Seroprevalence of hepatitis B and C infections among young adult males in Pakistan

This descriptive, cross-sectional study was conducted at 2 military hospitals in Pakistan from January 2004 to December 2005. Young adult males with age range 17-22 years from different districts of Pakistan were screened for hepatitis B surface antigens [HBsAg] and anti-hepatitis C antibodies [anti-HCV]. Out of 5707 young men tested, 95 [1.70%] were positive for anti-HCV and 167 [2.93%] for HBsAg. Although both viruses were distributed evenly throughout Pakistan, seroprevalence was higher in the provinces of Punjab and Sindh than in North-West Frontier province and Baluchistan and Azad Kashmir provinces. Health education to the general public, including barbers, would be an important tool for control/preventive measures

effect of fasting on QT Interval

QT interval reflects the total duration of ventricular depolarization and repolarization in the ECG. Experimental hypoglycaemia and spontaneous clinical episodes of hypoglycaemia lead to the lengthening of the heart rate corrected QT interval or QTc. This is associated with elevated risk of sudden death. To find out the effect of fasting blood glucose levels on QT interval and the corrected QT interval [QTc]. Fasting and post prandial blood glucose levels and ECG of healthy young adults were studied and QT interval, RR interval and QTc were determined. The fasting QTc came out to be 0.408 +/- 0.020 as compared to the post prandial value of 0.380 +/- 0.019. The student's t test showed a highly significant value [p<0.0001]. There is significant prolongation of QT interval and QTc during fasting but within normal physiological limits

Histopathological changes in the gastric mucosa with long-term use of a percutaneous gastrostomy tube [PEG]

Of 95 randomly selected patients using a percutaneous gastrostomy tube [PEG], 20 required tube replacement at least six months after the initial placement. In order to study the possible histopathological changes that might develop in the gastric mucosa with the prolonged use of PEG, gastric biopsies were taken during the replacement procedure. The overall procedure-related minor complication rate was 16.84%; the predominant complication was superficial peristomal wound infection. Other minor complications were tubal migration into the small bowel, surgical emphysema and stomal leak. Histopathological changes seen in six patients showed mild chronic nonspecific gastritis, the predominant cells being lymphocytes and plasma cells. There was no dysplasia or metaplasia. PEG is a safe method of feeding that does not predispose to significant gastric mucosal changes with long-term use. It has a low rate of morbidity even with markedly debilitated patients

Changing trends in drug resistance among typhoid salmonellae in Rawalpindi, Pakistan

We analysed the record of blood cultures carried out at the Armed Forces Institute of Pathology, Rawalpindi between 1996 and 2003. We isolated 477 Salmonella typhi and 410 S. paratyphi A from blood of patients suffering from typhoid fever. We observed a significant shift in the distribution and antimicrobial susceptibility of typhoid salmonellae. The isolation rate of S. typhi fell significantly while S. paratyphi A is emerging as a major pathogen. Resistance to conventional antityphoid drugs in S. typhi decreased dramatically from 80% to 14%, while in S. paratyphi A resistance increased from 14% to 44%. Susceptibility to the fluoroquinolones decreased in both. No resistance to third generation cephalosporins was detected

Clinical characteristics of Crohn's disease in Qater

To assess the clinical characteristics of Crohn's disease [CD] in Qatar. This is a retrospective descriptive study. We studied 50 CD patients admitted to Hamad General Hospital over a period of 8 years from January 1995 to December 2002. We retrospectively collected and analyzed the demographic and clinical data. We made the diagnostic classification of definite CD in accordance with the criteria based on the International Classification of Disease ninth revision [ICD-9]. We based the obtained information on the following parameters: the age at the time of admission, gender and Crohn's risk factor profiles. Of the studied population, 60% were males and 40% females. Sixty-two percent were Qataris and 38% expatriates. Most of the subjects were <40 years of age [80%]. Fifty-two percent had ileo-colonic disease, 24% colonic and 24% ileal disease. The majority of the Crohn's patients had the symptom of abdominal pain [84%], followed by weight loss [80%] and diarrhea [70%]. Pallor sign was most frequent in patients with inflammatory CD [76.9%] and obstructive CD [66.7%], whereas we found the anal signs in patients with fistulas [84.2%]. The study showed a relatively high frequency of ileo-colonic Crohn's disease compared to colonic and ileal diseases. We observed that the most frequent symptom is abdominal pain

Rapid detection of rifampicin susceptibility of mycobacterium tuberculosis in sputum specimens by mycobacteriophage assay

To evaluate the performance of FASTPlaqueTB-RIF TM, a newly introduced bacteriophage assay for rapid detection of rifampicin susceptibility of Mycobacterium tuberculosis in sputum specimens. A comparative study of 40 sputum specimens from patients of pulmonary tuberculosis, using FASTPlaqueTB-RIF TM and Bactec 460 TB system carried out at the Armed Forces Institute of Pathology, Rawalpindi between September and November 2001. Of the 40 clinical isolates of Mycobacterium tuberculosis tested for rifampicin [RIF] susceptibility using the Bactec 460 TB system, 28 isolates were resistant to RIF and 12 isolates were susceptible. FASTPlaqueTB-RIF TM identified 24 specimens as resistant to RIF. Three specimens that revealed susceptible isolates on Bactec 460, were resistant by FASTPlaqueTB-RIF' while four specimens which revealed resistant isolates on Bactec 460, demonstrated susceptibility to RIF by FASTPlaqueTB-RIF TM. The sensitivity and specificity of FASTPlaqueTB-RIF TM were 86% and 73% respectively. The predictive values of positive and negative tests were 0.89 and 0.67 respectively. The overall accuracy of the technique was 82%. The phage assay took 48 hours to perform. Early detection of rifampicin resistance by the mycobacteriophage technique direct from sputum specimens is a potentially useful new test which would allow decision regarding appropriate therapy to be made early thus having a positive impact on patient care and on prevention of spread of MDR TB

In-vitro activity of nitrofurantoin in enterococcus urinary tract infection

To compare in-vitro antimicrobial susceptibility of nitrofurantoin against commonly used antimicrobials for the treatment of urinary tract infection caused by enterococci. A total of 144 enterococci [Enterococcus faecalis, n=130, Enterococcus faecium, n=14] isolated and confirmed by biochemical tests at the department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, for a period of three years were included in the study. The antimicrobial susceptibility tests of isolated organisms were performed by standard disc diffusion method as recommended by NCCLS. In addition to nitrofurantoin [NIT], doxycycline [DOX], co-trimoxazole [COT], ampicillin [AMP], imipenem [IPM] and vancomycin [VAN] were used for antimicrobial susceptibility testing. One hundred and twenty seven [88%] isolates of Enterococci were susceptible to NIT while 72% [n = 103] to AMP, 13% to COT, 11% to DOX, 91% to IPM and 99% to VAN. Among the strains resistant to AMP, COT, DOX, IPM and VAN, 50-88% were susceptible to NIT. Nitrofurantoin is an effective antimicrobial in vitro and can be used for treatment of Enterococcus urinary tract infections

Multi-drug resistant tuberculosis in northern Pakistan

To determine the resistance pattern of Mycobacterium tuberculosis isolates in Rawalpindi-Islamabad. The study was carried out at the Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi between September 2000 and August 2002. We examined 1359 pulmonary and extra-pulmonary specimens from suspected cases of tuberculosis. The radiometric Bactec 460 TB system was used for culture and antimicrobial susceptibility testing. Mycobacterium tuberculosis was isolated from 325 clinical specimens. Antimicrobial susceptibility of the isolates was tested against the four first-line anti-tuberculous drugs [rifampicin, isoniazid, streptomycin and ethambutol]. Fifteen% of the isolates were resistant to a single drug, 28% were multi-drug resistant including 7% which were resistant to all the four drugs. The overall resistance against individual drugs was rifampicin 32%, isoniazid 37%, streptomycin 19% and ethambutol 17%. The increasing level of drug resistance among mycobacterial isolates in our population is most alarming. Strict implementation of control measures is required to combat this unfolding crisis

Changing pattern of prevalence and susceptibility of various urinary isolates in Rawalpindi / Islamabad

A number of 7585 microorganisms isolated from urine specimens between Jan 1989 and Dec 1993, at Armed Forces Institute of Pathology, Rawalpindi, were tested for their susceptibility to various antimicrobials. The disk diffusion technique [Kirby Bauer Method] using sensitest agar [Oxoid] [alone and/or with 5% horse blood] was adopted for various isolates against different antimicrobials. Escherichia coli remains the most common [46.96%] isolate, followed by pseudomonas aeruginosa [13.05%] and Klebsiella pneumoniae [12.99%]. There was no significant change in the rate of isolation of most of the organisms. However, there is decrease in isolation of Klebsiella pneumoniae from 1989 [20.07%] to 1993 [12.99%] and increase in isolation of Staphylococcus aureus [3.81% 9.80%] and streptococcus [Enterococcus] faecalis [0.55 to 4.81%]. Resistance of Escherichia coli against co-trimoxazole [COT] and ampicillin [AMP] has increased respectively from 40.32% and 39.65% [1989] to 76.18% and 77.98% [1993]. Resistance of Pseudomonas aeruginosa against ofloxacin [OFL] has increased from 46.3% [1989] to 60.83 h [1993]. Resistance of Klebsiella pneumoniae against nitrofurantoin [NIT] and norfloxacin [NOR] has increased respectively from 60% and 4.5% [1989] to 79.17% and 19.91% [1993]. Resistance of Staphylococcus aureus against AMP has increased from 86.85% [1989] to 95.09% [1993]. In 1993, all the isolates [excluding Pseudomonas aeruginosa and S. faecalis] revealed resistnace against NIT, 32.17% NOR, 20.31%; pipernedic acid, 37.19% COT, 78.68%; AMP, 86.83%; cephradine, 35.15%; gentamicin, 32.24%; OFL, 14.19% and ceftriaxone, 20.16%. It appears that AMP and COT should not be used empirically in urinary tract infection [UTI] and instead NIT or NOR may be preferred as empirical treatment of UTI

First quinolone resistant typhoid salmonella

The susceptibility of typhoid salmonellae to one of the quinolones [OFLOXACIIM] was first reported in 1986. Since then more than 1500 blood culture isolates have been tested in various Armed Forces Laboratories, for their susceptibility to different quinolones. As yet resistance to quinolones has not been reported from anywhere though we have reported that S.paratyphi A strains generally possessed higher MICs of the quinolones as compared to S.typhi. During May 1 992, a strain of S.paratyphi A was isolated from the blood of a clinically suspencpted typhoid case who had failed to respond to the empirical use of adequate dose of ofloxacin for eight days. This isolate of S.paratyphi A was subjected to extensive investigation as regards its susceptibility to the conventional antityphoids, as well as to all the available quinolones. The disk diffusion, broth dilution and agar dilution methods were used. The isolate was found to be fully sensitive to trimethoprim [TMP] and sulphamethoxazole [SMX]. Consequently the patient was successfully managed with cotrimoxazole [TMP + SMX]. Some of the recently isolated and lyophilized strains of S.paratyphi A were also re-evaluated. The susceptibility pattern of the isolate to various quinolones is discussed