Prevalence and antibiotic susceptibility of methicillin resistant Staphylococcus aureus and Acinetobacter baumannii in clinical samples from intensive care unit patients in a tertiary care hospital at Peshawar [Pakistan]

Multi-drug resistance in Staphylococcus aureus and Acinetobacter baumannii [A baumannii] can cause a wide range of infections, including bacteremia, pneumonia, urinary tract infection, peritonitis etc., which can lead to substantial morbidity and mortality, particularly in the ICU settings. These organisms have been shown to be increasingly resistant to a large group of antibiotics, especially [3-lactam antibiotics. The aim of the present study was to determine the prevalence and antibiotic susceptibility of methicillin resistant Staphylococcus aureus [MRSA] and A baumannii in patients admitted in Intensive Care Units [ICUs] of a tertiary care hospital in Peshawar, Pakistan. A total of 518 bacterial isolates were collected from different ICUs during die period from 1st November 2012 to 30 November 2013. Media, reagents and kits used for bacterial culture and analysis included blood agar, MacConkey's agar, mannitol salt agar, DNAase and Api Biomerieux 10s [France]. Antibiotic cefoxitin was used to check whether strains of Staphylococcus aureus were methicillin resistant or sensitive. The antibiotic susceptibility testing was performed by Mueller Hinton agar [MHA] by disc diffusion method. Out of a total of 518 cultures obtained, 42[8.1%] were MRSA positive and 33[6.37%] were positive for A baumannii. Vancomycin [40[95.23%]] and minocycline [33[78.57%]] were the most effective drugs against MRSA, while colistin [33 [100%]] and minocycline [20 [60.6%]] were the most effective against A baumannii. There is an increased frequency of multi-drug resistant Staphylococcus aureus and Acinetobacter baumannii [A baumannii] among patients in the ICU setting which calls for continuous surveillance to determine prevalence and effective antibiotic susceptibility of these bacteria

Comparison of the stylet and the gum elastic bougie in tracheal intubation in a simulated difficult airway

To compare the stylet and the gum elastic bougie in tracheal intubation of a simulated difficult airway. Randomized control trial. The study was conducted in Main Operation Theatre at Rehman Medical Institute, Peshawar from June 2009 to June 2010.6 patients, ASA grades I and II, undergoing elective surgical procedures requiring tracheal intubation were randomly divided in two groups. Difficult intubation scenario was simulated by applying a rigid Philadelphia collar in both groups. Patients in Group-A were intubated with a stylet and patients in Group-B were intubated using a gum elastic bougie. Both groups were then compared in terms of overall success in intubation, and number of intubation attempts. Statistical analysis was done by applying Chi-Square test and Students' T- test. Among the patients of Group-A, only 71.4% patients were successfully intubated using a stylet while 100% patients in Group-B were successfully intubated using a bougie. In the simulated difficult airway, tracheal intubation using a gum-elastic bougie has a higher success rate when compared to stylet assisted intubation and should be preferred in a difficult intubation scenario

comparison of the effects of erythromycin and metoclopramide on gastric fluid volume and pH in patients undergoing elective caesarean section

To compare the effects of erythromycin and metoclopramide on gastric fluid volume and pH in patients undergoing elective caesarean section. Randomized, controlled trial. The study was conducted in Gynaecology Ward and Operation Theatre, Rehman Medical Institute Peshawar from July 2009 to June 2010. We recruited 144 patients, ASA grades I and II, scheduled to undergo elective caesarean section and divided them in two equal groups of 72 patients each by simple random sampling. Patients in group A were given tablet erythromycin 250 mg and patients in group B were given tablet metoclopramide 10 mg orally with 10ml of water one hour before surgery. Both groups were then compared in terms of gastric fluid volume and gastric pH according to Robert and Shirleys' criteria, using a cut off value of 25 ml and pH 2.5, respectively. Statistical analysis was done by applying Chi-Square test and Students' T- test. Among the patients of group A 87.5% patients had acceptable volume [25ml] and 62.5% patients had acceptable pH of gastric fluid [pH >= 2.5]. In group B patients 69.4% patients had acceptable gastric fluid volume and 19.4% patients had acceptable pH of gastric fluid. Oral erythromycin reduces gastric fluid volume more effectively than metoclopramide, if given one hour before surgery. Erythromycin increases while metoclopramide has no effect on the pH of gastric fluid

Diabetic hand; management

A case series study held at surgical unit 1. BV Hospital Bahawalpur. Study was conducted from June 2006 to May 2009, to evaluate various aspects of diabetic hand and to establish a protocol to manage it. All diabetic patients presented with hand infection to the unit during this time were included in the study but patients having classical diabetic hand syndrome were excluded. Total 48 patients were admitted during the period under review. Male to female ratio was 2:1 and age was ranged from 31 to 48 years. Data was collected on Performa and shifted to computer program SPSS version 12. All patients were manual workers or house wives and 40 patients gave history of minor trauma to the digits during work. All patients were either undiagnosed [16 patients] or had uncontrolled diabetes. Most of them delayed seeking advice for their trauma and infection of hand properly. During treatment, 30 patients [62.5%] required amputation of one or more digits of the dominant hand including amputation of thumb in 19. Only 4 patients [8.33%] ended up in amputation of hand, whereas, no patient required amputation of forearm. No mortality was seen during study period. It was concluded that diabetic hand involves persons in active life period relatively in younger age group. Undiagnosed or uncontrolled diabetes is major contributory factor. Health education, early diagnosis and prompt treatment in specialized units may be helpful

Gall-stone ileus with multiple tuberculous strictures

Gall-stone ileus associated with tuberculous strictures is an uncommon cause of bowel obstruction related to a cholecystoenteric fistula. The stone usually obstructs the narrowest part of the intestine. The patient whose intestine is strictured due to tuberculosis or other disease, the stone can impact that part of the strictured area. We report such a case of gall-stone ileus in a patient of 80 years with multiple tuberculous strictures. After surgery, she responded to antituberculous drugs and did well

Serum anticardiolipin antibodies in recurrent abortion

The present study was carried out to detect the serum anticardiolipin antibodies [ACA] in recurrent abortion. Fifty women with history of recurrent abortions [Group A] were selected with twenty normal women of childbearing age as controls [Group B]. Routine haematological investigations like haemoglobin, TLC and Platelets were done by haematology autoanalyzer. PT, APTT and serum anti-cardiolipin antibodies [IgG and IgM] were done by commercially available kits. Serum anticardiolipin antibodies were raised in patients with recurrent abortion when comparing with controls. PT was prolonged in one patient and APTT was prolonged in four cases

comparative study of red cell folate and serum folate levels in patients on regular Hemodialysis

Sixty subjects were selected and were divided into two groups. Group A included 30 patients of end stage renal disease on regular dialysis and group B included 30 normal healthy subjects as control. Absolute values and Hb were done by hematology auto analyzer and serum and red cell folate were done by commercially available kits. Results were analyzed by using Student`s `t` test and level of significance was done. A significant decreased in serum and red cell folate in end stage renal disease patients with regular dialysis as compared to control

Long acting thyroid stimulator in Grave's diseases

Fifty eight patients suffering front Graves Disease [GD] and 30 normal healthy controls were studied to evaluate some of the immunological aspects of etiopathogenesis of Graves' Disease. Patients of GD included 14 first reported patients 22 hyper thyroid patients on drgus and 22 euthyroid patients in remission GD patients were diagnosed on the basis of clinical history, physical examination and laboratory investigations such as Radio Active Iodine Uptake .[RAIU] Serum Tri-iodothronine [T3] and Serum Thyroxine [T4] by Radio-immunoassay and thyroid scintigram. Mckenzie. Mouse Biological Assay was performed to detect and estimate Long Acting Thyroid Stimular [LATS] in GD -orients. Sixty four percent first reported and 54% hyperthyroid patients on drugs were LATS positive. LATS-Response Index [LATS-RI] was calculated in all LATS positive patients. This study, first of its kind in Pakistan, confines the presence of auto-antibodies in GD patients and is expected to stimulate further work in auto-immune thyroid disease in country