Primary drug resistance to antituberculous drugs in NWFP Pakistan

Objective: To assess the prevalence of Primary drug resistance to Antituberculous drugs in NWFP Method: A cross-sectional prevalence study was undertaken to evaluate the prevalence of drug resistance among new TB patients, using a non-probability convenience sampling methodology. Sample size was calculated according to the population and WHO\u27s estimated incidence of smear positive tuberculosis in the province/country. Sputum samples were obtained from 122 newly diagnosed patients of pulmonary tuberculosis from centres in Peshawar and Abbotabad in NWFP. Results: Sensitivities were performed by proportion method which showed the following resistance values in 118 eligible patients: 15 (12.7 %) samples showed primary resistance to one or more drugs. 8 (6.4%) isolates were resistant to a single drug, 2 (1.6%) were resistant to 2 drugs, 4 (3.2%) to 3 drugs, 1 (0.8%) to 4 drugs while none to all 5 first line agents. Resistance to Streptomycin (10µg/ml) was seen in 7 (5.9%), Isoniazid (1µg/ml) in 10 (8.4%), Rifampicin (5µg/ml) in 3 (2.5%), Ethambutol (10µg/ml) in 2 (1.6%) and Pyrazinamide in 6 (5,0%) samples. Primary Multidrug resistance was 2.5%.Conclusion: This study suggests that prevalence of MDR amongst untreated patients in NWFP is 2.5%, which is a cause of concern and should be addressed through effective TB control programmes with DOTS strategy (JPMA 58:437;2008)

Role of Counselling to Facilitate Compliance to the Dots for the Treatment of Tuberculosis

Objectives: The objective of the research was to determine and compare the effectiveness of structured counseling to improve adherence and continuation of directly observed treatment (DOTS). As multi drug&nbsp; resistance (MDR) is common due to default among TB patients, to overcome that counseling can play an important role. Methods: It was a comparative study. Research was conducted at the Pulmonology Unit of PGMI Govt. Lady Reading Hospital Peshawar on both in and out patients from January 2007 to May 2007. The sample comprised of sixty patients (N=60) diagnosed with pulmonary tuberculosis. The random sampling technique was used for the assignment of the patients to the experimental group (n= 30) and a control group (n=30). Data was analyzed with SPSS version 12. Results: The results indicated that the majority of the experimental group patients adhered to the therapy 25 (83.3%) till the last follow –up counseling session dropout rate was 5 (16.6%) while among control&nbsp; group 9 (30 %) continued the treatment and kept on coming up for follow up sessions their dropout rate was 21 (70%). Conclusion: Counseling of&nbsp; patients is important to optimize therapy, aid compliance and to inform patients’ of any potential complications of therapy.</p

Rationale use of unenhanced multi-detector CT (CT KUB) in evaluation of suspected renal colic

Objective: To assess the yield of non-contrast enhanced CT (CT KUB) across different ordering specialties and need of developing an algorithm for its rationale use. Materials and Methods: We retrospectively reviewed 1550 consecutive CT KUB studies requested for suspected renal colic carried out at a single institution in a calendar year. The data was analyzed for demographic characteristics, referring clinician and final diagnosis. Only patients with CT as primary imaging for clinically suspected reno-ureteral colic were included. Departments ordering these CT KUB examinations were divided into three divisions: Urologist, emergency room (ER) physician and others. Results: Of 1550 CT KUB performed in the study period 766 met the inclusion criteria. Urologists (57%), followed by ER physicians (30%) mostly ordered the examination. The overall positive yield for urolithiasis was 64% (n = 490), rate of incidental/alternate findings was 15% (n = 116) and 21% (n = 160) were negative. Urologist has the highest positive yield of 67.4% (n = 295) followed by ER physician 67% (n = 152) and others 42.5% (n = 43); p \u3c 0.001. Rate of incidental/alternate findings was highest in CT ordered by other specialties 23.7% (n = 24) followed by ER physician 17.6% (n = 40) and urologist 11.8% (n = 52); p = 0.005. Conclusion: There is statistically significant difference of yield across specialties. CT KUB as an initial imaging modality for suspected urolithiasis should be ordered in consultation with the urologist and ER physicians. Tool of good history taking and physical examination has proved to be essential steps in algorithm of ordering CT KUB, which can avoid unnecessary radiation exposure

The effectiveness of non-Invasive ventilation in Covid-19 patients

Background: Endotracheal intubation is avoided more often with noninvasive ventilation (NIV) in COVID-19 patients with hypoxemia. An endotracheal or tracheostomy tube is not required to use the NIV to deliver mechanical ventilation. When inflating the lungs for oxygenation, positive pressure is provided directly to the airway while negative pressure is applied externally to the abdomen and thorax to draw air into the lungs. Methods: The study was using a quasi-experimental (single-group pre- and post-test design) and sequential sampling approach. Patients hospitalised to the corona complex at LRH-MTI in Peshawar and who tested positive for COVID 19 PCR were selected for the study. Results: There were 34.8 percent of people in the study between the ages of 30 and 45, 38.5 percent between the ages of 46 and 60, and 26.2 percent between the ages of 61 and 75. Co-infections with a positive COVID-19 PCR were found in 47.8% (66) of patients. Overall, 53.6% of patients showed significant improvement after receiving NIV and were subsequently released. For 46.4% of these patients, the NIV did not work, leading to intubation or death. Co-existing diseases were present in the majority of individuals whose NIV attempts were unsuccessful.&nbsp

Effects of Multidrug Resistant Tuberculosis Treatment on Patients' Health Related Quality of Life: Results from a Follow Up Study.

At present, within the management of multidrug resistant tuberculosis (MDR-TB) much attention is being paid to the traditional microbiological and clinical indicators. Evaluation of the impact of MDR-TB treatment on patients' Health Related Quality of Life (HRQoL) has remained a neglected area.To evaluate the impact of MDR-TB treatment on patients HRQoL, and determine the predictors of variability in HRQoL along the course of treatment.A prospective follow up study was conducted at the programmatic management unit for drug resistant TB of Lady Reading Hospital Peshawar. Culture confirmed eligible MDR-TB patients were asked to self complete SF-36v2 at the baseline visit, and subsequently after the completion of 12 months of treatment and at the end of treatment. A score of <47 norm-based scoring (NBS) points on component summary measures and health domain scales was considered indicative of function impairment. General linear model repeated measures ANOVA was used examine the change and predictors of change in physical component summary (PCS) and mental component summary (MCS) scores over the time.A total of 68 out of enrolled 81 eligible MDR-TB patients completed SF-36v2 questionnaire at the three time points. Patients' mean PCS scores at the three time points were, 38.2±4.7, 38.6±4.4 and 42.2±5.2 respectively, and mean MCS were 33.7±7.0, 35.5±6.9 and 40.0±6.9 respectively. Length of sickness prior to the diagnosis of MDR-TB was predictive of difference in PCS scores (F = 4.988, Df = 1, 66), whereas patients' gender (F = 5.638, Df = 1, 66) and length of sickness prior to the diagnosis of MDR-TB (F = 4.400, Df = 1, 66) were predictive of difference in MCS scores.Despite the positive impact of MDR-TB treatment on patients' HRQoL, the scores on component summary measures suggested compromised physical and mental health even at the end of treatment. A large multicenter study is suggested to confirm the present findings

Nanotubes Formation in P. aeruginosa

The present study discusses a biofilm-positive P. aeruginosa isolate that survives at pH levels ranging from 4.0 to 9.0. The biofilm consortia were colonized with different phenotypes i.e., planktonic, slow-growing and metabolically inactive small colony variants (SCVs). The lower base of the consortia was occupied by SCVs. These cells were strongly attached to solid surfaces and interconnected through a network of nanotubes. Nanotubes were observed at the stationary phase of biofilm indwellers and were more prominent after applying weight to the consortia. The scanning electron micrographs indicated that the nanotubes are polar appendages with intraspecies connectivity. The micrographs indicated variations in physical dimensions (length, width, and height) and a considerable reduction in volume due to weight pressure. A total of 35 cells were randomly selected. The mean volume of cells before the application of weight was 0.288 &micro;m3, which was reduced to 0.144 &micro;m3 after the application of weight. It was observed that a single cell may produce as many as six nanotubes, connected simultaneously to six neighbouring cells in different directions. The in-depth analysis confirmed that these structures were the intra-species connecting tools as no free nanotubes were found. Furthermore, after the application of weight, cells incapable of producing nanotubes were wiped out and the surface was covered by nanotube producers. This suggests that the nanotubes give a selective advantage to the cells to resist harsh environmental conditions and weight pressure. After the removal of weight and proper supply of nutrients, these phenotypes reverted to normal planktonic lifestyles. It is concluded that the nanotubes are not merely the phenomenon of dying cells; rather they are a connectivity tool which helps connected cells to tolerate and resist environmental stress

Length of sickness for ≥1 year prior to the diagnosis of MDR-TB: difference in the estimated marginal means of MCS scores.

<p>Length of sickness for ≥1 year prior to the diagnosis of MDR-TB: difference in the estimated marginal means of MCS scores.</p

Predictors of two months culture conversion in multidrug-resistant tuberculosis: findings from a retrospective cohort study.

BACKGROUND: Various studies have reported culture conversion at two months as a predictor of successful treatment outcome in multidrug-resistant tuberculosis (MDR-TB). OBJECTIVES: The present study was conducted with the aim to evaluate the rate and predictors of culture conversion at two months in MDR-TB patients. METHODS: All confirmed pulmonary MDR-TB patients enrolled for treatment at Lady Reading Hospital Peshawar, Pakistan from 1 January to 31 December 2012 and met the inclusion criteria were reviewed retrospectively. Rate and predictors of culture conversion at two months were evaluated. RESULTS: Eighty seven (53.4%) out of 163 patients achieved culture conversion at two months. In a multivariate analysis lung cavitation at baseline chest X-ray (P = 0.006, OR = 0.349), resistance to ofloxacin (P = 0.041, OR = 0.193) and streptomycin (P = 0.017, OR = 0.295) had statistically significant (P<0.05) negative association with culture conversion at two months. CONCLUSION: A reasonable proportion of patients achieved culture conversion at two months. Factors negatively associated with culture conversion at two months can be easily identified either before diagnosis or early in the course of MDR-TB treatment. This may help in better care of individual patients by identifying them early and treating them vigorously

Flow diagram of patients screened, included and evaluated for impact of MDR-TB treatment on patients’ HRQoL.

<p>Flow diagram of patients screened, included and evaluated for impact of MDR-TB treatment on patients’ HRQoL.</p