Implementation of directly observed treatment short course at a trust hospital in Karachi

In Pakistan directly observed treatment short course has its own limitation, as we discovered daily attendance was not acceptable to the patients as it entailed loss of working hours and extra expense of daily travel and reluctance of young unmarried girls to attend daily because of social stigma and hence weekly attendance and free drugs were introduced with a responsible member of the family, i.e. mother in case of young unmarried girls and wives to see that the husband take his daily drugs this had better compliance and we have been able to achieve cure rate. In view of the heavy burden of tuberculosis in Pakistan directly observed treatment short course strategy was adopted throughout Pakistan. To audit the results of directly observed treatment short course implemented in a clinic where some modification were made because of compelling circumstances. Chiniot General hospital, Karachi is a trust hospital where all types of patients are treated and admitted at a subsidized cost. Tuberculosis clinic in collaboration with directly observed treatment short course was established with an understanding that patients would be seen free. All patients attending the tuberculosis clinic during the last three years ending 31[st] December 2004 and diagnosed as tuberculosis pulmonary/extra pulmonary were registered and provided free drugs for 8 months. Diagnosis of tuberculosis was made mainly by direct smear microscopy for acid fast bacilli, chest X-ray and mantoux test. Extra pulmonary diagnosis was made by fine needle aspiration, biopsies and cultures were done when required. A total of 692 patients with all form of tuberculosis who attended the free clinic were analyzed. There were 237 males and 455 females [M:F ratio 1:2]. Disease was pulmonary in 487[79%] cases and extra pulmonary in 205[29.6%] cases. Majority of extra pulmonary cases had pleural effusion, adenitis, followed by abdominal and bones tuberculosis. Weekly free drugs were provided for the full course of 8 months. Seventy-five percent [519] cases completed the full course of anti-tuberculosis drugs and were discharged as being cured. Joint pains were the chief complaints expressed by the patients during therapy while drug toxicity was uncommon. Thirteen cases developed drug induced hepatitis, 4 had multiple drug resistance and referred to Ojha Institute Karachi for further therapy. Three patients died during treatment. Tuberculosis is a treatable disease and 75% cases achieved cure but there was a high default rate. Reasons for this default need to be explored and addressed

Modulation of mRNA levels of liver arginase by insulin and vanadate in experimental diabetes.

This work was carried out to study the modulation of arginase expression in experimental diabetes. Here, we have demonstrated that liver arginase activity and mRNA levels increased significantly in diabetic condition. Insulin treatment reverses the increased activity and mRNA levels nearly to the control values. The reversal effects of vanadate are found to be similar to that of insulin and this observation further reiterates the insulin-like effects of vanadate. ELISA and slot blot assay observations are consistent with biochemical measurements of enzyme activity. These results show an increase in arginase activity and mRNA levels in diabetes and decrease in treated animals may be due to the transcriptional regulation of arginase gene.

Are non-specific reactions to tuberculin common?

There thousand four hundred eighty-five BCG scar negative school children were given tuberculin test. Results showed very little non-specific reactions, suggesting BCG should produce high levels of protection in our population

Byssinosis in ginning factories of rural Sindh

Frequency of byssinosis in 276 workers from 5 ginning factories of rural Sindh are described. Twenty-four [9%] had byssinosis, 178 were asymptomatic and the remaining 74 had other respiratory symptoms. Chronic obstructive pulmonary disease was present both in symptomatic and asymptomatic workers and was equally distributed amongst smokers and non-smokers. A possible involvement of some factors other than cigarette smoking is discussed

Diagnosis of pleural effusions

Sixty patients of pleural effusion with different aetiology are described. Various microbiological and biochemical parameters were done simultaneously in blood and pleural fluid to differentiate tuberculosis and non-tuberculosis effusions. Some biochemical tests were thought to be helpful in differential diagnosis but no single parameter was found diagnostic. Routine investigations of pleural fluid, sputum and pleural biopsy still remain the best method of diagnosis

Protein electrophoresis in tuberculosis

Serum electrophoresis was done in 31 patients with pulmonary tuberculosis and 62 age and sex matched controls. Protein values amongst controls were higher than those described by others. In tuberculosis there was significant decrease in total proteins, and albumin with corresponding increase in globulin, mainly due to an increase in gamma globulin fraction. There was no significant increase in alpha-2 levels. Decrease in albumin/alpha-2 ratio was significant in sputum positive cases, but it was due to reduction in albumin rather than increase in alpha-2 globulin. Decrease in albumin/alpha-2 ratio in this study was not diagnostic of tubercular activity

Criteria for diagnosis in pulmonary tuberculosis

In a retrospective study, case records of 1061 patients treated with antituberculosis drugs were examined to assess the criteria for diagnosis in each case. Seventy six percent had sputum examined for A.F.B. and 45% had mantoux test done. Five hundred and eighty one [55%] were diagnosed on radiology alone, while 262 [25%] had positive sputum for A.F.B. Only 50 [5%] of cases had positive Mantoux in addition to positive sputum and radiological changes. Practical significance of this practice is discussed

Hepatotoxicity to different antituberculosis drug combinations

Hepatotoxicity to different combinations of anti-tuberculosis drugs containing, Rifampicin [R], Streptomycin [S], Isoniazid [H], Pyrazinamide [Z] and Myambutol [E] is described in 47 patients who completed 6 to 9 months therapy. Seven cases [15%] showed signs of toxicity and in 4 patients [8.5%] the drugs had to be withdrawn. Two patients developed hepatitis, one with jaundice and the other with fever and deranged liver functions, while others 2 developed severe hypersensitivity reactions. Burning palms, difficulty in micturition, itching and giddiness were complained of by one patient each, which settled in due course without recourse to withdrawal of drugs

Serum protein electrophoresis in healthy subjects

Serum protein electrophoresis in 263 normal subjects [140 males, 123 females] of different age groups is reported. Mean values in males were higher for total proteins, albumin and beta globulin, while in females alpha-1 and alpha-2 globulins were significantly high. Differences in total globulin and gama globulin fraction were not significant

Pattern of non-tuberculosis admission at a thoracic unit

Tow hundred and twenty one patients of chest disease other than Tuberculosis were admitted at thoracic unit, Jinnah Postgraduate Medical Centre during the year 1982 [January - December] are analysed. Average ages for males and females were 49 and 42 years respectively. There was a male predominance in 40 - 60 years age group. Females were fairly equally represented in all age groups. Male to Female ratio was 2:1. Bronchial Asthma, Pneumonia, cor-pulmonale and carcinoma of Bronchus formed 68% of the total admissions. Forty four percent of all bronchial asthma were admitted in Status asthmaticus. Twelve patients [5.4%] left or died before a diagnosis could be established, while twenty four [10%] died and 11 [5%] left against medical advice

Pattern of admissions in a thoracic unit

Four hundred and fifty four patients were admitted at the Chest Unit of Jinnah Postgraduate Medical Centre during the year 1982. Two hundred and thirty two had tuberculosis while 222 other respiratory disorders. Majority of patients with tuberculosis presented in 10-40 years age group, and over 80% had pareanchymal disease. Thirty Eight percent were old cases, who had some form of chemotherapy before admission usually by general practitioners. Diagnosis was mainly clinico-radiological and only 3 patients had bacteriologically confirmed disease. Average stay in the hospital was 27.8 days for both sexes. Twenty two patients [9.4%] died mainly with advanced pulmonary disease or its complications and other associated diseases