ABSTRACT
Objective/background: Fluoroquinolones [FQs] are important anti-tuberculous drugs for the treatment of multidrug-resistant [MDR] tuberculosis. Resistance to FQs leads to fewer options for treatment of tuberculosis [TB], and infection with such strains may also require longer treatment duration. Trends of resistance in Mycobacterium tuberculosis [MTB] are indicators of MTB-resistance evolution. Drivers of such resistance need to be understood and studied to inform preventive strategies
Methods: Here, we present FQ-resistance rates and trends in Pakistan from 2010 to 2015 and compare rates with FQ-consumption data and rates in other community pathogens
Results: Our results reveal a recent decrease in FQ-resistance rates in MTB, but an increase in resistance for Haemophilus influenzae and Shigella spp. Correlation of FQ resistance with FQ consumption at the population level was weak for MTB, although strong associations were noted for H. influenzae and Shigella spp
Conclusion: We discuss the possible reasons for the decrease in resistance rates in TB, putative drivers of resistance other than volume of FQ consumption, and the possible impact of the National Tuberculosis Programme and drug regulatory activities
ABSTRACT
Study Design: An analysis of 14 cases of ruptured uterus was done during January 2003 to December 2003 in Obstetrics and Gynae Department of Lahore General Hospital, Lahore. The purpose of this Audit was to analyse the different management options, maternal and fetal outcome in uterine rupture. Material and Total no of births in 2003 was 4840. Total number of ruptured uterus found to be 14 [2.9%/1000] deliveries. Among these incomplete rupture were 3 [21.4%] and complete rupture were 11 [78.4%]. Regarding the common sites of uterine rupture lower uterine segment interior surface = 11 [78.4%]. Lower uterine segment posterior surface = 2 [14.2%] and upper uterine segment rupture was = 1 [7.14%]. The most common cause of uterine rupture was found to be multiparity and injudicious use of oxytocin by TBA in 5 cases. [35.7%] and previous uterine surgery in 5 cases [35.7%]. 2 cases [14.21] were due to cephalopelvic disproportion due to hydrocephalus and 2 [14.2%] cases were of malpresentation [transverse lie] mostly handled at home by TBAs. Hysterectomy, total or sub total was done in 7 cases [50%]. Repair of uterus was done in 5 cases [35.7%], in 2-cases [14.2%]. Bladder repair alongwith uterine repair was done. In two cases [14.2%] of scar dehiscence, repeat cesarean section was done. The maternal mortality was found to be zero, while intrauterine death were 10[71.4%] and alive babies were 4 [28.5%] high perinatal mortality of 71% were found. Ruptured uterus is avoidable catastrophe by proper education, training of patients and TBA's and by providing effective family planning services, transportation, diagnostic facilities and by reducing the unnecessary caesarean section