Antibiotic resistance modulation of Clostridium perfringens type D using indigenous plants extracts

Aims@#The study was aimed to explore the antimicrobial potential of ethanolic leaf extracts of Eucalyptus globulus, Moringa oliefera, Syzygium cumini and Citrus limon against antibiotic-resistant Clostridium perfringens type D (n=5).@*Methodology and results@#Antibiotic resistance pattern of C. perfringens type D isolates against tetracycline, gentamicin, ceftriaxone, amoxicillin and streptomycin was evaluated by disc diffusion method. Well diffusion and micro broth dilution methods were used to determine the anti-bacterial activity, sub-inhibitory concentrations and antibiotic resistance modulating effects of the plant extracts. Ethanolic extract of E. globules was selected to evaluate its modulatory impact and subjected to GC-MS analysis to separate and identify the phytochemicals. The results showed that the isolates were resistant to gentamicin (0 ± 0.00 mm), streptomycin (0 ± 0.00 mm), tetracycline (13.2 ± 2.28 mm) and ceftriaxone (0 ± 0.00 mm) while sensitive to amoxicillin (23.8 ± 1.30 mm) and tetracycline (13.2 ± 2.28 mm). Eucalyptus globulus exhibited the maximum anti-bacterial activity with a zone of inhibition (ZOI) of 14.6 ± 0.54 mm and minimum inhibitory concentration (MIC) (1500 ± 947.85 µg/mL). Other plant extracts (M. oliefera, S. cumini and C. limon) also showed anti-bacterial activity but couldn’t modulate the resistance. The activity of ceftriaxone associated with E. globulus extract was improved with 20.2 ± 0.20 mm ZOI at 78.125 µg/mL sub-inhibitory concentration.@*Conclusion, significance and impact of study: @#The study results indicate the possible use of the ethanolic extract of E. globulus alone or in combination with common antibiotics for the treatment of C. perfringens infections in small ruminants.

Biofuel production potential of indigenous isolates of Scenedesmus sp. from lake water in Pakistan

Aims@#This paper presents the report on biodiesel and biogas production at a laboratory scale from Scenedesmus strain.@*Methodology and results@#Previously isolated and identified Scenedesmus were grown in 10 Liter flask using BG-11 media at 16 h light and 8 h dark cycle. Oven-dried biomass (20 g) from 16-day-old culture of Scenedesmus was finely grounded and subjected to lipids extraction by chloroform-methanol-NaCl mixture. Microalgal lipids (6 mL) were subjected to transesterification by using NaOH leading to the production of 5 mL biodiesel and 4 mL of glycerin. Biodiesel was rich in methyl esters of linoleic acid, phosphorothioc acid and dodecanoic acid, as shown by gas chromatography-mass spectrometry (GC-MS) analysis. Oven-dried microalgae (2 g) without lipid extraction and leftover biomass (2 g) after lipid extraction were subject to biogas production through anaerobic digestion. Biogas (34, 27 and 19 mL) were recorded respectively in oven-dried whole biomass; lipid extracted biomass and control over a period of 15 days of anaerobic digestion.@*Conclusion, significance and impact of study@#It was concluded that water bodies are rich in diverse algae, especially Scenedesmus sp., and this algae can be cultured to produce biodiesel and biogas. But the lipid accumulation potential of microalgae requires special treatment and lipid extraction methods are not up to the mark, which is a major bottleneck in biofuel production from microalgae.

Molecular characterization of mycotoxin-producing Aspergillus parasiticus and sensitivity pattern to different disinfectants

Aims@#The study was aimed to isolate and characterize the mycotoxin-producing filamentous Aspergillus parasiticus from the feed samples. The sensitivity pattern of the isolates was assessed against different disinfectants.@*Methodology and results@#Fifty different feed samples were screened for A. parasiticus isolation. Isolates were subjected to macroscopic and microscopic characterization. Polymerase chain reaction was performed to confirm the isolates at the genomic level. Mycotoxin producing potential of the isolates was assessed by thin-layer chromatography (TLC). To quantify the toxins, high performance liquid (HPLC) was employed. The antifungal potential of disinfectants was determined by the well diffusion method followed by minimum inhibitory concentration (MIC) calculation. Out of twenty isolates of A. parasiticus, 11(55%) isolates were observed positive for toxin production. Three toxigenic isolates (AspP2, AspP4 and AspP8) were selected to evaluate their susceptibility against disinfectants by well diffusion method. AspP2 produced maximum (5.90 ng/mL) toxin, followed by AspP4 (3.11 ng/mL) and AspP8 (18.47 ng/mL). Terralin showed maximum fungicidal activity with 29.66 ± 8.08 mm zone of inhibition at 0.42 μg/mL MIC. Hypochlorite and Instru Star showed 99% disinfection with 30, 60 and 90 min contact time (6 mean log reduction) for all A. parasiticus isolates. Alpha Guard inhibited growth after 15 min contact time for all the isolates.@*Conclusion, significance and impact of study@#This study provides data indicating the contamination of feed samples with mycotoxin-producing A. parasiticus isolates and their sensitivity against commercially available disinfectants. Use of these disinfectants in appropriate concentrations and time could help prevent the contamination of food, feed and healthcare settings with the fungal species.

Lethal toxic Dose [i.p LD50], total protein contents and comparative hemolytic potential of [99mTc labeled and non-labeled] Naja naja karachiensis venom

Recent recognition about snake bite envenomation on June, 2017 as neglected tropical disease under categoryA by World Health Organization advocated again its undeniable importance. Present circumstances reasoned to work on a neglected subspecies of Naja naja, i.e., Naja naja karachiensis [N. n. karachensis] has been documented for frequent deaths in Pakistan. In this study median lethal toxic dose [LD50] was determined intraperitoneally in Swiss albino mice and was found to be 2.0microg/g [2.0mg/kg] equal in potency to Naja pallida [red spitting African cobra]. Total protein contents [188+/-0.011microg / 200microg of dry weight] were high enough [94%] to represent an arsenal of proteins. Furthermore, 99mTc was labeled 99.9% with venom and didn't find to alter hemolytic activity of venom in dose dependent manner at 125 microg/ml [p<0.5], 250 microg/ml [p<0.1] and 500 microg/ml [p<0.1] when compared with its crude form. Present work will pave the way for proteomics study in effective production of antidote against specific species of snakes as dare demand of it has been felt since long period of time in Pakistan

Factors affecting the visual outcome in acute central serous chorioretinopathy

Objective: To determine the visual outcome in patients with acute Central serous chorioretinopathy [CSCR] and to analyze the association of clinical, angiographic and tomographic factors with final visual outcome in Pakistani population

Methods: This study was conducted at AFIO Rawalpindi and PNS Shifa Naval hospital Karachi from November 2011 to August 2016. Fifty five eyes of 53 patients with acute CSCR were included. All patients underwent a detailed ophthalmic examination including SD OCT imaging at baseline, One month and three month and FFA was performed at baseline. Primary outcome measures were measurement of initial and final BCVA and CFT. SPSS 13.0 was used for the analysis of data

Results: Mean age of study population was 36.66 +/- 6.24 years. On OCT mean CFT at baseline was 467.49 +/- 144.80 microm in affected eye, whereas mean CFT measurements at final follow up was 244.67 +/- 32.99 microm [p <0.01]. Presenting mean log MAR BCVA was 0.47 +/- 0.25 and final mean log MAR BCVA was 0.18 +/- 0.14 [p <0.01]. Baseline BCVA showed statistically significant association with final BCVA [p=0.03]

Conclusion: Presenting VA of 6/12 or better is associated with favorable visual outcome in patients with acute CSCR

Diagnosis of urinary tract infection: medical imaging or laboratory based

Urinary tract infection [UTI] affects women more than males mainly due to smaller urethra and feminine genital anatomy. Symptoms of UTI includes painful micturaition, flank pain, fever etc while its signs are pyuria, bacteriuria and tenderness in flank. In order to rule out UTI, laboratory tests are primarily performed, most important are urine routine examination, urine culture and sensitivity test. Radiological evaluation of urinary system is also done to determine the underlying causes of infection and the extent of damage caused to the renal system by the infection

Hereditary tyrosinemia Type I, presentation in a two month old

Tyrosinemia is a metabolic disorder which manifests as increased levels of tyrosine in the blood

Hereditary Tyrosinemia Type I is one of the many causes of Tyrosinemia. It is due to the deficiency of the enzyme fumaryl acetoacetate hydrolase which leads to the rise in the serum levels of fumaryl acetoacetate and presents with a variety of different signs and symptoms such as neurological disorders, Hepatic and renal insufficiency and corneal depositions. It can be managed by the timely use of medication and dietary plan and fatality can be avoided if the disease is picked up in its earlier stages. We report a case of a 2-month-old baby with signs, symptoms and lab diagnosis suggestive of hereditary tyrosinemia

The case is discussed along with the drawbacks in our setup such as genetic testing and special tests required for a timely diagnosis for most metabolic disorders including neonatal liver disease such as hereditary tyrosinemia

Functional outcome of transforaminal lumbar inter body fusion: an experience at a tertiary care centre

Objective: To assess functional outcome of transforaminal lumbar inter body fusion [TLIF] with specific reference to improvement in pain by visual analogue score [VAS] and Oswestry disability index [ODI]

Study Design: Quasi-experimental study

Place and Duration of Study: The study was conducted at the Department of Spine Surgery of a tertiary care hospital in Rawalpindi from May 2004 to May 2013

Material and Methods: Thirty nine patients who underwent TLIF and completed one year of follow up in our department during the study period were included in the study. Cases were evaluated clinically and radiologically preoperatively and assessed for pain with VAS and general well being with ODI. After TLIF they were reassessed at 1, 3, 6 months and 1 year for improvement in VAS and ODI. Patient satisfaction and work status after surgery was also recorded at 1 year of follow up

Results: Out of 39 cases 19[48.7%] were operated for degenerated disc disease [DDD], 11[28.2%] for spinal stenosis and 7[17.9%] for spondylolisthesis and 2[5.2%] for trauma. A total of 28[71.79%] were males and 11[28.21%] were females. Common levels operated were 12 [30.8%] at L4-5, 11 [28.2%] at L5-S1, and 12[30.8%] at L4,5-S1, 2[5.1%] at L2-4 and 1[2.6%] each at L3-4 and L3-5. At 1 year of follow up median VAS score improved significantly from 7 to 2 and median ODI improved significantly from 76 to 34. Regarding patient satisfaction 26 [66.7%] patients were satisfied, 9 [23.1%] were partially satisfied and 4 [10.2%] were not satisfied with the surgical outcome

Conclusion: TLIF is a safe and effective procedure for reducing chronic low back pain as a result of DDD, instability and spondylolisthesis

Clinical comparative study of efficacy of Epley manoeuvre and Semont manoeuvre in benign paroxysmal positional vertigo

To compare the efficacy of Epley manoeuvre and Semont manoeuvre in the management of benign paroxysmal positional vertigo. Randomized controlled trials. ENT Department Combined Military Hospital [CMH] Kharian and Gilgit from March 2005 to February 2010. Hundred cases of benign paroxysmal positional vertigo [BPPV] were selected on Dix-Hallpike test by non probability convenient sampling technique and randomly divided into two groups of 50 cases each. Patients in group-1 were treated by Epley manoeuvre and patients in group-2 were treated by Semont manoeuvre. The patients were examined on first day, 3[rd]30 day, 7[th] day and after 01 month and clinical results were observed. In group-l, 68% cases showed immediate resolution of symptoms, 74% cases on 3[rd] day, 80% cases on 7[th] day and total 82% cases recovered completely after one month. In group-2, 62% cases showed immediate resolution of symptoms, 68% cases on 3[rd] day, 74% cases on 7[th] day and total 78% cases showed complete recovery after 1 month. There was insignificant difference between the two groups regarding recovery at different follow ups. It was concluded that Epley and Semont manoeuvres are equally effective in the management of BPPV

How common is the paediatric asthma in sialkot?

This study was conducted to see the parental feedback regarding the prevalence of asthma symptoms in their children. A cross sectional study. This study was conducted in a local school from December 2012 to March 2013. This is a questionnaire based descriptive cross-sectional study. We selected a local school in which there are around 500 students. We had 238 questionnaires back out of 500, showing response rate of 47.6%. We found that 38 students had asthma, almost 16%, and there was male predominance. Night cough was the most common complaint in these students. Parental asthma was noted in 18% of the asthmatics. This questionnaire based study revealed asthma to be more common in this part of Pakistan. More studies are required to see the validity of the observation. Asthma being more common and an important health concern, requires prompt health education of the public and health professionals as well as further research work

Association of Dermatological Conditions of External Ear with the Use of Cotton Buds.

Background: The habit of cleaning the external auditory canal with cotton buds is a common practice of the masses. It has strong association with neurodermatitis and contact dermatitis of the external ear. It is also associated with acute otitis externa, rupture of tympanic membrane causing bleeding and temporary hearing loss in some cases. In many cases the injury will heal but damage to minuscule bones deep inside the ear can cause permanent deafness. Objective: The objective of this study was to determine the association of dermatological condition of external ear with the use of cotton buds. Materials and Methods: This case control study was done from January to October 2012 in the Ear Nose Throat Department of Pakistan Level III Hospital, Darfur, Sudan. Sixty seven patients with dermatological diseases of external ear were cases and 83 subjects without dermatological diseases of external ear were selected as controls. Results: Among 67 cases, 58 were cotton bud users and among 83 controls only 29 were cotton bud users. Different types of dermatological diseases were neurodermatitis (34.32%), otitis externa (28.36%), contact dermatitis (26.87%) and wax impaction (8.95%). Ninety three percent of cotton bud users were ignorant of harmful effects of this bad habit. Conclusion: There is a strong association of dermatological diseases of external ear with the use of cotton bud which should be discouraged by fortifying the warning by manufacturers and health education at various educational levels.

Treatment and incidence of recurrence of varicose veins of lower limbs

To study the presentation of varicose veins of lower limbs, treatment in our patients; and to see the causes of recurrent varicose veins at Islam Medical College, Sialkot, Pakistan. Observational and descriptive study. This study was carried out at the Department of Surgery, Combined Military Hospital, Sialkot; from June 2007 to August 2010.Department of Surgery, and Islam Teaching Hospital, Sialkot from September 2010 to September 2013. Adult patients referred by general practitioners with varicose veins of lower limb were included in the study. Data of sixty seven patients with varicose veins of lower limb was collected from June 2007 to September 2013. Patients were distributed in four groups depending upon the surgical procedures carried out. Full detailed history, examination, and investigations were done. Results of treatment were assessed by regular follow up. Data of only those patients was included who could complete follow up for at least 6 months. Out of 67 patients included in our study, 25 cases were having recurrence; 8[32%] was recurrent cases from pervious surgeries from somewhere else and 17[68%] cases were diagnosed with recurrence after surgery at our hospitals. So, the incidence of recurrence in our cases exclusive remained to be 29%. Failure or recurrence in "Ligation" only was 38.5%, in ligation and reverse stripping was 30.7%, stab avulsions was 44.44% and in patients who underwent ligation, reverse stripping and stab avulsions was 12.5% after follow up of minimum 6 months. The patients are still on followup and the percentages are likely to increase with time as varicosities could be obvious. The anomalous double great saphenous veins, neovascularisation or missed tributaries of great saphenous vein during surgery and deep venous thrombosis before and after surgery were the most observed finding of recurrence. The recurrence of varicose veins was more in leg only as compared to both leg and thigh. Saphenofemoral ligation with below knee stripping and stab avulsions combined has the least frequency of recurrence, while Trendlenberg operation alone has the highest

Use of intranasal splints to prevent post operative nasal Synechia formation

This study was conducted to see the effect of intranasal splints in preventing post operative nasal synechia in patients who underwent intranasal surgery. Observational and descriptive study. This study was carried out at the Department of ENT, Islam Teaching Hospital, affiliated to Islam Medical College, Pasrur road, Sialkot, Pakistan: from June 2007 to December 2013. Fifty four patients coming to Islam Teaching Hospital Sialkot from September 2012 to December 2013 were selected. Intransal splints were used in all patients after the intransal surgery. Nasal pack was removed on 1[st] or second post operative day. Intranasal splints were removed on 7[th] post operative day in the clinic without anesthesia. Follow up was done on 7[th] post operative day, 2 weeks and then monthly for 3 months. In this study there were 36 cases [66.7%] were among male patients and 18 cases [33.3%] were among female patients. The Maximum age of the patients in this study was 45 years and minimum age of the patients was 9 years and mean age was 25.70. There were 2 cases [3.7%] of septal abscess drainage, 2 cases [3.7%] of septal hematoma drainage, 8 cases [14.8%] of Septoplasty, 2 cases [3.7%] septoplasty and bilateral partial inferior turbinectomy, 6 cases [11.1%] of septoplasty plus bilateral partial inferior turbinectomy, 4 cases [7.4%] of septoplasty plus left inferior turbinectomy and septoplasty plus manipulation of fractured nasal bones, 2 cases [3.7%] of septoplasty plus nasal cauterization, 20 cases [37%] of septoplasty plus right inferior turbinectomy, 2 cases [3.7%] of septoplasty plus right inferior turbinectomy plus trimming of right middle turbinate and septoplasty plus right intranasal polypectomy. There were 10 patients [18.5%] in which the nasal pack was removed on 1[st] day and 44 patients [81.5%] in which nasal pack was removed on 2[nd] day. Intranasal splints made of intravenous fluid bottle soft plastic are well tolerated and they were effective in preventing nasal synechia formation

Isolation and antibiotic susceptibility of E. coli from urinary tract infections in a tertiary care hospital

The study was conducted to isolate and determine the antibiotic resistance in E. coli from urinary tract infections in a tertiary care hospital, Lahore. Urine samples [n=500] were collected from patients with signs and symptoms of Urinary tract infections. Bacteria were isolated and identified by conventional biochemical profile. Antibiotic resistance pattern of E. coli against different antibiotic was determined by Kirby-Baur method. Bacterial etiological agent was isolated from 402 samples with highest prevalence of E. coli [321, 80%] followed by Staphylococcus aureus [9.4%], Proteus species [5.4%] and Pseudomonas species [5.2%]. The E. coli were highly resistant to penicillin [100%], amoxicillin [100%] and cefotaxime [89.7%], followed by intermediate level of resistance to ceftazidime [73.8%], cephradine [73.8%], tetracycline [69.4%], doxycycline [66.6%], augmentin [62.6%], gentamycin [59.8%], cefuroxime [58.2%], ciprofloxacin [54.2%], cefaclor [50%], aztreonam [44.8%], ceftriaxone [43.3%], imipenem [43.3%], and low level of resistance to streptomycin [30%], kanamycin [19.9%], tazocin [14%], amikacin [12.7%] and lowest to norfloxacin [11.2%]. Out of 321 E. coli isolates, 261 [81%] were declared as multiple drug resistant and 5 [1.5%] were extensive drug resistant. It is concluded that most of the urinary tract infections in human are caused by multiple drug resistant E. coli

Surgical treatment of upper cervical spine injuries [C1-C2]: experience in 26 patients

To describe the spectrum of operations in unstable upper cervical spinal injuries in [atlanto-axial] region at our unit. A cross-sectional study. Spine Unit, Department of Orthopedics, Combined Military Hospital [CMH], Rawalpindi from Jan 2001 to Dec 2008. Frequency of different kind of operations in 26 patients operated for upper cervical spinal injuries was reviewed. A performa was made for each patient and records were kept in a custom built Microsoft access database. Average age of patients studied was 27 years with male pre dominance. Total 12[46%] patients had Atlanto-axial instability, 8[31%] had Hangman's fracture and 6[23%] patients had odontoid peg fracture. While 11[42%] patients had no neurological deficit according to American spinal injury association impairment scale [AIS-E] and 15[58%] had partial neurological deficit. The patients were divided into three groups. Group A had odontoid peg fracture, Group B had atlanto-axial instability and Group C had Hangman's fracture. The spine was approached posteriorly in 19[73%] cases and anteriorly in 7[27%]. Pedicle screw fixation was done in 6[23%] patients, odontoid peg screw fixation in 6[23%], Gallie's fusion in 5[19%], occipito-cervical fusion in 4[15%], posterior transarticular fixation in 3[12%], anterior transarticular fixation and decompression in others, 9[60%] patients improved neurologically postoperatively and there was no deterioration of neurological status. Nonunion in two [8%] cases and implant failure in one [4%] were complications. Upper cervical injuries [C1-C2] are rare and their management is complex, necessitating lot of experience for their management. Early diagnosis and appropriate treatment is essential for good outcome. Each injury has to be managed at its own merit and a single operation may not be appropriate in all situations. General guidelines can be drawn from our study for the management of these cases on modern lines

Formulation and in vitro evaluation of nateglinide microspheres using HPMC and carbopol-940 polymers by ionic gelation method

This study involves the design and characterization of Nateglinide [NAT] microspheres to enhance patient compliance. Ionic gelation technique was used to prepare Nateglinide Microspheres by using rate controlling polymers Carbopol-940 and Hydroxypropylmethyl cellulose [HPMC]. Shape and surface were evaluated with Scanning electron microscopy [SEM]. Percentage Yield, Particle size analysis, Encapsulating Efficiency, Micromeritic analysis, Fourier Transform Infra-Red Spectroscopy [FTIR], Differential Scanning Colorimetry [DSC] were done for characterization of Microspheres. Drug release studies were performed at pH 1.2 and 7.2 using USP dissolution type-2 apparatus and release rates were analyzed by the application of different pharmacokinetic models. The size of microspheres was found to be varied from 781 Micro m to 853 Micro m. Rheological studies proved excellent flow behavior while percentage yield was found to be varied from 72% to 79%. Absence of drug-polymers interactions was confirmed from FTIR and DSC results. The microspheres prepared with sodium alginate showed cracks while microspheres obtained from blend of Carbopol-940 plus sodium alginate were smooth and spherical. Maximum entrapment efficiency [71.4%] was achieved for Microspheres with Carbopol-940. The greater retardation in drug release was observed for microspheres containing Carbopol-940 and release pattern followed Higuchi kinetics model and negligible drug release was observed at pH 1.2

Surgical treatment in lumbar spondylolisthesis: experience with 45 patients

Spondylolithesis is forward slipping of upper vertebra in relation to its lower one, which at times requires surgery. The objective of present study is to document the outcome of surgical treatment in spondylolisthesis of lumbosacral region. We reviewed outcome of surgery in 45 patients with spondylolisthesis. Improvement in pain intensity, neurological status and union achieved after surgery was studied. All patients requiring surgical treatment were included in the study. The patients were operated by single spine surgeon. A Performa was made for each patient and records were kept in a custom built Microsoft access database. Majority of our patient were in 4[th] and 5[th] decade with some male domination. Pain was main indication for surgery which was excruciating in 6, severe in 33, and moderate in 6 cases. The neurological status was normal in 34 cases while 11 patients had some deficit. L5-S1 was affected in 26, L4-L5 in 13 and multi or high level was found in rest of cases. Slip grade was measured with Meyerding grades, 18 had grade II, 15 had I, 9 had III and 3 had IV spondylolisthesis. Posterior lumbar inter body fusion [PLIF] was done in 24 patients, posterolateral, transforaminal lumbar inter body and anterior inter body fusion in others. Translaminar screw fixation, transpedicular transdiscal transcorporial and Delta fixation in some cases. Pedicle screw fixation was done in most cases, AO fixator internae and 4.5 mm screw in others. Average follow up was 2 years and 5 months, max 5 years and minimum 6 months. Pain relief was achieved in 82%, neurological improvement 60% and union in 91% cases. There was no deterioration of neurological status, two implant failure and one wound infection. Surgical procedure for Spondylolisthesis must be individualised. Young patients with spondylolysis can be treated with osteosynthesis and sparing of motion segment. PLIF provides satisfactory results in majority of low to moderate cases with some reduction. Transpedicular transdiscal transcorprial and delta fixation is good procedure for severe slips in adult.

Auricular angiolymphoid hyperplasia with eosinophilia

Angiolymphoid hyperplasia with eosinophilia is an uncommon, benign, angioproliferative cutaneous disorder. Previously, angiolymphoid hyperplasia with eosinophilia and Kimura's disease were regarded as identical conditions, however, recent work identifies them as separate entities. It is clinically manifested by solitary or multiple, red to brown firm papules and nodules, occurring in the head and neck region with a predilection for the peri-auricular area. It usually occurs during the early and mid-adult life. It is more common in Caucasians with equal gender involvement. We report this condition in a 32 years old adult Pakistani male having red-brown papules in left ear