Background Source case investigation, for children with tuberculosis (TB), is conducted to establish the source of infection and to minimize the extent of on-going transmission from infectious persons in the community. The aim of the study was to evaluate the secondary TB cases and to investigate the risk factors in developing TB among the household contacts (HHC) of children with active TB. Methods A prospective cross-sectional study was conducted where 443 caregivers, of 508 children with active TB receiving treatment, were interviewed using a structured questionnaire. Logistic regression analysis was used to examine the risk factors for TB. Results A total of 2397 family members at the median of 5 persons were recorded. Of these, 223 (9.3%) were screened on symptoms basis and 35 (15.7%) of these contacts were diagnosed with TB. Multivariate analysis revealed HHC with TB (OR = 15.288, 95% CI: 5.378–43.457), HHC with smoking (OR = 7.094, 95% CI: 2.128–23.648), and contact of > 18 h with TB individual (OR = 4.681, 95% CI: 1.198–18.294) as statistically significant risk factors of TB among the HHC. Conclusion With the current system of contact screening for TB, only 9.3% of all HHC were screened. The low rates of contacts screened are possibly a repercussion of the passive nature of the program, which mainly depend on distinctive clinical symptoms being experienced by the contacts. Strategies are required to certify adherence with contact screening among children with active TB and to critically consider the factors responsible for TB transmission.

BackgroundRegardless of the advancement in medical technologies, the diagnosis of tuberculosis (TB) in children has remained a challenge. Childhood TB is rampant and an important cause of morbidity and mortality. The objective of this study was to determine the trend of TB and treatment outcomes in children aged ≤14 years registered for TB treatment under DOTS course in three districts of Sindh, Pakistan.MethodsFor this retrospective study, records of TB children (≤14 years) registered for the treatment of TB from January 2011 to December 2015 in three districts of Pakistan, were collected. Demographic data, baseline weight, clinical manifestations, radiography, histopathology results and treatment outcomes were collected from TB unit registers.ResultsA total of 2,167 children were treated for TB during the study period. Of these, 1,199 (55.3%) were females and 1,242 (57.3%) were from urban areas. Over three-quarter of patients (76.9%) had pulmonary TB with 13.3% of sputum smear positive cases. The overall treatment success rate was 92.4%. In multivariate analysis, rural residents (OR: 2.146, p < 0.001), sputum smear positive cases (OR: 3.409, p < 0.001) and re-treated patients (OR: 5.919, p < 0.001), were significantly associated with unsuccessful treatment outcomes. However, age group ≤2 years, male and those who were underweight were found to have the highest risk of pulmonary tuberculosis (OR: 1.953, p < 0.001; OR: 1.262, p = 0.028; OR: 1.342, p = 0.008), respectively.ConclusionPatients at risk of treatment failure must be given particular attention. Moreover, strategies are needed to further improve the diagnosis and treatment of TB among children and improve the recording system.

BackgroundUnderstanding the explanations behind unsuccessful treatment outcomes in tuberculosis (TB) patients is important to improve treatment success. Treatment completion for TB is the mainstay of TB prevention and control. The study was aimed to assess the treatment outcomes and predictors for unsuccessful outcomes among children with TB.MethodsThis was a prospective multicenter study conducted in Sindh. Children aged ≤14 years enrolled from June to November 2016 were included. A structured data collection tool was used to gather information with respect to patients’ socio-demographic, clinical and microbiological data. Additionally, to collect the information related to socio-economic and education level of caregivers, validated questionnaire was administered to the caregivers. Treatment outcomes were assessed according to the World Health Organization (WHO) guidelines. The relationship of unsuccessful treatment outcome with socio-demographic and clinical attributes of TB patients was analyzed using logistic regression model.ResultsChildhood TB represented 19.3% (508/2634) of all TB cases in selected hospitals. Of these, 268/508 (52.8%) were females and one third of the children were aged ≤2 years (34.3%). In multivariate analysis, pulmonary smear positive TB (PTB+) (AOR = 5.910, 95%CI = 1.64–21.29), those with adverse drug reactions (AOR = 11.601, 95%CI = 4.06–33.12) and those who had known TB contacts (AOR = 3.128, 95%CI = 1.21–8.06) showed statistically significant association with unsuccessful treatment outcomes.ConclusionsThe high proportion of childhood TB cases (19.3%) demonstrates the continuation of TB transmission in the study setting. Furthermore, an increased focus on PTB+ patients, those with adverse drug reactions and household contact with TB is warranted.

Background: Adverse drug reactions (ADRs) are most common among cancer patients receiving treatment. AC therapy which is a combination protocol of Adriamycin (doxorubicin) and Cyclophosphamide are the common therapies used for breast cancer treatment due to their effectiveness and cost of therapy breast cancer. AC combination is administered every 3 weeks, and 4 cycles are given. Objectives: To assess various ADRs reported by patients on AC combination therapy and their severity to ensure safe and effective treatment. Design: Prospective observational. Setting: Cancer hospital Jamshoro Pakistan. Patients and Methods: A hospital based observational study included 160 female patients suffering from breast cancer and receiving AC combination for treatment by purposive sampling method from June 2015- January 2018 at cancer hospital Jamshoro Pakistan. ADRs reported were compared against international standard references of drug literature such as British National Formulary (BNF) 2017 and ADR severity assessment scale (Modified Hartwig and Siegel scale). Main Outcome Measures: Frequency and severity of ADRs. Results: The common ADRs reported were, nausea and vomiting, acidity, fatigue, hair fall as common non-hematologic and leukopenia among hematologic ADRs. Those patients reported high severity ADRs according to severity scale persist for longer duration and required antidote for management with medical intervention. Conclusion: The present study shows that a patient’s response towards AC therapy is critical and therefore each patient must be monitored and those at high risk of developing ADRs from this therapy must be provided additional care.

Pakistan and India have not yet normalized trade relations and gained the full benefits of bilateral trade despite significant developments to this end since 2011. Pakistan has yet to reciprocate the most-favored-nation status granted by India. This study investigates the benefits of trade liberalization between the two countries by studying the global competitiveness of Pakistan’s industrial sector from a policy perspective. We construct a revealed comparative advantage index for manufacturing products (HS 2-digit level) for Pakistan, India, and China for the period 2003–12, and then identify the changing patterns of comparative advantage for Pakistan. We find that 18 industries should be protected upon liberalizing trade with India. These industries are termed ‘vulnerable’ as they have moved from either borderline competitiveness to becoming uncompetitive or vice versa. Additionally, the excessive concessions granted to China in its free trade agreement with Pakistan and the resistance to opening up trade with India may have resulted in inefficient trade, i.e., imports from a less competitive partner and exports to a less lucrative market. We aim to establish a direction for further research to determine the ex ante impact of trade with India on the economy via a change in the production levels of these vulnerable industries, given the impact of free trade with China and the availability of Chinese substitutes.