Distribution of blood groups in population of Lehtrar road Islamabad

To determine the frequency of various blood groups in the population of Lehtrar road Islamabad and to compare the results with national and international studies. This cross sectional observational study was conducted at Rawal Institute of Health Sciences [RIHS], from Nov 01, 2011 till Nov 30, 2012. A total of 1,739 subjects including both male and females were analyzed. Blood was collected and ABO and Rh blood groupings were carried out by standard tube method using commercially prepared antisera and frequency of ABO and RhD blood groups was determined. Among ABO blood groups the most frequent was B [33.5%], followed by O [31.3%], A [22.5%] and AB [12.41%], group respectively. Among Rh +ve cases, blood group B was the most frequent with 542 [31.1%] individuals; however among Rh -ve individuals the most frequent blood group was O [63[3.6%]]. The current study revealed that blood group B is the most frequent blood group among the ABO blood group system with dominant RhD positivity in this region

[ effect of lavender essence via inhalation method on labor pain]

Studies have shown that half of the mothers complain severe or intolerable labor pain. Because of the side effects of pharmacological pain killers on mothers and neonates, those medications are used lower than non pharmacological methods in these days. The aim of this study was to investigate the effect of lavender essence inhalation on labor pain. In this randomized clinical trial study, 120 pregnant women were selected by convenient sampling method and divided in two groups of 60. Conducted cool vapor of essential oil of lavender was used in case group and the control group used only cool water vapor. Written consent was obtained and pain was estimated once before and 3 times after intervention. Analytical statistics such as t-test and X2 were used. The results showed that difference in the labor pain before and after intervention in lavender group was 0.81 +/- 2.48 and in control group was 0.90 +/- 1.90 and the difference was significant [P=0.03]. This study showed that aromatherapy could be a suitable alternative complementary medicine for labor pain

possible role of steroid hormones present in vitex negundo and its efficacy as a contraceptive

Vitex negundo is used as a contraceptive in traditional medicine. Most of the oral contraceptive pills used in allopathic medicine are the combination of estrogen and progesterone. Some contraceptive pills [mini pills] contain progesterone alone. The present study shows that the extract of Vitex negundo contains estrogen, testosterone and progesterone, their concentrations were found to be 947.7 pg/ml, 22.276 ng/ml and 6.022 ng/ml respectively. From these findings it is assumed that this high concentration of steroid hormones may contribute to its contraceptive action but it may have some side effects on the female reproductive physiology as it contains male hormone i.e. testosterone in addition to the progesterone and estrogen. On the basis of these findings, it is suggested that the trial of this drug on animals followed by clinical study should be carried out to see its anti-fertility activity and side effects

PAP smear screening for precancerous conditions of the cervical cancer

To find the presence of cervical cancer in PAP smears taken from Pakistani women of different age groups. Department of Cytology, Public Health Laboratory Division. National Institute of Health, Islamabad. Data of all cervical smears sent to the cytology department of NIH between 1st January 2001 to 31st December 2004 was retrospectively analysed to see the presence of malignancy. A total of 546 smears were assessed during the study period. Of these, 302[55.31%] showed inflammatory changes, 124[22.71%] were normal, 40[7.33%] were atrophic, 17[3.12%] showed dysplastic changes, in which 10 cases were of low grade squamous intraepithelial lesion [LSIL], and 07 cases were of high grade squamous intraepithelial lesion [HSIL]. Carcinoma in situ, was seen in 11 [2.02%]. Inadequate sample was reported in 52 [9.52%] cases with an advise to repeat the test. Awareness campaigns and screening program for cervical cancer in women of reproductive age is recommended especially in those having prolonged symptoms

Penetration and activity of antibiotics in brain abscess

Penetration of antimicrobial agents into the cerebrospinal fluid is dependent on numerous factors, including their serum protein binding, molecular size and lipid solubility, and degree of local inflammation. The choice of an appropriate agent is further complicated by diverse bacterial flora involved in brain abscess, local resistant patterns and activity of the drug in abscess environment. This update examines the conventional and newer agents in the above context for their role in the management of brain abscess

Genus and species-specific IgG and IgM antibodies for pulmonary tuberculosis

To evaluate three different enzyme immunoassays for serological diagnosis of pulmonary tuberculosis and to compare their diagnostic accuracy in different combinations. Design: A non-interventional comparative study. Place and Duration of Study: The study was carried out at the Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi between April and September 2001. Subjects and Sera from patients suffering from pulmonary tuberculosis [n=94] with sputum positive for acid fast bacilli [AFB] and sera from control group of healthy individuals [n=90] with sputum negative for AFB were tested by Pathozyme-Myco G EIA, Pathozyme-TB Complex Plus EIA and Pathozyme Myco M EIA kits for the genus-specific IgG and IgM, and the species-specific IgG antibodies against antigens of Mycobacterium tuberculosis. The detection of IgG against genus-specific antigens by Pathozyme-Myco G had a sensitivity of 46% and a specificity of 93%, of IgG against species-specific antigens by Pathozyme-TB Complex Plus had a sensitivity of 64% and specificity of 97% and of IgM against genus-specific antigens by Pathozyme Myco M had a sensitivity of 67% and specificity of 98%. When the results of these immunoassays were evaluated in combination, their sensitivity improved. Combination of genus-specific IgM and species-specific IgG yielded best results with a sensitivity of 87% and specificity of 93%. The sensitivity of serological diagnosis of tuberculosis is low, but it can be increased by utilizing a combination of several antigens

Treatment response in HCV related chronic hepatitis

To evaluate the virological response to treatment with interferon and ribavirin in patients with hepatitis C related liver disease. Design: A descriptive study. Place and Duration of Study: January to September 2002 at Virology Department, Armed Forces Institute of Pathology Rawalpindi. Material and Two hundred seventy-nine patients were included in the study. These patients had taken interferon and ribavirin treatment for HCV related chronic hepatitis, and were referred to AFIP for HCV RNA testing by polymerase chain reaction [PCR] between January 2002 and September 2002. Out of 279 cases, 229 had taken the treatment for 06 or 12 months and were tested for end-of-treatment response [ETR]. Fifty patients had completed their treatment regimens of 6 or 12 months treatment, at least 24 weeks before their PCR test and were having follow-up testing for sustained viral response [SVR]. The sera of these patients were tested for HCV RNA by PCR, using a commercial kit of Amplicor [Roche] for qualitative detection of HCV RNA. Out of 229 cases tested for end-of-treatment response, 198 [86.5%] had no detectable HCV RNA [responders] and 31[13.5%] were PCR positive [non-responders]. Thirty-eight out of 50 cases, tested for a sustained viral response, had a negative result for HCV PCR thus showing sustained response rate of 76%. The viral remission/response to interferon and ribavirin combination therapy in our patients was better than that quoted in other regions

Diagnosis of B-thalassaemia major in previously transfused patients

The study was conducted to evaluate the effects of blood transfusion[s] on the haematological picture of b-thalassaemia major. Design: Retrospective case control study. Place and Duration of Study: Department of Haematology, Armed Forces Institute of Pathology, Rawalpindi from January1999 to December 2000. Subjects and A total of 280 consecutive patients of b-thalassaemia major were studied. They were diagnosed by haematological parameters, and Hb-F estimation. Parent's study and PCR was also used when required. Out of the 280 patients 109 [39%] had received one or more blood transfusions [cases]. The remaining 171 patients who did not receive any transfusion served as controls. The mean MCV, MCH and Hb-F in cases were significantly higher than in the controls [p<0.05]. The mean Hb-F in 95 cases, which had received occasional [<4] transfusions, was higher [33%] than in the 14 cases who had received >4 transfusions [17%] [p=0.016]. In the occasionally transfused patients Hb-F level was directly related to the time since last transfusion. In 44/109 [40%] transfused patients [Hb-F >30%] the diagnosis of thalassaemia was not difficult. In 54/109 [50%] patients [Hb-F: 5-30%] the diagnosis was aided by parent's study, while PCR for thalassaemia mutations was required in 11/109 [10%] patients [Hb-F <5%]. In most transfused patients of thalassaemia major MCV and MCH were significantly higher while Hb-F was lower than in the un-transfused patients. There was a linear correlation between Hb-F level and time since last transfusion in the occasionally transfused patients. However, the reduction in Hb-F level was more marked and sustained in multipally transfused patients. Parent's study and PCR are useful aids in establishing the correct diagnosis in these patients

Incidence and multidrug resistance in typhoid salmonellae in Bahawalpur area

Typhoid fever is a major problem affecting milions of people all over the world specially the developing countries. Resistance of the salmonella isolates to conventional antityphoid drugs has continued to rise for the last 10-15 years. This study was done to determine the prevalence and susceptibity pattern of various salmonellae isolated in the region of Bahawalpur. A total of 107 blood cultures were performed out of which 42 were found to be positive for salmonella, 39 were Salmonella typhi and 3 were Salmonella paratyphi A. Among Salmonella typhi isolates 21 [53.8%] were resistant to ampicillin, chloramphenicol and Cotrimoxazole, one isolate was resistant to ampicillin and Chloramphenicol but sensitive to Cotrimoxazole. All the isolates were sensitive to the fluoroquinolones and 3rd generation cephalosporins. Inspite of all the drugs available, the problem of spread of typhoid continues. This study shows that the prevalence of overall resistance to Salmonella typhi is high in this area also. The continuous uninhibited use of antibiotics may lead to 100% resistance to these antibiotics and acquisition of resistance by other organisms also. The medical and public health officials must be prepared to tackle the future epidemics of multidrug resistant Salmonella typhi

Categorization of hbv carriers

Hepatitis B virus [HBV] carrier state can broadly be classified into ordinary and super categories on the basis of Hepatitis B 'e' Antigen [HBeAg] and antibody to Hepatitis B 'e' antigen [anti HBe]. A total of 523 cases of HBV infection were included in this retrospective study for the purpose of subcategorization. Out of 433, males 73.44% were ordinary carriers [HBeAg Non-reactive but having antibody to that antigen], 18.01% super carriers [converse serological state] and 8.41% doubly negative carriers. In 90 females tested, 65.55% were ordinary carriers, 26.66% were super carriers and 7.77% were doubly negative. This pattern may help clinicians in prophylaxis to their contacts and for prognostic considerations

Hepatitis B in health care personnel

The exposure of health care personnel to blood, its products and carriers of Hepatitis B is much greater as compared to other segments of population. This study gives prevalence of past exposure and carrier state of HBV in health care personnel of our setup. It has been seen in our study that the nurses and laboratory workers are the worst affected. Two hundred and thirty one health care personnel [155 laboratory workers, 28 members of dental staff and 48 operation theatre staff] were tested for their ongoing HBV carrier state [HBsAg] and evidence for exposure to HBV in the past.Out of these 92 [39.8%] showed evidence of exposure to the virus in the past by being antiHBc positive.Out of the exposed persons 18 [7.7% of the total] were the HBsAg carriers and 61 [26.4%] had already developed immunity against the HBV by virtue of being anti-HBs positive

Drug resistance in mycobacterium tuberculosis: a four years experience

OBJECTIVE: To assess the prevalence of drug resistance amongst the clinical isolates of M. tuberculosis. SETTING: Armed Forces Institute of Pathology, Rawalpindi. METHOD: Four first line anti-tuberculosis drugs, isoniazid [INH], rifampicin [RIF], ethambutol [ETH] and streptomycin [STR] were tested on 300 isolates from clinical samples, by agar dilution method on Lowenstein Jensen medium. The sensitivities were interpreted by the resistance ratio method. One hundred and fifty eight [52.66%] isolates were found resistant to one drug at least. Among the resistant isolates, 79 [26.33%] were resistant to INH, 72 [24.0%] to RIF, 84 [28.0%] to STR and 70 [23.33%] to ETH with or without resistance to other drugs. Multi-drug resistance [MDR] was found in 41 isolates [13.66%]. To overcome this problem there is a need to establish centres at a number of places all over the country with professionals trained to handle the emerging problem of MDR. Each centre must be equipped with adequate facilities for susceptibility testing so that the resistance pattern can be ascertained and treatment regimens tailored accordingly

Detection of serum IgM against salmonella typhi: a rapid diagnostic technique

Typhoid fever is a serious problem in underdeveloped countries and is responsible for significant morbidity and mortality. Accurate diagnosis requires isolation of the typhoidal salmonella from blood and other body fluids, which is time consuming and such facilities are limited to a few major cities of Pakistan. Clinical features vary tremendously that makes clinical diagnosis difficult. Widal test is the most widely used investigation for the diagnosis of typhoid fever. However the test lacks sensitivity and specificity. Recently a new serological test called typhidot test based on the principle of enzyme immunoassay, developed by the Malaysian Bio Diagnostic Research [MBDR] has been introduced in Pakistan. The test aims at the detection of IgM and IgG specific for salmonella typhi in the patients serum. We evaluated this technique with a view to find out its sensitivity and specificity for the infections with S. typhi. Twenty five serum samples from patients with a culture positive typhoid infection and one hundred samples from patients who were divided into four groups two having a strong clinical suspicion of typhoid one febrile due to conditions other than typhoid and one comprising healthy adults were subjected to typhoid test. Results are very good with sensitivity and specificity well above 90%. The rapidity and specificity of this procedure for the diagnosis of typhoid fever justifies its cost

Problem of multi- drug resistant typhoid fever in Rawalpindi/islamabad area

Typhoid fever is endemic in all the developing countries including Pakistan and emergence of multi-resistant S.typhi has added new dimension to the problem. All the 2551 isolates of typhoid salmonellae [S. typhi, n=2049 and S. paratyphi A, n=502] isolated during Jan 1987 and Dec 1995, were studied. Isolation of S. typhi resistant to conventional antityphoids i.e. chloramphenicol, ampicillin, cotrimoxazole, remained less than 10% till the end of 1989. Then multiresistant S. typhi siolated during subsequent years were increased; 1990 [65.94%], 1991 [56.32%], 1992 [49.42%], 1993 [56.9%] 1994 [66.67%] and 1995 [75.41%]. No S. typhi was found resistant to fluoroquinolones [ciprofloxacin, and offoxacin] and third gereration cephalosporins [ceftriaxone and ceftizoxime]. On the other hand, all the S. paratyphi A isolated were found susceptible to all the conventional antityphoids, fluoroquinolones and third gereration cephalosporins. We should recognize the problem of multiresistant S. typhi and expected danger of development of resistance against all the available antityphoid drugs. Our main stress should be towards prevention of the disease rather than for treatment

Alarming state of emerging resistance in salmonella typhi to conventional antityphoid drugs in the Kharian region

Enteric fever remains and important cause of mortality and morbidity in the under developed and the developing countries of the world. Once an illness of the hot weather, it is now endemic in Pakistan throughout the year. After the emergence of chloramphenicol [CAP] resistant Samonella typhi in Pakistan, this trend has been of the rise. In the Kharian region, about 93% of S. typhi are found resistant to conventional antityphoids [CAP, ampicillin and cotrimoxazole]. However, all the isolates remained susceptible to fluoroquinolones [ciprofloxacin and ofloxacin] and third generation cephalosporin [ceftriaxone] except S. paratyphi A which was uniformly sensitive to all the conventional antityphoids, fluoroquinolones and third generation cephalosporins

Cholera status at Rawalpindi/Islamabad, Pakistan

From 1947 to 1970, a number of cases of cholera occurred mainly in the East Wing of Pakistan. However, during this period and in subsequent years up to 1992, there were reports of sporadic cases of cholera in [West] Pakistan. In the year 1993, there was a sudden increase in the isolation rate of Vibrio cholerae 01 [71.65/1000 stool specimens] at Armed Forces Institute of Pathology [AFIP], Rawalpindi. However, the isolation rate of V.cholerae 01 again decreased [12.58/1000 stools specimens] during 1994. Fourteen isolates of V.cholerae non 01 were also obtained during these two years, but none of them was V.cholerae 0139. Tetracycline [TET] is no more the drug of choice for V.cholerae 01. There were 90.86% [n=169] and 90% [n=36] isolates of V.cholerae 01 resistant to TET during 1993 and 1994 respectively. However, doxcycline and minocycline were found very effective in vitro against V.cholerae 01. Ampicillin, cotrimoxazole and chloramphenicol resistance to V.cholerae 01 has increased significantly. All the V.cholerae 01 were uniformly sensitive to all the quinolones [nalidixic acid, enoxacin, ciprofloxacin and ofloxocin]. We must remain on guard against cholera through continuous surveillance as well as by assuring access to treatment and providing clean water and adequate sewage disposal

Changing pattern of prevalence and susceptibility of various urinary isolates in Rawalpindi / Islamabad

A number of 7585 microorganisms isolated from urine specimens between Jan 1989 and Dec 1993, at Armed Forces Institute of Pathology, Rawalpindi, were tested for their susceptibility to various antimicrobials. The disk diffusion technique [Kirby Bauer Method] using sensitest agar [Oxoid] [alone and/or with 5% horse blood] was adopted for various isolates against different antimicrobials. Escherichia coli remains the most common [46.96%] isolate, followed by pseudomonas aeruginosa [13.05%] and Klebsiella pneumoniae [12.99%]. There was no significant change in the rate of isolation of most of the organisms. However, there is decrease in isolation of Klebsiella pneumoniae from 1989 [20.07%] to 1993 [12.99%] and increase in isolation of Staphylococcus aureus [3.81% 9.80%] and streptococcus [Enterococcus] faecalis [0.55 to 4.81%]. Resistance of Escherichia coli against co-trimoxazole [COT] and ampicillin [AMP] has increased respectively from 40.32% and 39.65% [1989] to 76.18% and 77.98% [1993]. Resistance of Pseudomonas aeruginosa against ofloxacin [OFL] has increased from 46.3% [1989] to 60.83 h [1993]. Resistance of Klebsiella pneumoniae against nitrofurantoin [NIT] and norfloxacin [NOR] has increased respectively from 60% and 4.5% [1989] to 79.17% and 19.91% [1993]. Resistance of Staphylococcus aureus against AMP has increased from 86.85% [1989] to 95.09% [1993]. In 1993, all the isolates [excluding Pseudomonas aeruginosa and S. faecalis] revealed resistnace against NIT, 32.17% NOR, 20.31%; pipernedic acid, 37.19% COT, 78.68%; AMP, 86.83%; cephradine, 35.15%; gentamicin, 32.24%; OFL, 14.19% and ceftriaxone, 20.16%. It appears that AMP and COT should not be used empirically in urinary tract infection [UTI] and instead NIT or NOR may be preferred as empirical treatment of UTI

Cholera outbreak in 1993 at Rawalpindi and Islamabad

Seven pandemics of cholera have occurred since 1817; the seventh pandemic which started in 1961, n was caused by EITor biotype Vibrios. Until 1976, the antibiotic resistance was rare amongst the epidemic strains of cholera vibrios. They were sensitive to tetracycline [TET], chloramphenicol [CAP], ampicillin [AMP], gentamicin [GEIM] and nalidixic acid [IMAL]. The antimicrobial resistance was detected only in subsequent years. One hundred and seventy eight isolates of Vibrio cholerae serogroup O1, serotype Ogawa and biotype EITor from 1993 outbreak in Rawalpindi/Islamabad were tested for their susceptibility against various antimicrobials. Sensitivity was determined by disk diffusio method [Kirby Bauer] using Mueller-Hinton agar. Most of the strains were resistant to TET [91.0%], COT [91.0%] and CAP [80.3%]. However, only 6.5% and 3.3% of the strains were resistant to AMP and doxycycline [DOX]. Quinolones were found to be very effective in-vitro against all these isolates

guide to avail better service from clinical microbiology laboratory

Microbial diseases of different nature are one of the commonest problems faced by our nation including Armed Forces. The meager diagnostic resources for infectious diseases need appropriate utilization. The best out of the existing clinical microbiology laboratory services can be availed provided meticulous collection and transport of the samples is practiced and relevant clinical data is submitted