Predictors of Mortality in Pulmonary Haemorrhage during SLE: A Single Centre Study Over Eleven Years.

BACKGROUND: Pulmonary haemorrhage (PH) is a serious complication during Systemic Lupus Erythematosus (SLE). AIM: The aim was to present data on 12 patients of SLE with classic symptoms and signs of PH admitted throughout eleven years. METHODS: This retrospective study was carried out at King Abdul Aziz Specialist hospital in Taif-a tertiary care hospital in the western region of Saudi Arabia. The data was analysed from the case files of SLE patients who had episodes of PH throughout 11 years (January 2007 to December 2017). RESULTS: Twelve patients (10 females and 2 males) were found to have diffuse pulmonary haemorrhage during their SLE in the study period. Of 12 patients with confirmed pulmonary haemorrhage (hemoptysis, hypoxemia, new infiltrates on chest radiography, fall in haemoglobin and hemorrhagic returns of bronchoalveolar lavage with hemosiderin-laden macrophages) 4 patients had PH as the first presentation of SLE and 8 patients developed this complication during the disease. All patients presented with shortness of breath and hemoptysis. The most common extra-pulmonary involvement in the study cohort was renal (83%), which ranged from clinical nephritis, nephrotic syndrome to acute renal failure. All patients were managed in intensive care of the hospital, and of 12 patients, 9 (75%) required mechanical ventilation. All patients were uniformly treated with pulse Methylprednisolone; 9 received Cyclophosphamide, 6 received IVIG, and 4 received Plasmapheresis. Only 3 patients (25%) survived despite maximum possible support during their mean hospital stay of 18 ± 5 days. CONCLUSION: The requirement of mechanical ventilation and the association of renal and neuropsychiatric complications predicted mortality in patients with pulmonary haemorrhage.

Combining corticosteroids and acyclovir in the management of varicella pneumonia: a prospective study.

BACKGROUND: Studies found in the literature which describe the treatment of varicella pneumonia with a combination of acyclovir and corticosteroids tend to be retrospective in nature and limited with regard to the data supplied. METHODS: This prospective study was performed at King Abdul Aziz Specialist Hospital in Taif, Saudi Arabia. The study covered adult patients admitted with a diagnosis of varicella pneumonia over a period of 10 years (January 2003 to December 2012). All patients were treated uniformly according to the predefined protocol with acyclovir and corticosteroids. The clinical characteristics, laboratory investigations, hospital course, any complications and the treatment outcomes were studied. RESULTS: A total of 32 patients (25 males, mean age 43.5 ±14.5 years) were enrolled into this study; 3 patients (2 patients aged <12 years, 1 patient with advanced cardiac failure) were excluded. Of these 32 patients, 18 (58%) were current smokers, 16 patients (50%) were admitted to the intensive care unit and of these, 14 (87.5%) required mechanical ventilation. The mean duration of intensive care unit stay was 5.59 ±5.37 days. All patients were treated with intravenous acyclovir, corticosteroids and antibiotics were added when indicated. 31 patients improved and were discharged home. There was one death (a 32 year-old female with underlying systemic lupus erythematosus). CONCLUSIONS: Patients with varicella pneumonia are at high risk of respiratory failure. Early implementation of supportive therapy seems to positively influence the recovery rate and outcome. Our study supports treatment using a combination of acyclovir and corticosteroids.

Sweeper's lung disease: a cross-sectional study of an overlooked illness among sweepers of Pakistan.

BACKGROUND: Sweepers are prone to develop chronic obstructive pulmonary disease even without tobacco smoking. PURPOSE: To investigate roadside dust as a cause of air flow obstruction among sweepers, and the role of spirometry in its preclinical diagnosis. MATERIAL AND METHODS: One-hundred nonsmoking sweepers (aged 30-60 years) of both sexes sweeping on roads for 8-12 hours a day for the Capital Development Authority of Islamabad, Pakistan were used as study participants (Group A). One-hundred healthy nonsmokers (aged 30-60 years) in the same socioeconomic group and living in the same environment represented the nonsweeper group (Group B). After proper clinical evaluation and chest X-rays, spirometric evaluation was carried out in both groups. Comparisons were drawn between various spirometric parameters. RESULTS: Pulmonary function tests showed that the mean forced vital capacity was 78 ± 1.40 in the sweeper group (Group A) and 83 ± 0.86 in the nonsweeper group (Group B). Mean forced expiratory volume in 1 second was 66 ± 1.67 in Group A and 85 ± 0.85 in Group B (P < 0.05), a difference of 19%. The forced midexpiratory flow was 41% lower in Group A than in Group B (P < 0.0001). The pattern of pulmonary function obstruction was shown to be proportional to the duration of exposure to dust caused by sweeping. CONCLUSION: Occupational exposure to dust leads to an obstructive pattern among sweepers. Spirometry is the simplest, noninvasive technique to detect preclinical disease.