Seroprevalence of bovine echinococcusis in Pakistan / Soroprevalência de equinococcusose bovina no Paquistão

ABSTRACT: Cystic echinococcosis is a parasitic infection of worldwide distribution, which, despite causing significant loss of health and money, is still a neglected disease. The present study was performed to determine the prevalence of bovine hydatid disease at Research Centre for the Conservation of Sahiwal Cattle, Jahangirabad, Khanewal, Pakistan. Five hundred bovine serum samples were tested for the detection of bovine Echinococcus antibodies (IgG), using the ELISA kits. Antibodies of bovine Echinococcus were detected in 24.2% cattle. Female cattle showed higher disease prevalence (33.2%) compared to (6.02%) in male cattle. There was positive association between sex of cattle and prevalence (P<0.05). Positive correlation between disease prevalence and age was detected. Younger animals (<3 years old) had lower prevalence value of disease than to older animals (> 3 years old). It is concluded that there is high degree of exposure of cattle to Echinococcus at Research Centre for Conservation of Sahiwal Cattle, Khanewal, Punjab. Measures should be taken to reduce risk of disease to avoid its spread to humans as well as great degree of economic losses.

RESUMO: A equinococose cística é uma infecção parasitária de distribuição mundial que, apesar de causar perda significativa de saúde e dinheiro, ainda é uma doença negligenciada. O presente estudo foi realizado para determinar a prevalência da doença hidatídea bovina no Centro de Pesquisa para Conservação do Gado Sahiwal, Jahangirabad, Khanewal, Paquistão. Quinhentas amostras de soro bovino foram testadas para a detecção de anticorpos anti Echinococcus de bovinos (IgG), utilizando os kits ELISA. Anticorpos de contra Echinococcus bovino foram detectados em 24,2% dos bovinos. As fêmeas apresentaram maior prevalência de doenças (33,2%) em comparação com (6,02%) nos machos. Existe associação positiva entre sexo do gado e prevalência (P<0,05). Foi detectada correlação positiva entre a prevalência da doença e a idade. Animais mais jovens (<3 anos) apresentaram menor valor de prevalência da doença do que animais mais velhos (>3 anos). Conclui-se que existe um alto grau de exposição do gado ao Echinococcus no Centro de Pesquisa para Conservação do Gado Sahiwal, Khanewal, Punjab. Devem ser tomadas medidas para reduzir o risco de doenças e evitar sua propagação para os seres humanos, além de um grande grau de perdas econômicas.

Life cycle, survivorship and life expectancy of foliage spider (Marpissa bengalensis) in citrus orchard / Ciclo biológico, sobrevivência e expectativa de vida da aranha de Folhagem (Marpissa bengalensis) em pomar cítros

ABSTRACT: The post embryonic developmental stages of Marpissa bengalensis (Araneae; Salticidac), the 2nd most abundant predatory species in citrus orchard were collected from the experimental fruit garden, department of Horticulture, located at the campus of University of Agriculture Faisalabad andstudied. Life cycle was observed in the laboratory, which started from egg sac collected from the field along with gravid female and released into the spider cages. The incubation period ranged from 5-15 days. The average eggs hatched were 23.8 eggs/cocoon and hatching % under laboratory conditions was recorded as 73.18%. The average duration of spiderlings span on their mothers back was 7 days. An overall, mean duration of 3rd spiderling stage was of 7.46 days. All spiderlings hatched from 8 cocoons. At the 4th spiderling stage, the average duration was of 10.23 days. In the 5th spiderling stage, the spiderling spent an average of 19.82 days. The 6th and 7th spiderlings stages lasted a total of 23.14 days and 25.86 days respectively. During 8th spiderling stage, the duration was maximum and it was recorded in 28.08 days. On average, from hatching to adult stage, the spiderlings lasted 137 days to attained maturity. Greater mortality was observed in the 3rd and 4th spiderling stages, decreasing thereafter and reaching zero in the 8th spiderling stage.

RESUMO: Os estádios de desenvolvimento pós-embrionário de Marpissa bengalensis (Araneae; Salticidac), a segunda espécie predatória mais abundante no pomar cítrico, foram coletadas no pomar experimental de frutas do Departamento de Horticultura, localizado no campus da Universidade de Agricultura de Faisalabad, onde foram estudados. O ciclo de biológico foi estudado no laboratório, em que iniciou a partir de ovos coletados de fêmeas grávidas e soltas em cativeiro. O período de incubação variou de 5-15 dias. a média de ovos incubados foram 23,8 ovos/casulo e a porcentagem de incubação em condições laboratoriais foi de 73,18%. A duração média da fase imatura a foi de 7 dias. Uma duração geral, média do terceiro estádio da fase imatura, foi de 7,46 dias de todas as fases imaturas incubadas com 8 casulos. A partir do quarto estádio da fase imatura a duração média foi de 10,23 dias. No quinto estádio de imaturação, demorou uma média de 19,82 dias. O sexto e o sétimo estádios de imaturação duraram um total de 23,14 e 25,86 dias, respectivamente. Durante o oitavo estádio de imaturação a duração foi de 28,08 dias, sendo máxima. Em média, desde a incubação até o estádio adulto, o estádio de imaturação duraram 137 dias. A maior mortalidade foi observada nos terciro e quarto estádios de imaturação, diminuindo, a partir de então, e atingindo zero no oitavo estádio de imaturação.

Intravenous lignocain 2% [plain] efficacy in attenuation of stress response to laryngoscopy and endotracheal intubation with impact on in-hospital morbidity and mortality

Objective: To evaluate the efficacy of plain lignocain in attenuation of stress response to laryngoscopy and endotracheal intubation with impact on in-hospital mortality or morbidity

Study Design: A randomized control trial

Place and Duration of Study: Our study was carried out from December 2013-14, at tertiary-care hospital

Material and Methods: Patients [n=100 total] were randomized, using non-probability convenient sampling, dividing the population in two groups. Group A [n=50] as control, and in group B [n=50] Injection lignocain plain 2% 1.5 mg/kg was used 3 minutes prior to intubation. Both the groups were observed for changes in hemodynamic parameters i.e. heart rate [HR] systolic and diastolic blood pressure, Mean Arterial Pressure for every minute after baseline [0] and for 5 consecutive minutes [1, 2, 3, 4, and 5]. Deviation of >20% from baseline was considered significant. The mortality [death within hospital, irrespective of cause] and morbidity [defined as emergence of 4 condition as hypertensive encephalopathy, Acute Coronary Syndrome, Lab proven Myocardial Infarction and negative pulmonary edema] within 10 days of hospitalization were noted

Results: Statistically significant [p-value extremely significant at confidence interval of 98 degrees] results were obtained in the effect of study drug; however, 10 days of hospitalization remained inconclusive for emerging morbidity categories strictly due to the intubation reflexes. We consider few technicalities in peri-operative management resulted in such events

Conclusion: Lignocain is effective in blunting the pressor response towards laryngoscopy and intubation. However the impact on mortality/ morbidity for four conditions remained inconclusive

Bidirectional ventricular tachycardia of unknown etiology

A 45 years old male presented to the emergency department with palpitations, headache and apprehension. Hiselectrocardiogram revealed bidirectional ventricular tachycardia. He remained vitally stable and responded to intravenous beta-blocker. Initially digitalis toxicity was suspected but history was negative for digitalis intake. The cause remained unidentified in patient despite detailed investigations. During a short follow-up [of 6 months] he remained asymptomatic and no cause was further identified during this period. Some other unseen causes of bidirectional ventricular tachycardia need to be explored

Atrioventricular and interventricular groove and septal extension of right sinus of Valsalva aneurysm: a rare cause of complete heart block

A 26 years old male presented with vertigo and history of fall. The electrocardiogram revealed 2:1 second-degree heart block and later progression to complete heart block. Transthoracic echocardiography revealed aneurysm at the site of ascending aorta and computed tomographic scan showed an aneurysm of right sinsus of Valsalva extending into right atrioventricular and interventricular groove and causing complete heart block by compression on the conduction system. He also suffered from lymph node tuberculosis. This case report is unique because of rare presentation as complete heart block

Evolutionary root defines the structural basis of high and low level vancomycin resistance in enterococci

D-alanyl-D-lactate [Dlac] and D-alanyl-D-serine [Dser] ligases respectively mediates high and low level vancomycin resistance among enterococci. To date, the evolutionary relationship of both ligases is largely unaddressed. Also poorly understood are the molecular differences in the magnitude of vancomycin resistance. To address the mention, we constructed the phylogenetic tree of all vancomycin resistance conferring ligases with the wild type ligases [Dala]. Multiple sequence alignment and tertiary structures of the structurally unresolved proteins were constructed by homology modeling. Phylogenetic tree revealed that both Dlac and Dser are profoundly different from Dala as a result of continuous selection pressure. Separate clustering of Dlac and Dser also highlighted the structural basis of molecule in maintaining different level of resistance as exhibited by the bacteria. This notion was further augmented as the functionally key region, omega loop [omega-loop], was found relatively more structured in only Dlac. Moreover, the critically active residue, His-243/244, was also noticed to be restricted in Dlac and found replaced by non polar residues in Dser. The present study not only provides protein structural explanation of the different intensities of vancomycin resistance among enterococci, but also presents yet another example for the scope of evolutionary science in biomedicine

Experience with polyclonal immunoglobulin therapy in poly trauma patients with severe sepsis

To evaluate the effects of intravenous immunoglobulin therapy on progression of severe sepsis in patients of poly trauma. Quasi-experimental study. Combined Military Hospital Peshawar from June 2008 to Dec 2009. Forty six patients of poly trauma with severe sepsis were included. Along with the standard management i.e., surgical management, fluid resuscitation, antibiotics, analgesics, ionotropic, ventilatory and nutritional support, IVIG 5% [intravenous immunoglobulin] was infused over a period of 6 hours and repeated for three consecutive day. Sequential Organ Failure Assessment [SOFA] score was used to assess the progress in all the patients. At the time of enrolment mean SOFA score was 5.41 +/- 1.127 and on the 15th day it was 1.62 +/- 2.24, mean age was 39.21 +/- 10.26 years. Thirty four patients [73.91%] developed gram negative sepsis and eighteen patients [39.13%] developed septic shock. Mean duration of stay in ICU and on of these patients was 30.43%. The IVIG administration, when used along with the standard management appears to improve significantly the prognosis in patients of poly trauma with severe sepsis

Per-operative findings and post-operative complications with laparoscopic appendicectomy

To study the per-operative findings and post-operative complications that arise with laparoscopic appendicectomy. Material and Methods: This descriptive study was conducted in Surgical "A" and Surgical "C" Unit of PGMI, Lady Reading Hospital from April 2006 to December 2008. Patients with acute appendicitis, short history, age ranges from 15 to 50 years and recurrent appendicitis were included in this study, while patients with appendicular mass, appendicular abscess, pregnancy and with previous abdominal surgery were excluded. All the data was collected by using a proforma. Data was analyzed by descriptive statistics. Out of 60 patients admitted for Laparoscopic Appendicectomy [LA], 36[60%] were males and 24[40%] were females. Only 6[10%] patients required conversion from laparoscopic to open surgery. Problems and per-operative complications were encountered in 9[15%] patients. These were dense adhesions due to inflammation 4[6.66%], localized perforation 2[3.33%], diffuse peritonitis 2[3.33%] and bleeding during procedure 1[1.66%]. Postoperative complications were seen in 5[8.33%] cases, out of which 2[3.33%] patients developed port site infection, 1[1.66%] patient developed postoperative ileus, 1[1.66%] patient developed partial bowel obstruction and 1[1.66%] patient presented with right iliac fossa abscess. There was no mortality. All patients resumed normal activity within 6-7 days of operation and were well satisfied up to median follow-up of 5-6 months. Majority of the patients were males. Per-operative findings were adhesions, perforation and peritonitis. Post-operative complications were port-site infection, ileus and bowel obstruction. Majority recovered within a week time

Management of combat casualties received during war on terrorism in Federally Administered Tribal Area [FATA] and Swat Valley of Pakistan

The aim of this study was to highlight the excessive workload on the under staffed surgical teams, handling the combat mass casualties of 'war on terrorism'. Triage, nature of injuries sustained, operative management, post operative care and the outcome in terms of morbidity and mortality are discussed. This study was carried out at Combined Military Hospital [CMH] Peshawar Pakistan, from July 2008 to June 2009. A total of 1309 evacuated combat casualties were received at this hospital from the combat zone during this period and 1847 surgical procedures [1128 minor and 719 major] were performed. The major surgical procedures were performed for 80 abdominal, 204 orthopedic, 12 chest, 31 neurological, 17 vascular and 375 multiple injuries [including burns, amputations, foreign bodies, deep lacerated wounds, ENT, eye and orodental injuries]. Two surgical teams, each comprising of 2 anesthesiologists, 6 surgeons and 18 operating room assistants [ORA], worked alternatively, round the clock in 6 operating rooms. It was a race against the time as almost all the patients requiring major surgery, were in shock state. Resuscitation and surgical procedures had to start simultaneously. Only two trained nurses were looking after 11 critically ill patients in 1CU and just one nurse was available for 20-30 patients in the general ward at any given time. Out of a total of 1309 patients, 1298 survived, 29 required ventilatory support. Out of 10 patients of penetrating head injury 6 developed brain death and were removed from the ventilator, 4 were successfully weaned off. Five patients died due to septicemia, DIG [disseminated intravascular coagulation] and multiple organ dysfunction syndrome [MODS]. Combat casualties comprise of a spectrum of trauma; head injury, hemorrhage and septicemia are the main killers. Apart from optimal use of resources available, it is the shear dedication and commitment to the service that drives the men to work continuously for long hours to manage mass combat casualties efficiently and yield good result

Microcephaly: tracing the evolutionary lineage of ASPM gene

Microcephaly, in the form of congenital autosomal recessive disorder [MCPH], is characterized by the reduced occipital frontal head circumference >3 standard deviation of otherwise normal population of matching age and sex. The disease is primarily associated with mild to severe mental retardation. Earlier studies have unravelled that among Pakistani population, mutations in ASPM gene is strongly associated in MCPH. In the present study, we have explored the ancestral root of this disease and the process involved in its evolution using tools of bioinformatics. Experimental Methods: cDNA gene and protein sequences of ASPM gene were retrieved from NCBI database and subjected to the non-redundant BLAST. Consensus phylogenetic tree was developed after multiple sequence alignment and bootstrapping of the protein sequences of ASPM gene from different mammals using Neighbour Joining method, selecting non mammals as an out group. Comparisons of the gene synteny and exon and intron patterns of ASPM gene were also undertaken to investigate chromosomal changes during the course of human evolution. Different statistical evolutionary models namely, Codon Based Z test and Maximum Composite Likelihood Estimate were used in order to estimate the nature of nucleotide substitution and the type of selection pressure the gene has undergone. Phylogenetic tree based on ASPM gene clearly segregated all non mammalian members as an out group. Mammalian in group holds the established evolutionary lineage, based on morpho-genetic attributes of mammalian evolution, segregating monotremes at the beginning followed by the members of rodentia and finally radiation of the primates including humans. Orientation of the ASPM gene remains conserved between human and chimpanzee, however, it was found reversed along with two flanking genes, a zinc finger binding domain 41 and coagulation factor XIII, which suggest relatively recent event of gene inversion. Some earlier and, in comparison, more intricate chromosomal changes have also been detected among the lower order of mammals. Aligning ASPM gene exons with the primates and lower order mammals indicates transitional bias of mutation over transversion [R value= 1.563]. Holistically, codon based Z test revealed positive selection pressure on of ASPM gene from rodentia to primates. Briefly, the studies highlights the evolutionary events of ASPM gene in mammals especially primates including humans. Further studies in connection to correlating the cranial cavity size and ancestral gene sequences and in depth sequence comparison would be more insightful in this regard and studies in this connection are ongoing and will be reported shortly

Association between periurethral colonization with uropathogens and subsequent bacteriuria in catheterized patients

To determine the number of catheterized patients who develop bacteriuria due to the presence of organisms in their periurethral flora, which may subsequently cause Urinary Tract Infection [UTI] in these patients. Non-interventional, cohort study. This study was conducted on patients of Medical Intensive Care, Surgical and Urology Units of Combined Military Hospital, Lahore, from February to April 2006. A total of 60 hospitalized patients, who were catheterized for various underlying diseases, were included in the study. Urine samples and periurethral swabs were obtained from all patients and cultured on appropriate culture media. Various tests used for the identification of microorganisms were: Gram-staining, catalase test, coagulase test and esculin hydrolysis for the identification of Gram-positive bacteria, API 20e for Gram-negative bacilli, whereas lactophenol blue preparation and germ tube test were used for the identification of yeasts. Out of 60 patients, 41[68.3%] were males and 19 [31.7%] were females. The mean duration of catheterization was 4.5 days. In males, culture of periurethral swabs revealed coagulase negative staphylococci in 11 [40.7%], Staphylococcus aureus in 10 [37%] and Enterococcus fecalis in 3 [11.1%] patients. In females, the organisms isolated were coagulase negative staphylococci in 4 [25%], Staphylococcus aureus in 4 [25%], Enterococcus fecalis in 4 [25%], Pseudomonas aeruginosa in 2 [12.5%], Escherichia coli in 3 [18.6%] and Candida albicans in 3 [18.6%] patients. Twenty nine patients developed bacteriuria [p < 0.05]. Escherichia coli was the commonest organism causing bacteriuria in either gender followed by other Gram-negative organisms. Coagulase negative Staphylococcus was isolated in the urine of one male patient only. In males, 2 [10%] out of 20 patients with Gram-negative bacteriuria were colonized by the same organism, whereas in females, 4 [44.4%] out of 9 bacteriuric patients were colonized by the same organism. Predominantly Gram-positive organisms colonized the periurethral area in males as well as in the majority of females, whereas Gram-negative bacteria were mainly responsible for the bacteriuria in both genders. There was a significant association between periurethral colonization and subsequent bacteriuria, however, prior colonization with a particular organism is not a decisive event in the initiation of bacteriuria

Bilateral simultaneous testicular seminoma: a case report and review of literature

A case of 28 years old patient with bilateral testicular seminoma is reported here with literature review

Post SMR intranasal packing - do we really need it?

Sub mucous resection [SMR] for the deflected nasal septum [DNS] is the commonest nasal surgery all over the world. The unpleasant part of the whole event is postoperative nasal packing for 24 to 48 hours. Handsome numbers of patients delay the operation just to avoid the horrible experience of nasal packs by close friends or relatives. Many a times there is no bleeding at all on termination of operation but we still do nasal packing for the sake of doing it perhaps a fear of reactionary or primary bleed on the back of our mind. A variety of packing materials are being used most of which are not evidence based. This study was conducted at combined military hospital, Lahore over a period of one and half year from June 2006 to December 2007. A total of 72 patients were included in the study having moderate to marked deflection of nasal septum. All patients underwent classical SMR operation under local anesthesia. Only 04 patients were given nasal packs on termination of opearation. All patients were closely monitored for in 02 to 03 hours post operatively. All patients were seen on 2[nd], 5[th] and 15[th] day. 65 [90.27%] patients had no problem. 02 [2.7%] patients reported back with 24 in hours with septal haematoma. The operation was terminated in 01 [1.3%] patient just at the time of incision

Enterococci vs coliforms as a possible fecal contamination indicator: Baseline data for Karachi

Fecal contamination of drinking water is the major cause of water borne illnesses. For long time coliforms are exploited as fecal contamination indicator. However, recent studies indicate low survival rate of coliforms in stress conditions, hence it's use as indicator of fecal pollution is being abandoned in many parts of the developed world. Implementation of such strategy demands availability of local data in the cities like Karachi. The present study provides a comparison between coliforms and enterococcal load and its variation in sewage samples collected [June, August and November, 2006] from eighteen towns of Karachi. All the diluted samples were selective media to obtain colony-forming units [CFU] mainly for coliforms and enterococci. The bacteria isolated were identified on the basis of conventional microbiological methods. Observations thus obtained were subjected to rigorous statistical analysis. The total load of enterococci was found in range of 1.27-8.47 X 107 as compared to coliforms [3.03-13.9 X 107]. However, segregation of data reveals greater inter town variability in CFU/ml both in coliforms and enterococci as suggested by their cumulative standard deviation +1.5 X107. Furthermore, CFU/ml of both coliforms and enterococci also varies to variable scale when collected at different time intervals and at intra town level. Conclusively, the studies suggest high survival rate and lower variability of Enterococci compared to escherichia hence indicating its potential advantage to be used as fecal contamination indicator

Typhoid perforation still a common problem: situation in Pakistan in comparison to other countries of low human development

The objective of this study was to analyze the present situation of typhoid perforation and the factors behind the still common occurrence of the disease in our country. The study was conducted with the collection and retrospective analysis of the data of typhoid perforation treated in surgical unit III of Nishtar Hospital, Multan from January 1998 to September 2000. All the patients were received and operated upon in emergency ward of the hospital, after initial resuscitation as necessary investigation. Primary closure of perforation or primary exteriozation as loop ileostomy were the surgical options adopted. Among 31 patients, 25 were male and 7 female, with a male to female ratio of 3.57:1. Majority of patients were 15-30 years of age. Twenty six [81.25%] were from remote rural areas while only 6 [18.75%] were city dwellers. One patient expired before operation and 30 underwent exploratory laparotomy. Overall expiry rate was 12.5%. Wound infection and burst abdomen were the major post operative complications responsible for prolonged hospital stay. The factors leading to occurrence of typhoid perforation were identified as, lack of civic facilities like clean drinking water and sewage disposal, poverty, poor yield of primary health care system causing a delay in diagnosis and atypical presentation of typhoid and perforation due to the emergence of multi drug resistant strains of salmonella typhae. The results of the study were similar to those of Indian studies but better than African studies.The situation warrants attention of health care providers and policy makers

comparative study of caudal epidural block single dose Bupivacaine versus tramadol for postoperative analgesia in children

The management of postoperative pain in paediatric surgery focuses on complete pain relief with no or minimum possible untoward side effects. The effects of single dose caudal tramadol with single dose caudal bupivacaine in controlling the postoperative pain were compared in this randomized double blind study, conducted in children, presented for genital surgery/vesicolithotomy. 50 children ASA I and II between 2-6 years of age were randomly divided into 2 groups and evaluated for pain relief by Hannallah pain score scale while sedation was assessed with a 5 point test. For 24 hours postoperatively, the Hannallah pain score scale value showed no statistically significant difference among groups. Postoperative analgesia was maintained from 12-24 hours in both the groups. In conclusion, Tramadol used caudally as single dose was found to be as effective and safe agent as bupivacaine in reliving postoperative pain in children

Surgical intervention in acute limb ischaemia-two year experience in a surgical unit of Nishtar Hospital, Multan

This study was done to see the possibility of salvage of limb, by surgical intervention from the time of presentation after acute vascular occlusion. Fourteen patients were dealt with, suffering from acute limb ischaemia during 1st two years 1996-97 in surgical unit-ll. Limb salvage by surgical intervention in 14 patients in surgical unit-ll, Nishtar Hospital, Multan. Thromboembolism, fogarty catheter. Fourteen patients were admitted in emergency, in 2nd Surgical unit during 1996-97 with acute limb ischaemia, 11 [78.57%] were male and 3 [21.43%] were female. Majority of them were above the age of 40years. Operation was performed urgently in emergency theatre in all of them. Atheroembolectomy was done in all the patients. In one patient [7.1%], vein patch angioplasty was done. Fasciotomy was performed in 7 [50%] patients. In 2 [14.2%] patients, above knee amputation had to be done and in 1 [7.1%] gangrenous toes were amputated. Best results can be achieved only when the patient is diagnosed properly and immediately transported to the referral hospital. Proper equipment and all the possible sophisticated technical facilities should be available. Multi-disciplinary teams including vascular surgeon, vascular radiologist, cardiologist and general physicians should be available. All medical practitioners [not only the surgeons] should be informed about the acute limb ischaemia, importance of early and correct diagnosis as well as the critical time for referring the patient to proper hospital