ABSTRACT
Objective: Tuberculosis is a major cause of morbidity and mortality and diabetes is a leading risk factor of tuberculosis. Co-existence of tuberculosis and diabetes may increase the disease severity and worsen the treatment outcome. Therefore, objective is to find the anti-tuberculosis treatment outcome among pulmonary tuberculosis patients with or without diabetes mellitus; and to see the drug resistance pattern among treatment failure cases in both groups
Methodology: The cross-sectional study was carried out at PHRC Research Center FJMU Lahore in collaboration with PHRC TB Research Centre KEMU Lahore during the year 2013-14. The data of 268 patients including 187 pulmonary tuberculosis patients without diabetes and 81 with diabetes was analyzed. Anti-tuberculosis treatment according to current guidelines of Directly Observed Therapy [DOT] was provided to all patients; and were assessed for improvement of AFB smear; AFB culture and Chest X-Ray before and after four months of starting ATT. Data were analyzed by using Statistical Package for Social Sciences version 20
Results: Mean age of non-diabetic TB patients was 36+/-16 years; and of diabetic TB patients was 50+/-12 years. Mean duration of diabetes was 6+/-4 years. Other characteristics included 57.8 percent males, 42.2 percent females, and 53.7 percent had history of contact. Cough, expectoration, fever and weight loss were commonly occurring symptoms. Infiltration [76.1 percent] was the commonest type of lesion followed by consolidation [14.6 percent] and cavitation [9.3 percent]. Findings of AFB Smear conversion, AFB Culture, and Chest X-ray were improved with time in both groups; and rates of improvement were significantly higher among non-diabetic TB patients [p <0.05]. The frequency of drug resistance was lower among non-diabetic TB patients [7.0 percent vs. 19.8 percent] but the difference was insignificant. The rates of drug resistance and MDR were considerably higher among patients with poor glycemic control [p 0.036]
Conclusion: Therapeutic outcome of pulmonary tuberculosis was poor among diabetic TB patients as compare to non-diabetic TB patients. Therefore, along with anti-tuberculosis treatment, improvement of glycemic control must be considered among diabetic TB patients for better treatment outcome and reduced drug resistance rate
ABSTRACT
Background: Tuberculosis remains a major cause of morbidity and mortality in several parts of world. Genetic basis and mutations in katG and rpoB genes are responsible for isoniazid and rifampicin resistance in most of the cases of Mycobacterium tuberculosis
Objectives: To determine the mutations in katG and rpoB genes in confirmed multi-drug resistant tuberculosis isolates and to find the frequency of mutations Study design, settings and duration: This descriptive study was undertaken in PHRC TB research Centre, Department of Pulmonology, KEMU/Mayo Hospital Lahore. Polymerase chain reaction and genotyping was done at Institute of Molecular Biology and Biotechnology [IMBB], University of Lahore, Lahore from June 2013 to July 2014
Patients and Methods: A total of 100 acid-fast bacilli smear positive specimens of MDR TB suspects and rifampicin resistant on GeneXpert were collected. Drug susceptibility of isoniazid and rifampicin was carried out by standard drug proportion method. Gene amplification and sequencing was done to detect mutations in katG and rpoB genes
Results: A total of the 53% were females and 47% males with male to female ratio of 1:1.1. Mutations in rpoB Gene were found to be 98% of rifampicin resistant cases and in katG 76.7% of isoniazid resistant cases. Most of the mutations [60%] in rpoB Gene were observed on codon 531 while all the mutations in katG Gene were observed on codon 315. No novel mutation was found in this study
Conclusion: Mutation pattern of rpoB gene that confers rifampicin resistance is different to a little extent from other national and international studies while pattern is same for katG gene that confers isoniazid resistance. No novel mutation was observed in present study
ABSTRACT
Background: Patients having tuberculosis are registered in the TB DOTS program for their treatment. During the treatment sputum samples are sent periodically to the laboratory to check treatment efficacy. Usually after two months of treatment sputum smear becomes negative but presence of multiple cavities in the lung, bacillary load, diabetes mellitus and tobacco smoking, slows the sputum smear conversion time
Objectives: To determine the factors affecting sputum smear conversion time in newly diagnosed pulmonary tuberculosis patients
Study design, settings and duration: This cross sectional, analytical study was done by Pakistan Medical Research Council, TB Research Centre in collaboration with Institute of TB and Chest Medicine King Edward Medical University/Mayo Hospital, Lahore from April 2013 to March, 2014
Patients and Methods: All newly diagnosed pulmonary tuberculosis patients who were registered and given treatment by the DOTS program were included in the study. All patients underwent sputum smear microscopy along with Complete Blood Count and ESR at the time of enrollment. The patients were followed for next 6 months while on treatment. Sputum samples were tested at 2[nd] and 6[th] month to check the sputum conversion rate and indirectly to see the efficacy/compliance to treatment
Results: A total of 400 patients were enrolled with slightly more males [52%] as compared to females [48%]. Smear became negative within two months of starting treatment in 85.7% patients while in 14.2% it remained positive at 2[nd] and 6[th] months of therapy. There were more females [10.7%] whose sputum smear did not became negative as compared to males [3.5%]. Predominant factors affecting sputum smear conversion were low resistance, raised initial bacillary load, decreased hemoglobin level, and long duration of symptoms at the time of diagnosis
Conclusion: Factors like low resistance, high initial bacillary load and decreased hemoglobin levels affect the sputum smear conversion and should be addressed while assessing efficacy of anti-tuberculosis treatment
Subject(s)
Humans , Male , Female , Sputum , Tuberculosis, Pulmonary/therapy , Cross-Sectional StudiesABSTRACT
To assess the economic burden of dengue infection by calculating cost per patient and disability adjusted life years lost. The cross-sectional study was conducted in Islamabad, Lahore, Faisalabad and Karachi from July 2012 to March 2013. Residential addresses and telephonic numbers of dengue patients were taken from the records of Pakistan Institute of Medical Sciences, Islamabad, Mayo and Ganga Ram Hospital, Lahore, Civil Hospital, Karachi, and Allied Hospital, Faisalabad. A total of 250 dengue confirmed cases - 50 from each hospital - were randomly selected. Information regarding duration of illness and out-of-pocket expenses were collected to estimate the direct cost, while indirect cost [number of work days missed by the patient] was calculated from disability adjusted life years using Murray's formula. Overall, there were 162[65%] men and 88[35%] with a mean age of 30.4 +/- 13.5years. More than half 138[55%] were below 30 years of age. Socio-economically, 145[58%] belonged to low, 70[28%] middle and 35[14%] to high socioeconomic groups. Of the total, 210[84%] cases had dengue fever followed by 32[12.8%] dengue haemorrhagic fever and 8[3.2%] dengue shock syndrome cases. Average duration of illness was 32 +/- 7.1 days. Overall direct cost per patient was Rs.35, 823 [US$358] and average pre-hospitalisation, hospitalisation and post-hospitalisation was Rs.6154, Rs.21, 242 and Rs.8, 427 respectively. The overall disability adjusted life years per million population was 133.76. Although the government had provided free treatment for dengue in public-sector hospitals, still patients had to pay Rs.21, 242 during hospital stay, resulting in substantial burden which needs to be addressed
Subject(s)
Humans , Male , Female , Cost of Illness , Cross-Sectional Studies , Severe DengueABSTRACT
Background: Prompt and accurate diagnosis of multi drug resistant tuberculosis is essential to avoid unnecessary delay in treatment. The conventional methods for testing drug susceptibility requires 4-6 weeks for isolation of Mycobacterium tuberculosis and another 4-5 weeks for testing susceptibility thus delaying the diagnosis and treatment
Objectives: To validate the drug susceptibility testing of isoniazid and rifampicin with Genotype MTBDRplus kit and comparing with the conventional standard drug proportion method. Study type, settings and duration: This cross sectional study was carried out in PMRC TB Research Centre, King Edward Medical University Mayo Hospital Lahore in collaboration with Shaukat Khanum Memorial Cancer Hospital and the Research Centre from November 2008 to October 2009
Materials and Methods: A total of 77 AFB smear positive and negative specimens from adult patients suffering from pulmonary and extra pulmonary TB were included in this study. Samples were processed for drug sensitivity testing by drug proportion method using Lowenstein Jensen medium and also on Genotype MTBDRplus assay
Results: Out of 77 specimens 74% were pulmonary and 26% extra pulmonary. There were 29 females and 48 males with a mean age was 30 years. Culture positivity on LJ medium was 69% while that on MTB PCR was 79%. Out of 53 culture positive specimens, 8[15%] were MDR while out of 61 MTB PCR positive specimens 9[14.7%] were MDR
Conclusion: Genotype MTBDRplus assay, is a highly sensitive technique for diagnosis of MDR TB in smear positive and smear negative complicated suspects; but it requires expensive instruments and skilled personnel
ABSTRACT
Close contacts of multi drug resistant tuberculosis patients are expected to be at increased risk of developing the disease and therefore need screening on priority basis to have an effective TB control program. Active household contact screening is an effective and cheaper way to detect and treat MDR-TB at its early stages. To determine active TB cases among household contacts of MDR-TB patients in a tertiary care setting. Descriptive study, conducted at PMRC TB Research Centre in collaboration with Institute of Chest Medicine, King Edward Medical University/Mayo Hospital, Lahore from November 2012 to December 2013. Patients suffering from MDR-TB and seeking treatment from Institute of Chest Medicine were selected as index patients. Their contacts [spouses, children, parents, siblings and other relatives] underwent sputum smear microscopy. Those found positive for AFB were subjected for MTB RIF assay by GeneXpert to determine rifampicin resistance. Data was analysed using IBM Statistics SPSS version 20.0. A total of 692 contacts of 112 MDR-TB patients were studied. Among them, 374[54%] were males and 318[46%] female. Seventeen contacts were found smear positive and of these 15[88%] were also confirmed as MTB by GeneXpert. Four [23%] contacts were rifampicin resistant. Of the affected contacts, majority were sisters [23.5%]. Active TB was detected in contacts of patients having MDR-TB with few also showing rifampicin resistance. TB screening should be done in all contacts of TB patients, especially those having drug resistance
Subject(s)
Humans , Male , Female , Tuberculosis, Multidrug-Resistant/transmission , Tuberculosis/epidemiology , Tuberculosis/prevention & controlABSTRACT
To assess the efficacy and diagnostic yield of third sputum smear among pulmonary TB patients. This retrospective data analysis was done at PMRC TB Research Centre in collaboration with Institute of Chest Medicine, King Edward Medical University/Mayo Hospital Lahore, from January 2010 to December 2011. Patients presenting with respiratory symptoms, having abnormal chest X-rays and having a clinical suspicion of tuberculosis were asked to submit three sputum samples on two consecutive days [1[st]spot, 2[nd]early morning, 3[rd]spot] for acid-fast bacilli smear microscopy. Smears were prepared and stained by Ziehl-Neelsen method. A total of 7785 TB suspects submitted three sputum samples making a total of 23,355 slides for checking acid-fast bacilli using smear microcopy examinations. The smear positivity rate was 11.8%. About 12% suspects fulfilled the case definition of having one positive smear confirmed by a second smear, while, only 2.5% suspects fulfilled the case definition based on third smear in combination with first or second. A total 1164[15%] suspects had at least one positive smear; of these 896[77%] were positive in first smear, 190[16%] were negative in first smear but positive in second and 78[6.7%] were positive in third smear after two negative smears. Recently changed WHO criteria for examination of two sputum smears is based on evidences collected from the globe however, for Pakistan the value of third smear which picked almost 7% cases is quite significant and should still be practiced. Checking AFB using 3 sputum smears should still be practiced in Pakistan especially, for those who are initially negative on 2 smears
Subject(s)
Humans , Sputum/microbiology , Reproducibility of Results , Sensitivity and Specificity , Specimen HandlingABSTRACT
Tuberculosis is a major health problem and addiction to either tobacco, drugs or both are considered as major risk factors for the spread of disease. To determine the frequency and type of tobacco and other drug addictions in patients suffering from any type of tuberculosis. Cross-sectional, descriptive study done by PMRC TB research center, at Institute of Chest Medicine; King Edward Medical University/Mayo Hospital Lahore from March 2012 to July 2012. All patients confirmed with Mycobacterium tuberculosis infection, either pulmonary or extra pulmonary, were included in the study. A semi structured questionnaire was used to record the information relating to personal profile, microbiological data and the information relating to the drug and tobacco addiction. A total of 202 patients were selected out of whom 110[54.5%] had pulmonary tuberculosis, 91[45%] extra pulmonary tuberculosis and 1[0.5%] had both pulmonary and extra pulmonary tuberculosis. Among 202 cases, 40[19.8%] were addicted to tobacco [35 males, 5 females] and 5 were drug addicts [4 males 1 female] while 8 [all males] were both tobacco and drug addicts. After tobacco addiction, cocaine and alcohol were the most common addictions in these tuberculosis patients. Almost 20% patients with tuberculosis are addicted to tobacco or drugs
ABSTRACT
The rapid spread of metallo- Beta-lactamase producing clinical pathogens is a matter of great concern and with the addition of NDM-1 it poses more threat for public health as NDM-1 positive isolates show resistance to most of the antibiotics. The current study was carried out to determine the prevalence of extended-spectrum Beta-lactamases [ESBLs] and metallo- Beta-lactamases [MBLs], particularly NDM-1 in clinical multi-drug resistant isolates from two tertiary care hospitals in Pakistan. A total of 356 clinical isolates were included in the study where 301 isolates were collected from the Pakistan Institute of Medical Sciences [PIMS], Islamabad and 55 were collected from the Mayo Hospital Lahore. The isolates were screened for ESBLs and MBLs production by phenotypic method and PCR was performed to detect the presence of blaVIM, blaIMP and blaNDM-1 genes. Out of 356 clinical isolates, 160 showed carbapenem resistance. Of these 160 isolates, 131 displayed MBLs production as accessed by combined disk method. In MBLs producing organisms, PCR amplification confirmed 31 [23.6%] isolates harboring blaNDM-1 gene, 33 [25.1%] isolates having blaVIM gene and 2 [1.5%] isolates displaying blaIMP gene. Plasmid profile analysis of NDM-1 positive organisms showed variable number of plasmids which were stable during serial passages in antibiotic free media. The prevalence of ESBL producing organisms was recorded to be 87.5%. The results show a high level of NDM-1 positive organisms from variety of samples at both hospitals, implicating the spread of MBL genes in clinical isolates