SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS https://www.nepjol.info/index.php/SAARCTB <p>The official peer-reviewed journal of SAARC TB and HIV/AIDS Centre. Full text articles available.</p> SAARC Tuberculosis and HIV/AIDS Centre (STAC) en-US SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS 1818-9741 <p>Copyright © SAARC Tuberculosis and HIV/AIDS Centre (STAC), all rights reserved, no part of this publication may be reproduced, stored in a retrieval<br>system or transmitted in any form or by any means without prior permission of the STAC.</p> Editorial Vol.16(2) https://www.nepjol.info/index.php/SAARCTB/article/view/23335 <p>No abstract available</p> R.P. Pant ##submission.copyrightStatement## 2018-12-31 2018-12-31 16 2 10.3126/saarctb.v16i2.23335 Prevalence of multi-drug resistance and its risk factors among tuberculosis patients in Kaski, Nepal https://www.nepjol.info/index.php/SAARCTB/article/view/23336 <p><strong>Introduction: </strong>Multidrug-resistant tuberculosis is an intense and feared problem, difficult to control and has shown a trend of increase worldwide. MDR-TB poses a therapeutic and infection control challenge with significantly higher rates of morbidity and mortality. Hence, this study was conducted with objective to assess prevalence of multidrug resistance and its risk factors among Tuberculosis patients in Kaski district.</p> <p><strong>Methods: </strong>The main component of the study comprised institutional based cross sectional study design which was conducted in directly observed treatment short course (DOTS) centers in Kaski district. The study period was from July 2016 to December 2016. The sample size for the study was 175 participants. Data collection was done through interview with used interview schedule, and review of patient treatment cards. Data were entered in Epidata software and analyzed by using SPSS 20 version software.</p> <p><strong>Results: </strong>The prevalence of multidrug resistance in Kaski district was 5.7 per cent. Variables such as TB history in past, TB treatment in past, and cured in past are found statistically significant (p&lt;0.005). People with prior history of TB were shown to be 19 times more likely to get MDR TB than those with no prior history (OR=19.056, CI: 4.522-80.294). People with complete TB treatment in past were 0.2 times less likely to get MDR TB than those with incomplete TB treatment in past (OR=0.182, CI: 0.075-0.441).</p> <p><strong>Conclusion: </strong>Present of previous TB infection and prior treatment outcome (to be defaulted or failed in treatment) were also identified as the risk factors for developing MDR TB. Proper surveillance system is to be established in terms of complete treatment to all TB patients that leads the prevention from MDRTB and prevent potent expensive costs from medical care for MDRTB patients.</p> D. Yadav D.K. Yadav R.K. Yadav ##submission.copyrightStatement## 2018-12-31 2018-12-31 16 2 1 7 10.3126/saarctb.v16i2.23336 Challenges in the diagnosis of drug-resistant tuberculosis by GeneXpert MTB/Rif in Nepal https://www.nepjol.info/index.php/SAARCTB/article/view/23337 <p><strong>Introduction: </strong>GeneXpert MTB/Rif assay is an automated, cartridge-based nucleic acid amplification test that can accurately detect both tuberculosis and Rifampicin resistance. Since its introduction, there has been a steady uptake of this technology by the National Tuberculosis Program of Nepal. Nevertheless, a large number of drug-resistant TB cases remains undiagnosed. This study aims to examine the challenges in diagnosis of drug-resistant tuberculosis by the GeneXpert MTB/Rif assay in Nepal and explore the possible solutions.</p> <p><strong>Methods: </strong>This was a cross-sectional study consisting of two parts – a quantitative part assessing the individual details and a qualitative part assessing the challenges on the diagnosis of drug-resistant TB by GeneXpert MTB/Rif assay. Data were collected from the GeneXpert operators, clinicians and program managers from 16 centers across the country and analyzed by IBM SPSS for Windows v23 and QDA Miner 4 Lite. Descriptive statistics were used to summarize the sociodemographic and other characteristics of the study participants using mean, standard deviation and proportions as appropriate.</p> <p><strong>Results: </strong>A total of 48 technical manpower participated in the study. The mean age was 39.95 years and a majority of them (77.3%) were male. The major challenges identified were inadequate training, frequent power failure, difficulty in maintaining appropriate steady temperature, module failure which is often not replaced in time, issues with calibration and timely availability of cartridges as well as appropriate ways to store the new cartridges and safe disposal of the used cartridges.</p> <p><strong>Conclusion: </strong>A number of challenges limit the optimal utilization of GeneXpert MTB/Rif assay warranting action.</p> S.K. Shrestha N.P. Shah K.K. Jha R.P. Pant L.R. Joshi R.P. Bichha K.B. Karki ##submission.copyrightStatement## 2018-12-31 2018-12-31 16 2 8 15 10.3126/saarctb.v16i2.23337 Tuberculosis infection control measures at health facilities providing tuberculosis services in Nepal https://www.nepjol.info/index.php/SAARCTB/article/view/23338 <p><strong>Introduction: </strong>Globally there were an estimated 10.6 million new tuberculosis patients and 1.7 million deaths from TB in 2016. There is an evidence of tuberculosis transmission at health care settings where health care workers and patients come in contact with people having tuberculosis. This study aims to explore infection control measures at health facilities in terms of administrative, environmental and personal protective measures needed for infection control.</p> <p><strong>Methods: </strong>This is a cross-sectional study carried out at 79 health facilities across the country. The study continued for three months starting from January 2018 to March 2018. Trained enumerators from health sciences background collected the information using semi-structured questionnaire. Written consent was obtained prior interview.</p> <p><strong>Results: </strong>All the selected health facilities participated in the study. Around 44% of health facilities have infection prevention plan, but very few of them have budgeted for tuberculosis infection control activities. Less than one third of health facilities (24 out of 79 HFs) have provision to separate presumptive tuberculosis patients, however, only 50% (12 HFs) have turned such provision into action. Only 15 HFs (38%) out of 40 HFs having N95 or FPP2 mask for health workers. Around half of the HFs (44%, 35 out of 79) was found to have cross ventilation.</p> <p><strong>Conclusion: </strong>Tuberculosis infection plan needs to be developed and implemented by all the health facilities to strengthen administrative, managerial, and environmental and person protective measures of inaction control to minimize the risk of TB transmission at health facilities.</p> N. Adhikari R. Bhattarai R. Basnet L.R. Joshi ##submission.copyrightStatement## 2018-12-31 2018-12-31 16 2 16 20 10.3126/saarctb.v16i2.23338 Proteomic profile of pulmonary and extra pulmonary TB samples https://www.nepjol.info/index.php/SAARCTB/article/view/23341 <p><strong>Introduction: </strong>Tuberculosis (TB) is a major health problem in India, so early diagnosis and treatment of Mycobacterium tuberculosis (<em>M.tb</em>.) infection can prevent deaths from this pathogen. The secretion of proteins by <em>M.tb. </em>is important in diagnostic purposes for generation of therapeutic drugs and vaccines candidates for TB. The objective of this study was to identify the protein expression (biomarkers) in TB and Tuberculosis meningitis (TBM) using proteomic approach.</p> <p><strong>Methods: </strong>In this study, using Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDSPAGE), we analyzed the secretory proteins of M.tb. in serum, cerebrospinal fluid (CSF) samples. The identified proteins were determined by Total Lab- 100 Quantity One densitometry software.</p> <p><strong>Results: </strong>Our study showed that protein bands expressed in CSF samples reveals the presence of 72kD, 70kD, 44kD, 40kD &amp; 16kD predominantly in TBM patients compared to healthy individuals. The electrophoretogram identified 97kD, 72kD, 44kD, 38kD, 29kD &amp; 16kD predominant proteins in serum samples of TB patients.</p> <p><strong>Conclusion: </strong>The detection of secretory proteins in serum and CSF samples of <em>M.tb. </em>in TB and TBM patients gives reliable and early diagnosis of TB and TBM. The secretory proteins can be useful as immunodiagnostic and vaccine targets which can serve as important biomarkers</p> J. Kumar C. Cheekavolu V.L. Ashalatha P. Leela H.F. Daginawala ##submission.copyrightStatement## 2018-12-31 2018-12-31 16 2 21 27 10.3126/saarctb.v16i2.23341 Community acquired Stenotrophomonas maltophilia causing empyema in an adult with HIV https://www.nepjol.info/index.php/SAARCTB/article/view/23342 <p><strong>Introduction: </strong><em>Stenotrophomonas maltophilia (S. maltophilia) </em>is multidrug resistant (MDR) organism usually associated with hospital acquired infections. Here we report a rare case of community acquired <em>S. maltophilia </em>empyema in a human immunodeficiency virus (HIV) positive patient.</p> <p><strong>Case Report: </strong>A 54 year old male presented with cough, breathlessness and chest pain for one month. On investigation, radiological picture was suggestive of massive right empyema. Pleural fluid culture grew <em>S. maltophilia </em>repeatedly which was treated with cotrimoxazole and levofloxacin based on antibiogram. Following improvement patient was discharged on anti-retro viral and anti-tubercular treatment.</p> <p><strong>Conclusion: </strong>Community acquired invasive <em>S. maltophilia </em>infections should be kept as differential diagnosis in immunocompromised patients. Being MDR, appropriate microbiological identification and susceptibility play an important role in treatment and outcome of these patients.</p> P. Sharma S.D. Duggal S. Gupta R. Gur S. Kaushik T. Bharara ##submission.copyrightStatement## 2018-12-31 2018-12-31 16 2 28 31 10.3126/saarctb.v16i2.23342