Etiology, clinical, radiological, and microbiological profile of patients with non-cystic fibrosis bronchiectasis at a tertiary care hospital of Pakistan

Objectives: To identify the etiology of non-cystic fibrosis bronchiectasis (NCFB), to assess the clinical presentation, radiological findings, and microbiological profile of patients presenting with a diagnosis of bronchiectasis in a tertiary care center of Pakistan.Methods: This was a prospective observational cohort study where patients with a diagnosis of bronchiectasis proven by high-resolution computed tomography (HRCT) were evaluated for etiology, clinical characteristics, microbiology, radiology, spirometric profile, and in-hospital outcomes.Results: During the study period, 196 patients were diagnosed with NCFB. The majority of the patients were men 76.5% (n = 150) and 83.6% (n = 163) of the total patients were younger than 60 years of age. The majority of these patients (58.7%, n = 111) had a duration of symptoms between 5-10 years. The etiology of bronchiectasis was identified in 92.9% of cases. Post-infectious bronchiectasis was the most common cause (67.8%, n = 133), followed by chronic obstructive pulmonary disease (COPD) (9.2%, n = 18), and allergic bronchopulmonary aspergillosis (ABPA) (7.1%, n = 14). Among the post infectious causes, a history of TB was present in 85% (n = 114/133) of patients. Obstructive impairment was the most common spirometric pattern, observed in 68.9% (n = 135) of patients. Pseudomonas aeruginosa was the most commonly isolated organism (36.2%, n = 71). Hemoptysis was the most frequent complication found in 20.9% of patients (n = 41). Out of these 196 patients, 94.4% (n = 185) received medical management and were discharged from the hospital. Respiratory failure was significantly associated with the Pseudomonas group as compared to non-pseudomonas group [(n = 21 (29%) vs n = 18 (14.4%) p = 0.01]. During hospitalization seven patients (3.6%) were died because of respiratory failure.Conclusions: Post TB bronchiectasis was the leading cause of non-cystic fibrosis (CF) bronchiectasis in this cohort, with Pseudomonas was the commonest pathogen isolated from the respiratory specimen, which was significantly associated with respiratory failure. On spirometry, obstructive impairment was found in the majority of patients and hemoptysis was the most frequent complication

Obstructive sleep apnoea: Potential role of tumour necrosis factor alpha as a circulating biomarker

Objective: To assess the relationship of tumour necrosis factor-alpha with obstructive sleep apnoea and its severity in Pakistani population. Method: The cross-sectional study was conducted at the Sleep Laboratory of Dow University Hospital, Karachi, from December, 2018, to March, 2020, and comprised patients of either gender having symptoms of snoring, witnessed apnoea or daytime sleepiness. They were divided into four groups on the basis of obstructive sleep apnoea status. Those without obstructive sleep apnoea were in Group A, mild status in Group B, moderate in Group C and severe obstructive sleep apnoea in Group D. Polysomnography was done to confirm obstructive sleep apnoea status and to categorise the subjects using apnoea-hypopnea index, while enzyme-linked immunosorbent assay was used to assess their tumour necrosis factor alpha levels.. Data was analysed using SPSS 20. Results: Of the 150 subjects, 94(63%) were males. The overall mean age was 49.68±12.14 years. There were 50(33.33%) subjects in Group A, 19(12.66%) Group B, 23(15.33%) Group C and 58(38.66%) in Group D. Mean tumour necrosis factor-alpha level was 3.88±1.65pg/mL in Group A, 9.97±4.33pg/mL in Group B, 12.65±4.46pg/mL in Group C and 12.83±4.33pg/mL in Group D. Mean tumour necrosis factor-alpha levels had significant association with the severity of obstructive sleep apnoea (p&lt;0.001). Conclusion: Higher levels of tumour necrosis factor-alpha were found to be associated with obstructive sleep apnoea, and can be considered a potential biomarker for early diagnosis. Key Words: Sleep, Obstructive sleep apnoea, Biomarker, TNF-alpha, Inflammation, Sleep-related breathing disorder.</jats:p

Mutational Frequencies in Mycobacterial rpoB gene using GeneXpert/MTB Rif Assay in Rifampicin Resistant patients at a tertiary care setting in Urban Sindh, Pakistan: Analysis from a Five-Year Period

Objectives: To assess the mutational frequencies in Mycobacterial rpoB gene using GeneXpert/MTB Rif Assay in rifampicin resistant patients during 2013-2017 at a tertiary care setting in Urban Sindh, Pakistan.&#x0D; Methods: This Retrospective Descriptive Cross-Sectional Study was conducted at the TB laboratories, Ojha Institute of Chest Diseases, Dow University of Health Sciences. The record of 713 positive cases of Rifampicin Resistant Tuberculosis from January 2013 to December 2017 were analysed. These were diagnosed using GeneXpert® that detects mutations in the 81 base pair region of rpoB gene with the help of five molecular probes A, B, C, D and E. All invalid and extra pulmonary samples were excluded.&#x0D; Results: In total, 713 cases were found to be rifampicin resistant during the five-year period, among which 374 (52.45%) were males while 339 (47.55%) were females. Among the five standard probes A, B, C, D and E, 97.48% of the cases had a single mutation. Among these, mutations in Probe E (66.48%) were the most common, followed by Probe B (14.3%) and Probe D (11.08%). Only 13 cases (1.82%) of double mutations and five cases (0.7%) of triple mutations were detected.&#x0D; Conclusion: The rpoB gene Probe E region 529-533 appears the most potent site for a mutation and development of rifampicin resistance in the rpoB gene in Mycobacterium tuberculosis, that encodes the β-subunit of RNA polymerase. The most affected age-group in both males and females is 19-45 Years.&#x0D; doi: https://doi.org/10.12669/pjms.37.4.3875&#x0D; How to cite this:Alamgir M, Sajjad M, Baig MS, Noori MY. Mutational Frequencies in Mycobacterial rpoB gene using GeneXpert/MTB Rif Assay in Rifampicin Resistant patients at a tertiary care setting in Urban Sindh, Pakistan: Analysis from a Five-Year Period. Pak J Med Sci. 2021;37(4):1151-1154. doi: https://doi.org/10.12669/pjms.37.4.3875&#x0D; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</jats:p

Impact of Continuous Positive Airway Pressure Therapy on Body Weight in patients with Obstructive Sleep Apnea

Aim: To determine the impact of Continuous Positive Airway Pressure therapy on body weight in Obstructive Sleep Apnea patients and assess the relationship between the weight change and other associated symptoms of Obstructive Sleep Apnea. Methods: From a Tertiary care Hospital, Karachi we enrolled 184 Obstructive Sleep Apnea patients of both gender with age more than 18 years of whom 92 patients were exposed to Continuous Positive Airway Pressure while 92 patients were not exposed. In a pre-and post-treatment, information on height, weight, Body mass Index, and neck circumference were recorded. Sleep score was evaluated through Epworth Sleepiness Scale. Results: Results revealed that CPAP effects on weight and BMI. 24% of participants exposed with CPAP gained weight (p=0.03) whereas 72% of participants reduced the weights (p=0.004). The paired t-test showed the mean difference of 3.53±7.5kg (mean±SD, p-value: 0.00). The multivariate analysis showed that CPAP lessens the poor concentration (OR: -4.852; p-value: &lt;0.001), decreases daytime sleepiness (OR: -3.91; p-value: &lt;0.001) and the persons who used dietary plan with CPAP therapy were 6.3 times (p-value: &lt;0.001) more likely to change the weight. Conclusion: The weight of the patient changes with the treatment of OSA after taking a minimum of six months of CPAP therapy. The frequency of weight change in this study population was directed toward weight loss. Elimination of OSA symptoms is directly linked with weight reduction. Keywords: Obstructive sleep apnea, Continuous Positive Airway Pressure therapy, Bodyweight.</jats:p

Rising HIV seroconversion rates &amp; associated risks among employees of organization ‘X’: A case control study, Pakistan, 2017

Background and Objectives: In 2004 Pakistan escalated from ‘low-prevalence’ to ‘concentrated’ phase of HIV epidemic. Despite global decline in HIV incidence since 1997, rate of HIV infections in Pakistan is persistently rising since 1990. Available literature focusses on key populations or localized outbreaks limited by short study duration and regional applicability of results. We studied HIV seroconversion trends over a period of 8 years in a geographically diverse population and evaluated associated risk factors.&#x0D; Methods: A desk review of HIV surveillance data from 2010 to 2017 was carried out at Armed Forces Institute of Pathology. A case was defined as any adult employed in organization ‘X’, initially screened for HIV but later seroconverted on ELISA and western blot. Case-control study was conducted on cases diagnosed in 2017. Age and sex matched controls were identified from same population sub-group. Structured telephonic interviews were conducted and statistical analysis done at 5% margin of error.&#x0D; Results: The annual HIV diagnosis rate remained relatively stable till 2015 (&lt; 40 /100,000/yr) after which it rose sharply to 60/100,000/yr in 2016. Upward trend continued in 2017 to reach 125/100,000/yr (&gt;200% increase from baseline). Acquisition of HIV was significantly associated with commercial sex activities (OR=9; 95%CI: 1.25-395).&#x0D; Conclusion: HIV seroconversion rates among employees of organization X have increased significantly in the past two years. Unlike HIV outbreaks previously reported from Pakistan, sexual route seems to be the predominant mode of transmission. Focus is mandated on prevention of sexual transmission of HIV at national level as well for all vulnerable populations.&#x0D; doi: https://doi.org/10.12669/pjms.36.6.1735&#x0D; How to cite this:Mansoor E, Azam N, Niazi SK, Sheikh N, Baig MA, Azim MT, et al. Rising HIV seroconversion rates &amp; associated risks among employees of organization ‘X’: A case control study, Pakistan, 2017. Pak J Med Sci. 2020;36(6):1349-1354.   doi: https://doi.org/10.12669/pjms.36.6.1735&#x0D; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</jats:p

Relationship of neutrophil lymphocyte ratio, monocyte lymphocyte ratio and neutrophil monocyte ratio with treatment response in pulmonary tuberculosis patients during intensive phase treatment

Abstract Objective To determine the relationship of Neutrophil Lymphocyte Ratio (NLR), Monocyte Lymphocyte Ratio (MLR), and Neutrophil Monocyte Ratio (NMR) with treatment response in Pulmonary Tuberculosis (PTB) patients during intensive phase treatment (IPT). Methods This analytical cross-sectional study was conducted at Ojha Institute of Chest Diseases (OICD), Dow University of Health Sciences, from February to December 2021. 100 patients were enrolled using purposive sampling technique. Both male and female of age 18 and above, rifampicin sensitive newly diagnosed cases of PTB by Acid Fast Bacilli (AFB) microscopy and Gene Xpert MTB/RIF were included. SPSS version 26 was used to analyze data. Numerical data was expressed in median and interquartile range and categorical data was expressed in frequencies and percentages. Results Out of total 100 patients, 81% (n = 81) showed treatment response with negative AFB Sputum Smear Microscopy (SSM) after 2nd month. Out of 81% (n = 81) of the patients who achieved treatment response, 83.9% (n = 68) also had decreased NLR, 85.2% (n = 69) had decreased MLR and 83.9% (n = 68) had decreased NMR from baseline. However 19% (n = 19) did not achieved treatment response with positive AFB SSM after 2nd month of ATT (Anti tuberculosis treatment), among them 10.52% (n = 2) were INH resistant with no decrease in all the ratios after 2nd month. Conclusion Leukocyte ratios decreased significantly from baseline as PTB was treated in patients who achieved treatment response with negative AFB SSM after two months of ATT and hence these ratios could be used as markers to monitor the treatment response