Naseem S.,Indus Hospital |
Mubashar N.,Ziauddin Memorial Hospital |
Ansari B.,Indus Hospital
Asian Biomedicine | Year: 2013
Background: Human rabies is a fatal infectious disease that is entirely preventable if correct and timely postexposure prophylaxis is given. Unfortunately, rabies immunoglobulin (RIG) administration, a life-saving biological, is often avoided by emergency room health care providers (HCPs) Objective: To understand the practices of HCPs for administration of RIG in severe dog-bite exposures, which are common causes of emergency room visits in Pakistan. Methods: A cross-sectional study was conducted among 103 HCPs working in seven hospitals in three cities of Pakistan. Results: Of 103 HCPs who responded to the questionnaires, 97.1% had administered rabies vaccine and 31.1% had administered ERIG in the past three years of their practice; three quarters said they would prefer to use HRIG if available. Thirty-five percent said they would not inject wounds at all, 24.3% would only vaccinate a patient with severe dog bites, but not administer RIG. More than 55% were concerned about the cost of human and equine RIG. Conclusion: Although there is awareness about the use of RIG, this life saving biological is grossly underused because of poor availability in clinics and emergency rooms (ERs) even though stocked by local suppliers. Hospitals and animal bite centers must make RIG available for severe exposures.
Salahuddin N.,Indus Hospital |
Mubasharb K.,Ziauddin Memorial Hospital |
Baig-Ansaria N.,Indus Hospital
Asian Biomedicine | Year: 2014
Background: Human rabies is a fatal infectious disease that is entirely preventable if correct and timely postexposure prophylaxis is given. Unfortunately, rabies immune globulin (RIG) administration, a life-saving biological, is often avoided by Emergency Room health care providers (HCPs). Objective: To understand the practices of HCPs for administration of RIG in severe dog-bite exposures, which are common causes of emergency room visits in Pakistan. Methods: A cross-sectional study was conducted among 103 HCPs working in seven hospitals in three cities of Pakistan. Results: Of 103 HCPs who responded to the questionnaires, 97.1% had administered rabies vaccine and 31.1% had administered ERIG in the past three years of their practice; three quarters said they would prefer to use HRIG if available; 35% said they would not inject wounds at all, 24.3% would only vaccinate a patient with severe dog bites, but not administer RIG. More than 55% were concerned about the cost of human and equine RIG. Conclusion: Although there is awareness about use of RIG, this life saving biological is grossly underused because of poor availability in Emergency Rooms (ERs) even though stocked by local dealers. Animal bite centers must make RIG available for severe exposures.
Codlin A.J.,Interactive Research and Development IRD |
Javaid M.,Indus Hospital |
Qazi F.,Interactive Research and Development IRD |
Khan M.S.,Interactive Research and Development IRD |
Khan M.S.,London School of Hygiene and Tropical Medicine
BMC Infectious Diseases | Year: 2012
Background: In South Asia, it is estimated that 80% of patients choose to attend a private facility for their healthcare needs. Although patients generally believe that the private-sector provides high quality services, private diagnostic laboratories are largely unregulated and little is known about the accuracy of results provided. This study assesses the accuracy of sputum smear microscopy for pulmonary tuberculosis diagnosis in private laboratories operating in Karachi, Pakistan. A novel evaluation methodology was designed in which patient-actors submitted sputum specimens spiked with cultured Mycobacterium tuberculosis (Mtb) for testing such that laboratories were not aware that they were being assessed.Methods: Smear-negative sputum specimens from Indus Hospital TB Program patients were collected and combined with an attenuated, cultured Mtb strain to create Mtb-spiked samples; for negative standards, no Mtb was added to the smear-negative sputum specimens. Seven of the largest private laboratories across Karachi were chosen for evaluation and were sent six Mtb-spiked and one Mtb-negative sputum specimens. Patient-actors pretending to be laboratory customers submitted these specimens to each laboratory for testing over a three day period.Results: Only three laboratories accurately classified all the Mtb-spiked specimens which were submitted. A further three misclassified all the Mtb-spiked specimens as smear-negative, thus providing the 'patients' with false negative results.Conclusions: TB sputum smear microscopy services are highly variable across private laboratories and are often of extremely poor quality. Engagement, capacity building and rigorous monitoring of standards at private laboratories are of vital importance for the control of TB. Our findings, while specific for TB diagnostic tests, could be symptomatic of other tests performed in private laboratories and warrant further investigation. © 2012 Codlin et al.; licensee BioMed Central Ltd.
Seddon J.A.,University of Cape Town |
Seddon J.A.,London School of Hygiene and Tropical Medicine |
Furin J.J.,Case Western Reserve University |
Gale M.,Médecins Sans Frontières |
And 9 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2012
The management of children with drug-resistant tuberculosis (DR-TB) is challenging, and it is likely that in many places, the roll-out of molecular diagnostic testing will lead to more children being diagnosed. There is a limited evidence base to guide optimal treatment and follow-up in the pediatric population; in existing DR-TB guidelines, the care of children is often relegated to small "special populations" sections. This article seeks to address this gap by providing clinicians with practical advice and guidance. This is achieved through review of the available literature on pediatric DR-TB, including research studies and international guidelines, combined with consensus opinion from a team of experts who have extensive experience in the care of children with DR-TB in a wide variety of contexts and with varying resources. The review covers treatment initiation, regimen design and treatment duration, management of comorbid conditions, treatment monitoring, adverse events, adherence promotion, and infection control, all within a multidisciplinary environment. Copyright © 2012 by the American Thoracic Society.
Hasan Z.,Aga Khan University |
Rao N.,University of Karachi |
Salahuddin N.,Indus Hospital |
Islam M.,Aga Khan University |
And 3 more authors.
Scandinavian Journal of Immunology | Year: 2012
Improved tools are required to study immunopathogenesis of tuberculosis (TB). Mycobacterium tuberculosis antigen-stimulated T cell-based assays can detect TB but are less effective when responses are compromised such as in severe disease. We investigated immune responses to M. tuberculosis whole sonicate (MTBs), recombinant antigens ESAT6 and CFP10 in whole blood cells of healthy endemic controls (EC, n=42) and patients with pulmonary (PTB, n=36) or extrapulmonary (ETB, n=41) disease. Biomarkers of T cell activation (IFNγ) or modulation (IL10) and chemokines, CXCL9, CXCL10 and CCL2, secretion were measured. MTBs, ESAT6 and CFP10 all induced IFNγ responses in TB. ESAT6-induced IFNγ was elevated in TB as compared with EC. MTBs stimulated the highest IFNγ levels but did not differentiate between TB and EC. However, MTBs-induced CXCL10 (P=0.004) was reduced, while IL10 (P<0.001) was raised in TB as compared with EC. Between sites, MTBs-induced CCL2 (P=0.001) and IL10 secretion was higher in PTB than ETB (P<0.001). In comparison of disease severity, MTBs-induced IFNγ (P=0.014) and CXCL10 (P=0.022) levels were raised in moderate as compared with far advanced PTB. In ETB, MTBs-induced IL10 levels were greater in less-severe (L-ETB) than in severe disseminated (D-ETB) cases, P=0.035. Within the L-ETB group, MTBs-induced IFNγ was greater in patients with tuberculous lymphadenitis than those with pleural TB (P=0.002). As immune responses to MTBs were differentially activated in TB of different sites and severity, we propose the utility of MTBs-induced IFNγ, CXCL10 and IL10 as biomarkers in TB. © 2011 The Authors. Scandinavian Journal of Immunology © 2011 Blackwell Publishing Ltd.
Masood K.I.,Aga Khan University |
Rottenberg M.E.,Karolinska Institutet |
Salahuddin N.,Indus Hospital |
Irfan M.,Aga Khan University |
And 5 more authors.
BMC Infectious Diseases | Year: 2013
Background: Appropriate immune activation of T cells and macrophages is central for the control of Mycobacterium tuberculosis infections. IFN-γ stimulated responses are lowered in tuberculosis (TB), while expression of Suppressor of Cytokine Signaling (SOCS) molecules - 1 and 3 and CD4+CD25+FoxP3+T regulatory cells is increased. Here we investigated the association of these molecules in regard to clinical severity of TB.Methods: Peripheral blood mononuclear cells (PBMCs) were isolated from patients with pulmonary TB (PTB, n = 33), extra-pulmonary TB (ETB, n = 33) and healthy endemic controls (EC, n = 15). Cases were classified as moderately advanced or far advanced PTB, and less severe or severe disseminated ETB. M. tuberculosis -stimulated IFN-γ, SOCS1, SOCS3 and FoxP3 gene expression and secretion of Th1 and Th2 cytokines was measured. Statistical analysis was performed using Mann-Whitney U, Wilcoxon Rank and Kruskal Wallis non-parametric tests.Results: In un-stimulated PBMCs, IL-6 (p = 0.018) and IL-10 (p = 0.013) secretion levels were increased in PTB while IL-10 was also increased in ETB (p = 0.003), all in comparison with EC. M. tuberculosis-stimulated IL-6 (p = 0.003) was lowered in ETB as compared with EC. SOCS1 mRNA expression in M. tuberculosis stimulated PBMCs levels in moderately advanced PTB (p = 0.022), far advanced (p = 0.014) PTB, and severe ETB (p = 0.009) were raised as compared with EC. On the other hand, SOCS1 mRNA titers were reduced in less severe ETB, in comparison with severe ETB (p = 0.027) and far advanced PTB (p = 0.016). SOCS3 mRNA accumulation was reduced in far advanced PTB (p = 0.007) and FoxP3 mRNA expression was increased in less severe ETB as compared with EC (p = 0.017).Conclusions: The lowered SOCS1 mRNA levels in patients with less severe extra-pulmonary TB as compared to those with more severe ETB and PTB may lead to elevated IFN-γ pathway gene expression in the latter group. As localized ETB has shown to be associated with more effective Th1 immunity and adaptive responses, this suggests a role for SOCS1 in determining disease outcome in extra-pulmonary TB. © 2013 Masood et al.; licensee BioMed Central Ltd.
PubMed | Indus Hospital and Aga Khan University
Type: | Journal: International journal of mycobacteriology | Year: 2017
Pakistan ranks sixth among high-tuberculosis (TB)-burden countries worldwide and fifth worldwide for diabetes incidence. Although both these factors are independently known, the rate of diabetes among TB patients is not well known. We aimed to determine the prevalence of diabetes among patients with TB presenting at tertiary care health centers in Karachi, Pakistan.A total of 216 patients with TB were recruited and their blood samples were taken for testing of glycosylated hemoglobin (HbA1c) and random blood sugar. Diabetes was defined as HbA1c>6.5% and random blood sugar>180mg/dL, pre-diabetes as HbA1c 5.7-6.4%, and normoglycemia as HbA1c<5.7%.Data for 211 patients were available and showed that 24 (11.4%) patients had diabetes. Of these, 17 were newly diagnosed, while seven were known diabetics. Prediabetes was identified in 45 (21.3%) cases. Of the TB patients, 165 were newly diagnosed, while 46 were retreatment cases. The majority of patients (60%) were underweight with a body mass index of <18.5.This study identified 11.4% diabetics among TB patients presenting to a tertiary care facility. Despite the high diabetes incidence in Pakistan, 71% of the diabetics in the group studied did not know their status. Given the negative impact of diabetes on treatment outcomes of TB, it is important that screening for diabetes be included as initial workup for TB patients. Identification and management of diabetes would result in improved outcomes for TB treatment.
Alam A.,Indus Hospital |
Amanullah F.,Indus Hospital |
Baig-Ansari N.,Indus Hospital Research Center |
Lotia-Farrukh I.,Interactive Research and Development |
Khan F.S.,Interactive Research and Development
BMC Research Notes | Year: 2014
Background: Chronic kidney disease (CKD) is being increasingly recognized as a leading public health problem. However, there are limited data available with respect to prevalence of CKD in Pakistan, a developing South Asian country. The study presents the baseline findings of prevalence and risk factors for adult kidney disease in a Pakistani community cohort. Methods. A total of 667 households were enrolled between March 2010 and August 2011 including 461 adults, aged 15 and older. Mild kidney disease was defined as estimated Glomerular Filtration Rate (eGFR) ≥60 ml/min with microalbuminuria ≥ 30 mg/dl and moderate kidney disease was defined as eGFR <60 ml/min (with or without microalbuminuria). Results: The overall prevalence of kidney disease was 16.6% with 8.6% participants having mild kidney disease and 8% having moderate kidney disease. Age was significantly associated with kidney disease (p < 0.0001). The frequency of diabetes, hypertension and smoking differed significantly among the three groups, i.e., no kidney disease, mild kidney disease and moderate kidney disease. Conclusion: Our study results suggest that the burden of kidney disease in this population is found considerable and comparable to neighboring developing countries. We believe that these results have critical implications on health and economics of these countries and due to the epidemic of diabetes, hypertension, cardiovascular disease, smoking and association with worsening poverty, further rapid growth is expected. There is an urgent need for early recognition and prevention strategies based on risk factors and disease trends determined through longitudinal research. © 2014 Alam et al.; licensee BioMed Central Ltd.
Amanullah F.,Indus Hospital |
Amanullah F.,Harvard University |
Ashfaq M.,Interactive Research and Development |
Khowaja S.,Interactive Research and Development |
And 5 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2014
SETTING: Urban Karachi, Pakistan. OBJECTIVE: To describe the yield of a contact investigation protocol implemented among children living with drug-resistant tuberculosis (DR-TB) patients. DE S I GN: We implemented a contact investigation protocol in households of DR-TB patients treated at the Indus Hospital, Karachi, between January 2008 and April 2011. This included a detailed history and physical examination, tuberculin skin test, chest radiograph, smear microscopy and culture of sputum or gastric aspirate specimens, and drug susceptibility testing. Treatment supporters who visited DR-TB patients at home referred all child contacts for baseline evaluation and performed monthly assessments. We evaluated two age groups: 1) children aged <5 years, and 2) those aged 5-14 years. RESULTS: Among 133 children aged <15 years in 40 households, 40.4% (51/125) were moderately to severely underweight (weight-for-age Z-score <-2). Overall, 7.5% (10/133) had TB disease. This proportion was 6.5% (2/31) in those aged <5 years and 7.8% (8/102) in those aged 5-14 years. Seven (7/10) were smear-positive, and 4/10 had culture-confirmed multidrug-resistant Mycobacterium tuberculosis. CONCLUSION: We detected a high prevalence of TB in children who live with DR-TB patients, regardless of the age of the child. Child contacts of DR-TB patients are a high-yield population for detecting TB cases. © 2014 The Union.
Raza S.,Brigham and Women's Hospital |
Sajun S.Z.,Indus Hospital |
Selhorst C.C.,Brigham and Women's Hospital
Journal of the American College of Radiology | Year: 2012
Purpose: The aim of this study was to assess the attitudes of women and general practitioners (GPs) living in Karachi, Pakistan, regarding breast cancer, mammographic screening, and local barriers to breast health care. Methods: This study was performed using questionnaires designed specifically for women and for GPs in Karachi. Geographically dispersed collaborators identified GPs from neighborhoods across Karachi; snowball sampling located additional GPs and women in neighboring areas. Trained local community health workers conducted one-on-one surveys and used specially equipped (openXdata) mobile phones to enter and upload participant responses in real time. Results: The survey included 200 women (median age, 35 years; range, 24-63 years), and 100 GPs (49% men, 51% women). Women's knowledge of breast cancer incidence, diagnosis, and treatment was proportionate to educational level, while willingness to address breast health issues and interest in early detection were high regardless of education level. Very few women had ever undergone clinical breast examinations (16%) or mammography (9%). Among GPs (median time practicing, 12 years; range, 1-40 years), most understood major risk factors and importance of early detection. However, 20% did not believe breast cancer occurs in Pakistan, and 30% believed that it is a fatal disease. Female GPs were more likely to perform clinical breast examinations (98%) than male GPs (24%). Conclusions: This study has identified specific areas to target for educational and early detection programs. Women need more awareness and access to routine examinations and mammography; GPs need more education regarding the incidence and management of breast cancer. Male GPs would benefit from having trained female assistants to perform clinical breast examinations. © 2012 American College of Radiology.