Synergistic effect of antibiotics against bacterial pathogens causing diarrhea isolated from children <5 years of age

Background: Infant mortality rate due to diarrhea is high in Pakistan. The alarming increase in antimicrobial resistance of bacterial pathogens causing diarrhea has made the treatment more complicated. This study was designed to determine the in vitro synergistic [combined] effect of different antibiotics against these pathogens in order to determine whether the combined antibiotic therapy may be used to treat diarrhea

Objectives: To study the antibiotic resistance pattern of bacterial pathogens causing diarrhea isolated from children <5 years. To study the synergistic effect of antibiotics against bacterial pathogens causing diarrhea. Study design, settings and duration: A cross sectional study conducted at Pakistan Health Research Council [PHRC], Jinnah Postgraduate Medical Center and National Institute of Child Health, Karachi over a period of twenty months

Materials and Methods: Bacterial pathogens including Salmonella, Shigella, Vibrio, Escherichia coli and Aeromonas causing diarrhea were collected. Their sensitivity and resistance pattern was performed by disk diffusion method and combined the effect of existing antibiotics including ampicillin [AMP], cefotaxime [CTX], Cefixime [CFM], Co-trimoxazole [SXT] and Ofloxacin [OFX] was performed by checkerboard method. The study was approved by Ethical Review Board of National Institute of Child Health, Karachi

Results: Most of the combinations showed indifferent and antagonistic activity against bacterial pathogens causing diarrhea. But only AMP-SXT and CFM-OFX yielded synergistic activity against Vibrio and Aeromonas respectively. AMP-CFM and AMP-OFX exhibit synergistic effect against Escherichia coli while no combination of antibiotics proved as synergistic for Salmonella and Shigella

Conclusion: Little synergistic activity of different antibiotic combinations was observed against diarrheal isolates and most of the combinations exhibited indifferent and antagonistic activity. Hence this can be concluded that single antibiotics are effective than combination

Correlation between hyperhomocysteinemia and common carotid artery intima media thickness in carbamazepine treated epileptic patients using ultrasonography

Objective: The objective was to assess the role of homocysteine in the development of atherosclerosis in common carotid artery in the carbamazepine treated epileptic patients

Methods: This study was conducted in the Department of Biochemistry, Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Center [JPMC], Karachi. Three hundred individuals, aged 34 +/- 9.5 years were selected and divided into three groups. Each group comprised of 100 subjects labeled as Group-A [control group had healthy individuals], Group-B [newly diagnosed epileptic patients without antiepileptic therapy], Group-C [epileptic patients on Carbamazepine therapy, which was further subdivided into C-l having epileptic patients on Carbamazepine therapy less than 1 year n=33, C-ll had epileptic patients on Carbamazepine therapy 1-2 years n = 33 and C-lll comprised of epileptic patients on Carbamazepine therapy more than 2 years n = 34]. Blood concentration of homocysteine was measured and ultrasound of Common Carotid Artery for intima-media thickness was performed

Results: Significantly elevated level of homocysteine was observed in epileptic patients on CBZ therapy. Common Carotid Artery Intima-media thickness [CCAIMT] was observed significantly high throughout group Cbut it was more profound in Group-C-lll. Homocysteine was found positively correlated with right CCA IMT, left CCA IMT and mean CCA IMT

Conclusion: Hyperhomocysteinemia was linked with increased risk of atherosclerosis in CBZ treated epileptic patients

Comparison of single versus double plate fixation in inter and supracondylar fractures of distal humerus in adults

To compare the outcome of supracondylar and intercondylar fractures of humerus treated by single and double plates. Comparative study. This study was conducted in the Department of Orthopaedics, Lahore General Hospital, Lahore and Department of Orthopaedic and Trauma Hayatabad Medical Complex Peshawar. Thirty patients of intercondylar and supracondylar fractures of distal humerus were divided randomly into two groups. Fifteen cases were managed by single plate and K wire and 15 cases by bicondylar plate fixation. All patients were operated through posterior transolecranon approach. Elbow exercises were started at second postoperative day. Patients were followed at two weeks and thereafter monthly, with clinical examination and x-rays. The mean age of the patients was 40.3 years. The healing time was sixteen weeks in both the groups. The final grading of the results showed better resulted with double plate fixation with excellent to good results in 13 [86.6%] and fair to poor in 2 [13.3%]. The outcome in single plate was excellent to good in 6 [40%] and fair to poor in 9 [60%]. The results of dual plate fixation is better than single plate fixation in intercondylar and supracondylar fractures of humerus