Serological markers of Hepatitis B infection: a study to reduce cost and improve interpretation

Serological markers of hepatitis B infection are useful markers for the diagnosis and monitoring of infection, but complex interpretation and high cost limit their clinical usage in the developing world. The objective of the study was to develop simple and cost effective panels for the diagnosis of hepatitis B infection to improve its interpretation and reduce cost. All those persons who were serologically investigated for the diagnosis or exposure to Hepatitis B infection on a standard panel at the clinical laboratory of Liaquat National Hospital, Karachi during the period 1997-2002 and found reactive for any of these markers were included in the study. Six cost effective sub panels of different serological states of hepatitis B infection were developed and their efficiency and cost evaluated against the performance and cost of a standard panel of hepatitis B serological states. Out of 511 serological presentations of hepatitis B tests evaluated, 434[85%] presentations were easily interpretable on the standard panel and 475 [93%] on the proposed cost effective sub panels. Proposed sub panels reduced the cost ranging from 80% to 50% Appropriate and judicious selection of hepatitis B markers against the use of standard panel of 6 markers altogether can improve the interpretation of the test and reduce the cost effectively

Prevalent nosocomial gram negative bacilli and their sensitivities by mic's. an analysis of the data of Liaquat National Hospital-1999

To evaluate the prevalence of aerobic gram-negative bacilli and their sensitivity pattern, at Liaquat National Hospital Karachi, in the year 1999. Perspective collection of clinically significant 100 nosocomial gram-negative bacilli from ICU's. One hundred consecutive gram-negative isolates were identified by standard cultural methods and minimum inhibitory concentrations were checked, using E-Test strips. The samples were taken from Intensive Care Units between October and December 1999. The most frequent isolates were Escherichia coli 31 percent followed by Pseudomonas aeruginosa 22 percent, Klebsiella spp 18 percent, Proteus Mirabilis 13 percent, Pseudomonas spp 4 percent, Serratia spp 4 percent, Acinotobacter spp 3 percent. Most of the isolates of dominant species in the year 1999 that is E-Coli, Pseudomonas aeruginosa Proteus spp and Klebsiella spp were multi-resistant to Quinolones, Broad Spectrum Penicillin and cephalosporins [2nd, 3rd and also the 4th generation]. The study indicates that only imipenem has inhibited most of the isolates and susceptibility was 96 percent. Other antibiotics include broad-spectrum penicillins and quinolones have not inhibited more than 60 percent of the organisms. Therefore, imipenem represents a preferable emperic initial therapy when there is concern that an infection may be caused by a producer of ESBLs. Amikacin along with one broad spectrum B-lactam drug could be an another alternate