Formulation, evaluation and release rate characteristics of medicated jelly of vitamin C

Medicated jelly formulations are patient friendly dosage form for pediatric, geriatric and dysphagic patients. These formulations offer rapid dissolution and absorption of drugs through oral mucosa therefore show the early onset of action. The objective of the study was to develop and evaluate oral jelly formulations of vitamin C. Slurry method was adopted using glucose 103gm, sugar 67gm, gelatin 10gm and sorbitol 6.56gm. Preformulation studies were performed including the organoleptic profile, pH, and solubility of both drugs. The medicated jelly of Vitamin C was prepared and evaluated for physical characteristics, weight variation, syneresis, pH, taste and palatability, drug content, release rate characteristics and stability studies. All the jellies were found to have patient welcoming taste and were palatable. All formulations showed more than 50% drug release within 15 minutes, while 93% drug was released in 30 minutes. The results of release kinetics showed that the formulation followed the zero order release kinetics. Thus the drug was released at constant rate independent of the drug concentration involved in the process. All the medicated jellies were found to remain stable stored for 60 days at different temperatures. The present study revealed that medicated jellies of vitamin C could be employed orally in an effective form as an alternative solid oral dosage form for special population such as pediatrics, geriatrics and patients with dysphagia

Frequency of hepatitis C virus infection and estimation of serum alanine aminotransferase in HCV positive patients

Hepatitis C virus [HCV] has emerged as a leading cause of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma worldwide. Hepatitis C is rapidly emerging as a major health problem in developing countries including Pakistan. Serum Alanine Aminotransferase [ALT] is the most frequently utilized screening test in routine evaluation of liver damage. This study was conducted to determine the seroprevalence of hepatitis C virus infection and its association with serum alanine aminotransferase. Determination of the seroprevalence of hepatitis C virus infection and its association with serum alanine aminotransferase in patients at social security hospital, Islamabad. A cross sectional study was conducted at clinical laboratory of social security hospital Islamabad, from May 2009 to October 2009. All samples referred to social security hospital for hepatitis profile were included in the study. All patients were screened serologically for hepatitis C virus antibodies and serum alanine aminotransferase was determined in selected HCV positive patients only. Out of 1006 blood samples 146 were positive for anti-HCV antibodies with an overall positivity of 14.5%. Out of these 55% cases were males and 45% were females. Seroprevalence of HCV was found to be 8% in the age group of <20 years, and almost equal i.e. 46% and 49% in 20-40 years and >40 years age groups respectively. Serum ALT was determined in total 83 patients only: they showed levels less than 30U/L in 25% patients, 30-45U/L in 15% patients, 46-60U/L in 19% patients, 61-100U/L in 29% patients and more than 100U/L in 12% patients. The present study revealed that prevalence of HCV was 14.5% and ALT levels were found to be more than 45U/L in 75% of the anti HCV positive cases, showing the significance of this biochemical marker as diagnostic tool in such patients

Extended Spectrum beta-lactamases in pyogenic gram-negative bacilli

To determine the frequency, distribution and sensitivity pattern of extended spectrum beta-lactamases producing Gram-negative bacilli from pus samples. Cross Sectional Comparative Study Study, place and duration: This study was conducted at the Microbiology Department, Fauji Foundation Hospital, Rawalpindi over a period of two years from 04/ 2004 to 03 / 2006 Inclusion criteria: All pus samples were included. Exclusion criteria: Dried pus swabs were not included in the study. Multidrug resistance and ESBLs-production were studied in a total of 138 Enteric Gram-negative Rods [GNR] obtained from pus specimens by the help of double disc diffusion technique. Susceptibility testing was done to various groups of antimicrobials. Frequency of ESBLs-production was 56.5%. ESBLs-positivity was highest at 61-70 years of age group [24.3%], followed by 11-20 yrs [17.5%]. ESBLs-positivity in females versus males was 58.2%: 54.2% and highest in indoor patients [92.3%]. ESBLs-production was highest amongst Escherichia coli [55.1%] followed by Klebsiella pneumoniae, [29.5%], Pseudomonas aeruginosa [9.0%], Aeromonas spp [2.6%]. The antibiotics showing best activity against ESBLs-producing K pneumoniae and E coli were beta lactam beta -lactamase inhibitors [piperacillin /tazobactam 100% and 80%-] and carbapenems [imipenem 100% each and meropenem 75% and 100%] respectively. ESBLs producing GNRs had a more antibiotic-resistant profile than non- ESBLs producers. They were not only resistant to beta-lactams but showed cross-resistance towards a wide variety of commonly used other antimicrobials. ESBLs producers are more resistant as compared to non-ESBLs producers. Considering the high prevalence of ESBLs in Enteric Gram-negative rods, it is suggested that all such isolates should be tested for the production of ESBLs in the routine microbiology laboratory

Frequency of enteric gram negative rods isolated from various clinical samples

To determine the frequency of gram negative rods in both nosocomial and community acquired infections in our setting. This descriptive study was conducted at the Microbiology Department of Fauji Foundation Hospital, Rawalpindi over a period of two years [April 2004 to March 2006]. All pus, urine, blood and HVS received during the study period were included. Samples without properly filled forms, dried swabs and improperly transported samples were excluded. Two thousand and ninety one Enteric Gram Negative Rods [EGNR] were isolated over a period of two years, They were most commonly found in urine samples [40.7%], followed by pus [37.1%], HVS [12.0%], sputum [6.12%] and blood [3.92%] samples. The most common EGNR isolated was Escherichia coli [49.7%] followed by Klebsiella pneumoniae [23.4%], Pseudomonas aeruginosa [19.5%] and Proteus species [1.81%]. The most commonly isolated Enteric Gram negative rod from urine samples [n 852] was E. coli [622] followed by Klebsiella pneumonia [189], Providentia [18] and Enterobacter species [13]. The most commonly isolated Gram negative rod from pus samples [n 852] was Pseudomonas aeruginosa [290] followed by E. coli [227], Klebsiella pneumoniae [18] and Proteus species. The most commonly isolated EGNR from HVS samples was E. coli [130] followed by Klebsiella pneumoniae [68] and Pseudomonas aeruginosa [51]. The most common EGNR found in sputum [n 128] was Klebsiella pneumoniae [56] followed by Pseudomonas aeruginosa [40] and E. coli [30]. In blood samples the most common organism isolated was E. coli, followed by Pseudomonas and Klebsiella.

Qualitative analysis of sputum specimens submitted for acit fast bacilli [AFB] microscopy to a teaching hospital at Rawalpindi

To find out the quality of sputum specimens submitted for AFB microscopy, to categorize these specimens on the basis of their quality and to compare the frequency of AFB positive smears in each category of these specimens. Five hundred and seventy convenient sputum samples from patients referred for AFB microscopy of sputum were examine after Ziehi Neelsen staining. Based on Heinman and Radano's criteria for sputum, all the sputa under study were divided into sputum and non-sputum categories. The non-sputum category was sub-divided into saliva and mixed samples based on the ratio of pus cells and epithelial cells. All the smears for qualitative categorization and for AFB were examined by the qualified microbiologist. The frequency of AFB positive smears in each category was calculated. Out of 570 specimens submitted, only 110 [19%] were found to be sputum specimens, while 324 [57%] were saliva and 136 [24%] were declared as mixed. The frequency of AFB positive smears was the highest in samples categorized as sputum, 23.6% [26 out of 110] followed by mixed samples 7.35% [10 out of 136], and saliva 0.31% [1 out of 324]. The overall frequency of AFB positive smears was 6.49% [37 out of 570]. Quality of sputum specimen plays a major role in the detection of AFB from the sputum smears. As evident from this study, the frequency of AFB positive smears in the sputum was found to be much higher as compared to saliva and mixed samples

Aerobic vaginal pathogens and their sensitivity pattern

The vaginal flora is a complicated environment, containing dozens of microbiological species in variable quantities and relative proportions. The frequent cause of vaginal discharge is an infection or colonization with different microorganisms. Some pathologic conditions causing vaginitis are well defined yet, 7-72% of women with vaginitis may remain undiagnosed and such forms of abnormal vaginal flora neither considered as normal, nor can be called bacterial vaginosis have been termed as 'intermediate flora' and its management probably differ from that of bacterial vaginosis. It is of crucial importance in pregnant females at risk of preterm delivery. The present study has been conducted especially to elucidate this type of aerobic vaginal isolates and their culture and sensitivity towards currently used antibiotics. This study was conducted at the Microbiology Department of Fauji Foundation Hospital, Rawalpindi over a period of two years [April 2004-March 2006]. One thousand, nine hundred and twenty three high vaginal swabs, both from indoor and outdoor patients were collected, cultured and their susceptibility to various antibiotics was determined. Significant growth was obtained in 731 samples. The highest frequency of infection [39.5%] was observed at 31-40 years followed by 41-50 years [35.8%]. About 76% were from outdoor and 24% were from indoor patients. Staphylococcus aureus was the most prevalent vaginal pathogen at 11-60 yrs and with highest prevalence at 31-40 years followed by 41-50 years. It was a predominant pathogen in both indoor [35%] as well as outdoor [41.6%] patients, followed by enteric gram-negative bacilli and other gram-positive cocci. There were very few antibiotics among the conventionally available aminoglycosides, third generation cephalosporins, penicillin, quinolones, sulfonamides and tetracyclines possessing good sensitivity [>80%] against any one the common aerobic vaginal pathogens. The effective chemotherapeutics agents belong to the groups of carbapenems and beta-lactams beta-lactamase inhibitor combinations. The high prevalence of gynaecological infections demands that the patients with gynaecological symptoms be investigated thoroughly. Culture must invariably be done. Currently the antibiotics showing good sensitivity are very expensive. So there is a need for an effective antimicrobial policy. Effective drug should be reserved for the treatment of serious life threatening situations only

Extended spectrum beta-lactamases in urinary gram -negative bacilli and their susceptibility pattern

Beta-lactamases of Gram-negative bacteria are the most important mechanism of resistance against beta-lactams. Two types of beta-lactamases can confer resistance against third generation cephalosporins; inducible chromosomal beta-lactamases, and extended-spectrum beta-lactamases. The extended-spectrum beta-lactamases producing strains of Enterobacteriaceae have emerged as a major problem in hospitalized as well as community based infections resulting in range of infections from uncomplicated urinary tract infection to life threatening sepsis. To find out the prevalence of extended-spectrum beta-lactamases producing Gram- negative bacilli among urinary isolates and their sensitivity pattern. The study was conducted at the Microbiology Department of Fauji Foundation Hospital, Rawalpindi over a period of two years [April 2004-March 2006]. Multidrug resistance and extended-spectrum beta-lactamases production was studied in 111 enteric Gram-negative bacilli isolated from urine of symptomatic patients [1-70 years] including males and females from indoor and outdoor patients by using double disc diffusion technique. Prevalence of extended-spectrum beta-lactamases production was seen in 71 [61.2%] enteric gram-negative organisms, the most prevalent gram-negative organism was Klebsiella pneumoniae 40 [71.4%] followed by Escherichia coli 27 [62.8%] and Pseudomonas aeruginosa 3 [25%]. The extended-spectrum beta-lactamases producers were more prevalent in indoor patients 63 [88.7%] compared to outdoor patients 8 [11.3%], more in females 43 [60.6%] than males, 28 [39.4%]. The extended-spectrum beta-lactamases producing gram-negative rods had more antibiotic-resistant profile than non-producers. All enteric gram negative rods should be tested for the production of extended-spectrum beta-lactamases in routine microbiology laboratory

Extended Spectrum beta-Lactamases in enteric gram-negative bacilli: Related to age and gender

Extended Spectrum beta-Lactamases [ESBLs]-producing strains of Enterobacteriaceae have emerged as a major problem in hospitalized as well as community based patients. Infections due to ESBLs-producers range from uncomplicated urinary tract infection to life threatening sepsis. The objective of this study was to find out the prevalence of ESBLs-producing Gram- negative bacilli among clinical isolates. This descriptive study was conducted at the Microbiology department of Fauji Foundation Hospital, Rawalpindi over a period of two years [March 2004-April 2006]. Six hundred and nine isolates of Enteric Gram-negative rods from various samples were tested for ESBLs- production by double disc synergy test. In 176 ESBLs-producing isolates, source of samples in term of indoor/outdoor was analyzed. In 165 ESBLs-producing isolates, patients' gender and age was analysed from 3 months to 70 years. The ESBLs-producing isolates were more commonly isolated from indoor patients [88.1%] as compared to outdoor patients [11.9%]. Escherichia coli was found to be most prevalent organism in indoor patients while Klebsiella pneumoniae, was the most prevalent organism in outdoor patients. ESBLs were most commonly isolated from female patients [64.3%] suffering from urinary tract infections [[41.5%], as compared to male patients [35.7%] in which the organisms were most commonly isolated from pus samples [54.2%]. ESBLs-producing Enteric Gram-Negative rods were most frequent at later part of life where they were most common [27.9%] at 61-70 years, followed by 41-50 years of age group [20.0%]. Another peak [13.3%] was also seen at younger age group [11-20 years]. The least prevalence [5.5%] was seen in two age groups [0-10 and 31-40 yrs]. In case of female patients, ESBLs-producing EGNR were most frequently [29.2%] isolated from middle age group [41-50 years] followed by later age groups [51-60 and 61-70 years, [15.1% and 25.5%]. Considering the high prevalence of ESBLs in Enteric Gram-negative rods, it is suggested that all such isolates should be tested for the production of ESBLs in the routine microbiology laboratory

Frequency of seropositive blood donors for hepatitis B, C and HIV viruses in railway hospital Rawalpindi

This study was conducted from March 2001 to May 2002 at Railway Hospital Rawalpindi, a teaching hospital attached with Islamic International medical college, to assess the frequency of hepatitis B, C and HIV in healthy blood donors. Five hundreds and eighty blood donors were screened for HBsAg, 563 donors for Anti-HCV Antibodies and 553 donors for Anti-HIV Antibodies with the help of rapid immuno chromatographic method. The Hepatitis C virus was found to be most common [6.21%] whereas Hepatitis B virus was next in prevalence [5.86%]. Out of 553 blood donors none was found to be positive for HIV virus. The preventive strategies be adopted for Hepatitis B and C viruses which constitute a major public health problem in Pakistan

Value of urinary gram staining in the diagnosis of urinary tract infection in catheterized patients

This study was designed to evaluate the urinary Gram stain as a screening test for the diagnosis of urinary tract infection in catheterized patients, using quantitative urine culture as gold standard. Gram staining and urine culture were carried out on urine samples from 107 catheterized patients. The sensitivity, specificity, positive predictive values and negative predictive values of the test were 73.5%, 77.7%, 76.4% and 75.0% respectively. It is concluded that due to high false negative [26.5%] and false positive [22.3%] rate, Gram staining is not reliable screening test for the diagnosis of urinary tract infections, especially in catheterized patients

Urinary tract infection: prevalent organisms and their sensitivity pattern in catheterized patients

This prospective study was designed to find out the prevalent organisms and their sensitivy pattern in indoor catheterized patients. Six hundred urine sample of indoor catheterized patients were collected from the catheter, quantatively cultured and their susceptibility to various antibiotics was tested. Among 600 patients, 402 were males and 198 females. The age of the patients was between 3-90 years. Among 600 urine sample, 341 [56.8%] were positive for causative agents [> 105 bacteria/ml] while 259 [43.2%] urine sample were negative. Escherichia coli [24.9%], Klebsiella pneumoniae [21.9%], mixed [14.3%], Pseudomonas aeruginosa [10.5%] and candida species [9.9%] were the major isolates which constituted 81.5% of the total isolates. The sensitive pattern of all the organisms has dramatically changed when compared with the previous studies and there was not a single antibiotic which has shown an overall 100% sensitivity against the most common urinary pathogens. Considering the resistance situation, amikacin, aztreonam, tobramycin and cefoperazone in that order can be recommended as a blind therapy for seriously ill septicaemic patients associated with urinary tract infection before we get culture and sensitivity report

Pyuria as predictor of bacteriuria in catheterized patients

Six hundred and nine urine samples were analyzed for pyuria to assess its efficacy as a predictor of bacteriuria, in catheterized patients, using different techniques of pus cells estimation. In 235 and 323 urine samples, pus cells were counted per high power field in centrifuged and uncentrifuged urine respectively, while in 51 urine samples pus cells were counted per cubic millimeter in uncentrifuged urine. All the urine samples were simultaneously cultured. Pyuria [pus cells > 10/HPF or CMM] was correlated with bacteriuria [colony count > 10[5] per ml]. The overall efficacy of pyuria as a predictor of bacteriuria was low [52.01-60.78%] and there was no significant difference among the different techniques. It was concluded that pyuria as predictor of bacteriuria is the least reliable technique to be recommended in routine clinical practice