Primary posterior mediastinum hydatid cyst

Primary posterior mediastinal hydatid cyst is a serious health problem for the Mediterranean countries. We diagnosed a case of a 46-year-old female with a primary posterior mediastinum hydatid cyst on CT and MRI. It was provisionally identified as either a hydatid cyst or bronchogenic cyst or neuroenteric cyst. CT guided aspiration with 18 gauge needle confirmed as hydatid sand. This is very rare in this population but it should be kept in mind when one is looking at any cyst in the posterior mediastinum.

Use of tigecycline [tygacil] against drug resistant organisms in eastern region

This study was designed to look for sensitivity and resistant pattern of tigecycline in different gram positive and gram negative infections which were resistant to different antibiotics and also look for various methods to prevent drug resistance against tigecycline [tygacil] group of antibiotic. Three hundred seventy five [375] isolates which includes MRSA [Methicillin Resistant Staphylococcus Aureus], VRE [Vancomycin Resistant Enterocooci], ESBL [Extended Spectrum Beta Lactamase], Stenotrophomonas maltophilia and MDR [Multi Drugs Resistant] Acinetobacter species were identified with the help of colonial characteristics, gram staining, biochemical reactions including API strips system, and special techniques used for each organism. Sensitivity was done with help of disc diffusion [Kirby Bauer] method for tigecycline [tygacil] 15 ug disc provided by company. This is a retrospective study which has showed that MRSA were 100% sensitive to tigecycline and VRE were also 100% sensitive to this antibiotic. The ESBL were 90% sensitive and Stenotrophomonas maltophilia 87% to tigecycline. The MDR Acinetbacter species were only 41% resistant which was high in 2008 as compared to overall sensitivity pattern. Male and female were almost equal in this study. Highest number of cases was reported from 70-80 years age group. The different isolates were from different locations from human body and different wards including ICU [Intensive Care Unit]. Tigecycline exhibit high in vitro activity against most of the commonly encountered gram positive and gram negative resistant organisms which were pathgens in this region. We should take care not to get antibiotic resistance to be developed against tigecycline by appropriate uses and preventive measures [hand hygiene etc.]

MRSA [methicillin resistant staphylococcus aureus] and MSSA [methicillin sensitive staphylococcus aureus] and their antibiotic activity pattern in eastern region of Saudi Arabia

Infection with MSSA and MRSA is quite common in the region as well as around the globe which results in a substantial number of morbidities and mortalities in a population. This study is designed to find out frequencies of MSSA and MRSA in the Pediatric and adult populations in the Eastern Region. We also assess prevalence of Community Associated [CA] MRSA and Hospital Associated [HA] MRSA along with antibiotic sensitivity pattern. It is a case series study. It was done at the King Abdulaziz Hospital [National Guard Health Affairs] Al-Ahsa, Kingdom of Saudi Arabia. A total of 1930 comprising of MRSA 463 and MSSA 1467 which were confirmed by CLSI [Clinical Laboratory Standard Institute] 2008. All standards of JCIA [Joint Commission for International Accreditation] and CAP [College of American Pathologist] were followed, as our laboratory is accredited by both, in MRSA identification of CA-MRSA [Community associated] and HA-MRSA [Hospital associated] were also done. Antibiotics sensitivity pattern is also recorded. Overall MRSA isolates were 24.0% whereas MSSA were 76.0%. MRSA varies from 22-26% from 2006 to 2008 and MSSA varies from 74-76% from 2006 to 2008. The overall male and female were 52.0% and 48.0% respectively with a ratio of 1.1:1.0. The total CA MRSA were 72.0% and HA MRSA were 28.0%. Both MRSA and MSSA were 18.55% Pediatrics and 81.45% were adults. MRSA is 100% sensitive to vancomycin, 98.0% to rifampin whereas MSSA is 100% sensitive to ciprofloxacin, cloxacillin, vancomycin and 99.0% to trimethoprim with sulfamethoxazole. It is evident from this study that both MRSA and MSSA are quite common in Eastern Region of Saudi Arabia. We should use antibiotics properly to avoid emergence of resistance and also implement infection control practices to overcome spread of these infections in the population

ESBL [extended spectrum beta-lactamases] and non-ESBL isolates in urinary tract infection

To determine the prevalence of Extended Spectrum Beta-Lactamase [ESBL] among Entero-bacteriaceae isolated from urine culture in a tertiary care hospital and comparing it with Non-ESBL. The organisms identified were Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytocia and Proteus mirabilis in ESBL as well as in the control group. We carried out this study at the King Abdul Aziz National Guard Hospital Al-Ahsa, Kingdom of Saudi Arabia during the period from January 2006 to August 2008. We tested a total of 1522 isolates of the family Enterobacteriaceae from urine culture for the prevalence of Extended Spectrum Beta-Lactamase [ESBL] and Non-ESBL production by the standardized disc diffusion method and confirmed by the ESBL E-test strips. All cases of Urinary Tract Infection [UTI] irrespective of age, sex, color, race, cast and creed were included in this study. Single isolates were included in this study. Four organisms for which initial screening as well as confirmatory facilities were present [Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytocia and Proteus mirabilis] as well as comparable Non-ESBL. UTI with two or more organisms as isolates were excluded from this study. The patients with urinary catheters and long term care were also excluded from this study. Two hundred eighty one [18.5%] of the isolates out of 1522 were ESBL producers and 1241[81.5%] were Non-ESBL producers. The ratio between ESBL and Non-ESBL was 1:4.4. Among these ESBL, 207 [73.7%] were Escherichia coli, 67 [23.8%] were Klebsiella pneumoniae followed by 6 [2.1%] Proteus mirabilis and 1 [0.4%] Klebsiella oxytocia. In Non-ESBL producer isolates there were 886 [71.4%] Escherichia coli, 309 [24.9%] Klebsiella pneumoniae, 42 [3.4%] Proteus mirabilis and 4 [0.3%] Klebsiella oxytocia. The ESBLs were 100% sensitive to Imipenam and Meropenam. The penicillins, cephalosporin's and aztreonams were 100% resistant against ESBL. Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Klebsiella. oxytocia that produced ESBL were present in quite a high number. Extended Spectrum Beta-Lactamase gram-negative bacilli present significant diagnostic and therapeutic challenges to the management of infections due to these organisms. Microbiology laboratories should start reporting ESBL producing Enterobacteriaceae isolates due to their importance in respect to antibiotic therapy and infection control aspects

Extracranial primitive, neuroectodermal tumors in Pakistan

Our objective was to diagnosed these tumors by CT [Computerized tomography] and MRI [Magnetic Resonance Imaging]. The study was conducted between August-2002 to December-2003 in radiology department of Shaukat Khanum Memorial Cancer Hospital and Research Centre [SKMCH and RC], which is a tertiary care center for cancer patients. The patients included in this study were diagnosed cases of non CNS PNET, who had been referred for staging work up and treatment. The biopsy was done either in the radiology department and later processed by pathology department of this hospital or the pathologists reviewed slides of biopsy done in other hospitals. The diagnosis was based on characteristic histology of the tumor and on presence of a positive MIC2 antibody. Case-series. In concordance to previous studies, PNET was found more in males than females [55% vs. 45% respectively]. Maximum no of patients belonged to 10-20 years of age group [47.6%]. As for the radiological features like presence of calcification, adenopathy and pleural effusions, observations made in this study were quite different from previous studies. Calcification was seen in 21.4% in comparison to previous reported incidence of 10%. Lymphadenopathy was seen only in 9.5% of our study patient in comparison to 83.3% of previous study done. Again pleural effusion in contrast to a reported incidence of 45-85% respectively was seen in 7.1% of our study patients. The tumor either due to local infiltration or due to metastases was mostly non-resectable at presentation [90%]. Resection was possible in three long bone PNET's, where amputation at the uninvolved proximal joint was done. This study analysis showed no difference with results obtained by others. However, the observed frequency of radiological features was very different to that reported in others studies. Again it was observed that the CT and MR findings of PNET are nonspecific and these imaging modalities help in delineating the local extent of the disease and metastatic spread. More multicenter studied are needed to support this study

Prevalence of hepatitis g virus [HGV] amongs blood donors in our population

Ali types of hepatitis are quiet common in our population. Hepatitis G Virus [HGV] infection is relatively new viral infection and a little work is done on it. The objective of this study is to find out prevalence HGV infection in blood donors [Professional and Volunteer blood donors]. It is a comparative study. This study was done at Abbasi Shaheed Hospital and KMDC, Karachi from 1[st] July 1995 to 30[th] June 1999. Three hundred seventy-one [371] blood donors were screened for HGV infection by Polymerase Chain Reaction [PCR] for HGV RNA. These blood donors includes 173 professionals and 198 volunteers. Three hundred seventy one [371] blood donors were screened for HGV with 05 [1.35%] positive cases. In professional donors group out 173 there were 04 [2.31%] positive for HGV where as in volunteer donor group only one [0.5%] was positive forHGV out of 198. All were male and highest positive cases for HGV were in 50-59 years age group in professional donors and 01[2.2%] in volunteer donor group. HGV infection is present in both professionals as well as volunteers donors with a ratio of 4:1. It is advisable to include HGV testing or screening mandatory for each blood bag before transfusing it to individual to minimize serious outcome of HGV infacture as people suffered from HBV, HCV and HIV

Sterile supply department of different hospitals and their sterilization testing profile

The objective of this study is to determine whether Sterile Supply Department [SSD] or Central Sterile Supply Department [CSSD] of different hospitals are performing sterilization testing profile as per international recommendation or not. Hospitals based cross sectional descriptive study. The study was conducted at different hospitals SSD or CSSD and their sterilization testing profile activities during January 1998 to June 2001. Seventy two hospitals with number of beds above 50 to less than 3000 were selected both from public and private sectors and their sterilization testing profile were recorded. 72. Number of beds above 50 and less than 3000 were included in this study. SPSS version. Number of beds less than 50 and more than 3000 were not included in this study. Total 72 hospitals were included in this study out of which 22 [30.5%] were from public sector and 50[69.5%] were from private sector. In public sector out of 22 hospitals only 01 [4.5%] was performing complete sterilization test profile at their SSD or CSSD and in private 05 [10.0%] out of 50 hospitals. There is significant difference in public and private hospitals. Sterilization testing profile P < 0.005 which is significant, yet both were not up to the mark. It seems from this study that private hospitals sterilization testing profile activity is more than twice as compare to public hospitals but we can not comprised on proper sterilization at both settings as this results in infection during procedures, government is requested to make some legislation on it

Surveillance of needle stick injuries [NSI] and sharp injuries at two centers in Pakistan

A base line studies to assess the Needle Stick Injuries [NSI] and sharp injuries and its outcome in health care providers. Descriptive study. Based on collection of relevant data spreading over a period of five years [from 1995-2000] from two tertiary care centers one public and other private. This study was conducted in 1342 healthcare workers [Public sector 612 and private sector 730]. Individuals comprising of doctors, nurses, laboratory technicians, operation theatre Staff and staff in other department of tertiary care centers. The method involved was proper filling of NSI Protocol form and informing directly concerned department and laboratory investigations for Hepatitis B Virus [HBV], Hepatitis C Virus [HCV] and Human Immunodeficiency Virus [HIV] at both the centers and additional Hepatitis G Virus [HGV] and culture at only one center [Public center]. Total positive cases at public sector hospital were 364 [59.5%] out of 612 and 317 [43.4%] out of 730 at private sector hospital. Out of 612 NSI cases there were 260 [42.5%] HBV, 64 [10.5%] HCV, 03 [0.5%] HGV 01[0.1%], bacterial infection 36[5.9%] and 248[40.5%] negative at public sector hospital. At private sector hospital out of 730 NSI cases there were 272 [37.3%] HBV, 42 [5.7%] HCV, 03 [0.4%] HIV and [413 56.6%] were negative. Data collected was analyzed by statistical tests. NSI is a major healthcare workers problem. It is necessary to deal with it amicably and effectively

Effectiveness and safety of herbal medicine for impotency

The aim of the study was to find out the effect of different natural herbal products on patients having impotence of unknown cause. A descriptive study. This study was conducted from January,2002 to December, 2003 in SOPD of Abbasi Shaheed Hospital, Karachi. This was hospital base study conducted in 50 patients of age ranging from 25-60 years attending Surgical Out Patients Department [SOPD] of Abbasi Shaheed Hospital, Karachi. The catchments area of hospital is mostly the district central Karachi with poor socio-economic status of the patients. The subjects included in the study were married active and healthy men. All individuals were proper clinical history along with examinations was recorded on proforma. Some specific investigations were done to rule out any cause of impotence and side effects were also recorded. Data collected was analyzed by statistical tests. The results were analyzed which showed that out of 50 patients 39 [78.0%] got benefit from the product, 08 [16%] had improvement in their symptoms while 03 [06%] had no improvement at all. These products Anacardium occidental, Asparagus descends, Cureuligo orchiodes, Orchis mascula and Macuna pruriens are natural herbal products gather in capsule known as Successor, which can be safely given to the patients having impotence of unknown cause. It has also been observed that there was some increased in sperm count on semen analysis seen in oligospermia cases. It can results in increase the motility and sperm count

Surveillance of toxoplasmosis in different groups

Two hundred and twenty three serum samples were screened for the antitoxoplasma antibodies of IgG type by a direct agglutination method, of these 78 [34.9%] were sero-positive. In high risk groups 71 [40.1%] of 177 cases were positive, while in the low risk groups 7[15.2%] out of 46 cases were positive. Seropositive males were more than females, and the disease increased steadily with age. Of the high risk group the prevalence of toxoplasmosis was 53.7% in immunocompromised group, 44.7% in animal handlers, 39.8% in pregnancy wastage group and 25.8% in a congenitally abnormal children. A high percentage prevalence of toxoplasmosis was noticed in high risk groups as compared with low risk group

Toxoplasmosis in children with congenital anomalies

Toxoplasma gondii sero-surveillance study was conducted in a total number of 48 children with or without congenital anomalies, out of which 9 [18.8%] were sero-positive. In children with congenital anomalies, out of 31 cases 8 [25.8%] were sero-positive, while only one [5.9%] seropositive case was noticed out of 17 normal children. All cases were tested for the presence of immunoglobulin of IgG type, specific for toxoplasma gondii by direct agglutination