Paraplegia Following Spinal Cord Contusion from an Indirect Gunshot Injury / 대한신경손상학회지

Spinal cord injuries are debilitating and life threatening. Paraplegia due to direct traumatic gunshot injury to the spinal cord is common. The most common cause of spinal cord injury is road traffic accidents. This is followed by spinal cord injury due to a fall from a height. Most of the spinal cord injuries due to gunshot wounds occur as a result of direct traumatic effects. We present a rare case of a 49-year-old male with trauma. He developed paraplegia after a gunshot wound injury to the neck and contusion to the spinal cord, with no direct trauma. Paraplegia due to direct gunshot injury can have many different outcomes. In our case, the patient was managed conservatively, and the outcome was favorable.

Type and frequency of mutations in katg and rpob genes in multi-drug resistant strains of mycobacterium tuberculosis complex.

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

Factors affecting sputum smear conversion time in newly diagnosed pulmonary tuberculosis patients

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

Active case detection among household contacts of multi drug resistant tuberculosis patients in a tertiary care setting

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

Incremental yield of submitting three sputum specimens for the diagnosis of pulmonary tuberculosis

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

High prevalence and upward trend of pulmonary tuberculosis in leukemia, lymphoma and lung cancer patients

To document the prevalence and any increasing or decreasing trend of tuberculosis in cancer patients. Design: An analysis and comparison of patients suffering from cancers along with tuberculosis for years 1976, 1987 and 1999. Place and Duration of Study: The record of all these patients was collected from different hospitals of Lahore, specially Mayo Hospital, Services Hospital and patients managed privately by the authors of this study. Subjects and In the years 1976, 1987 and 1999, total cancer patients were 1100, 1481 and 1628 respectively. Patients were diagnosed on the basis of history, physical examination, sputum for AFB, culture for AFB, tuberculin skin test and x-ray chest. In few difficult cases, Mycodot blood test was also performed. In patients with head and neck cancers, 3.6%, 3.9% and 4.4% had tuberculosis in the years 1976, 1987 and 1999 respectively. In lung cancer patients the prevalence of tuberculosis was 5.6%, 4.9% and 6.9% for each respective year. In case of leukemia and lymphoma, the prevalence of tuberculosis was 9.8%, 11.25% and 11.21% for the years 1976, 1987 and 1999 respectively. A statistically significant difference was seen in leukemia, lymphoma and lung cancer cases for the prevalence of pulmonary tuberculosis as compared to all other cancers combined over respective years