Fluoroquinolone consumption and -resistance trends in mycobacterium tuberculosis and other respiratory pathogens: ecological antibiotic pressure and consequences in Pakistan, 2009-2015

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

Human organ and tissue transplantation in Pakistan; when a regulation makes a difference

Organ transplantation must be viewed in relation to the prevailing cultural, religious and socio-economic conditions of a nation. Over the past two decades, Pakistan has emerged as one of the largest centres for commercial renal transplantation. Government efforts, supported by professional associations, civil society organizations and the media, along with World Health Organization technical assistance, have led to the development of legislation regulating this practice and curbing organ trade in conformity with international guidelines. Although only two years have passed since the enactment of the law, there is evidence that conditions have significantly improved, raising hopes for ethical and safe organ transplantation in Pakistan. This study reviews the salient features of the legislation and lists the foreseeable evolving challenges and opportunities

Spectrum of pathological lesions in cystoscopic bladder biopsies: a clinicopathologic study

To determine the clinicopathologic characteristics and frequencies of different pathological lesions in cystoscopic bladder biopsies in patients with bladder diseases. Design: A single- institution based retrospective observational study. Place and Duration of Study: The study was conducted in the Department of Histopathology, Sindh Institute of Urology and Transplantation [SIUT], Karachi over a period of five years [December, 1996 to December, 2001]. Subjects and All patients, who presented to the urology clinic of SIUT between December 1996 and December 2001 with haematuria, dysuria, urgency and frequency and in whom a cystoscopy and bladder biopsy were performed to elucidate the nature of underlying pathology, were included in this study. A total of 784 patients were studied. Clinical and demographic data and pathological diagnoses were retrieved from the original surgical biopsy reports. Bladder biopsies were received in 10% buffered formalin, gross examination done and processed for paraffin embedding. Histologic sections were stained routinely with Hematoxylin and Eosin, PAS and PAS with diastase. Sections were examined under the light microscope to document the pathologic diagnosis. Of the total 784 patients, 577[73.6%] were males and 207 [26.4%] were females with an overall male to female ratio of 2.8:1. Age range was wide [4 to 86 years]. The spectrum of pathological lesions included tumours: 497 cases [63.7%], followed by acute and chronic non-specific inflammation: 86[11%], cystitis cystica and glandularis: 40 [5%], Tuberculosis: 17[2.16%], squamous metaplasia: 13[1.65%] and a number of other rare lesions. Among the tumours, transitional cell tumours [TCC] were most common [95.3%]. Tumours were more common in males than in females [male to female ratio: 5.3:1] and peaked in 4th through 7th decades. Pathologic staging was possible in 89.7% of the cases. A majority of these cases [62%] presented with superficial disease, while in 38% the disease was muscle-invasive when first diagnosed. Grading was possible in all except two cases, which contained only necrotic tissue. A vast preponderance of tumours [74.5%] were well-differentiated, while 25.5% belonged to poorly-differentiated category [Grade 3 and 4]. In a significant number of biopsies: 105 cases [13.4%], no significant pathology was noted. TCC is the most common lesion in cystoscopic bladder biopsies

Prevalence of genitourinary tuberculosis

The purpose of study was to diagnose and treat genitourinary tuberculosis in the Pakistani population and to save the organs before they were irreversibly damaged. Patient and methods: A total number of 45 cases were included in the two year study. All the cases were treated as out patients unless some surgery was required. Diagnosis was based on positive urine cultures for tuberculosis, typical histological findings or both. In few cases diagnosis was presumptive and subject to response to empirically given anti-tuberculosis therapy, was diagnostic. Chemotherapy was given for 6 months. Of the forty five cases 29 were males and 16 females. The commonest clinical presentation were non-specific bladder symptoms. Low grade pyrexia was not very common. Pyuria was present in 78% of cases, and of these 49% had sterile pyuria. In 47% urine stain for AFB was possible while urine culture for AFB was positive in 38% cases. Genitourinary tuberculosis should be suspected in presence of sterile pyuria, chronic cystitis, epididymitis, haemospermia and chronic discharging scrotal sinuses

Acute renal failure [ARF] following snake bite: a study of 35 cases

Objectives To study the prevalence, common presentation and factors causing mortality in snake bite induced ARF. Methods From January 1990 to December 1998, a total of 1716 cases of ARF were registered at SlUT [criteria of defining ARF was a rise in creatinine of> 2 mg% and normal size kidneys on ultrasound in a person without any previous systemic illness]. In 35 patients there was a history of snake bite preceeding ARF. Results of laboratory investigations and modalities of renal replacement therapy and outcome were analysed. Results Among 1716 cases of ARF, 764[43.4%] were due to medical causes, 485[28.2%] surgical, 298[17.3%] obstetrical and 169 [9.8%] due to miscellaneous and unknown causes. Thirty five patients, 22 males, 13 females, age range from 6- 65 years from the medical group, developed ARF after snake bite. The most common presentation was anuria and bleeding diathesis. Haemodialysis was started immediately after admission in 31 and peritoneal dialysis in 2 patients and two died before initiation of therapy. Twenty three [66%] patients recovered from renal failure in 2-3 weeks, 6 [17%] required long term dialysis [five of them had cortical necrosis], and 6 [17%] patients expired. Conclusion Bleeding diathesis induced by snake envenomation carries bad prognosis both in terms of mortality and morbidity with irreversible renal failure being the cause. Early initiation of dialysis therapy leads to rapid renal recovery

Analysis of known risk factors for bladder cancer in pakistani population

The association of aetiological agents incriminated for bladder cancer are well recognized. They are divided into two groups, occupational and non-occupational. The commonest occupational agents are 2-naphlthylamine, benzidine, aminobiphenyl, dichlorobenzidine, orthodianisidine and orthotolidine. Recognized non-occupational agents include tobacco, recurrent chronic bladder infection/infestation, coffee and drugs. This study was conduced to evaluate these factors in patients with bladder cancer in our population. Of 250 cases studied, 203 were males and 47 females with a male to female ratio of 4.3:1. In 13.6% cases occupational factors were established with an average duration of exposure of 12 years. Majority [68%] of patients had smoking as the predominant non-occupational factor. In this group average cigarettes smoked per day was 23 with a range of 15 to 90. The duration of smoking ranged between 5 to 55 years with an average of 26 years. Sixty patients [24%] were neither smokers nor had any associated high risk occupation