Background: Tuberculosis (TB) is fatal and life threatening infectious disease. The transmission rate of tuberculosis is very high. Various drugs are used as treatment for TB. Recently it has been observed that one of the most important factor for fast TB spread is development of anti-TB drug resistant mycobacterium tuberculosis (MTB). Various combination of drugs like isoniazid (INH), rifampicin (RIF), Streptomycin(SM), pyrazinamide (PZA) or ethambutol (EMB) are in global use for TB treatment. Improper usage of these drugs makes the person prone to develop anti-TB drug resistant tuberculosis. Aim: To evaluate association of embB gene with ethambutol resistance in Mycobacterium Tuberculosis. Methods: 104 Specimens of sputum from suspected tuberculosis patients were processed for inoculation in Lowenstein J Medium after it has been decontaminated properly. Kit method by using QIAamp DNA Mini kit was utilized for extraction of DNA. Then region from base 6953 to 10249 of embB gene was amplified through PCR and then followed by sequencing with the aid of softwares blast2seq and ClustalW2. Three primer sets were utilized to amplify embB gene. Ethambutol (EMB) Resistant MTB specimens were processed to study mutation in embB gene. Results: Out of the total 104 sputum specimens, 14 samples were found to have ethambutol resistance. These 14 samples were then processed for mutational analysis. DNA sequence analysis of these 14 samples confirmed embB gene mutation in 10 samples. Mutational analysis revealed that 08 samples showed mutation at codon 306 and two samples showed mutation at 319 codon. The reported mutation Methionine →Isoleucine was seen in 07 samples with ATG codon replaced by ATA codon at codon position 306. One sample showed mutation as Methionine →Isoleucine with ATG codon replaced by ATC codon at codon position 306. Two samples showed mutation as Tyrosine →Serine with TAT codon replaced by TCT at 319 codon position in embB gene. Conclusion: This study concludes that mutation of certain genes particularly point mutation of embB gene at codon 306 and 319 is associated with drug resistance of ethambutol in ethambutol resistant mycobacterium tuberculosis patients. Keywords: Ethambutol, embB gene, Mycobacterium tuberculosis.
Early onset neonatal sepsis is invariably very common and serious problem worldwide, especially it is one of the important etiological factor for deaths of neonates in Pakistan. Acute renal failure is frequently seen in neonates with sepsis. Objectives: The aim of present study was to determine the correlation of renal function tests (Blood Urea and creatinine) with early onset neonatal sepsis. Study Design: Descriptive study. Setting: Department of Paediatric Medicine Sir Ganga Ram hospital, Lahore. Period: Six months from 20th March to 20th September 2018. Material & Methods: Total 300 cases of neonatal sepsis with acute renal failure were included in this study after taking informed consent from the parents. Cases selection was done with help of a predefined inclusion and exclusion criteria. Daily blood urea and serum creatinine were calculated from birth to first 7 days of life. If any of blood urea or serum creatinine was deranged, the neonate was labelled as having acute renal failure. Data was entered and analysed using SPSS software version 21. Results: Mean age of all cases was 2.82±1.56 days. The minimum and maximum age limits of the neonates were 1 and 7 days respectively. Gender distribution of neonate showed that 57% of the neonates were male and 43% were females. At the 2nd day of life, mean serum creatinine level was 1.12±0.39, at 3rd day 1.19±0.51, at 4th day 1.41±0.38, at 5th day 1.33±0.39, at 6th day 1.19±0.39, and at 7th day mean serum creatinine level was 1.09±0.31 respectively. At 2nd day of birth mean blood urea was 54.82±34.77, at 3rd day59.50±28.22 at 4th day 74.94±30.37, at 5th day 67.09±26.94, at 6th day 56.09±25.76, at 7th day mean blood urea level was 47.66±22.47 respectively. Frequency of acute renal failure was observed in 28.3% of the neonates while the remaining 71.7% of neonates did not suffer from acute renal failure. Conclusion: Early onset neonatal sepsis contributes significantly to development of acute renal failure in neonates.
Objectives: Community acquired pneumonia (CAP) is frequent amongst pediatric population all over the world while hyponatremia is a common electrolyte abnormality in hospitalized patients that has been shown to be associated with considerable morbidity and mortality. We aimed to determine the frequency of hyponatremia in children with community acquired pneumonia (CAP). Study Design: Cross Sectional study. Setting: Pediatrics Department, Services Hospital, Lahore. Period: July 2018 to January 2019. Material & Methods: A total of 100 cases up to 2 years of age of either gender, diagnosed cases of CAP during the last 72 hours, were enrolled. Demographic profile, age and gender were recorded. Every child with CAP was evaluated for the presence of hyponatremia. Mean and standard deviation were calculated for age. Frequency and percentages were noted for categorical variable like gender and presence/absence of hyponatremia. Results: Out of 100 cases of CAP, 57 (57.0%) were male and 43(43.0%) female. There were 45 (45.0%) cases who were less than 1 year of age while 55 (55.0%) were between 1-2 years of age. Mean age was calculated as 1.55 years with standard deviation of 0.52 years. Frequency of hyponatremia in children with CAP was recorded in 24 (24.0%) whereas 76 (76.0%) had no findings of the morbidity. Conclusion: Frequency of hyponatremia was high (24.0%) among children with CAP. Every patient who present with CAP should be evaluated for hyponatremia.
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