Pakistan Journal of Chest Medicine

Impact of Co-morbidities on Treatment Outcome of Multidrug-Resistant Tuberculosis in Khyber Pakhtunkhwa

2024-10-25T14:02:02-04:00

Introduction

In the ongoing battle against both drug-susceptible and drug-resistant tuberculosis (DR-TB), multi-morbidity is becoming more and more acknowledged as a severe public health hazard.

Co-morbidities should be adequately handled while treating MDR tuberculosis by enlisting the help of specialists from other fields.

Objective

To analyze various co-morbidities and its effect on final outcome of multi-drug resistant tuberculosis patients.

Materials and methods:

Study design and settings: This prospective descriptive study was carried at department of pulmonology, Lady Reading Hospital, Peshawar, from 1^st June 2021 till 30^th May 2022. Sampling: A total of 157 participants with multi-drug resistant tuberculosis were registered which was confirmed based on PCR reporting resistance of the pathogen towards isoniazid and rifampicin. Co-morbidities were assessed in terms of diabetes mellitus, COPD, HIV and CKD. Analysis: Data analysis was performed using SPSS version 24.

Results

Male to female ratio was 1.7: 1. Age of the patients ranged from 20 to 60 years with mean age of 39. 37 ± 6.143 years. Mean BMI of the patients was 23.285 ± 2.5843 kg/m². Diabetes mellitus was the most frequent comorbidity observed in 48 patients (30.6%), followed by COPD in 33 patients (21.0%). This study showed that successful outcome of the study cases was 112 (71.4%) and unsuccessful outcome was 45 (28.6). Crosstabulation between comorbidities and final outcome showed that positive significant association was found among comorbidities and unsuccessful outcome (P-value <0.005)

Conclusion

Comorbidity is common among multidrug-resistant tuberculosis individuals in our local population. The most common concurrent illnesses is diabetes mellitus. Authorities must explore the involvement of additional professions, particularly endocrinologists.

Effects of body weight changes on Treatment Outcomes among Multidrug-Resistant Tuberculosis Patients in Peshawar

2024-11-20T12:51:58-05:00

Background: Multidrug-resistant tuberculosis (MDR-TB) is a major global health concern, particularly in low-resource settings such as Peshawar, Pakistan. Nutritional status, reflected by body weight changes during treatment, is a critical factor influencing treatment outcomes.

Objective: This study examines the relationship between body weight changes and MDR-TB treatment outcomes to inform targeted interventions.

Methodology: A retrospective cohort study was conducted among 185 MDR-TB patients undergoing treatment in Peshawar. Patients were categorized based on weight changes during treatment: weight gain (>5%), stable weight, and weight loss (<5%). Final treatment outcomes were analyzed across these categories.

Results: Patients with weight gain ≥5 kg (32.4%) showed the highest treatment success rate (90.0%), with minimal failure (6.7%) and default (3.3%). Patients with weight gain 2–4.9 kg (21.6%) had a success rate of 80.0%, with failure and default rates of 15.0% and 5.0%, respectively. Stable weight (18.9%) was associated with a success rate of 68.6%, and higher failure (20.0%) and default (11.4%) rates. Weight loss 2–4.9 kg (16.2%) and ≥5 kg (10.8%) showed significantly poorer outcomes, with success rates of 50.0% and 40.0%, failure rates of 26.7% and 45.0%, and default rates of 23.3% and 15.0%, respectively.

Conclusion: Body weight changes significantly influence MDR-TB treatment outcomes. Weight gain during treatment is associated with improved recovery, while weight loss predicts higher rates of failure and mortality. Nutritional support should be integrated into MDR-TB treatment protocols to enhance outcomes, particularly in resource-limited settings like Peshawar.

Drug-Induced Liver Injury in Young Female with Primary Tuberculous Lymphadenitis Mimicking Lymphatic Malignancy: A Case Study

2024-02-16T06:45:16-05:00

Background: Drug-induced liver injury (DILI) is a side effect that is often found in tuberculosis (TB) treatment and interferes the effectiveness of treatment. Risk factors for DILI during treatment of pulmonary tuberculosis are age, gender, and comorbid conditions such as hepatitis and use of hepatotoxic drugs.

Case Report: A 22-year-old female presented with persistently enlarged, inflamed, painful right-sided neck swelling with purulent discharge for 7 months. The patient reported no history of comorbid diseases and risk factor other than passive smoking at home. Other symptoms are night sweats, loss of appetite, and significant weight loss. Initially, she was diagnosed with lymphatic malignancy, but after tissue sampling, she was diagnosed with tuberculous lymphadenitis without pulmonary TB based on histopathological examination, which revealed necrotizing granulomatous inflammation. GeneExpert was performed on sputum sample showing a negative result. The patient initially started first-line anti-TB therapy consisting of isoniazid, rifampin, pyrazinamide, and ethambutol. After 58 doses, the patient developed complaints of decreased appetite, nausea, and vomiting, without any improvement of the neck lumps. Laboratory results showed significant increase of ALT and AST. We diagnosed the patient with DILI and anti-tuberculosis drugs were stopped temporarily.

Discussion: We present a unique case of a young woman, without comorbid chronic disease, with TB-lymphadenitis and DILI. DILI is a major side effect in TB treatment, causing therapy failure due to the non-adherence of treatment. A number of cohort studies have shown that the risk factors for DILI in patients receiving TB treatment are age>35 years, male gender, and history of comorbid disease such as hypertension and diabetes.

Personalized Pleural Biopsies: Advancing Precision in Pleural Disease Diagnosis

2024-09-29T07:00:44-04:00

The diagnosis of pleural disease, particularly in cases of malignant pleural effusion, remains a clinical challenge due to the limitations of traditional fluid analysis. Emerging evidence supports the use of pleural biopsies, with thoracoscopic biopsy recognized as the gold standard, offering superior diagnostic sensitivity. However, image-assisted needle biopsies, such as ultrasound-guided procedures, provide a valuable alternative for patients who cannot undergo thoracoscopy, achieving similar diagnostic yield in select cases. This personalized approach to biopsy selection - guided by imaging findings and molecular diagnostics - allows for enhanced diagnostic precision, especially in the era of precision oncology, where molecular profiling is increasingly essential for treatment planning. Future research will focus on optimizing biopsy strategies to further refine pleural disease diagnostics, ensuring individualized patient care.

China's tobacco smoking epidemic: prevalence, illness load, obstacles, and future plans

2024-02-06T02:00:05-05:00

China accounts for almost one-third of worldwide tobacco production and consumption, and despite current tobacco control efforts, the smoking rate remains frighteningly high, with 350 million smokers and 740 million passive smokers. Alarmingly, more young people and women are becoming smokers. With 1.2 million fatalities linked to tobacco use each year, the related mortality rate is startling, and estimates indicate that number will rise to 2 million by 2025. The tobacco industry's strong opposition, sociocultural factors that encourage smoking start, a lack of public knowledge about the dangers of smoking, and insufficient government backing are all blamed for the ineffectiveness of the present tobacco control policies. Government commitments are required in order to carry out effective and urgent intervention activities. It is imperative to take comprehensive action at several levels, such as lowering the availability of tobacco products, raising taxes on tobacco products, improving public health education, restricting tobacco advertising, lowering secondhand smoke exposure, and offering strong support for quitting smoking. To address this important public health issue, the healthcare community should take the lead in anti-tobacco initiatives and actively participate in smoking cessation programs.