Clinical Presentation, Histology, and Outcomes of Immunoglobulin A Nephropathy: A Single-Center Experience from Pakistan.

Clinical presentation, kidney biopsy findings, and clinical outcomes of immunoglobulin A nephropathy (IgAN) are highly variable. The objective of this study is to study the clinical presentation, histologic patterns, and outcomes of IgAN in the Pakistani population, as no significant data are available in international literature from this part of the world. A retrospective chart review was conducted of all patients with biopsy-proven IgAN between January 2007 and December 2017. Of a total of 977 renal biopsies, 50 patients had biopsy-proven IgAN (5.1%). The median age at the time of biopsy was 34 years (27-42); 92% of patients were between 18 and 40 years. Thirty-eight (76%) were male. Ninety-two percent of patients had significant proteinuria of >1 g/day, with 32% having nephrotic range proteinuria. The mean estimated glomerular filtration rate (eGFR) at presentation was 46.58 mL/min/1.73 m2. Seventy-eight percent of patients were hypertensive at the time of presentation and most of them had uncontrolled hypertension (HTN). The most common lesion on light microscopy was focal necrotizing glomerulonephritis (26%), followed by mesangial expansion with segmental/global glomerulosclerosis (22%). Crescents were seen in 38% of cases. Of 50 patients, a follow-up of at least six months was available for 32 patients. Most of the patients who had an eGFR of <30 mL/min at presentation progressed to kidney failure at six-month follow-up period. IgAN usually presents in young male adults in the age range of 18-40 years, with most patients having severe clinical presentation characterized by nephrotic-range proteinuria, HTN, renal insufficiency, and severe histological stages.

The quality of patient care in oncology departments in Karachi, Pakistan: patients' perceptions.

PURPOSE: This study aims to assess the quality of care among adult oncology patients in tertiary care hospitals in Karachi by using an international standard of quality of care and to identify domains where improvement is needed. DESIGN/METHODOLOGY/APPROACH: This is a cross-sectional study carried out at two tertiary care hospitals of Karachi, Pakistan, belonging to private and public sector, respectively, between February and April 2018. Face-to-face interviews were conducted using a modified questionnaire having five-point Likert scale questions regarding satisfaction of patients with doctors, nursing staff, information provided and the hospital standards. SPSS 20 was used for statistical analysis, and the results were expressed using mean, frequencies, percentages and p-values. FINDINGS: The authors approached 415 patients, out of which 389 patients agreed to participate in the study. For both hospitals, the lowest mean scores were for sections pertaining to satisfaction with psychosocial support and information provided. The mean satisfaction score of patients from the private hospital were found to be significantly higher as compared to patients from the public hospital for all domains of patient care (p-value < 0.01 using t-test for two independent samples). The data showed an increasing trend of "satisfied" responses as the household income increased. RESEARCH LIMITATIONS/IMPLICATIONS: A comparative study should be conducted with the aim of pinpointing the differences in areas in which there is a significant difference in positive satisfaction levels between private and public sectors. Similar research could also be expanded adding other variables that affect quality of care such as doctor's approach to their patients, time given during each consultation and patient's understanding of doctor's knowledge. Further studies can be done to bridge the gaps between what a doctor views as standard care and what the patient knows will help them receive a more holistic approach to care. PRACTICAL IMPLICATIONS: Assessing the quality of care helps determine gaps in care and allocating health resources accordingly. In clinical practice, emphasis needs to be given on increased duration and improved quality of patient counselling to improve the low satisfaction levels of patients regarding the psychosocial support. Addressing patients' concerns should be made part of clinical teaching from an undergraduate level. As far as patient access to doctors of the specific speciality is concerned, hospital managements should adopt systems to ensure continuum of care and come up with mechanisms to bridge the discrepancy between a patient's needs and doctor availability. SOCIAL IMPLICATIONS: After being identified as a major deficiency, training doctors in the sensitivities of the population and demographics, especially with respect to socio-economic statuses, can aid in enhancing patient satisfaction to the treatment. Implementation of patient-centred care leads to greater satisfaction with care, which, in turn, increases a patient's self efficacy in managing important aspects of their care and improves health care-related quality of life. ORIGINALITY/VALUE: Cancer patients have long-term exposure to the hospital environment. A patient's satisfaction with the quality of care is an important determinant in patient compliance to the treatment protocol and required hospital visits. There is a dearth of research on the outpatient quality of care in the oncology departments in Karachi. This study provides an overview of the quality of care available to cancer patients in Karachi both in public and private sectors. The results of our study identify the gaps in the quality of care being provided to the patients in a developing country like Pakistan, which can be used to improve the quality of care, leading to better patient outcomes.

Cytokines and endometrial receptivity after intracytoplasmic sperm injection - A cohort study at Islamabad.

OBJECTIVE: To evaluate the role of tumour necrosis factor alpha and interleukin-6 in conception after assisted reproductive treatment. METHODS: The longitudinal cohort study was conducted from August 2014 to May 2015 and comprised patients undergoing intracytoplasmic sperm injection at the Islamabad Clinic Serving Infertile Couples, Islamabad, Pakistan. During the procedure, endometrial thickness was measured on the day of ovulation induction and serum tumour necrosis factor alpha along with interleukin-6 were measured on the embryo transfer day. Subjects were divided into groups, with non-pregnant females in Group A and those with confirmed foetal cardiac activity in Group B and non-pregnant females were divided into two groups. The difference between the groups and the association of cytokines with endometrial thickness were measured. . RESULTS: Of the 131 subjects, 79(60%) were in Group A and 52(40%) in Group-B. The mean level of interleukin-6 was 49.65±3.04 in Group B and 104.14±76.03 in Group A, with significant inverse correlation with endometrial thickness (p<0.001). The level of tumour necrosis factor alpha were significantly higher in Group-B compared to Group-A (p<0.001). CONCLUSIONS: The pro-inflammatory cytokine, tumour necrosis factor alpha, takes part in preparation of endometrial lining for implantation of embryo in assisted reproductive treatment procedures.