Molecular basis of quinolone resistance in clinical isolates of Klebsiella pneumoniae from Pakistan

Antibiotic resistant Klebsiella pneumoniae, is associated with various nosocomial infections that are difficult to treat. This study is designed to find out the patterns of resistance against commonly used antibiotics in K. pneumoniae clinical isolates with special attention to fluoroquinolones. A total number of 200 K. pneumoniae clinical isolates collected from various tertiary care hospitals of Punjab, Pakistan for a span of 1 year were investigated. Isolates were identified biochemically and genetically using VITEKR system and species-specific PCR, respectively. Antibiogram of isolates was studied by using disc diffusion and broth micro-dilution assays. Highest infection of K. pneumoniae detected in urinary tract [43%] followed by respiratory tract [25.5%]. Most of the isolates displayed strong resistance against ampicillin, cefotetan, tazobactam, cefuroxime, cefixime, ceftriaxone, ampicillin-sulbactam imipenem, meropenem, ciprofloxacin and moxifloxacin, while sensetive to cefotaxime. Chromosoaml mutation was deteted in gyrA gene, gyrA harbors a strong mutation which provides resistance against ciprofloxacin by substituting Ser83 -> Ile. However, no mutation was detected in gyrB gene. Moreover, qnrB1 plasmid born resistant gene was only detected among qnrA, qnrB and qnrS. The story depicts an alarming situation of antibiotic resistance among K. pneumoniae associated with various nosocomial infections

Incidence of intestinal tuberculosis in patients presenting in emergency with intestinal perforation- a review of 1000 patients

Objective: The present study was undertaken to document the presentation of intestinal tuberculosis in patients with intestinal perforation that present to the emergency department of Nishtar Hospital Multan

Study Densign: Observational / Descriptive / cross sectional study

Place and Duration of Study: This study was conducted at Nishter Hospital, Multan. from 2007-2015

Materials and Methods: A proforma was filled which was approved by hospital ethical committee. 1000 patients who were admitted in in A and E department Nishtar Hospital,Multan with intestinal perforation were included in this study

Histopatology specimen were sent. Results were labeled as either presence or absence of intestinal tuberculosis

Results: 1000 patients, complying with the inclusion criteria were included in the study. The mean age of the patients was 45 +/- 5 years. 289 [ 28.9%] were in the age group of 20-30 years of age.312[31.2%] were in the age group 31-40 years.243 [24.3] were in age group [24.3%]. 156 [15.6%] were from age group 51-60

Regarding age, majority of the patients 532 [53.2%] were females, and 468 [46.8%] were males

Duration of symptoms ranged from 1 day to >3 days. 312 [31.2%] had symptoms for 1-2 days. 432 [43.2%] had symptoms for 2-3 days and 256 patients had symptoms for more than 3 days. All had histological evaluation

Conclusion: 23% patients were found to have tuberculosis

Demographic and clinical characteristics of 100 consecutive patients with diabetic foot presented in Nishter hospital Multan

Objective: To study the incidence of infected diabetic foot among diabetic admissions on the surgical floor

Study Design: Quasi-experimental study

Place and Duration of Study: This study was conducted at the Surgical Unit-IV, Nishtar Hospital Multan from June 2013 to March 2016

Materials and methods: The study on diabetic foot management was carried out involving 100 patients with septic foot complications in diabetics

Results: Out of 100 patients, 59 [59%] were male, 41 [41%], were female, 76 [76%] patients were admitted through emergency, 18 [18%] through outpatient department and only 6 [6%] patients were referred from physicians. Family history of diabetes was found in 45% of the patients in both parents. As regards age, most of the patients i.e. 50 [50%] patients were in age group 61-70 years. In 25 [25%] patients left foot was involved, right foot was involved in 55 [55%] patients while in 20 [20%] patients both feet were involved. As regards management of patients, 15 [15%] patients were taking insulin, 30 [30%] were on OHA, 30 [30%] were controlled by diet and remaining 20% had no treatment. Planter infection and infection on dorsal aspect was seen in 30% patients respectively

Conclusion: No aspect of regimen of therapy for diabetics is more important than the proper care of his feet

Sternal wound infection following CABG: a review of 1121 patients

To know incidence of sternal wound infection, microbacteria involved and associated risk factors so as practical steps should be made before hand to counter theses problems. Case series study. This study was conducted at Ch. Pervaiz Ellahi, Institute of Cardiology, Multan from 2012-2014. Microbiological testing was conducted under supervision of a consultat microbiologist attached to the hospitals performing cardiac surgery. Infections were classified as in-hospital SSIs if occurring during the hospital stay, or post-discharge. Infections were recorded as sternal or harvest site infections. Associated Potential risk factors were recorded. A proforma was filled which was approved by hospital ethical committee. Over the study period, 1121 patients had CABG. Predominantly patients were male [mostly in age range of 50-76 with median age of 63 years]. ASA score of 3 was recorded in majority of patients. The majority of patients were recorded as having an ASA score of 3 or 4, a clean wound, and antibiotic prophylaxis administered. Antibiotic prophylaxis in almost all cases.97 patients had sternal site infections, with one half of the cases detected in-hospital and the other half post-discharge. Gram-positive bacteria were detected in 56% of cases having infections. 43% had Gram-negative bacteria and fungi [e.g. Candida albicans] 1 case. The incidence of MRSA is increasing and to counter these we had to adopt methods

Prevalence of methicillin-resistant staphylococcus aureus [MRSA] in intensive care unit of CPEIC, Multan

We undertook a study to determine the prevalence of MRSA colonization on admission to our intensive care unit [ICU] and the incidence of MRSA colonization in the ICU. Case series study. This study was conducted in ICUs in Chaudhry Pervaiz Ellahi Institute of Cardiology, Multan from January 2012, to December 2012. We included 1230 patients in which 766 were CABG and remaining 464 were for some congenital heart disesase. All patients were screened within 24 hours after ICU admission. For the intact skin specimen, a single swab was used to sample 4 different sites [the axilla and groin on both sides]. Sternotomywound were sampled also. Pre-moistened swabs were used to collect nasal and skin samples. Swabs were plated on Chapman agar alone. Data were analysed by using spss 11. Descriptive analysis were done along with p value. There were 1230 admissions to the ICU during the study. MRSA was isolated from 80 [6.8%] of 1,185 admission swabs taken, from 42 [7%] of 596 admission swabs where patients had both admission and discharge swabs taken, and from the discharge swabs of 63 [11.4%] of 554 remaining patients who had negative admission swabs. This study confirmed that there is a significant rate of acquisition of MRSA in our ICU. It also raised concerns about trauma patients being at increased risk compared with other patients. We are in the process of conducting a cohort study to assess risk factors for the acquisition of MRSA among trauma patients

Mitral valve replacement on beating heart; safety an evaluation

Cardiac reperfusion injury is a well-described complication occurring after ischemia or following cardioplegic arrest. The primary aim of this study was to evaluate and compare safety of Mitral valve replacement on beating heart without using cross clamp with the conventional Mitral valve replacement. It was a retrospective observational study for study duration from 2012-2014. A total of 50 patients were randomly selected and were divided in 2 groups, 25 patients in each group. This study was conducted at the Department of Cardiovascular Surgery of Choudhry Pervaiz Elahi Institute of Cardiology, Multan. We divided the patients in two groups. All operations were carried out by team led by a consultant surgeon in our institution. Our patients had the age range from 12 to 65 years [Mean ages=32.5 years +/- 13.9000] the mostly this study included males 60%. The study included Group A and Group B [beating heart versus conventional heart surgery] both groups contained randomized controlled patients with purposeful sampling. Minimum operative time 100 minutes or maximum operative time 160 minutes [Mean 195 +/- 95.75] The P value remained non significant that P <0.001. The CPB time was 22 to 388 minutes [104.8 +/- 97.4. Cross Clamp time, ICU stay intubation time, drainage, inotrope remained almost same in both groups. With P <0.001 Outcome variables of the patients. The hazards of cardiopulmonary bypass and Cardioplegia are well known. Various studies have demonstrated decreased accumulation of extra cellular fluid, diminished lactate production and greater preservation of high energy stores when a strategy of myocardial protection simultaneous antegrade/ retrograde continous normothermic, normokalemic blood perfusion was used. These findings were the basis for using beating heart technique for mitral valve replacement, Aortic cross-clamping, Cardioplegia, and reperfusion injury leads to myocardial ischemia and is a critical issue in mitral valve surgery despite novel approaches to myocardial protection. Myocardial edema induced by the lack of myocardial contractions and impaired lymphatic flow due to Cardioplegia in the heart remaining in diastole is another cause of myocardial dysfunction. Outcomes obtained using this strategy of myocardial protection seem to compare favorably to those of historical series in which conventional myocardial protection with cardioplegic arrest were used

Frequency of risk factors for breast cancer

[awaissabir2000@yahoo.com] To evaluate the frequency of risk factors for breast cancer. Main outcome measures were the above-mentioned risk factors in 50 diagnosed cases of breast cancer. Descriptive study. Surgical Unit-III, Nishter Hospital Multan. 50 female patients with proven diagnosis of breast cancer were evaluated with special emphasis on etiological risk factors. Findings were recorded in the proforma and results obtained were compared with national and international studies. 60% patients were in age group of 35-55 years, 50% had age of menarche 11 years, age of first full term pregnancy was between 15-25 years in 64% cases 60% patients belonged to lower middle class. 8% patients had family history of breast cancer. 56% patients had age at menopause above 50 years. No patient gave past history of breast cancer. It was concluded that in area of Multan, breast cancer is more common in patients having age between 35-55 years, early age of menarche, lower middle socio-economic status and late menopause

Risk factors in the causation of duodenal ulcer perforation in region of Southern Punjab

Despite the wide spread use of gastric antisecretory agents and eradication therapy, the incidence of perforation of duodenal ulcer remains more or less the same [5 10%]. There are certain well-defined risk factors that indicate, an increased liability to develop the disease The association of various probable risk factors such as H. Pylon, inadequate dietary intake, smoking, alcohol, ABO blood group and non-steroidal anti-inflammatory drugs has been studied. To evaluate the probable risk factors for perforation of duodenal ulcer, highlighting any prevalent one in the occurrence of perforation in our region. Study design:-Descriptive/Retrospective study. 3[rd] surgical unit Nishter Hospital Multan. Subjects:-All the patients having DU perforation were included. 62 patients with DU perforation were evaluated with special emphasis on etiological risk factors. Findings were recorded in the proforma and results obtained were compared with national and international studies. Stress, Smoking, NSAIDs and H. Pylori are the important factors in the causation of duodenal ulcer perforation. In our series stress is involved in 80% of cases. Followed by smoking [69%], H. Pylon [64%] and NSAIDs [55%]. Stress, smoking; H-Pylon infection and NSAIDS abuse are the factors in southern Punjab which cause perforation of duodenal ulcer

Application of alvarado scoring system in diagnosis of acute appendicitis

Appendicitis is an important differential diagnosis in patients with right iliac fossa pain. Acute appendicitis is one of the most common surgical emergencies with a life time prevalence of approximately 1 in 7[2]. To analyze the Alvarado score in relation to the diagnosis and management of acute appendicitis. This study was carried out in Surgical Unit III, Nishtar Medical College/hospital Multan. The study period was from January 2003 to December 2005. Sample size consisted of 100 patients. All these patients presented in A and E department Nishtar Medical College. Hospital Multan. Patients of any age group and both genders presenting to the emergency department with pain in right lower quadrant of abdomen were included in the study. Patients with presentation of urological, gynecological or surgical problems other than appendicitis and especially patients with mass in right iliac fossa were excluded from the study. Only 11 patients had increased severity of symptoms with score 7 or more on reevaluation with in first 24 hours. These 11 patients underwent appendicectomy. Operative findings and histopathological reports showed that 6 patients had inflammed appendix and the remaining 5 patients had normal appendix. Total number of surgeries performed in our study was 73 [73%]. Among these patients 42 were males and 31 were female. Operative findings and histopathological reports showed that 64 patients [87.68%] had inflammed appendix. Negative appendicectomy rate in our study was 12.32%. In our study we found the positive predictive value for Alvarado Score is 87%. The Alvarado score can be used as an objective criterion in selecting patients for admission. Its application improves diagnostic accuracy and consequently reduces negative exploration and complication rates

Use of 12.5 mm poly venyl ethylene [Pve ] hose pipe as a traction stent for palliation of dysphagia in advanced/ inoperable carcinoma esophagus

From March 2000 to November 2003, 39 PVE funneled hose pipe pieces were inserted as esophageal stents in 27 males and 12 females with mean age of 60 years [range=42-82 years]. Average hospital stay was 7 days [range = 5-20 days]. Procedure related morbidity was 40% while mortality was 10.25%. There was little effect of age, sex, type and level of tumor on morbidity and mortality. In patients who could be discharged home, dysphagia score improved form average of 4.2 to 2.5. Average post procedural survival was 4.2 months. 7 [20%] patients required readmission for stent malfunction. Only five of them required a second procedure to re-establish the passage. Slipping of stent occurred in only one case where a second stent was inserted. Our technique for manufacturing and insertion of the stent is described. Review of literature and a discussion to support our practice is included. We conclude that although self expanding metallic stents are the current gold standard world wide for palliation of dysphagia due to advanced carcinoma of esophagus, a molded PVE stent can be used in place of conventional traction and pulsion tubes where affordability is a problem. Using the described technique a reliable relief of dysphagia with acceptable morbidity and mortality rates can be achieved