Efficacy of bronchial wash cytology and its correlation with biopsy in lung tumours

Objective: To evaluate bronchial wash cytology with histology in our set up

Material and Methods: Seventy three specimens were obtained by flexible fiberoptic bronchoscope at pulmonology department of Military Hospital Rawalpindi. All the preserved samples were processed under standard conditions. The slides were stained with Papanicolaou and Haematoxylin and Eosin stains

Results: A total of 73 patients were studied. The age range was 21 to 80 years . Male to female ratio was 8:1. Complete cytological and biopsy consensus was found in 55 [77.4%] cases. Cytology revealed 24 cases as malignant and nine as atypical/suspicious. Benign and inadequate were 29 and 2 respectively. Histopathology of these cases confirmed 24 [32.9%] as malignant and 29 [39.8%] as benign. True positive alongwith suspicious/atypical were 33 and true negative cases were 29. False positive was one case only whereas false negative cases were eight. The bronchial wash cytology showed sensitivity [80.5%], specificity [96.6%] and accuracy [87.3%]. Positive predictive value and negative predictive value were 97% and 78.4% respectively. The commonest types of tumours were squamous cell carcinoma and small cell carcinoma

Conclusion: It is concluded that bronchial wash cytology is a valuable tool and yields almost same information as biopsy. It is useful in patients with evidence of obstruction or risk of haemorrhage

Frequency of extended spectrum beta lactamase producing gram negative bacilli among clinical isolates at clinical laboratories of army medical college, Rawalpindi

Background: This study was carried out in Microbiology department of Army Medical College, Rawalpindi to find out the frequency of extended spectrum beta lactamase producing gram negative bacilli among clinical isolates recovered from clinical specimens received from Military Hospital, Rawalpindi

Methods: This study was carried out from 1[st] Jan 2002 to 30[th] Dec 2002. A total of 812 consecutive Gram-negative bacilli were recovered during the study period from various samples including urine, blood, pus, sputum, high vaginal swab [HVS], aspirates, i/v canula/ Central venous lines [CVP], chest tubes and catheter tips. Extended spectrum beta lactamase detection in these isolates was carried out by Kirby Bauer disc diffusion method on Mueller Hinton agar. A susceptibility disk containing amoxicillin-clavulanate was placed as the inhibitor of beta lactamase in the center of the plate, and cefotaxime, ceftazidime, ceftriaxone and aztreonam disks were placed 30 mm [center to center] from the amoxicillin-clavulanate disk. Enhancement of the zone of inhibition of the oxyimino-beta-lactam caused by the synergy of the clavulanate in the amoxicillin-clavulanate disk was considered as evidence of ESBL production. Escherichia coli ATCC 25922 and K. pneumonia ATCC 700603 were used as control strains

Results: The frequency of ESBL producing gram negative bacilli among the clinical isolates was 45%

Changing epidemiology and sensitivity pattern of vibrio cholerae at Rawalpindi

Objective: To establish the serotypes of Vibrio cholerae [VC] endemic in our set up and to determine the sensitivity pattern of the organism

Methods: The study was carried out on 123 isolates of Vibrio cholerae isolated from stool samples of patients of diarrhea. Samples were collected in plain containers/alkaline peptone water. Inoculation was done on TCBS agar, McConkey's agar and Salmonella Shigella agar. Identification of the organisms was based on, sucrose fermentation on TCBS agar a positive oxidase test and biochemical profile by API 20 E galleries. Serological confirmation was done by standard antisera. Biotypes were confirmed by Voges-Proskauer [vp] reaction, Polymixin B [50 i.u] sensitivity and sheep red cell haemolysis. Antibiotic sensitivity was carried out against Ampicillin, Tetracycline, Trimethoprim/Sulphamethoxazole, Erythromicin, Nalidixic acid, Ofloxacin and Ciprofloxacin by Kirby Bauer disc diffusion technique

Results: A total of 123 isolates recovered during the period 1997-2002 were studied. All strains belonged to sero type O1. Till 1998 all strains were of biotype EL Tor. Classical biotype appeared in 1999 and remained the dominant variety during 2000-2001. Year wise comparison of the antimicrobial sensitivity pattern shows that resistance to Nalidixic acid emerged in 1999 and is uniformly continuing whereas resistance to Ampicillin and Tetracycline has fallen to very low levels. No isolate was resistant to the fluoroquinolones

Conclusion: 1. Vibrio cholerae O1 is endemic in Rawalpindi. 2. EL Tor was the biotype causing epidemics predominantly in our set up till 1998. Now the Classical variety has emerged and both types are probably co-existing. 3. All the isolates in our study were completely resistant to Nalidixic acid but sensitive to the fluoroquinolones and Erythromycin. Ampicillin and Tetracycline which were earlier resistant have reverted to sensitive

current susceptibility patterns of methicillin resistant staphylococcus aureus to conventional anti staphylococcus antimicrobials at Rawalpindi

Objective: To evaluate current susceptibility of MRSA to commonly used anti-staphylococcus antimicrobials at Rawalpindi. Design: An observational study

Place and duration of study: Pathology Laboratories, Army Medical College, Rawalpindi during the period January 2001 to January 2004

Material and Methods: One hundred eighty five consecutive, non-duplicate strains of Methicillin resistant Staphylococcus aureus [MRSA] isolated from different clinical samples were identified by standard microbiological methodology between January 2001 and January 2004. They were studied for their susceptibility to co-trimoxazole, erythromycin, tetracycline, gentamicin, chloramphenicol, ciprofloxacin, and vancomycin by disc diffusion technique using modified Kirby-Bauer method

Results: All the MRSA were sensitive to vancomycin. Approximately 38.3% strains revealed resistance to chloramphenicol, 77.2% to co-trimoxazole, 89.7% to erythromycin, 88.6% to tetracycline, 97.8% to gentamicin and 98.9% to ciprofloxacin

Conclusion: Most of the MRSA were multidrug resistant. These strains revealed higher degree of resistance [>75%] to routine anti-staphylococcus antimicrobials in comparison to the previous study of 1985- 87. The p-values have been highly significant in case of erythromycin, tetracycline, gentamicin, fluroquinolone and vancomycin. The p-values in case of chloramphenicol has not been significant. Vancomycin is yet a life saving anti-staphylococcus antimicrobial in MRSA infections in Rawalpindi

ESBL producing Nosocomial Enterobacteria isolated from clinical specimens detected by double disc diffusion method

To identify extended spectrum betalactamases [ESBL] producing organisms of Enterobacteriacae family from clinical specimens. Simple descriptive study Setting: The study was carried out in Microbiology Department of Army Medical College, Rawalpindi from 1 Jan 02 to 31 Dec 02 on clinical samples received from admitted patients in Military hospital, Rawalpindi Samples consisting of urine, blood, high vaginal swabs, catheter tips, fluids including CSF, sputum, chest tube, [HVS] and IV canula central vascular line specimens received for routine culture from outpatient as well as indoor cases of Rawalpindi/Islamabad. The samples were inoculated on Blood agar and Mac Conkeys agar [chocolate agar was also used for sputum and CSF]. Urine samples were cultured on CLED agar. The samples were incubated at 37C under aerobic conditions. 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 37°C in ambient air for 24 hrs. ESBL producing strains were identified by double disc diffusion method test according to Jarlier et al [1988]. Clavulanate was applied as the inhibitor of beta lactamases [AMO/CLAY disc].The results were tabulated as frequencies. 1. Forty seven percent of clinical isolates yielded ESBL producing enterobacteria. 2. Enterobacter cloacae, Klebsiella oxytoca, Proteus mirabilis and Klebsiella pneuumoniae were the most frequent ESBL producing bacteria. These bacteria were frequently recovered in fluids, drainage tubes/ catheter tips and canulas

Frequency of campylobacter jejuni in diarrhoea/dysentery in chidren in Rawalpindi and Islamabad

To determine the frequencyof Campylobacter jejuni infection in children suffering from diarrhoea/dysentery in the Department of Microbiology, Army Medical College and Military Hospital, Rawalpindi, from 29 August 2002 to 29 November 2002.The study was carried out on one hundred stool samples of children up to the age of twelve years admitted with diarrhoea/dysentery in Military hospital, Rawalpindi. The samples were collected in clean polypropylene containers containing Cary Blair medium. These were transported to the Microbiology Department, Army Medical College, Rawalpindi within 1-2 hours. The samples were inoculated on Modified Preston [Oxoid] and Karmali media [Oxoid] beside other routine stool culture media. The cultures were incubated at 42oC under microaerophilic conditions. The growth after 48 hours was provisionally identified by colonial morphology, oxidase test, Gram staining and motility. The organisms were identified to species level by hippurate hydrolysis, urease test, nitrate reduction, catalase test, H2S production and resistance to cephalothin.Eighteen% of samples yielded the growth of Campylobacter jejuni. Mean age of children with Campylobacter jejuni infection was 18 months with peak incidence from 12 to 21 months. Male female ratio was 1.7:1. All the children had loose motions. Seven out 18 [39%] had a combination of symptoms of loose motions, vomiting and pain abdomen. Those having fever with or without other complaints constituted 11 out of 18 [61.11%] i.e. more than 50% of all the children yielding C. jejuni had fever. About 90% of diarrhoeal stools had blood and fifty% also had mucous. There was either history of chicken meat consumption or contact with cattle and pets in most of the cases and both in some of them.Campylobacter jejuni is a frequent cause of diarrhoea/ dysentery in children in our set up. In children it is often related to pets keeping and chicken meat consumption. In the remaining, untreated drinking water may be the source. Campylobacter jejuni frequently presents with blood and mucous in stools with sporadic cases presenting with watery diarrhoea

Co-activation of Gi and Gq proteins exerts synergistic effect on human platelet aggregation through activation of phospholipase C and Ca2+ signalling pathways

Our previous studies have shown that subthreshold concentrations of two platelet agonists exert synergistic effects on platelet aggregation. Here we studied the mechanism of synergistic interaction of 5-hydroxytryptamine (5-HT) and epinephrine mediated platelet aggregation. We show that 5-HT had no or little effect on aggregation but it did potentiate the aggregation response of epinephrine. The synergistic interaction of 5-HT (1-5 microM) and epinephrine (0.5-2 microM) was inhibited by alpha2-adrenoceptor blocker (yohimbine; IC50= 0.4 microM), calcium channel blockers (verapamil and diltiazem with IC50 of 10 and 48 mM, respectively), PLC inhibitor (U73122; IC50=6 microM) and nitric oxide (NO) donor, SNAP (IC50=1.6 microM)). The data suggest that synergistic effects of platelet agonists are receptor-mediated and occur through multiple signalling pathways including the activation PLC/Ca2+ signalling cascades.

BCG lymphadenitis: a study of knowledge attitude and practice of mothers, including effect on completion of vaccination schedule

Lymphadenitis occurs as a complication in some children who have been administered BCG vaccine. The purpose of this study was to find out the knowledge that mothers/ guardians possessed about this adverse effect; their attitude regarding other vaccinations and their practice in treating adentitis. A total of 103 mothers were questioned at the outpatient department of the Sindh Government Hospital, Korangi, Karachi. 60.2% mothers did not know about the cause of swelling, 78.6% described it as a "Dana". 36.9% of mothers with knowledge about it had been informed by doctors or paramedics. 48.5% mothers had delayed completing the vaccination series, of whom 75.6% had been advised to do so by medical personnel. 91.3% patients had not been given any treatment prior to coming to the hospital. The delay in completion of vaccination though not statistically significant, is important enough to be evaluated in a multicentric controlled study. This will ensure that the expanded programme of immunization is a complete success