Comparison of GeneXpert MTB/RIF Assay in Broncho Alveolar Lavage and Gastric Lavage Samples

Objective: To compare the yield from Gastric lavage (GL) and Broncho alveolar lavage (BAL) samples in adult patients suspected case of Tuberculosis but not producing sputum. Methodology: 80 adults with suspected case of tuberculosis but not producing sputum were recruited. 72 patients were then subjected to one gastric lavage followed by Broncho-alveolar lavage in the same morning. The collected samples were subjected to GeneXpert MTB/RIF assay. Result: Of the 72 patients samples, the mean age was 38.6 years. 41 (56.9%) were male and 31 (43.1%) were female. History of TB contact was present in 25 (34.7%) patients. 37 (51.4%) patients had GeneXpert MTB/RIF positive on BAL and/or GL samples. The GeneXpert MTB/RIF of BAL fluid was positive on 35 (48.6%), which was not significantly greater than that for specimens from GL, which was 28 (38.9%) (p > 0.05). In 26 (36.1%) cases, GeneXpert MTB/RIF was positive in both BAL and GL samples. Conclusion: This study showed the yield of GeneXpert MTB/RIF in GL was comparable to BAL to detect Mycobacterium tuberculosis complex. Patients who can’t produce sputum, GL can be a good alternative to BAL to detect Mycobacterium tuberculosis complex in resource poor areas and patients who do not tolerate Bronchoscopy.

The Prevalence of Hyponatremia in Pulmonary Tuberculosis Patients, a Tertiary Care Hospital Experience from Pakistan

Introduction: Tuberculosis (TB) is one of the major public health problems in Pakistan. Our country ranks fifth in tuberculosis high-burden countries worldwide. Hyponatremia is considered as one of the most common and important electrolyte abnormality in Pulmonary TB (PTB) patients. This study will show the prevalence of hyponatremia in PTB in our population. Objective: To evaluate the prevalence of hyponatremia in pulmonary tuberculosis patients. Study Design: Cross-sectional, descriptive study at Jinnah postgraduate medical centre Karachi from August 2017 to August 2018. Material and Methods: In this cross-sectional study, all patients with TB admitted in chest ward were enrolled. Patients having tuberculous meningitis, syndrome of inappropriate Ant diuretic hormone (SIADH), Renal failure, pneumonia, Cirrhosis taking medicines (diuretics, ACEI, and ARBs) were excluded. A pre-designed questionnaire was used to assess hyponatremia and its potential causes other than TB. Chi-square or Fischer exact test was used to identify factors associated with hyponatremia. Results: Ninety-six patients with mean age were 40.14 ± 13.02 years (ranging 18 - 65 years). Predominantly, patients were females 50 (52.08%). Overall Serum Na, Mean ± SD was 130.53 ± 6.99 (Ranging 110 - 146). Sixty one patients (63.5%) were younger than 40 years. Forty patients (41.66%) were smokers: 16 (16.7%) had diabetes mellitus (DM), and 15 (15.6%) had hypertension. Sixty-nine (71.87%) patients had hyponatremia of which 45 (73.77%) were less than 40 years (p = 0.375). Diabetes mellitus, female gender, smoking, hypertension and duration of disease were not associated with increased risk of hyponatremia having P Values: p = 0.082, p = 0.39, p = 0.57, p = 0.20 and p = 0.45 respectively. Conclusion: Hyponatremia is associated with tuberculosis and is more common with diabetes, hypertension, smoking and young age.