ABSTRACT
The concept of sutureless mesh as well as light weight mesh came into play because of inguinodynia. Thisstudy was chosen most importantly to determine the post-operative persisting chronic pain after the use ofsutureless mesh. Data was collected from patients attending Govt. Medical College & Hospital, Jammu OPD,admitted in the department of surgery that underwent sutureless mesh hernioplasty for inguinal hernias. Thesepatients were followed up at 3 days, 3 weeks, 3 months and 6 months for postoperative pain, any recurrenceor development of complications. In this study, 40 patients having inguinal hernia were taken. 38 (95%) weremales and 2 (5%) were females. The age of the patients ranged between 30 to 80 years with mean age of54.53±14.88 years. Post-operative pain was studied according to VISUAL ANALOG SCALE scoring, out of10. Mean post-operative pain score after 3 days was 2.70±1.16, which decreased to 0.85± 1.10 at 3 weeks(68.52% decrease) and after 3 months it was 0.30±0.72 (with an 88.89% decrease). There were no othercomplications. The study concluded that the use of self-fixating mesh in open inguinal hernia repair is asimple, safe, rapid and effective option and is associated with low post-operative pain.
ABSTRACT
Objective: To determine the in vitro susceptibility of MRSA clinical isolates to ceftaroline, using interpretation of zones of inhibition by disk diffusion method. Study Design: Descriptive cross sectional. Place and Duration of Study: The study was carried out at the Department of Microbiology, Combined Military Hospital Peshawar, from Jan to Dec 2014
Material and Methods: To carry out this descriptive cross sectional study, clinical specimens were obtained from indoor and outdoor patients of Combined Military Hospital Peshawar. All the isolates of MRSA cultured with CLSI guidelines and identified with standard microbiological procedures, from clinical specimens of pus, body fluid, urine, tissue and blood were included in the study. The antimicrobial susceptibility pattern of ceftaroline was determined according to CLSI guidelines. The data was analyzed in SPSS [version 19] software
Results: Out of a total 190 MRSA isolates, 183 [96.3%] were susceptible to ceftaroline in vitro, whereas 5 [2.6%] were resistant and 2 [1.1%] were intermediate in their response to ceftaroline
Conclusion: Ceftaroline can be used effectively against infections caused by MRSA as it has shown very high in vitro activity against MRSA strains of clinical origin
ABSTRACT
Background: Mean platelet volume [MPV], platelet distribution width [PDW] and P-LCR [platelet large cell ratio] are known platelet volume indices [PVI]. Currently, the platelet volume indices [PVI] have emerged to determine its value as biomarker of liver fibrosis
Objectives: The present study determined the Platelet volume indices [PVI] as non invasive physiological marker of liver fibrosis in chronic hepatitis C patients
Study Design: Case control study
Study Settings: Department of Gastroenterology, ISRA University Hospital and Asian Institute of Medical Sciences [AIMS] Hyderabad from May- December 2014
Subjects and methods: A sample of 64 patients; 32 controls and 32 chronic hepatitis C cases were studied. Subjects were selected by non-probability [purposive] sampling as per inclusion and exclusion criteria. Roche Hitachi Hematolyzer was used for platelet count and platelet volume indices. Liver fibrosis was determined from liver biopsies by METAVIR Score. Data was analysed on Statistix 10.0 [USA] at 95% confidence interval [P<0.05]
Results: The PVI [MPV, PDW and P-LCR] and platelet count were raised in cases compared to controls [p<0.05]. PVI showed major differences for METAVIR SCORE F[0] -F[4] of liver fibrosis [p<0.05]. MPV, PDW and P-LCR showed positive correlation [r= 0.93, r= 0.80 and r= 0.75] with METAVIR [p <0.0001] respectively
Conclusion: The Platelet volume indices may be used as non-invasive physiological markers for liver fibrosis in chronic hepatitis C patients instead of invasive technique of liver biopsy
ABSTRACT
Objective: To determine the frequency of hepatitis B and C virus among the healthy blood donors
Study Design: Cross sectional study
Place and Duration of study: This was carried out at Pakistan Air Force [PAF] Hospital Islamabad from January 2015 to April 2017
Patients and Methods: The blood donors were both male and female came from Islamabad and surroundings. A detailed medical history and examination was carried out by medical officer. All donors were provided questionnaire and consent Performa. The blood donors negative for previous history of viral hepatitis and other contraindications for blood donation were included in study. All donations were screened for HBV surface antigen [HBsAg] and anti-HCV antibodies by ELISA
Results: A total of 2185 healthy blood donors were enrolled. Out of them, 2137 [97.8%] were male and 48[2.2%] were female. In female donors, HBsAg was negative in all donors and anti-HCV antibodies was positive in 2[4.16%]. Whereas, in males HBsAg was positive in 34[1.59%] and anti-HCV antibodies was positive in 81[3.79%]
Conclusion: The prevalence of HCV among blood donors was high as compared to HBV. Hepatitis B and C are one of major sources of transfusion transmitted diseases. Prevention of transfusion transmitted diseases is possible with vigilant donor selection and strict screening process
ABSTRACT
Objective: To determine, the susceptibility pattern of carbapenamase producing enterobacteriaceae [CPE] against polymyxinB, tigecycline and fosfomycin
Study Design: Descriptive cross sectional
Place and Duration of Study: The study was carried out in the Department of Microbiology PNS Shifa Karachi, from 26 Sep 2013 to 25 Mar 2014
Material and Methods: All specimens were inoculated on blood and macConkey agar, incubated aerobically at 35degreeC - 37degreeC for 18 to 24 hours. After identification of gram negative rods by colony morphology, Gram's staining and biochemical reactions, these were screened for Carbapenems resistance with imipenem and meropenem 10 microg discs along with routine first and second line antibiotics by Kirby-Bauer disc diffusion technique according to Clinical Laboratory Standard Institute [CLSI] guide lines. All isolated CPE were saved and then inoculated on Mueller-Hinton agar [MHA]. Antimicrobial susceptibility against polymyxin B, Tigecycline and Fosfomycin was done by Kirby-Bauer disc diffusion method using disc polymyxin B 300 units, Tigecycline 15microg and Fosfomycin 200microg. Zone diameters greater than 24 mm were taken as sensitive for Tigecycline 15microg, 16mm for Fosfomycin 200 microg and 12 mm for polymyxin B 300 units
Results: Clinical specimens of 171 patients who fulfilled the inclusion criteria were included in our study. Mean +/- SD of age was 42.02 +/- 22.367 with C.I [38.65 - 45.40]. Out of 171 patients 110 [64%] were male and 61 [36%] were female. In vitro susceptibility results revealed that all the 171 [100%] CPE isolates susceptible to PolymyxinB, while susceptibility against Fosfomycin and Tigecycline was 132 [77%] and 49 [29%] respectively
Conclusion: CPE were found to be 100% susceptible to polymyxinB, while for Fosfomycin and Tigecycline susceptibility was 77% and 29% respectively
ABSTRACT
Objectives: The present study was conducted to estimate brain natriuretic peptide [BNP] in heart failure patients and its association with left ventricular ejection fraction [LVEF]
Study design: Case control study
Place and duration: Department of Medicine, Cardiology and Physiology, Isra University, Hyderabad from July 2014- Dec 2014
Subjects and methods: A sample of 60 subjects comprising of 30 normal controls [group I] and 30 diagnosed cases of heart failure [group II] were selected through non-probability purposive sampling as per inclusion and exclusion criteria. Blood samples were collected for the estimation of BNP. Left ventricular function was assessed by echocardiography. Data were analyzed on SPSS 21.0, Student's t-test and chi-square test were used for continuous and categorical variables respectively. Pearson's correlation was used for association of BNP and LVEF. P value
Result: Mean age [+/-SD] of controls and cases were 51.5+/-5.56 and 50.6+/-5.25 years respectively [p=0.91]. of 60 subjects; 46 [76.6%] were male and 14 [23.3%] were female. BNP in controls and cases was noted as 77.06+/-,24.02pg/ml and 17506.3 +/-13348 pg/ml respectively. BNP was significantly increased in heart failure patients and it showed inverse correlation with ejection fraction [r =-0.76, p=0.0001]
Conclusion: It is concluded that the BNP may be used an indicator of left ventricular function in settings where echocardiography facility is not available
ABSTRACT
Objective: The objective of this study was to compare 5/0 polypropylene suture with 5/0 chromic catgut in small clean pediatric facial laceration repair in terms of cosmetic outcome
Study Design: Randomized controlled trial
Place and Duration of Study: Combined Military Hospital, Rawalpindi from 26[th] May 2012 to 25[th] Nov 2012
Patients and Methods: A total of 300 patients of both gender under 12 years of age, with small clean facial lacerations were selected and divided in two equal groups using random number tables. All the patients underwent suturing in minor operating theater of trauma centre CMH Rawalpindi as day care cases, under local anesthesia and aseptic measures. In group 1, polypropylene 5/0 suture was used where as in group 2 chromic catgut 5/0 was used for suturing
Aseptic dressing was applied. All patients were reviewed on 5[th] day [for stitch removal in polypropylene group] and 3 months post-operatively to establish cosmetic outcome which was determined by scar visual analog score both by parents of the child and consultant surgeon
Results: The mean VAS [visual analog score] as observed by Consultant surgeon was 79.14 and 78.63 for polypropylene and chromic catgut groups respectively
The mean VAS observed by the parents of the child for respective groups was 76.67 and 76.03. The significance value was 0.961 for parental VAS and 0.988 for surgeons VAS depicting insignificant difference in both suture groups
Conclusion: There is no long-term difference in cosmetic outcomes of both the sutures in the repair of facial lacerations in the pediatric population. No difference in complication rate of wound was observed. In addition, the parents of the children in absorbable suture group expressed satisfaction over prevention of psychological trauma of stitch removal
ABSTRACT
Objectives: To determine the accuracy of first morning void urine specimen for Albumin to Creatinine Ratio [ACR] comparing with 24-hour urinary albumin excretion in detecting trueroalburninuria in type 2 diabetics
Study Design: Cross Sectional study
Place and Duration of Study: Military Hospital Rawalpindi, from Apr 2013 to Oct 2013
Patients and Methods: One hundred and twenty patients with type 2 Diabetes Mellitus [DM] fulfilling the inclusion criteria were included in study using consecutive non-probability sampling. A standard protocol was followed for specimen collection. Urine collection was started from the next day of admission
Results: Mean random plasma glucose level was 174.54 +/- 33.06 mg/dL, mean HbAlc was 8.5 +/- 1.32%, mean urinary albumin 130.26 +/- 47.25 mg/24 hour and mean ACR was 104.30 +/- 51.56 mg/g. Area under ROC curve was 0.964 for microalbuminuria by ACR. Spearman's rank-order coefficient [rs] was 0.696 for ACR and 24 hour albumin excretion
Conclusion: ACR in first morning void urine accurately detected early microalbuminuria in type 2 diabetics
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Creatinine , Diabetes Mellitus, Type 2 , Cross-Sectional Studies , Urine Specimen CollectionABSTRACT
Abstract: Epilepsy is one of the most common neurological disorders, affecting approximately 50 million people worldwide. Medications are still the most common therapeutic choice for seizure control. In clinical practice anti-epileptic drugs that were licensed before valproate are called traditional antiepileptic drugs while those licensed after valproate are called new generation antiepileptic drugs
Objective: To compare the efficacy of sustained release formulation of valproate and topiramate monotherapy for control of epilepsy in elliptic patients. Study design: Randomized controlled trial. Setting: OPD, Medical Department, Allied hospital Faisalabad. Duration of study: 6 months duration after approval of synopsis from 30-07-2015 to 30-11-2015
Methodology: Patients with definite diagnosis of epilepsy with generalized tonic clonic seizures between 13 to 17 years of both genders were recruited from medical ward and OPD who fulfilled the inclusion were enrolled in the study. After approval from hospital ethical review committee. Informed consent was taken from each participant of the study. Patients were divided randomly into group A and group B using computer generated random number table. Group A was given sustained released formulation of valproate 500mg once a day and titrated up with weekly increments of 250mg/per day up to maximum of 2000mg/day in two divided doses to control seizures. Group B was given topiramate 25mg twice daily and titrated up in increments of 50 mg weekly to control seizures up to a maximum of 800 mg per day in 2 divided doses. Follow up was done by telephonic contact by asking about control of generalized tonic clonic seizures. Data was collected through self-conducted interviews using a standardized proforma. Efficacy was measured in terms of control of seizures
Results: In our study out of 330 cases, 165 in each group, 41.82%[n=69] in group-A and 40%[n=66] group-B were between 13-40 years of age while 58.18%[n=96] in group-A and 60%[n=99] in group-B were between 41-70 years of age ,mean was calculated as 41.79 +/- 10.66 and 42.12 +/- 10.37 years, 61.21%[n=101] in group-A and 54.55%[n=90] in group-B were male while 38.79%[n=64] in group-A and 45.45%[n=75] in group-B were females. Comparison of efficacy in both groups shows that 39.39%[n=65] in group-A AND 25.45%9[n=42] in group-B were treated effectively, p value was calculated as 0.006 showing a significant difference
Conclusion: We concluded that the efficacy of sustained release formulation of valproate is significantly higher when compared topiramate monotherapy for control of epilepsy in epileptic patients
ABSTRACT
To evaluate the frequency and antimicrobial susceptibility pattern of Acinetobacter species isolated from pus and pus swab specimens at a tertiary care setting. Cross-sectional observational study. Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from July 2008 to July 2012. Data regarding positive culture and antimicrobial sensitivity pattern was retrieved from the pus and pus swab culture records of the Microbiology Department, AFIP, Rawalpindi. Only those pus and pus swab specimens which yielded the growth of Acinetobacter species were included in the study. Out of 2781, 1848 were of pure pus while 933 were pus swab specimens. Out of 2538 culture positive isolates, 276 [10.9%] were identified as Acinetobacter species. Among 276 Acinetobacterspp., 245 [88.8%] were Acinetobacter baumannii and 31 [11.2%] were Acinetobacter johnsonii. Male/female ratio of the affected patients was 5.6:1. Doxycycline was the most sensitive antibiotic to which 45% of the tested isolates were sensitive. Sensitivity to all other antimicrobials was 15% or less. About 11% of soft tissue and wound infections are caused by Acinetobacter species in our set up particularly in male. Doxycycline was the most sensitive antibiotic. Sensitivity to all other antimicrobials was 15% or less. In vitro sensitivity to carbapenems is very low
Subject(s)
Suppuration , Tertiary Healthcare , Cross-Sectional Studies , Cross Infection , Wound InfectionABSTRACT
To determine the antimicrobial susceptibility pattern of bacterial pathogens in the patients of urinary tract infection reporting at a tertiary care hospital. Laboratory based study. Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from January to December 2012. A total of 440 culture positive bacterial isolates from 1110 urine samples; submitted over a period of one year were included in this study. Identification of bacterial isolates was done by standard biochemical profile of the organisms. The antimicrobial susceptibility of culture positive bacterial isolates was performed by disk diffusion method as recommended by Clinical Laboratory Standard Institute guidelines [CLSI]. Out of the 440 culture positive urine samples, 152 [34.6%] were from indoor patients whereas 288 [65.4%] from outdoor patients. Gram negative bacteria accounted for 414 [94%] of the total isolates while rest of the 26 [6%] were Gram positive bacteria. The most prevalent bacterial isolate was Escherichia [E.] coli 270 [61.3%] followed by Pseudomonas [P.] aeruginosa 52 [12%] and Klebsiella [K.] pneumoniae 42 [9.5%]. The susceptibility pattern of E. coli showed that 96.2% of the bacterial isolates were sensitive to imipenem, 85.1% to amikacin, 80.7% to piperacillin/tazobactam and 72.6% to nitrofurantoin. In case of P. aeruginsosa, 73% bacterial isolates were sensitive to tazobactam/piperacillin, 69.2% to sulbactam/cefoperazone and 65.38% to imipenem. The antibiogram of K. pneumoniae has revealed that 76.1% of the bacterial isolates were sensitive to imipenem and 52.3% to piperacillin/tazobactam. Nitrofurantoin and imipenem were the most effective antimicrobials amongst the Enterococcus spp. as 92.3% showed susceptibility to this bacterial isolate. Majority of the bacterial isolates were sensitive to imipenem and piperacillin/tazobactam while susceptibility to most of the commonly used oral antibiotics was very low. Among the oral antimicrobials, nitrofurantoin showed good susceptibility against Enterobacteriaceae family and Gram positive organisms
ABSTRACT
To determine the in vitro activity of Fosfomycin tromethamine against extended spectrum beta-lactamase producing uropathogens. Experimental study. Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from October 2011 to October 2012. A total of 381 culture positive ESBL producing isolates from 2400 urine samples submitted over a period of one year were included in this study. Identification of isolates was done by standard biochemical profile of the organisms. The antimicrobial susceptibility of culture positive isolates was performed by disk diffusion method as recommended by Clinical Laboratory Standard Institute guidelines [CLSI]. The antimicrobial activity of Fosfomycin to various isolates revealed that 93% of E. coli, 64% Klebsiella spp. 50% Proteus spp. 75% Enterobacter cloacae, 100% Citrobacter freundii, 100% Burkholderia spp. 100% Serratia spp. and 50% Stenotrophomonas maltophilia were susceptible to this chemical compound. Fosfomycin showed excellent effectiveness to most of the common ESBL producing bacteria such as E. coli, Klebsiella and Proteus spp
Subject(s)
Humans , Male , Female , Urinary Tract Infections/therapy , Urinary Tract Infections/diagnosis , Tromethamine , beta-Lactamases/drug effects , In Vitro Techniques , Fosfomycin/pharmacologyABSTRACT
To determine the types of pathogens causing blood stream infections and their drug susceptibility profile in immunocompromised patients. Cross-sectional, observational study. Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from January to September 2012. Blood culture bottles received from immunocompromised patients were dealt by two methods, brain heart infusion [BHI] broth based manual method and automated BACTEC system. The samples yielding positive growth from either of two methods were further analyzed. The identification of isolates was done with the help of biochemical reactions and rapid tests. Antimicrobial susceptibility of the isolates was carried out as per recommendations of Clinical and Laboratory Standards Institute [CLSI]. Out of the 938 blood culture specimens received from immunocompromised patients, 188 [20%] yielded positive growth. Out of these, 89 [47.3%] isolates were Gram positive and Gram negative each, while 10 [5.3%] isolates were fungi [Candida spp.]. In case of Gram positive isolates, 75 [84.3%] were Staphylococcus spp. and 51 [67%] were Methicillin resistant. Amongst Gram negative group 49 [55.1%] isolates were of enterobacteriaceae family, while 40 [44.9%] were non-lactose fermenters [NLF]. In vitro antimicrobial susceptibility of Staphylococci revealed 100% susceptibility to vancomycin and linezolid. The enterobacteriaceae isolates had better susceptibility against amikacin 85.7% compared to tigecycline 61.2% and imipenem 59.2%. For NLF, the in vitro efficacy of aminoglycosides was 72.5%.The frequency of Gram positive and Gram negative organisms causing blood stream infections in immunocompromised patients was equal. Vancomycin in case of Gram positive and amikacin for Gram negative organisms revealed better in vitro efficacy as compared to other antibiotics.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Microbial Sensitivity Tests , Immunocompromised Host , Cross-Sectional Studies , Gram-Positive Bacteria , Gram-Negative Bacteria , In Vitro TechniquesABSTRACT
To determine the in vitro susceptibility of chloramphenicol against methicillin-resistant Staphylococcus aureus. Cross-sectional study. Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from January to June 2012. One hundred and seventy four isolates of methicillin-resistant Staphylococcus aureus were included in this study using cefoxitin [30 microg] disc for detection. Minimum inhibitory concentration [MIC] of chloramphenicol against MRSA was determined by using E-strip [AB BIO DISK]. The susceptibility was determined by swabbing the Mueller-Hinton agar [MHA] plates with the resultant saline suspension of MRSA and applying E-strip of chloramphenicol from AB Biodisk Sweden and determining the MIC of chloramphenicol [in microg/ml]. Clinical and Laboratory Standards Institute [CLSI] recommendations of /= 32 microg/ml as resistant were followed in interpreting the results. Out of the 174 MRSA isolates, 132 [75.86%] isolates were susceptible to chloramphenicol with MICs of A[2] 8 microg/ml, 38 [21.84%] were resistant >/= 32 microg/ml while 4 [2.30%] were in intermediate range with MIC of 16 microg/ml. Chloramphenicol has shown good in vitro activity against MRSA and is likely to have a key role in the treatment of MRSA infections providing us a good alternative to newer expensive antimicrobials in resource limited countries
ABSTRACT
Aim of this study was to compare the forcedexpiratory volume in one second [FEV1] in smokervs. non smoker doctors
Material and Methods:Individuals were divided into two equal andmatched groups of fifty each. Their ages rangedbetween 27 to 57 years with an average of 18.2 packyears of smoking. Individuals with history ofpulmonary, cardiac, musculoskeletal, neurologicalor any systemic disease which could decline lungfunctions were excluded. Moderate smoking wasdefined as cigarette smoking of 10 pack years.Desktop Spirometer [Geratherm respiratory GmbH]was used in the study and GOLD criteria of COPDwas applied to detect the abnormalities
Results:Mean Age of individuals was 37.65 +/- 7.16 yearsand mean [ +/- SD] height was 174.33 +/- 7.54centimeters. FEV1 was normal in 32 [32%]subjects out of 100 [n=100], out of which 06 weresmokers and 26 were non smokers. Signs of airwayobstruction [FEV1 < 80% predicted] were found in68 [68%] subjects, among whom 44 subjects weresmokers and 24 were non-smoker. Smokers had ahistory of 10 to 41 pack years of smoking with amean of 18.2 pack years. P-value was calculatedusing Chi-square test, which turned out to be 0.00
Conclusion: The prevalence of persistent air flowobstruction is high in asymptomatic smokers. A lowFEV1 in an asymptomatic smoker indicatesindividual with high risk of developing COPD
ABSTRACT
To determine antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus in a tertiary care setting. Descriptive study. Microbiology Department, Armed Forces Institute of Pathology, Rawalpindi from March 2011 to April 2012. Two hundred isolates of MRSA recovered from various clinical specimens sent to AFIP for culture and sensitivity were identified using standard microbiological techniques and the antimicrobial susceptibility was carried out employing Kirby-Bauer disc diffusion technique as recommended by Clinical and Laboratory Standards Institute. The Susceptibility pattern of isolates was recorded in percentages. Of the 200 MRSA isolated, all[100%] were susceptiblr to vancomycin and Linezolid followed by 88% to tigecycline, 81% to chloramphenicol, 66% to amikacin, 62.5% to clindamycin, 52.5% to doxycycline, 36% to trimethoprim-sulfamethoxazole, 29% to gentamicin, 28.5% to erythromycin and 26.5% to ciprofloxacin. The results show that linezolid and vacomycin hold excellent in vitro efficacy against MRSA whereas doxycyline, clindamycin, trimethoprim-sulfamethoxazole, gentamicin, erthromycin and ciprofloxacin have poor sensitivity.
Subject(s)
Microbial Sensitivity Tests , Tertiary Care CentersABSTRACT
One of the major health hazards that has erupted in Pakistan within the recent past years and has caused loss of life of many young people is Dengue Fever. Main objective was to find clinico-pathologic parameters which are essentially associated with complications and contribute to the adverse outcome. This prospective study was conducted on 106 seropositive cases of dengue fever. Patients were taken from Abbasi Shaheed Hospital, Karachi from June 2008 to March 2009. The most common 3 hematological abnormalities were thrombocytopenia and leucopenia. Platelets count below 50 x 10 / microL was seen in [78%] cases and 49% 3 patients had total white cell count below 4 x10 /microL. Partial thromboplastin time was significantly prolonged in [26%] cases whereas prothrombin time was normal in all patients. Liver enzymes both Aspartate Aminotransferase [AST] and Alanine Amino-transferase were significantly elevated in [60%] patients. Blood urea nitrogen [BUN] and creatinine was deranged in [23%] patients. Fever was the most common clinical presentation [86% of the patients]. Hematological parameters [low platelet count, low total leucocytes count, prolonged APTT and raised hematocrit] and biochemical parameters [raised aminotransferases, blood urea nitrogen] have strong association with the complications of dengue fever and hence are associated with the poor outcome of disease
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Dengue/pathology , Dengue/complications , Prospective Studies , Alanine Transaminase , Blood Urea Nitrogen , PrognosisABSTRACT
This case report describes an outbreak of multidrug resistant Acinetobacter baumannii in the intensive care unit of a tertiary care hospital. Three patients were infected on the same day from an Ambu bag which was used on all the patients. The outbreak was immediately identified and the source was traced within one week. Appropriate measures were taken and a continuous surveillance was carried out resulting in reporting of no such case from the intensive care unit in the last 6 months
Subject(s)
Humans , Male , Acinetobacter baumannii/pathogenicity , Acinetobacter Infections , Disease Outbreaks , Intensive Care Units , Drug Resistance, MultipleABSTRACT
To determine the diagnostic value of ST segment depression limited to recovery phase of Exercise Tolerance Test [ETT]. An observational cross-sectional study. The study was carried out at Punjab Institute of Cardiology, Lahore, from March to August 2007 for a period of 6 months. In this study, 100 patients were selected with purposive non-probability sampling technique and were divided into two groups, group A having ST segment depression during exercise phase of ETT, and group B having ST segment depression only in recovery phase after undergoing ETT according to Bruce protocol. The patients were subjected to coronary angiography later on. The chi-square or Fischer's exact test of significance was applied at 0.05 level of significance to compare the coronary angiographic finding between two groups. Diagnostic value of ST segment depression was computed keeping angiographic finding as gold standard. There were no major differences between the two groups regarding angiographic finding. Significant coronary artery stenosis [>50% narrowing] was found in 68 [93%] patients of group A and 23 [85%] patients of group B [p=0.18]. Three vessel disease was found in 30 [41%] patients in group and 7 [26%] patients in group B [p=0.08]. Left main stem disease was found in 5 [6.8%] patients of group A and 1 [3.7%] patient of group B. Normal coronaries were found in 6% of patients among group A and 14% of patients among group B[p=0.12]. Specificity, sensitivity, Positive Predictive Value [PPV] and Negative Predictive Value [NPV] of ST segment depression in recovery phase was 55, 25, 85 and 6 percent respectively [95%Cl; 1.16-2.25]. In patients undergoing exercise stress test, ST segment depression occurring only in recovery phase of ETT has a diagnostic value largely comparable with that of ST segment depression induced during exercise phase of ETT. Thus careful evaluation of ST segment depression occurring only in recovery phase may add significantly to the clinical information derived from the results of ETT