Microbiology and Drug Resistance Pattern in Clinically Significant Isolates of urine from Medical Wards of a Tertiary Care Hospital in North India.

Urinary tract infections (UTIs) are one of the most common bacterial infections encountered in clinical practice both in community and hospital settings in all age groups. It is the second most frequently occurring infection in general population after upper respiratory tract infection .Urinary tract infections (UTIs) are the leading cause of Gram negative sepsis in hospitalized patients and are the origin for about half of all hospital acquired infections caused by urinary catheters and are associated with considerable cost in terms of morbidity and economic and research expenditure. Material And Methods: This prospective cross sectional study was carried out in the Department of Microbiology of Government Medical College, Srinagar. A total of 800 patients were taken up for the study. The sample falling under the set inclusion criteria were selected from the urine specimen received in the laboratory for urine culture and sensitivity from Hospitalized patients (IPD). Culture and sensitivity reports and patient data obtained from hospital records was analyzed for this study. Out of 800 samples taken up for the study 208 (26%) were culture positive and 592Results: (74%) were negative. 208 positive samples 125(60.10%) were females and 83(39.90%) were males. female predominance was observed with 71% whereas 29% males were affected by UTI. UTI was predominantly in females of age group (21-40 yrs). most common organism isolated on culture was Escherichia coli(43.26%) both in short stay patients (<48hrs hospital stay) /OPD 22.59% as well as in IPD (>48hrs hospital stay) 20.67%.E.coli was isolated from patients of both uncomplicated and complicated UTI. The second most common organism isolated in our study was Enterococcus faecalis(22.59%), the rate of isolation was much higher 18.75% in inpatients (>48hrs hospital stay) and only 3.84% in OPD/short stay patients (<48hrs hospital stay). In our study Enterococcus spp ranked second amongst uropathogens, in IPD patients isolation rate was almost 5 times higher. Pseudomonas spp was 1 isolate in OPD (0.48%) and 6 (2.88%) in IPD, Acinetobacter 3 (1.44%), Proteus 1 (0.48%) found only in hospitalized patients (stay >48hrs). E.coli showed following sensitivity pattern 96.7% to nitrofurantoin, 93.3% to imipenem, 90.0% to amikacin, 75.6% to gentamycin, 73.3% to cefoperazone-salbactam and meropenem both, 68.9% to pipercillin tazobactam.The sensitivity to TMP-SMX was 45.6%, and to ceftriaxone and cefipime was only 22.2% and 21.1% respectively. The organism also showed resistance to drugs like levofloxacin 82.2% and ciprofloxacin 76.7%.Enterococcus faecalis isolated in our study was sensitive to Vancomycin 95.74% followed by Linezolid (93.6%), Nitrofurantoin (78.7%), HL-Amikacin (74.5%),HL- Gentamycin (70.2%). Enterococcus faecalis showed resistance to drugs commonly used to treat UTI i.e. 91.5% resistant to Ciprofloxacin and 89.4% resistant to Levofloxacin. Gram negative bacteria were most predominantConclusion: microorganisms resulting in more than 50% infections causing urinary tract infection. In our study we have seen that Gram positive cocci especially Enterococcus result in UTI in a significant proportion of patients. In our study Enterococcus spp ranked second amongst uropathogens, in IPD patients isolation rate was almost 5 times higher. The implementation of antibiotic stewardship programs is crucial to minimize resistance. Appropriate antibiotics need to be prescribed based on the antibiotic susceptibility testing which will be narrow spectrum, effective and less expensive with least side effects.

Study of anti-diabetic, beta-carotene-bleaching inhibiting and iron chelating properties of Carissa opaca root extracts

Abstract Degenerative diseases diabetes and oxidative stress constitute a major health concern worldwide. Medicinal plants are expected to provide effective and affordable remedies. The present research explored antidiabetic and antioxidant potential of extracts of Carissa opaca roots. Methanolic extract (ME) was prepared through maceration. Its fractions were obtained, sequentially, in hexane, chloroform, ethyl acetate and n-butanol. An aqueous decoction (AD) of the finely ground roots was obtained by boiling in distilled water. The leftover biomass with methanol was boiled in water to obtain biomass aqueous decoction (BAD). The extracts and fractions showed considerable porcine pancreatic α-amylase inhibitory activity with IC50 in the range of 5.38-7.12 mg/mL while acarbose had 0.31 mg/mL. The iron chelating activity in terms of EC50 was 0.2939, 0.3429, 0.1876, and 0.1099 mg/mL for AD, BAD, ME, and EDTA, respectively. The EC50 of beta-carotene bleaching activity for AD, BAD, ME, and standard BHA were 4.10, 4.71, 3.48, and 2.79 mg/mL, respectively. The total phenolic content (TPC) and total flavonoid content (TFC) of AD and BAD were also considerable. In general, ethyl acetate fraction proved to be the most potent. Thus, the C. opaca roots had excellent antioxidant activity while having moderate α-amylase inhibitory potentia

Immune-related therapeutics: an update on antiviral drugs and vaccines to tackle the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic rapidly spread globally. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, is a positive-sense single-stranded RNA virus with a reported fatality rate ranging from 1% to 7%, and people with immune-compromised conditions, children, and older adults are particularly vulnerable. Respiratory failure and cytokine storm-induced multiple organ failure are the major causes of death. This article highlights the innate and adaptive immune mechanisms of host cells activated in response to SARS-CoV-2 infection and possible therapeutic approaches against COVID-19. Some potential drugs proven to be effective for other viral diseases are under clinical trials now for use against COVID-19. Examples include inhibitors of RNA-dependent RNA polymerase (remdesivir, favipiravir, ribavirin), viral protein synthesis (ivermectin, lopinavir/ritonavir), and fusion of the viral membrane with host cells (chloroquine, hydroxychloroquine, nitazoxanide, and umifenovir). This article also presents the intellectual groundwork for the ongoing development of vaccines in preclinical and clinical trials, explaining potential candidates (live attenuated-whole virus vaccines, inactivated vaccines, subunit vaccines, DNA-based vaccines, protein-based vaccines, nanoparticle-based vaccines, virus-like particles and mRNA-based vaccines). Designing and developing an effective vaccine (both prophylactic and therapeutic) would be a long-term solution and the most effective way to eliminate the COVID-19 pandemic.

Familial Predictors Of Smoking In Adolescents; A Comparison Of Smokers And Non-Smokers

@#Adolescence stage is filled with enormous changes and challenges. At this stage, adolescents are not mentally mature so they failed to adjust to the changes of their life and are at greater risk of developing smoking habit. Many psychosocial factors contribute to adolescents’ smoking, among them family role is prominent. So, the present correlational study aimed to highlight the familial predictors of smoking in adolescents. It was hypothesized that parenting styles, lack of parent-child communication, less parental monitoring, parents and sibling smoking would be related to adolescents smoking. Data was collected from 150 adolescents (smokers: 70, non-smokers: 80) throughconvenient sampling technique. Parental bonding instrument and parental monitoring questionnaire were used. Binary Logistic regression revealed less Parental care and father’s monitoring, lack of mother-child communication and siblings’ smoking as significant predictors of smoking. The study implications are discussed with its application in health, social and counseling psychology.

Anthropometric, Physical Fitness And Kinematics Analysis Of The Jump Shot Of Female Handball Players - A Case Study Of The Islamia University Bahawalpur, Pakistan

Background: This study was designed in two poles, 1st to examine the kinematic parameters of the handball jump shot and 2nd to compare the anthropometric, and physical fitness of novice and skilled female handball players of the university level. Methods: This study design was cross-sectional, and a purposive sampling method was adopted for selecting the participants. The sample consisted of (n = 20) novice, and (n = 20) university female handball players. The selected variables were standing broad jump, vertical jump, flexibility, 30-m dash, agility, stride length, stature, body mass, arm length, upper arm girth, leg length, chest girth, waist girth, hip girth, thigh girth, calf girth, hand length, handbreadth and shoulder breadth, pelvic breadth, transverse breadth, elbow and knee breadth, handgrip and arm span, left and right knee angle, left and right elbow angle. An Independent t-test was applied to examine differences between skilled and novice players in kinematics and anthropometric variables. Results: Results showed the skilled female players were significantly higher than the novice players in the following as right elbow angle at the start of movement (<. 03), left elbow angle at the start of movement (<. 00), right knee angle at the start of movements (< .03), stride length at release (< .01), 30-meter dash (< .04), handgrip strength(< .02), agility (< .03), forearm girth (< .03), thigh girth (< . 03) and arm span (< .04). Conclusion: It was concluded the higher angle of elbows, right knee along with more prolonged stride increase the movement capacity of skilled female handball player while attempting the jump shots than novice female players. On the other hand, the anthropometric and fitness measures as arm span, thigh girth, running speed, handgrip strength, and agility increase the performance of skilled players than the novice. The female handball coaches may enhance the performance of novice players by focusing on the specific training of extension and flexion of elbows and stride movement as well as enhancing the physical fitness of female handball players. Future studies would focus on the training of handball players to increase the jump shot performance of players.

Clinical Profile and Complications of Continuous Ambulatory Peritoneal Dialysis in Kashmir

Introduction: Diabetes Mellitus is a syndrome characterizedby chronic hyperglycemia and disturbances of carbohydrate,fat and protein metabolism with absolute or relative deficiencyof insulin secretion and/or insulin action. It is one of themost common non-communicable diseases in the world.Adiponectin is a protein secreted exclusively by adipocytesthat regulates glucose and lipid metabolism. It has been foundto influence the body’s response to insulin thereby modulatinginsulin action and resistance. Several studies have found thatadiponectin levels are inversely associated with the severityof diabetes mellitus. Our study, thus, aims to compare theassociation between levels of adiponectin, fasting bloodglucose, body mass index and waist-hip ratio in patients ofdiabetes mellitus.Material and Methods: This case control study was done inpatients of type 2 diabetes mellitus attending Medicine OPDand ward from October 2016 to September 2018. A total of 88people were included in the study; 44 cases and 44 controls.Results: This study shows that serum adiponectin level issignificantly decreased in type 2 diabetes mellitus patients ascompared to controls and it also shows negative correlationwith fasting blood glucose, body mass index and waist-hipratio.Conclusion: It can be concluded that serum adiponectinestimation may be a useful biomarker for the diagnosis oftype 2 diabetes mellitus and it may be a useful adjunct in thetreatment of type 2 diabetes mellitus.

An in silico investigation of phytochemicals as potential inhibitors against non-structural protein 1 from dengue virus 4

Dengue fever has emerged as a big threat to human health since the last decade owing to high morbidity with considerable mortalities. The proposed study aims at the in silico investigation of the inhibitory action against DENV4-NS1 of phytochemicals from two local medicinal plants of Pakistan. Non-Structural Protein 1 of Dengue Virus 4 (DENV4-NS1) is known to be involved in the replication and maturation of viron in the host cells. A total of 129 phytochemicals (50 from Tanacetum parthenium and 79 from Silybum marianum) were selected for this study. The tertiary structure of DENV4-NS1 was predicted based on homology modelling using Modeller 9.18 and the structural stability was evaluated using molecular dynamics simulations. Absorption, distribution, metabolism, excretion and toxicity (ADMET) along with the drug-likeness was also predicted for these phytochemicals using SwissADME and PreADMET servers. The results of ADMET and drug-likeness predictions exhibited that 54 phytochemicals i.e. 25 from Tanacetum parthenium and 29 from Silybum marianum showed effective druglikeness. These phytochemicals were docked against DENV4-NS1 using AutoDock Vina and 18 most suitable phytochemicals with binding affinities ≤ -6.0 kcal/mol were selected as potential inhibitors for DENV4-NS1. Proposed study also exploits the novel inhibitory action of Jaceidin, Centaureidin, Artecanin, Secotanaparthenolide, Artematin, Schizolaenone B, Isopomiferin, 6, 8-Diprenyleriodictyol, and Anthraxin against dengue virus. It is concluded that the screened 18 phytochemicals have strong inhibition potential against Dengue Virus 4.

How Blood Groups Correlate with Capacity of Drinking Water?

The objective of the present study was to correlate the blood grouping with the capacity of drinking water. Total of 172 subjects participated in the present study. The subjects were students of Bahauddin Zakariya University Multan, Pakistan. For determining the blood type a slide with 3 drops of antiserum A, B and D was taken. The 3 blood drops were mixed with drops of antiserum A, B, and D respectively on the slide. Blood clusters together with antisera D shows the +ve Rh factor. Our variable was capable of drinking water per day and our work was to correlate the variable with blood group. All the subjects were questioned about how many glasses of water they drink per day according to blood group. It was concluded from the present study that female who had blood group AB- have greatest mean value and had a maximum capacity of intake of water and in males who had blood group O+ have a maximum value of mean that showed that O+ male had the greatest capacity of drinking water.

Barriers to the early initiation of Insulin therapy among diabetic patients coming to diabetic clinics of tertiary care hospitals

Background and Objective: Initiation of Insulin therapy during earlier stages has proved to significantly improve health outcomes among diabetics in comparison to oral medications. Not only patients but physicians are also often resistant to early initiation of insulin therapy. The objective was to assess misconceptions and barriers to early initiation of insulin therapy among diabetic patients coming to a diabetic clinic

Methods: This cross sectional study was conducted on 300 patients selected by convenience sampling arriving in Diabetes Outdoor Clinics of Mayo and Services Hospitals, Lahore during August 2017 to May 2018. The data was entered and analyzed by using SPSS version 17

Results: Out of 300 patients included in study, 39% [n= 117] were males and 61% [n=183] were females. The mean age of the participants at presentation was 48.46+/-13.15 years with a range of 13 to 80 years. Study participants considered it embarrassing to inject insulin in public place [p-value 0.01]. The fear associated with lifelong commitment to insulin therapy once it is started, was also found statistically significant [p-value 0.001]particularly in subjects who have long duration of DM [>5 years]

Conclusion: Perceptions of diabetic patients about insulin therapy are still barriers to early initiation of therapy and tend to prevail in Pakistan and around the globe

Microwave assisted extraction of phytochemicals an efficient and modern approach for botanicals and pharmaceuticals

The final quality of pharmaceutically active herbal preparation is significantly contributed by extraction procedures. Hence in the last decade Microwave assisted extraction [MAE] has been introduced. This is an efficient and modern tool with multiple benefits as compared to the traditional methods of extraction. The benefits are in terms of reduction in cost, time of extraction, amount of solvent used, energy consumptions and low CO2 emission. Therefore present study was planned to give brief overview on applications of microwave assisted extraction of natural products. It is also discussed that how the various parameters of microwave assisted extraction like nature of the solvent, temperature, particle size, power level of microwaves and time of irradiation influences the extract yields of plant parts. This review also emphasizes the application of MAE for increased production of phyto-medicines, sweeteners, spices and all other commercial products related to botanicals

Ameliorating role of methanolic leaves extract of Fraxinus xanthoxyloides against CCl4-challanged nephrotoxicity in rats

Roots, bark, stem/twigs, and leaves of Fraxinus xanthoxyloides are being used regionally for the cure of malaria, jaundice, internal injuries, pneumonia, pain, rheumatism and also in fracture of bones. Our objective was to assess the methanolic leaves extract of F. xanthoxyloides for its antioxidant capability against oxidative stress induced by carbon tetrachloride [CCl[4]] in the kidney of Sprague-Dawley rats. Duration of this experiment was 30 days and doses were given on alternative days. Urine of rats was assessed for kidney function and renal tissues for antioxidant enzymes activity, biochemical markers, comet assay and histopathology. Enhanced urinary creatinine, urobilinogen levels and decreased creatinine clearance, protein contents, and albumin levels were observed by CCl[4] administration when matched to controls. CCl[4] injection also decreased the level of reduced glutathione, catalase, super oxide dismutase, peroxidase, glutathione s-transferase, glutathione reductase, and tissue protein while elevated the levels of thiobarbituric acid reactive substances, DNA damages and H[2]O[2] in renal tissues of experimental animals. Co-treatment of FXM and silymarin, lead to the restoration of all the above tested parameters of kidney. Through this study we affirmed the ameliorating role of F. xanthoxyloides in oxidative stress affiliated disorders of kidney

Epigenetics: Quest for no-escape to HIV, a persistent pathogen

Acquired Immune Deficiency Syndrome [AIDS] is a disease infection mix, which is primarily because of 'deficient' immune system. Human Immune-deficiency Virus [HIV] makes the immune system susceptible to many infections by infiltrating it. Many researchers believe that HIV is a mutated form of Simian Immune-deficiency Virus [SIV]. After being clinically discovered in 1981 in America, it is said to have caused 36 million deaths. Treatment of AIDS has been a 'burning ' issue ever since its discovery. There is no cure for AIDS! Although, Recombinant Transcriptase Inhibitors [RTis] are being considered a major treatment against HIV that can not only lessen the effect of HIV but also can prolong the life of HIV positive patients. More recent advancement includes 'transplantation of transgenic stem cells' in HIV positive patients. As latency of HIV provirus in host genome is the preeminent weapon of this virus against RTis that compel it to hide from host immune system and a persistent pathogen thereof. Thus, epigenetic activation of latent provirus pool by methyl inhibitors along with nontoxic chemical drugs seems to be a more promising treatment to avoid the burden of lifelong RTI

Effect of Lactobacillus casei on serum interleukins following enteropathogenic E. coli infection in experimental rabbits

In the present study we investigated the pro-inflammatory and anti-inflammatory effect of Lactobacillus casei following infection with multi-drug resistant enteropathogenic Escherichia coli infection in experimental rabbits. For this purpose, 40 adult rabbits were divided into different groups and were infected with multi-drug resistant E. coli AZ1 strain except the control groups. The rabbits were orally administered with L. casei SABA6 strain in two different ways i.e. pre-treatment and post-treatment and both were continued for 7 days. The rabbits were sacrificed sequentially at 0, 4, 7 and 10 days post infection [dpi]. Serum and intestinal tissue samples were collected from each rabbit. Intestinal tissue samples were subjected to histopathological examination that showed microscopic lesions at 4 and 7 dpi among infected group. The serum samples were processed for determination of Interleukin-6 [IL-6, pro-inflammatory] and Interleukin-10 [IL-10, anti-inflammatory] using ELISA. It was found that oral administration of L. casei SABA6 reduces the eruption of intestinal epithelial cells and reduces the incidence of diarrhea. Further, L. casei SABA6 also resulted in immuno modulation by significant increase in concentration of IL-6 and IL-10 particularly at 4 and 7 dpi and protects against E. coli AZ1 infection. Altogether, it was concluded that increased IL-6 and IL-10 levels were responsible for protection against EPEC infections. The sequential sacrifice of experimental animals could be adopted for future studies to find out pathogenesis and virulence mechanism of EPEC infections along with protective efficacy of different probiotics

Determination of anti-oxidative, anti-microbial activity and heavy metal contents of Leucoagaricus leucothites

Mushrooms, a treasure of diverse bioactive scaffolds, have been widely admired due to their nutritional and medicinal significance all over the world. The current study intended to evaluate the therapeutic potentiality of an edible mushroom, Leucoagaricus leucothites [Vittad.] Wasser. Thus, anti-oxidant potential of L. leucothites was determined using DPPH assay and for the determination of anti-microbial potential agar dilution procedure was followed. TOS [total oxidant status], TAS [total anti-oxidant status], and OSI [oxidative stress index] values were evaluated utilizing Rel Assay Kits. For the assessment of heavy metal contents, wet decomposition approach with atomic absorption spectrophotometry was adopted. Screening of phytochemicals present in ethanolic extract of L. leucothites were determined by HPLC. TAS, TOS and OSI values were found to be 8.291mmol/L, 10.797ìmol/L and 0.130 respectively. Our results declared that heavy metal contents are generally in the safe range. Phytochemical analysis of L. leucothites has affirmed the presence of important phenolics such as gallic acid, catechin, and hesperidin. Investigations on antioxidant and anti-microbial potential of L. leucothites has uncovered the fact that this naturally occurring, biologically active, and therapeutically effective mushroom specie has natural borne anti-oxidant and anti-microbial potential and it would be worthwhile to use it for nutritional as well as medicinal purpose

Efficacy of terlipressin in upper gi bleeding due to liver cirrhosis

Background: Upper Gastrointestinal bleeding [GI] bleeding can be a fatal and life threatening emergency and need emergency treatment to avoid unwanted morbidity and mortality

Objective: To determine the efficacy of Terlipressin in cases of upper GI bleeding due to liver cirrhosis

Methodology: In this case series, there were total 50 cases of upper GI bleed within last 24 hours due to liver cirrhosis of both genders, falling in the age range of 30-70 years, presenting to medical wards and emergency department. Terlipressin was injected in a dose of 1mg every 6 hour. This therapy was given for maximum of 72 hours. The efficacy was labeled as yes when there was no bleeding episode over 12 hours. Data was entered and analyzed by sing SPSS version 21

Results: In this study, there were total 50 cases out of which 35 [70%] were males and 15 [30%] females. The mean age and duration of cirrhosis were 49.45+/-6.85 years and 4.87+/-2 years respectively. The efficacy was almost equal in both genders [p= 0.95]. The efficacy was slight better in age group 30-49 years where 16 [69.56%] out of 23 cases had it [p= 0.12]. The efficacy was significantly better in Class A where 4 [80%] out of 5 cases had it as compared to Class B and C with p= 0.01

Conclusion: Terlipressin has good efficacy in treating upper GI bleed in cases with liver cirrhosis and this is significantly better in cases with Child Pugh Class A

Pattern of injuries among motorcyclists during road traffic accidents

Background: Motorcyclists are prone to injuries during road traffic accidents

Objective: To assess the frequency and pattern of injuries associated with Motorcycle related road traffic accidents in Emergency department of a tertiary care hospital

Methodology: A total of 500 patients of road traffic accident were included in this cross sectional study, from 1st March to 31st July 2017. This study was conducted in Emergency Department of Sheikh Zayed Hospital, Rahim Yar Khan. Data was collected by filling a questionnaire after interview of patients or attendant. Frequency of motor cycle related injuries and their pattern were noted. Informed consent was taken. Data was coded and analyzed by using SPSS version 20

Results: Injured patients included in the study were 500. A large number of injured, 397 [79.4%] persons were riding on motorcycles. The injuries ranged from minor abrasions to severe head injuries and poly-trauma. Majority of cases were of head injury 164 [41%]

Conclusion: Head injuries are the most common and fatal injuries among motorcyclists. Major causes of accidents in motorcyclists were not following safety measure, over speeding, not wearing helmet, behavioral issues and poor enforcement of traffic laws

Frequency of thumb pain among mobile phone user students

Background: Prolonged and frequent use of mobile phone leads to pain in thumb and hand. Primary prevention strategies have largely been confined to reducing the mobile phone use as it will prevent the repetitive microtrauma

Objective: To assess the frequency and nature of thumb pain among mobile phone user students of Sheikh Khalifa Institute of Allied Health Sciences, Sheikh Zayed Medical College, Rahim Yar Khan

Methodology: A cross sectional study was conducted in students of Sheikh Khalifa Institute of Allied Health Sciences, Rahim Yar Khan from 1st October to 31st December 2017. The study subjects were mobile phone user students with ages ranging from 18 to 25 years. Data was collected through non- randomized convenient sampling technique. A performa was designed and 110 study subjects were interviewed regarding the frequency of thumb pain among mobile phone users, after taking their verbal consent. All the data collected was analysed on SPSS version 20.0

Results: From the data of 110 mobile phone users, it was observed that 40% subjects had thumb pain and 60% had no pain. Results showed that only 16.4% were male and 83.6% females. It was noted 91.8% were right handed and 8.2% were left handed

Conclusion: It was concluded that thumb pain is common among students mostly caused by overuse of thumb in mobile phone users. Frequent use of mobile phone for different activities for prolonged periods of time leads to pain and inflammation in thumb and hand

Use of performance enhancing drugs, their effects and types used by the students of faisalabad medical university

Objectives: To find out the percentage of students from Faisalabad Medical University that are currently using Performance enhancing drugs, to find out the types of Performance enhancing drugs that are currently being used by the students and to find out the effects of these performance enhancing drugs on the health of the students

Study Design: Cross sectional study

Setting: 25 students each from 2nd year, 3rd year, 4th year and 5th year studying at Faisalabad Medical University were included in the study

Study Period: January, 2015 to June, 2015

Materials and methods: A total of one hundred medical students were anonymously given a 10-item questionnaire. 25 students each from 2nd year, 3rd year, 4th year and 5th year were involved in the study. The team randomly distributed the questionnaire among the students on alternative days. The completed questionnaire was sealed in envelopes and analyzed

Results: The age of the students completing the Performa ranged from 19-25 years. In the male population the highest use of PEDS was observed in the age group of 22 years, while the lowest use of PEDS was observed in the age group of 19 years. The highest percentage of females that used PEDS was observed in the age group of 22 years as well similar to the male ratio of PEDS use at the high level. The lowest use of PEDS was observed at the age group of 19 and 25 which was 5 % in both age groups

Conclusion: The results indicated that PEDS were used by the male students in a higher percentage as compared to the female students. The Caffeinated energy drinks were used more commonly. The results of this strategic survey have provided for the first-time valuable information about the use of PEDS by students of FMU to achieve desirable effects. It demonstrates that the use of PEDS in the students was high as compared to expected results; especially higher in those male students involved in sports or gym activities specifically bodybuilding athletes

Susceptibility pattern of Mycobacterium Tuberculosis to 1[st] line Anti Tuberculosis therapy

Objective: To determine the susceptibility pattern of Mycobacterium Tuberculosis [MTB] to 1[st]line Anti tuberculosis therapy

Study design: Cross sectional study

Study Setting: Department of Biochemistry, Allied Hospital, Faisalabad

Study Duration: July 2017 to March 2018

Methodology: This was a cross sectional study carried out at Department of Biochemistry, Allied Hospital, Faisalabad during July 2017 to March 2018. In this study the cases of both gender with age more than 15 years were included. The cases that have already taken ATT were excluded. Sputum samples were obtained and then processed at solid Lowenstein Jensen [LJ] media for at least 6 weeks, MTB isolated from these sample were then tested for their susceptibility to the 1st line ATT drugs. The MIC of the studied drugs per ml of LJ medium for susceptibility testing were 0.2 mcg for isoniazid, 02 mcg for streptomycin, 05 mcg for Ethambutol, 100 mcg for pyrazinamide and 01 mcg for rifampicin

Results: In this study there were total 115 cases; out of which 72 [62.60 percent] were males and the mean age of the participants was 35.19+/-10.67 years. Drug resistance was seen in 36 [32.17 percent] of cases and few of the cases had more than 1 drug involvement. The most common drug to which was resistance was seen was streptomycin affecting 19 [16.52 percent] of the cases. it was followed by Isoniazid where it was seen in 17 [14.78 percent] of the cases. Single drug resistance was seen in 30 [26.08 percent] of the cases. three and four drug resistance were seen in 2 [1.73 percent] of cases each

Conclusion: Drug resistance is seen in almost every 3[rd] case and the most common drug to show resistance is streptomycin

Is hepatovenocaval syndrome a different entity from budd-chiari syndrome in children?

Objective: To differentiate between clinical and demographic spectrum, and outcome in hepatovenocaval syndrome [HVCS] and Budd-Chiari syndrome [BCS]. Study Design: Descriptive study. Place and Duration of Study: Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Children Hospital, Lahore, from January 2014 to January 2017

Methodology: All children less than 18 years of age, presenting with ascites and visible veins over abdomen, flanks and back were enrolled in the study. Real time Doppler Ultrasonogram was performed in all children for documentation of intrahepatic part of IVC obstruction along with or without hepatic venous obstruction. Children meeting inclusion criteria underwent liver profile, coagulation profile, diagnostic paracentesis for SAAG gradient, and Gadolinium enhanced multiphasic MR scan. Liver biopsy and venography was performed in selected patients

Results: A total of 92 children presented with ascites, among them 58 children met our inclusion criteria. Intrahepatic IVC obliteration, i.e. HVCS, found in 67% [n=39] and hepatic venous outflow obstruction, i.e. BCS was found in 33% [n=19] children. Children with BCS were older than HVCS with mean age of 9.5 +/-2.58 versus 4.12 +/-0.977 years. HVCS group had 14 boys and 24 girls with a ratio of 1:1.8, while BCS had a ratio of 1:0.9 with 10 boys and 9 girls. No etiological factor was found for HVCS, while most of patients with BCS had a procoagulant disorder. Caudate lobe hypertrophy was a consistent feature in BCS, while IVC obstruction was found in HVCS persistently. Orthotopic liver transplant was needed in three cases [7.6%] of HVCS and four [20.96%] of BCS cases. Antibiotic therapy has a good role in HVCS, while anticoagulation and diuretics had good result in BCS

Conclusion: Hepatovenocaval syndrome [HVCS] mostly affected younger children, especially girls. BCS usually affected older age groups with pro-coagulant disorders who responded to anticoagulation and diuretic. Further studies are needed to compare both conditions