Prevalence of Bronchial Asthma in School Going Children: A Cross-Sectional Study from Uttar Pradesh

Background: Asthma is coined as a chronic inflammatory disorder and disarrays of the airways and respiratory tract which manifests as recurrent episodes of wheezing, breathlessness, chest tightness, and cough. The World Health Organization recognizes asthma as a major health problem. Although asthma can occur at any age, children and young adults are the age groups which are affected more commonly. Objectives: The objective of this study is to find the prevalence of bronchial asthma in school?going children (6–16 years) and its associated factors. Materials and Methods: A cross?sectional study among the school?going children in the age group of 6–16 years was done in the field practice areas of urban health and training center and rural health and training center of the Department of Community Medicine, JNMCH, A. M. U., Aligarh, U.P. the study done for a period of one year. The validated questionnaire (International Study on Allergy and Asthma in Childhood) was used. The sample size was taken as 902. The data were entered and analyzed in the SPSS statistical software version 20.0. Chi-square was used. Results: The prevalence of asthma among the study population was found to be 26.9%. Family history of smoking and history of allergy in an individual came out to be a significant factor associated with asthma. The association is also significant between asthma and the diet of an individual. Conclusions: Asthma among school children is a public health problem in urban and rural areas. There was a rising pattern in the prevalence of asthma at national and subnational levels.

Concept of cervical ectopy/Quruhal Rahim in Unani system of medicine: a review

Cervical ectopy is one of the commonest gynecological conditions seen in OPD’s, about 80-85% of women suffer from cervical ectopy during their life time. Many a times, it is an accidental finding in an asymptomatic woman coming for routine gynecological examination. Although it is a benign lesion, but may predispose to complications like infertility, cervical intraepithelial neoplasm, risk of various sexually transmitted infections like C. trachomatis, N. gonorrhoea, human papilloma virus, human immunodeficiency virus, cytomegalovirus and shows malignant changes as it progresses. Ectopy occurs when the columnar epithelium lining the endocervix, extends onto the ectocervix. As the disease takes 10-20 years to progress from pre invasive to invasive disease, preventive measures such as screening and treatment modalities should be adopted. Early diagnosis of cervical ectopy is important for its effective management and for prevention of its long-term sequel. The treatment option available in conventional medicine includes surgical procedure either electro or, cryocautery, but have their own complications. Hence, this treatment is limited due to its complications and contraindications and need for safer alternate therapy. In Unani system of medicine, various formulations are available as treatment of quruhal rahim, which have been recommended to be used locally in the form of humool for immediate healing of wound, exhibiting the properties of anti-inflammatory (muhallile warm), desiccant (mujaffif), wound healing (mundamile qurooh), sedative (musakkin), antiseptic (dafa’e ta’ffun) etc. This review article gives a detailed description of cervical ectopy as mentioned in classical Unani text including its etiopathogenesis, clinical presentation and principles of treatment as well as evidence-based Unani medicine.

Indications and effectiveness of arthroscopic lavage and debridement in osteoarthritis knee

Background: Degenerative joint disease will afflict most of the people if they live long enough. The majority of patients with osteoarthritis present to orthopaedic surgeons seeking relief of pain and associated restoration of function. Various intraarticular and periarticular structures may be the cause of pain. Improvement in osteoarthritis by arthroscopic lavage and debridement is seen due to various mechanisms.Methods: In a prospective study from July 2016 to December 2018, 35 patients with primary osteoarthritis knee were assessed for effectiveness of arthroscopic lavage and debridement in relieving symptoms of osteoarthritis of knee and to determine the indications of arthroscopy in osteoarthritis of knee. Assessment was done using variables as age of the patient, body mass index, varus deformity, radiographic grading and arthroscopic grading.Results: A declining trend was seen on follow up over time; 91.4% excellent to good results seen at one month follow up, 76.1% at six months, 49.93% at twelve months, 37.5%, at eighteen months, 23.07% at twenty-four months and 28.5% at thirty months. Results at six month follow up when compared, were better for age less than 50 years (88.8% Vs 73.1% in >50 years age), normal weight patients with BMI 18.5 to 25(94.5% Vs 58.5% in overweight), varus angulation <100(93.1% Vs 0% in >100), radiological grade I and II (95-100% Vs 45-50% in grade III and IV) and arthroscopic grade I and II (94-100% Vs 0-77% in grade III and IV).Conclusions: Arthroscopic lavage and debridement is an effective method of treatment for osteoarthritis knee in patients with grade I and grade II osteoarthritis having symptoms of pain and locking due to loose bodies or degenerative meniscal tears.

Fingertip reconstruction: study of functional and cosmetic results of various local flaps and grafting techniques in patients attending a tertiary care center in North India

Background: Finger injuries are becoming more common with the increasing use of mechanical, industrial, and household appliances. There are six main types of repair for this injury. The replacement of skin loss in digital injuries, particularly on the volar aspects, is an important part of hand-injury management. It would be of value to know the best type of cover, especially for sensory reinnervation as well as for subjective evaluation, cosmetic appearance and freedom from complications. The objective of this study was to measure incidence of age, sex, site, pattern of injury as well as to evaluate and compare the functional and cosmetic results of the various local flap and grafting techniques in finger reconstruction distal to metacarpophalangeal joint.Methods: In a prospective study between May 2014 to October 2018 consisting of 50 patients (43 males, 7 females), aged between 2 years and 54 years, with soft tissue loss distal to metacarpophalangeal joint were treated with either free split-thickness skin grafts, palmar flaps, cross-finger flap or pedicle flaps from the abdomen. The follow-up period ranged from 10 days to 15 months from the date of surgery. Subjective and objective evaluation was done and graded as excellent, good, fair and poor.Results: In this series there were 2 good and 6 fair results for split skin grafting; 9 good and 6 fair results for v-y plasty; 5 excellent, 12 good and 4 fair results for cross finger flap; 1 good and 1 fair result for radial artery based flap; 1 excellent and 1 good for first metacarpal artery based flap and 2 good results for abdominal flap. Overall 6(12%) had excellent, 27(54%) had good and 17(34%) had fair results. None of them had poor results.Conclusions: The group of patients with cross-finger flaps had less subjective complaints and more normal objective testing results than the other groups. When an extensive tactile pad avulsion exists, the cross-finger pedicle flap offers the best long-term result with fewer secondary problems. The exclusive use of any one method cannot be advocated since each serves an useful purpose under proper conditions.

A Prospective Comparative Clinical Study on Repair of Paraumbilical Hernias with Mayo’s and Mesh Techniques and their Postoperative Complications

Background: “Paraumbilical hernia” occurs through Linea Alba either above or below umbilicus. The current trend is to use a mesh forthe repair irrespective of the size. The conventional suture method of Mayo’s is also being practiced in various centers. An attempt ismade in this study to compare both the methods especially in relation to their post-operative complications in the long-term follow-up.Aim of the Study: The aim of the study to study and compare Mayo’s method and use of mesh technique in the surgicalmanagement of repair of paraumbilical hernias in relation to their post-operative complications.Materials and Methods: A cross-sectional prospective clinical study was conducted in the Department of General Surgeryof Malabar Medical College Hospital, Modakkallur. Atholi, Kozhikode, Kerala, wherein 58 patients undergoing surgery forparaumbilical hernia were included in the study. The patients were assigned to these groups using random numbers from www.randomizer.org. The patients belonging to Group A were subjected to Mayo’s operation and Group B were subjected to Meshtechnique. All the patients were asked thorough history taking followed by investigations of surgical profile before undertakingthe surgery. All the patients were followed up from day 1 postoperatively for 2 years.Observations and Results: A total of 58 patients with paraumbilical hernia were divided into 2 equal groups comprising of29 each. The mean age in Group A was 43.65 ± 4.10 years and in Group B was 44.60 ± 3.20 years. There were 18 femalesand 11 males in Group A and 17 females and 12 males in Group B. The patients belonging to the age group of 33–62 yearswere 21/29 (72.41%) in group A and 23/29 (79.31%) in Group B. There was no statistical significance in the incidence amongthe two groups as P = 0.153 (P taken significantly at <0.05). The male to female ratio in Group A was 1:1.63 and 1:1.41 inGroup B. Pain was complained in the post-operative period in 19/29 (65.51%) patients in Group A and 16/29 (55.17%) patientsin Group B. Hematoma was observed in 5/29 (17.24%) patients in Group A and 7/29 (24.13%) patients in Group B. Seromawas observed in 4/29 (13.79%) patients in Group A and 3/29 (10.34%) patients in Group B.Conclusions: In a follow-up of 2 months to years, among the procedures used classical Mayo’s repair had 4/29 recurrencesand 1/29 were noted in patients underwent mesh repair. Even though Mayo’s repair for paraumbilical has been the procedureof choice in many centers, but the tension-free mesh repair has an advantage of having no recurrences and can be used in thepresence of bigger defect and weaker abdominal muscle tone, thus showing a superior and favorable procedure than Mayo’s repair.

Evaluation of cepheid GeneXpert MTB/RIF assay for Mycobacterium tuberculosis detection and rifampicin resistance in clinical specimen

Background: Timely diagnosis and treatment of tuberculosis is important to treat the disease and to reduce transmission. The WHO recommends using GeneXpert MTB in developing, high-burden countries.  A study was conducted to evaluate the performance of Xpert assay for the detection of M. tuberculosis and rifampicin resistance in clinical specimen.Methods: About 615 consecutive samples were simultaneously subjected to culture and phenotypic drug susceptibility test for M. tuberculosis and analysis by GeneXpert assay. Confirmed Mycobacterium tuberculosis in a positive culture was used as a reference standard for TB diagnosis.Results: The assay achieved a sensitivity of 96.75% (268/277) and 76.47% (26/34) for smear positive and smear negative pulmonary specimen respectively. In extrapulmonary specimen, the sensitivity was 50% (1/2) and 42.8% (3/7) for smear positive and smear negative specimen respectively. An additional 48 M. tuberculosis were detected by Xpert assay which were smear and culture negative. The Xpert assay identified 100% of the phenotypic rifampicin susceptible isolates and 74.19% of the phenotypic rifampicin resistant isolates. Discordant results were seen in 8 (2.76%) isolates. 6 of these isolates were confirmed to be rifampicin resistant by the reference lab.Conclusions: Present study indicates that Xpert MTB/RIF assay is an effective and rapid tool for the rapid diagnosis of Mycobacterium tuberculosis. The sensitivity is comparable to culture in smear positive specimen but less sensitive than culture for smear negative specimen. In cases with high index of suspicion or discordance for rifampicin results, confirmation should be done by other methods due to false negative results on Xpert assay.

Elder abuse among residents of Shivamogga: a cross sectional study

Background: As per the WHO estimates the global population of people aged 60 years and above will increase from 900 million in 2015 to about 2 billion in 2050. Abuse of elderly has become a problem even in India. Due to social taboo, the elder abuse at community setting is usually not reported. Even though elder abuse is an important public health problem, very little is known about the extent of abuse especially in developing countries. Methods: A community based cross-sectional study was conducted in Shivamogga. A total of 200 elderly persons were interviewed using a pretested semi structured questionnaire. The person showing suggestive score was further asked about type of abuse and perpetrator of mistreatment. Results: Our study showed total prevalence of elder abuse in the community to be 24%. The extent of abuse was more among females especially the housewives. The most common type of abuse was verbal abuse followed by psychological abuse. Son was the common perpetrator of mistreatment. Conclusions: Elder abuse is much prevalent in the community. There is a need for further studies to generalise the findings.

Repair of an Iatrogenic Furcal Perforation with Mineral Trioxide Aggregate: A Case Report with 6-Month Follow-Up

Furcal perforations are significant iatrogenic complications of endodontic treatment and could lead to endodontic failure.Successful treatment depends on the immediate sealing of the perforation and prevention of infection. Several materials usedinitially to repair the perforation were considered inadequate due to their bacterial leakage and lack of biocompatibility to theunderlying tissues. Recently, mineral trioxide aggregate (MTA) has been regarded as an ideal material for perforation repair,retrograde filling, pulp capping, and apexification. Successful management of an iatrogenic furcal perforation using MTA onmandibular first molar is described in this case report. The tooth was endodontically treated and coronally restored with resincomposite. After 6 months, the absence of periradicular radiolucent lesion indicated a successful outcome of sealing the furcalperforation using MTA.

Comparing the profile of respiratory fungal pathogens amongst immunocompetent and immunocompromised hosts, their susceptibility pattern and correlation of various opportunistic respiratory fungal infections and their progression in relation to the CD4+T-cell counts

Introduction: Invasive fungal infections are increasingly common in the nosocomial setting. Materials and Methods: The patients were divided into two groups immunocompetent and immunocompromised that is, patients with significant neutropenia <500 neutrophils/?l for longer than 10 days. microscopy, culture, identification of isolates were done and some specilised tests on serum and BAL for antigen detection were performed. Results: Majority of the patients were young adult males in this study. A higher prevalence of 26.7% was seen in immunocompromised patients. Amongst yeasts, Candida albicans was the predominant species followed by the National AIDS Control that is, Candida glabrata, Candida dubliniensis, Candida parapsilosis and Candida tropicalis in the same order. Amongst moulds, Aspergillus fumigatus was the most common species followed by Aspergillus flavus and Aspergillus niger. Mucor and Penicillium marneffei were seen in a lower prevalence. By Broth microdilution method, isolates of Candida spp. were most sensitive to caspofungin, amphotericin B, ketoconazole and fluconazole in the same order. Isolates of Aspergillus spp. were most sensitive to caspofungin, amphotericin B and itraconazole in the same order. By disc diffusion method, resistance to fluconazole was observed in 6.9% isolates of C. albicans. 50% of C. dubliniensis and 20% of C. glabrata showed resistance to fluconazole. A total mortality of 27.7% was observed during this study. This was distributed as 24.1%, 26.7%, 50%, 50%, 100% and 0% among by patients of candidiasis, aspergillosis, cryptococcosis, pneumocystosis, mucormycosis and penicilliosis. Fifteen per cent were lost to follow-up. Conclusion: Patterns of invasive fungal infections are changing in many ways. In the midst of these evolving trends, IFI of the respiratory tractcontinue to remain important causes of morbidity and mortality. Diagnostic tools can be adequately used only if the treating physician is aware of the propensity of patients to acquire a fungal infection. Thus, continuous awareness and education is crucial for successful management of patients. Judicious use of antifungal medications as prophylactic measures must be employed, particularly in the critically ill and patients of HIV.

The first series of laparoscopic radical cystectomies done in South Africa

Background: Radical cystectomy (RC) with extended lymphadenectomy and urinary diversion remains the standard of care for muscle-invasive urothelial carcinoma. Laparoscopic radical cystectomies (LRC) have been performed at Groote Schuur Hospital (GSH) since 2009. We aimed to audit our data regarding complications and oncological outcome and compare it to data obtained from patients undergoing open radical cystectomy (ORC) by the same surgeon since 2007.Methods: All adult patients who underwent open and laparoscopic RC from 2007 to 2013 have been included in the study. Data on demographics, operative time, intraoperative blood loss, postoperative complications, margin positivity, and lymph nodes was obtained retrospectively by means of folder review.Results: Thirty (30) patients who underwent LRC and 32 who underwent ORC were included in the study. Participants undergoing ORC experienced shorter operative duration (301 minutes versus 382 minutes; p-value < 0.0001), increased blood loss (1376 ml versus 779ml; p-value = 0.0023) and transfusion requirement (2 units versus 0; p-value = 0.071) in contrast to LRC. Postoperative complications were more prevalent in the ORC arm compared to the LRC arm (61% versus 43%). Patients with a past medical history were at higher risk of experiencing postoperative complications (p-value = 0.04; Risk Ratio: 1.6). Margin positivity was comparable between the two arms. A higher number of nodes was sampled by the laparoscopic technique in this study (overall p-value = 0.07).Conclusion: Laparoscopic RC is associated with longer operative times, decreased blood loss, and equivalent oncological outcomes when compared to ORC. Laparoscopic RC is a feasible option in our setting

In-Vitro Transcription analysis of NSSAfrom HCV-3a circulating in Pakistani patients with chronic hepatitis C and their differential response to antiviral therapy

Objective: Mutations in HCV nonstructural protein 5A [NS5A] play a vital role in virus resistance The aim of this study was to develop a correlation between NS5A mutations [genotype 3a] and virolosical response towards interferon alpha [IFN-alpha] plus ribavirin therapy

Methods: In this study, which was conducted from 09-02-2013 to 25-11-2015 in the rural area of Province Smdh - Pakistan, total patients' responses to peg-IFN therapy were investigated. Patients were given peg-IFN therapy for 24 to 48 weeks and categorized as sustained virologic responders [SVR] or non-responders [NR] to HCV infection. HCV NS5A region [2215-2335] of genotype 3a was identified in both responders and non-responders

Results: Twenty-four NR with 24 SVR isolates showed significant mutations within the nonstructural protein 5A region in HCV genotype 3a. The New Zealand [NZL1] [GenBank D17763] differences were observed by using gene. The ISDR mutations for nonstructural protein 5A in non-responders have been reported as a possible explanation of HCV interferon resistance

Conclusion: Based on these results, it is suggested that decreased SVR is caused by the increased mutations in nonstructural protein 5A sequences. When the sequence outside the Protein kinases R binding domain [PKRBD] [2281-2335] was examined, significant differentiations were observed among the SVR and NR classes at few amino acid strains

Serous Surface Papillary Adenocarcinoma: a rare variant of serous carcinoma - report of two cases.

Serous tumors constitute about 25% of all ovarian tumors. Serous adenocarcinomas are the commonest form of the malignant epithelial ovarian tumors accounting for 26% of the cases. The commonest morphologic form is the cystadenocarcinoma. Serous surface papillary adenocarcinoma is a very rare morphologic entity which is often bilateral and highly aggressive. Reports showing an exact incidence are not available in literature. We present a case of serous surface papillary adenocarcinoma confined to ovary.

Hemiplegia following mild head injury in a child with Sturge-Weber syndrome - a diagnostic dilemma

Sturge-Weber syndrome [SWS] is a neurocutaneous disorder with skin, eye, and brain involvement. Hemiplegia in children with SWS after a mild head injury is known to occur in up to one-fifth of cases. A 3-year male child presented with a sudden onset hemiplegia following a mild head injury. He was known to have seizure disorder and was being treated with sodium valproate. CT scan of the brain showed contusion. He was admitted for neurological observations and the patient made complete recovery with conservative treatment. MRI scan of the brain done 5 days later which showed venous malformation of choroid plexus on the left side. These changes were considered to be consistent with a preexisting cerebral lesion which coincidentally got detected at neuroimaging done after the mild head injury. There is need for good seizure control as it is likely to be associated with better neurological outcome. The case emphasizes the need for clinical correlation with findings at neuroimaging in children with SWS presenting with head injuries

value of diffusion weighted magnetic resonance imaging 3 tesla in detection and staging of bladder carcinoma

Background: To evaluate the value of diffusion weighted magnetic resonance imaging [DWMRI] in detection and T- staging of bladder carcinoma and correlation with histopathological staging

Patients and Methods: An analytic prospective study was conducted at the MRI units of Al-yarmook teaching hospital in the period from January of 2015 to December 2015, 42patients [36 male and 6 female] presented with hematuria [40 patients] and 2 patients presented with pelvic pain were enrolled prospectively, they underwent conventional magnetic imaging [MRI] and diffusion weighted MRI using 3 tesla MR units [Achieva; Philips medical systems, the Netherlands]. Diffusion weighted images were obtained using a single shot echo planar imaging sequence EPI with b value 0,500 sec/mm [2]. ADC value map was reconstructed and mean ADC value were measured in 42 patients .and histological examination was done to all patients

Results: Correlation between standard MR staging of bladder carcinoma and histopathological results revealed that 17 patients [40%] had the same T -staging while 17 patients [40%] over staged. DWI and ADC values were able to declare the cause of overstating by discrimination between tumoral tissue and peritumoral inflammation. Statistically significant difference is found between ADC value of bladder tumor and those of urine

Conclusion: Diffusion weighted MR imaging at 3 tesla is new and good imaging modalities for detection and staging of bladder carcinoma, without using contrast media, so can used in patient with renal impairment or contrast media allergy

Molecular epidemiology and clinical features of Hepatitis C Virus [HCV] in epidemic areas of Interior Sindh, Pakistan

Objective: Highly variable genome of HCV and high prevalence in many geographical areas made it necessary to conduct local population studies. This study has been conducted to show HCV parameters along with clinical features in the local population of interior Sindh, province of Pakistan

Methods:Present study was conducted in from August 2010 to November 2015 in the rural areas of Sindh, Pakistan. All the 31560 screened samples selected for the study were tested by second Generation Enzyme Linked Immunosorbent Assay [ELISA Biokit 480and96]

Results:Total 31560 people were screened for HCV and out of these 13.67% [n= 4314] HCV infected patients. When 4314 samples of patients were examined; the anti-HCV was significantly higher in males 2814 [14.98%] than in females 1500 [11.74%] with P value = 0.06. The age of the patients ranged from 18 to 65 years. Out of 4314 HCV samples, 3020 [70%] were of Genotype 3a, 237[5.5%] of Genotype 2a, 108 [2.5%] of Genotype- 1a, 216 [5%] of Genotype 1b, 237 [5.5%] of Genotype 3b and 43 [1%] of Genotype 4. Additionally, 108 [2.5%] had co-infection and 345 [8%] samples showed no result-designated as untypable by the genotyping

Conclusion:This study showed that HCV is most frequently reported disease with genotype 3a being the most prevalent genotype

Frequency and Sensitivity of Extended Spectrum Beta-Lactamase Positive Organisms in a Secondary and Tertiary Level Hospital Network in Dhaka.

Background: Extended spectrum β-lactamase (ESBL) positive organisms are now a global health concern including in Bangladesh. These are associated with treatment failure, increased morbidity and mortality and increased health care costs. In this study, frequency of ESBL positive organisms in some health care centres in Dhaka city has been observed and their current status of antibiogram has also been observed. Objective: To observe the current status of antibiogram of ESBL positive organisms. Materials and Methods: This cross-sectional study was done in the Department of Microbiology, Bangladesh Institute of Health Sciences (BIHS) General Hospital, Dhaka, Bangladesh from March, 2012 to February, 2013. Only E. coli and Klebsiella spp. from pus and urine specimens were included in this study. Isolation, identification and antibiotic sensitivity of the organisms were done by standard procedures. Results: Organisms (Escherichia coli and Klebsiella spp.) isolated from urine and pus collected from different sites of 472 subjects were studied. Predominant organisms were Escherichia coli (82.8%) and remaining 17.2% were Klebsiella spp. ESBL positive organisms were higher in Escherichia coli (54.5%) than in Klebsiella spp. (44.4%) and higher in pus (77.0%) than in urine (49.1%) isolates. Imipenem is the most effective drug for treating ESBL positive organisms followed by colistin, tigecycline and piperacillin/tazobactam. Conclusion: Imipenem, colistin, tigecycline and piperacillin/tazobactam drugs should be kept reserved and used only when other effective drugs are not available so that emergence of resistance against these drugs is deferred. While reporting the culture and sensitivity tests, the ESBL positive organisms should be pointed out with comment like this – “The organisms are ESBL positive and resistant to penicillins, cephalosporins and monobactams”.

SPECIATION AND ANTIBIOGRAM PATTERN OF TRIBE PROTEEAE WITH SPECIAL REFERENCE TO EXTENDED SPECTRUM BETA LACTAMASE (ESBL) AND CARBAPENEMASE DETECTION

Background:Proteusis a common uropathogen causing urinary tract infections in catheterised patients and those with urinary tract abnormalities. It may also lead to pyelonephritis, renal stones & bacteraemia. Multidrug resistant Proteeae isolates are major problem in treating nosocomial infections. Beta lactamase production is being increasingly demonstrated in most of the Proteus species. Apart from ESBL, Carbapenemase production is also emerging, thereby limiting the treatment options. Aim: To isolate, speciate and study the antibiotic resistance pattern of the Proteeae isolates. To identify the extended spectrum beta lactamase andcarbapenemase producing strains of Proteeae isolates by employing phenotypic methods. Materials and Methods: A total of 145 isolates of Proteus species isolated from different clinical samples- urine, pus and sputum, were included in this study. Antibiotic sensitivity testing was performed by Kirby-Bauer disk diffusion method. Screening tests for ESBL &Carbapenemase production was confirmed by Disk diffusion method and Modified Hodge test respectively. Results: Out of the 145 Proteeae isolates, from various clinical samples 70 were from wound swabs, 62 from urine, and 13 from respiratory specimens. The species were identified as 64 P.mirabilis, 48 P.vulgaris, 19 M.morganii, 5 Prov.stuartii and 9 Prov.rettgeri.Different antibiotic resistance patterns were observed in different species. Providencia species showed resistance to most of the antibiotics than the Proteus species and M morganii. Of the total, 52 (36%) were ESBL producers. Among the ESBL producers 6 (11.5%) were Carbapenamase producers. Conclusion: The increasing incidence of multi drug resistant strains in Tribe Proteeae has made antimicrobial susceptibility testing more important. Avoidance of indiscriminate use of antibiotics is the first step in prevention of newly emerging drug resistant strains.

Association of hyperuricemia with metabolic syndrome

Uric acid levels are often increased in subjects with metabolic syndrome but it is unclear whether it plays a causal role or it is a marker for metabolic syndrome. To find the association of hyperuricemia with various components of metabolic syndrome. The cross sectional analytical study was carried out in Sir Ganga Ram Hospital, Lahore, Pakistan. Total 600 subjects of both genders aged 30-70 years were recruited in the study. Demographic, clinical and biochemical variables were recorded by using a questionnaire. Fasting blood sample was used to estimate plasma glucose, serum lipid profile and uric acid. The cut-off for hyperuricemia was serum uric acid level >/=7.0 mg/dl for males and >/=5.7 mg/dl for females. Metabolic syndrome was diagnosed if subjects had any 3 of the 5 criteria described as per ATP III guidelines. The data was analyzed using SPSS Version 20. The study included 216 [36%] males and 384 [64%] females with mean age 47 +/- 10 years. Out of total 447 subjects, 62 [13.9%] with metabolic syndrome had hyperuricemia. Whereas 62 [75.6%] subjects out of total 82 subjects with hyperuricemia had metabolic syndrome. Different parameters of metabolic syndrome were statistically correlated with hyperuricemia but none showed significant correlation. Chi square and Wald Statistic [Logistic regression algorithm] showed that by using G-to-S [general to specific] approach hyperuricemia was significantly associated with female gender but did not show any association with metabolic syndrome. There was no association present between metabolic syndrome and hyperuricemia; therefore uric acid levels might not be important in the diagnosis of metabolic syndrome

COPD in Non-smokers-Prevalence and Risk Factors.

Studies on COPD have largely focused on the smoking rather than the non-smoking population. Hence we conducted the study to identify the non-smoking causes of COPD. The study was conducted in the Department of Tuberculosis and Respiratory Diseases, Jawaharlal Nehru Medical College, AMU, Aligarh during 2011-2013 on 450 COPD patients. The aim of the study was to find out proportion of non smokers among all COPD patients, identify risk factors for COPD among non smokers and classify non-smoking COPD patients according to severity. Maximum patients (35.41%) among non smoker COPD group had more than one risk factor for COPD. Most of the patients among non smoker COPD were found to be having severe to very severe disease (63.5%). 34.4% patients had moderate COPD and very few patients had mild COPD (3%). On comparing disease severity among non-smoker and smoker COPD patients, we found that proportion of patients with very severe disease was more in smoker group (39.2% in smoker vs. 29.2% in non smoker), while proportion of patients with mild to moderate disease were more in non smoker group (35.5% in non smoker vs. 24% in smoker). Patients with severe disease in both groups were found to be of equal proportion (33.3% in non smoker vs. 36.7% in smoker).