ABSTRACT
Background: Pulmonary Tuberculosis [TB] is traditionally classified into primary and post primary tuberculosis; both have distinct characteristics on radiology. Adetailed knowledge of different radiological patterns is helpful in diagnosis of TB
Objective: To determine the frequency of various radiological presentation of post primary tuberculosis in adult sputum smear positive patients
Methodology: This cross sectional study was carried out at Department of Pulmonology, Sheikh Zayed Medical College / Hospital, Rahim Yar Khan on adult sputum smear positive pulmonary TB patients. A total of 250 new cases of pulmonary TB with no previous history of Anti-Tuberculosis treatment were included in this study. Socio demographic data and findings of X -ray Chest from each sputum smear positive patient were collected and recorded on a predesigned performa. The data was entered and analyzed by using SPSS version 17
Result: Out of 250 patients, 146 were male and 104 were female with mean age of 35.76 +/- 16.25 years. Left lung was most affected in 40.4% cases, right lung in 35.6%, while 24% has bilateral involvement. Duration of illness prior to diagnosis was 3 +/- 1.66 months. Among the radiological presentation, cavitation was seen in 49.2% cases, alveolar consolidation in 42.4%, nodular pattern in 3.2%, reticulonodular pattern in 3.2% and reticular pattern in 2% cases. There was significant association of alveolar consolidation with male gender [0.03] while reticulonodular pattern was significantly seen in female gender [0.007]. Majority of the patients were young; 42.8% were below the age of 30 years and 82% patients were below the age of 50 years and there was a delay of > 03 months in the diagnosis
Conclusion: According to this study, cavitations and alveolar consolidation were the commonest radiological presentations of post primary TB. Majority of patients were young and there was a considerable delay in diagnosis
ABSTRACT
Background: tuberculosis is an important infectious health issue and its control strongly rely upon effective treatment. The drug resistance and its pattern are important determinant of the treatment regimen, its duration and outcome
Objective: to determine the frequency and pattern of drug resistance among 1[st] line anti tuberculosis treatment
Methodology: it was a cross sectional study carried on 100 cases of smear positive TB. This study was conducted from 1[st] January 2010 to 30 June 2011. Detailed demographic data and history of ATT was taken and their sputa were sent for drug susceptibility testing on LJ media. The cases with drug resistance and no previous history of ATT were labeled as primary while those with previous history of ATT were labeled as secondary resistant cases. The data was entered and analyzed by using SPSS version 15
Results: out of 100 patients enrolled, drug susceptibility report was available for 87 isolates as sputum failed to grow any organism in 13 patients. Out of these 87 cases, 48 [55.17%] were males and 39 [44.83%] females with age range of 9-91 years. Seventeen out of 87 patients [19.5%] had previous history of ATT. Out of 87 isolate, 62 [71.26%] were sensitive to all 1[st] line drugs [R, H, E, Z, S] while 25 [28.74%] were resistant to one or more drugs. Primary resistance was seen in 17 [24%] out of 70 cases in contrast to secondary in 8 [47%] out 17. The difference between primary and secondary resistance among various drugs was statistically significant for isoniazid [p value 0.003] and pyrazinamide [p value 0.036] while the difference to streptomycin, ethambutol and rifampicin was insignificant with p values of 0.20, 0.35 and 0.09 respectively. There was no case of primary MDR-TB and 5.9% of secondary MDR-TB. None of the sociodemographic parameter was significantly associated with drug resistance
Conclusion: resistance to 1[st] line anti-tuberculosis drugs at Rahim Yar Khan is still common. There are good number of patients in which this resistance pattern compromise the currently recommended regimens. However, larger surveillance studies are needed to strengthen this evidence
ABSTRACT
Background: Pakistan has a high burden of drug resistant TB. Effective management of these cases needs the inclusion of 2[nd] line anti-tuberculosis drugs. A comprehensive knowledge of susceptibility pattern to these drugs is mandatory to formulate the best possible regimen
Objective: to determine the susceptibility pattern of 2[nd] line anti tuberculosis drugs
Methodology: this cross sectional study was carried out at Department of Pulmonology, Sheikh Zayed Medical College / Hospital, Rahim Yar Khan on smear positive cases of PTB. This study was conducted from 1[st] March 2010 to 30[th] April 2011. A total of 64 smear positive tuberculosis patients of any age and sex regardless of previous treatment with 1[st] line ATT and no history of prior exposure to 2[nd] line ATT were included. Sociodemographic data like age, sex, marital status and income were recorded. Early morning sputum samples were cultured on LJ medium at a reference lab. Drug susceptibility testing [DST] was done for ethionamide, amikacin, kanamycin, capreomycin and ofloxacin to determine the presence of resistance. The data was analyzed on SPSS version 15
Results: in this study, out of total 64 cases, 36 [56.25%] were males and 28 [43.75%] females with age range of 9 to 76 years. Thirteen cases [20.31%] had previous exposure to 1[st] line ATT. Twelve [18.8%] were resistant to one or more drugs. Resistance was highest for ofloxacin [14.1%] followed by ethionamide [6.3%], capreomycin [3.1%], amikacin [1.6%] and kanamycin [1.6%]. Sociodemographic characteristics also did not show any statistically significant association with drug resistance
Conclusion: there is high frequency of resistance to ofloxacin and ethionamide. To avoid addition of further resistance, DST should be available as early as possible by conventional methods or by rapid genotypic methods at the start of treatment
ABSTRACT
Background: Treatment outcome is key indicator to assess the effectiveness of TB control program
Objective: To determine the treatment outcome in tuberculosis patients registered at Department of Pulmonology, Sheikh Zayed Medical College / Hospital, Rahim Yar Khan
Patients and Methods: All the patients registered at DOTS clinic, Department of Pulmonology, Sheikh Zayed Medical College / Hospital, Rahim Yar Khan from 1[st] January, 2008 to 31[st] December 2009, were followed up till completion of their prescribed regimen to determine the WHO endorsed treatment outcome. Patients were classified according to site of disease [pulmonary vs extra pulmonary], history of previous treatment and sputum smear status
Results: Of the 1607 registered TB patients, majority of the patients [83.9%] were newly diagnosed, young [median age: 30 years] and have pulmonary TB [74.9%]. Overall treatment success rate was 77%. New cases fared better [80.6%] than previously treated patients [53.7%]. Among previously treated group, treatment outcome was as follows; relapse [62.7%], treatment after default [52.7%] and treatment failure [33.3%]. Extra pulmonary tuberculosis cases fare better than pulmonary case with success rate of 87.7% and 72.5%, death rate 11% and 3.2%, failure rate 1.9% and 0.2% and default rate of 6.9% and 10.6% respectively
Conclusion: Considering the WHO standard of 85% treatment success rates, only the newly diagnosed patients were close to achieve the target. Previous exposure to anti tuberculosis treatment especially inadequate one was closely associated with poor outcome. Efforts should be made to ensure proper management of all TB cases
ABSTRACT
Background: Worldwide, tuberculosis and viral hepatitis are common diseases and both remain underdiagnosed and under-treated. Co-infection with tuberculosis and hepatitis is likely to make diagnosis, management and control of either disease difficult and challenging
Objective: To determine prevalence of HCV and HBV infection among PTB patients at Rahim Yar Khan, Pakistan
Patients and Methods: One hundred sputum smear positive pulmonary tuberculosis patients were screened for HCV and HBsAg. In this cross-sectional study, from 1st April to 31st December, 2010 results were analyzed by age, gender, marital, educational and socioeconomic status by using SPSS version 15
Results: Sociodemographic data showed that 66% patients were young between 15-49 years. Only 8 patients had history of blood transfusion, 4 had traveled abroad and none was drug abuser. Most of them were poor. Out of 100 patients [56 male and 44 female] 22% patients were positive for HCV and 3% for HBsAg. Prevalence of HCV infection was significantly higher in married [p value 0.03] and in those with history of blood transfusion [p value 0.004]. No significant statistical difference of prevalence of HCV between male and female, urban and rural, educated and uneducated and in those who traveled abroad or not was found
Conclusion: Prevalence of HCV infection among the pulmonary tuberculosis patients at Rahim Yar Khan [22%] is alarmingly high as compared with general adult Pakistani population [approx. 4.7%]
ABSTRACT
Background: Universal HIV testing for all TB patients regardless of their individual risk factors is being recommended by most of the authorities including WHO in recent guidelines
Objective: To determine the prevalence of HIV infection among Pulmonary TB patients presenting at Department of Pulmonology, Rahim Yar Khan, Pakistan
Patients and Methods: In this cross sectional study, one hundred consecutive newly registered smear positive pulmonary TB patients presented at Department of Pulmonology, Sheikh Zayed Medical College, Rahim Yar Khan from 1[st] April to 31[st] December 2010 were included in this study. Interviews were conducted to record the sociodemographic data and various HIV related risk factors for all patients. Consent was taken from the patients to be included in this study and for HIV testing. Test was done by ICT method at department of pathology of this institute. The data was entered and analyzed in SPSS version 15
Results: Out of 100 TB patients in this study, 56 were male and 44 were female. Majority [51%] of the patients were uneducated. Only 24% were earning more than ten thousands rupees per month. Sixty six percent patients were aged between 15-49 years. All the patients gave their consent for HIV testing. Only 4 of the 100 subjects had travelled abroad, 8 had history of blood transfusion and none of the patients admitted any history of drug abuse. None of the 100 patients in this study was positive for HIV infection
Conclusion: Despite the presence of risk factors in considerable number of participants of this study, HIV infection was not detected in any of the Pulmonary TB patient. This finding put a question mark over universal recommendation of HIV testing in all TB patients worldwide. However, larger study including all TB patients, both Pulmonary as well as Extra Pulmonary is required to confirm this finding
ABSTRACT
Breast feeding provides complete and balanced nutrition to the baby. The survey done in 1995 by health ministry, Pakistan reported that although 94% of the children were ever breastfed, only less than 16% of the children were exclusively breastfed. To assess the knowledge, attitude and practices regarding breastfeeding among undergraduate students of medical colleges of Karachi. Female medical students from Clinical and preclinical years. Cross sectional study. Liaquat National Medical College [LNMC] and Sir Syed College of Medical Sciences [SSCMS], Karachi. 3 months. Total 222 female students filled a multiple choice semi-structured questionnaire. Out of total 222 female students 32.9% were in pre-clinical group while 67.1% were in clinical group. It was observed that educational level of the student was strongly associated with the knowledge regarding initiation of breastfeeding and age till which exclusive breastfeeding should be continued [p=0.000]. Clinical group had more knowledge regarding colostrums as compare to the pre-clinical group [p=0.000]. A significant difference was found between preclinical and clinical students regarding the knowledge of breastfeeding. In this study most students were from clinical level of undergraduate medical education which made them more aware regarding the significance of breastfeeding