Comparison of NEWS2 and PSI as mortality predictors in patients with community acquired pneumonia.

In the West, National Early Warning Score 2 (NEWS2) is commonly applied to predict the severity of illness using only bedside variables unlike the extensive Pneumonia Severity Index (PSI). The objective of this study was to compare these scores as mortality predictors in patients admitted with community acquired pneumonia (CAP). This cross-sectional study was conducted in Jinnah Postgraduate Medical Centre, Karachi, Pakistan, for six months in 2020 on 116 patients presenting with CAP. Cases of aspiration pneumonia, hospital acquired pneumonia, pulmonary tuberculosis, pulmonary embolism, and pulmonary oedema were excluded. In-hospital mortality was taken as the outcome of this study. The mean age of the participants was 46.9±20.5 years. The in-hospital mortalities were 45(38.8%). NEWS2 was 97.8% sensitive but only 15.5% specific in predicting the outcome, whereas PSI was less sensitive (68.9%) but more specific (50.7%), which showed that in comparison with PSI, NEWS2 is a more sensitive mortality predicting score among hospitalised CAP patients.

Long term nitrofurantoin induced interstitial lung disease: a case series and literature review.

BACKGROUND AND AIM: In the UK, prophylactic use of nitrofurantoin is recommended in women who have 3 or more UTI per year. Reported cases of nitrofurantoin-induced pulmonary toxicity are limited and the exact mechanism of chronic nitrofurantoin induced lung reaction is unclear. In England, the national trend for prescribing Nitrofurantoin has gone up significantly in the last 10 years. We reviewed 10 cases of nitrofurantoin-induced pulmonary fibrosis diagnosed in last 8 years at our ILD Service. We aimed to reviewe patient demographics, time to presentation, lung function and imaging characteristics. METHODS: We reviewed our ILD database from the year 2012 to 2020. 10 patients were identified diagnosed as Nitrofurantoin Induced Interstitial Lung Disease. All the cases were reviewed in MDT comprising Radiologists and clinicians with interest for ILD. We documented age, sex, initial renal function, eosinophil count, spirometry and radiology findings. In this case series, we focus on various CT findings and reversibility of radiological abnormality following cessation of Nitrofurantoin. RESULTS: The mean age of our patient cohort is 80 years and all were female. The mean time to presentation from prescription was 17 months. Pre-treatment mean eGFR was 76ml/min/1.73m2.7 out of 10 patients had CT findings of ground glass opacity and traction bronchiectasis. 4 patients were treated with prednisolone. The patients in this series improved symptomatically with or without treatment with steroid following cessation of nitrofurantoin therapy, but irreversible changes in the chest imaging may contribute to long term morbidity. CONCLUSIONS: Cautious counselling should be undertaken prior to nitrofurantoin prescription regardless of renal function.

The Cavity as a Lasting Abode for Tuberculous Bacilli: An Observational Study.

The aim of this study was to determine the factors associated with persistent sputum positivity at the end of 2 months of treatment in patients presenting with (drug-susceptible) pulmonary tuberculosis at a tertiary care hospital in Karachi. A cross-sectional study was conducted at the Department of Chest Medicine (Ward 12), Jinnah Postgraduate Medical Center (JPMC), Karachi, over 6 months. A sample of 73 consenting, newly diagnosed, smear-positive drug-susceptible pulmonary tuberculosis patients was studied. Demographic (age, gender, height, weight and duration of tuberculosis, BMI, socioeconomic, occupational, marital, educational and residential statuses) and clinical factors (chest X-ray extent and cavities, initial smear results, diabetic and smoking statuses) which may be associated with sputum non-conversion were entered in a proforma. Patients were followed up at 2 months of treatment with a sputum smear. Data analysis was done on SPSS (Statistical Package for Social Sciences-version 20.0). Rate of sputum positivity after 2 months of anti-tubercular drug treatment was 17.8%. None of the above-mentioned demographic and clinical factors was associated with persistence of sputum positivity except for the presence of CXR cavities, which made it 5.5 times more likely that the patient would remain smear-positive at 2 months (p = 0.035). The finding of chest radiograph cavities makes it highly likely that a pulmonary tuberculosis patient may remain infectious or have an unfavorable outcome despite taking treatment for 2 months. Clinicians and national policy-makers should thus bear in mind the implications this can have with regard to disease control and therefore pay particular attention to such patients in terms of stringent monitoring and directly observed treatment short-course (DOTS) provision. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s42399-021-01098-6.

Post-COVID-19 Symptom Burden: What is Long-COVID and How Should We Manage It?

The enduring impact of COVID-19 on patients has been examined in recent studies, leading to the description of Long-COVID. We report the lasting symptom burden of COVID-19 patients from the first wave of the pandemic. All patients with COVID-19 pneumonia discharged from a large teaching hospital trust were offered follow-up. We assessed symptom burden at follow-up using a standardised data collection technique during virtual outpatient clinic appointments. Eighty-six percent of patients reported at least one residual symptom at follow-up. No patients had persistent radiographic abnormalities. The presence of symptoms at follow-up was not associated with the severity of the acute COVID-19 illness. Females were significantly more likely to report residual symptoms including anxiety (p = 0.001), fatigue (p = 0.004), and myalgia (p = 0.022). The presence of long-lasting symptoms is common in COVID-19 patients. We suggest that the phenomenon of Long-COVID may not be directly attributable to the effect of SARS-CoV-2, and believe the biopsychosocial effects of COVID-19 may play a greater role in its aetiology.

Liaison of Sugar Control With Time to Sputum Culture Conversion in Multi-Drug Resistant Tuberculosis.

Background Many elements have been studied repeatedly that influence time to sputum culture conversion in multi-drug resistant tuberculosis (MDR-TB). Deranged sugars not only hamper one's infection contesting ability but also increase the chances of drug resistance. Our aim was to establish whether or not glycemic control alters MDR-TB treatment outcome. Methods A prospective cohort study was conducted at the TB Clinic of Jinnah Postgraduate Medical Center, Karachi, Pakistan. Newly diagnosed MDR-TB cases were started on WHO-recommended treatment regime. HbA1c (hemoglobin A1c or glycated hemoglobin) was tested at the start of treatment irrespective of the previous diabetic status. Sputum samples, 30 days apart, were taken during the initial phase of the MDR TB treatment until two consecutive samples showed conversion. Pearson's correlation coefficient was calculated to see the link between time to sputum culture conversion and HbA1c. Results Among 47 patients, 19 (40.4%) new cases, whereas 28 (59.8%) were previously treated for drug-sensitive TB. Our 39 patients converted during six months, of which 18 (46%) converted in one month, 14 (35.9%) in two months, 6 (15.4%) in three months, and only 1 in five months. Mean time to sputum culture conversion was 1.77 ± 0.9 months. There was a slightly negative correlation between HbA1c and sputum culture conversion time (r = -0.075, p = 0.649). Conclusions Sugar control does not affect sputum culture conversion in MDR-TB when an optimal treatment regime is applied.

DECAF versus CURB-65 to Foresee Mortality among Patients Presenting with an Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Objective To compare the precision of DECAF (Dyspnea, Eosinopenia, Consolidation, Acidemia, Atrial Fibrillation) and CURB-65 scoring systems in prediction of mortality among patients presenting with an acute exacerbation of chronic obstructive pulmonary disease (COPD). Material and methods A prospective, cross-sectional study was done at the Department of Pulmonology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan over a period of seven months, May 2019 through November 2019. Previously diagnosed patients of COPD (for more than six months), of either sex, aged between 40 and 70 years admitted primarily with an exacerbation were included in the study by non-probability consecutive sampling. Patients with myocardial infarction, chronic kidney disease and malignancy were excluded. All relevant data including patients' demography, history, examination, DECAF and CURB-65 scores and in-hospital mortality were recorded on a proforma and later analyzed by using SPSS, version 20.0 (IBM Corp., Armonk, NY). Receiver operating characteristic (ROC) curve was drawn for comparison of accuracy of both scoring systems in prediction of in-hospital mortality (based on area under the curve (AUC)). Results There were 34 (29.8%) in-hospital mortalities while 80 (70.2%) survivals. AUC for DECAF score was 0.777 (0.673-0.881) and of CURB-65 was 0.715 (0.613-0.817) that reveals fair accuracy of the tests. Sensitivity of DECAF and CURB-65 scoring systems was almost similar i.e. 67.65% and 64.71% respectively, however DECAF was more specific than CURB-65 (86.25% compared to 68.75%, respectively). Conclusion The findings of our study suggest the use of a combination of scoring systems for prediction of in-hospital mortality in acute exacerbation of COPD based on appropriateness, access to facilities and clinician's preference.

A Case Report on Complicated Tuberculous Meningitis.

Tuberculous meningitis (TBM) is associated with significant complications of central nervous system. It is accompanied by nonspecific and heterogeneous clinical symptoms. We focused on the significance of early diagnosis and prompt treatment. We describe a case of TBM in a 19-year-old Asian female. She had a progressive motor weakness with no sensory findings. She was started on antituberculous therapy. Her magnetic resonance imaging (MRI) contrast of dorsolumbar spine showed syringomyelia. Her culture and sensitivity for Mycobacterium tuberculosis (MTB) came negative. She was given a therapeutic trial of quinolones and Steroids. She had an uneventful recovery and was followed up for the past one year.

The role of contrast-enhanced ultrasound imaging in the follow-up of patients post-endovascular aneurysm repair.

Endovascular aneurysm repair is a minimally invasive technique for the treatment of abdominal aortic aneurysms. Patients who undergo endovascular aneurysm repair are potentially at risk of developing problems related to the graft such as the development of endoleaks. Endoleaks can cause expansion of the aneurysmal sac, which can potentially lead to rupture. It is for this reason that lifelong surveillance of patients is required to assess the graft and the aneurysmal sac. This article discusses the role of contrast-enhanced ultrasound in the follow-up of patients post-endovascular aneurysm repair. Contrast-enhanced ultrasound is rapidly becoming a powerful, accurate and cost-effective tool to complement computed tomography in the follow-up of endovascular aneurysm repair patients. Real-time imaging of contrast filling into the arterial system means that contrast-enhanced ultrasound is an excellent problem-solving tool, particularly when assessing for the type and anatomy of endoleaks. In some instances, contrast-enhanced ultrasound can detect endoleaks when other modalities are equivocal.