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