Percutaneous dilatational tracheostomy: a prospective analysis about the safety of procedure among ICU patients

Objective: To evaluate the percutaneous dilatational tracheostomy procedure safety among the critically ill Medical ICU patients

Methodology: The study was descriptive and conducted in Medical ICU, Department of Pulmonary and Critical Care Medicine, Services Institute of Medical Sciences, Lahore, from February 2015 to May 2016. Fifty three Medical ICU patients underwent tracheostomy procedure through percutaneous dilatational technique using both Grigg's and Ciaglia's methods. Procedure was performed at bed side using local anesthesia, sedation and systemic analgesia, under bronchoscopic guidance. Patients were monitored for intraprocedural and postprocedural complications like: hemorrhage, stomal infection, injury to adjacent structures, arrhythmias, transient hypoxemia, transient hypotension, paratracheal insertion, pneumothorax, sub-cutaneous emphysema, loss of airway, accidental decannulation, tracheal ring fracture and new lung infiltrate or atelectasis

Results: A total of 53 procedures were performed. Intraprocedural complications included: Transient hypoxemia 4/53 [7.5%] and hypotension 3/53 [5.6%], hemorrhage 3/53 [5.6%] and one case of paratracheal placement. No procedure related mortality was noted. 10 patients died during the ICU stay due to the primary underlying disease and one patient died after a successful decannulation. 36 patients had uneventful decannulation. Six patients were directly discharged from ICU

Conclusion: Percutaneous dilatational tracheostomy is a safe procedure with low complications rate and suitable for critically ill ICU patients

Antibacterial activity of different plant extracts and antibiotics on pathogenic bacterial isolates from wheat field water

The present work was carried out to study bacterial pathogens isolated from wheat field water and also effect of some plant extracts on these bacterial pathogens. Five bacterial strains were isolated from wheat field water. Different morphological and biochemical tests were performed to identify and characterize bacterial pathogens. Among isolated strains two belonged to genus Staphylococcus sp., other two were Pseudomonas spp. and one strain belonged to genus Salmonella sp. Effect of various parameters such as temperature, pH, antibiotics and heavy metals of these pathogens were also studied. Optimum temperature for all bacterial strains was 37°C and optimum pH was 7 except strain 3 which had pH 6. Different antibiotics with different potency were applied to check the resistance of bacterial strains against them. Among these antibiotics Cloxacillin and Teicoplanin were most potent while Oxacillin was as less potent antibiotic because three bacterial strains were resistant against it. While remaining antibiotics proved as potent. Seven heavy metals which were zinc [Zn[+2]], copper [Cu[+2]], Ferrous [Fe[+2]], mercury [Hg[+2]], Nickel [Ni[+2]], chromium [Cr[+2]]and cobalt [Co[+2]] with different concentrations were applied to bacterial strains. Minimum inhibitory concentration of heavy metals for all bacterial was different. Different plant extracts [Artemezia incise, Colebrookia oppositifolia, Rhynchosia pseudocajan] checked for their antibacterial activity against these pathogens. These plant extracts showed antibacterial activity against antibiotic and metal resistant bacterial isolates

Effect of medicinal plants, Heavy metals and antibiotics against P pathogenic bacteria isolated from raw, Boiled and pasteurized milk

Present study has been undertaken to isolate and identify the bacterial flora in raw, boiled and pasteurized milk. Agar disc diffusion method was used to determine their sensitivity using medicinal plants, antibiotics and heavy metals. Methylene blue reduction test was used to test the quality of milk samples. Total 10 pathogenic strains were isolated, five strains were isolated from raw milk, three from boiled milk and 2 two from pasteurized milk. To determine optimum conditions for growth, these pathogenic microorganisms were incubated at various temperatures and pH. Gram's staining and biochemical tests revealed that these pathogenic bacteria include Lactobacillus sp., E. coll, Salmonella sp., Pseudomonas sp., Streptococcus sp. and Staphylococcus. Ribotyping revealed S2 as Pseudomonas fluorescens, S5 as Lactococcus lactis and S9 as Lactobacillus acidophilus. Prevalence of pathogenic organisms provided the evidence that contamination of milk arises during milking, transportation and storage of milk. Raw milk is more contaminated than other two types of milk because it contains highest percentage of pathogenic organisms and pasteurized milk was found to be of best quality among three types. So it is recommended to drink milk after proper boiling or pasteurization. Proper pasteurization and hygienic packing of milk is essential to minimize contamination in milk which can save human beings from many milk borne diseases. Our study suggests that antimicrobial use in animal husbandry should be minimized to reduce the hazard of antibiotic resistance. Plant extracts are better alternative against pathogenic bacteria in milk