Fluoroquinolone consumption and -resistance trends in mycobacterium tuberculosis and other respiratory pathogens: ecological antibiotic pressure and consequences in Pakistan, 2009-2015

Objective/background: Fluoroquinolones [FQs] are important anti-tuberculous drugs for the treatment of multidrug-resistant [MDR] tuberculosis. Resistance to FQs leads to fewer options for treatment of tuberculosis [TB], and infection with such strains may also require longer treatment duration. Trends of resistance in Mycobacterium tuberculosis [MTB] are indicators of MTB-resistance evolution. Drivers of such resistance need to be understood and studied to inform preventive strategies

Methods: Here, we present FQ-resistance rates and trends in Pakistan from 2010 to 2015 and compare rates with FQ-consumption data and rates in other community pathogens

Results: Our results reveal a recent decrease in FQ-resistance rates in MTB, but an increase in resistance for Haemophilus influenzae and Shigella spp. Correlation of FQ resistance with FQ consumption at the population level was weak for MTB, although strong associations were noted for H. influenzae and Shigella spp

Conclusion: We discuss the possible reasons for the decrease in resistance rates in TB, putative drivers of resistance other than volume of FQ consumption, and the possible impact of the National Tuberculosis Programme and drug regulatory activities

Investigating inspection practices of pharmaceutical manufacturing facilities in selected Arab countries: views of inspectors and pharmaceutical industry employees

There are few studies that explore inspection practices of pharmaceutical facilities from the viewpoint of inspectors and industry employees. In this descriptive, cross-sectional study, inspectors and quality assurance staff from 4 Arab countries - the United Arab Emirates, Saudi Arabia, Egypt and Jordan - were surveyed about their inspection practices and views. There was considerable variation in inspection practices across countries and between the inspectorate and quality assurance staff within countries. Divergence was found in views associated with payment mechanisms. There was mutual agreement by both groups that inspectors were in short supply and that they needed to be better trained. Inspectors appeared to have less authority than expected in order to control pharmaceutical manufacturing and marketing activities. Compounding this was a dearth of policy which would support a more uniform and systematic approach to the inspection process within and across countries

Unusual sex differences in tuberculosis notifications across Pakistan and the role of environmental factors

In developing countries, only one-third of new tuberculosis cases notified are from women. It is not clear whether tuberculosis incidence is lower in women than men, or whether notification figures reflect under-detection of tuberculosis in women. Pakistan, however, presents an unusual pattern of sex differences in tuberculosis notifications. While 2 of the 4 provinces [Sindh and Punjab] report more notifications from men [female to male ratios 0.81 and 0.89 respectively in 2009], the other 2 provinces [Khyber-Pakhtunkhwa and Balochistan] consistently report higher numbers of smear-positive tuberculosis notifications from women than men [1.37 and 1.40]. No other country is known to have such a large variation in the sex ratios of notifications across regions. Large variations in female to male smear-positive notification ratios in different settings across a single country may indicate that environmental factors, rather than endogenous biological factors, are important in influencing the observed sex differences in tuberculosis notifications.

Short-duration furazolidone therapy in combination with amoxicillin, bismuth subcitrate and omeprazole for eradication of helicobacter pylori

Resistance to metronidazole is one of the most common reasons for Helicobacter pylori treatment failure with the classic triple therapy. The clarithromycin-based regimen is not cost-effective for use in developing countries. Though furazolidone is a great substitute it has many side effects. Decreasing the duration of treatment with furazolidone to 1 week may help decrease the drug's side effects. to study the efficacy and side effects of furazolidone when given for 1 week in combination with bismuth subcitrate, amoxicillin, and omeprazole. One hundred and seventy-seven patients with duodenal ulcer were randomly divided into two groups. Group I received omeprazole 2 x 20 mg + amoxicillin 2 x 1 g + bismuth subcitrate 4 x 120 mg for 2 weeks, with furazolidone 2 x 200 mg in the first week only. Group II received the same regimen, except that 1 week of furazolidone was followed by 1 week of metronidazole in the second week. Control endoscopy was performed after 6 weeks. Three biopsies from the antrum and three from the corpus were taken for urease testing and histology. Eradication was concluded if all tests were negative for H pylori. One hundred and fifty-seven patients completed the study. Two subjects from group I and three from group II did not tolerate the regimen and were excluded from the analysis. No serious complication was detected in any patient. The eradication rates by per-protocol [PP] analysis and intention-to-treat [ITT] analysis were 89% and 79.3% in group I and 86.6% and 74.4% in group II, respectively. One week of furazolidone in combination with 2 weeks of amoxicillin, omeprazole, and bismuth subcitrate is a safe and cost-effective regimen for the eradication of H pylori. Adding metronidazole to the above regimen does not increase the eradication rate

[Effect of mother's position in active phase of labour on length of labour]

Using of some methods that regulate uterine contraction and accelerate labor is necessary. One of these methods is mother's position in active phase of labour. The purpose of this study was to evaluate the mother's position in active phase of labour on length of active phase, Apgar score and type of delivery. In this clinical trial study, a total of 200 pregnant women who referred to Emam Khomeyni hospital of Falavarjan were selected using simple method. They subsequently, were randomly divided in 4 groups of lateral, sitting, ambulating, and free position. [Each group consisted of 50 women]. Sampling was done during labor and a questionnaire was used for data collection. Data analysis was descriptive and analytic statistic and the software used in this research was SPSS. The length of active phase in primipara, multipara, the 5 minute Apgar, the length of the active phase in partial cephalo pelvic disproportion [CPD] and the type of delivery all were 3.57 +/- 0.52, 2.23 +/- 0.31, 2.46 +/- 0.25, and 2.25 +/- 0.16 hours, respectively. The length of "active phase in primipara was more than that in 3 others [P<0.01]. Also, the mean of the second phase of pregnancy in these two groups was more than the earlier one [P<0.01]. There was no difference among the four groups in the case of Apgar. However, Apgar of 8-10 in the fifth minutes in the sleep group was more than that of the other groups [P<0.001]. Regarding the findings of this research, the mother's position except lateral position can effectively decrease the length of the active phase of labor, improve the 5 minute Apgar score and decrease rate of c/s. Mothers position in labor also improve the length of the active phase of labor in woman with partial cephalo pelvic disproportion [CPD]

Increased isolation of Vibrio cholerae O1 serotype Inaba over serotype Ogawa in Pakistan

Although the predominant Vibrio cholerae serotype in Pakistan is Ogawa and serotype Inaba is rare, there has been a significant increase in the isolation of Inaba in our referral laboratory in Karachi. This paper reports this observation and further analysis of previous cholera data from 1993 to 2005 to assess the trend of occurrence and resistance pattern of V. cholerae strains. From January to September 2005, 245/3292 [7.4%] specimens yielded growth of V. cholerae. Of these, 243 were serotype Inaba, outnumbering serotype Ogawa. This recent Inaba strain is 100% resistant to cotrimoxazole, 3% resistant to chloramphenicol and not resistant to ampicillin, tetracycline and ofloxacin. This sensitivity pattern is almost similar to that of the previous predominant serotype Ogawa

[ comparative study on pregnancy and delivery complications in patients involved and not involved in polycystic ovary disease [PCOD]]

Polycystic ovary syndrome [PCOS] is one of the most prevalent endocrine disorders in reproductive age and is also considered as the most popular cause of infertility due to lack of ovary release. On the other hand, present condition of high expenses of infertility treatment and midwifery science slogan as "deliver a healthy infant to a healthy mother" all reflect the necessity to take care of these patients and to check their pregnancy stages precisely. This study aimed to investigate the pregnancy complications among patients with polycystic ovary syndrome. This was an analytic prospective cohort study. The population studied comprised all Iranian nullipars women with pregnancy of one quite healthy fetus. They were divided into two groups including 47 subjects with PCOS and 100 subjects with no PCOS. Pregnancy and delivery complications such as pregnancy sweat, diabetes, eclampsy and early delivery were recorded. The data were collected through interview and analyzed by descriptive inferential statistics through SPSS . The findings of the study showed that the rates of abnormalities in screening tests of diabetes, pregnancy diabetes and eclampsy in pregnant women with PCOS were more than those in controls but there was no significant difference between the two groups in early delivery. Since obesity seems to be the major cause of diabetes and eclampsy in patients with PCOS, these patients need critical care during pregnancy and screen them properly for diabetes and eclampsy

Diagnostic value of 5' Nucleotidase on kala - Azar patients

5'-Nucleotidase activity was measured in the sera of [67] Kala-azar patients before treatment and at different stages of treatment with pentostam as well as in [30] age matcher normal children. The changes in 5'-NT isoenzyme profile were also followed among the above cases. A change of the activity of the enzyme with the progress of the disease was observed. Our result suggest also that there are changes in the 5'-NT isoenzyme profile with the severity of the disease

Impact of antibiotic usage on resistance in microorganisms; urinary tract infections with E-coli as a case in point

In this study, we sought to establish a correlation between consumption of flouoroquinolones in our hospital and the emergence of ofloxacin resistant strains of E.coli in the urinary specimens. Data of all urinary samples, received at Aga Khan University Hospital between January 1995 and December 2002, was retrieved and analyzed. Specimens yielding E-coli as an isolate were included in this study. E. coli Isolates showing >103 colonies were identified using standard microbiological techniques. Antibiotic susceptibility of E-coli was tested using Kirby Bauer disc diffusion method. Antimicrobial usage data, obtained through hospital Pharmacy as unit utilized per year for Quinolones in different medical and surgical units was available only for the period of 1997- 2002. Among 32,722 urinary specimens E.coli [53%] was the most frequent isolate. Steady increase in the number of ofloxacin resistant E.coli was noted, 24% in 1995 to 55% in 2002. Maximum quinolone resistant E coli have been observed in Medical units, 41% in 1997 increasing to 70% in 2002, followed by Surgery units [35% to 54%] and Pediatrics [12 to 38%]. Sharp increase in ofloxacin consumption in our hospital, 1997 [28613 units] to 2002 [96880 units] has been observed. Trends in quinolone resistance correlate significantly with utilization in the same period as shown by linear regression. E- coli resistance against most antibiotics has been on a rise particularly for quinolones. The utilization of quinolones correlates with increasing resistance in our hospitalized patients

Comparison of double disc and combined disc method for the detection of extended spectrum B lactamases in enterobacteriaceae

To compare double disc approximation and combined disc method for their ability to detect extended spectrum b lactamase [ESBL] production in enterobacteriaceae and determine the percentage of isolates which are falsely reported as sensitive in absence of ESBL detection, in a clinical microbiology laboratory of a tertiary care hospital between September - October 2002. Selected isolates were identified according to standard biochemical tests. Disc susceptibility tests were performed according to NCCLS. ESBL detection by combined disc [cefotaxime [30ug] versus cefotaxime plus clavulanate [30+10 ug]] was compared with detection using double discs [amoxy-clavulanic acid [20+10 ug] and aztreonam [30ug] applied 10 mm apart]. Results were interpreted according to NCCLS and analysed on SPSS version 10. ESBL production was detected in 140 [30%] isolates by combined disc method and 139 [29.5%] by double disc method. There was no significant difference between two methods. Of the ESBL positive isolates 41[29%] gave zone diameters that were within the sensitivity range cutoff and would have been falsely reported as being beta lactam sensitive in absence of ESBL detection. ESBL detection should be routinely performed in clinical laboratories as false reporting would result in treatment failure despite in vitro sensitivity. No difference was found between the combined disc and double disc methods hence either of two could be used

Arthroscopic synovectomy in management of chronic synovitis of the knee

Arthroscopic synovectomy was done for 23 knees in 21 patients during the period from February 1996 till January 1999. The age ranged from 16 to 54 years old with an average of 31.9 years. The aetiology was rheumatoid arthritis in 9 knees [7 patients], chondromatosis synvii in 2 knees, pigmented villonodular synovitis in 3 knees, chondrocalcinosis in one knee, tuberculous synovitis in 2 knees and post traumatic synovitis in 6 knees. The follow up period ranged from 6 to 38 months with an average of 18.34 months. Satisfactory results were obtained in 78.26% of cases. Arthroscopic synovectomy yielded satisfactory results as those published for open synovectomy but with less postoperative morbidity, with better functional capacity with more rapid return to activity with shorter hospital stay

Cutaneous cautery in sciatica

Cutaneous cautery is a form of alternative medicine sometimes used for patients with sciatica. We describe the clinical significance of its relics in five patients who had previousely undergone cutaneous cautery. Although it does not provide lasting improvement, its scars are useful indicators of the chronicity and authenticity of symptoms. As such, they may influence patient selection and outcome of surgery. Their sites may assist clinical localization of the disc lesion

Cutaneous cautery in sciatica

We describe five cases of cutaneous cautery in patients with chronic sciatica. The cautery was used as a traditional therapy when modern conservative treatment had failed. in all cases, intervertebral disc prolapse was later confirmed and, in four cases, operated on with good results. Cutaneous cautery is an alternative medicine that does not cause lasting improvement of the symptoms of sciatica However in such cases, the presence of the scars resulting from cautery constitute useful signs indicating genuine symptoms, chronicity and, possibly, assist in localising the level of the disc lesion. Cautery is a possible index for patient selection and an indicator of subsequent success should operative treatment be elected