Frequency and risk factors of frequent exacerbations of asthma in patients in a tertiary care hospital: a hospital-based comparative study

Objective: To determine the frequency of recurrent exacerbations in asthma patients and compare the risk factors for frequent and non-frequent exacerbations. Study Design: Cross-sectional study. Place and Duration of Study: KRL Hospital Islamabad from Jun to Dec 2016

Patients and Methods: Non-probability technique was used to sample two hundred and eighty one patients. Asthma exacerbations were defined by GINA guidelines. Frequent exacerbations were defined as two or more in the previous year. Data regarding demographics and risk factors were collected. Inhaler technique was checked. BMI and blood eosinophil levels were measured. SPSS 22 was used for data analysis

Results: Out of total 281 patients, frequent asthma exacerbations were observed in 143 [50.9%] patients. Female gender [p=0.00] and lower education [p=0.02] led to frequent exacerbations. Patients education about disease or treatment [p=0.03], URTI [p=0.00], allergen exposure [p=0.00], drug history [p=0.04], treatment step-II [p=0.00], medication non-compliance [p=0.00], incorrect inhaler technique [p=0.01], anxiety [p=0.01], previous ICU admission [p=0.02] and blood eosinophilia [p=0.00] were significantly associated with frequent exacerbations. Of these, independent predictors were patient education [p=0.02], URTI [p=0.00], allergen exposure [p=0.00], drug history [p=0.00], treatment step-II [p=0.03], medication non-compliance [p=0.02], anxiety [p=0.01] and eosinophilia [p=0.00]

Conclusion: Majority of our patients underwent frequent exacerbations. Risk factors found to be associated with frequent exacerbations were female gender, lower education, patient unawareness, URTI, allergen and drug exposure, treatment step-II, medication non-compliance, anxiety and blood eosinophilia

To determine correlation between biochemical parameters of nutritional status with disease severity in HCV related liver cirrhosis

Objective: To identify correlation between biochemical parameters of nutritional status with disease severity in HCV related liver cirrhosis in patients attending tertiary care hospital

Methods: Total 259 HCV related liver cirrhosis patients who attended the outpatient department of KRL Hospital, Islamabad from June 2016 to January 2018 were included in this crosssectional study. HCV status was confirmed with PCR. Cirrhosis was preestablished by ultrasound, while cirrhosis severity was gauged by CTP score. Biochemical parameters for nutrition status included serum albumin, creatinine, cholesterol, LDL, HDL, triglycerides, hemoglobin, ferritin, sodium, potassium, magnesium and calcium. Other demographic and clinical data were also recorded

Results: The mean age of patients was 58.73 +/- 6.04 years with 57.1% being males. The average BMI was 22.72 +/- 1.69 kg/m[2]. Majority patients i.e. 123 [47.5%] belonged to CTP-A, 67 [25.9%] were in CTP-B and 69 [26.6%] in CTP-C groups. Significant negative correlations of cirrhosis severity were established with BMI, albumin, creatinine, cholesterol, LDL, TG, HDL, hemoglobin, sodium and magnesium indicative of malnutrition. Analysis of biochemical parameters amongst individual cirrhosis groups revealed significant negative correlation across the same factors in group CTP-C, while CTP-A correlated positively with these parameters. The only significant correlation found in CTP-B was with albumin, HDL, hemoglobin, sodium and magnesium

Conclusion: Considering limitations of standard ways alone to assess malnutrition in liver cirrhosis, biochemical parameters are valid to aid in diagnosing malnutrition

Intralobar bronchopulmonary sequestration with large aberrant vessel presenting as recurrent pneumonias

Bronchopulmonary sequestration is a rare congenital malformation of the lower respiratory tract comprising of a nonfunctioning lung tissue mass that lacks normal communication with the tracheobronchial tree. The diagnosis may be easily missed as many of the symptoms of bronchopulmonary sequestration overlap with that of other pulmonary diseases. Bronchopulmonary sequestration can be complicated by recurrent infections, hemorrhage and malignant transformation and, therefore, needs to be timely diagnosed and resected to decrease both morbidity and mortality. A high degree of suspicion in the differential diagnosis helps diagnose the positive cases. The parenchymal abnormalities associated with bronchopulmonary sequestration are best visualized using computed tomography, although their appearance is variable. We report the case of a 14 years old boy with intralobar bronchopulmonary sequestration with the sole manifestation of recurrent pneumonias

prospective study of factors predicting postoperative pulmonary complications [PPC] in patients undergoing noncardiothoracic surgery under general anaesthsia in a developing country

Post-operative pulmonary complications after non-cardiothoracic surgery are common and can adversely affect morbidity, mortality and length of hospital stay. Knowledge as regards factors predicting postoperative pulmonary complications in our local setting is imperfect. To study factors predicting post-operative pulmonary complications in developing countries. Data of consecutive 404 patients undergoing non-cardiothoracic surgery under general anesthesia with tracheal intubation was collected prospectively from Jan 2009 to Dec 2010. Chi-square was used for univariate analysis. Multivariate analysis was conducted using forward stepwise logistic regression. The mean age was 36 +/- 18 years with slight male predominence [54% vs 46%]. 22% [n=89] were smokers and the mean Body Mass Index was 23 +/- 4.5 kg/m2 with 35% [n=141] overweight and obese. 5% [n=20] of subjects had pre-existing chronic lung conditions while 23% [n=92] had non-pulmonary chronic conditions. 70% [n=282] of the surgeries were done electively and the mean duration of anesthesia was 78 +/- 44 minutes. The overall postoperative pulmonary complications rate was 8% [n=31] with atelactasis [48%, n=16] followed by bronchospasm [25%, n=8] and pneumonia [16%, n=5] being the commonest complications. The duration of hospital stay was significantly longer [11 +/- 9 days, p=0.00] in patients with post-operative pulmonary complications and 29% [n=9] of them required mechanical ventilation. Logistic Regression analysis identified premorbid chronic chest conditions, emergency surgery and prolonged duration of anesthesia as significant predictors of post-operative pulmonary complications while age, gender, Body Mass Index, smoking history and non-pulmonary premorbids were insignificant in this regard. Post-operative pulmonary complications after non-cardiothoracic surgery are common and lead to increased morbidity and prolonged hospital stay in our setting. We identified pre-existing chest disease, prolonged anesthesia and emergency surgery as significant predictors of post-operative pulmonary complications

audit of fibreoptic bronchoscopy service at KRL Hospital Islamabad

Fibreoptic bronchoscopy is an important diagnostic and therapeutic tool for a wide spectrum of thoracic disorders in interventional pulmonology. The British Thoracic Society published comprehensive guidelines in 2001 on the use of fibreoptic bronchoscopy. The purpose of this audit was to evaluate the performance of our bronchoscopy service in the light of these guidelines with a view to identify areas for further improvement. In this prospective audit a series of 50 consecutive bronchoscopies performed at KRL Hospital Islamabad was studied. For each examination we recorded patient demographics, indication of the procedure, radiological information, pre-procedure evaluation by the pulmonologist, the bronchoscopic appearance and histopathological and microbiological findings, where indicated, and any untoward events associated with the procedure. The mean age was 48.8yrs [SD +/- 17.9] with male predominance [M 78%, F 22%].The main indication of the procedure was sampling of bronchial washings for microbiological assessment [n=25; 50%], followed by evaluation of suspected malignancy[n=15; 30%], hemoptysis [n=9; 18%] and persistent cough [n=1; 2%]. Chest X-rays were abnormal in majority of patients [n=46; 92%] and radiological appearance of pulmonary mass lesion was seen in 24% [n=11] of abnormal CXRs. Thirty percent [n=15] of bronchoscopies were abnormal with 93% diagnostic yield of specimens obtained for histopathological assessment. A low diagnostic yield of 24% was observed in cases of specimens collected for microbiological assessment. No major procedure related complications were observed during or after the procedures. Fibreoptic bronchoscopy is a safe procedure provided all basic precautions are taken. The procedure should be considered in all patients with a mass lesion on CXR. Although thehistopathological diagnostic yield was well above the recommended standard in cases of endoscopically visible malignancy but a low diagnostic microbiological yield was observed especiallyin cases being evaluated for tuberculosis. The latter may be attributed to less selective study population and sub-optimal microbiological service. Hence the audit was useful in identifying an area for furtherimprovement. In a developing country, like Pakistan, gender bias is rampant even when it comes to access the healthcare facilities