Severity of COVID-19 in bacillus Calmette-Guérin vaccinated population

Purpose@#Considering the cross-protection reported for bacillus Calmette-Guérin (BCG) vaccination on viral respiratory infections, it has been proposed that it could reduce the severity of coronavirus disease 2019 (COVID-19). The objective of the current study is to investigate the association between the severity of COVID-19 with prior BCG vaccination in adult patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. @*Materials and Methods@#Adult patients (18 years or above) with positive SARS-CoV-2 polymerase chain reaction admitted in July 2020 were included in this cross-sectional study. Patients were classified into non-severe, severe, and critical diseases. History of prior BCG vaccination and the presence of a BCG vaccination scar were recorded. @*Results@#Out of 103 patients, 64 patients with prior history of BCG vaccinations were compared with 39 patients without BCG vaccination in childhood. The median age was 55 years and 64 years in BCG vaccinated & non-BCG vaccinated patients (p-value=0.002). There was male predominance in both groups and frequent comorbid illnesses were hypertension and diabetes mellitus. Severe COVID-19 was found in 91 patients (88.3%) followed by non-severe disease and critical diseases i.e., 7 (6.8%) and 5 (4.9%) patients, respectively. No association of prior BCG vaccination with disease severity of COVID-19 was found in this study and mortality was 8.7%. Out of nine patients who expired only 2 (22.2%) had a prior history of BCG vaccination (p-value=0.01). Secondary infections were present in 26 patients and the majority had pneumonia. @*Conclusion@#The BCG vaccine has no impact on the severity of COVID-19 but could have a protective role with a low mortality rate in already infected patients.

New Oral Anticoagulants versus Warfarin for Cerebral Venous Thrombosis: A Multi-Center, Observational Study / 대한뇌졸중학회지

No abstract available.

Helicobacter pylori outer membrane protein Q genotypes and their susceptibility to anti-adhesive phytotherapeutic agents / 中西医结合学报

<p><b>OBJECTIVE</b>Helicobacter pylori is a Gram-negative organism. Its outer membrane protein Q (HopQ) mediates host-pathogen interactions; HopQ genotypes 1 and 2 are found associating with gastroduodenal pathologies. The authors measured the anti-adhesion effects of the extracts of Abelmoschus esculentus, Zingiber officinale, Trachyspermum ammi, Glycyrrhiza glabra, Curcuma longa and Capsicum annum against HopQ genotypes and H. pylori cytotoxin-associated gene A (CagA).</p><p><b>METHODS</b>DNA was extracted by polymerase chain reaction of the HopQ genotypes (i.e., type 1, type 2 and CagA) from 115 H. pylori strains. The effect of the extracts from selected dietary ingredients was determined using a gastric adenocarcinoma cell line and a quantitative DNA fragmentation assay. The anti-adhesive effect of these extracts on H. pylori was tested using an anti-adhesion analysis.</p><p><b>RESULTS</b>C. annum, C. longa and A. esculentus showed prominent anti-adhesion effects with resultant values of 17.3% ± 2.9%, 14.6% ± 3.7%, 13.8% ± 3.6%, respectively, against HopQ type 1 and 13.1% ± 1.7%, 12.1% ± 2%, 11.1% ± 1.6%, respectively, against HopQ type 2. C. longa (93%), C. annum (89%) and A. esculentus (75%) had better anti-adhesive activity against H. pylori with HopQ type 1 compared to HopQ type 2 with respective values of 70%, 64% and 51%. Extracts of C. annum (14.7% ± 4.1%), A. esculentus (12.3% ± 4.1%) and Z. officinale (8.4% ± 2.8%) had an anti-adhesion effect against CagA-positive H. pylori strains compared to CagA-negative strains.</p><p><b>CONCLUSION</b>The anti-adhesion properties of the tested phytotherapeutic dietary ingredients were varied with HopQ genotypes. HopQ type 1 was found to be more sensitive to extracts of C. annum, C. longa and A. esculentus compared to the HopQ type 2 genotype.</p>

Impact of chronic kidney disease on short term clinical outcomes of patients undergoing coronary revascularization

When compared with medical treatment, coronary revascularization is an effective tool to restore cardiac functions in patients suffering from chronic kidney disease but at times it is associated with poor clinical outcome. This study was done to determine the short term clinical outcome in chronic kidney disease patients undergoing coronary revascularization i.e coronary artery bypass graft or percutaneous coronary intervention. Cross sectional study, conducted at coronary revascularization center of Aga Khan University Hospital, Karachi between January 2012 and August 2013. All chronic kidney disease patients were enrolled and grouped into mild, moderate and severe kidney disease cases according to creatinine clearance estimated by the Cockroft-Gault equation. The primary outcome was in-hospital major adverse cardiac cerebral events, including myocardial infarction, stroke, and death. A total of 159 patients were included in the study [122 males and 37 females] whose mean age was 65 +/- 9.6 years. Based on the creatinine clearance, 59 cases had severe, 79 moderate and 21 mild chronic kidney disease. Before revascularization, 20 patients with severe, 3 patients with moderate and 2 patients with mild kidney disease were on long term hemodialysis. In the moderate to severe group, 79 patients underwent percutaneous coronary intervention whereas, in the mild group, 15 patients underwent coronary artery bypass graft. Though the rate of failed PCI [uncrossable total occlusions of coronary artery] was similar among the 3 groups but complete revascularization was more evident 18 [85.7% and 60 [75.9%] in mild to moderate cases respectively. During hospitalization, 9 [15.3%] patients died in severe cases out of whom 2 [3.4%] died due to cardiogenic cause and 7 [11.9%] died due to non-cardiogenic causes. Mortality in moderate group was similar 9 [11.4%] and among them, 2 patients died due to cardiogenic cause and rest due to non-cardiogenic cause but none died in mild group. Though all 3 groups of chronic kidney disease patients had similar clinical and angiographic findings but poor clinical outcome was noted in patients having moderate to severe chronic kidney disease irrespective of whether they underwent PCI or CABG

Clinical predictors of mortality in hospitalized patients with infective endocarditis at a tertiary care center in Pakistan

To evaluate the clinical characteristics and predictors of in-hospital mortality in patients with infective endocarditis at a tertiary care centre in Pakistan. The cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from January 1, 2002, to December 31, 2006, and comprised 84 consecutive patients hospitalised with infective endocarditis. All patients underwent verification of the diagnosis according to the Modified Duke criterion. Data was collected through a questionnaire and analysed using Student's t test, Chi square and Fisher's exact test. Univariate and multivariate logistic regression analysis was performed to assess predictors of mortality. Of the total, 53[63%] patients were male and 31[37%] female. The mean age of the patients was 42 +/- 17 years. Overall, 34[41%] patients had rheumatic valve disease as a predisposing condition. The most commonly affected valve was mitral in 43[51%] patients, and the most commonly isolated organism was methicillin-resistant staphylococcus aureus in 12[14.3%]. Overall in-hospital mortality was 27[32.1%], while 18[21%] patients developed congestive cardiac failure, 15[18%] developed arrhythmias, 16[19%] developed peripheral embolism and renal failure was present in 38[54%]. Besides, 17[20%] patients underwent surgical intervention. The final multivariate model that can be used to predict mortality in this study consisted of the presence of neurological complications [p <0.001] Odds Ratio 7.26, Confidence Interval [2.27-23.18], congestive cardiac heart failure [p <0.023] Odds Ratio 5.39, Confidence Interval [1.26-23.04], and arrhythmias [p <0.034] Odds Ratio 4.21, Confidence Interval [1.11-15.88]. Significant predictors of mortality in hospitalised patients with infective endocarditis in our study were the presence of neurological complications, congestive cardiac heart failure, and the presence of arrhythmias

Mode of coronary revascularization and short term clinical outcomes in patients with chronic kidney disease

Percutaneous coronary intervention [PCI] and coronary artery bypass graft [CABG] surgery are two alternative methods for coronary revascularization, but it remains controversial as which one is associated with lower risks of worse clinical outcomes for chronic kidney disease [CKD] patients. We determined the mode of coronary revascularization [PCI vs. CABG] which is associated with lower risk of mortality and morbidity in CKD patients. In this cross sectional study, 159 patients with CKD were enrolled from single center of coronary revascularization at Aga Khan University Hospital Karachi between January 2012 and August 2013. All patients with CKD underwent PCI or CABG. The primary outcome was in-hospital composite of death, myocardial infarction [MI], or stroke. We evaluated which mode of coronary revascularization was associated with reduced risks of clinical outcomes. Out of 159 patients with CKD, 85 [53.5%] received PCI and 74 [46.5%] received CABG. The primary finding of this study is that more patients with moderate to severe CKD underwent PCI and more patients with mild to moderate CKD underwent CABG. In both these categories, no difference was observed in clinical outcomes. There are few factors like age, ST- elevation myocardial infarction [STEMI], non-ST elevation myocardial infarction [NSTEMI] and number of coronary artery disease predicted PCI as treatment strategy in patients with moderate to severe CKD. Patients with moderate to severe CKD have similar rates of short term clinical outcomes whether they underwent PCI or CABG. Therefore, PCI can be acceptable and less invasive treatment option alternative to CABG, particularly in patients with moderate to severe CKD

Association of airborne Aspergillus with asthma exacerbation in Southern Pakistan

BACKGROUND: Exposure to airborne fungi has been related with exacerbation of asthma in adults and children leading to increased outpatient, emergency room visits, and hospitalizations. Hypersensitivity to these airborne fungi may be an important initial predisposing factor in the development and exacerbation of asthma. OBJECTIVE: This study was conducted to determine an association between fungal types and spore concentrations with the risk of asthma exacerbation in adults. METHODS: This cross-sectional study was conducted from May 2008 to August 2009 at the Aga Khan University Hospital Karachi, Pakistan. All adult (age≥16 years) patients presenting to the hospital with acute asthma exacerbation were enrolled after informed consent. A home survey was conducted for each patient to assess their environmental characteristics. Indoor air samples were also obtained from the patient's home to determine the type and spore concentration of fungi within the week of their enrollment in the study. RESULTS: Three hundred and ninety-one patients with an acute asthma exacerbation were enrolled during the study period. The mean age of participants was 46 years (standard deviation, ±18 years) and 247 (63.2%) were females. A trend of higher asthma enrollment associated with higher Aspergillus concentrations was found in two consecutive summers. A total of nineteen types of fungi were found in air samples. Aspergillus spp. was the most frequently isolated fungus with acute asthma exacerbation. CONCLUSION: An association of higher concentration of indoor Aspergillus spp. with asthma exacerbation in adults was observed in this study.

Six-minute walk test performance in healthy adult Pakistani volunteers

To determine the six-minute walking distance [6MWD] for healthy Pakistanis, identify factors affecting 6MWD, compare published equations with the local data and derive an equation. Cross-sectional study. Two medical institutes of Karachi, from January to May 2011. Subjects between 15 and 65 years were prospectively enrolled after screening. A standardized 6MWT was administered. SpO[2], HR, BP and dyspnoea scores were determined pre- and post-test. Two hundred and eleven [71%] men and 85 [29%] women participated. Mean 6MWD was 469.88 +/- 101.24 m: men walked 502.35 +/- 92.21 m and women walked 389.28 +/- 74.29 m. On univariate analysis, gender, height, weight and age showed a significant relationship with the 6MWD. Gender and age were identified as independent factors in multiple regression analysis, and together explained 33% of the variance. The gender-specific prediction equations were: 6MWD [m] for men = 164.08 + [78.06 [asterisk] 1] - [1.90 [asterisk] age in years] + [1.95 [asterisk] height in cms] 6MWD [m] for women = 164.08 - [1.90 [asterisk] age in years] + [1.95 [asterisk] height in cms]. 6MWDs among the volunteer subjects were shorter than predicted by reference equations in literature. Height, gender and weight combined explained 33% of the variance. The moderate over-estimation of the 6MWD in Pakistani subject. The proposed equation gives predicted [mean] 6MWDs for adult Pakistani naive to the test when employing standardized protocol

Comparison of the virulence markers of helicobacter pylori and their associated diseases in patients from Pakistan and Afghanistan

Helicobacter pylori is a Gram-negative bacteria, which is associated with development of gastroduodenal diseases. The prevalence of H. pylori and the virulence markers cytotoxin-associated gene A and E [cagA, cagE] and vacuolating-associated cytotoxin gene [vacA] alleles varies in different parts of the world. H. pylori virulence markers cagA, cagE, and vacA alleles in local and Afghan nationals with H. pylori-associated gastroduodenal diseases were studied. Two hundred and ten patients with upper gastrointestinal symptoms and positive for H. pylori by the urease test and histology were included. One hundred and nineteen were local nationals and 91 were Afghans. The cagA, cagE, and vacA allelic status was determined by polymerase chain reaction. The nonulcer dyspepsia [NUD] was common in the Afghan patients [P = 0.025]. In Afghan H. pylori strains, cagA was positive in 14 [82%] with gastric carcinoma [GC] compared with 29 [45%] with NUD [P = 0.006], whereas cagE was positive in 11 [65%] with GC and 4 [67%] with duodenal ulcer [DU] compared with 12 [18%] with NUD [P < 0.001 and 0.021, respectively]. The vacA s1a/b1was positive in 10 [59%] of GC compared with 20 [31%] in NUD [P = 0.033]. In Pakistani strains, cagE was positive in 12 [60%] with GC, 7 [58%] with GU, 12 [60%] with DU compared with 11 [16%] with NUD [P < 0.001, 0.004, and < 0.001, respectively]. In Pakistani strains, cagA/s1a/m1 was 39 [33%] compared with Afghans in 17 [19%] [P = 0.022]. Moderate to severe mucosal inflammation was present in 51 [43%] Pakistani patients compared with 26 [28%] [P = 0.033] in Afghans. It was also associated with grade 1 lymphoid aggregate development in Pakistani patients 67 [56%] compared with 36 [40%] [P = 0.016] in Afghans. Distribution of H. pylori virulence marker cagE with DU was similar in Afghan and Pakistan H. pylori strains. Chronic active inflammation was significantly associated with Pakistani H. pylori strains

APACHE II scores as predictors of cardio pulmonary resuscitation outcome: evidence from a tertiary care institute in a low-income country

The aim of this study was to demonstrate that APACHE II scores can be used as a predictor of the cardio-pulmonary resuscitation [CPR] outcome in hospitalized patients. A retrospective chart review of patients admitted, from 2002 to 2007, at the Aga Khan University Hospital, Karachi, was done for this study. Information was collected on 738 patients, constituting all adults admitted in general ward, ICU, CICU and SCU during this time, and who had under-went cardiac arrest and received cardiopulmonary resuscitation during their stay at the hospital. Patient characteristics, intra-arrest variables such as event-witnessed, initial cardiac rhythm, pre arrest need for intubation and vasoactive drugs, duration of CPR and survival details were extracted from patient records. The APACHE II score was calculated for each patient and a descriptive analysis was done for demographic and clinical features. The primary outcome of successful CPR was categorized as survival >24 h after CPR versus survival <24 h after CPR. Multivariable logistic regression was used to assess the association between the explanatory variables and successful CPR. Patients with APACHE II scores less than 20 had 4.6 times higher odds of survival compared to patients with a score of >35 [AOR: 4.6, 95% CI: 2.4-9.0]. Also, shorter duration of CPR [AOR: 2.9, 95% CI: 1.9-4.4], evening shift [AOR: 2.1, 95% CI: 1.3-3.5] and Male patients [AOR: 0.6, 95% CI: [0.4-0.9] compared to females were other significant predictors of CPR outcome. APACHE II score, along with other patient characteristics, should be considered in clinical decisions related to CPR administration

Perception and knowledge about dietary intake in patients with liver cirrhosis and its relationship with the level of education

To determine patients perception and knowledge regarding diet in cirrhosis and its relationship with the level of patients education. Cross-sectional observational study. This study was conducted at Gastroenterology Outpatient Clinics at the Aga Khan University Hospital, Karachi, the Aga Khan Health Services, Malir, Karachi and Hamdard University, Karachi, from January to December 2010. Consecutive adult patients with compensated cirrhosis were enrolled. Demographic data, level of education, type and reason of food restriction as well as the source of dietary information was asked. Baseline laboratory test were performed, and nutritional status was assessed by BMI normogram. Ninety patients, 58% male were enrolled. Mean age of the patient was 49 +/- 11 years. Overall 73% of the patients were restricting fat, meat, fish and eggs in their diet; 53% were in uneducated group and 47% were in educated group [CI, 0.24-1.62, p-0.34]. Twenty two patients [62.8%] in uneducated and 21 in educated group [68%] were restricting diet on the advice of their doctors, whereas 13 in uneducated group [37%] and 11 in educated group [32%] believed these dietary components to be harmful for the liver. Thirty two of uneducated patient [71.1%] and 28 of educated patients [62.2%] believed that vegetables, fruits and sugarcane had a beneficial effect on the liver. Main source of dietary information to the patients was the doctor. On sub-group analysis those who restricted diet irrespective of their educational level, had more patients with BMI less than 18.5 kg/m[2], [CI 0.01-0.94, p-0.001], haemoglobin less than 12 g/dl [CI 0- 0.03, p-0.001] and serum albumin less than 3 g/dl [CI 0.1- 03, p-0.001]. Both educated and uneducated classes of the patients have improper knowledge and perception of diet in cirrhosis. Patients with cirrhosis who restricted diet, had relatively low BMI, haemoglobin and albumin as compared to those who did not restrict. Main source of dietary information to cirrhotic patients were health care personnels

Small intestinal bacterial overgrowth and lactose intolerance contribute to irritable bowel syndrome symptomatology in Pakistan

The symptoms of irritable bowel syndrome resemble those of small intestinal bacterial overgrowth [SIBO]. The aim of this study was to determine the frequency of SIBO and lactose intolerance [LI] occurrence in patients with diarrhea-predominant irritable bowel syndrome [IBS-D] according to Rome III criteria. In this retrospective case-control study, patients over 18 years of age with altered bowel habit, bloating, and patients who had lactose Hydrogen breath test [H2 BT] done were included. The "cases" were defined as patients who fulfill Rome III criteria for IBS-D, while "controls" were those having chronic nonspecific diarrhea [CNSD] who did not fulfill Rome III criteria for IBS-D. Demographic data, predominant bowel habit pattern, concurrent use of medications, etc., were noted. Patients with IBS-D were 119 [51%] with a mean age of 35 +/- 13 years, while those with CNSD were 115 [49%] with mean age 36 +/- 15 years. Patients in both IBS-D and CNSD were comparable in gender, with male 87 [74%] and female 77 [64%]. SIBO was documented by lactose H2 BT in 32/234 [14%] cases. It was positive in 22/119 [19%] cases with IBS-D, while 10/115 [9%] cases had CNSD [P = 0.03]. LI was positive in 43/234 [18%] cases. Of these, 25/119 [21%] cases had IBS-D and 18/115 [16%] cases had CNSD [P = 0.29]. SIBO was seen in a significant number of our patients with IBS-D. There was no significant age or gender difference in patients with or without SIBO

Model for end-stage liver disease [MELD] score as a useful prognostic marker in cirrhotic patients with infection

To determine the association of Model for End stage liver disease [MELD] score to the outcome of cirrhotic patients with bacterial infection and to compare it with Child-Turcott-Pugh [CTP] score. Descriptive study. The Aga Khan University Hospital, Karachi, from January 2005 to December 2007. Patients with diagnosis of liver cirrhosis and bacterial infection were included. Demographic features, laboratory data and type of infection were recorded. Multiple logistic regression assays were applied to determine the factors associated with poor outcome in cirrhotics with infection. Receiver-Operating Characteristics [ROC] were used to determine the cut-off values of CTP score and MELD score with the best sensitivity and specificity. A total of 530 patients, 313 male [59%] with a mean age of 53 +/- 13 years were analyzed. Spontaneous bacterial peritonitis was the predominant infection seen in 369 [69%] patients. One hundred and eighty six [35%] patients died. Factors associated with poor outcome were a CTP score of more than 11 [p=0.001], raised blood urea nitrogen [p=0.020], raised creatinine [p=0.004], shock [p=0.002], and MELD score > 22 [p=0.03]. An eight percent increase in mortality rate was noticed with every one point rise in MELD score above 22. ROC curve showed that the specificity of CTP and MELD score to predict poor outcome in these patients was 36% and 59% respectively. Child-Turcott-Pugh score more than 11, raised BUN and creatinine, shock and high MELD score were poor prognostic markers in cirrhotic patients with infection. MELD score had better specificity than CTP score in determining outcome