Antibacterial potential of indigenous medicinal plants against methicillin-resistant Staphylococcus aureus isolated from septic wounds

Aims@#This study was aimed to screen indigenous medicinal plants for their antibacterial potential against methicillin-resistant Staphylococcus aureus (MRSA).@*Methodology and results@#Three indigenous plants (Nigella sativa, Zingiber officinale and Calotropis procera) and thymoquinone were screened for antibacterial activity against MRSA, isolated from septic wounds of patients admitted to Mayo Hospital Lahore, Pakistan. Isolated bacteria were screened for methicillin and cefoxitin resistance by the Kirby-Bauer method, followed by mecA gene-specific polymerase chain reaction (PCR). Confirmed MRSA was processed for antibacterial activity of plant extracts and thymoquinone followed by cytotoxicity assay of plant extract having least minimum inhibitory concentration (MIC) value. Out of total samples (n=100), S. aureus (29%), MRSA (26%) and vancomycin-resistant S. aureus (VRSA) (21.7%) isolates were recovered based on morphology, biochemical profile and antibiotic susceptibility testing. Nigella sativa showed the highest antibacterial activity (10.06 ± 6.53 mm) against MRSA followed by Z. officinale (4.06 ± 3.72 mm) and C. procera (3.65 ± 3.33 mm) in comparison to standard thymoquinone (17.93 ± 10.14 mm). The least MIC value recorded was for Z. officinale at 36.89 ± 3.75 μg/mL. Zingiber officinale was the most effective antibacterial agent, followed by N. sativa and C. procera and non-toxic for eukaryotic cells at all tested concentrations (1500 μg/mL to 2.92 μg/mL).@*Conclusion, significance and impact of study@#It was concluded that Z. officinale may be used as an effective alternative for treating septic wound infection in local or topical preparations. As pathogenic S. aureus is becoming life-threatening among antibiotic-resistant bacteria and traditional plants are in used for centuries to treat septic wound infections.

Inheritance Pattern and Association of Qualitative and Quantitative Traits in Cotton (Gossypium hirsutum L.) for Sustainable Breeding Goal

Background: Cotton (Gossypium hirsutum L.) is the most important fiber crop of the world and commonly known as white gold. It plays an important role in the economy of Pakistan. It provides raw material to the local textile industry and generates considerable amount of foreign exchange. The yield of cotton is lower in Pakistan. Knowledge of association among different traits is important for the development of cultivars with better yield and quality characters. Materials and Methods: In this research, two parents (PB-38 and Jambo Okra) and their crosses sown in randomized complete block design with three replications to sort out best performing genotypes for these profitable traits (plant height, number of sympodial branches, number of monopodial branches, leaf type, boll size, boll shape, number of bolls per plant, boll weight, ginning out turn, 100 seed weight and seed cotton yield). Results: Analysis of variance (ANOVA) revealed that parental and their F2 population showed significant differences for all the observed traits. Correlation and inheritance pattern of all characters provides information of association among all traits and percentage of inheritable attributes. Conclusions: The association and inheritance pattern study provide us useful information for effective selection and sustainable breeding programs. Heritability estimations revealed that heritability of traits fluctuate as following order; monopodial branches> ginning outturn>boll weight>sympodial branches>plant height>yield>number of bolls plant-1 with heritable percentages 99%, 90%, 89%, 64%, 60%, 60% and 55% respectively.

Frequently isolated bacteria and their culture and sensitivity pattern in a medical ICU

Empirical antibiotic therapy in seriously ill patients requires careful selection of antibiotics. This study was planned to determine the pattern of bacterial infections and culture sensitivities in patients admitted to a medical intensive care unit [ICU]. Patients with positive bacterial cultures from specimens of blood, urine, endo-tracheal tube, suction catheter, and tracheal aspirates were included. Data regarding microbial isolates and their culture sensitivities was collected. Escherichia coli [E. coli], Pseudomonas aerogenosa [PA], Klebsiella pneumonea [KP], Staphylococcus aureus [SA] and methicillin resistant Staphylococcus aureus [MRSA] were the most frequently isolated bacteria. E coli showed 100% sensitivity to sulbactam potentiated sulfoperazone, and meropenam. PA were sensitive to gentamycin, imepenam, and sparfloxacin in > 70% cases. All KP isolates were sensitive to amikacin, imepenam and sparfloxacin. SA were 100% sensitive to amikacin. MRSA were 100% sensitive to vancomycine and linezolid. Based on these results, sulbactam potentiated cefoperazone in combination with amikacin seems the best empirical antibiotic regimen. Imipenam usage can be an alternative

In-hospital complications of acute right ventricular myocardial infarction

To determine the in-hospital complications of acute right ventricular myocardial infarction[RVMI]. This study was conducted at Cardiology Department, Lady Reading Hospital, Peshawar from May to October 2009. A total of 100 patients with acute RVMI were evaluated for in-hospital complications. Male patients were 77 [77%] and females 23 [23%]. Patient's mean age was 59.96+12.3 years with age range 28-82 years. Total in-hospital complication events were 174. In-hospital complications were present in 77% patients. Cardiogenic shock was the commonest complication with frequency of 25.8%followed by acute left ventricular failure [LVF] in 17.8% and atrioventricular blocks [AV Blocks] in 14.3% respectively. Re-infarction occurred in 5.7% [10] patients. Thirty eight patients died in our study [21.8%]. Among RVMI patients, 65% stayed in-hospital for more than 4 days. Frequency of complications is higher and cardiogenic shock is the most common complication in acute RVMI patients

Evaluation of lipids and lipoprotein levels in opium and heroin addicts in Punjabi population

Objective: the present study was conducted to assess lipid and lipoprotein levels in opium [50 subjects] and heroin-addicted men [50 subjects] against non-opium and non-heroin addicted men [25 healthy individuals] as control subjects from Punjabi population

Material and Methods: the biochemical estimations: total lipids, total lipids, TC, TGs, HDL, LDL, VLDL and Chylomicron levels were carried out on fully automatic clinical chemistry analyzer on 12hour fasting blood samples. The variables for each group were presented as means+/- standard deviations. Results were considered statistically significant if p

Results: our study concluded that the cholesterol, triglyceride and Very Low Density Lipoprotein levels were higher in opium addicts than heroin addicts. Total lipid levels were decreased significantly in heroin addicts as compared to control subjects. However, no significant difference in High Density Lipoprotein and Chylomicron levels was noted in heroin and opium addicts in comparison to controls

Conclusion: it may therefore be suggested that opium addicts are at higher risk to develop atherosclerosis leading to ischemic heart disease than heroin addicts

Are drains really required in thyroid surgery

Background: Traditional use of drain in thyroid surgeries was to avoid any possible hematoma. The aim of the present study was to prospectively determine whether the use of the drain in thyroid surgery really helps the patient or it just adds morbidity to patients' post operative recovery phase

Patients and Methods: 132 patients who underwent total thyroidectomy without drain placement for benign conditions of thyroid were evaluated for outcome in terms of in hospital stay, wound infection, hematoma formation and re-exploration owing to untoward bleed. The study was conducted for 42 months with one month followup period. Results were compared with the control group from hospital records during the same study period

Results: Hematoma developed in 4 [3%] patients, infection in 2 [1.5%], hypocalcemia in 28 [21%] and recurrent laryngeal nerve [RLN] palsy 01[.75%] patients. There was no re-exploration for hematoma nor any in hospital mortality. In hospital stay was 1.8 days on average

Conclusion: Use of drain in thyroid surgery has no added benefit in terms of patient outcome rather it may increase the cost of treatment, patient's morbidity and hospital stay

Evaluation of performance of basic life support and clinical skills among interns in mayo and allied hospitals of king Edward medical university, Lahore

Training of medical students on basic life support and clinical skills is an important part of under graduate medical education. Teaching hospitals can provide these skills efficiently. To compare the performance of basic life support and clinical skills among trained and non-trained medical graduates, working as interns in Mayo and Allied Hospitals of King Edward Medical University. Study type settings and duration: Cross sectional study conducted in the Department of Medical Education, King Edward Medical University, Lahore from May 2010 to April 2011. A total of 227 medical graduates [academic year of 2010] were trained for basic life support of child and adult, neonatal resuscitation, airway opening maneuvers, endotracheal tube insertion and aseptic techniques. They were divided into two groups; group A consisted of 125 King Edward Medical University graduates who, as students were trained in above mentioned skills and now as interns, were working in emergency and intensive care units of Paediatrics, Neonatology, Medicine, Surgery and Gynecology and Obstetrics of Mayo and Allied Hospitals of King Edward Medical University. Group B consisted of 125 interns who graduated from other medical schools, and had not learnt above mentioned skills as undergraduate students. Interns of both the groups were interviewed using a structured questionnaire for importance of learning the skills at undergraduate level and performance of above mentioned skills as an intern. Study group A was also interviewed about grading the skills that they learnt as undergraduate students. Data was entered in SPSS 17. Chi square test was applied to compare the performance of the skills while, logistic regression analysis was done to calculate odds ratio and 95% confidence interval. In group A, 74[59%] interns performed basic life support for child and adult well. Almost 79[63%] performed neonatal resuscitation, 63[50%] airway opening maneuvers, 37[30%] endotracheal tube insertion and 91[73%] aseptic techniques well. In group B, 98[78%], 120[96%], 104[83%], 117[94%], and 81[65%] interns were unable to perform above mentioned skills respectively. The difference between the groups was statistically significant for all the skills. Training of basic life support and clinical skills' courses at undergraduate level can result in better performance of these skills in their practical life

Breastfeeding during month of Ramadan; a community based study

To study breastfeeding practices during month of Ramadan. Descriptive study. It was a community based study in research area of the department of Social ant Preventive Pediatrics, King Edward Medical University/ Mayo hospital, Lahore and was conducted in four weeks, Month of Ramadan 2008/ 1429 Hijri. Total of 734 mothers were present in study area during study period. Among them, 137 lactating mothers with children of age 24 months or younger were interviewed. Most mothers had infants aged 12 months or younger [77%]. Sixty one percent were male. Sixty one percent mothers were older than 25 years of age. Majority were educated upto higher secondary level [66%]. Among infants younger than 6 months of age, 69% were exclusively breastfed. Fifty seven percent mothers were fasting. Among these, most mothers [59%] felt that fasting would decrease the quality of milk. Fifty nine percent of lactating mothers during fast felt thirst, weakness and dizziness [without any other associated medical illness]. Among nonfasting mothers [43%], 61% did not fast due to lactation. Eighty seven percent of the total mothers had the knowledge about relaxation given by Islam regarding breastfeeding during the holy month of Ramadan. Overwhelming majority of breast feeding mothers knew about religious relaxation for fasting during lactation but they preferred to observe it as their religious duty. Majority of lactating women had subjective felling of thirst, weakness or dizziness

Toxicity of imidacloprid [nicotinoid] against earthworm, pheretima posthuma with reference to its effects on protein

Imidaclorprid was studied for its effects on earthworm [P. posthumd]. The organism was reared in laboratory at 25 °C with relative humidity 80%, in whole moist soil with compost / manure as food medium contained in wide mouth jars covered with muslin cloth. Imidacloprid [Nicotinoid] was used as test material. Earthworms were exposed to the under test compound through contact method cum feeding method. Average mortalities of imidacloprid were found to be 20, 40, 60, 70 and 80%, against 0.04, 0.08, 0.16, 0.32, and 0.64 ppm respectively and LD50 was determined statistically and found to be 0.11 ppm. Effect of this pesticide on total protein content was determined in head, clitellum and abdominal regions of treated earthworm P. posthuma. Protein was found to be 21.6 mg/ml in head region, in clitellum region it was found to be 36.6, and 30.9 mg/ml in abdominal region respectively, whereas in the control batches it was 27.7, 26.1 and 30.3 mg/ml in head, clitellum and abdominal region respectively. This pattern indicates an increase in protein contents in the clitellum region, a decrease in head region and almost unaffected protein contents was found in the abdominal regions under the effects of imidacloprid on earthworms

Prevalence of asymptomatic left ventricular diastolic dysfunction in normotensive type 2 diabetic patients

To determine the frequency of asymptomatic left ventricular diastolic dysfunction in normotensive type 2 diabetic patients. This descriptive case series study was conducted on 80 normotensive Type 2 diabetic patients at Cardiology Department, PGMI Lady Reading Hospital Peshawar from March 2007 to March 2008. Detailed history and physical examination was performed on every patient. The glycemic status was defined on the basis of HbA1c. Exercise tolerance test was performed on every patient to exclude major ischemia. Echocardiography was performed in left lateral position. Main outcome measure was left ventricular diastolic dysfunction. We enrolled 80 normotensive Type 2 diabetic patients in the study that fulfills the inclusion criteria. Left ventricular diastolic dysfunction was found in 53% [43/80]. There were 20 [47%] males and 23 females [53%] among subjects presenting with diastolic dysfunction. Subjects with diastolic dysfunction the mean age were 55 +/- 15 years. Patients having no left ventricular diastolic dysfunction mean age were 52.5 +/- 7 years. There is a high prevalence of asymptomatic left ventricular diastolic dysfunction in normotensive type 2 diabetic patients

Risk factor analysis in asphyxiated newborns and their outcome in relation to stage of hypoxic ischemic encephalopathy

Hypoxic ischemic encephalopathy [HIE] is one of the common causes of neonatal mortality and long term sequale. The incidence is reported at 2-9/1000 live births. To find out the frequency of risk factors in asphyxiated newborns and outcome of these newborns in relation to the stage of hypoxic ischemic encephalopathy in hospital setting. Prospective descriptive study. This study was conducted in the Neonatology Unit of the Department of Paediatrics Unit-II, King Edward Medical University/Mayo hospital, Lahore, over a period of six months from April 01, 2006, to September 30, 2006. All the asphyxiated babies admitted during study period were included in study. Babies having congenital anomalies were excluded. The mothers were interviewed by using a pre-tested structured questionnaire. Out of 449 total admissions in study period, 227[51%] babies were asphyxiated. Eighty five [37%] newborns had stage I HIE, 39% had stage II and 24% had stage III HIE. One hundred and sixty four [73%] were full term. Majority of the newborns were male [60%]. One hundred and thirteen [49%] newborns were between 1.5 and 2.5kg. One hundred and thirty four [59%] babies delivered normally while seventy four [33%] were delivered by caesarian section. Hundred and sixty seven [74%] newborns were referred from government hospitals. Most of the deliveries [80%] were conducted by doctors. Majority of the mothers [48%] were below 25 years of age, 34% mothers were primigravida and 33% mothers received general anesthesia during labor. One hundred and sixty five [73%] babies had cephalic presentation. None of the deliveries were attended by a paediatrician in any of the cases. Maternal hypertension was found in 53 [23%] mothers, gestational diabetes in 9 [4%], hypoxia in 6 [3%], anemia in 31 [14%], toxemia in 19 [8%], pelvic abnormality in 30 [13%] and antepartum hemorrhage in 14 [6%]. No mother was found to be smoker. Eight [4%] babies had cord around the neck during delivery. One hundred and ten [48%] newborns were brought to the neonatal unit within one hour of delivery. Majority 21% of HIE I remained admitted in neonatology unit for less than 24 hours while 27[12%] of babies of HIE III died within 24 hour of admission. Among the factors studied, gestational age, weight, mode of delivery, birth attendant, sedation during labor and late arrival in neonatal unit were found to be significant with p value of < 0.05. HIE is caused by the risk factors that may be antepartum, intrapartum or postpartum. Monitoring for the known risk factors of asphyxia, proper training of primary birth attendants and improvement in neonatal resuscitation services can minimize the incidence of HIE

Yield of plain film radiograph in the diagnosis of osteomyelitis in patients with diabetic foot in a tertiary care hospital

To determine the yield of plain film radiograph [PFR] in the diagnosis of osteomyelitis in patients with diabetic foot in a tertiary care hospital. This hospital based non-interventional, descriptive study was conducted on 60 patients. Patients of both sexes, above the age of 12 years who were known diabetics and were clinically thought of osteomyelitis were included in the study. These patients were admitted in medical wards of Post Graduate Medical Institute, Lady Reading Hospital Peshawar, from January to December 2002. Patients were selected by non-probability convenient sampling method after obtaining an informed consent. Out of 60 patients, 14 [23.33%] were having type I Diabetes Mellitus [DM] and 46 [76.66%] patients were having type 2 DM. Age of the patients ranged from 24 to 75 years, with a mean age of 52.4 years. Twelve patients [20%] had history of trauma and 21 [35%] patients had ill-fitting shoes, as risk. factors for diabetic foot. Plain film radiograph detected changes of osteomyelitis in 37 [62.57%] of patients, with a sensitivity of [77.08%] and specificity of about 75%. Plain film radiograph yields valuable anatomical Information at a lower cost. II has a reasonably good detection power and its easy availability even at primary and secondary care centers makes it the imaging of first choice in the study of diabetic foot. It could be followed by a three-phase, bone scan and additional imaging as and when needed

phase II study of gemcitabine concurrent with radiation in locally advanced squamous cell carcinoma of head and neck: a trial of the cancer research group Pakistan

To evaluate the efficacy and toxicity of weekly gemcitabine as a radiosensitizer concurrent with radical radiotherapy in locally advanced carcinoma of head and neck. From August 2001 to January 2002, thirty-nine patients with stage III or IV B inoperable carcinoma of head and neck were enrolled. Patients with histopathologically confirmed squamous cell carcinoma with at least one bidimensionally measurable lesion, no prior chemotherapy or radiotherapy, and a KPS of 60 or above were included. Patients with nasopharyngeal, glottic or sub-glottic cancer were excluded. Gemcitabine 150mg/m2 or a total dose not exceeding 200 mg was given on day 1, 8, 15, 22, 29, and 36 during radiation treatment. Radiation was delivered with conventional fractionation to a total dose of 66-70Gy. Miller's criteria was used for response evaluation. RTOG/EORTC acute radiation [and chemotherapy] morbidity scoring system and WHO grading of acute and sub acute toxicity criteria were used for documentation of toxicity. All 39 patients were evaluable for toxicity but only 35 patients were evaluable for response. An overall response rate of 94.3% [95% CI; 80.8-99.3] was seen with a partial response rate of 71.4% and complete response rate of 22.9% [95%CI; 10.4-40.1]. Grade 3 mucositis was seen in 28 patients [71.8%]. Grade 4 mucositis was seen in 2 patients [5.1%]. Pharyngeal toxicity was the second-most common toxicity. Grade 2 toxicity was seen in 12 patients [30.8%] and grade 3 in 6 patients [15.4%]. Despite vigorous symptomatic and supportive care acute toxicities led to treatment interruption in 40% of patients. A high overall response rate and a high rate of acute toxicity are seen at a weekly gemcitabine dose of 150mg/m2 concurrent with radiation. This shows that gemcitabine is a potent radiosensitizer with a marked tumor and normal tissue radio sensitization

Familial hypercholesterolemia Type II-A

Familial hypercholesterolemia is an autosomal dominant disorder, clinically manifested by xanthomas, and is characterized by elevated levels of total and LDL cholesterol with normal triglycerides. We report the case of a 10 year old girl who had xanthomas and xanthelasmas with no evidence of complications. Drug therapy along with lipid lowering diet was offered

Right Morgagni Hernia

Morgagni hernia is anomaly of the sternal insertions of the diaphragmatic bundle and represents 2% of all surgically treated diaphragmatic hernias. We report here a case of 4 month old male infant who had Morgagni hernia