Burn wound infection; significance of rule of nine in microbial surveillance

Burn injuries are common and major health problem throughout the world. The burn wound represents as a favorable area for opportunistic colonization of microorganisms with exogenous and endogenous origin. In burns patients infections arise from multiple sources. Burn wounds become initially colonized and infected with Gram positive bacteria, mainly Staphylococci, that are superseded during the second week by Gram Negative bacteria. it is a microbial surveillance retrospective study; that aimed to evaluate the significance of Rule of nine in diagnosis of aerobic bacterial burn wound infection and carried out in between June 2007 to September 2011 in the Department of Pharmaceutics, University of Karachi.Descriptive retrospective study. A total of 118 patient irrespective of age, sex, date and time of burn, date and time of hospital admission, interval between time of burn and hospital admission, degree and percentage [%] of burn and duration of hospital stay [when specimen collected] were registered for this study. All patients were divided into two groups [A and B]. Out of 58 patients of group A isolation rate per patient was 1.1 while in group B it becomes 3.0. According to TBSA the isolation rate in group B rises with rise in TBSA. Most prevalent organism in these patients was found S. aureus[23%] P.aeruginosa[21%]. Burn patients are incubator for variety of aerobic bacteria and rate of isolation of these organisms increase with rise in TBSA. The wounds of these patient must required continuous microbial surveillance that may reduce the rate of mortality

Smokeless tobacco consumption in a multi-ethnic community in Pakistan: a cross-sectional study

Smokeless tobacco is commonly used in south Asia. In addition to causing oral and pharyngeal cancers, its harmful effects are comparable to smoking tobacco. A cross-sectional survey with systematic sampling was conducted in 2010-2011 to investigate smokeless tobacco use in a multi-ethnic, semi-urban population in Islamabad, Pakistan [n = 2030]. The prevalence of smokeless tobacco use was 16.0% [21.6% among males and 8.8% among females]; 51.7% of smokeless tobacco users were also cigarette smokers. The rate of smokeless tobacco use was comparatively high among Pakhtun males [38.2%] and Sindhi females [22.4%]. The associations between smokeless tobacco use and ethnicity, age group, income level and cigarette smoking were statistically significant among male smokeless tobacco users. Of the sample 41.4% [840/2030] had inadequate knowledge about the health problems associated with smokeless tobacco. Appropriate interventions are needed to raise awareness of the health risks and to prevent smokeless tobacco use

Risk factors for surgical site infection in clean surgeries in Abbasi Shaheed Hospital

To assess the risk of surgical site infection in clean surgeries associated with age, sex and duration of surgery in Abbasi Shaheed Hospital. This study is a Case control study and was conducted in surgical Unit-1, Abbasi Shaheed Hospital, Karachi from January 2006 to December 2008. Its sample size is Non-probability, convenience and 150 patients were taken for this study in which 100 patients with healthy surgical site were taken as control while 50 patients with infected surgical site were taken as the cases. All male and female patients of age between 18 to 55 years were included in this study. For ail diabetic and non-diabetic patients who were admitted in ward for elective clean surgery, same method of skin preparation was under taken with povidone iodine and spirit. Control were patients without surgical site infection while cases were patients with surgical site infection. All patients received three doses of prophylactic antibiotic first generation cephalosporin 500 mg i/v Shourly preoperatively. SPSS version 10 was used to analyze the data. The ages of the patients were between 18-55 years with increased risk of surgical site infection with increasing age. Out of 50 patients with surgical site infection, 28 [56%] were diabetic and 22 [44%] were non-diabetic. It was seen that 24 patients [16%] had surgery of duration 46-60 minutes and 12 of them [50%] had surgical site infection as compared to 36% in surgery of less than 30 min. Odd ratio of infection for diabetes, duration of surgery, age and gender were 10.3, 6.5, 3.1 and 1.3 respectively. Significant association was found between type, duration of surgery and ASA score. Adjusted analysis revealed a significant relation between age, ASA class, diabetes mellitus, uncontrolled postoperative blood glucose level, duration of surgery and surgical site infection. Mastectomy was significantly associated with surgical site infections along with longer duration and ASA class III

Primary health care: what is it and what is it not? Views of teaching faculty at an undergraduate medical college in Pakistan

Over 30 years after the Alma-Ata declaration on primary health care in 1978 there are still misconceptions about the basic concept of primary health care. This study aimed to investigate the knowledge and opinions about various aspects of primary health care and its appropriate implementation among the teaching faculty at Shifa College of Medicine in Islamabad, Pakistan. A structured questionnaire was answered by 70 physicians present at the end of the month seminar. Two-thirds of the doctors [67.1%] believed that primary health care involved only basic health care for common illnesses. Few respondents suggested that community-oriented programmes [4.3%], maternal and child health [2.9%], screening [1.0%] or treatment of noncommunicable diseases [2.9%] should be components of primary care. The concepts to primary health care as defined at Alma-Ata in 1978 were not well understood by teaching faculty from the basic and clinical health sciences in this medical college

Desmoid tumour of lower abdomen

A desmoid tumour is slow growing fibromatosis with aggressive infiltration of adjacent tissue and extremely unusual systemic metastases. We report a case of a female patient aged 25 years who had a mass in lower abdomen for 2 years. There was no previous history of any surgical intervention. Preoperative evaluation included ultrasound and computed tomography. Patient underwent primary resection with wide margins. Histology revealed a desmoid tumour

Bilobed gallbaldder

We report a rare case of duplication anomaly of gallbladder in a female aged 17 years, who presented with right hypochondrial pain for 3 months. Ultrasound findings suggested multiple stones in gallbladder and per-operatively she was found to have bilobed gallbladder. This case emphasizes the need for complete removal of both gallbladders during initial surgery, as a failure of this may result in recurrence of symptoms and stones and a need for re-exploration

Proportion of bile micro-organisms and their culture and sensitivity to various antibiotics in patients with gallstones

To provide scientific basis for selecting a prophylactic antibiotic in the cases of elective cholecystectomy, according to our local conditions. Descriptive Study. General Surgery department of Abbasi Shaheed Hospital Karachi from 1st Jan, 2004 to 31st Dec 2004. Fifty patients with chronic cholecystitis ranged between 20 to 65 years were admitted through outpatient department. These patients also included high risk patients with diabetes mellitus, ischaemic heart diseases, hypertension and immunocompromised patients. Patients with acute cholecystitis, empyema, obstructive jaundice, common bile duct stone, carcinoma of gallbladder or biliary tree, cirrhosis and patients having septic foci elsewhere were excluded. Patients were selected according to convenient sampling. During cholecystectomy bile was sent for culture and sensitivity. For analysis of data SPSS-10 was used. In this study positive bile culture was found in 44 percent of cases and most prevelant organisms were E.coli and Klebsiella. With regard to antibiotic sensitivity. Amikacin, quinolone, imipiname and piperacillin has shown almost 90% sensitivity. Prophylactive antibiotic should be used in all cases of elective cholecystectomy

Complications of colostomy in Abbasi Shaheed hospital

To describe the different complications of colostomy that developed after its construction either in emergency or elective surgery in Abbasi Shaheed Hospital Karachi. Descriptive study from January 2006 to Dec. 2007 during which fifty patients who were above 12 years of age were admitted in Surgical Unit-I, of Abbasi Shaheed Hospital, Karachi, through emergency and out patient department. Information of patients including history, clinical examination, investigations, and indication of surgery, operative procedure and operative findings were collected. Gut preparation was done in elective cases only. Detail about stoma, its type, complications and treatment were observed carefully. Emergency colostomies were performed in emergency theatre while elective cases were done in main theatre. Patients were followed up from the construction of colostomy to the fourth post operative week to analyze the complications associated with stoma formation. Reversal of colostomy was done after 8th to 12th post operative period. Among them 40 patients 80% were males and 20% were females. Students, labors and old age were mostly affected class. Most of them were victims of terrorism. Intestinal trauma due to gun shots and stab were the leading cause while the intestinal pathology like tuberculosis, carcinoma, volvulus, intestinal obstruction were found to be the less common causes of stoma formation. 40 patients [80%] were operated in emergency theatre while 10 patients [20%] under went elective faecal diversion. Majority of Colostomies were temporary loop colostomies, formed only for diversion and decompression of distal segment. Out of fifty patients, none of the patients had any major post operative complications like necrosis, prolapsed, parastomal hernia and fistula formations. Only twelve patients [24%] developed complications. Abdominal wall infection in two patients [4%] and skin excoriation in 3 patients [6%] around the stoma were found the commonest local complications. Retraction in 2 patients [4%], stenosis in two patients [4%] with stoma obstruction in 1 [2%] and detachment in 1 [2%] were found. All these cases required refashioning of Colostomy. Stoma bleeding and pain was also observed and treated in 2 patients [4%]. The psychological trauma of having colostomy with a bag on the belly was a considerable problem which patient had during the period, which was reduced and post operative counseling and training was given. Stoma surgery has a wide range of clinical implication. It is relatively a save procedure either to reduce leakage of distal colonic repair or to provide sufficient time for the healing of intraperitonial trauma. The complications occurred in only 24% patients among which skin excoriation and skin infection occured in a few patients. Having an artificial anus was a mental torture for patients

Changing frequency of hepatitis-B and hepatitis-C positive cases among blood donors screened in blood bank at Nishtar hospital, Multan

To determine the change in frequency of Hepatitis-C and B in blood donors presented for screening at blood bank of Nishtar Hospital, Multan. This cross sectional, descriptive hospital based study was carried out in Community Medicine Department, Nishtar Medical College, Multan in collaboration with the Blood Bank at Nishtar Hospital, Multan. A total of 300 donors were screened for hepatitis-B and hepatitis-C during the month of June 2009. Among 300 blood donors screened for hepatitis-B and hepatitis-C, 92.7% were males while females were only 7.3%. Among all blood donors screened, 6% were found hepatitis-B positive and 5.3% were found hepatitis-C positive. Hepatitis-B and hepatitis-C are increasing at an alarming rate in Multan and the surrounding areas. Aggressive measures are needed for control this epidemic

Physiological studies on duration and types of dormancy in some grape CVS

This study was carried out for two successive seasons on "Flame, Superior and Thompson" Seedless grapevine cultivars grown in sandy soil under drip irrigation system. Dormancy types and periods, changes in endogenous hormones and thickness of scale layer in relation to de-scaling, exposure to various chilling and ODD regimes were investigated, in addition to the thermal requirements for some phenological stages. Results indicated that grape buds exhibit a short shallow dormancy period, Part of it is attributed to Endo-dormancy and other to Para-dormancy which are basically due to the scales. Scale layers diameter increased markedly during the dormancy period. Such increment might restrict bud growth and expansion, it may be a source of ABA. On the other hand, dormancy period of the three considered grape cultivars may depend on the interaction between both chilling and ODD with various degrees. It was clear that scaling increased bud burst percentage in most sampling dates. Results concerning endogenous hormones emphasized general increase in the promoting hormones [IAA and GA3] and general decrease in ABA at post dormancy, whereas the reverse was detected in the deep dormancy. GA3 was not detected at both Pre- and deep dormancy phases

Results of ultrasound findings in cases of pure cystic scrotal swellings in patients of all ages in ash

To describe the results of ultrasound findings in pure cystic scrotal swellings in patients of all ages in ASH. It was a descriptive case series carriedout from Jan 2003 to Dec 2005 in SOPD and Surgical unit-1, Abbasi Shaheed Hospital and KMDC, Karachi. A total of 100 patients were taken who had pure scrotal swellings which were cystic in nature clinical examinations. These patients were treated in this hospital during this period. All patients [n=100] attending SOPD of Abbasi Shaheed Hospital with presenting complain of pure scrotal swellings were clinically examined with especial attention to get above the swelling, fluctuation and transillumination test and their size of the swelling also noted by an inch tape. An inform consent was taken and ultrasound of scrotum was done in ultrasound department to confirm the cystic swelling of scrotum and also to measure the size of the swelling. These patients were then divided into three groups according to the size of the scrotal swelling in which Group A [n=22] patients had size <5cm in diameter, Group B [n=51] had size 05-10cm in diameter and Group C [n=27] had size >10cm in diameter. All patients were admitted for surgery [exploration of the scrotal swelling]. On exploration of the scrotum [n=100], about 39% [n=39] of patients had < 50 ml of fluid, 32% [n=32] of patients had 50-100 ml of fluid while 29% [n=29] of patients had >100 ml of fluid in the sac. About 77% [n=77] of patients had clear amber coloured fluid, about 13% [n=13] had serous fluid with calcifications, about 07% [n=07] had pussy fluid and only 03% [n=03] had bloody fluid in the sac. Therefore about 90% of the patients had hydrocele [n=90], about 07% had pyocele [n=07] and only 03% of patients had haematocele [n=03]. No malignancy was found in this study. Most of the patients coming in this hospital with pure cystic scrotal swellings had hydroceles [90%], some of the patients had pyoceles [07%] while few had haematoceles [03%]. All most all cystic scrotal swellings were benign in nature and no malignancy was found in this study

Microbiology of burn patients of civil hospital Karachi

After initial period of shock, infection remains a major and most serious complication in burn patients. The flora of the burn wound is constantly changing and the potential risk of burn wound sepsis persists until complete healing of burn wound. In burn patients most of the infections are thought to be of nosocomial origin. Gram positive cocci are considered with increasing frequency in nosocomial infection. Gram negative organism cause trouble in different ways, pus containing toxins convert partial thickness burns into full thickness burn, causing general illness, failure of graft taking and most important is septicemia Pseudomonas aeruginosa is highly pathogenic in the injured immuno suppressive burn patients. Most common isolates belongs to family Enterobacteriacae i.e. 36 [63.3%]. Second common isolates were belonging to Genus Staphylococci 15 [26%]. The prevalence of Pseudomonas aeruginosa was relatively less that was 07 [10.4]. Gram positive Staphylococci were 100% sensitive to Vancomycin, Chloramphenicol, and Imipenem. Pseudomonas aeruginosa were highly sensitive to Ciprofloxacin and Amikacin i.e. 83.3% Imipenem was highly effective against [97.6%] isolates of Enterobacteriacae. Ciprofloxacin was the second most effective drug that was effective against 87.5%isolates of Enterobacteriaicae

Role of enterobactereacae in burn wound sepsis in Karachi

The over all prevalence of the Enterobacteriacae in present study was more than 50% in which the most prevalent organisms belongs to Proteus Spp. [38,3%] that followed by Enterobacter Spp. [22.4%]. The prevalence of E. coli and Kleb, Pneumoniae was 10%, Imipenem was the most effective [98%] drug against Enterobacieieacae. Ciprofloxacin was the second most effective [82%] drug. Amikacin and fourth generation Cefepirne were the third effective [>70%] drugs against these bacteria. Ciprofloxacin was the less effective [60-64%] drug against KIeb. pneumonia and E. coli than the rest of the isolates of Eiiterobactereacae. Arnikacin [49%] and Cefepime [44%] were less effective against Proteus Spp. More than 50% isolates were sensitive to Piperacillin, Gentamicin and Tobramycin. Amoxicillin and Augmentin were ineffective against these bacteria in this study

Usefulness of entry test. what first professional MBBS part one results show?

To see how students admitted after entry test in Nishtar Medical College, Multan, perform in First Professional MBBS Part-I, we analyzed the results of three successive sessions i.e. N-51, N-52 and N-53. A total number of 437 students' results were analyzed. We grouped the students into top 50 of F.Sc [F.Sc-50], top 50 of Entry Test [ET-50] and top 50 of MBBS Part-I results [MBBS-50]. When we analyzed the MBBS-50 group, it was seen that in N-51 [Session 2002-2003], twenty one of MBBS-50 students were from F.Sc-50 group, twenty of MBBS-50 were from ET-50 group. In N-52 [Session 2003-2004], seventeen of MBBS-50 were from F.Sc-50 group. eighteen of MBBS-50 were from ET-50 group. In N-53 [session 2004-2005], twenty eight of MBBS-50 students were from F.Sc-50 group; eleven of MBBS-50 students were from ET-50 group. So in three successive MBBS batches [i.e. N-51, N-52 and N-53 batches], F.Sc-50 group contributed more as compared with the ET-50 group. Less number of students failed from F.Sc-50 group as compared with ET-50 group. F.Sc-50 group also have more high achievers as compared with ET-50 group. F.Sc-50 group showed improvements in its performance over the three years period. We conclude that F.Sc results are reflecting more precisely the students' performance in future as compared with the entry test results

Intestinal tuberculosis - a common cause of intestinal obstruction

To assess the prevalence and presentation of intestinal tuberculosis in cases of mechanical bowel obstruction. Retrospective study from Oct. 1999 to Sept. 2005. Surgical Unit I, Abbasi Shaheed Hospital, Karachi. All patients [> 10 years of age] presenting with mechanical bowel obstruction. The data and files of all the cases of dynamic bowel obstruction was retrieved and analyzed with reference to age, sex, symptomatology and examination findings, investigations, aetiology, surgical procedures performed and outcome. A total of 163 patients were admitted with mechanical bowel obstruction over a period of six years. The ages of the patients varied between 10-74 years, maximum cases being seen between 30-40 years, with a male preponderance [60.1%]. Abdominal pain [40.5%], vomiting [20.2%] and constipation[16. 0%] were the prominent modes of presentation. Intestinal Tuberculosis [70.6%] was the most common cause of intestinal obstruction, followed by irreducible inguinal hernias [17.2%] and malignancies [7.4%]. Less than half [46.0%] the tuberculous patients were already on anti-tuberculous treatment at the time of presentation. About 9% of the tuberculous cases were managed conservatively, while the rest were operated upon; right hemicolectomy being the most frequent [47.6%] procedure performed. Histopathology was positive for tuberculosis in all the cases. Five patients of intestinal Tuberculosis died due to Tuberculous peritonitis. Intestinal Tuberculosis is the leading cause of mechanical bowel obstruction in our part of the world. Many patients of abdominal tuberculosis, managed conservatively on anti-tuberculous treatment, develop signs and symptoms of acute obstruction. Hence early surgical intervention is recommended to improve the morbidity and mortality of such patients

Hypolipidemic effects of high fat sunflower oil and nigella sativa [Kalonji] on serum lipid profile of albino rats

Diet is the main factor affecting serum lipid concentrations. We studied the changes in serum lipid profile by high fat sunflower oil diet. We also documented the effects of Nigella Sativa [Kalonji] on serum lipid profile. Thirty two albino rats were divided into two groups i.e. one control [C] groups and other experimental [E] group having equal number of rats. Study was carried out for twelve weeks. Fasting blood samples were drawn by heart puncture for serum lipid profile under ether anaesthesia. Estimations were done by recommended methods. Statistical methods were done by using student's "t" test. We found decrease in total cholesterol by 9.6%, triglyceride by 4.21%, LDL cholesterol by 12.0% and HDL cholesterol by 10.4%. We concluded from study that polyunsaturated fatty acid in high concentrations [20%] has lipid-lowering effect and Nigella sativa has got HDL cholesterol raising effect, which has anti-atherogenic potential

Effects of low fat diet and nigella sativa [Kalonji] on serum lipid probile of albino rats

Diet influences serum levels of total cholesterol, triglyceride and individual lipoproteins. We compared the serum lipid changes in albino rats fed on low fat sunflower oil diet and Nigella Sativa. Thirty two albino rats were divided into two groups, one control [C] group fed on low fat sunflower oil and other experimental [E] group fed on low fat sunflower oil diet and Nigella Sativa. The study was carried out for twelve weeks. Fasting blood samples were taken by heart puncture under ether anaesthesia for serum lipid profile. Estimations were carried out by recommended methods. Statistical methods was done by using students's "t" test. We found an increase in total cholesterol, triglyceride, high-density lipoprotein cholesterol [HDL-c] and low-density lipoprotein cholesterol [LDL-c]. We concluded from the study that polyunsaturated fatty acids in low proportions and Nigella Sativa has HDL-c raising effect, which has anti-atherogenic potential

Thiamine and Nacl effects on zea mays L. plants

The possibility of applying saline conditions for the irrigation of Zea mays and their effects on growth and some metabolic aspects were tested. Germination of Zea mays under saline irrigation with NaCl concentrations 300, 600 and 900 mg/L and presoaking in water and thiamin [vitamin B1] solution [200 mg/L] were studied. It was noticed that NaCl treatments reduced fresh and dry weights of Zea mays plants, while presoaking grains in thiamin solution [200 mg/L] alleviated the inhibitory effect of NaCl by increasing these parameters. Moreover, the nutritive elements K, Ca and the proline contents were also increased by increasing NaCl concentration. Thiamin application reversed such effect. The electrophoretic banding patterns of peroxidase and esterase isozymes showed different profiles under the salt stress and application of thiamin. SDS-PAGE electrophoretic patterns of water soluble protein fraction extracted from Zea mays grains which were previously soaked in thiamin and those which were irrigated with different salt treatments were studied