Bronchiectasis unrelated to cystic fibrosis (non-CF bronchiectasis) has become a major respiratory disease in developing nations. The dilated mucus filled airways promote bacterial overgrowth followed by chronic infection, bronchial inflammation, lung injury and re-infection Accurate pathogen identification and antimicrobial susceptibility allowing appropriate treatment, in turn, may break this vicious cycle. To study the spectrum and antimicrobial spectrum of pathogen yielded from respiratory specimens in adult patients with acute exacerbation of non-cystic fibrosis (CF) bronchiectasis. This cross-sectional study was performed at the pulmonology clinics of the Aga Khan University, Karachi, Pakistan from 2016-2019. Respiratory specimens were collected from adult patients with acute exacerbation of non-CF bronchiectasis presenting in pulmonology clinics. Microbial cultures were performed using standard methodology. Susceptibility testing was performed and interpreted using Clinical Laboratory Standard Institute criteria.  A total of 345 positive cultures from 160 patients presenting with acute exacerbation were evaluated. The most frequent organisms were Pseudomonas aeruginosa (n=209) followed by Hemophilus influenzae (n=40) and Staphylococcus aureus (n=24). High rates of antimicrobial resistance were found in all these pathogens. Proportion of Pseudomonas aeruginosa strains resistant to ciprofloxacin, imipenem, ceftazidime and piperacillin-tazobactam were 27.1%, 16.8%, 14.8% and 13.1% respectively. 65% of Hemophilus influenzae strains were resistant to cotrimoxazole and ciprofloxacin and 66.7% of Staphylococcus aureus strains were resistant to methicillin. High antimicrobial resistance in non-CF bronchiectasis patients against commonly used antimicrobials is a concern and highlight need for urgent community level interventions to improve clinical outcome in these patients.

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Introduction: Pulmonary hypertension (PH) is associated with increased mortality, and lung diseases are the second most common cause of PH. Transthoracic echocardiogram (TTE) is often employed for PH diagnosis in low-to-middle income countries. Methods: A retrospective chart review of adult patients hospitalized from June 2012 to May 2021. Patients with pulmonary artery systolic pressure (PASP) ≥ 35 mmHg on TTE were included in the study. Patients with group 1 PH, group 2, or group 5 PH were excluded. Results: 128 patients were included, with females being 69.5%. Group 3 PH consisted of 79.7% and Group 4 PH consisted of 20.3%. Obesity hypoventilation syndrome / obstructive sleep apnea (OHS/OSA) consisted of 31.3% of the population and was the most common etiology of PH. The overall 1-year mortality after diagnosis of PH was 20.3%, with bronchiectasis having the highest group-specific 1-year mortality of 45.5%. 1-year hospital readmission was seen in 46.9% of patients. The difference in mortality rates between the groups was statistically significant (x2 = 18.1, P=0.004). The mean PASP was 59.2 ± 16.5 mmHg. On multivariate analysis, patients who did not have 1-year hospital readmission or were treated with diuretics, had decreased odds of 1-year mortality. Conclusion: Clinical outcomes of patients with group 3 PH vary based on causative etiology. Patients with bronchiectasis had the highest 1-year mortality and 1-year readmission rate. Currently, TTE based diagnosis for PH is a reality in LMIC.

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Objective: To assess the diagnostic accuracy of different cut-off values of pleural fluid adenosine deaminase levels as a diagnostic method for tuberculous pleural effusion. Method: The prospective study was conducted from 2014 to 2016 at the Aga Khan University Hospital, Karachi, and comprised pleural fluid samples of adult patients with and without tuberculosis which were tested for adenosine deaminase levels, and divided into tuberculosis group A and non-tuberculosis group B. Sensitivity, specificity, negative predictive value and positive predictive value were calculated using different cut-offs. Data was analysed using IBM SPSS (Statistical Package for Social Sciences) version 21.0 (IBM Corp., Armonk, NY). Results: Of 155 patients, 46(29.7%) had tuberculosis; 30(65.2%) males and 16(34.8%) females. Those who did not have tuberculosis were 109(70.3%); 69(63.3%) males and 40(36.7%) females. The adenosine deaminase levels were elevated in group A compared to group B (p<0.001). The cut-off of 30U/L showed the highest sensitivity (71.7%) and negative predictive value (87.4%), and a specificity of 82.6%. The cut-off of 50U/L showed the highest specificity (89.9%) with sensitivity 52.2%, and the cut-off of 40U/L showed the highest positive predictive value of 68.9% with sensitivity 67.4% and specificity 87.2%. Conclusion: Pleural fluid adenosine deaminase testing for diagnosing tuberculosis pleuritis revealed highest sensitivity and moderate specificity for cut-off value of 30U/L. Key Words: Tuberculosis, Pleural effusion, Adenosine deaminase, Diagnosis.