In vitro susceptibility of MRSA clinical isolates to ceftaroline

Objective: To determine the in vitro susceptibility of MRSA clinical isolates to ceftaroline, using interpretation of zones of inhibition by disk diffusion method. Study Design: Descriptive cross sectional. Place and Duration of Study: The study was carried out at the Department of Microbiology, Combined Military Hospital Peshawar, from Jan to Dec 2014

Material and Methods: To carry out this descriptive cross sectional study, clinical specimens were obtained from indoor and outdoor patients of Combined Military Hospital Peshawar. All the isolates of MRSA cultured with CLSI guidelines and identified with standard microbiological procedures, from clinical specimens of pus, body fluid, urine, tissue and blood were included in the study. The antimicrobial susceptibility pattern of ceftaroline was determined according to CLSI guidelines. The data was analyzed in SPSS [version 19] software

Results: Out of a total 190 MRSA isolates, 183 [96.3%] were susceptible to ceftaroline in vitro, whereas 5 [2.6%] were resistant and 2 [1.1%] were intermediate in their response to ceftaroline

Conclusion: Ceftaroline can be used effectively against infections caused by MRSA as it has shown very high in vitro activity against MRSA strains of clinical origin

Effectiveness of platelets rich plasma versus corticosteroids in tennis elbow treatment

Background: Tennis elbow is a common condition causing discomfort and pain on the lateral aspect of the elbow especially during gripping activities

Objective: To compare the treatment with injection Platelets Rich Plasma and injection corticosteroid for tennis elbow in terms of symptoms relief. Methodology: This randomized controlled study was conducted in the Department of Orthopedics and Spine Unit, Hayatabad Medical Complex, Peshawar from 27th July 2016 to 26th July 2017. A total of 52 cases of tennis elbow were selected in OPD and randomly allocated in two groups to receive corticosteroids [Group A] and Platelets Rich Plasma [PRP] [Group B] and followed up to determine the effectiveness of either intervention. All information was recorded on a proforma. Pain intensity was recorded using VAS after three weeks postoperatively. Data analysis was done using SPSS 16 version

Results: A total of 52 patients with tennis elbow were selected and divided in two equal groups. There were 11 male and 15 females in steroid [group A] and 12 male and 14 female patients in PRP [group B]. In group A, the mean baseline VAS was 6.5 +/- 1.2 and in group B it was 6.7 +/- 1.4 but the difference was statistically not significant with a p-value of 0.71. All patients were subjected to standard therapy as per their allocated groups and were again assessed on 3 weeks follow up. On follow up, the mean pain scores using Visual Analogue Scale in group A was 4.19 +/- 2.6 and in group B was 3.42 +/- 2.61. We observed that of the overall sample of 52, the improvement was observed in 71 % of patients. Group A showed effectiveness in 54 % of patients and group B showed effectiveness in 88 % of patients. This difference was statistically significant having a p value of 0.001

Conclusion: Platelets Rich Plasma [PRP] is an effective alternative to corticosteroid in the treatment of tennis elbow

Antimicrobial susceptibility pattern of polymyxin B, tigecycline and fosfomycin against carbapenamase producing enterobacteriaceae [CPE]

Objective: To determine, the susceptibility pattern of carbapenamase producing enterobacteriaceae [CPE] against polymyxinB, tigecycline and fosfomycin

Study Design: Descriptive cross sectional

Place and Duration of Study: The study was carried out in the Department of Microbiology PNS Shifa Karachi, from 26 Sep 2013 to 25 Mar 2014

Material and Methods: All specimens were inoculated on blood and macConkey agar, incubated aerobically at 35degreeC - 37degreeC for 18 to 24 hours. After identification of gram negative rods by colony morphology, Gram's staining and biochemical reactions, these were screened for Carbapenems resistance with imipenem and meropenem 10 microg discs along with routine first and second line antibiotics by Kirby-Bauer disc diffusion technique according to Clinical Laboratory Standard Institute [CLSI] guide lines. All isolated CPE were saved and then inoculated on Mueller-Hinton agar [MHA]. Antimicrobial susceptibility against polymyxin B, Tigecycline and Fosfomycin was done by Kirby-Bauer disc diffusion method using disc polymyxin B 300 units, Tigecycline 15microg and Fosfomycin 200microg. Zone diameters greater than 24 mm were taken as sensitive for Tigecycline 15microg, 16mm for Fosfomycin 200 microg and 12 mm for polymyxin B 300 units

Results: Clinical specimens of 171 patients who fulfilled the inclusion criteria were included in our study. Mean +/- SD of age was 42.02 +/- 22.367 with C.I [38.65 - 45.40]. Out of 171 patients 110 [64%] were male and 61 [36%] were female. In vitro susceptibility results revealed that all the 171 [100%] CPE isolates susceptible to PolymyxinB, while susceptibility against Fosfomycin and Tigecycline was 132 [77%] and 49 [29%] respectively

Conclusion: CPE were found to be 100% susceptible to polymyxinB, while for Fosfomycin and Tigecycline susceptibility was 77% and 29% respectively

Effects of canola oil supplemented with atherogenic element and Nigella sativa [kalonji] on serum lipids in albino rats - An experimental study

To compare effects of canola oil supplemented with atherogenic element and Nigella sativa serum lipids in albino rats. Study was conducted at Pathology Department of Postgraduate Medical Institute, for 12 weeks. [Laboratory based randomized controlled trials]. Seventy two albino rats were selected and randomly divided into six groups of twelve animals with equal number of male and female in each. Fourteen days after acclimatization to the environment and basal diet, fasting blood samples [zero week] were collected by heart puncture under ether anesthesia and experimental diets were started which were continued for 12 weeks. All parameters were measured using enzymatic colorimetric methods. Estimations of serum lipids showed increase in total cholesterol [TC] and High Density Lipoprotein Cholesterol [HDL-c] levels but fall in LDL-c concentrations in groups fed on canola oil diet. On the other hand, even atherogenic supplemented groups had decrease in cardio-protective HDL-c and raised LDL-c; although statistically non-significant Thus canola oil diets were not hyperlipidaeinic and prevented adiposity. Nigella sativa [NS] diets significantly decreased serum total cholesterol and LDL-c while HDL-c was raised but non-significantly. Thus Nigella sativa prevented deposition of lipids in tissues, thus preventing tendency to obesity and atherogenesis by decreasing LDL-c in serum Nigella sativa produces antilipidaemic and anti-obesity effects by decreasing low density lipoprotein cholesterol level which is statistically significant in two out of the three groups fed on Ns; it also increased high density cholesterol which was however nonsignificant in comparison with canola oil alone

Analysis of primary intrathoracic extrapulmonary hydatid cysts a rare clinical entity

To evaluate the anatomic location of cysts, operative characteristics of intrathoracic extrapulmonary hydatid cyst and to determine the outcome of aggressive surgical interventions.Case series. Thoracic Surgery Unit Lady Reading Hospital Peshawar from 1[st] July 2008 to 30[th] June 2011. All patients admitted to Thoracic unit from July 2008 to June 2011 with intra thoracic hydatid cysts were evaluated prospectively as to age, sex, symptoms, diagnostic procedures, anatomic location of cysts, surgical procedures, complications, and outcomes. Chest radiography, computed tomography, and thoracic and abdominal ultrasonography had been performed preoperatively in all of them. Bronchoscopy and spirometry was also performed in all patients for assessment and operability.Echocardiography had been used in 2 patients to determine the contiguity of the cyst to the pericardium. Cystectomy and wide resection were the chief operative procedures. Most of the patients were having cysts in the pulmonary parenchyma only 10 patients had intrathoracic cysts in extrapulmonary locations. This group of patients was included in the study. We excluded patients who had a parenchymal cyst that had perforated to the pleura, myocardial hydatid and patients who had Total of 149 patients were operated for hydatid cystectomy, out of these 139 patients had pulmonary hydatid and 10 patients had intrathoracic extrapulmonary hydatid cysts. These 10 patients constitute our study group; out of these 7 were men and 3 women whose mean age was 39.14 +/- 16.8 years range, [16-69 years]. Eight [80%] of these were symptomatic, most commonly with chest pain, two patients were asymptomatic. There were 2 [20%] mediastinal hydatid, 2 [20%] diaphragmatic, 2 [20%] pericardial, 2 [20%] oblique fissure, and 1 [10%] each in chest wall and pleural hydatid in our study. Albendazole [10 mg/kg] was prescribed to all patients for as long as 3 months postoperatively. No complication, recurrence, or death occurred during the follow up period of 13 +/- 15.4 months [range, 2-36 months].The extrapulmonary location of Hydatid cysts within the thorax is very rare. This rarity may cause difficulties in diagnosis. To avoid recurrence, it is necessary to resect the affected tissues completely and an anthelmintic medical regimen post operatively

Frameless stereotactic biopsy of intracranial lesions: evaluation of efficacy and complications

Objective: Frameless stereotactic biopsy has been shown in multiple studies to be a safe and effective procedure for the diagnosis of brain lesion. In this study the authors will evaluate the safety of the procedure and associated complications including neurological deficits in our set up of developing countries

Methods: Forty two patients with different brain lesions were biopsied using frameless stereotactic procedure between the periods of March 2009 - March 2014 for the assessment of diagnostic yield and related complications

Results: During the study period, forty two patients were biopsied for the evaluation of the complications related to the biopsy site. Neurological decline occurred in 1 patient. A higher number of needle passes was associated the presence of a postoperative hematoma. Infection occurred in one patient and overall diagnostic yield was 95%

Conclusion: Frameless stereotactic biopsy is a safe and effective method of tissue diagnosis for small lesions located in the eloquent and non-eloquent region of brain. With careful planning, frameless biopsy remains a valuable and safer tool for diagnosis of brain lesion, independent of the location of these lesions

Carcinoma breast; late presentation facts and factors

To evaluate the factors responsible for the late presentation of carcinoma of breast in Pakistani women. Prospective, Cross sectional, Interventional. Women Medical Complex Sialkot and Surgical Unit II. Aziz Bhatti Shaheed [Teaching] Hospital. Nawaz Sharif medical College, University of the Gujrat. Study. January 2009 to June 2012. A total of 87 patients of all age groups with carcinoma of breast were enrolled in this study. Mean age of presentation with breast cancer was 43 years. Stage III carcinoma breast was the most common presenting stage seen in 56 [64.36%] women. Socio economic status, delay in presentation and diagnosis, fear of mastectomy and its social consequences found to be major factors in the late presentation of carcinoma of breast. There is need to launch cancer public health campaign mechanisms, should include teaching of Breast Self Examination [BSE] to patients, Clinical Breast Examination [CBE] to health workers. Strenuous efforts should be made to break the vicious cycle of late presentation, poor treatment outcome and reluctance of patients to present to health facilities because of social mindset

Asthma control among asthmatic patients: a single center study

Background: Asthma, when uncontrolled is a crippling condition and due to increasing allergens, the patients are increasing in number worldwide

Objective: To determine the level of asthma control in southern Punjab and impact of education level, habitat and gender on it

Subjects and Methods: This cross sectional study was conducted in the outpatient consultant's clinic, Bahawal Victoria Hospital, Bahawalpur, from 1[st] February to 30[th] September, 2011. All the patients diagnosed as having asthma by the physicians, were interviewed about the control of asthma. The data was collected on a questionnaire that included questions on the level of control of asthma and other related variables. Data was entered and analyzed by SPSS version 10

Results: A total of 768 patients were included in study, out of which 75% were having poorly controlled asthma. There were 224 [29.2%] females and 544 [70.8%] males. Fifty percent patients were of young age group. Middle age and elderly were 37% and 12% each. In the patients of urban area 61.53% were educated while from rural area 38.46% were educated. Among poorly controlled asthma group 320 [55%] were from rural area and 256 [44%] from urban area. In poorly controlled group 32 [5.55%] were on no treatment. Hundred percent of partially controlled and well controlled were having physician prescriptions. In well controlled group 64 [66.66%] were young. In poorly controlled group 288 [50%] were young. In well controlled group 100% were educated while in poorly controlled group 288 [50%] were uneducated. In poorly controlled group 32 [5.55%] were on no treatment while 544 [94.44%] were on some medications with prescription. In fully controlled group 100% patients had prescription

Conclusion: Asthma control is mostly poor in rural areas of Southern Punjab and almost half of the patients are uneducated, and young

Hemorrhoidectomy VS rubber band; comparison of post operative complications

To compare open hemorrhoidectomy and Rubber Band Ligation [RBL] in the management of 2nd and 3rd degree hemorrhoids in terms post operative and hospital stay. Experiential Randomized Control Trial. Department of surgery, Allied Hospital and Independent University Hospital Faisalabad. Dec 2008 to May 2009. 100 consecutive patients with second and third degree hemorrhoids were randomly divided into two groups. Group A [50 patients] were operated by open hemorrhoidectomy [Milligan morgan technique] while in group B [50 patients] rubber band ligations was performed. Open hemorrhoidectomy was performed under spinal anesthesia while rubber bands were applied with local xylocaine gel using Barron's rubber band ligator. All the three hemorrhoids were ligated in single session. Average hospital stay was 24 hours in patient operated by open hemorrhoidectomy as compared to one hour in rubber band ligation. 60% patients in group A developed moderate to severe pain requiring I/V morphine derivatives while 40% developed mild pain and treated with NSAIDS. In group B only 20% patients developed moderate pain and were dealt with I/M diclofenac sodium. Eightyeight percent patients in group A and 60% patients in group B developed mild to moderate bleeding in first postoperative week, which was self limiting. 6 patients developed severe bleeding after hemorrhoidectomy requiring blood transfusion. During six month follow up, two patients [4%] of open hemorrhoidectomy and 3 patients [6%] of RBL presented with recurrence and respective procedures were repeated. Rubber band ligation is safe, quick, economical and effective method for the treatment of 2nd and 3rd degree hemorrhoids

Extensively drug-resistant tuberculosis case in the thames Valley, UK and public health interventions

This study describes the first case of extensively drug-resistant tuberculosis [XDR-TB] in the Thames Valley and South East Region and discuss the public health implications, highlighting the need to integrate current epidemiological knowledge with clinical expertise in order to diagnose drug-resistant tuberculosis [TB] early. The management of the XDR-TB patients is challenging with few treatment options, expensive therapy, side effects of drugs and a longer course of the treatment

Partial weight bearing; new quantitative approach

The objective of this study was to quantify scientifically the partial weight bearing advice to the patients so that the treating surgeons and treated patients know exactly how much weight they should bear on the treated limb. Descriptive study. The study was conducted at combined military hospital Sialkot and combined military Hospital Quetta from May, 2003 to Dec, 2006. We studied 150 patients who were operated for osteosynthesis in lower limb. We excluded all patients below age 10 years, poly trauma patients operated for bilateral leg fractures, and associated upper limb fractures. Patients were advised to place studied limb on weighing machine and exert required force. Depending upon implant used, quality of fixation and bone density, 5 to 10 kilogram of weight bearing was started two to three weeks after the operation. This force was gradually increased by 5 to 10 kilograms two weekly interval as union progressed. Average age of the patients was about 40 years most of them were young males, with 5:1 ratio to females. Femur was most commonly involved bone in 81 [54%] patients, while tibia in 69 [46%] patients. Road traffic accident was most common etiology in 95 [63.33%] patients, history of fall, nonunion, and field injuries were etiology in other cases. Locally made implants were used in all cases. External fixator was applied in 45 [30%] and internal fixation was done in 105 [70%] cases. Bone grafting was done in 24 cases. We achieved union in 97.3% patients. Union was achieved in mean 15.1 weeks in internal fixations and 17.3 weeks in external fixators. We had 21 [14%] minor and 8 [5%] major complications most of them in patients requiring external fixators. Quantifying partial weight bearing advice gives confidence to patient that how much weight bearing to be done depending upon fracture geometry, implant used its fixation and bone quality. By avoiding nonspecific terms toe touch, heel touch and partial weight bearing we can advise exactly to bear required weight by this simple method. The result of study shows excellent union rates even in open fractures and infected nonunion. To our knowledge this is the first attempt to quantify partial weight bearing advice. The result of this study will help in understanding the patient regarding weight bearing

Frequency of different HCV genotypes in Faisalabad

Hepatitis C Virus [HCV] is thought to be one of the major causative agent of viral hepatitis. A large number of HCV infected patients develop chronic hepatitis which often results in liver cirrhosis and even progress to hepatoma The HCV genotype is the strongest predictive parameter for sustained virological response [SVR]. Patients with different HCV genotypes respond differently to antiviral therapy. Firm evidence has been established that patients with genotypes 2 and 3 are more likely to achieve SVR to combination therapy than Genotype 1 patients. A total of 93 patients from Faisalabad, who were HCV RNA positive were tested for genotyping. Out of the 93 tested serum samples 84 were typable and 9 were found to be untypable. In the typable samples most prevalent genotype was found to be type 3a and common cause of untypable genotypes was a low viral load. The most common type of HCV infection in Faisalabad is due to genotype 3a and the common cause of untypable genotype is probably low viral load

Tube thorocostomy: management and outcome in patients with penetrating chest trauma

Penetrating chest trauma is common in this part of the world due to present situation in tribal areas. The first line of management after resuscitation in these patients is tube thoracostomy combined with analgesia and incentive spirometry. After tube thoracostomy following surgery or trauma there are two schools of thought one favours application of continuous low pressure suction to the chest tubes beyond the water seal while other are against it. We studied the application of continuous low pressure suction in patients with penetrating chest trauma. This Randomized clinical controlled trial was conducted in the department of thoracic surgery Post Graduate Medical Institute Lady Reading Hospital Peshawar from July 2007 to March 2008. The objectives of study were to evaluate the effectiveness of continuous low pressure suction in patients with penetrating chest trauma for evacuation of blood, expansion of lung and prevention of clotted Haemothorax. One hundred patients who underwent tube thoracostomy after penetrating chest trauma from fire arm injury or stab wounds were included in the study. Patients with multiple trauma, blunt chest trauma and those intubated for any pulmonary or pleural disease were excluded from the study. After resuscitation, detailed examination and necessary investigations patients were randomized to two groups. Group I included patients who had continuous low pressure suction applied to their chest drains. Group II included those patients whose chest drains were placed on water seal only. Lung expansion development of pneumothorax or clotted Haemothorax, time to removal of chest drain and hospital stay was noted in each group. There were fifty patients in each group. The two groups were not significantly different from each other regarding age, sex, pre-intubation haemoglobin and pre intubation nutritional status. Full lung expansion was achieved in forty six [92%] patients in group I and thirty seven [74%] in group II. Partial lung expansion or pneumothorax was present in three [6%] in group I and 10 [20%] in group II. One patient in group I and three [6%] patients in group II had no response. The mean time to removal of chest drains were 8.2 +/- 3.14 days in group I and 12.6 +/- 4.20 days in group II. The length of hospital stay was 7.2 +/- 2.07 days and 12.4 +/- 3.63 days in group I and II respectively. Clotted Haemothorax requiring surgery developed in three [6%] patients in group I and 8 [16%] patients in group II. Placing chest tubes on continuous low pressure suction after penetrating chest trauma helps evacuation of blood, expansion of lung and prevents the development of clotted Haemothorax. It also reduces the time to removal of chest drains, the hospital stay and the chances of surgery for clotted Haemothorax or Empyema

Hydrocele; surgery vs. sclerotherapy

A hydrocele is an abnormal collection of serous fluid within the tunica or processes vaginalis. It is treated by surgery and sclerotherapy. To compare the results of surgery and sclerotherapy in the treatment of scrotal hydrocele. Randomized control trial. Department of Surgery, Allied Hospital, Faisalabad; Period: April 2001 to March 2002. 50 consecutive male patients with provisional diagnosis of hydrocele. Patients stratified into three age groups and each stratum equally and randomly divided into two groups for sclerotherapy [A] or surgery [B]. 1% Sodium tetradecyle sulphate [STD] was used as sclerosant after aspiration of hydrocele. Surgical procedures used were Jaboulay's, Lord's and subtotal excision. Follow up done for three months. Age range was from 15 to 75 years. Hydrocele was right, left and bilateral in 56%, 42% and 2% patients. Postoperative complications included pain [24% and 20%], hematoma [8% and 12%], infection [8% and 12%], recurrence [40% and 12%] and complications related to anesthesia [0% and 36%] in group A and B respectively. Results of sclerotherapy and surgery for hydrocele are comparable with advantage of economy and convenience for sclerotherapy. However, larger study is recommended with comparison between different sclerosants to find the best one with high success rate and minimum complications

Comparison between mass closure and layered closure in major abdominal laparotomies

To compare the. number of complications after continuous layered closure with continuous mass closure in major abdominal laparotomies and to describe the frequency and types of complications after each procedure. From December 2002 to July 2003. The study was conducted in Surgical Unit-I in Nishtar Hospital, Multan. A total 50 patients, 25 in each group. In group-A, 17 [70%] were male and 8 [30%] were female while in group-B there were 16 [64%] male and 9 [36%] female. Age of the patient varied from 13 years to 30 years. In group-A 11 [44%] patients were from elective laparotomies and 14 [56%] from emergencies, while in group-B 8 [32%] patients were from elective operation and 17 [68%] from emergency. In group-A, 6 [24%] had midline incisions while 19 [76%] had paramedian incisions. In group-A clean wound were 12 [48%] and clean contaminated were 13 [52%]. In group-B clean wound were 9 [36%] and clean contaminated were 16 [64%] patients. Group-A had 2 [8%] patients with chest infection and cough in 5 [20%], while in group-B had 1 [4%] patient with chest infection, 2 [8%] with hemorrhage. In group-A small bowel 8 [32%], stomach and duodenum 2 [6%], billiary tract 6 [24%], major abdominal vessels 2 [8%], liver and spleen 1 [4%], colon 3 [12%] and miscellaneous 3 [12%]. In group-B the corresponding figures are small. In group-A wound dehiscence occurred in 2 [8%] patients out of 25 whereas in group-B the dehiscence occurred in none of 25 patients. Using non-absorbable monofilament polyprophylene [prolene] is better than the conventional layered closure with regard to gain of early and late wound strength

Pattern of dyslipidemia CRF in patients with CRF

[1]To find the pattern of dyslipidemias in patients with CRF. [2.]To compare the results with international studies. Prospective observational study. In Medical Unit I, II, III and Nephrology ward of Allied Hospital Faisalabad. [06 Months] From: Nov 2004 to April 2005. Allied Hospital is a teaching hospital attached with Punjab Medical College Faisalabad having 1100 beds. Chronic renal failure, a very common disease, is accompanied by many complications. One of such complications is abnormality of lipids. The lipids are disturbed in a characteristic manner. This disturbed lipid pattern predisposes the patients to atherosclerotic complications and increased mortality due to cardiovascular and cerebrovascular accidents. Present study was conducted to determine the pattern of dyslipidemias in patients of CRF.50 patients diagnosed to have CRF were subjected to fasting lipid profile, irrespective of cause and sex. Maximum patients had elevated triglyceride levels [46%]. A considerable percentage [16%] had decreased HDL levels and a small percentage had elevated LDL [4%]. Total lipids were found to be elevated in 04 patients [8%]. All the patients with elevated total lipid were suffering from diabetes mellitus. Total cholesterol was elevated in 08 patients [16%]. This disturbed lipid pattern has role in atherosclerosis. The patients of CRF who are already having disturbed endothelial function are more prone to it