters of nutritional status with disease severity in HCV related liver cirrhosis in patients attending tertiary care hospital. METHODS: Total 259 HCV related liver cirrhosis patients who attended the outpatient department of KRL Hospital, Islamabad from June 2016 to January 2018 were included in this cross-sectional study. HCV status was confirmed with PCR. Cirrhosis was pre-established by ultrasound, while cirrhosis severity was gauged by CTP score. Biochemical parameters for nutrition status included serum albumin, creatinine, cholesterol, LDL, HDL, triglycerides, hemoglobin, ferritin, sodium, potassium, magnesium and calcium. Other demographic and clinical data were also recorded. RESULTS: The mean age of patients was 58.73 ± 6.04 years with 57.1% being males. The average BMI was 22.72 ± 1.69 kg/m2. Majority patients i.e. 123 (47.5%) belonged to CTP-A, 67 (25.9%) were in CTP-B and 69 (26.6%) in CTP-C groups. Significant negative correlations of cirrhosis severity were established with BMI, albumin, creatinine, cholesterol, LDL, TG, HDL, hemoglobin, sodium and magnesium indicative of malnutrition. Analysis of biochemical parameters amongst individual cirrhosis groups revealed significant negative correlation across the same factors in group CTP-C, while CTP-A correlated positively with these parameters. The only significant correlation found in CTP-B was with albumin, HDL, hemoglobin, sodium and magnesium. CONCLUSION: Considering limitations of standard ways alone to assess malnutrition in liver cirrhosis, biochemical parameters are valid to aid in diagnosing malnutrition.

Intralobar bronchopulmonary sequestration with large aberrant vessel presenting as recurrent pneumonias.

Bronchopulmonary sequestration is a rare congenital malformation of the lower respiratory tract comprising of a nonfunctioning lung tissue mass that lacks normal communication with the tracheobronchial tree. The diagnosis may be easily missed as many of the symptoms of bronchopulmonary sequestration overlap with that of other pulmonary diseases. Bronchopulmonary sequestration can be complicated by recurrent infections, hemorrhage and malignant transformation and, therefore, needs to be timely diagnosed and resected to decrease both morbidity and mortality. A high degree of suspicion in the differential diagnosis helps diagnose the positive cases. The parenchymal abnormalities associated with bronchopulmonary sequestration are best visualized using computed tomography, although their appearance is variable. We report the case of a 14 years old boy with intralobar bronchopulmonary sequestration with the sole manifestation of recurrent pneumonias.

Right atrial invasion by metastatic esophageal adenocarcinoma with direct connection to liver.

Common causes of right sided intra-cardiac atrial masses include primary cardiac tumors (atrial myxoma), atrial thrombus, tumor thrombus with hepatocellular or other thoracoabdominal cancers and metastatic lesions. Invasion of atria by gastrointestinal tumors is rare and that with esophageal ones seldom observed. Esophageal cancers rather present with dysphagia, odynophagia or systemic symptoms. Due to the lack of a serosal layer, esophageal tumors usually spread early in their course. Typical sites of spread include liver, gut, mediastinum, lungs and draining lymph nodes. We report a case of metastatic esophageal adenocarcinoma presenting with direct extension of metastatic tumor thrombus from liver to right atrium via inferior vena cava.