Medicine and Health Sciences Commons^™

Impact Of Compensated Cirrhosis On Survival In Patients With Acute-On-Chronic Liver Failure, Kessarin Thanapirom, Tongluk Teerasarntipan, Sombat Treeprasertsuk, Ashok Choudhury, Manoj K. Sahu, Rakhi Maiwall, Viniyendra Pamecha, Richard Moreau, Saeed Hamid, Amna Subhan Butt

Section of Gastroenterology

Background and aims: Acute-on-chronic liver failure (ACLF) is considered a main prognostic event in patients with chronic liver disease (CLD). We analyzed the 28-day and 90-day mortality in ACLF patients with or without underlying cirrhosis enrolled in the ACLF Research Consortium (AARC) database.
Methods: A total of 1,621 patients were prospectively enrolled and 637 (39.3%) of these patients had cirrhosis. Baseline characteristics, complications and mortality were compared between patients with and without cirrhosis.
Results: Alcohol consumption was more common in cirrhosis than non-cirrhosis (66.4% vs. 44.2%, p < 0.0001), while non-alcoholic fatty liver disease/cryptogenic CLD (10.9% vs 5.8%, p < 0.0001) and chronic HBV reactivation (18.8% vs 11.8%, p < 0.0001) were more common in non-cirrhosis. Only 0.8% of patients underwent liver transplantation. Overall, 28-day and 90-day mortality rates were 39.3% and 49.9%, respectively. Patients with cirrhosis had a greater chance of survival compared to those without cirrhosis both at 28-day (HR = 0.48; 95% CI 0.36-0.63, p < 0.0001) and 90-day (HR = 0.56; 95% CI 0.43-0.72, p < 0.0001), respectively. In alcohol CLD, non-cirrhosis patients had a higher 28-day (49.9% vs. 23.6%, p < 0.001) and 90-day (58.4% vs. 35.2%, p < 0.001) mortality rate than cirrhosis patients. ACLF patients with cirrhosis had longer mean survival than non-cirrhosis patients (25.5 vs. 18.8 days at 28-day and 65.2 vs. 41.2 days at 90-day). Exaggerated systemic inflammation might be the reason why non-cirrhosis patients had a poorer prognosis than those with cirrhosis after ACLF had occurred.
Conclusions: The 28-day and 90-day mortality rates of ACLF patients without cirrhosis were …

Performance In Mortality Prediction Of Saps 3 And Mpm-Iii Scores Among Adult Patients Admitted To The Icu Of A Private Tertiary Referral Hospital In Tanzania: A Retrospective Cohort Study, Nadeem Kassam, Eric Aghan, Samina Somji, Omar Aziz, James Orwa, Salim R. Surani

Internal Medicine, East Africa

Background: Illness predictive scoring systems are significant and meaningful adjuncts of patient management in the Intensive Care Unit (ICU). They assist in predicting patient outcomes, improve clinical decision making and provide insight into the effectiveness of care and management of patients while optimizing the use of hospital resources. We evaluated mortality predictive performance of Simplified Acute Physiology Score (SAPS 3) and Mortality Probability Models (MPM0-III) and compared their performance in predicting outcome as well as identifying disease pattern and factors associated with increased mortality.

Methods: This was a retrospective cohort study of adult patients admitted to the ICU of the …

Hip Replacement For Femur Neck Fracture In The Elderly, Effects Of Delayed Surgical Intervention On Morbidity And Mortality, A Retrospective Comparative Study, Ahmed Habib, Shah Fahad, Muhammad Atif, Javeria Saeed, Pervaiz Hashmi, Mujahid Jamil Khattak

Section of Orthopaedic Surgery

Hip fracture is one of the most common injuries in the elderly population. Delay in operating on patients with hip fracture is associated with greater mortality and morbidity. A retrospective review of medical charts of patients who underwent primary total hip replacement (THR) for neck of femur fractures at our tertiary care level 1 trauma was carried out. Data was collected from the patients' charts and analysed for 30-day mortality and morbidity. A total of 96 patients were included in the study. Out of the 36 patients in the delayed THR group, mortality within 30 days was observed in 4 …

Causes And Circumstances Of Maternal Death: A Secondary Analysis Of The Community-Level Interventions For Pre-Eclampsia (Clip) Trials Cohort, Annet M. Aukes, Kristina Arion, Jeffrey N. Bone, Jing Li, Marianne Vidler, Mrutyunjaya B. Bellad, Zahra Hoodbhoy, Rahat Qureshi, Sana Sheikh, Zulfiqar Ahmed Bhutta

Centre of Excellence in Women and Child Health

Background: Incomplete vital registration systems mean that causes of death during pregnancy and childbirth are poorly understood in low-income and middle-income countries. To inform global efforts to reduce maternal mortality, we compared physician review and computerised analysis of verbal autopsies (interpreting verbal autopsies [InterVA] software), to understand their agreement on maternal cause of death and circumstances of mortality categories (COMCATs) in the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials.
Methods: The CLIP trials took place in India, Pakistan, and Mozambique, enrolling pregnant women aged 12-49 years between Nov 1, 2014, and Feb 28, 2017. 69 330 pregnant women were …

Red Blood Cell Transfusion In Critically-Ill Children And Its Association With Outcome, Hafsa Sohail, Shah Ali Ahmed, Parveen Usman, Farah Khalid, Anwar Ul Haque, Qalab Abbas

Department of Emergency Medicine

Objective: To determine the indications and threshold of haemoglobin levels for packed red blood cell transfusion and its association with outcomes in a paediatric intensive care setting.
Methods: The retrospective study was conducted in the paediatric intensive care unit of the Aga Khan University Hospital, Karachi, and comprised medical records of all inpatients with age between 1 month and 16 years who received packed red blood cell transfusions between January and December 2017. Data was retrieved from the hospital database and was analyzed using SPSS 22.
Results: Of the 147 subjects with a mean age of 67.89±65.8 months, 76(51.7%) were …

Factors Associated With Mortality Among Hospitalized Adults With Covid-19 Pneumonia At A Private Tertiary Hospital In Tanzania: A Retrospective Cohort Study, Nadeem Kassam, Eric Aghan, Omar Aziz, Hanifa Mbithe, Kamran Hamid, Reena Shah, Salim Surani, James Orwa, Samina Somji

Internal Medicine, East Africa

Background: The emergence of the novel coronavirus disease 2019 (COVID-19) has caused millions of deaths worldwide. There has been paucity of data for hospitalized African patients suffering from COVID-19. This study aimed to identify factors associated with in-hospital mortality in patients suffering from COVID-19 in Tanzania.

Methods: This was a single center, retrospective, observational cohort study in adult patients hospitalized with confirmed COVID-19 infection. Demographics, clinical pattern, laboratory and radiological investigations associated with increased odds of mortality were analyzed.

Results: Of the 157 patients, 107 (68.1%) patients survived and 50 (31.8%) died. Mortality was highest in patients …

Burden Of Transport-Related Injuries In The Eastern Mediterranean Region: A Systematic Analysis For The Global Burden Of Disease Study 2017, Gbd 2017 Emr Transport Injuries Collaborators, Saeid Safiri, Mark J M. Sullman, Timo Lajunen, Tetiana Hill, Amir Almasi-Hashiani, Maziar Moradi-Lakeh, Farshad Farzadfar, Sadaf G. Sepanlou, Zulfiqar Ahmed Bhutta

Centre of Excellence in Women and Child Health

Background: Transport-related injuries (TIs) are a substantial public health concern for all regions of the world. The present study quantified the burden of TIs and deaths in the Eastern Mediterranean region (EMR) in 2017 by sex and age.
Methods: TIs and deaths were estimated by age, sex, country, and year using Cause of Death Ensemble modelling (CODEm) and DisMod-MR 2.1. Disability-adjusted life years (DALYs), which quantify the total burden of years lost due to premature death or disability, were also estimated per 100000 population. All estimates were reported along with their corresponding 95% uncertainty intervals (UIs).
Results: In 2017, there …

Malignant And Non-Malignant Causes Of Hypercalcemia: A Retrospective Study At A Tertiary Care Hospital In Pakistan, Sabiha Banu, Sumera Batool, Saadia Sattar, Muhammad Qamar Masood

Section of Diabetes, Endocrinology and Metabolism

Background: Hypercalcemia is a common electrolyte abnormality presenting with a variety of symptoms. The common causes are primary hyperparathyroidism and malignancy associated with hypercalcemia. However, iatrogenic hypercalcemia with the overzealous use of vitamin D has now emerged as another important cause of hypercalcemia over the past decade.
Objective: This study aims to evaluate the causes of hypercalcemia, management strategies, and outcomes in patients admitted with hypercalcemia in a tertiary care hospital. Method: It is a retrospective study done at Aga Khan University Hospital (AKUH), Karachi after taking approval from the ethical review committee (ERC). Data were gathered about all patients …

Prevalence And Mortality Of Epilepsies With Convulsive And Non-Convulsive Seizures In Kilifi, Kenya, Symon M. Kariuki, Anthony Ngugi, Martha Z. Kombe, Michael Kazungu, Eddie Chengo, Rachael Odhiambo, Amek Nyaguara, Brian G. Neville, Charles Rjc Newton

Population Health, East Africa

Objectives: The prevalence of all epilepsies (both convulsive and non-convulsive seizures) in Low- and Middle- Income Countries (LMIC), particularly sub-Saharan Africa is unknown. Under estimation of non-convulsive ep- ilepsies in data from these countries may lead to inadequate and sub-optimal allocation of resources to control and prevent epilepsy. We determined the prevalence of all types of epilepsies and compared the mortality be- tween convulsive seizures and non-convulsive seizures in a resource limited rural area in Kenya.

Methods: Trained clinicians identified cases of epilepsy in a randomly selected sample of 4,441 residents in the Kilifi Health and Demographic Surveillance System site …

Referral Pattern And Outcomes Of Neonates From Secondary Care Setting Of Aga Khan University Hospital To Tertiary Care Centers In Pakistan, Suneeta Khemani, Nazia Shamim, Adnan Mirza, Nadia Mohammad, Safdar Kagazwala, Shakeel Ahmed

Department of Paediatrics and Child Health

Objective: To determine the reasons of neonatal referrals from secondary-care to tertiary-care setting, and to assess neonatal outcomes for the referred cases.
Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data from July 2015 to June 2019 Related to all neonates born after 32 weeks of gestation at the satellite secondary-care centres in Kharadar, Garden and Karimabad who had been referred to the main tertiary care hospital. The reason for referral, need of mechanical ventilation, referral place and neonatal outcome were noted. Data was analysed using SPSS 22.
Results: Of the 348 cases, …

Clinical Characteristics And Outcomes Of Covid-19: Experience At A Major Tertiary Care Center In Pakistan, Nosheen Nasir, Kiren Habib, Iffat Khanum, Naveera Khan, Zehra Abdul Muhammad, Syed Faisal Mahmood

Section of Internal Medicine

Introduction: Limited data exist on clinical characteristics and outcomes of hospitalized COVID-19 patients in low-middle income countries. We aimed to describe the clinical spectrum and outcomes of hospitalized COVID-19 patients at a tertiary-care center in Karachi, Pakistan.
Methodology: We conducted an observational study of adult COVID-19 patients hospitalized between February-June 2020. Patients with a discharge diagnosis of COVID-19 and PCR positivity were included. We created logistic regression models to understand association of clinical characteristics with illness severity and in-hospital mortality.
Results: The study population comprised 445 patients [67% males, median age 53 (IQR 40-64) years]. Majority of patients (N = …

Bovine Lactoferrin To Prevent Neonatal Infections In Low-Birth-Weight Newborns In Pakistan: Protocol For A Three-Arm Double-Blind Randomized Controlled Trial, Shabina Ariff, Sajid Bashir Soofi, Almas Aamir, Michelle D'Almeida, Arzina Aziz Ali, Ashraful Alam, Michael Dibley

Department of Paediatrics and Child Health

Background: Sepsis is a common and severe complication in premature neonates, particularly those born with low birth weights (<2500 >g). Neonatal sepsis is steadily emerging as a leading cause of neonatal mortality in Pakistan. Lactoferrin is a natural product with broad-spectrum antimicrobial properties and glycoprotein that is actively involved in innate immune host responses. Clinical trials have revealed its protective effect on sepsis, but lactoferrin dosage, duration, and role in the prevention of sepsis are still uncertain.
Objective: We aimed to establish the efficacy of bovine lactoferrin in the prevention of late-onset sepsis and to determine the optimal dose and …

Evaluation Of Serum Ferritin For Prediction Of Severity And Mortality In Covid-19- A Cross Sectional Study, Sibtain Ahmed, Zeeshan Ansar Ahmed, Imran Siddiqui, Naveed Haroon Rashid, Maheen Mansoor, Lena Jafri

Department of Pathology and Laboratory Medicine

Background: Ferritin even though widely recognized as a representative of total body iron stores, its prognostic utility is linked with COVID-19. This study was aimed at evaluation of the association of ferritin with severity in Coronavirus disease 2019 (COVID-19), hospitalized patients and to test the hypothesis that it is an independent predictor of mortality.
Material and methods: This study was conducted at Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University (AKU), Karachi. Medical records of all in-patients including both genders, and all age groups with documented COVID-19 from 1st March to 10^th August 2020 were reviewed. …

Impact Of Social Isolation On Mortality And Morbidity In 20 High-Income, Middle-Income And Low-Income Countries In Five Continents, Ryo Naito, Darryl P. Leong, Shrikant Ishve Bangdiwala, Martin Mckee, S V. Subramanian, Sumathy Rangarajan, Shofiqul Islam, Alvaro Avezum, Karen E. Yeates, Syed Iqbal Azam

Community Health Sciences

Objective: To examine the association between social isolation and mortality and incident diseases in middle-aged adults in urban and rural communities from high-income, middle-income and low-income countries.
Design: Population-based prospective observational study.
Setting: Urban and rural communities in 20 high income, middle income and low income.
Participants: 119 894 community-dwelling middle-aged adults.
Main outcome measures: Associations of social isolation with mortality, cardiovascular death, non-cardiovascular death and incident diseases.
Results: Social isolation was more common in middle-income and high-income countries compared with low-income countries, in urban areas than rural areas, in older individuals and among women, those with less education and …

Acute Necrotizing Pancreatitis: Has Conservative Management Replaced Surgery? Perspective From A Tertiary Care Centre In Pakistan: A Cross-Sectional Study, Fatima Mannan, Roger Christopher Gill, Abdul Ahad Sohail, Abdul Rehman Alvi, Khabir Ahmad

Department of Surgery

Background: The main purpose of this study was to review the trends in management of patients presenting with acute necrotizing pancreatitis (ANP) over the last seven years and its effect on morbidity and mortality.
Methods: A cross-sectional study was conducted on all patients presenting with the diagnosis of acute necrotizing pancreatitis to the Aga Khan University Hospital in between the year 2008-2015. The study population was broadly categorized in to two groups based on the way these were managed. The first group consisted of patient who underwent surgery for acute necrotizing pancreatitis while the second group was composed of those …

Global Trends In Adolescents' Road Traffic Injury Mortality, 1990-2019, Uzma Rahim Khan, Junaid A. Razzak, Martin Gerdin Wärnberg

Department of Emergency Medicine

Objective: The aim of this study was to determine the trends of road traffic injury (RTI) mortality among adolescents aged 10-14 years and 15-19 years across different country income levels with respect to the type of road users from 1990 to 2019.
Methods: We conducted an ecological study. Adolescents' mortality rates from RTIs at the level of high-income countries (HICs), upper-income to middle-income countries (UMICs), lower-income to middle-income countries and low-income countries were extracted from the Global Burden of Disease study. Time series were plotted to visualise the trends in mortality rates over the years. We also conducted Poisson regression …