Clinical outcomes of pneumocystis pneumonia from a tertiary care centre in Pakistan.

Objective: To assess the predisposing immunocompromised states, administration of pneumocystis jirovecii pneumonia prophylaxis, the disease course and outcomes of patients with pneumocystis jirovecii pneumonia. Methods: The retrospective study was conducted at the Aga Khan University Hospital in Karachi. The medical records of patients diagnosed with pneumocystis jirovecii pneumonia from January 1995 to October 2015 were retrieved. Baseline characteristics, clinical course, treatment, and mortality rates were noted. SPSS 19 was used for data analysis. Results: Of the 37 patients, 24(64.9%) were men and 13(35.1%) were women. The overall mean presenting age was 47.08±16.21 years(range: 19-83 years). Ten (27%) patients were positive for human immunodeficiency virus; 12(32.4%) had an underlying autoimmune disease; 3(8.1%) were transplant recipients; 10(27%) had an underlying malignancy, and 19(51.3%) were on long-term corticosteroid therapy. Only 2(5.4%) patients had received pneumocystis jirovecii pneumonia prophylaxis with trimethoprim-sulfamethoxazole. Moreover, 8(21.6%) patientsrequired intensive care unit admission with a mean stay of 2.03±4.91 days (range: 1-22 days).The overall mortality rate was 7(18.9%). Conclusion: Pneumonia due to pneumocystis jirovecii was found to be a life-threatening disease in the immunocompromised population. The high mortality burden and resource intensive management of the disease emphasizes the need for PCP prophylaxis in immunosuppressed individuals

Etiology and outcome of severe community acquired pneumonia in immunocompetent adults.

BACKGROUND: Community Acquired Pneumonia (CAP) is a commonly encountered disease, one third of which is Severe Community Acquired Pneumonia (SCAP) that can be potentially fatal. There is a paucity of data on etiology and outcome of patients with SCAP in South Asian Population. METHODS: A retrospective cross-sectional study was conducted from March 2002 till December 2008 on patients of 16 years and above who were admitted with the diagnosis of SCAP in accordance to the criteria of American Thoracic Society Guidelines (2001). The patients underwent clinical and diagnostic evaluations to detect the severity of illness as well as the etiology and other risk factors influencing the eventual outcome of SCAP. RESULTS: A total of 189 patients were included in the study. The mean age was 60 ± 18.0 years and 110 (58%) patients were males. The most common isolated pathogens were Staphylococcus aureus (15 patients), Streptococcus pneumoniae (14 patients) and Pseudomonas aeruginosa (9 patients). The highest mortality was seen in patients with Pseudomonas aeruginosa (89%) and Staphylococcus aureus (53%). Overall mortality rate was 51%. On univariate analysis, septic shock (p \u3c0.001), prior antibiotic use (p = 0.04), blood urea nitrogen \u3e 30 mg/dl (p = 0.03), hematocrit \u3c 30% (p = 0.03) and Acute Physiology and Chronic Health Evaluation (APACHE) II score \u3e 20 (p \u3c 0.001) were significantly different between the patients who survived as compared to those who did not. On multivariate analysis, septic shock (p \u3c0.001, OR: 4.70; 95% CI= 2.49-8.87) was found to be independently associated with mortality. CONCLUSION: The microbes causing SCAP in our study are different from the usual spectrum. Staphylococcus aureus and Pseudomonas aeruginosa were the common causative pathogens and associated with high mortality. It is important to establish clinical guidelines for managing SCAP according to the etiologic organisms in our setting

Coinfection with Lichtheimia corymbifera and Aspergillus flavus in an Immune-Competent Patient Mimicking as Pulmonary-Renal Syndrome

Lichtheimia corymbifera and Aspergillus flavus pulmonary coinfection has been rarely reported in immune-competent patients. We report case of a young male who presented with clinical features of pulmonary-renal syndrome and was later diagnosed to have bilateral polymicrobial fungal lung infection

Association of airborne Aspergillus with asthma exacerbation in Southern Pakistan.

Background: Exposure to airborne fungi has been related with exacerbation of asthma in adults and children leading to increased outpatient, emergency room visits, and hospitalizations. Hypersensitivity to these airborne fungi may be an important initial predisposing factor in the development and exacerbation of asthma. Objective: This study was conducted to determine an association between fungal types and spore concentrations with the risk of asthma exacerbation in adults. Methods: This cross-sectional study was conducted from May 2008 to August 2009 at the Aga Khan University Hospital Karachi, Pakistan. All adult (age≥16 years) patients presenting to the hospital with acute asthma exacerbation were enrolled after informed consent. A home survey was conducted for each patient to assess their environmental characteristics. Indoor air samples were also obtained from the patient’s home to determine the type and spore concentration of fungi within the week of their enrollment in the study. Results: Three hundred and ninety-one patients with an acute asthma exacerbation were enrolled during the study period. The mean age of participants was 46 years (standard deviation, ±18 years) and 247 (63.2%) were females. A trend of higher asthma enrollment associated with higher Aspergillus concentrations was found in two consecutive summers. A total of nineteen types of fungi were found in air samples. Aspergillus spp. was the most frequently isolated fungus with acute asthma exacerbation. Conclusion: An association of higher concentration of indoor Aspergillus spp. with asthma exacerbation in adults was observed in this study

Atypical pathogens causing community-acquired pneumonia in adults.

Objective: To determine the frequency of community-acquired respiratory pathogens with special focus on atypical organisms in patients presenting to a tertiary care facility with community-acquired pneumonia (CAP). Methods: The descriptive study on adult patients was conducted from February 2007 to March 2008 at the Aga Khan University Hospital, Karachi. It comprised 124 consenting patients of age 16 and above who presentd with a diagnosis of community-acquired pneumonia. The diagnostic modalities used were based on significant changes in antibody titer or persisting high antibody titers in the case of Mycoplasma pneumoniae and Chalmydia pneumoniae infections, or bacterial antigen in urine, in the case of Legionella pneumophila serogroup 1 infection. Pyogenic bacteria were identified on the results of respiratory secretions or blood cultures. Continuous data and categorical variables were worked out using SPSS version 15. Results: Among the 124 patients enrolled, an etiologic agent was identified in 44 (35.4%) patients. The most common organism was Mycoplasma pneumoniae (n=21, 17%), followed by Chlamydia pneumoniae (n=15, 12%), Streptococcus pneumoniae (n=9, 7%), Haemophilus influenzae (n=2, 1.6%), Klebsiella pneumoniae (n=2, 1.6%) and Staphylococcus aureus (n=1, 0.8%). Streptococcus pneumoniae was the most common organism isolated from blood cultures. No cases of Legionella pneumophila serogroup 1 were identified. Conclusions: Mycoplasma pneumoniae and Chalmydia pneumoniae are significant etiologic agents for community-acquired pneumonia occurring in Karachi. Local treatment guidelines for community-acquired pneumonia should include therapy directed specifically at these agents

Seroprevalence of SARS-CoV2 Antibodies among Patients and Healthy Individuals of Lahore

Objective: To determine the seroprevalence of SARS-CoV2 antibodies in patients and healthy individuals presenting to a tertiary care hospital in Lahore. Study Design: Cross-sectional study Place and Duration of Study: Pathology Department of Surayya Azeem Hospital, Lahore Pakistan, from May to Jul 2020. Methodology: The study included clinically suspected patients of COVID-19 referred by clinicians and healthy individuals presenting to the hospital for the SARS-CoV-2 antibody test, irrespective of age and gender. Results: The SARS-CoV-2 antibody positivity was 704(59.4%) in our study. Out of 1184 individuals tested, 690 patients had a positive clinical history of COVID-19 infection, and 517(74.9%) were positive for COVID-19 antibodies. Out of 494 asymptomatic healthy individuals, positivity for COVID-19 antibodies was 187(37.8%). It was observed that positivity was significantly higher 169(44.0%) in contacts of COVID-19 infection patients compared to asymptomatic healthy individuals 18(16.3%). Conclusion: Our study shows that the seroprevalence of SARS-CoV-2 antibodies in the general public in Pakistan has greatly increased

Outcome and mortality rate of COVID-19 infection among health workers and general population

Objective: To determine the outcomes and mortality rate of Covid-19 infection among health workers and general population. Material and methods: An observation study was conducted in Department of Pulmonology Pak Red Crescent Medical College & Teaching Hospital,Dina Nath, Kasur, Punjab. Total 210 Covid-19 patients which were divided in two groups equally, group A healthcare workers and group B general population. Outcomes and mortality rate were assessed between both groups using Chi Square and Independent Samples T-test. Results: Mean age in group A was was 41.29±11.37 years while 42.61±16.15 years in group B. ICU admissions was significantly lower in group A 7 (6.7%) while 22 (21.0%) in group B. Mechanical ventilation need was significantly lower 6 (5.7%) in group A than group B 19 (18.1%). Mortality rate was significantly lower in group A than group B 4 (3.8%) vs 15 (14.3%). The mean hospital stay in group A was significantly shorter 9.41±3.333 days than in group B 13.18±3.956 days. Conclusion: From our study we conclude that the mortality rate was higher in the general population as well as the admission to ICU and need for mechanical ventilation as compared to the healthcare workers

Impacts of climate change on wheat phenology and yield in Indus Basin, Pakistan

Aim of this study is to quantify the impacts of climate change on phenology and yield of winter wheat in rainfed and irrigated regions of Pakistan by using integration of two well-known crop models including STICS and APSIM with CORDEX-SA regional climate models (RCMs). A number of different adaptation strategies based on early sowing (i.e. S1:10 and S2:20 days), irrigation (I1:15% and I2:30% additional water) and a combination of sowing and irrigation adaptations were examined to recover the potential losses that would occur due to climate change. The data for the wheat phenology, biomass (t/ha) at different stages and yield (t/ha) was obtained from several experiments at national research institutes in Pakistan under both rainfed and irrigated conditions. After calibration and validation of both crop models (STICS and APSIM), the current climate data were replaced with the CORDEX-SA RCM-projections for climate change impact analysis. A significant rising and declining trends were observed in temperature and precipitation patterns, respectively, for the selected study regions. Consequently, a substantial impact of climate change on wheat phenology (anthesis stage, maturity stage, growing length), biomass (t/ha) and yield (t/ha) was observed under scenario periods for RCP4.5 and RCP8.5. Additionally, the adaptation strategies on wheat for rainfed regions showed a substantial improvement in wheat biomass and yield simulated by STICS model particularly for sowing-2 under RCP4.5. Irrigated regions showed more improvement for irrigation-2 (I2) and combination of sowing-1 + irrigation-2 (S1 + I2) using the STICS model under both RCPs. Overall, it was observed that changes in crop phenology had a stronger impact in terms of crop yield for RCP8.5 as compare to RCP4.5. This study provides a valuable understanding and way forward for the better wheat management under changes in precipitation and temperature patterns. The study also discuss in detail, the adaptation strategies to cope with potential damage, over two different irrigation zones (rainfed and irrigated) in Pakistan

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)