Reading, Pakistan
Reading, Pakistan

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PubMed | Lady Reading Hospital Peshawar, Sarhad University of Science and Information Technology and Quaid-i-Azam University
Type: | Journal: BMC infectious diseases | Year: 2016

Multi-drug resistant tuberculosis (MDR-TB) is a major public health problem especially in developing countries. World Health Organization (WHO) recommends use of Xpert MTB/RIF assay to simultaneously detecting Mycobacterium tuberculosis (MTB) and rifampicin (RIF) resistance. The primary objective of this study was to determine the frequency of MDR-TB in patients suspected to have drug resistance in Khyber Pakhtunkhwa. The frequency of probes for various rpoB gene mutations using Xpert MTB/RIF assay within 81bp RRDR (Rifampicin Resistance Determining Region) was the secondary objective.A total of 2391 specimens, received at Programmatic Management of Drug Resistant TB (PMDT) Unit, Lady Reading Hospital (LRH) Peshawar, Pakistan, between October 2011 and December 2014, were analyzed by Xpert MTB/RIF test. MTB positive with rifampicin resistance were further analyzed to first line anti-mycobacterial drug susceptibility testing (DST) using middle brook 7H10 medium. The data was analyzed using statistical software; SPSS version 18.Out of 2391 specimens, 1408 (59%) were found positive for MTB and among them, 408 (29%) showed rifampicin-resistance with four different rpoB gene mutations within 81bp RRDR. The frequency of various probes among RIF-resistant isolates was observed as: probe E, in 314 out of 408 isolates; B, 44 out of 408; A, 5 out of 408; D, 34 out of 408; and probe C was observed among 6 out of 408 RIF-resistant isolates. The probe A&B and E&D mutation combination was found in only 1 isolate in each case, while B&D mutation combination was detected among 3 out of 408 RIF-resistant isolates.Hence, it is concluded from our study on a selected population, 29% of patients had MDR-TB. Probe E related mutations (also known as codon 531and 533) were the most common rpoB genetic mutation [314 (77%)], acknowledged by Xpert MTB/RIF assay. Least mutation was detected within the sequence 511 (1.2%).

Ahmad N.,Universiti Sains Malaysia | Javaid A.,Postgraduate Medical Institute Peshawar | Sulaiman S.A.S.,Universiti Sains Malaysia | Basit A.,Postgraduate Medical Institute Peshawar | And 3 more authors.
PLoS ONE | Year: 2016

Background At present, within the management of multidrug resistant tuberculosis (MDR-TB) much attention is being paid to the traditional microbiological and clinical indicators. Evaluation of the impact of MDR-TB treatment on patients' Health Related Quality of Life (HRQoL) has remained a neglected area. Objective To evaluate the impact of MDR-TB treatment on patients HRQoL, and determine the predictors of variability in HRQoL along the course of treatment Methods A prospective follow up study was conducted at the programmatic management unit for drug resistant TB of Lady Reading Hospital Peshawar. Culture confirmed eligible MDR-TB patients were asked to self complete SF-36v2 at the baseline visit, and subsequently after the completion of 12 months of treatment and at the end of treatment. A score of <47 normbased scoring (NBS) points on component summary measures and health domain scales was considered indicative of function impairment. General linear model repeated measures ANOVA was used examine the change and predictors of change in physical component summary (PCS) and mental component summary (MCS) scores over the time. Results A total of 68 out of enrolled 81 eligible MDR-TB patients completed SF-36v2 questionnaire at the three time points. Patients' mean PCS scores at the three time points were, 38.2±4.7, 38.6±4.4 and 42.2±5.2 respectively, and mean MCS were 33.7±7.0, 35.5±6.9 and 40.0±6.9 respectively. Length of sickness prior to the diagnosis of MDR-TB was predictive of difference in PCS scores (F = 4.988, Df = 1, 66), whereas patients' gender (F = 5.638, Df = 1, 66) and length of sickness prior to the diagnosis of MDR-TB (F = 4.400, Df = 1, 66) were predictive of difference in MCS scores. Conclusion Despite the positive impact of MDR-TB treatment on patients' HRQoL, the scores on component summary measures suggested compromised physical and mental health even at the end of treatment. A large multicenter study is suggested to confirm the present findings. © 2016 Ahmad et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Attaullah S.,University of Peshawar | Khan S.,Kohat University of Science and Technology | Naseemullah,Lady Reading Hospital Peshawar | Ayaz S.,Kohat University of Science and Technology | And 4 more authors.
Virology Journal | Year: 2011

Background: Hepatitis B Virus (HBV) may progress to serious consequences and increase dramatically beyond endemic dimensions that transmits to or from health care workers (HCWs) during routine investigation in their work places. Basic aim of this study was to canvass the safety of HCWs and determine the prevalence of HBV and its possible association with occupational and non-occupational risk factors. Hepatitis B vaccination coverage level and main barriers to vaccination were also taken in account. Results: A total of 824 health care workers were randomly selected from three major hospitals of Peshawar, Khyber Pakhtunkhwa. Blood samples were analyzed in Department of Zoology, Kohat University of Science and Technology Kohat, and relevant information was obtained by means of preset questionnaire. HCWs in the studied hospitals showed 2.18% prevalence of positive HBV. Nurses and technicians were more prone to occupational exposure and to HBV infection. There was significant difference between vaccinated and non-vaccinated HCWs as well as between the doctors and all other categories. Barriers to complete vaccination, in spite of good knowledge of subjects in this regard were work pressure (39.8%), negligence (38.8%) un-affordability (20.9%), and unavailability (0.5%). Conclusions: Special preventive measures (universal precaution and vaccination), which are fundamental way to protect HCW against HBV infection should be adopted. © 2011 Attaullah et al; licensee BioMed Central Ltd.

Khan S.,Kohat University of Science and Technology | Attaullah S.,University of Peshawar | Ali I.,University of Agriculture, Peshawar | Ayaz S.,Kohat University of Science and Technology | And 3 more authors.
Virology Journal | Year: 2011

Aim. High prevalence of Hepatitis C virus (HCV) has been reported among the dialysis patients throughout the world. No serious efforts were taken to investigate HCV in patients undergoing hemodialysis (HD) treatment who are at great increased risk to HCV. HCV genotypes are important in the study of epidemiology, pathogenesis and reaction to antiviral therapy. This study was performed to investigate the prevalence of active HCV infection, HCV genotypes and to assess risk factors associated with HCV genotype infection in HD patients of Khyber Pakhtunkhwa as well as comparing this prevalence data with past studies in Pakistan. Methods. Polymerase chain reaction was performed for HCV RNA detection and genotyping in 384 HD patients. The data obtained was compared with available past studies from Pakistan. Results: Anti HCV antibodies were observed in 112 (29.2%), of whom 90 (80.4%) were HCV RNA positive. In rest of the anti HCV negative patients, HCV RNA was detected in 16 (5.9%) patients. The dominant HCV genotypes in HCV infected HD patients were found to be 3a (n = 36), 3b (n = 20), 1a (n = 16), 2a (n = 10), 2b (n = 2), 1b (n = 4), 4a (n = 2), untypeable (n = 10) and mixed (n = 12) genotype. Conclusion: This study suggesting that i) the prevalence of HCV does not differentiate between past and present infection and continued to be elevated ii) HD patients may be a risk for HCV due to the involvement of multiple routes of infections especially poor blood screening of transfused blood and low standard of dialysis procedures in Pakistan and iii) need to apply infection control practice. © 2011 Khan et al; licensee BioMed Central Ltd.

PubMed | Lady Reading Hospital Peshawar, Institute of Public Health and Quaid-i-Azam University
Type: Journal Article | Journal: PloS one | Year: 2016

Drug resistant tuberculosis (DR-TB) is a major public health problem in developing countries such as Pakistan.The current study was conducted to assess the frequency of drug resistant tuberculosis including multi drug resistance (MDR- TB) as well as risk factors for development of DR-TB, in Punjab, Pakistan.Drug susceptibility testing (DST) was performed, using proportion method, for 2367 culture positive Mycobacterium tuberculosis (MTB) cases that were enrolled from January 2012 to December 2013 in the province of Punjab, Pakistan, against first-line anti-tuberculosis drugs. The data was analyzed using statistical software; SPSS version 18.Out of 2367 isolates, 273 (11.5%) were resistant to at least one anti-TB drug, while 221 (9.3%) showed MDR- TB. Risk factors for development of MDR-TB were early age (ranges between 10-25 years) and previously treated TB patients.DR-TB is a considerable problem in Pakistan. Major risk factors are previous history of TB treatment and younger age group. It emphasizes the need for effective TB control Program in the country.

Shaheen S.,Lady Reading Hospital Peshawar | Khattak N.N.,Kohat Institute of Medical science | Parveen T.,Khyber Medical College
Medical Forum Monthly | Year: 2014

Objective: To determine the effectiveness of vaginal Misoprostol for the second trimester termination of pregnancy. Study Design: Prospective randomized trial. Place & Duration of Study: This study was carried out in the Unit of Post Graduate Medical Institution Peshawar / Lady Reading Hospital Peshawar from 1st January till 31st December 2006. Materials and Methods: A total of 100 patients were included in this study. Misoprostol 400 microgram, was administered intra-vaginally and repeated after every 4 hours up to a maximum of five doses or until the termination of pregnancy, which ever was earlier. The exclusion criteria were as allergy to prostaglandin, a previous classic caesarean section or Hysterectomy, active vaginal bleeding, severe asthma and epilepsy. Results: Period of gestation ranged from 12 to 20 weeks. Indications for 2nd trimester termination of pregnancy were chromosomal or structural fetal anomalies (anencephaly) whether dead or alive, missed abortion intrauterine fetal death. Success rate at 48 hours was 90%. The median induction to termination interval was 16 hours. Few women suffered gastrointestinal side effects such as nausea (6%), vomiting (3%) and diarrhea (1%). Conclusion: 400 Microgram of Vaginal Misoprostol is highly effective way of cervical ripening and termination of second trimester pregnancy.

Ali M.,Lady Reading Hospital Peshawar | Usman M.,Lady Reading Hospital Peshawar
Journal of Postgraduate Medical Institute | Year: 2013

Traumatic brain injury (TBI) is leading cause of death and disability worldwide. Every year about 1.5 million affected people die and several millions receive emergency treatment. TBI with current best practice, results in only about one third of patients being able to live independently in the long term. Although people from all age groups may be affected; the TBI is more common in young age because of the exposure of this age to more chances of accidents on roads, work place and during leisure activities. Decompressive craniectomy is a surgical operation to decrease intracranial pressure, has been used with increasing frequency. Neurological surgeons however do not know whether the operation achieves its goal of improving patient outcomes. The question is considered of great importance internationally. In Pakistan and especially in the province of Khyber Pukhtunkhwa, firearm injuries are more common and children are more prone to fall. The incidence of TBI is on the rise in developing countries. Anything that can improve the outcome from TBI has the potential of improving the lives of many head injured patients.

To study the effect of thrombolytic therapy in term of success and failure on the type of ST elevation MI, using streptokinase. This was a comparative study, conducted at Department of Cardiology, Lady Reading Hospital, Peshawar, from October 2006 to October 2007. Patients with first acute myocardial infarction were divided into group A (successful thrombolysis) and group B (unsuccessful thrombolysis) using ECG criteria. Total number of patients were 200. Group A included 136 (68%) patients and group B included 64 (32%) patients. There were total 88 (44%) patients of anterior MI with 47 patients in group A and 41 patients in group B (34.6% vs 64.0%, p < 0.001). There were total 110 (55.0%) patients of inferior MI with 88 patients in group A and 22 patients in group B (64.7% vs 34.4%, p < 0.001). Lateral myocardial infarction was diagnosed in 2 (1%) patients with 1 patient each in group A and group B (0.7% vs 1.6%, p = 0.583). Anterior MI was associated with a higher rate of thromblysis failure while inferior MI and lateral wall MI was associated with a higher rate of successful thrombolysis.

Ahmad N.,Lady Reading Hospital Peshawar | Ashfaq M.,Lady Reading Hospital Peshawar | Javed M.,Lady Reading Hospital Peshawar | Khan Q.,Lady Reading Hospital Peshawar
Journal of Postgraduate Medical Institute | Year: 2012

Objective: To study the frequency of symptoms, composition and complications of clinically suspected non radio-opaque foreign body aspiration; which is a difficult diagnostic challenge resulting in delayed referral for bronchoscopy. Methodology: This descriptive analysis of 400 cases of foreign body aspiration was done in the department of ENT & Head and Neck surgery, Lady Reading Hospital Peshawar from 2003-2006. One hundred cases were selected with presumptive diagnosis of foreign bodies in tracheobronchial tree. The inclusion criteria were non witness and non radio-opaque foreign bodies. We reviewed their hospital record to ascertain history diagnosis and treatment. Age, sex, location in tracheobronchial tree, witnessed or un-witnessed events, symptoms, radio graphic findings, anatomical abnormalities noted at endoscopy and complications were recorded. Radio opaque foreign bodies were excluded from the study. Results: A total of hundred cases were included. Age range was from 2-5 years. Males were 70% and females were 30%. Delay in presentation was from 10 days to 4 years. Common symptoms at presentation were cough 55% and asthma 20%. Radiological findings were abnormal in 90% of cases. Upon bronchoscopy 70% were positive for foreign body and 30% were negative. Peanuts (30%) and whistles (28%) were the commonest foreign bodies No death occurred in this study and minor complications of the procedure were only 15%. Conclusion: Aspiration of foreign bodies in children can lead to serious morbidity if not recognized and treated in time; hence early referral is essential.

Hafiz-Ur-Rehman,Lady Reading Hospital Peshawar
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2010

Pericardial effusion (PE) is not an uncommon finding in serial echocardiographic evaluation of patients with AMI, especially when infarction is anterior and extensive. The objective of this study was to determine the frequency of pericardial effusion after first myocardial infarction and its effects on in-hospital morbidity and mortality. This descriptive study was performed in the Department of Cardiology, PGMI, LRH Peshawar, from July 2007 to December 2007. Main outcome measure was frequency of pericardial effusion. Out of 200 patients with first acute myocardial infarction (AMI), mean age was 56 +/- 18 (28-90 years). Majority of patients (31.5%) were in the age range of 51-60 years. Males were 65.5% and 34.5% were females. Pericardial effusion was found in 4.5% patients on day 0, in 12.5% patients on day 2 and in 15% patients on day 4. Left ventricular failure was documented in 19 (9.5%) patients without and 42 (21%) patients with pericardial effusion (p<0.05%). Cardiogenic shock was reported in 5 (2.5%) patients without and 16 (8%) in patients with pericardial effusion and mitral regurgitation was found in 3 (1.5%) patients in each group. Death was recorded in 1 (0.5%) patient without pericardial effusion and was 1.5% (n=3) in patients with pericardial effusion. Pericardial effusion was seen in one third of the patients with first acute myocardial infarction. In acute phase of myocardial infarction, the chances of development of pericardial effusion increases as the time passes. Left ventricular failure was the commonest in-hospital morbidity followed by cardiogenic shock and mitral regurgitation. In-hospital mortality was more in patients with pericardial effusion.

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