Mortality in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Lower and Higher Decaf Scores

Background: To determine diagnostic accuracy of DECAF score in predicting mortality in patients with acute exacerbation of chronic obstructive pulmonary disease having DECAF score <4 and within 7 days of hospital admission keeping actual mortality as gold standard. Methods: In this cross sectional validation study, 146 Patients with COPD were selected from emergency and OPD of Fauji Foundation Hospital Rawalpindi presenting with signs and symptoms of acute exacerbation of COPD from 15 may 2017-15 Nov. 2017.The procedure began after taking informed consent of the patients. Clinical features documented and investigations were sent. The expense of all the tests was borne by the hospital administration and not the patient. A specially designed Performa was used for data collection. RESULTS: Mean age (years) in the study is 64.90+0.93. Patients with DECAF score of 1, 2 and 3 are (2.7+26+35.6 =64.3) are 64 %. The cases with DECAF score of 4 are 26.7% and the cases with DECAF score of 5 and 6 are 8.9%. DECAF score versus mortality with different age groups and duration of smoking gave reasonably high values of sensitivity and, specificity. Also the PPV and NPV values are appropriate. The minimum diagnostic accuracy is 71.23% indicating that this test is appropriate in predicting the true status of the cases.CONCLUSION: The study concludes that DECAF score is a useful predictor of mortality in patients admitted with acute exacerbation of COPD. Patients admitted in hospital with high DECAF score of should be admitted in intensive care unit because they may require invasive ventilation due to respiratory failure and high mortality. KEYWORDS: Chronic obstructive pulmonary disease, acute e

Comparison of Bacterial Load measured by X-pert / MTB RIF Assay with Smear & Myco-Bacterial Culture, as a marker for monitoring disease outcome in Cavitary Pulmonary Tuberculosis

Introduction: Tuberculosis (TB) is one of the major public health problems in Pakistan. Treatment depends on the diagnosis and bacterial load. The smear and culture of the sputum sample are considered as the gold standard. However, another recently invented diagnostic criteria i.e. X-PERT / MTB RIF Assay can also give high accuracy and can be used as a substitute for sputum culture. Objective: To determine the validity of Xpert MTB/RIF and sputum smear in monitoring the outcome of cavitary pulmonary tuberculosis by taking culture as the gold standard Study design: Descriptive Cross-sectional Study. Setting: Department of Pulmonology, Fauji Foundation Hospital Rawalpindi. Duration: 15th Feb to 15th Dec 2018. Materials and Methods: 250 Patients who meet the criteria were integrated into the study. A sputum sample was taken two times and two samples were sent to the laboratory of the hospital for Xpert MTB/RIF, sputum smear, and culture. Findings were recorded. Then patients were given standard treatment for tuberculosis. Data was entered in SPSS 23. Age, laboratory variables like HB, Platelets count, etc. were presented as mean and standard deviation. Gender, outcome of diagnosis were presented as mean and standard deviation. Sensitivity, specificity measure on –rays, findings, smear test, and Xpert MTB/RIF. Results: Total 187 patients including 12 (6.4%) male and 175 (93.6%) female. The mean age was 44.14+17.13 years. Positive findings on X-pert and smear were found in 35(53%) patients and MTB/ RIF were found in 41(62.1%). Sensitivity, specificity of X-pert MTB/RIF were found to be 77.6% and 13.6% at baseline while 40% and 40% respectively at end of treatment. Conclusion: Thus, X-pert MTB/RIF is an important tool than sputum smear and AFB culture in monitoring the outcome of cavitary pulmonary tuberculosis

Comparison of High Intensity Non-Invasive Ventilation With Low Intensity Non-Invasive Ventilation In Patients With Acute Copd Exacerbation

Objective: To determine the outcome of high intensity non-invasive positive pressure ventilation (HI-NPPV) as compared to low intensity non-invasive positive pressure ventilation (LI-NPPV) in patients with acute COPD exacerbations. Methodology: This Randomized controlled trial Department of PulmonologyFauji Foundation Hospital Rawalpindi from  31st December 2016 to 30thJune 2017. Arterial blood gases will be taken at admission. If values of pH and paCO2 meet the criteria for non-invasive ventilation then patients will be enrolled in the study. Patients will be randomly divided into two groups by lottery method. GROUP A and GROUP B. GROUP A will receive high intensity NIV (HI-NPPV) and GROUP B will receive low intensity NIV (LI-NPPV) by TRIOLOGY machine. Expiratory positive airway pressure (EPAP) will remain between 4 to 6 cmH2O.  Arterial blood gases (ABGs) will be done at baseline and then 72 hours after admission. Improvement in PaCO2, HCO3, and FEV1 will be recorded 72 hours from baseline and collected on proforma (attached). Results: Mean age (years) in the study was 55.54+3.81. There were 08 male patients included the study meeting the inclusion criteria. Of these, 05 and 03 male patients among both the groups respectively. Similarly, there were 92 female patients included the study meeting the inclusion criteria, of these, 45 and 47 female patients among both the groups respectively. Outcome of the study was assessed in terms of mean PaCO2 (mmHg), HCO3 (mmol/L) and FEV1 at baseline and after 72 hours. Mean PaCO2, HCO3 and FEV1 at baseline was 64.87+5.22, 33.75+4.17 and 0.66+0.04 respectively. After 72 hours, mean PaCO2 (mmHg) , HCO3(mmol/L), and FEV1 among both the groups was 63.98+6.58 vs 41.46+2.40, 33.10+4.81 vs 23.12+2.01, 0.66+0.05 vs 0.72+0.04 with following P value of (0,000, 0.000, 0.000) respectively. Conclusion: High intensity non-invasive positive pressure ventilation (HI-NPPV) has no different outcome as compared to low intensity non-invasive positive pressure ventilation (LI-NPPV) in patients with acute COPD exacerbations

Comparison of Bacterial Load measured by X-pert / MTB RIF Assay with Smear & Myco-Bacterial Culture, as a marker for monitoring disease outcome in Cavitary Pulmonary Tuberculosis

Introduction: Tuberculosis (TB) is one of the major public health problems in Pakistan. Treatment depends on the diagnosis and bacterial load. The smear and culture of the sputum sample are considered as the gold standard. However, another recently invented diagnostic criteria i.e. X-PERT / MTB RIF Assay can also give high accuracy and can be used as a substitute for sputum culture. Objective: To determine the validity of Xpert MTB/RIF and sputum smear in monitoring the outcome of cavitary pulmonary tuberculosis by taking culture as the gold standard Study design: Descriptive Cross-sectional Study. Setting: Department of Pulmonology, Fauji Foundation Hospital Rawalpindi. Duration: 15th Feb to 15th Dec 2018. Materials and Methods: 250 Patients who meet the criteria were integrated into the study. A sputum sample was taken two times and two samples were sent to the laboratory of the hospital for Xpert MTB/RIF, sputum smear, and culture. Findings were recorded. Then patients were given standard treatment for tuberculosis. Data was entered in SPSS 23. Age, laboratory variables like HB, Platelets count, etc. were presented as mean and standard deviation. Gender, outcome of diagnosis were presented as mean and standard deviation. Sensitivity, specificity measure on –rays, findings, smear test, and Xpert MTB/RIF. Results: Total 187 patients including 12 (6.4%) male and 175 (93.6%) female. The mean age was 44.14+17.13 years. Positive findings on X-pert and smear were found in 35(53%) patients and MTB/ RIF were found in 41(62.1%). Sensitivity, specificity of X-pert MTB/RIF were found to be 77.6% and 13.6% at baseline while 40% and 40% respectively at end of treatment. Conclusion: Thus, X-pert MTB/RIF is an important tool than sputum smear and AFB culture in monitoring the outcome of cavitary pulmonary tuberculosis

Comparative Evaluation of Lamina Cribrosa Anatomical Parameters with Retinal Nerve Fiber Layer Thickness Defects In Primary Open-angle Glaucoma Cases And Controls

OBJECTIVES To assess the lamina cribrosa (LC) anterior lamina cribrosa depth (ALCD), lamina cribrosa thickness (LCT) and retinal nerve fiber layer thickness (RNFLT) in primary open-angle glaucoma (POAG) cases and age-matched controls and to compare these anatomical variables among POAG cases and age-matched controls. METHODOLOGY The case-control study was researched at Al-Ain Eye Institute, Karachi, in four month’s duration (November 2018 till February 2019). Expert eye specialist recruited 57 POAG cases and 46 age-matched healthy controls. Observation of intraocular pressure (IOP) and open angle was done using Goldmann tonometry and Slit-lamp biomicroscopy with stereoscopic ophthalmoscopy respectively. Visual field parameters of mean deviation (MD) and pattern standard deviation (PSD) measured using Humphrey Field Analyzer. Highly sensitive spectral domain ocular coherence tomography with enhanced depth imaging (EDI-OCT) was used to determine ALCD, LCT and RNFLT. RESULTS Statistically significant results were produced by RNFLT defects when it is compared in groups of mild with moderate cases of POAG (P-value 0.037). ALCD and LCT did display an association with RNFLT defects but did not produced statistically significant results. CONCLUSION Assessments of ALCD and LCT can provide important prognostic evidence about RNFLT and can assist in future planning of mild and moderate cases suffering from POAG

Bacteriological and Physicochemical Analysis of Groundwater of Kasur

Earth is a blue planet because of the rudimentary cause of life, that is water. All the biochemical reactions which are pre-requisite for nourishing life of animals and plants, use water as a basic element. Being a universal solvent, it dissolves almost all minerals present in the soil. It is one of the basic and necessary compounds responsible for the survival of life. The main purpose of research was to determine the quality of groundwater in Kasur near the tanneries. The study is focused on the bacteriological and physicochemical (pH, Temperature, DO, BOD, CO2, TOSM, TDS, TM and heavy metals) parameters. We selected four sites as Din Garh, Qatal Garhi, Mangal Mandi and Kot Haleem Khan for investigation. Coliforms were present in high concentration that produce viruses and bacterial diseases such as typhoid fever, hepatitis, gastrocnemii, dysentery and ear infections. World Health Organization (WHO) has justified that the drinkable water must have zero level of coliform and E.coli. Regarding the Total Suspended Matter (TSM), the values ranged from 0.3-0.5g/l in DIN GHARH, 0.2-0.5g/l in QATAL GHARHI, 0.2-0.5g/l in MANGAL MANDI and 0.2-0.6g/l in KOT HALEEM KHAN. The study concludes that the water pollution due to tanneries in Kasur have changed the bacteriological and physicochemical properties of ground water to a considerable level which is not drinkable. It also conclude that groundwater was contaminated with high concentrations of BOD, TOSM, TDS, TM and Heavy metals due to discharge of industrial effluents.  Full Tex

Association of rs10490924 in ARMS2/HTRA1 with age-related macular degeneration in the Pakistani population

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