Therapeutic outcome of Pulmonary tuberculosis in type-2 diabetes patients

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

Adverse drug reactions of first line anti-tuberculosis drugs used in DOTS implemented setting in Lahore

Background: Tuberculosis [TB] is a major health problem in most countries despite the availability of effective chemotherapy. The frequency and nature of anti-TB drugs induced adverse drug reactions [ADRs] have been matter of concern in many countries. In our programme patients take their medicines under the direct observation of a health care provider. It is therefore, important to monitor ADRs and increase awareness of health care providers about ADRs and their management

Objective: To get an over view of adverse drug reactions caused by first line anti-tuberculosis drugs used in the treatment of TB cases in directly observed therapy short course [DOTS]

Study design, settings and duration: This descriptive observational study was carried out at chest clinic of Sir Ganga Ram Hospital, Lahore for a period of one year

Patients and Methods: Patient aged >/=15 years of age registered for treatment of tuberculosis in treatment category I at Model Chest Clinic, Sir Ganga Ram Hospital, Lahore were included in the study after obtaining consent. All patients were advised to visit health facility immediately if they had any feeling of drug reaction

Results: A total of 760 TB patients registered in treatment category I were included in the study. Out of 760 patients, 306 [40.2%] patients showed Adverse Drug Reactions [ADR] with anti TB drugs. Joint pain was the most common ADR, reported by 16.7% patients followed by skin itching in 11.5%, anorexia, nausea, abdominal pain in 7.63% and jaundice in 3.68% patients. Rash and visual impairment was reported by 0.26% each. Within gender, ADRs were mostly reported by females [41.9%] as compared to male patients [37.6%]. Age wise majority [36%] of ADRs were reported by patients aged between 15-54 years as compared to those aged 55 years or above [4.2%]. Most adverse effects settled themselves or with addition of some anti-allergic drugs for few days and in only 4.2% cases one or more ant TB drugs had to be discontinued

Conclusion: ADRs were observed in 40.2% TB patients but most reactions were of mild intensity and settled without any intervention. Only 4.2% reaction were severe enough to stop the drug and replace it with another drug

Association of hyperuricemia with metabolic syndrome

Uric acid levels are often increased in subjects with metabolic syndrome but it is unclear whether it plays a causal role or it is a marker for metabolic syndrome. To find the association of hyperuricemia with various components of metabolic syndrome. The cross sectional analytical study was carried out in Sir Ganga Ram Hospital, Lahore, Pakistan. Total 600 subjects of both genders aged 30-70 years were recruited in the study. Demographic, clinical and biochemical variables were recorded by using a questionnaire. Fasting blood sample was used to estimate plasma glucose, serum lipid profile and uric acid. The cut-off for hyperuricemia was serum uric acid level >/=7.0 mg/dl for males and >/=5.7 mg/dl for females. Metabolic syndrome was diagnosed if subjects had any 3 of the 5 criteria described as per ATP III guidelines. The data was analyzed using SPSS Version 20. The study included 216 [36%] males and 384 [64%] females with mean age 47 +/- 10 years. Out of total 447 subjects, 62 [13.9%] with metabolic syndrome had hyperuricemia. Whereas 62 [75.6%] subjects out of total 82 subjects with hyperuricemia had metabolic syndrome. Different parameters of metabolic syndrome were statistically correlated with hyperuricemia but none showed significant correlation. Chi square and Wald Statistic [Logistic regression algorithm] showed that by using G-to-S [general to specific] approach hyperuricemia was significantly associated with female gender but did not show any association with metabolic syndrome. There was no association present between metabolic syndrome and hyperuricemia; therefore uric acid levels might not be important in the diagnosis of metabolic syndrome

Role of mycobacterium culture in the diagnosis of smear negative pulmonary tuberculosis suspects attending tertiary care setting

Sputum smear testing for acid fast bacilli is the gold standard for the diagnosis of tuberculosis. The role of culture in cases that are negative on sputum smear testing is being emphasized for early diagnosis of disease and prompt initiation of treatment. To correlate the role of culture in diagnosing smear-negative pulmonary tuberculosis suspects. Descriptive study carried out in chest clinic of Sir Ganga Ram Hospital, Lahore in collaboration with Institute of Public Health Lahore from January 2012 to June 2012. Materials and Adults over 15 year of either gender having symptoms and X-ray findings consistent with pulmonary tuberculosis were selected. The sputa of sputum smear negative cases were inoculated on Lowenstein-Jensen medium culture medium to isolate the organism and correlate the culture positivity and negativity in smear negative cases. A total of 88 sputa were negative for acid fast bacilli on smear which were subjected to culture on Lowenstein-Jensen medium. Of these 31[35%] grew acid fast bacilli and were thus confirmed positive by culture while rest 57 remained negative on culture. There was no significant difference in the symptoms and extent of lesions on X-ray between those who were culture positive or negative. Sputum culture should be done for the diagnosis or exclusion of smear negative clinically suspected and X-ray positive cases of pulmonary tuberculosis. Policy message: All clinically suspected and X-ray positive but sputum smear negative cases should undergo sputum culture for Mycobacterium tuberculosis on Lowenstein-Jensen medium. The facilities to culture the micro organism should be made available at district level by the tuberculosis control program

Diabetic eye screening in Sir Ganga Ram hospital, Lahore

Diabetic retinopathy is the optical complication that may lead to impaired vision. It is one of the most prevalent but preventable blinding disease. Its early diagnosis is prerequisite for the prevention of the visual loss and blindness associated with diabetic complication. To estimate frequency of eye examination and various types of retinopathy; and to find the association between diabetic retinopathy and its risk factors. The cross sectional study was conducted from Apr-Sep 2012 by PMRC Research Centre, FJMC, Lahore. Using non probability convenient sampling, eighty known type II diabetics were recruited. Venous blood was drawn for plasma glucose level [GOD-PAP] and glycosylated hemoglobin [Ion-Exchange Resin]. Arterial blood pressure was measured using digital apparatus [Oscillometric method]. Visual acuity was tested by Snellen's chart and dilated fundus examination was done to screen diabetic retinopathy. Data was analyzed using Statistical Package for Social Sciences [SPSS-20]. The study included 41% males and 59% females. Mean age was 51 +/- 9 [33-67] years. Diabetics who never screened for retinopathy were 54.3%; and who examined during last year as per IDF guidelines were 25.7%. The frequency of bilateral and unilateral NPDR was 22.5% and 5%, respectively. The occurrence of NPDR was slightly higher in left eye, whereas PDR was more prevalent in right eye. The visual acuity was equal or better than 6/12 in better eye of 80% study participants; and was 6/18-6/36 in better eye of 20% participants. DR was significantly associated with longer duration of diabetes [p-0.010], poorly controlled diabetes [p-0.044] and hypertension [p-0.006]. Odd ratios [95% CI] showed that duration of diabetes [>/= 20 years], glycosylated hemoglobin [>/= 7.5%,]Systolic blood pressure [>/= 140 mm/ Hg] and diastolic blood pressure [>/= 90 mm/Hg] had 3-5 times higher risk of retinopathy. Conclusion: Majority of patients were neither knew nor referred for eye examination. Strict control of diabetes and hypertension may prevent or delay diabetic retinopathy. Policy Message: Annual eye examination must be prescribed by the physician/ diabetologist. An education and awareness program for diabetics and community based survey is highly recommended

Impact of age, gender and diabetes on serum lipid levels

To see the effects of age, gender and diabetes on serum lipid levels. Cross sectional analytical study conducted at PMRC Research Centre, Fatima Jinnah Medical College, Lahore from Jun-Dec 2011. One hundred type 2 diabetes mellitus and equal numbers of gender matched healthy controls were randomly selected for the study. After an overnight fasting, blood specimens were drawn for lipid profile where total cholesterol, high density lipoprotein cholesterol and triglycerides were measured by standard enzymatic endpoint methods and LDL-cholesterol by Friedweld's formula. Statistical analysis was done using SPSS-15. Odd ratios of age for total cholesterol [OR 1.198]; high density lipoprotein cholesterol [OR 1.144]; and low density lipoprotein cholesterol [OR 1.576] revealed that subjects aged 45 years or more had greater risk of having deranged lipid levels. Female gender had higher high density lipoprotein cholesterol [p 0.000] and triglycerides [p 0.001]. Odd ratios of men for total cholesterol [OR 0.775]; high density lipoprotein cholesterol [OR 0.183]; and low density lipoprotein cholesterol [OR 0.683] illustrated that men were significantly less prone to dyslipidemia than women. Odd ratio of diabetes for high density lipoprotein cholesterol [OR 1.802] suggested that diabetics had 1.8 times more risk of having low high density lipoprotein cholesterol. Diabetic females over 45 years of age have significantly high chances of having disturbed or high lipid profile. All persons in general and diabetics in particular over the age of 45 years should be screened for dyslipidemia and informed using behavior change communication to prevent disease complications

Pregnancy related medical problems at a tertiary care hospital

To estimate pregnancy related medical problems in cases visiting care hospital for antenatal care tertiary .Retrospective OPD based study done at medical research laboratory of Ganga Ram Hospital, Lahore from January 2011 to December 2011. A total of 1806 pregnant cases visited the biochemistry laboratory out of which 1000 cases fulfilled the criteria and had complete record available and were selected for analysis. Variable including hemoglobin, blood group and Rh factor, fasting and post prandial plasma glucose, viral markers like HBsAg, Anti-HCV and Anti-HIV l/ll and complete urine examination. Data was analyzed using Statistical Package for Social Sciences [SPSS-15]. The mean age of women was 25.4 +/- 4.29 years and 78.1% were between 21-30 years. The mean fasting and post parandial glucose levels were 84.03 +/- 15 mg/dl and 134.30 +/- 23 mg/dl respectively. Gestational diabetes mellitus was found in 96 cases [6.9%]. HBsAg was present in 1.2%, HCV in 8.5% and both B and C were present in 1 case. None had HIV l/ll infection. Blood group 'B' was commonest [34.2%], followed by group 'O' [30.6%], group 'A' [24.5%] and 'AB' [10.7%]. Rhesus factor [Rh] showed 94% Rh-positive cases and 6.0% Rh negative. Overall anemia was present in 61.1% cases with mild anemia in 87.5%, moderate in 12.2% and severe in 0.1%. Urinary tract infection was seen in 10.1 % cases. Anemia was common in pregnancy. Urinary tract infection [10%], hepatitis C virus exposure [8.5%] and gestational diabetes mellitus [7%] were common. Although the screening of HCV is not recommended internationally but the rate of HCV infection is on increase in Pakistan so there is a need of proper screening of HCV along with routine antenatal screening. It will help to identify asymptomatic women, who may benefit from antiviral therapy at a time when they are more receptive to medical intervention

Thyroid status and urinary iodine levels in women of endemic goiter area

To determine the thyroid function tests and urinary iodine levels in women belonging to goiter endemic area. Descriptive study conducted in women of goiter endemic area in Saggian Lahore. Saggian Lahore is a goiter endemic area. A total of 293 women between the ages of 18-45 years residing in the area were clinically screened for goiter. Of them 73 women having goiter were recruited for the study. Information regarding demographic profile clinical presentation and physical examination of the goiter was recorded on a questionnaire. The goiter size was graded according to WHO, UNICEF and the International Council for the Control of Iodine Deficiency Disorder. About 5ml of blood sample was drawn from each women and run for thyroid function tests i.e. T3 T4 and TSH using Elisa kits [Human scientific Co. Germany]. Urinary iodine was checked by chemical method. Mean age of 73 women was 28.5 years. Marital status showed that 48[65.7%] were married and 25[34.3%] were unmarried. Visible diffuse goiter was seen in 56[77%] cases. Pressure symptoms as cough and shortness of breath was seen in 30[41%] and 31[42.5%] women respectively. Among the 73 women 24.6% [18 cases] took treatment for goiter. Adverse pregnancy outcome secondary to goiter was seen in 58% [28 cases] out of 48 married women. Thyroid function tests result showed that 72% [53 cases] were euthyroid, 18% [13 cases] were hypothyroid, and 10% [7 cases] were hyperthyroid. Urinary iodine levels showed that 99% women were iodine deficient. Thyroid functions do not indicate iodine deficiency in all cases of goiter, therefore, Urinary iodine levels need be estimated while investigating goiter cases. Policy message: Iodine deficiency should be diagnosed and treated on priority basis

Factors responsible for failure to initiate tuberculosis treatment among smear positive tuberculosis patients

Tuberculosis is a major health problem in many parts of the world. Delay in initiation of the treatment may result in prolonged infectious state, drug resistance, relapse and death. To determine the factors responsible for not starting tuberculosis treatment among smear positive tuberculosis patients. Study type, settings and duration: This cross sectional study was done at Pakistan Medical Research Council TB Research Center, King Edward Medical University, Lahore, from 5th March 2010 to 5th December 2010. Patients and Methods: Fifty sputum smear positive patients of tuberculosis who did not register themselves in treatment register and presumably did not initiate anti tuberculosis treatment were contacted using telephone or traced by their home addresses. Once contact was established, they were inquired about the reasons for not starting tuberculosis treatment. Of 50 patients 38[76%] belonged to the lower socio economic class and 12[24%] to the lower middle class. Fourteen patients [28%] were illiterate and 23[46%] had only 8 years of education. Of the 50 cases 41[82%] were taking treatment from traditional healers and 4% did not go back to the DOTS program. Physical condition of the patient, social, domestic and religious issues also played some role in default. Lack of health education and poverty were the main factors responsible for non compliance from treatment. Policy message: Sputum testing sites should have a paramedic who should educate the patients about the benefits of treatment and the dangers of default or partial treatment

first and second line anti TB drug resistance pattern in Lahore

For the control of tuberculosis at national level, DOTS strategy [Directly observed therapy short course] is being implemented by National TB Control Program in collaboration with WHO. This programme if managed properly can cure nearly all-new TB patients. To determine the in vitro susceptibility pattern of second line drugs in multi drug resistant tuberculosis and inform tuberculosis control authorities and clinicians for appropriate management. A total of 1180 Mycobacterium tuberculosis positive patients receiving anti tuberculosis drugs and suspected of having drug resistance were referred to this Center for drug susceptibility testing. Sputa of all these patients were subjected to culture against first line of anti TB drugs. Those resistant to both INH and RIF were subjected to 2nd line of drug susceptibility testing. Out of 1180 suspected MDR-TB cases, 201[17%] showed resistance against both INH and RIF thus, confirming MDR-TB. Using the definition of extreme drug resistant TB [XDR-TB] i.e. MDR TB plus resistance to any one of floroquinolone and one of three injectables i.e. amikicin, kanynamicin and capreomycin, 4[2%] cases were XDR-TB. The frequency of XDR-TB was 2%. For MDR TB cases second line of anti tuberculosis drugs are still very effective

Efficacy of fix dose combination [atorvastatin and amlodipine] in treatment of uncontrolled hypertension and dyslipidemia

Background: The fixed-dose combination containing the antihypertensive agent amlodipine and the statin, atorvastatin, is the first combination of its kind designed to treat two risk factors for cardiovascular disease [CVD], i.e., hypertension and dyslipidemia. In this study, blood pressure an lipid lowering effects of combination of amlodipine and atorvastatin were evaluated in uncontrolled hypertensive patients. Methods: Thirty patients both male and female in the age group 35–60 years attending the Hypertensive Clinic of PMRC FJMC suffering from uncontrolled hypertension wer selected. Baseline blood pressure was checked after half hour rest in sitting and standing position using mercury sphygmomanometer. Blood sample was collected from all patients after overnight fasting for assessment of serum cholesterol, triglycerides, LDL and HDL cholesterol levels. They were prescribed with fixed dose combination of 5 mg amlodipine and 10 mg atorvastatin. Patients were followed for their blood pressure measurement after every 4 weeks up to 12 weeks. At the end of 12 weeks their fasting blood sample was taken again for determination of serum cholesterol, triglyceride, LDL and HDL cholesterol levels. Results: Systolic blood pressure after 4, 8 and 12 weeks was significantly lower at all intervals from baseline. When systolic blood pressure after 8 and 12 weeks was compared with 4 weeks, the effect was again significant [p=0.024, p=0.002 respectively].There was no significant reduction seen in 8 versus 12 weeks [p=0.493]. Diastolic blood pressure at 4, 8 and 12 weeks was significantly lower from baseline. Diastolic blood pressure after 4 and 8 weeks when compared with 8 and 12 weeks was not significantly low [p=0.99 and 0.91 respectively]. Lipid profile of the patients was significantly reduced from baseline after twelve weeks of fixed dose combination of treatment [p<0.000]. Conclusion: Combination therapy proved to be effective in controlling hypertension and dyslipidemia than single pill. It also improved patient's compliance. It is suggested that polypill should be prescribed instead of multiple drugs. Keywords: combination therapy, atorvastatin, amlodipine, uncontrolled hypertension, dyslipidemia

Association of insulin resistance with obesity in children

Insulin resistance is the primary metabolic disorder associated with obesity. Little is known about its role as a determinant of the metabolic syndrome in obese children. To assess the association of insulin resistance with metabolic syndrome in obese and non obese children. Study type and settings: Cross sectional analytical study conducted among children of ten Municipal Corporation high schools of Data Ganj Buksh Town Lahore. A total of 46 obese and 49 non obese children with consent were recruited for the study. Fasting blood glucose, serum insulin, high density lipoprotein cholesterol, triglycerides, cholesterol, non HDL-cholesterol LDL cholesterol were measured using standard methods. Data were analyzed by using statistical software SPSS-Version 15. A total of 95 children 49 obese and 46 non obese were recruited for the study. A significant association of serum triglyceride [p<0.001], high density lipoprotein cholesterol [p<0.001], fasting blood glucose [p<0.001], and insulin levels [p<0.001], was seen between the two groups. For each component of metabolic syndrome, when insulin resistance increased so did odds ratios for cardio metabolic risk factors. Insulin resistance was seen in 34.7% children. Metabolic syndrome was found in 31.6% children reflecting that obese children are at high risk for metabolic syndrome and have low HDL-cholesterol and high triglycerides levels

Multi drug resistance tuberculosis: pattern seen in last 13 years

Drug resistance in tuberculosis is a serious problem throughout the world especially, after the emergence of multi drug resistant TB strains. To estimate drug resistance in TB patients and compare it with previous studies to see the changing trends. The PMRC Research Centre receives sputum samples from all the leading hospitals of Lahore. This retrospective analysis was done from 1996 to 2008 on the multi drug resistant TB strains that were seen during these years. Five first lines tuberculosis drugs were tested on Lowenstein Jensen medium using standard proportion method. A total of 2661 confirmed isolates of Mycobacterium tuberculosis were seen over the past 13 years. Of the total, 2182 were pulmonary and 479 were extra pulmonary specimens. The patients comprised of those with and without history of previous treatment. These specimens were subjected to drug susceptibility testing. Almost half of the patient had some resistance; multiple drug resistance were seen in 12.3% and 23.0% cases without and with history of previous treatment respectively. overall resistance to rifampicin was 26.4%, isoniazid 24.1% streptomycin 21.6% ethambutol 13.4% and pyrazinamide 28.4% respectively. Statistically significant difference was seen between primary and acquired resistance. When compared with the reports from previous studies from the same area, there was a trend a gradual increase of drug resistance. Resistance to anti tuberculosis drugs in high. TB Control Program should start "DOTS Plus" schemes for which drug susceptibility testing facilities should be available for correctly managing the patients

Prevalence of dyslipidemia in patients with type-2 diabetes mellitus

The dyslipidaemia associated with type-2 diabetes is associated with raised plasma triglycerides, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol and very low-density lipoprotein cholesterol levels and is a risk factor of cardiovascular disease. To assess the lipid abnormalities in patients with type-2 diabetes. A cohort study carried out at Diabetic Clinic of PMRC Research Centre, FJMC, Lahore, Pakistan. Eight years case records of type-2 diabetic patients seen at the research centre from 1999-2006 were reviewed. The research centre is a specialized centre for diagnosing and treating diabetes mellitus. All the patients were recruited for their follow up check up and laboratory investigations for dislipidemia. Adult treatment panel III guidelines for dyslipidaemia were followed. A 12 hours fasting blood sample was collected from each patient for serum total cholesterol, triglycerides, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and glucose as well as glycosylated hemoglobin [HbA1c] by using standard methods at Biochemistry laboratory of the research centre. LDL-C/ HDL-C ratios, Very low-density lipoprotein cholesterol [VLDL-C] and body mass index was calculated after anthropometery body mass index [BMI] >/= 25 was considered as overweight while >/= 30 obese. HbA1c<6.1 was considered as poor glycemic control. Data was analyzed by using statistical software SPSS-15. a total of 1200 type-2 diabetes were seen in 8 years. There was poor glycemic control, in 87.5% subjects judged on blood HbA1c levels. These patients had higher total cholesterol, LDL-C and low HDL-C levels in blood. The percentage of patients with high, borderline and near optimal risk LDL-C was 62.7, 26.9 and 10.4% respectively, while HDL-C >40mg/dl were seen in 67%. Raised VLDL-C [above 40 mg/dl] was seen in 32.9% cases. The group with high LDL and VLDL is at risk of developing cardiovascular disease. Hypertriglyceridaemia was found in 55% and hypercholesterolaemia in 45.4% cases. Obesity as indicated by body mass index was found in 53.7% patients. Statistically significant association of hypercholesterolemia, hypertriglyceridemia, hypo HDL cholesterolemia and VLDL-C was found with advancing age while only hypertriglyceridemia and VLDL-C showed a positive association with duration of diabetes. A significant association of hyperglycemia [raised HbA1c] was seen with hypertriglyceridemia and high LDL-C along with high body mass index i.e. obesity. Hypertriglyceridemia, high LDL-C and VLDL-C, low HDL-C levels and obesity were the pattern of dyslipidemia found in our diabetic population

Diagnosis of tuberculosis: molecular versus conventional method

Tuberculosis is as old as mankind. One third of the world's population carries the bacillus. Tuberculosis remains the single greatest contributor to the world's morbidity and mortality. Zheil Neelsen stained smears for acid-fast bacilli and culture on Lowenstein Jensen media are the methods being used for the diagnosis of Mycobacterium tuberculosis in most developing countries. Zheil Neelsen smear is rapid but less sensitive and culture is more sensitive and specific but results in delay in definitive diagnosis. Polymerase chain reaction test for the diagnosis of tuberculosis is not well evaluated in developing countries. To compare the ability of polymerase chain reaction to diagnose Mycobacterium tuberculosis rapidly in pulmonary and extra-pulmonary clinical specimens, and compare it with the yield of smear positivity and culture. This was a comparative study which was carried out at PMRC TB Research Center, King Edward Medical University, Mayo Hospital Lahore in collaboration with Shaukat Khanum Memorial Cancer Hospital from November 2008 to October 2009. Clinically suspected cases of pulmonary and extra-pulmonary patients with symptoms of fever, fatigue, anorexia and weight loss were asked to submit their sputum or respective samples for the diagnosis of tuberculosis. Direct and concentrated smears were prepared and stained by Zheil Neelsen method and were subjected to culture on Lowenstein Jensen media. Decontaminated specimens were checked for mycobacteria using polymerase chain reaction where amplicons were used for detection to membrane bound probes on the strips. A total of 98 specimens were processed for acid-fast bacilli smear, culture and polymerase chain reaction. These included 67 specimens from cases having strong clinical suspicion of tuberculosis while, 31 sputum specimens from non-tuberculosis subjects served as negative controls. Over all polymerase chain reaction positivity was 62.2%, culture positivity was 52% and smear positivity was 35.7%. Polymerase chain reaction testing was the most specific, rapid and sensitive method for the diagnosis of tuberculosis while culture is specific but it takes 4 to 6 weeks to provide results and smear testing is the cheapest but least sensitive test. Early diagnosis of TB is cornerstone for proper treatment and control of this deadly disease. PCR testing is specific, rapid and sensitive method for diagnosis of TB especially in complicated cases

Role of alanine transaminase as an indicator of non alcoholic fatty liver patients with type-2 diabetes mellitus

This study was carried out to see the role of Alanine transaminase [ALT] as an indicator of Non Alcoholic Fatty liver disease [NAFLD] in patients having Type-2 Diabetes Mellitus. This was a descriptive study carried out al PMRC FJMC Lahore. A total of 63 diabetic cases that were diagnosed on ultrasonography as nonalcoholic fatty liver were recruited in this study. Demographic profile of the patients were recorded and all were subjected to lab investigation which included random blood glucose, serum triglycerides and liver function tests including viral marker of the hepatitis. Fatty liver was more prevalent in female patients 47 out of 63 [74.6%] and is more common above 40 years of age, median age being 46 years. The duration of disease was prolonged with median of 6 years. It is seen that 28/63 [44.5%] were hypertensive, 31% had hyperlipidemia and 9.5% were having ischemic heart disease. Majority of patients 28 out of 63 [44.5%] had hepatomegaly. The liver enzymes results showed that 12 of the 63 [19%] were positive for hepatitis B and C and had ALT level raised with mean of 63.00 +/- 40.66. While, among the other 51 patients without hepatitis B and C ALT level were within normal range in 36 [71%] of the cases. While in rest of 29%%15 out of 51 they were only mildly elevated. Thus showing that ALT has no role as an indicator of fatty liver. Alanine transaminase is not an indicator of NAFLD and mild elevation can be due to the metabolic disturbances in type-2 diabetic patients. It is therefore, suggested that ultrasound graph is a good tool to detect the NAFLD in its early stage

Clinico-pathological profile and treatment outcome in smear negative pulmonary tuberculosis patients at a teaching hospital

Tuberculosis remains the single highest contributor to the world's morbidity and mortality. Early diagnosis and prompt treatment is essential to prevent its transmission. To see the treatment response of anti tuberculosis drugs in smear negative patients and study the predictors of culture positive among smear negative tuberculosis patients. This descriptive study was carried out at Chest Clinic, Sir Ganga Ram hospital in collaboration with PMRC TB Research Centre Mayo hospital, Lahore. Ninety four sputum smear negative patients clinically and radiologically suggestive of tuberculosis were selected. These patients were put on anti tuberculosis drugs without waiting for their culture results. They were then followed for 8 months to see their treatment outcome. A total of 94 smear negative patients were selected and given anti tuberculosis treatment. Of these 37 [39%] were culture positive and 57 [61%] were culture negative. Of the 37 culture positive patients 36 [97%] showed clinical or radiological improvement as compared to 46 [81%] out of 57 in culture negative cases. Symptoms of cough with sputum production was significantly associated with culture positivity. On x-ray chest moderate lesion with diffuse infiltration was more common finding in 64% while extensive and cavitatory lesion was seen in 24% of all cases. Association of extensive and cavitatory lesion were seen in culture positive group. Response to anti tuberculosis drugs in sputum smear negative tubercolosis suspects was found to be effective in majority of the patients. Cough, sputum and extensive cavitatory lung lesion were the predictors of culture positive cases. There is need to train physicians on the use of anti tuberculosis therapy in smear negative suspected pulmonary tuberculosis cases, especially if they have productive cough and cavitatory lung lesions

Screening of tuberculosis in Kharal Abbasian Azad Kashmir

To detect active tuberculosis in two areas of district Bagh, which were worst hit during October 8, 2005 earthquake leaving millions of people homeless and exposed to harsh weather and infections. This cross sectional study was done at Huda Bari camp and village Bani Pasari of district Bagh, Azad Kashmir from 17-24 November 2006. All cases above the age of 12 years complaining of fever, cough and weight loss for more than six weeks were screened for tuberculosis on 2 consecutive days by sputum microscopy for acid fast bacilli. Out of 247 suspected cases screened, 12[4.8%] cases of tuberculosis were picked by positive sputum microscopy for acid fast bacilli in the sputum. Of 12 cases 5 were on anti-tuberculous treatment before earthquake but had discontinued the treatment following this disaster, and developed symptoms in due course of time. Rest 7 cases were new, and were picked during screening. The reporting and recording system for tuberculosis in Azad Kashmir was very efficient and most paramedics had already located almost all known tuberculosis patients who were displaced due to earthquake and had motivated them to continue with the treatment for tuberculosis. Of 247 suspected cases of tuberculosis 12 cases [5%] had active tuberculosis. Timely relocation and treatment of already known cases and identification of the new cases had been a major step in averting another disaster following earthquake

Multidrug resistance tuberculosis in Lahore

To estimate drug resistance in TB patients and compare it with the previous studies to see if there is a changing trend. PMRC TB research centre Mayo hospital Lahore which is a specialized centre on research and diagnosis of tuberculosis. The centre receives sputum samples from all the leading hospitals of Lahore. This work was done from 2004 to 2006 where five first lines anti tuberculosis drugs were tested on LJ.medium using standard proportion method. A total of 582 confirmed isolates of Mycobacterium tuberculosis were seen. Of the total 454 were pulmonary and 128 extra pulmonary specimens from 582 patients. These patients comprised of those with and without history of previous treatment. These sputa were subjected to drug susceptibility testing. Almost half of the patients had some resistance; multiple drug resistance [MDR] was seen in 12.8% and 27.0% cases without and with history of previous treatment respectively. Overall resistance to rifampicin was 26.6%, to isoniazid 23.5%, streptomycin 19.5%, ethambutol 11.8%, and to pyrazinamide 29.7%. Statistically significant difference was seen between primary and acquired resistances. When compared with the reports from previous studies from the same area, there was a trend of gradual increase of drug resistance in this area. Resistance to anti tuberculosis drugs is high in Lahore. The current approach may not be adequate and innovative approaches such as DOTS-Plus may have to be employed to effectively control MDR TB