Gulab Devi Chest Hospital Research Articles

Evaluation of serum electrolyte abnormalities in type II diabetic patients presenting in Gulab Devi hospital, Lahore

Background: The hallmark of diabetes mellitus (DM) is hyperglycemia brought on by an absolute or relative insulin shortage. Globally, the prevalence of DM is a major cause for worry. The International Diabetes Federation estimates that 26.7% of Pakistan's adult population would have diabetes in 2022, totalling over 33,000,000 cases 1. Patients with diabetes are more likely to experience electrolyte imbalances, which may be caused by an imbalance in the distribution of electrolytes. Electrolytes play a vital role in the maintenance of blood acid-base balance, composition of body fluids, blood clotting, muscle and nerve conduction. Impaired electrolytes balance in diabetics may lead to micro and macrovascular complications. Aims and objectives: The objective of this study is to investigate disturbances in serum electrolytes including Sodium (Na+), Potassium (K+) and Chloride (Cl) in Type II diabetics. Methodology: This has been a descriptive cross-sectional study where random sampling technique was used. 3cc clotted blood samples of 100 Type II diabetic patients were collected from diabetic OPD and medicine wards of Gulab Devi Chest Hospital Lahore and processed in the Pathology lab of Gulab Devi Educational Complex. Results: Out of 100 samples of type II diabetic patients, there were 65 patients in which serum sodium levels were decreased. Serum potassium and serum chloride were slightly increased in some patients. Conclusion: In this study, serum sodium levels were significantly decreased in type II diabetic patients, while no significant alteration was observed in serum potassium and chloride levels. Serum electrolytes should be routinely measured in diabetics to prevent complications.

Therapeutic Drug Monitoring of Isoniazid Among Newly Diagnosed Pulmonary Tuberculosis Patients

Introduction: Tuberculosis has a higher incidence in lower income countries. Positive treatment outcomes may be fewer due to comorbidities like diabetes mellitus and immunosuppressive illnesses. The Global Tuberculosis Network working under the umbrella of World Health Organization has composed different committees. The TB Pharmacology Committee has given the concept of precision medicine and treatment based on drug susceptibility testing. Achievement of optimum plasma levels of anti-tuberculous drugs by therapeutic drug monitoring (TDM) is imperative and being emphasized to achieve a TB cure. Aims and Objectives: To determine the levels of INH in low responders to ATT have lower plasma levels of Isoniazid. Place and Duration of study: University of Health Sciences and Gulab Devi Chest Hospital, Lahore, for 1 year from August 2017- July 2018. Material and Methods: A first dose therapeutic drug monitoring (TDM) of isoniazid (INH) was planned in 25 newly enrolled sputum positive tuberculous patients at Gulab-Devi Hospital. The work was approved by Ethical Review Committee. Fixed dose combination (FDC) of anti-tuberculous drugs was given under direct observation and blood samples were withdrawn at two hours (C2h) and six hours (C6h) on days one, 14 and 56th of drug therapy. Samples of sputum for acid fast bacilli (AFB) were also taken during blood sampling. Method development and validation of isoniazid estimation by high-performance liquid chromatography was carried out. Plasma INH concentration in test samples was measured with Shimadzu Chromatographic System, Japan. Data was entered and analyzed using SPSS version 20. A p value ? 0.05 was taken as statistically significant. Results: Among 25 patients enrolled to the current study, the mean plasma levels of isoniazid were 1.29±0.79 µg / ml and 0.56±0.43 µg / ml at two hours and six hours respectively throughout the research duration. Most of the patients had lesser plasma INH levels than the target ranges (< 3µg / ml). Sputum for acid fast bacilli was found 100% positive on day one and 14 however sputum conversion was 56% after four weeks drug therapy. Conclusion: An early TDM monitoring has revealed low plasma INH concentration. Correction of dose to achieve expected plasma INH level will have promising effect on sputum culture conversion. It will minimize the total statewide burden of slow responders and tuberculosis resistant cases.

Wound Healing in Diabetic Patients

Introduction: Diabetes mellitus (DM) is a very common disease that results from the body’s inability to maintain blood glucose level within normal limits. Blood glucose levels are either too high or too low. One study shows that up-to 30% people with DM experience skin problems. If blood sugar levels are well controlled, the rate of wound healing and developing a severe infection is significantly less. Regarding management of wound in diabetic patients, keep wounds dry with meticulous dressing, limb elevation, protect the surgical fixation in splint or braces for an extended period of time and patient education to keep in touch wither consultant and promptly report any unusual discomfort, pain, wound discharge, soaking of dressing and systemic symptoms. Objectives: the objective of this study is to identify the risk of wound infection and rate of healing in diabetic patient. Materials and Methods: The study was conducted at orthopedic department of Gulab Devi hospital. It was a Cross sectional study. The data was collected from September 2021 to February 2022. Non–Probability purposive sampling technique was used. The data was collected from indoor of Gulab Devi Chest Hospital Lahore and informed consent was taken from all the patients. The target populations were those who have diabetes mellitus and treated in orthopedic ward at Gulab Devi hospital Lahore. Diabetic patients enrolled in the presented study n=60. Results: our patient population was 28 to 55 year old with mean age 40years. 83% were in 35 to 40 age group. Wound problems were frequently encountered in patients with uncontrolled diabetes and 50% (n=30) of these patients had at least one wound complication after operation. And 71% (n=43) patients had increased pain and delayed recovery of their surgical wounds. When it comes to the relationship between bone health and diabetes, 63% (n=38) patients had history of previous bone fracture and 61% (n=37) patients had deformity of bone. Due to diabetic neuropathy 68% (n=41) patient were weight bearing on fracture site without concern. And the risk of diabetes include slow wound healing 75%. Practical implication; we aim to raise awareness among treating surgeons and physicians of patients presenting with diabetes and planning to undergo surgical intervention. Meticulous wound care and strict control of blood sugar levels are paramount to successful outcome. Conclusion: Diabetes mellitus is a systemic disease associated with uncontrolled blood sugar levels with systemic manifestations. Our study has proved an association of high wound complication with DM patients. Strict diabetic control as well as extra vigilance and meticulous techniques are needed to prevent complications in this group of patients. Keywords: Diabetes mellitus, infected wound, diabetes complications, wound healing

Positive correlation of serum interleukin-13 and total immunoglobulin E in bronchial asthma patients

Background: Asthma is a chronic inflammation of airways, associated with hyper-responsiveness of the bronchial tree, resulting in reiterated attacks of cough, wheezing, chest tightness, and breathlessness. Aapproximately 4 Pakistani adults out of 100 persons have been reported to suffer from asthma in year 2002-03.This study focuses on determining interleukin-13 (IL-13) and immunoglobulin E (IgE) in asthma patients and healthy subjects. Settings and Design: Methods and Material: The study assessed the level and correlation of IL-13 and IgE in bronchial asthma patients. Fifty bronchial asthma patients with allergy history and thirty healthy individuals were included. The patients were selected from Gulab Devi Chest Hospital, Lahore, Pakistan. Total serum IgE and IL-13 were determined by ELISA technique.SPSS (Version 20.0) software was used for statistical analysis. Kolmogorov-Smirnov, Shapiro-Wilk test, Student t-test and Mann-Whitney test have been used in analysis. Results: The mean (±SD) values of IL-13 concentration (pg/ml) in asthmatics and controls (healthy) were 1574 (± 409) and 390 (± 23). Moreover, median (IQR) value for both groups were 1415.8 (1398-1554) and 394.3 (384.3- 404.3), respectively. Conclusions: To sum up, we have found that bronchial asthma patients had significantly increased level of total serum IgE and IL-13 and we found a positive correlation between these parameters. Bangladesh Journal of Medical Science Vol. 21 No. 03 July’22 Page: 596-600

Serum adenosine deaminase activity: A novel test for early diagnosis of pulmonary tuberculosis - What about efficacy?

Background: Pulmonary tuberculosis is a tremendous public health problem, increasing significantly, especially in developing countries. Getting a TB-free globe appears to be not more than a dream. Mycobacterial culturing is the gold standard for precise diagnosis but requires six-week time, in the meantime, patients remain a source of inadvertent disease dissemination in the community. The unavailability of sputum also poses a challenge several times. As adenosine deaminase level measurement is easy, rapid and independent of a sputum sample, this study was conducted to determine the diagnostic efficacy of adenosine deaminase activity for pulmonary tuberculosis.Patients and methods: This prospective study was conducted at Pulmonology-OPD, Gulab Devi Chest Hospital, Lahore, from 01-01-2019 to 30-06-2019. A total of 300 sputum smear-positive patients with clinical and radiological evidence consistent with diagnosis of pulmonary tuberculosis and 30 normal participants without any clinical, radiological or haematological evidence of tuberculosis were included. While, smear-negative patients and those having any evidence of hepatic disease, hematopoietic malignancy, infectious mononucleosis, typhoid or pregnancy were excluded. The serum ADA level of each participant was determined. All patients were subjected to AFB culture. Diagnostic accuracy was determined by considering sputum culture as a gold standard.Results: At cut-off value of >15 IU/L, a sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 98.30%, 100.00%, 100.00%, 85.71%, 98.46% respectively were defined. Conclusion: Serum ADA level, having excellent sensitivity and specificity, can diagnose pulmonary tuberculosis even if sputum sample is not available.

Clinical manifestations, associated risk factors and treatment outcomes of Chronic Pulmonary Aspergillosis (CPA): Experiences from a tertiary care hospital in Lahore, Pakistan.

Chronic pulmonary aspergillosis (CPA) has a wide spectrum of illnesses depending on the progression of the disease and comorbid conditions. However, there is an inadequacy of investigations regarding clinical, laboratory, risk factor and prognostic data on CPA. The current study is aimed to consider the clinical manifestations, risk factors and outcomes of CPA. Retrospective records of all patients with a confirmed diagnosis of CPA who sought treatment at Gulab Devi Chest Hospital Lahore, Pakistan from January 2017 to December 2019 were evaluated. Data regarding demographics, clinical manifestations, comorbidities, radiographic and microbiological findings, length of hospital stay (LOS) and intensive care unit (ICU) admission was collected and analyzed to identify the factors associated with mortality. The independent factors associated with mortality were also identified by appropriate analyses. A total of 218 CPA patients were included in this study. The mean age was 45.75 ± 6.26 years. Of these, 160 (73.4%) were male, and 65 (29.8%) had diabetes. The mean LOS was 18.5 ± 10.9 days. The most common type of CPA was simple aspergilloma (56%) followed by chronic cavitary pulmonary aspergillosis (CCPA) (31.2%). About one half of the patients had a history of pulmonary tuberculosis (TB) and treatment response rates were low in patients with active TB. The overall mortality rate was 27.1%. ICU admission was required for 78 (35.8%) patients. Diabetes mellitus (DM), hematological malignancies and chronic kidney disease (CKD) were the common underlying conditions predicting a poor outcome. Mean LOS, hematological malignancies, consolidation and ICU admission were identified as the independent factors leading to mortality. CPA had a significant association with TB in the majority of cases. Treatment response rates in cases with active TB were comparatively low. Cases with high mean LOS, hematological malignancies, consolidation, ICU admission, CKD and DM experienced poor outcomes. High mean LOS, hematological malignancies, consolidation and ICU stay were identified as independent risk factors for mortality. Future large prospective studies, involving aspergillus specific immunoglobulin G (IgG) antibody testing, are required for a better understanding of CPA in Pakistan.

Histopathological Evaluation of Endoscopic Esophageal Biopsies

Background: Esophageal lesions have a wide range of clinical and pathologic spectrum. Understanding the endoscopic and pathologic features of esophageal lesions is critical for detecting, differentiating, and managing them. Esophageal lesions incidence might be neoplastic or non-neoplastic. Aim: The current study aims to assess the clinical, endoscopic and histopathological evaluation of Esophageal Lesions. Materials and Methods: The current cross-sectional study was conducted on 102 esophageal lesions received at the Pathology Department of Gulab Devi Chest Hospital, Lahore for the period during June 2020 to May 2021. Endoscopy was used to obtain esophageal biopsies of either gender, regardless of their age. Each case was microscopically evaluated, and biopsy specimens were immediately secured in 10% buffered neutral formalin. Data analysis and collection was done in SPSS version 21. Results: Out of 102 endoscopic esophageal biopsies referred to Pathology Department for histopathological evaluation,male and female prevalence were 68 (66.7%) and 34 (33.3%) respectively. The overall mean age was 53.24±6.73 with an age range from 21 to 80 years. Based on age, the patient’s biopsies were categorized into six groups. A higher prevalence of esophageal lesions was observed in 51-60 (36.3%) years followed by age group 61-70 years (23.5%). Of the 102 patient’s biopsies,66 (64.7%) biopsy revealed squamous cell carcinoma, squamous dysplasia cases were 12 (11.8%), squamous papilloma was seen in one (0.98%) case, Adenocarcinoma cases were 4 (3.9%), Barrett’s esophagus was 4 (3.9%), esophagitis was 11 (10.8%) and squamous epithelium only was present in 4 (3.9%) cases. Conclusion: Esophageal cancer is the common digestive tract malignancy. Malignancy can be distinguished from non-neoplastic masses on endoscopy by their symptoms, appearanceand size. For an early esophageal disease diagnosis, endoscopy is a popular and developed inspection means which can identify Barrett’s esophagus and squamous dysplasia from malignant lesions,which can help in proper treatment and follow-up. Microscopic evaluation of lesions labeled as inflammatory on endoscopy can turn out to be malignant. This demonstrates the importance of microscopic examination as a confirmatory diagnostic tool. Accurate diagnosis can be carried out on microscopic examination with immunohistochemistry and histochemical stains. Keywords: Esophagus; Epithelial lesions; Sub-epithelial lesions; Endoscopy

Assessing Prevalence of Osteoporosis and Identifying Risk Factors in Interstitial Lung Disease Patients

Background: Chronic lungdiseases are severe diseases which have a wide prevalence of osteoporosis in them. These chronic lung diseases include cystic fibrosis, bronchial asthma, bronchiectasis, and chronic obstructive pulmonary disease. However, there is only limited data available that define its risk factors and its prevalence in patients that have Interstitial Lung Disease (ILD). Objective: The purpose of this research is to study patients with ILD and determine the risk factors and prevalence of osteoporosis in ILD patients. Study Design: A cross-sectional study Place and Duration: This study was conducted at Gulab Devi Chest Hospital Lahore from December 2021 to December 2022 Methodology: A total of 80 patients participated in this research. This research is a cross-sectional analysis of all of those patients who had ILD. Every patient that was already admitted to the hospital was a part of this study. The clinical data and demographics of each participant were noted down. In order to measure the density of the bone mineral, an absorptiometry scan (x-ray), which was of dual-energy, of the femoral neck of the patient was performed. To identify osteoporosis, T-scores were considered, as we were following the guidelines of the World Health Organization. The risk factors were identified by conducting multivariate as well as univariate logistic regression analysis. Results: The majority of the sample size were females, representing 67.5 percent of the participants (n=54). The average age was 55.8 years. There were 32 patients in whom osteoporosis was identified. Univariate analysis showed certain factors that were positively related to osteoporosis. These factors include the time period of symptoms, female gender, and a low hemoglobin level. Multivariate analysis showed the hemoglobin level and the time period of symptoms as independent risk factors. Conclusion: In patients that are diagnosed with Interstitial Lung Disease, osteoporosis is a common problem. The existence of osteoporosis in these patients can be determined by low hemoglobin levels and the longer time period of the symptoms. Keywords: Interstitial Lung Disease. Osteoporosis, chronic lung disease, adults

Effect of anti-tuberculosis treatment on weight of tuberculous patients following up in Gulab Devi Hospital, Lahore

Background: Tuberculosis is the most prevalent disease in Pakistan. Multiple studies have been conducted on disease pattern and anti-tuberculosis therapy however; there is sparse literature of anti-tuberculosis therapy on weight gain of patients. The objective of this study was to measure the effect of anti-tuberculosis treatment on weight of the patient.
 Subjects and methods: It was a cross sectional study conducted for a period of 1 year at Pulmonology and Surgical OPD of Gulab Devi Chest Hospital Lahore. Interview of 400 patients were recorded and there record of weight and height was collected at start of the treatment, at 02 months and at 6 months of treatment.
 Results: Mean weight change in 400 patients were 3.06 ± 3.97 Kg. Out of 400 patients 310 had weight gain, 50 patients had weight loss and in 40 patients weight remain unchanged. Mean weight gain in 310 patients was 4.53 ± 2.95 kg with maximum weight gain of 16 Kg. Mean weight loss in 50 patients was 3.67 ± 2.63 Kg with maximum weight loss of 14 Kg.
 Conclusion: A significant weight gain was seen in patients undergoing anti tuberculosis treatment. Younger age group, treatment completion and drug compliance had positive association with weight gain of the patient. Diabetes mellitus was the only co morbidity found to have negative association with weight gain of the patient.

Pulmonary Tuberculosis; A Dominant Etiology of Pulmonary Hypertension in Endemic Areas

Background: Many patients with chronic lung disorders like infections, COPD, ILD, OSA & Thrombo-embolism, present with dyspnea, not showing adequate improvement by conventional treatment. Most of these were diagnosed as pulmonary hypertension by further multidisciplinary work-up. Such patients show reduced life expectancy due to late diagnosis and insufficient treatment. Many TB patients often remain undiagnosed in this context. The understanding of etiology and risk factors is essential for a high index of suspicion. Objective: To explore the etiology of Pulmonary Hypertension in chronic respiratory patients. Study Design: A Retrospective Observational Study. Settings: Male pulmonology ward, Gulab Devi Chest Hospital, Lahore Pakistan. Duration: 37 months from January 2014 to February 2017. Methodology: 231, consecutive cases, having Age >14 years with clinical and radiological suspicion of pulmonary hypertension were included. Patients having Age >90 years and <14years, not willing for further investigations were excluded. Detailed history, physical examination, radiological, hematological, bacteriological biochemical and immunologic findings were recorded. PH was diagnosed by ECG, Echocardiography, CT-Angiography. HRCT thorax & PFTs, were employed to recognize the underlying lung disorders. Risk factors were identified. Data tabulated, analyzed statistically and conclusions were drawn. Results: 69/231 (29.87%) cases with active and 76/231(32.90%) with old-treated TB, 50(21.64%) COPD, 10(4.32%) pneumonia, 5(2.16%) CLD, six bronchiectasis and three cases of chest deformities were diagnosed PH. Cigarette smoking, DM and obesity were major risk factors. Conclusion: Pulmonary Tuberculosis can be the dominant etiology of PH in high prevalence populations.

Diagnostic Accuracy of Sonographic Septations in Tuberculous and Malignant Pleural Effusions

Background: Discrimination between tuberculous (TB) and malignant pleural effusions is a real practical challenge because both exist as exudative lymphocytic type. Transthoracic ultrasonography not only identifies and quantifies pleural effusion but also displays sonographic septations, which are frequently seen in TB pleural effusions and can help in differentiation between tuberculosis and malignancy successfully, without any invasive procedure. We designed this study to determine the diagnostic usefulness of these septations for tuberculous and malignant pleural effusions.
 Material and Methods: This prospective study was conducted in the OPD of Gulab Devi Chest Hospital Lahore, Pakistan, a 1500 bedded tertiary care hospital, from November 2016 to February 2018. Total of 339 consecutive cases, aged 14-83 years with radiological evidence of pleural effusion were included in the study. After detailed history, thorough physical examination, radiological, haematological and biochemical findings were recorded. Pleural fluid macroscopic, cytological, microbiologic and biochemical analysis results were also recorded. Ultrasonography was done, septated and non-septated pleural effusions identified and findings were noted. SPSS-16 was used for statistical evaluation. Fisher Exact test was utilized for comparison between TB and malignant cases with P-value < 0.05 taken as significant. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy and positive likelihood ratio were calculated.
 Results: Out of total 339 cases, 49 (14.45%) were malignant and 290 (85.55%) were non-malignant. In the malignant group, only 03 cases (6.12%) showed sonographic septations. In the non-malignant group, 259/290 (89.31%) cases showed tuberculous etiology and 187/259 (72.20%) of these cases displayed sonographic septations. By considering septations as predictor of TB, statistical analysis revealed a sensitivity of 79.23%, specificity of 92.85%, PPV of 98.42%, NPV of 44.31% and diagnostic accuracy of 81.29%, respectively.
 Conclusions: Sonographic septations can be a valuable predictor of tuberculosis, in a population with high prevalence of the disease. We found it to be a useful feature in differentiating between a malignant and tuberculous etiology, in exudative lymphocytic pleural effusions. It can be used with confidence in patients who are unfit for interventional procedures.

Factors affecting Quality of Sleep in Intensive Care Unit

Background: The etiology of sleep disruption in intensive care unit is poorly known and often ignored complication. It is caused by the environmental factors especially pain, noise, diagnostic testing and human interventions that cause sleep disruption. Light, medications and activities related to patient care interfere with patient’s ability to have good sleep. There are multi-factorial environmental etiologies for disruption of sleep in ICU.
 Objective: The objective of this study was to evaluate the factors disturbing the sleep quality in intensive care unit (ICU) admitted patients.
 Methodology: A cross sectional study was designed involving 150 patients admitted in intensive care unit and high dependency unit of Gulab Devi Chest Hospital. The duration of study was from September 2015 to March 2016. The questionnaire was made and filled with the help of patients. The data was analyzed using SPSS version 16.00.
 Results: Mean age of patients was 50.46+10.96 with maximum age of 65 and minimum age of 30 years. There was 53.33% male patients and 46.67% females participating in this study. The sleep quality was significantly poor in ICU than at home. After analysis, 54.67% patients were with poor quality of sleep due to pain and 48.67% were due to noise of environmental stimuli. The other factors were alarms, light and loud talking.
 Conclusion: Current study shows that reduced sleep quality is a common problem in ICU with multi-factorial etiologies. Patient reported the poor sleep quality in ICU due to environmental issues that are potentially modifiable.
 Conclusion: Current study shows that reduced sleep quality is a common problem in ICU with multi-factorial etiologies. Patient reported the poor sleep quality in ICU due to environmental issues that are potentially modifiable.

FREQUENCY AND CAUSES OF PERIPROCEDURAL MYOCARDIAL INFARCTION IN COMPLEX CORONARY INTERVENTIONS

Objective: To examine the frequency and cause sof periprocedural myocardialinfarction (PMI) in complex coronary interventions. Methodology: This cross sectional study was conducted at catheterizationlaboratory of Gulab Devi Chest Hospital, Lahore in 6 months duration from June2016 to January 2017. Patients aged between 30 to 80 years undergoingcomplex coronary interventions were included. Blood samples for creatinekinase-MB evaluation were drawn at three different times i.e. Once beforeprocedure, 8-10 and 24 hours after the procedure. CKMB level >3× ULN wasconsidered as PMI. Association of different factors with PMI was also observed. Results: A total of 72 consecutive patients were included in the study.Mean ageof patients was 53.65+11.84 years. There were 56(77.78%) males. PMI wasdetected in 14 (19.44%)patients, with 3–5× ULN in 13.88% and >5× ULN in5.55% of patients. Statistics of study showed that revascularization of left mainstem lesion (1.38 % vs 0 %, p=0.04), in-stent restenosis (2.77 % vs 1.38 %,p=0.03) and procedural complications such as side branch occlusion(1.38%vs0%, p=0.04) and slow/no reflow (4.16 % vs 1.38 %, p=0.004)weresignificantly associated with CKMB elevation following complex coronaryintervention. Conclusion: PMI is common in patients undergoing complex coronaryinterventions. Key Words: Complex coronary intervention, Creatine kinase MB, No reflow,Periprocedural myocardial infarction.

A cross sectional study on the definite diagnosis of tuberculous pleural effusion at Gulab Devi Chest Hospital.

Establishing the definite causative etiology of pleural effusion is often quite problematic due to the paucibacillary nature of mycobacterium, while malignancy and other bacterial infections also cause pleural effusion. Therefore, knowing the exact cause is mandatory before the start of any anti tuberculosis therapy. The present study was aimed to differentiate among different causes of pleural effusion in suspected TB patients. Study Design: Cross sectional study. Setting: A cross sectional study was carried out at Gulab Devi Chest Hospital over the period of seven months. Total 32 patients were enrolled in the study following the inclusion criteria and after taking written informed consent from the patients and approval from the ethical committee. Period: From 1st September 2014 to 31st March 2015. Materials and Methods: Pleural effusion was aspirated by the registered clinician and the sample was processed for cytology, relative density, culture and PCR. Results: Total of ~10% patients were found positive for bacteria other than MTB and 25% were positive for MTB as evidenced by the growth on culture. Two of the MTB culture positive samples were positive for MTB DNA whereas, one culture negative sample was found positive by PCR. Our findings showed that no patient sample was test positive by AFB smearing which is the most commonly used diagnostic tool for MTB. MTB is the major cause of pleural effusion in our studied population but other bacterial infections cannot be neglected. Moreover, PCR is more robust method of detection as MTB culture takes ~6 weeks for positive results. Conclusion: Therefore, we suggest that the efficacy of the PCR should be tested on larger population and a definite diagnosis should be made before the start of any therapy.

Assessment of Knowledge, Attitude and Practice of Hand Hygiene in Healthcare Workers of Gulab Devi Chest Hospital Lahore, Pakistan

Background: Hand hygiene is a general term referring to any action of hand cleansing by using water and detergent and for the removal of transient microorganisms from hands. Hand hygiene is recognized as the leading measure to prevent cross-transmission of microorganisms and to reduce the incidence of healthcare associated infections. There are many experiences that the lack of knowledge, attitude and poor practice in hand hygiene in healthcare workers transmit infection in patients and in other healthcare workers.
 Methodology: This descriptive study was conducted in Gulab Devi Chest Hospital. I had taken 100 healthcare workers to complete my research. The sampling technique of my research was cross-sectional sampling technique, use to collect the data.
 Results: In this research knowledge was not good in all HCWs, Overall knowledge of hand hygiene by all HCWs was less than 50%. The attitude in nurses and medical student in this research was moderate doctors and technologists have poor attitude in hand hygiene. The practices among HCWs in Gulab Devi Chest Hospital were also poor which was less than 50%.
 Conclusion: The HCWs in Gulab Devi Hospital had poor knowledge, practices on hand hygiene. However, attitudes of medical student and nursing had satisfactory.

Assessment of Knowledge, Attitude and Practice of Hand Hygiene in Healthcare Workers of Gulab Devi Chest Hospital Lahore, Pakistan

Assessment of Knowledge, Attitude and Practice of Hand Hygiene in Healthcare Workers of Gulab Devi Chest Hospital Lahore, Pakistan

Drug resistance profile of Mycobacterium tuberculosis and predictors associated with the development of drug resistance.

Drug-resistant tuberculosis (DR-TB) is a major challenge to national TB control programmes in developing countries. In the Pakistan province of Punjab, the extent and development of DR-TB is not well known. The current study was therefore conducted to assess the incidence and predictors of DR-TB in Punjab Province. Drug susceptibility testing was performed for 863 confirmed culture-positive Mycobacterium tuberculosis isolates using the proportion method. Patients were enrolled in the Programmatic Management of Drug-Resistant TB Unit of Gulab Devi Chest Hospital (Lahore, Pakistan) from August 2011 to September 2013. Data analysis was performed using IBS SPSS Statistics v.20. Multivariate logistic regression analysis was performed to assess risk factors for DR-TB. The rate of resistance to at least one drug (i.e. DR-TB) was 35.0% (302/863) and the rate of multidrug-resistant TB (MDR-TB) was 30.0% (259/863). Among DR-TB cases, the number of females was relatively higher (167/302; 55.3%) compared with males. The majority of DR-TB patients resided in a rural area (229/302; 75.8%). Significant predictors of DR-TB were age 18-45 years, previous TB treatment, rural residence, being a housewife, being married, duration of sickness >1year and unemployment. The problem of DR-TB in Pakistan is significant. The strongest risk factors were young age and previous anti-TB treatment. Being married, being a housewife, rural residence and unemployment were also risk factors, culminating in an urgent need for effective control, early diagnosis and treatment policies for DR-TB.

Daily Activity Related Quality of Life in Chronic Obstructive Pulmonary Disease in Adults

Abstract:
 Background: The significant reason for anguish as well as incapacity is chronic obstructive pulmonary disease (COPD). Activities of daily living might be relentlessly curbed among patients with COPD and appraisal needs evaluation regarding influence of infirmity and detriments on day-to-day living. The primary objective was to know the daily activity associated quality of life in COPD adults. The secondary objective was to analyze demographical profile, such as gender and age of COPD subjects as well as evaluate the physical activity related breathlessness in COPD patients.
 Methodology: This study was executed at Gulab Devi Chest Hospital. We used cross sectional study design to collect the data. For collecting the statistics of 150 subjects aged 40-60 years of either gender Saint George’s Questionnaire was liable. It included the patient’s biodata, effect of COPD on physical activities and limitations in routine work.
 Results: The ages of 150 COPD patients selected were between 40 and 60 years. Patients were classified into two categories on the basis of disease severity according to GOLD criteria 71 (47.3%) were with moderate severity and 79 (52.7%) were with severe severity. 113 (75.3%) patients were smokers while 37 (24.7%) patients were non-smokers. 110 (73.3%) COPD patients were active smokers in comparison 40 (26.7%) COPD patients were passive smokers. COPD patients with current smoking status were 79 (52.7%) and with past smoking status were 71 (47.3%). 19 (12.7%) COPD patients felt breathlessness while sitting and lying. 53(35.3%) COPD patients felt breathless while getting washed or dressed. 85(56.7%) COPD patients felt breathless while walking around the home. 114 (96%) COPD patients discerned breathlessness while walking up a flight of stairs. 145 (96.7%) COPD patients had breathlessness while playing sports or games. 146 (97.3%) COPD patients experienced difficulty in breathing during activities like carrying load. 88 (58.7%) COPD patients discerned breathlessness during entertainment or recreation. 88 (58.7%) COPD patients discerned breathlessness during entertainment or recreation. 7 (4.7%) COPD patients felt breathlessness while moving from bed or chair.
 Conclusion: As with the progression of COPD impairment in activities become worse due to breathlessness causing decline in patient’s ability making them unable to complete their task to fulfill the needs of life and ultimately become bed bound due to shortness of breath.

Risk of adverse treatment outcomes among new pulmonary TB patients co-infected with diabetes in Pakistan: A prospective cohort study.

PurposeThe escalating burden of diabetes in countries tackling high burden of tuberculosis (TB) has adverse implications for co-infected individuals and National TB control efforts. We aimed to study whether there was a difference in treatment outcome among diabetic and non-diabetic pulmonary TB patients and identify the determinants of treatment outcome among the two groups.Materials and methodsThis prospective cohort study recruited new patients of pulmonary tuberculosis (PTB) aged 15 years and above who were diagnosed at and registered with Gulab Devi Chest Hospital, Lahore, Pakistan for anti-tuberculosis treatment (ATT). PTB patients were screened for diabetes using random and fasting blood glucose tests. Diabetic and non-diabetic PTB patients were followed up at second, fifth and sixth month of ATT and 6 months after ATT completion to determine treatment outcome. Multivariate logistic regression analysis was conducted to assess association between various factors and treatment outcome.ResultsOf 614 PTB patients, (n = 113 [18%]) were diabetic and (n = 501 [82%]) non-diabetic. Final model showed that diabetics were more likely to experience an unfavorable outcome as compared to non-diabetics (adjusted odds ratio [aOR] = 2.70, 95% Confidence Interval [CI] = 1.30 to 5.59). Other predictors of unfavorable outcome included rural residence (aOR = 1.98, 95% CI = 1.14 to 3.47), body mass index less than 18.50 (aOR = 1.89, 95% CI = 1.03 to 3.47) and being a smoker (aOR = 2.03, 95%CI = 1.04 to 3.94).ConclusionOur study shows unfavorable treatment outcome among diabetic PTB patients. Integrated models of care with screening/testing and management for diabetes and TB could improve TB treatment outcomes.

WILKIN’S SCORE

Objectives: To assess the predictive value of Wilkin’s score in determining theprocedural success of Percutaneous Transvenous Mitral Commissurotomy. Study Design:Cross sectional study. Setting: Catheterization Laboratory of Gulab Devi Chest Hospital, Lahore.Period: April 2016 to March 2017. Methods: All patients with valve area <1.5cm², pliable orborder line pliable valve were included in study. Patients who had LA thrombus, severe mitralregurgitation, severe valvular calcification were excluded from study. Patients were evaluatedclinically and echocardiographically 24 hours before and after procedure. Valve morphology wasassessed using 2D echocardiography. Wilkins’ score’s sensitivity and specificity and predictiveaccuracy at score >8 was also assessed. Mean was used to express quantitative data whilequalitative data was presented using frequency tables. One-sample kolomogorov smirnov testwas applied to see normality of data. Paired sample t-test was applied for normally distributedwhile Wilcoxon test for non-normally distributed data. Results: There were 26(23.6%) male and84(76.4%) female with mean age 32.30±11.40 years. Successful results of PTMC with MVA ≥1.5were obtained in 97 (88.2%) while it remained unsuccessful in 13 (11.8%) patients. Successfulresults with Wilkins score <8 were obtained in 22(95.6%) and unsuccessful in 1(4.3%) patient.While with Wilkin score ≥8, it remained successful in 75(86.2%) and unsuccessful in 12(13.7%)patients. Sensitivity and specificity of Wilkins score for the success of PTMC was 22.68% and92.31% respectively. Conclusion: The success of PTMC depends upon valve morphology.Wilkins score is the best determinant to predict the likelihood of success or failure of procedureand therefore should be used to select suitable patients prior to PTMC.