ABSTRACT
Objectives: This study was designed to determine the comparative efficacy of different scoring system in assessing the prognosis of critically ill patients
Methods:This was a retrospective study conducted in medical intensive care unit [MICU] and high dependency unit [HDU] Medical Unit III, Civil Hospital, from April 2012 to August 2012. All patients over age 16 years old who have fulfilled the criteria for MICU admission were included. Predictive mortality of APACHE II, SAP II and SOFA were calculated. Calibration and discrimination were used for validity of each scoring model
Results:A total of 96 patients with equal gender distribution were enrolled. The average APACHE II score in non-survivors [27.97+8.53] was higher than survivors [15.82+8.79] with statistically significant p value [<0.001]. The average SOFA score in non-survivors [9.68+4.88] was higher than survivors [5.63+3.63] with statistically significant p value [<0.001]. SAP II average score in non-survivors [53.71+19.05] was higher than survivors [30.18+16.24] with statistically significant p value [<0.001]
Conclusion:All three tested scoring models [APACHE II, SAP II and SOFA] would be accurate enough for a general description of our ICU patients. APACHE II has showed better calibration and discrimination power than SAP II and SOFA
ABSTRACT
Typhoid remain an increasing problem in Third world countries like Pakistan. A reliable, easy and affordable rapid diagnostic test is a need for our clinicians, many of whom consider Typhidot to be promising. Typhidot has been used as the only tool to diagnose typhoid fever by general practitioners and consultants despite its low sensitivity and specificity causing misdiagnosis and treatment. We therefore conducted this study to evaluate the sensitivity and specificity of Typhidot in patients with fever. A retrospective analysis of a total of 145 febrile patients was done. Blood culture and Typhidot along with other relevant investigations had been performed in each case. Sensitivity, specificity and the association of Typhidot to the diagnosis was found using SPSS v16.0. Out of 145 patients, 15 [10.3%] had positive blood culture for Salmonella typhi, 7 [4.8%] had positive culture for salmonella paratyphi and 94 [64.8%] had positive culture for other organisms. Twenty nine [20%] patients had negative culture results. Forty seven [32.4%] patients had only IgM positive on Typhidot, 7 [4.8%] had both IgM and IgG positive and 91 [62.8%] had both IgM and IgG negative. Amongst the 130 patients with diseases other than typhoid, 50 [38.5%] showed a positive Typhidot result. Amongst the 15 patients with typhoid, 11 [73.3%] showed a negative Typhidot result. The sensitivity of Typhidot was found to be 26.7% and the specificity was 61.5%. The Positive Predictive Value [PPV] was 7.4% and the Negative Predictive Value [NPV] was 87.9%. Even though Typhidot is rapid, easy and affordable, its use should be discouraged due to low sensitivity and specificity and insignificant [p=0.067] association to the disease
Subject(s)
Humans , Male , Female , Sensitivity and Specificity , Fever , Retrospective StudiesABSTRACT
To assess inpatient management of non-critically ill type 2 diabetics with different insulin regimen. We reviewed the medical records of all non-critically ill type 2 diabetic patients more than 18 years of age in medical department of civil hospital Karachi and Dow University of Health Sciences from January 2011 to December 2012. We collected the data from case records in data collection sheets that fulfill the inclusion criteria and divided the study subjects into three groups according to insulin regimen they received. A total of 416 patients were analyzed out of which 220 were male. Subjects were divided into three groups according to insulin regimen they received. Majority were put on sliding scale of insulin [44.7%], while 33.1% and 22.1% subjects received basal bolus and pre-mixed insulin regimen respectively. Patients treated with basal bolus regimen had greater improvement in glycaemic control with short duration of hospital stay as compared to other two groups. The mean hyperglycaemic events were higher in sliding scale group while mean hypoglycaemic events were higher in basal bolus group. In non-critically ill type 2 diabetic patients the basal bolus regimen is superior to sliding and pre-mixed insulin regimen. Sliding scale should be discouraged in non-critically ill type 2 diabetic patients
ABSTRACT
To determine major risk factors and management outcome of diabetic foot ulcers in order to prevent amputation. Cross-sectional descriptive study. Study was conducted at the Department of Medicine, Civil Hospital Karachi, from January 2005 to December 2006. One-hundred and sixteen consecutive diabetic patients, with foot ulcers of Wagner's grade 1 to 4 were assessed at baseline for demographic information, detailed history, neuropathy, peripheral pulses and frequency of diabetic complication. Glycemic control was determined on the basis of HbA1c levels. Appropriate medical and surgical treatments were carried out and patients were followed-up until healing or for 6 months as end point of study. Outcome was recorded as healed, incomplete healing and amputated. A majority of subjects had type 2 diabetes [95.7%] with male predominance [66%]. The mean age was 54.29 +/- 7.71 years. Most of the patients were overweight, hyperglycemic and had diabetes > 10 years duration. Neuropathic ulcers were found in 91 [78.4%] patients, while rest of the 25 [22.6%] had neuroischemic ulcers. Wound cultures revealed polymicrobial organisms. Foot ulcers of 89 [77.7%] patients healed without amputation and 17 [14.7%] patients had minor or major amputations. Long-duration of diabetes, poor glycemic control and type of foot ulcers had effect on prognosis [p<0.05]. Effective glycemic control, optimal wound care, aggressive medical management and timely surgical intervention may decrease disabling morbidity with better outcome of diabetic foot ulcer