Mazhar Ali Khan

Objective: The study aims to determine the pattern of antibiotic sensitivity in typhoid patients with positive bloodcultures.Study Design: A cross-sectional study.Place and Duration of the Study: Department of Medicine, MTI, LRH Peshawar, Pakistan from Jan 052019 to Dec 05 2019.Methods: One hundred male and female patients attended. Patients ranged from 10 to 55. Each patient’s age, gender, and BMI were collected after informed written permission. Each patient had a fever. Each patient was tested forsalmonella in their blood. The Kirby Bauer Disc Diffusion technique was used by NCCLS to measure and interpretantibiotic susceptibility. Research data was evaluated using SPSS 22.0.Results: The 100 patients were 42 (42.6%) female and 58 (58.4%) male. Most of the 40 patients (40.2%) were15–25. Paratyphi 30 (30.6%) was less common than typhi 65 (65.4%). Our investigation found that azithromycin,cotrimoxazole, gentamicin, chloramphenicol, and azithromycin were more sensitive than ciprofloxacin and ofloxacin(10.2% vs. 7.1%). Both medicines have significant resistance. Salmonella typhi was resistant to 94 (94.4%) nalidixicacids.Conclusion: We found a wide range of antimicrobial sensitivity patterns, including significant cotrimoxazole andchloramphenicol sensitivity. For 18 years, quinolones have been routinely utilized yet have low sensitivity.Keywords: Typhoid, Antibiotic sensitivity, Blood cultures, Salmonella, Quinolones

Background: Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), which is chronic, asymptomatic, inflammatory, progressive, and slow-moving. Objectives: The objective of the study were distribution of acute and chronic infections, treatment outcomes, immune cell levels, viral load, and gender-related disparities in liver enzyme levels. Methodology: The study employed the Abbott PCR apparatus for real-time thermocycling, the MINDRAY BA-88A Semi-Automatic Clinical Chemistry Analyzer, and flow cytometry to analyze samples from Hepatitis C Virus (HCV) infected patients, with a specific emphasis on evaluating CD56 and CD16 markers on Natural Killer (NK) cells. Results: This study findings highlighted 87.5% of patients exhibited liver cirrhosis, a severe condition linked to liver failure, while 12.5% had hepatocellular carcinoma. Out of 150 patients 52% had acute HCV infection, 10% had chronic infection, and 38% endured treatment. CD56+ NK cell levels averaged 21±4, with males at 22±6 and females at 18±4, suggesting gender-related differences. CD16+ NK cells averaged 9±4 overall, with males at 8±2 and females at 12±4. Viral load ranged from 62,000-65,000IU/mL (41.33%) to 310,000-418,000IU/mL (7.33%). Genotype 3a was most prevalent (51.70%), while 1a, 2a, and 3b constituted 10.80%, 13.80%, and 17.10%, respectively. Gender disparities were noted in ALT (males: 127±8, females: 113±2), AST (males: 131±4, females: 117±1), and GGT (males: 62±3, females: 49±2) levels. Conclusion: The study concluded that the liver cirrhosis as the predominant condition in HCV-infected patients, indicating substantial liver damage due to HCV infection. The study also emphasized the potential of HCV treatment in mitigating liver cancer risk.

The most common virus on the earth is bacteriophage (or phages) that are present in all organisms. Their classification is currently being evaluated based on the phage's unique and antibacterial properties. The phage replicates within the host through a lytic or lysogenic process following infection and use of a bacterial cell machine. Phage has become an effective therapeutic drug against pathogens after twort and Filex d'Herelle discovery of bacteriophage in the 1900s, and subsequent research has been conducted. Nevertheless, bacteriophage therapy has become an unavoidable option for research due to the recent occurrence of bacterial antibiotics resistance. Around fifty years after antibiotic were found, antibiotics resistance is key risk for health care. Antimicrobial resistance is a rising big issue in global healthcare. The WHO, 1st report on antimicrobial resistances globally, has emphasized the threat of a forthcoming post antibiotics age, where little infection could be not treatable and once again will be fatal. Considering the present condition, producing therapeutic agent that are complementary to antibiotics play great role to fight against antibiotic resistance. The crisis requires development and implementation of new therapeutic agents against infections and phage therapy is suitable to control infectious diseases because safety of phage therapy. There is a perception with regards to phage therapy that phages are usually safe, on the bases of fact that they are ubiquitous in nature and our continued contact to phages in the environment and furthermore that they are widely used without adverse effects in many of the world. with this positive interpretation, the application of phage therapy must be verified by current research studies. bacteriophage preparations contain detrimental substances, such as toxins of gram-negative bacteria, during the formulation process of bacteriophage and that can be remove by different purification methods. Phages effects normal flora GIT negligibly due to specificity in nature and they infect only a small number of bacterial species.

Objectives: This study aimed to assess the time to sputum culture conversion (SCC) and its determinants among multidrug-resistant tuberculosis (MDR-TB) patients. Methods: This cross-sectional study was conducted from January 2019 to January 2020. A total of 252 MDR-TB patients presenting at a tertiary level teaching hospital in Peshawar, Khyber Pakhtunkhwa (KP), were included. The patient’s demographic and clinical data were collected using a structured questionnaire. Time to SCC was calculated from the initiation of treatment till the patient had two consecutive negative cultures. The Cox proportional-hazards analysis was performed to check strength and association between the determinants and time for SCC. Results: Out of 252 MDR-TB patients enrolled, sputum culture conversion was observed in 76.6% of the patients by the end of six months. While, 19.0% of the patients failed to achieve negative culture and remained positive after interim report of their treatment. Age > 45 years (HR = 15.22; 95% CI: 7.27-31.83; p<0.001), female gender (6.22; 2.90-13.36; p<0.001), BMI < 18.5 kg/m2 (10.28; 5.25-20.11; p<0.001), weight loss (0.03; 0.01-0.06; p<0.001), smoking (0.10; 0.05-0.21; p<0.001), diabetes mellitus (0.02; 0.00-0.04 p<0.001) and disease severity on chest X-ray (CXR) (0.03; 0.01-0.09; p<0.001) were the significant determinants of delayed sputum culture conversion. Conclusion: MDR-TB patients with older age, low BMI, weight loss, diabetes, smokers and those with disease severity on CXR are less likely to respond to treatment as they displayed delayed SCC. Therefore, such patients should be meticulously followed up for successful management. doi: https://doi.org/10.12669/pjms.38.4.5058 How to cite this:Iqbal Z, Khan MA, Aziz A, Nasir SM. Time for culture conversion and its associated factors in multidrug-resistant tuberculosis patients at a tertiary level hospital in Peshawar, Pakistan. Pak J Med Sci. 2022;38(4):1009-1015. doi: https://doi.org/10.12669/pjms.38.4.5058 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.

Background: Tuberculosis (TB) is one of the diseases causing a high rate of morbidity and mortality worldwide. Amongst high TB burden countries, Pakistan ranks fifth, with an estimated new TB case of 510,000 emergings each year. Worldwide resistance to anti-tubercular drugs is a serious public health issue. Objective: This study was aimed to determine Mycobacterium tuberculosis (MTB) prevalence both in respiratory and non-respiratory clinical samples, their resistance to the first line Anti-tubercular drug especially to Rifampicin, hence to determine Multidrug-resistant Tuberculosis prevalence in the region. Method: This study was carried out to elucidate Mycobacterium tuberculosis (MTB) prevalence and their Rifampicin resistance among patients of Ayub teaching hospital and nearby districts in Hazara division of Pakistan from July 2017 to September 2019. Total 276 clinical samples were collected (both respiratory and non-respiratory) and screened by Zeihl-Neelsen (ZN) staining initially for the presence of Acid-Fast bacilli (AFB). Samples were further subjected to GeneXpert assay for detection of Mycobacterium Tuberculosis and Rifampicin resistance. Results: Out of 276 samples, 68 (24.64%) were AFB smear-positive while MTB was detected in 28 (20.29%) respiratory samples, and 9 (6.52%) in non-respiratory samples. Rifampicin resistance detected in 2 pulmonary samples (1.45%) and nil (0%) in non-respiratory samples . Conclusion: The possible reason for the low prevalence rate of resistance to Rifampicin in the current study is due to the small sample size and mixing of new and retreated cases. Still, the study could play its role to help government and health governing bodies in formulating sufficient plans regarding drug-resistant TB control.

Background: Tuberculosis (TB) still remain a global public health problem. TB is deadly disease caused by a bacterium named Mycobacterium tuberculosis (MTB). Now a day TB is resurgence in the form of drug resistant TB (DR-TB). In order to improve adherence to anti-TB treatment, the World Health Organization (WHO) promotes the use of directly observed therapy (DOT), in which patients undertake medications under the direct observation of a health care provider. Objectives: The present study was conducted with the aim to find out treatment outcome of 11 months STR treatment for MDR-TB patients at PMDT LRH. Results: This study was conducted from July 2017 to March 2020. In this study only those patients were enrolled who were eligible for newly assigned 11 months short treatment of MDR-TB. All those patients who were achieved final outcomes at time of this final draft were included in this study. The numbers of such patients were 109. Mean age of study cases was 19.544 with standard deviation ±15.947. Majority of study cases (56.0%) were females. For study purpose, study cases were divided into four different groups, of which most of the cases belonged to the age group form 45 years to 64 years of age. About 77.1% of these cases achieved successful treatment outcome and remaining 22.9% of study cases achieved unsuccessful treatment outcome. Conclusion: The findings of the current study have several clear implications for TB control efforts. In light of these findings, it could be concluded that to reduce DR-TB transmission in the community, improvement of treatment outcomes, via ensuring adherence, paying special attention to poor and patient having very far residency form the treatment site. Treatment adherence made better by offering a short, highly effective treatment regimen for MDR-TB because of the main challenge in achieving the successful treatment outcome is the large number of pills that patients must ingest every day. This study also concluded that with the experience and dedicated team it is very easy to achieve best success rate for any type of treatment.

Background: Different strategies have been employed to improve treatment adherence of TB patients. Individual patient care and follow-up, clear lines of communication, compliance aids, educational materials, and incentives have all been shown to improve adherence. Objective: The objective of this Study is to investigate the role of Clinical Pharmacist in relation to the adherence to treatment of MDR-TB and XDR-TB. Methodology: The pilot study was conducted in the PMDT Lady Reading hospital Peshawar. Data was collected by using questionnaire which was designed to collect demographic variables as well as knowledge, attitude and adherence to the treatment of MDR-TB. This study includes all patients who enrolled from Jan 2012 to Dec 2013. All data collected were then coded, edited and entered to Statistical Package for the Social Sciences (SPSS), version 16.0 software and analyzed. Results: Among study cases 58.47% were male and 41.53% were female. Among study cases 23.88% patients need Pharmaceutical care. Most of the patients faced side effects of drugs, of which Gastrointestinal issues. Conclusion: Patients' adherence to TB treatment improved when a pharmacist provided patient education on medication use and addressed patients' pharmaceutical care issues.

Objective: To see the importance and frequencies of different IHC markers in the diagnosis of Malignant Mesothelioma(MM) in patients with suspected mesothelioma presented with pleural effusion.Material and Methods: This was a cross sectional analysis, conducted at Pulmonology unit, Lady Reading HospitalPeshawar, Pakistan from January 2016 to December 2017. Patients with pleural effusion and suspected mesotheliomawere included. Pleural biopsies were sent for IHC and SPSS was used for statistical analysis. Those with Granulomatousinflammation, possible TB and chronic non specific inflammation on histopathology were excluded from the study.Results: A total of 141 cases were identified of which 60 patients were excluded who turned out to be Granulomatousinflammation/chronic non specific inflammation or non diagnostic biopsies report. Remaining 81 patients were includedwith median age 55.04% years range, 24–75 years ±15.688 SD, 46 patients (56.8%) were males and most of thecases (one fourth) were from age group above 50 years. MM was relatively common in males as compared to female(56.8% vs 43.2%). Of those 53 (65%) were diagnosed with MM and 28(34.6%) were Metastatic Adeno-carcinoma onthe basis of histopathology and IHC markers. Calretinin was the most frequent marker present in 46 (86.8%) cases ofMM followed by WT1 and Cytokeratin in 45 (84.9%) cases each. Similarly the most commonly found marker in cases ofMetastatic Adeno-carcinoma (MA) was TTF1 in 22 (78.5%) which was absent in 100% cases of MM. Similarly, Calretininand HBME was absent in 26 (92.8%) cases of MA. On the other hand Cytokeratin was also present in 42.8% cases ofMA. Calretinin was found to have more sensitivity (86.79%), specificity (92.86%), PPV (95.83%) and accuracy (88.89%)in diagnosing MM on histological samples and TTF1 was the most suitable IHC for the identification of MAConclusions: Calretinin, Cytokeratin , HBME and WT1 are useful IHC marker in the diagnosis of MM. Calretinin isthe most sensitive and specific IHC markers on histopathological samples in MM. While in case of MA , TTF1 was themost suitable marker.

<b>Background:</b> Diagnosis of malignant mesothelioma (MM) remains a challenge, especially in developing countries where resources in pathology are limited. The present study was aimed to evaluate cost-effective biomarkers to predict the probability of MM in biopsy samples in order to accelerate the diagnostic workup of the potential cases. <b>Methods:</b> We conducted a study at Pulmonology unit, Lady Reading Hospital Peshawar, Pakistan. Qualitative data (gender, frequency of biomarkers) was presented as frequency and percentage; while quantitative data (age) was presented as means and standard deviation. <b>Results:</b> Total of 81 cases were enrolled in the study. The median age was 55.04 years (range, 24–75 years) and 46 patients (56.8%) were males. Most of the cases (one fourth) were from age group above 50 years. Out of 81 suspected cases of MM, 53 (65%) were MM and 28(34.6%) were Metastatic Adeno-carcinoma (MA) as diagnosed by Abram’s close pleural biopsy. The most frequent marker present in MM case was Calretinine in 46 (86.8%), followed by WT1 and Cytokeratin in 45 (84.9%) cases each. Similarly the most commonly found marker in cases of MA was TTF1 in 22 (78.5%) cases. On the other hand TTF1 was absent in 100% cases of MM. Similarly Calretinine and HBME was absent in 26 (92.8%) cases of MA. One unresolved issue in this result was the presence of Cytokeratin among 42.8% cases of MA. <b>Conclusion:</b> This study shows that Calretinine, Cytokeratin, HBME and WT1 are useful marker that can enhance the speed and accuracy of diagnostic workup in case of suspected MM. More large scale and robust studies are needed to give guideline recommendations

Background: Multidrug-resistant tuberculosis (MDR-TB) is a potential threat to global tuberculosis control. Its management is recommended by WHO in a tertiary care hospital setting with a dedicated team with linkages with TB control programme in the community. Methods and Methodology: Drug Resistant TB patients were managed at LRH even before this from 1 October 2008 till the launch of PMDT on February 2012. Data during these times were saved in hard as well as in soft. For study purposes all data were converted into SPSS and analyzed the data for percentage and differences by using chi square testing. A P-value of 0.05 was considered to be statistically significant. Objective: In this study the outcome of patients of cohort of “Pre-PMDT” from Oct 2008 to Dec 2011 is compared with cohort of “Post-PMDT” implementation from2012 till Dec 2014. Results:  From 2008 to 2014, 956 MDR-TB patients were included in this study. The patients were classified into two cohorts: Pre- PMDT cohort of Non GLC patients (n = 285) and Post- PMDT cohort of GLC patients (n = 671). Statistically significant difference was found in the treatment outcomes of pre and post PMDT. Successful treatment outcome were found to be statistically significant with Post PMDT cohort patients (p = .000) while unsuccessful treatment outcome with Pre PMDT cohort patients (p =.020). Most of the Post- PMDT patients 487 (72.58%) were cured as compared to Pre-PMDT cohort 14 (5%) and found statistically significant (p = .000). Default rate was found to be high in Pre-PMDT cohort 49 (17.2%) as compared to Post-PMDT cohort 5 (0.71%) and statistically significant (p = .000). Failed 1 (0.35%), died 67 (23.50%), transfer out 20 (7%) in Pre- PMDT cohort and failed 36 (5.37%), died 118 (17.59%), transfer out 8 (1.19%) in Post-PMDT. Conclusion: The study shows significant improvement in treatment outcome of Post PMDTcohort as far as Default rate is concerned.

<b>Background:</b> Multidrug Resistance TB (MDR-TB) is a growing threat to TB control programme. Its treatment in children is challenging, yet most developing countries do not specifically address pediatric MDR-TB. <b>Methods:</b> A prospective study conducted in Khyber Pakhtunkhwa (KPK) province of country Pakistan. Analysis of data for 160 children &lt;15 years of age with MDR-TB with final outcomes, were presented here for their disease characteristics, outcomes and factor responsible for unfavorable outcomes. <b>Results:</b> A total of 1168 patients with MDR-TB were enrolled in KPK. Of these, 160 (13.6%) were children. The age distribution of patients was bimodal. 30.6% had close MDR-TB contacts. 83.7% had received first-line agents previously of which approximately 50% achieved failure outcome before enrollment in treatment for MDR-TB. Resistance pattern showed that 47.8% of the strains were resistant to four first line ATT followed by 21.7% to three and 8.7% to two and three FLDs. Sixty five percent of the strains were resistant to EMB, followed by PZA (62.5%), SM (36.3%) and Ofx (34.4%). Resistance to second line drugs also found (Am (3.1%), Cm (2.5%) and ETO (3.8). Major drug adverse events found was Arthralgia 33 (20.6%) followed by gastritis 16.25%, psychiatric issue (14.3%), body aches (6.8%) and least common was tinnitus (1.25%). 81.3% of the study cases achieved successful outcome (died 15.0%), treatment failure 2.5% and loss to follow up (1.3%)). Predictors for poor outcomes is lung cavitation (OR 1.69, 0.006-0.068, P=0.001) and additionally resistance to SLDs (OR 3.024, 0.673-0.068, P=0.001). <b>Conclusion:</b> MDR-TB among children can be treated successfully in resource-poor settings.

Background: Tuberculosis (TB) is a disease of interest from a long time and killed more of its infected peoples than any other infectious diseases. It is also known as disease of poverty as it mainly affects persons of poor countries. Due to this disease an average of 20-30% of annual household income loses of diseased person.Objective: To determine the profile and treatment outcome of TB patients enrolled for treatment at DOTS center, department of Pulmonology, Lady Reading hospital Peshawar (LRH), Pakistan.Methodology: This study was conducted at Department of Pulmonology, LRH Peshawar, Pakistan. Secondary data was collected from 2013 to 2017. Data were edited manually before entry to a computer and then entered to Microsoft excel programme. Demographic and clinical data such as age, sex, type of TB and treatment outcome were retrieved from TB 03 register using dataextraction sheets. A descriptive analysis was conducted to get summary values of treatment outcome of TB and other explanatory variables. Finally, the results were presented in the form of tables and charts.Results: Total 1235 TB patients were registered during this study period, of which 8 patients were NE so excluded from the study. Thus for our study we included 1227 TB patients for analysis. Of the total included, 630 (51.3%) were males. Mean age of participants were 36.8 years with SD of ±16.3. Moreover, high proportions of TB patients; 363 (29.4%) and 323 (26.3%) were in the age groups of 11-20 and 21-30 years, respectively. Among PTB cases, 89.6% of patients achieved successful outcomes and in EP cases 92.5% were achieved successful outcomes, whereas 5.8% patients were died among EP cases.Conclusion: This study showed that TB mainly affected individuals in the reproductive age group. The proportion of patients who were successfully treated was above the MDG target of 85% treatment success rate and comparable with the milestone target of > 90% treatment success rate. This study concluded that TB is still a major public health problem at the studied area.

INTRODUCTION: Pakistan ranks 4th among 22 multidrug resistant tuberculosis (MDR-TB) high burden countries. The increasing rate of MDR-TB in Pakistan underscores the importance of effective treatment programs of drug-resistant TB. Clinical management of MDR-TB requires prolonged multidrug regimens that often cause adverse events (AEs). MATERIALS AND METHODS: This retrospective case series study include all patients who were enrolled for MDR-TB treatment during January 2014 till April 2015 at Programmatic Management of Drug Resistant TB (PMDT) unit at tertiary care hospital, Lady Reading Hospital (LRH) Peshawar Pakistan. In this study we sought to ascertain the occurrence of treatment related adverse events and factors associated with these events. Here we also examined the frequency of and reasons for changing drug regimens. We further sought to determine whether the occurrence of adverse events negatively impacts the treatment outcome and management of adverse effects without requiring the discontinuation of MDR-TB therapy. RESULT: At the time of analysis final outcomes of all 200 enrolled patients exist. Among these 52.5% were females and (81.5%) were aged ≤ 44 years. Among study cases 155 (77.2%) experienced at least one adverse event during treatment. The most commonly reported events were psychiatric issues (70%) whereas the less common was skin rashes (7.5%). A change in drug dose due to adverse events occurred in 16.5% cases, while 13.5% cases had at least one drug discontinued temporarily. Younger age and lung cavities at baseline were positive association with occurrence of adverse events. Association was also found between adverse events and treatment outcomes (OR 0.480, 0.236-0.978, p= 0.041). CONCLUSIONS: Adverse events were prevalent among MDR-TB patients treated at PMDT-LRH Peshawar. All patients who were younger aged and cavitory lungs should be closely monitored for occurrence of adverse events.

Background: Both depression and Multi-drug resistant tuberculosis (MDR-TB) are global public health problems with substantial impact on human health. However, depressive state among MDR-TB patients has not been well investigated in Pakistan. Objective: To assess frequency of depression and to identify factors associated with depression at baseline among MDR-TB patients in our centre. Method and design: This was a cross sectional study conducted at programmatic management of drug resistant TB unit (PMDT), Lady Reading Hospital Peshawar (LRH), Pakistan. A total of 289 MDR-TB patients were included in the study, which were enrolled for treatment in this unit from January 2012 till December 2013 and assessed at the time of registration for depression. Convenient sampling technique was used for data collection. Result: A total of 289 patients were included in this study. Among total, 201(69.55%) of the study participants were classified depressed, 127 patients (63.18%) had mild depression, 61 patients (30.35%) had moderate depression, 13 patients (6.46%) were diagnosed with severe depression. Depression was found in 127 (43.9%) MDR-TB patients at the time of registration associated with different factors. Conclusion: Gender, duration of illness, residence, co-morbidity and past TB treatment were associated and independent risk factors of depression.

Background: Multidrug-resistant tuberculosis (MDR-TB) is an increasing challenge to health services globally. Although new drugs are in development, current guidelines still recommend prolonged use of injectable antimicrobials (usually Amikacin, Kanamycin or Capreomycin). Methods: We conducted a retrospective study of patients initiating treatment for MDR-TB at Programmatic Management of Drug Resistant TB unit, Lady Reading Hospital (PMDT-LRH) Peshawar between January 2012 and December 2013. Objective: Objective of the present study is to find out the incidence of ototoxicity (defined both clinically and on audiological testing), its associated factors and its effects on final outcome. Results: The choice of injectable antimicrobial varied. Total of 543 patients treated with injectable antimicrobials for MDR-TB were included in the analysis. Of 543 MDR-TB patients, 476 (87.7%) received amikacin and 67 (12%) received capreomycin. All the patients received baseline screening by audiometry at the time of registration for MDR-TB treatment and 36.83% had more than one audiogram. Among 543 patients, 200 (36.83%) patients showed evidence of ototoxicity. Most of the male patients (p= 0.010), age between 25 to 44 (p= 0.012), comorbidity (p= 0.023), duration of illness (p=0.010), past TB treatment outcome (p= 0.047) and use of amikacin (p= 0.031) were significantly associated with ototoxicity. Conclusions: Long-term morbidity from injectable treatment is significant in this setting, and the data suggest capreomycin might be associated with less ototoxicity when compared with amikacin. There is a need for more highquality clinical data to inform future guidelines for treatment and monitoring.

Objective: To analyze the clinical and histopathologic parameters of patients with breast cancer from the north West population of Pakistan. Study Design: Cross sectional descriptive study. Place and Duration of Study: Data was extracted from the Institute of Radiology and Nuclear Medicine Hospital, Peshawar and Khyber Teaching Hospital, Peshawar from March 2014 to December 2016. Materials and Methods: Demographic, clinical and histopathological data was extracted from patient files using proformas. The following parameters were assessed: age, family history, marital status, side and type of surgery, resection margins, tumor markers, foci, tumor grade, TNM stage and lymph node, vascular and lymphatic invasion. Data was analyzed for descriptive statistics. Logistic regression was performed by stratifying patients according to the disease stage as early stage (ES) (stage I and II) and late stage (LS) (stage III and IV) to get odds ratios (ORs) and P -values. Results: Clinical and histopathological data of 362 patients with breast cancer was profiled. From the available data 82 (33%) patients were early stage breast cancer, while 167 (67%) were late stage breast cancer. The mean age of patients in the ES breast cancer (45.8 years) was not statistically different from LS breast cancer (45.8 years) (p=0.99). ER+ cases were 62%, PR+ cases were 47% and HER2 positive cases were 49%. Lymph node invasion (p

Background: Diagnosis of paediatric tuberculosis remains a challenge due to the difficulty in obtaining samples from children and the low sensitivity of culture confirmation. Drug resistance in TB continues to be a significant challenge in South Africa. Microbiologic confirmation of tuberculosis in children is necessary to exclude drug-resistant tuberculosis in face of the high multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) rates reported in the adult population. We describe the rates of drug-resistant TB in children less than 5 years old from KwaZulu Natal – a province in South Africa with the highest burden of both TB and HIV disease. Methods & Materials: A retrospective descriptive analysis was done of specimens from children less than 5 years old submitted to TB reference laboratory in KwaZulu-Natal, South Africa. Data was collected from 2012 to 2014. Specimens cultured included respiratory samples, lymph node aspirates, pleural and peritoneal fluid, cerebrospinal fluid, bone and tissue samples. Cultures were performed using the automated Mycobacterial Growth Indicator Tube 960 system (Becton Dickinson) and identification and susceptibility was confirmed with the line probe MTBDR plus assay (Hain-Life Science). From 2012 the Xpert MTB/RIF was introduced into the diagnostic algorithm for MTB detection and Rifampicin resistance. Results: 903 children were found to have culture-confirmed TB during this 3 year period. Drug susceptibility testing showed susceptible MTB ranging from 71-82% in the various age groups. Overall the resistance to isoniazid and rifampicin (MDR) rates ranged from 11-16% with the highest rates found in 2 year old age group. Extensively drug-resistant TB (0-2.1%) was present in all age groups. INH mono-resistance was 3,4% and Rifampicin mono-resistance was 2.8%. Conclusion: High rates of Mycobacterium tuberculosis including extensively drug resistant TB were found in children less than one, which indicates the burden of TB infection among woman during childbearing years. INH mono-resistance is of concern as this will not be detected by the current diagnostic algorithm that includes the Xpert MTB/RIF for MTB detection and Rifampicin resistance. Children with INH mono-resistance may benefit from high-dose isoniazid therefore bacteriological confirmation through culture is important in management of childhood TB.

Background: Both depression and Multi-drug resistant tuberculosis (MDRTB) are global public health problems that have a substantial impact on human health. However, depressive state among MDR-TB patients has not been well investigated in Pakistan. Objective: To find out the frequency of depression at baseline (at the time of registration) in currently diagnosed MDR-TB patients and the emergence of depression during MDR-TB treatment in registered MDR-TB patients in PMDT. Design: The longitudinal study was conducted at PMDT centre, Lady Reading Hospital Peshawar (LRH) on patients enrolled for MDR-TB treatment from 1th May 2012 to 30 August 2013. A total of 213 patients were included in this study. All newly diagnosed MDR-TB patients at the time of registration and on every follow up. Result: The total of 213 MDR-TB patients were recruited for the study. Out of 213 registered patients, 139 (65.5%) had depression at baseline. At the end of 1st quarter, only 47 (33.81%) out of 139 still had depression and at the end of 2nd quarter this number further decreased to 35 (15.10%). While the emergence of depression was 36% at the end of both 1st and 2nd quarter.

OBJECTIVE: To assess the profile of TB/multidrug-resistant TB (MDR-TB) among household contacts of MDR-TB patients. METHODS: Close contacts of MDR-TB patients were traced in the cross-sectional study. Different clinical, radiological and bacteriological were performed to rule out the evidence of TB/MDR-TB. RESULTS: Between January 2012 and December 2012, a total of 200 index MDR-TB patients were initiated on MDR-TB treatment, out of which home visit and contacts screening were conducted for 154 index cases. Of 610 contacts who could be studied, 41 (17.4%) were diagnosed with MDR-TB and 10 (4.2%) had TB. The most common symptoms observed were cough, chest pain and fever. CONCLUSIONS: The high incidence of MDR-TB among close contacts emphasize the need for effective contact screening programme of index MDR-TB cases in order to cut the chain of transmission of this disease.

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.