Molecular detection of mutations in isolates of multidrug resistant tuberculosis and tuberculosis suspects by multiplex allele specific PCR

For lowering prevalence of drug resistance it is necessary to diagnose TB in tuberculosis sputum suspect patients instead of TB-cultured samples which required a long time of culturing. Comparison of the results of drug resistant bacterial genes in both tuberculosis suspect sputum and multi-drug resistant DNA isolates detected by MASPCR. In the current study, the genetic mutations linked with INH, RIF as well as EMB drugs were detected by MASPCR simultaneously in MDR as well as TB suspect sputum isolates. 175/291 samples belonged to MDR and 116/291 samples belonged to tuberculosis suspect group. In all the isolates, presence of Mycobacterium tuberculosis-species [100%] was confirmed by targeting hupB gene. In MDR group, maximum prevalence of gene mutation was detected in rpoB531 [92.57%] and embB306 [97.71%] while in TB-suspect group, equal percentage [96.55%] of mutation was detected in rpoB531 and embB306 by MAS-PCR. Collectively, rpoB531 [n=274, 94.15%] and embB306 [n=283, 97.25%] mutation were observed in maximum tuberculosis cases. MAS-PCR technique yielded reliable results and showed massive Isoniazid, Rifampicin and Ethambutol drugs resistance in TB-isolates from Pakistan; hence it can be used in clinical laboratories with high burden of tuberculosis to detect drug resistance rapidly and cost effectively

Diagnostic evaluation of pancytopenia

Objective: the aim of this study is to evaluate pancytopenia and to know frequency of diseases presenting as pancytopenia

Methods: this is a retrospective study. Seventy six patients irrespective of age and sex were included in this study from August 2008 to June 2011. Patients on chemotherapy and radiotherapy were excluded from study. Blood counts on hematology analyzer, peripheral smear examination, bone marrow aspiration and trephine biopsies of all patients were performed according to standard protocols

Results: diseases leading to pancytopenia in this study in descending order of frequency were aplastic anemia 29[38%], hypersplenism 20[26.3%]. megaloblastic anemia 15[19.7%],myelodysplastic syndrome[MDS] 10[13 .15% ], acute leukemia 1 [1.3%] and granuloma formation in bone marrow 1 [1.3%]

Conclusions: aplastic anemia, hypersplenism and megaloblastic anemia were common causes of pancytopenia in this study

Relapsing fever, a rare disease in Saudi Arabia

Background: relapsing fever is an acute febrile illness caused by blood spirochetes belonging to genus borrelia. This spirochete can be acquired through the bite of an infected soft tick [Ornithodoros species] or contact with an infected louse [Pediculus humanus] and thus constituting two types of relapsing fever [RF] depending upon the responsible vector i.e. Tick borne relapsing fever [TBRF] and Louse-borne relapsing fever [LBRF]. It is characterized by recurrent cycles of pyrexia which are separated by intervals of apparent recovery. During pyrexia, organisms are found in blood. While during afebrile period, organisms hide themselves in spleen, liver and even central nervous system

Methods: one hundred and thirteen patients presenting with high grade fever were studied for disease pattern. They underwent routine and special investigations for meningitis, malaria, dengue, enteric fever, HBV, HCV and HIV on quality control maintained analyzers by standard methods

Results: all the 113 patients after diagnosis were classified as enteric fever [41], malaria [37], meningitis [20], dengue fever [14] and a patient of relapsing fever i.e. Borrelia recurrentis. This patient was brought in unconscious state, looked jaundiced, dehydrated, had hepatosplenomegaly. His CBC showed WBC 10. 7X1 0A9/L, Hb 10.5g/dl, Platelet count 35x10"9/1. Giemsa stained blood film showed multiple number of spiral shaped organisms- borrelia recurrentis. He had signs of splenic rupture; he underwent splenectomy. Histopathology of spleen for spirochetes confirmed spiral shaped organisms [borrelia recurrentis]

Conclusions: there is very little information about borrelia infection in Saudi Arabia. The prevalence or incidence in Saudi Arabia is unknown. Its apparent rarity may be due to under diagnosis and under reporting. A high index of suspicion in appropriate clinical situations will lead to its early recognition and treatment

Cardiomyopathy-tachycardia induced?: review

Tachycardia-induced cardiomyopathy. if diagnosed and treated, in time is a reversible cause of heart failure. The clinical manifestations, neurohumoral mechanisms, and treatment of this condition are like any other type of heart failure. Uniquely, treatment of the tachycardia responsible for the condition, often results in clinical improvement and gross resolution of the heart failure. It is not known weather it scars the myocardium. which could increase the vulnerability to future development of heart failure but it is well known that once myocardium has dilated and thinned out, complete reversal to normality is not possible. The importance of restoring and maintaining sinus rhythm, or at least controlling the ventricular rate in these patients cannot be overemphasized. In patients with pacemakers, using demand mode pacing and sequential dualchamber pacing is important. Various standard therapeutic options can help contain the damage and probably reverse it. Treatment modalities of recent past like radiofrequency catheter ablation and pacing, ICDs and ventricular resynchronization have to be brought to the benefit of common people in terms of cost and availability. Further research in the field of causes and control of arrhythmias, apoptosis, fibrosis, remodeling, cardiomyocytes genesis and implants, may discover more pivotal and focused therapeutic targets for intervention. Until then, heightened awareness of this condition, possible prevention, timely and judicious use of available resources are only hope for its management

Health hazards of hospital waste to sanitary workers at combined military hospital, Rawalpindi

This study was aimed at identifying the health hazards posed by hospital wastes to the sanitary workers of Combined Military Hospital, Rawalpindi and to make recommendations for the improvement of their health status. A total number of 93 workers are employed in sanitary and housekeeping activities. Among them are 66 male and 10 female sanitary workers and 17 Ayas [female housekeepers]. A cross sectional study of all the above-mentioned workers was conducted using a structured open and closed ended questionnaire. Data was compiled and analyzed using SPSS ver 10.0 software. This study revealed that 46% of workers were illiterate and 49% had attended primary school. Mean age was 31.8 +/- 8.4 years. None of the sanitary workers received any training in handling of hospital wastes. They were not routinely inspected for identification of their health problems. They were not provided with protective equipment and were never vaccinated against hepatitis B. Although some form of segregation of hazardous and non-hazardous wastes was practiced in CMH, Rawalpindi, majority [56%] of them collected and carried the two kinds of wastes in the same vehicle. 48% of them reported of sustaining one or more injuries at work. Frequently reported injuries were: cuts [47%], pricks [34%], falls [15%] and burns [4%]. 26% of them reported of contracting skin diseases from wastes, while 12% caught ENT disorders, 9% gastrointestinal disorders, 6% respiratory diseases and 8% hepatitis. It is concluded from this study that sanitary workers of CMH, Rwp are unaware of the risks and hazards associated with handling of hospital wastes. They are exposed to biological, physical and toxic substances routinely. But they lacked the required knowledge, skills and protections to safeguard their health. There is a need to improve the training and education of all hospital housekeeping staff in the principles of management of hospital waste