Susceptibility of avian pathogenic Escherichia coli from Zoo birds in Indonesia to antibiotics and disinfectants

Antibiotic resistance in avian pathogenic Escherichia coli [APEC] is a common problem in the Indonesian poultry industry. Zoo birds have been postulated as sentinels, reservoirs, and potential spreaders of antibiotic resistance, although much is still unknown about the strains of zoo birds. Disinfection can reduce the infection burden. However, little is known about the presence of resistance against these products. Sixty one APEC strains were isolated from Indonesian zoo birds. The resistance to different classes of antibiotics as well as the minimum inhibitory concentrations [MIC] and minimum bactericidal concentrations [MBC] of five disinfectants most often used in the poultry industry was determined. Resistance to tetracycline [42.6%], sulfonamides [24.5%], ampicillin [22.9%], gentamicin [19.6], nalidixic acid [18.03%] and streptomycin [16.3%] was high, but resistance to other tested antibiotics was low and none of the isolates were resistant to extended spectrum beta-lactamase [ESBL] producers. Sixteen strains [26.2%] were found positive for multi drug resistance. The MIC of the disinfectants for the APEC strains showed normal distribution, indicating that there was no acquired resistance. MBCs were similar to MICs using the broth dilution method, showing the bactericidal effect of the disinfectants. Phenotypic resistance to commonly used disinfectants could not be found, indicating that the current use of disinfectants in the zoo and aviaries did not select for resistance. Significantly high resistance rates against commonly used antibiotics in Indonesian zoos is worrisome and indicates that widespread use of antibiotics could have negative implications for animal health and the environment. Proper use of antibiotics and surveillance programs to monitor antimicrobial resistance in pathogenic bacteria are warranted

lenalidomide induced toxic epidermal necrolysis and del [5q]: co-occurrence of rarities

Primary myelofibrosis [PMF] is a clonal, BCR-ABL1 negative myeloproliferative neoplasm characterised by splenomegaly, leukoerythroblastic peripheral blood picture and bone marrow fibrosis. Different cytogentic abnormalities are documented in PMF which have impact on clinical outcome and overall survival. Del 5q31 is documented in only 0.8% of PMF patients and is associated with poor outcome and increased risk of progression to acute leukemia. Anemia with del 5q responds frequently to lenalidomide treatment. We are reporting case of a middle-aged male who presented with constitutional symptoms, myelofibrosis; and calreticulin type 2 mutation was present. His cytogenetics showed del 5q positivity. He was started on lenalidomide but developed toxic epidermal necrolysis, resultantly lenalidomide was stopped. Skin eruptions are a known entity in patients with lenalidomide therapy; but to date, there is no reported case of lenalidomide induced toxic epidermal necrolysis [TEN] in patients with myelofibrosis

Pseudoaneurysm of left proximal common carotid artery following penetrating trauma

A 33-year male with history of penetrating trauma to left upper chest in 2006, presented through Medical unit to Radiology Department with complain of hemoptysis. Chest X-ray showed a soft tissue lesion in left upper lobe with a linear metallic foreign body. Contrast enhanced CT scan of chest and later CTA was performed which showed a saccular aneurysm arising from mediastinal part of left common aortic artery surrounded by thrombosis with a cylindrical linear metallic foreign body. He was planned for endovascular repair with stenting which he could not afford due to financial constraints. He is currently on conservative follow up. Vascular lesions can be serious complications resulting from blunt or penetrating trauma, when presenting with hemoptysis due to pseudaoneurysms formation even after so many years of trauma

Post-heretic neuralgia; intra-lesional triamcinolone in the treatment

Objectives: To assess the efficacy of intra-lesional triamcinolone in for the treatment of Post Herpetic Neuralgia. Study Design: Prospective interventional study. Setting: Dermatology Department of Dow University Hospital. Period: July 2014 to June 2015

Patients and Methods: Twenty nine patients with diagnosis of Post Herpetic Neuralgia were included after taking written and informed consent. An insulin syringe was used for the injections and the medicines were injected intralesionally. The mixture contained 30/70% of triamcinolone to xylocaine ratio for local infiltration in post herpetic scars. Pain relief assessment was done with the help of visual analogue scale [VAS] after two months. Mean pain score before therapy and after therapy was compared with one sample student t test

Results: Out of total 29 patients 14 were male and 15 were females. The mean age +/- SD was found to be 45.9 +/- 15.4 years. The most common region involved was Chest. The mean +/- SD duration of Symptoms was 5.58 +/- 1.80 weeks. The mean pain score before therapy was 6.86 +/- 1.66 which after one month of therapy reduced to 3.72 +/- 1.86. The reduction in pain was statistically significant [p<0.001]

Conclusion: Post Herpetic Neuralgia can be effectively treated by the local infiltration of a mixture of triamcinolone and lignocaine. It is recommended that long-term follow-up studies should be done with corticosteroids only or in combination with local anesthetics to additionally evaluate the effectiveness of such treatment in postherpetic neuralgia

Frequency of subclinical hypothyroidism in patients with proliferative diabetic retinopathy

To determine the frequency of subclinical hypothyroidism in patients with proliferative diabetic retinopathy. Cross Sectional Study. This study was conducted in Dow University Hospital, Dow University of Health Sciences, Karachi from 1[st] January 2012 to 31[st] December 2012. One hundred and nineteen patients attending the medicalOPD Dow University of Health Sciences were included in study. 119 patients were enrolled in study .47.1% were male and 52.9% were female patients mean age was 55.75 +/- 7.85 years, Mean HbA1[c] value was 8.02 +/- 1.46%, Subclinical hypothyroidism was identified in 26.9% the patients. Subclinical hypothyroidism is associated with the development of proliferative diabetic retinopathy in the patients suffering from type 2 diabetics

Chronic hepatitis C virus; dermatological manifestations of interferon plus ribavirin therapy in patients

To determine the frequency and pattern of dermatological manifestations in patients receiving interferon and ribavarin for hepatitis C. The study was conducted in the Dermatology out patients department [OPD] of Dow University Hospital Karachi from April -November 2013.Patients diagnosed with hepatitis C who received interferon a[3 MIU subcutaneously thrice weekly] plus ribavirin [1200 mg daily for 24 weeks].Detailed history and dermatological examination including mucous membrane, hair and nails was performed initially and then monthly for six months and findings were recorded. A total of 109 patients were included in the study. Frequency of various skin diseases in these patients werepruritis 44[40.36%], transient alopecia 14[12.84%],generalized morbiliform rash in 22 [20.18%],photosensitivity in 8[7.33%], secondary hyperpigmentation in 17[15.59%] patients. Lichen Planus was observed in 6 [5.50%] patients while brittle nails were seen in 5 [4.58%], glossitis in 4[3.66%],chelitis in 8[7.33%]and generalized exfoliating dermatitis in 9[8.25%] patients. Apthous ulceration was observed in 7 [6.42%] patients. HCV and its treatment with interferon plus ribavirin is associated with significant dermatological complications. Physicians should be aware of these side effects and patients should be counseled before starting treatment

Repetitive nerve stimulation test, an investigation that helps in confirming diagnosis in seronegative myasthenia gravis

To assess the effectiveness of Repetitive Nerve Stimulation Test in the diagnosis of Seronegative Myasthenia Gravis. Descriptive Observational. This study was conducted at Dow University of Health Sciences and Jinnah Postgraduate Medical Centre during the period of three years from 2010 to 2013. A total 129 cases, both out patients as well as inpatients, who were diagnosed as a case of Myasthenia Gravis clinically and by other investigations including, Edrophonium Test, Chest Radiology, and Acetylcholine Receptor antibodies were studied. Out of 129 cases, of Myasthenia Gravis, who were admitted or came in outpatient department, 55 subjects are male. On Repetitive Nerve Stimulation study at 3Hz, significant decrement was found in trapezius in 16 [88%] patients who are Seronegative and in 90 [81%] seropositive patients. Repetitive Nerve Stimulation Test is a promising tool in the diagnosis of Myasthenia Gravis and should be a part of investigations used to diagnose this neuromuscular junction disorder especially in Seronegative cases, for confirming the diagnosis

To assess vitamin d levels in patients diagnosed as fibromyalgia in patients attending dow university hospital

To assess the Vitamin D levels in patients diagnosed as fibromyalgia in patients attending Dow University Hospital Karachi. Descriptive study. This study was conducted at Dow University Hospital, Karachi from 21[st] January 2013 to 30[th] December 2013. 83 patients were selected from the outpatient department of medicine OPD. among 83 patients who were enrolled in the study 60 [72.71%] were male and 23were [27.71] were females ages were between 7 and 70 years, the vitamin D levels ranged between 2 and 58with mean vitamin D level found to be 12,58 which is counted as moderate deficiency. 83 patients with fibromyalgia were included in study. Among them who were enrolled in the study 60 [72.28%] were male and 23 [27.71%] were females .The subjects included in study age between 17 and 70 with mean age of 39.69 years. The fibromyalgia was gauged on clinical assessment. Vitamin D levels were classified. Vitamin D levels ranged between 2 and 58 with mean 12.58. As objective of study to assess vit D levels in diagnosed fibromyalgia patients in our population it was found that relationship between two parameters in significant. Vitamin D deficiency is frequently diagnosed in patients with fibromyalgia and nonspecific musculoskeletal pain in study population

Serum B12 deficiency; neuropsychiatric manifestations

To determine the frequency of various neurological and psychiatric symptoms associated with B12 deficiency. Observational and descriptive study. The study was conducted on patients presenting to the neurology clinics and inpatients who were admitted through the emergency department at Aga khan University Hospital Karachi, from 1 st July 2011 to March 2012. 150 patients of either gender and age more than 18 years. Detailed history was taken from all the patients with special regard to anemia. Inclusion criteria were that patients above 18 years of age of either sex with low serum B12 levels. Patients having any type of neurological tumors, major ischemic stroke, major intracranial haemorrhage, patients on neuroleptic medications and any evidence of toxin induced neuropathy were excluded. All patients underwent for specific investigation complete blood count, serum B12 levels [derived by Radio Assay method [RIA]. Further investigations Nerve Conduction Studies / Electromyography and CT Scan / Magnetic resonance Imaging of the Brain / spinal cord were carried out as and when required, depending on the clinical scenario. There were 69 [46%] males and 81 [54%] females. Female to male ratio was 1:0.8. The age ranged between 18 to 90 years with the mean age of 45.7+ 5.6. Out of 150 patients 107 patients [71.3%] had severe vitamin B 12 deficiency while 43 [28.7%] had mild to moderate deficiency. Neurological manifestations which were observed included; Memory was impaired in 13 [8.7%] of the patients. Dysarthia, along with other cerebellar signs [Nystagmus and dysdiadochokinesia] was present in 9 patients [6%]. 4 patients [2.7%] sought medical attention regarding their abnormal gait and their neurological examination revealed extensor planter responses and hyperreflexia. Cranial nerve examination revealed Anosmia in 2 [1.3%] and upper motor neuron facial weakness in 1 [0.66%] patients. Motor weakness was found in 2 patients [1.3%], and spasticity in 2 [1.3%] patients. 5 patients [3.3%] had sensory complains and were found to have impaired pain and touch perception. Proximal muscle weakness in one patient while another patient had asymmetric muscle weakness and rest of the patients had normal muscle power. None of the patient had autonomic dysfunction. In six neuropsychiatric problems were commonly seen in vitamin B12 deficient people. In these patients depression was observed in 16%, agitation 12.7%, memory impairment 8.7%, cerebellar signs and dysarthria 6%, sensory symptoms 3.3% and gait abnormality and hyperreflexia and extensor planters 2.7%. Various Neuropsychiatric problems are associated with vitamin B12 deficiency and the most common Neuropsychiatric illness found in these patients were depression, agitation, and memory impairment

To determine the frequency of chronic backache in the nursing staff of tertiary care hospital

To Determine the frequency of chronic backache in the nursing staff of a tertiary care hospital. Cross sectional study. This study was carried out at Civil Hospital Karachi from 1[st] November 2011 to 30[th] April 2012. Two hundred seventy two patients were included who fulfilled the inclusion criteria after taking the informed consent. The SPSS version 14 was applied to the data. Data was analyzed through SPSS software. 49 [18%] males and 223 [82%] females. The mean age of study population was 43 +/- 7.5 years and mean duration of job was 19.3 +/- 7.6 years. 10 [3.7%] subjects had history of daily duration of work of less than 6 hours and only 06 [2.2%] work for more than 12 hours daily as compared to this 256 [94.1%] study subjects work for 6-12 hours daily. 05 [1.8%] had history of posture of sitting at most of their working hours, followed by 10 [3.7%] standing, 85 [31.3%] mobile and 172 [63.2%] subjects had non-specific posture. 197 [72.4%] had backache as compared to this 75 [27.6%] did not had backache. Out of 197, 05 [1.8%] had backache at thoracic area, another 05 [1.8%] had backache at cervical and lumbar areas followed by 20 [7.4%] had backache at cervical area and 167 [61.4%] had backache at lumbar area. 77 [28.3%] had the history of radiation of backache. 7 [2.6%] had backache for <6 weeks, 32[11.8%] had backache for 6 weeks to 3 months and 158 [58.1%] had back ache for >3 months. The findings of this study suggest that backache is a common problem in the population of nurses in Pakistan. LBP is a widespread disease affecting nurses but not a major cause of sickness absence in the workplace. Poor knowledge of back care ergonomics and unavailability of lifting equipment are major predisposing factors to LBP among nurses [occupation hazard oriented]

Comparison of cephalometric norms of pleasing faces reporting to OPD of orthodontic department L.U.M.H.S Jamshoro / Hyderabad

This study was aimed to analyze cephalometric norms in Pakistani population in comparison with the standards of European-American Adults. Cross sectional study. This study was carried out at Dental OPD Department of Orthodontic Dentistry Liaquat University Hospital Hyderabad/Jamshoro from August 2012 to December 2012. Cephalometric norms were analyzed on a sample of 60 patients, with full complement of permanent teeth and no previous orthodontic treatment. The consent was taken and the patients were informed for the amount of radiation exposure related to cephalometric radiography. Lateral cephalometric radiographs of the patients were exposed in centric occlusion. The cephalometric radiographs of patients were traced manually on acetate papers. Each radiograph of the patient was traced at the same sitting to minimize tracing errors. In this study nasolabial angles were measured for comparison with European-American Adults. The database of study sample measurements was developed in SPSS version 17. The arithmetic mean, range and standard deviation for all the concerned variables were determined using the above-mentioned software with the help of SPSS processor. P value < 0.05 was considered significant. The results suggest that the study sample comprised of [53.3%] males and 28 [46.7%] females. Nasolabial angle of the patients were statistically analyzed and the minimum angle noted was 90 degree, maximum was 150 degree, mean angle was 108.45 degree and standard deviation was 10.98 degrees [p < 0.001]. Females showed more sharp nasolabial angles [p < 0.01]. Comparisons revealed statistically significant differences in cephalometric norms between the study population in comparison to standers of European-American population

Outcome of allogeneic haematopoietic stem cell transplantation in aplastic Anaemia

To analyze factors associated with survival, rejection and graft versus host disease in aplastic anaemia patients undergoing allogeneic haematopoietic stem cell transplantation [SCT] from HLA matched sibling donors. Analytical study. Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan from July 2001 to June 2010. Consecutive aplastic anaemia [AA] patients undergoing haematopoietic stem cell transplantation from HLA-matched sibling donors at this centre were included in this study. Potential factors affecting overall survival, rejection, disease-free survival and graft versus host disease were analyzed. Survival analysis was done by Kaplan-Meier method. Cox regression model was applied for multivariate analysis. Ninety male and thirty-five female patients with AA were included in the study. Median age was 18 years. Conditioning regimens used were cyclophosphamide [Cy] plus antilymphocyte globulin [ALG] or antithymocyte globulin [ATG], fludarabine [FLU] +Cy+ATG, Campath 1-H +Cy in 89, 30 and 6 cases respectively. GVHD prophylaxis used was ciclosporin [CSA] plus prednisolone and short methotrexate in 81 while 44 received CSA plus prednisolone. At a median follow-up of 1185 days OS and DFS were 84% and 78% respectively. Factors associated with better OS were male sex, Flu/Cy/ATG conditioning and use of bone marrow as stem cell source. Flu/Cy/ATG conditioning regimen, bone marrow as stem cell source and CSA, prednisolone and short methotrexate regimen were associated with better survival in AA

Relapsed diffuse large B-cell lymphoma treated by reduced-intensity allogeneic stem cell transplantation with donor lymphocyte infusion

A 42 years old male with relapsed diffuse large B-cell lymphoma was given second-line chemotherapy followed by reduced intensity allogeneic stem cell transplantation from HLA matched brother. Twelve weeks posttransplant, his disease relapsed evidenced by the appearance of lymphoma cells in the peripheral blood and declining donor chimerism. Donor lymphocyte infusion was given that induced complete lymphoma remission. The patient is well 3 years posttransplant with his disease in complete remission