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.

/pdf/time-for-culture-conversion-and-its-associated-factors-in-27soj09l.pdf

Time for culture conversion and its associated factors in multidrug-resistant tuberculosis patients at a tertiary level hospital in Peshawar, Pakistan

Introduction and development of aluminium ion free silicate based bioactive glass ionomer cement based on glass flakes and setting modifier (citrate) for direct posterior dental restorations

Background: Clinically significant microbes have evolved over time and developed such mechanisms to protect themselves from synthetic drugs. This study aims to determine the antimicrobial activity of culinary condiments against multi-drug resistant clinical pathogens. 
Methodology: The antimicrobial activity of Allium sativum (garlic) and Zingiber Officinale (ginger) was assessed against clinical pathogens such as E. coli, P. aeruginosa, and S. aureus. with the aid of wet experiments, namely disc diffusion method, and well agar technique. 
Results: It was observed that both A. sativum and Z. officinale in their neat form were very effective against tested pathogens ranges from 16 ± 0.623 mm to 36 ± 0.816 mm and 19 ± 0.707 to 20 ± 1.414 mm respectively as compared to the other concentrations with peptone water and distal water. However, extract A. sativum showed more antibacterial strength than Z. officinale. 
Conclusion: Natural antimicrobial agents obtained from herbs and spices could be effective alternatives to treat various infections with minimum to no side effects.

In-Vitro evaluation of antimicrobial activity of Allium sativum and Zingiber Officinale against multi-drug resistant clinical pathogens.

Objective: The present study aimed to determine the frequency of anemia in patients with pulmonary TB presenting at Nishtar Hospital Multan and its classification as per the severity and morphological characteristics.&#x0D; Methods: This retrospective cross-sectional study was conducted at Nishtar Hospital Multan. A total of 109 TB patients were enrolled and underwent physical and systemic examination. Blood samples were collected to estimate complete blood counts (CBC), liver and renal function tests (LFT; RFT), serum albumin, and C - reactive protein (CRP) levels. Abdominal ultrasound was performed when suspected of any organomegaly. Hemoglobin was estimated using an automated analyzer (SYSMEX-SP100) and repeated manually among doubted cases. Before inclusion, written informed consent was obtained from all patients before inclusion, and the collected data was analyzed using SPSS version 22.0.&#x0D; Results: The female majority (54%) in the studied sample, with a mean age of 38 ± 15.3 years, and most belonged to low socioeconomic status (80%). Moreover, 43% were from Multan, 30% from D.G. Khan, and the remaining were from Khanewal, Layyah, and Vehari districts. Anemia was found in 82.56% of the enrolled TB patients. Most patients were moderately weak (Hb &lt; 10 g/dl &gt; 7 g/dl), and microcytic anemia was found in more than 80% of the anemic patients. CRP level was raised in 70% of these patients, and there was hypoalbuminemia in 80%. Furthermore, females were more anemic than males.&#x0D; Conclusion: In our study, anemia was prevalent in TB patients, specifically microcytic anemia. Hence, TB patients must be monitored for dietary deficiencies and inflammatory modulators to avoid such complications 

pdf/frequency-of-anemia-in-patients-with-pulmonary-tb-presenting-136373bf96.pdf

Frequency of anemia in patients with pulmonary TB presenting at Nishtar Hospital Multan

Background: Tuberculosis affects millions of people across the globe annually. Pakistan is ranked 5th among the leading TB countries in the world. Anemia is a common observation among TB patients with the multifactorial phenomenon. The present study aimed to determine the frequency of anemia in patients with pulmonary TB and its classification as per the severity and morphological characteristics. Methodology: This retrospective cross-sectional study was conducted at DHQ Hospital Timergara, Lower Dir. A total of 109 TB patients were enrolled and underwent physical and systemic examination. Blood samples were collected to estimate complete blood counts (CBC), liver and renal function tests (LFT; RFT), serum albumin, and C-reactive protein (CRP) levels. Abdominal ultrasound was performed when any organomegaly was suspected. Hemoglobin was estimated using an automated analyzer (SYSMEX-SP100), and it was repeated via manual method among doubted cases. Written informed consent was obtained from all patients before inclusion, and the collected data was analyzed using SPSS version 22.0. Results: There was a female majority (54%) in the studied sample, with a mean age of 38 ± 15.3 years. Majority of them belonged to low socioeconomic status (80%). Moreover, 43% of them were from Dir Lower, 30% from Dir Upper, while the remaining were from Bajaur district, Chitral, and Malakand Swat districts. Anemia was found in 82.56% of the enrolled TB patients. Most patients were moderately weak (Hb &lt; 10 g/dl &gt; 7 g/dl), and microcytic anemia was found in more than 80% of the anemic patients. CRP level was raised in 70% of these patients, and there was hypoalbuminemia in 80%. Furthermore, females were more anemic than males. Conclusion: In our study, anemia was prevalent in TB patients, specifically microcytic anemia. Hence, TB patients must be monitored for dietary deficiencies and/or inflammatory modulators to avoid such complications. 

Frequency of anemia in patients with Pulmonary Tuberculosis.

Background: The high burden of multi-drug resistance tuberculosis (MDR TB) is a matter of great concern.  The increasing resistance to anti tuberculosis drugs has been the area of growing concern and are posing threats to TB control. The aim of this study was to evaluate the drug resistance patterns for the first line and second line anti-Tuberculosis drugs in multiple drug resistant tuberculosis (MDR-TB) patients.
Method: The study was retrospective, observational, employing purposive, non-random sampling technique for data collection conducted at the TB Clinic- of the different healthcare centers in the provinces of Pakistan Sindh and Baluchistan from December 2010 to May 2016. All bacteriologically confirmed TB patients who were found to be Rifampin Resistant (RR) on Genotypic drug susceptibility testing (GXP), or detected to be drug resistant on phenotypic Universal drug susceptibility testing were enrolled into the study.
Results: Out of total 3776 patients, 96.3% were resistant to Rifampicin and 94.7% were resistant to Isoniazid. 25.5% isolates were resistant to all five first line drugs. Resistances against Pyrazinamide and Ethambutol was 54.2% and 51.6% respectively. 36.3% patients were resistant to Fluoroquinolones (FQ), 9.7% were resistant to Ethionamide (Eto) and 4.1% were resistant to both FQ and Eto. 33.5% patients were MDR plus resistant to FQ.  However, the resistance to both FQ plus Aminogycosides was quite low, 2.7%.
Conclusion: The drug resistance rates are quiet high in MDR-TB for both first line and second line drugs. The standardized MDR TB regimen needs to be updated, based on the prevalence of drug resistance patterns in the community for the effective management of drug resistant TB.

/pdf/resistance-patterns-among-multidrug-resistant-tuberculosis-eedi4t5juw.pdf

Resistance Patterns among Multidrug-Resistant Tuberculosis Patients: A Multi-Center Study from Pakistan

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Resistance Patterns among Multidrug-Resistant Tuberculosis Patients: A Multi-Center Study from Pakistan