Role of vitamin D in reducing number of acute exacerbations in chronic obstructive pulmonary disease [COPD] patients

Background and Objective: Chronic obstructive pulmonary disease [COPD] is characterized by chronic incompletely reversible poor airflow and air trapping and usually this debilitating disorder limits the outside activities of the patients depriving them of sunlight which is a rich source of Vitamin D. The objective of this study was to determine the effect of vitamin D supplementation in reducing number of acute exacerbation in COPD patients

Methods: This randomized control trial was conducted at East Medical Ward Mayo Hospital Lahore from January to December 2015 as exacerbations of COPD are season dependent. Diagnosis was confirmed by performing Pulmonary Function Tests [PFTs]. Basic demographical information was obtained and baseline PFTs of the patient was done. Only Group A patients was treated with oral vitamin D intake of 2000 IU daily for 6 months. Vitamin D level was measured at 0, 2, 4, and 6 months and exacerbation of COPD, FEV1 and FVC was measured weekly. Both the groups were given standard treatment for exacerbation of COPD. Spirometry was repeated at each visit. Blood samples were collected every 2 months for vitamin D. Supplementation was stopped if vitamin D level exceeded 100ng/ml

Results: The mean age of the patients was 46.28 +/- 8.83 years, the male to female ratio was 1.8:1. The mean 25[OH] level at baseline was 24.08 +/- 2.58 and at 6th month was 29.60 +/- 8.74. The mean FVC at baseline was 77.83 +/- 5.49 and at 6th month was 91.34 +/- 5.52. The exacerbation at baseline was present in all 120[100%] patients and at 6th month was reduced to 4[3.3%]

Conclusion: Vitamin D supplementation has significant effect in reducing number of acute exacerbation in COPD patients when it is given for prolonged period

Clinical audit of dengue related deaths in 2011 at mayo hospital lahore pakistan

Background and Objective: Dengue infection has evolved into an epidemic during last few years in Pakistan and has been associated with poor outcomes. Literature with respect to mortality risk factors in Dengue infection is not sufficient. This compelled us to conduct this study to find out major contributory factors to death in patients with dengue viral infection at one of Asia's ancient hospital setting with an aim to recognize complications at earliest and improve case management in future

Methods: A retrospective observational study of 95 adult dengue deaths was performed at Mayo Hospital Lahore from July 1st 2011 to 31st December 2011 during a major dengue epidemic. Patients who tested positive by dengue IgM in the presence of acute fever fulfilling the World Health Organization criteria for Dengue Fever, Dengue Hemorrhagic Fever or Dengue Shock Syndrome and died within same setting, were included. Data regarding demographic profile, clinical and laboratory parameters along with treatment details were obtained and analysed. All records examined were anonymized

Results: Median age was 36 years [range13-80 years] among 95 deaths due to Dengue. Male gender comprised 60 [63.1%]. Co-morbidities existed in 74 [77.9%] with hypertension in 21 [22.1%] diabetes in 11 [11.58%], liver disease in 9 [9.47%] and ischemic heart disease in 8[8.4%] cases. Patients presented at second day of fever for admission [range 1-8 days] and death occurred at a median of 4 days [range 30 minutes to 23 days]. Hospital stay was for less than a week for seventy nine [83.2%] patients and 16 [16.8%] were admitted for more than 7 days, Critical care was required in 67[71%]. Severe hepatitis occurred in 41 [43.1%], acute renal impairment occurred in 32 [33.7%] and disseminated intravascular coagulation in 16 [16.8%]. Deaths were due to prolonged shock 49 [51.5%] fluid overload 46 [48.4%] and massive bleeding 18[19%] leading to organ failure

Conclusion: Decompensated shock complicated by either massive plasma leakage, frank bleeding, multi organ failure or deranged clotting profile results in enhanced mortality in Dengue infection. Co-morbidities especially Diabetes are poor prognostic factors in predicting Dengue mortality

Profile of hepatic involvement in dengue infections in adult Pakistani population

Objectives: To estimate the range of hepatic involvement in dengue infections by assessing clinical and biochemical profile of adult dengue infected patients

Methods: Serologically confirmed 220 adult cases of dengue infections admitted to Mayo hospital from June 2013 to November 2013 were classified as having dengue fever, dengue haemorragic fever and dengue shock syndrome. The frequency and range of bilirubin, liver enzymes derangement and presence of liver enlargement in each group was calculated and further stratified according to age and gender. Patients with positive viral serology, chronic liver disease, malaria and typhoid were excluded from the study

Results: About 60% of DHF patients had hepatomegaly compared to 40% of DF patients. Liver dysfunction was more common in DF compared to DHF [38.15 vs 18.6%]. Hyperbilirubinemia was noted in 40 [18.2%] patients, 28 [12.7%] in DF and 12[5.5%] in DHF. The mean serum bilirubin was higher in DHF [0.87+0.33] compared to DF [0.74+0.27]. Bilirubin was higher in male patients and in younger [<20 years] age group. ALT was elevated more frequently in male patients in age group of 31-40 years and in DF patients as compared to DHF [72[32.7% vs 40[18.2%]]. The mean serum ALT level was 103.7 U/l in DHF and 69.2U/I in DF. AST was raised in all DHF patients as compared to DF in which 40% patients had normal AST levels. Alkaline Phosphate was high in all DHF patients with a mean of 278.7. It was raised in most of the DF patients as well and majority of patients were in age group of 31-40 years

Conclusion: Liver involvement is very common in dengue infections and is not limited to elevation of transaminases only. Bilirubin and Alkaline phosphatase are also raised in considerable number of patients. Therefore in adults with fever, jaundice, hepatomegaly and altered liver function tests, the diagnosis of dengue infection should be strongly considered in areas where dengue infection is endemic

Unhappy doctors in Pakistan: what are the causes and what can be done?

To determine if the general perception of doctors being unhappy is true as well as to explore the underlying causes for this phenomena. This is a cross sectional study that was conducted over a six months period in two tertiary care hospitals in Lahore. Data was collected by using a structured questionnaire. Demographic information and data assessing perception of overall physicians being unhappy in Pakistan, and their own personal level of satisfaction in life was collected. Possible reasons for unhappiness among doctors from a list of factors was also explored. Finally the respondents were asked about their intentions for near future of remaining/ leaving Pakistan. The data was analyzed by using the statistical package for the social sciences [SPSS version 17]. Six hundred and one [49% males] with the mean age of 28 years [s.d 5.95] participated in a self-reported survey. Majority of the participants [393; 65%] were junior doctors. Fifty nine percent of respondents believe that overall Physicians in Pakistan are unhappy. When asked directly about their own level of unhappiness, respondents gave almost equivocal reply [43% dissatisfied vs 42% satisfied]. Low pay [87%], increase workload [73%], no positive feedback [70%], job insecurity [64%] and poor mutual support [47%] being the most significant causes responsible for this unhappiness. High proportion of doctors [55%] would prefer to be in any other country than Pakistan. This study demonstrated that unhappy doctors are a worldwide phenomenon, Pakistani Doctors being no exception. High proportion of doctors intending to leave Pakistan is a source of concern for the health services. We need to accept the causes and take steps to address the issues identified