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Original Articles

Assessment of the nutritional status of tuberculosis patients visiting public sector hospitals in Bhakkar district, Punjab, Pakistan

Niaz Ali Khan

Nearly 1.7 billion people are exposed to tuberculosis (TB) globally, and low- and middle-income countries (LMICs) are the major contributors to the burden of TB. Malnutrition affects the severity of illness, the effectiveness of treatment regimen, and the recovery process. Moreover, TB is often referred to as a disease of a poor population.  Therefore, this descriptive cross-sectional study was conducted at DHQ Hospital in Bhakkar District and tehsil headquarters (THQ) hospitals in Mankera and Kaloor Kot to assess the nutritional status of TB patients. Data were collected from 329 adult TB patients via a purposive sampling technique with a semistructured questionnaire. Patients’ nutritional status was assessed via BMI and malnutrition indicators adopted from Mini Nutritional Assessment (MNA®). The associations between sociodemographic factors and BMI with malnutrition were analyzed via chi-square tests, with the significance level set at p < 0.05. Among the 329 respondents, 55.6% were at high risk of malnutrition, and 36.5% were malnourished. A BMI of less than 19 was observed in 5.5% of patients, with a statistically significant association between BMI and malnutrition (p = 0.001). However, no significant associations were found between sex or marital status and malnutrition, with p values of 0.194 and 0.339, respectively. The study concluded that malnutrition is prevalent among TB patients, with 36.7% malnourished and 50.46% at risk of malnourishment. The findings revealed no significant associations between malnutrition and sex or marital status, but a significant relationship was observed between malnutrition and BMI, indicating the importance of addressing malnutrition as a critical component of TB management.

Understanding antibiotic use and resistance: knowledge, attitudes, practices, and training needs of paramedical students

Mati Ullah

The inappropriate overuse of antibiotics is considered the main source of antimicrobial resistance (AMR). Therefore, this study aimed to assess the knowledge, attitudes, and practices of antibiotic use and resistance among paramedical students. In addition, the study also assessed the perceptions, knowledge gaps, and educational needs of paramedical students regarding antibiotic use, resistance and related training. This descriptive cross-sectional study was conducted at Khyber Medical University by recruiting 500 students from twelve different paramedic disciplines. The self-administered questionnaire was distributed online through email and WhatsApp, resulting in 364 completed responses and a response rate of 72.8%. The study revealed that 41.21% of paramedic students were using antibiotics without a prescription, 23.63% admitted that they discontinued their prescribed antibiotic course once they felt better, 95.88% recognized the term ‘antibiotics’, and 79.67% acknowledged that inappropriate use contributed to resistance. A sex comparison revealed that male students (81.32%) were significantly more likely to complete their prescribed antibiotic courses than their female counterparts were (67.29%) (p = 0.002). This study identifies gaps in paramedical students' knowledge, attitudes, and practices related to antibiotic use and resistance. Despite a general awareness of key concepts, misconceptions and improper practices were also common. Therefore, there is a dire need to upgrade the curriculum and implement integrated modules on antibiotic stewardship, infection control, and responsible antibiotic use, which could enhance students' knowledge, enable them to make informed decisions, and contribute significantly to combating antibiotic resistance.

Surgical outcomes of patients with corrosive ingestion: a retrospective analysis

Farhan Majeed

Corrosive ingestion can cause severe complications, including perforation, stricture, and fistula, which often require surgical intervention to prevent further damage. This retrospective observational study analyzed surgical outcomes and gender differences in ingestion types (accidental vs. suicidal) and causative substances (acid, alkali, ammonia, detergent, or mixed) among 99 patients at a tertiary care hospital in Rawalpindi from January 2002 to January 2024. The average age of the patients was 30.36 ± 10.18 years, with 61.62% female patients and 38.38% male patients. Accidental ingestion was more common in males (94.74%), whereas suicidal ingestion was more common in females (21.31%, p = 0.026). Mixed substances were the most common substances ingested, particularly among females (60.66%, p = 0.048). All patients underwent upper gastrointestinal endoscopy, and diagnostic laparoscopy or feeding jejunostomy was the most common surgical procedure (57.58%). The esophagus (68.69%) was the most affected site. Surgical site infections (16.16%) and strictures (11.11%) were the most frequent complications, with a mortality rate of 4.04%. Our study concluded that timely surgical management could reduce the risk of complications and enhance patient outcomes. Corrosive ingestion often affects multiple areas of the gastrointestinal tract that require several surgical interventions. In certain cases, complex procedures, such as colon interposition and total laryngopharyngoesophagectomy (TLPO), which require skilled surgeons as well as advanced management centers, are performed to manage corrosive injuries. Therefore, improving these patients’ outcomes via interventions focused on training in complex surgical procedures is crucial. However, more research is needed to identify the most effective approaches for the surgical management of corrosive ingestion.