Mazhar Ali Khan

Characteristics and treatment outcomes of patients with multi-drug resistant tuberculosis at a tertiary care hospital in Peshawar, Pakistan

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.

Screening outcomes of household contacts of multidrug-resistant tuberculosis patients in Peshawar, Pakistan

OBJECTIVEnTo assess the profile of TB/multidrug-resistant TB (MDR-TB) among household contacts of MDR-TB patients.nnnMETHODSnClose 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.nnnRESULTSnBetween 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.nnnCONCLUSIONSnThe 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.

In-vitro Evaluation of Antimicrobial Branded Herbal Formulations for their Efficacy

In the present research work forty six herbal antimicrobial branded products were investigated for their antibacterial/antifungal activities using well diffusion method. Those herbal products were collected from local market which were manufactured by well-known herbal manufacturer and have clear recommendations against various microbial infections. These antimicrobial products were tested on the basis of pathogeneses caused by different microorganisms as indicated on the label. Among the tested branded formulations, only nine herbal preparations exhibited better antimicrobial activities, while rest of herbal formulations were devoid of antimicrobial effect. B34 and B30 demonstrated antibacterial activity when tested against Salmonella paratyphi. B18 was the only product, which showed activity against Pseudomonas aeruginosa. The pathogenic fungi Candida albican that causes various infections was sensitive to herbal products like B42, B41, B43 and B14 as like to their sensitivity to antifungal drug (Griseofulvin). The results of the present study indicated the poor quality of herbal products being sold in the market with very high label claims. Only 9 out of 46 sampled products with antimicrobial label claimed qualify to some extent for medicinal use. As any health authority (DRA/MOH) in Pakistan does not regulate the herbal products, there was no control or check on the manufacturers and prescriber of these medicines. All the tested products contained herbs, which had proven data for their antimicrobial activity, still most of them failed to produce any pharmacological results.

Depression and its Associated Factors with Multidrug-Resistant Tuberculosis at Baseline

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. nObjective: To assess frequency of depression and to identify factors associated with depression at baseline among MDR-TB patients in our centre. nMethod 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. nResult: 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. nConclusion: Gender, duration of illness, residence, co-morbidity and past TB treatment were associated and independent risk factors of depression.

Occurrence of adverse events in patient receiving community-based therapy for multidrug-resistant tuberculosis in Pakistan

IntroductionnPakistan 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).nnnMaterials and MethodsnThis 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.nnnResultnAt 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).nnnConclusionsnAdverse 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.

P115 Screening outcomes of household contacts of multidrug-resistant tuberculosis patients in peshawar, pakistan

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 emphasise the need for effective contact screening programme of index MDR-TB cases in order to cut the chain of transmission of this disease. References WHO. Multidrug resistant TB (MDR-TB): 2014 updated global report. Geneva: World Health OrganisationOrganization, 2014. WHO. Global tuberculosis report 2015. Geneva: World Health OrganisationOrganization, 2015. Khan MA, Mehreen S, Basit A, Khan RA, Javaid A. Predictors of poor outcomes among patients treated for multidrug-resistant tuberculosis at Tertiary Care Hospital in Pakistan. American-Eurasian J Toxicol Sci 2015;7(3):162–172.