Molecular detection of multi drug resistant tuberculosis [MDR-TB] in MDR-TB patients' attendant in North Western Pakistan

Objective: To determine the drugs susceptibility pattern of mycobacterium tuberculosis [M.TB] in multi-drug resistant tuberculosis [MDR-TB] patients' attendants in North Western, Pakistan

Study Design: Cross sectional study

Place and Duration of Study: This study was conducted at Peshawar Tuberculosis Research Laboratory [PTRL], Provincial TB Control Program Hayatabad Medical Complex Peshawar, [KP] from August 2013 to March 2014

Material and Methods: A cross sectional study in which four hundred and eighty sputum samples from MDR-TB patients' attendants were processed for the detection of M.TB through Ziehl-Neelsen staining, Lowenstein-Jensen, BACTEC MGIT-960 culture and line probe assay

Results: Out of 480 samples, 06 [2.1%] were found positive for M.TB through Ziehl-Neelsen staining while 10 [2.8%] were positive through LJ and BACTEC MGIT-960 culture. The 10 positive samples were further subjected to drugs susceptibility testing and line probes assay test to find out rifampicin, isoniazid, streptomycin and ethambutol resistant and it was found that 6 M.TB isolates were resistant while 4 were sensitive to rifampicin and isoniazid. Among the 6 resistant M.TB strains, 4 showed mutation in rpoB gene at 531, 516 and 526 codons

Conclusion: Majority of MDR-TB patients' attendants had drug-resistant tuberculosis and the rate of drug susceptible TB was low

Effectiveness of non-mesh [shouldice] versus mesh [lichtenstein] repair in inguinal hernia

To evaluate the optimum method of repair for inguinal hernia with respect to low rate of recurrence, minimum postoperative pain and cost effectiveness. Retrospective and Comparative study. This study was conducted between 2004-2007 in the surgical department DHQ Hospital Karak from. Either 320 patients were randomly allotted to mesh or non-Mesh repair. They were followed up at the 1[st] week and then 1, 6,12,18,24 and 36[th] month. Clinical outcome that is, recurrence rate, quality of life, Post-oparative pain etc were noted. After 3 year, the recurrence rates were significantly different for the two types of repairs. The Shouldice is usually suited in primary and unilateral inguinal hernial repair in adult males. In addition, The Lichtenstein is best for bilateral and recurrent inguinal hernial repair in old patients [>60 Yrs] and in elective states of repair

Assessment of left ventricular systolic and diastolic function by tissue doppler imaging after acute myocardial infarction

Objective: To evaluate left ventricular systolic and diastolic function by Tissue Doppler imaging after acute myocardial infarction. Methods: It was a hospital based, prospective descriptive study, from 1st July 2010 to 31st Dec. 2010. Total of 200 patients having acute myocardial infarction underwent detailed tissue Doppler imaging [TDI] echocardiographic examination for evaluation of left ventricular systolic and diastolic function on day 3, in echocardiographic section of Govt. Lady Reading Hospital, Peshawar. Peak systolic [Sm], peak early diastolic [Em] and peak late diastolic [Am] velocities were recorded at 4 different sites of the mitral annulus. The ejection fraction and pulse wave TDI diastolic parameters were also recorded. Using SPSS version 16 data was analysed, frequencies and Mean +/- SD were determined for categorical and numerical variables, respectively. A p-value =0.05 was considered significant. Results: Total study sample was 200 patients having acute myocardial infarction [MI]. The sample was divided into 4 groups, i.e., anterior MI, inferior MI, septal MI, and lateral MI. There were 122 men and 78 women and the mean age was 42 +/- 5 SD. There was a marked reduction in Sm velocity at mitral annulus, especially at the infarction sites. The mean peak systolic velocity from 4 mitral annulus sites was well correlated with ejection fraction [p=0.0001]. Similar to systolic velocities, Em velocity was also reduced, especially at the infarction sites. The mean peak early diastolic velocity from 4 mitral annulus sites was well correlated with ejection fraction [p=0.0001]. The mean Em velocity was correlated well with isovolumic relaxation time [IVRT]. There was no correlation between mean Em velocity and deceleration time [DT]. Conclusion: Tissue Doppler Imaging is a reliable, accurate and easily reproducible modality of echocardiography. The reduced peak systolic velocity and reduced peak early diastolic velocity seems to be an expression of regionally reduced systolic and diastolic functions, respectively. While the reduced mean systolic velocity and reduced mean early diastolic velocity from 4 mitral annulus sites are expressions of globally reduced systolic and diastolic functions, respectively and were correlated well with the ejection fraction. Keywords: Tissue Doppler imaging, ejection fraction, peak systolic velocity, peak early diastolic velocity, deceleration time, isovolumic relaxation time

Changing trend of presentation of acute coronary syndrome in peshawar over the last sixteen years

Background: Once considered as disease of the affluent and developed countries, coronary artery disease is emerging as epidemic in the developing world in general and South Asia in particular. Objective: To observe the trend of presentation of acute coronary syndrome in the local population over the last 16 years. Material and Methods: Clinical audit from 1995 to 2010 was carried out in which the data was retrieved from the computerised database of the Department of Cardiology, Lady Reading Hospital Peshawar. The period was divided into four quartiles, and the data of each quartile was analyzed for the total number of admissions, the type of ACS, whether ST-elevated MI or non-ST elevated ACS [comprising unstable angina and non-STEMI], age, gender and mortality. Results: The total admissions into the unit in the first quartile [1995–1998] were 23, 827, in the second quartile [1999–2002] 29, 005, in the third quartile [2003–2006] 33, 206 and in the fourth quartile [2007–2010] were 40, 110. Total ACS brunt constituted 8340 [35%], 10, 384 [35.8%], 12, 180 [36.68%] and 14, 920 [37.2%] patients respectively. The mean age of patients was 49.70 +/- 6.4 years, 48.21 +/- 7.2 years, 47.38 +/- 7.1 years and 46.81 +/- 6.2 years respectively. Women were 2356 [28.25% of the total ACS burden] in the first quartile, increasing to 3554 [34.225%], 4817 [39.55%] and 6281 [42.1%] in the following quartiles. STEMI constituted 45.88% [3826] of the total ACS presentations in the first quartile, 47.24% [4905] in the second, 49.55% [6035] in the third and 49.87% [7440] in the last quartile. The mortality rate, however, remained constant throughout [8.4% to 8.8%]. Conclusion: An increasing trend is seen in the burden of CAD in the local population with increasing presentation as STEMI. It is also evident that CAD is occurring at younger ages and more so in the female population

frequency of GAstric malignancy in patients undergoing endoscopy for dyspepsia

To find out the frequency of Gastric Malignancy in endoscoped patients presenting with dyspepsia. A descriptive study carried out for 12 years. Gastroenterology Department of CMH Quetta from 1991-95, CMH Peshawar 1995-2000 and CMH Lahore 2000-2003. Patients came from Baluchistan, Sind, NWFP, and Punjab respectively. Hundred adult patients, who presented with symptoms suggestive of upper digestive tract disease and were confirmed to have gastric malignancy on histopathology of the gastric lesion. Out of 5000 patients presenting with dyspepsia, 100 patients were ascertained to have gastric malignancy on endoscopic biopsy and registered in the study. Twenty four [24%] were female and 76 [76%] male. The Age ranged from 25 to 85 years with average 54.51 years. Ninety four [94%] patients had adenocarcinoma including 20[20%] signet ring carcinoma, 4[4%] lymphoma, 1[1%] adenosquamous carcinoma and 1[1%] had leiomyoblastoma. Eighty- five [85%] were registered in Peshawar and Quetta out of two thousands i.e. one out of every 23rd gastroscoped patient, while 15[15%] were diagnosed in Lahore out of 3000 i.e. one out of 200. Gastric Malignancy is the cause of dyspepsia in 4. 25% patients in Baluchistan and NWFP and 0.5% in Punjab, who presented with upper digestive tract disturbances, substantive enough to warrant endoscopy. Hence gastric malignancy is much more common in Baluchistan and NWFP as compared to Punjab. The average age is 54 .51 years

Comparison of loading dose of 300mg versus 600mg of clopidogrel on platelet aggregation in patients with coronary artery disease

Objective: to study the effects of loading dose of 300mg versus 600mg of clopidogrel on platelet aggregation in patients with coronary artery disease [CAD]

Material and Methods: this study was conducted on patients with CAD, not already taking any anti-platelet drugs, admitted in cardiology department Lady Reading Hospital from 1st June to 15th July 2005. Patients were randomized into two groups. Baseline platelet aggregation was measured followed by oral clopidogrel 300mg [group A] or600mg [group B]. Platelet aggregation was measured serially at 2, 4 and 6 hours

Results: total number of patients was 52 [16 males and 36 females]. In-group A, the baseline mean platelet aggregation was 2.36 +/- 1.5 ohms, there was significant difference at 2 hours i.e. 1.24 +/- 1.2 ohms [P<0.001], 4 hours i.e. 1.05 +/- 1.05 ohms [P<0.001] and at 6 hours i.e. 0.71 +/- 0.72 ohms [P< 0.001] as compared to baseline. In-group B, the baseline mean platelet aggregation was 2.32 +/- 1.98 ohms. There was significant difference in platelet aggregation time at 2 hours i.e. 1.37 +/- 1.39 ohms [P< 0.001] 4 hours i.e. 0.92 +/- 0.97 ohms [P<0.001] and at 6 hours i.e. 0.35 +/- 0.61 ohms [P< 0.001] as compared to baseline. No significant difference was observed on platelet aggregation in-group "A" and group "B" at 2 hours [P=0.479], 4 hours [P=0.858] and 6 hours [P=0.756]

Conclusion: clopidogrel 300mg as a loading dose is as effective as clopidogrel 600 mg in inhibiting platelet aggregation in patients with coronary artery disease