Effectiveness of simple strategies in reducing multidrug resistant blood stream infections in neonatal intensive care unit of tertiary care hospital in Karachi, Pakistan

To report reduction in transmission of multidrug resistant organisms from the neonatal intensive care unit after the implementation of simple risk-reduction strategies. Using a pre-and-post design, the study was carried out from June 2010 to December 2011 at the neonatal intensive care unit of Aga Khan University Hospital, Karachi, which is 12-bed, level III facility. The intervention comprised hand washing certification for all staff, use of chlorhexidine instead of povodine iodine for skin preparation, use of non-sterile gloves for diaper change, implementation of barrier nursing for clinically-suspected and culture-proven infections, provision of separate intubation and central line trolley for each room and limiting the use of umbilical catheters to 7 days. Data is reported for 3-month pre-intervention period, one-month implementation phase, and for 3-month post-intervention phase. Data for 12 months post-implementation is reported to show sustainability. The average pre intervention rates of bloodstream infections due to extended spectrum beta lactamase, Acinetobacter, Pseudomonas and methicillin resistant staphylococcus aureus were 4.7, 3.3, 1.2 and zero respectively. The average number of admissions during the 3 phases was almost similar [49, 46 and 53 respectively]. There was sustained reduction in rates for all organisms 12 months after the intervention period. Nosocomial transmission of multi drug resistant organisms within the neonatal intensive care unit can be effectively reduced by adopting simple strategies

Study of upper and lower endoscopic findings in children with chronic diarrhea attending Alexandria university children's hospital

Objectives: Chronic diarrhea is a major problem worldwide with high morbidity and mortality. Study design: it is a retrospective study. The medical records of the patients with chronic diarrhea who were subjected to endoscopic evaluation were revised. The study was conducted on patients who attended the pediatric Gastroenterology and Endoscopy unit of Alex and ria Children's University Hospital along two years from January 2012 to December 2013. Methodology: The medical records were revised for: history, clinical examination, laboratory investigation and endoscopic findings. Results: forty patients were included in this study. The age range of the patients was from three months to eleven years. Patients from rural areas more than from urban regions, sixty five percent of the patients were males. Mucoid diarrhea was the most common type of diarrhea. Failure to thrive was evident in abetalipoproteinemiaandinflammatory bowel disease. Fecal calprotectin above 150mg/kg is highly specific and sensitive f or inflammatory bowel disease. Esinophilic enteroclolitis was the most common disease [57.5%] followed by celiac disease [15%] then ulcerative colitis [12.5%]. Conclusion: Management of patients with chronic diarrhea should be initiated and followed in a specialized Pediatric GIT unit since it requires experience and close clinical endoscopic and pathological assessment.

Study of upper and lower endoscopic findings in children with chronic diarrhea attending Alexandria university children's hospital

Objectives: Chronic diarrhea is a major problem worldwide with high morbidity and mortality. Study design: it is a retrospective study. The medical records of the patients with chronic diarrhea who were subjected to endoscopic evaluation were revised. The study was conducted on patients who attended the pediatric Gastroenterology and Endoscopy unit of Alex and ria Children's University Hospital along two years from January 2012 to December 2013. Methodology: The medical records were revised for: history, clinical examination, laboratory investigation and endoscopic findings. Results: forty patients were included in this study. The age range of the patients was from three months to eleven years. Patients from rural areas more than from urban regions, sixty five percent of the patients were males. Mucoid diarrhea was the most common type of diarrhea. Failure to thrive was evident in abetalipoproteinemiaandinflammatory bowel disease. Fecal calprotectin above 150 mg/kg is highly specific and sensitive for inflammatory bowel disease. Esinophilic enteroclolitis was the most common disease [57.5%] followed by celiac disease [15%] then ulcerative colitis [12.5%]. Conclusion: Management of patients with chronic diarrhea should be initiated and followed in a specialized Pediatric GIT unit since it requires experience and close clinical endoscopic and pathological assessment.

Hormonization of traditional medicine with modern medicine.

To evaluate the contemporary role of traditional medicine in maintaining health, to develop a scientific approach to policy–making in traditional medicine, and, ultimately, to assess how traditional medicine can be harmonized with modern medicine. There is dire need for identifying research requirements in traditional medicine on the past research, barriers to the acceptance of traditional medicine, research methodology and evidence–based medicine. In the course of these discussions, we concluded that there were challenges to the harmonization of traditional and modern medicine. Better access to information, facilitating appropriate clinical trials, improving rigour in clinical trials, improving education and collaboration of practitioners and researchers, and respecting traditional practices in research were all identified as important steps towards achieving harmonization. We should be believed that evidence–based research could be an essential step towards the harmonization. Findings of well–designed and well–performed research should be disseminated as widely as possible. This should include the preparation and dissemination in English and native languages of rigorous systematic reviews based on the research literature from various countries. Research that establishes the value of traditional medicine in promoting health and wellness beyond treating diseases should be encouraged. Clinical trials of widely used and established traditional remedies should be encouraged and undertaken prior to obtaining the results of extensive ‘pre–clinical’ basic research. This is done by support training in research methodologies by encourage in conducting of high quality research.

Seperation and determination of anticoagulant cumarins which have different therapeutical effects by HPLC

The separation and determination of some anticoagulants drugs like cumarins derivatives were done directly by high performance liquid chromatography reverse phase.We got two separate mobile phases in different percentages, the first one is water 5%: methanol 95%, and the second is water 20%: acetonitril 80% with PH = 4 for both mobile phases. The steady phase was a column of octadecyle 5 micrometre [250mm X 46mm] Nucleosil, then we have got the best results of separation and retention time and determination of the concentrations using different wave lengths of U. V as a detector, that there was a special maximum wave length for each cumarin derivative, where coefficient variation was between 0.04%-3.9% and the limit of detection was between 0.3-1.9 microgram/ml for studied cumarins depending on the mobile phase and cumarin derivative. The assay method was used to qualify the purity of studied cumarin compounds especially used in human uses and quantify and separate it of other compounds in addition to toxicity cases. This method is accurate and sensitive based on quantitative studies

Seperation and determination of anticoagulant cumarins HPLC

The separation and determination of some anticoagulants drugs and cumarins derivatives sodium warfarin were done directly by high performance liquid chromatography reverse phase [where steady phase is less polar than mobile phase]. We used two separate mobile phases in different percentages, the first one is water: methanol, and the second is water: acetonitril with PH = 4 till we got the best percentages. The steady phase was a column of octadecyle 5 micron Nucleosil [250 mmx 46mm], then we've got the best separation and retention time and determination of the concentrations using maximum wave length of U.V 283n.m for sodium warfarin [cumarin derivative], where variation coefficient was 0.12%-3.5% and the limit of detection was 1.9-0.5 micro g/ml. The assay method was used to qualify the purity of studied sodium warfarin used in human uses as an anticoagulant and quantify and separate it of other compounds in tablets in pharmaceutical companies. Consequently our results showed a very good correlation and they were useful for quality control in the drug industries