On allergic rhinitis

Introduction International guidelines recommend a severity-based approach to management in community-acquired pneumonia. CURB65, CRB65 and the Pneumonia Severity Index (PSI) are the most widely recommended severity scores. The aim of this study was to compare the performance characteristics of these scores for predicting mortality in community-acquired pneumonia. Methods A systematic review and meta-analysis was conducted according to MOOSE (meta-analysis of observational studies in epidemiology) guidelines. PUBMED and EMBASE were searched (1980–2009). 40 studies reporting prognostic information for the PSI, CURB65 and CRB65 severity scores were identified. Performance characteristics were pooled using a random effects model. Relationships between sensitivity and specificity were plotted using summary receiver operator characteristic (sROC) curves. Results All three scores predicted 30 day mortality. The PSI had the highest area under the sROC curve, 0.81 (SE 0.008), compared with CURB65, 0.80 (SE 0.008), p=0.1, and CRB65, 0.79 (0.01), p=0.09. These differences were not statistically significant. Performance characteristics were similar across comparable cut-offs for low, intermediate and high risk for each score. In identifying low risk patients, PSI (groups I and II) had the best negative likelihood ratio 0.08 (0.06–0.12) compared with CURB65 (score 0–1) 0.21 (0.15–0.30) and CRB65 (score 0), 0.15 (0.10–0.22). Conclusion There were no significant differences in overall test performance between PSI, CURB65 and CRB65 for predicting mortality from community-acquired pneumonia.

https://thorax.bmj.com/content/thoraxjnl/65/10/878.full.pdf

Severity assessment tools for predicting mortality in hospitalised patients with community-acquired pneumonia. Systematic review and meta-analysis

In Pakistan more than 10 million people are living with Hepatitis C virus (HCV), with high morbidity and mortality. This article reviews the prevalence, genotypes and factors associated with HCV infection in the Pakistani population. A literature search was performed by using the keywords; HCV prevalence, genotypes and risk factors in a Pakistani population, in Pubmed, PakMediNet and Google scholar. Ninetyone different studies dating from 1994 to May 2009 were included in this study, and weighted mean and standard error of each population group was calculated. Percentage prevalence of HCV was 4.95% ± 0.53% in the general adult population, 1.72% ± 0.24% in the pediatric population and 3.64% ± 0.31% in a young population applying for recruitment, whereas a very high 57% ± 17.7% prevalence was observed in injecting drug users and 48.67% ± 1.75% in a multitransfused population. Most prevalent genotype of HCV was 3a. HCV prevalence was moderate in the general population but very high in injecting drug users and multi-transfused populations. This data suggests that the major contributing factors towards increased HCV prevalence include unchecked blood transfusions and reuse of injection syringes. Awareness programs are required to decrease the future burden of HCV in the Pakistani population.

Hepatitis C virus in Pakistan: A systematic review of prevalence, genotypes and risk factors

Background Several scoring systems have been used to predict mortality in patients with community-acquired pneumonia. The properties of commonly used risk stratification scales were systematically reviewed. Methods MEDLINE and EMBASE (January 1999–October 2009) were searched for prospective studies that reported mortality at 4–8 weeks in patients with radiographically-confirmed community-acquired pneumonia. The search focused on the Pneumonia Severity Index (PSI) and the three main iterations of the CURB (confusion, urea nitrogen, respiratory rate, blood pressure) scale (CURB-65, CURB, CRB-65), and test performance was evaluated based on ‘higher risk’ categories as follows: PSI class IV/V, CURB-65 (score ≥3), CURB (score ≥2) and CRB-65 (score ≥2). Random effects meta-analysis was used to generate summary statistics of test performance and receiver operating characteristic curves were used for predicting mortality. Results 402 articles were screened and 23 studies involving 22 753 participants (average mortality 7.4%) were retrieved. The respective diagnostic odds ratios for mortality were 10.77 (PSI), 6.40 (CURB-65), 5.97 (CRB-65) and 5.75 (CURB). Overall, PSI had the highest sensitivity and lowest specificity for mortality, CRB-65 was the most specific (but least sensitive) test and CURB-65/CURB were between the two. Negative predictive values for mortality were similar among the tests, ranging from 0.94 (CRB-65) to 0.98 (PSI), whereas positive predictive values ranged from 0.14 (PSI) to 0.28 (CRB-65). Conclusions The current risk stratification scales (PSI, CURB-65, CRB-65 and CURB) have different strengths and weaknesses. All four scales had good negative predictive values for mortality in populations with a low prevalence of death but were less useful with regard to positive predictive values.

https://thorax.bmj.com/content/thoraxjnl/65/10/884.full.pdf

Value of severity scales in predicting mortality from community-acquired pneumonia: systematic review and meta-analysis

Hepatitis C virus (HCV) is a member of Flaviviridae family and one of the major causes of liver disease. There are about 175 million HCV infected patients worldwide that constitute 3% of world's population. The main route of HCV transmission is parental however 90% intravenous drug users are at highest risk. Standard interferon and ribavirin remained a gold standard of chronic HCV treatment having 38-43% sustained virological response rates. Currently the standard therapy for HCV is pegylated interferon (PEG-INF) with ribavirin. This therapy achieves 50% sustained virological response (SVR) for genotype 1 and 80% for genotype 2 & 3. As pegylated interferon is expensive, standard interferon is still the main therapy for HCV treatment in under developed countries. On the other hand, studies showed that pegylated IFN and RBV therapy has severe side effects like hematological complications. Herbal medicines (laccase, proanthocyandin, Rhodiola kirilowii) are also being in use as a natural and alternative way for treatment of HCV but there is not a single significant report documented yet. Best SVR indicators are genotype 3 and 2, < 0.2 million IU/mL pretreatment viral load, rapid virological response (RVR) rate and age <40 years. New therapeutic approaches are under study like interferon related systems, modified forms of ribavirin, internal ribosome entry site (HCV IRES) inhibitors, NS3 and NS5a inhibitors, novel immunomodulators and specifically targeted anti-viral therapy for hepatitis C compounds. More remedial therapies include caspase inhibitors, anti-fibrotic agents, antibody treatment and vaccines.

/pdf/hepatitis-c-treatment-current-and-future-perspectives-4yey7rqchr.pdf

Hepatitis C Treatment: current and future perspectives

Sustained virological response based on rapid virological response in genotype-3 chronic hepatitis C treated with standard interferon in the Pakistani population

CONTEXTE : Hopital Universitaire Aga Khan, Karachi, Pakistan. OBJECTIF: Comparer de maniere prospective chez les patients hospitalises pour une pneumonie acquise dans la collectivite (CAP) la mortalite a 30 jours en fonction de scores de gravite CURB65 et CRB65 et dans trois groupes a risque de mortalite (faible, intermediaire ou eleve) se basant sur ces scores. SCHEMA: Etude observationnelle longitudinale de cohorte chez les patients adultes repondant a la definition de la CAP entre octobre 2006 et mai 2007. RESULTATS : Au total, 137 patients ont ete inclus. La mortalite a 30 jours a ete de 13,1%. Les aires sous la courbe des caracteristiques operationnelles du receveur ont ete respectivement de 0,863 pour les scores CURB65 et 0,835 pour les scores CRB65. Les risques de deces chez les patients dans le groupe a haut risque de mortalite du score de CURB65 ont ete de 15,4 et pour ceux de CRB65 de 11,1 en comparaison avec le groupe de reference constitue de patients combines a risques de mortalite faible ou intermediaire ; les scores CURB65 et CRB65 ont classifie respectivement 46% et 24,8% des patients dans le groupe a faible risque de mortalite. La duree du sejour hospitalier a augmente lorsque les groupes a risque de mortalite reposaient sur le score CURB65, mais pas lorsqu'ils reposaient sur le score CRB65. CONCLUSION : Il n'y a pas de difference significative entre les scores CURB65 et CRB65 pour la prediction d'une mortalite a 30 jours. Les deux techniques de classement, et le score CURB65 en particulier, ont permis de classer une proportion raisonnable de patients dans le groupe a faible risque de mortalite, grâce a quoi ils ont pu quitter la salle d'urgence et etre traites comme patients externes.

Prospective comparison of prediction rules of mortality risk for CAP in a developing country.

Background: Hepatitis B and hepatitis C are global health care problems causing morbidity and mortality. Much of it could be prevented by better education of the masses regarding its spread. The study was conducted to assess the knowledge base of internet users of Pakistan to help in formulating education strategies. Methods: A survey questionnaire consisting of 20 close ended questions was designed and hosted on a website. The responses submitted at the website were auto-emailed to the author. Results: A total of 1024 complete responses were included. The survey shows increased level of awareness according to the educational status. The knowledge status of lowest education level was also adequate possibly due to access to internet to these respondents. Conclusion: Internet users in Pakistan have adequate core knowledge regarding hepatitis.

https://www.ayubmed.edu.pk/JAMC/PAST/20-1/Zuberi.pdf

Appraisal of the knowledge of Internet users of Pakistan regarding hepatitis using on-line survey.

Objective: To determine the frequency of acute HCV infection after needle stick injury and its treatment outcome. Methodology: Patients with HCV positive needle stick injury and reporting within 72 hours of incident were selected. Co-infections with HBV, HDV, HIV, hematological disorders and depression were excluded. Anti-HCV was done at presentation and those testing positive were excluded. HCV RNA was done after two weeks or anti-HCV after six weeks of incident. Those testing positive were kept under observation for 16 weeks for spontaneous resolution. After this period HCV RNA and Genotype were done and therapy with Peg-interferon was started. Rapid, early and sustained virological responses were checked. Results: Two hundred eight patients with HCV positive needle stick injury were selected, 10 (4.8%) developed acute HCV infection out of them one (10%) had spontaneous recovery during the observation period of 16 weeks. seven (77.8%) achieved rapid virological response and eight (88.9%) achieved sustained virological response. Conclusions: Acute HCV is an uncommon disease to diagnose; it has favorable response to therapy if initiated early after a strict surveillance of patients for 8-16 weeks.

/pdf/frequency-of-acute-hepatitis-c-after-needle-stick-injury-and-2idekhd7au.pdf

Frequency of acute hepatitis C after needle stick injury and its treatment outcome.

Objective: To evaluate risk factors having significant effect on mortality of smear positive Pulmonary Tuberculosis (PTB) inpatients.
Methods: A descriptive cross-sectional study was conducted at Ojha Institute of Chest Diseases, Dow University Hospital Ojha Campus, Karachi. One hundred and seventy (170) inpatients of smear positive PTB confirmed by Acid Fast Bacilli (AFB) smear, aged between 13-80 years were enrolled by using consecutive sampling technique while patients with drug resistant Tuberculosis (TB) and extra pulmonary TB were excluded from the study. Selected patients were interviewed for collecting demographic data and risk factor data by using a standard questionnaire.
Results: Out of 170 PTB inpatients, mortality was observed in 23 (13.5%) patients among which male patients were 12 (52.2%), and female were 11 (47.8%). Mortality was significantly associated with increasing age (p=0.003), socioeconomic status (p=0.019), anemia (p=0.03), Chronic Liver Disease (CLD) (p=0.005), Diabetes Mellitus (DM) (p=0.001), Human Immunodeficiency Virus (HIV) (p=0.007), Hypertension (HTN) (p=0.006), recurrent TB (p=0.001), and smoking (p=0.001).
Conclusion: Increasing age, poverty, smoking history, and presence of comorbidities like DM, CLD, HIV, hypertension, and anemia are associated with higher mortality in smear positive PTB cases.
doi: https://doi.org/10.12669/pjms.35.5.919
How to cite this:Hameed S, Zuberi FF, Hussain S, Ali SK. Risk factors for mortality among inpatients with smear positive pulmonary tuberculosis. Pak J Med Sci. 2019;35(5):1361-1365. doi: https://doi.org/10.12669/pjms.35.5.919
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

/pdf/risk-factors-for-mortality-among-inpatients-with-smear-5452old3o0.pdf

Faisal Faiyaz Zuberi

Papers

Sustained virological response based on rapid virological response in genotype-3 chronic hepatitis C treated with standard interferon in the Pakistani population

Prospective comparison of prediction rules of mortality risk for CAP in a developing country.

Appraisal of the knowledge of Internet users of Pakistan regarding hepatitis using on-line survey.

Frequency of acute hepatitis C after needle stick injury and its treatment outcome.

Risk factors for mortality among inpatients with smear positive pulmonary tuberculosis.