Multidrug resistant tuberculosis in Punjab, Pakistan

Background: Tuberculosis [TB] can be traced back to the beginning of the mankind. It is a bacterial infectious communicable disease. Globally, TB is the second major cause of death from infectious diseases. MDR-TB is a type of tuberculosis that is resistance to at least two first line anti-tuberculosis drugs Isoniazid [INH] and Rifampicin [RMP] with or without resistance to other drugs. Multidrug resistant TB [MDR-TB] caught attention, when it emerged in the USA in 1990. Globally 425,000 new cases emerge annually, which is almost 5% of the annual global TB burden. Pakistan is included in 27 high burden MDR-TB countries, with almost 2% to 3.2% for newly diagnosed and 35% for previously treated patients. The overall aim of this study was to assess the burden and the distribution of resistance for four anti-tuberculosis medications

Method: A cross sectional study design was used. Data was collected from the hospital records of microbiology department, for the patients between the duration of January 2008 to December 2011. Forms of 300 patients were collected and analyzed. Epi-data and SPSS software were used for analysis. An outcome variable was developed and analysed. Correlation of resistance was analysed with different independent variables such as age, sex, residence [rural/urban], duration of disease, TB treatment history, smear reports and sensitivity results

Results: The results of this study showed the variation of resistance to four different drugs, but most resistance was found for rifampicin and lowest for Ethambutol. The resistance was found Isoniazid [49%], Streptomycin [52%], Rifampicin [68%], and Ethambutol [25%]. Resistance between male/female and rural/urban was not prominently different. Among the different TB types, MDR-TB patients were found to be more resistant, with the highest resistance for Rifampicin [80%] and the lowest resistance for Ethambutol [31%]. The extent of the lesion had no association with the resistance prevalence. Age was significantly associated with resistance. Previous ZN smear negative reported cases appeared to be more resistant

Conclusion: This study suggests for improvements in the early detection and treatment. Old test techniques such as ZN smear should also be replaced by more reliable and efficient laboratory techniques. There is also a need to improve the record keeping system in order to have complete information about the diseases and patients

Efficacy of aloe vera gel in the treatment of vulval lichen planus

To compare the efficacy of aloe vera gel and placebo in the topical management of vulval lichen planus. Randomized, double-blind, placebo-controlled trial. Department of Dermatology, Isra University Hospital, Hyderabad, from January 2007 to January 2008. Thirty-four female patients were randomized into two groups to receive aloe vera gel or placebo for local application for 8 weeks. Clinical data and treatment response was graded according to Thongprasom criteria. Z-test was used for comparing response between the groups. Thirty-four consecutive patients participated in the study. We found erosive and ulcerative lesions in 83% and 17%, respectively. The most common site of vulval lichen planus was the labia minora. Fourteen [82%] out of 17 patients treated with aloe vera had a good response i.e. clinically improved by at least 50% after 8 weeks of treatment, while one [5%] of 17 placebo-treated patients had a similar response [p < 0.001]. Furthermore, one patient [5%] treated with aloe vera had a complete clinical remission. No side-effects were found in both groups. Aloe vera gel was a safe and effective treatment for patients with vulval lichen planus

Hyperhomocysteinaemia and acute myocardial infarction in patients admitted at Isra Uneversity Hospital, Hyderabad

Myocardial infarction is a major consequence of coronary artery disease. Recently many reports have been suggested that hyperhomocysteinemia had an important role in myocardial infarction. Plasma homocysteine level was determined in 60 myocardial infarction patient [Group A] and 35 healthy controls [Group B]. Statistically significant difference was observed in plasma homocystine concentrations between the patients of acute myocardial infarction [Group A] and in normal healthy individuals [Group B]. The level of homocystine in patients of myocardial infraction is significantly increased when compared with controls. This indicates a strong association between hyperhomocysteinemia and acute myocardial infraction in the peoples of Hyderabad, thus showing plasma homocysteine as a risk factor for myocardial infarction