ABSTRACT
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
ABSTRACT
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
ABSTRACT
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
ABSTRACT
In recent years several studies recommended the estimation of total as well as bio-available and free testosterone levels to assess the variations provided by the measurements and thus developing the foundation for interpreting hormone status in all groups of men. Therefore present study documents the current testosterone status i.e. total, free and bio-available, including sex hormone binding globulin [SHBG] in variable age groups of men [n = 78] between 14 years to 65 years. They were grouped as male aged 14-24 yrs [young] [n = 24], 25-35 yrs [adult] [n = 20], 36-50 yrs [middle aged] [n.= 29] and 51-65 yrs [older] [n - 15]. Scrum total testosterone and SHBG were measured by Electro Chemiluminescence's [ECL] technology whereas bio-available and free testosterones were calculated from pre-described calculation methods. Total testosterone levels are comparable to each other in adult and middle age groups, however significantly differ [P < 0.001] among older and younger group. Moreover, highest level of significant difference in free testosterone values were obtained for younger men in comparison with middle age group [P< 0.001] and moderate level of significance was noted when same was compared with adult and middle aged groups [P < 0.05]. The assessment of data was gave similar outcome for bio-available testosterone as well; accept when older group was compared with middle aged men, which was found to be non-significant, in conclusion, the levels of total, free, bio-available testosterone and SHBG were compared with their normal ranges and noted to be match-able with their respective age groups accordingly
ABSTRACT
It has been demonstrated that Type 2 Diabetes Mellitus [T2DM] patients, with the presence of microalbuminuria [MA] had higher postprandial triglyceride than those without MA. The present study further investigates this potential association and to elaborate the degree of dependence of T2DM with MA condition on onset of high postprandial [PP] triglyceridemia in our setting. A total of 32 patients with T2DM were included in the study during February 2007 and December 2008 and were divided into two groups according to the presence [n = 15, MA+ve] or absence of MA [n=l 7, MA-ve]. Blood was drawn in the fasting state and at 2 and 6 h after the standard mixed breakfast test meal for biochemical analysts. Plasma ApoA, triglycerides, glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, creatinine and Glycosylated hemoglobin Ale [HbAlc] levels were determined using standard methods. 24 hr albumin and urinary micro albumin showed highly significant difference [P<0.001] in values in MA-ve and MA+ve groups, whereas glycosylated HbAlc and duration of T2DM doesn't exhibit any significant difference. Biochemical constituents such as glucose, total cholesterol and HDL-cholesterol exhibited mild [P<0.05] to moderate [P<0.01] significance when compared within the groups of MA-ve and MA +ve patients in fasting and postprandial conditions. Comparatively highest level of constantly significant difference in values was noted only in triglycerides when MA +ve were compared with MA-ve, which remains high not only at 2 hrs. Postprandial [P<0.001] but also after 6 hrs. Under same conditions [P<0.001]. The data strongly support the theory and observations that in patients with T2DM and co-existence of MA, hypertriglyceridemia prevails, which further complicates the already co-morbid hyperlipidemic state in these patients
ABSTRACT
One of the acute-phase biomarkers that have recently been investigated for its clinical utility in tuberculosis pleural effusion is C-reactive protein [CRP] which has already been commonly used as a marker of inflammation and tissue injury. Therefore, the present study was undertaken to analyze the viability of CRP as a diagnostic aid for tuberculosis in lymphocytic pleural effusions. Fifty two [n = 52] patients with lymphocytic pleural effusion with definite diagnosis of a disease condition, were taken into the test group and classified into no tuberculosis [n = 28] group and tuberculosis pleurisy group where sputum culture was positive for Mycobacterium tuberculosis in pleural effusion [n = 24]. CRP in pleural fluid was analyzed by automated turbid metric immunoassay method as per description of the manufacturer and normal reference value in serum is
ABSTRACT
Background: Several past and recent investigations have focused on the detection and use of reliable tumor markers, such as CEA, NSE and CYFRA 21-1 in pleural fluids, as a less invasive replacement method. Some studies have dealt with the NSE levels of pleural fluid in diseases such as NSCLC, SCLC and benign pulmonary disease such as tuberculosis
Aim: Therefore the present study was undertaken to assess NSE levels in serum and pleural fluid of patients with pulmonary cancer and to compare the data with NSE levels of tuberculosis pleurisy to determine its diagnostic utility and efficacy
Materials and Methods: Pleural fluids were obtained from 13 patients with carcinomatous pleurisy due to SCLC, 6 patients with carcinomatous pleurisy due to non-small cell lung cancer, and 29 patients with tuberculosis pleurisy for comparison purpose. Determination of NSE levels was performed by ECL technology according to the manufacturerAEuro[]s instructions
Results: NSE results of cytology-positive SCLC were significantly elevated [P<0.001] when compared with those of cytology-negative SCLC, NSCLC and tuberculosis. Pleural effusion of all 29 tuberculosis patients and two NSCLC patients showed moderate significance [P<0.05 and P<0.01, respectively] as compared to SCLC patients
Conclusion: It is concluded that determination of pleural fluid NSE levels seems to be an effective means to differentiate carcinomatous pleurisy due to SCLC from that of due to NSCLC, tuberculosis pleurisy and cytology-negative pleural effusions in SCLC. However, it is suggested that further studies with larger group of patients is needed to strengthen diagnostic specificity and sensitivity