Synergy in penicillin, cephalosporin, amphenicols, and aminoglycoside against MDR S. aureus isolated from Camel milk

Abstract This study investigated the synergy testing of penicillin, cephalosporin, amphenicols, and aminoglycoside in the camel milk (n=768 samples), subsequently used for isolation of MDR S. aureus targeting mecA gene. Antibiotic susceptibility of S. aureus showed >90% isolates were sensitive to ciprofloxacin and trimethoprim and resistant against oxacillin, ampicillin, and cefoxitin. Further, 50-85% of the S. aureus were sensitive to gentamicin, oxytetracycline, and chloramphenicol and resistant against cefotaxime, vancomycin, and cefixime. Minimum inhibitory concentration (MIC) of cefotaxime, (C) and ampicillin (A) in combination with gentamicin (G) was reduced by 99.34% and 70.46%, respectively, while with chloramphenicol (Ch), reduction was 57.49% and 60%, respectively. In addition, the Fractional Inhibitory Concentration Index (FICI) of G+A, Ch+C and Ch+G combinations showed synergy against 80%, 60%, and 30% of MDR S. aureus, respectively. Similarly, C+A and Ch+G displayed indifferent interaction against 70 % and 30% of isolates, respectively, while the later showed additive interaction against 10% of MDR S. aureus. Altogether, our results described effective combination of gentamicin and chloramphenicol with ampicillin and cefotaxime to combat MDR S. aureus

Noncommunicable Disease Risk Factors Among Adolescent Boys and Girls in Bangladesh: Evidence From a National Survey

Objectives@#To assess the prevalence of noncommunicable disease (NCD) risk factors and the factors associated with the coexistence of multiple risk factors (≥ 2 risk factors) among adolescent boys and girls in Bangladesh. @*Methods@#Data on selected NCD risk factors collected from face to face interviews of 4,907 boys and 4,865 girls in the national Nutrition Surveillance round 2018-2019, was used. Descriptive analysis and multivariable logistic regression were performed. @*Results@#The prevalence of insufficient fruit and vegetable intake, inadequate physical activity, tobacco use, and being overweight/obese was 90.72%, 29.03%, 4.57%, and 6.04%, respectively among boys; and 94.32%, 50.33%, 0.43%, and 8.03%, respectively among girls. Multiple risk factors were present among 34.87% of boys and 51.74% of girls. Younger age (p < 0.001), non-slum urban (p < 0.001) and slum residence (p < 0.001), higher paternal education (p = 0.001), and depression (p < 0.001) were associated with the coexistence of multiple risk factors in both boys and girls. Additionally, higher maternal education (p < 0.001) and richest wealth quintile (p = 0.023) were associated with the coexistence of multiple risk factors in girls. @*Conclusion@#The government should integrate specific services into the existing health and non-health programs which are aimed at reducing the burden of NCD risk factors.

Noncommunicable Disease Risk Factors Among Adolescent Boys and Girls in Bangladesh: Evidence From a National Survey

Objectives@#To assess the prevalence of noncommunicable disease (NCD) risk factors and the factors associated with the coexistence of multiple risk factors (≥ 2 risk factors) among adolescent boys and girls in Bangladesh. @*Methods@#Data on selected NCD risk factors collected from face to face interviews of 4,907 boys and 4,865 girls in the national Nutrition Surveillance round 2018-2019, was used. Descriptive analysis and multivariable logistic regression were performed. @*Results@#The prevalence of insufficient fruit and vegetable intake, inadequate physical activity, tobacco use, and being overweight/obese was 90.72%, 29.03%, 4.57%, and 6.04%, respectively among boys; and 94.32%, 50.33%, 0.43%, and 8.03%, respectively among girls. Multiple risk factors were present among 34.87% of boys and 51.74% of girls. Younger age (p < 0.001), non-slum urban (p < 0.001) and slum residence (p < 0.001), higher paternal education (p = 0.001), and depression (p < 0.001) were associated with the coexistence of multiple risk factors in both boys and girls. Additionally, higher maternal education (p < 0.001) and richest wealth quintile (p = 0.023) were associated with the coexistence of multiple risk factors in girls. @*Conclusion@#The government should integrate specific services into the existing health and non-health programs which are aimed at reducing the burden of NCD risk factors.

Evaluation of GeneXpert MTB/RIF assay for detection of pulmonary tuberculosis on sputum samples

Objective: To analyse the diagnostic performance of MTB/RIF assay for the diagnosis of pulmonary tuberculosis and detection of rifampicin resistance using sputum samples

Study Design: Observational cross-sectional study

Place and Duration of Study: Provincial TB Reference Laboratory [PTRL], Hayatabad Medical Complex, Peshawar, Pakistan, from January to October 2015

Methodology: A total of 268 participants were consecutively enrolled in the study after meeting the inclusion criteria. Their sputum samples were collected and processed by N-acetyl-L-cysteine-sodium hydroxide [NALC-NaOH] method and GeneXpert MTB/RIF assay

Results: This study determined the overall sensitivity and specificity of MTB/RIF assay, it was 92.4% [86/93] and 97.1% [138/142], respectively. The sensitivity was 98.4% [60/61] in culture proven smear positive samples, whilst sensitivity in culture proven smear negative samples was 93.7% [30/32], using culture as reference standard

Conclusion: GeneXpert MTB/RIF assay could greatly improve early diagnosis of PTB in smear negative cases as well as multidrug resistant tuberculosis

Detection of Mycobacterium tuberculosis and Mycobacterium bovis from human sputum samples through multiplex PCR

Tuberculosis [TB] has a long history and being present even before the start of recording history. It has left detrimental effects on all aspect of the life and geared the developments in the science of health. TB is caused by Mycobacterium tuberculosis complex [MTBC] including five species M. tuberculosis, M. bovis, M. africanum, M. canetti, and M. microti. M. tuberculosis and M. bovis infect both animals and humans. Therefore, differentiation of these two closely related species is very important for epidemiological and management purpose. We undertook the present study to characterize mycobacteria isolated from sputum of known TB patients by conventional methods and further, by multiplex PCR [mPCR] to detect the prevalence of Zoonotic TB [TB caused by M. bovis]. Sputum samples from TB patient were collected from two tertiary care hospitals in Peshawar i.e. Lady Reading Hospital and Hayatabad Medical Complex. All the samples were subjected to Ziehl Neelsen [ZN] stain, culture on Lowenstein Jensen [LJ] and Stone Brink medium, Nitrate reduction test and multiplex PCR. A total of hundred mycobacterial strains were isolated from these samples on the basis of ZN staining, cultural and biochemical methods. Later on, these isolates were subjected to multiplex PCR by using pncATB-1.2 and pncAMT-2 primers specific to M. tuberculosis and JB21, JB22 primers specific to M. bovis. By means of conventional method, these hundred cultures isolates were differentiated into M. tuberculosis [ninety six] and M. bovis [four]. Furthermore, by mPCR, it was determined that out of hundred isolates, ninety-eight were identified as M. tuberculosis and two isolates as M. bovis. This molecular method enables to differentiate M. bovis from M. tuberculosis in human sputum

Frequency of ABH secretors and non secretors: a cross sectional study in Karachi

ABO blood group and secretor status is valuable in relation to some diseases in clinical and forensic medicine. Across the globe there are geographic and racial differences in the frequency of secretors and non-secretors. Aim of this study was to evaluate the status of ABH blood group secretors and non-secretors in Karachi [Pakistan]. Blood and saliva samples were randomly collected from one hundred and one [n=101] healthy adult students [76 male, 25 female] ranging in age from 15 to 40 years. Their ABO and Rhesus blood groups were determined by conventional methods, and their secretor status was studied by hemagglutination inhibition method of saliva. Results showed that 64.4% of the study population were ABH blood group secretors while 35.6% were non-secretors. Frequencies of the secretor status among various ABO blood groups were 71.4% in group A, 79.5% in group B, 45.5% in group AB, and 61.5% in group O. Frequency of ABH secretor is high [64.4%]. Blood group B has the highest secretor [79.5%] frequency while Blood group AB has the lowest [45.5%]

Perception of ethical issues, encountered in under graduate medical and dental education

Bioethics has recently gained importance in the developing world. It's teaching in Medical Schools needs careful attention. The aim of this study was to assess the conceptual knowledge for adequacy of the current system of bioethics education and to identify the learning needs of Pakistani medical and dental students. The present study included 114, third year medical students, who had been provided introductory course on bioethics in 1[st] and 2[nd] years. A questionnaire containing 20 clinical situations was answered and assessed against standards. Thirty six percent of participants had forgotten the term bioethics. Patient's opinion and life saving research was recognized as most important where as performing surgery and informing patients about doctor's mistakes was considered as not worthy of obtaining consent. A wide range of gap in knowledge and attitude was identified in bioethics

Dental phobia in patients seeking dental treatment

Phobia against dental procedures is recognized as an important factor in inhibiting patients from seeking dental treatment. To study the types and levels of dental phobia in patients seeking dental treatment. Fatima Memorial Dental College Hospital, Lahore from August, 2008 to January, 2009. All adult patients coming for dental scaling, extraction, filling and root canal treatment who consented to participate in the study were included, while those with impaction, extensive periodontal treatment and edentulous were excluded. All patients were interviewed regarding their fears about dental procedures using structured questionnaire. The information was classified into 3 scales as strongly negative [phobic] moderately negative and neutral. A total of 76 patients were selected for the study. Dental phobia presenting as lack of confidence to ask questions from the dentist was observed in 30% patients while 96% had some previous bad experience at a dental clinic. Varying levels of phobia were noted for all other types of services as well as for the dentist's attitude towards the patients. Dentists should recognize the existence of dental phobia in patients coming for treatment and need to develop skills in minimizing phobia. To reduce fear and phobia dentists need to communicate more with the patients before undertaking any treatment

Risk factors for hypoxic ischemic encephalopathy in children

To determine underlying risk factors in neonates with hypoxic ischemic encephalopathy. Case-control study. Neonatology Unit at the Children's Hospital and the Institute of Childhealth, Lahore, from March to July 2005. All neonates [153] with the diagnosis of Hypoxic Ischemic Encephalopathy [HIE] were included in the study. Controls [187] were selected from admissions on the same day. Possible risk factors such as maternal age, parity, antenatal monitoring, place of delivery, prolonged second stage of labour, type of delivery, type of attendant at delivery and the gestational age were noted and compared. Sixty one [39.9%] mothers of asphyxiated babies reported no antenatal visits compared to 24.1% in the control group [OR 2.1, 95% Cl 1.3-3.2; p=0.002]. Only 6.5% of cases were born in government hospitals [teaching and district] in comparison to 20.9% of controls [OR 3.8, 95% Cl 1.9-7.6; p=0.001]. In 28.1% of cases, mothers had history of prolonged 2nd stage of labour in comparison to 5.9% of controls [OR 6.3, 95% Cl 3.3-11.9; p<0.001]. Fifty five cases [35.9%] were delivered by unskilled birth attendants compared to 28 [14.9%] controls [OR 3.2, 95% Cl 1.9-5.3; p<0.001]. No significant difference was found in maternal age, maternal parity, gestational age and the mode of delivery between the two groups. Delivery by unskilled birth attendant, prolonged second stage of labour, birth in a non-government hospital setup and absence of antenatal care were significant risk factors for hypoxic ischemic encephalopathy in neonates. Improvement in antenatal and intrapartum care may be helpful in decreasing the frequency of this problem

Phased introduction of hepatitis-B vaccination in Pakistan

The study was undertaken to assess the level of sero-protection of children up to five years of age who had received at least one dose of HB vaccination in their infancy. It is a cohort study to follow up vaccinated children from four weeks after completion of vaccination to one, three and five years of age of the children. The study was conducted in three districts of North West Frontier Province [N.W.F.P] from August 1991 to 1996. WHO/EMRO supplied single dose of vaccine for HBV in 1991. Five hundred randomly selected children fulfilling the inclusion criteria of having received at least one dose and 100 each of those children having received two or one dose of the vaccine: serology was conducted by using commercial ELISA. [Abbott]. Anti HBs was detected in 70% of infants who had received all the three doses, four weeks after completion of vaccination. After one year the sero-protection was raised to 90%, it fell to 80% after 3 years and 70% after 5 years. The group with two doses of the vaccine had anti HBs positive rates of 70%, 50% and 16% after one, three and five years respectively. The group having one dose had anti HBs positive rates of 50%, 30% and 6% and one, three and five years respectively. Sero conversion was best in children who had received full course and was significantly lower in those having received partial vaccination

Role of thyroid peroxidase antibodies in the outcome of pregnancy

To assess the prevalence of Thyroid peroxidase [TPO] auto antibodies among pregnant women and its relation with their pregnancy outcome. Cross-sectional analytical study. The study was carried out at Zayed Medical Complex, Lahore, in the department of Obs/Gynae and NHRC from July 2000 to July 2002. The study included 1500 Euthyroid pregnant women, ages 18 - 40, registered for antenatal care at Obs/Gynae department. Previous fertility history was recorded and thyroid peroxidase antibody level was assessed by ELISA method. A cut off value of TPO antibody of upto 100U/ml was considered negative and more than 100 U/ml was considered positive.The cases were followed for the outcome of their pregnancy and compared with TPO antibody levels. A comprehensive proforma was used to collect the data. The prevalence of positive TPO autoantibodies was found to be 11.2%. The raised TPO autoantibodies were found to have higher risk of abortion [O.R 49.2] and prematurity [O.R.8.1]. The complications were found to be significantly raised among positive TPO autoantibodies cases, when analysed by parity and age of mother at time of registration. Thyroid autoimmune diseases among euthyroid pregnant women may contribute to low-birth-weight of neonates and high abortion rate in all pregnancies. Raised levels of TPO autoantibody is a good marker to assess early hypothyroidism state and should form a screening modality in Pakistan

Microalbuminuria as an indicator of kidney function among diabetics

To find out the role of microalbuminuria as an indicator of kidney function among diabetics. Comparative study. Diabetes control clinic of Shaikh Zayed Hospital, Lahore, a tertiary care hospital, was the venue. The study was conducted during March 2002 to August 2003. Timed overnight urine samples were collected from all subjects and albumin was estimated using Radioimmunoassay [RIA] method. Albumin excretion rate [AER] was assessed in three groups including normals, Type 1 and Type 2 diabetics. AER over 30 mg/min was considered as significant. A significantly higher proportion of AER was observed in both types of diabetes. A higher proportion of increased AER was observed in females of Type 2 diabetics. The study has indicated that irrespective of the duration and type of diabetes the damage to the kidney can be avoided if good glycemic control is achieved