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 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

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

The Prevalence & Severity of Depression in patients with chronic obstructive airway disease

Objective:  To determine the Prevalence & Severity of depression in Chronic Obstructive Airway Diseases (COPD) patients. Background: Chronic Obstructive Airway Disease is a chronic heterogeneous disease that is also progressive. Depression is a common entity in chronic diseases. COPD causes long-term respiratory symptoms and depression is commonly found in these patients. The symptoms of these two diseases are overlapping and depression in COPD patients’ needs to be diagnosed and adequately treated. Untreated patients lead to poor control of respiratory symptoms and further deterioration of the illness. Our study aimed to determine prevalence and severity of depression in COPD patients using HAM-D score. Material and Methods: This study was conducted in Medicine & Pulmonology OPD, Fuji Foundation Hospital, Rawalpindi from August 2019 to February 2021. Using a cross sectional study design, a total of 169 cases of COPD were recruited and tested for the presence of absence of depression using the HAM-D rating scale and observations were recorded. Results: Total 169 patients recruited in this study with female & male percentage of 59% and 47% respectively.  The Mean duration of illness was 11.5 years ± 6.48. The incidence of Anxiety & Depression was high (45% and 36%) in moderate to severe disease with total prevalence of 54 % among participants in the study. Conclusion: Anxiety & depression is commonly prevalent in COPD patients. Female patients are found to have more psychological disturbance irrespective to their COPD severity. Psychological impairment must be carefully evaluated in patients having COPD.

Recherche d’indicateurs de ruissellement et des risques d’érosion au moyen de tests d’infiltrométrie dans le bassin versant du Rhéraya (Haut-Atlas occidental, Maroc)

L’objectif de ce travail est d’étudier les risques de ruissellement et d’érosion dans le bassin versant du Rhéraya (Haut-Atlas du Maroc) au moyen d’un irrigateur manuel à rampe sur 1 m2. Nous recherchons des indicateurs faciles à déterminer directement sur le terrain (états de surface du sol) ou à partir des tests en laboratoire (stabilité des agrégats, texture, matière organique), qui soient bien corrélés avec l’infiltrabilité et la turbidité issues des tests d’infiltrométrie. Pour les différents sols affleurant dans le bassin, les résultats ont mis en évidence une grande variabilité de l’infiltrabilité (de 1 à 70 mm.h‑1) et de turbidité des eaux de ruissellement (de 1,5 à 325 g.L‑1). La turbidité a pu être mesurée correctement grâce à la mise au point d’un nouveau dispositif de collecte des eaux de ruissellement de l’irrigateur. Bien que l’infiltrabilité et le ruissellement soient la résultante d’interactions entre toutes les caractéristiques physiques du sol, certaines apparaissent dominantes dans notre contexte. Nous montrons ainsi que l’infiltrabilité est déterminée principalement par la texture et l’ouverture de la surface du sol et que la turbidité est due essentiellement à la surface de sol nu exposée au ruissellement. Ces indicateurs cartographiables offrent la possibilité d’une spatialisation des risques d’érosion au niveau du bassin versant.The objective of this study was to investigate the risks of runoff and erosion of soils in the Rheraya catchment (High Atlas, Morocco) using infiltrometer tests on 1 m2 plots. We were looking for indicators that are easily obtained directly from field observations (ground surface features) or by laboratory tests (aggregate stability, soil texture and organic matter), and are well correlated with infiltrability and turbidity measurements from the infiltrometer tests. For the various soils present in the study area, the results show a large variability of infiltrability values (from 1 to 70 mm·h-1) and turbidity (from 1.5 to 325 g·L-1). The turbidity was correctly measured thanks to the development of a new runoff collector that doesn’t disturb the soil. Although runoff and erosion are the result of interactions among many parameters, some of these appear to be dominant in our case. The measurements show that the infiltrability was correlated mainly with texture and soil surface opening, whereas turbidity was related to the surface of bare soil that was exposed to runoff. These indicators may be used to determine the spatialization of potential erosion in the Rheraya catchment

Phytochemical and antioxidant potential of selected plants from Mianwali, Pakistan

Plants have been used since ancient times as an important source of biologically active substances. Specific activities of these plant extracts are generally linked to the presence of secondary metabolites together with their phenolic contents. Present study aimed at investigating the total phenolic and flavonoid contents, and antioxidant activity of selected plants from five different families. The total phenolic content was measured using Folin-Ciocalteu assay and total flavonoid content by aluminum chloride colorimetric method. The antioxidant capacity was estimated by phosphomolybdinium assay. Our findings indicates that total phenolic content for methanolic extracts ranged from 27.07 to 59.11 mg GAE/g DW, and total flavonoid content ranged from 38.37 to 124.23 mg QE/g DW, with an antioxidant activity ranging from 55.82 to 129.06 mg AAE/g DE. Following trend was shown in the assessment of total phenolic and flavonoid contents: Rhazya stricta>Cicer arietinum>Solanum melongena>Solanum surattense>Solanum nigrum>Withania sominifera>Sisymbrium irio>Withania coagulans>Raphanus sativus>Fagonia indica>Brassica napus. While the antioxidant capacity followed the trend: Cicer arietinum>Solanum nigrum>Withania coagulans>Rhazya stricta>Raphanus sativus>Solanum melongena>Withania sominifera>Solanum surratense>Fagonia indica>Brassica napus>Sisymbrium irio. It is also seen that both wild and cultivated plants have higher medicinal value, which can be linked to the phenolic and flavonoid content, and antioxidant potential. Findings of the study revealed that wild plants possess higher phenolic content compared to cultivated plants, whereas cultivated plants had higher antioxidant activity

Actinobacteria: Potential Candidate as Plant Growth Promoters

Plant growth enhancement using plant beneficial bacteria has been viewed in the sustainable agriculture as an alternative to chemical fertilizers. Actinobacteria, among the group of important plant-associated bacteria, have been widely studied for its plant growth promotion activities. Actinobacteria are considered as a limelight among agriculturists for their beneficial aspects toward plants. They are naturally occurring spore-forming bacteria inhabiting the soil and known for their plant growth-promoting and biocontrol properties. The mechanisms behind these activities include nitrogen fixation, phosphate solubilization, siderophore production, and other attributes such as antifungal production of metabolites, phytohormones, and volatile organic compound. All these activities not only enhance the plant growth but also provide resistance in plants to withstand unfavorable conditions of the environment. Hence, this chapter emphasizes on the plant growth traits of actinobacteria and how far it was studied for enhanced growth and bio-fortification