Evaluation of antibiotic resistant bacteria in underground drinking water and transfer of their resistant character to normal flora of the body

The untreated surface water for drinking and domestic use is an alarming situation to public health especially in prevalence of antibiotics resistant bacteria. This investigation aimed to isolate and identify the antibiotic resistance bacteria in underground water samples in district Dera Ismail Khan, Pakistan. The underground water samples were collected from four different places using hand pumps [Khyber town, riverside, Gomal University and united town]. Cultured on nutrient agar media, identified by Gam staining and biochemical tests. There after antibiotic resistance assay were performed by measuring zone of inhibition of different antibiotics by disc diffusion method. Six different bacterial colonies were isolated and identified as Enterobacteriaceae, Serriata specie, Proteues, Pseudomonas, all these bacterial colonies were 33% resistant to chloramphenicol with and 100% resistant to amoxicillin. Some colonies were also considered as resistant, according to the criteria of National Committee for Clinical Records [NCCL] that less than 10mm zone of inhibition are considered as resistant. Subsequently, the chloramphenicol resistance bacteria were analyzed for their ability to transfer resistant gene to sensitive bacteria. In in-vitro method, an isolate M1b [resistant] was found capable to transfer resistance gene to M1a isolate [sensitive] in nutrient rich environment. It was concluded that antibiotics resistance bacteria found in underground water, moreover capable of transferring the antibiotic resistant character to suitable recipient i.e. normal flora of the body or to other pathogens by conjugation

Toxicological Investigation of Ethanolic Extract of Epipremnum aureum in Rodents.

The present study was aimed to explore the acute and sub chronic toxicity studies with orally administered ethanolic leave extract of Epipremnum aureum. For the acute toxicity study, the animals were divided into four groups and each group receives a dose of (50, 500, 2000) mg/kg except control group which receives only 1% CMC. They were observed for 14days for signs of toxicity. In case of sub chronic toxicity, the Sprague dawley rats were fed with ethanol extract (100, 600, and 1000) mg/kg per day for 28 days. The parameters measured include organ weight, biochemical test, haematological test and histopathological observations. Acute oral administration of Epipremnum aureum did not show any mortality, CNS and ANS toxicities. Similarly in subchronic toxicity studies, Epipremnum aureum did not show any visible signs of toxicity. There were also no significant differences between the control and extract treated groups in terms of their organ weight, haematological and biochemical parameters. Histopathological examination did not reveal any remarkable and treatment related changes. A no-observed adverse-effect level for extract is 2000 mg/kg for rats under the conditions of this study. Hence, the extracts could be considered safe at the doses administered since they did not provoke toxic effect on the key organs examined and also did not alter any biochemical and haematological parameters.

Prevalence and patterns of impacted maxillary canine in a Peshawar sample

Maxillary canines are important aesthetically and functionally, but impacted canines are more difficult and time consuming to treat. Permanent maxillary canine impaction has been reported in about 1% to 5% of the population. The objective of this study was to determine the prevalence of impacted maxillary canine in patients visiting to Khyber college of dentistry, Peshawar. A total of 500 patients of 15 years and above were examined clinically. Those having maxillary canine impaction were advised Anterior Occlusal View and panoramic radiograph to determine the patterns of impaction by vertical parallaxing technique. Data were processed in SPSS version 16.0. The chi-squared test was used to reveal any differences in the distribution of impacted maxillary canines when stratified by gender and location [left or right]. A p-value of <0.05 was accepted as statistically significant. Out of 500 patients examined 20[4%] had maxillary canine impaction. The mean age was 19.05 +/- 3.15 years. Age was ranged from 15 to 25 years. Female to male ratio was1.85:1. Females had more impaction of maxillary canine than males[p=0.000]. Palatal were the most common in males while buccal were in females. Left side was commonly involved in impaction in both genders

Causes of recurrent pneumoniaamong children

Background: Respiratory tract infections remain the commonest cause of pediatric morbidity and mortality particularly in developing countries. A sub group of these children has recurrent pneumonia which may be the presentation of an underlying more serious systemic or local pathology

Objective: To determine the frequency of underlying causes of recurrent pneumonia, among pediatric patients

Patients and Methods: This descriptive study was conducted in the department of Pediatrics, Sheikh Zayed Hospital/ Medical College, Rahim Yar Khan, from 1[st] January, 2011 to 31[st] December, 2011. All the patients presented to the department and diagnosed as recurrent pneumonia were included in the study

Results: During the study period of one year, recurrent pneumonia was diagnosed in 292 patients. An underlying illness could be identified in 282 [97%] while in 10 [3%] cases the underlying cause could not be diagnosed. Underlying illnesses included neurodevelopmental disability in 183 [63%] cases, recurrent bronchiolitis with aspiration pneumonia 30 [10%], congenital heart disease 23 [8%], bronchiectasis 07 [2.3%], bronchial asthma 07 [2.3%], anomalies of the respiratory system 05 [1.7%], cleft palate 05 [1.7%], gastroesophageal reflux disease 04 [1.3%], down syndrome without CHD 04 [1.3%], severe malnutrition 03[1%], ciliary dyskinesia 03[1%], foreign body 02 [0.6%], thalassemia 02 [0.6%] and nutritional rickets 02 [0.6%]

Conclusion: Recurrent pneumonia is relatively common in our country as are recurrent respiratory tract infections. Common underlying illnesses included neurodevelopmental disability, recurrent bronchiolitis with aspiration pneumonia, congenital heart disease, down syndrome, bronchiectasis, bronchial asthma, anomalies of the respiratory system and cleft palate

Chronic gout and hyperuricemia; treatment with febuxostat versus allopurinol

To assess the urate-lowering efficacy and safety of Febuxostat versus Allopurinol in subjects with hyperuricemia and gout. Randomized controlled trial. Department of Orthopaedic and Trauma Surgery Mardan Medical Complex Teaching Hospital Bacha khan Medical College Mardan from February 2012 to March 2013. Fifty patients of chronic gout and hyperuricemia fulfilling the inclusion criteria were divided into two equal groups by random method having 25 patients each and received either a fixed dose [80 mg] of Febuxostat [Group A] or Allopurinol [Group B] 300mg once daily for 16 weeks. The primary end point was the percentage of patients reaching serum urate level <6.0 mg/dl [360 micro mol per liter] at final visit. The secondary end points include reduction in the incidence of gout flares and adverse drug reactions. There were 16[64%] males and 9[36%] females with mean age 44.92 years in group A while group B had 15[60%] males and 10[40%] females with mean age 46.24 years. At final visit Febuxostat group had mean uric acid level of 4.72 mg/dl +/- 1.56 SD while Allopurinol group had mean serum uric acid level of 6.34 mg/dl +/- 1.82 SD with majority of patients [84%, n=21] in group A achieving serum uric acid level of < 6 mg/dl [360 micro mol/l] while only 60 percent [n=15] of the patients in group B had serum urate level of < 6 mg/dl.[P= <0.05]. Gout flare was reported in 12% [n=3] of group A patients and 36% [n=9] in group B patients. Adverse drug reactions were reported in 12% [n=3] of group A patients while 24% [n=6] in group B. Febuxostat lowerd serum uric acid levels more potently than Allopurinol while having minimal gout flares and side effects

Prevalence of pneumoconiosis among coal miners of Cherat, district Nowshera - Pakistan

The objective of this study was to assess the prevalence of pneumoconiosis among coal miners. This cross-sectional study was conducted among 400 coalminers of Cherat, District Nowshera, KPK, Pakistan, from July 2012 to June2013. Coal miners who worked for more than six months were included. Medical camps were arranged in study areas in which Pulmonary Function Tests and CXR was conducted to estimate the prevalence of pneumoconiosis. The demographic variables were also noted on a semi structured proforma. The medical examinations of coal miner's revealed that approximately71% [n=284] of coal miners have sign and symptoms of occupational respiratory health problems. The coal miners showed an increased prevalence of coal workers pneumoconiosis [49.50%] i.e. about 47% [n=188] on Chest X-rays [P/A View] and 52.50% [n=210] on Pulmonary Function Tests has findings of coal workers pneumoconiosis. Only 31.75% [n=127] of coal miners have normal pulmonary function tests and 35% [n=140] have normal chest x-ray findings during medical assessment. The prevalence of the pneumoconiosis was high [49.50%] among the Cherat coal miners; and needs proper consideration and attention from the health sector and mining department in order to reduce the high burden of pneumoconiosis among coal miners

Role of percutaneous autologous bone marrow grafting in non-union tibia

To evaluate the efficacy of percutaneous autologous bone marrow grafting in patients with tibial diaphyseal non-union. Descriptive case series. Orthopaedic Surgery Unit, Mardan Medical Complex Teaching Hospital, Bache Khan Medical College Mardan, from March 2011 to October 2012. Fifteen patients [mean age 41.6 year] with tibial non-union were treated with a single percutaneous autologous bone marrow injection. The bone marrow was aspirated from the anterior iliac crest and injected at fracture site. The procedure was carried out under general or spinal anesthesia. The patients were followed up after every four weeks and the rate of healing was assessed clinically as well as radiologically. Union Scale Score was used to assess the progress of union. A score of six or more was considered as sound union. Majority [73.3%, n=11] of the patients achieved a solid union after an average period of 14 weeks [range 12-20 weeks]. Four [26.6%] patients however could not achieve union. The average time duration between the procedure and injury was 37 weeks [range 36-40 weeks]. The average pre injection Union Scale Score was 2 [0-3]. The mean Union Scale Score at the end of study was 5.8 [0-7] and in united cases it was 6.4 [6-7]. Percutaneous autologous bone marrow injection provided an effective safe and easy bone grafting in non-union tibia

Primary osteosarcoma distal femur; incidence of pulmonary metastasis detected at the time of diagnosis

This study was designed to estimate the incidence rate of pulmonary metastasis at the time of diagnosis of primary osteosarcoma distal femur in a tertiary care hospital. Descriptive case series. Orthopaedic Surgery Unit, Mardan Medical Complex Teaching hospital, Bacha Khan Medical College, Mardan, KPK, Pakistan from March 2011 to September 2012. Nine patients of primary osteosarcoma distal femur were assessed with CT chest for pulmonary metastasis. The frequency and patterns of pulmonary metastasis on CT chest were documented. After the biopsy reports all patients were referred for neo adjuvant chemotherapy before any definite surgical procedure. The histological types of osteosarcoma were noted. Nine patients including 7 male [77.7%] and 2 females [22.2%] with mean age 12.4 years were included in our study. 66.6% [n=6, 5 males, 1 female] had pulmonary metastasis on CT chest at initial presentation while 33% [n=3,2 males,1 female] had no pulmonary metastases on CT chest. Three [50%] patients had pulmonary metastasis in the right lung, 1[16.6%] had on left side while 2[33.3%] had bilateral pulmonary involvement. Of the cases with metastases at diagnosis, 55.5% had osteoblastic histology of osteosarcoma compared with 33.3% of those with non metastatic disease. Majority of osteosarcoma distal femur presented with pulmonary metastasis at initial presentation. A high index of suspicion accompanied by careful examination of the limb and appropriate radiographs at initial assessment may reduce the incidence of such delays in diagnosis and the associated risks

Effect of olive oil on transdermal penetration of flurbiprofen from topical gel as enhancer

The present study was conducted to formulate and evaluate flurbiprofen transdermal gel. A standard calibration curve was constructed to obtain a regression line equation to be used for finding out the concentration of drug in samples. Olive oil was used as penetration enhancer and was added in different concentrations to some selected formulations to see its enhancement effect on in vitro drug release profiles. The prepared gels were evaluated for several physico-chemical parameters to justify their suitability for topical use. The in vitro drug release studies were carried out by using Franz cell diffusion apparatus across both synthetic membrane and excised albino rabbit skin. In order to investigate the drug release mechanism a kinetic approach was made by employing Korsmeyer kinetic model to the in vitro drug release profiles of flurbiprofen. The flurbiprofen topical gels were successfully prepared and could be beneficial for topical use

Chronic tennis elbow; outcome of autologous blood injections for the treatment

To evaluate the results of autologous blood injection as a treatment for chronic tennis elbow [Lateral Epicondylitis]. Study Descriptive case-series. Orthopaedic Surgery Unit Mardan Medical Complex Teaching hospital Bacha Khan Medical College Mardan KPK, from April 2010 to June 2011. A total of 22 patients with tennis elbow [lateral epicondylitis] were injected with 2 mL of autologous blood under the extensor carpi radialis brevis in the Out-Patient Department [OPD]. Patients rated their pain on a Visual Analogue Scale[VAS] scale of 0 to 10 with 0 representing no pain and 10 the worst pain they had ever experienced, and categorized themselves according to Nirschl score[1-7]. After the procedure pain rating and Nirschl score were recorded every 3rd week for a minimum of 6 months. If pain relief was not relieved entirely 6 weeks after the autologous blood injection a repeat injection was offered to the patient. Seventeen patients [77.2%] received one injection of autologous blood and had resulted in lowering their mean pre-injection pain score and Nirschl sore of 6.2 and 6 to 0.1 and 1.1 post-injection respectively. Five patients [22.7%] received two injections and their average pre-injection pain score of 6.8 and Nirschl score of 6.2 were lowered to 0.2 and 1 respectively. Autolgous blood injection is an effective way to treat patients of chronic tennis elbow as demonstrated by decrease in pain and fall in Nirschl score and we therefore recommend it as a first line treatment for chronic tennis elbow

relation of vertical facial pattern with sagittal craniofacial dimensions: a study

The aims of this study were to assess the relation of sagittal and vertical facial dimensions in lateral cephalometric analysis and occurrence of hyperdivergeney in various facial profiles. This study was conducted on 200 patients in the Department of Orthodontics Khyber College of Dentistry Sagittal analysis was done by measuring ANB angle, and vertical relation was determined by MMA angle and Lower Face height ratio. Ninety eight patients were skeletal class I [49%] followed by 92 patients [46%] in skeletal class II. Forty eight percent patients were normodivergent followed by 37% hyper divergens facial profile. Fifty one patients [52.04%] of skeletal class I patients were normo divergent and 43 patients [46.73%] of skeletal class II patients were hyperdivergent. Most of normodivergent patients were skeletal class I and hyperdivergent were class II