Estimation of the contribution of private providers in tuberculosis case notification and treatment outcome in Pakistan

To improve involvement of the private sector in the national tuberculosis [TB] programme in Pakistan various public-private mix projects were set up between 2004 and 2009. A retrospective analysis of data was made to study 6 different public-private mix models for TB control in Pakistan and estimate the contribution of the various private providers to TB case notification and treatment outcome. The number of TB cases notified through the private sector increased significantly from 77 cases in 2004 to 37 656 in 2009. Among the models, the nongovernmental organization model made the greatest contribution to case notification [58.3%], followed by the hospital-based model [18.9%]. Treatment success was highest for the district-led model [94.1%] and lowest for the hospital-based model [74.2%]. The private sector made an important contribution to the national data through the various public-private mix projects. Issues of sustainability and the lack of treatment supporters are discussed as reasons for lack of success of some projects

Treatment outcomes of various types of tuberculosis in Pakistan, 2006 and 2007

Measuring treatment outcome is important for successful tuberculosis [TB] control programmes. The purpose of this study was to examine the outcomes of various types of TB cases registered in Pakistan over a 2-year period and compare those outcomes among the different provinces and regions of the country. A retrospective, cohort study was conducted in which TB treatment outcome reports were reviewed. Of the 349 694 pulmonary TB cases registered in Pakistan during 2006 and 2007, 309 154 [88.4%] were treated successfully. Treatment success was significantly higher in new smear-positive cases and lower in retreatment cases. Among the provinces and regions, treatment success was significantly higher in 4 out of 8 provinces. Treatment success needs to be improved, particularly in retreatment cases. The national TB control programme should review the provincial and regional programmes and learn lessons from well-performing programmes. Patient factors that may affect the treatment outcome should be also studied

Prevalence and antimicrobial susceptibility of methicillin resistant staphylococcus aureus [MRSA]

The isolation rate of MRSA from different specimens was determined. Between January 1999 and June 2002, 448 out of 1322 [35.67%] isolates were found to be MRSA. A detailed study of these isolates showed a high prevalence of MRSA in patients in ICU's and special care wards. The yield of MRSA was highest from endotracheal secretions [100%], bronchial washings [70%], and catheter tips [51.85%] followed by sputum [40.54%], ear swabs [40%], fluids [37.25%], pus/wound swabs [34.83%] and blood cultures [28.07%]. Vancomycin remains the drug of choice with no resistance detected. The resistance to ciprofloxacin was 86.61%, to erythromycin 85.5% and to gentamicin 81.03%. After vancomycin, fusidic acid was the most sensitive drug with only 21.21% of the isolates exhibiting resistance. In view of the high prevalence of MRSA in our community, authorities must introduce more effective measures to control its spread; otherwise, it may seriously disrupt the efficient delivery of the health system in the country

Effect of gram on blood sugar

The effect of wheat bread and whole gram on postprandial blood glucose levels was studied in 25 healthy individuals and 25 diabetic patients. The values of blood glucose levels obtained were compared with blood glucose levels after glucose load. Blood glucose levels decreased after gram meal more than wheat bread and glucose in both healthy and diabetic subjects

Effect of honey on blood sugar

Effect of honey on blood sugar in 15 normal volunteers and 15 known diabetic patients observed by giving 75 g. glucose and 83 ml honey on two consective days. In normal volunteers, glucosee and honey showed the same peak at 30 minutes but honey gave somewhat lower blood glucose response after 60 minutes and 90 minutes. In diabetics, blood glucose levels were raised almost equally at all time with glucose and honey except at 120 minutes when the peak moved lower side. Honey when taken in small doses [15 g and 30 g; 1 or 2 dessert spoonful] caused a rise blood sugar both in normal as well as diabetic persons and this rise was dose related thus negating hakim's claim that honey in small doses does not effect blood sugar levels

Rotavirus enteritis in hospitalized infants and young children

The relative importance of rotaviral diarrhoea was assessed by etiological evaluation of 264 patients suffering from acute diarrhoea admitted in Diarrhoeal Diseases Control Centre, Nishtar Hospital, Multan. Rotavirus was found to be the second most common enteropathogen [28.4%], the first most common being E. coli, although neonates and older children were found to be affected less frequently [12%]. Mixed rotaviral and bacterial infection was found in 6.4% of patients. Collectively rotavirus was isolated from 34.8% of patients. There was no change in the relative frequency of rotaviral diarrhoea with the change of season. Breast fed babies had a slightly lower incidence of rotaviral diarrhoea. Roughly 75% of patients had isonatremic dehydration, but the incidence of hyponatremia was more [16.8%] in rotaviral group while hypernatremic dehydration was more frequently seen [15.8%] in non-viral group. Episodes of rotaviral diarrhoea more often resulted in severe symptoms and slightly higher mortality