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 the WHO Retreatment Regimen with the Six Drugs Regimen in Patients of Pulmonary Tuberculosis

Objective: To compare the frequency of early response of WHO retreatment regimen with the six drugs regimen in pulmonary tuberculosis retreatment Category patients.Study design: Randomized control trial (RCT)Place and Duration: Chest Department, Fauji Foundation Hospital Rawalpindi from 22nd May 2016 to 22nd November 2016.Methodology: Patients who had previously been treated for pulmonary tuberculosis for at least 1 month duration and is a failure, relapse or defaulter case presenting in Fauji Foundation Hospital Rawalpindi, both indoor and outdoor were enrolled in the study. Patients were randomized by lottery method to either of the two treatment arms; WHO retreatment regimen or six drug formulations. Clinical features were documented, baseline investigations, AFB smear, Gene Xpert and AFB Culture were sent. Drugs were given on once daily dosage. AFB smear and AFB culture were repeated at 3rd month of treatment. They had a regular follow up in Chest OPD and had monthly visits to the ophthalmology department for visual acuity, fundoscopy and to ENT department for audiometry. Their chest X-ray was done baseline then 3 months. Blood complete picture and liver function tests, serum uric acid, renal function tests were performed baseline, at 2 weeks then 3 months. After their treatment was completed they were followed to look for relapse.Results: Total 490 patients were included according to the inclusion criteria of the study. Patients were divided into two equal groups. Mean age (years) in the study was 40.00+21.10. There were 33 (6.7) male and 457 (93.3) female patients whereas the frequency of early response of WHO retreatment regimen with the six drugs regimen in pulmonary tuberculosis retreatment category patients was 187 (76.3) and 211 (86.1) respectively which was statistically significant (p-value 0.000).Conclusion: The study concludes that six drug regimen was superior to WHO standard regimen in the success rate of pulmonary tuberculosis retreatment category patients which useful in bringing new facts regarding management of retreatment category patient in our country as well as worldwide because of the limited research was done on this category of 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.

Comparison of the WHO Retreatment Regimen with the Six Drugs Regimen in Patients of Pulmonary Tuberculosis

Objective: To compare the frequency of early response of WHO retreatment regimen with the six drugs regimen in pulmonary tuberculosis retreatment Category patients.Study design: Randomized control trial (RCT)Place and Duration: Chest Department, Fauji Foundation Hospital Rawalpindi from 22nd May 2016 to 22nd November 2016.Methodology: Patients who had previously been treated for pulmonary tuberculosis for at least 1 month duration and is a failure, relapse or defaulter case presenting in Fauji Foundation Hospital Rawalpindi, both indoor and outdoor were enrolled in the study. Patients were randomized by lottery method to either of the two treatment arms; WHO retreatment regimen or six drug formulations. Clinical features were documented, baseline investigations, AFB smear, Gene Xpert and AFB Culture were sent. Drugs were given on once daily dosage. AFB smear and AFB culture were repeated at 3rd month of treatment. They had a regular follow up in Chest OPD and had monthly visits to the ophthalmology department for visual acuity, fundoscopy and to ENT department for audiometry. Their chest X-ray was done baseline then 3 months. Blood complete picture and liver function tests, serum uric acid, renal function tests were performed baseline, at 2 weeks then 3 months. After their treatment was completed they were followed to look for relapse.Results: Total 490 patients were included according to the inclusion criteria of the study. Patients were divided into two equal groups. Mean age (years) in the study was 40.00+21.10. There were 33 (6.7) male and 457 (93.3) female patients whereas the frequency of early response of WHO retreatment regimen with the six drugs regimen in pulmonary tuberculosis retreatment category patients was 187 (76.3) and 211 (86.1) respectively which was statistically significant (p-value 0.000).Conclusion: The study concludes that six drug regimen was superior to WHO standard regimen in the success rate of pulmonary tuberculosis retreatment category patients which useful in bringing new facts regarding management of retreatment category patient in our country as well as worldwide because of the limited research was done on this category of tuberculosis

Toward an Ethical Understanding of the Controversial Technology of Online Reverse Auctions

case study, narrative, online reverse auctions (ORAs), storytelling, unethical behavior,