High incidence of common femoral Deep Vein Thrombosis in critically ill Covid19 patients

Objective

To estimate the incidence and prevalence of deep venous thrombosis, and to evaluate the discriminative capacity of D-dimer in its diagnosis.

METHODS

The prospective, observational study was conducted at the critical care unit of a tertiary care hospital in Pakistan from February to September 2021 and comprised consecutively admitted adult critically ill patients who were receiving therapeutic-dose anticoagulation therapy. All patients were screened on day one for deep venous thrombosis by colour doppler and compression ultrasonography. Patients who did not have deep venous thrombosis on the first scan were followed every 72 hours. Data was analysed using SPSS 26.

RESULTS

Of the 142 patients, 99(69.7%) were male and 43(30.3%) were female. The overall mean age was 53.20+/-13.3 years. On the first scan, 25(17.6%) patients had deep venous thrombosis. Of the remaining 117 patients, 78(68.4%) were followed every 72 hours, and 23(29.48%) of them developed deep venous thrombosis. The most common site for DVT was the common femoral vein 46(95.8%) and most deep venous thrombosis cases were unilateral 28(58.33%). D-dimer levels showed no discriminative capacity for diagnosis of deep venous thrombosis (p=0.79). There were no significant risk factors for the development of deep venous thrombosis.

Conclusion

There was a high incidence and prevalence of deep venous thrombosis despite therapeutic-dose anticoagulation therapy. The most common affected site was the common femoral vein and most deep venous thrombosis were unilateral. D-dimer levels had no discriminative capacity for the diagnosis of deep venous thrombosis DVT.

Frequency of hospital acquired pneumonia and its microbiological etiology in medical intensive care unit

OBJECTIVE

The objectives were to assess the frequency of hospital acquired pneumonia (HAP) in patients admitted to intensive care unit (ICU) and to determine the frequencies of different etiological organisms in these patients.

METHODS

This was descriptive cross sectional study, which was carried out in medical ICU of Shifa International Hospital Islamabad from January 2013 to January 2014. A total of 1866 patients were admitted in the department of medicine including medical ICU. They were evaluated for HAP and the causative organisms were cultured from these patients. Identification was carried out by standard biochemical profile of the organisms.

RESULTS

The total number of patients admitted in medical ICU for any reason were 346. HAP was diagnosed in 88 patients (25.4%). The average age of patients admitted in Medical ICU with HAP was 48 years with the range of 16 to 82 years. 56 were male and 32 females. 42 patients (47.7%) died in medical ICU with HAP. Microbiological analysis showed that Pseudomonas aeruginosa were 27 (30.6%), Acinetobacter spp. were 12 (13.6%), Candida albicans were 12 (13.6%), Klebsiellapneumoniae were 9 (10.2%), Streptococcus spp. were 9 (10.2%), Escherichia coli were 5 (5.6%), Stenotrophomonas spp. were 4(4.5%), Methicillin Resistant Staphylococcus Aureus (MRSA) were 4 (4.5%) others organisms 6 (6.8%).

CONCLUSION

The frequency of HAP in Medical ICU of our hospital is 88 out of 346 (25.4%). The commonest organism identified was Pseudomonas aeruginosa (30.6%) followed by Acinetobacter and Candida albican (13.6% each).

Fibromyalgia complicating disease management in rheumatoid arthritis

OBJECTIVE

To evaluate frequency of fibromyalgia in rheumatoid arthritis and its effect on disease activity score.

STUDY DESIGN

Cross-sectional study.

PLACE AND DURATION OF STUDY

The Indus Hospital, Karachi, from December 2010 to May 2011.

METHODOLOGY

All adult patients of either gender diagnosed as rheumatoid arthritis on the basis of clinical, laboratory and X-ray criteria were included in the study. The sample data was separated into two groups depending on presence or absence of fibromyalgia and 28 joint disease activity score (DAS-28) value was evaluated.

RESULTS

There were 31 (25.83%) patients with rheumatoid arthritis and fibromyalgia (RAFM) out of the total 120. The median (IQR) age of patients was 40 (32 - 51) years. All were females. The overall female frequency was 79 (88.8%). The median (IQR) DAS-28 score in RA group was 4.9 (3.66 - 5.71), while the median (IQR) DAS-28 score in RAFM was 7.04 (6.62 - 7.64) [p < 0.0001]. The number of patient getting combination therapy of DMARD in RAFM group was 61.3% while in RA group was 42.7%.

CONCLUSION

DAS-28 was found to be significantly higher in RAFM patients probably because of higher perception of pain.

Frequency of factors associated with knee osteoarthritis

OBJECTIVE

To determine the frequency of factors associated with knee osteoarthritis.

METHOD

A cross sectional study was conducted in the department of medicine at Liaquat National Hospital Karachi from September 2007 - March 2008 on patients diagnosed with osteoarthritis of knee. One hundred patients of age more than 18 years, and of either gender were consecutively included. Those patients with family history, occupations like farmers, mill workers and jack hammer operators, females with hormonal replacement therapy, patients with hyperparathyroidism, haemochromatosis and systemic lupus erythematosus were excluded. The patients were then graded on the basis of knee joint X-ray findings into four grades. The main outcome variables of the study were factors associated with osteoarthritis which included obesity, age, gender, smoking and anaemia.

RESULTS

The mean age was 56.28 +/- 8.786 years. The mean BMI was 29.434 +/- 7.849 years and mean Haemoglobin was 11.77 +/- 1.670 mg/dl. The frequency of factors associated with osteoarthritis was age 55 years in 60 (60%) patients. Gender included 74 (74%) females and 26 (26%) males. Smokers were 25 (25%), obesity was present in 33 (33%) and anaemia was present in 7 (50%) women and 16 (61.5%) males.

CONCLUSION

The study found that females of age greater than 55 years mostly noted to visit a tertiary care hospital due to knee osteoarthritis.

Role of APACHE score in predicting mortality in chest ICU

OBJECTIVE

To determine the first 24 hours mean values of APACHE II score for two outcomes (alive or dead) in patients admitted in chest ICUs.

METHODS

A prospective study was conducted in the Department of Chest, Jinnah Postgraduate Medical Centre Hospital, Karachi from January 2009 to December 2009. Patients of all ages and either gender admitted in chest ICU for any cause, were consecutively enrolled. All patients with incomplete records and missing variables including laboratory investigations or who had not been followed up due to any reason were excluded. Patients who were readmitted in the ICU were also excluded. The main outcomes were the first 24 hours mean APACHE II score of the sample and first 24 hours mean APACHE II score of patients who were later discharged or had died.

RESULTS

The mean age of the patients was 53.16 +/- 19.29 years. Out of 143 participants 84 (58.7%) were males and 59 (41.3%) females. The main diagnosis included COPD with acute exacerbation 63 (44.05%), post TB fibrosis 17 (11.88%), acute severe asthma 14 (9.79%) and pneumonia 12 (8.39%) patients. The results found that 63 out of 143 patients were alive whereas 80 patients died. The mean APACHE II score on first 24 hours was 20.09 +/- 7.49. The mean 24 hours APACHE II score of patients who were discharged and who died was 18.93 +/- 7.19 and 22.33 +/- 7.80 respectively.

CONCLUSION

Our preliminary results showed that it is recommended to determine the cut off levels of APACHE II scores in patients admitted with chest ICU.

Drug resistance to tuberculosis in a tertiary care setting in Karachi

OBJECTIVE

To evaluate the resistance pattern of tuberculosis cases.

METHODS

A descriptive study was done in two out patient referral clinics from January 1999 to March 2003. All TB cases that had cultures positive for mycobacterium tuberculosis were evaluated.

RESULTS

Data from 71 proven culture positive patients was available. Resistance to at least one antituberculous drug was found in 44 (60.5%) cases. Primary, Initial and Secondary Resistance to at least one drug was 7.0%, 21.1% and 32.3% respectively. Out of 7.0% primary resistance cases, there were 5.6% of single drug resistance, 1.4% Multiple Drugs and zero percent of Multi drug Resistance (MDR). Initial resistance cases (out of 21.1%) included 12.6% to single drug, 7% to multiple drugs and 1.4% MDR. Acquired Resistance Cases (out of 32.3%) included 5.6% each to single and multiple drugs and 21% MDR. Single drug resistance (for primary, initial and acquired) showed 14% resistance for Isoniazid, 4.2% for Rifampicin, 2.8% each for Ethambutol and Streptomycin and 1.4% to Pyrazinamide.

CONCLUSION

In this cohort of patients, Primary resistance to at least one drug was 7.0% and no MDR. Among individual drugs, resistance to Isoniazid was highest (14%) and lowest for Pyrazinamide (1.4%).