Antibacterial and anti-biofilm activity of the lipid extract from Mantidis ootheca on Pseudomonas aeruginosa / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

The aim of this study is to assess the antibacterial and anti-biofilm properties of the lipid extract from Mantidis ootheca against the gentamycin resistant Pseudomonas aeruginosa. The chemical composition of the lipid extract and its relative proportion were determined using the technique of gas chromatography coupled with mass spectrometry (GC-MS). Antibacterial susceptibility tests were performed using a disc diffusion assay and the minimum inhibition concentration (MIC) was determined by way of the agar dilution method. The anti-biofilm test was carried out with crystal violet staining and scanning electron microscopy (SEM). There were 16 compounds detected, and the most abundant components were sesquiterpenoids, monoterpenes, and trace aromatic compounds. The MIC for P. aeruginosa was 4 mg/ml and the eradication effect on preformed biofilms was established and compared with a ciprofloxacin control. The results of our study indicated that a lipid extract from M. ootheca could be used as a topical and antibacterial agent with anti-biofilm activity in the future.

Lack of uniformity in screening, diagnosis and management of gestational diabetes mellitus among health practitioners across major cities of Pakistan

Objective: To determine knowledge, attitude and practice [KAP] regarding management of Gestational Diabetes Mellitus [GDM] among Health Care Providers in major cities of Pakistan

Methods: A knowledge, attitude and practice [KAP] questionnaire based study was conducted in major cities in Pakistan from health care providers in public and private hospitals and clinics. Questionnaires were provided to the health care providers regarding screening, diagnosis and management of patients with GDM. Data analysis was done using IBM SPSS 20

Results: A total of 210 doctors took part in the study. 55[26%] reported using fasting blood glucose as screening test for GDM whereas 129[61.4%] respondents used Oral Glucose Tolerance based WHO criteria for diagnosing GDM. Thirty six [17%] and 98[46.7%] doctors referred their patients to Gynecologists. For treating GDM, 64[30.5%] doctors prescribed insulin [NPH/Regular, 70/30 Mix]. 112[53.5] doctors used combination of capillary glucose by glucometer and plasma blood glucose tests for monitoring of glycemic control of patients with GDM

Conclusion: There is lack of agreed screening tests and criteria for diagnosis and management of GDM patients. Doctors need to be educated to follow evidence based diagnostic and management guidelines so that GDM patients can be effectively managed. Recently released South Asian Federation Societies and Pakistan Endocrine Society guidelines could be much needed consensus guidelines for doctors to apply in their daily practice to improve GDM diagnosis and treatment

Philadelphia Chromosome Positive Chronic Myelogenous Leukemia In Childhood: A Rare Case Report

CML is a clonal hematopoietic stem cell disorder. As per WHO classification, CML is included in Myeloproliferative disorder. Adult type - CML is rare in childhood constituting about 3% of childhood leukaemia. We have reported such a case in a 7yr old male child. Peripheral blood smear and bone marrow revealed features of chronic myeloproliferative disorder and cytogenetic analysis has proved Ph chromosome positivity. We report one such case of Philadelphia positive CML in a 7 year old male patient with chief complaints of fever on & off since 4-5 months and sense of abdominal fullness since 1 month, on examination pallor was found with mild hepatomegaly and moderate splenomegaly. The clinical differential diagnosis was malaria, storage disorder or tropical splenomegaly. Though biological behaviour and prognosis are identical to that of adult type, we are reporting this case because of its extremely uncommon incidence.

Analysis of hemoglobin electrophoresis results and physicians investigative practices in Saudi Arabia.

BACKGROUND AND OBJECTIVES: Riyadh and central province falls in a moderate prevalent zone of hemoglobinopathies in Saudi Arabia. However, it has been observed that the physicians working in Saudi Arabia invariably advise all cases of anemia for hemoglobin electrophoresis (HE). The present work was carried out to study the yield of the HE in Riyadh and the investigative practices of the physicians advising HE. SETTINGS AND DESIGN: The study was carried out in the hospitals of King Saud University from 2009 to 2011 in order to assess the yield of HE in referred cases of clinical anemia. MATERIALS AND METHODS: A total of 1073 cases divided in two groups of males and females had undergone complete blood count and red blood cell morphology. Cellulose acetate HE was performed and all the positive results were reconfirmed on the high performance liquid chromatography (HPLC). The results were analyzed for the type of hemoglobinopathies. For statistical analysis Statistical Package for Social Sciences 15 version (SPSS Inc., Chicago, IL, USA) was used. RESULTS: A total of 405 males and 668 females blood samples were included in the present study. 116 (28.5%) males and 167 (25%) females showed an abnormal pattern on HE. The incidence of beta thalassemia trait was higher in females while sickle cell trait was predominantly seen in males. Red cell indices were reduced considerably in thalassemias, but were unaffected in sickle cell disorders, except those which had concurrent alpha trait. The total yield of HE was 26.6% which was much less than expected. CONCLUSION: The physicians are advised to rule out iron deficiency and other common causes of anemia before investigating the cases for hemoglobinopathies, which employs time consuming and expensive tests of HE and HPLC.

A comparative study of hematological parameters of α and β thalassemias in a high prevalence zone: Saudi Arabia.

BACKGROUND AND AIMS: Saudi Arabia falls in the high prevalent zone of αα and β thalassemias. Early screening for the type of thalassemia is essential for further investigations and management. The study was carried out to differentiate the type of thalassemia based on red cell indices and other hematological parameters. MATERIALS AND METHODS: The study was carried out on 991 clinically suspected cases of thalassemias in Riyadh, Saudi Arabia. The hematological parameters were studied on Coulter STKS. Cellulose acetate hemoglobin electrophoresis and high-performance liquid chromatography (HPLC) were performed on all the blood samples. Gene deletion studies were carried out by restriction fragment length polymorphism (RFLP) technique using the restriction endonucleases Bam HI. STATISTICAL ANALYSIS: Statistical analysis was performed on SPSS 11.5 version. RESULTS: The hemoglobin electrophoresis and gene studies revealed that there were 406 (40.96%) and 59 (5.95 %) cases of β thalassemia trait and β thalassemia major respectively including adults and children. 426 cases of various deletion forms of α thalassemias were seen. Microcytosis was a common feature in β thalassemias trait and (-α/-α) and (--/αα) types of α thalassemias. MCH was a more significant distinguishing feature among thalassemias. β thalassemia major and α thalassemia (-α/αα) had almost normal hematological parameters. CONCLUSION: MCV and RBC counts are not statistically significant features for discriminating between α and β thalassemias. There is need for development of a discrimination index to differentiate between α and β thalassemias traits on the lines of discriminatory Indices available for distinguishing β thalassemias trait from iron deficiency anemia.

Determination of neuron specific enolase [NSE] in small cell lung carcinoma [SCLC] and non-small cell lung carcinoma [NSCLC] patients

Neuron specific enolase [NSE] is routinely used as tumor marker in Small cell lung carcinoma [SCLC], and to some extent in non-small cell lung carcinoma [NSCLC]. In Pakistan, tumor marker technology is not a new one. It is however mostly directed towards uses in hepatic, breast, ovarian, uterine and colorectal cancers, whereas availability and general practice of its use for diagnosis of respiratory metastasizing disease such as lung cancer is seldom and rare, especially the SCLC/NSCLC specific NSE. The aim of present study is to determine the potential usefulness of NSE in diagnosis and prognosis of SCLC and NSCLC patients in our setting. Fifty-eight patients of lung cancer were identified and selected, between January 2004 to December 2007, and divided into various groups depending upon their clinical stage of disease. NSE level was determined in all patients and clinical history data and related pathophysiological components of all selected patients were carefully assessed and compulsorily followed to avoid any bias. Cancer status of patients were evaluated by data available from multiple bronchoscopies, X rays, cytology and histopathology examinations and grouped as SCLC with all five stages [I, II, IIIA, IIIB and IV] and NSCLC with only stage IV. NSE level was also determined in Healthy subjects and patients with non-malignant lung diseases [NMLD] for comparison. We observed significant elevation in levels in NSE for different stages of SCLC and NSCLC in comparison with healthy and NMLD groups. Most significant increase was noted in SCLC stage IV not only in comparison with healthy [P <0.001] and NMLD groups [P < 0.001] but also with stage I [P <0.001] within the group. Elevated difference in NSE levels was also correlated with stage II, IIIA and IIIB of SCLC group. As regard NSCLC, where patients belonged only to stage IV of disease, significant difference was observed with healthy [P <0.01] when compared with NSCLC, whereas non-significant difference in NSE levels was noted in group-SCLC stage II, IIIA and IIIB. In comparison, all stage IV patients [n=7] of SCLC exhibited higher levels of NSE with a range of 136.19 ng/ml to 175.01 ng/ml, higher than detected in patents of stage IV in NSCLC. The result of our study suggests that NSE appears to be a useful tumor marker for SCLC and to some extent, NSCLC. Moreover, NSE exhibits higher levels in some stages of SCLC suggesting, its specificity, not only for advanced stage of SCLC but also for SCLC in general as compared to NSCLC. Its determination, therefore, is beneficial in the diagnosis, treatment and a possible follow-up for patients survival

Assessment of sub-clinical hypothyroidism and hyperthyroidism status in adult patients

Generally sub-clinical hypothyroidism and hyperthyroidism are diagnosed on the basis of laboratory evaluation and mostly such patients' manifest with mild or devoid of any clinical signs or symptoms. It is known to be a common disorder, also refer to as sub-clinical thyroid disease particularly in middle-aged and elderly individuals. Moreover, it is reported that most patients who were found to have sub-clinical hyperthyroidism depicts TSH values between 0.1 to 0.45 micro IU/L and those with sub clinical hypothyroidism between 4.5 to 10 micro IU/L. In this respect, studies were carried out during January 2006-Dec 2007 in 230 adult patients [98 males, 132 females] for evaluation of sub-clinical thyroid disease. TSH and thyroid hormones [T3 T4, FT3 and FT4] levels of all patients were determined by standard methods to assess the extent of the sub-clinical status. In female group which comprised of 132 patients, a total of n =28 [21.20%] exhibited sub-clinical thyroid disorders [n = 18; 13.63% Sub-clinical hypothyroidism, n=10; 7.57% sub-clinical hyperthyroidism], whereas 59 [44.69%] exhibited true-thyroid disorder. Subsequent assessment in males shows that out of 98 patients; n = 15 patients [15.30%] showed sub-clinical thyroid disorders [n = 9; 9.18% sub-clinical hypothyroidism; n = 6; 6.12% sub-clinical hyperthyroidism], whereas 20 [20.40%] without any sub-clinical or true thyroid disease, respectively and thus presented as normal. It is concluded that sub-clinical thyroid dysfunction prevails in females with 12.17% occurrence whereas 6.52% in males. Furthermore, the evaluation and subsequent review of existing literature and reports, it is also advisable that routine screening for thyroid disease through clinical investigations aided with lab findings be promoted, especially in pregnant women

Hepatitis 'B' and 'C' viral infections in patients with hepatocellular carcinoma

Chronic exposure to Hepatitis B and C viral infections are strongly suspected of causing hepatocellular carcinoma [HCC]. Moreover, in considerable numbers of HCC cases, the patients found positive for Hepatitis infections. The development HCC is related to the integration of viral DNA into the genome of host hepatocytes. It is noted that African and Far East counties, where HCC is common, have high rates of hepatitis carriers, probably with vertical transmission, of viruses from generation to generations. The scope of present study is to evaluate the incidence of HBV or HCV infections in patients with HCC. A brief clinical history of 98 patients [Males; n = 59, Females n = 39] with confirmation of HCC along with base-line value of alpha-fetoprotein [AFP], is taken and cumulated. In all patients, AFP values were found to be elevated ranging from 15 to 1329 ng/ml in males [mean 184.82 +/- 39.26 ng/ml] and 17.00 to 1218 ng/ml in females [mean 179.26 +/- 41.11 ng/ml] with relevant clinical data. It was noted that in most of the confirmed cases of HCC, hepatitis infections of HBV and HCV origin is prevalent. In male HCC patients, 19 were diagnosed with HBV whereas 21 with HCV infection. In females 12 HCC patients were HBV positive and 14 with HCV. Remaining patients were investigated thoroughly for any infection, but found devoid of any. However, cirrhosis of biliary origin, haemochromatosis cystic fibrosis and drug-induced cirrhosis are persistent infections. The results are presented in relation to various risk factors, and clinical and diagnostic characteristic

Evaluation of urinary protein to creatinine ratio as a predictor of end-stage renal disease

To evaluate the role of urinary protein to creatinine [P:C] ratio as a predictor of end-stage renal disease [ESRD] in renal failure patients. This study was conducted at Liaquat National Medical College and Hospital, Karachi from Jan-Dec 2006 on 121 patients [77 males, 44 females] with acute renal failure [ARF] and chronic renal failure [CRF]. Clinical history, relevant investigations, renal status, dialysis routine and frequency were recorded. Random Urine samples [single void] were collected and the P:C ratio were calculated. Out of 121 patients, 21 patients developed ESRD including 16 males [12 CRF, 4 ARF] and 5 females [all CRF]. Statistical analyses shows no significant difference between sum of P:C ratio of CRF and ARF patients. However moderate significance [P < 0.05] was noted among P:C ratio of ESRD patients when compared with males CRF and ARF groups. Similarly, female groups also showed non-significant difference, whereas ESRD patients [FCES], depicts moderate [P < 0.05] significance when compared with female CRF and ARF groups. P:C ratio of males and females ESRD groups showed no significance difference. Mean P:C ratio in male CRF end stage category was 4.12 +/- 0.82 [range 2.5 - 9.1] where as in male ARF end stage 3.78 +/- 1.67 [range 1.80- 7.12]. Mean P:C ratio in female CRF end stage category was 3.94 +/- 0.79 [range 1.76 - 5.98]. Patients with > 1.0 of P:C ratio has developed ESRD. Higher the ratio of P:C, the more was risk of deterioration of clinical condition

Pin tract care in locally made external fixators: a new treatment protocol

To calculate the frequency of pin tract infection in locally made external fixator pins using our set protocol. Descriptive study. This study was conducted in Combined Military Hospital Sialkot and Combined Military Hospital Quetta over a period of 3 years and 6 months from May 2003 to November 2006. A total of 451 Pin tracts from 50 external fixator were studied in forty nine patients. Inclusion criteria was all external fixator pins to the limbs excluding the skeletal tractions. Local Shanz screws and Kirschner wires of two different sizes were studied. The protocol was twice a day cleaning of pin tracts with povidone iodine [pyodine], twice a week soap and water bath with soft brushing where main wound was healed. At the time of removal of fixator the pin tracts were curetted and washed with 0.9% normal saline. Average age of the patients was 32.91 years most of them were young males, 23 [47%] in 3rd and 4th decade. Only 4 [8.1%] were females. Tibia was most commonly involved bone in 38 patients [77.5%], while femur in 6 patients [12.2%] and foot and upper limb were affected in only a few cases. Road traffic accident was most common etiology in 33 [67.34%] patients either presenting as open fractures or infected nonunion. Out of 451 pin tracts, 233 [51.66%] were locally made shanz screw half pins and 218 [48.33%] were locally made Kirschner wires full pins. The mean fixator time was about 17 weeks with maximum 48 weeks and minimum 7 weeks. Maximum follow up was 12 months minimum follow up was 3 months after removal of fixator. We had 25 [10.72%] minor pin tract infections of shanz screws, 5 [2.29%] minor pin tract infections of kirschner wires. We had to remove and change 3 [1.28%] Shanz pins. We had no true complication. Standardizing a set protocol for pin tract care irrespective of wound type has shown excellent results with minimum morbidity. This simple method not requiring any expensive equipment can be tried in any hospital to avoid pin sores

Role of FNAC and antithyroid antibodies in the diagnosis of thyroid disorders.

Multiple parameters are needed to diagnose thyroid disorders. 100 cases of thyroid swellings were studied by clinical assessment, hormonal assay, fine needle aspiration cytology (FNAC), antithyroglobulin (Tg) and antimicrosomal (Tm) antibodies and histopathology. The cases were divided into four groups. Cases of thyroiditis on FNAC showed predominance of lymphocytes (76%), hurthle cells (77%), epithelioid cells and giant cells (31%) and high titres of Tg (66%) and Tm (92%). Non toxic goitre was characterized by colloid and foam cells (100%) and low positivity for Tg and Tm (25%). Toxic goitre showed colloid (30%). Hurthle cells, anisonucleosis of acinar cells (38%), fire flare (62%) and high positivity for Tg and Tm (73%). Neoplasia was diagnosed mainly by cell morphology on FNAC and a low positivity for Tg and Tm (30%). FNAC in correlation with thyroid antibodies is useful in diagnosing autoimmune thyroiditis, goitre, Grave's disease and malignancy of thyroid. Antibodies have a specific role in the diagnosis of early stage of thyroiditis.