Background: Multidrug resistant tuberculosis(MDR-TB) is becoming a major threat to tuberculosis control programs in Ethiopia. Objectives: To determine risk factors of MDR-TB patients in Amhara National Regional State, Ethiopia. Methods: Case-control study was conducted from May 2013 to January 2014. Resistance to rifampicin and isoniazid were done molecularly using line probe assay. TB patients infected with MDR-M.tuberculosis and non MDR-M.tuberculosis strain were considered as cases and controls, respectively. Data was collected using structured questionnaire with face to face interview. Patients’ clinical record review was also done.Multivariate analysis was computed to determine the risk factors of MDR-TB. Results: A total of 153 MDR-TB and equal number of non MDR-TB patients’ participated in the study. Patients who had TB treatment failure (AOR=13.5,CI=2.69-70), cavitations on chest x-ray (AOR=1.9,CI=1.1-3.38) and contact with MDR-TB patients (AOR=1.4,CI=0.19-0.39) were more likely to be MDR-TB patients. Low monthly income (AOR=1.1,CI=0.34-0.47),alcohol consumption (AOR=1.5,CI=0.2-0.98) and young age (AOR=2.9,CI=1.07-7.68) were the other risk factors of MDR-TB. Conclusions: TB treatment failure, cavitation on chest X-ray, contact with MDR-TB patients and low socioeconomic status were important risk factors for development of MDR-TB. Therefore, strict adherence to directly observed therapy, appropriate management of TB patients and advice on the value of nutrients are helpful to control the spreading of MDR-TB.

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Risk factors for multidrug resistant tuberculosis patients in Amhara National Regional State.

Multidrug-resistant Mycobacterium tuberculosis and associated risk factors in Oromia Region of Ethiopia.

Acinetobacter baumannii is a Gram-negative bacteria associated with hospital-acquired infections. Definitely, antimicrobial resistance and biofilm formation capabilities of clinical isolates have threading potential to persistence in the hospital environment and colonization on medical equipment. Twenty-seven multidrug-resistant clinical isolates were selected from a collection of A. baumannii samples isolated from clinical settings. PCR assays showed the frequencies of genes related to biofilm formation: ompA (100%), bap (30%) and blaPER-1 (44%). Polyclonal antibodies against recombinant AbOmpA8-346 and Bap1-487 proteins were obtained by the mouse immunization method. Western blotting revealed all isolates expressed AbOmpA and only eight isolates were positive for Bap factor. Two strains that had their bap gene disrupted with ISAba125 did not express Bap protein. Our findings showed that all double-negative bap/blaPER-1 isolates were recovered from the bloodstream and had low biofilm formation capabilities, and mostly belonged to type D wrinkled colony morphology. However, clinical isolates extracted from the throats of patients were blaPER-1-positive and had a great capacity to form biofilm, and also mostly belonged to type C wrinkled colony morphology.

Molecular detection of genes related to biofilm formation in multidrug-resistant Acinetobacter baumannii isolated from clinical settings.

Multi Drug Resistant Tuberculosis (MDR-TB)

OBJECTIVE To determine the prevalence and resistance pattern of multidrug-resistant tuberculosis. METHODS This cross-sectional study was carried out from January 2010 to June 2014 in nine tertiary care hospitals implementing programmatic management of drug-resistant tuberculosis in Punjab, and comprised retreatment tuberculosis cases. Data was collected from the Electronic Nominal Review System. SPSS 17 was used for data analysis. RESULTS Of the 1,250 cases, 861(69%) were of multidrug-resistant tuberculosis confirmed through drug sensitivity testing. The mean age was 32 (±13.5 SD) years. Besides, 664(53%) were males and 1,208(97%) resided in urban areas of Punjab. Multidrug-resistant tuberculosis was found to be more prevalent in the most productive age group, i.e. 15-45 years, with 709(57%) cases (p<0.05), in urban areas1, 208(97%) cases (p<0.05) and in the pulmonary site 852(68%) cases (p<0.05). Overall, 391(41%) cases showed resistance to all first-line anti-tuberculosis drugs while 239(28%) showed resistance to oral first-line drugs. Besides, 526(42%) cases showed resistance to fluoroquinolones and 650(52%) to second-line drugs. Of them, 420(81%), (p<0.05) patients showed highly significant resistance to fluoroquinolones and 26(5%) to ethionamide. CONCLUSIONS There is a need to fully implement national tuberculosis guidelines with a focus on expansion and effective implementation of directly observed therapy short course in order to prevent further emergence of drug resistance.

Prevalence and drug resistance pattern of MDR TB in retreatment cases of Punjab, Pakistan.

Objective To determine the frequency of common risk factors for multi-drug resistant tuberculosis in patients presented at a tertiary care hospital, Peshawar. Study design Cross-sectional, observational study. Place and duration of study Pulmonology Department, Khyber Teaching Hospital, Peshawar, from December 2006 to October 2007. Methodology Patients with positive AFB culture and sensitivity results and found resistant to both rifampicin and isoniazid with or with resistance to other first line anti-tuberculosis drugs, were recruited from both Pulmonology Ward and Outpatient Department (OPD). Informed verbal consent was taken and a questionnaire administered to all participants of the study. Information regarding demographics, education status, occupation, monthly household income, AFB C/S, details of past history of tuberculosis and family history of TB or Multi-Drug Resistant (MDR-TB) was recorded. Data was analyzed on SPSS version 11. Results A total of 30 patients of MDR-TB were interviewed. Male (n=17) and female (n=13) ratio was 1.3:1. Mean age was 34.2+/-15.3 years. Ninety-two percent female and 52.9% male were uneducated. In 56.7%, monthly income was less than 5,000 rupees and in 40% between 5,000-10,000 rupees. All patients had previous history of Antituberculous Treatment (ATT), in which 20% had undertaken ATT course once, 53.3% twice and 26.7% thrice in the past. In the study group, 13 (43.3%) patients had not completed their first ATT course and 11 of them were receiving ATT from a general practitioner (GP) at that time. Seven (23.3%) patients had family history of TB but no one had documented MDR-TB in the family. Resistance to RH was present in all patients; moreover, 56.7% had resistance to RHEZ+S. Conclusion The most common factors in the study group were previous history of tuberculosis, repeated courses of ATT, prescribed by different clinicians and unsupervised treatment by a GP during the initial course of ATT.

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Risk factors for multi-drug resistant tuberculosis in patients at tertiary care hospital, Peshawar.

Background: Tobacco use is becoming an epidemic in both sexes in Pakistan includingNWFP. Objective: To determine the factors leading to tobacco use among female tobacco users and to gain insight into their perception about tobacco related health hazards. Methods: A cross-sectional survey among female tobacco users. The sample was consecutive and informations were collected through a structured questionnaire via face to face interview. Results: Total of 89 female tobacco users were interviewed . The mean age of study population was 54.6% 13 yrs (range: 28-85).Out of 89, 91% were married,71% were housewives,76% were uneducated, 65% were current tobacco users, 35% ex-tobacco users and 46% had a family income of less than Rs. 5000/ month. Cigarette smokers were 25%, snuff users 66% whereas 8% had used huqqa. Sixty six percent of the educated females with family income of more than Rs. 10,000/ month were using cigarette whereas snuff use was more commonly in the uneducated females. Forty eight percent started using tobacco as a treatment for their medical illness whereas 15% stated that their husband's pursuation was a major factor for starting the tobacco use. Despite the fact that 64% were suffering from different tobacco related health problems, more than50%of the study population respectively disagreed with the statements such as; that tobacco causes cancer, breathing problems, teeth and gum problems, related to asthma, its use in public place is hazardous for non-users and cigarette smoke is injurious to health of pregnant women. Eighty four percent were unable to recall any reason for starting tobacco use but 61% of the study population was willing to quit this habit. Conclusion:  There is a lot of misconception about tobacco usefulness in certain medical conditions and the knowledge about tobacco related health hazards among female tobacco users is very low.

https://www.pjcm.net/index.php/pjcm/article/view/408/352

Female Tobacco Users: Causative Factors and their Perception about Tobacco health hazards

Background: Tuberculosis is a common disease and health education is essential for the patients and their relatives for effective treatment of the index case and prevention of infection spread among the relatives and others Objective & Methods: We conducted this cross-sectional study in the catchment population of Emergency Satellite Hospital (ESH) Nahaqi,a TB diagnostic & treatment centre, to assess the impact of different DOTS treatment modalities on the knowledge about TB and attitude of the patients and their relatives Results: Total of 133, 58 males and 75 females, patients and their attendants accepted the invitation to participate in the study Fifty seven percent were currently taking TB treatment, 43 had taken treatment in the past whereas 33 had never suffered from TB Out of 100 patients treated under DOTS program, 21, 25 and 54 had taken treatment under supervision of LHW, relative or self respectively Ninety two percent of the TB patients had taken treatment regularly with no interruption and none have defaulted Correct response for exact duration and free of cost availability of Anti Tuberculous treatment (ATT) was given by 93 and 98% of the study population Though 84% had the adequate knowledge about spread of TB bacilli but 6, 11 and 9% still think that handshaking, sharing utensils and I/V injections are also routes for getting or spreading infection Seventy four percent and 70% of the study population will visit doctor immediately if they develop joint pains or jaundice while taking ATT Conclusion: Despite the use of different DOTS modalities in the study sample, the knowledge about the disease in the patients and relatives is satisfactory

https://www.pjcm.net/index.php/pjcm/article/download/363/322

Naveed Khan

Papers

Risk factors for multi-drug resistant tuberculosis in patients at tertiary care hospital, Peshawar.

Female Tobacco Users: Causative Factors and their Perception about Tobacco health hazards

Community survey of knowledge and attitude of tuberculosis among tuberculous patients and their attendants in a rural setup