Prevalence of human immunodeficiency virus infection among the diagnosed tuberculosis patients in Karachi, Pakistan

Background: People living with HIV are from 26-31 times more likely to develop TB than persons without HIV. TB is the most common presenting illness among people living with HIV, including among those taking antiretroviral treatment and it is the major cause of HIV-related death. HIV/AIDS has driven TB epidemics in a number of countries including Pakistan where Tuberculosis is endemic and is a major public health challenge. People living with HIV/AIDS continue to be a group at high risk for tuberculosis (TB). National surveillance is important to indicate the magnitude and burden of both diseases. To control the problem, the WHO recommends the establishment of coordinated strategy for both diseases. In this study we aimed to determine the prevalence of HIV/AIDS among diagnosed Tuberculosis (TB) patients in Karachi, Pakistan.Methods: A cross sectional study was conducted, in the year 2015 among the diagnosed TB patients to detect TB/HIV co-infection in the two selected sentinel sites of Karachi, Pakistan. Trained investigators used a standardized multiple-choice and open-ended questionnaire to collect the data regarding demographic profile and collected samples for HIV tests of identified cases. Written informed consent was obtained and questionnaire was completed by respondents selected through simple random sampling. 1257 TB patients underwent the rapid assay for HIV serological testing and subsequent ELISA test was done for confirmation of the HIV. The data were analyzed using IBM SPSS Statistics version 20.0 and Microsoft excel.Results: Among the 1257 patients tested 680 (54%) were men and 577 (46%) women and largest number of patients 56% belonged to the age group 19-40 years. In our study prevalence of HIV among identified Tuberculosis patients was 1.4%.Conclusions: The prevalence of HIV/AIDS among Tuberculosis patients is 1.4%. Future research needs to be directed toward this sensitive issue and social support programs with treatment services should be ensured for HIV positive TB patients to reduce the disparities in provision of health services for this vulnerable stratum of our society.

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Prevalence of human immunodeficiency virus infection among the diagnosed tuberculosis patients in Karachi, Pakistan

Background: People living with HIV are from 26-31 times more likely to develop TB than persons without HIV. TB is the most common presenting illness among people living with HIV, including among those taking antiretroviral treatment and it is the major cause of HIV-related death. HIV/AIDS has driven TB epidemics in a number of countries including Pakistan where Tuberculosis is endemic and is a major public health challenge. People living with HIV/AIDS continue to be a group at high risk for tuberculosis (TB). National surveillance is important to indicate the magnitude and burden of both diseases. To control the problem, the WHO recommends the establishment of coordinated strategy for both diseases. In this study we aimed to determine the prevalence of HIV/AIDS among diagnosed Tuberculosis (TB) patients in Karachi, Pakistan.Methods: A cross sectional study was conducted, in the year 2015 among the diagnosed TB patients to detect TB/HIV co-infection in the two selected sentinel sites of Karachi, Pakistan. Trained investigators used a standardized multiple-choice and open-ended questionnaire to collect the data regarding demographic profile and collected samples for HIV tests of identified cases. Written informed consent was obtained and questionnaire was completed by respondents selected through simple random sampling. 1257 TB patients underwent the rapid assay for HIV serological testing and subsequent ELISA test was done for confirmation of the HIV. The data were analyzed using IBM SPSS Statistics version 20.0 and Microsoft excel.Results: Among the 1257 patients tested 680 (54%) were men and 577 (46%) women and largest number of patients 56% belonged to the age group 19-40 years. In our study prevalence of HIV among identified Tuberculosis patients was 1.4%.Conclusions: The prevalence of HIV/AIDS among Tuberculosis patients is 1.4%. Future research needs to be directed toward this sensitive issue and social support programs with treatment services should be ensured for HIV positive TB patients to reduce the disparities in provision of health services for this vulnerable stratum of our society.

Prevalence of multi-drug resistant tuberculosis in Karachi, Pakistan: identification of at risk groups

Multidrug-resistant tuberculosis (MDR-TB) is a possible threat to global tuberculosis control. Despite a disease prevalence of 263/100 000 population Pakistan lacks information on prevalence of drug resistant TB. Our objective was to estimate prevalence of MDR and associated risk factors in Patients with pulmonary tuberculosis in Karachi. Six hundred and forty consenting adult Patients were enrolled from field clinics from July 2006 to August 2008 through passive case finding. Prevalence of MDR-TB with 95% confidence interval (CI) was calculated with Epi-Info. Logistic Regression analyses were performed for risk factors associated with MDR. Overall MDR rate was 5.0%, 95% Cl: 3.3-6.6% (untreated 2.3%, treated 17.9%). Mean age was 32.5 (+/- 15.6) years and there were 292 (45.6%) females and 348 (54.4%) males. Factors independently associated with MDR were: female gender (OR 3.12, 95% CI: 1.40-6.91), and prior history of incomplete treatment (OR 10.1, 95% CI: 4.71-21.64). Ethnic groups at higher risk for MDR included Sindhis (OR 4.5, 95% CI: 1.42-14.71) and Pashtoons (OR 3.6, 95% CI: 1.12-11.62). This study reports an overall MDR rate of 5.0% in our study population. It further highlights the need for MDR prevention through re-focusing Directly Observed Treatment, Short-course DOTS delivery with emphasis on women and certain high risk sub groups. (C) 2010 Royal Society of Tropical Medicine and Hygiene

Fluoroquinolone Resistance among Mycobacterium tuberculosis Strains from Karachi, Pakistan: Data from Community-Based Field Clinics ▿

A fluoroquinolone (FQ) resistance rate of 5.9% is reported in 205 Mycobacterium tuberculosis isolates from patients presenting to field clinics in Karachi, Pakistan (2006 to 2009). FQ resistance among multidrug-resistant (MDR) strains was 11.1% (5/45), and it was 4.9% (5/103) in M. tuberculosis strains susceptible to all first-line agents. Spoligotyping of resistant strains did not show dominance of one strain type. Our data reflect considerable FQ-resistant M. tuberculosis isolates and the need to consider inclusion of FQ within first-line sensitivity testing in such settings

Characterizing Mycobacterium tuberculosis isolates from Karachi, Pakistan: drug resistance and genotypes

Objectives: To study the prevalence, risk factors, and genotypes of drug-resistant Mycobacterium tuberculosis in Karachi. Methods: Pulmonary tuberculosis (TB) Patients were recruited in a cross-sectional study (2006-2009). Drug susceptibility testing was performed for culture-positive cases (n = 1004). Factors associated with drug resistance were evaluated using logistic regression analysis. Strains were typed using spoligotyping and mycobacterial interspersed repetitive units-variable number tandem repeat (MIRU-VNTR). The associations of genotype and drug resistance were explored using the Chi-square test. Results: Resistance rates - new and previously treated - were as follows: multidrug-resistant (MDR)-TB, 2.4% and 13.9%, respectively, rifampin (RIF) monoresistance, 0.1% and 0.6%, respectively, any isoniazid (INH) resistance, 8.9% and 28.5%, respectively, and INH monoresistance, 3.0% and 6.3%, respectively. Prior TB treatment was a risk factor for MDR-TB (adjusted odds ratio (AOR) 6.8, 95% confidence interval (CI) 3.5-13.1) and INH monoresistance (AOR 2.4, 95% CI 1.1-5.2). Additional risk factors included low socioeconomic status for INH monoresistance (AOR 3.3, 95% CI 1.7-6.5), and belonging to Balouchi (AOR 9.2, 95% CI 2.5-33.4), Sindhi (AOR 4.1, 95% CI 1.2-13.5), or Pakhtun (AOR 3.4, 95% CI 1.0-11.2) ethnicity for MDR-TB. Although Central Asian strain (55.6%) was the most prevalent genotype, MDR-TB was significantly associated with Haarlem (H) genogroup (crude OR 9.2, 95% CI 3.6-23.8). Conclusion: An MDR-TB rate of 2.4% is reported in new Patients. Low RIF monoresistance supports the use of RIF as a marker for MDR-TB in this population. The need to strengthen TB care in the identified at-risk groups is emphasized. Based on INH resistance rates, a review of national treatment/prevention regimens relying on INH is suggested

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

BackgroundTranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding.MethodsWe did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124.FindingsBetween July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98).InterpretationWe found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial.</div