Characteristics and treatment outcomes of patients with multi-drug resistant tuberculosis at a tertiary care hospital in Peshawar, Pakistan.

OBJECTIVES: To determine characteristics and treatment outcomes of multidrugs resistant tuberculosis (MDR-TB) patients and risk factors for poor outcomes in MDR-TB patients in a tertiary care hospital in Peshawar, Pakistan.  METHODS: This retrospective study was conducted at the Programmatic Management of Drug Resistant TB Unit, Lady Reading Hospital Peshawar, Pakistan and included all MDR-TB patients registered between January 2012 and December 2012. A special proforma was used for data collection. Analysis was performed using SPSS version 16, after exporting data from the proforma. Differences in proportions were assessed using Pearson's Chi square test whereas for predictors of poor outcomes, multivariate logistic regression analysis with Wald Statistical criteria using backward elimination method was performed.  RESULTS: The treatment success rate was 74.3%. In univariate analysis, poor outcomes were associated in patients with age ≥44 years (odds ratio [OR]=0.250; 95% confidence interval [CI]: 0.114-0.519, p=0.001), rural residence (OR=0.417; 95% CI: 0.18-0.937, p=0.03), lung cavitation (OR=0.22; 95% CI, 0.007-0.067, p=0.001), resistance to second line drugs (SLD) (OR=3.441; 95% CI: 1.579-7.497, p=0.001), and resistance to ofloxacin (OR=2.944; 95% CI: 1.361-6.365, p=0.005); whereas multivariate logistic regression analysis, poor outcomes were associated in patients with age ≥44 years (OR=0.249, 95% CI: 0.075-0.828, p=0.023), rural residence (OR=0.143, 95% CI: 0.052-0.774, p=0.032), and cavitatory lungs (OR=0.022, 95% CI: 0.007-0.072, p=0.000).  CONCLUSION: The MDR-TB patient needs special attention for better treatment outcomes. The presence of older age, rural area residence, resistance to ofloxacin, SLD resistance, and cavitary disease are independent prognostic factors for poor outcome in patients with MDR-TB.

Changes in fatty acid content and composition in silage maize during grain filling.

BACKGROUND: The stage of maturity at harvest has a major effect on the fatty acid (FA) content and composition of forage plants consumed by dairy cows. The present study investigated the dynamics of FA content and composition in stover (leaves and stem) and ears (cob, shank and husks) of two maize genotypes (G2 and G6) grown on sandy and clay soils and harvested at 14, 42, 56, 70 and 84 days after flowering (DAF). In addition, the FA content and composition of six maize genotypes (G1-G6) grown on the two soil types were compared at the normal harvest time of early genotypes in the Netherlands (70 DAF). RESULTS: The contents of total FAs and major individual FAs in both stover and ears changed significantly (P < 0.001) during the grain-filling period (14-84 DAF). In stover the contents of C16:0, C18:2, C18:3 and total FAs declined (P < 0.001) while those of C18:0 and C18:1 increased (P < 0.001) with progressive grain filling. The rate of decline in C18:3 and total FA contents was slower during 14-56 DAF as compared with 56-84 DAF. In ears, the contents of C16:0, C18:1, C18:2 and total FAs increased up to 56 DAF and then remained more or less constant until 84 DAF. At 70 DAF the content of polyunsaturated fatty acids (PUFAs) in both stover and ears did not differ among the six genotypes. However, the average contents of C16:0, C18:3 and total FAs in stover were higher (P < 0.05) on clay soil, whereas those of C18:0 and C18:1 were higher on sandy soil. CONCLUSION: The results demonstrate that the maximum PUFA content in silage maize is harvested around 56 DAF, in the present study at a T(sum) of 927 °C.d or at an ear dry matter content of 440 g kg(-1) , which is before the onset of rapid senescence. Any further delay in harvesting will cause a rapid decline in C18:3 content in maize silages.