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Background: Tuberculosis (TB) is the world's tenth most common cause of death, and it continues to be a serious global health problem, generating considerable morbidity and mortality. According to the World Health Organization (WHO) Global Tuberculosis Report 2020, there were an estimated 10 million new tuberculosis cases and 1.4 million tuberculosis deaths globally in 2019. TB incidence and mortality rates have decreased since the WHO end TB Strategy was adopted in 2014; nonetheless, the rate of decline has been far slower than predicted, highlighting the need for better, more focused implementation of this strategy. Objectives: To determine the comparative sensitivity of smear microscopy (SM) for acid fast bacilli (AFB) versus Gene Xpert MTB/RIF assay on endobronchial washings of the Sputum Smear Negative/Sputum scarce patients with suspected Pulmonary tuberculosis (PTB) keeping culture as gold standard. Methodology: This Cross-sectional validational study was carried out in the Department of Pulmonology, Ayub Teaching Hospital Abbottabad, Pakistan from 28th March to 28th September 2022. All patients of any gender having age 20 to 75 years with TB who were sputum smear negative or had scare sputum were included. Patients who were already diagnosed as PTB and those who were already on anti tuberculous treatment were excluded. Results: Mean age of the patients was 47.02±14.65 years ranging from 20 to 75 years with 44(50.6%) males and 43(49.4%) females. In comparative sensitivity of Gene Xpert with respect to culture as gold standard the sensitivity of Gene Xpert was 93.24% while its specificity was 84.62% with positive predicted value (PPV) of 97.18%, negative predicted value (NPV) of 68.75% and accuracy of 91.95%. In comparative sensitivity of AFB SM with respect to culture as gold standard, the sensitivity of SM was 74.32% and specificity was 53.85%, PPV was 90.16%, NPV was 26.92% and the accuracy was 71.26%. Conclusion: Gene Xpert is more sensitive than SM to detect mycobacterium TB and rifampicin resistance. Gene Xpert can be utilized for earlier detection of rifampicin resistant TB cases on the endobronchial washings while waiting for detailed culture results in suspected PTB cases having either sputum negative or sputum scarce disease. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article discusses the potential role of vitamin D as an adjunctive therapy for multidrug-resistant tuberculosis (MDR-TB) and its implications for improving treatment outcomes. It also discusses the impact of vitamin D on immune response, the mixed results from clinical trials on vitamin D supplementation, and the need for further research to determine optimal dosing and patient selection.

Background: Pulmonary Tuberculosis (PTB) is a chronic infectious disease caused by mycobacterium tuberculosis. PTB remains a global health problem with an enormous burden of disease. It is a preventable disease and the associated mortality is reduced in recent few decades but it still remains one of the top ten causes of death globally. It has enormous psychological and social effects on affected individuals. A lot of patients develop depression during illness which can be managed in a better way with timely intervention. The present study was conducted to determine the frequency of depression in pulmonary tuberculosis patients. Methodology: This descriptive, cross-sectional study was conducted at Pulmonology Department of a tertiary care teaching hospital in Pakistan from January 2020 till July 2020. Patients of both genders and age between 20-80 years having PTB with duration of 5 months or more were enrolled for study. Each patient underwent history, clinical examination and sputum microscopy, Gene Xpert and mycobacterial culture for the diagnosis of PTB. Depression was diagnosed using Hospital Anxiety and Depression Scale (HADS). All the above mentioned information along with age, gender and address was recorded on a proforma. Data was entered into SPSS version 24 for analysis. Depression was stratified among age and gender. Post stratification chi square test was used at 5% level significance. Results: Out of total 225 patients 35% were in age range 20-40 years, 46% in age range 41-60 years and 19%in age range 51-80 years. Mean age of the participants was 41 (± 14.49) years. There were 155 (69%) male patients while 70 (31%) patients were females. Mean weight was 63 ( ± 11.45) Kg. Depression was diagnosed in 19% (n=43) patients while 81% (n=182) patients had no depression. Conclusion: The frequency of depression was 19% in patients presenting with pulmonary tuberculosis. Proper assessment of these patients is required for timely diagnosis and management of depression in order to reduce the problems of these TB patients. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD), is linked to the development of depression. Depression is a prevalent mental health disorder that causes a lot of emotional distress as well as functional damage. The goal of this study was to find out how often depression is and how severe it is in patients with COPD. Methodology: A descriptive cross-sectional research was carried at department of Pulmonology, Ayub Teaching Hospital (ATH) Abbottabad, Pakistan from July 2019 to June 2020. In this study, a total of 179 COPD patients who visited this unit for the purpose of diagnosis and treatment of COPD was enrolled in the study. Patients were asked to complete the Becks Depression Inventory-13 (BDI-13) questionnaire after a thorough medical history and physical examination. To obtain final score, all the answers were marked. All data was entered into a Microsoft Excel spreadsheet before being transferred to SPSS version 24 for analysis. For the purposes of analysis, a percentage and chi square test were used. Results: Out of total 179 study cases, 59 (32.96%) were found to have depression. The majority of depressive patients (n=48) were mild/moderately depressed. The Chi square test was done to find out any possible significant association between age and gender with COPD. After analysis, it was observed that there was no significant association found between age and gender and level of depression among study COPD patients. Positive significant level was defined as a P-value of less than 0.05. Conclusion: Psychiatric disorders are among the most common health problems in the world. Depression is one of the most common psychological problems that COPD patients confront. According to the findings, there was a high prevalence of depression among the study participants. This research also implies that a thorough assessment of the severity of depression and its related risk factors will take some time. Early diagnosis and meticulous evaluation may aid in the treatment of depression in COPD patients, and this must be included in and may be a component of their overall care. [ABSTRACT FROM AUTHOR]

The article focuses on the profound impact of stigma-related depression in multidrug-resistant tuberculosis (MDR-TB) patients, highlighting the urgent need for holistic care. Topics discussed include the dual burden of MDR-TB and stigma, the multi-dimensional nature of stigma, and strategies for addressing stigma-related depression through awareness, mental health screening, and empowerment of patients.

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 atPMDTLRH. Results: This study was conducted fromJuly 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 MDRTB 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. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is one of the diseases causing high rate of morbidity and mortality worldwide. Amongst high TB burden countries Pakistan ranks fifth, with an estimated new TB cases of 510,000 emerging 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 nonrespiratory samples. Rifampicin resistance detected in 2 pulmonary samples (1.45%) and nil (0%) in non-respiratory samples. Conclusion: The possible reason of low prevalence rate of resistance to Rifampicin in current study is due to 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. [ABSTRACT FROM AUTHOR]

Background: Resistance to the first-line drugs is a major issue in tuberculosis (TB) control. Globally 20% of previously treated TB cases have been reported to have multi-drug resistant tuberculosis (MDR-TB). Pakistan is among the top high TB burden countries with an annual incidence of 270 per 100,000 and estimated to have more than 13000 MDR-TB cases. In the province of Khyber Pakhtunkhwa (KPK) the annual incidence of TB is around 55,000 out of which around 5% are retreatment cases. So a survey was needed to determine prevalence of MDR-TB in KPK. Objectives: Objective of the present study is to find out the prevalence of MDR-TB among previously treated (Category II) pulmonary tuberculosis patients in the province of Khyber Pakhtunkhwa, Pakistan. Methodology: A total of 131 cultures positive retreatment patients were included in this cross sectional study. Drug susceptibility testing with Isoniazid, Rifampicin, Streptomycin, Ethambutol and Pyrazinamide were performed with standard technique. Results: Of the 131 patients, 54 (41.2%) showed resistance to one or more drugs. Resistance with isoniazid and rifampicin [MRD-TB] was seen in 20 patients (15.3%). Resistance to streptomycin was highest (31.3%), followed by isoniazid (26.0%). Conclusion: The result of this study showed prevalence of drug resistance of 41.2% and MDR-TB of 15.3% with the first line ATT among retreatment cases of pulmonary tuberculosis. [ABSTRACT FROM AUTHOR]

Background: Occurrence of Tuberculosis (TB) in the form Multidrug Resistant TB (MDR-TB) poses challenges to the health systems throughout the world. Familiarities with risk factors related to disease transmission and exact rate of disease can be used to decrease the infection rate and control of disease. Objective: Present study was conducted with the aims to find out rate and factors responsible for the occurrence of MDR- TB in a tertiary care hospital Peshawar, Khyber Pakhtunkhwa. Methodology: This is a cross sectional descriptive study conducted at PMDT Unit, Lady Reading hospital Peshawar, Pakistan with time duration of six months form February 2018 to August 2018. Data of interest through special designed proforma were collected from all suspected cases visited this unit for their checkup. Data was then entered into Microsoft excel sheet and transferred into SPSS software for analyses purposes. Results: A total of 846 respondents were included in this study including 429 (50.7%) females and 417 (49.3%) males. Majority of the cases 455 (53.7%) were in most gainful age group of > 42 years. Urbanized population accounted for 411 (48.5%). Majority of the respondent lacked education and conjugal status indicated 592 (69.9%) of married participants. Our result found that association between uneducated participants were 69% more likely to contract MDRTB than those who were illiterate (OR = 1.693, 95% CI [.976-2.938], P = .059). Participants residing in urban areas have 60% lower chances of MDR-TB than rural once. Close contact of patients with MDR-TB has also showed association within increase and occurrence of disease. Conclusion: The patients of TB and MDR-TB are already suffered a lot by the myths and stigmas that surround the illness. It is highly recommended the community that only food and shelter is not enough, the patient required full support of family and colleagues need full guidance and counseling. Provide financial and practical support for the treatment of disease. All suspected cases with lower education level, residence of far flung areas and close contact of MDR-TB must nominated as special cases for disease occurrence and treated as special cases to stop and cut the chain of this disease. [ABSTRACT FROM AUTHOR]

The article focuses on the role of D-Dimer, a protein fragment indicative of clot breakdown, in unraveling the complexities of COVID-19, highlighting its significance as an indicator, prognostic tool, and monitoring parameter. Topics discussed include the understanding of D-Dimer as a marker of coagulation processes, its early warning signal for disease progression in COVID-19 patients, and its use in predicting disease severity and monitoring treatment response.