Current antibiotic resistance trend in clinical isolates of staphylococcus aureus from a tertiary care hospital

Staphylococcus aureus [S. aureus] has remained always an important pathogen of common infections acquired in community and as well as serious nosocomial infections. With advent of penicillins and cephalosporins, infections could be effectively treated, but with the global emergence of Methicillin Resistant Staphylococcus aureus strains [MRSA] physicians were again left with limited treatment options. This scenario of increasing resistance is even more intense and challenging for developing countries like Pakistan. Hence with this background the study was carried out to establish the frequency of MRSA in clinical specimens and look into the available antibiotic treatment options. Samples of pus, blood, urine, body fluids and catheter tips submitted for culture in Microbiology department between August to September 2012, from outdoor and indoor adult patients of Pakistan Institute of Medical Sciences Islamabad, yielding growth of S. aureus were included in the study. After identification by standard methods, antibiotic susceptibility of the isolates was performed by Kirby Baeur disc diffusion method. The study was retrospective descriptive and observational. Total 106 S. aureus were isolated. 45.3% of them were MRSA and majorities were from pus samples of hospitalized patients. All MRSA were 100% sensitive to vancomycin, whereas 87.5% to chloramphenicol. To rest of the non -beta lactam drugs, resistance of 80% or more was noted. S. aureus is a common clinical isolate from patients in this region of Pakistan and significant number were MRSA especially from hospitalized patients. Treatment options are limited to vancomycin and chloramphenicol

In vitro biological screening of the stem of Desmodium elegans

Objective:To explore the medicinal importance of the stem of Desmodium elegans, methanolic extract, and its different solvent fractions were evaluated for brine shrimp lethality, insecticidal and phytotoxicity, antifungal, and antibacterial activities. Methods:The methanolic extract and its solvent fractions were tested for cytotoxic, phytotoxic, insecticidal, antifungal, and antibacterial effects using our previous published protocols. Results:The methanolic, DCM, ethyl acetate and n-butanol fractions exhibited insecticidal effect against Callosobruchus analis and Rhyzopertha dominic. The methanolic extract, n-hexane, DCM ethyl acetate and n-butanol showed 75, 85, 85, 65 and 5%phytotoxicity at the tested concentration of 500μg/mL respectively. The solvent fractions (DCM and ethyl acetate) were effective against F. solani (10%and 20%inhibition respectively). All the tested samples were devoid of cytotoxic and antibacterial effects. Conclusions:It was concluded that this plant can be practiced for control of weeds and insects.

Gastric carcinoma: location, morphological and histological profile

To know the common tumor location, morphological and histological types of gastric carcinoma. This cross sectional study was conducted in gastroenterology unit HMC from January to August 2010. One hundred and thirteen patients of more than 30 years of age and having endoscopic and biopsy proven gastric carcinoma were included in the study. All patients after necessary investigation were prepared for endoscopic examination, upper gastrointestinal endoscopy was done and findings were recorded. Biopsies of the lesions were taken for histopathological confirmation. Seventy five [66.4%] patients were male and 38 [33.6%] were female. The mean age was 56.02 +/- 12.11 years. Antrum was involved in 29[25.7%] cases alone, body alone was involved in 16[14.2%] cases, body and antrum in combination were involved in 15[13.3%] cases, cardia and fundus in 15[13.3%] cases, cardia alone in 13[11.5%] cases, fundus alone in 6[5.3%] cases, fundus, antrum and body in combination in 5[4.4%] cases, cardia, fundus and body in combination in 3[2.7%] cases and cardia and body in combination were involved in 2[1.8%] cases, while stomach was diffusely involved in 9[8.0%] cases. Tumor was polypoid/fungating in 51[45.1%] cases, ulcerated in 43[38.1%], infiltrating in 17[15.0%] and fungating and ulcerated in 2[1.8%] cases. Intestinal type gastric carcinoma was present in 39[34.5%] cases and diffuse type gastric carcinoma was present in 74[65.5%] cases. Gastric carcinoma is a male predominant neoplasm which commonly involves the antrum, usually as fungating or ulcerated lesion and majority of gastric carcinoma are diffused type gastric carcinomas

Kikuchi disease with associated systemic lupus erythematosus: a case report

This case report describes a 28 year old male patient presenting with low-grad fever, symmetrical polyarthritis, rash on palms, neck and trunk, oral ulcers and cervical, axillary and hilar lymphadenopathy. Other systemicexamination was unremarkable. Patient was diagnosed as Kikuchi-Fujimoto's disease on the basis of lymph node histopathology, which showed the pathognomonic [Acute Histiocytic Necrotizing Lymphadenitis]. Concurrently diagnosis of systemic lupus erythematosus [SLE] was also made because of the presence of five out of eleven criteria for the diagnosis of SLE. The five criteria which were present in this patient were oral ulcers, arthritis, proteinuria of 1295 mg/24 hrs, positive Antinuclear Antibody and positive anti-double stranded DNA

Experience of stapled haemorrhoidectomy operation at Mayo Hospital

The aim of study was to assess the outcome of treatment for 3[rd] and 4[th] Degree Haemorrhoids by a new surgical procedure- Procedure for Prolapsed Haemorrhoids [PPH] or also known as Stapled Haemorrhoidectomy [SH]. A prospective study at West Surgical Unit Mayo Hospital/ King Edward Medical University Lahore was undertaken of 32 patients between Oct.2004 and Jan.2006. The outcome studied were patients' profiles, length of operation, post-operative complications and recurrence. A total of 32 patients 13 women [44%] and 19 men [56%] had surgery. The median age was 36 [range 23-64] years. The main indications were bleeding 84.3 percent, heamorrhoidal prolapse with 4[th] degree were 59.3 percent. The median duration of operation was 19 [15- 34] minutes. Minor complications occur in two patients: bleeding in one and significant postoperative pain in an other patient. However, this is small study without any long term follow-up but our experience of stapled haemorrhoidectomy confirm it as a safe and effective procedure for prolapsed harmorroids

Unusual soft tissue tumours of the abdominal wall

To highlight the importance of remembering unusual tumours in the differential diagnosis of Soft Tissue Tumours of the Abdominal wall. Retrospective, decriptive study conducted between June 2000 to June 2003. Hamdard University Hospital and other private hospitals in Karachi. All patients presenting with Unusual Soft Tissue tumours of the Abdominal wall. The biodata, symptoms and signs of these patients were recorded and analyzed. They were extensively investigated; besides routine investigations Ultrasound, CT Scan and MRI were done where indicated. All the tumors were surgically excised and the diagnosis was confirmed on histopathology and immunohistochemical studies. Ten patients, six females and four males, aged 16-59 years, were seen with Unusual Soft tissue Tumours of the Abdominal Wall. Most of them [90%] presented with a swelling, while some had pain [30%] and fever [10%].Surgical excision and histopathology revealed them as desmoid tumour [n-6], rhabdomyosarcoma [n-2], urachal remnant tumour [n-1] and port-site metastatic tumour [n-1]. There was no recurrence in all the patients, except the one with urachal remanant. He died inspite of further excision, radio and chemotherapy. Abdominal wall tumours are rare. They may be innocent like the lipoma, or may show variable behavior like the desmoid tumour, or may be very aggressive like the rhabdomyosarcoma. They need proper clinical workup before embarking upon surgery, which should be wide surgical excision as they show aggressive infiltration in the surrounding tissues. They also require proper follow-up as they are famous for recurrence

Self resolving abnormalities of the lower limbs in children

To identify Self Resolving Orthopaedic conditions like Bow legs, Knock knees and Intoe gait in children, and differentiate them from serious pathological disorders like Rickets and Dysplasia. Prospective, descriptive study carried out from 1993 to 2004. Patients were seen, diagnosed and followed-up in the Out-patient Clinic of the Orthopaedic Departments of SESSI Hospital, Landhi [1993-1994] and Hamdard University Hospital [1994-2004]. All children who presented with the above mentioned Self Resolving Conditions. The data of all the patients with self resolving deformities of the legs i.e. bow legs, knock knees and intoe gait was collected and analyzed, to evaluate their frequency and compared with pathological conditions like rickets and epiphyseal dysplasia. The patients were followed-up till 2004. Out of the 400 children seen during the study period, 62% showed improvement in the rotational deformities of the legs without any active treatment; 33% deformities were due to rickets, while 5% patients had either epiphyseal dysplasia or epiphyseal injury. It is beneficial to know the natural history of the self resolving conditions like bow legs, knock knees, etc. to avoid unnecessary, expensive and prolonged treatment for them. The physicians should have a high index of suspicion, to differentiate them from pathological conditions like rickets which produces similar deformities and epiphyseal injuries or dysplasia which requires good clinical evaluation and need surgical intervention