PRICE COVID19 Data Report December 2021 Pakistan Registry of Intensive Care

Pakistan Registry of Intensive Care (PRICE) is a platform that has enabled standardized COVID-19 clinical data collection based on ISARIC/WHO Clinical Characterization Protocol. The near real-time data platform includes epidemiology, severity of illness, microbiology, treatment and outcomes of patients admitted with suspected or laboratory confirmed COVID19 infection to 67 intensive care and high dependency units across the country. Data has been extracted and analysed at regular intervals to inform stakeholders and improve care practices. This is our 28th report including all patients with suspected or confirmed COVID-19 from 26th March 2020 to 26th December 2021. Key findings from 8624 patients who met eligibility criteria, are as follows: Median age of 60 years (IQR 50-70). The most common symptoms were shortness of breath (n = 6428, 77.8%), fever (n = 6091, 73.8%), and Cough (n = 3354, 38.9%) The most common comorbidity was hypertension followed by diabetes. During the course of illness 2804 (32.6%) patients received non-invasive ventilation, whereas 2474 (28.8%) patients had mechanical ventilation as their highest organ support. In addition, 2246 (26.1%) patients needed haemodynamic support and 1249 (14.7%) patients required renal replacement therapy as their highest organ support. Median APACHE II score was 18 Overall mortality at ICU discharge was 39.2% Increasing age and requirement for invasive mechanical ventilation were independent risk factors for mortality increased the risk of death

Spontaneous platelet recovery time in primary and secondary dengue infection in a tertiary care hospital.

OBJECTIVE: To determine the spontaneous platelet recovery time in primary and secondary dengue infection in a tertiary care hospital. METHOD: The cross-sectional observational study was conducted at Abbasi Shaheed Hospital, Karachi, from July 2010 to January 2011, and comprised 138 seropositive patients with ages 13 years and above who fulfilled the World Health Organisation criteria of probable dengue infection, and presented with platelet count of <50,000/mm3 were enrolled. Serology was performed using rapid immunochromatographic assay and enzyme-linked immunosorbent assay with differential detection of immunoglobulin M and G. Spontaneous platelet recovery time (days) in both primary and secondary dengue infection was recorded. SPSS 20 was used for statistical analysis. RESULT: Of the total 138, patients, 38(27.5%) had primary infection and 100(72.5%) had secondary infection. Male-to-female ratio was 2.3:1. Among primary and secondary infections, platelet count on presentation was not significantly different (p<0.64). Mean spontaneous platelet recovery time was 3±2.6 days and 3±1.87 days in primary and secondary infection respectively. Higher platelet count at presentation was associated with early recovery time (p<0.033). Of 108(78%) patients who presented with platelet count of 20,000-<50,000/mm3, platelet count of 36(33.33%) rose to >50,000/mm3 within 2 days, and 62(57.4%) rose to >50,000 in 3-5 days. In primary and secondary dengue infections, no statistically significant difference was observed in spontaneous platelet recovery time (-=0.87). CONCLUSION: Platelet count at presentation and spontaneous platelet recovery time do not significantly differ in primary and secondary dengue infection.

Epidemiology of rheumatoid arthritis in a tertiary care unit, Karachi, Pakistan.

OBJECTIVE: To determine the frequency, demographic characteristics, associated co- morbidities and extraarticular manifestations in patients with rheumatoid arthritis (RA) visiting the rheumatology clinic at a tertiary care hospital, Karachi. METHOD: A retrospective medical chart review of 4900 patients, who visited the rheumatology clinic at Liaquat National Hospital, from January 2005 to June 2007, was conducted. All patients with RA, of both gender and ages 16 years and above, who fulfilled the 1987 ACR criteria were included. Demographic characteristics, base line co-morbidity and extra-articular manifestations were recorded according to pre-defined criteria. RESULT: Among 4900 patients, 633 (12.9%) visited the rheumatology clinic with RA, female to male ratio being 4:1. The mean age of onset was 38.5 +/- 12.4 years in females and 44.8 +/- 13.12 years in males. Among the age group 16-29 years females were more affected, whereas greater number of males presented between 50-75 years of age. Co-morbidities were found in 35.38% of RA patients. Cardiovascular disease including hypertension (13.79%) and ischaemic heart disease (6.6%) were the most common co-morbidities. RA factor was positive in 85.05% of the patients with hypertension and 88.09% of the patients with ischaemic heart disease. Extra-articular manifestations were reported in 3.47% of patients. Interstitial lung disease (1.57%) was the most common extra-articular manifestation. CONCLUSION: Significant proportion of patients with female predominance visited the rheumatology clinic at a tertiary care hospital due to RA. Rheumatoid factor may predict the risk of developing cardiovascular disease in patients with RA. The frequency of extra-articular manifestation was lower than that reported in western population.

Serodiagnosis of dengue infection using rapid immunochromatography test in patients with probable dengue infection.

OBJECTIVE: To determine the frequency of seropositive dengue infection using rapid immunochromatographic assay in patients with probable dengue infection as per WHO criteria. METHOD: A cross-sectional observational study was conducted at Abbasi Shaheed Hospital, Karachi from July 2008 to January 2009. Patients presenting with acute febrile illness, rashes, bleeding tendencies, leucopenia and or thrombocytopenia were evaluated according to WHO criteria for probable dengue infection. Acute phase sera were collected after 5 days of the onset of fever as per WHO criteria. Serology was performed using rapid immunochromatographic (ICT) assay with differential detection of IgM and IgG. A primary dengue infection was defined by a positive IgM band and a negative IgG band whereas secondary infection was defined by a positive IgG band with or without positive IgM band. RESULT: Among 599 patients who met the WHO criteria for dengue infection, 251(41.9%) were found to be ICT reactive among whom 42 (16.73%) had primary infection. Secondary infection was reported in 209 (83.26%). Acute phase sera of 348 (58.09%) were ICT non reactive. Four patients died because of dengue shock syndrome among which three had secondary infection. CONCLUSION: Early identification of secondary infection in acute phase sera using rapid ICT is valuable in terms of disease progression and mortality. However in highly suspected cases of dengue infection clinical management should not rely on negative serological results.