Pakistan Journal of Chest Medicine

Radiological Differentiation of Multi-Drug Resistant and Drug-Sensitive Tuberculosis Using Chest X-Rays

2026-09-16T16:53:12+00:00

Background: Tuberculosis continues to pose a significant global health challenge, with increasing incidence of multidrug-resistant TB (MDR-TB). Radiological features have the potential to distinguish MDR-TB from drug-sensitive TB (DS-TB). Early radiographic identification facilitates timely diagnosis and treatment, particularly in resource-limited settings.

Objective: To compare chest X-ray findings between cases of multidrug-resistant TB (MDR-TB) and drug-sensitive TB (DS-TB).

Methodology: This retrospective comparative study included 240 pulmonary TB patients (120 with MDR-TB and 120 with DS-TB). Chest X-rays were assessed for lesion size, cavitation, consolidation, and non-parenchymal changes. Findings were compared between groups based on lung zones and cavity characteristics. Data analysis was performed using SPSS, with p < 0.05 considered statistically significant.

Results: Patients with MDR-TB exhibited a higher prevalence of large lesions (93.3%) and multiple cavities (68.3%). Consolidation and fibrosis were more frequently observed in MDR-TB, whereas infiltrates were predominant in DS-TB. The upper lung zones were primarily affected in MDR-TB, often with extensive bilateral involvement. Non-parenchymal features such as pleural thickening and tracheal deviation occurred more frequently in MDR-TB.

Conclusion: Chest X-rays demonstrate distinct radiographic patterns in MDR-TB compared to DS-TB. The presence of large lesions, multiple cavitations, and chronic fibrotic changes is suggestive of drug resistance. Recognition of these radiological differences can facilitate early suspicion of MDR-TB. Radiographic assessment continues to be a valuable tool for TB evaluation, particularly in low-resource settings.

Cost-Effective Monitoring of MDR-TB Treatment: A Comparative Assessment of C-Reactive Protein and Erythrocyte Sedimentation Rate in a High-Burden Setting

2026-09-02T18:33:19+00:00

Background:

Monitoring treatment response in multidrug-resistant tuberculosis (MDR-TB) is challenging, particularly in resource-limited settings. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are inexpensive and routinely available inflammatory markers that may provide complementary information during treatment.

Objective:

To compare the effectiveness and potential cost implications of serial CRP and ESR measurements for monitoring treatment response among patients with MDR-TB during the first three months of therapy.

Methodology:

This prospective prognostic cohort study was conducted at the Programmatic Management of Drug-Resistant Tuberculosis Unit of Lady Reading Hospital and Khyber Medical College, Peshawar, from January 2024 to June 2025. Patients with confirmed MDR-TB were followed for three months with monthly clinical assessment, sputum examination, CRP, and ESR measurements. Treatment response was assessed by sputum conversion. Changes in biomarkers were analyzed using repeated-measures ANOVA, while factors associated with unfavorable outcomes were assessed using logistic regression.

Results:

Of 102 enrolled patients, 92 completed follow-up and were included in the final analysis. The mean age was 37.2 ± 13.8 years, and 52.2% were male. Sputum conversion was achieved in 65 (70.6%) patients. Mean CRP decreased progressively from 30.8 ± 27.4 mg/dL at baseline to 19.8 ± 18.6, 12.4 ± 12.9, and 9.6 ± 10.2 mg/dL at months 1, 2, and 3, respectively (P < 0.001). ESR similarly declined from 52.6 ± 31.8 to 40.2 ± 28.5, 29.8 ± 24.6, and 24.4 ± 22.1 mm/h (P < 0.001). CRP improved in 88.0% and ESR in 85.9% of patients.

Conclusion:

Serial CRP and ESR demonstrated significant declines during MDR-TB treatment and may serve as useful complementary markers of treatment response. ESR may be particularly practical where resources are limited, although formal cost-effectiveness studies are required.

Antibiotic Prescribing Practices and Antimicrobial Resistance in Pediatric Pneumonia

2026-09-25T13:43:33+00:00

Background: Antimicrobial resistance (AMR) among pediatric pneumonia patients presents a significant challenge, particularly in low- and middle-income countries such as Pakistan, where empirical antibiotic use is prevalent and stewardship interventions remain limited. Comprehensive knowledge of local prescribing practices, resistance patterns, and treatment outcomes is essential for effective stewardship and enhanced patient care.

Objective: To determine the prevalence and antimicrobial susceptibility patterns of bacterial pathogens isolated from pediatric pneumonia patients and to evaluate antibiotic prescribing practices in a tertiary care hospital.

Methodology: This prospective observational study enrolled 423 pediatric patients diagnosed with pneumonia. Data collection included antibiotic prescribing patterns, specimen microbiology, antimicrobial susceptibility, and clinical outcomes. Respiratory specimens underwent bacterial identification and susceptibility testing. Associations among prescribing practices, resistance, and clinical outcomes were analyzed.

Results: Nearly all patients (98.3%) received antibiotics, with 59.8% receiving combination therapy and 87.3% treated intravenously. Clinically significant bacteria were isolated from 41.9% of processed specimens. Among these isolates, 68.3% demonstrated resistance to at least one antibiotic, and 34.5% were classified as multidrug-resistant. Streptococcus pneumoniae was the most frequently identified pathogen, exhibiting substantial resistance to ampicillin-cloxacillin and penicillin. Inappropriate initial empirical therapy was observed in 57.2% of culture-positive cases and was associated with increased antibiotic switching and prolonged hospital stays.

Conclusion: This pediatric pneumonia cohort showed antibiotic resistance. Improved antimicrobial stewardship, guided by local surveillance data, is urgently required to optimize therapy, mitigate resistance, and improve patient outcomes.

Optimal Finger Selection for Perfusion Index Measurement in Patients with Stable Chronic Obstructive Pulmonary Disease

2026-03-18T03:14:03+00:00

Background: Chronic obstructive pulmonary disease (COPD) may effect chronic hypoxemia due to ventilation–perfusion mismatch. The perfusion index (PI) based on pulse oximetry reflects peripheral perfusion and may vary by measurement site.
Objective: To evaluate differences in PI values among fingers to determine the most reliable site for PI measurement in patients with COPD.
Methodology: This descriptive, cross-sectional observational study included patients with stable COPD attending the Pulmonology Clinic at Kolonel Abundjani General Hospital in August 2025. Subjects were recruited using
consecutive sampling. Patient characteristics, including sex, age, smoking history, and the Brinkman index, were obtained from medical records. Perfusion index measurements were taken from all fingers of both hands using a pulse oximeter and analyzed using descriptive statistics.
Results: A total of 22 patients with stable COPD were included. Most participants were male (86.4%) and aged over 55 years (86.4%), with the majority having a history of smoking and a Brinkman index of 200–600 (45.5%). The highest mean PI value in the right hand was observed in the ring finger (4.89 ± 3.12), while in the left hand it was found in the index finger (5.59 ± 3.41). PI values tended to be higher in several fingers of the left hand. A significant difference was observed only in the middle finger between the right and left hands (p = 0.012). Age and smoking history were not significantly associated with PI values (p > 0.05).
Conclusion: PI measurements in patients with stable COPD varied across different fingers. The thumbs showed relatively more stable values and may represent more reliable sites for PI assessment.

Frequency and Patterns of New Allergen Sensitization in Patients with Recurrent Allergic Symptoms During Subcutaneous Allergen Immunotherapy

2026-10-10T15:16:58+00:00

Background: Allergen immunotherapy (AIT) remains the sole disease-modifying intervention for allergic respiratory diseases. Nevertheless, symptom recurrence occurs in some patients during therapy, possibly due to new allergen sensitizations.

Objective: To determine the frequency and patterns of new allergen sensitization among patients with respiratory allergic diseases who experience recurrence of allergic symptoms during subcutaneous allergen immunotherapy (SCIT).

Methodology: This multicentre observational study was conducted at four healthcare centres in Rawalpindi and Islamabad, Pakistan, from January 2024 to December 2024. The study included 422 patients with allergic rhinitis and/or bronchial asthma who had received SCIT for at least two years and subsequently experienced symptom recurrence following initial improvement. Skin prick testing (SPT) was repeated to identify new sensitization patterns. Data analysis was performed using SPSS version 26.

Results: Allergic symptom recurrence during SCIT was observed in 22.8% (422/1850) of patients screened. Among those with symptom recurrence, new sensitization was identified in 51.2% (216/422). Pollen sensitization was the most prevalent, occurring in 31.6% of patients, followed by sensitization to house dust mites (18.5%) and molds (12.0%). Most new sensitizations were detected in patients who experienced symptom recurrence during the third year of therapy (45.8%). No statistically significant association was observed between new sensitization and age, sex, diagnosis, or immunotherapy duration.

Conclusion: New sensitization frequently develops in patients who experience symptom recurrence during SCIT. Repeating SPT to identify evolving sensitization patterns is recommended for these patients, especially for those with symptom recurrence during the third year of therapy.

Association of C-reactive Protein with Disease Severity and Clinical Outcomes in Hospitalized Patients with COVID-19: A Multicentre study from Lahore, Pakistan

2026-05-15T07:13:40+00:00

Background: C-reactive protein (CRP) is an acute-phase inflammatory biomarker that has been associated with disease severity and adverse outcomes in patients with COVID-19. Early identification of patients at higher clinical risk is particularly important in resource-limited healthcare settings.

Objective: To assess the association of CRP levels with disease severity, ICU admission, ventilatory support, and in-hospital mortality among patients with PCRconfirmed COVID-19 in three public-sector tertiary care hospitals in Lahore, Pakistan.

Methodology: This retrospective multicenter study was conducted at Fatima Memorial Hospital, Jinnah Hospital, and Sir Ganga Ram Hospital, Lahore from April 1 to July 31, 2020. The final analytical sample comprised 635 patients with PCRconfirmed COVID-19. Demographic characteristics, comorbidities, CRP levels, disease severity, ICU admission, ventilatory support, and in-hospital outcomes were analyzed using SPSS version 24.0. Consecutive sampling was used.

Results: Of 635 patients, 145 (22.8%) had moderate disease and 490 (77.2%) had severe disease. Median CRP was higher in the severe group than in the moderate group (180 vs 58 mg/L). ICU admission occurred in 522 patients (82.2%). In-hospital mortality was 31.5% (200/635); 191 of 200 patients who died (95.5%) had severe disease, with a median CRP of 210 mg/L (IQR 170–280 mg/L).

Conclusion: Higher CRP levels were associated with severe disease and in-hospital mortality in this cohort. Because the study did not evaluate adjusted prognostic performance, receiver operating characteristic curve/area under curve, sensitivity, or specificity, interpret these findings should be interpreted as associations rather than evidence of independent predictive validity.