Frequency of culture positive tuberculosis in exudative pericardial effusion

To evaluate the frequency of culture positive tuberculosis and to determine the sensitivity of drugs in exudative pericardial fluid. Descriptive observational study. This study was conducted on patients admitted in cardiology and Medical wards of Civil Hospital Karachi from 1[st] November 2010 to 30[th] April 2011. In this study 50 patients of pericardial effusion diagnosed on the basis of history, physical examination, electrocardiography, chest x-ray PA view and echocardiography underwent pericardiocentesis under fluoroscopy. Pericardial fluid D/R was done and all the patients having exudative pericardial fluid [protein] 3 gm% and LDH > 200 IU were selected. All the exudative pericardial effusion were sent for AFB culture and sensitivity on L.J. medium. Inclusion criteria were all patients with the diagnosis of exudative pericardial effusion above 12 years of age of either sex. Exclusion criteria were all patients with transudative pericardial effusion and below 12 years of age. 3 [6%] patients had culture positive for mycobacterium tuberculosis on L.J medium. 5 [10%] had culture positive of other bacteria of which 2 [4%] had culture positive for resistant Staphylococcus aureus, 2 [4%] had culture positive for Streptococcus pneumonia and 1 [2%] had culture positive for Streptococcus viridans and 42 [84%] patients had culture negative for AFB and other bacteria. Out of 50 patients, 16 [32%] were in age group between 20-40 years, 22 [44%] were in age group between 41-60 years and 12 [24%] were in age group> 60 years. Out of 16 patients having age between 20-40 years, 1 [6.25%] had culture positive for AFB, 3 [18.75%] had culture positive for other bacteria and 12 [75%] had culture -ve for all organism. Out of 22 patient having age between 41-60 years, 2 [9.09%] had culture +ve for AFB, 2 [9.09%] had culture for other bacteria and 18 [81.81%] had culture negative for all organisms. Out of 12 patients having age >60 years, none [0%] had culture +ve for AFB, none [0%] had culture +ve for other bacteria and all 12 [100%] had culture negative for all organisms. All 3 patients having culture positive for AFB were found to be sensitive to all antituberculous drugs. The concluded that frequency of culture positivity is only 6% for Mycobacterium Tuberculosis, so this should not be the investigation of choice to confirm tuberculous pericardial effusion. However, other parameters should also be looked for in establishing the diagnosis of pericardial effusion like clinical parameters, the prevalence of tuberculosis in relative area, ESR, MT, Mycobacterium tuberculosis DNA PCR and Mycobacterium tuberculosis culture on BACTEC

frequency causative organisms and their sensitivity to the commonly used antibacterial agents in cases of urinary tract infections

Frequency causative organisms and their sensitivity to the commonly used antibacterial agents in cases of urinary tract infections. Observational study This study was conducted at Medical Wards of Civil Hospital Karachi from 1st November 2010 to 30th April 2011. This study consisted of 415 patients were selected for urine culture and sensitivity from medical O.P.D. and hospitalized patients in medical wards. Detailed history was taken from all the patients with special regard to symptoms and duration of UTI. Inclusion criteria were that all patients who had symptoms of urinary tract infection like frequency of micturition by day and night, painful voiding [dysuria], suprapubic pain and tenderness, hematuria, smelly urine, urgency, loin pain or swelling and patients who had more than 6 pus cells in urine D/R examination. Urine samples from OPD patients were randomly assigned to different reputable clinical pathological laboratories including pathological laboratory of Civil Hospital, Karachi, for urine culture and sensitivity. 415 patients 265[63.8%] were females and 150[36.2%] were males. 415 urine samples who were subjected to urine culture and sensitivity examination. Only 200 [48.2%] samples were found to had infection i.e. significant growth of 105 of microorganism/ml or more, while 142 [34.2%] samples did not show growth of any organism, and 73 [17.6%] samples showed growth between 104 and 105 of microorganism/ml . E. Coli 49.5% is the commonest organism causing UTIs in outpatients as well as in hospitalized patients. The second commonest organism in OPD is Klebsiella 16%, while in hospitalized patients it is Pseudomonas. The antibiotics susceptibility of the isolated organisms during the study and shows the percentage of sensitivity of the isolated organisms. E. coli the most common organism isolated showed high resistance pattern to ampicillin, amoxicillin, and co-trimoxazole 62%, 60%, 70%, respectively. E. coli the most common organism isolated showed a high sensitivity pattern to amoxicillin/clavulanic acid 85%, pipemidic acid 80%, norfloxacin 85%, ofloxacin 92%, ciprofloxacin 90%, tobramicin 98%. Generally a higher percentage of the organisms isolated were sensitive to all these antibiotics except amoxicillin/clavulanic acid which had a high resistance pattern to Pseudomonas 77%. Escherichia coli is still the commonest organism causing urinary tract infection, in outpatients as well as in hospitalized patients

Outcome with and without aspiration of the amoebic liver abscess at civil hospital, Karachi

To compare the outcome with and without aspiration of the amoebic liver abscess. Comparative study. This study was conducted at Medical Wards of Civil Hospital Karachi from August 2010 to September 2011. Study consisted of 100 patients and divided into two groups. Both the groups received medical therapy from day 1 which included Metronidazole injection 500mg i/v 8 hourly. Liver abscess was diagnosed on clinical features, ultrasound finding, aspiration with clinical study and serological tests for amoebiasis In Inclusion criteria; age greater than 12 years and less than 60 years and Evidence of liver abscess on abdominal ultrasound. In Exclusion criteria; a] Patients of less than 12 years and more than 60 years and pregnant woman. Mean age of ALA in Group A 36.98+ 3.25 years in both group with male female is ratio of 4:1. Anaemia was present in 76% cases, leukocytosis was found in 90% case. Among them 4[4.44%] cases had leukocyte count greater than 30,000/mm3 with absolute neutrophilia. 16[17.77%] patients had TLC in the range of 21,000-30,000/mm3. However, the majority of cases 70 [77.77%] had TLC in the range of 10,000-20,000/mm3 and only 10 patients had normal TLC. ESR was found in triple figure in 24% cases, whereas in 40% cases it was between 50 and 100 and in 36% patients found below 50mm/1st hour. Liver aspiration was done in 72 cases. The colour of aspirate was reddish brown in 60 cases [83.33%] and yellowish in 12 cases [16.66%]. Air bubbles were not demonstrated in any case. Trophozoites of Entamoeba histolytica were demonstrated in 5 cases [10%]. Serologic test for ALA i.e. indirect haem agglutination test was proved to be very specific with 100% showing high antiamoebic antibody titre. The mean abscess size 6.5 cm in Group A and 7.3 cm in group B. The mean abscess size and the impact of aspiration in terms of normalization in fever, TLC and improvement in LFTs. Percutaneus aspiration is a safe and effective treatment of amoebic liver abscess disease