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Home > Identification of Risk Factors in Multi Drug Resistant Tuberculosis Patients and Clinical Trial With Linezolid

Identification of Risk Factors in Multi Drug Resistant Tuberculosis Patients and Clinical Trial With Linezolid

Thesis Info

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Author

Tubassum, Masood Nizam

Program

PhD

Institute

The University of Lahore

City

Lahore

Province

Punjab

Country

Pakistan

Thesis Completing Year

2018

Thesis Completion Status

Completed

Subject

Public Health

Language

English

Link

http://prr.hec.gov.pk/jspui/bitstream/123456789/12741/1/Masood%20Nizam%20Tabassum_Public%20Health_2018_UoL_PRR.pdf

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676724753235

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INTRODUCTION Tuberculosis is a chronic infectious bacterial disease caused by Mycobacterium tuberculosis. Multi drug resistant tuberculosis is a form of tuberculosis caused by a strain of Mycobacterium tuberculosis complex which are resistant to at least Isoniazid and Rifampicin with or without resistance to any other first line antituberculosis treatment (ATT). Multiple factors have been identified those lead to multi drug resistance response to tuberculosis. Treatment of multi-drug resistant tuberculosis requires treatment with second line drugs, usually four or more TB drugs for a minimum period of 6 months and probably extending for 18-24 months if rifampicin resistance has been identified. Linezolid is an antibiotic used for the treatment of serious infections caused by gram positive bacteria and in highly resistant tuberculosis strain and cases that are otherwise complicated to treat. OBJECTIVES The objectives of this study were to determine the demographic features of participants in this study, to determine risk factors in multi-drug resistant tuberculosis and to conduct a clinical trial for the determination of efficacy of linezolid in patients with multi drug resistant tuberculosis. Study design; To determine the demographic features of Tuberculosis, cross sectional study, to determine the risk factors in patients with Tuberculosis and multi-drug resistant Tuberculosis, analytical cross sectional study and to conduct the clinical trial for examining the efficacy of Linezolid for treatment of multi drug resistant tuberculosis, clinical trial was conducted by using the study design of experimental epidemiology (Single blind randomized control trial phase-4) Study Universe: Public sector Hospital, Lahore Pakistan. Study population: Tuberculosis and multi-drug resistant tuberculosis patients registered or followed by Outpatient Department of public sector Hospital Lahore Sampling Technique;: Convenient sampling for project-1 & 2 and Simple Random Sampling for project-3 Study Duration: One year (1st Dec 2016 to 30th Nov2017) DATA COLLECTION PROCEDURE; using convenient sampling/simple random sampling technique, data collected through a questionnaire. Subjects from public sector hospital were enrolled in the study according to inclusion and exclusion criteria. They were investigated, examined, monitored and data recorded in a questionnaire. Statistical analysis was done using SPSS version RESULTS; During demographic analysis of patients with tuberculosis, it was observed that female cases were higher than male cases. Age group 18-34 years was maximally affected by tuberculosis. The disease had a decreasing trend with aging. In both genders number of cases was decreasing with increase of age. There were only a few cases above 60 years of age. Majority of cases belonged to Lahore or its suburbs. . Majority of the cases belonged to urban area, had lower class and low socioeconomic status. Males were more educated as compared to females. Majority of the cases were relapsed. Two third cases had extra pulmonary Tuberculosis. In extra pulmonary tuberculosis, majority of cases involved lymph nodes. The risk factors for tuberculosis and multi-drug resistant tuberculosis were not common. In randomized control trial with Linezolid, 90% cases of multi-drug resistant tuberculosis were pulmonary tuberculosis. Treatment with Linezolid proved to be effective in 60% cases. CONCLUSION; In this study analysis of demographic profile showed that the number of female patients was increasing. The age group 18-44 years was maximally affected. In randomized control trial with Linezolid, 90% cases of multidrug resistant tuberculosis were pulmonary. Treatment with Linezolid proved to be effective in 60% cases with multi-drug resistant tuberculosis.
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المبحث الأول: فصول السنة والمشاعر

المبحث الأول: فصول السنة والمشاعر

قصیدة )کآبة الفصول الأربعة (لنازک الملائكة [1]

نحن نحیا في عالم کلّہ دم

عٌ وعمرٌ یفیض[2] یأساً وحزناً

تتشفی[3] عناصر الزمن القا

سي بأھاتنا وتسخر منّا

في غموض الحیاۃ نسرب[4] کالأ ش

باح بین البکاء والآھاتِ

کلّ یومٍ طفلٌ جدیدٌ ومیتٌ

ودموعٌ تبکي علی المأساۃ

ثم ماذا؟ في أيّ عالمنا المح

زن نلقٰی العزاء[5] عمّا نقاسي؟

عند وجہ الطبیعۃ الجھم [6] أم عن

د فؤاد الزمان وھو القاسي

قد عبرنا نھر الحیاۃِ حیارَی

في ظلام الفصول والسنوات

وثبتنا علیٰ أسانا خریفاً

وربیعاً فما جمالُ الحیاۃ؟

طالما مرّ بي الخریفُ فأصغي

تُ لصوتِ القمریّۃ[7] المحزونِ

وأنا في سکون غرفتي الدج

یاء أرنو[8] إلی وجوم[9] الغصون

طالما في الخریفِ سرت الی الحق

ل وأمعنتُ في وجومي[10] وحزني

کیف لا والکآبۃُ المرّۃ الخر

ساءُ قد رفرفتُ علی کلّ غصن

والحمامُ الجمیلُ قد ھَجَر الاّع

شاش سأمان [11]من وجوم السھوب

کارڈز میں کفالہ کی شرعی و فقہی حیثیت اور عصرِ حاضر کے مالیاتی اداروں میں اس کا عملی تطبیق

Cards are the plastic money of current era, and Kafala by means of their warranty is little much we know about. In this article we will discuss the necessity, use and framework of Kafala for the Debit & Credit cards issued by banks and financial institutes, in the light of Qur’an and Sunnah, Ijma-e-Umma and religious researchers.

Mapping of Genes Involved in Human Hereditary Infertility

Introduction: The World Health Organization defines infertility as the failure of achieving conception after one year of unprotected intercourse. Worldwide, approximately 15% of couples are affected by infertility and genetic anomalies account for 15-30% of male factor infertility. Nearly 15% of infertile males suffer from azoospermia in the form of obstructive azoospermia or non-obstructive spermatogenic failure. Polycystic Ovary Syndrome (PCOS) was contributing 6-10% infertility in female population. Environmental and genetic factors are involved. However; etiology of PCOS still remains debatable. Primary Ovarian Insufficiency (POI) or Premature Ovarian Failure (POF) affects 1- 2% of women, and is characterized by amenorrhea before the age of 40 years. POI is heritable in up to 30% of individuals. Methodology: The study presented in the dissertation describes clinical and genetic analysis of twelve Pakistani infertile families (A-L) exhibiting azoospermia, POF, PCOS, Y chromosome microdeletions and chromosomal aberrations. These families were collected from different districts of Khyber Pakhtunkhwa Pakistan. Informed consents were taken from all the participants. Results: In this study, we investigated four azoospermic families (A-D) by whole exome sequencing (WES) analysis. WES data analysis of family A with two males with obstructive azoospermia and two fertile members (mother and brother) revealed a novel nonsense variant c.2326C>T (p.R776X) in dominant X-linked ADGRG2. WES data analysis and Sanger sequencing of family B with one azoospermic male, one fertile brother and parents revealed a compound heterozygous variant in AFF4, including c.3319A>G (p.T1107A). In family C one proband and parents samples were subjected for WES analysis, but no pathogenic variants were identified. WES data analysis of family D with one infertile brother, one fertile brother and parents revealed a novel nonsense variant c.646G>A (p.G216R) in X-linked AR. In family E, WES was performed for four family members and seven potential variants were identified but Sanger sequencing failed to confirm any pathogenic variant. Family F has two daughters displaying primary amenorrhea, elevated LH/FSH levels, atrophic uteri, reduced ovarian reserves, and normal 46XX karyotypes. WES analysis of five family members (parents, two affected daughters and one unaffected daughter) revealed a novel frame shift variant (c.709delC, p.Leu237fs) in the luteinizing hormone/choriogonadotropin receptor (LHCGR) gene. PCOS Families G, H and I were investigated for pathogenic variants. SNP microarray and WES analysis failed to identify pathogenic variants in PCOS families. Family J showed Y chromosome microdeletions (AZFc) in two azoospermic brothers. Families K and L exhibited chromosomal aberrations; OX and XXY karyotypes in azoospermic members in families respectively. Conclusion: Four families revealed novel variants as the likely cause of infertility (ADGRG2, nonsense variant (c.2326C>T); AR nonsense variant (c.646G>A); AFF4 compound heterozygous (c.3319A>G); LHCGR, frame-shift variant (c.709delC). WES in four families (three PCOS one POF) families could not identify genetic causes in the coding region. One family exhibited “Y” chromosome microdeletion (AZFc region deletion) and two families were found with chromosomal aberrations (XXY and OX).