Sociodemographic, clinical characteristics, and outcomes of influenza pneumonia patients admitted in a tertiary care hospital in Karachi, Pakistan: Findings from a cross-sectional study

Objective: To determine the sociodemographic, clinical characteristics, and outcomes of influenza pneumonia patients in tertiary care hospital, Karachi Pakistan.Study design: A cross-sectional study.Place and duration of study: The Aga Khan University Hospital Karachi Pakistan from January 2013 to December 2018. Methodology: All adult patients who were older than 18 years and suspected to have viral pneumonia were included in the study. Data were abstracted on 105 patients and were entered on preformed proforma after reviewing the files of patients.Results: Ninety-four (89.5%) patients were influenza positive and 15.2% (n=16) had been vaccinated. Around 92.4% (n=97), 81.9% (n=86) and 61.9% (n=65) patients had cough, fever and shortness of breath, respectively; and 63.8% (n=67), 16.2% (n=17), and 2.9% (n=3) patients had consolidation, nodules, and cavitation, respectively. Almost 91.4% (n=96) patients were given treatment and discharged home; however, 7.6% (n=8) died. Procalcitonin, creatinine, HCO3 , lactate, and bilirubin level were increased in 2nd group (mortality group) after 48 hours; however, the results were only significant for HCO3 (p = 0.035).Conclusion: Influenza pneumonia is very common in our population and older people are more likely to be affected by this disease. Patients can be prevented from adverse outcomes and complications, if diagnosed and treated in time

Cyclosporin in dermatology: A practical compendium

Cyclosporine A belongs to calcineurin inhibitor family, which has the ability to selectively suppress T-cells. Owing to its immune-modulatory effects, it had been in use for graft versus host diseases and organ transplant rejection for many years, but in dermatology, it was first approved for use in 1997 in the treatment of psoriasis. Other off label indications for skin diseases includes atopic dermatitis, chronic spontaneous urticaria, lichen planus, pyoderma gangrenosum, alopecia areata, granuloma annulare and several others. A thorough search of Medline-PubMed database, Google Scholar and Uptodate was performed for evidence-based and peer-reviewed information. We have summarized the use of cyclosporine in dermatological diseases with respect to its, dosage, safety considerations and monitoring guidelines. Furthermore, brief overview of its pharmacology, drug interactions, use in pregnancy and lactation has been discussed. Despite of its common adverse effects like nephrotoxicity and hypertension, cyclosporine offers good safety profile when used in skin diseases. Decision to start cyclosporine therapy is individualized and it should be based on analysis of risk versus benefit. Nevertheless, CYA is preferred over other immunosuppressants in dermatology because of early therapeutic response and less myelosupression. This article offers concise but detailed summary of this beneficial immune-suppressive agent in skin diseases

A simple discharge criteria for transfer of patients from intermediate care to general care: a prospective observational study

Objective: To develop and apply a simple criterion for transfer of patients from intermediate care to general care. Method: The prospective study was conducted in the intermediate care units of Aga Khan University Hospital, Karachi, from July to December 2018. A discharge criterion for transfer of patients from intermediate care to general care was developed according to which patients with vital signs and Glasgow Coma Scale score within a preset range were considered stable enough for transfer from intermediate care to general care. After labelling the patients on the basis of the criterion, it was determined on the following day which patients remained stable enough for transferred to general care, and which patients became unstable. Data was analysed using SPSS 19. Results: Of the 49 patients with mean age 63.0±16.9 years, 28(57.1%) were males. Overall, 43(87.7%) patients remained stable on the next day. Of them, 33(67.3%) patients were transferred out from intermediate care on the subsequent day, while 8(16.3%) were not transferred out due to primary physician’s decision, 1(2%) due to heparin infusion, and 1(2%) due to family request. The condition of the remaining 6(12%) patients deteriorated. Conclusions: A simple discharge criterion is proposed for intermediate care solely based on clinical parameters. Significant majority of the patients remained stable and were transferred out of intermediate care. Key Words: Criteria, Discharge, Intermediate care, Simple, Throughput

Quality of life index in patients with vitiligo

Objective: To ascertain the quality of life (QoL) impairment among the Pakistani population with vitiligo and to determine the relationship between sociodemographic and clinical characteristics. Study design: Cross-sectional study. Place and Duration of the Study: Dermatology Outpatients at the Aga Khan University in collaboration with outpatients of seven tertiary care hospitals of Sindh, Punjab, KPK, Balochistan, and AJK to collect data from March 2015 to April 2019. Methodology: All clinically diagnosed patients of vitiligo, who signed consent and assent forms, were included in the study. A validated 25-item, QoL scale for vitiligo was used. Socio-economic status of the patients, clinical assessment of the disease and patients\u27 engagement in social and domestic lives was noted. Results: Five hundred and seventy-three patients were enrolled in the study, having mean age 29.8 ± 16.2 years. In 306 (53.4%) males and 267 (46.65%) females; 21.8% were below 18 years. Mean vitiligo QoL index was 38.4 ± 11.8. Patients of vitiligo with disease duration 5-10 years, those affected on exposed parts, more than five body sites, rapidly progressing disease and of female gender had a higher impairment of quality of life. These scores were found significantly higher as compared to other levels of these parameters (p\u3c0.05). Conclusion: Patients with vitiligo experience low self-esteem. The disease adversely affects their quality of life. The authors recommend the use of disease-specific instruments to assess the quality of life which enables the treating physician to devise best possible management plan individuall

Quality of life index in patients with vitiligo

Objective: To ascertain the quality of life (QoL) impairment among the Pakistani population with vitiligo and to determine the relationship between sociodemographic and clinical characteristics. Study design: Cross-sectional study. Place and Duration of the Study: Dermatology Outpatients at the Aga Khan University in collaboration with outpatients of seven tertiary care hospitals of Sindh, Punjab, KPK, Balochistan, and AJK to collect data from March 2015 to April 2019. Methodology: All clinically diagnosed patients of vitiligo, who signed consent and assent forms, were included in the study. A validated 25-item, QoL scale for vitiligo was used. Socio-economic status of the patients, clinical assessment of the disease and patients\u27 engagement in social and domestic lives was noted. Results: Five hundred and seventy-three patients were enrolled in the study, having mean age 29.8 ± 16.2 years. In 306 (53.4%) males and 267 (46.65%) females; 21.8% were below 18 years. Mean vitiligo QoL index was 38.4 ± 11.8. Patients of vitiligo with disease duration 5-10 years, those affected on exposed parts, more than five body sites, rapidly progressing disease and of female gender had a higher impairment of quality of life. These scores were found significantly higher as compared to other levels of these parameters (p\u3c0.05). Conclusion: Patients with vitiligo experience low self-esteem. The disease adversely affects their quality of life. The authors recommend the use of disease-specific instruments to assess the quality of life which enables the treating physician to devise best possible management plan individuall