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IntroductionTuberculosis is a major health problem in Pakistan. The prevalence of pulmonary as well as extrapulmonary tuberculosis is quite high. Tuberculin skin test, radiological imaging, and sputum smear microscopy have limitations in the diagnosis of tuberculosis. Xpert MTB/RIF was recently approved for the diagnosis of pulmonary tuberculosis and has shown promising results. The aim of this study was to determine the diagnostic accuracy of Xpert MTB/RIF in sputum smear-negative pulmonary tuberculosis using acid-fast bacilli (AFB) culture as the gold standard.Materials and methodsThis cross-sectional study was conducted at Iqbal Yad Chest Clinic and Nazimabad Chest Clinic of Ojha Institute of Chest Diseases, Dow University of Health Sciences. Patients of either gender aged 18-65 years suspected to have pulmonary tuberculosis with at least two sputum samples negative for AFB underwent Xpert MTB/RIF testing. Early morning sputum samples were obtained and sent for AFB smear microscopy, Xpert testing and also for culture analysis.ResultsMean age of the patients was 37.48 ±17.49 years. There were 84 (37.3%) females and 141 (62.7%) males. Positive findings on Xpert MTB/RIF were found in 147 (65.3%) patients whereas AFB culture showed positive findings in 174 (77.3%) patients. Sensitivity, specificity, positive predicted value, negative predicted value and overall diagnostic accuracy of Xpert MTB/RIF was found to be 84.48%, 100%, 100%, 65.38%, and 88%, respectively.ConclusionXpert MTB/RIF has high sensitivity, specificity, and diagnostic accuracy in diagnosis of sputum smear-negative cases of pulmonary tuberculosis.

Objectives: To assess the mutational frequencies in Mycobacterial rpoB gene using GeneXpert/MTB Rif Assay in rifampicin resistant patients during 2013-2017 at a tertiary care setting in Urban Sindh, Pakistan. Methods: This Retrospective Descriptive Cross-Sectional Study was conducted at the TB laboratories, Ojha Institute of Chest Diseases, Dow University of Health Sciences. The record of 713 positive cases of Rifampicin Resistant Tuberculosis from January 2013 to December 2017 were analysed. These were diagnosed using GeneXpert® that detects mutations in the 81 base pair region of rpoB gene with the help of five molecular probes A, B, C, D and E. All invalid and extra pulmonary samples were excluded. Results: In total, 713 cases were found to be rifampicin resistant during the five-year period, among which 374 (52.45%) were males while 339 (47.55%) were females. Among the five standard probes A, B, C, D and E, 97.48% of the cases had a single mutation. Among these, mutations in Probe E (66.48%) were the most common, followed by Probe B (14.3%) and Probe D (11.08%). Only 13 cases (1.82%) of double mutations and five cases (0.7%) of triple mutations were detected. Conclusion: The rpoB gene Probe E region 529-533 appears the most potent site for a mutation and development of rifampicin resistance in the rpoB gene in Mycobacterium tuberculosis, that encodes the β-subunit of RNA polymerase. The most affected age-group in both males and females is 19-45 Years. doi: https://doi.org/10.12669/pjms.37.4.3875 How to cite this:Alamgir M, Sajjad M, Baig MS, Noori MY. Mutational Frequencies in Mycobacterial rpoB gene using GeneXpert/MTB Rif Assay in Rifampicin Resistant patients at a tertiary care setting in Urban Sindh, Pakistan: Analysis from a Five-Year Period. Pak J Med Sci. 2021;37(4):1151-1154. doi: https://doi.org/10.12669/pjms.37.4.3875 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: Pulmonary impairment is a common manifestation in previously treated pulmonary tuberculosis (PTB) patients. Approximately 40-60% of patients with history of complete anti-tuberculosis therapy (ATT) developed the obstructive, restrictive or mixed patterns of lung disease. Objective: To determine the frequency and type of impairment of lung function in previously treated PTB patients. Methods: A descriptive cross-sectional study was conducted at Ojha Institute of Chest diseases, Dow University of Health Sciences, Karachi during the period of six months from April 2021 to September 2021. One hundred and forty four previously treated PTB patients with age of 18-60 years were selected through consecutive sampling. Spirometry of each patient was performed by trained spirometry technician and lung function was assessed by an experienced pulmonologist. Data was interpreted with SPSS v. 25.0. Results: Out of 144 previously treated PTB patients, male were 83 (57.6%) and female were 61 (42.4%). Impaired pulmonary function was present in 87 (60.4%) patients, out of which 49 (56.3%) patients had obstructive impairment; 23 (26.4%) patients had restrictive impairment while 15 (17.2%) patients had mix pattern. Conclusion: Prevalence rate of impaired pulmonary function was higher in treated PTB patients who have completed ATT. Obstructive pulmonary impairment was the most common pulmonary impairment followed by restrictive and mixed pulmonary impairment.

Objective: To assess the relationship of tumour necrosis factor-alpha with obstructive sleep apnoea and its severity in Pakistani population. Method: The cross-sectional study was conducted at the Sleep Laboratory of Dow University Hospital, Karachi, from December, 2018, to March, 2020, and comprised patients of either gender having symptoms of snoring, witnessed apnoea or daytime sleepiness. They were divided into four groups on the basis of obstructive sleep apnoea status. Those without obstructive sleep apnoea were in Group A, mild status in Group B, moderate in Group C and severe obstructive sleep apnoea in Group D. Polysomnography was done to confirm obstructive sleep apnoea status and to categorise the subjects using apnoea-hypopnea index, while enzyme-linked immunosorbent assay was used to assess their tumour necrosis factor alpha levels.. Data was analysed using SPSS 20. Results: Of the 150 subjects, 94(63%) were males. The overall mean age was 49.68±12.14 years. There were 50(33.33%) subjects in Group A, 19(12.66%) Group B, 23(15.33%) Group C and 58(38.66%) in Group D. Mean tumour necrosis factor-alpha level was 3.88±1.65pg/mL in Group A, 9.97±4.33pg/mL in Group B, 12.65±4.46pg/mL in Group C and 12.83±4.33pg/mL in Group D. Mean tumour necrosis factor-alpha levels had significant association with the severity of obstructive sleep apnoea (p<0.001). Conclusion: Higher levels of tumour necrosis factor-alpha were found to be associated with obstructive sleep apnoea, and can be considered a potential biomarker for early diagnosis. Key Words: Sleep, Obstructive sleep apnoea, Biomarker, TNF-alpha, Inflammation, Sleep-related breathing disorder.