The Relation of ABO Blood Group to the Severity of Coronavirus Disease: A Cross-Sectional Study From a Tertiary Care Hospital in Karachi.

Background Blood groups are considered to have an impact on the occurrence and severity of coronavirus disease. While among Chinese and Caucasian, blood group O individuals were less and group A were more likely to have severe disease and mortality, data on South Asians aren't available.  Objective This study aimed to find out the association of disease severity with blood group among coronavirus disease 2019 (COVID-19) patients. Materials and methodology Data were collected on a predesigned questionnaire containing details of patient demographics, medical comorbidities, clinical presentation, and laboratory parameters. Multiple logistic regression was used to determine the association of the blood group with the severity of coronavirus disease. Result Among the study participants, blood group B has the highest distribution (39.8%), followed by O (30.0), A (21.9%), and AB (8.1%). About three-fourths (69.9%) had mild to moderate disease while 30.0% had severe disease. Age, gender, hypertension, diabetes mellitus, and hemoglobin level were all associated with disease severity among COVID-19 patients in univariate analysis on P-value for selection (<0.25). The final model showed that the odds of disease severity is 3.62 times higher among males (OR: 3.62, 95% CI: 2.15-6.08) and 2.00 times higher among diabetic patients (OR: 2.00, 95% CI: 1.10-3.01) as compared to female and non-diabetic respectively. However, there was no significant association found between blood group and disease severity. Conclusion Blood groups don't have any role in forecasting the severity of coronavirus disease. However, the male gender and diabetics are prone to have severe disease.

Diabetes Mellitus Does Not Predict Discharge in Hospitalized Patients With Acute Pyelonephritis: A Study From Karachi, Pakistan.

Introduction The incidence of acute pyelonephritis (APN) in the diabetic population is comparatively higher and tends to be more complicated, with serious outcomes. Although complicated pyelonephritis (PN) needs hospital admission and intravenous antibiotics, the magnitude of hospital stay due to comorbidities is limited. This study's aim was to assess the impact of diabetes mellitus on length of hospital stay among patients with PN. Methods We did a retrospective data review of 520 randomly selected hospitalized patients of PN from March 2015 to December 2019 from a tertiary care center. Electronic medical records were used for identifying medical conditions through ICD-10 coding. Length of stay (LOS) was categorized as < five days and ≥ five days. Chi-squared tests were used to compare categorical parameters. Logistic regression models were used for multivariate analyses. Results The study included 520 patients with PN; 194 (37.3 %) men and 326 (62.7%) women. Overall, there were 353 (67.8 %) and 167 (32.1 %) patients with LOS < five and ≥ five days respectively. Most of the patients had lower urinary tract symptoms (90%); among them, the majority (92%) were discharged within five days. Likewise, half of the patients had diabetes (51.2); among them, 53% were discharged after five days. Older age (OR:1.7, 95%CI: 1.1 - 2.6), upper urinary tract symptoms (OR:1.6, 95%CI: 1.1 - 2.4), lower urinary tract symptoms (OR:1.9, 95%CI: 1.1 - 3.5), creatinine greater than 1.5 mg/dl (OR:1.6, 95% CI: 1.1 - 2.4) was positively associated with LOS ≥ 5 days after adjusting for other covariates. Diabetes mellitus was not found to be associated with LOS ≥ 5 days (OR: 0.9, 95%CI: 0.8 - 1.5). Conclusion In patients with acute PN, diabetes mellitus is not independently associated with prolonged hospital stay beyond five days.

Neutrophils to Lymphocyte Ratio: Earliest and Efficacious Markers of Sepsis.

Background Neutrophil to lymphocyte ratio (NLR) can be easily calculated from the white cell differential count and is considered an auspicious marker for predicting different diseases, including sepsis. In this study, we aimed to compare the efficacy of NLR as a sepsis marker by comparing it with other markers of sepsis, such as C-reactive protein (CRP), procalcitonin, and the Sequential Organ Failure Assessment (SOFA) score. Methods A cross-sectional analytical study was conducted at the Aga Khan University Hospital from July 2019 to December 2019. A total of 168 patients who were admitted to the medicine department with a diagnosis of sepsis on arrival or during the hospital stay were enrolled. The neutrophil to lymphocyte ratio was calculated to form venous samples taken on admission and compared to the level of CRP, procalcitonin, culture reports, and the SOFA score as a predictor of sepsis. Results Out of 168 patients, 55.3% were male. The median age of the participants was 68.40 (interquartile range (IQR): 19.5) years in males and 64.0 (IQR: 18.0) in females. Procalcitonin was performed in 121 (72%) and CRP performed in 61 (36.3%) patients. The NLR showed significant associations with all the tested lab parameters of sepsis, such as CRP (p = 0.02), procalcitonin (p = 0.01), and SOFA score (p = 0.01). Values when analyzed according to culture-positive showed higher values in culture-positive samples but were not statistically significant. Conclusion Neutrophil to lymphocyte ratio is a cheap and rapidly available predictor of sepsis and has shown a significant correlation with other relatively expensive and non-rapidly existing markers of inflammation and sepsis. However, large prospective studies are needed to prove its real effectiveness as a marker of sepsis and its prognosis.

Electrolyte Imbalance at Admission Does Not Predict the Length of Stay or Mortality in Dengue-Infected Patients.

Background A pattern of both clinical and biochemical abnormalities is associated with dengue virus infection (DVI). Among the various DVI-related biochemical defects, electrolyte imbalance is one that can alter the morbidity and mortality among patients. However, there is a dearth of evidence to assess the relationship between electrolyte imbalance and the length of stay or mortality in dengue-infected patients in Pakistan. In the current study, we aimed to investigate the association between electrolyte imbalance at the time of admission and the length of stay and mortality among dengue-infected patients. Methods We conducted a retrospective study at a large tertiary care hospital from November 2018 to November 2019. All patients with known chronic diseases and coinfections or those who were taking diuretics therapies or angiotensin-converting enzyme inhibitors were excluded. Our main exposure of interest was electrolytes imbalance and the outcome measure was the length of stay and mortality. Results A total of 1,008 dengue patients were enrolled with a mean length of stay of 2.56 days. Around 29.3% had hyponatremia and 23.2% had hypokalemia at the time of admission, and 21.9% of patients had a stay beyond three days. In multivariable analysis, hyponatremia [adjusted odds ratios (aOR) = 1.29; 95% confidence interval (CI): 0.59-2.84] and hypokalemia (aOR = 2.36; 95% CI: 0.91-6.10) were not found to be associated with the length of stay. However, patients with high troponin levels at admission had a prolonged stay beyond three days (aOR = 5.74; 95% CI: 2.34-14.11). There was a statistically significant association of creatinine levels (aOR = 14.74; 95% CI: 4.19-15.85) and diabetes mellitus (DM) (aOR = 4.36; 95% CI: 1.21-15.74) with mortality after controlling for potential confounders. Conclusion Electrolyte imbalance at admission is not a predictor of length of stay or fatalities in the hospital among patients with DVI. However, troponin levels at admission can increase hospitalization days whereas DM and renal injury have been found to worsen mortality rates.

Biallelic mutations in the LPAR6 gene causing autosomal recessive wooly hair/hypotrichosis phenotype in five Pakistani families.

BACKGROUND: Autosomal recessive wooly hair/hypotrichosis is an inherited disorder of hair characterized by less dense, short, and tightly curled hair on the scalp and sometimes less dense to complete absence of eyebrows and eyelashes. Autosomal recessive wooly hair/hypotrichosis phenotypes are mostly associated with pathogenic sequence variants in LIPH and LPAR6 genes. METHODS: To find out the molecular basis of the disease, five families with autosomal recessive wooly hair/hypotrichosis were recruited for genetic analysis. Direct Sanger sequencing of LIPH and LPAR6 genes was carried out using BigDye chain termination chemistry. P2RY5 protein homology models were developed to study the effect of mutation on protein structure in a family having novel mutation. RESULTS: Sanger sequencing revealed a novel homozygous missense mutation (c.47A>T) in the LPAR6 gene in family A, while recurrent mutation (c.436G>A) was detected in the rest of the four families (B-E). Protein homology models for both native and mutant P2RY5 protein were developed to study the difference in subtle structural features because of Lys16Met (K16M) mutation. We observed that P2RY5K16M mutation results decrease in the number of ionic interactions detrimental to the protein stability. Protein modeling studies revealed that the novel mutation identified here decreased the number of ionic interactions by affecting physicochemical parameters of the protein, leading to an overall decrease in protein stability with no major secondary structural changes. CONCLUSION: The molecular analysis further confirms the frequent involvement of LPAR6 in autosomal recessive wooly hair/hypotrichosis, while the bioinformatic study revealed that the missense mutation destabilizes the overall structure of P2RY5 protein.