Multi-Drug-Resistant Tuberculosis Peritonitis: A Case Report.

The increasing incidence of tuberculosis raises concerns globally, impacting both developing and developed nations. Abdominal tuberculosis stands out as the most prevalent form of extrapulmonary tuberculosis. This case report details the diagnostic journey of a young male with abdominal TB complicated by concurrent HIV infection. The patient presented with night sweats and substantial weight loss, concurrently receiving a naive human immunodeficiency virus (HIV) diagnosis with an undetectable CD4 count. Imaging revealed abdominal lymphadenopathy concealing the pancreatic head while bronchoscopy unveiled TB in the lung. The patient faced septic shock and bilateral pulmonary embolism, possibly due to immune reconstitution inflammatory syndrome (IRIS). The patient then developed ascites, and a diagnosis of TB peritonitis was made based on low serum ascites albumin gradient (SAAG) and a positive acid-fast bacillus (AFB) result in the para-aortic lymph node. Treatment complexity arose from drug resistance to isoniazid and ethambutol.

Pakistani urban population demonstrates a poor knowledge about cancers: a pilot survey.

BACKGROUND: This cross-sectional study was carried out to assess the perceptions and level of knowledge of a Pakistani urban population regarding presentations, risk factors, and screening of cancers. METHODS: From 4 tertiary care hospitals, 439 subjects were recruited through convenient sampling method and interviewed using a standard questionnaire. RESULTS: More than 90% of subjects demonstrated poor knowledge. Good knowledge was associated with female gender, being married, higher socioeconomic status, and level of education. CONCLUSIONS: Our sample demonstrates an inadequate knowledge regarding the presentations, risk factors, and screening of cancers. Efforts aiming to correct these deficiencies might result in a successful and cost-effective model for primary and secondary prevention of major cancers in Pakistan.

Awareness and use of Benzodiazepines in healthy volunteers and ambulatory patients visiting a tertiary care hospital: a cross sectional survey.

BACKGROUND: Indiscriminate prescription of Benzodiazepines in Pakistan and subsequent availability over-the-counter without prescription is a major public health problem, requiring systematic inquiry through research. Additionally, there is limited data on the awareness and use of Benzodiazepines from developing countries making it impossible to devise meaningful health policies. METHODOLOGY/PRINCIPAL FINDINGS: This was an Observational, Cross-Sectional study. conducted at Aga Khan University. A total of 475 (58.5% males, 41.5% females) people visiting a tertiary care hospital were interviewed by means of a structured questionnaire. The results showed that majority of population was aware of one or more Benzodiazepines (80.4%) and 30.4% had used them at some point in life. 42.4% of the users had been using it for more than a year. Commonest reason for use was sleep disturbance. Frequency of usage was higher for females, married individuals, educated (>Grade12), high socioeconomic status and housewives. More (59%) were prescribed than not and of them most by GP (58.5%). Only 36.5% of them were particularly told about the long-term addiction potential by the use of these drugs. CONCLUSION: Easy availability, access to re-fills without prescription and self prescription compounded with the lack of understanding of abuse potential of benzodiazepines constitutes a significant problem demanding serious consideration from health policy makers.

Extranodal non-Hodgkin's lymphomas--a retrospective review of clinico-pathologic features and outcomes in comparison with nodal non-Hodgkin's lymphomas.

OBJECTIVE: The primary objective of this study was to analyze the anatomic distribution, clinical features and outcome of Diffuse large B-cell lymphoma (DLBCL) patients according to the primary site (extranodal vs. nodal) with applicability of International Prognostic Index (IPI). METHODOLOGY: A retrospective review (1988 to 2004) of 557 cases of DLBC. RESULTS: The median age was 48.7 +/- 15.3 years; M:F ratio was 2:1. The distribution according to the primary site was: lymph node (N-NHL), 322 cases (58%) of which 145(44%) were stage IV, 76(23%) stage III, 60 (18%) stage II and 47 (15%) stage I. The extra nodal sites (EN-NHL) 235 (42%) cases included gastro-intestinal tract (44%), upper aerodigestive tract (19%), bones (8%), spine (5%), and unusual sites less than 3% each as breast, CNS, testis, lungs and skin. The median survival rate was 4.8 years and 6.3 years in N-NHL and EN-NHL respectively. In the latter this varied greatly depending on the primary site and stage of disease at presentation. In the univariate analysis factors associated with good prognosis were: age less than 60 years, early stage (I-II), extranodal involvement primarily gastric or bone, 0-1 extranodal site, 0-1 performance status, lack of B symptoms and normal LDH level. In the multivariate analysis age, performance status, stage of disease and level of LDH were the main variables predicting overall survival; no nodal or extranodal site maintained their prognostic value. CONCLUSION: Patients with EN-NHL present more frequently with early stage disease then those with N-NHL; overall survival in both groups largely depended on IPI and not on the site of origin of the malignancy.

Factors influencing in-hospital length of stay and mortality in cancer patients suffering from febrile neutropenia.

INTRODUCTION: Febrile neutropenia (FN) is a major complication of chemotherapy, costly in terms of morbidity, mortality and associated financial expenditure. The present study was conducted with the goal of highlighting FN as a serious problem in Pakistan, with the longer term objective of improved cancer survival, reduction in length of stay (LOS) in hospital, morbidity, mortality and costs in our existing developing country scenario. METHODS: A cross-sectional descriptive study was conducted on patients, > or =18 years, admitted with FN as a consequence of chemotherapy at a referral hospital in Karachi from 1st September 2006 to 30th April 2007. RESULTS: A total of 80 patients [43 (53.8%) males and 37 (46.2%) females] were selected. The mean age was 47.4 (SD +/-16.6; range 18-79) years. Sixty eight patients (86%) were < or = 65 years, 50% were < or = 50 years. Overall, inhospital mortality was 11%; 4% for patients on granulocyte colony stimulating factor (G-CSF) prophylaxis as against 20% for those without. The cause of death was either pneumonia or septic shock. Mean LOS was 7.53 (SD +/-3.8; range 2-17) days. Hematological malignancies, older age, severity of dehydration, pneumonia and culture positivity were significantly associated with LOS and death. Those above 50 years of age were 1.5 times as likely to be hospitalized longer and > three times as likely to die. Bacteremia conferred a 5-fold and pneumonia an 8-fold increase in the risk of death. CONCLUSION: The results of this study indicate that age, vital instability, dehydration, high creatinine, culture positivity and hematological malignancies are high risk factors in chemotherapy induced FN. Identification of FN risk factors with poor outcomes may help in devising protocols for modified dosage or including GCFs initially. This may help reduce the cost of cancer care as well as mortality and morbidity. Prospective studies of FN in multiple centers in Pakistan may be beneficial in evaluating these risk factors further.