High Burden of Antibiotic Resistant Bacteria Isolated from Tracheal Culture in a Tertiary Care Institute

Introduction: Multidrug resistant bacteria is causing a veryserious problem in the proper treatment and management ofsick patients in ICU’s. Study aimed to find out antimicrobialsusceptibility pattern of bacterial isolates from trachealculture.Material and methods: This study was carried over a periodof 6 months from July to December 2017 in the departmentof microbiology. Total of 470 tracheal aspirates were studied.Each specimen was streaked on 5% sheep blood agar andMacConkey agar. After isolation and identification, sensitivityof selected organisms against different antibiotics was studiedResults: Out of 470 tracheal aspirates, 328 samples showedsingle bacterial growth, 76 were sterile; contaminants weregrown in 58 samples and in remaining 8 samples yeast weregrown. The incidence of positivity in our study was 83.8%,with gram negative bacteria outnumbering the gram positiveones. Of the 328 samples which showed bacterial growth,Acinetobacter spp 159(40.3) was the most common organismfollowed by Klebsiella pneumoniae 72(18.2), Pseudomonasspp 46(11.6), Escherichia coli 27(6.8), Staphylococcus aureus13(3.2), Klebsiella oxytoca 5(1.26), Enterococcus spp 3(0.76),Proteus spp, Citrobacter spp, Providencia stuartii 1(0.25)each. Also XDR (extensively drug resistant) bacteria wereisolated at a high frequency (67%) with Acinetobacter spp.being the most common 128(56.6)) followed by Klebsiellaspp. 39(17.2) Pseudomonas spp. 38(16.8), and E.coli 12(5.3).Conclusion: Gram negative were main organisms responsiblefor lower respiratory tract infections in hospitalized patientsand the majority of the isolates belong to XDR and MDRcategory.

Genetic study in congenital heart defects

Background: Congenital heart diseases (CHD) are relatively common with a prevalence ranging from 3.7 to 17.5 per 1000 live births. Little is known about genetic link with respect to congenital heart disease. Iroquoise (Irx) homeobox genes have been widely studied and their expression in both developing and adult heart. Author tried to study the role of irx4 and irx5 genes in structural congenital heart disease, keeping the focus on study reported by Cheng Z et al.Methods: Author studied reported mutation site sequences in 25 various congenital heart disease patients and control healthy relatives of patients. It is a unique study and there has not been such a study reported in literature till date. Besides comparison with healthy related controls, author took cardiac tissue biopsy in patients while doing corrective cardiac surgery. However, blood samples were taken from controls due to ease of feasibility.Results: Although, there were no sequence variations in the studied exon regions, but author got a base pair sequence change at 6 bp intron region, which is near the exon splice site in irx4 gene. Besides two ASD patient’s male children (one child each) had ASD prompting us to believe some role of sex linkage. However later needs pedigree analysis and sex chromosome studies for further analysis.Conclusions: Gene sequence in the Kashmiri population is unique. There is possibility of role of irx genes in CHD. ASD might have sex linkage in some.

Clinicoepidemiological Profile of Organophosphorus Poisoning in a Tertiary Care Center

Introduction: Organophosphorus compounds are widelyused as insecticides. Organophosphorus poisoning hasa significant morbidity and mortality and is a commonoccurrence due to their easy accessibility. Study aimed toassess clinicoepidemiological profile of organophosphoruspoisoning.Material and methods: Our study was a hospital basedprospective study conducted over a period of two yearsinvolving all the patients of organophosphorus (OP)poisoning, admitted in the medical emergency of the hospital.These patients were evaluated for demographic and clinicalprofile and followed till the time of discharge or death.Results: 102 cases of OP poisoning were admitted, majoritybelonged to the age group of 15-25 years (54.9%) and were ofrural origin (84.3%). Females (67.64%) outnumbered males.97 cases had taken it with suicidal intent. Miosis was themost consistent clinical feature (93.13%). 64 patients (62.7%)needed admission in ICU. Respiratory failure was the mostcommon complication. Mortality rate of 14.7% was observed.Conclusion: OP compounds are ingested mostly with suicidalintent due to their easy availability mostly by young andproductive population. Initial management and resuscitationin periphery is invaluable

Steps taken to alleviate under-reporting of transfusion reactions at a public sector hospital in Pakistan

No abstract available.

Does preoperative predictive lung functions correlates with post surgical lung functions in lobectomy.

Background: Patients with normal pulmonary function tolerate removal of an entire lung without respiratory problems. In patients witth impaired pulmonary function, post resectional function is of importance for the assessment of surgical risk. This necessitates the ability to measure the relative contribution of the parenchyma to be resected to the total lung function and the predicted postoperative lung functions. Objective: To determine preoperative lung functions as assessed with split lung functions and correlates with postsurgical lung functions and to determine the effect of lung resections on spirometric lung function. Material and methods: All those patients planned for lung resection surgery were included in the study. Predicted postoperative FEV1 and FVC were calculated. Preoperative spirometry was performed within a week before surgery. Predicted postoperative values were calculated. Postoperative spirometry was performed at the end of first month, third month, and sixth month for each patient. The relationship between potential predictors and postoperative complications were assessed. The predicted values were correlated with measured values (actual values) during the postoperative follow up. Results: Lobectomy was done in 64 persons. The predicted postoperative FEV1 and FVC correlated well with observed FEV1 and FVC in lobectomy (p<.05). The mean preoperative FEV1/L were 1.8 and the mean predicted postoperative (L) FEV1 were 1.4. The mean FEV1 at 1 month follow up were 1.6 and the mean FEV1 at 3 month follow up were 179.8.

Characteristics of pseudoaneurysms in Northern India; risk analysis, clinical profile, surgical management and outcome

Objective: To determine the risk factors, clinical characteristics, surgical management and outcome of pseudoaneurysm secondary to iatrogenic or traumatic vascular injury

Methods: This was a cross-sectional study being performed in department of cardiovascular and thoracic surgery skims soura during a 4-year period. We included all the patients referring to our center with primary diagnosis of pseudoaneurysm. The pseudoaneurysm was diagnosed with angiography and color Doppler sonography. The clinical and demographic characteristics were recorded and the risk factors were identified accordingly. Patients with small swelling [less than 5-cm] and without any complication were managed conservatively. They were followed for progression and development of complications in relation to swelling. Others underwent surgical repair and excision. The outcome of the patients was also recorded

Results: Overall we included 20 patients with pseudoaneurysm. The mean age of the patients was 42.1 +/- 0.6 years. Among them there were 11 [55%] men and 9 [45%] women. Nine [45%] patients with end stage renal disease developed pseudoaneurysm after inadvertent femoral artery puncture for hemodialysis; two patients after interventional cardiology procedure; one after femoral embolectomy; one developed after fire arm splinter injury and one formed femoral artery related pseudoaneurysm after drainage of right inguinal abscess. The most common site of pseudoaneurysm was femoral artery followed by brachial artery. Overall surgical intervention was performed in 17 [85%] patients and 3 [15%] were managed conservatively

Conclusion: End stage renal disease is a major risk factor for pseudoaneurysm formation. Coagulopathy, either therapeutic or pathological is also an important risk factor. Patients with these risk factors need cannulation of venous structures for hemodialysis under ultrasound guide to prevent inadvertent arterial injury. Patients with end stage renal disease who sustain inadvertent arterial puncture during cannulation for hemodialysis should receive compression dressings for 5 to 7 days

Comparative study of granisetron versus combination of granisetron with dexamethasone in the prevention of postoperative nausea and vomiting in the patients undergoing elective plastic surgical procedures in head and neck region

Postoperative nausea and vomiting is a major challenge with an incidence of 70% to 80%. This study evaluated the efficacy of Granisetron with or without Dexamethasone in reducing postoperative nausea and vomiting in patients undergoing elective plastic surgery procedures in Head and Neck region. A prospective, randomized, double blinded study of 90 patients undergoing plastic surgery procedures in Head and Neck region under general anesthesia with prophylactic Granisetron alone or combination of granisetron and dexamethasone or placebo was done. The main outcome measures were the occurrence of vomiting and severity of nausea up to 24 hours postoperatively. There was statistically significant difference in occurrence of postoperative nausea and vomiting when prophylaxis of granisetron alone or in combination with dexamethasone was given versus no prophylaxis. Although addition of dexamethasone further decreased the incidence of nausea and vomiting but the difference was not statistically significant It was concluded that in patients undergoing plastic surgery procedures in Head and Neck region, the addition of dexamethasone to granisetron decreased the incidence of postoperative nausea and vomiting up to 24 hours

Frequency of head and neck lesions according to histopathologic diagnosis

Retrospective study is conducted to determine the frequency of head and neck lesions histopathological diagnosis and to contribute in base line data of head and neck lesions at DDRRL/OJHA campus, Karachi. The study includes data from 2nd February 2008 to 31st December 2010. The most common head and neck lesions affecting male 53.9% [n=758] and female 46.04% [n=647]. Patients of all age group are included. Both incisional and excisional biopsies are included and previously diagnosed lesions on the basis of histopathology are excluded. Among 1,405 head [n=860] and neck [n=545] biopsies, Squamous cell carcinoma was 399. The most frequently affected site of oral cavity was right buccal mucosa with OSCC. Thyroid goiter was most commonly reported neck lesions. This study showed that premalignant lesion was less commonly submitted biopsies as compare to malignant lesions

Double blind placebo controlled study on "efficacy of lignocaine pretreatment in reducing pain during injection of propofol" in patients undergoing elective maxillofacial surgeries

This study was undertaken to evaluate the incidence and severity of pain on Injection of Propofol and to find the efficacy of lignocaine pretreatment in reducing such pain. 150 patients undergoing different Maxillofacial Surgeries with American Society of Anesthesiologists class 1 and 2 [ASA 1 and 2] were randomly allocated in two groups, Group A [Saline group] and Group B [Lignocaine group] who received saline and lignocaine as pretreatment respectively. Another anesthetist who was blinded to study recorded pain on a 4-point pain scale. The incidence of pain on giving Propofol was 57.33%. There was reduction of pain by 32% in the patient group who received Lignocaine pretreatment. It was concluded that lignocaine is an effective measure to decrease the incidence and severity of pain on injection of Propofol

Predictors of clinical course of subacute sclerosing panencephalitis: experience at the children's hospital, Lahore

To determine the clinical course of Subacute Sclerosing Panencephalitis [SSPE] and different factors affecting the clinical course. Descriptive study. The Children's Hospital, Lahore, from October 2005 to May 2008. All serologically confirmed patients of SSPE were registered and clinical staging of these patients were done from stage-I to stage-IV. Clinical course of these patients was classified by using neurological disability index as fulminant, acute, subacute, and chronic course. Clinical course was analyzed for any difference with age, gender, immunization for measles, measles infection, nutritional status and correlation with age of onset of SSPE, [Spearman's correlation], using statistic package for social science [SPSS] V. 14. A total of 57 cases [41 males, 16 females] with mean age of 7.45 years were studied. Forty [71.4%] of them were vaccinated with single dose at about 9 months of age, 41% [23/57] had measles infections 2 years of age. Using the Neurology Disability Index for these patients 10.5% had fulminant, 17.5% had acute, 49.2% subacute and 22.8% had chronic course. Age, gender, age at measles infection, SSPE onset age and nutritional status were poor predictors of clinical course of SSPE. Unvaccinated patients showed significantly more rapid course of disease [p = 0.04]. Clinical course of SSPE cannot be predicted at the onset of this catastrophic disorder. Children not immunized against measles had a significant rapid course of disease

Comparison of closed and open methods of pneumoperitonium in laparoscopic cholecystectomy

Pneumoperitonium is the first step in laparoscopic surgery including cholecystectomy. Two commonly used methods to create pneumoperitonium are closed and open technique. Both have advantages and disadvantages. The current study was designed to compare these two techniques in terms of safety and time required to complete the procedure. This was a randomized controlled prospective study conducted at Department of Surgery, Ayub Hospital Complex Abbottabad, from 1[st] June 2007 to 31[st] May 2008. Randomization was done into two groups randomly using sealed envelopes containing the questionnaire. Seventy envelopes were kept in the cupboard, containing 35 proformas for group A and 35 for group B. An envelope was randomly fetched and opened upon selection of the patient after taking the informed consent. Pneumoperitonium was created by closed technique in group A, and by open technique in group B. Time required for successful pneumoperitonium was calculated in each group. Failure to induce pneumoperitonium was determined for each technique. Time required to close the wounds at completion, total operating time and injuries sustained during induction of pneumoperitonium were compared in both techniques. Out of the total 70 patients included in study, 35 were in group A and 35 in group B. Mean time required for successful pneumo'peritonium was 9.17 minutes in group A and 8.11 minutes in group B. Total operating time ranged from 55 minutes to 130 minutes in group A and from 45 minutes to 110 minutes in group B. Mean of total operating time was 78.34 and 67 minutes in group A and B respectively. Mean time needed to close the wound was 9.88 minutes in group A and 4.97 minutes in group B. Failure of technique was noted in three patients in group A while no failure was experienced in group B. In two cases in group A minor complications during creation of pneumoperitonium were observed while in group B no complication occurred. No patient died in the study. We concluded from this study that open technique of pneumoperitonium was, less time consuming and safer than the closed technique

Carcinoma of prostate in clinically benign enlarged gland

Carcinoma of the prostate is one of the common tumours of old age in men. This cross sectional study was conducted to detect carcinoma of prostate in clinically benign enlarged gland and to evaluate the efficacy of Digital rectal Examination in detection of prostatic cancer in patients presented at Khyber Teaching Hospital, Peshawar from July 1998 to July 1999. Patients presenting with lower urinary tract symptoms over the age of 50 years were evaluated on English version of International Prostate Symptoms Score [IPSS], clinically examined and post-voiding residual urine determined on abdominal sonography. The selection criteria were; Severe IPSS, absence of signs of malignancy on Digital Rectal Examination [DRE] and post-voiding residual urine more than 100 ml. Thus a total 100 patients were selected for further study. Four ml blood was taken to assess Prostate Specific Antigen [PSA] level pre-operatively. All these patients underwent either transvesical prostatectomy or transurethral resection of prostate [TURP] and enucleated prostatic tissues were sent to histopathology. Eighty-five percent patients had PSA level up to 10 [eta]g/ml. PSA level of 15 [15%] patients were above 10n gm/ml out of which 13 [13%] patients were having PSA in range of 11-12 [eta]g/ml and two [2%] had PSA level between 20-25 [eta]g/ml. Histopathology report of 2% patients turned out as adenocarcinoma of the prostate. Out of 100 patients who were having clinically benign DRE findings, 2 turned out as Carcinoma of the prostate histologically

Aspiration and tetracycline sclerotherapy of primary vaginal hydrocoele of testis in adults

Primary Vaginal Hydrocoele of Testis is a common condition which is primarily treated surgically. Many patients with Hydrocoele of testis are either not willing or are unfit for surgery. This study was done to know the safety, efficacy and outcome of tetracycline induced sclerotherapy of Primary Vaginal Hydrocoele of Testis in adults. This quasi experimental study was done in Shahina Jamil Hospital, attached with Frontier Medical College and Ayub Teaching Hospital, Abbottabad from March 2006 to April, 2007. Thirty-seven patients with primary vaginal hydrocoele were included in the study. Aspiration and instillation of Tetracycline was done after spermatic cord block with 2% lignocaine. Procedure time, Peri and Post-procedure complications, number of injections for cure and patients' satisfaction with the procedure were recorded. Patients were discharged home 3 to 4 hours after the procedure and followed up after one week, one month, three months and six months. Direct admission and re-admissions were recorded. The mean age of patients was 47 years. Mean procedure time was 45 minutes. All patients were cured. Mild postprocedure pain occurred in 12 [40%], moderate pain in 14 [46%] patients and severe pain in 4 [13.3%] patients. No patient developed haematoma or local infection. One patient [3.3%] had micturition problem. Two [6.6%] patients had minimal recurrence. One injection was sufficient for cure in all patients. 28 [93%] patients were satisfied while 2 [6.6%] patients were not satisfied with this procedure. No patient was admitted in the hospital after the procedure. Aspiration and injection of tetracycline in Primary vaginal Hydrocoele of Testis in adults is safe, effective and very economical procedure

Role of ultrasound in acute appendicitis

Misdiagnosis of acute appendicitis is a common and crucial problem in general surgery. Graded compression ultrasonography is one of the new diagnostic technique that is reported to have improve the diagnostic accuracy and clinical outcome. The aim of current study is to assess the role of this diagnostic modality in the management of acute appendicitis. This is a cohort observational study comparing the adverse outcome in two different groups of patients admitted with suspected acute appendicitis at two different hospitals in two different countries. The first group of 200 patients at Ayub Teaching Hospital Abbottabad, Pakistan, was managed without preoperative ultrasonography. In the second group of 200 patients admitted at Najran General Hospital Najran Saudi Arabia, graded compression abdominal ultrasonography was routinely performed preoperatively. Diagnostic accuracy of the protocol in each group was measured statistically and rates of negative appendicectomy and perforation were determined. Addition of routine ultrasonography in clinical assessment for acute appendicitis decreases the sensitivity but significantly increases the specificity of the protocol thereby reducing the false positive rate translating into decreased negative appendicectomy rate. Rate of negative appendicectomy was 22.5% in group one and 4.7% in group two.Perforation rate was 15.6% in group 1 and 15% in group two. Proper clinical assessment is the mainstay of diagnosis in acute appendicitis and addition of routine ultrasound by graded compression technique can improve the diagnostic accuracy and adverse outcome

Pulmonary lymphangioleiomyomatosis: a rare presentation.

Pulmonary lymphangioleiomyomatosis (LAM) is a rare idiopathic, cystic disease. We report a case of LAM who presented with nonchylous, bilateral pleural effusion and progressive respiratory failure.

Vaccination against hepatitis B among doctors at a teaching hospital in Lahore

Hepatitis B is still a major cause of morbidity and mortality, but the disease is preventable, specially through awareness of its spread, screening and vaccination. Setting: Study was done at Sir Ganga Ram Hospital/Fatima Jinnah Medical College to examine the vaccination status against Hepatitis B among the doctors from the Departments of Medicine, Surgery, Gynae and Pathology. Material and In this descriptive study, a total of 110 doctors participated. It took into account different aspects like their vaccination status, status of the booster dose, whether they checked their immunologic status before or after vaccination and reason for not being vaccinated. A total of 71.8% of doctors working in the institution were vaccinated. The results showed that the status was better in the female doctors. A total of 81.5% consultants got themselves vaccinated followed by 74.3% house officers and only 63.6% medical officers who were probably most involved with the patients. Regarding the post-vaccination status 87.5% consultants, 7.1% medical officers and none i.e. 0% house officer had their post vaccine antibody titre checked. Among the house officers 66.6% received their booster dose [where applicable] followed by consultants and medical officers. Lack of awareness was mentioned as the biggest reason for not being vaccinated. Awareness through health education regarding Hepatitis B and bringing down the cost through other methods of vaccination is important in this country where the disease is very common

Octreotide in the management of entero-cutaneous fistulae

Efficacy of Octreotide [Somatostatin] in the conservative management of postoperative Enterocutaneous fistula was studied in seven patients with age ranging 1 to 70 years. Four out of seven fistulae closed within 21 days of starting the drug. One case, where fistula took over a month to close, responded well in reducing the output significantly within to days of starting therapy. The cases and the results are discussed. Favourable results following Octreotide therapy in this study need strengthening by further studies

seroepidemiology of hepatitis B in haemodialysis units

A seroepidemiologic study for hepatitis-B virus [HBV] markers in 64 chronic renal failure patients from four haemodialysis units of Karachi was conducted. Hepatitis-B surface antigen [HBsAg] was detected in 17.2% of patients and 5.4% of controls, while antibody to hepatitis N surface antigen [anti-HBs] was dected in 21.9% of patients as compared to 3.6% of the control group [p < .OS]. Eight of the 39 HBV seronegative patients became HBsAg positive during study period of 10 months. Sample collected from dialysis machines demonstrated about 11% positive, while 40% of the samples from units floors were found to be positive for HBsAg. One of the staff members developed HBsAg during study period while two had anti IIBs. The prevalence of HBsAg among family contacts of the patients was 7.4%, however, spouses seemed to be at higher risk