Public health education and health system needs in Pakistan: a mixed methods study

Background: Pakistan has recently observed a significant growth in public health education programmes. Little is known about the structure of these programmes nor whether they are adequately responsive to national health system needs.

Aims: We reviewed existing public health degree programmes in Pakistan along with an exploration of the national public health market and health system needs.

Methods: A mixed-methods study was conducted between January 2015 and March 2016. Seventeen public health degree programmes were reviewed for programmatic and instructional attributes. Thirteen key-informant interviews were conducted to explore health system needs and challenges related to public health workforce.

Results: We found substantial variation in public health academic programmes in terms of offered courses, credit hours, number of faculty and tuition costs. About 70% of public health degree programmes were generic [i.e. with no specific concentration track] and only 18% offered practicums. Overall median tuition cost in 2016 was US$ 10 350. During key-informant interviews, emerged themes for challenges included lack of practical public health skills, limited knowledge of latest theoretical principles, poor communication skills and insufficient IT orientation. Identified themes about knowledge and skills areas to address future public health challenges of Pakistan included system thinking mind set, healthcare IT skills, and leadership and management skills.

Conclusions: Public health education in Pakistan falls short of meeting current national challenges. Pakistan needs a national public health accreditation body for regulating education, harmonizing global standards to local context and developing relevant career pathways

Detection of Amp-C Beta-Lactamases in Urinary isolates of Escherichia Coli through various Phenotypic methods

Objective: To determine the prevalence of Amp C beta lactamases in urinary isolates of Escherichia coli [E. coli], and to evaluate and compare different phenotypic methods for its detection in a cost effective way

Study Design: Descriptive study

Place and Duration of Study: Department of Microbiology, Combined Military Hospital Lahore Pakistan, from Jan 2016 to Jun 2016

Material and Methods: Modified Three Dimensional Test [M3DT] taken as Gold standard, Modified Hodge Test [MHT] [Cefoxitin], Nitrocephin test and three screening strategies for the detection of Amp C Beta-lactamases were tested on urinary isolates of E. coli collected during a period of 06 months

Results: Modified Hodge Test, was found to be simple, highly specific and sensitive in detecting these enzyme producers. Collectively these tests detected 45.07% of E. coli to be Amp C producers

Conclusion: Each of the three tests can be used as an acceptable phenotypic confirmatory tool when Amp C production in E. coli is suspected

Trend of increased resistance to antibiotics in intensive care unit isolates of a tertiary care hospital over two years 2009 and 2010

To asses the antibiotic resistance pattern of Intensive Care Unit bacterial isolates over two year period; 2009 and 2010. This observational study was carried out on Intensive Care Unit isolates of Services Hospital Lahore in the Microbiology section of Department of Pathology, Services Institute of Medical Sciences Lahore. All samples processed for microbial cultures were tested for anti-biotic sensitivity / resistance pattern studied and compared. In 2009,790 samples and in 2010 886 samples were submitted from ICUs to Microbiology Section for culture. Of these, 42% and 46% were culture positive respectively. Gram negative isolates were 294 in 2009 and 308 in 2010. Resistance to all drugs tested was exhibited by 26 [8.78%] and 39 [12.60%] isolates in 2009, 2010. The total number of Acinetobacter isolated increased to 102 in the year 2010 from 74 in the year 2009 with 28 more Acinetobacters than in 2009 and the number exhibiting extensive drug resistance doubling to 28 from 14. Resistance to Imipenem, Tazobactem and Amikin drugs increased in Acinetobacters, Klebsiella and resistance of E coli to Imipenem also increased but decreased in Pseudomonas and E coli. ORSA and coagulase negative staphylococci with Oxacillin resistance were also on the rise, doubling in number from 12 to 25 and 14 to 31 in 2009 and 2010. Acinetobacter species are on the rise in the intensive care units as is their extensive and multi drug resistance pattern. Increasing Carbepenem resistance is alarming limiting our therapeutic options. Judicious use of antibiotics and curtailing nosocomial infections would deter this upward trend

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

Association of blood group types to Hepatitis B and Hepatitis C virus infection

Frequency of Hepatitis B Surface Antigen [HBsAg] and Hepatitis C Virus Antibodies [Anti-HCV] among blood donors of Lahore and their association with blood group types. To study the frequency of Hepatitis B Surface Antigen [HBsAg] and Hepatitis C Virus Antibodies [Anti-HCV] in blood donors of Lahore and to assess the association with blood group types. The design of study will be cross sectional descriptive study. It was held in the Pathology Department, Nawaz Sharif Social Security Hospital, Lahore, during the period January, 2006 to December, 2008. A total of 16695 blood donors were screened for HBsAg and Anti-HCV by rapid test devices based on immuno-chromatographic technique following the instruction given by the manufacturer. In the present study, devices manufactured by Acon, USA were used. The specimens reactive on screening by devices were confirmed on ELISA. The results were subjected to chi-square analysis for determination of statistical difference between the values among different categories. Among 16695 blood donors, 467 [2.79%] were positive for HBsAg and 1326 [7.94%] were positive for Anti-HCV. The frequency of HBsAg was seen to decrease significantly [p < 0.01] from 2006 to 2008 [4.23% to 2.31%]. However, frequency of anti-HCV was seen to rise significantly [< 0.01] from 2006 [6.69%] to 2008 [7.82%]. Comparison of HBsAg and anti-HCV positivity among RhD positive and RhD negative donors showed that there was no significant difference for HBsAg positivity [2.79% vs 2.85%]. However, significantly higher number of RhD positive donors had HCV infection as compared to RhD negative donors [8.25% vs 3.66%]. High frequency of HCV infection in blood donors need implementation of strict screening policy for donors and public awareness campaigns about preventive measure to reduce the spread of this infection as well as other transfusion transmissible infections. Association of HCV infection with blood group types needs more studies to get more knowledge about this aspect

Comparative nephrotoxic effects of gentamycin and tobramycin

To compare the nephrotoxic effects of two aminoglycosides namely, gentamycin and tobramycin on rabbits. Comparative study. Allama Iqbal Medical College Lahore, from January 2010 to December 2010. The serum levels of creatinine and electrolytes [sodium and potassium] were measured in different groups of rabbits [control group-A, gentamycin group B and tobramycin-group C]. Rabbits in group B and C received laboratory diet and 32 mg/kg/day of gentamycin and tobramycin were given through intramuscular [IM] route twice daily for 7 days. Blood samples were collected on day 1, 10, 16, and 22 of drug administration. Each rabbit of all groups was sacrificed on 22[nd] day of experiment. Kidneys were removed and histological examination of the 4 components of the renal tissue [glomeruli, tubules, blood vessels and interstitial tissue] was carried out. Level of serum creatinine was significantly increased in both experimental groups [B and C] as compared to the control group A. On the other hand, level of serum sodium was insignificantly increased in groups B and C, whereas level of serum potassium was significantly decreased in groups of rabbits receiving gentamycin and tobramycin as compared to control group. There was no significant difference in nephrotoxicity between gentamycin and tobramycin

HIV Infection, HIV/HCV and HIV/HBV co-infections among Jail Inmates of Lahore

Human immunodeficiency virus [HIV] infection constitutes an important prison health care concern but data on HIV epidemiology among jail inmates of developing world including Pakistan is limited. The present study was carried out to find out the prevalence of HIV infection among inmates of two jails of Lahore, Pakistan. Cross sectional prevalence survey of a total of 4915 jail inmates [4498 male and 417 females] was conducted during a seven months period, from May 2009 to November 2009 in the inmates of "District and Central Jails of Lahore". They were divided into four groups according to age. A blood sample was collected from each survey participant. All collected blood samples were screened for HIV antibodies, HBsAg and anti-HCV with rapid testing immunochromatographic [ICT] kits. All positive test results were confirmed by using the ELISA technique. The overall HIV prevalence rate was 2.01% and 77.78% of them had co-infections. HIV/HCV co-infection was detected in 73.74% of HIV positive inmates. Among women prisoners, one Pakistani and four Africans were found HIV positive. HIV infection and HBV/HCV co-infection was more prevalent in the age group 16-30 years. The prevalence rate of HIV infection and its HBV/HCV co-infection in jail inmates is much higher than the general population and the prevalence rate reported earlier from other jails in Pakistan. Health information on jail populations is important as this is a vulnerable group, with frequent movement in and out of the general community. Urgent prevention efforts are needed as HIV prevalence is already 2%

Assessment of health services on relevant primary health care principles in internally displaced people of Pakistan

SPHERE based assessment of internally displaced persons camp was done to assess health services on relevant primary health care principles using a cross-sectional survey in Jalozai Camp, Pakistan. Most of the households [74%, n=87] had access to health education addressing issues to protect and promote their health which was provided at household level [83%, n=72], community level [44%, n=38] and health centre level [13%, n=11]. All the health facilities were culturally and socially acceptable in terms of language, separate waiting rooms, presence of female health providers and language translators. A referral system was in place which provided free transport in [67%, n=2] health facilities to tertiary care hospitals. Health services provided were culturally and socially acceptable and efforts on health education were also appreciable, except that no health education or intervention was done on HIV AIDS. Referral should be made to referral facilities within the districts instead of directly to tertiary care hospitals

Sero-prevalence of HCV and associated infections with HIV and HBV among prisoners in Lahore

Hepatitis C Virus [HCV] infection and its co-infection with HIV or HBV is associated with an accelerated course of the disease and may result in more rapid progression of either or both, but knowledge on these dynamics in the imprisoned is scarce particularly in the developing world. Hence in this study we evaluated the prevalence of HCV infection and its associated co-infections with HBV or HIV in the prison population of Lahore. This was a descriptive cross-sectional study aimed to estimate the prevalence of HCV infection in prisons of Lahore [Pakistan] between May and November 2009. In this study, 4915 prisoners participated; 91.5% of them were males, and 8.5% females. Median age of prisoners was 28 years. Jail inmates were tested for serological markers-HBsAg, HCV antibodies and HIV antibodies-by chromatographic immunoassay. Initially reactive sera were retested for HBV and HCV with ELISA and for HIV with another rapid method. In total, 783 [15.93%] prisoners were positive for HCV and 105 [2.13%] of all prisoners were registered having co-infection with HIV, HBV or both. Among 783 HCV positive prisoners 72 [9.19%] had HIV co-infection, HCV/HBV co-infection was observed in 30 cases [3.83%] and triple co-infection [HCV/HBV/HIV] in three cases [0.38%]. The prevalence rate of HCV infection is quite high in the prison population of Pakistan and is mainly complicated with HIV co-infection. It is imperative that HCV, HIV and HBV prevention strategies be intensified in this community

Bacteriological quality of drinking water in Lahore

It is well established that a large number of infectious diseases are transmitted primarily through water supplies contaminated with human and animal excreta particularly faeces. The purpose of the study was to assess bacteriological quality of drinking water in Lahore-Pakistan. It is a cross sectional descriptive study performing the Lahore city during the months of April and May 2008. A total of 530 water samples were collected from different localities of whole of the Lahore city. These represented areas with different socio-economic conditions. The samples were collected in sterilized containers and brought to the laboratory within two hours of collection. All the samples were tested for contamination with bacteria using multiple tube method to determine most probable number of total coliforms and faecal coliforms using standard procedure. Among 530 water samples, 197 samples [37.2%] were positive for bacterial contamination. It was observed that bacterial contamination was maximum in areas with low SEC [43.6%], followed by intermediate SEC [36.5%] and high SEC [22.9%]. The difference was found to be statistically significant [p<0.15] between areas with High and Low SEC while it was non-significant [p>0.5] between areas with Low and Intermediate SEC. Bacterial contamination is significant pro Hem in Lahore. Regular monitoring and chlorination/establishment of water filtration plants can improve this situation

Bacterial pathogens responsible for blood stream infection [BSI] and pattern of drug resistance in a tertiary care hospital of Lahore

The present retrospective analysis was carried out to determine the pattern of bacterial agents responsible for blood stream infection [BSI] in a tertiary care hospital of Lahore and to get an updated knowledge about their antibiotic resistance pattern. It is a cross sectional descriptive study, carried out in the Microbiology Section, Department of Pathology, Services Institute of Medical Sciences [SIMS], Lahore during the period April, 2006 to December, 2006. Among the 1814 blood cultures 1382 [76%] were received from pediatrics/ neonatology wards and 432 [24%] from adult patients. In a total of 508 [27.9%] blood cultures, 465 yielded monomicrobial growth and 43 polymicrobial growth. A total of 454 [97.6%] of the monomicrobial growths were bacterial isolates and 11 [2.4%] were Candida Spp. Gram negative bacteria [Enterobacteriaceae + nonfermenter bacteria] comprised the majority of bacterial isolates. Amongst the gram-negative bacteria the most common organism was Klebsiella Spp. while amongst the gram-positive organisms Staph. aureus was the most common isolate. It was seen that 31.25% Staph. aureus isolates were resistant to Oxacillin, 93.7% of Klebsiella Spp. and E. coli isolates were resistant to 3rd generation Cephalosporins and 6.49% of Pseudomonas Spp. and Acinetobacter Spp. whereas resistant to Carbapenems in the present study. As BSI is an emergency, for appropriate management of these cases an updated knowledge about the causative agents and their susceptibility pattern to antibiotics is required to start appropriate empirical antibiotic therapy till the results of the microbiology report are available. The alarming finding is the high resistance seen amongst Enterobacteriaceae against 3rd generation cephalosporins [93.7%], oxacillin resistance among Staph aureus [31.25%] and increasing resistance against Carbepenems among Pseudomonas and Acinetobacter isolates [6.49%]. In conclusion there are grave implications of these findings for our already strained health care system as the presence of these multidrug resistant organisms leads to longer hospital stay, more expensive/ toxic drugs and higher mortality

Methicillin resistant staphylococcus aureus: a study in a tertiary care hospital

This study was carried out to find the frequency of Methicillin Resistant Staphylococcus aureus [MRSA] in a tertiary care hospital. This is a cross sectional descriptive study performed in Pathology Department, Nawaz Sharif Social Security Hospital, Multan Road, Lahore, during the period January, 2008 to December, 2008. Two hundred and thirty three consecutive, non-duplicate strains of Staphylococcus aureus were isolated from a variety of clinical specimens of pus/ pus swab, throat swab, sputum, urine, semen, ear swab, vaginal swab, blood, pleura/fluid and cerebrospinal fluid were studied for Methicillin resistance. Standard methodology using modfied Kirby- Baur disk diffusion method was adopted. Oxacillin [1 micro g disk] was used to detect Methicillin resistance. An inhibition zone of less than 10 mm was taken as indicative of MRSA. Out of 233 Staphylococcus aureus isolates, 81 [34.76%] were found to be Methicillin resistant. The yield of MRSA was highest from pus/ pus swab and sputum samples [40.0%], followed by throat swab [35.71%], urine, blood and pleural fluid [33.33%], semen [30.43%], vaginal swab [27.27%], ear swab [24.0%], and cerebrospinal fluid [20.0%]. The high prevalence of MRSA in our setup should not go without serious concern. Implementation of strict aseptic techniques and suitable antimicrobial policy may reduce the spread of MRSA in our environment

comparison of skin test reactions in patients with allergic and vasomotor rhinitis

Background: Allergic and vasomotor rhinitis are the most common forms of noninfectious rhinitis with similar signs and symptoms. Various environment allergens have been held responsible for allergic type of rhinitis

Aims: To find out the common environmental allergens responsible for sensitivity in patients with allergic rhinitis and compare the findings in vasomotor rhinitis patients

Methods: Ninety subjects were selected for the present study. Out of these, 30 were patients with allergic rhinitis, 30 were patients with vasomotor rhinitis and 30 were healthy subjects as control. Patients were labeled as allergic rhinitis on the basis of eosinophils in nasal smears. Sensitivity to common environmental allergens was determined by skin prick test using Ben Card allergy test kit, strictly following manufacturer's instructions

Results: Common environmental allergens responsible for sensitivity in allergic rhinitis patients were house dust [86.6%], house dust mites [70%], mixed thrashings [80%], straw dust [56.6%], hay dust [66.6%], mixed feathers [43.3%], cat fur [53.3%], cotton flock [50%], tree pollens [40%] and grass pollens [43,3%]. Sensitivity to these allergens was observed in significantly less [p>0.01] percentage of vasomotor rhinitis and control groups. Sensitivity to house dust, house dust mites and cat fur was of severe degree in majority of allergic rhinitis patients. While sensitivity to mixed thrashings, straw dust, hay dust and mixed feathers was of moderate to severe degree in majority of these patients

Conclusion: Skin prick tests provide an effective method to find out sensitivity to different allergens in cases with allergic rhinitis to differentiate these from patients with vasomotor rhinitis. Based on these findings the physicians can manage the patients in better way

Assessment of knowledge, attitude and skills of lady health workers

Government of Pakistan launched National Program for Family Planning and Primary Health Care in 1994. Lady Health Worker has a key role in providing these services. This study was designed to assess the quality of these services. It was a descriptive, cross-sectional study, conducted at District Kohat, Pakistan, in July 2005. Lady Health Workers with a job experience of more than 24 months were interviewed to assess their knowledge, attitude and skills, in terms of variables according to their job description. These variables included home visits, antenatal care, family planning, newborn care, vaccination, growth monitoring, common diseases, medicines and referrals. Fifty lady health workers were interviewed. Knowledge of lady health workers was above 36%, attitude score above 88% and skill assessment score above 86%. Sixty four percent lady health workers had established their health houses. Seven lady health workers showed non-satisfactory results with poor health house management. Much improvement in skills was required in the use of contraceptives. There was poor display of knowledge regarding vaccination schedule and insufficient knowledge 36% for the doses of common medicines. This study opened a window to peep through deficiencies of health system. It showed that most of the LHWs had optimum knowledge and an optimistic attitude. Deficiencies were seen in vaccination and contraception. It is recommended to arrange workshops and courses for LHWs on regular basis to refresh their knowledge

Frequency of hepatitis B and hepatitis C among cataract patients

In Pakistan the frequency of Hepatitis B and C virus infection ranges from 8-15% in the general population with variations in different parts of the country. Patients undergoing any surgical procedure may have these infections, demanding special precautions. The aim of this study was to determine frequency of hepatitis B and C among patients undergoing elective cataract surgery. It was a descriptive study based on survey in which all patients above the age of 25 years, presenting for cataract surgery to Mehmood Eye Hospital, District Dera Ismail Khan, Pakistan were screened for Hepatitis B and C infections, from 1st July 2004 to 31st May 2006. The findings were recorded on a structured compilation sheet and analyzed. Those found positive on screening test were confirmed by Enzyme Linked Immunosorbant Assay [ELISA]. Total number of patients screened was 1130. The frequency of hepatitis B and C [combined] was found to be 5.75%[65/1130]; out of which 3.18% [36/1130] were HBsAg positive and 2.57% [29/1130] anti-HCV positive. Out of them, 39 were males [60%] and 26 females [40%]. The frequency of HBV was 72% [26/ 36] in males and 28% [10/36] in females. The frequency of HCV was 45% [13/29] in males and 55% [16/29] in females. The proportion of HBsAg to anti-HCV was 55%[36/65] to 45% [29/65]. The frequency of hepatitis B and C [combined] was more in age group ranging between 45 - 74 years, in both sexes. The frequency of hepatitis B among age groups 25 - 34, 35 - 44, 45 - 54, 55 - 64, 65 - 74 and 75 years and above was 3% [1/36], 6% [2/36], 17% [6/36], 33% [12/36], 28% [10/36], and 13% [5/36], respectively. The frequency of hepatitis C among age groups 25 - 34, 35 - 44, 45 - 54, 55 - 64, 65 - 74 and 75 years and above was 3% [1/29], 3% [1/29], 10% [3/29], 38% [11/29], 28% [8/29], and 18% [5/29] respectively. The frequency of hepatitis B and C [combined] among urban and rural populations was 45% [29/65] and 55% [36/65] respectively. One of the interesting findings was that none of the patient was found to be suffering simultaneously from both hepatitis B and C. The prevalence of HBsAg and anti-HCV in patients presenting for surgery is high, requiring routine preoperative screening of all the patients

Staphylococcus aureus and MRSA nasal carriage in general population

Assessment of Staphylococcus aureus [S. aureus] and MRSA nasal carriage in our general population. Cross-sectional analytical study. A private Pathology Laboratory in Lahore city from January 2002 to December 2003. Nasal swabs were obtained from the apparently healthy persons accompanying the patients attending the laboratory. These swabs were inoculated on blood and mannitol salt agar plates and incubated at 37°C. The isolate[s] were identified as S. aureus on the basis of colony morphology, Gram staining, catalase and coagulase tests. Sensitivity to Oxacillin was determined using standard Kirby Bauer technique. Nasal swabs from 1660 subjects from the community were studied. Out of these samples, a total of 246 [14.82%] samples were positive for growth of S. aureus [nasal carriers of S. aureus]. Out of 246 S. aureus isolates, 48 [19.51%] isolates were methicillin resistant S. aureus [MRSA]. Nasal carriage was higher in males [15.47%] as compared to females [13.26%], in urban areas [16.99%] as compared to rural areas [11.32%] and in the year 2002 [16.02%] as compared to year 2003 [13.08%]. However, the difference was significant only for the urban vs. rural comparison [p<0.05]. MRSA isolates were also significantly higher among S. aureus isolates from the nasal cavities of urban subjects [22.98%] as compared to rural ones [11.11%]. Maximum nasal carriage was present in the age group upto 9 years [20.23%] with decrease in the age groups 10-19, 20-29 and 30-39 years followed by small rise in the older subjects. The nasal S. aureus carriage as well as methicillin resistance among these isolates are more common in urban community

Awareness about causes of gastrointestinal tract [GIT] malignancies

To determine the knowledge of doctors, nurses, patients and public about the causes of gastrointestinal cancers and dissemination of this knowledge. Design: A cross-sectional analytical study. Place and Duration of Study: This study was carried out in the Department of Oncology, King Fahad Hospital, Al-Madinah Al-Munawara, Kingdom of Saudi Arabia and was completed in four months from February 2003 to June 2003. Subjects and About 200 doctors, nurses and patients suffering from GIT cancer and general public were selected. Each subject was asked to fill up a proforma designed to assess his knowledge about the risk factors for GIT malignancies. A majority of doctors and nurses had good knowledge about the causes of GIT malignancies. The knowledge of patients and general public was low. Out of all four groups, it was poorest in the patient's group. The difference in the knowledge of medicos and patients/public reflects that medicos should convey this knowledge to the patients in particular and general public in general, which is their responsibility besides medical treatment

Qualitative assessment of bacteriological quality and chlorination status of drinking water in Lahore

Qualitative assessment of bacteriological quality and chlorination status of drinking water in Lahore. Design: Descriptive study. Place and Duration of Study: Lahore city from October 2000 to September 2001. Materials and A total of 2160 water samples from distribution system were tested from nine different localities of Lahore. These localities represented areas with different socioeconomic conditions [SEC]. Twenty water samples were tested from each locality from the same taps each month. All the water samples were subjected to H2S strip test for determination of bacteriological contamination as well as orthotolidine test for detection of chlorine. Four hundred and forty-six [20.64%] samples were positive for bacterial contamination. It was observed that contamination was the maximum in low SEC areas [32.22%], followed by intermediate SEC areas [18.47%] and high SEC areas [11.25%]. The difference was found to be statistically significant [p<0.01] among different areas. Only 27.73% samples were chlorinated. Positivity of samples for chlorine was the lowest in areas with low SEC[20.69%] and highest [32.77%] in areas with high SEC, the difference being statistically significant. Maximum contamination was present in samples tested during summer months[June-August] of the year [31.11%], followed by autumn months [September-November] of the year [20.9%], spring months [March-May] of the year [18.7%] and winter months [December-February] of the year [11.85%]. Samples tested during summer months showed the highest positivity [77.96%] for chlorine [p<0.001] as compared with other months of year. Among chlorinated samples 12.32% showed bacterial contamination. However, contamination was significantly higher [p<0.001] among non-chlorinated samples. Bacterial contamination of piped water is a significant problem in Lahore. Regular chlorination and monitoring of water supplies can improve it

Antimicrobial resistance of community and hospital acquired staphylococcus aureus isolates to oxacillin and glycopeptides

To determine sensitivity pattern of Staphylococcus aureus isolates from the community and hospitals to methicillin, glycopeptides and other antimicrobial agents. Design: Descriptive study. Place and Duration of Study: Private Pathology Laboratory in Lahore from January 2001 to April 2002. Subjects and A total of 714 Staphylococcus aureus [S.aureus] isolates from the community and hospital were tested. Community acquired S.aureus strains [n=434] were isolated from specimens like pus from boils/pimples and nasal swabs of patients with asthma attending a local allergy clinic. The hospital acquired S.aureus [n=280] were isolated from specimens like pus from wounds/discharging sinuses, ear swabs, blood and urine. All the isolates were subjected to sensitivity test against Oxacillin, Vancomycin, Teicoplanin, Penicillin, Imipenem, Cefipime and other anti-staphylococcal agents by standard Kirby-Bauer disk diffusion method. Beta lactamase production by all the isolates was also determined by acidimetric test. Significantly higher number of hospital acquired S.aureus isolates [p<0.01] were beta lactamase producing [96.07%] as compared to community acquired [81.79%]. Methicillin [Oxacillin] resistance was also higher among hospital strains [31.1%] as compared to community ones [14.1%]. No isolate from the community showed resistance to glycopeptides. While 0.3% and 0.7% of all S.aureus isolates were interpreted as resistant to Vancomycin and Teicoplanin respectively as there was no zone of inhibition. The resistance to these drugs was a bit higher among the MRSA [1.1% and 2.3% respectively]. More than 90% of nosocomial MRSA strains were sensitive to Ofloxacin and Fucidic Acid. Resistance to Erythromycin, Lincomycin and Gentamicin was 70.1, 33.3 and 39.1% in that order. In general resistance to different antimicrobial was lower among S.aureus strains of community origin as compared to those of hospital origin. Methicillin and multiple drug resistance is quite a significant problem in nosocomial as well as community acquired S.aureus strains. Moreover, it appears that resistance to glycopeptides has also emerged in our nosocomial S. aureus strains. Microbiology laboratories should make efforts not only to regularly screen S.aureus isolates for sensitivity to glycopeptides but also to determine MIC of the isolates