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PMRC TB RESEARCH CENTRE
 


DR. Rizwan Iqbal
Research Director
PMRC TB Research Centre

KEMU/Mayo Hospital, Lahore 


Brief History and Introduction

PMRC TB Research Centre, Mayo Hospital, King Edward Medical University, Lahore was established in 1973. At present it has well equipped research laboratory with latest equipment. The centre has qualified staff for laboratory diagnosis of Mycobacterium tuberculosis, which includes microscopy, culture, and drug susceptibility testing for first line as well as second line of anti tubercular drugs. Almost all the departments of Mayo hospital are utilizing diagnostic facilities of PMRC centre on regular basis. About 95% of TB patients are provided free diagnostic facilities.
The centre is working in close collaboration with National and Provincial TB Control Program, providing microscopy facility to patients enrolled under DOTs program. Around 50 patients visit TB centre each day to get their tests done. The centre is also working for NTP AS “National Referral Laboratory for monitoring Drug Resistance in anti TB drugs”.
The centre has recently been renovated and equipped to cater the growing needs in this field of research. Apart from working on first line anti TB drugs since its establishment now centre has started to work on second line of anti TB drugs.
Main function of PMRC is to promote, organize, coordinate and undertake health research in the country.
The Council funds the projects submitted on the subjects related to human health and disease, which are accepted from both public and private sector. There are four categories in which research projects are invited: 1) Routine projects ( Researcher’s interest), 2) High Priority Area (Disasters, floods, flu, outbreaks), 3) Multicentre projects ( to generate national data), 4) Dr. S.J. Zuberi grant.
Faculty List


Sr. No

Name

Qualification

Designation

1.

Prof. Dr Faisal Masood

MBBS, FRCP

Vice Chancellor/ Honorary Director

2.

Dr Rizwan Iqbal

MBBS

Research Director

3.

Muhammad Kashif Munir

M. Phil. (Mol. Bio.)

Research Officer

4.

Arslan Ahmed Salam

M. Sc. (Microbiology)

Research Officer

5.

Sana Rehman

M. Phil. (Microbiology)

Research Officer



Objectives
To identify the resistant cases of TB in DOT Programme.
     
To facilitate postgraduate students to carry out their research work in the various field    of tuberculosis.

Collaborative research on various aspects of pulmonary and extra pulmonary tuberculosis especially at molecular level.

Training postgraduate medical students and paramedical staff of Punjab in TB DOTS Programme.

To provide technical skill and supervise adjoining centre’s, government chest clinics and independent bodies involved in the process of control and eradication of tuberculosis.

Research priorities
Regular monitoring and updating the pattern of first and second line anti TB drug resistance.

To work at molecular level in the field of tuberculosis.

Collaborative research with national and provincial TB control programme.

To facilitate the post graduate students of M Phil and PhD in research and guide in thesis write up.
Mycobacteriology Laboratory
The centre is fully equipped with most updated equipment such as biological safety cabinet (Class 11 B), incubator (Germany make), inspissator (UK make) international centrifuge (Germany make), PH meter, table top (UK make), oven (Hot Air) (Germany make), Analytical Balance (Germany make), Pipetting Syringes (Germany make) and Slide Drawing Plate (Spain make) being donated by National TB Control Programme, Islamabad. Now we can perform microscopy, isolation, identification and culture sensitivity of M. tuberculosis isolates more efficiently. In addition all facility is in use to determine multi and multiple drug resistance among the isolated strains of M. tuberculosis. This facility is extended to all institutes, hospitals and private sector institutes.
Induction of GeneXpert Facility
PMRC TB Research Centre, KEMU, Lahore has succeeded in receiving the GeneXpert from National TB Control Program (NTP), Islamabad. GeneXpert is PCR equipment designed and programmed to perform anti tubercular drug resistance testing within 2 hours, mainly for Rifampicin and Isoniazid two main drugs used for the treatment of tuberculosis. On development of resistance against these drugs patient is labeled as multi drug resistant (MDR) for the treatment of tuberculosis and has to be put on second line of treatment which is very expensive and duration of treatment is also for minimum of 2 years may be more varying from patient to patient. At present MDR tuberculosis in Pakistan is around 15% which is quite alarming.
Before putting the patient on second line of treatment for MDR TB, confirmation through “GeneXpert” is a prerequisite of World Health Organization. With the grace of God PMRC TB Research Centre has succeeded in getting this expensive and latest equipment along with regular supply of kits depending on our work load, which are also very expensive from NTP, Islamabad


Research projects from K.E.M.U, Lahore
Research projects are invited from all departments of King Edward Medical University up to the funding of 5 lac rupees, and we help them to get funds for these projects from Pakistan Medical Research Council, Islamabad.
Research Facilities & Linkages
The centre is affiliated to the Postgraduate Medical Institute, Centre of Excellence in Molecular Biology (CEMB) and University of Punjab, Lahore for providing all facilities of training to postgraduate students of these Institutions.
Hameed Latif Hospital, Shalimar Hospital, Lahore General Hospital, Lady Wallington Hospital, Lady Atchison Hospital, and various other hospitals inside and outside Lahore also send their specimens for screening of TB patients to this center. It also has the referral TB diagnostic facility for Microscopy, culture, Identification and determining the anti TB drug susceptibility patterns.

Number of Research Publications (During the last 5 years)

  1. Iqbal R., Munir K., Bashir S., Arif A., Rao M H., Mirbahar A., Akhtar T., Firdous R., Asim M. Screenin for tuberculosis among household contacts of index patients. Pak J Med Res. 2013; 52(4): 96-101. (Declared best paper for the year 2013 among all publications of PMRC.)
  2. Munir M A., Alam S E., Khan Z U., Saeed Q., Arif A., Iqbal R., Saqib M A N., Qureshi H. Dengue fever in patients admitted in tertiary care hospitals in Pakistan: A retrospective analysis.J Pak Med Assoc. 2014; 64(5): 553-9.
  3. Salam A A., Rehman S. Frequency and type of addiction among tuberculosis patients. Pak J Med Res. 2013; 52(3): 64-6.
  4. Iqbal R., Munir M K., Saeed S., Salam A A., Rehman S., Qadeer E., Khan S U. Drug Resistant Tuberculosis among Patients in Chest Unit of Mayo Hospital Lahore. Pak. Journal of Chest Medicine. 2013: Oct-Dec.; 19(4).
  5. Nahid F., Khan A A., Rehman S., Zahra R. Prevalence of metallo-β-lactamase NDM-1-producing multi-drug resistant bacteria at two Pakistani hospitals and implications for public health. JIPH. 2013; 6(6): 487-93.
  6. Rehman S., Iqbal R., Munir M K., Salam A A., Saeed S. Incremental yield of submitting three sputum specimens for the diagnosis of pulmonary tuberculosis. PJMR. 2013; 52 (2): 35-38.
  7. Iqbal R., Shabbir I., Mnir M K. The first and second line anti TB drug resistance pattern in Lahore. PJMR. 51(1): 1-4, 2012.
  8. Munir M K., Iqbal R., Shabbir I., Chaudhry K. Factors responsible for failure to initiate tuberculosis treatment among smear positive tuberculosis patients. PJMR. 51(2): 34-37, 2012.
  9. Rao M H., Arain G M., Khan M I., Talreja K L., Ali G., Munir M K., Naz S., Hussain I., Ahmed J.  Assessment of Knowledge, Attitude and Practices Pattern of Hand Washing in Some Major Public Sector Hospitals of Pakistan (A Multi-Center Study). PJMR. 51(3): 76-82, 2012.
  10. Sadaruddin A., Ghafoor F., Alam S E., Naz S, Khan I M, Mohyuddin G,  Shahid A., Taseer I,  Habibullah S, Akhtar T, Iqbal R, Goraya A, Talreja K, Arif A. Seroprevalence of Measles Antibodies in School going Children in Pakistan. PJMR. 50(2): 38-43, 2012.
  11. Iqbal R.,Tabassum M N., Shabbir I., Munir K et al. Multi drug resistance tuberculosis: It’s pattern seen in 13 years. PJMR. 50(1): 10-14, 2011.
  12. Munir M K., Anwar N., Iqbal R., Shabbir I., Nosheen S. Diagnosis tuberculosis: Molecular versus conventional method. PJMR. 50(2): 50-54, 2011.
  13. Shabbir I., Iqbal R., Anwar M., Qadeer E., Ahmed N. An improved record system for tracing outcome of “transferred-out” DOTS patients. Eastern Mediterranean Health Journal. 17(2): 88-92, 2011.
  14. Iqbal R. Munir M K. Dengue fever: Special Communication. PJMR. 50(1): 42-44, 2011.
  15. Munir M K., Shabbir I., Iqbal R., Khan S U. Comparison of detection of acid fast bacilli in clinical samples by AFB smear microscopy and culture in the diagnosis of tuberculosis in tertiary care settings. Pak. J Chest Med 15. (4). 14-18, 2009.
  16. Iqbal R, Shabbir I. World Asthama Day. Editorial. Pak. Jour. of Medical & Health Sciences, Vol.1 No.1; 1, 2009.
  17. Munir MK, Shabbir I, Iqbal R, Comparison of AFB Smear Microscopy and Culture from Specimens Received for Diagnosis of Extra Pulmonary Tuberculosis: Pak. Jour. of Medical & Health Sciences, Vol.1 No.1; 59-61, 2009.
  18. Munir MK, Shabbir I, Iqbal R, Khan SU. Diagnosis of extra pulmonary
    tuberculosis: Conventional versus newer methods. Pakistan Journal 
    of Chest Medicine 2009; 15: No. 1: 11-14.
  19. Shabbir I, Iqbal R, Qadeer E. Screening of tuberculosis in 
    Kharal Abbasian Azad Kashmir. Pak J Med Res 2009; 48: 1-3
  20. Iqbal R, Shabbir I, Khan SU, Saleem S, Munir K. Multidrug resistance tuberculosis in Lahore. Pakistan J Med Res 2008; 47: 22-25.
  21. Saleem S, Shabbir I, Iqbal R. Value of three sputum smears microscopy in diagnosis of pulmonary tuberculosis. Pakistan J Med Res 2007; 46: 94-97.
  22. Shabbir I, Iqbal R, Chaudhary A. New strategy for transferred out patients to have better treatment outcome. ( Paper accepted for publication in Eastern Mediterranean Journal )
  23. Shabbir I, Iqbal R, Khan SU. Analysis and correlation of sputum smear and X-Ray results in pulmonary tuberculosis patient admitted in Tertiary Care Hospital. Pakistan J Med Res 2007; 46: 67-69.

Completed Research Studies (During 2011-April 2014)

  • Burden of Non communicable diseases survey of Pakistan.
  • To study the frequency of confirmed dengue fever cases among patient presenting with fever to a tertiary care hospital and a private lab.
  • Review of health system in prisons of Punjab, Pakistan.
  • Study of dengue fever case management and association of co-morbidities with deaths. (Multicentre study)
  • Assessment of economic burden of dengue fever/dengue hemorrhagic fever in Pakistan during 2011 epidemic. (Multicentre study)
  • Frequency and type of addiction among tuberculosis patients.
  • Global Youth Tobacco survey of Pakistan.
  • To study the first and second line of anti TB drug resistance pattern in treatment failure cases thus to establish invitro susceptibility pattern of second line of anti TB drugs in multi and multiple drug resistance cases.
  • To study the factors responsible for failure to initiate tuberculosis treatment among smear positive tubercular patients.
  • Screening for tuberculosis among the house hold contacts of Index patients: PMRC multi centre study. 
  • Multi drug resistance anti TB drugs monitoring on regular basis to furnish data on pattern of TB drug resistance.


On Going Research Studies:

  • Factors affecting sputum smear conversion time among newly diagnosed                          pulmonary tuberculosis patients.
  • Comparison of GeneXpert MTB/RIF assay with conventional standard proportion method for determination of drug susceptibility in multidrug resistant TB suspects.
  • Type and frequency of mutations in katG and rpoB genes in multi drug resistant strains of Mycobacterium tuberculosis complex.
  • Measles Seroprevalence in children between 18 to 24 months of age. (Multi centre study).
  • Seroprevelance of dengue IgG antibodies in Pakistani Population. (Multi centre study).
  • Therapeutics outcome of pulmonary tuberculosis in type 2 diabetes patients.
  • To study the type and extent of X-ray lesions among smear positive and smear negative patients for the diagnosis of pulmonary tuberculosis.
  • Long term follow up of MDR TB patients after 3-4 years of starting second line anti tubercular drugs.

Services

  • Microscopy of mycobacterium by direct and concentration method using ZN stain and fluorescent microscopy.
  • Pulmonary and extra pulmonary culture of mycobacterium on LJ Medium.
  • Rapid diagnosis of MDR TB by using Rifampicin resistance as marker detected by GeneXpert (Recommended by WHO).
  • Anti TB drug sensitivity of 1st and 2nd line by standard proportion method.

Key Aim of PMRC Center
Our main aim is to get PMRC TB Research Center recognized as W.H.O. Referral center on TB which will be the first and only of its kind in Pakistan. All our efforts are focused in this direction Dr. Salman H. Siddiqi presently Becton. Dickenson. Fellow in USA and our Honorary Technical Advisor is providing all the technical expertise and guidance to achieve this prestigious goal.


 
 
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