Objective: To determine the diagnostic accuracy of elevated C reactive protein (CRP) and ferritin in predicting severe Covid-19 infection using the World Health Organization’s (WHO) Covid-19 severity classification as gold standard. Study Design: Descriptive study. Place and Duration of Study: This study was conducted at the Pak Emirates Military Hospital, Rawalpindi, from January 1st 2021 till April 30th 2021. Ethical review committee’s (ERC) approval was taken and good clinical practice guidelines were followed. Material and Methods: Baseline blood samples were sent to the hospital laboratory for the measurement of C reactive protein and ferritin levels. PCR was taken as gold standard for the diagnosis of Corona virus disease. Patients were classified into severe and non-severe categories using WHO classification of severity. Sensitivity, specificity, diagnostic accuracy, negative predictive value and positive predictive value were calculated for elevated CRP and ferritin. Results: There were 65 (57.5%) patients who had severe Covid-19 disease and 48 (42.5%) patients who had non-severe Covid-19 disease. Among the patients with severe Covid-19, 57 (87.7%) had elevated CRP levels, and 50 (76.9%) patients had elevated ferritin levels. Testing ferritin levels, against the severity of Covid-19 patients, there was a sensitivity of 76.9%, specificity of 79.2%, positive predictive value (PPV) of 83.3%, negative predictive value (NPV) of 71.7% and diagnostic accuracy of 77.8%. Testing CRP levels, there was a sensitivity of 87.7%, specificity of 85.4%, PPV of 89.1%, NPV of 83.6% and diagnostic accuracy of 86.7%. Conclusion: The results from our study show that CRP has a slightly improved diagnostic accuracy as compared to ferritin. However, both these markers have value in the prediction of severity of Covid-19 infection. Keywords: Covid-19, elevated C reactive protein and ferritin.
Objective: To assess the smoking abstinence rate after a twenty-minutes structured counselling session. Study Design: Prospective Cohort Study. Place and Duration of Study: Respiratory Clinic, Pak Emirates Military Hospital, Rawalpindi Pakistan from Jun to Dec 2020. Methodology: A total of 400 active smokers visiting respiratory clinics were inducted into counselling sessions of twenty-minute duration for a structured smoking cessation counselling advice during which additional information regarding age, motivation status, duration of smoking, previous cessation attempts etc., was also recorded. All candidates were followed by telephone for six months for subject-reported abstinence status. Results: All the study participants were males between 39 to 64 years of age (mean age: 52.27 ± 4.78 years), of which 23 lost to follow-up, 102 (25.5%) remained quitters successfully, while the remaining 305 candidates relapsed at the end of 6 months. The highest relapse was observed at the end of 3 months, while the lowest relapse rate was observed in the fifth and sixth months since the quit date. Younger age had more odds of successful cessation rate than others (OR=6.13 CI 95%, p<0.001). Those with a motivation score of 8 or more had more probability of abstaining (OR=5.38, CI 95%, p-value=0.001) Conclusions: The smoking abstinence rate in these counselling sessions was as significant as in other smoking cessation programs. The probability of quitting was more in younger adults and highly motivated ones.
Objective: To ascertain the benefit of a standardized Basic Life Support (BLS) workshop on the different healthcare cadres in hospitals.Study Design: Cross-sectional analytical study.Place and Duration of Study: The study was carried out at the Medicine Department of Medicine of CombinedMilitary Hospital, Peshawar, Pakistan, from November 2021 to May 2022.Materials and Methods: A hundred individuals participated in the study, including house officers, residents and paramedical staff. It was done through convenient sampling. After consent, their knowledge before the start of the workshop was evaluated through pretest self-structured questionnaires formulated by the American Hearts Association accredited trainers. Afterwards, they underwent a Basic Life Support workshop conducted as per American Heart Association (AHA) standards. At the end of the workshop, they were evaluated by posttest questionnaires. The demographic data of all individuals, including age, gender, education status anddesignation, was recorded. Data were analyzed through SPSS version 21. Paired T-test was applied. A p value of0.05 or less was considered statistically significant at the start of the study.Results: The individuals comprised 55 males and 45 females. It included residents, house officers andparamedical staff with mean ages of 27.86±1.17 years, 24.08±0.28 years and 30.56±2.90 years, respectively.Residents had better pretest scores than house officers and paramedical staff (P value <0.001). There wasstatistically significant improvement in the scores of all individuals (P value <0.001).Conclusion: BLS workshops have helped improve the knowledge of the hospital staff regardless whichevermedical offshoot. Residents had better pretest scores, but house officers improved posttest scores the most.
Nocardiosis is a neglected, unusual disease caused by aerobic, gram positive, actinomycete in the genus Nocardia. Nocardial infection most often occurs in immunocompromised patients. It has varied geographical distribution and a range of clinical presentations. Lungs are the primary sites of nocardial infection in more than two-third of cases. We report a case from a tertiary care setup in Karachi where nocardiosis occurred in an immunocompetent patient with an isolated CNS involvement.
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