Pulmonology Commons^™

Estimating The Pre- And Post-Diagnosis Costs Of Tuberculosis For Adults In Pakistan: Household Economic Impact And Costs Mitigating Strategies, Shama Razzaq, Aysha Zahidie, Zafar Fatmi

Community Health Sciences

Background: Despite free tuberculosis (TB) care in Pakistan, patients still have to bear high costs, which push them into poverty. This study estimated the pre- and post-diagnosis costs households bear for TB care, and investigated coping mechanisms among adults ≥ 18 years in Karachi, Pakistan.
Methods: We conducted a cross-sectional study comprising of 516 TB patients identified with completion of at least one month intensive treatment from four public sector health facilities from two institutes in Karachi, Pakistan. A standardized questionnaire to estimate patient's costs was administered. The study outcomes were direct medical and non-medical costs, and indirect costs. The …

Protocol For A Cluster Randomised Controlled Trial Of Secondary Distribution Of Hepatitis C Self-Testing Within The Context Of A House-To-House Hepatitis C Micro-Elimination Programme In Karachi, Pakistan, Sonjelle Shilton, Dania Ali, Alyia Hasnain, Adeel Abid, Jessica Markby, Muhammad S. Jamil, Niklas Luhmann, Pamela Nabeta, Stefano Ongarello, Saeed Hamid

Medical College Documents

Background: Globally, just 21% of the estimated 58 million people living with hepatitis C virus (HCV) know their status. Thus, there is considerable need to scale-up HCV testing if the World Health Organization (WHO) 2030 hepatitis elimination goals are to be achieved. HCV self-testing may assist with this; however, there are currently no data on the real-world impact of HCV self-testing. With an estimated 5% of the general population living with HCV, Pakistan has the second highest HCV burden in the world. This study aims to evaluate the acceptability and impact of home delivery of HCV self-testing for secondary distribution …

Balancing Science And Public Policy In Pakistan's Covid-19 Response, Zulfiqar Ahmed Bhutta, Faisal Sultan, Aamer Ikram, Adil H. Haider, Assad Hafeez, Muhammad Islam

Department of Paediatrics and Child Health

Background: Coronavirus disease 2019 (COVID-19) has affected the world in an unprecedented manner and South Asian countries were among the first to experience imported cases. Pakistan's response to COVID-19 has been under scrutiny for its granularity, reach and impact.
Aims: to evaluate objectively the chronology and depth of the response to COVID-19 in Pakistan.
Methods: We evaluated available national and subnational epidemiological and burden information on COVID-19 cases and deaths in Pakistan, including projection models available to the Government at an early stage of the pandemic.
Results: Pakistan, with a population of 215 million and considerable geographic diversity, experienced case …

Acceptance Of Covid-19 Vaccine In Pakistan: A Nationwide Cross-Sectional Study, Mohammad Aadil Qamar, Omar Irfan, Rubaid A. Dhillon, Areesh Bhatti, Mir Ibrahim Sajid, Safia Awan, Wajiha Rizwan, Ali Bin Sarwar Zubairi, Zouina Sarfraz, Javaid Ahmed Khan

Department of Paediatrics and Child Health

Introduction: The coronavirus disease 2019 (COVID-19) vaccine is available across various countries worldwide, with public-private partnerships ensuring all individuals are vaccinated through a phased approach. Irrespective of the geographical spread, several myths pertaining to the COVID-19 vaccine have stemmed, ultimately limiting the national administration of vaccines and rollouts. This study assessed the acceptance of the COVID-19 vaccine among the general public in Pakistan.
Methods: A pre-validated questionnaire was administered from January 2021 to February 2021 to assess the public attitude and acceptance of the COVID-19 vaccine. Logistic regression analyses were run to identify factors associated with the acceptance among the …

Serial Lung Ultrasounds In Pediatric Pneumonia In Mozambique And Pakistan, Amy Sarah Ginsburg, Muhammad Imran Nisar, Lola Madrid, Jennifer L. Lenahan, Benazir Baloch, Pio Vitorino, Jun Hwang, Alessandro Lamort, Nee Kanth, Fyezah Jehan

Department of Paediatrics and Child Health

Lung ultrasound (LUS) is a promising point-of-care imaging technology for diagnosing and managing pneumonia. We sought to explore serial LUS examinations in children with chest-indrawing pneumonia in resource-constrained settings and compare their clinical and LUS imaging courses longitudinally. We conducted a prospective, observational study among children aged 2 through 23 months with World Health Organization Integrated Management of Childhood Illness chest-indrawing pneumonia and among children without fast breathing, chest indrawing or fever (no pneumonia cohort) at 2 district hospitals in Mozambique and Pakistan. We assessed serial LUS at enrollment, 2, 6, and 14 days, and performed a secondary analysis of …

Knowledge, Attitude And Perception Of Pakistanis Towards Covid-19; A Large Cross-Sectional Survey, Zoya Fatima Rizwan Ladiwala, Rubaid Azhar Dhillon, Ibrahim Zahid, Omar Irfan, Muhammad Sharjeel Khan, Safia Awan, Javaid Ahmad Khan

Medical College Documents

Background: The Novel Coronavirus Disease (COVID-19) has created havoc globally as countries worldwide struggle to combat this pandemic. Since prevention and social isolation are known to be the only ways to prevent the spread of COVID-19, this has created challenges among the lower-middle income countries (LMIC) including Pakistan, as it battles between an under-resourced healthcare, an economic shutdown, and widespread myths and misconceptions. Therefore, a study was conducted to evaluate the knowledge, attitude and perceptions regarding COVID-19 as public understanding is vital to help facilitate the control of this outbreak.
Methods: A pre-validated online questionnaire was distributed among the general …

Evaluation Of Semi-Quantitative Compared To Quantitative Cultures Of Tracheal Aspirates For The Yield Of Culturable Respiratory Pathogens - A Cross-Sectional Study, Salima Rattani, Joveria Farooqi, Ghazala Jabeen, Saeeda Chandio, Qaiser Kash, Aijaz Khan, Kauser Jabeen

Department of Pathology and Laboratory Medicine

Background: Diagnosis of lower respiratory tract infections (LRTI) depends on the presence of clinical, radiological and microbiological findings. Endotracheal suction aspirate (ETSA) is the commonest respiratory sample sent for culture from intubated patients. Very few studies have compared quantitative and semi-quantitative processing of ETSA cultures for LRTI diagnosis. We determined the diagnostic accuracy of quantitative and semi-quantitative ETSA culture for LRTI diagnosis, agreement between the quantitative and semi quantitative culture techniques and the yield of respiratory pathogens with both methods.
Methods: This was a cross-sectional study conducted at the Aga Khan University clinical laboratory, Karachi, Pakistan. One hundred and seventy-eight …

Clinical Presentation, Cardiac Magnetic Resonance Findings, And Prognosis Of Patients With Arrhythmogenic Right Ventricular Cardiomyopathy - An Experience From Pakistan, Intisar Ahmed, Fateh Ali Tipoo Sultan

Section of Cardiology

Objectives: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart-muscle disease, characterized by fibro-fatty replacement and ventricular arrhythmias, that primarily affects the right ventricle (RV). We aimed to look at the clinical presentation, cardiac magnetic resonance (CMR) imaging findings and prognosis of patients with ARVC in Pakistan.
Material and methods: It is a retrospective observational study, 17 consecutive patients with CMR and other findings consistent with ARVC, were enrolled from 2010 to 2019 at a single center.
Results: Out of 17 patients, 12 (70.6%) were male with a mean age of 33.5 ± 17.5 years. Family history of sudden cardiac …

Invasive Pulmonary Infection By Syncephalastrum Species: Two Case Reports And Review Of Literature, Memoona Irshad, Nosheen Nasir, Urooj Haider Hashmi, Joveria Farooqi, Syed Faisal Mahmood

Section of Internal Medicine

Background: Syncephalastrum species belong to the class Zygomycetes and order Mucorale. These are found in the environment and tropical soil, usually presenting as colonizers and rarely cause human infection. Syncephalastrum racemosum is a species of the genus Syncephalastrum and is the most commonly identified pathogen. Most cases are reported in immunocompromised individuals, such as patients on long term steroids, poorly controlled diabetes, or patients with malignancy.
Case presentation: We are describing two cases of rare fungal infection by Syncephalastrum species causing invasive pulmonary manifestation. Both patients had compromised immune status and presented with worsening dyspnea to the emergency room. Both …

Molecular Characterization Of Multidrug-Resistance In Gram-Negative Bacteria From The Peshawar Teaching Hospital, Pakistan, A. Masseron, L. Poirel, B. Jamil Ali, M. A. Syed, P. Nordmann

Section of Pulmonary & Critical Care

Extended-spectrum β-lactamases, carbapenemases, 16S rRNA methylases conferring pan-drug aminoglycoside resistance and colistin resistance were investigated among Gram-negative bacteria recovered from clinical samples (infections) from 200 individuals hospitalized at the Khyber Teaching Hospital of Peshawar, north Pakistan, from December 2017 to March 2018. Out of 65 isolates recovered, 19% were carbapenem resistant and 16% carried a bla NDM-1 gene, confirming the widespread distribution of NDM producers in this country. The association of the NDM carbapenem-resistance determinant, together with the extended-spectrum β-lactamase CTX-M-15 and 16S rRNA methylases, was frequent, explaining the multidrug-resistance pattern observed. All isolates remained susceptible to colistin.

Identification Of Policy Priorities To Address The Burden Of Smokeless Tobacco In Pakistan: A Multimethod Analysis, Kamran Siddiqi, Ziauddin Islam, Zohaib Khan, Faraz Siddiqui, Masuma Mishu, Omara Dogar, Vandana Shah, Javaid Khan, Subhash Pokhrel, Romaina Iqbal

Section of Pulmonary & Critical Care

Introduction: We assessed the magnitude of smokeless tobacco (ST) use in Pakistan and identified policy gaps to help ascertain short-, medium-, and long-term priorities. We then elicited stakeholders' views as to which of these identified priorities are most important.
Methods: In a multimethod study, we: analyzed Global Tobacco Surveillance System data sets to estimate ST consumption and disease burden; conducted a documentary review to identify gaps in policies to control ST in comparison with smoking; elicited stakeholders' views in an interactive workshop to identify a set of policy options available to address ST burden in Pakistan; and ranked policy …

Epidemiology Of Asthma And Associated Factors In An Urban Pakistani Population: Adult Asthma Study-Karachi, Shama Razzaq, Asaad Ahmed Nafees, Unaib Rabbani, Muhammad Irfan, Shahla Naeem, Muhammad Arslan Khan, Zafar Fatmi, Peter Burney

Community Health Sciences

Background: This study was conducted in order to determine the prevalence of asthma and associated risk factors in the adult population of Karachi, Pakistan.
Methods: This multi-stage, cross-sectional survey was conducted from May 2014-August 2015; comprising 1629 adults in 75 randomly selected clusters in Karachi, Pakistan. Definitions included: 'self-reported asthma', 'reversibility in FEV₁^' and 'respiratory symptoms and reversibility in FEV₁'.
Results: Prevalence of asthma was 1.8% (self-reported) (95% CI: 1.0-2.6), 11.3% (reversibility in FEV₁) (95% CI: 9.4-13.3) and 6.6% (symptoms and reversibility in FEV₁) (95% CI: 5.1-8.1). Asthmatics were more likely to …

Factors Associated With Month 2 Smear Non-Conversion Among Category 1 Tuberculosis Patients In Karachi, Pakistan, Kimberly A. D'Souza, Syed M A. Zaidi, Maria Jaswal, Shahid Butt, Saira Khowaja, Shifa Salman Habib, Amyn A. Malik

Community Health Sciences

Predictors of smear non-conversion at baseline can help identify cases at risk for failure of tuberculosis treatment. Retrospective data for smear-positive Category 1 patients in Karachi, Pakistan, was analyzed. Predictors of sputum conversion were determined using multiple logistic regression with sputum conversion as outcome variable and patient demographics, baseline weight, baseline sputum smear grade, case-finding approach as explanatory variables. Age ≥35 years, baseline sputum grade of 3+ were significantly associated with predicting sputum smear positivity at month 2 of treatment. Monitoring compliance to TB treatment should be considered amongst older patients and those with a high sputum grade at baseline.

Identifying Constraints For Hospital Infection Control Management Via Mckinsey 7s Framework In Pakistan, Shagufta Perveen, Shifa Salman Habib

Community Health Sciences

Background: In Pakistan, structured guidelines for hospital infection control and prevention are deficient in most public sector facilities. There is dearth of literature available on management of hospital-care acquired infections and related issues. This study aims to understand infection control management as a proxy measure for quality of health care provided at a public sector tertiary care hospital in Karachi, Pakistan. In this study, we identify barriers to implementation of infection control measures and highlight key areas for quality improvement.
Methods: A cross sectional study was carried out in 2008 using qualitative research methods. In-depth interviews were conducted with hospital …

Emergence Of Fluoroquinolone Resistance Among Drug Resistant Tuberculosis Patients At A Tertiary Care Facility In Karachi, Pakistan, Syed Mohammad Asad Zaidi, Abdul Haseeb, Shifa Salman Habib, Amyn Malik, Saira Khowaja, Nausheen Saifullah, Nadeem Rizvi

Community Health Sciences

Background: Pakistan is classified as one of the high multi-drug resistant tuberculosis (MDR-TB) burden countries. A poorly regulated private sector, over-prescription of antibiotics and self-medication has led to augmented rates of drug-resistance in the country. Pakistan's first national anti-tuberculosis drug resistance survey identified high prevalence of fluoroquinolone resistance among MDR-TB patients. Further institutional evidence of fluoroquinolone drug-resistance can support re-evaluation of treatment regimens as well as invigorate efforts to control antibiotic resistance in the country.
Findings: In this study, data for drug-susceptibility testing (DST) was retrospectively analyzed for a total of 133 patients receiving MDR-TB treatment at the Chest Department …

Assessing Decision Of Inpatient Or Outpatient Care In Community Acquired Pneumonia: Apt Care Study, Saleem Ullah, Javaid Khan, Amanullah Khan, Irfan Hashemy

Section of Pulmonary & Critical Care

Objective: To estimate the proportion of community-acquired pneumonia patients with disagreement between Confusion, Uraemia, Respiratory rate, Blood pressure, age > 65 years recommendation and physician\\\'s decision to hospitalise or not.
Methods: This cross-sectional nation-wide, non-interventional, cross-sectional study was carried out across 10 cities of Pakistan from December 2011 to May 2012, and recruited consenting adult patients with confirmatory diagnosis of community-acquired pneumonia on chest X-ray. Confusion, Uraemia, Respiratory rate, Blood pressure, age > 65 years recommendation for each patient was determined at the time of analysis. This recommendation was compared with treatment decision made by the physician. Disagreement was considered when the …

Tobacco Control Laws In Pakistan And Their Implementation: A Pilot Study In Karachi, Javaid Ahmed Khan, Abdul Malik Amir Humza Sohail, Muhammad Arslan Arif Maan

Section of Pulmonary & Critical Care

Objective: In order to limit the high prevalence of tobacco use in Pakistan various tobacco control laws have been implemented. The objective of this study is to serve as a pilot study to assess the implementation of these laws in the largest city of Pakistan, Karachi.

Methods: A cross-sectional study was conducted in Karachi. The implementation of tobacco control laws in 'smoke-free' places, the adherence of tobacco companies to these laws, the regulation of cigarette sale, and the awareness and views of the general public regarding tobacco control laws were assessed via direct observation by visits and through self-administered …

How Well Can Physicians Manage Tuberculosis? A Public-Private Sector Comparison From Karachi, Pakistan, Maliha Naseer, Ali Khawaja, Amin S. Pethan, Salik Aleem

Community Health Sciences

Background: Tuberculosis (TB) is endemic in Pakistan which ranks fifth amongst the twenty two countries designated to be highly burdened by TB according to the World Health Organization. However, there is paucity of data regarding the knowledge of diagnosis of TB and its management amongst public and private practitioners. In this study, we endeavor to identify this gap in knowledge regarding the diagnosis and management of TB between public and private doctors and the factors affecting these knowledge scores in urban Pakistan.
Methods: This cross sectional survey was conducted between June and December 2011. Doctors from public hospitals, private hospitals …

Cross-Sectional Study Identifying Forms Of Tobacco Used By Shisha Smokers In Pakistan, Sameer-Ur-Rehman, Mohammed Ali Sadiq, Maria Adnan Parekh, Ali Bin Sarwar Zubairi, Philippe. Frossard, Javaid Khan

Section of Otolaryngology, Head & Neck Surgery

Objectives: To estimate the frequency of different forms of tobacco intake such as smoker's tobacco, chewable tobacco and snuff tobacco among shisha smoker's and to study the patterns and predictors of shisha smoking affecting youth from different cities of Pakistan.
Methods: A cross-sectional study was conducted including youth from four cities. Participants were asked to fill out a data collection tool at shisha cafes, shopping malls and restaurants. Data was analyzed using SPSSv.18.
Results: A total of 406 participants, 296 (73%) males and 110 (27%) females were included in the study. There were 163 (40%) cigarette smokers; 65 (16%) chewed …

Cross-Sectional Study Identifying Forms Of Tobacco Used By Shisha Smokers In Pakistan, Sameer Ur Rehman, Mohammed Ali Sadiq, Maria Adnan Parekh, Ali Bin Sarwar Zubairi, Javaid Khan, Philippe M. Frossard

Department of Medicine

Objectives: To estimate the frequency of different forms of tobacco intake such as smoker's tobacco, chewable tobacco and snuff tobacco among shisha smoker's and to study the patterns and predictors of shisha smoking affecting youth from different cities of Pakistan.
Methods: A cross-sectional study was conducted including youth from four cities. Participants were asked to fill out a data collection tool at shisha cafes, shopping malls and restaurants. Data was analyzed using SPSSv.18.
Results: A total of 406 participants, 296 (73%) males and 110 (27%) females were included in the study. There were 163 (40%) cigarette smokers; 65(16%) chewed tobacco …

Clinical Characteristics, Management And Outcome Of Major Pulmonary Embolism: An Experience From A Tertiary Care Center In Pakistan, Shahid Javed Husain, Ali Bin Sarwar Zubairi, Kulsoom Fatima, Muhammad Irfan, Muhammad Atif, Muhammad Ammad Saeed

Department of Medicine

Objective: To evaluate the clinical characteristics, risk factors, management and outcome of major pulmonary embolism (PE) in a tertiary care center of Karachi.
Methods: Medical records of all patients who underwent a spiral CT scan of the chest for suspected pulmonary embolism were reviewed between January 2000 and June 2007 at the Aga Khan University Hospital, Karachi. Patients having evidence of major pulmonary embolism on spiral CT scan were selected.
Results: A total of 30 patients (10 males, 20 females) with mean age 52 ± 14.59 years were identified who fulfilled our predefined criteria for major pulmonary embolism. Risk factors …

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 …

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 …