Venous catheter tip infections in intensive care units of a tertiary care hospital

Objective: To determine the local and changing patterns of bacterial growth and antibiotic sensitivity for appropriate empiric treatment before culture results are available. Study Design: Retrospective observational study. Place and Duration of Study: This study was conducted at Khan Research Laboratories Hospital, Islamabad, Pakistan, from Jul 2014 to Dec 2016

Material and Methods: One hundred and seventy five patients having positive cultures of venous catheter tips performed after following standard protocol were included. Age, gender, common pathogens, their sensitivity and resistance to 27 antimicrobial drugs were taken into account. Statistical Package for Social Sciences [SPSS] version 20 was used for data analysis

Results: Total number of patients included were 175. 56.5% [n=99] were females while 43.4% [n=76] were males. Minimum age was 16 years while maximum age was 93 years. Mean age was 58.15 +/- 17.94 years. 175 patients having culture positive venous catheter tips, were available for analysis. Majority of the patients were admitted in Medical ICU, 78.3% [n=137]. Staphylococcus epidermidis [S. Epidermidis] was the most common isolate 24.6% [n=43] followed by Escherichia coli [E. coli] 21.7% [n=38], Staphylococcus aureus [S.aureus] 18.8% [n=33], Klebsiella pneumonia [K. pneumoniae] 14.3% [n=25], Acinetobacter baumannii [A.baumannii] 5.7% [n=10]. S. epidermidis showed maximum sensitivity to Linezolid i.e. 100% followed by Minocyclin, 88%, Vancomycin 86%. It was resistant to Ampicillin 93%. E. colishowed maximum sensitivity to Amikacin i.e. 95% followed by Imipenem 87%, while being resistant to Amoxicillin/clavulanic acid [97%] and Ciprofloxacin [92%]. Staphylococcus aureus showed maximum sensitivity to Linezolid i.e. 97% followed by Vancomycin [90%] while showing resistance to Ampicillin [100%], Ciprofloxacin [88%] and Levofloxacin [85%]. Klebsiella pneumoniae showed decreased sensitivity to Amikacin, Imipenem, Meropenem i.e. 64% while 100% resistant to Amicillin, Amoxicillin/clavulanic acid. Acinetobacter baumannii showed maximum sensitivity to Colistin i.e. 90%. Pseudomonas aeruginosa showed maximum sensitivity to Polymyxin B [100%] and Colistin [87%], while resistant to Ceftazidime and Quinolones [37%]

Conclusion: Antibiotic pool for catheter related infections is shrinking. Commonly used as well as reserved antibiotics are no longer effective as before

Correlation of C-reactive protein and cardiac enzymes with angiographic severity of coronary artery disease in Pakistani patients with acute coronary syndrome

Objective: To determine the correlation of C-reactive protein [CRP] levels with the severity of coronary stenosis on angiography and the association of cardiac enzymes with the degree of stenosis in acute coronary syndrome [ACS] patients. Secondly, to compare association of angiographic severity of vascular stenosis with CRP in patients with ST segment elevation myocardial infarction [STEMI] and non-STEMI / Unstable angina [UA]

Study Design: Prospective, descriptive study

Place and Duration of Study: Khan Research Laboratories [KRL] Hospital, from October 2014 to March 2015

Methodology: CRP was measured on diagnosis of ACS in 70 patients. Cardiac enzymes were measured 6 hours after the onset of chest pain. Angiographic scoring for degree of stenosis and number of culprit vessels was done. Two groups consisting of patients with STEMI [group 1] and with NSTEMI/UA [group 2] were made

Results: No correlation was found between CRP levels and angiographic stenosis in patients with ACS [r=0.162, p>0.05]

No association was found between eosinophil count and severity of stenosis [p=0.88]. Rise of cardiac enzymes and degree of coronary stenosis showed a positive correlation [p <0.001]. There was significant difference in the means of coronary artery stenosis scores between the two groups [Gensini score of groups 1 and 2: 35.9 +/- 4 and 14 +/- 8, respectively] p<0.001, but there was no significant difference in CRP levels

Conclusion: CRP is a marker of inflammation in ACS rather than a risk factor for determining the severity of vascular stenosis. Rise in cardiac enzymes still grade high in predicting severity of vascular stenosis than eosinophil count or CRP levels

Antifungal efficacy of amphotericin B encapsulated fibrin microsphere for treating Cryptococcus neoformans infection in Swiss albino mice

Abstract A natural and biocompatible fibrin microsphere is one of the most promising dual delivery vehicle as compared to other traditionally designed delivery modalities. It represents sustained delivery of encapsulated drug and is easily biodegradable in the blood circulation. In the present study, we evaluated the systemic augmentation of the antifungal activity of amphotericin B loaded in fibrin microsphere (AMB-fibrin microsphere) against cryptococcosis in Swiss albino mice. Mice infected with Cryptococcus neoformans were treated with 0.5 mg/kg AMB-fibrin microsphere that was given alternately for 7 days. The antifungal potential of AMB-fibrin microsphere was assessed on the basis of reduction of cfu count in the systemic circulation and various vital organs of infected mice. The formulation was found to be highly effective in reducing intracellular pathogen from the experimental animals where fibrin microsphere significantly controlled the release of amphotericin B for longer time duration. The AMB-fibrin microsphere chemotherapy was significantly more effective than free amphotericin B in reducing the fungal burden and showed better survival efficacy (p < 0.05). The current study demonstrating the use of novel amphotericin B loaded fibrin microsphere not only imparts protection to the encapsulated amphotericin B but also offers an effective strategy to decrease the drug associated toxicities.

Awareness about periodontal disease among patients- a study

Periodontal diseases can lead to tooth loss. The bacterial plaque is the main etiology of periodontal diseases, while many other factors such as hormonal changes, diabetes, poor nutrition, smoking, and stress may affect the initiation and progression of gingival and periodontal diseases. The objective of this study was to evaluate the knowledge about periodontal oral health and causes of inflammatory periodontal diseases among patients of our local population. A total of 105 patients presented to out-patient department of Khyber College of Dentistry, Peshawar were included in this study. Age, gender, economic level, educational level, occupation and specific questions about periodontal diseases were recorded. Questions related to periodontal diseases like meaning and causes of periodontal disease, relation to the risk factors, prevention and treatment of periodontal diseases. Each question was provided with different options [Yes and No] to patients were requested to answered. The collected data were processed and analyzed by SPSS [statistical Package for Social Sciences] version 17.0. Percentages and frequencies were tabulated and shown in the form of charts. Of total 105 patients 74[70.47%] were males and 31[29.52%] females. The most common age decade was third. Most of participants belonged to medium income families and most of their had university level education. Educated patients were using tooth brush while illiterate patients used miswak wooden stick. University level educated patients were more aware about the meaning, risks factors and causes of periodontal diseases

Patterns and frequency of dental caries in primary teeth

Primary teeth play an important role in mastication, speech and occlusion of permanent dentition. Due to high prevalence of dental caries in primary teeth, it is essential to educate parents about prevention and management of dental caries of children. The objective of this study was to determine the pattern and prevalence of caries in primary teeth among children reporting to Khyber College of Dentistry, Peshawar. Total 900 children having age 4 to 7 years were includes in this study. Dental caries was assessed using sterilized mouth mirror and dental probe under dental chair light in primary teeth. The collected data were analysed in SPSS version 16.0. Percentages and frequencies were calculated for examined and affected teeth. Z-test was applied for statistical difference among girls and boys. P<0.05 was considered significant. Out of total of 900 children, 478[53.11%] affected by caries. The posterior teeth had greater prevalence of caries. In anterior teeth, central incisors[10%] followed by lateral incisors[8.09%] were affected by dental caries. Canine[3%] were least affected. In posterior teeth, second molars were affected more than first molars by caries. Girls were having less caries than boys.[p<0.05]

Effect of some plants' extracts used in Sudanese folkloric medicines on carrageenan-induced inflammation

Investigations for anti-inflammatory potential and categorization of Sudanese medicinal plants according to their potency. Anti-inflammatory effect of plants' extracts of 17 genera were studied using the carrageenan induced inflammation in rats' paws. The plant extracts were obtained using methanol and dichloromethane as solvent and administered intra peritoneally at the concentration of 2g/kg body weight. The results obtained in this experiment strongly support and validate the traditional uses of these Sudanese medicinal plants to treat various inflammatory diseases. 63.9% of plants extracts showed marked inhibition of inflammation induced by carrageenan [78.3% out of this percentage represented by methanolic extract], 27.8% showed no activity and 8.3% enhanced the carrageenan induced inflammation. The anti-inflammatory effect of many of these plants has not been reported previously, yet they have been extensively used in Sudanese folkloric medicine. The result of this study justify the traditional medicinal use of the evaluated plants species in treating inflammatory disorders and helped in categorizing the investigated plants into most useful, moderately useful and least useful category for inflammatory diseases. Out of the 17 investigated plant species 05 belongs to most useful and 06 belongs to moderately useful category. However, toxicity studies are required to prove the safety of these plant materials

Complaints among patients wearing metal ceramic fixed partial dentures

The objective of this study was to assess the causes of failure of tooth supported fixed partial dentures due to biological and technical complications. A total of 115 patients who had problems with their metal ceramic FPDs were included in this study. Age, gender, oral hygiene habits, reason for tooth loss [caries, periodontal disease, and trauma], and level of education [university, secondary, primary school and illiterate] were recorded in history. Detailed intra-oral clinical examination was carried out following the standard techniques of inspection, palpation, percussion and probing. Radiographic examination, when necessary, was also done. Prostheses evaluation included the recording of location of FPD in jaw, the technical complications of de-cementation, ceramic deboning and chipping, fracture of metal-frame, esthetic, occlusal problems, pain on chewing, dislodgement and secondary caries. Out of 115 total patients having FPDs with complaints 55[47.8%] were males and 60[51.7%] were females. Age range was from 20 to 65 years. Maximum number of missing teeth in single patients in both arches was 13 replaced with FPD. Most of the patient were employing tooth brush as oral hygiene measure [74.7%].illiterate patients having compliant FPD were carrying the maximum number [37.1%]. Caries [83.4%] were the common cause of tooth loss followed by periodontal problems [9.5%]. In both dental arches posterior FPDs were more numerous than anterior. In maxilla it was 25[21.6%] while in mandible 37[31.9%]. So it was more in posterior mandible than posterior maxilla.The most common complaint was pain on chewing 58[50.0%] followed by esthetics 18[15.5%. A high number of patients wearing fixed partial denture are having complaints which emphasize need for proper case selection, diagnosis and treatment planning on the behalf of the practitioners

Role of magnesium sulfate in the management of acute asthma

Objectives: To determine the supportive role of magnesium sulfate in the management of acute sthmatic patients

Study design: A descriptive comparative study

Place and duration: The Study was conducted from January 2010 to June 2010 at Department of Medicine, Isra University Hospital, Hyderabad, Liaquat University Hospital, Hyderabad and Institute of Chest Diseases, Kotri, Sindh

Methodology: Acute asthmatic patients between ages of 10 to 40 years reporting to emergency department were enrolled in the study. They were divided into two groups. Groups I patients [n = 36] received oxygen inhalation, nebulization by ventoline and intravenous hydrocortisone. Group II patients [n = 37] received oxygen, ventoline nebulization, intravenous hydrocortisone and IV magnesium sulfate 25 ml /kg body weigh diluted in 100 ml of normal saline delivered over a period of 30 minutes

Results: Seventy three patients were included in this study. Baseline parameters were compared in the two groups. Both group showed significant improvement in pulse rate which was 90.9 +/- 8.46 in group I [without magnesium] and 82.3 +/- 5.11 beat per minute in group II [with magnesium]. Oxygen saturation after 120 minute was 95.9 +/- 2.02 and 96.2 +/- 1.5% in group I and group II, respectively. Similarly, after 120 minutes, PEFR was 205 L/minute in group I as compared to 237 L/minute in group II

Conclusion: This study suggested that there was benefit of adding IV magnesium sulfate to ventoline nebulization and intravenous hydrocortisone in the treatment of severe or life threatening asthma

Justification for hysterectomies and frequency of histopathological lesions of hysterectomy at a teaching hospital in Peshawar, Pakistan

To determine the justification for hysterectomies and the frequencies of histopathological lesions and complications in hystrectomised patients. As a part of a quality assurance process at the Mercy Teaching Hospital, hysterectomies performed between 1[st] January, 2010 and 1[st] Jan 2012 were retrospectively analyzed for presenting complaints, surgical indication, histologic findings, and postoperative complications. The hysterectomy was considered justified if the preoperative diagnosis was verified by the pathology report or if significant alternate pathology was present. A total of 123 hysterectomies were performed during this period. Eleven [8.9%] patients' results could not be traced. The other 91.1% had some pathology found. Histologic findings reconfirmed the clinical diagnoses. The hysterectomies were considered justified if p=0.000. Hysterectomy was performed abdominally in 88[71.5%] patients, vaginally in 35 patients [28.4%]. The most common indication for hysterectomy was fibroid related menorrhagia n=40[32.5%], followed by third degree uterovaginal prolapse n=30[24.4%], and dysfunctional uterine bleeding 29[23.6%] patients. Fever was the most common 7[5.7%] post operative complication followed by urinary tract infection 5[4.9%] The incidence of postoperative fever was greater following abdominal surgery, while urinary tract infection was greater following vaginal hysterectomy [P=0.370]. Almost 91.1% of all hysterectomies in this study were justified. Clinical diagnoses were related to presenting complaints [p=0.000] and were confirmed by histopathogic findings [p=0.000]. Most of the hysterectomies were carried out abdominally in part because fewer patients presented with prolapse

Presentation of myasthenia gravis

100 cases of myasthenia gravis managed at PIMS between 1991 and 1994 were analyzed. 61 were female and 39 males. Ptosis and diplopia was the most common presenting symptom. Tensilon test and EMG were positive in 88% and 92% cases respectively. 12 cases had only occular myasthenia. Plasmapheresis was performed in myasthenic crisis and before thymectomy. 42 cases were operated. 82% cases showed significant improvement. 8 patients died two after thymectomy and 6 at home. Symptomatic improvement and EMG were used as guide to improvement. This study stresses the similarities and dissimilarities of our patients from other reported series