Trend of increased resistance to antibiotics in intensive care unit isolates of a tertiary care hospital over two years 2009 and 2010

To asses the antibiotic resistance pattern of Intensive Care Unit bacterial isolates over two year period; 2009 and 2010. This observational study was carried out on Intensive Care Unit isolates of Services Hospital Lahore in the Microbiology section of Department of Pathology, Services Institute of Medical Sciences Lahore. All samples processed for microbial cultures were tested for anti-biotic sensitivity / resistance pattern studied and compared. In 2009,790 samples and in 2010 886 samples were submitted from ICUs to Microbiology Section for culture. Of these, 42% and 46% were culture positive respectively. Gram negative isolates were 294 in 2009 and 308 in 2010. Resistance to all drugs tested was exhibited by 26 [8.78%] and 39 [12.60%] isolates in 2009, 2010. The total number of Acinetobacter isolated increased to 102 in the year 2010 from 74 in the year 2009 with 28 more Acinetobacters than in 2009 and the number exhibiting extensive drug resistance doubling to 28 from 14. Resistance to Imipenem, Tazobactem and Amikin drugs increased in Acinetobacters, Klebsiella and resistance of E coli to Imipenem also increased but decreased in Pseudomonas and E coli. ORSA and coagulase negative staphylococci with Oxacillin resistance were also on the rise, doubling in number from 12 to 25 and 14 to 31 in 2009 and 2010. Acinetobacter species are on the rise in the intensive care units as is their extensive and multi drug resistance pattern. Increasing Carbepenem resistance is alarming limiting our therapeutic options. Judicious use of antibiotics and curtailing nosocomial infections would deter this upward trend

HIV Infection, HIV/HCV and HIV/HBV co-infections among Jail Inmates of Lahore

Human immunodeficiency virus [HIV] infection constitutes an important prison health care concern but data on HIV epidemiology among jail inmates of developing world including Pakistan is limited. The present study was carried out to find out the prevalence of HIV infection among inmates of two jails of Lahore, Pakistan. Cross sectional prevalence survey of a total of 4915 jail inmates [4498 male and 417 females] was conducted during a seven months period, from May 2009 to November 2009 in the inmates of "District and Central Jails of Lahore". They were divided into four groups according to age. A blood sample was collected from each survey participant. All collected blood samples were screened for HIV antibodies, HBsAg and anti-HCV with rapid testing immunochromatographic [ICT] kits. All positive test results were confirmed by using the ELISA technique. The overall HIV prevalence rate was 2.01% and 77.78% of them had co-infections. HIV/HCV co-infection was detected in 73.74% of HIV positive inmates. Among women prisoners, one Pakistani and four Africans were found HIV positive. HIV infection and HBV/HCV co-infection was more prevalent in the age group 16-30 years. The prevalence rate of HIV infection and its HBV/HCV co-infection in jail inmates is much higher than the general population and the prevalence rate reported earlier from other jails in Pakistan. Health information on jail populations is important as this is a vulnerable group, with frequent movement in and out of the general community. Urgent prevention efforts are needed as HIV prevalence is already 2%

Bacteriological quality of drinking water in Lahore

It is well established that a large number of infectious diseases are transmitted primarily through water supplies contaminated with human and animal excreta particularly faeces. The purpose of the study was to assess bacteriological quality of drinking water in Lahore-Pakistan. It is a cross sectional descriptive study performing the Lahore city during the months of April and May 2008. A total of 530 water samples were collected from different localities of whole of the Lahore city. These represented areas with different socio-economic conditions. The samples were collected in sterilized containers and brought to the laboratory within two hours of collection. All the samples were tested for contamination with bacteria using multiple tube method to determine most probable number of total coliforms and faecal coliforms using standard procedure. Among 530 water samples, 197 samples [37.2%] were positive for bacterial contamination. It was observed that bacterial contamination was maximum in areas with low SEC [43.6%], followed by intermediate SEC [36.5%] and high SEC [22.9%]. The difference was found to be statistically significant [p<0.15] between areas with High and Low SEC while it was non-significant [p>0.5] between areas with Low and Intermediate SEC. Bacterial contamination is significant pro Hem in Lahore. Regular monitoring and chlorination/establishment of water filtration plants can improve this situation

Staphylococcus aureus and MRSA nasal carriage in general population

Assessment of Staphylococcus aureus [S. aureus] and MRSA nasal carriage in our general population. Cross-sectional analytical study. A private Pathology Laboratory in Lahore city from January 2002 to December 2003. Nasal swabs were obtained from the apparently healthy persons accompanying the patients attending the laboratory. These swabs were inoculated on blood and mannitol salt agar plates and incubated at 37°C. The isolate[s] were identified as S. aureus on the basis of colony morphology, Gram staining, catalase and coagulase tests. Sensitivity to Oxacillin was determined using standard Kirby Bauer technique. Nasal swabs from 1660 subjects from the community were studied. Out of these samples, a total of 246 [14.82%] samples were positive for growth of S. aureus [nasal carriers of S. aureus]. Out of 246 S. aureus isolates, 48 [19.51%] isolates were methicillin resistant S. aureus [MRSA]. Nasal carriage was higher in males [15.47%] as compared to females [13.26%], in urban areas [16.99%] as compared to rural areas [11.32%] and in the year 2002 [16.02%] as compared to year 2003 [13.08%]. However, the difference was significant only for the urban vs. rural comparison [p<0.05]. MRSA isolates were also significantly higher among S. aureus isolates from the nasal cavities of urban subjects [22.98%] as compared to rural ones [11.11%]. Maximum nasal carriage was present in the age group upto 9 years [20.23%] with decrease in the age groups 10-19, 20-29 and 30-39 years followed by small rise in the older subjects. The nasal S. aureus carriage as well as methicillin resistance among these isolates are more common in urban community

Awareness about causes of gastrointestinal tract [GIT] malignancies

To determine the knowledge of doctors, nurses, patients and public about the causes of gastrointestinal cancers and dissemination of this knowledge. Design: A cross-sectional analytical study. Place and Duration of Study: This study was carried out in the Department of Oncology, King Fahad Hospital, Al-Madinah Al-Munawara, Kingdom of Saudi Arabia and was completed in four months from February 2003 to June 2003. Subjects and About 200 doctors, nurses and patients suffering from GIT cancer and general public were selected. Each subject was asked to fill up a proforma designed to assess his knowledge about the risk factors for GIT malignancies. A majority of doctors and nurses had good knowledge about the causes of GIT malignancies. The knowledge of patients and general public was low. Out of all four groups, it was poorest in the patient's group. The difference in the knowledge of medicos and patients/public reflects that medicos should convey this knowledge to the patients in particular and general public in general, which is their responsibility besides medical treatment

Qualitative assessment of bacteriological quality and chlorination status of drinking water in Lahore

Qualitative assessment of bacteriological quality and chlorination status of drinking water in Lahore. Design: Descriptive study. Place and Duration of Study: Lahore city from October 2000 to September 2001. Materials and A total of 2160 water samples from distribution system were tested from nine different localities of Lahore. These localities represented areas with different socioeconomic conditions [SEC]. Twenty water samples were tested from each locality from the same taps each month. All the water samples were subjected to H2S strip test for determination of bacteriological contamination as well as orthotolidine test for detection of chlorine. Four hundred and forty-six [20.64%] samples were positive for bacterial contamination. It was observed that contamination was the maximum in low SEC areas [32.22%], followed by intermediate SEC areas [18.47%] and high SEC areas [11.25%]. The difference was found to be statistically significant [p<0.01] among different areas. Only 27.73% samples were chlorinated. Positivity of samples for chlorine was the lowest in areas with low SEC[20.69%] and highest [32.77%] in areas with high SEC, the difference being statistically significant. Maximum contamination was present in samples tested during summer months[June-August] of the year [31.11%], followed by autumn months [September-November] of the year [20.9%], spring months [March-May] of the year [18.7%] and winter months [December-February] of the year [11.85%]. Samples tested during summer months showed the highest positivity [77.96%] for chlorine [p<0.001] as compared with other months of year. Among chlorinated samples 12.32% showed bacterial contamination. However, contamination was significantly higher [p<0.001] among non-chlorinated samples. Bacterial contamination of piped water is a significant problem in Lahore. Regular chlorination and monitoring of water supplies can improve it

Antimicrobial resistance of community and hospital acquired staphylococcus aureus isolates to oxacillin and glycopeptides

To determine sensitivity pattern of Staphylococcus aureus isolates from the community and hospitals to methicillin, glycopeptides and other antimicrobial agents. Design: Descriptive study. Place and Duration of Study: Private Pathology Laboratory in Lahore from January 2001 to April 2002. Subjects and A total of 714 Staphylococcus aureus [S.aureus] isolates from the community and hospital were tested. Community acquired S.aureus strains [n=434] were isolated from specimens like pus from boils/pimples and nasal swabs of patients with asthma attending a local allergy clinic. The hospital acquired S.aureus [n=280] were isolated from specimens like pus from wounds/discharging sinuses, ear swabs, blood and urine. All the isolates were subjected to sensitivity test against Oxacillin, Vancomycin, Teicoplanin, Penicillin, Imipenem, Cefipime and other anti-staphylococcal agents by standard Kirby-Bauer disk diffusion method. Beta lactamase production by all the isolates was also determined by acidimetric test. Significantly higher number of hospital acquired S.aureus isolates [p<0.01] were beta lactamase producing [96.07%] as compared to community acquired [81.79%]. Methicillin [Oxacillin] resistance was also higher among hospital strains [31.1%] as compared to community ones [14.1%]. No isolate from the community showed resistance to glycopeptides. While 0.3% and 0.7% of all S.aureus isolates were interpreted as resistant to Vancomycin and Teicoplanin respectively as there was no zone of inhibition. The resistance to these drugs was a bit higher among the MRSA [1.1% and 2.3% respectively]. More than 90% of nosocomial MRSA strains were sensitive to Ofloxacin and Fucidic Acid. Resistance to Erythromycin, Lincomycin and Gentamicin was 70.1, 33.3 and 39.1% in that order. In general resistance to different antimicrobial was lower among S.aureus strains of community origin as compared to those of hospital origin. Methicillin and multiple drug resistance is quite a significant problem in nosocomial as well as community acquired S.aureus strains. Moreover, it appears that resistance to glycopeptides has also emerged in our nosocomial S. aureus strains. Microbiology laboratories should make efforts not only to regularly screen S.aureus isolates for sensitivity to glycopeptides but also to determine MIC of the isolates

Environemntal allergens in patients with allergic rhinitis

To find out the common environmental allergens responsible for sensitivity in patients with allergic rhinitis. Design: Descriptive cross sectional study. Place and Duration of Study: A local allergy clinic in an urban area of Lahore during the year 2000-2001. Subjects and Eighty patients with allergic rhinitis irrespective of age and sex were studied. These cases were selected on the basis of symptoms like sneezing, itching, watery nasal discharge and eosinophilia in nasal secretions. Forty matched healthy subjects as controls were also studied. Allergy test was performed on all the subjects by skin prick test to determine sensitivity to common environmental allergens using Bencard [England] allergy kit. Common environmental allergens responsible for sensitivity in allergic rhinitis patients were house dust [82.5%], house dust mites [73.7%], mixed threshing [80%], straw dust [58.7%], hay dust [63.7%], mixed feathers [45%], cat fur [57.5%], cotton flock [56.2%], tree pollens [45%] and grass pollens [48.7%]. Sensitivity to these allergens was observed in significantly higher [P<0.01] percentage of allergic rhinitis patients as compared with control subjects. Sensitivity to house dust, house dust mites and cat fur was of severe degree in majority of allergic rhinitis patients. While sensitivity to mixed threshing, straw dust, hay dust and mixed feathers was of moderate to severe degree in majority of these patients. Skin prick tests provide an effective and definitive mean to find out sensitivity to different allergens in cases with allergic rhinitis. Based on these findings, the physician can manage these patients in better way

Study of risk factors for carcinoma breast in adult female general population in Lahore

To evaluate some of the established risk factors for the breast cancer in adult female population. Design: It was a prospective study. Place and Duration: This study was conducted in Oncology Department, Services Hospital, Lahore, from August, 1999 to August, 2000. Subject and One hundred breast cancer patients and 100 control subjects enrolled for interview and the percentage of positives was analyzed. Proforma containing demographic characteristics and established risk factors for breast cancer was established. All the female subjects, above 15 years of age, were subjected to the questions in this proforma. To keep uniformity medical officers were briefed for filling this proforma. The data gathered was analyzed statistically. Out of established risk factors, family history of breast cancer and use of oral contraceptive pills were proved significantly positive with a value of p<0.001, infertility and history of early menarche was positive with statistically significant difference of p<0.05. Menstrual disturbance, late menopause, history of pregnancy after 30 years of age and history of breast-feeding had no statistically significant difference [p>0.05]. This study showed that there is a family tendency for breast cancer and estrogenic hormones are playing some role. More possibility of breast cancer was found in infertile and those having early menarche

Knowledge, attitude and preventive practices for breast cancer

To determine the knowledge and practice of breast cancer in medical community. Design: A cross sectional study. Place and Duration of Study: The study was carried out in the Department of Oncology, Services Hospital, Lahore and completed in one month. Subjects and About 200 female doctors and nurses of the Hospital were involved. Each subject was asked to fill up a proforma designed to assess knowledge, risk factors and preventive practices of the breast cancer. Using non-probability convenience sampling technique, breast self-examination [BSE] and mammography was performed as screening of breast cancer. A majority had good knowledge of the risk factors and screening method for the early detection of breast Cancer. Majority had the consensus on the benefit of mammography. Conclusions: The study shows that although medical professionals had fairly good knowledge about screening methods and risk factors of breast cancer their preventive practices were scanty in high risk population and, therefore, physicians and nurses need proper training

Study of risk factors for carcinoma breast in adult female general pouplation in Lahore

To evaluate some of the established risk factors for the breast cancer in adult female population. Design: It was a prospective study. Place and Duration: This study was conducted in Oncology Department, Services Hospital, Lahore, from August, 1999 to August, 2000. Subject and One hundred breast cancer patients and 100 control subjects enrolled for interview and the percentage of positives was analyzed. Proforma containing demographic characteristics and established risk factors for breast cancer was established. All the female subjects, above 15 years of age, were subjected to the questions in this proforma. To keep uniformity medical officers were briefed for filling this proforma. The data gathered was analyzed statistically. Out of established risk factors, family history of breast cancer and use of oral contraceptive pills were proved significantly positive with a value of p<0.001, infertility and history of early menarche was positive with statistically significant difference of p<0.05. Menstrual disturbance, late menopause, history of pregnancy after 30 years of age and history of breast-feeding had no statistically significant difference [p>0.05]. This study showed that there is a family tendency for breast cancer and estrogenic hormones are playing some role. More possibility of breast cancer was found in infertile and those having early menarche