Investigation of Staphylococcus aureus, prevailing in the environment of Khyber Teaching Hospital, Peshawar, Pakistan

The hospital environment plays an important role in the spread of microorganisms, including multi drug resistant [MDR] strains. Patients can acquire Methicillin-Resistant Staphylococcus aureus [MRSA] which can reside in the clinical setup that are not cleaned and can spread through air droplets, bed clothing, and healthcare workers. The purpose of this study was to investigate the prevalence of S. aureus in the Khyber Teaching Hospital [KTH]. A total of 200 samples were collected from the floor, walls, air and inanimate objects in different wards of the KTH, during May 2012 to September 2012. These samples were screened for the recovery of S. aureus. Recovered organisms were subjected to susceptibility testing and investigated for the detection of various toxin and antibiotic resistance genes by Polymerase Chain Reaction [PCR]. A total of 64 samples yielded S. aureus, out of which 37 [57.81%] were proved as MRSA. No isolate was found resistant to Vancomycin, however 81.25% of the isolates were found susceptible to Linezolid and Amikacin. The susceptibility to Fusidic acid, Chloramphenicol, Rifampicin, Doxycycline and Meropenem was observed as 79.69%, 76.56%, 75.00, 73.44% and 68.75% respectively. The frequency of sea, seb and sec genes were 56.25%, 43.75% and 12.5% in the recovered isolates. Erm C was more prevalent [28.12 %] than the ermA and ermB. The prevalence of pvl in MRSA was 21.62 % which is less than 33.33% in the MSSA isolates. S. aureus and especially MRSA are frequently prevalent in the KTH. Therefore, every immune-compromised patient is prone to infections caused by S. aureus. This will lead to high morbidity/mortality rate, prolong hospital stay and add extra cost to the health system

Evaluation of management of tibial non-union defect with Ilizarov fixator

Tibial bone defect lead to limb shortening and functional deficit and needs proper treatment. There are various treatment modalities for bone defect in long bone to restore length and function of the limb, i.e. bone grafting, vascularised bone graft, allograft and bone transport. Bone transport can be done through fixators [uniplaner or ring] and intramedullary nail system. This study was conducted on management of tibial non-union with Illizarov external fixator. METHOD: This descriptive study was performed on 58 patients in Agency Headquarter Hospital, Bajawar and Lady Reading Hospital, Peshawar, from January 2000 to January 2006. Patients of either gender with age between 9 to 58 years, having nonunion [clean and infected nonunion] in tibia with defect of 2 to 7cm due to trauma or firearm injury were included in the study. These patients were followed up upto one year. Outcome measures were according to the classification of Association for the Study and Application of the Method of Ilizarov [ASAMI], which is based on radiological [defect filling] and clinical [functional] findings. Out of 58 patients, 44 [75%] were male and 14 [25%] were female. Mean age was 30 years [9 to 58 years]. 38 [65.52%] patients had infected non-union while 20 [34.48%] had clean non-union. Right tibia was involved in 32 patients [51.17%] and left was involved in 26 [44.83%] patients. The cause of initial trauma was road traffic accident in 27 patients [46.55%], firearm injury in 23 patients [39.65%] and a simple fall in 8 patients [13.79%]. The length of average bone defect was 2.90 cm [200-7.00cm]. Radiological results were excellent in 33 [58.89%] patients, good in 12 [20.68%] patients, fair in 8 [13.79%] patients and poor in 5 [8.62%] patients. The clinical results were excellent in 33 patients [56.89%], good in 18 patients [31.05%], fair in 4 [6.89%] patients and poor in 3 patients [5.17%]. Ilizarov ring fixator is excellent treatment modality for tibial non-union with a defect, regarding bone union, deformity correction, infection eradication, limb length achievement and limb function but this needs prolonged learning curve for fresh orthopedic surgeons

Effects of 3,4-dihydroxyacetophenone on cytosolic calcium in pulmonary artery endothelial and smooth muscle cells during acute hypoxia / 华中科技大学学报（医学）（英德文版）

The effects of 3, 4-Dihydroxyacetophenone (3, 4-DHAP) on cytosolic free calcium [Ca2+]i in pulmonary artery endothelia (PAECs) and smooth muscle cells (PASMCs) during acute hypoxia were studied. Porcine pulmonary artery endothelial and smooth muscle cells (PASMCs) were cultured primarily, and they were divided into 4 groups: groups incubated under normoxia or hypoxia and those with or without treatment with 3,4-DHAP. The [Ca2+]i of both PAECs and PASMCs was measured by determining the fluorescence of fura 2 AM on spetrofluorometer. Our results showed that hypoxia caused significant elevation of [Ca2+]i, in both PAECs and PASMCs, 3,4-DHAP could attenuate the hypoxic elevation of [Ca2+]i only in PASMCs but not in PAECs. It is concluded that 3,4-DHAP decreases the hypoxic elevation of [Ca2+]i in PASMCs. This might contribute to its inhibitory effect on hypoxic pulmonary vasoconstriction.

Effects of 3,4-dihydroxyacetophenone on cytosolic calcium in pulmonary artery endothelial and smooth muscle cells during acute hypoxia / 华中科技大学学报（医学）（英德文版）

The effects of 3, 4-Dihydroxyacetophenone (3, 4-DHAP) on cytosolic free calcium [Ca2+]i in pulmonary artery endothelia (PAECs) and smooth muscle cells (PASMCs) during acute hypoxia were studied. Porcine pulmonary artery endothelial and smooth muscle cells (PASMCs) were cultured primarily, and they were divided into 4 groups: groups incubated under normoxia or hypoxia and those with or without treatment with 3,4-DHAP. The [Ca2+]i of both PAECs and PASMCs was measured by determining the fluorescence of fura 2 AM on spetrofluorometer. Our results showed that hypoxia caused significant elevation of [Ca2+]i, in both PAECs and PASMCs, 3,4-DHAP could attenuate the hypoxic elevation of [Ca2+]i only in PASMCs but not in PAECs. It is concluded that 3,4-DHAP decreases the hypoxic elevation of [Ca2+]i in PASMCs. This might contribute to its inhibitory effect on hypoxic pulmonary vasoconstriction.

Surgical management of abdominal tuberculosis

To evaluate various surgical procedures for abdominal tuberculosis.This study was conducted in general surgical department of Pakistan Institute of Medical Sciences Islamabad from January 1997 to December 1999. The study included 50 consecutive cases of abdominal tuberculosis diagnosed on tissue histopathology. All these patients underwent laparotomy for management of their abdominal tuberculosis and at the same time tissue was obtained for confirmation of diagnosis. Laparotomy findings were, adhesions and b and s in 25[50%], strictures in 21[42%], isolated enlarged mesenteric lymph nodes in 2[4%] cases and involvement of liver and appendix in one case each. Two or more of the above findings were present in most of the patients. The operative procedures performed were resection and end to end anastomosis in 16 strictures, stricturoplasty in 6, Rt hemicolectomy in one and resection and ileostomy in 3 strictures which were associated with proximal perforations. Lysis of adhesions was possible in 19[38%] cases. Only biopsy was taken in 8[16%] and in 2[4%] appendectomy was performed. It was concluded that surgery is required for complications of abdominal tuberculosis and at the same time tissue is obtained for diagnosis