Sarcoidosis: epidemiology, characteristics, and outcomes over 10 years - a single-center study in Pakistan.

BACKGROUND: Sarcoidosis is a multisystem granulomatous inflammatory disease which remains under-diagnosed in a tuberculosis endemic region such as Pakistan. RATIONALE: To determine the distribution, clinical characteristics, diagnostic and treatment modalities and the disease course in the Pakistani population. METHODS: A cross-sectional review of sarcoidosis patients from Jan-1,2010 to Dec-31,2019 was done. Multivariable logistic and cox-regression models were used to identify the independent risk-factors associated with disease relapse. Kaplan-Meier curves were used to assess the DFS. RESULTS: 222 patients, with mean age 44 ± 12 years, predominantly females (57.7%) and mean BMI 29 ± 6 were diagnosed sarcoidosis. Significant co-morbidities affected 36.5%, 90% were nonsmokers, and 50.3% belonged to moderate SES. Total 178 (80.2%) were symptomatic with 115 (51.8%) having multi-organ involvement. Stage-I radiological disease was predominant (52.5%). Histopathological diagnosis was obtained in 161 (72.5%) patients. Out of 113 mediastinal lymph-nodes, NNGI was present in 99, with highest yield in Station-07 (68.6%). Treatment was instituted in 108/178 (60.7%) symptomatic patients with steroids alone and in 26 (14.6%) with S+IS, with better clinical and radiological response duration in patients receiving steroid monotherapy (p-values=0.01 and 0.001,respectively, along with overall higher survival time (p-value = 0.04). Risk factors identified for relapse included high SES (AOR5.52;95%CI(1.10-28.40),0.04), steroid monotherapy (AOR0.22; 95%CI(0.10-0.87),0.03), symptomatic response after one year (AOR3.40; 95%CI(1.02-11.10),0.04), and radiological response duration (AOR1.10; 95%CI(1.05-1.20),0.04). CONCLUSION: Sarcoidosis is a dynamic disease with a variable clinical and geographical spectrum but good overall prognosis.

Off-Hour Admission Is Associated with Poor Outcome in Patients with Intracerebral Hemorrhage.

The mortality of stroke increases on weekends and during off-hour periods. We investigated the effect of off-hour admission on the outcomes of intracerebral hemorrhage (ICH) patients. We retrospectively analyzed a prospective cohort of ICH patients, admitted between January 2017 and December 2019 at the First Affiliated Hospital of Chongqing Medical University. Acute ICH within 72 h after onset with a baseline computed tomography and 3-month follow-up were included in our study. Multivariable logistic regression analysis was performed for calculating the odds ratios (OR) and 95% confidence interval (CI) for the outcome measurements. Of the 656 participants, 318 (48.5%) were admitted during on-hours, whereas 338 (51.5%) were admitted during off-hours. Patients with a poor outcome had a larger median baseline hematoma volume, of 27 mL (interquartile range 11.1-53.2 mL), and a lower median time from onset to imaging, of 2.8 h (interquartile range 1.4-9.6 h). Off-hour admission was significantly associated with a poor functional outcome at 3 months, after adjusting for cofounders (adjusted OR 2.17, 95% CI 1.35-3.47; p = 0.001). We found that patients admitted during off-hours had a higher risk of poor functional outcomes at 3 months than those admitted during working hours.

Clinical Characteristics of COVID-19-Infected Cancer Patients in Pakistan: Differences Between Survivors and Non-Survivors.

BACKGROUND: Cancer patients are considered as highly vulnerable individuals in the current COVID-19 pandemic. We studied the clinical characteristics of survivor and non-survivor COVID-19-infected cancer patients in Pakistan. PATIENTS AND METHODS: We did a retrospective study of 70 cancer patients with PCR-confirmed COVID-19 infection from Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore and Peshawar, Pakistan between April 13 and July 09, 2020. These patients were discharged from the hospital or had died by July 09, 2020. Clinical, pathological and radiological characteristics were compared between survivors and non-survivors by fisher's exact test and chi-square test. Univariable and multivariable logistic regression models were performed to explore the risk factors of mortality. RESULTS: Seventy cancer patients with SARS-CoV-2 infection were enrolled and the majority were males 38 (54.3%). 57 (81.4%) had solid tumors and 13 (18.6%) had hematological malignancies. Dyspnea (44 cases) was the most common symptom (62.9%). Complications were reported in 51 (72.9%) patients during the course of disease. 19 (27.1%) patients were admitted to an intensive care unit (ICU). A significant increase in the C-reactive protein level and neutrophil count was observed in the deceased patients as compared to the surviving patients. D-dimer values of ≥0.2 mg/L were significantly associated with mortality (P=0.01). We identified two independent risk factors associated with death, ICU admission (P=0.007) and D-dimer (P=0.003). CONCLUSION: Pakistani cancer patients with COVID-19 infection reported poor prognosis. Intensive surveillance of clinicopathological characteristics of cancer patients infected with COVID-19 especially D-dimer values may play a pivotal role in the outcome of the disease.

Surgical vs. Conservative Management for Lobar Intracerebral Hemorrhage, a Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Outcomes regarding the conventional surgical and conservative treatment for the lobar intracerebral hemorrhage (ICH) have not been previously compared. The current meta-analysis was designed to review and compile the evidence regarding the management of patients with lobar intracerebral hemorrhage. METHODS: Online electronic databases, including PubMed, Embase, Medline, Cochrane Library, and Google Scholar, were searched for randomized controlled trials (RCTs). Studies were selected on the basis of the inclusion and exclusion criteria. Trials with CT-confirmed lobar intracerebral hemorrhage patients of which treatment regimen was started within 72 h following the stroke were included. Low quality trials were excluded. Death or dependence was defined as primary outcome and death at the end of the follow up was the secondary outcome. RESULTS: One hundred five RCTs were screened and 96 articles were excluded on the basis of abstract. Nine articles were assessed for the eligibility and 7 trials were included that involved 1,102 patients. The Odds ratio (OR) for the primary outcome was 0.80 (95% CI, 0.62-1.04, p = 0.09) and for the secondary outcome was 0.79 (95%CI, 0.60-1.03, p = 0.09). CONCLUSION: Our findings suggested that surgical treatments did not significantly improve the functional outcome as compared with the conservative medical management for patients with lobar ICH.

Predicting the survival in patients with malignant pleural effusion undergoing indwelling pleural catheter insertion.

CONTEXT: Malignant pleural effusion (MPE) is a common comorbid condition in advanced malignancies with variable survival. AIMS: The aim of this study was to predict the survival in patients with MPE undergoing indwelling pleural catheter (IPC) insertion. SETTINGS AND DESIGN: This was a cross-sectional study conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. METHODS: One hundred and ten patients with MPE who underwent IPC insertion from January 2011 to December 2019 were reviewed. Kaplan-Meier method was used to determine the overall survival (OS) of the patient's cohort with respect to LENT score. STATISTICAL ANALYSIS USED: The IBM SPSS version 20 was used for statistical analysis. RESULTS: We retrospectively reviewed 110 patients who underwent IPC insertion for MPE, with a mean age of 49 ± 15 years. 76 (69.1%) patients were females, of which majority 59 (53.6%) had a primary diagnosis of breast cancer. The LENT score was used for risk stratification, and Kaplan-Meier survival curves were used to predict the OS. The proportion of patients with low-risk LENT score had 91%, 58%, and 29% survival, the moderate-risk group had 76%, 52%, and 14% survival, and in the high-risk group, 61%, 15%, and 0% patients survived at 1, 3, and 6 months, respectively. In addition, there was a statistically significant survival difference (P = 0.05) in patients who received chemotherapy pre- and post-IPC insertion. CONCLUSIONS: LENT score seems to be an easy and attainable tool, capable of predicting the survival of the patients with MPE quite accurately. It can be helpful in palliating the symptoms of patients with advanced malignancies by modifying the treatment strategies.

Endobronchial Ultrasound Guided Transbronchial Needle Aspiration Of Mediastinal And Hilar Lymph Nodes- Five Years Of Experience At A Cancer Setting Hospital In Pakistan.

BACKGROUND: Endobronchial Ultrasound (EBUS) guided Transbronchial needle aspiration (TBNA) offers a minimally invasive diagnostic tool for mediastinal lymphadenopathy (ML). This study is done with the objective to determine the diagnostic utility of EBUS TBNA for ML in cancer and non-cancer patients. METHODS: This cross-sectional study, in which data was collected retrospectively included TBNA cytopathology and microbiology results of all patients who underwent EBUS at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore between July 2013 until July 2018. They were analysed to determine sensitivity and specificity of EBUS. RESULTS: Total 609 patients, comprising 362 (59%) male and 470 (77%) cancer patients were included. Mean age was 52±18 years. TBNA cytology was malignant in 118 (25%) cancer and 20 (14%) non-cancer patients. Percentage malignant ML was highest in small cell lung cancer (93%) among thoracic and renal cell carcinoma (35%) among extra thoracic cancers. Only 27% cancer patients with flourodeoxyglucose-18 avid ML had malignant cytology. Sarcoidosis was diagnosed in 115 (19%) patients (sensitivity 91%, specificity 97%) while tuberculosis in 76 (12%) (Sensitivity 87% and specificity 98%). Endobronchial Ultrasound changed management in 76% cancer patients via multidisciplinary meetings with no reported complications and estimated sensitivity and specificity of 98% and 100% respectively. CONCLUSIONS: Endobronchial Ultrasound is an accurate diagnostic tool for ML and can facilitate multidisciplinary cancer care.

Indications and clinical outcomes of indwelling pleural catheter placement in patients with malignant pleural effusion in a cancer setting hospital.

BACKGROUND: The placement of indwelling pleural catheters (IPC) is an effective outpatient approach for the management of malignant pleural effusions (MPE). AIMS: The indications and outcome of IPC in patients with MPE. Risk stratifications, prevention and management of IPC-related complications. METHODS: We retrospectively reviewed the clinical data of patients with MPE who underwent IPC insertion from July 2011 to July 2019. The multivariable logistic regression model was used to identify the independent risk factors associated with IPC infection and the Kaplan-Meier method to determine the overall survival. RESULTS: A total of 102 patients underwent IPC insertion during the stipulated period and the mean age was 50.49 ± 14.36 years. Seventy-one (69.6%) were females. The indications were Trap Lung in 38 (37.3%), failed talc pleurodesis in 28 (27.5%) and as a primary intervention in 36 (35.3%). The infection rate was 25.5%, of which 65.4% patients had nosocomial infections. Post-IPC overall median survival time was 9.0 ± 2.50 weeks with highest in patients with trap lung (18 ± 1.50 weeks). In multivariable analysis, following variables were identified as a significant independent risk factor for IPC infection: Multiloculated MPE (AOR 2.80; 95%CI (1.00-9.93), 0.04), trap lung (AOR 7.57; 95%CI (1.39-41.25), 0.01), febrile neutropenia (FN) (AOR 28.55; 95%CI (4.23-19.74), 0.001), IPC domiciliary education (AOR 0.18; 95%CI (0.05-0.66), 0.001) and length of hospital stay (AOR 1.16; 95%CI (1.01-1.33), 0.03). CONCLUSION: IPC insertion is an effective management for MPE with reasonable survival benefits. Infection is the most common complication, of which mostly are nosocomial infections with higher incidence in multiloculated effusions, trap lung, FN and with lack of domiciliary IPC care education.

Indications and clinical outcomes of fully covered self-expandable metallic tracheobronchial stents in patients with malignant airway diseases.

BACKGROUND: Airway stenting is an efficacious approach in management of malignant airway disease (MAD) with improvement in survival outcome. OBJECTIVE: To determine the indications and long-term clinical outcomes of tracheobronchial stenting in patients with MAD. METHODS: A cross-sectional review of 51 patients who underwent airway stenting from June 2011 to June 2019 was done. Paired t-test was used to compare mean difference of clinical characteristics between pre- and post-airway stenting. Kaplan-Meier curves were used to assess overall survival. RESULTS: A total of 51 patients had stent insertion with mean age 46.63±17.10years including 27(52.9%) females. Mainly 37(72.5%) patients had esophageal and 06(11.8%) had lung cancer. The main indications were bronchial stenosis 18(35.3%), tracheal stenosis 11(21.6%) and Tracheo-esophageal/bronchial fistula 13(25.5%). Obstruction was intrinsic, extrinsic and mixed in 20(39.2%), 13(25.5%) and 5(9.8%) patients, respectively. There was statistically significant mean difference in pre- and post-procedure oxygen saturation (mean (M)=89.8, standard deviation (SD)=6.70 vs M =95.5,SD=2.54.p =0.001) and performance status (M =3.65,SD =0.6 vs M =2.59, SD=0.83.p =0.001). Overall median survival was 16±3.44 weeks, highest amongst patients with intrinsic obstruction (27±6.51 weeks). CONCLUSION: Airway stenting is an effective endoscopic procedure to re-establish airway patency in MAD with minimal complications..

Frequency of chronic neuropathic pain and its association with depression in the elderly in Pakistan.

Chronic neuropathic pain is secondary to other musculoskeletal pain. The following study aimed to determine the frequency of chronic neuropathic pain and its association with depression in the elderly. A crosssectional survey was carried out on 306 participants at the National Institute of Rehabilitation Medicine (NIRM) Hospital, in Islamabad over a period of 6 months from September 2017 to February 2018. Population of ? 60 years of age with chronic pain for >6 months were included, whereas patients with malignant origin of pain, intermittent pain and psychological pain were excluded. Data was collected by using DN4 and DASS Questionnaires were analysed by SPSS. Of the 271 participants with the mean age of 66 } 5.8 years, 216 (79.9%) were male. The frequency of patients suffering from chronic neuropathic pain was 53.9%. Data showed among the elderly a strong association of chronic neuropathic pain with anxiety and stress (P<0.05), but not with depression (P>0.05).