Randomized Evaluation of a Remote Management Program to Improve Guideline-Directed Medical Therapy: The DRIVE Trial.

BACKGROUND: Several SGLT2i (sodium-glucose transport protein 2 inhibitors) and GLP1-RA (glucagon-like peptide-1 receptor agonists) reduce cardiovascular events and improve kidney outcomes in patients with type 2 diabetes; however, utilization remains low despite guideline recommendations. METHODS: A randomized, remote implementation trial in the Mass General Brigham network enrolled patients with type 2 diabetes with increased cardiovascular or kidney risk. Patients eligible for, but not prescribed, SGLT2i or GLP1-RA were randomly assigned to simultaneous virtual patient education with concurrent prescription of SGLT2i or GLP1-RA (ie, Simultaneous) or 2 months of virtual education followed by medication prescription (ie, Education-First) delivered by a multidisciplinary team driven by nonlicensed navigators and clinical pharmacists who prescribed SGLT2i or GLP1-RA using a standardized treatment algorithm. The primary outcome was the proportion of patients with prescriptions for either SGLT2i or GLP1-RA by 6 months. RESULTS: Between March 2021 and December 2022, 200 patients were randomized. The mean age was 66.5 years; 36.5% were female, and 22.0% were non-White. Overall, 30.0% had cardiovascular disease, 5.0% had cerebrovascular disease, and 1.5% had both. Mean estimated glomerular filtration rate was 77.9 mL/(min‧1.73 m2), and mean urine/albumin creatinine ratio was 88.6 mg/g. After 2 months, 69 of 200 (34.5%) patients received a new prescription for either SGLT2i or GLP1-RA: 53.4% of patients in the Simultaneous arm and 8.3% of patients in the Education-First arm (P<0.001). After 6 months, 128 of 200 (64.0%) received a new prescription: 69.8% of patients in the Simultaneous arm and 56.0% of patients in Education-First (P<0.001). Patient self-report of taking SGLT2i or GLP1-RA within 6 months of trial entry was similarly greater in the Simultaneous versus Education-First arm (69 of 116 [59.5%] versus 37 of 84 [44.0%]; P<0.001) Median time to first prescription was 24 (interquartile range [IQR], 13-50) versus 85 days (IQR, 65-106), respectively (P<0.001). CONCLUSIONS: In this randomized trial, a remote, team-based program identifies patients with type 2 diabetes and high cardiovascular or kidney risk, provides virtual education, prescribes SGLT2i or GLP1-RA, and improves guideline-directed medical therapy. These findings support greater utilization of virtual team-based approaches to optimize chronic disease management. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06046560.

Chagas cardiomyopathy in Boston, Massachusetts: Identifying disease and improving management after community and hospital-based screening.

BACKGROUND: Limited data exist regarding cardiac manifestations of Chagas disease in migrants living in non-endemic regions. METHODS: A retrospective cohort analysis of 109 patients with Chagas disease seen at Boston Medical Center (BMC) between January 2016 and January 2023 was performed. Patients were identified by screening and testing migrants from endemic regions at a community health center and BMC. Demographic, laboratory, and cardiac evaluation data were collected. RESULTS: Mean age of the 109 patients was 43 years (range 19-76); 61% were female. 79% (86/109) were diagnosed with Chagas disease via screening and 21% (23/109) were tested given symptoms or electrocardiogram abnormalities. Common symptoms included palpitations (25%, 27/109) and chest pain (17%, 18/109); 52% (57/109) were asymptomatic. Right bundle branch block (19%, 19/102), T-wave changes (18%, 18/102), and left anterior fascicular block (11%, 11/102) were the most common electrocardiogram abnormalities; 51% (52/102) had normal electrocardiograms. Cardiomyopathy stage was ascertained in 94 of 109 patients: 51% (48/94) were indeterminate stage A and 49% (46/94) had cardiac structural disease (stages B1-D). Clinical findings that required clinical intervention or change in management were found in 23% (25/109), and included cardiomyopathy, apical hypokinesis/aneurysm, stroke, atrial or ventricular arrhythmias, and apical thrombus. CONCLUSIONS: These data show high rates of cardiac complications in a cohort of migrants living with Chagas disease in a non-endemic setting. We demonstrate that Chagas disease diagnosis prompts cardiac evaluation which often identifies actionable cardiac disease and provides opportunities for prevention and treatment.

Postoperative outcomes, predictors and trends of mortality and morbidity in patients undergoing hip fracture surgery with underlying aortic stenosis: a nationwide inpatient sample analysis.

BACKGROUND: Hip fractures frequently necessitate hospitalization, especially among patients aged 75 and above who might concurrently suffer from aortic stenosis (AS). This study focuses on postoperative outcomes, potential determinants of morbidity and mortality, as well as evolving trends in patients with AS undergoing surgical repair of hip fractures. METHODS: A retrospective analysis of the Nationwide Inpatient Sample from 2008 to 2019 was conducted. Hip fracture cases were identified, and a subgroup with AS was isolated using the ICD-9 and ICD-10 diagnostic codes. We compared baseline characteristics, postoperative in-hospital outcomes and trends in mortality and morbidity between patients with and without AS. RESULTS: From the dataset, 2,834,919 patients with hip fracture were identified on weighted analysis. Of these, 94,270 (3.3%) were found to have concurrent AS. The AS cohort was characterized by higher mean age and elevated burden of cardiovascular comorbidities, such as coronary artery disease, peripheral vascular disease, pulmonary hypertension, congestive heart failure and cardiac arrhythmias. Postoperative mortality following hip fracture surgery was greater in the AS groups compared to non-AS group (3.3% vs 1.57%, p < 0.001). Risk factors such as congestive heart failure (OR, 2.3[CI, 2.1-2.6]), age above 85 years (OR, 3.2[CI, 2.2-4.7]), cardiac arrhythmias (OR, 2.4[CI, 2.2-2.6]), end-stage renal disease (OR, 3.4[CI, 2.7-4.1]), malnutrition (OR, 2.3[CI, 2.1-2.7]) and AS (OR, 1.2[CI, 1.08-1.5] were associated with increased adjusted odds of postoperative mortality. AS was linked to higher adjusted odds of postoperative mortality (OR, 1.2 [CI, 1.1-1.5]) and complications such as acute myocardial infarction (OR, 1.2 [CI, 1.01-1.4]), cardiogenic shock (OR, 2.0[CI, 1.4-2.9]) and acute renal failure (OR, 1.1[CI, 1.02-1.2]). While hospital stay duration was comparable in both groups (average 5 days), the AS group incurred higher costs (mean $50,673 vs $44,607). The presence of acute heart failure in patients with AS and hip fracture significantly increased mortality, hospital stay, and cost. A notable decline in postoperative in-hospital mortality was observed in both groups from 2008-2019 though the rate of major in-hospital complications rose. CONCLUSION: AS significantly influences postoperative in-hospital mortality and complication rates in hip fracture patients. While a reduction in postoperative mortality was observed in both AS and non-AS cohorts, the incidence of major in-hospital complications increased across both groups.

Prevalence and Outcomes of Patients With Acute Ischemic Stroke and Concomitant Non-ST-Elevation Myocardial Infarction (Results from the National Inpatient Sample 2016 to 2019).

Acute myocardial infarction (MI) may concomitantly occur with acute ischemic stroke. The incidence and outcomes of acute non-ST-elevation MI (NSTEMI) in acute ischemic stroke are not well studied. We examined hospitalized patients with acute ischemic stroke and a concomitant NSTEMI diagnosis who were included in the National Inpatient Sample 2016 to 2019. Acute ischemic stroke and NSTEMI were defined by using the International Classification of Diseases, Tenth Revision codes. Patients with ST-elevation MI were excluded. The outcomes were expressed as percentages. A multivariable logistic regression analysis was used to examine the association of concomitant acute ischemic stroke and NSTEMI with the primary outcome of mortality and the secondary outcomes. A subgroup analysis of patients with NSTEMI with acute ischemic stroke that underwent percutaneous coronary intervention (PCI) (angiography and angioplasty) was also performed. Of the total hospitalized patients with acute ischemic stroke (n = 1,726,265), 1.60% (n = 27,630) patients (mean age 73.5 years, 52.2% women, 67% White race) had NSTEMI diagnosed during the hospitalization. Of these, 14.1% (n = 3,890) died in the NSTEMI group and 3.4% (n = 57,670) died in the non-NSTEMI group. The most common outcomes in the NSTEMI group were Acute kidney injury 31.8%, Intracranial hemorrhage 6.6%, and sepsis 6.13%. NSTEMI in acute ischemic stroke was associated with mortality (odds ratio [OR] 3.60, 95% confidence interval [CI] 3.29 to 3.93, p ≤0.001), ICH (OR 1.46, 95% CI 1.30 to 1.63, p <0.001), and having any of the secondary outcomes (OR 2.73, 95% CI 2.57 to 2.90, p <0.001). PCI was performed in 9.14% of patients with acute ischemic stroke with NSTEMI. PCI was associated with having any of the secondary outcomes (OR 0.83, 95% CI 0.7 to 1.02, p = 0.8), mortality (OR 0.35, 95% CI 0.23 to 0.54, p <0.001), and ICH (OR 0.42, 95% CI 0.25 to 0.7, p = 0.01). In conclusion, NSTEMI in acute ischemic stroke is associated with increased mortality and other adverse events. PCI in the subgroup of patients with NSTEMI was not associated with increased mortality or intracranial bleeding.

Multi-classification deep neural networks for identification of fish species using camera captured images.

Regular monitoring of the number of various fish species in a variety of habitats is essential for marine conservation efforts and marine biology research. To address the shortcomings of existing manual underwater video fish sampling methods, a plethora of computer-based techniques are proposed. However, there is no perfect approach for the automated identification and categorizing of fish species. This is primarily due to the difficulties inherent in capturing underwater videos, such as ambient changes in luminance, fish camouflage, dynamic environments, watercolor, poor resolution, shape variation of moving fish, and tiny differences between certain fish species. This study has proposed a novel Fish Detection Network (FD_Net) for the detection of nine different types of fish species using a camera-captured image that is based on the improved YOLOv7 algorithm by exchanging Darknet53 for MobileNetv3 and depthwise separable convolution for 3 x 3 filter size in the augmented feature extraction network bottleneck attention module (BNAM). The mean average precision (mAP) is 14.29% higher than it was in the initial version of YOLOv7. The network that is utilized in the method for the extraction of features is an improved version of DenseNet-169, and the loss function is an Arcface Loss. Widening the receptive field and improving the capability of feature extraction are achieved by incorporating dilated convolution into the dense block, removing the max-pooling layer from the trunk, and incorporating the BNAM into the dense block of the DenseNet-169 neural network. The results of several experiments comparisons and ablation experiments demonstrate that our proposed FD_Net has a higher detection mAP than YOLOv3, YOLOv3-TL, YOLOv3-BL, YOLOv4, YOLOv5, Faster-RCNN, and the most recent YOLOv7 model, and is more accurate for target fish species detection tasks in complex environments.

Antibiotic Antibiogram in Patients With Complicated Urinary Tract Infections in Nephrology Unit of South Waziristan.

Objectives To evaluate the antibiotic antibiogram in patients with complicated urinary tract infections (cUTIs) presenting to a Nephrology unit of South Waziristan. Methods A cross-sectional study was conducted at the Department of Nephrology, Sholam, South Waziristan. The study included all patients who presented with cUTIs and the symptoms included urinary urgency, hematuria, dysuria, suprapubic discomfort, and increased frequency. Those patients with clinical manifestations but are on antibiotics within the past five days were excluded. Results A total of 158 patients were included in the study with 113 (71.5%) females and 45 (28.5%) males. A total of 95 (60%) cases had gram-negative microbes, 47 (30%) had gram-positive cocci, and 16 (10%) had candida infection. In our study, the highly prevalent uropathogenic gram-positive bacteria showed the highest sensitivity to Linezolid, Rifampicin, and Vancomycin. Methicillin-resistant staph aureus was detected in 25% of isolates. All isolates of candida were sensitive to fluconazole. Gram-negative bacteria were highly resistant to ceftazidime, cefepime, ceftriaxone, and ciprofloxacin. Conclusion The development of bacterial resistance against multiple antibiotics is a global crisis that restricts the drug of choice for the treatment of cUTIs. In our study, we showed that overall, E.coli (gram negative) and S. Aureus (gram-positive) showed variable resistance to many antibiotics including ceftazidime, cefepime, piperacillin-tazobactam, ceftriaxone, and clindamycin.

Managing Customer Citizenship Behavior in Aviation Sector Through Relational Benefits: Mediating Role of Relationship Quality.

The aim of this research is to investigate the mediating role of relationship quality in the relationship between relational benefits and customer citizenship behavior. Data were gathered through a systematic sampling from 334 passengers. A Survey technique was used to collect the data from respondents from multiple airports. Data were analyzed through partial least square structural equation modeling (PLS-SEM) using SmartPLS 3.3. The results of the study reveal that altruistic benefits, confidence, and self-expression benefits have a positive relationship with relationship quality while socialization benefits have a non-significant relationship with relationship quality. Similarly, relationship quality mediates the relationship between altruistic benefits, confidence and self-expression benefits, and customer citizenship behavior while relationship quality does not mediate the relationship between socialization benefits and customer citizenship behavior. This study uncovers the relational benefits and its role in the generation of customer citizenship behavior in the aviation sector and the role of relationship quality that could help managers to cultivate the benefits of customer citizenship behaviors.

Incubating Green Synthesized Iron Oxide Nanorods for Proteomics-Derived Motif Exploration: A Fusion to Deep Learning Oncogenesis.

The nanotechnological arena has revolutionized the diagnostic efficacies by investigating the protein corona. This displays provoking proficiencies in determining biomarkers and diagnostic fingerprints for early detection and advanced therapeutics. The green synthesized iron oxide nanoparticles were prepared via Withania coagulans and were well characterized using UV-visible spectroscopy, X-ray diffraction analysis, Fourier transform infrared spectroscopy, and nano-LC mass spectrophotometry. Iron oxides were rod-shaped with an average size of 17.32 nm and have crystalline properties. The as-synthesized nanotool mediated firm nano biointeraction with the proteins in treatment with nine different cancers. The resultant of the proteome series was filtered oddly that highlighted the variant proteins within the differentially expressed proteins on behalf of nano-bioinformatics. Further magnification focused on S13_N, RS15, RAB, and 14_3_3 domains and few abundant motifs that aid scanning biomarkers. The entire set of variant proteins contracting to common proteins elucidates the underlining mechanical proteins that are marginally assessed using the robotic nanotechnology. Additionally, the iron rods indirectly possess a prognostic effect in manipulating expression of proteins through a smarter route. Thereby, such biologically designed nanotools provide a dual approach for medical studies.

Quantifying Serum Derived Differential Expressed and Low Molecular Weight Protein in Breast Cancer Patients.

BACKGROUND: Searching the biomarker from complex heterogeneous material for early detection of disease is a challenging task in the field of biomedical sciences. OBJECTIVE: The study has been arranged to explore the proteomics serum derived profiling of the differential expressed and low molecular weight protein in breast cancer patient. METHODS: Quantitative proteome was analyzed using the Nano LC/Mass and Bioinformatics tool. RESULTS: This quantification yields 239 total protein constituting 29% of differentially expressed protein, with 82% downregulated differential protein and 18% up-regulated differential protein. While 12% of total protein were found to be cancer inducing proteins. Gene Ontology (GO) described that the altered proteins with 0-60 kDa mass in nucleus, cytosol, ER, and mitochondria were abundant that chiefly controlled the RNA, DNA, ATP, Ca ion and receptor bindings. CONCLUSION: The study demonstrate that the organelle specific, low molecular weighted proteins are significantly important biomarker. That act as strong agents in the prognosis and diagnosis of breast cancer at early stage.

Adaptive Resource Utilization Prediction System for Infrastructure as a Service Cloud.

Infrastructure as a Service (IaaS) cloud provides resources as a service from a pool of compute, network, and storage resources. Cloud providers can manage their resource usage by knowing future usage demand from the current and past usage patterns of resources. Resource usage prediction is of great importance for dynamic scaling of cloud resources to achieve efficiency in terms of cost and energy consumption while keeping quality of service. The purpose of this paper is to present a real-time resource usage prediction system. The system takes real-time utilization of resources and feeds utilization values into several buffers based on the type of resources and time span size. Buffers are read by R language based statistical system. These buffers' data are checked to determine whether their data follows Gaussian distribution or not. In case of following Gaussian distribution, Autoregressive Integrated Moving Average (ARIMA) is applied; otherwise Autoregressive Neural Network (AR-NN) is applied. In ARIMA process, a model is selected based on minimum Akaike Information Criterion (AIC) values. Similarly, in AR-NN process, a network with the lowest Network Information Criterion (NIC) value is selected. We have evaluated our system with real traces of CPU utilization of an IaaS cloud of one hundred and twenty servers.

ASSOCIATION OF MATERNAL PERIODONTITIS WITH LOW BIRTH WEIGHT IN NEWBORNS IN A TERTIARY CARE HOSPITAL.

BACKGROUND: Low birth weight is a major public health problem in Pakistan. So there is a need for identification of its modifiable risk factors like periodontitis which will reduce its burden on the society. The objectives of the study were to find out the association between maternal periodontitis and low birth weight in new-borns of all gestational ages delivered in a tertiary care hospital of Abbottabad as well as to see the frequency of periodontitis severity in these subjects. METHODS: A hospital-based matched case-control study was conducted among 160 postpartum mothers in Gynaecology/Obstetrics- B ward Ayub Teaching Hospital, Abbottabad. The 80 cases were mothers of low birth weight babies (< 2,500 g), the 80 controls were mothers of normal weight babies (> 2,500 g) matched with maternal age and gestational age. Data was collected through the hospital records, interview and a periodontal examination. RESULTS: Periodontitis was more in the cases than in the controls (OR: 4.167, 95% CI: 2.142-8.109, p = 0.000). On multivariate logistic regression, periodontitis was found to be a significant independent risk factor for low birth weight (aOR: 3.173, 95% CI: 1.429-7.047, p = 0.005). Other significant risk factors were educational level (aOR: 3.408, 95% CI: 1.452-7.996, p = 0.005), socioeconomic status (aOR: 3.173, 95% CI: 1.366-7.368, p = 0.007), maternal nutrition (aOR: 3.071, 95% CI: 1.392-6.778, p = 0.005) and moderate/severe anaemia (aOR: 3.035, 95% CI: 1.052-8.756, p = 0.040). CONCLUSIONS: Periodontitis is found to be a strong, independent, and clinically significant risk factor for low birth weight. So periodontal therapy should form a part of the antenatal care of the pregnant women in Abbottabad.

Effect of size on the surgical management of pulmonary hydatid cyst.

BACKGROUND: Hydatid cyst disease is a parasitic disease caused Echinococcus granulosus. Hydatid cysts of 10 cm or greater in diameter are called "giant" cysts and traditionally have been considered to be more difficult to treat surgically often requiring pulmonary resection. In this study we reviewed our experience with pulmonary hydatid cysts. METHODS: This study was carried out in Thoracic surgery unit Lady Reading Hospital Peshawar, from 1st June 2007 to 31st May 2012. Patients admitted with intra-thoracic hydatid cysts were evaluated. Patients were divided into 2 groups, i.e., patients who had cysts < 10 cm (group A) and those who had large cysts which were 10 cm (group-B). Data regarding age, sex, symptoms, diagnostic procedures, anatomic location of cysts, surgical procedures, complications, and outcomes were collected and analysed. RESULTS: Total of 224 patients underwent hydatid cystectomy. Group A comprised 190 patients (85%), Group-B comprised 34 patients (15%). Large cysts were more common in younger patients. The most frequent complaints were cough, chest pain, and dyspnea. Patients with large cysts were more often symptomatic at presentation. In both groups, lower-lobe locations predominated. Parenchyma-saving operations were almost uniformly performed for each group; however, a higher percentage of patients in group B required anatomic resection (5.8% vs. 1%). Cystic rupture occurred more frequently in group-B than in group-A (26% vs. 12%). There were no deaths in either group, and the morbidity was 23 (12%) in (group-A) and 6 (17.6%) in (group- B). CONCLUSION: Large hydatid cysts of the lung occurred more often in younger patients and were more often symptomatic at presentation. Regardless of size, the cysts could usually be surgically treated without lung resection, and size did not appear to influence short-term post-perative outcomes.

Treatment of chronic hepatitis-C with standard interferon and ribavirin.

BACKGROUND: The prevalence of hepatitis-C is on the rise in Pakistan. Treatment of chronic hepatitis-C with pegylated interferon is expensive as compared to standard interferon. The objective of the study was to find out the end treatment response rate with standard interferon and ribavirin. METHODOLOGy: This case series study was conducted in Ayub Teaching Hospital Abbottabad.and Orush General Hospital over a period of two years. 170 patients were included in the study. These patients were HCV PCR positive either by qualitative or quantitative assay, had no other comorbidity or decompensated disease. The treatment started with standard interferon and ribavirin for six months. After the six months at the end of treatment again HCV PCR assay was done to detect hepatitis-C virus in the blood. Those who were PCR negative were responders and positive are non-responder. RESULTS: The cumulative response rate was 73.5%, both sexes responded equally. Patients below 30 years had the highest response rate and similarly patients having normal liver had better response than those having any degree of fibrosis. Baseline haemoglobin and ALT level did not have significant effect on treatment. CONCLUSION: Standard interferon is equally effective and comparable with the pegylated interferon which is costly and out of reach of many patients. It is therefore recommended, that combination of standard interferon and ribavirin may be the first line of treatment for chronic hepatitis-C treatment in Pakistan and pegylated interferon may be reserved for non-responders or relapsed cases.

Pattern of sexually transmitted diseases in patients presenting at Ayub teaching hospital, Abbottabad.

BACKGROUND: Sexually transmitted diseases are present in all societies across the globe. Different cultures and societies show a different spectrum of these diseases. The last study conducted in Hazara division was back in 1995. We have conducted this study to see the recent trends and patterns of sexually transmitted diseases in the region. METHODS: This cross-sectional study was conducted in Ayub Teaching Hospital, Abbottabad and included patients over a five year period from January 2010 till December 2014. Case sheets of 512 presenting with sexually transmitted diseases whose diagnosis was confirmed by related lab investigation were analysed retrospectively. Patients of all ages and both sexes were included. RESULTS: Out of these 512 patients only 47 were females and 465 were males. The age varied from 15-66 years. Gonorrhoea was the commonest disease with 231 cases. Genital warts were diagnosed in 60 cases. Non- gonococcal urethritis was seen in 57 patients. Genital Molluscum contagiosum was seen in 45 patients. Syphillis was diagnosed in 41 patients. Thirty-one cases of herpes genitalis, 25 cases of Chancroid, 13 cases of Lymphogranuloma venereum, were also seen. Five patients were found positive for HIV. Overwhelming majority of the patients were between the age of 19-35 years. 61% of the patients were married. The source of infection in male patients was mainly prostitutes (70%) but also included homosexual boys (21 %), married women (7.5%) and eunuchs (1.5%). The main source of infection in females was from husbands. CONCLUSION: The number of STD patients presenting in the region has increased significantly. The main factor is obviously the rise in population but also signifies the change in cultural and moral values.

Aetiology of tricuspid regurgitation.

BACKGROUND: Tricuspid regurgitation (TR) is regarded as a secondary disorder. Aim of the study was to know what percentage is secondary to heart and lung disease and its prevalence in normal adults. METHODS: Two hundred and 30 adults with clinically detectable TR were studied clinically to know the cause of TR. RESULTS: Thirteen percent of the adults were normal without any detectable cause for TR. In others, 24% of TR cases were secondary to ischemic heart disease (IHD) and hypertension was found in 14% cases. Sixteen percent had rheumatic heart disease (RHD) while chronic obstructive lung disease was found in 23% cases. The rest of 10% cases of TR had cardiomyopathy (CMP) and congenital heart disease as secondary causes. CONCLUSION: Ischemic heart disease, COPD and hypertension are common causes of TR. Others include RHD, CMP and congenital heart disease. Thirteen percent of apparently normal adults had TR.

Levosulpiride in premature ejaculation.

BACKGROUND: Premature ejaculation is one of the most common sexual disorders. A large number of treatment options have been used so far for the treatment of this dysfunction and still a large number of experts are doing research in this field. Here we have tried to research on the beneficial effects of levosulpiride in the treatment of PE. METHODS: Eighty-eight patients form different areas of Hazara division suffering from PE were chosen. Sixty-four patients were given levosulpiride and the remaining 24 patients were given placebo. RESULTS: Out of 64 patients who have been given levosulpiride, 30 patients showed very good improvement, 14 patients showed some improvement, 14 patients showed little and 6 patients showed no improvement. CONCLUSION: Levosulpiride have very good beneficial effects in the treatment of PE.

Presentation of typhoid fever patients in Hazara Division and response to different treatment regimens.

BACKGROUND: Response to treatment can vary in patients with typhoid fever. This study was carried out on a group of typhoid patients who were treated in Medical B ward of Ayub Teaching Hospital. Resistance to antibiotic is commonly acquired by Salmonella typhi and is widely reported. Objective of study was to identify such resistance in patients coming from parts of Hazara Division. METHODS: All patients who presented with typhoid fever and admitted to Medical B Unit from 1st July to 30th September 2002 were included in study. Out of 76 patients 46 (60%) were male. Epidemiological date, presenting symptoms, finding on physical examination, laboratory investigation and radiological examination were recorded. Then one of six commonly used treatment regimens were started. Response to treatment was studied. RESULTS: Common presenting symptoms and signs were recorded. Headache and fever were seen in 100% of patients. Cough and hypotension were among presenting features in 65% of patients. Leucocyte count of Less than 4 x 10(3)/dl was seen in 11% of samples. Liver functions and Renal function were found altered in 30% of patients. Study of response pattern to different regimens suggested relatively poor response to flouroquinolones. Fever of those patients who were treated with chloamphenicol and cefexime, settled early as compared to patients on other regimens. CONCLUSIONS: In addition to well known presenting features of typhoid like headache, fever, cough, hypotension and leucopenia abnormalities of renal and liver functions were commonly seen. Response to quinolone was poor suggesting emergence of resistance of salmonella typhi in this area.