ABSTRACT
Abstract Introduction Total thyroidectomy remains highly technical, with a significant risk of recurrent laryngeal nerve (RLN) compromise and hypoparathyroidism. After identifying RLN, at the level of the ligament of Berry, local factors may compel the surgeon to either dissect along the nerve or the thyroid capsule. Objective The objective of the present study is to compare these two approaches in terms of outcomes and complication rates. Methods This is a retrospective analysis from September, 2013 to April 2019 of 511 consecutive patients undergoing thyroidectomy. General demographics and disease parameters were recorded. At the discretion of the surgeon and according to the demands of the local operative factors, the patients either had dissection along the RLN or along the thyroid capsule. Perioperative and postoperative parameters such as blood loss, duration of surgery, hospital stay, pain scores, analgesia requirements and complications were recorded. The groups were compared with the Pearson chi-squared test or with the Fisher exact test. A p-value < 0.05 was considered statistically significant. Results The incidence of transient hypocalcaemia and transient RLN compromise were higher when dissection was performed along the nerve as opposed to the plane along the thyroid capsule. Other parameters including operative time, hospital stay, pain scores, analgesia requirement, wound infection, seroma, hemorrhage, and recurrence did not differ between the groups. Subgroup analysis of the patients who presented with complications showed that local factors, malignancy, and extent of surgery correlated positively with complications when dissected along the RLN. Conclusion Dissection along the capsule of the thyroid during thyroidectomy is a safer plane in terms of low rate of transient RLN injury and hypoparathyroidism as opposed to dissection along the nerve.
ABSTRACT
Objective: To scrutinize patterns of multi-drug-resistant uropathogenic Escherichia coli (UPEC) strains and particularly of fluoroquinolone-resistance this is an alternative choice for the treatment of urinary tract infections. Methods: Bacterial samples (n = 250) were collected from out-patients from August 2012 to August 2014 Islamabad. Antibiotic susceptibility profiling and determination of mini-mum inhibitory concentrations (MICs) and minimum bactericidal concentrations were performed according to the guidelines of Clinical and Laboratory Standards Institute (CLSI, 2012). Genes, qnrA, qnrB and qnrS were identified by DNA amplification and sequencing. Results: The highest percentage of UPEC isolates were resistant to co-trimoxazole (82%) followed by cephalothin (80%), 2nd Gen, 3rd Gen and 4th Gen cephalosporins, respectively. Resistance against gentamicin, amikacin remained 29% and 4%. For other drugs including nitrofurantoin, tetracycline, carbapenem and beta-lactam inhibitors remained below 10%. Altogether, 59% of the isolates were resistant to at least three antibiotics including one fluoroquinolone. Overall, MICs for ciprofloxacin remained (MIC≥256 mg/mL) and for levofloxacin (MIC≥16 mg/mL and 32 mg/mL). No significant differences were observed regarding MIC values of extended spectrum b-lactamase (ESBL) and non-ESBL producers. For qnrS and qnrB positive isolates MICs remained above 32 mg/mL. Prevalence of UPEC was significantly higher among females and 40% of the isolates were ESBL producers. Conclusions: Higher percentages of ESBL producing UPEC were associated with uri-nary tract infections. Moreover, the majority of these isolates were multi-drug resistant and fluoroquinolone-resistant.
ABSTRACT
Purpose: This study was designed to evaluate the immunogenicity of hepatitis B vaccine in infants of rural and urban Pakistan and to find out the vaccine efficacy. Methods: A sample of 400 subjects was taken by simple random method from the rural and urban areas (200 from Rural and 200 from urban areas) of Rawalpindi District Pakistan. The serum samples were analyzed by Enzyme Linked Immunosorbant assay (ELISA) for the quantitative determination of antiHBs antibodies. Results: As 88 (22%) infants out of the total 400 were found to be seropositive at baseline. The post vaccination results showed that about 15 (7.53%) of infants had inadequate levels of antibodies (i.e. <10 IU/L). Overall 92.46% infants showed a positive response to the vaccine. The females showed higher titers of antiHBs against vaccination as compared to that of males. Infants of urban areas showed higher titers as compared to that of rural areas. Conclusion: Our results reinforces that the Hepatitis B vaccine has a good tolerability and is highly immunogenic among infants. It is recommended that serosurvey of HBsAg and vaccine coverage at country level should be done.
ABSTRACT
Objective: To evaluate physico-chemical properties and antimicrobial potential of indigenous honey samples against different reference strains including Escherichia coli ATCC 8739, Enterobacter aerogenes ATCC 13048, Pseudomonas aeroginosa ATCC 9027, Bacillus subtilis ATCC 6633, Staphylococcus aureus ATCC 25923, Salmonella typhi ATCC 14028, Klebsiella pneumonia ATCC 13883, Aspergillus niger ATCC 16404, Rhizopus oligosporus PCSIR1, Candida albicans ATCC 14053 and Candida utilis ATCC 9950. Methods: By using standard methods samples were evaluated for their antimicrobial properties including additive effect of starch and non-peroxidase activity, antioxidative properties (phenol contents, flavonoid contents, 1,1-diphenyl-2-picrylhydrazyl radical scavenging activity). Prior to this evaluation, complete physico-chemical properties including pH, color, ash contents, protein contents, moisture contents, hydroxymethyl furfural contents, total sugar contents, reducing sugar and non-reducing sugar contents were analyzed. Results: Relatively higher ash contents were found in the Siddar honey i.e. (0.590 0±0.033 6)%and small honey showed relatively higher protein contents i.e. (777.598±9.880) mg/kg. The moisture contents of tested honey samples ranged between 13.8%-16.6%, total sugar contents from 61.672%-72.420%and non-reducing sugar contents from 1.95%-3.93%. Presences of phenolic contents indicate higher antioxidant potential of these honey samples. All bacteria showed clear inhibition zones in response to tested honey samples whereas fungi and yeast showed inhibition at higher concentrations of these honey samples. For Escherichia coli, Bacillus subtilis, Salmonella typhi, Pseudomonas aeroginosa and Aspergillus niger, overall the small honey showed the higher activity than other honey samples. Conclusion: Physico-chemical analysis of honey samples confirmed good quality of honey according to the standards set by European Union Commission and Codex Alimentarius Commission. Evaluation of these honey samples confirms antimicrobial potential of particular types of honeys indigenous to Pakistan.
ABSTRACT
Methicillin resistant Staphylococcus aureus (MRSA) and methicillin resistant coagulase negative staphylococci (MRCoNS) are the important nosocomial infectious agents. There is a growing concern about the rapid rise in the resistance of Staphylococcus aureus to presently available antimicrobial agents. The aim of this study was to evaluate the prevalence rate of MRSA and MRCoNS and their rate of resistance to different antistaphylococcal antibiotics used broadly for treatment. Out of the total 350 staphylococcal isolates from different clinical specimens 148 isolates (60.40%) were identified as MRSA by oxacillin screen agar method, and 46 isolates (43.80%) were screened as MRCoNS. All the MRSA and MRCoNS isolates were tested for antibiotic resistance pattern by disc diffusion method for 16 different antibiotics. All the isolates of MRSA and MRCoNS were multi-drug resistant. Antibiotic resistance pattern of these isolates was high against penicillin. All the MRSA strains were resistant to penicillin and oxacillin (100%), followed by cephalothin and nalidixic acid (89.18%), cotrimoxazole (86.48%), erythromycin (85.81%), cephalaxin and cephradine (83.10%), levofloxacin (80.40%), imipenem (77.70%), gentamicin (76.35%), tetracycline (59.45%), ciprofloxacin (44.59%), chloramphenicol (18.24%) and rifampicin (10.13%). The MRCoNS strains also showed closely similar drug resistance pattern with 97.82% isolates being resistant to penicillin, followed by oxacillin (95.65%), cephalothin (86.95%), cephradine (82.60%), levofloxacin and nalidixic acid (80.43%), erythromycin, cephalaxin and imipenem (78.26%), cotrimoxazole (73.91%), gentamicin (69.56%), ciprofloxacin and tetracycline (63.04%), chloramphenicol (13.04%) and rifampicin (6.52%). However, all the MRSA and MRCoNS isolates, even those with very high oxacillin MIC (>130 μg/ml) were uniformly susceptible to vancomycin. Chloramphenicol and rifampicin also showed excellent activity against methicillin-resistant isolates. Overall, data presented in this study indicated a slightly higher methicillin resistant rate in MRSA compared to MRCoNS strains. Multi-drug resistance rates in our MRSA and MRCoNS isolates were, 58.10 and 32.60%, respectively. Application of ß-lactamase production method revealed that 84% of MRSA and 87% of MRCoNS strains tested positive for the ß-lactamase production. This study indicated a high level prevalence of MRSA and MRCoNS strains resistance against widely used antimicrobial agents. An appropriate knowledge on the current antibiotic susceptibility pattern of MRSA and MRCoNS is essential for appropriate therapeutic regime determination.
ABSTRACT
Southern corn leaf blight caused by Cochliobolus heterostrophus is a major foliar disease of maize crop in Pakistan. The disease affects leaves, leaf sheaths, ears and maize grains. Suitable physiological conditions which include different nutrient media, temperature, pH, carbon and nitrogen sources were determined for growth and reproduction of the pathogen. Among all media used viz, the best supporting medium was found to be Richard’s agar for the growth of pathogen after 7 days of incubation. Different temperatures (20, 25, 30 and 35ºC) were selected for mycelia growth of the pathogen, among which maximum growth was found to be at 30ºC (80 mm colony size) and minimum at 35ºC (35 mm). Maximum radial colony growth of the pathogen was observed at neutral pH (80 mm). Sucrose and potassium nitrate (KNO3) were found to be the most appropriate sources of carbon and nitrogen respectively.
ABSTRACT
The present study is vital to the understanding of bioremediation of structurally different azo dyes by some unusual Brown-rot fungi. Bioremoval of each dye (20 mg l-1) was tested in two different culture media under static and shaking conditions by taking inocula from different fungi. Fungal strains showed varying dyes removal abilities, though considerable high in case of Acid Red (AR) 151(di-azo) as compared to Orange (Or) II (mono-azo). With an exception of Aspergillus tereus SA3, all the fungal isolates showed higher removal of dyes in SDB. Under static condition, the maximum decolorizing fungal strains were; Aspergillus flavus SA2 (67 percent) and Alternaria spp. SA4 (57 percent) in AR 151, while Penicillium spp. (34 and 33 percent) in Orange II, in SDB and STE, respectively. Bioremoval of dyes was considerably increased when experiments were shifted from static to shaking mode. It was specifically increased ( percent) in; AR 151 (255) with Penicillium spp., Or II with A. flavus SA2 (112) and Alternaria spp. (111). The primary mechanism of dyes removal proved to be fungal biosorption. However, reduction of dyes (onto fungal) with formation of their products (α. naphthol, sulphalinic acid and aniline) furthermore revealed that dyes (specifically azo) were actually biodegraded.