Antibiotic susceptibility in commonly isolated pathogens from urinary tract infection in a cohort of subjects from low socioeconomic strata

Background and Objective: Urinary tract infection is one of the commonest infections seen in clinical practice. Lack of compliance and unjustified antibiotic prescriptions has resulted in bacterial resistance and is proving as a major challenge in the management of these infections. Our aim was to identify the sensitivity pattern of commonly used antibiotics against urinary tract infections so as to suggest an improvised line of action against bacteria causing urinary tract infections

Method: This was a hospital based cross sectional study extended over a period of four months. Patients were recruited from outpatients department of a tertiary care hospital in an industrial area of Karachi. Adult patients with symptomatic and documented UTI in urine detailed report [pus cells >10] were enrolled after informed consent. A clean catch midstream urine was collected for culture and sensitivity testing using the standard microbiological procedure. Data is analyzed on SPSS 16

Results: A total of 184 samples were collected in 4 months. The Male to Female ratio was 1:2 [n=58/126] with mean age 48.5+/-12 years. 83[45.6%] patients were between 45-60 years. Most common isolated pathogen was Eschericia coli 108[59%] followed by staphylococcus aureus 30[16.4%] and Klebsiella 20[11%]. 55[30%] pathogens showed sensitivity to 4-6 antibiotics, 22[12%] strains to 7-9 antibiotics, 33[18%] were sensitive to

Conclusion: In this low socioeconomic cohort with UTI nearly half the isolated pathogens has shown resistance to most of the commonly used antibiotics recommended in the guidelines especially the floxacin group probably because of its unwarranted use. Therefore, a revised line of management should be developed locally in accordance with the susceptibility pattern of the urinary pathogens to avoid further resistance as well as morbidity of the patient

Anemia in hospitalized patient: prevalence, etiology and risk factors

Background: Anemia is seen in a large proportion of the population especially in developing countries. It poses a major challenge to improving the health indices especially in the female and pediatric populations. Anemia causes increased disability, morbidity and mortality. Presence of anemia prolongs hospital stay and increases the possibility of re-admission. The diagnosis and management of anemia in hospitalized patients will improve outcomes of this population

Objective: The objective of this study was to determine the prevalence of anemia, its etiology and its association with various risk factors

Study Design: Cross-sectional study

Place and Duration of Study: Department of Medicine, United Medical and Dental College, Karachi from May, 2016 to December, 2016

Methodology: All adult patients admitted in the medical wards of Creek General Hospital were included in the study. Anemia was defined as a hemoglobin of <13g/dl in males and <12g/dl in females. All anemic patients were taken as cases while non-anemic patients were taken as controls. Critically ill patients, patients with active bleeding and pregnant women were excluded from the study. The data was recorded on a detailed proforma, and the etiology, severity, type of anemia and associated factors were recorded. The data was presented as means with standard deviation for continuous variables and as percentages for categorical variables. Comparison of different factors with anemia was computed using SPSS 20.0. Chi-square and student t- test were used and p-value of <0.05 was considered significant

Results: Around 71% of the patients were found to be anemic. 72.5% of the female population and 67% of the male population were anemic. The commonest cause of anemia was infection. Majority of the women had microcytic anemia. There was no relationship of age, income, educational status, number of dependents and diet on the presence of anemia. In women anemia was significantly related to breast feeding and parity. Infectious diseases, nutritional deficiency and gastrointestinal loss were the most common causes of anemia in the studied population

Conclusion: Anemia is very common in hospitalized medical patients. Infection and nutritional deficiencies are the most cause of this anemia

Deliberate self poisoning at national poisoning control centre

OBJECTIVE: To identify the risk factors contributing towards deliberate self-poisoning

METHODOLOGY: A prospective and descriptive study of patients admitted in National Poisoning Control Centre, Ward-5, Jinnah Post Graduate Medical Centre, Karachi conducted over six months. All adult patients presenting with deliberate self-poisoning were included in the study

The cases with accidental or homicidal poisoning and poisoning for purpose of theft and burglary were excluded from the study. The information was gathered using a questionnaire generated from World Health Organization IPCS INTOX "Recording Format for Toxic Exposure".The data was analyzed on computer package SPSS ver. 14.0. The results were obtained as numbers and percentageswith means and standard deviation where applicable

RESULTS: 374 patients were analyzed during this period. The age group most frequent [54.3 %] is within the range of 15-24 years and 61.5 % of the subjects were male. Most of the patients were illiterate, with no employment and were unmarried. The toxic substance most commonly employed for attempted suicide was pesticide; it was taken most frequently orally, at home and during daytime. It was the first attempt for the majority of the subjects. Most subjects belonged to lower socioeconomic class and had no dependents. 34.5 % had history of drug abuse, 16.3 % had history of psychiatric illness. Few subjects had physical illness or history of suicide or parasuicide in family

CONCLUSION: Deliberate self-poisoning is a significant problem among the male youth in Pakistan

Lower socioeconomic status, changing social mores and stress contribute towards deliberate self-poisoning

Pancytopenia: megaloblastic anemia is still the commonest cause

To find out the frequency of the different causes of Pancytopenia and also to specifically detect the percentage of vitamin B12 deficieny amongst these patients. It is a prospective study carried out in Medical Unit I [Ward 5] of Jinnah Postgraduate Medical Centre Karachi from March to August 2007. A total of 88 patients were included after a detailed history and examinations the information was recorded on Proforma. Findings of aspiration and trephine biopsies were interpreted in the light of history, clinical examination and peripheral blood findings. Out of 88 patients suffering from Pancytopenia, a large number [40.90%] were diagnosed as Megaloblastic Anemia, out of which 77.77% had vitamin B12 deficiency. Aplastic anemia was found in 28 [31.88%] patients followed by other less common causes. Megaloblastic anemia was found in largest number of patients who were found to have Pancytopenia on initial investigations and majority of such patients were found to be deficient in Vitamin B

Pericardial cyst: a rare congenital anomaly

Pericardial cyst is an uncommon congenital abnormality that can occur in the middle mediastinum. The clinical presentation is variable and can range from asymptomatic patients in whom the diagnosis is incidental to those cases with complaints such as pain or heaviness in chest, difficulty in breathing or cough. These cysts can lead to cardio-pulmonary complications such right main stem bronchus obstruction, ventricular outflow obstruction, pulmonary artery stenosis, arrhythmias or cardiac temponade which can prove fatal. Due to the variable nature of patients' complaints and grave complications associated with pericardial cyst, a detailed work-up is necessary to reach a diagnosis. We present this case in a middle-aged man who presented with feeling of heaviness in chest. He underwent thorough work-up in order to detect a pericardial cyst

Malarial hepatopathy in falciparum malaria

To evaluate the clinical, biochemical and sonographic changes in patients with falciparum malaria and jaundice. A case series. This study was conducted at Medical Unit-1 [Ward 5], Jinnah Postgraduate Medical Centre, Karachi, from January 2006 to November 2007. A total of 62 adult patients, regardless of age and gender, with peripheral blood film evidence of falciparum malaria, who had jaundice, were included. Any patient with evidence of infection with Plasmodium vivax or other causes of liver disease [e.g. viral hepatitis, cirrhosis, portal hypertension, amoebic liver abscess, unexplained hepatomegaly, ascites, history of alcoholism, taking hepatotoxic drugs, past history of jaundice] was excluded on the basis of history, relevant clinical examination and investigations. Age of the patients ranged from 13-48 years [mean 26.04 +/- 8.33]. All patients were febrile and icteric, with pallor in 67.7%, hepatomegaly in 30.6%, splenomegaly in 70.9% and impaired consciousness in 20%. Serum bilirubin levels ranged from 3 to 24 mg%. Thirty two [51.6%] had serum bilirubin 3-6 mg%, 20 [32.2%] had 6-10 mg% and 10 [16.1%] had >10 mg%. ALT levels ranged from 20-870 IU/L and AST levels 24-1210 IU/L respectively. INR ranged from 1-1.3. Twenty eight patients [45%] had predominantly conjugated or mixed hyperbilirubinemia and serum transaminases were more than three times normal. Ultrasonography revealed hepatomegaly with decreased echogenicity in 22 [35.4%], splenomegaly in 48 [77.4%] and both hepatomegaly and splenomegaly in 16 [25.8%]. Gallbladder wall thickness was increased in 5 [8.06%] patients. There was no evidence of biliary dilatation. A significant percentage of patients having falciparum malaria with jaundice fulfill the criteria for malarial hepatopathy. It should be considered in patients presenting with acute febrile illness with jaundice so that specific treatment can be given

Nutritional iron deficiency in women of child bearing age- what to do?

Iron deficiency is the most common aetiology of anaemia worldwide and has several risk factors. Although iron deficiency anaemia [IDA] can occur at any age, women from reproductive age group are particularly vulnerable to develop IDA due to increased nutritional demand during pregnancy. Objective was to determine the frequency and nutritional risk factor of iron deficiency anaemia in women of child bearing age. This descriptive, cross sectional study was conducted from October 2005 to March 2006 at the Department of Medicine, Ward-5, and out-patients department of Jinnah Postgraduate Medical Centre, Karachi. Two hundred non-pregnant females of child bearing age were included in the study; 100 with no previous pregnancy and remaining 100 with at least one prior history of pregnancy. All the relevant information, i.e., demographic and socioeconomic was collected through a questionnaire. Two hundred patients with signs and symptoms of anaemia were recruited. Out of them 89 patients were found to be having iron deficiency anaemia in various age groups. Results also showed that dietary habit of patients was one of the causative factors leading to iron deficiency anaemia. To overcome iron deficiency anaemia a thorough and comprehensive strategy is required, i.e., educating the subjects to consume food rich in iron, community based program, monitoring severely anaemic cases and their treatment

Frequency of sensory motor neuropathy in type 2 diabetics

To determine the frequency of sensory motor neuropathy in type 2 diabetics at the time of presentation to the hospital. Non interventional, descriptive. The study was conducted at Medical Unit-1, Jinnah Postgraduate Medical Center, Karachi, from November 2005 to April 2006. Patients of different ages and either gender with history of confirmed diabetes for ten years and above, on regular follow up were included. Those with non-diabetic causes of hyperglycemia or neuropathy were excluded. Relevant features like age, gender, treatment, symptoms, signs, nerve conduction study [NCS] results, duration of Diabetes mellitus [DM], fasting blood sugar [FBS] and serum values of glycosylated hemoglobin [HB1Ac] were recorded. Out of a total of 300 patients, there were 111 female and 189 male patients. Mean age was 58 +/- 11.23 years. Mean duration of diabetes was 13.6 +/- 5.48 years. One hundred and twenty three patients had symptoms of neuropathy. Clinical examination revealed mixed sensory and motor signs in 135 [45%] patients. Nerve conduction studies revealed abnormalities in 159 [53%] patients. Among patients having an abnormal NCS, the fasting blood glucose [FBS] was <120 mg/dl in 12 [7.5%] patients, while it was > 120mg/dl in 147 [91%] patients. The glycosylated hemoglobin ranged from 4-15% with mean of 8.1% and standard deviation of 2.5%. This showed significant association [p <0.001] of peripheral neuropathy with abnormal FBS, HB1Ac and duration of diabetes. NCS diagnosed the neuropathy in more than half of the total number of patients, including both symptomatic and asymptomatic patients. Majority of the patients revealed symmetrical and a mixed type [motor and sensory] polyneuropathy. This shows that nerve conduction may not be concordant with the clinical signs and symptoms. NCS detects neuropathy much earlier, before it becomes evident clinically. The neuropathy is associated with abonromal fasting blood sugar, HB1AC and duration of diabetes

Association of non alcoholic fatty liver with type 2 diabetes mellitus

Background: Non alcoholic fatty liver disease [NAFLD] is a common chronic condition of which Diabetic fatty liver accounts for a large proportion, with 50 to 75% of the subjects demonstrating fat in the liver on Ultrasound. As a result of epidemic increase in obesity, hyperlipidemia and our diabetes mellitus patients, the prevalence of NAFLD in the general population is increasing. The aim of this study is to determine the frequency of NAFLD in type 2 diabetic patients in our setup at Jinnah postgraduate Medical Center, Karachi Pakistan

Methods: A total of 120 type 2 diabetic patients were included in the study. Patients with known chronic liver disease and history of alcohol intake were excluded. These patients were evaluated by abdominal ultrasonography to determine the presence of fatty liver. They were divided into fatty liver group and non fatty liver group; and were further evaluated by measurement of body mass index, HbA1c, liver function tests and lipid profile. The data obtained was analyzed using SPSS version 10.0

Results: Out of 120 type 2 diabetic patients, 73 [60.8 %] had fatty liver on ultrasonography. An increase in the BMI and levels of HBA1c, ALT, AST, alkaline phosphatase and GGT, total cholesterol, triglycerides, LDL and a decrease in HDL was observed in the fatty liver group as compared to non fatty liver group

Conclusion: The prevalence of NAFL is higher in type-2 diabetic patients. Obesity, dysglycemia, dyslipidemia and elevated liver enzymes are seen more frequently in fatty liver than nonfatty liver type-2 diabetic patients

Acute organophosphate insecticide poisoning

To describe the clinical course, diagnosis, out come of acute organophosphate [OP] insecticide poisoning. Descriptive study. At National Poisoning Control Centre [NPCC], Medical unit 1, Jinnah Post Graduate Medical Centre, Karachi, from 1st January 2000 to 31st December 2007. A total of 6539 pts were admitted to the ICU of NPCC, out of which 2708 [41%] were of organophosphate poisoning. Lab investigations done included blood complete picture, urea, creatinine, ABG's and serum cholinesterase levels. Data was retrieved from the files on a structured performa. Variables of the study include gender, mode of exposure, clinical course, management and complications. There were 1391[51%] were males and 1317 [48%] females. 713 [26%] had accidental exposure, while 1995 [73%] attempted suicide. The majority of patients exhibited the classic clinical features of parasympathetic over activity. 1608 patients received atropine, while pralidoxime alone was given to only 399 patients and atropine along with pralidoxime was given to 701 patients. Complications encountered during their treatment and stay in the hospital included aspiration pneumonia observed in 310 patients, hyperglycemia in 982 patients. 102 patients had respiratory failure and thus required mechanical ventilation with mean ventilation duration of 2.3 +/- 1.5 days. 500 patients had urinary tract infection and 789 patients developed cellulitis or phlebitis. A total of 147 patients died making a mortality rate of 0.05%. The widespread use of organophosphates as a household and agricultural pesticide, in the absence of adequate regulations and education in their use is probably the most important reason for OP poisoning in an agricultural country like Pakistan. Despite severe toxicity in most of our cases, there were very few fatalities. This reflects the necessity of early diagnosis, treatment and the implementation of advanced supportive care in ICU

Deliberate self harm: frequency and associated factors

To determine the frequency of deliberate self harm and its associated factors. Descriptive study. The study was conducted at NPCC [National Poison Control Centre], medical unit I, Jinnah postgraduate medical centre Karachi, from 1st sept-31st December 2004. A Total of 150 patients of deliberate self harm by means of poisoning who were admitted in NPCC, were included in the study. Data was retrieved from the files on a structured Performa. The variables of study include gender, age, marital status, monthly income and number of dependents and history of prior attempts. Out of 150 patients, 86 patients [57%] were females and 64 [43%] males, mean age was 20 years + 5 years. 71 patients [47%] were unmarried and 72 [48%] married. 100 patients had monthly income of 6000 or less. 128 patients [85%] had more than 3 dependents. 5% of patients had a prior history of deliberate self harm. Deliberate self harm is more common in females particularly of younger age group. Various psychosocial factors are involved in motivation. To prevent repeated acts of deliberate self harm or suicidal attempts in cases of Para suicide, an individualized plan should be made to counsel high risk individuals and to educate them by addressing different aspects of precipitating factors, as well as a proper treatment of psychiatric problem

Drug overdose; study conducted at national poison control center

A prospective study of 588 cases of drug overdose was carried out in National Poison Control Centre [NPCC], Jinnah Postgraduate Medical Centre Karachi [JPMC] from 1999-2002. It was done to determine the incidence of renal, hepatic, respiratory, neural and cardiac injuries or toxicity. In this study all age groups were included above 8 years. various investigations were carried out that include blood CP, sugar, electrolytes, urea, creatinine, blood gases, electrocardiogram, ultrasound and Urine examination. The drug Overdose cases admitted from 1999-2002 were exposed to various drugs, such as benzodiazepines, barbiturates, non-steroidal anti-inflammatory drugs [NSAID], beta-blockers, carbamezapine, and Vitamin-A. The mortality rate was 2.89% with a male/ female ratio of 76.47%: 23.53%. However the recovery was 94.22%. These drug overdose cases were found to be the consequences of suicidal, accidental or homicidal attempts. This study may help in determining the goals for reducing the morbidity and mortality of drug over dose as it shows the rate of incidence, gender ratio, clinical presentations, diagnostic evaluations, complications, management, outcome and medicolegal aspects

Frequency of hepatitis-C virus in the spouses of HCV positive patients and risk factors of the two groups

To find out frequency of HCV in the spouses of HCV positive cases and risk factors of the two groups. Study Design: Descriptive study. Place and Duration: Ward 5 JPMC Karachi from August 2003 to January 2004. Patients And Fifty patients infected with HCV, aged 18 year and above of both sexes and their spouses were included through structured questionnaire while others suffering from HBV, HIV and other etiologies were excluded. Samples were collected from the spouses for anti-HCV using micro particle enzyme immunoassay [MEIR] method. Data was analyzed using SPSS. Anti-HCV detected in 9 [18%] spouses of positive cases. The risk factors were unsterlized injections by GPs [58%], previous surgery and dental procedure in 48% patients, blood transfusion and sharing of shaving razors equally figured in 19 [38%] patients, sharing of towels 40% and toothbrush was 28%. Duration of marriage contributed a major role; average duration was 17.86 ' 8.91 years. There was high frequency of HCV in the spouses of positive cases and major risk factors were blood transfusion, I/V drug abuse, unsterlized injections, previous surgery, dental procedures and longer duration of marriages

Effects of diazepam and promethazine on uterine contractions induced by prostaglandin E2 [PGE2]

This study was conducted at Basic Medical Sciences Institute, Jinnah Post Graduate Medical Center, Karachi. It was done to observe the inhibitory effects of diazepam and promethazine, on uterine contractions induced by prostaglandin E2 [PGE.2]. The drug interaction, in vitro, proved that both diazepam and promethazine are tocolytic in vitro