Antimicrobial susceptibility patterns of clinical isolates of Pseudomonas aeruginosa isolated from patients of respiratory tract infections in a Tertiary Care Hospital, Peshawar

Objective: This study aims to determine the prevalence and susceptibility pattern of Pseudomonas aeruginosa and multidrug-resistant [MDR] isolates in patients suffering from respiratory tract infection

Methods: A cross sectional study was conducted from January to December 2014 in Northwest General Hospital and Research Centre, Peshawar. A total of 615 sputum samples were collected from both in and out-patients. Sputum samples were collected as per standard procedure and were inoculated on Blood, MacConkey and Chocolate agar. The isolates were identified by standard protocols using biochemical tests. The antibiotic susceptibility pattern of each isolate was checked as per Clinical and Laboratory Standards Institute [CLSI] guidelines using Kirby- Bauer's disc diffusion method

Results: Out of 615 sputum samples, 354 [57.56%] were culture positive. Out of these a total of 71 [20.05%] strains of Pseudomonas were isolated, where 54.93% was from males and 45.07% were from females [Mean age was 44.29 +/- 22.72]. Highest sensitivity was seen to Amikacin [92.86%] followed by Meropenem [91.55%] while lowest sensitivity was seen to Cefoperazone + Sulbactam [16.9%]. There were 39.44% MDR strains, out of which 25% were Extensively Drug Resistant [XDR] and 10.71% were Pan Drug Resistant [PDR]. In vitro susceptibility of MDR isolates showed highest sensitivity to Amikacin [82.14%] followed by Carbapenems [78.57%]. All MDR isolates were resistant to Cefoperazone + Sulbactam. Resistance to Piperacillin + Tazobactam was 96.43%

Conclusion: Pseudomonas aeruginosa is one of the commonly isolated organisms and it is becoming more resistant to commonly used antibiotics. Carbapenems and aminoglycosides were the two classes of drugs that showed highest activity against Pseudomonas aeruginosa

prospective observational study assessing the outcome of Sepsis in intensive care unit of a tertiary care hospital, Peshawar

Objective: The current study aims to explore the factors associated with outcome among patients with severe sepsis and septic shock admitted to the intensive care unit, Northwest General Hospital and Research Centre, Peshawar, Pakistan

Methods: A prospective observational study was carried out at intensive care unit of our hospital from February 2014 to October 2015. Data was collected using a structured format and statistical analysis was done using SPSS version 20®. Regression model was applied to identify the factors contributing to the outcome of severe sepsis and septic shock. P-value less than 0.05 was considered statistically significant

Results: Majority of the patients meeting the criteria of this study were male 147 [54.9%] with a mean age of 54.8. The most common source of sepsis was lung infections [42.2%] followed by urinary tract infections [18.7%], soft tissue infections [6.3%] abdominal infections [6%] and in 6.3% patients the source remained unknown. Further analysis has revealed that increase in number of days of hospitalization was observed to be slightly associated with the outcome of the treatment [1.086 [1.002 - 1.178], 0.046]. Moreover, the risk of mortality was the higher among the patients with septic shock 22.161[10.055 - 48.840], and having respiratory, kidney and central nervous system complications. Overall it is seen that septic shock alone was found responsible to cause death among 32.0% of the patients [Model 1: R2 0.32, p=0.000], and upon involvement of the organ complications the risk of mortality was observed to 42.0%

Conclusion: Chances of recovery were poor among the patients with septic shock. Moreover, those patients having respiratory and urinary tract infection are least likely to survive

Purple urine bag syndrome

Purple Urine Bag Syndrome [PUBS] refers to the purple discoloration of urine and is commonly observed in bed ridden patients with long-term urinary catheters. Although typically benign, the purple discoloration is alarming to both the patients and their attendants. This case report presents an uncommon case of PUBS in a 60-year-old lady with hypertension, type II diabetes, and chronic kidney disease stage 5, who presented to the emergency room with bilateral diabetic foot ulcers of 3 months duration, dry gangrene of ring finger and infected middle and little fingers with abscess over the palmar aspect of right hand of 20 days duration. PUBS is generally associated with alkaline urine as was observed in this patient, although it has also been reported in acidic urine. PUBS has long been documented in association with constipation and so has its association with diarrhea, a finding also observed in this case report

Complete pain relief after combining radiofrequency and phenol for lumbar sympathectomy

Lumbar sympathectomy alleviates pain such as complex regional pain syndrome, phantom limb pain and other peripheral neuropathies. Different modalities have been used to manage complex syndromes including sympathectomy. Both radiofrequency [RF] and phenol injection are established methods of performing sympathectomy. We present a case with possible diagnosis of chronic regional pain syndrome in a 56 year old lady who presented as an emergency with severe unbearable pain in her right leg. As a result of compromised circulation in the legs, the distal phalanx of second toe was amputated. Diagnostic lumbar sympathectomy with local anaesthetics provided short and temporary pain relief. Lumbar sympathectomy by means of radiofrequency combined with phenol injection was used; the symptoms were alleviated within 12 hours. Follow-up at different intervals has shown remarkable subjective and objective recovery with improved circulation, discoloration and complete healing. To the best of our knowledge this is the first case report of sympathectomy combining the two modes of RF and phenol injection in the same session

Cerebral venous thrombosis and cerebral infarction: a rare disease with a rare cause

We present a case of cerebral venous thrombosis and cerebral infarction associated with diabetic ketoacidosis. The patient presented with vomiting, headache, lethargy and altered sensorium. CT venography provided the final diagnosis; therefore, anticoagulant was used, which resulted in the improvement of neurological outcome. Neurological deterioration during an episode of diabetic ketoacidosis is usually assumed to be caused by cerebral edema. Neuroimaging should always be performed in suspected cerebral edema associated with diabetic ketoacidosis in order to exclude other pathologies.

Need for chest tube after video assisted thoracoscopic [VATS] lung biopsy

To observe the effects of early removal of chest tube drain after video assisted thoracoscopic [VATS] lung biopsy. We prospectively evaluated the removal of chest tube drain at six hours or 24 hours after the VATS-lung biopsy in fifty consecutive patients with no evidence of air leak after the lung biopsy. Our results show that removal of chest tube drain at 6 hours was not associated with complications such pneumothorax, atelectasis or pleural effusion as compared to the 24 hours removal of the drain[p>0.05]. Early removal of chest tube drain is safe in patients where air leak has been documented to be absent. Since it was a non-randomized evaluation, further randomized study in our population is needed to confirm these findings

Surgical outcome of supracondylar and intercondylar fractures femur in adults treated with dynamic condylar screw

To evaluate the surgical outcome of supracondylar and intercondylar fractures of femur in adults treated with dynamic condylar screw. This descriptive study was carried out in department of Orthopedics, Lady Reading Hospital Peshawar from October 2006 to October 2007. Thirty-five consecutive adult patients with supracondylar and intercondylar femur fractures fulfilling the inclusion criteria were managed with dynamic condylar screw and were followed for a minimum of six months post-operatively. Relevant data like time to union, knee range of movement and complications associated with these fractures treated with dynamic condylar screw was recorded. In 45.71% cases road traffic accident was responsible for the fracture followed by 28.57% cases due to fall from height, and 25.71% cases due to firearm injury. 74.28% fractures were closed fractures and 25.71% fractures were open. Average time of union was 15 weeks. Two patients [5.71%] had delayed union while two patients [5.71%] had non-union. There were six patients with knee stiffness and two with limb shortening of up to 1.5 cm. Infection was noted in two patients, treated successfully with debridement and I.V. antibiotics. Two patients developed wound hematoma. The overall outcome were good to excellent in 26 patients [74.28%]. Moderate outocme were obtained in three patients [8.57%] and poor in six patients [17.14%]. The dynamic condylar screw is an easy, less technically demanding and rewarding method of treatment for supracondylar and intercondylar fracture of femur in adults

Toxicity of cadmium on the growth and yield of Solanum melongena L.

Heavy metal cadmium is biomagnified through food chain and causes Itai-Itai disease in human. The present investigation reports the results of the effect of cadmium on seed germination, germination relative index (G.R.I.), seedling growth, chlorophyll stability index (CSI) and yield of Solanum melongena L. cv Pusa uttam. Effect of different concentrations of heavy metal cadmium (CdCl2) in Hoagland's nutrient solution (10(-2) M, 10(-4) M, 10(-5) M and 10(-8) M) were employed for all seedling and physiological parameters of brinjal. Cadmium showed toxic effects at high concentrations 10(-2) M but promotory at lower concentration (10(-8) M) with regard to growth and yield.

Prioritizing patients for coronary angiography using simplified treadmill score in high risk Asian subjects in Saudi Arabia

Our aim was to prioritize and identify patients for coronary angiography using simplified treadmill score in high risk Asian subjects. Consecutive patients referred for chest pain were evaluated based on clinical history and Treadmill Exercise Stress tests and Duke treadmill score and The Simplified treadmill score were plotted into risk categories and high risk patients were referred for coronary angiography. A total of 212 subjects with 95% males underwent Treadmill Stress test of whom 51[24%] were designated as high risk group with a Simplified treadmill score of >60, who were advised Coronary angiography but only 22% of the high risk group underwent Coronary angiography and almost all were found to have two or three vessel disease. The Simplified treadmill score can prioritize patients for coronary angiography using the high risk probability ratio of Simplified treadmill score in Asian subjects

Transfusion related acute lung injury

TRALI [Transfusion related acute lung injury] is a devastating complication of Blood transfusions or its components irrespective of the blood grouping and cross match, We report a case of a Philipino house wife who had blood transfusion for her vaginal lacerations and developed acute pulmonary edema immediately afterwards. Antigranulocyte antibodies were not found in the donors. The patient recovered after supportive treatment. TRALI is not an uncommon complication of Blood transfusion that is under-reported and under-diagnosed

Nucleolar organizer regions in normal bone marrow

The silver colloid technique for nucleolar organizer regions [AgNORs] was applied to bone marrow smears in 20 cases of normal morphology marrow. The AgNORs were recorded in the form of 'clusters' and 'dots'. Each developing cell type of myeloid and erythroid series revealed a different pattern of 'clusters' and 'dots'. 'Clusters' associated with proliferation while mature, non-dividing forms contained only 'dots'. 'Clusters' and 'dots' have different biologic significance and the method should be adopted while evaluating marrow smears

Percutaneous needle biopsy in exudative ascites

Seventy-two patients with exudative ascites were subjected to percutaneous needle biopsy of peritoneum. The overall diagnostic yield was 64%, with the commonest finding being caseous granuloma [39%], followed by metastatic carcinoma [25%]. The procedure was safe and easy to perform on the bed side. Peritoneal tissue was obtained in all cases, without any major complications