Visceral leishmaniasis; validity of polymerase chain reaction in the diagnosis

Leishmaniasis is a disease caused by protozoan parasite of genus Leishmania which is transmitted through bites of infected sand flies. It has been reported that Polymerase chain reaction [PCR] is more sensitive and specific test for the diagnosis of visceral leishmaniasis than bone marrow examination. This recent study is a renewed effort to validate the role of PCR in the diagnosis of visceral leishmaniasis. The objective of this study was to determine the sensitivity and specificity of PCR in the diagnosis of visceral leishmaniasis. 25 March 2009 to 24th March 2010. Armed forces institute of pathology, Rawalpindi. Cross sectional [Validation] study. A total number of 59 patients of visceral leishmanaisis diagnosed on bone marrow examination with equal number of negative controls were studied. The subjects were tested for the presence of visceral leishmaniasis by polymerase chain reaction. All the 59 patients were also found to be positive for visceral leishmaniasis by PCR. None of the negative control was positive on PCR. The study validates that PCR is equally sensitive and specific test to bone marrow examination in the diagnosis of visceral leishmaniasis

Acute respiratory failure in Pakistani patients: Risk factors associated with mortality

To assess the outcome and risk factors associated with mortality in patients with acute respiratory failure [ARF]. Observational study. The Aga Khan University Hospital, Karachi, between January 1997 and June 2001. All adult patients admitted with a medical cause of acute respiratory failure were reviewed. The primary outcome measure was mortality and secondary outcome measures were factors associated with mortality in ARF. Multiple logistic regression analysis was used to identify the independent risk factors for mortality. A total of 270 patients were admitted with ARF. Hypercapnic respiratory failure was seen in 186 [69%] and hypoxemic in 84 [31%] cases. Pneumonia and COPD exacerbation were the most common underlying causes of ARF. Ventilator support was required in 93 [34.4%] patients. Hospital mortality was 28%. Chronic renal failure, malignancy, hypokalemia, severe acidosis [pH <7.25], septicemia and ARDS independently correlated with mortality. Mortality rate increased sharply [84%] with the presence of three or more risk factors. Acute respiratory failure has a high mortality rate [28%]. Development of ARDS or septicemia was associated with high mortality. Presence of more than one risk factor significantly increased the mortality rate

Knowledge, Attitude and misconceptions regarding tuberculosis in Pakistani patients

To assess knowledge of patients with tuberculosis; about their disease and misconceptions regarding TB. A cross sectional study was conducted at Out-patient clinics of two teaching hospitals [private and public] in Karachi, Pakistan. A questionnaire was filled for the purpose. A total of 170 patients were interviewed, 112 from private and 58 from a public sector hospital. Cough, fever, bloody sputum and chest pain were recognized as the common symptoms of TB. Eleven [7%] patients thought TB was not an infectious disease and 18 [10.6%] did not consider it a preventable disease. Contaminated food was considered the source of infection by 81 [47.6%] and 96 [57%] considered emotional trauma/stress the causative agent of TB. No counseling about preventing spread was received by 81 [50%] patients and 97 [57%] considered separating dishes as an important means of preventing spread. Thirty one [18%] patients would have discontinued their medications following relief of symptoms. Thirty nine [23%] of the respondents thought that TB could lead to infertility and 66 [38.8%] believed that there were reduced chances of getting married following infection. Misconceptions concerning TB are common in Pakistani patients. Lack of knowledge on Tuberculosis is alarming

Thrombocytopenia in critically ill surgical patients; a study evaluating attributable patient's mortality and transfusion requirement

Thrombocytopenia is a well known complication in the surgical intensive care unit [ICU] patients. The influence of thrombocytopenia on patient`s mortality is difficult to assess. Thrombocytopenia results in increased mortality and transfusion requirement of platelets and other blood products, has not been confirmed by previous studies. We performed a case control study in surgical intensive care unit of Combined Military Hospital Rawalpindi in which 119 critically ill surgical patients developed thrombocytopenia of less than 50x10e9 platelets/L. These patients were carefully matched with control patients for the severity of underlying disease and important variables. Purpose of study was to evaluate attributable mortality and transfusion requirement in thrombocytopenic patients at that unit.. Fifty-two [44%] cases died versus forty [33%] control patients. Eighty one [76%] matched pairs had a concordant outcome and in 25% of those pairs, the cases died [exact binomial probabilities 0.036]. The estimated at tributable mortality rate was 18.4% [95% confidence interval 3.12-11.8] and the estimated odds ratio was 2.6 [95% confidence interval 1.02-7.10]. The estimated attributable transfusion requirement was 23% [95% confidence interval 5.3-43.5] and the estimated odds ratio was 1.51. This study suggests that thrombocytopenia of less than 50x10e9/L seems to be a marker of severity the illness and increases risk of death. Thrombocytopenia also leads to more blood product consumption

Risk factors associated with development of ventilator associated pneummonia

To assess the risk factors associated with development of ventilator associated pneumonia [VAP]. A case control study. Intensive Care Unit [ICU] at the Aga Khan University Hospital, Karachi, between January 1999 and June 2000. All patients with assisted mechanical ventilation were assessed for the development of VAP. Risk factors associated with development of VAP were determined. Adult patients who developed pneumonia, 48 hours after ventilation, were called cases while those who did not develop pneumonia were called controls. Seventy [28%] out of 250 mechanically ventilated patients developed VAP [rate of VAP was 26 cases per 1000 ventilator days]. Shock during first 48 hours of ventilation [odds ratio [OR], 5.95; 95% confidence interval [CI], 2.83-12.52], transport out of ICU during mechanical ventilation [OR, 6.0; 95% CI, 2.92-12.37], re-intubation [OR, 4.23; 95% CI, 2.53-9.85], prior episode of aspiration of gastric content [OR, 3.07; 95% CI, 1.35-7.01], and use of antibiotics prior to intubation [OR,2.55; 95% CI, 1.20-5.41] were found to be independently associated with a higher risk of developing VAP. Gram negative organisms and Staphylococcus aureus were responsible for over 90% of cases. Patients with VAP had higher crude mortality rate [57.1%] compared with controls [32.2%]. Ventilator associated pneumonia is associated with a high mortality. This study has identified risk factors associated with VAP

Knowledge regarding management of tuberculosis among general practitioners in northern areas of pakistan

To assess the knowledge of General Practitioners [GPs] in NWFP and northern areas of Pakistan regarding diagnosis and management of tuberculosis. A cross-sectional survey of general practitioners [GPs] from North West Frontier Province [NWFP] and northern areas of Pakistan was done. The sampling strategy was convenience sampling. The data was collected on a structured questionnaire after taking verbal consent. Out of 88 GPs 43% regarded sputum microscopy and 22% chest radiograph as confirmatory tests for the diagnosis of pulmonary TB. During follow up of pulmonary TB patients, 32% doctors considered chest radiograph as the best investigation while sputum microscopy was chosen by only 28%. Eighty seven percent of GPs correctly identified TB as a droplet infection but 6% considered sexual contact to be the main mode of spread of this disease. Two third of the prescriptions, written for a 60 kg man with newly diagnosed smear-positive pulmonary TB, were not in line with national guidelines. Only 3% of the GPs knew all the five components of DOTS. Severe deficiencies were seen in the management of TB by GPs of Northern areas of Pakistan. National TB control Program must take appropriate measures to educate and train the GPs in TB management. Without involving the GPs, TB control will remain a problem in Pakistan

Chronic pulmonary Thromboembolism

Chronic pulmonary thromboembolism is a rare but treatable cause of pulmonary hypertension. We are describing two patients with limited mobility and dyspnoea. Neither of the patients had clinical evidence of deep vein thrombosis. A high level of clinical suspicion is required for the diagnosis. Spiral CT scan establishes the diagnosis avoiding the need for pulmonary angiography. Surgical endarterectomy is the treatment of choice. Life-long anticoagulation therapy is recommended for patients in whom surgery cannot be performed. Untreated, the condition carries a high mortality