Treatment outcomes and adverse drug reactions among patients with drug-resistant tuberculosis receiving all-oral, long-term regimens: First record viewing report from Pakistan

Objective: To assess the effectiveness and adverse drug reactions of all-oral regimens for patients with multidrug-resistant tuberculosis. Methods: This retrospective study was conducted at 10 Programmatic Management of Drug Resistant Tuberculosis sites in Punjab province of Pakistan. Patients receiving treatment for drug resistant tuberculosis from July 2019 to December 2020 with at least interim result i.e. 6th month culture conversion or final outcomes (cured, complete, lost to follow-up, failure, death) available, were included in the study. Data was extracted from electronic data management system. For the reporting and management of adverse drug events, active tuberculosis drug safety monitoring and management was implemented across all sites. All the data was analyzed using SPSS version 22. Results: Out of 947 drug resistant tuberculosis patients included in this study, 579 (68%) of the patients had final outcomes available. Of these, 384 (67.9%) successfully completed their treatment. Out of 368 (32%) patients who had their interim results available, all had their 6th month culture negative. Combining new medications was thought to result in serious adverse outcomes such as QT prolongation. However, this study did not record any severe adverse events among patients. Conclusions: All-oral regimens formulation guided by overall treatment effectiveness resulted in treatment outcomes comparable to those obtained with traditional injectable treatment.

Effects of high-intensity interval training and strength training on levels of testosterone and physical activity among women with polycystic ovary syndrome

Objective@#Polycystic ovary syndrome is a diverse endocrine disorder characterized by hyperandrogenism and ovulatory dysfunction. Hyperandrogenism affects body morphology, resulting in excess weight (overweight or obesity). This study aimed to evaluate the efficacy of high-intensity interval training on serum testosterone levels, body fat percentage, and level of physical activity among women with polycystic ovary syndrome. @*Methods@#Fifty participants were enrolled in the study and randomly allocated into two groups. Group A performed highintensity interval training on alternate days per week (total of 12 weeks) and group B performed strength training on alternate days per week (total of 12 weeks). Baseline and 12th-week assessments included serum testosterone levels, body fat percentage using the skinfold method, and level of physical activity assessed using the International Physical Activity Questionnaire. @*Results@#After 12 weeks of intervention, both groups showed significant improvements in all the outcomes. However, group A (high intensity interval training) showed statistically significant results compared to group B (strength training) in lowering serum testosterone levels (P=0.049) and body fat percentage (P=0.001) and increasing physical activity levels (P=0.006). @*Conclusion@#After 12 weeks of exercise, both exercises benefited the participants; however, high-intensity interval training specifically was found to be a more effective exercise regimen than strength training in reducing serum testosterone levels and body fat percentage and enhancing levels of physical activity in women with polycystic ovary syndrome.

Changes in doppler ultrasound indices of hepatic circulation after treatment with beta blockers: a pilot study

Background: Portal hypertension is a serious complication of liver cirrhosis. Doppler ultrasound assessment may be a non-invasive and cost-effective means of evaluating portal hemodynamics in patients with portal hypertension

Aims and objectives: To assess efficacy of Doppler ultrasound in detecting changes in hemodynamics of hepatic circulation after beta-blocker administration

Methodology: 11 patients with liver cirrhosis and portal hypertension were included. All underwent Doppler assessment of portal vein velocity [PVV], spleno-portal index [SPI], congestive index [CI], liver vascular index [LVI], dampening index [DI], hepatic artery velocity [HAV], splenic artery velocity [SAV], hepatic artery resistive index [HARI] and splenic artery resistive index [SARI]. They were started on beta-blocker carvedilol 6.25 mg once daily and recalled after two weeks for repeat assessment

Results: Out of 13 enrolled, 4 were lost to follow up and one stopped carvedilol. 8 remained. The changes in parameters were: PVV: reduction in 3 [37.5%], no change in 1 and increase in 4[50%] patients; SPI: reduction in 3 [37.5%] and increase in 5 [62.5%]; CI: reduction in 3 [37.5%], no change in 1 and increase in 4 [50%]; LVI: decrease in 3 [50%], no change in 1 and increase in 2; DI: decrease in 5 [62.5%] and increase in 3 [37.5%]; HAV: increase in 4 [50%], no change in 1 [12.5%] and decrease in 3 [37.5%]; SAV: decrease in 4 [50%] and increase in 4 [50%]; HARI: increase in 7 [87.5%] and decrease in 1 [12.5%]; SARI: reduction in 3 [37.5%] and increase in 3 [37.5%]. 3 patients achieved reduction in 5 [PVV, LVI, DI, SARI and SAV] parameters. DI had the largest number of patients with observable reduction and HARI with the largest number showing observable increase in measured parameters

Conclusion: Doppler ultrasound represents a cost effective means of assessing the hemodynamics of hepatic circulation and any associated changes due to diseases and drugs

Autoimmune complications in chronic lymphocytic leukemia: a single center experience

Chronic lymphocytic leukemia [CLL] is characterized by the progressive accumulation of B cells with mature appearance and a distinctive immunophenotype in peripheral blood, bone marrow, lymph nodes and other lymphoid tissues. Autoimmune complications are common in CLL and by far the most common manifestation is autoimmune hemolytic anemia [AIHA], followed by immune thrombocytopenia [ITP] and pure red cell aplasia [PRCA]. The study was carried was carried out to see the spectrum of autoimmune complications in patients diagnosed with CLL. This cross sectional study was carried out to describe the clinical presentation, haematological parameters and complications of CLL in patients coming to Shaikh Zayed Hospital [SZH], Lahore over a period of 6 years from June 2002 to July 2008. CLL cases were diagnosed according to the National Cancer Institute [NCI] criteria. The collected data was entered into SPSS version 13 for analysis. Thirty one patients were diagnosed with CLL and in 6 [19.4%] patients the disease was complicated by AIHA and in 1 [3.2%] patient by ITP at presentation. Autoimmune cytopenias were observed in 22% of 31 patients. Autoimmune hemolytic anaemia was more common than ITP, no patients of PRCA were recognized

Biodisposition of isoniazid after oral administration in teddy goats

Objective: to investigate the bio disposition of isoniazid in Teddy goats

Design: Experimental study

Material and methods: bio disposition of isoniazid [INH] was investigated in eight Teddy goats after single oral administration at the rate of 10 mg/Kg body weight. Blood samples were collected from each animal at pre-determined time intervals after drug administration. Plasma was isolated after centrifugation and analyzed for INH using spectrophotometer

Results: concentration versus time profile of each animal was used to determine the bio disposition of INH. Data was best described by two compartment open pharmacokinetic [PK] model and various PK parameters were calculated which were significantly different from the values in the literature

Conclusions: based on the results of this study it was concluded that disposition studies of imported antimicrobial drugs should always be conducted under indigenous conditions to rationalize their dosage regimen for local animal species

Use of single layer extra mucosal interrupted suture intestinal anastomosis: three year experience

Objective: to see the outcome of single layer extramucosal interrupted suture gut Anastomosis

Study design: prospective analytical

Setting and methods: this study was carried out in the Department of Surgery Unit-I Muhammad Medical College Mirpurkhas, from August 2004 to July 2007. A total of 72 patients were included in this study in which gut anastomosis was performed with single layer extramucosal interrupted suture. Patients of all ages and sex groups were included in whom end-to-end anastomosis was required in small and large intestine. Polyglactin [Vicryl 2/0 and 3/0] material was chosen on round body needle

Results: end-to-end anstomosis in 72 patients was done in cases of ileal perforation 37 / 72 [51.38%] and right hemicolectomy 09/72 [12.50%]. Intussusception was the cause in 11/72 [15.27%] cases, mass at recto-sigmoid junction was found in 02/72 [02.77%] strangulated inguinal hernia in 07/72 [09.72%] patients, jejunal diverticulosis in 01/72 [01.38%], caecal volvulous in 02/72 [02.77%] and sigmoid volvulous in 02/72 [02.77%] cases. Anastomosis leakage occurred in only 02/72 cases. Mortality remained 1/72 [01.38%]

Conclusion: single-layer extramucosal interrupted suture gut anastomosis is safe method of hand sewing technique. It is suitable for all anastomosis in the gastrointestinal tract

Surgical experience with cardiac myxomas

Cardiac myxomas are the most common benign intracardiac tumours. We studied the clinical presentation of cardiac myxomas and the morbidity, mortality and recurrence rate following surgery at our institution over a 6 year period. This historical longitudinal study was performed at department of Cardiac Surgery, Armed forces Institute of Cardiology and National Institute of Heart Diseases Rawalpindi, Pakistan between January 2002 and March 2008 a total number of 8506 cardiac operations were performed. Of these 34 patients [19 males, 15 females] underwent complete excision of primary or recurrent intracardiac myxomas. Pre-operative diagnosis was established by echocardiography. All patients underwent operation soon after the diagnosis of a myxoma was made. Complete tumour excision followed by close inspection and copious saline irrigation of the cardiac chambers was done in each case. Of the 32 patients who survived the surgery, 29 patients were followed up at regular intervals for recurrence. The mean follow-up period was 34 months. Cardiac myxomas constituted 0.40% of the total cardiac operations at our institution. They most commonly occurred in the fourth decade. The commonest location was the left atrium [LA] [79%] followed by the right atrium [RA] [14%]. Only one patient had myxoma in the right ventricle [RV]. Patients with LA myxoma simulated mitral stenosis clinically whereas patients with RA and RV myxomas presented with features of right heart failure. A smaller percentage presented with embolic and constitutional symptoms. There were two early deaths. One recurrence was noted at 27 months after surgery. No late deaths were observed in the study. Cardiac myxomas form a very small percentage of the cardiac cases. A high index of suspicion is essential for diagnosis. Echocardiography is the ideal diagnostic tool as also for follow-up. Immediate surgical treatment is indicated in all patients. Cardiac myxomas can be excised with a low rate of mortality and morbidity

Effect of band ligation on portal hypertensive gastropathy and development of fundal varices

Use of endoscopic therapies for esophageal varices has resulted in increased prevalence of fundal varices and severe portal hypertensive gastropathy. This study was meant to compare the effect of band ligation and sclerotherapy on development of fundal varices and portal hypertensive gastropathy. Patients with esophageal varices presenting in the endoscopy unit of Shiakh Zayed Hospital, with at least one previous endoscopy were included. Patient's past record was reviewed for findings and type of treatment given for varices during first endoscopy, number of endoscopies till date, number of esophageal varices band ligation [EVBL] or sclerotherapy sessions. All patients underwent upper GI endoscopy and findings were recorded. Type of treatment patient rendered during first endoscopy either EVBL or sclerotherapy was correlated to the presence of fundal varices and severity of portal hypertensive gastropathy observed on present endoscopy, using Chi square test [chi [2]]. Eighty one patients were included. Mean age of patients was 48.7 +/- 12.63. Esophageal varices band ligation was carried out during first endoscopy in 49 [60.5%] patients and sclerotherapy in 31 [38.2%] patients. On fresh endoscopy, fundal varices were seen in 25 [30.8%] patients. Severe portal hypertensive gastropathy was found in 26 [32.1%] and mild in 54 [66.7%] patients. Severity of portal hypertensive gastropathy and presence of fundal varices in recent endoscopy was significantly more in patients with EVBL in first endoscopy. Band ligation of esophageal varices is associated with more frequent development of fundal varices and worsening of portal hypertensive gastropathy compared to sclerotherapy

Value of Quantitative HCV RNA in management of Chronic Hepatitis C patients with genotype 2 and 3

Determination of viral load by quantitative polymerase chain reaction [PCR] for hepatitis C virus [HCV] is part of workup before initiating interferon and ribavirin combination therapy for chronic hepatitis C. This study was carried out to determine predictive value of baseline viral load in patients with viral genotype 2 and 3, for response to therapy. Patients with chronic hepatitis C and genotype 2 and 3 were included in study. Viral load was determined before starting treatment with standard interferon and ribavirin for six months in all patients. Patients were checked for cod of treatment [EOT] and sustained viral response [SVR] by qualitative PCR for HCV. Response to therapy was correlated with baseline viral load by student`s t test. Total of 55 patients were included. Male to female ratio was 1.1/1 [29/26]. Six patients were of genotype 2, one patient was harboring both genotype 2 and 3 while rest of 48 patients had genotype 3 of hepatitis C virus. Baseline viral load was less than 2 million copies/ml in 25 patients while 30 patients had viral load in excess of 2 millions copies/ml. Treatment was completed in 50 patients. Sustained viral response [SVR] was seen in 31 patients and 19 patients were non-responders. No significant association was found between response to therapy and baseline viral load. Pre-treatment viral load is not predictive of response to combination therapy with interferon in patients with genotype 2 and 3

Bedside diagnosis of spontaneous bacterial peritonitis using reagent strips

To determine the efficacy of reagent strip for bedside diagnosis of spontaneous bacterial peritonitis [SBP]. Cross-sectional analytical study. Place and Duration of Study: Shaikh Zayed Postgraduate Medical Institute from November 2003 to August 2004. Patients with cirrhosis and ascites underwent diagnostic paracentesis. Fluid was checked for leukocyte esterase released by PMN by using Combur 10 urine strip and graded for color change from 0-3. Fluid was also analyzed by cytology for PMN count. Results of both methods were compared to determine sensitivity, specificity and accuracy of strip for diagnosis of SBP. Of 214 paracentesis performed, SBP was diagnosed in 38 patients whereas 176 were negative for infection. Strip test was 97.7% sensitive and 89.4% specific with positive predictive value of 90%, negative predictive value of 97.7% and accuracy of 96.2%, when reagent strip grade 3 was considered as positive for diagnosis. Reagent strip is a quick bedside test, highly sensitive and specific for the diagnosis of SBP, based on polymorphonuclear count in ascitic fluid, to initiate early treatment, thus improving patient's outcome

Non-endoscopic prediction of presence of esophageal varices in cirrhosis

To identify hematological, biochemical and ultrasonographic predictors of esophageal varices in patients of cirrhosis. Cross-sectional, analytical study. Department of Gastroenterology, Shaikh Zayed Postgraduate Medical Institute, Lahore, from September 2003 to March 2004. One hundred and one patients with established cirrhosis and no history of variceal bleed underwent physical examination, hematological, biochemical tests and abdominal ultrasound examination. Esophagogastroduodenoscopy [EGD] was carried out in all patients. Presence of varices on EGD was correlated with hematological, biochemical and ultrasonographic variables by regression analysis. Esophageal varices were seen in 65 patients while 36 patients had no varices. High grade varices were seen in 15 patients and 50 patients had low grade varices. Serum albumin less than 2.95g/dl, platelet count less than 88 x 10[3]/micro L and portal vein diameter more than 11mm were associated with presence of varices. High grade varices were predicted by serum albumin < 2.95g/dl and portal vein diameter more than 11mm. Patients with serum albumin < 2.95g/dl, platelet count < 88 x 103/mL and portal vein diameter > 11mm are more likely to have high grade varices. These patients are candidates for surveillance endoscopy

Gastric vascular ectasia

In this paper the condition Gastric Vascular Ectasia [GAVE] is reviewed and two patients of gastric vascular antral ectasia are reported [GAVE]. It is suggested that the diagnostic possibility of Gastric antral vascular ectasia should be considered in any elderly patient, more so in females, with persistent unexplained Iron deficiency anaemia

Dyslipidemias in type II diabetes mellitus patients in a teaching hospital of Lahore, Pakistan

To know the pattern of dyslipidemias amongst type II diabetic patients. Design: Observational study. Setting: Hospital based study on type II diabetic patients, who were either admitted or reported to outpatient department/diabetic clinic on take days of Unit-I of Sir Ganga Ram Hospital, Lahore, Pakistan. Subjects: One hundred consecutive type II diabetics between the age of 40-70 years. Those who had hyperlipidemia due to other causes e.g. nephrotic syndrome, hypothyroidism and type-I diabetes mellitus were excluded. Main Outcome Measures: Dyslipidemias One hundred patients suffering from type II diabetes mellitus were included in the study. Out of these 64% were females and 36% were males. The age range was 41-70 years with mean of 56.1 +/- 9.38. Out of these 100 patients, duration of diabetes mellitus of less than 10 years was noted in 43% of patients and more than 10 years in 57%. Random blood sugar was 229.34 +/- 6.23 and fasting blood sugar was 153.5 +/- 4.45 when it was seen in the total study subjects, random blood sugar 210.51 +/- 7.68 and fasting blood sugar 143.83 +/- 5.35 in sub group whose duration of illness was less than 10 years. In sub group whose DM was for more than 10 years random blood sugar was 257.91 +/- 12.81 and fasting blood sugar was 171.21 +/- 8.14. Serum cholesterol was 226.88 +/- 18.48 in the patients as one group, in illness of less than 10 years, it was 191.72 +/- 5.72 and in illness of more than 10 years duration it was 213.11 +/- 6.70. Serum triglyceride in illness of less than 10 years duration was 191.83 +/- 8.05 and where it was more than 10 years, it was 210.04 +/- 8.90. Serum HDL-C was 36.25 +/- 0.45 in patients illness of less than 10 years and 35.57 +/- 0.60 in more than 10 years. Serum LDL - C was 127.1 +/- 3.99 in patients with less than 10 years of diabetes mellitus and 147.5 +/- 5.20 in patients with more than 10 years of illness. Fifty-eight patients were hypertensive, 43% of the male patients were smokers. Conclusions: Diabetic dyslipidemia is an important cause of morbidity. Duration of diabetes is associated with higher incidence of dyslipidemia. Type II DM is associated with a marked increase in the risk of CHD. Dyslipidemia is believed to be a major cause of increased risk. In this study we found elevated total serum cholesterol, LDL-C but normal HDL-C. Patients should be educated to get checked regularly for lipid abnormalities and if found to be abnormal, should control blood sugar and lipids very effectively