Evaluation of antibiotic resistant bacteria in underground drinking water and transfer of their resistant character to normal flora of the body

The untreated surface water for drinking and domestic use is an alarming situation to public health especially in prevalence of antibiotics resistant bacteria. This investigation aimed to isolate and identify the antibiotic resistance bacteria in underground water samples in district Dera Ismail Khan, Pakistan. The underground water samples were collected from four different places using hand pumps [Khyber town, riverside, Gomal University and united town]. Cultured on nutrient agar media, identified by Gam staining and biochemical tests. There after antibiotic resistance assay were performed by measuring zone of inhibition of different antibiotics by disc diffusion method. Six different bacterial colonies were isolated and identified as Enterobacteriaceae, Serriata specie, Proteues, Pseudomonas, all these bacterial colonies were 33% resistant to chloramphenicol with and 100% resistant to amoxicillin. Some colonies were also considered as resistant, according to the criteria of National Committee for Clinical Records [NCCL] that less than 10mm zone of inhibition are considered as resistant. Subsequently, the chloramphenicol resistance bacteria were analyzed for their ability to transfer resistant gene to sensitive bacteria. In in-vitro method, an isolate M1b [resistant] was found capable to transfer resistance gene to M1a isolate [sensitive] in nutrient rich environment. It was concluded that antibiotics resistance bacteria found in underground water, moreover capable of transferring the antibiotic resistant character to suitable recipient i.e. normal flora of the body or to other pathogens by conjugation

Acute lower respiratory tract infection; therapeutic role of zinc in patients

ABSTRACT: Zinc is an essential rnicronutrient with catalytic role in over a hundred specific metabolic enzymes in human metabolism regulates the expression of the metallothionein gene, apoptosis and synaptic signaling and needed for many aspects of immune system. Thus the zinc 'supplementation in patients with acute lower respiratory tract infections might have potential benefits

Objectives: To evaluate the efficacy of zinc supplementation in patients with acute lower respiratory tract infections. Study design: Quasi experimental study. Setting: Study was conducted in the pediatrics department Independent hospital Faisalabad; the indoor patients meeting the inclusion criteria from 26[th] January to 25[th] July 2013 were included in study

Material and methods: 100 children meeting the inclusion criteria were included in the study which were divided into two groups with random allocation i.e. Group A [Odd number] and Group B [Even number]. Group A was given zinc supplementation 20mg of elemental zinc for 14 days. Along with antimicrobials, oxygen and antipyretics for fever while 50 children in Group B were given with antimicrobials. Oxygen and antipyretics for fever without zinc

Results: Baseline clinical parameters were comparable in both groups at admission. Outcome measures considered were duration of fever, tachypneoa, chest indrawings and total duration of hospital admission. Effect of zinc supplementation is significant with p-value of less than 0.05 for duration of tachypnoea and chest indrawings and total duration of hospital admission while result showed p-value equal to 0.05 that is just significant for duration of fever

Analysis of identifiable risk factors precipitating acute encephalopathy in chronic liver disease, at PNS Shifa Karachi

Background: Hepatic encephalopathy is one of the most debilitating manifestations and frequent complication in patients suffering from chronic liver disease

Objective: To determine the frequency of identifiable risk factors precipitating hepatic encephalopathy in patients with chronic liver disease, at PNS Shifa Karachi and their correlation with grades of hepatic encephalopathy, length of hospital stay and mortality. Study Design: It was a cross sectional study Period: 24 Oct 2014 to 31 Aug 2015

Methods: during which 96 patients of clinically diagnosed hepatic encephalopathy associated with CLD were enrolled. Hepatic encephalopathy was graded and precipitating factors identified based on history, clinical examination and relevant laboratory investigations. Management was carried out according to the latest guidelines. Patients were followed up till discharge/death from the hospital and duration of hospital stay. Mortality was recorded

Results: Majority of patients [57.3%] had one precipitating factor; more than one factor was found in 43.5%. Gastrointestinal bleed was the most common precipitating factor identified in 42 [44%] patients followed by Infection in 36 patients [38%], diuretic therapy in 10 patients associated with electrolyte imbalance [11%], constipation in 8 [9%] patients, use of high protein diet in 7[6.72%], sedative /tranquilizers in 4[3.84 %] and large volume paracentesis in 4 [3.84%] were least common factors, Mean hospital stay was 11 +/- 1.8 days. Mortality was 15 % with 14 patients expiring during the hospital stay. There was no statistically significant correlation between the various precipitating factors and grade of hepatic encephalopathy, length of hospital stay and mortality [p >0.05]

Conclusion: Commonest precipitating factors of hepatic encephalopathy in patients of liver cirrhosis are, gastrointestinal bleed, infection, electrolyte imbalance and constipation. There is no correlation between the various precipitating factors and grade of hepatic encephalopathy, length of hospital stay and mortality. There is a need to improve the awareness of patients and attendants about the precipitating factors and their avoidance. This also includes effective control measures against rising cases of hepatitis C and hepatitis B as it is the leading cause of liver cirrhosis in Pakistan

Phototherapy; frequency of hypocalcemia in neonates undergoing in Tertiary Care Hospital in Faisalabad

Hyperbilirubinemia is the most common abnormal physical finding in first few weeks of lif and its most common management is phototherapy. Amongst other common complications a less known complication of phototherapy is hypocalcemia

Objectives: to study the incidence of phototherapy induced hypocalcemia in neonates and to have a comparison between preterm and term neonates

Study design: descriptive cross-sectional study

Setting: paediatric Unit II DHQ Hospital Faisalabad, which is a tertiary care centre for all kind of patients

Duration of study with dates: six months from 1-11-2012 to 30-04-2013

Methods: 196 neonates with hyperbilirubinemia full term / preterm neonates admitted in pediatric DHQ hospital faislabad were selected. Inclusion criteria. 1] Hyperbilirubinemia. 2] No hypocalcemia on admission. 3] Received phototherapy for hyperbilirubinemia. Serum Calcium levels were measured in all neonates before and 48 hours after receiving phototherapy. Incidence of hypocalcemia among all neonates was calculated as an absolute percentage and the sample population was also divided into preterm / full term neonates to evaluate the incidence of hypocalcemia in these two groups individually

RESULTS: mean serum calcium in neonates was 7.5+- 1.5 mg / dl .16.84% of neonates were found to have calcium level below the cut off value. 33 out of 196 developed hypocalcemia after phototherapy and out of these 54% were preterm and 45% were term neonates < P-value [0.01]>

Conclusion: phototherapy induces hypocalcemia in neonates more so in preterm neonates

Impact: consideration for additional calcium supplementation should be undertaken in all neonates undergoing phototherapy and further randomized trials need to be done with these concerns

Bilateral primary squamous cell carcinoma of breast in a pre menopausal woman

Primary squamous cell carcinoma of breast is an extremely rare histological variant and constitutes about less than 1% of breast cancers. All published cases of primary squamous cell carcinoma of breast are unilateral. Bilateral involvement of breast is not reported in the literature. We present a case of bilateral primary squamous cell carcinoma of breast in a pre menopausal woman presenting as fungating breast mass. This report discusses the clinical presentation, radiological and histology findings along with review of the literature

Identification and preservation of the external laryngeal nerve during thyroid surgery: surgical and anatomic considerations

Iatrogenic injuries of external branch of superior laryngeal nerve [EBSLN] during thyroid surgery are not uncommon due to the possibility of anatomic variations in the relationship of this nerve with superior thyroid vessels and the result may be devastating to those patients who rely on their voices professionally. The study included 2 groups. Group A was a prospective nonrandomized analytical series of all consecutive patients undergoing thyroidectomies for various conditions in Surgical Unit II, Shaikh Zayed Postgraduate Medical Complex, Lahore, Pakistan during a three years period [November 2004 - November 2007]. This group consisted of 133 patients. Male to female ratio was 1:3. Mean age was 35.22 years [range: 17-71 years]. Ninety one [68.42%] patients had bilateral dissection [total, sub-total or neartotal thyroidectomies] and 42 [31.57%] had unilateral dissection [hemithyroidectomy I lobectomy and isthumusectomy]. Thus, a total of 224 superior polar dissections were carried out. Three [3 .296 %] patients out of the 91 patients in the bilateral dissection group had asymmetrical nerves. Eighty one [60.9%] patients had benign disease, 32 [24.06%] had malignancy and 20 [15.03%] had toxic goiter. Nerve could not be identified in 42 [18.75%] polar dissections [positive identification in 182 [81.25%] polar dissections]. Three [2.25 %] patients in this study had clearly documented EBSLN injury as determined by voice changes, patient interview and IDL. In Group B, the anterior neck triangles of 19 embalmed human cadavers [i.e. 38 neck half preparations] of both sexes and variable ages with neither enlarged thyroid glands nor any other signs of abnormality in this region were dissected in the dissection halls of two medical colleges in Lahore. The course and topographical relations [especially in relation to the superior thyroid vessels, superior pole of the thyroid and the cricothyroid muscle] of the EBSLN as well as bilateral asymmetry were noted as for Group A. Nerves were classified according to classification of Cernea et al. Good knowledge of the anatomy and relations of the EBSLN with meticulous dissection and ske letonisation and individual ligation of the superior polar vessels is the key to success

Urinary tract infection

Over two years, 9892 mid-stream urine samples from patients attending the Aga Khan University Hospital, Karachi were cultured. Significant bacterial growth was seen in 23.5% samples. Further identification of these organisms revealed 40% of E. coli, 16% Pseudomonas aeruginosa, 11% Klebsiella aerogenes, 5.0% Enterobacter sp., 13% Prat sp., 4.0% Serratia liquifaciens, 1.0% Acinetobacter sp., 3.0% Citrobacter sp., 4.0% Enterococci, 0.5% Staphylococcus aureus. Results of sensitivity tests performed with antibiatics Ampicillin, Cotrimoxazole, Nitrofurantoin, Nalidixic acid, Gentamicin, Amikacin, Pipemedic acid, Cefotaxime, Azactam and Carbenicillin did not reveal any distinct pattern

Neisseria meningitidis storage identification and MIC determination

The significance Minimum inhibitory Concentration [MIC] of determination for Meningococci is described and according to the present study a shift the sensitivity of Meningococcus is occurring, local isolates show higher Minimum Inhibitory Concentration for Chloramphenicol and Azactam. Strains of Meningococcus can successfully be stored in a domestic freezer