Frequency of spontaneous bacterial peritonitis in hospitalized patients with cirrhosis and hypoalbuminemia

Background: Spontaneous bacterial peritonitis [SBP] is one of the complications in patients of cirrhosis. These patients when exposed to infection are likely to develop SBP. Various studies refer its frequency to around 30%, yet no study has estimated its frequency in hospitalized cirrhotic patients with serum albumin <3.5 g/dl

Objectives: To find out the frequency of SBP in hospitalized patients with cirrhosis and hypoalbuminemia

Methodology: This cross sectional study was conducted in Medical wards of Mayo hospital, Lahore from August 2010 to January 2011. A total of 110 cirrhotic patients recently hospitalized and having serum albumin < 3.5 g/dl in their initial investigations were investigated. Relevant history, examination and investigations were carried out and recorded in the proforma

Results: Of 110 patients under study, 60 were males[54.5%] and 50 were females[45.5%]. Total 54 patients [49.1%] had SBP. Patients having SBP were older [52.6 +/- 12.8 years] compared to others [45.4 +/- 10.2 years]. Among those having SBP, 38[70%] patients were > 40 years of age. The mean ascitic fluid white cell count in SBP patients was 884 +/- 260 cells/uL versus 236 +/- 108 cells/uL. The mean neutrophil count in ascitic fluid was 643 +/- 181 cells/uL versus 137 +/- 65 cells/uL. HCV was the commonest etiology of cirrhosis 59 [54%], HBV in 29 [26%], combined HBV and HCV in 10 [9%], and non-viral in 12 [11%]

Conclusion: SBP is a common complication of cirrhosis and its frequency is higher in those cirrhotic patients who also have hypoalbuminemia [<3.5gm/dl]

Primary isolated hepatic tuberculosis

Isolated hepatic tuberculosis without pulmonary or bowel involvement is a diagnostic challenge and can cause considerable morbidity. A young lady from Lahore presented with fever, pain in right hypochondria, nausea and weight loss. CT scan of abdomen showed multiple small hypodense non-enhancing lesions and a heterogeneous texture of liver. Biopsy confirmed the diagnosis of hepatic tuberculosis. It was concluded a case of isolated hepatic tuberculosis without evidence of other primary sites involvement. It is important to consider tuberculosis in the differential diagnosis when suspecting lymphoproliferative or metastatic diseases in a patient with vague symptoms and abnormal hepatic texture on CT

comparative characterization of indigenous keratinase enzymes from district Khairpur, Sindh, Pakistan

To isolate and characterize keratinolytic fungi and bacteria from indigenous soils, a total of 80 samples were collected from Ghari Mori District. Khairpur, and these organisms were isolated using standard microbiological technique. The isolated keratinolytic microorganisms comprised: Absidia sp., Chrysosporium asperatum, Chrysosporium keratinophilum, Entomophthora coronata, Bacillus subtilis and Staphylococcus aureus and their keratinolytic properties were distinguished from the production of keratinase by measurement of zone of hydrolysis on skimmed milk agar [P<0.05]. C. keratinophylum and B. subtilis produced largest zone among all the isolated species. The crude keratinase revealed that the optimum time for production of the enzyme was seven days, optimum temperature 30°C and optimum pH 9 for C.keratinophylum but for B. subtilis, the optimum time was three days, optimum temperature 37°C and optimum pH 7. The enzyme activity of C. keratinophylum and B. subtilis were determined to be 220 U/ml and 260 U/ml respectively [P< 0.05]

Microbial diversity in the sandy soil of Nara Thar desert Khairpur, Sindh, Pakistan

The microbial diversity was studied by Standard Plate Count and Direct Root Inoculation in the Nara Desert eco-region soil Khairpur, Sindh, Pakistan. It was found that the bacterial count was 200000 to 280000 per gram of soil whereas fungal count was 84000 to 110000. Among the bacterial diversity it was observed that there was existence of Bacillus sp., and halophilic Gram negative rods and cocci and five species of fungi belonging to three genera viz, Aspergillus, Alternaria and Cunninghamii were present. Hence more exploration is needed to recover many other micro-organisms and their relation with various plants and people of this eco-region

Fungal biota of the domestic animals in a city in Pakistan

To determine the prevalence of Keratinophillic fungi from domestic animals in Sukkur City Sindh Pakistan. A total of seven hundred and fifty hair samples from three groups [buffalo, goat and cow] of animals were collected in sterilized polythene bags in Sukkur city. Hair pieces measuring 2cm were placed on the agar plates supplemented with 0.05 g/l chloramphenicol for obtaining the fungal growth on hair. Hairs showing the whitish mycelial growth were transferred to freshly prepared Sabouraud's Dextrose Agar [SDA] for cultural growth and pure culture were maintained at 5oC in refrigerator. Out of 750 hair samples collected from three domestic animals which were studied in Sukkur city, Sindh, Pakistan, five hundred ninety four [594] isolates belonged to 8 genera and 9 species were isolated. A. candidus and Alterneria alternate were almost equally prevalent species represented by 14.81% and 14.48% respectively of the total number of isolates. A. niger and Chrysosporium asparatum were equal in their prevalence and represented 12.63% and 12.46%. Exophiala sp comes next constituting 12.29% followed by Stemphyllium sp. 10.94%. Other species isolated less frequently included Cladosporium 8.08%, Acrimonium sp.7.41% and Penicillium sp. 6.90%. The isolation frequency of fungal biota was significantly greater in buffalo from cow and goat [respectively 40.06%, 33.33% and 26.60% p = 0.02]. Keratinophillic fungi were isolated from domestic animals and the prevalence of these fungi in domestic animals may have a role in transmission of skin and other infections in human population

Multi-drug resistance of thermo-tolerant Escherichia coli isolated from drinking water of Khairpur city, Sindh, Pakistan

Antibiotic susceptibility was determined by disc diffusion method. It was observed that the indole negative thermo-tolerant Escherichia coli isolated from drinking water of Khairpur was susceptible to twenty antibiotics and resistant to sixteen out of thirty six antibiotics. Occurrence of antibiotic resistant Escherichia coli in drinking water indicates the need for continued surveillance and monitoring of these bacteria

study on gastrointestinal parasitic infections in khairpur, Sindh, Pakistan

A three year study was carried out from January 2005 to December 2007 at the Department of Microbiology, Shah Abdul Latif University, Khairpur and Bhittai Lab., Khairpur Mirs, Sindh, Pakistan, One thousand six hundred twenty stool samples were examined using Wet mount technique [WMT] in normal saline and iodine. Entamoeba histolytica 225 [13.88%], Ascaris lumbricoides 190 [11.72%], Giardia lamblia 29 [8.95%], H. nana 25 [7.71%], Entamoeba coli 22 [6.79%] and Necator americanus 20 [6.17%] were reported. Generally infection was most prevalent in patients aged 12-42 years. To reduce the prevalence of various parasites, the level of environmental sanitation, socioeconomic status of population and water supply should be improved

Bacteriological quality of drinking water of Sukkur City

To determine the bacteriological quality of drinking water of Sukkur city. A descriptive study was carried out at the Department of Microbiology, Diagnostic and Research Centre, Shah Abdul Latif University, Khairpur, Sindh from January to December 2007. A total of 120 samples were analyzed by membrane filter method. Drinking water samples from main storage, distribution line and consumer taps were analyzed. All 120 samples [100%] were found contaminated with total coliform bacteria and 98 [82%] samples were found to be contaminated with thermotolerant Escherichia coli. Chlorine [residual] was not found in any of the samples. Drinking water samples were heavily contaminated with coliform and faecal coliform organisms making it unsuitable for drinking. Pakistan population should be encouraged to use boiled water for drinking, till the time that safe drining water is made available to all

Herpes zoster ophthalmicus - acute ocular manifestations and role of oral acyclovir

To determine the frequency and severity of acute ocular complications in patients of Herpes Zoster Ophthalmicus [HZO] and to evaluate the role of oral Acyclovir in the treatment of HZO. A quasi-experimental study. The study was conducted at eye department of CMH Pano Aqil and CMH Peshawar from Jan 2004 to Jun 2006. Thirty Seven patients of HZO were prospectively evaluated for protocol defined ocular manifestations of HZO. Frequency and duration of acute ocular manifestations were analyzed and compared in between those patients who received oral acyclovir within 72 hours of rash onset [Group A, n = 19] and those who received it after 72 hours of rash onset [Group B, n = 18]. The most frequent acute ocular manifestations were conjunctivitis [63% in Gp A; 50% in Gp B], acute epithelial keratitis [37% in Gp A; 39% in Gp B], and anterior uveitis [11% in Gp A; 39% in Gp B]. In between group difference in the frequencies of various ocular complications was not statistically significant. However, incidence of overall keratitis, anterior uveitis and glaucoma was more in group B. Moreover, mean duration of acute ocular signs was longer in group B. The results suggested that early initiation of oral acyclovir treatment [within 72 hours of rash onset] has a beneficial role in limiting the frequency and duration of acute ocular complications of HZO

Enumeration of total and fecal coliform bacteria in drinking water of Khairpur Sindh

The number and range of total coliform and fecal coliform bacteria were analyzed in the drinking water of Khairpur city to determine the quality of the water supplied to the residents of the city. The bacteriological study was carried out for indicator organisms i.e total coliform and fecal coliform [E. coli] by membrane filtration methods. A total of 90 samples were collected from three sites, thirty samples each from main reservoir [water works], distribution line and consumer taps [households, hotels and schools]. All samples were found contaminated [100%] with total coliform [TC] as well as fecal colifom [FC] bacteria. The counts were higher than the maximum microbial contaminant level established by World Health Organization [WHO]. The higher densities of bacteria were found in consumer taps [4-4.30 log cfu/100 ml] per 100 ml, followed by distribution line [3.79-4.20] and main reservoir [3-3.94 log cfu] per 100 ml total and fecal coliform. The pH and residual chlorine of water samples were also determined. It was observed that pH was within the limits of WHO standard [6.5-8.5], the residual chlorine was not detected in any sample of drinking water

Hair bait technique a method for isolation of the keratinases producing micro-organisms from soil

This paper states the methods of keratin baiting for isolation of keratinases producing microbes. Hair Bait Technique [HBT] is a specific method for isolation of the keratinases producing microbes [fungi and bacteria] from soil. There are several industrial and domestic applications of these enzymes

Cataract surgery; intraocular pressure in non-glaucomatous eyes with pseudo exfoliation syn drome

To investigate the course of intraocular pressure after cataract surgery in patients having pseudo exfoliation syndrome but without any evidence of glaucoma. Prospective age-matched comparative type. Department of Ophthalmology, Combined Military Hospital, Peshawar and Military Hospital, Rawalpindi. From 1st November 2003 to 30th April 2004. Ninety five patients having cataract, were divided into two groups. Group I consisted of forty five patients with pseudo exfoliation syndrome and Group II comprised control group of fifty patients not having pseudo exfoliation. All the patients underwent extra-capsular cataract extraction with posterior chamber intraocular lens implantation. The intra- ocular pressure was measured pre-operatively as well as on 7th post-operative day, 1st and 3rd post-operative months, in addition to other pre- and post-operative evaluation. Statistically, there was no significant difference in the pre-opera tive intraocular pressure between the two study groups. At 7th post-operative day, the intraocular pressure was below 18 mm of Hg in all the patients. First and 3rd month after the surgery, a decrease in intraocular pressure was observed. The inter-group differences in intraocular pressures at 1st and 3rd post-operative months were statistically not significant. Seven days after extra-capsular cataract extraction with posterior chamber intraocular lens implantation, no increase in intraocular pressure was observed in the eyes with pseudo exfoliation syndrome. Three months after cataract surgery, intraocular pressure levels decreased in eyes with pseudo exfoliation syndrome similarly as in control group

Occurrence of acute bacterial meningitis in Khairpur Mir's, Sindh, Pakistan

The cases of acute bacterial meningitis in age group 1 to 5 years were studied by standard diagnostic methods at Civil Hospital Khairpur Mir's, Sindh, Pakistan, during 2001 [one year study]. It was found that gram positive diplococci caused infections in 42.20% and gram negative rods and diplococci in 26.17%, whereas 31.54% cases have shown no bacteria

Human cutaneous alternariosis: a case study

A case of human cutaneous alternariosis of elbow caused by Alternaria alternata was reported in a 50 years-old man. The diagnosis was made by direct microscopic examination and repeated isolation of fungus in culture

Prevalence of hypertension and obesity in a rural district of Pakistan

A high prevalence of hypertension, obesity ond cardiovascular disease in urban and immigrant Pakistanis is generally attributed to their changed lifestyle. However, no studies have reported the prevalence of these conditions in the large rural population of Pakistan, from where immigrants have often originated, and where the traditional lifestyle is still followed. We, therefore, studied the prevalence of [and factors associated with] obesity and hypertension in this population group. Age, sex, occupation, smoking status, weight, height, waist, hip circumference and blood pressure were recorded in all subjects > 25 years in this typical village of Punjab, Pakistan. Of 470 subjects, 35% smoked, twenty were hypertensive [4.3%] and 30 were sedentary [6.4%]. Nine [1.9%] had body mass index [BMI] >= 30 kg/m[2], 28 [5.9%] BMI of 25-29 kg/m[2] and 134 [28.5%] BMI<18.5 kg/m[2]. Blood pressure significantly and positively correlated with BMI, waist, hip and waist/hip ratio. Sedentary individuals were more likely to be young, obese and have higher blood pressure. Although obesity and hypertension were not common, the small number of sedentary individuals were more likely to suffer from them. These findings are relevant in prevention and management of obesity/ hypertension in urban and immigrant Pakistanis

Diabetic control and serum lipids in diabetics attending a Pakistani hospital

Diabetes Mellitus is more prevalent in Asians as compared to White Caucasians. Hence, it has great importance as a public health problem. There is a paucity of data about the state of lipids in this disease, from Pakistan. We studied diabetic patients attending outpatients clinic and recorded their personal characteristics, details of their disease and measured their blood glucose, lipids and glycosylated haemoglobin. Design: Case series. Setting: Patients attending outpatients department of a teaching hospital. Subjects and Seventy consecutive diabetics attending the outpatients department were enrolled in the study. Their age, sex, disease duration, body mass index [BMI]; treatment history, occupation and social class were recorded. Fasting plasma sample was collected and glucose, cholesterol [total, HDL, LDL], triglycerides and glycosylated haemoglobin [HBA] estimated. Data was analysed using SPSS statistical package. Most of the patients were non-insulin dependent [N1DDM] diabetics 90%, sedentary workers [70%] and females [66%]. Mean duration of diabetes was 6.2 years [SD 5.2]. Plasma glucose [mean 201 mg/dl], HBA [mean 7.92], triglycerides [mean 215.9 mg/dl] and total cholesterol [mean 221.4 mg/dl] were recorded. About a quarter of cases had a BMI > 28 Kg/m2 and 15% had a BMI > 30 Kg/m2. HDL and LDL cholesterol mean values were 44.1 mg/dl and 134.2 mg/dl respectively. There was good correlation between HBA and fasting plasma glucose. However, the correlation between fasting plasma glucose and various lipid parameters was poor. Conclusions: Majority of diabetics attending hospital outpatients were suffering from NIDDM. A significant proportion of them were obese. As a group they exhibited poor diabetic control and had only modest elevation of plasma lipids. The correlation between fasting plasma glucose [and HBA] and lipid levels was poor. However, there is good correlation between fasting plasma glucose and glycosylated haemoglobinm, highlighting usefulness of the latter for monitoring