Serum enolase-2, high-sensitivity C-reactive protein, and serum cholesterol in smear-positive drug-naïve pulmonary tuberculosis.

BACKGROUND: Pulmonary tuberculosis (PTB) is a chronic granulomatous disease caused by Mycobacterium tuberculosis. The present study determined the serum human enolase-2 (ENO-2), high-sensitive C-reactive protein (hs-CRP), and serum cholesterol levels as biological marker of disease activity and treatment response in smear-positive drug-naïve PTB. MATERIALS AND METHODS: This case-control study was done in the Department of Medicine, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro/Hyderabad, Sindh, from January 2015 to April 2016. Thirty-five sputum smear-positive drug-naïve PTB patients and thirty controls were studied. MTB culture and drug sensitivity were performed at the Diagnostic and Research Laboratory of LUMHS. Serum ENO-2, hs-CRP, and serum cholesterol were estimated at baseline, 3rd and 6th month of antituberculosis (TB) therapy. RESULTS: Serum ENO-2 and hs-CRP were found raised in PTB compared to controls and showed decrease of 13% and 21.55%, 19.6% and 31.5% at 3rd and 6th month, respectively (P = 0.0001). Serum ENO-2 revealed positive correlation with hs-CRP (r = 0.734, P = 0.0001), and serum cholesterol revealed negative correlation with ENO-2 and hs-CRP (r = -0.509, P = 0.0001) and (r = -0.566, P = 0.0001), respectively. CONCLUSION: The present study reports the baseline ENO-2 and hs-CRP were raised, and serum cholesterol was low in smear-positive PTB patients and the ENO-2 and hs-CRP were reduced by anti-TB drug therapy.

Berberine protects against metformin-associated lactic acidosis in induced diabetes mellitus.

OBJECTIVES: Causality of occurrence of metformin-associated lactic acidosis (MALA) is a clinical problem. Currently, there is no drug available to prevent MALA. The present study was conducted to evaluate the protective effect of Berberine (BBR) against MALA in induced diabetic rat model. MATERIALS AND METHODS: A sample of 75 healthy male Wistar rats was randomly selected according to inclusion and exclusion criteria. 75 male Wistar rats were randomly divided into a control and 4 experimental groups. Streptozotocin (STZ) in citrate buffer (pH 4.5) at a dose of 45 mg/kg was injected for induction of diabetes mellitus and rats achieving fasting blood glucose >250 mg/dl were included. Blood samples were collected 18 hr after the last dose of metformin and berberine. Ethical approval was taken before the study was conducted. Staistix 10.0 (USA) software was used for data analysis. RESULTS: Berberine decreased MALA. Metformin, metformin + BBR 50 mg/kg bwt, and metformin + BBR 100 mg/kg bwt showed serum lactate as 1.87±0.4 mmol/lL, 1.62 ± 0.44 mmol/l and 1.47± 0.45 mmol/l, respectively (P=0.0001). Insulin resistance and liver enzymes were improved in BBR treated rats. CONCLUSION: The present study reports berberine protects against MALA in streptozocin-induced diabetes mellitus.

Current Trends of Drug Resistance Patterns of Acinetobacter baumannii Infection in Blood Transfusion-dependent Thalassemia Patients.

OBJECTIVE: The present study aimed to evaluate the current trends of drug resistance patterns of Acinetobacter baumannii infection in blood transfusion-dependent thalassemia patients. STUDY DESIGN: This study was a cross sectional study, conducted at the Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad, Sindh, Pakistan from October 2014 to January 2016. SUBJECTS AND METHODS: Of 921 blood samples, A. baumannii strains were isolated from 100 blood samples. Blood samples were processed for the isolation, identification, and drugs sensitivity as per the Clinical and Laboratory Standards Institute. A. baumannii strains were identified by microbiological methods and Gram's staining. API 20 E kit (Biomeriuex, USA) was also used for identification. Data were analyzed on Statisti × 8.1 (USA). RESULTS: Mean ± standard deviation age was 11.5 ± 2.8 years. Nearly 70% were male and 30% were female (P = 0.0001). Of 921 blood transfusion-dependent thalassemia patients, 100 (10.8%) patients showed growth of A. baumannii. Drug resistance was observed against the ceftazidime, cefixime, cefepime, imipenem, meropenem, amikacin, minocycline, tigecycline, and tazocin except for the colistin. CONCLUSION: The present study reports drug-resistant A. baumannii in blood transfusion-dependent thalassemia patients. National multicenter studies are recommended to estimate the size of the problem.

QTc-interval, heart rate variability and postural hypotension as an indicator of cardiac autonomic neuropathy in type 2 diabetic patients.

OBJECTIVE: To evaluate the QTc-interval, heart rate variability and postural hypotension in predicting cardiac autonomic neruopathy (CAN) in type 2 diabetes mellitus (DM) patients METHODS: The comparative cross-sectional study was conducted in the Department of Medicine, Muhammad Medical College Hospital, Mirpurkhas, Sindh, from September 2008 to December 2009. A total of 186 type-2 diabetes mellitus patients with a QTc value of > 440 ms were studied. The QT interval was measured on electrocardiographic (ECG) recordings. The patients with HbA1c levels < or = 7% were considered as well-controlled. A cut-off of 5 years was selected for the known duration of diabetes. The longest and shortest R-R intervals on ECG, and heart rate variability (HRV) were determined. An HRV of less than 20 beats per minute was accepted as CAN. The relationship of postural hypotension (PH) and heart rate variability to the duration and control of diabetes were also evaluated. The relationship of cardiac autonomic neuropathy with diabetes control was also determined. Data was analysed using SPSS 10.0 (Chicago, Illinosis, USA). The comparison of differences in means was calculated by the student t-test and the difference in proportions was compared by the Chi-square test. A p-value of < 0.05 was considered significant. RESULTS: The mean age was 47 +/- 13 years, and the mean duration of diabetes was 13 +/- 7 years. All cases had QTc prolongation with mean 0.52 +/- 0.19. Median QTc intervals were 0.590 (range. 0.515-0.780) and 0.631 (range 0.530-1.869) for males and females respectively. Cardiac autonomic neuropathy manifestations were prominent in diabetics of +/- 5 years when compared with patients for < 5 years (p < 0.003). The postural hypotension difference increased while the heart rate variation decreased with the duration of diabetes (p < 0.002). The PH on standing was significantly related with the control (p < 0.002) as well as the duration of diabetes (p < 0.002). Heart rate variation with respiration was significantly related to the duration (p < 0.005), but not to the control (p = 0.59) of diabetes. QTc showed a significant correlation with the duration of diabetes, postural hypotension and heart rate variation with respiration (p < 0.005, p < 0.013, p < 0.004) respectively. CONCLUSIONS: Prolonged QTc interval, heart rate variation and postural hypotension are relatively easy, quick and inexpensive methods to measure cardiac autonomic neuropathy.

A comparative study of the typhidot (Dot-EIA) and Widal tests in blood culture positive cases of typhoid fever.

Seventy-six blood culture positive typhoid cases and forty-eight controls were studied. The typhidot test was positive in 74 (97.36%) cases, with a sensitivity, specificity and positive predictive value of 96%, 89.5%, and 95%, respectively, compared to the Widal test which was positive in 56 (73.68%) cases with a sensitivity, specificity, and positive predictive value of 72%, 87%, and 87%, respectively (P = 0.001). In the control group, seven (14.5%) cases tested positive for the Widal test and two (4.16%) for the typhidot (P = 0.001), yielding the sensitivity and specificity for the Widal test and the typhidot test of 63% and 83%, and 85% and 97%, respectively. We conclude that the Dot-EIA (enzyme immunoassay; typhidot) is a more sensitive and specific test which is easy to perform and more reliable compared to the Widal test and that it is useful in early therapy.

Drug resistance patterns in pulmonary tuberculosis.

OBJECTIVE: To determine the resistance patterns of mycobacterium tuberculosis (MTB) isolates among category I and II patients of pulmonary tuberculosis. METHODS: This cross sectional study was conducted at the Department of Medicine, Liaquat University of Medical and Health Sciences Jamshoro, from November 2008 to September 2009. Patients were divided into category I and II. The sputa were collected, stained with Ziehl-Nielsen (Z-N) staining and ultimately inoculated on Lowenstein-Jensen (L-J) media for six weeks. Out of 890 pulmonary tuberculosis (PTB) patients, the growth was obtained in 285 cases. The Drug sensitivity testing (DST) for Isoniazid (INH), Rifampicin (RIF), Ethambutol (EMB) Pyrazinamide (PZA) and Streptomycin (SM) were performed. The data was analyzed on SPSS 10.0. A p-value of <0.05 was taken as significant. RESULT: Out of 285 cases, 176 (61.75%) were male and 109 (38.24%) female. The mean age was 37 +/- 19.90 years. The DST showed drug sensitive and drug resistant isolates in 80 (28.05%) and 205 (71.92%) cases respectively (p=0.001). The drug resistant tuberculosis (DR-TB) rates for individual drugs; INH, RIF, EMB, PZA and SM were 51,22%, 15.4%, 13.33%, 9%12, and 3.85% respectively (p=0.03). The MDR-TB isolates were detected in 120 (42.10%) cases, including 5 (5.88%) in category I and 115 (57.50%) in category II patients (p=0.0001). CONCLUSION: Drug resistant and multidrug resistant tuberculosis was observed mainly in category II patients. However, primary MDR was also observed in category I patients and reflects dissemination of MDR cases within the community.

Cardiac autonomic neuropathy (CAN) in type-1 diabetes mellitus patients and its association with the duration of disease and glycemic control.

OBJECTIVE: To determine the frequency of Cardiac Autonomic Neuropathy (CAN) in type-1 Diabetes mellitus patients and its association with the duration of disease and glycemic control. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Medicine, Liaquat University Hospital, Hyderabad/Jamshoro, from December, 2004 to April, 2005. METHODOLOGY: Fifty patients of type-1 Diabetes Mellitus (DM) of >or=10 years duration were selected. CAN was evaluated in terms of presence of resting tachycardia, loss of sinus arrhythmia and heart rate response to Valsalva maneuver by electrocardiogram (ECG). An R-R variation with respiration of >15 beats per minute was taken normal, while 10-15 beats and <10 beats per minute were taken as borderline and definitive CAN respectively. QTc intervals were measured. Patients with HbA1c levels<7% were considered as well-controlled. The associations between CAN, the duration of diabetes and the diabetic control were determined. RESULTS: The mean age was 35.16+/-10.58 years with 32 males and 18 females. The mean values for the known duration of diabetes and HbA1c were 13+/-7.3 years and 9.36+/-2.5 mg/dl respectively. Definitive and borderline CAN were noted in 20% and 24% respectively. Variability of heart rate with respiration was significantly related to the duration but not to the control of the diabetes (p<0.05). QTc showed a significant correlation with the known duration of diabetes and heart rate variability with respiration (p<0.05). Most of the patients had uncontrolled glycemic status. CONCLUSION: Cardiac autonomic neuropathy is common in long standing type-1 diabetics. CAN resulted in prolonged QTc interval that may result in cardiac arrhythmias and even death. Intensive glycemic control improves the cardiac autonomic nerve functions.

Thrombocytopenia in plasmodium falciparum malaria.

BACKGROUND: Malaria is usually associated with reduced blood cell counts & mild to moderate thrombocytopenia is a common association of malaria. The cause of thrombocytopenia is poorly understood, but the immune-mediated lysis, sequestration in the spleen and dyspoietic processes in the marrow with diminished platelet production have all been postulated. This study was conducted to evaluate thrombocytopenia in the patients suffering from acute Plasmodium falciparum malaria. METHODS: This descriptive case series study was conducted at a tertiary care hospital, Liaquat University of Medical & Health Sciences Jamshoro, over a one-year period. A total of 370 Plasmodium falciparum positive on peripheral blood film were studied. Full blood counts were determined by using automated Coulter analyzer. Thick & thin smears were stained with Giemsa stains and studied by haematologist. Data was analyzed using the SPSS version 10.0. RESULTS: Out of 370 patients, 260 were male & 110 were female, with M:F ratio of 2.36:1. Mean age was 34 +/- 1.7 years (range 16-53 years). Haemoglobin values were 12.7 +/- 1.4g% and white blood cells counts were found 12600 +/- 450/microL. Out of 370, 114 (30.81%) had normal platelet counts, and 256 (69.18%) had thrombocytopenia (p < 0.05). The mild, moderate and severe thrombocytopenia were found in 39 (10.5%), 180 (48.6%) and 37 (10%) respectively (p < 0.05). CONCLUSIONS: We found high frequency of mild to moderate thrombocytopenia in the Plasmodium falciparum malaria. Finding of thrombocytopenia is of diagnostic help as it raises the suspicion of malaria.

Suicidal Isoniazid poisoning.

Accidental or intentional Isoniazid poisoning may manifest within half to three hours as intractable seizure, acidosis, and coma. Single high dose of pyridoxine was used as an antidote with good response as reported earlier. Ingestion of more than 80 mg/kg body weight produces severe central nervous system symptoms and a dose of 125 mg/kg is potentially lethal if not promptly treated. We report a case of suicidal attempt with use of Isoniazid, who developed grand mal seizures and was controlled with diazepam and symptomatic treatment.

Frequency of cardiac autonomic neuropathy in patients with type 2 diabetes mellitus reporting at a teaching hospital of Sindh.

OBJECTIVE: To determine the frequency of Cardiac Autonomic Neuropathy (CAN) in patients with type 2 Diabetes mellitus. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Medicine, Liaquat University Hospital, Jamshoro, Hyderabad from December 2004 to April 2005. METHODOLOGY: Patients with type 2 Diabetes Mellitus (DM) of at least 10 years duration were selected. CAN was evaluated in terms of presence of resting tachycardia, loss of sinus arrhythmia and heart rate response to Valsalva maneuver by ECG. A R-R variation with respiration of > 15 beats per minute, 10-15 beats per minute and <10 beats per minute were taken as normal, borderline CAN and definitive CAN, respectively. QTc intervals were measured. The association between CAN, diabetic control and duration of diabetes were determined. RESULTS: The mean age was 53.62+/-8.30 years, with male to female ratio of 1:1. Mean values for known duration of diabetes and HbA1c were 14+/-3.5 years and 11.36+/-3.6 mg/dl respectively. Definitive and borderline CAN was noted in 30% and 40% patients respectively. Variability of heart rate with respiration was significantly related to duration but not to the control of diabetes (p < 0.05). QTc showed a significant correlation with the known duration of diabetes and heart rate variability with respiration (p < 0.05). Most of the patients had very bad glycemic status as evidenced by HbA1c. CONCLUSION: CAN is common in long-standing diabetics, specifically those treated with oral hypoglycemic agents than those with insulin. Intensive glycemic control is associated with a better cardiac autonomic nerve functions.