Critical Care Commons^™

Treatment Outcome Of Multi-Drug Resistant Tuberculosis Treated As Outpatient In A Tertiary Care Center, Zeeshan Waheed, Muhammad Irfan, Ahmed Suleman Haque, Muhammad Owais Khan, Atif Zubairi, Noor Ul Ain, Javaid A. Khan

Section of Pulmonary & Critical Care

INTRODUCTION: Community-based out-patient treatment for multidrug-resistant tuberculosis (MDR TB) is relatively new concept with reported successful outcomes.

OBJECTIVE: To assess the treatment outcomes of HIV negative multidrug-resistant tuberculosis (MDR TB) patients treated as outpatient at a tertiary care center in Karachi, Pakistan.

METHODS: A retrospective observational study of 53 consecutive, culture proven HIV negative MDR TB patients (resistant at least to both Isoniazid (H) and Rifampin(R) treated at Aga Khan University Hospital, Karachi between August 1999 and March 2007. Data were collected on predesigned performa regarding patient’s demography, clinical features, radiological findings, drug sensitivity, treatment and outcome.

RESULTS: A total …

Drug Resistance Pattern In Multidrug Resistance Pulmonary Tuberculosis Patients, Nisar Ahmed Rao, Muhammad Irfan, Mir Mir Soomro, Zeeshan Mehfooz

Section of Pulmonary & Critical Care

Objective: To evaluate accuracy of modified Kenneth Jones scoring criteria (MKJSC) as a screening tool to diagnose tuberculous meningitis in children. Study Design: Cross-sectional study. Place and Duration of Study: Paediatric Medicine, Unit-I, Bahawal Victoria Hospital, Bahawalpur, from May 2006 to March 2007. Methodology: A total of 100 children admitted through emergency in Paediatric Medicine, Unit-I, were included who were having fever and features suggestive of central nervous system (CNS) infection. Lumbar puncture was done in all patients after written consent. Findings of lumbar puncture were taken as gold standard for the diagnosis of TBM. MKJSC was applied on each …

Ccl2 Responses To Mycobacterium Tuberculosis Are Associated With Disease Severity In Tuberculosis, Zahra Hasan, Jacqueline M. Cliff, Hazel M. Dockrell, Bushra Jamil, Muhammad Irfan, Mussarat Ashraf, Rabia Hussain

Section of Pulmonary & Critical Care

Background

Leucocyte activating chemokines such as CCL2, CCL3, and CXCL8 together with proinflammatory IFNγ, TNFα and downmodulatory IL10 play a central role in the restriction of M. tuberculosis infections, but is unclear whether these markers are indicative of tuberculosis disease severity.

Methodology

We investigated live M. tuberculosis- and M. bovis BCG- induced peripheral blood mononuclear cell responses in patients with tuberculosis (TB) and healthy endemic controls (ECs, n = 36). TB patients comprised pulmonary (PTB, n = 34) and extrapulmonary groups, subdivided into those with less severe localized extrapulmonary TB (L-ETB, n = 16) or severe disseminated ETB (D-ETB, …

Treatment Outcome Of Multi-Drug Resistant Tuberculosis In A Tertiary Care Hospital In Karachi, Nisar Ahmed Rao, Zeeshan Mahfooz, Muhammad Irfan

Section of Pulmonary & Critical Care

Objective: To assess the outcomes of pulmonary multidrug-resistant tuberculosis (MDR-TB) patients treated at Ojha Institute of Chest Diseases (OICD), a reference hospital for TB in Karachi, Pakistan. Methods: Clinical study for the period 1996-2006, with follow-up until June 2007 was performed. All the culture and sensitivity proven cases of MDR pulmonary TB were initially admitted for 3-6 months till the sputum converted negative. Treatment regimen was decided on individual basis, and included 4-6 drugs. Supervised treatment was given to all patients during the hospitalization. After discharge from the hospital, patients were followed at monthly interval at the outpatient department of …

Differential Live Mycobacterium Tuberculosis- , M. Bovis Bcg-, Recombinant Esat6-, And Culture Filtrate Protein 10-Induced Immunity In Tuberculosis, Zahra Hasan, Bushra Jamil, Mussarat Ashraf, Muniba Islam, Maqboola Dojki, Muhammad Irfan, Rabia Hussain

Section of Pulmonary & Critical Care

The high prevalence of Mycobacterium tuberculosis makes it imperative that immune responses to evaluate could be predictive of infection. We investigated live Mycobacterium- and recombinant antigen-induced cytokine and chemokine responses in patients with active tuberculosis (TB) compared with those of healthy controls from an area where TB is endemic (ECs). M. tuberculosis-, M. bovis BCG-, ESAT6-, and culture filtrate protein 10 (CFP10)-induced responses were determined in peripheral blood mononuclear cells from patients with pulmonary TB (n = 38) and ECs (n = 39). The levels of the cytokines gamma interferon (IFN-γ) and interleukin-10 (IL-10) and the …

Chest Radiographs In Acute Pulmonary Embolism, Ali Bin Sarwar Zubairi, Shahid Javed Husain, Muhammad Irfan, Kulsoom Fatima, Muhammad Atif Zubairi, Muhammad Islam

Section of Pulmonary & Critical Care

Background: Pulmonary embolism (PE) is a serious clinical entity carrying significant morbidity and mortality. Clinically, it is a difficult condition to diagnose and remains under treated condition in Pakistan due to non-availability of objective tests and lack of awareness among physicians.This study was conducted to determine the chest radiographic presentation in known cases of acute PE presenting to a tertiary care hospital.
Methods: Hospital records of patients with a diagnosis of acute PE were reviewed from June 2000 until June 2004. Fifty diagnosed cases of acute PE on Spiral Computed tomography (CT) of the chest demonstrating an intraluminal-filling defect were …

Clinical Characteristics Of Pulmonary Tuberculosis In Adult Pakistani Patients With Co-Existing Diabetes Mellitus, A Jabbar, S F. Hussain, A A. Khan

Section of Pulmonary & Critical Care

A review was made of the records of all patients with pulmonary tuberculosis and diabetes mellitus admitted over a 5-year period to a teaching hospital in Karachi, Pakistan. Among 42358 patients, the total number with both tuberculosis and diabetes was 173. The prevalence of tuberculosis in diabetic patients was 10-times higher than in non-diabetic patients and prevalence increased with duration of diabetes. The lower lung field was most frequently involved, followed by the upper and middle. Bilateral involvement was seen in half and an associated pleural effusion in one-third of the patients. Cavitating lesions were seen in 32% of men …

Broncho Alveolar Carcinoma (B.A.C.), Ahmed N. Abbasi, Muhammad Irfan, Syed Arsalan Raza

Section of Pulmonary & Critical Care

No abstract provided.

Systemic Lupus Erythematosus Presenting As Hemolytic Uremic Syndrome: A Case Report, Malik Anas Rabbani, Bushra Ahmad, Sabeen Fatima Mekan, Suhail Muzaffar, Syed Sohail Ali

Section of Pulmonary & Critical Care

Associating systemic lupus erythematosus (SLE), with an initial presentation of hemolytic uremic syndrome (HUS) is rare. We report a case of 21-year old Afghani female admitted to our hospital with an initial complaint of high grade fever and diffuse maculopapular rash and swelling of lower limbs. Diagnosis of atypical HUS was established according to the clinical triad of HUS without a veriotoxin-producing organism in her stool and the pathological finding compatible to thrombotic microangiopathy. In addition, her symptoms fulfilled the 1982 revised criteria for the classification of SLE. After pulse methylprednisolone, cyclophosphamide and plasmapheresis therapies, her laboratory findings and general …

Smoking Prevalence, Knowledge And Attitudes Among Medical Students In Karachi, Pakistan, F M. Khan, S J. Husain, A Laeeq, A Awais, S F. Hussain, J A. Khan

Section of Pulmonary & Critical Care

A survey of smoking prevalence and attitudes was made among medical students randomly selected from classes at the Aga Khan University, Karachi, Pakistan. Of 271 respondents, 14.4% were current smokers (22.0% male and 3.8% females) and 3.3% ex-smokers. A majority of students recognized the dangers associated with active as well as passive smoking although only 55% of current smokers planned to quit in the near future. Most smokers (96%) believed that they as well as other health professionals needed training on smoking cessation and 95% of all students believed that doctors should play a role model in smoking cessation by …

Severe Hypercalcemia In Tuberculosis, A Soofi, A Malik, J Khan, S Muzaffar

Section of Pulmonary & Critical Care

No abstract provided.

Treatment Failure Of Tuberculosis Due To Concomitant Pathology, Z A. Qasim, A R. Sarwari, S M. Jilani

Section of Pulmonary & Critical Care

No abstract provided.

Tuberculosis Diagnosis And Treatment Practices Of Private Physicians In Karachi, Pakistan, J Khan, A Malik, H Hussain, N K. Ali, F Akbani, S J. Hussain, G N. Kazi, S F. Hussain

Section of Pulmonary & Critical Care

In a densely populated urban area of Karachi, Pakistan, a questionnaire survey was made of the knowledge and practices of 120 private general practitioners about the diagnosis and treatment of tuberculosis (TB). The majority knew that cough, fever and weight loss were the main symptoms of TB, but less than half knew that blood in sputum, poor appetite and chest pain were associated with the disease. Only 58.3% of physicians used sputum microscopy for diagnosing TB and 35.0% used it as a follow-up test. Only 41.7% treated TB patients themselves, the remaining referring their patients to specialists. Around 73.3% of …

General Physicians' Perspective Of Sleep Apnea From A Developing Country, Syed Fayyaz Hussain, Sumaiya Zahid, Raana Haqqee, Javaid Ahmed Khan

Section of Pulmonary & Critical Care

To assess the knowledge of general physicians about the diagnosis and management of obstructive sleep apnea (OSA), a self-administered questionnaire, containing 15 questions, was distributed to 160 doctors attending a pulmonary CME program in March 2002. After 15 minutes of response time, the questionnaires were collected. The data were entered and analyzed using SPSS (Version 10.0) software. One hundred and twenty (75%) questionnaires were returned. Only 41% of responders had ever read an article about OSA and 36% had suspected it at least once in their practice. The majority (61-77%) of responders were aware of the common symptoms of OSA, …

A Hospital Based Preliminary Report On Sleep Disordered Breathing In Pakistani Population, R Haqqee, S F. Hussain, M Mujib, H R. Ahmad

Section of Pulmonary & Critical Care

Background: Sleep Disordered Breathing is an important medical condition leading to significant morbidity and mortality. Western studies have shown its prevalence in middle age to be 9% in women and 24% in men. The aim of this study was to have a preliminary assessment on the frequency of Sleep Disordered Breathing in Pakistani subjects.

METHOD: Patients attending a medical clinic were surveyed. A sleep questionnaire elicited information about snoring, witnessed apnea, nocturnal choking and excessive daytime sleepiness. Data were recorded for age, height, collar size and weight. Epworth Sleepiness Scale was used to assess excessive daytime sleepiness. Statistical analysis …

Disseminated Bipolaris Infection In An Immunocompetent Host: An Atypical Presentation, J A. Khan, S T. Hussain, S Hasan, P Mcevoy, A Sarwari

Section of Pulmonary & Critical Care

No abstract provided.

Postprandial Glucose Response To Mango, Banana And Sapota, Z Contractor, F Hussain, A Jabbar

Section of Pulmonary & Critical Care

Objective: Mango and Sapota are two fruits indigenous to Indian subcontinent. The objective of this study was to evaluate postprandial blood glucose response to mango and sapota in comparison to banana in patients with diabetes mellitus Type 2.METHOD: The plasma glucose response to mango, sapota and banana were determined in ten diabetic patients. Blood was tested at 0, 30, 60, 120 and 180 minutes following the ingestion of test meal.Results: The results showed that the blood glucose response to these three fruits was not different in terms of area under the curve and postprandial change in blood glucose from baseline.CONCLUSION: …

Why Physicians And Lay People Smoke And How Can It Be Reduced?, S B. Memon, A M. Memon

Section of Pulmonary & Critical Care

Objective: The objective of this study was to find out the level of knowledge the physicians and lay people have pertaining to the effect of cigarettes, why certain physicians smoke and what measures could be applied to reduce the rate of smoking.

Methods: A questionnaire was administered to the one hundred physicians who smoke, one hundred non-smoking physicians and one hundred lay people who smoke to determine their attitude towards this addition. Subjects were chosen using convenience sampling. The physicians were picked from six hospitals of Karachi.

Results: When the smoking physicians were asked what could motivate them …

Role Of Fibreoptic Bronchoscopy In The Management Of Immunocompromised Patients With Pulmonary Infiltrates, S F. Hussain, I Malik, J A. Khan

Section of Pulmonary & Critical Care

Immunocompromised patients are prone to develop various pulmonary complications. The range of diagnostic possibilities is wide, infection being the commonest cause. Non-invasive diagnostic tests are often unrewarding. In this study, we have evaluated the diagnostic efficacy and safety of fibreoptic bronchoscopy in immunocompromised patients with pulmonary infiltrates. Patients tolerated the procedure well. This technique identified the etiology in up tp 75% of cases. After treatment based on the result of bronchoscopy, 63% patients improved and were discharged.

Tuberculosis Presenting As Polyarthritis, J A. Khan, M Y. Ahmadani

Section of Pulmonary & Critical Care

No abstract provided.

Dyslipidemia And Its Relation With Body Mass Index Versus Waist Hip Ratio, A Jabbar, A Irfanullah, J Akhter, Y K. Mirza

Section of Pulmonary & Critical Care

To study the magnitude of dyslipidemia in asymptomatic subjects and its relation to body mass index (BMI) and waist-hip-ratio (WHR), 88 subjects attending the health analysis programme were examined and their age, sex, BMI, WHR, fasting blood glucose and lipids were measured. The distribution of the lipid levels and the frequency of dyslipidemia were noted. Forty-eight percent had a total cholesterol of > 200 mg/dl and 50% had an HDL-cholesterol of < 40 mg/dl. On comparing the means of total cholesterol to BMI and WHR, it was found that total cholesterol level was statistically significant for WHR above and below 0.9 for males and 0.8 for females, whereas not so for BMI above and below 27 kg/m2. The prevalence of dyslipidemia in asymptomatic people in this group emphasizes the need for routine health screening for early institution of preventive measures. The correlation with WHR rather than BMI points towards importance of measuring parameters of central obesity rather than body weight and height only.

Renal Tubular Acidosis With Muscle Paralysis, A M. Nagaria, A Jabbar, J A. Khan

Section of Pulmonary & Critical Care

No abstract provided.

Endobronchial Tuberculosis--Manifesting By Coughing Up Of Bronchial Cartilage, A M. Memon, A Shafi, H Thawerani

Section of Pulmonary & Critical Care

No abstract provided.

Allergic Bronchopulmonary Aspergillosis: An Unusual Complication Of Bronchial Asthma, S F. Hussain, J A. Khan, M A. Khan

Section of Pulmonary & Critical Care

Asthma is a common medical problem in Pakistan. Allergic Bronchopulmonary Aspergillosis (ABPA), an immune mediated disease, is an unusual complication of bronchial asthma which can result in bronchiectasis, pulmonary fibrosis, respiratory failure and death. Early diagnosis is important so that with proper therapy permanent lung damage can be prevented. First described in 19521 , ABPA was thought to be a rare disorder, but with increased awareness amongst the physicians and better diagnostic techniques, äases are being recognized more frequently. The clinical features of ABPA (cough, fever, hemoptysis and lung infiltrates) are usually mistaken for pulmonary tuberculosis (TB). We present three …

An Audit On Hospital Management Of Bronchial Asthma, J A. Khan, S Saghir, G Tabassum, S F. Husain

Section of Pulmonary & Critical Care

Medical audit is a new concept in developing countries like Pakistan. We carried out this retrospective study on bronchial asthma. The purpose was to see if care given to patient with asthma meets the accepted international standard or not. During this audit several deficiencies were found. Documentation in notes about signs indicating severity of asthma was very poor. Peak flow recording in the notes was also very deficient. There was no documentation in notes whether inhalers technique of the patients has been checked or not. This audit shows that care given to asthma patients is far from satisfactory and we …

Diagnostic Evaluation Of Pleural Effusion And The Role Of Needle Pleural Biopsy, S F. Hussain, S Mujahid, J A. Khan

Section of Pulmonary & Critical Care

No abstract provided.

Cryptic Disseminated Tuberculosis: An Often Missed Diagnosis, A Jabbar

Section of Pulmonary & Critical Care

No abstract provided.

Endobronchial Tuberculosis Simulating Bronchial Asthma, J A. Khan, N Islam, J Akhter, S F. Hussain

Section of Pulmonary & Critical Care

No abstract provided.

Sweet's Syndrome, A Jabbar

Section of Pulmonary & Critical Care

No abstract provided.

Testotoxicosis: Gonadotrophin-Independent Male Sexual Precocity, A A. Aziz, S M. Jafri, N U. Haque

Section of Pulmonary & Critical Care

In this era of rapidly developing investigational tools and pharmacology, the pathophysiology of precocious puberty is becoming well defined. What was previously thought to be a form of gonadotrophin releasing hormone (GNRH)-dependent central precocious puberty is now classified as GNRH-independent familial testotoxicosis. We present two such cases and review the clinical features, pathophysiology and treatment of testotoxicosis.