Diseases Commons^™

Allergic Bronchopulmonary Aspergillosis: Radiological And Microbiological Profile Of Patients Presented In An Outpatient Pulmonary Clinic In A Developing Country, Nousheen Iqbal, Muhammad Irfan, Mustafa Bin Ali Zubairi, Maaha Ayub, Safia Awan, Kauser Jabeen, Ali Bin Sarwar Zubairi

Section of Pulmonary & Critical Care

There is limited data available about allergic bronchopulmonary aspergillosis (ABPA) in Pakistan. The aim of the study was to describe the radiological and microbiological profile of ABPA patients presenting to the outpatient pulmonary clinic of a tertiary care hospital in Karachi, Pakistan. A retrospective study was conducted on ABPA patients who presented to the pulmonary outpatient clinic at Aga Khan University Hospital, Karachi, Pakistan, from January 2017 to December 2019. Data was collected on microbiology and radiology features on predesigned proforma. A total of 7759 asthmatic patients presented at the outpatient pulmonology clinic during the study period. Of the 245 …

Allergic Bronchopulmonary Aspergillosis Misdiagnosed As Smear Negative Pulmonary Tuberculosis; A Retrospective Study From Pakistan, Nousheen Iqbal, Muhammad Dawood Amir Sheikh, Kauser Jabeen, Safia Awan, Muhammad Irfan

Section of Pulmonary & Critical Care

Background: Undiagnosed allergic bronchopulmonary aspergillosis (ABPA) can lead to chronic persistent symptoms. In country like Pakistan where tuberculosis (TB) is endemic, a significant proportion of ABPA patients are misdiagnosed as smear negative TB before reaching a diagnosis of ABPA due to chronicity of symptoms.This lead to empiric use of ATT(Anti-tuberculous therapy) and delay in primary diagnosis. The aim of the study is to determine such proportion of ABPA patients.|
Material and methods: This retrospective study was conducted at the outpatient pulmonology clinic of a tertiary care hospital in Karachi, Pakistan from January 2017 to December 2018. Xpert MTB/Rif, TB smear …

Persistence Of Post-Covid Lung Parenchymal Abnormalities During The Three-Month Follow-Up, Ali Bin Sarwar Zubairi, Anjiya Shaikh, Syed Muhammad Zubair, Akbar Shoukat Ali, Safia Awan, Muhammad Irfan

Section of Pulmonary & Critical Care

Introduction: COVID-19-associated pulmonary sequalae have been increasingly reported after recovery from acute infection. Therefore, we aim to explore the charactersitics of persistent lung parenchymal abnormalities in patients with COVID-19.
Material and methods: An observational study was conducted in patients with post-COVID lung parenchymal abnormalities from April till September 2020. Patients ≥18 years of age with COVID-19 who were diagnosed as post-COVID lung parenchymal abnormality based on respiratory symptoms and HRCT chest imaging after the recovery of acute infection. Data was recorded on a structured pro forma, and descriptive analysis was performed using Stata version 12.1.
Results: A total of 30 …

Post Tuberculosis Radiological Sequelae In Patients Treated For Pulmonary And Pleural Tuberculosis At A Tertiary Center In Pakistan, Syed Muhammad Zubair, Mariyam Gohar Ali, Muhammad Irfan

Section of Pulmonary & Critical Care

Treating tuberculosis (TB) is not the end of the disease because of the wide spectrum of post TB sequelae associated with the disease. There is insufficient data on post TB radiological sequelae. The aim of this study is to evaluate the post TB radiological sequelae on chest x-rays in patients who had completed the treatment for pulmonary and pleural TB at a tertiary care hospital of a high TB burden country. This is a retrospective cross-sectional study conducted on patients treated for pulmonary and pleural TB. Adult patients (18 years or above) with a clinical or microbiological diagnosis of pulmonary …

Post Covid-19 Tuberculosis: An Emerging Threat Of Pandemic, Aqusa Zahid, Nousheen Iqbal, Sarosh Moeen, Muhammad Irfan

Section of Pulmonary & Critical Care

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) pandemic has hit the world hard. Millions of people have died due to the infection and several have suffered with what are now known as post COVID-19 squeal. Among these squeals one is immunosuppression which leaves patients prone to severe opportunistic infection. We here report a case of young female who was infected by COVID-19 and later developed cavitary pneumonia which upon investigation turned out to be due to mycobacterium tuberculosis. Through this report we aim to highlight the importance of high index of suspicion for infection like Mycobacterium tuberculosis after …

Factors Associated Within 28 Days In-Hospital Mortality Of Patients With Acute Respiratory Distress Syndrome, Nadia Sharif, Muhammad Irfan, Javaid Hussain, Javaid Khan

Section of Pulmonary & Critical Care

Objective. To determine the factors leading to in-hospital mortality within 28 days in hospitalized patients with ARDS. It was a prospective observational cohort study conducted in Intensive Care Unit of Aga Khan University Hospital Karachi from March to August 2011. Methodology. Data was collected from patients admitted in the intensive care unit on the basis of inclusion and exclusion criteria. The patients were followed daily for 28 days to record any in-hospital complications and the outcome of patients. Results. Total of 46 patients were included during this period out of which 56% (26) were males and 43% (20) were females. …

Bronchial Carcinoid Presenting As Multiple Lung Abscesses, Zeeshan Waheed, Muhammad Irfan, Saulat Fatimi, Ruqaiya Shahid

Section of Pulmonary & Critical Care

Bronchial carcinoid tumours is a rare group of pulmonary malignant neoplasm that is derived from neuroendocrine system. Bronchial carcinoid usually present with hilar masses, atelactasis, bronchiectasis, or post-obstructive pneumonia. This case describes a very unusual presentation of bronchial carcinoid tumour with multiple lung abscesses involving the whole lung. This report is of an adult lady who presented with multiple lung abscesses involving her whole of the right lung. She was found to have an endo-bronchial lesion in her right main bronchus which eventually turned out to be carcinoid tumour. She responded to resection and antibiotic therapy.

Expression Of M. Tuberculosis-Induced Suppressor Of Cytokine Signaling (Socs) 1, Socs3, Foxp3 And Secretion Of Il-6 Associates With Differing Clinical Severity Of Tuberculosis, Kiran I. Masood, Martin E. Rottenberg, Naseem Salahuddin, Muhammad Irfan, Nisar Rao, Berit Carow, Muniba Islam, Rabia Hussain, Zahra Hasan

Section of Pulmonary & Critical Care

Background

Appropriate immune activation of T cells and macrophages is central for the control of Mycobacterium tuberculosis infections. IFN-γ stimulated responses are lowered in tuberculosis (TB), while expression of Suppressor of Cytokine Signaling (SOCS) molecules – 1 and 3 and CD4⁺CD25⁺FoxP3⁺T regulatory cells is increased. Here we investigated the association of these molecules in regard to clinical severity of TB.

Methods

Peripheral blood mononuclear cells (PBMCs) were isolated from patients with pulmonary TB (PTB, n = 33), extra-pulmonary TB (ETB, n = 33) and healthy endemic controls (EC, n = 15). Cases were classified …

Pulmonary Hyalinising Granuloma: A Rare Pulmonary Disorder, Arsalan Rahatullah, Zeeshan Waheed, Javaid A Khan, Nasir-Ud-Din

Section of Pulmonary & Critical Care

Pulmonary hyalinising granulomas are rare, noninfectious fibrosclerosing lesions of the lung which can mimic metastatic disease. It was first described in literature by Engleman et al in the year 1977. Its etiology is unknown but they may be caused by an exaggerated immune response. The patient typically presents with cough, chest pain. dyspnoea or haemoptysis in association with multiple bilateral parenchymal nodules. We report the case of a 20 years old male who presented with a 12-month history of worsening dry cough. His plain chest radiograph and subsequent CT scan revealed bilateral pulmonary nodules. A CT guided biopsy of the …

Assessing Two Spirometric Criteria Of Pre-Bronchodilator And Post-Bronchodilator Fev1/Fvc Ratio In Detecting Air Flow Obstruction, Zeeshan Waheed, Muhammad Irfan, Ahmed Suleman Haque, Najmul Hasan Siddiqui, Safia Awan, Beenish Syed, Javaid Khan

Section of Pulmonary & Critical Care

OBJECTIVES: To assess the Pre-bronchodilator criteria and the Post-bronchodilator criteria of FEV1/FVC ratio in diagnosing Airflow obstruction.

METHODS: An observational study was conducted from 1988 to 2006 at the Aga Khan University Hospital Patients referred to the pulmonary function test laboratory for spirometry with bronchodilator reversibility at the hospital during the above said period were enrolled. Forced spirometry was performed according to ATS guidelines. All patients who had pre-bronchodilator criteria of airflow obstruction were analyzed and compared with the post bronchodilator criteria.

RESULTS: A total of 4222 individuals underwent spirometry out of which 4072 individuals were studied. Using the pre …

Treatment Outcome Of Multi-Drug Resistant Tuberculosis Treated As Outpatient In A Tertiary Care Center, Zeeshan Waheed, Muhammad Irfan, Ahmed Suleman Haque, Muhammad Owais Khan, Atif Zubairi, Noor Ul Ain, Javaid A. Khan

Section of Pulmonary & Critical Care

INTRODUCTION: Community-based out-patient treatment for multidrug-resistant tuberculosis (MDR TB) is relatively new concept with reported successful outcomes.

OBJECTIVE: To assess the treatment outcomes of HIV negative multidrug-resistant tuberculosis (MDR TB) patients treated as outpatient at a tertiary care center in Karachi, Pakistan.

METHODS: A retrospective observational study of 53 consecutive, culture proven HIV negative MDR TB patients (resistant at least to both Isoniazid (H) and Rifampin(R) treated at Aga Khan University Hospital, Karachi between August 1999 and March 2007. Data were collected on predesigned performa regarding patient’s demography, clinical features, radiological findings, drug sensitivity, treatment and outcome.

RESULTS: A total …

Hughes-Stovin Syndrome, Umair Khalid, Taimur Saleem

Section of Pulmonary & Critical Care

Hughes-Stovin Syndrome (HSS) is a very rare clinical disorder characterized by thrombophlebitis and multiple pulmonary and/or bronchial aneurysms. Less than 40 published cases of HSS have been described in English medical literature so far. The exact etiology and pathogenesis of HSS is unknown, possible causes include infections and angiodysplasia. HSS has also been considered as a variant of Behcet's disease (BD). Patients with HSS usually present with cough, dyspnea, fever, chest pain and haemoptysis. The management of HSS can either be medical or surgical. Medical management includes the use of steroids and cytotoxic agents. Cyclophosphamide, in particular, is a favored …

Negative Pressure Pulmonary Oedema: A Rare Complication Following General Anaesthesia, Zeeshan Waheed, Javaid Khan

Section of Pulmonary & Critical Care

An important cause of pulmonary oedema is Negative Pressure Pulmonary Oedema (NPPE) which characteristically develops soon after extubation from an endo-tracheal intubation. In this case report we identified a case of previously healthy man who was intubated for General Anaesthesia for extraction of impacted molar tooth. Soon after extubation he developed severe respiratory distress. Immediate diagnosis of NPPE secondary to post extubation laryngospasm was made. He was promptly treated with 100 percent oxygen via CPAP (continuous positive airway pressure) mask and within an hour he markedly improved and subsequently became asymptomatic. NPPE is an important cause of morbidity and need …

Causes Of Smoking In Pakistan: An Analysis Of Social Factors, Sobia Nizami, Zain A Sobani, Emmon Raza, Noor-Ul-Ain Baloch, Javaid Khan

Section of Pulmonary & Critical Care

OBJECTIVE: To determine the factors contributing to the initiation and propagation of smoking in visitors to a major tertiary health center in Karachi, Pakistan.

METHODS: Seven major contributing factors to the initiation and propagation of smoking were presented to consenting study participants (n=170) in a questionnaire. Participants were then requested to use their experience and opinion to rate each of the given factors on a scale of 1 to 5 regarding its importance as a causative factor in the initiation and propagation of smoking. Results were analyzed using SPSSv16.0.

RESULTS: Preliminary analysis revealed occupational stress relief as the most important …

The Efficacy Of Spirometry As A Screening Tool In Detection Of Air Flow Obstruction, Nabeel Manzar, A. Suleman Haque, Bushra Manzar, Muhammad Irfan

Section of Pulmonary & Critical Care

Background/Objectives: In developing countries, spirometry has not been considered a part of routine medical check-up. The purpose of the study was to establish the usefulness of spirometry as a primary screening tool in detecting air flow obstruction (AFO) during routine medical check-up (RMC). Methods: This was a hospital based, retrospective, non-randomized case series study of 3696 participants, who presented to hospital for routine medical check-up. All subjects were assisted at the Pulmonary Medicine Department, from January 2003 till December 2008 who, having met other inclusion criteria, underwent spirometry. Data were analyzed using proportion, group means, standard deviations and …

Lung Carcinoma: Its Profile And Changing Trends, Saad Siddiqui, Mohammed Usman Ali, Mahrukh Ayesha Ali, Noreen Shah, Shagufta Nasreen

Section of Pulmonary & Critical Care

BACKGROUND: Lung Carcinoma is the leading causes of morbidity and mortality worldwide with an incidence of 1.3 million cases per year. This study was undertaken to determine prevalence of various histological types of lung carcinoma and to analyse their changing trends with time.

METHODS: This is a retrospective analytical study. A total of 330 cases of lung carcinoma were analysed from 2003 to 2008. Cases from Khyber Pakhtunkhwa and Federally Administered Tribal Area (FATA) were included in this study. Furthermore, only cases of lung carcinoma were considered while other malignancies were excluded.

RESULTS: Squamous Cell carcinoma was found in 42.7% …

Drug Resistance Pattern In Multidrug Resistance Pulmonary Tuberculosis Patients, Nisar Ahmed Rao, Muhammad Irfan, Mir Mir Soomro, Zeeshan Mehfooz

Section of Pulmonary & Critical Care

Objective: To evaluate accuracy of modified Kenneth Jones scoring criteria (MKJSC) as a screening tool to diagnose tuberculous meningitis in children. Study Design: Cross-sectional study. Place and Duration of Study: Paediatric Medicine, Unit-I, Bahawal Victoria Hospital, Bahawalpur, from May 2006 to March 2007. Methodology: A total of 100 children admitted through emergency in Paediatric Medicine, Unit-I, were included who were having fever and features suggestive of central nervous system (CNS) infection. Lumbar puncture was done in all patients after written consent. Findings of lumbar puncture were taken as gold standard for the diagnosis of TBM. MKJSC was applied on each …

Variables Predictive Of Outcome In Patients With Acute Hypercapneic Respiratory Failure Treated With Noninvasive Ventilatio, Nawal Salahuddin, Muhammad Irfan, Shereen Khan, Muhammad Naeem, Ahmad Suleman Haque, Shahid Javed Husain, Nisar Ahmed Rao, Ali Bin Sarwar Zubairi, Javaid Khan

Section of Pulmonary & Critical Care

OBJECTIVE: To assess results with NIV in acute hypercapneic respiratory failure and to identify outcome predictors.

METHODS: This was a retrospective observational study on consecutive patients presenting with acute type II respiratory failure and meeting criteria for NIV use over a 5 year period. Patients presenting with haemodynamic instability, inability to protect their airway, malignant arrhythmias and recent oesophageal surgery were excluded. Univariate and Multivariate regression analysis was used to determine the impact on survival. A p value of < 0.05 was considered statistically significant. Software used was SPSS 14.

RESULTS: Total numbers of patients included were 119; 52.9% were males. Mean age was 63.4 +/- 11.9 years. Overall Survival to …

Ccl2 Responses To Mycobacterium Tuberculosis Are Associated With Disease Severity In Tuberculosis, Zahra Hasan, Jacqueline M. Cliff, Hazel M. Dockrell, Bushra Jamil, Muhammad Irfan, Mussarat Ashraf, Rabia Hussain

Section of Pulmonary & Critical Care

Background

Leucocyte activating chemokines such as CCL2, CCL3, and CXCL8 together with proinflammatory IFNγ, TNFα and downmodulatory IL10 play a central role in the restriction of M. tuberculosis infections, but is unclear whether these markers are indicative of tuberculosis disease severity.

Methodology

We investigated live M. tuberculosis- and M. bovis BCG- induced peripheral blood mononuclear cell responses in patients with tuberculosis (TB) and healthy endemic controls (ECs, n = 36). TB patients comprised pulmonary (PTB, n = 34) and extrapulmonary groups, subdivided into those with less severe localized extrapulmonary TB (L-ETB, n = 16) or severe disseminated ETB (D-ETB, …

Wegener's Granulomatosis: A Diagnostic Challenge, Ali Bin Sarwar Zubairi, Hammad Bin Liaquat, Shahid Javed Husain, Kulsoom Fatima

Section of Pulmonary & Critical Care

Wegener's Granulomatosis (WG) is a necrotizing granulomatous vasculitis that primarily involves small vessels in the body. Patient usually presents in the fourth to fifth decade. The clinical presentation is variable; however, majority of patients (90%) seek medical attention for nasal and sinus symptoms with or without lower respiratory symptoms of cough, dyspnoea and haemoptysis. The typical form of WG tends to involve the triad of upper and lower respiratory tract and the kidneys; while involvement of other organs like ocular, cutaneous, rheumatological, neural, gastrointestinal and lower genito-urinary tract is occasionally seen. A "limited" form with clinical findings isolated to the …

Treatment Outcome Of Multi-Drug Resistant Tuberculosis In A Tertiary Care Hospital In Karachi, Nisar Ahmed Rao, Zeeshan Mahfooz, Muhammad Irfan

Section of Pulmonary & Critical Care

Objective: To assess the outcomes of pulmonary multidrug-resistant tuberculosis (MDR-TB) patients treated at Ojha Institute of Chest Diseases (OICD), a reference hospital for TB in Karachi, Pakistan. Methods: Clinical study for the period 1996-2006, with follow-up until June 2007 was performed. All the culture and sensitivity proven cases of MDR pulmonary TB were initially admitted for 3-6 months till the sputum converted negative. Treatment regimen was decided on individual basis, and included 4-6 drugs. Supervised treatment was given to all patients during the hospitalization. After discharge from the hospital, patients were followed at monthly interval at the outpatient department of …

Community Acquired Pneumonia: Risk Factors Associated With Mortality In A Tertiary Care Hospitalized Patients, Muhammad Irfan, Syed Fayyaz Hussain, Khubaib Mapara, Shafia Memon, Mohammed Mogri, Muniza Bana, Amna Malik, Sara Khan, Nadia A Khan

Section of Pulmonary & Critical Care

OBJECTIVE: To evaluate risk factors associated with mortality in patients hospitalized with CommunityAcquired Pneumonia (CAP) from a developing country.

METHODS: An observational study was conducted on adult patients admitted with a diagnosis of CAP from January 2002 to August 2003 at Aga Khan University hospital, Karachi, Pakistan. Clinical records were reviewed for demographic characteristics, clinical and laboratory features, hospital course, and risk factors associated with mortality.

RESULTS: A total of 329 patients (187 males) were admitted with CAP. Two-third of patients had underlying co-morbid medical illnesses. Complications developed in 15.7% cases and the overall mortality rate was 11%. Risk factors …

Assessment Of Asthma Control Using The Asthma Control Test At A Tertiary Care Centre In Karachi, Pakistan, Sana Shoukat, Saqib Ali Gowani, Ameer Ali Khowaja, Javaid Khan

Section of Pulmonary & Critical Care

The aim of our study was to assess asthma control among asthmatics at a tertiary care setting in Karachi using ACT questionnaire. The ACT questionnaire was filled by known asthmatics in January 2007. A total of 150 questionnaires were filled of which, 61 (40%) were males and 89 (60%) females. Mean ACT score was 17.71 +/- 4.41. Association between sex and asthma control was not statistically significant. Significant association was seen with asthma control and Ipratropium bromide inhaler. Asthma control among patients at a tertiary care centre is moderate. ACT can be used to follow patients in the hospital.

Primary Drug Resistance Against Mycobacterium Tuberculosis In Karachi, Nisar Ahmed Rao, Muhammad Irfan, Shahid Javed Hussain

Section of Pulmonary & Critical Care

OBJECTIVE: To evaluate the primary drug resistance of new culture positive cases of pulmonary tuberculosis in Karachi.

METHODS: All new suspected pulmonary tuberculosis patients were recruited initially. They were instructed to produce three-sputum samples for smear examination and on one of the specimen's culture was applied. Bronchoscopy and bronchial wash was done in patients who were not expectorating. Bronchial wash was then applied for both smear and culture for Mycobacterium tuberculosis.

RESULTS: Out of 79 cases recruited initially, 52 were able to produce sputum while bronchoscopy was performed in the remaining. AFB direct smear was positive in 32/52 sputum and …

Socio-Demographic Correlates Of Exhaled Breath Carbon Monoxide In Karachi's Adult Population, Majid Shafiq, Sumera Khan, M. Rizwanulhaq Khawaja, Suleman Haque, Javaid Khan

Section of Pulmonary & Critical Care

OBJECTIVE: To examine the relationship between CO levels and putative factors including smoking status among residents of Karachi, an urban center with very high levels of air pollution.

METHODS: Two hundred and eighteen volunteering subjects were asked to maximally exhale into a Smokerlyzer breath CO analyzer. Each of the volunteers was also asked to reply to a questionnaire-based interview seeking demographic information as well as details of exposure to tobacco, traffic fumes and other air pollutants.

RESULTS: Out of the 218 participating subjects, 75% were males and 27% were current or ex-smokers. The mean CO level was 2.92 parts per …

Bleomycin Induced Pneumonitis: A Case Successfully Managed With High-Dose Steroids, Shahid Javed Husain, Ali Bin Sarwar Zubairi, Muhammad Irfan

Section of Pulmonary & Critical Care

No abstract provided.

Chest Radiographs In Acute Pulmonary Embolism, Ali Bin Sarwar Zubairi, Shahid Javed Husain, Muhammad Irfan, Kulsoom Fatima, Muhammad Atif Zubairi, Muhammad Islam

Section of Pulmonary & Critical Care

Background:

Pulmonary embolism (PE) is a serious clinical entity carrying significant morbidity and mortality. Clinically, it is a difficult condition to diagnose and remains under treated condition in Pakistan due to non-availability of objective tests and lack of awareness among physicians.This study was conducted to determine the chest radiographic presentation in known cases of acute PE presenting to a tertiary care hospital.

Methods:

Hospital records of patients with a diagnosis of acute PE were reviewed from June 2000 until June 2004. Fifty diagnosed cases of acute PE on Spiral Computed tomography (CT) of the chest demonstrating an intraluminal-filling defect were …

Knowledge, Attitude And Misconceptions Regarding Tuberculosis In Pakistani Patients, Javaid Ahmed Khan, Muhammad Irfan, Amna Zaki, Madiha Beg, Syed Fayyaz Hussain, Nadeem Rizvi

Section of Pulmonary & Critical Care

Objective:

To assess knowledge of patients with tuberculosis; about their disease and misconceptions regarding TB.

Methods:

A cross sectional study was conducted at Out-patient clinics of two teaching hospitals (private and public) in Karachi, Pakistan. A questionnaire was filled for the purpose.

Results:

A total of 170 patients were interviewed, 112 from private and 58 from a public sector hospital. Cough, fever, bloody sputum and chest pain were recognized as the common symptoms of TB. Eleven (7%) patients thought TB was not an infectious disease and 18 (10.6%) did not consider it a preventable disease. Contaminated food was considered the …

Pulmonary Langerhans Cell Histiocytosis, Muhammad Irfan, Javed Hussain, Riaz Lakdawala, Fayyaz Hussain, Javaid Khan

Section of Pulmonary & Critical Care

No abstract provided.