Characteristics and treatment outcomes of patients with multi-drug resistant tuberculosis at a tertiary care hospital in Peshawar, Pakistan

Multi drug resistance-tuberculosis (MDR-TB) is considered amongst one of the fatal medical and public health issue. Greater frequency of adverse reactions has been observed using 2nd line antituberculosis drugs, which rises the rate of morbidity. Hypokalemia and hyponatremia are common in patients receiving MDR-TB treatment. This study was aimed to assess the effect of amikacin as multidrug resistance tuberculosis treatment on serum sodium and potassium level. A total 179 subjects (82 males and 97 females) were screened within the period of one year for their serum electrolyte levels before and during the treatment. Their body weight and sociodemographic characteristics were also taken into considerations. Data were expressed in the form of mean ± standard error using One-way analysis of variance (ANOVA), followed by Dunnett's test. All the statistical analyses were performed using GraphPad Prism v. 6. The results showed that amikacin caused a significant (p< 0.05) hypokalemia when used in combination with other drugs having no known effect on serum potassium level which proved to be the side effect of amikacin. The average serum potassium level in both intensive and continuation phase was significantly lower (p< 0.05) than the baseline (3.73 mmol/L), however, in the continuation phase the potassium level (3.58 mmol/L) was slightly higher than that of intensive phase (3.54 mmol/L). The average serum sodium level in both phases; intensive and continuation, remained in steady state (137.25 mmol/L and 137.87 mmol/L respectively) throughout the study period as compared to the base line (135.5 mmol/L). The amikacin drug lowered serum potassium level but had no effect on sodium level. It is concluded that the serum electrolytes should be monitored during the course of treatment and corrected accordingly.

(1) Background: The occurrence, intensity, and characteristics of adverse drug reactions (ADRs) caused by anti-tuberculosis (TB) drugs have consistently been a subject of worry. There is a lack of published research from Pakistan regarding the negative effects of anti-TB treatment on children, specifically about ADRs. In this study, we aimed to investigate the ADR associated with anti-DR-TB treatment in children. (2) Methods: A prospective longitudinal study was conducted in the multicenter setting of Khyber Pakhtunkhwa, Pakistan. A total of 450 TB children in multicenter hospitals under ATT were assessed for ADRs. Naranjo Causality Assessment and Hartwig’s Severity Assessment Scale were used to evaluate the causality and severity. (3) Results: A total of 300 (66.66%) ADRs were reported in 450 people with DRTB. Anemia was the most frequently observed ADR (37.6%) followed by nausea and vomiting (18.6%). On multivariate analysis, the independent variables that had a statistically significant positive association with ADRs were participants aged, 5–14 years (AOR, 0.3 (0.1–0.5), p ≤ 0.001), normal weight (1.1 (2.0–1.9), p < 0.001), and children having comorbidities (AOR, 0.5 (0.1–0.8), p ≤ 0.001). (4) Conclusions: Our findings advocate for personalized treatment approaches, incorporating nutritional support, comprehensive comorbidity management, and vigilant monitoring to mitigate ADRs and improve treatment outcomes.

The main objective of this study was to find out changes in level of haemoglobin concentration associated with high and low altitude areas of Khyber Pakhtunkhwa (KPK). A randomized blood samples were collected from 215 healthy male and female belonging to 20-50 years of age from June 2018 to November 2018. The subjects of the current study were selected from four different district of Khyber Pakhtunkhwa (Abbottabad, Dera Ismail Khan, Peshawar and Swat). Haemoglobin levels of the subjects were analyzed on Nihon Kohden Hematology analyzer (Celltac X MEK-6410K). There was an increase in haemoglobin level, at high altitude namely Abbottabad and Swat as compare to a selected low altitude region i.e. Dera Ismail Khan and Peshawar. We found statistically significant difference in Mean haemoglobin level at high-altitude region (14.25±1.40) and low-altitude region (13.58±1.28). Haemoglobin concentration increases in the blood with elevated altitudes and, thus, at high-altitude areas anemia was less frequent. The mechanism that produces the mean differences showed that altitude may play a vital role in haemoglobin production. This study provides the basis for future research in this area that explores the process of haemoglobin production at both cellular and molecular level. This will focus not only on haemoglobin or red blood cells but also on the tissues they supply.