Assessment of Bacteriological Pattern and Antimicrobial Susceptibility in Deep Neck Space Abscess

Background: Deep neck abscess is a common clinical entity in developing countries like ours. Despite the widespread use of antibiotics, deep neck infections do not disappear and remain one of the most difficult emergencies encountered in daily clinical practice. The extent and severity of the illness could become life-threatening. Therefore, coping with deep neck abscess remain a challenge to otolaryngologists. This study aimed to analyze the bacteriological pattern and antimicrobial susceptibility in deep neck space abscesses. Material & Methods: It was a cross-sectional observational study. 50 patients with deep neck space abscesses fulfilling the inclusion and exclusion criteria admitted to the department of ENT & Head Neck Surgery, Rangpur Medical College Hospital, Rangpur, from 1st July 2017 to 30th December 2017 were enrolled in this study. Pus from deep neck space abscess was collected by either aspiration or incision and drainage with proper aseptic measure and sent by sterile test tube to microbiology department immediately. Data were collected by detailed history taking and clinical examination & investigations with informed written consent and analyzed by SPSS (version 20). Results: In this study most commonly involved deep neck spaces were Submandibular (38%), Peritonsillar (32%), Retropharyngeal (14%), and parapharyngeal (8%) spaces. Streptococcus viridans was the most prominent organism 14 (28%) followed by Klebsiella pneumonia 9(18%) and Staph. aureus 4 (8%). The most effective antibiotic was Ceftriaxone 34(79%) followed by Cefuroxime 30 (70%) and Erythromycin 23(54%). Aerobic organisms were highly sensitive to Cefuroxime (83%) and Ceftriaxone (83%) followed by Erythromycin (48%). Anaerobic organisms were sensitive to Clindamycin (100%), Metronidazole (100%), and Erythromycin (100%) followed by Ceftriaxone (75%). Conclusion: The most frequently isolated organism in deep neck space abscesses were Streptococcus viridans and Staphylococcus aureus and sensitivity results showed the majority of isolates are susceptible to Ceftriaxone and Cefuroxime

Prevalence and Antimicrobial Susceptibility Pattern of Pathogens Isolated from Different Age Groups with Urinary Tract Infection at Tangail, Bangladesh

Background: Urinary tract infections (UTIs) are commonly detected in several hospitals and typical medical health centres. The antibiotic policy must be updated based on current knowledge about causative agents and their antibiotic susceptibility patterns. The goal of this study was to find out exactly how frequently microbes cause urinary infections and their antibiotic susceptibility patterns. Methods: Mid-stream urine samples were analyzed microscopically for a routine examination, and bacterial pathogens were isolated by conventional culture method using Chromogenic UTI media and MacConkey agar culture media. A group of biochemical parameters were utilized for bacterial identification and characterization. Finally, in vitro antimicrobial susceptibility was performed by the Kirby- Bauer disc diffusion methods against 14 commercially available antibiotics. Results: A total of 1288 clinical samples from UTI patients were obtained aseptically, with 398 showing positive growth with a range of bacteria. Females have a higher prevalence of UTI than males. E. coli was the most common pathogen found (82.86%), followed by Enterococcus faecalis (8.44%), Klebsiella pneumoniae (5.63%), Pseudomonas aeruginosa (2.81%), and Proteus mirabilis (0.26%). The majority of the bacteria had a high sensitivity to Meropenem (98.25%); moderate sensitivity to Amoxicillin, Azithromycin, Ciprofloxacin, Gentamicin, Levofloxacin, Ceftriaxone, Cefepime, and Nitrofurantoin; and low sensitivity (20%) to Cefixime, Cephradine, Cefuroxime, Clindamycin, and Trimethoprime. Conclusion: These findings have clinical and epidemiological implications, improving study to identify causative pathogens and pathogen sensitivity patterns in urinary tract infections, as well as clinicians' knowledge of how to choose the best antibiotics and, ultimately, contributing to patient diagnosis and treatment.

Antibiotic susceptibility patterns of bacterial isolates of patients with upper respiratory tract infections

Abstract To evaluate the antibiotic susceptibility patterns in URTIs reporting to tertiary hospitals of Lahore. A cross-sectional study employing 259 culture sensitivity reports obtained from tertiary care hospitals of Lahore. Using SPSS, descriptive statistics were used to estimate frequencies and percentages. In URTIs, S. aureus (5%) was the frequent gram-positive isolate followed by MRSA (1.5%) and MSSA (1.5%), while P. aeruginosa (15.8%) was the prevalent gram-negative isolate followed by Klebsiella (13.1%) and E. coli (6.9%). Against P. aeruginosa, ceftazidime (7.7%), cefuroxime/ceftriaxone (4.6%), amoxicillin (4.3%) and ciprofloxacin (4.2%), were tested resistant, while imipenem (11.2%), ciprofloxacin (9.2%), amikacin (9.2%), meropenem/ levofloxacin/gentamicin (8.1%) and piptaz (6.9%) were found sensitive. Against Klebsiella, carbepenems (7.3%), amikacin (6.5%), ciprofloxacin (5.4%) and gentamicin (5%) were tested sensitive, whereas, ceftazidime (8.5%), ceftriaxone (5.8%), cefaclor (5.5%), ampicillin (4.6%), co-amoxiclave (4.2%) and ciftazidime/ciprofloxacin (3.8%) were found resistant. Overall, imipenem (35%), meropenem (30.8%) and amikacin (31.9%) were the three most sensitive antibiotics, while ceftazidime (25.4%), ceftriaxone (19.2%) and ampicillin (18.5%) were the three most resistant antibiotics. Data suggested that P.aeruginosa and Klebsiella, were the most frequent bacterial isolates in URTIs of Lahore. These isolates were resistant to ampicillin, cefuroxime and ceftazidime, but were sensitive to carbapenem and aminoglycosides

Evaluation of Outcome of Non-cemented Total Hip Arthroplasty in Avascular Necrosis of Femoral Head in 25 to 40 Years Age Group

Background: The proper treatment of Avascular Necrosis(AVN) of Femoral Head has become a major challengeworldwide in younger age group as they are main effectiveforce of family and society. The patients who are young andsuffer from AVN of femoral head become immovable, worklessand unproductive. Thus they become burden to family andsociety. The Hip Replacement is a better way of treatment forthis type of patients, making them pain free and movable andimproving their everyday activity.Objective: To evaluate outcome of non-cemented total hiparthroplasty in avascular necrosis of femoral head among theactive younger age group of patients.Method: This was a prospective observational study of 30patients and all the patients had done non-cemented total hiparthroplasty (THA) through lateral approach at the NationalInstitute of Traumatology and Orthopaedic Rehabilitation(NITOR), Dhaka.Results: Mean age of the patients was 32 ±5.12 years,patients were diagnosed as Avascular Necrosis of FemoralHead in which 63% were affected at Right sided Hip 37%patients were at Left sided hip. Final outcome after six monthsof operation evaluated with Modified Harris Hip Score revealedthat, there was significant (p<0.005) improvement in functionalability of the patients after THA. Among the 30 studied cases,21 (70%) patients carried slight pain and 63.4% of them wereable to walk unlimitedly. Outcome of supporting functionanalysis indicated 76.7% patients could walk and climb stairswithout support and 100% patients could sit on chair, 66.7%patients among them could walk without limping. On clinicalassessment of deformity, range of motion before and afteroperation, significantly resolved the deformities and increasedthe range of motion (2100-2300). After evaluation with ModifiedHarris Hip Score showed that 60% excellent (HHS 90-100),30% good (HHS 80-89), 10% had fair (HHS 90-100) outcome.Conclusion: The progressive study of the patients of THAshowed that non-cemented THA has resulted in a better wayamong the younger age group of people

Association of hypertension and dyslipidaemia with increasing obesity in patients with Type 2 Diabetes Mellitus

The study was performed to estimate the association of hypertension and dyslipidaemia with increasing body weight and obesity in Type II diabetics of Lahore, Pakistan. An observational study was conducted by enrolling 2708 obese diabetics from four diabetes care centres of Lahore, Pakistan. Data was collected for a period of 7 months. Associations were estimated using chi-square, binary and multinomial logistic regression. Data suggested that blood pressure, systolic and diastolic, exhibited continual increase with increasing body weight and obesity class in diabetes patients with 41.8% increase in the prevalence of hypertension in obesity class III subjects (OR; 1.91, p=0.02). Likewise, triglycerides and total cholesterol exhibited continual increase in their mean values with increasing obesity, i-e., an overall increase in the prevalence of dyslipidaemia of 27.2% in obesity class 3 subjects (OR; 1.94, p=0.29). Taken together, this data suggested that hypertension is potentially associated with increasing obesity in diabetics, while dyslipidaemia demonstrated plausible association only with obesity class 3.

Investigations of Acacia modesta Wall. leaves for in vitro anti-diabetic, proliferative and cytotoxic effects

ABSTRACT The leaves of Acacia modesta Wall. have been shown to possess diverse pharmacological properties. Therefore, we aimed at evaluating anti-diabetic, cytotoxic and proliferative effects of extracts of Acacia modesta Wall. leaves. After evaluating the primary and secondary metabolites, anti-diabetic activity of various extracts was assessed by α-amylase inhibition, glucose uptake by yeast cells and non-enzymatic glycosylation of hemoglobin assay. Cytotoxicity and proliferative potential was assessed by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) and short term proliferation assays, respectively, using human liver carcinoma cell line, HepG2. Among other extracts, chloroform extract exhibited 34.16% inhibition of α-amylase, 90.65% inhibition of hemoglobin glycosylation and 94.75% glucose uptake employing α-amylase inhibition, non-enzymatic glycosylation of hemoglobin and glucose uptake by yeast cells assays, respectively. Moreover, extracts exhibited no significant effects on HepG2 cell viability and proliferation. So, this data suggested that chloroform extract of leaves of Acacia modesta Wall., exhibited higher anti-hyperglycemic activity in comparison to extracts in other solvents, while no extract demonstrated cytotoxic and proliferation effects when tested using HepG2 cell line

Association of post-traumatic stress disorder and work performance: A survey from an emergency medical service, Karachi, Pakistan / 世界急诊医学杂志（英文）

@#BACKGROUND: The purpose of the study was to explore the association between post-traumatic stress disorder (PTSD) and work performance of emergency medical services personnel in Karachi, Pakistan. METHODS: Emergency medical service personnel were screened for potential PTSD using Impact of Event Scale-Revised (IES-R). Work performance was assessed on the basis of five variables:number of late arrivals to work, number of days absent, number of days sick, adherence to protocol, and patient satisfaction over a period of 3 months. In order to model outcomes like the number of late arrivals to work, days absent and days late, negative binomial regression was applied, whereas logistic regression was applied for adherence to protocol and linear for patient satisfaction scores. RESULTS: Mean scores of PTSD were 24.0±12.2. No association was found between PTSD and work performance measures: number of late arrivals to work (RRadj 0.99; 0.98–1.00), days absent (RRadj 0.98; 0.96–0.99), days sick (RRadj 0.99; 0.98–1.00), adherence to protocol (ORadj 1.01; 0.99–1.04) and patient satisfaction (β 0.001％–0.03％) after adjusting for years of formal schooling, living status, coping mechanism, social support, working hours, years of experience and anxiety or depression. CONCLUSION: No statistically significant association was found between PTSD and work performance amongst EMS personnel in Karachi, Pakistan.

Prevalence and management of anemia in pre-dialysis Malaysian patients: A hospital-based study / Anemia em pacientes pré-diálise: prevalência, gravidade, manejo

Summary Objective: Anemia, a common complication of chronic kidney diseases (CKD), is involved in significant cardiovascular morbidity. Therefore, the objective of our study was to investigate the prevalence and severity of anemia in pre-dialysis patients, as well as to determine the predictors of anti-anemic therapy. Method: A retrospective, observational study was conducted on adult pre-dialysis patients receiving treatment at the Hospital Universiti Sains Malaysia from January 2009 to December 2013. Results: A total of 615 eligible cases were included. The mean age of patients was 64.1±12.0 years. The prevalence of anemia was 75.8%, and the severity of anemia was mild in 47.7% of the patients, moderate in 32.2%, and severe in 20%. Based on morphological classification of anemia, 76.9% of our patients had normochromic-normocytic anemia whereas 21.8 and 1.3% had hypochromic-microcytic anemia and macrocytic anemia, respectively. Oral iron supplements were prescribed to 38.0% of the patients and none of the patients was given erythropoietin stabilizing agents (ESA) or intravenous iron preparations. In logistic regression, significant predictors of anti-anemic preparation use were decreased hemoglobin and hematocrit, and advanced stages of CKD. Conclusion: The results of the present study suggest that the prevalence of anemia in pre-dialysis patients is higher than currently accepted and it is found to be correlated with renal function; prevalence increases with declined renal function. An earlier identification as well as appropriate management of anemia will not only have a positive impact on quality of life but also reduce hospitalizations of CKD patients due to cardiovascular events.

Resumo Objetivo: anemia é uma complicação comum de doenças renais crônicas (DRC) e está significativamente envolvida na morbidade cardiovascular. O objetivo de nosso estudo foi investigar a prevalência e a gravidade da anemia em pacientes adultos pré-diálise, bem como determinar fatores preditores da terapia antianêmica. Método: estudo retrospectivo observacional foi realizado em pacientes pré-diálise adultos que recebiam tratamento no Hospital Universiti Sains Malaysia de janeiro de 2009 a dezembro de 2013. Resultados: ao todo, 615 casos elegíveis foram incluídos. A idade média dos pacientes foi de 64,1±12,0 anos. A prevalência de anemia foi de 75,8%, e a gravidade da anemia foi considerada leve em 47,7%, moderada em 32,2% e grave em 20% dos pacientes. Com base nas características morfológicas da anemia, os pacientes foram classificados em anemia normocrômica normocítica (76,9%), anemia hipocrômica microcítica (21,8%) e anemia macrocítica (1,3%). Suplementos de ferro oral foram prescritos para 38% dos pacientes e a nenhum dos pacientes foram dados eritropoietina, agentes estabilizadores (ESA) e preparações de ferro por via intravenosa. Na regressão logística, os preditores significativos de utilização da preparação antianêmica foram diminuição da hemoglobina e do hematócrito e estágios avançados da DRC. Conclusão: os resultados do presente estudo sugerem que a prevalência de anemia em pacientes pré-diálise é maior do que o atualmente aceito e está associado com a função renal; a prevalência aumenta com a diminuição da função renal. A identificação precoce e o manejo adequado da anemia não só terão um impacto positivo na qualidade de vida, mas também reduzirão internações de pacientes com DRC decorrentes de eventos cardiovasculares.

Study on Self-medication Practices among University Students of Bangladesh.

Aims: To know how much knowledge and awareness university students of Bangladesh have about commonly used medicines. Study Design: The study was conducted on 1200 students randomly selected from 9 university of Bangladesh, in which 87.5% were master’s student and remaining 12.5% were honor’s students. Each willing participant shared their opinion. Place and Duration of Study: Dhaka University (DU), Jahangirnagar University (JU), Eastern University (EU), East West University (EWU), Daffodil International University (DIU), North South University (NSU), International Islamic University Chittagong (IIUC), University of Information Technology & Science (UITS) and University of Science & Technology (USTC), Bangladesh, from May to July 2012. Methodology: Questionnaires were distributed among the students, information about students and knowledge about self-medication practices of medicine was determined. Results: The present study revealed that most frequently used medicine was analgesic/antipyretic (58.75%), followed by antiulcerants (40.17%), antibiotics (18.17%), antihistamines (10.58%) and antitussive (9.33%). 54.5% students took analgesic/antipyretic based on self-decision, followed by 49.83% antibiotics, 43.5% antiulcerants, 46.83% antitussives and 31.08% antihistamines respectively. Based on retailer advice 25% students took antimicrobials. 47.83% students said that they took antibiotics because of fever, 27% said the reason was infection, 13.58% took antibiotics because of GI disease and 12.5% mentioned others. 67.67% had no idea about side effect of antibiotics, followed by 53.17% for analgesic/antipyretic, 53.2% for antihistamine, 47.75% for antitussives and 28% for antiulcerants. Conclusion: Self-medication was practiced with a range of drugs from the analgesic/antipyretic to antibiotics. Most of the students didn’t know about the side-effects of these medicines as well as the antibiotics resistance. Although the practice of self-medication is unavoidable; drug authorities and health professionals need to educate students about the health hazards of self-medication.

Morpho-histometric evaluations of pre-pubertal, pubertal and post-pubertal vesicular gland of indigenous bulls of Bangladesh / Evaluaciones morfohistométricas de la glándula vesicular prepuberal, púberal y postpuberal de bovinos nativos de Bangladesh

The present observation was aimed to evaluate the gross and histometric parameters of the vesicular glands of indigenous bulls. Twenty-eight bulls of three age groups were selected from the local market: the pre pubertal group A (<1 year n=4), pubertal group B (1.5­2.5 years, n=16) and post pubertal or adult group C (above 3 years, n=8). The weight, length (anterio-posterior), width (latero-medial) and the thickness (dorso-ventral) of the both left and right vesicular glands were recorded separately after slaughter of each animal. The left and right vesicular gland shows significantly different (p<0.01), in weight and length in every group. Left vesicular glands were slightly higher than the right in all parameters. The lobules of the gland showed folded mucosa, lined with pseudostratified columnar epithelium. Three types of cells were identified in the epithelium containing A, B and C cell. Type A cells were tall columnar cells having distinct cell boundaries with the oval, round or elongated nucleus. Type B cells were located in the basal lamina having round or oval nucleus with indistinct cell boundaries. Type C cells were narrow columnar cells interspersed between A cells with darkly stained cytoplasm. Lamina propria consisted of loose connective tissue surrounded the alveoli, tubules and some solid end pieces. The numbers of secretory end pieces were variable. The diameters of luminated or non-luminated acini of the glandular end pieces and ducts were increased gradually and significantly (p<0.01) with the advancement of age. The epithelial height of the duct and alveoli were increased with the advancement of age, but no significantly differences among them. Tunica adventitia and muscularis grew with the advancement of age while the interstitial tissue shrunk equally. Above all parameters help to conclude that the vesicular glands of the pubertal indigenous bulls were more functional.

El presente estudio tuvo como propósito evaluar los parámetros macroscópicos e histométricos de las glándulas vesiculares de toros autóctonos. Veinticuatro toros fueron seleccionados en el mercado local y agrupados según la edad en: grupo prepuberal A (<1 año; n=4), grupo puberal B (1.5­2,5 años; n=16) y postpuberal o adulto C (por sobre 3 años; n=8). Se registró el peso, longitud (antero-posterior), ancho (latero-medial) y espesor (dorso-ventral) de las glándulas vesiculares izquierda y derecha por separado, después de sacrificado cada animal. Las glándulas vesiculares izquierda y derecha presentaron diferencia significativa (P<0,01) en cuanto al peso y longitud en cada grupo. Las glándulas vesiculares izquierdas fueron ligeramente mayores en relación a la derecha en todos los parámetros. Los lóbulos de la glándula mostraron una mucosa plegada, cubierta con epitelio columnar pseudoestratificado. Se identificaron tres tipos de células en el epitelio, conteniendo células de tipo A, B y C. Las células de tipo A eran células columnares altas con núcleos ovalados, redondos o alargados. Las células de tipo B se localizaron en la lámina basal, presentando un núcleo redondo o oval con límites celulares indistintos. Las células de tipo C eran células columnares estrechas intercaladas entre las células de tipo A, presentando un citoplasma oscuro. La lámina propia estaba constituida por tejido conectivo laxo, rodeada de alvéolos, túbulos y algunas piezas terminales sólidas. El número de extremos de secreción fue variable. El diámetro de los acinos con luz y sin luz de las piezas terminales y conductos glandulares aumentaron de manera gradual y significativa con el avance de la edad (P<0,01). La altura del epitelio del conducto y alvéolos aumentó con el avance de la edad, pero sin diferencias significativas entre ellos. Las túnicas adventicia y muscular aumentaron con el avance de la edad, mientras que el tejido intersticial se retrajo de manera proporcional. A partir de todos los parámetros analizados, se puede concluir que las glándulas vesiculares de los toros del grupo puberal fueron las más funcionales.

Prevalence, belief and awareness of preferring traditional healthcare system in urban and rural people of Noakhali district, Bangladesh.

Healthcare systems contribute a major role in maintaining good health. The study was conducted to analyze the prevalence, belief and awareness of preferring traditional healthcare systems in urban and rural people of Noakhali district of Bangladesh. Data were collected randomly from 400 respondents aging 20 to 60 years by personal inter-viewing with a well structured questionnaire during October 20, 2011 to December 20, 2011. Study stated that, overall 79% of the respondents were found to feel comfortable in using traditional healthcare system whereas only 21% prefer the modern system. Urban people showed their belief mostly in homeopathy (23%), ayurvedic/unani (18%) and herbal medicine (17%) of traditional healthcare system whereas Kaviraji (27%), herbal medicine (18%) and spiritual healing (11%) were the systems on which rural people showed their much faith and belief for the treatment of different ailments. Jaundice and sexual problems were the two dominant disease conditions for which traditional healthcare systems were most preferred by the respondents. Beside these 68% of urban and 88% of rural as well as 57.64% of educated and 97.82% of uneducated respondents were not aware about the appropriate healthcare system for different diseases. Belief in no side effect and safe remedy, mass population of the study area preferred different traditional healthcare systems but most of them were not aware about the exact therapy.

Drug compliance after stroke and myocardial infarction: A comparative study.

BACKGROUND: Stroke and myocardial infarction (MI) are both life-threatening diseases of vascular origin with a tendency to recur. In both conditions, risk of recurrence is reduced through similar drug regimens. AIM: To determine if compliance with prescribed medication after stroke or MI was similar in the two populations. SETTING AND DESIGN: Retrospective data collection and cross-sectional telephonic survey of patients discharged from a single academic medical center. MATERIALS AND METHODS: Adult patients consecutively discharged over a two-year period with a diagnosis of first-ever stroke (ischemic or hemorrhagic) or first-ever MI (ST-elevation) were identified through ICD-9 codes. Clinical details were abstracted from hospital records. Medication compliance was assessed through a structured telephone interview. STATISTICAL ANALYSIS: Bivariate analysis using Chi-square and Fisher exact tests, to determine the prevalence of noncompliance in stroke versus MI patients and differences in baseline characteristics and multivariate analysis with logistic regression to determine independent predictors of noncompliance. RESULTS: Follow-up data was collected for 298 stroke and 275 MI patients. Compliance was lower in stroke patients (68% stroke patients compliant with at least half their discharge prescriptions versus 90% MI patients; P < 0.001). Literacy and post-discharge follow-up were associated with greater compliance (P < 0.05 for both). Compliance was highest with anti-hypertensive drugs (98% after MI, 78% after stroke), followed by anti-platelet agents (94% after MI, 75% after stroke) and anti-lipid agents (70% after MI, 59% after stroke). Patients reported simply not feeling the need, acquiring fresh medical advice or a perceived lack of benefit, as reasons for not complying with their discharge prescriptions. Conclusions: Although similar drugs are involved, compliance with prescribed regimens is appreciably lower after stroke than after MI. Our findings underscore the need for better patient education regarding secondary prevention after stroke.