[Isolation, morphological characterization and host range determination of Iranian bacteriophages against Salmonella reference collection]

Background and Aim: Salmonella spp. is important in medicine. Most related infections are self-limited. Antibiotics are used for high risk patients such as children, old individuals and immune-compromised patients. Overuse of antibiotics has led to increased emergence of multi-drug resistant bacteria which are life-threatening. Phage therapy is an alternative method to reduce antibiotic use

Materials and Methods: Waste water samples were collected from sewage system of Rasht City twice a month. Prepared suspensions of Salmonella reference collection A [SARA] number 1, 6 [S. typhimurium] and 46, 48, 51 [S. paratyphi B] and double LB broth were mixed with filtrated waste water. After centrifugation and filtration, serial dilutions were prepared and phages were isolated. Morphologic characteristics were determined using TEM [Transmission electron microscopy]. Finally, to assess the spectrum effect of the bacteriophages, we determined host range against 19 SARA strains

Results: Clear plaque formation on double layer LB agar indicated lysis of the test strains by isolated phages. The results of host range showed that some of the phages were able to lyse a number of other bacteria of SARA collection. Imaging with TEM indicated that the isolated phages against SARA collection belonged to Siphoviridae and Podoviridae families

Conclusion: This is the first report of phage isolation against Salmonella reference collection in Iran. SARA no. 51 [S. paratyphi B] was lysed by S. typhimurium phage. It means that the isolated phage may lyse S. typhi, which is an important human pathogen

Comparative efficacy of prolene and prolene-vicryl composite mesh for experimental ventral hernia repair in dogs

In this study, efficacy of two hernia mesh implants viz. conventional Prolene and a novel Prolene-Vicryl composite mesh was assessed for experimental ventral hernia repair in dogs. Twelve healthy mongrel dogs were selected and randomly divided into three groups, A, Band C [n=4]. In all groups, an experimental laparotomy was performed; thereafter, the posterior rectus sheath and peritoneum were sutured together, while, a 5 × 5 cm defect was created in the rectus muscle belly and anterior rectus sheath. For sublay hernioplasty, the hernia mesh [Prolene: group A; Prolene-Vicryl composite mesh: group B], was implanted over the posterior rectus sheath. In group C [control], mesh was not implanted; instead the laparotomy incision was closed after a herniorrhaphy. Postoperative pain, mesh shrinkage and adhesion formation were assessed as short term complications. Post-operatively, pain at surgical site was significantly less [P<0.001] in group B [composite mesh]; mesh shrinkage was also significantly less in group B [21.42%, P<0.05] than in group A [Prolene mesh shrinkage: 58.18%]. Group B [composite mesh] also depicted less than 25% adhesions [Mean +/- SE: 0.75 +/- 0.50 scores, P

Monitoring bacterial diversity in a full-scale municipal wastewater treatment plant in Dubai by fluorescence in situ hybridization technique

In this study, the bacterial diversity in the activated sludge system of a full-scale municipal wastewater treatment plant in Dubai was monitored over a period of one year using ribosomal RNA [rRNA] targeted oligonucleotide probes for a defined phylogenetic group of bacteria by the Fluorescence in situ hybridization [FISH] technique. The largest fraction of the bacterial community in the sludge samples belonged to the gamma-subgroup of proteobacteria [25%] followed by gram positive bacteria of high G+C content [l 6%], gram positive bacteria with low G+C content [9%], beta-proteobacteria [8%] and alpha-proteobacteria [5%] with respect to the population percentages stained by DAPI [4,6-diamino-2-phenylindole].A specific nocardioform actinomycete, simultaneously targeted by both HGC69a and MNP1 probes, was predominantly found throughout the study period in all activated sludge mixed liquor samples. The nocardioform actinomycetes group members were detected in both branched and single cell morphorypes. Most of the previously published genus and species specific probes failed to hybridize to the sludge samples. In conclusion, the overall bacterial community populations detected by the sub-group specific 16S rRNA targeted oligonucleotide probes in FISH technique remained almost constant throughout the period of study irrespective of treatment plant conditions

Seminal fructose in various classes of infertile patients

A great number of substances have been found in sperm plasma but so far it has not been possible to provide evidence of clinical significance for all of them. Fructose occupies the most important place on biochemical investigations. Fructose acts as a donor of energy to the spermatozoa. Fructose is secreted from the seminal vesicles and the accessory sex glands. It is the major carbohydrate found in seminal plasma, and appears essential for normal sperm motility. We present results of a prospective study of seminal fructose in patients referred for routine semen analysis prior to infertility treatment. Qualitative measurement of fructose in seminal fluid was carried out by Resorcinol method. Fructose level in various groups of male infertility, and sperm concentration in various groups was estimated. They were classified as azoospermic, oligozoospermic, polyzoospermic, normozoospermic, asthenozoospermic, and teratozoospermic on the basis of sperm concentrations, motility and morphology respectively. It is indicated that the true corrected fructose level is a simple method for assessment of the seminal vesicular function

Malaria control in Pakistan: new tools at hand but challenging epidemiological realities

Malaria is endemic in Pakistan and constitutes a national health priority However the parasite and vectors are showing resistance to common antimalarial drugs and insecticides. The provinces of Balochistan, Sindh and Khyber Pakhtunkhwa and the Federally Administered Tribal Areas have the highest malaria burden. Districts and agencies bordering Afghanistan and Islamic Republic of Iran account for 37% of the malaria burden with an annual parasite incidence [API] exceeding 4.5/1000 population per year. Moreover, there has been a growing risk of Ptasmodiumfatdparum malaria incidencein areas where previously P. vivax was predominant New and effective control tools have been introduced such as rapid diagnostic tests, artemisinin-based combination therapy and long-lasting insecticide-treated nets. This paper reports the progress achieved in the implementation of a malaria control strategy in Pakistan, shares major outstanding challenges and unearths the potential of performance-based implementation for advancing resource mobilization and collaborative partnerships

Changes in serum lipid profile of albino rats fed on canola oil supplemented with atherogenic elements: 18 weeks study

Amongst lipid lowering factors, the dietary intervention for treating hyperlipidaemia and atherosclerosis associated ailments is physiological and gratifying. Canola is rich in monounsaturated fatty acids and is locally cultivated and cost effective. The criterion of the study was to determine the status of serum lipid profile in albino rats fed on canola oil diets for prolonged period of 24-weeks and to compare the same with those fed on canola oil supplemented with atherogenic elements. Results demonstrate that moderate amounts of canola oil [2.9% in diet] has triglyceride and cholesterol lowering effects. Both moderate and high amounts of canola oil [20%] decrease serum LDL-c profiles and resist lowering of HDL-c levels in rats fed with canola oil alongwith atherogenic elements. Conclusions: These findings reveal canola oil amongst the important supplement of monounsaturated fatty acids in animals and these findings may be generalized for humans

Management of soft tissue defects of hand with local [posterior interosseous] flaps

Observational case series study. To evaluate the role of Local Flaps in the management of the soft tissue injuries of hand. Study was conducted at BV Hospital, Bahawalpur from June 2002 to May 2003. In this study, we selected cases in which direct skin closure was not possible due to large defect or skin grafting was contraindicated for example in cases where bones and tendons were exposed, or in certain conditions where some secondary procedures may have to be carried out like tendon repair, tendon grafting nerve repair or fixation of fracture. Patients with severely crushed, non-salvageable hands, manageable with primary suturing and skin grafts and Patients with peripheral vascular disease, Elderly diabetic and Patients medically unfit for anesthesia. A total of 10 patients were treated between June 2002 and May 2003. There were 8 males and 2 females [male to female ratio 4:1]. Mean age of the patients was 26.26 years with range between 10 and 60 years. Most common cause of skin defects was agriculture machine injury [6 cases] followed by roadside accidents [2 cases], blast injury [I cases], and electric burn [1 cases]. In 7 patients there was an uneventful recovery. One flap was lost completely, partial flap loss occurred in one case, marginal necrosis and infection noted in one case. Local [posterior interosseous island] flaps are useful for coverage of the skin defects over the hand when applied with proper indications

Potassium induced salinity tolerance in wheat [triticum aestivum L.]

Water culture experiments were conducted to study the response of ten wheat genotypes to external K application [10 mmol KCI dm[-3]] at seedling stage under saline condition [0 and 100 mmol NaCl dm[-3]]. The data showed that there was an increase in the shoot and root length with the application of external K. The increase was more pronounced under control than under saline conditions. The better performing genotypes under two treatments were Bhitai, NIAB-41, NIAB-1076 and Khirman. The enhanced growth of these genotypes under saline condition might be due to the quick response to external K application, resulting in high K/Na ratio. The results indicated that the genotypes, which have the ability of enhanced K/Na discrimination, might perform better under saline conditions when sufficient potassium is applied in the rooting medium

Incidence of erythromycin resistance in clinical isolates of streptococcus pyogenes at afip, rawalpindi

Erythromycin Is a useful alternative to penicillin in treating Streptococcus pyogenes infections. However, increasing resistance to erythromycin is being reported from various parts of the world. to determine the frequency of erythromycin resistance among Streptococcus pyogenes isolates identified at Armed Forces Institute of Pathology, Rawalpindi. Descriptive non-interventional study. Jan 2003 to Sep 2004. Clinical specimens which yielded growth of catalase negative f3 hemolytic colonies on Blood agar were identified as Strept. pyogenes by Gram stain, bacitracin sensitivity, PYRase test and Lancefied grouping. Only one isolate per patient was included in the study. Antimicrobial susceptibility of the isolates was done by standard disk diffusion technique. Bacterial suspensions were inoculated on Blood agar followed by application of erythromycin [15microg], penicillin [10U], cephradine [30microg], ofloxacin [5microg] and doxycyline [30microg], disks. The plates were incubated overnight under aerobic conditions at 37°C. The results were interpreted according to NCCLS guidelines. A total 185 Streptococcus pyogenes isolates were recovered from 180 patients. Most of the specimens were of pus [n=119] followed by throat swab [n=-24]. Erythromycin resistance was 30%. All the isolates were susceptible to penicillin and cephradine while resistance to doxycyline was 70%. Erythromycin resistance among Streptococcus pyogenes was high; therefore, erythromycin might not be a useful alternative for treating systematic and serious infections due to Streptococcus pyogenes

Acute sarcoid arthropathy

A case of middle aged female with acute arthritis, mediastinal lymphadenopathy and diabetes mellitus is described. The patient underwent mediastinal lymph node biopsy and was diagnosed as having acute sarcoidosis [Lofgrens syndrome]. She was treated with systemic steroids and responded well

Emerging bacterial resistance patterns in febrile neutropenic patients: experience at a tertiary care hospital in Pakistan

To look at the clinical presentations, spectrum and site of isolation of the organisms, sensitivity patterns of the organisms and the antibiotic prescribing practices for the treatment of febrile neutropenic patients at our hospital. The data were collected retrospectively from the records of all neutropenic patients with an absolute neutrophil count [ANC] of less than 500/ml admitted during the period of 3 years from August 1999 to July 2002 at AKUH. Out of the total of 404 patients, 65% had hematological malignancies and around half of them had leukaemia, 86% of the patients presented with fever. A total of 124 bacterial organisms were isolated from 96 patients among which 47% were gram positive and 53% were gram negative organisms; 16.1% of the patients had septicaemia. Coagulase Negative Staphylococci [CoNS] were the most common gram positive and E coli was the most commonly isolated gram negative organism. Most of the gram positive organisms were isolated from blood [67%]. There was emerging resistance to all commonly used antibiotics including imipenem, cloxacillin, vancomycin and amikacin. The average duration of neutropenia was 6.4 days. The mortality rate was 6%. There is increasing trend of gram negative organisms developing resistance to commonly used antibiotics. Gram positive bacteria including Enterococcus spp. and CoNS are also showing emerging resistance to vancomycin

Frequency and echocardiographic study of dilated cardiomyopathy in children presenting with cardiac failure

To evaluate the role of echocardiography in diagnosis of dilated cardiomyopathy as a cause of cardiac failure in children. Design: This was descriptive study. Children presenting with cardiac failure from indoor patients were selected and echocardiography along with chest X- ray, ECG, cardiac enzymes and ASO titre was performed in all patients. Setting: Hospitalized patients included in the study were selected from the Department of Child Health, Khyber Teaching Hospital. Fifty hospitalized patients with congestive heart failure were selected consecutively from hospitalized patients. Main Outcome: Role of echocardiography in the diagnosis of dilated cardiomyopathy in children presenting with cardiac failure. Out of fifty patients admitted with cardiac failure 27 [54%] cases were found to be dilated cardiomyopathy while congenital heart disease, myocarditis and rheumatic heart disease were found in 12 [24%], 8 [16%] and 3 [6%] cases respectively. Dilated cardiomyopathy is an important cause of cardiac failure in children and echocardiography is an important tool to diagnose and differentiate dilated cardiomyopathy from other causes of cardiac failure

Serum lipid profile in patients of acute and transient psychotic disorders

Forty subjects, aged 15-45 years were randomly selected. Subjects were separated age wise into 1st group [15-30 years] and 2nd group [31-45 years]. They were divided into groups A and C. Group A included twenty patients of acute and transient psychiatric disorder while group C includes 20 age and sex matched normal controls. Serum total cholesterol [TC], Serum triglyceride [TG], Serum HDL-c and Serum phospholipid were done by using colorimetric methods. Serum LDL-c was calculated by Friedwald equation. Results obtained were analyzed by using students 't' test and level of significance was done. Altered lipid metabolism was found in patients of acute and transient psychotic disorders with decreased Serum TC, LDL-c and phospholipids

Efficacy of nebulised colomycin in bronchiectasis

Bronchiectasis is a chronic debilitating disorder due to the destruction of the bronchial walls and their supporting tissues. It is often complicated by acute-on-chronic bacterial infections. The purpose of this study was to assess the efficacy of nebulised colomycin in reducing the need for hospitalisation and intravenous antibiotic treatment in patients with bronchiectasis. This was a retrospective case control study. It was carried out at the Department of Chest Medicine, Gwynedd Hospital, Bangor, NW Wales, UK, and covered a period of sixty two months from Sept 1996 to Nov 2001. Records of all patients with established bronchiectasis receiving nebulised colomycin during Aug and Nov 2001 were retrieved and analysed for the number of admissions before and after commencing treatment with colomycin. Data was also collected, regarding sputum culture reports at the time of admission. There was an apparent reduction in the number of admissions after starting nebulised colomycin in patients with bronchiectasis. However, the response was not uniform among all patients and there were several other factors contributing to this. The study suggests that use of nebulised colomycin may be helpful in maintaing patients with bronchiectasis in stable state and reduce their need for hospitalisation. However a more elaborate, multi-centre prospective study is needed to confirm this impression/finding

Midazolam and thiopentone co-induction: looking for improvement in quality of anaesthesia

To evaluate improvement in quality of anaesthesia induction using thiopentone and midazolam for co-induction of anaesthesia. An additional end point was taken as loss of response to a tetanic stimulation [50 Hz] delivered for 5 seconds after the loss of verbal contact and eyelash reflex. Ninety ASA I and II patients, within the age range of 20-60 years were studied. Patients were randomly divided into three equal groups; A, B and group C Onset of induction and loss of response to a tetanic stimulation was achieved earlier in group B as compared to the other study groups [p<0.05]. Co-induction with midazolam 0.02 mg.kg-1 followed by thiopentone 3 mg.kg-1 was superior to other two groups. Induction of anaesthesia in this group was found to be smoother and faster, provided better hemodynamic stability, better airway maintenance and with lesser incidence of untoward effects

Spetrum of complications and mortality of bacterial meningitis: an experience from a developing country

The aim of this study was to obtain data on predisposing factors, causative organisms and their associated mortality and complications related to acute bacterial meningitis. The chart review of all patients in whom acute bacterial meningitis was diagnosed at The Aga Khan University Hospital from January 1995 through December 2001. One hundred ninety-four patients were included in study. There were 146 males and 48 females. The mean age of our study population was 41 +/- 12.3 years. One hundred and ninety [97.9%] patients had communityacquired meningitis-, only 4 [2.0%] patients developed meningitis nosocomially. The two most common predisposing factors were diabetes mellitus [13.9%] and otitis media [7.7%] among all 194 patients. A significant proportion of patients with complications had diabetes mellitus [24.6%, p<0.001]. CSF and blood cultures were positive in 53 [27.3%] and 42 [21.6%] patients respectively-, there was no statistical difference found. The most common organisms isolated were Streptococcus pneumoniae in 35 [36.8%] patients followed by Neisseria meningitides in -30 [31.5%] -patients. Approximately 68% of -positive cultures -yielded S. pneumoniae and N. meningitides [p<0.0001]. The overall mortality rate was 22.1%. The mortality rate for Streptococcus pneumoniae was 17.1%. The highest mortality was observed in patients with Pseudomonal meningitis where all four patients expired followed by mortality rate of 85.7% in Escherichia coli afflicted patients [p<0.001]. Complications occurred in 73 [37.6%] patients with persistent complications in 31 [42.4%] patients. Complications resolved in 34 [46.5%] patients. The most common complications were seizures [12.8%] and cranial nerve palsies [11.3%]. Seizures were more likely to occur in older patients [p<0.05] whereas hydrocephalus was more common in younger patients [p<0.05]. Bacterial Meningitis remains a serious disease associated with substantial morbidity and mortality. Most cases are community acquired with S. Pneumoniae being the most common pathogen. Old age, diabetes mellitus, a positive culture, seizures as a complication and late stage in the disease are the important predictors of a poor outcome

audit of blood cross-match ordering practices at the aga khan University Hospital: first step towards a maximum surgical blood ordering schedule

OBJECTIVE: In the absence of an explicit maximum blood order policy, ordering for blood transfusion is frequently based on subjective anticipation of blood loss instead of evidence based estimates of average requirement in a particular procedure. This study was done to assess current practice and the feasibility of a prospective randomized work to develop practice guidelines. METHOD: We audited transfusion data for elective surgical procedures in our hospital during the last 2 years. Cross-matched to transfused ratio [C/T ratio] and Transfusion Index [Ti] for each of the elective surgical procedures was performed during the study period. C/T ratio is used as a measure of the efficiency of blood ordering practice. It should ideally be between 2 and 2.5. We compared our results with the ideal. Data was analyzed for 32 elective surgical procedures in 2131 patients. Majority [2079] [97.56%] of the patients had C/T ratios higher than 2.5. Only 12 in 450 [21.11%] patients, had a Transfusion Index [Ti] higher than 0.5. There were 13 procedures in which both C/T ratio was greater than 2.5 and Ti less than or equal to 0.5. In vast majority of elective surgical procedures routine cross match is not necessary. We propose a draft Maximum Surgical Blood Ordering Schedule [MSBOS]. It provides guidelines for frequently performed elective surgical procedures by recommending the maximum number of units of blood to be cross-matched preoperatively. Implementation of MSBOS will result in about 60% reduction of cost to the patients

Malignant tumors of nose and paranasal sinuses

It is a study of 20 cases of sinonasal malignancies seen over a period of 5 years. The commonest age affected was fifth [35%] and sixth [30%] decades. The disease was more frequently seen amongst males compared to females with a ratio of 3:1. The commonest histological variant was squamous cell carcinoma [70%] followed by adenocarcinoma [15%], adenoid cystic carcinoma [5%], non-Hodgkin's lymphoma [5%] and haemangiopericytoma [5%]