Methods of plant growth-promoting fungi application to enhance the growth and yield of wheat var. Ibaa99

Aims@#The main aim of the study was to evaluate some methods of application of Aspergillus niger AD1 and Trichoderma hamatum T-113 for enhancing the growth and yield of wheat var. Ibaa99 in pots and field conditions.@*Methodology and results@#Plant growth-promoting fungi (PGPF) loaded with peat moss were used at a rate of 100, 150 and 200 mL pot-1 or m-2 in filed soil; seed treatment (coating) with fungi suspension 19 × 107, soil treatment and combination of all the three methods was employed in the study. Wheat seeds were sown in pots and field plots during 2018-2019, and data regarding various growth and yield attributes were recorded. In both pot and field trials, the results revealed that the best treatments for the desired plant growth and yield attributes were peat moss 150 mL alone or in combination with soil and seed treatments. The soil physicochemical parameters were also improved after inoculation with selected fungal isolates in different application methods compared with un-inoculated control treatment in both pot and field conditions.@*Conclusion, significance and impact of study@#The PGPF play a vital role represented phytoremediation, phytostimulation and bio-fertilization. The isolates of PGPF, which were applied with peat moss at 150 mL to the pot and in the field alone or combined with seed treatment and soil application, were significantly the best effective method for improving wheat attributes.

Screening outcomes of household contacts of multidrug-resistant tuberculosis patients in Peshawar, Pakistan

OBJECTIVE@#To assess the profile of TB/multidrug-resistant TB (MDR-TB) among household contacts of MDR-TB patients.@*METHODS@#Close contacts of MDR-TB patients were traced in the cross-sectional study. Different clinical, radiological and bacteriological were performed to rule out the evidence of TB/MDR-TB.@*RESULTS@#Between January 2012 and December 2012, a total of 200 index MDR-TB patients were initiated on MDR-TB treatment, out of which home visit and contacts screening were conducted for 154 index cases. Of 610 contacts who could be studied, 41 (17.4%) were diagnosed with MDR-TB and 10 (4.2%) had TB. The most common symptoms observed were cough, chest pain and fever.@*CONCLUSIONS@#The high incidence of MDR-TB among close contacts emphasize the need for effective contact screening programme of index MDR-TB cases in order to cut the chain of transmission of this disease.

Screening outcomes of household contacts of multidrug-resistant tuberculosis patients in Peshawar, Pakistan

Objective To assess the profile of TB/multidrug-resistant TB (MDR-TB) among household contacts of MDR-TB patients. Methods Close contacts of MDR-TB patients were traced in the cross-sectional study. Different clinical, radiological and bacteriological were performed to rule out the evidence of TB/MDR-TB. Results Between January 2012 and December 2012, a total of 200 index MDR-TB patients were initiated on MDR-TB treatment, out of which home visit and contacts screening were conducted for 154 index cases. Of 610 contacts who could be studied, 41 (17.4%) were diagnosed with MDR-TB and 10 (4.2%) had TB. The most common symptoms observed were cough, chest pain and fever. Conclusions The high incidence of MDR-TB among close contacts emphasize the need for effective contact screening programme of index MDR-TB cases in order to cut the chain of transmission of this disease.

Autonomy to the teaching hospitals in light of mti 2015 reform act; way forward

The objective behind any health reform should be better quality, efficiency and sustainability of health care. Reform of the system is needed to achieve this. One important aspect of the reform is greater autonomy to the major teaching hospitals, including selected district hospitals. There should be a major effort to agree what is the intention behind autonomy and exactly what is expected to be passed to the control of the major hospitals in terms of autonomy for management decisions, financial procedures and performance, planning and development, human resource management and clinical performance1. The principle of decisions made at the lowest level practical should prevail. This means that autonomy and decentralization should also be passed down within hospitals to departmental levels2. Needless to mention that success of any reform agenda to be implemented rests on the agreement and full backing of the majority of the stakeholders

Clinicians approach to euthanasia in the province of Khyber Pakhtunkhwa

Objective: to determine the knowledge of clinicians and their opinion about legalization, obstacles in practicing euthanasia and factors that may compel them to practice euthanasia

Methodology: a questionnaire based descriptive study was conducted at public and private hospitals of Khyber Pakhtunkhwa. A questionnaire was distributed randomly to 540 doctors of different specialties and general practitioners. Questions were related to their knowledge, views about legalization, factors and obstacles in practicing euthanasia. The questionnaire was collected from the doctors who filled the form and consented to participate in the study

Results: the response rate was 55%, among them 79% were males. Only 61% [185] knew the meaning of euthanasia, whereas 36% [109] knew about its guidelines and 2% [6] had no knowledge of euthanasia. Amongst clinicians who knew about euthanasia, 84% did not and 16% agreed with its legalization. Reasons mentioned for disagreement with its legalization were religion 95%, moral 61%, ethical 44%, emotional 41% and social 37%. Of those clinicians who agreed with its legalization, 90% would and 10% would not practice it on their patients. Out of them 40% would adopt no resuscitation method, 40% would administer lethal drugs and 20% would withhold or withdraw the treatment

Conclusion: majority of responding clinicians were not aware of euthanasia and any related guidelines. They disagreed with the practice as well as legalization of euthanasia

Frequency of lung cancer diagnosed bronchoscopically in a tertiary care chest facility

To evaluate various types of lung malignancies diagnosed through bronchoscopy, and their presentations. This descriptive study was based in a tertiary care chest facility in Peshawar. Duration of the study was from June 2005 - June 2009. The material was obtained from the bronchoscopy record in the chest clinic. All the patients bronchoscoped from June 2005 - June 2009 were studied for their outcome. This study included 425 patients, 306 [72%] were males and 235 [55.3%] of patients were between 31-60 years age. Ninety two [21.6%] patients were diagnosed with lung cancer; of which 73 [79.5%] patients were males and 19 [20.5%] were females. Sixty five [70.7%] of the 92 patients initially presented with shadow on the Chest radiograph, 9 [9.80%] patients had superior vena caval obstruction, 8 [8.70%] patients presented with lung collapse, 6 [6.52%] with haemoptysis, and 4 [4.35%] patients with hoarseness of voice. Forty three [46.7%] patients were diagnosed with squamous cell carcinoma, 29 [31.5%] with adenocarcinoma, 17 [18.5%] with small cell type carcinoma and 3 [3.30%] patients had large cell type carcinoma. Fifty four [58.7%] patients of the 92 were smokers or had a history of smoking, Anthracosis was found in 45 [10.6%] patients out of all the 425 patients. Commonest type of lung cancer in this study was squamous cell [46.7%] followed by adenocarcinoma [31.5%] and small cell carcinoma [18.5%]. Squamous cell carcinoma was strongly associated with cigerrete smoking as compared to adenocarcinoma in this study

Percutaneous image guided cutting needle biopsy of mediastinal masses: diagnostic yield and complications

To evaluate image guided cutting needle biopsy of mediastinal masses for diagnostic yield and complications. This was a descriptive study. Computed Tomography [CT] and ultrasound guided biopsies of mediastinal masses were performed in 30 patients. Tissue core obtained, were preserved in formalin and sent for histological examination. X-ray chest taken for evidence of pneumothorax and mediastinal widening. Hemoptysis, pneumothorax other complication were recorded. Definite histological diagnosis was obtained in all 30 patients. 70% [n=21] were malignant disease and 30% [n=9] were benign pathologies. Sensitivity and specificity, positive and negative predictive values were 100%. Pneumothorax occurred in 7% [n=2] cases. Hemoptysis occurred in 10% [n=3] cases. Chest intubation was not required in cases of pneumothorax. No hemodynamic instability occurred. There was no major complication. Image guided percutaneous transthoracic cutting needle biopsy in mediastinal masses is an accurate procedure for specific histological diagnosis and has a low complication rate

Morbidity and mortality in children in rural community of district Peshawar

In Pakistan more than 20 million people are under five years age. The aim of this study was to determine the mortality rate, morbidity and its various causes in children of less than 5 years age in a rural community of District Peshawar. This descriptive study was conducted in the village Budhni of District Peshawar, from 1[st] January 2005 to 31[st] July 2006. Sampling technique was purposive. The data was analyzed in PMRC Research centre PGMI, Peshawar by using SPSS version 14. Descriptive statistics was given for qualitative variables and presented in the form of frequency and percentage. Two hundred and eighty-three children under 5 years age, presented to Budhni Health Centre during the study period. Male to female ratio was 1.9:1. Nine deaths occurred in children under 5 years during the study period. Most of the deaths 7[78%] were in the neonatal period. Among the diseases, acute respiratory infection was the leading disease comprising 27% of the total. Causes of death were neonatal jaundice [22%], diarrhea [11%], fits [11%], and unknown [45%]. Majority of deaths occurred in the neonatal period, which enhances the importance of antenatal care in the first month after birth. Infant/Child mortality in this region can be reduced by improvement in the health care system at peripheral level

Outcome of tuberculosis patients registered during 2007 in major teaching hospitals of Peshawar

To evaluate the efficiency of TB diagnostic centers of teaching Hospitals of Peshawar against the set target of treatment success rate of 85% in the teaching hospitals of Peshawar. This descriptive study on data analysis was carried out in National TB Programme [NTP] Centers in major teaching hospitals of Peshawar, NWFP. The patients included in this study were registered from 01/01/07 to 31/12/07. National TB Program [NTP] registers from the three teaching hospitals i.e. Lady Reading Hospital, Khyber Teaching Hospital, and Hayatabad Medical Complex, were studied. All the patients registered in year 2007 were studied for their outcome. The study included 306 patients. Male were 153 [50%] and 153 [50%] females. 191 [62.4%] patients were below 30 years of age, 87 [28.4] patients were between the ages of 31-60 years of age and 28 [9.2%] patients were above the age of 61 years. 149 [48.7%] patients had pulmonary tuberculosis, whereas 157 [51.3%] patients extra pulmonary tuberculosis. Among the Pulmonary tuberculosis patients 101 [67.8%] were smear positive, while 38 [25.5%] patients were smear negative. Out of these 306 patients, 294 [96.1%] patients were new cases and 12 [3.92%] patients were relapses. All registered patients included in the study were followed for 8 months at monthly intervals. 110 [35.9%] patients were cured, 194 [63.4%] patients completed their treatments. Only in 1 patient treatment failed, 1 died, while none of the patients defaulted. The treatment success rate was 99.4%.The performance of TB Control Programme at three teaching hospitals of Peshawar in year 2007 was excellent, showing treatment success rate of 99.4% which is way above the target set by W.H.O. of 85%

Primary drug resistance to anti-tuberculous drugs in Karachi

To assess the frequency of primary drug resistance among newly diagnosed tuberculosis cases in Karachi. Multicentric study involving various TB clinics and treatment centres of Karachi between. April to December 2005. The frequency of drug resistance among new TB patients was evaluated using a non-probability convenient sampling methodology. Sputum sample was obtained from 140 newly diagnosed sputum smear-positive patients of pulmonary tuberculosis from various centres of Karachi. Sensitivities were performed by proportion method. Fifteen [11.5%] samples in 130 eligible patients showed primary resistance to one or more drugs. Ten [7.6%] of the isolates tested were resistant to a single drug, none were resistant to 2 drugs, 4 [3.0%] to 3 drugs and 1 [0.76%] to 4 drugs while 1 [0.76%] to all 5 first line agents. Resistance to streptomycin [10 ug/ml] was seen in 8 [6.1%], isoniazid [1ug/ml] in 12 [9.2%], Rifampicin [5 ug/ml] in 4 [3.0%], ethambutol [10 ug/ml] in 1 [0.76%] and pyrazinamide in 6 [4.6%] samples. Primary Multi-Drug Resistance [PMDR] was found in 2 [1.5%] patients. [Isoniazid 1 ug/ml, rifampicin 5 ug/ml with or without other drugs]. In the studied patients, primary drug resistance to at least one anti-tuberculosis drug was 11.5%. It requires an efficiently working anti-tuberculosis programme to prevent escalation including resistance

Study of current management of community acquired pneumonia and strategies for improvement

To see that the patients admitted with community acquired pneumonia [CAP] are managed in accordance with British Thoracic society recommendations and guidelines. All patients admitted with Community-Acquired Pneumonia in medical wards admitted in large district general hospital setting in UK, were audited. The study period was between September and October 2002. Permission for the study was taken from the local hospital trust audit department. Seventy one sets of notes were reviewed leaving 38 patients appropriate for inclusion into the study. The findings observed in the record revealed that, Respiratory rate was not recorded in 36.8% [n=14] patients, level of confusion not recorded in 47.4% [n=18], Blood cultures not sent in 42.1% [n=16] patients, sputum not sent for culture in 47.4% [n=18] cases. Inappropriate antibiotics used 18.4% [n=7], treatment time of senior review not documented in 36.8% [n=14], radiographic findings not documented in 13% [n=5] cases. No follow up arrangements were made in 13.2% [n=5]. Average time of senor review was 6 hours and average time of antibiotic given after admission was 2 hours. This audit shows that even in a developed country with well-established guidelines for management of different diseases, guidelines for management of community-acquired pneumonia are not strictly adhered to. More efforts need to be made for dissemination and implementation of these guidelines

Surgical interventions in multidrug-resistant tuberculosis: retrospective analysis of 27 patients treated at a tertiary level care center

To assess the results of surgery for Muttidrug- Resistant Tuberculosis [MDR-TB]. Retrospective analysis was done in 27 cases of multidrug- resistant tuberculosis in whom some surgical interventions were carried out at department of Thoracic surgery, Lady Reading Hospital Peshawar between the years 2002 to 2007. There were 18 male and 9 female patients in the age group of 14-54 years. All were sputum positive at the time of surgery. Majority of patients were treated with pulmonary resections [pneumonectomy [n=07], bitobectomy [n=08] and lobectomy [n=10]], while primary thoracoplasty with apicotysis was done in two patients. Post operatively 2[nd] line anti tubercular chemotherapy was prescribed for 24 months. There was one early and one Late death. Postoperative complications were seen in three cases. One patient developed bronchopleural fistula with empyema. At a mean follow-up of one year bacteriological cure was achieved in 24 patients. Judiciously performed adjuvant surgery can yield excellent long term bacteriological cure with acceptable mortality in multidrug- resistant tuberculosis. Morbidity and drug compliance remain as problem areas

Bronchodilator response to nebulized salbutamol in elderly patients with stable C.O.P.D

To assess the response of elderly patients with stable COPD to beta-2 agonist. Material and This inter ventional study was conducted in Pulmonology unit, Lady Reading Hospital, Peshawar. Patients were recruited after considering inclusion and exclusion criteria. A detailed history and clinical examination performed. On first day, baseline pulmonary function test [PET] [FEV 1, FVC, FEV1/FVC, PEFR] was taken. Then 3 ml normal saline [placebo] was administered via cho-neb nebulizer. PET measurements were repeated after 15, 30, 60 and 120 minutes. The best of three readings was recorded. On next day, the same protocol was applied except that placebo was replaced by nebulized salbutamol 5 mg [1 ml] plus 2 ml normal saline was administered via nebulizer. Out of 40 patients fulfilling entry criteria 30 completed the study. Age range was from 60-80 years. The mean baseline for FEV1 and FVC were 0.52 and 0.76 respectively. There was no significant difference in the mean baseline values on two days. The results expressed as mean and peak percentage changes about the baseline are shown in tabular and graphical form. 60% patients responded to salbutamol and 25% to normal saline. Analysis of variance comparing change in FEV1 between salbutamol and normal saline revealed highly significant drug effect [P<0.01]. The drug effect comparing changes in EV.0 was statistically not significant [P>0.05]. Salbutamol can produce useful bronchodilatation in elderly patients with stable COPD which can be readily assessed using spirometry

Career planning by the doctors in NWFP

To determine the extent to which a doctor in NWFP has the knowledge and opportunity to plan his career at right time and reasonable cost. This prospective descriptive study was conducted at the Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar from August 2006 to January 2007. Relevant information's were recorded on a questionnaire prepared in accordance with the objectives of the study. This study comprised of 82 individuals who responded to the questionnaire, with age ranging from 25-35 years [mean age 28.13 years, SD +/- 2.8, median 30 years]. Out of 82 respondents, 25 [30.5%] had received some kind of orientation about career planning while 56 [68.3%] had received no orientation so far [one respondent did not answered this question]. Out of 82, sixty-two [75.6%] were either self motivated to attempt a postgraduate exam or were guided by their teachers. In terms of time lost, 29 [35.4%] replied that they had wasted their time in thinking/choosing, while 13 [15.8%] pointed out to have wasted additional time in switching over their career from one field to another. Similarly, in terms of finance, 07 [8.07%] responded to have suffered financially. In NWFP due attention has not been paid to career planning and even the well educated class [doctors] are wasting their precious time and finances due to lack of guidance in career planning field