Frequency of extended spectrum beta-lactamases [ESBL] producing nosocomial isolates in a tertiary care Hospital in Rawalpindi

To find out the frequency of extended spectrum beta-lactamases [ESBL] producing organisms among Gram negative rods from clinical specimens. This was a descriptive study. The study was carried out in the Microbiology Department of Army Medical College, Rawalpindi from 1 Jan 03 to 31 Dec 03 on clinical samples received from admitted patients in Military hospital, Rawalpindi. It was carried out on clinical specimens of urine, blood, pus, catheter tips, fluids including CSF, sputum, chest tube, HVS and i/v canula/CVP line obtained from admitted patients in Military Hospital, Rawalpindi. The organisms were identified by standard techniques. Confirmation to the species level was done by API 20 E and API NE where required. Sensitivity testing was carried out by Modified Kirby Bauer disc diffusion method on Mueller Hinton agar incubated at 35o C in ambient air for 24 hrs. ESBL producing strains were identified by double disc diffusion method test according to Jarlier et al. Clavulanate was applied as the inhibitor of beta lactamases [AMO/CLAV disc]. The results were tabulated as frequencies. Forty three percent of clinical isolates yielded ESBL producing gram negative rods. Enterobacter cloacae [76%], Klebsiella oxytoca [68%] Acinetobacter baumanni, [63%] and Aeromonas hydrophila [50%] were the most frequent ESBL producing bacteria. Production of ESBL among Gram negative rods is frequent in Military Hospital, Rawalpindi. Infection control measures are required to control their spread

Mixed germ cell tumours of the pineal region

Intracranial mixed germ cell tumours, particularly with the occurrence of germinoma and teratoma components, are very rare. On many occasions, the diagnosis is only reached after a second surgical resection of what is believed to be a tumour recurrence. The authors report two young adolescent males who presented with headache, vomiting and Parinaud's syndrome. Cranial CT and MRI scans demonstrated a large heterogeneous pineal region tumour. Through a supracerebellar infratentorial approach, in both patients, a complete excision of the tumour was achieved of a histopathologically proven mixed germ cell tumour, predominantly teratoma with elements of germinoma. The patients received adjuvant chemotherapy and radiotherapy and remained tumour free during their follow-up. The authors discuss the management of this rare entity and emphasize the importance of detailed histopathological examination