To determine the association between asthma severity and hospital admission measured by Pediatric Respiratory Assessment Measure (PRAM) score at Indus Hospital and Health Network, Karachi, Pakistan, 2020-2021

Objectives: To determine the association between asthma severity and the likelihood of hospitalization by using Pediatric Respiratory Assessment Measure (PRAM) score for pediatric patients who present to the emergency department (ED) with mild, moderate or severe asthma exacerbations and those who received standard intensive asthma therapy. Methods: This was a retrospective study conducted in children aged between 2 to 14 years. The data was entered and analysed using Statistical Package for the Social Sciences (SPSS) version 21. To be included in the study, the children must have received “intensive asthma therapy” defined as administration of systemic corticosteroids with three albuterol treatments and ipratropium. Results: A total of 437 patients were enrolled in the study out of which 250 were male and 187 were female. The mean age was 6.1 ± 3.4 years with a minimum age of two and a maximum age of 14 years. The 4-hour PRAM score (AUC = 0.88) overall significantly improved the predictive value of admission (p value <0.001) as compared to the PRAM score calculated at triage (AUC = 0.81). Conclusion: The 4-hour PRAM score is the best predictor for the need of hospitalization. It is suggested that these results are applied clinically in the pediatric ED to improve patient flow and to better facilitate intensive therapy of patients at triage to decrease the need for hospitalization. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5783 How to cite this:Kazi U, Gul Rukh S, Zawawi S, Laila S, Fareeduddin M, Saleem SG. To determine the association between asthma severity and hospital admission measured by Pediatric Respiratory Assessment Measure (PRAM) score at Indus Hospital and Health Network, Karachi, Pakistan, 2020-2021. Pak J Med Sci. 2022;38(2):345-350. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5783 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.

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The Pediatric Respiratory Assessment Measure: A Valid Clinical Score for Assessing Acute Asthma Severity from Toddlers to Teenagers

The Journal of Pediatrics ◽

10.1016/j.jpeds.2007.08.034 ◽

2008 ◽

Vol 152 (4) ◽

pp. 476-480.e1 ◽

Cited By ~ 116

Author(s):

Francine M. Ducharme ◽

Dominic Chalut ◽

Laurie Plotnick ◽

Cheryl Savdie ◽

Denise Kudirka ◽

...

Keyword(s):

Acute Asthma ◽

Clinical Score ◽

Asthma Severity ◽

Assessment Measure

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Outcome of Corticosteroid Injection in De Quervain's Tenosynovitis

10.53350/pjmhs2115113288 ◽

2021 ◽

Vol 15 (11) ◽

pp. 3288-3292

Author(s):

Wahid Bakhsh ◽

Asad Ullah Jan ◽

Muhammad Shafiq ◽

Naveed Iqbal ◽

Muzafar Hussain Buriro ◽

...

Keyword(s):

Pain Score ◽

Triamcinolone Acetonide ◽

Corticosteroid Injection ◽

Mean Value ◽

Injection Pain ◽

P Value ◽

Duration Of Symptoms ◽

De Quervain’S Tenosynovitis ◽

Minimum Age ◽

The Mean

Background: De Quervain's tenosynovitis is a painful and swollen stenosing tenosynovitis of the first dorsal compartment of the wrist. After analysing the patient's medical history and doing a physical examination, a diagnosis is made. Finkelstein's test is almost always positive. Objective: The goal of this study was to investigate the effectiveness of local corticosteroid injections in the treatment of de Quervain's tenosynovitis. Material & Methods: The study enrolled fifty patients with De Querven's Tenosynovitis. NSAIDs were provided orally and topically to all patients for an average of six weeks with no obvious improvement. Using a visual analogue scale, it was determined how much soreness would be felt in the first dorsal compartment and how much pain would be felt during the Finkelstein test. The edoema was removed by injecting a mixture of 1 mL (10 mg) triamcinolone-acetonide and 1 mL of 1% lidocain hydrochloride into the affected wrist's first dorsal compartment. They were subsequently examined every two weeks for twenty-four weeks. After a local triamcinolone acetonide injection, pain and discomfort on the radial side of the wrist were alleviated, and a negative Finkelstein test was done. Results: The mean age among the patients was 36.6 years with 12.4 SD. The maximum age was 60 years and the minimum age was 25 years old. The duration of symptoms in 4-8 weeks was observed, the mean value was 6 weeks with 1.4 as SD the minimum duration recorded was 4 weeks with 8 weeks as maximum duration. At the start of the week of appearance of symptoms the pain score was 6.44 with 1.6 as SD. The minimum pain score was 4 and maximum pain score was 8. Pain score at 4 weeks was 0.66 with 1.6 as SD. As per the independent t-test the p value was less than 0.05 so the test was significant statistically. Conclusion: One or two local steroid injections in the first dorsal compartment can give considerable pain and inflammation alleviation in people with de Quervain's tenosynovitis.

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Abstract 57: Risk Factors For Severe Reductions In Blood Pressure After Treatment Of Severe Inpatient Hypertension

Hypertension ◽

10.1161/hyp.78.suppl_1.57 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Lama Ghazi ◽

Fan Li ◽

Eric Chen ◽

Michael Simonov ◽

Yu Yamamoto ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cohort Study ◽

Hospital Admission ◽

Antihypertensive Treatment ◽

Treatment Guidelines ◽

P Value ◽

Antihypertensive Medications ◽

Black Race ◽

Oral Medications

Background: Incident severe HTN during hospitalization is far more common than admission for HTN, however treatment guidelines are lacking. Severe inpatient HTN is poorly studied, therefore our goal is to characterize inpatients who develop severe HTN and assess BP response to antihypertensive treatment. Methods: This is a cohort study of adults admitted for reasons other than HTN and developed severe HTN within a single healthcare system. We defined severe inpatient HTN as the first documentation of BP elevation (>180 systolic or >110 diastolic) at least 1 hour after hospital admission. Treatment was defined as receiving antihypertensive medications within 6 hours of BP elevation. We studied the association between treatment and BP drop ≥30%. Results: Among 224,265 hospitalized adults, 23,147 developed severe HTN of which 40% were treated. Compared to inpatients who did not develop severe HTN, those who did were older, more commonly women and Black, and had more comorbidities. Of the treated and untreated patients, 45.5 and 46.4% had a MAP drop ≥30% (p-value= 0.2). Risk factors for severe MAP drop include older age, Black race, HTN, and diabetes. Additionally, treatment vs. no treatment and treatment with intravenous vs. oral medications were associated with greater odds of MAP drop ≥30% ( Table 1 ). Conclusion: While there was no difference in the proportion of treated and untreated patients with severe MAP reduction, after adjustment for factors independently associated with HTN we found that treatment was associated with severe BP drop. Further research is needed to phenotype inpatients with severe HTN to help establish treatment guidelines.

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Abstract P237: Common Genetic Variation in Caspase Enzymes and Survival of Sudden Cardiac Arrest

Circulation ◽

10.1161/circ.125.suppl_10.ap237 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Catherine O Johnson ◽

Rozenn N Lemaitre ◽

Nona Sotoodehnia ◽

Barbara McKnight ◽

Kenneth M Rice ◽

...

Keyword(s):

Cardiac Arrest ◽

Genetic Variation ◽

Hospital Admission ◽

Hospital Discharge ◽

A Priori ◽

Sudden Cardiac Arrest ◽

Population Based ◽

Minor Allele ◽

P Value ◽

Brain Resuscitation

Background: Reperfusion following ischemia due to sudden cardiac arrest (SCA) is necessary for survival, but results in additional injury to affected tissues. Regulation of apoptosis has been shown to be important in determining the extent of reperfusion injury. Caspases (CASP) are essential enzymes in the apoptotic cascade and we therefore hypothesized that genetic variation in these enzymes might influence cardiac and brain resuscitation after SCA. To test this, we examined three genes (CASP2, CASP3, CASP9) in a population-based study of SCA survival. Methods: Subjects (mean age 67, 80% male, of European descent) were out-of-hospital SCA patients found in ventricular fibrillation (VF) and attended by paramedics in King County, WA (n=1614). To investigate cardiac resuscitation, we compared subjects who survived to hospital admission (n=827) with those who did not (n=787); for brain resuscitation, we compared subjects who survived to hospital discharge (n=448) with those who did not (n=1166). Associations of 19 SNPs were examined using logistic regression comparing each additional copy of the minor allele. Based on a priori hypotheses, models were adjusted for: age; gender; time from 911 call to arrival of emergency medical services; whether the event was witnessed; occurred in public; and whether bystander CPR was administered. We used within-gene permutation tests to adjust p-values for multiple comparisons. Results: Two SNPs in CASP3 were associated with SCA survival. The A allele of rs4647688 (minor allele frequency (MAF) 0.20) was associated with lower rates of survival to hospital admission (OR (95% CI), adjusted p-value: 0.78 (0.65, 0.93), p =0.043). The T allele of rs2705897 (MAF 0.26) was associated with a higher rate of survival to hospital admission (1.27 (1.07, 1.51), p =0.049). These two SNPs are in almost complete linkage equilibrium (r 2 =0.091). No SNPs in CASP3 were significantly associated with survival to hospital discharge, and no SNPs in CASP2 or CASP9 were significantly associated with either outcome. Conclusions: CASP3 variants are associated with SCA survival in this population. Further work is needed to explore the effect of these variants on regulation of apoptosis during reperfusion following VF arrest, and to replicate these findings in other populations.

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Promoting Research Culture at Indus Health Network

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.icon-suppl.1861 ◽

2019 ◽

Vol 36 (ICON-Suppl) ◽

Author(s):

Shaukat Ali Jawaid

Keyword(s):

Open Access ◽

Original Work ◽

Research Culture ◽

Health Network ◽

Creative Commons ◽

Special Supplement ◽

Open Access Article

doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1861 How to cite this:Jawaid SA. Promoting Research Culture at Indus Health Network. Pak J Med Sci. Special Supplement ICON 2020. 2020;36(1):S2. doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1861 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.

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A clinical study to determine the relationship between serum vitamin D levels and severity of asthma

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20172673 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1397

Author(s):

Pragalatha Kumar ◽

Aruna Gowdra ◽

Arathi Arathi ◽

Ananya Sampath

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Serum Vitamin ◽

Asthma Severity ◽

Severe Form ◽

P Value ◽

Serum Vitamin D ◽

Vitamin D Levels ◽

Children With Asthma ◽

Age And Sex

Background: Vitamin D deficiency has been rediscovered as a public health problem worldwide. Few studies have shown that vitamin D deficiency is associated with asthma severity. The objective of present work was to study the serum vitamin D levels and its relationship with asthma severity in children.Methods: A prospective cohort study of 100 children with asthma between the age group of 5 to 15 years and age and sex matched 40 healthy controls who had come to Indira Gandhi Institute of Child Health, Bengaluru was done. These children’s serum vitamin D levels were estimated and correlated with asthma severity.Results: A total of 100 children with asthma and 40 healthy age and sex matched controls were evaluated. The study group had lower vitamin D (34.95 ng/ml) levels as compared to the control group (57.94 ng/ml) which was statistically significant (p<0.05). 68.4% children had significantly low vitamin D levels and severe form of asthma (p value <0.001). There was also a marked rise in absolute eosinophil count in those who had low vitamin D levels (56.6%) (p-value <0.0001).Conclusions: Vitamin D deficiency is an important risk factor for asthma severity. It modifies the immune system and reduces the inflammation. In the present study, low serum vitamin D levels were significantly correlated with severe form of asthma. There was a significant rise in the absolute eosinophil count in those who exhibited deficiency of vitamin D.

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Barriers to the early initiation of Insulin therapy among diabetic patients coming to diabetic clinics of tertiary care hospitals

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.1.237 ◽

2018 ◽

Vol 35 (1) ◽

Author(s):

Iqra Arshad ◽

Sara Mohsin ◽

Sana Iftikhar ◽

Tahseen Kazmi ◽

Luqman F. Nagi

Keyword(s):

Insulin Therapy ◽

Tertiary Care ◽

Cross Sectional Study ◽

Early Initiation ◽

P Value ◽

Diabetic Patients ◽

Cross Sectional ◽

Creative Commons ◽

Oral Medications ◽

Tertiary Care Hospitals

Background and Objective: Initiation of Insulin therapy during earlier stages has proved to significantly improve health outcomes among diabetics in comparison to oral medications. Not only patients but physicians are also often resistant to early initiation of insulin therapy. The objective was to assess misconceptions and barriers to early initiation of insulin therapy among diabetic patients coming to a diabetic clinic. Methods: This cross sectional study was conducted on 300 patients selected by convenience sampling arriving in Diabetes Outdoor Clinics of Mayo and Services Hospitals, Lahore during August 2017 to May 2018. The data was entered and analyzed by using SPSS version 17. Results: Out of 300 patients included in study, 39% (n= 117) were males and 61% (n=183) were females. The mean age of the participants at presentation was 48.46±13.15 years with a range of 13 to 80 years. Study participants considered it embarrassing to inject insulin in public place (p-value 0.01). The fear associated with lifelong commitment to insulin therapy once it is started, was also found statistically significant (p-value 0.001)particularly in subjects who have long duration of DM (>5 years). Conclusion: Perceptions of diabetic patients about insulin therapy are still barriers to early initiation of therapy and tend to prevail in Pakistan and around the globe. How to cite this:Arshad I, Mohsin S, Iftikhar S, Kazmi T, Nagi LF. Barriers to the early initiation of Insulin therapy among diabetic patients coming to diabetic clinics of tertiary care hospitals. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.237 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.

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Outcome of abdominal binder in midline abdominal wound Dehiscence in terms of pain, psychological satisfaction and need for reclosure

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.4.3671 ◽

2021 ◽

Vol 37 (4) ◽

Author(s):

Ahmed Siddique Ammar ◽

Syed Asghar Naqi ◽

Shehrbano Khattak ◽

Ahmed Raza Noumani

Keyword(s):

Sampling Technique ◽

Wound Dehiscence ◽

P Value ◽

Emergency Laparotomy ◽

Abdominal Wound ◽

Creative Commons ◽

Surgical Ward ◽

Group A ◽

Abdominal Wound Dehiscence ◽

Group B

Objective: To assess the role of abdominal binder in patients with midline wound dehiscence after elective or emergency laparotomy in terms of pain, psychological satisfaction and need for reclosure. Methods: It was a comparative study done at EAST Surgical Ward of Mayo Hospital, Lahore from 1st January 2018 to 31st December 2019. One hundred and sixty-two (162) patients were included in this study with post-operative midline abdominal wound dehiscence and after informed consent by consecutive non probability sampling technique. Patients were divided into two groups by lottery method into eighty-one patients each. Group-A included patients where abdominal binder was applied and Group-B included patients without abdominal binder. In both groups pain score, psychological satisfaction and need for reclosure was assessed and compared. Results: Patients with abdominal binder shows significantly less pain (P value =0.000) and more psychological satisfaction (P value = 0.000) as compared to the patients where abdominal binder was not used. However, there was no difference in reducing the need for reclosure in patients who use abdominal binder (P value = 0.063). Conclusion: Although abdominal binder helps in reducing the pain and improving the psychological satisfaction in patients with midline abdominal wound dehiscence yet it doesn’t help in healing of wound and reclosure of the dehisced abdominal wound is needed. doi: https://doi.org/10.12669/pjms.37.4.3671 How to cite this:Ammar AS, Naqi SA, Khattak S, Noumani AR. Outcome of abdominal binder in midline abdominal wound Dehiscence in terms of pain, psychological satisfaction and need for reclosure. Pak J Med Sci. 2021;37(4):1118-1121. doi: https://doi.org/10.12669/pjms.37.4.3671 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.

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Knowledge and perception of Sepsis among Doctors in Karachi Pakistan

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.38.icon-2022.5775 ◽

2021 ◽

Vol 38 (ICON-2022) ◽

Author(s):

Faiza Ahmed ◽

Lubna Abbasi ◽

Fivzia Herekar ◽

Ahsun Jiwani ◽

Muhammad Junaid Patel

Keyword(s):

Critical Care ◽

Work Experience ◽

Cross Sectional Study ◽

P Value ◽

Common Belief ◽

Cross Sectional ◽

Health Networks ◽

Creative Commons ◽

Adequate Knowledge ◽

Open Access Article

Objectives: To assess knowledge and perception among Pakistani physicians towards sepsis. Methods: This cross-sectional study was conducted in Indus Hospital and Health Networks from September 2020 to March 2021. The International Sepsis Survey questionnaire was adapted, and its link was sent to trainee physicians as well as specialists, and consultants practicing in various hospitals via social media. Knowledge and perception were scored and 50% was considered the cut-off score for adequacy. Data was analyzed using SPSS version 26. Results: Analysis was done on 222 respondents who completed the survey. 37.9% of the participants had adequate knowledge. Knowledge regarding sepsis was significantly associated with specialty, ICU/CCU/HDU, and work experience (P-value <0.0001). More recent trainee physicians and those with more experience in critical care areas demonstrated better knowledge. Over 2/3rd of the respondents strongly agreed that sepsis remains one of the unmet needs in critical care today. Conclusion: A common belief exists that sepsis remains a challenge to treat among doctors. Moreover, there is consensus that it is the most frequently miss diagnosed condition in critical care and a dire need exists for its early diagnosis. Additionally, prompt management of presumed sepsis is imperative to improve outcomes. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5775 How to cite this:Ahmed F, Abbasi L, Herekar F, Jiwani A, Patel MJ. Knowledge and perception of Sepsis among Doctors in Karachi Pakistan. Pak J Med Sci. 2022;38(2):380-386. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5775 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.

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Factors affecting spirometry reference range in growing children

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.6.1212 ◽

2019 ◽

Vol 35 (6) ◽

Author(s):

Sara Sadiq ◽

Nadeem Ahmed Rizvi ◽

Fahad Khalid Soleja ◽

Muaz Abbasi

Keyword(s):

Reference Range ◽

Forced Expiratory Volume ◽

P Value ◽

Strong Positive Correlation ◽

Linear Regression Models ◽

Factors Affecting ◽

Independent Variables ◽

Creative Commons ◽

Forced Expiratory Flow ◽

Expiratory Flow

Objectives: To find out the association of weight, height and age with spirometry variables and to generate a regression equation by taking weight as an independent variable beside age and height among children and adolescents of Karachi. Methods: A modified form of ISSAC questionnaire was used. The spirometry variables recorded were Forced vital capacity (FVC), Forced expiratory volume in 1 second (FEV1), FEV1/FVC, Peak expiratory flow rate (PEF), Forced expiratory flow between 25% and 75% expired volume (FEF25-75). A person’s correlation coefficient among boys and girls were calculated for all spirometry variable considering age, height and weight as independent variables. The linear regression models were calculated. Results: The results reported a linear correlation of lung function variables with all three independent variables (i.e. p-value = 0.000), in which age and height manifested a strong positive correlation while weight reported a moderately significant correlation. All spirometry variables such as FVC, FEV1, PEF and FEF25-75 reported a significant coefficient of dependency and coefficient of correlation individually with age, height and weight. Conclusion: It is concluded that beside age, height and weight both also have significant correlation with lung volumes so these should be taken into account when using spirometry as a diagnostic test. doi: https://doi.org/10.12669/pjms.35.6.1212 How to cite this:Sadiq S, Rizvi NA, Soleja FK, Abbasi M. Factors affecting spirometry reference range in growing children. Pak J Med Sci. 2019;35(6):1587-1591. doi: https://doi.org/10.12669/pjms.35.6.1212 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.

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