First case of pulmonary hydatid cyst in a pregnant Syrian refugee woman in Malaysia

@#Pulmonary hydatid cyst (PHC) in pregnancy is a very rare pathology. We report here a case of ruptured PHC during pregnancy in a 26-year old Syrian (refugee) woman who presented with complaints of productive cough with metallic taste and dyspnoea. PHC was suspected due to her clinical and radiological findings. Interestingly, the sputum examination confirmed the diagnosis as numerous protoscoleces were present. Serology for Echinococcus infection revealed positive at high titre. Early diagnosis and prompt treatment by providing care improves the patient outcome. Parasitological examination of the respiratory specimen in suspected ruptured PHC is desirable as a valuable detection tool.

Pneumonia in rheumatoid arthritis patients

Purpose: The purpose of this study was to compare the clinical characteristics of pneumocystis pneumonia [PCP] between patients with rheumatoid arthritis [RA] being treated with biologics and those being treated without biologics

Methods: From 220 patients with RA in our institution, we enrolled 12 patients who had developed pneumocystis pneumonia throughout the course of their management. They were divided into two groups according to the treatment they were receiving for rheumatoid arthritis: the biologics group [n = 6] and the nonbiologics group [n = 6]. Clinical characteristics of pneumocystis pneumonia were compared between the two groups

Results: At pneumocystis pneumonia diagnosis, the biologics group showed significantly lower serum levels of -D-glucan and C-reactive protein than the nonbiologics group, whereas the biologics group had significantly higher lymphocyte counts than the nonbiologics group. In the nonbiologics group, lower lymphocyte counts were associated with higher -D-glucan levels; nonetheless, this was not witnessed in the biologics group

Conclusion: The finding that rheumatoid arthritis patients being treated with biologics developed pneumocystis pneumonia with relatively normal lymphocyte counts and lower -D-glucan levels suggests that the pathophysiology of pneumocystis pneumonia in those patients is different from that in patients being treated with other antirheumatic drugs

Association and implications in triple negative and triple positive breast cancer: relationship with sociodemographic and reproductive factors in pakistan

Background and Objectives: Triple negative and triple positive breast cancer have adverse effects than other types of breast cancer. However, triple negative has poor prognosis with short survival as compared with triple positive breast cancer. Good prognosis is one of the key factors for successful treatment trial. This study aimed to find out the association of sociodemographic and reproductive features like parity, menopause, number of child bearing as risk factors in the development and prognosis of triple negative and triple positive breast cancer

Methods: This study is a part of an ongoing project which is being conducted in Karachi from 2013 to 2020. Informed consent from triple negative breast cancer [n=134] and triple positive breast cancer [n=87] patients were taken prior to their recruitment into the study. Demographic, anthropometric, reproductive and disease history of patients were recorded. Means, frequency distribution, data classification and association analyses were done by SPSS version 17.0

Results: Statistical analyses revealed that delayed first child bearing age and lower number of children are associated with the development of triple negative breast cancer. However, no significant effect of these parameters has been observed on the outcomes of triple positive breast cancer

Conclusions: Reproductive factors have more pathological implications than sociodemographic factors in both triple positive and triple negative breast cancer development. These findings might prove to be beneficial for effective and better breast cancer management

Hepatosplenic mucormycosis post autologous stem cell transplant

Mucormycosis is a life threatening fungal infection and remains an important cause of morbidity and mortality in immunocompromised patients after hematopoietic stem cell transplant. We report here a case of hepatosplenic mucormycosis in a patient after autologous stem cell transplant. A young man with anaplastic large cell lymphoma underwent autologous hematopoietic stem cell transplant after achieving complete remission with standard chemotherapy and consolidative radiotherapy. He was found to have incidental hepatosplenic hypodensities on follow up imaging, that were proved to be mucormycosis on histopathology after getting CT-guided biopsy of splenic lesions. He was treated with intravenous amphotericin-B followed by complete radiological resolution of hepatosplenic lesions. Although these infections are often life threatening but limited disease may have better outcome if diagnosed and treated early and aggressively

CNS relapse of diffuse large B cell Lymphoma: a single centre experience

Background and Objective: Central nervous system [CNS] relapse of diffuse large B cell lymphoma [DLBCL] is relatively uncommon and nearly fatal. Two years CNS relapse risk is 0.8% in low, 3.9% in intermediate and 12 % in high risk patients. Our aim was to study, the baseline characteristics and outcome in term of median survival of DLBCL patients with CNS relapse

Methods: This is a retrospective analysis. All patients of DLBCL with CNS relapse from 2006 to 2014 were included. Data were collected from computerized Hospital Information System and analyzed for characteristics and median survival

Results: Out of twenty one patients included in the study, 14[66.3%] males and 7[33.7%] were females. On initial diagnosis of DLBCL, median age was 37.4 years [27-47]. Ann Arbor stage of I-IV was in 3 [14.3%], 2[9.5%], 4[19%] and 12[57.1%] patients, respectively. Extra-nodal involvement was noted in 16[76.2%], high LDH in 18[85.7%], bone marrow involvement in 8[38.1%] and bulky disease in 5[23.8%] patients. International Prognostic Index [IPI] score was 1 in 4[19%], 2 in 9[42.9%], 3 in 8[38.1%] patients. Extra-nodal sites were gut in 2[9.1%] while 1[4.5%] patient of each of following organs involvement was seen: cervix, gluteal muscle, iliac bone, liver, ovaries, pancreas, parotid gland and testes. Chemotherapy CHOP was given to 16[76.2%] and RCHOP in 5[23.8%] patients. Prophylactic intrathecal methotrexate was given to 10[47.6%] patients. Complete response was in 10 [47.6%], partial response was in 3 [14.3%] and disease progression was in 8 [38.1%] patients. CNS relapse occurred in 17 [81%] patients within six months after completion of therapy. CNS relapse along with systemic disease was in 14[66.6%] patients. Isolated CNS relapse was noted in 7[33.3%] patients. Second line chemotherapy regimens were HDMTX 5[23.8%], HDMTX/ TRIO IT 3[14.2%], HDMTX/HDAC 2[9.5%], HCVAD 3[14.2%], ICE 4[19.4%], DHAP 1[4.7%], ICE/HDMTX 1[4.7%], none 2[9.5%]. Overall median survival of CNS relapsed patients was 54 days

Conclusion: Patients with DLBCL who had advanced stage, high LDH and extra-nodal involvement at initial presentation are at high risk for CNS relapse. About half of the patients had CNS relapse despite primary CNS prophylaxis. Once relapsed in CNS, these patients have very poor prognosis

MRI features of posterior reversible encephalopathy syndrome

Background and Purpose: posterior Reversible Encephalopathy Syndrome [PRES] represents a clinico-radiological constellation of neurological symptoms and radiological features. The syndrome tends radiologically to be present with certain features and patterns. Our aim in this study is to investigate the PRES radiological features by which it does present in our community and to correlate the findings clinically

Methods: the MR images obtained for the 17 patients included in the study were analyzed for the PRES features and patterns. Fluid Attenuation Inversion Recovery [FLAIR] sequence was the mainly used sequence for assessment. Diffusion images with their apparent diffusion coefficient maps, T[2*] images, and Angiography were also utilized for further assessment and characterization

Results: most of the cases demonstrated a bilateral involvement [94%]. The regional distribution supra-tentorially included parietal and occipital affection in 94%, frontal lobe affection in 76%, and temporal lobe affection in 71%. Infra-tentorial involvement was noted in 41% of the cases. Pattern percentages were slightly different from those available in the literature with the Holo-hemispheric Watershed pattern being the most common [35%]

Conclusion: the originally described PRES features are present in the majority of the studied cases. The identified PRES patterns may reflect underlying clinical or pathological correlations, and hence can vary across communities

Determinant Factors Of Depression: A Survey Among University Students

@#We compared the determinant factors of depression; among faculties in university, among junior and senior students, and gender differences among representative samples of faculties in university. Centre for Epidemiological Studies Depression (CES-D) consisting for 20 questions was used to assess the status of well-being of students. A total of 240 students participated and completed the assessment forms. The results were then compared and analyzed using the IBM SPSS Statistics version 21. There was no effect of faculty on depression (p=0.854). The association between year of study and depression was not statistically significant (p≥0.05). Likewise, the association between gender and depression was statistically not significant (p≥0.05). The study revealed absence of statistically significant effect of faculty on depression. It was also found that gender and depression as well as year of study and depression were not statistically significant.

Compliance to medical treatment in patients of chronic simple glaucoma: study of factors causing non-compliance

Objective: To determine how many patients with glaucoma do not comply with medical therapy and study the factors which make them distinguishable from complying patients

Study Design: Cross sectional comparative study

Place and duration: At Glaucoma clinic, Al-Shifa Trust Eye Hospital, Rawalpindi over a period of 6 months from 1[st] May 2006 to 30[th] Nov 2006

Methodology: A pre-tested structured questionnaire was used. The data collected was of patient's age, years of glaucoma diagnosis, number of medicines advised their educational level, socioeconomic conditions and distance they travel to the hospital. Patients were asked of difficulty in self administration of medicines and whether or not the medicine finished before the visit and is it available near their home? Non compliance was regarded as the missing of prescribed medicines for 1 day or more as reported by the patient. The patients were grouped as compliers [group 1] and non-compliers [group 2], and all the variables were analyzed to find any significant intergroup differences by using SPSS version 16

Results: Of 100 patients, 65% were males and 35% were female patients of glaucoma. Among them, the compliers were 61 [group 1] and non compliers were 39 [group 2]. Statistically significant difference in compliance behavior was found in relation to number of medicines prescribed [p=0.039], problems with self administration of drops [p=0.05], eye drops finished before follow up visit [p=0.001], and non-availability of medicines at pharmacy near home [p=0.034]

Conclusion: Several interrelated factors may contribute to noncompliance. Poor compliance may be due to less educated patients, problems with managing multiple eye drops and the complex regimens. Problems with self administration of medicines and poor socioeconomic status may be the reason behind discontinuation of medicines. All these factors must be looked into in a glaucoma patient non compliant to medical treatment

To determine the comparative values of lipid profile between ischemic and hemorrhagic stroke

Objectives: To determine the relationship of total cholesterol, HDL-C and their ratio among ischemic and hemorrhagic stroke

Study Design: An observational prospective comparative study

Place and duration: This research work was carried out from 1[st] June 2014 to 31[st] December 2014 at department of medicine Bahawal Victoria Hospital Bahawalpur

Methedology: Hundred patients between 30 to 90 years of age, who were admitted by the department of general medicine BVH Bahawalpur with first ever stroke and verified by CT scan brain, were included in the study. Patients who had history of coronary heart disease or lipid lowering drugs, neurological deficits secondary to epilepsy, infective or metastatic disorder, or pre-existing severe cognitive disorder were excluded from this study. A detailed history and physical examination details along with fasting lipid profile were collected from patient records in the hospital medical department. Mean values of quantitative data were presented as mean SD [standard deviation].Frequency percentage of total cholesterol, high density lipoproteins and triglycerides in both groups of ischemic and hemorrhagic stroke, were determined and compared using proportion test for any significant difference taking p-value of < 0.05 as significant

Results: Quantitative data of CVA, comprising [50 each of ischemic and hemorrhagic cases] was analyzed. Mean age of presentation was 56 years. In 50 ischemic patients mean total cholesterol was raised above normal reference range. It was 218.30 +/- 79mg/dl in ischemic stroke while it was 194 +/- 26.7mg/dl in hemorrhagic cases and it was highly significant at P value of < 0.001.The mean HDL concentration was 33.10 -7.33 in patients of ischemic stroke while it was 39.02-4.22 in hemorrhagic cases with p value of o.oo2 [highly significant]. Serum triglycerides levels turned out to be normal in both groups

Conclusion: Hypercholesterolemia and low HDLC was seen significantly in ischemic CVA group as compared to hemorrhagic counterpart

Prevalence of usual and unusual skin manifestations of systemic lupus erythematosus in a tertiary care hospital

Objective: To determine prevalence of different types of skin manifestations in SLE in our country

Methods: The study was carried out at the Rheumatology and Immunology Department, Shaikh Zayed Hospital, Lahore. 125 patients who were diagnosed with SLE on basis of American College of Rheumatology classification criteria for SLE and also having skin manifestations were included from June 2011 till June 2015 from outdoor and inpatient departments

Results: SLE specific skin manifestations were as follow: malar rash was seen in 83 [71.6%] patients, photosensitivity in 61 [49.12%] patients, oral ulcers in 39 [31.35%], maculopapular rashes in 29 [23.46%], discoid rash in 26 [20.7%], subacute cutaneous lupus erythematosus [SCLE] in 6 [5.18%] patients. The SLE non-specific skin manifestations included: vasculitic rash in 50 [40.0%], non-scarring alopecia in 39 [30.9%], palmar erythema in 26 [21.1%], vasculitic ulcers in 7 [4.9%], livedo reticularis in 5 [3.8%], digital gangrene in 3 [2.7%], and Raynaud's phenomenon in 3 [2.2%] patients. Patients having SLE specific skin manifestations like malar and discoid rash were more likely to have internal organ involvement, while with those having SLE non-specific skin manifestations were seen with acute flare of disease. ANA and anti-ds DNA antibodies were positive in 92% and 63% patients, respectively

Conclusion: Skin manifestions in SLE are important disease parameters which can give important diagnostic and disease activity information. Thorough focus on dermatological aspect is very important for diagnosis and treatment in this entity

prevalence of iron deficiency anemia in female medical students of different medical colleges of Khyber Pakhtoonkhwa, Pakistan

Objective: Iron deficiency anemia [IDA] is very common in adolescent and adults, especially female. In medical students, it is caused by a number of causes, "including overwork, decrease appetite due to stress and unnecessary dieting". Very little data is available at national level about these health conscious medical students. This "descriptive, cross sectional study, was conducted in public and private Medical colleges of KPK". The main objective of the study was "to determine the Prevalence of IDA in female medical students of KPK"

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at the department of Pharmacology, Khyber Girls' Medical College, Peshawar From December-2015 to May-2016

Materials and Methods 390-female medical students aged 19 to 24 years have participated in this study'. After formal consent and recording of their demographic information, "Hemoglobin [Hb] and Mean Corpuscular Volume [MCV] was done using digital Sysmex XT-4000i hematology analyzer". Serum ferritin [S-Ferritin] was done using Architect I-2000 analyzer. The identity of all students was kept confidential. All students with, "Hb<12g/dl, MCV<76um [3] and S-Ferritin <11ng/ml were labeled as having IDA and students having Hb>12g/dl, MCV>76um [3] but S-Ferritin<11ng/ml were labeled as having Iron deficiency [ID], but not IDA"

Results: Complete data of all "390 students were available for further analysis". The mean age of the students was 21 +/- 1 years. IDA was present in 6.66% [n=26/390] students, while ID was present in 41.54% [n=162/390] students. Normal iron status was found in 51.80% [n=202/390] students

Conclusion: It is concluded that "ID and IDA are very common in female medical students of KPK. All female medical students should be encouraged to take extra iron to replenish their iron store"

Outcomes of first line chemotherapy in patients with chronic lymphocytic leukemia

Objective: Chronic lymphocytic leukemia [CLL] is a heterogeneous disease in terms of survival with and without treatment. Many chemo and immunotherapeutic agents are available to treat this indolent disease. Aim of this study was to determine the outcomes of patients with chronic lymphocytic leukemia treated with different available chemotherapeutic regimens

Methods:All patients with diagnosis of CLL from 2008 to 2013 were included. Data were collected from hospital information system. Objective response rate [ORR] in terms of complete or partial response [CR, PR], stable or progressive disease [SD, PD], overall survival [OS], and progression free survival [PFS] were calculated

Results:Fifty seven patients were included; 42 [74%] male and 15 [26%] were female. Patients with Binet stage A 10 [18%]; B 20 [35%] and C were 27[47%]. Median age was 50.9 years. Forty six [80%] were treated and 11[20%] remained on watch and wait. Treatment indications were B symptoms 14 [30%], symptomatic nodal disease 18[39%], thrombocytopenia 4[9%], anemia 7[15%] and doubling of lymphocyte count 3 [7%]. Chemotherapy regimens used were FC in 38 [83%], FCR 5[11%], chlorambucil 2[4%] and CVP in 1[2%] patient. Twenty two [56%] patients had CR, 13[33%] PR, 3[7.6 %] SD, and 1[2.5%] had PD. ORR was 89%. Median PFS was 23.1 months and median 3 years OS was 55%

Conclusion:Majority of patients was in a relatively younger age group and presented with advanced stage disease requiring treatment. Small number of patients received rituximab due to cost. PFS and OS are comparable with published literature

Chemotherapy alone or combined chemotherapy and involved field radiotherapy in favorable risk early-stage classical Hodgkin lymphoma - a 10 years experience

Objective: To determine the outcome of patients with early-stage [stage I-II] favorable risk classical Hodgkin lymphoma treated with chemotherapy alone or combined modality treatment [CMT] utilizing chemotherapy and involved field radiotherapy

Methods: This retrospective study was done at Department of Medical oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan from January 2004 to December 2013

Results: There were 101 patients, with male predominance [71.3%]. Mean age was 34 years. Sixty three [62.4%] patients received CMT and 38 [37.6%] patients had chemotherapy alone. Ninety eight percent patients had ABVD chemotherapy. Dose of radiotherapy ranged from 20 to 36 gray. Difference between baseline characteristics and major toxicities among the two groups was insignificant. Patients treated with CMT had better overall survival compared to chemotherapy alone: 100% versus 91% at five years and 96% versus 81% at 10 years, respectively [p=0.03]. Progression free survival was also better with CMT against chemotherapy alone at five years [98% versus 81%] and 10 years [82% versus 71%] [p=0.01]

Conclusion: Favorable risk classical Hodgkin lymphoma patients had better overall survival and progression free survival when treated with CMT against chemotherapy alone

Resection and reconstruction of cervical tracheal stenosis

Background: Tracheal resection and primary re anastomosis for tracheal stenosis or tracheal tumor is not uncommon operation

Objective: To assess the aetiology of stenosis of cervical trachea and their surgical reconstruction

Patients and Methods: This is a retrospective study of forty patients with cervical tracheal stenosis ,who were treated at Ibn Al Nafees Hospital during six years period from January 2006 to October 2012 .It illustrates the diagnostic methods and the surgical techniques of reconstruction

Results: Most of the patients ,were male [80%] and only [20%] were female .The most common etiological factor was post intubation stenosis [70%],less common cause was traumatic stenosis and the least was neoplastic stenosis . Progressive dyspnea was the most common presenting clinical feature .The mean length of resection was three rings .Seven patients developed complications, and dealt with successfully with one mortality

Conclusion: Bronchoscopy and radiography remain the main diagnostic tool for evaluating it .Resection and end to end anastamosis is the best method of treatment In special cases .Some cases can be treated by endoscopy and laser therapy

Gender difference in components of metabolic syndrome among patients of Type 2 diabetes

Diabetes mellitus, hypertension, obesity and dyslipidemia are the integral components that constitute metabolic syndrome. It has emerged as cause of substantial mortality with gender difference. To compare the gender characteristics of metabolic syndrome in subjects of type 2 diabetes mellitus. This observational comparative prospective study was conducted in medical ward of BVH Bahawalpur over period of 6 month from January 2014 to June 2014. Sample size of 100 diagnosed cases of type 2 diabetics [comprising equal number of males and females] were collected. As defined by WHO and IDF, variables of metabolic syndrome studied were BMI, hypertension, hyperglycemia and hyperlipidemia. The lipid values were interpreted in normal or high risk category by applying NCEP ATPIII criterion. Fasting sample were collected for sugar and lipid profile. Anthropometric, demographic and biochemical data was tabulated. Continuous and categorical variables were displayed as mean +/- standard deviation and percentage respectively. Student 't' test was use to assess the difference for the lipid profile at 5% significance level. Female patients were found to be overweight, hypertensive and had uncontrolled hyperglycemia as compared to male subjects. Their systolic blood pressure was 150 +/- 25.75 and diastolic was 90 +/- 17mm/hg. The mean blood glucose concentration was 246.64 +/- 105mg/dl. In age group 35-44 years, the mean triglycerides and cholesterol levels in females were 184.54 +/- 42.05 and 192.5 +/- 34mg/dl respectively. HDL-C was 33.2 +/- 5.19mg/dl. In females with age group of 45-54 years, the mean concentration of triglycerides, total cholesterol and HDL-C were 217.75 +/- 77.6mg/dl, 190.95 +/- 14.4mg/dl and 31.75 +/- 3.8mg/dl respectively, and all were in high risk category when compared to cut off values determined by NCEP/ADA. While in females of age group 55-64 years, the values of TGs, total cholesterol and HDL-C were 204 +/- 154.11mg/dl, 200.09 +/- 47.8 mg/dl and 33.4 +/- 4.6mg/dl respectively and again all these values were significantly raised. Female genders were affected in all respects. They had higher BMI, hypertension, hyperglycemia and hyperlipidemia as compared to male counterparts

Impact of rituximab and IPI on survival in diffuse large B cell lymphoma patients treated at a tertiary level cancer centre in Pakistan: a single-centre experience

To determine the impact of Rituximab and international prognostic index score on survival in diffuse large B-cell lymphoma patients. The retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from January to May 2013 and comprised record of patients with diffuse large B-cell lymphoma who were treated from 2007 to 2010. Baseline international prognostic index score, stage at presentation were noted and the records were divided into two groups A and B on the basis of the type of chemotherapy. SPSS 19 was used for statistical analysis. Of the 93 patients in the study whose records were reviewed, 54[58%] were men. Overall median age was 43 years [range: 18-76]. Stages at presentation were stage-I 14 [15.1%], stage-II 41 [44.1%], stage-III 20 [21.5%] and stage-IV 18 [19.4%]. International prognostic index risk categorisation was low risk 59[63.4%], low intermediate risk 23[24.7%], high intermediate risk 10[10.8%] and high risk 1[1.1%]. There were 31[33%] patients in Group A and 62[67%] in Group B. Median follow-up was 3.9 years [range: 1.2-6.1]. Overall survival at 4 years was 66.4%; for Group A 65.3% and for Group B 66.7% [p<0.4]. On the basis of risk categories, overall survival was statistically significant [p<0.001] between the groups. International prognostic index risk categorisation had statistically significant impact on survival. However, there was no evidence of a significant survival benefit between types of chemotherapy. Further controlled trials are needed in this regard

Keratometry, axial length and intra-ocular lens power variations observed during biometry

Objective: To document the variations in keratometry, axial length of eye and intra-ocular lens [IOL] power observed during biometry of cataract patients and to find any significant gender difference

Study Design: A retrospective review of the biometry records

Place and Duration: Saeed Eye and Medical Complex, Rawalpindi from 1st Nov 2010 to 31st Dec 2014

Methodology: Patients of senile cataract were included from the biometry records. Keratometry readings of vertical and horizontal corneal meridian [K1 and K2] were measured with automated keratometre and axial length was measured with contact A-scan. Power of IOL was calculated by using SRK-T formula in patients with axial lengths between 22 and 26, Hoffer Q for axial lengths <22mm and Haigis for axial lengths >26 mm with A-constant of 118. The data was analyzed with SPSS version 16

Results: 908 patient records were analyzed. The mean +/- SD keratometry readings [K1 and K2] were 43.46 +/- 1.68 D and 44.41 +/- 1.98 D respectively. The mean +/- SD axial length was 23.45 +/- 1.20mm. SRK-T was used in 818 [90.1%] cases, Hoffer Q in 68 [7.5%] and Haigis in 22 [2.4%] of cases. The mean +/- SD intra-ocular lens power was 20.22 +/- 3.06D. Gender based comparison showed that the mean +/- SD K1 in males [42.95 +/- 1.54D] was less than 43.88 +/- 1.67D for females [p=0.0001]. The mean +/- SD K2 for males [43.9 +/- 1.66D] was also less in females [44.78 +/- 1.70D] [p=0.0001]. The mean +/- SD axial length of eyes in males was 23.81 +/- 1.23mm significantly more than 23.16 +/- 1.08mm in females [p=0.0001]. The mean +/- SD IOL power was 19.68 +/- 3.19D in males and 20.67 +/- 2.86D in females [p=0.0001]

Conclusion: The mean keratometry readings [K1 and K2] were 43.46 +/- 1.68 D and 44.41 +/- 1.98 D respectively. The mean axial length was 23.45 +/- 1.20mm and mean intra-ocular lens power was 20.22 +/- 3.06D. Gender based analysis showed that females have more keratometric readings but shorter axial lengths than males and required more power of IOL to be implanted after cataract surgery

Surgical site infection; in-vitro anti-bacterial activity of different brands of ceftriaxone against bacteria commonly implicated in surgical site infection and their cost effectiveness

Ceftriaxone is used in wide range of day to day microbial infections in clinical practice3. Despite the incumbent drug regulating authority in Pakistan, there is scanty literature comparing the anti-microbial efficacy of different available br and s of ceftriaxone. Objectives: To know the in-vitro activity of various br and s of ceftriaxone against bacteria most commonly isolated from surgical site infection [SSI]. A comparison of five days cost of these br and s will also be done. Design: Experimental study. Period: Feb 2013 to Aug 2013 Setting: Surgical "C" unit Lady Reading Hospital [LRH] in collaboration with departments of pharmacology Khyber Girls Medical College [KGMC] and microbiology department of Lady Reading Hospital Peshawar. Material and Methods: Isolates of five bacteria i.e. Staphylococcus aureus, Proteus mirabilis, Escherischia coli, enterobacter Spp, and Klebsiella pneumoniae, found sensitive to ceftriaxone were grown on 50 slops each and the zone of inhibition was checked for each of the ten br and s of ceftriaxone. Results: The zones of inhibitions of different br and s of ceftriaxone against the above mentioned bacteria were not significantly different. The cost of therapy was significantly different for ten br and s. Conclusions: Various br and s of ceftriaxone of variable cost had no influence on their activity against bacteria involved in SSI.

Study to determine the antimicrobial sensitivity and resistance pattern of various strains against commonly prescribed antibiotics

The main objective of this study was to determine the sensitivity and resistance of various bacterial strains both gram negative and gram positive against commonly used antibiotics. Experimental / Retrospective study. This study was conducted in Hayatabad Medical Complex at Microbiology Laboratory for a period of six month studies from 6.8.2013 to 10.02.2014. The study was conducted in which both in-door and out-door patients were randomly selected for this specified period of time. Bacterial strains used were Staphylococcus Aureus, Escherichia Coli, Pseudomonas Aeruginosa and Proteus Mirabilis against commonly prescribed antibiotics i.e; Ceftraixone, Amoxicillin, Amikacin and Cefepime and to find out the sensitivity and resistance pattern. Among the selected antibiotics Ceftraixone was found to be sensitive in 84.6% of out-door patients and 75% of in-patient against Pseudomonas Aeruginosa, 71.4% of out-door patients and 68.4% of in-patients against Escherichia Coli, 52% of out-door patients and 60% in-patient against Staphylococcus Aureus and least sensitive against Proteus Mirabilis 25% out-patients and 16.7% in-patients. Amoxicillin was 40%, 6.6% and 0% sensitive in in-patients and 16%, 17.1%, 0.7% and 0% in out-patients against Staphylococcus Aureus, Escherichia Coli, Pseudomonas Aeruginosa and Proteus Mirabilis respectively. Amikacin was 44%, 35%, 33.3% and 0% sensitive in in-patients and 36%, 37.2%, 32% and 0% in out-patients against Staphylococcus Aureus, Escherichia Coli, Pseudomonas Aeruginosa and Proteus Mirabilis respectively. Cefepime was most sensitive against Proteus Mirabilis 25% in out-door patients and 16.7% in in-door patients while least sensitive against Pseudomonas Aeruginosa both in out-door and in-door patients. It is concluded from the results obtained that Ceftraixone, Amoxicillin and Amikacin were more than 60% sensitive against the selected strains of bacteria except Proteus Mirabilis while Cefepime is least sensitive i.e; less than 25% against all these antibacterial strains. These results should be considered in future prescribing of antibiotics against these bacterial strains to avoid resistance and to prescribe appropriate treatment for the patients

Taguchi's experimental design for optimizing the production of novel thermostable polypeptide antibiotic from Geobacillus pallidus SAT4

Polypeptide antimicrobials used against topical infections are reported to obtain from mesophilic bacterial species. A thermophilic Geobacillus pallidus SAT4 was isolated from hot climate of Sindh Dessert, Pakistan and found it active against Micrococcus luteus ATCC 10240, Staphylococcus aureus ATCC 6538, Bacillus subtilis NCTC 10400 and Pseudomonas aeruginosa ATCC 49189. The current experiment was designed to optimize the production of novel thermostable polypeptide by applying the Taguchi statistical approach at various conditions including the time of incubation, temperature, pH, aeration rate, nitrogen, and carbon concentrations. There were two most important factors that affect the production of antibiotic including time of incubation and nitrogen concentration and two interactions including the time of incubation/pH and time of incubation/nitrogen concentration. Activity was evaluated by well diffusion assay. The antimicrobial produced was stable and active even at 55degree C. Ammonium sulphate [AS] was used for antibiotic recovery and it was desalted by dialysis techniques. The resulted protein was evaluated through SDS-PAGE. It was concluded that novel thermostable protein produced by Geobacillus pallidus SAT4 is stable at higher temperature and its production level can be improved statistically at optimum values of pH, time of incubation and nitrogen concentration the most important factors for antibiotic production.