Randomized controlled trial on prevention of postpartum haemorrhage with sublingual misoprostol or oxytocin

Failure of the uterus to contract adequately after child birth [a tonicity] is the most common cause of postpartum hemorrhage and misoprostol produces a rapid peak concentration, and is more effective than oral administration. We compared the postpartum blood loss with 400microg sublingual misoprostol and after standard care using 10 iu intramuscular oxytocin. Randomized controlled trial. This study was conducted in a Department of Obstetrics and Gynecology Ghulam Muhammad Mahar Medical College Teaching Hospital Khairpur Sindh during 2011. 60 women for each group were assigned to receive the study medications with in 1 minute of clamping and cutting the cord. Chi-square and studentt-test were used to test categorical and continuous outcomes. Mean postpartum blood loss and PPH [>500ml], >10% pre- to postpartum decline in hemoglobin and reported side effects. The mean estimated blood loss with sublingual misoprostol was 200 +/- 125ml [n=60] and 360 +/- 136ml with oxytocin [n=60] P-value 1000 ml of blood. Hemoglobin decline of > 10% observed that 11.6% and 45.0% in women after receiving misoprostol and oxytocin [P

Antibiobitc susceptibility pattern of bacterial isolates from patients admitted to a tertiary care hospital in Lahore

To determine the antimicrobial sensitivity pattern of bacterial isolates from patients admitted in a tertiary care hospital of Lahore. The study was carried out in Department of Pathology, Postgraduate Medical Institute, Lahore from January 2010 to June 2010. The samples from the hospital were sent to microbiology laboratory for bacteriological examination. They were cultured onto Blood and MacConkey agar plates; organisms were identified by their colonial morphology, Gram Staining and appropriate biochemical tests using standard recommended protocol. Antimicrobial susceptibility pattern of the bacterial isolates recovered from different clinical specimens against penicillins,, cephalosporins, fluoroquinolones, carbapenems, aminoglycosides and trimethoprim sulphmethoxazole was determined using modified Kirby Bauer method. Among the 925 different clinical samples, 379 organisms were isolated. Escherichia coli and Klebsiella species were the most prevalent isolates followed by Pseudomonas and Staphylococcus spp. High degree of resistance was observed among gram negative organisms to all groups of antibiotics. Resistance to amikacin ranged from 12- 18% among different species of Gram negative isolates whereas the range of carbapenem resistance was 1.4 - 9.5%. The percentage of oxacillin resistance among staphylococcal isolates was 33.1%, but all were sensitive to vancomycin. High frequency of resistance observed in the present study indicates that antibiotic resistance among nosocomial isolates is a serious problem. There is a continuous need of surveillance of sensitivity patterns of antimicrobial agents in our set up to know about the trend of this problem

Nosocomial methicillin-resistant staphylococcus aureus frequency in a tertiary care hospital, Lahore, Pakistan

Methicillin-resistant Staphylococcus aureus [MRSA] is one of the most important nosocomial pathogens world wide. The present descriptive study was carried out to determine the frequency of MRSA isolates in Jinnah Hospital Lahore, which is a major tertiary care hospital. Staphylococcus aureus [S. aureus] isolates recovered from various clinical samples received from inpatient departments of Jinnah Hospital Lahore [JHL] were included in the study. Screening for MRSA was done by modified Kirby-Bauer disc diffusion technique according to the CLSI guide lines. A total of 864 isolates of S. aureus were cultured. Two hundred and forty [27.77%] were found to be MRSA. Maximum isolation was from endotracheal tubes and ceritral venous [CV] catheters. MRSA infections are emerging as a serious health problem in our set up. Joint efforts by clinicians, clinical microbiologists, hospital management and public health authorities are required to meet the challenge of MRSA on the forefront

Frequency of extended spectrum beta lactamase producing gram negative bacilli among clinical isolates

Extended-spectrum beta-lactamase [ESBL]-producing bacteria are emerging pathogens. They are descended by genetic mutation from native beta-lactamases found in gram negative bacteria, especially infectious strains of Escherichia coli and Klebsiella species. Clinicians, microbiologists, infection control practitioners, and hospital epidemiologists are concerned about ESBL-producing bacteria because of the increasing incidence of such infections, the limitations of effective antimicrobial drug therapy, and adverse patient outcomes. The present study was undertaken to determine the frequency of ESBL producing gram negative bacilli recovered from clinical specimens in our setup. A total of 3099 gram negative isolates recovered from various clinical samples during the period of January 2007 to December 2008 were processed for the detection of ESBL production. Among them 35.5% bacterial strains were found to be ESBL producers. The commonest ESBL producing organism isolated was Escherecia coli [44.8%], followed by Klebsiella pneumoniae [38.6%]. Production of ESBLs by gram negative bacteria is emerging as a widespread problem in our setup. Appropriate infection control and antibiotic management strategies are needed to stem the spread of this emerging form of resistance

Vulvovaginal candidiasis in pregnancy

Vulvovaginal candidiais [VVC] is a common cause of vaginitis during pregnancy. Although the disease is rarely life threatening, it is a source of great physical and psychological discomfort and suffering. High Vaginal swabs [HVS] were collected from 50 pregnant women and subjected to Gram's smear, 10% KOH wet mount and culture. Candida was isolated from 48% of all cultures. However, Gram's smear and KOH mount revealed only 38% positivity with 10% showing both Candida spores and pseudohyphae. Multigravidae [60%] were more commonly affected than primigravidae [40%]. The common presenting signs and symptoms of VVC in present study were excessive vaginal discharge [100%], vaginal pruritis [91.6%] and vaginal burning [75%]. Although Gram's stain/ KOH mount is a valuable method in rapid diagnosis of symptomatic VVC as the invasive forms of yeast can also be demonstrated, yet its low sensitivity as compared to cultures could restrict the use in routine practice. Thus the best approach for the diagnosis of VVC is a combination of culture and Gram's smear/ or KOH mount

Bacterial meningitis: a diagnostic approach

Over a thirteen months period, 456 patients clinically suspected of having bacterial meningitis were investigated. Cerebrospinal fluid [CSF] specimens were examined by Gram's stain, white cell [WBC] counts and culture techniques. Gram's stain and cultures of CSF [232] with a cell count of less than 10 cells/mm[3] were consistently negative. However, of the CSF specimens [88] with cell counts greater than l00/mm[3], 28 [6.7%] and 23 [5.2%] of the specimens were positive by cultures and Gram's stain respectively. A total of 31 isolates were identified by culture. Streptococcus pneumoniae [22.4%], Escherichia coli [16%], and Coagulase negative Staphylococci [16%] were the predominant organisms, followed by Haemophilus influenzae [6.4%] and Neisseria men ingitidis [2.6%]. Thus it was concluded that Gram's stain and perhaps culture of CSF with cell counts of less than l0/mm[3] are of no practical diagnostic significance and may be eliminated as routine procedures. The gold standard for the diagnosis of bacterial meningitis is raised WBC cell count [>100/mm[3]], positive Gram's smear and/ or culture of CSF specimen

Prevalence and antimicrobial susceptibility of methicillin resistant staphylococcus aureus [MRSA]

The isolation rate of MRSA from different specimens was determined. Between January 1999 and June 2002, 448 out of 1322 [35.67%] isolates were found to be MRSA. A detailed study of these isolates showed a high prevalence of MRSA in patients in ICU's and special care wards. The yield of MRSA was highest from endotracheal secretions [100%], bronchial washings [70%], and catheter tips [51.85%] followed by sputum [40.54%], ear swabs [40%], fluids [37.25%], pus/wound swabs [34.83%] and blood cultures [28.07%]. Vancomycin remains the drug of choice with no resistance detected. The resistance to ciprofloxacin was 86.61%, to erythromycin 85.5% and to gentamicin 81.03%. After vancomycin, fusidic acid was the most sensitive drug with only 21.21% of the isolates exhibiting resistance. In view of the high prevalence of MRSA in our community, authorities must introduce more effective measures to control its spread; otherwise, it may seriously disrupt the efficient delivery of the health system in the country

Chromoblastomycosis: an unusual cutaneous dematiaceous fungal infection

Chromoblastomycosis is a chronic fungal infection with a slow evolution, caused by dematiaceous fungi inducing skin lesions being difficult to treat and have frequent recurrences. The clinicopathological features and diagnosis of one such case is reported here to share our experience with others. A nine years old male with a three years history of a slowly spreading painless skin lesion involving the whole of right cheek and nose. The patient gave a typical history of trauma in that region followed by a dark red skin eruption, which gradually grew to form erythematous papule. Physical examination revealed large hyperkeratotic, raised, thick crusted, verrucous plaques with areas of scaring and ulceration on the right cheek and nose extending down in a tumorous fashion. A small scaly lesion was observed next to the right eyebrow. However, the borders of the lesion were well defined and the surrounding skin was normal. No lymphadenopathy was seen

Comparison of prevalence of intestinal parasites in children and adult population

A study to investigate the prevalence of intestinal helminthes and protozoa was carried out in children [below 12 years of age] and adult population of residents of quarters of Institute of Public Health. Parasitic infestation was prevalent in 60% of children and 30% of adult population. In children protozoal infestation was found in 44% of the cases and helminthic infestation in 16% of the children population. Whereas in adult population, protozoal infection was found in 30% and helminthic infestation was found in none