Objective To compare the diagnostic performance of the GenoType MRBDR plus assay with the gold standard phenotypic drug susceptibility testing in the detection of drug resistance among culture isolates obtained from patients in Karachi, Pakistan. Design Mycobacterium tuberculosis isolates were obtained from 96 consecutive tuberculosis patients found to have resistance to isoniazid from two health centers in Karachi (January-November 2017). Isolates were tested for drug resistance against rifampin and isoniazid using the MTBDR plus assay. Results were compared with conventional drug-susceptibility testing and the frequency of specific mutations were reported. Results The MTBDR plus assay had a sensitivity for rifampin resistance of 98.8% (95% CI: 93.4–100) and for isoniazid resistance of 90.6% (95% CI: 83.0–95.6). The MTBDR plus assay showed mutations in rpoB in 81 of the 96 (84.4%) isolates. Of the 87 isolates showing resistance to isoniazid via the MTBDR plus assay, 71 (74.0%) isolates had mutations in the kat G gene only, 15 (15.6%) isolates had mutations in the inh A promoter region, and 1 (1.0%) showed mutations in both genes. Conclusion The GenoType MTBDR plus assay in Pakistan can identify subgroups at high-risk of having isolates with mutations in the kat G and/or inh A genes. Understanding the local burden of these mutations have implications for local diagnostic and treatment guidelines.

Background: The hepatitis C virus (HCV) has been recognized as the cause of thrombocytopenia (defined as a platelet count of < 150,000 platelets/uL) occurring in patients with chronic hepatitis C. Thrombocytopenia occurs in 64% -76% of patients with cirrhosis and/or fibrosis, compared with 6% of non-cirrhotic patients with chronic liver disease. Objectives: The aim was to study the prevalence of thrombocytopenia in HCV patients without cirrhosis and splenomegaly. Patients and Methods: A cross-sectional study was carried out in the gastrointestinal out patient department (G.I. OPD) of the Sindh institute of urology and transplantation (SIUT) from September-November 2013. 30 patients aged between 18 -60 years with a positive anti-HCV result were included. Patients with enlarged spleen, liver cirrhosis on an ultrasound of the abdomen, and thrombocytopenia related to other causes were excluded from the study.