Effects of isoflurane and xylazine on inducing cerebral ischemia by the model of middle cerebral artery occlusion in mice / 한국실험동물학회지

Preclinical ischemic stroke studies extensively utilize the intraluminal suture method of middle cerebral artery occlusion (MCAo). General anesthesia administration is an essential step for MCAo, but anesthetic agents can lead to adverse effects causing death and making a considerable impact on inducing cerebral ischemia. The purpose of this study was to comparatively assess the effect of isoflurane and xylazine on transient cerebral ischemia in a mouse model of MCAo. Twenty animals were randomly divided into four groups: sham group (no MCAo), control group (MCAo under isoflurane, no agent till reperfusion), isoflurane group (MCAo under isoflurane continued till reperfusion), xylazine group (MCAo under isoflurane, and administration of xylazine till reperfusion). The survival rate, brain infarct volume, and neurologic deficits were studied to assess the effect of isoflurane and xylazine on the stroke model. Our results showed that the body weight showed statistically significant change before and 24 h after surgery in the control and Isoflurane groups, but no difference in the Xylazine group. Also, the survival rate, brain infarct volume, and neurologic deficits were slightly reduced in the isoflurane group at 24 h after reperfusion injury. However, the xylazine and control groups showed similar BIV and neurologic deficits. Interestingly, a high survival rate was observed in the xylazine group. Our results indicate that the modified method of inhalation anesthetics com‑ bined with xylazine can reduce the risk of mortality and develop a reproducible MCAo model with predictable brain ischemia. In addition, extended isoflurane anesthesia after MCAo is associated with the risk of mortality.

Group B Streptococcus Colonization, Antibiotic Susceptibility, and Serotype Distribution among Saudi Pregnant Women

Background@#Group B Streptococcus (GBS) comprises the normal flora of the female urogenital tract and can be transferred to neonates during delivery, causing invasive diseases.This study was performed to investigate the colonization rate, antibiotic susceptibility, and serotype of GBS among Saudi pregnant women. @*Materials and Methods@#In this cross-sectional study, vagino-rectal swabs from 400 pregnant women were collected over a period of one year. Identification of GBS isolates and determination of their antibiotic susceptibility were performed using the Microscan Walk Away system. The isolates were then typed using both latex agglutination and capsular genebased multiplex polymerase chain reaction assays. @*Results@#Sixty (15.0%) subjects were colonized by GBS, with serotype Ia as the dominant type (30.0%) followed by serotype III and V (25.0%, each). Only 43 (71.7%) isolates were typed by latex agglutination, whereas the remaining isolates were not typable or were non-specifically typed as compared to the genotyping assay, which revealed the specific type of each GBS isolate. The highest resistance rates were observed for erythromycin and clindamycin (16.7%, each), which were mainly restricted to the prevalent serotypes. @*Conclusion@#This study is the first to report the distribution of GBS serotypes based on molecular genotyping in Saudi Arabia. GBS colonization was evident among pregnant women, and resistance to erythromycin and clindamycin was predominant among serotypes Ia, III, and V. Molecular genotyping using capsular gene-based multiplex PCR provided reliable typing of the investigated GBS isolates in terms of sensitivity and specificity as compared to conventional serotyping using latex agglutination.

Comparison of wound healing with and without adjuvant topical oxygen therapy in infected diabetic wounds

Diabetes mellitus [D.M] is one of the main problems in health systems and a global public health threat that has increased dramatically over the past 2 decades. Patients with D.M are prone to multiple complications such as diabetic foot ulcer [DFU]. Despite of the advantages of debridement, adequate debridement must always precede the application of topical wound healing agents, dressings or wound closure techniques

Objective: The objective of the study was to compare the efficacy of adjuvant topical oxygen therapy with conventional methods and conventional methods alone in management of infected diabetic wounds

Study Design: Randomized Control Trial

Setting: Surgical Unit III, Allied Hospital, Faisalabad

Period: 4 months from March to June 2017

Methodology: A total of 120 cases included in this study were admitted either through OPD or emergency ward. Group A [Topical oxygen therapy was given along with conventional methods]. Group B [Only conventional methods of wound care were applied]. All patients were given single dose IV antibiotic half an hour before induction of anesthesia. All diabetic patients were administered regular insulin to control blood glucose levels. Good debridement was done, removing all dead tissue. Simple available cellophane bag applied, sterilized with antiseptic solution, tailored according to size of affected part used tapped on open side of body of patient like tourniquet. 100% oxygen was given in bag with routinely available oxygen cylinder exposing whole affected part of body or limb. Oxygen in chamber was given for maximum one and a half hour twice daily in one sitting for 7-10 days. Gram positive, gram negative and anaerobic cover was given with antibiotics. Wound was washed daily with normal saline. After clinical improvement patient was discharged and called for follow up at outdoor on weekly basis initially and then fortnightly for 6 months

Results: Mean age was calculated as 49.56+/-7.02 and 49.11+/-6.59years in group A and B respectively. 53.33% [n=32] in group A and 58.33% [n=35] in group B were males, while 46.67% [n=28] in group A and 41.67% [n=25] in group B were females. Comparison shows that 46.67% [n=28] in group A and 26.67% [n=16] in group B had efficacy; p value was calculated as 0.02 showing a significant difference

Conclusion: Efficacy of adjuvant topical oxygen therapy with conventional methods is significantly higher when compared with conventional methods alone in management of infected diabetic wounds

Blepharophimosis Ptosis Epicanthus Inversus Syndrome (BPES) type 1 in an Indian Family / Journal of the ASEAN Federation of Endocrine Societies

@#Blepharophimosis ptosis epicanthus inversus (BPES) is a relatively rare congenital disorder, which usually presents with classical eye manifestations. In some cases, it is associated with premature ovarian failure (POF). BPES is of two types, type I and type II. Type I is associated with POF along with eyelid malformations, while Type 2 has only eyelid malformations. Here, we report a family of BPES, in whom two sisters presented with secondary amenorrhea. On eye examination, they have blepharophimosis, ptosis, epicanthus inversus and telecanthus. Investigations revealed hypergonadotropic hypogonadism. Their father also has similar eye manifestations. Diagnosis of BPES type I was made and both were started on hormone replacement therapy. To make timely diagnosis of BPES, every patient with POF should specifically be checked for eye manifestations.

Formulation, evaluation and release rate characteristics of medicated jelly of vitamin C

Medicated jelly formulations are patient friendly dosage form for pediatric, geriatric and dysphagic patients. These formulations offer rapid dissolution and absorption of drugs through oral mucosa therefore show the early onset of action. The objective of the study was to develop and evaluate oral jelly formulations of vitamin C. Slurry method was adopted using glucose 103gm, sugar 67gm, gelatin 10gm and sorbitol 6.56gm. Preformulation studies were performed including the organoleptic profile, pH, and solubility of both drugs. The medicated jelly of Vitamin C was prepared and evaluated for physical characteristics, weight variation, syneresis, pH, taste and palatability, drug content, release rate characteristics and stability studies. All the jellies were found to have patient welcoming taste and were palatable. All formulations showed more than 50% drug release within 15 minutes, while 93% drug was released in 30 minutes. The results of release kinetics showed that the formulation followed the zero order release kinetics. Thus the drug was released at constant rate independent of the drug concentration involved in the process. All the medicated jellies were found to remain stable stored for 60 days at different temperatures. The present study revealed that medicated jellies of vitamin C could be employed orally in an effective form as an alternative solid oral dosage form for special population such as pediatrics, geriatrics and patients with dysphagia

Studies on self-nanoemulsifying drug delivery system of flurbiprofen employing long, medium and short chain triglycerides

The aim of the study was to successfully design, formulate and evaluate self-nanoemulsifying drug delivery system [SNEDDS] of poorly aqueous soluble drug viz. flurbiprofen using long [LCT], medium [MCT] and short chain triglycerides [SCT]. The SNEDDS are thermodynamically stable lipid based drug delivery systems which consist of mixture of oil, surfactant and co-surfactant. Upon aqueous dilution, this mixture produces nano-emulsion spontaneously on slight agitation. The excipients intended to be used were screened for their potential to dissolve the drug and to form clear dispersion upon aqueous dilution. Labrafil M 1944 CS, capryol-90 and triacetin were selected as long, medium and short chain triglycerides, respectively, as lipids while tween-80 and polyethylene glycol-400 [PEG-400]/ethanol [3:1 ratio] were selected as surfactant and co-surfactant, respectively. The excipients were studied at every possible combination ratios using pseudo-ternary diagram. The LCT, MCT and SCT-SNEDDS were optimized using thermodynamic studies, percentage transmittance value, viscosity, refractive index [RI], electrical conductivity, globule size analysis and in-vitro drug release studies. The drug release profiles of optimized SNEDDS were then compared with market product at different pH mediums. The LCT-SNEDDS was considered to be superior for enhancement of the drug bioavailability when compared with other SNEDDS formulations and market product

Health outcomes in low, medium, high and very high human developed countries: a cross comparison with Pakistan

Background: Health is a key component of human development and economic growth of a country in addition to education and gross domestic product

Objectives: To determine the health outcomes in four human development index countries and to make a comparison of these with the heath indicators of Pakistan

Materials and Methods: The data used in the current study was a secondary data obtained from United Nations Development Report [UNDP] published in 2015 including several variables representing health outcomes of a country

Results: Pakistan spent 2.8% of its gross domestic product in public health programs which is lower than the average amount spent by low, medium, high and very high human development index countries. Number of medical doctors available per 10,000 people in Pakistan is 8.3 which is higher than the average number in low human development index [1.3], almost similar with the medium human development index [8.2] but much lower than the high [18.7] and very high [28.7] human development index countries. All the health outcome variables were significantly [p< 0.01] different across the four types of human development index groups

Conclusion: Low life expectancy, high mortality ratios, low vaccinations, child malnutrition, less number of physicians and a very low percentage of gross domestic product spent on health are the major barriers in human development of the country

Validation and application of high performance liquid chromatographic method for the estimation of metoclopramide hydrochloride in plasma

The objective of this study was validation of a reverse phase HPLC method for the estimation of metoclopramide HCl in plasma already validated for determination of metoclopramide HCl in tablets dosage form. A reverse chromatographic method was used for estimation of metoclopramide HCl with the mobile phase of acetonitrile, 20mM potassium dihydrogen phosphate buffer solution [pH 3.0 adjusted with orthophosphoric acid] in the ratio of 40: 60. The column used was Waters C18 3.9x300mm micro Bondapak [RP]. The flow rate of the mobile phase was 2ml/ minute. The detector was set at the wavelength of 275nm. This method validated in plasma and was found to be linear, with correlation coefficient [R[2]], value of 0.9988, in the range of 48 ng/ml-0.25ng/ml. The method modified was accurate, precise, sensitive and showed good stability results. The % RSD of the retention time and peak area of metoclopramide HCl was 0.19% and 1.44% respectively. All the parameters such as specificity, linearity, range, accuracy, precision, system suitability, solution stability, detection and quantification limits were evaluated to validate this method and were found within the acceptance limits. The method can be effectively used for estimation of metoclopramide HCl in plasma

Non-islanded distally based sural artery flap: a reliable solution for an unreliable flap

Objective: to assess the reliability of non-islanded distally based sural artery flap, in terms of number of flap failure [partial and major flap necrosis], number of surgeries related to the problem for which flap surgery was performed, hospital stay and return to work, for coverage of soft tissue defects of the distal one-third of leg, ankle and heel

Study Design: cohort study

Place and Duration of Study: department of Plastic Surgery and Burn Unit, Mayo Hospital, KEMU, Lahore, Pakistan, from January 2003 to March 2014

Methodology: distally based sural artery flaps in 87 patients requiring coverage of distal lower lumb were studied, retrospectively. They were divided into two groups. G1 included 46 cases in which distally based sural artery flap was islanded. G2 included 41 cases in which flap was not islanded and pedicle was raised. The variables that were measured in two groups included age, gender, size and cause of defect, co-morbidities, number of surgeries, total hospital stay, return to work and flap related complications. Independent sample t-test and tests of proportions were used for comparison with significance at p < 0.05

Results: the mean age of patients was 38.4 +/- 16.2 years in G1 and 35.1 +/- 18.6 years in G2. In G1, 34 cases were traumatic, 5 caused by diabetic ulcers and another 7 cases were trophic ulcers in paraplegic patients caused by pressure sores. In G2, the cause was trauma in 32 cases, diabetic ulcers in 7 cases, trophic ulcers in 2 cases. The mean number of surgeries in G1 was 3 +/- 1 and 2 +/- 1 in G2 [p < 0.001]. The mean hospital stay in G1 was 43.1 +/- 3.6 days while 27.9 +/- 2.1days in G2 [p < 0.001]. There was epidermolysis in 21 out of 46 islanded distally based sural artery flaps [G1] and in 9 out of 41 non-islanded flaps [G2] [p=0.0203]. Partial necrosis occurred in 12 of flaps in G1 and in only 3 of G2 flaps [p=0.024]

Conclusion: distally based sural artery flap can be made more reliable and with lesser complications by raising the pedicle with skin rather than islanding the flap

Operating room [or] utilization and efficiency; a study to find out methods for improvement

Introduction: Operating room [OR] is a key department in any institution and it runs with heavy resources. Improper running carries not only loss of revenue but it also effects patient care. Delays in operating room are deleterious and methods to decrease these delays are important not only for patient care, but to maximize operating room resource utilization

Objective: To determine the causes effecting the OR utilization and efficiency and to find out ways to overcome it. Study Design: Observational Study. Period: 15-01-2011 to 08-06-2011. Setting: King Khalid Hospital, KSA

Patients and Methods: Operating room baseline data was collected for one month and it was compared with historical data of the last six month. Operating room utilization was found to be 41% overall and 34% for elective cases [benchmark 85%]. In patient pathway, on average 17 min were required from call to ward to enter in operating room. First incision time was 11%=8-8:30, 31% = 8:30-9 and 58%= 9+. Cancelation was 9%. Various improvement projects were started including surgical list management, OR rescheduling, start on time dashboard, pre-anesthesia clinic and reinforcement of day surgery program

Results: The results showed 47% improvement in elective OR utilization and OR utilization reaching 69%. There was 76% improvement in emergency case booking and 18% improvement in pre/ post-op process time. There was 64% improvement in 1[st] cases before 9 am

Conclusion: Integrated management working can improve the working and outcome of the operating room resulting in high efficiency and best patient satisfaction

Prevalence of resistance to 1[st] line anti tuberculosis drugs at Rahim Yar Khan

Background: tuberculosis is an important infectious health issue and its control strongly rely upon effective treatment. The drug resistance and its pattern are important determinant of the treatment regimen, its duration and outcome

Objective: to determine the frequency and pattern of drug resistance among 1[st] line anti tuberculosis treatment

Methodology: it was a cross sectional study carried on 100 cases of smear positive TB. This study was conducted from 1[st] January 2010 to 30 June 2011. Detailed demographic data and history of ATT was taken and their sputa were sent for drug susceptibility testing on LJ media. The cases with drug resistance and no previous history of ATT were labeled as primary while those with previous history of ATT were labeled as secondary resistant cases. The data was entered and analyzed by using SPSS version 15

Results: out of 100 patients enrolled, drug susceptibility report was available for 87 isolates as sputum failed to grow any organism in 13 patients. Out of these 87 cases, 48 [55.17%] were males and 39 [44.83%] females with age range of 9-91 years. Seventeen out of 87 patients [19.5%] had previous history of ATT. Out of 87 isolate, 62 [71.26%] were sensitive to all 1[st] line drugs [R, H, E, Z, S] while 25 [28.74%] were resistant to one or more drugs. Primary resistance was seen in 17 [24%] out of 70 cases in contrast to secondary in 8 [47%] out 17. The difference between primary and secondary resistance among various drugs was statistically significant for isoniazid [p value 0.003] and pyrazinamide [p value 0.036] while the difference to streptomycin, ethambutol and rifampicin was insignificant with p values of 0.20, 0.35 and 0.09 respectively. There was no case of primary MDR-TB and 5.9% of secondary MDR-TB. None of the sociodemographic parameter was significantly associated with drug resistance

Conclusion: resistance to 1[st] line anti-tuberculosis drugs at Rahim Yar Khan is still common. There are good number of patients in which this resistance pattern compromise the currently recommended regimens. However, larger surveillance studies are needed to strengthen this evidence

Susceptibility pattern of 2[nd] line anti tuberculosis drugs at Rahim Yar Khan

Background: Pakistan has a high burden of drug resistant TB. Effective management of these cases needs the inclusion of 2[nd] line anti-tuberculosis drugs. A comprehensive knowledge of susceptibility pattern to these drugs is mandatory to formulate the best possible regimen

Objective: to determine the susceptibility pattern of 2[nd] line anti tuberculosis drugs

Methodology: this cross sectional study was carried out at Department of Pulmonology, Sheikh Zayed Medical College / Hospital, Rahim Yar Khan on smear positive cases of PTB. This study was conducted from 1[st] March 2010 to 30[th] April 2011. A total of 64 smear positive tuberculosis patients of any age and sex regardless of previous treatment with 1[st] line ATT and no history of prior exposure to 2[nd] line ATT were included. Sociodemographic data like age, sex, marital status and income were recorded. Early morning sputum samples were cultured on LJ medium at a reference lab. Drug susceptibility testing [DST] was done for ethionamide, amikacin, kanamycin, capreomycin and ofloxacin to determine the presence of resistance. The data was analyzed on SPSS version 15

Results: in this study, out of total 64 cases, 36 [56.25%] were males and 28 [43.75%] females with age range of 9 to 76 years. Thirteen cases [20.31%] had previous exposure to 1[st] line ATT. Twelve [18.8%] were resistant to one or more drugs. Resistance was highest for ofloxacin [14.1%] followed by ethionamide [6.3%], capreomycin [3.1%], amikacin [1.6%] and kanamycin [1.6%]. Sociodemographic characteristics also did not show any statistically significant association with drug resistance

Conclusion: there is high frequency of resistance to ofloxacin and ethionamide. To avoid addition of further resistance, DST should be available as early as possible by conventional methods or by rapid genotypic methods at the start of treatment

comparative study to evaluate the chronotropic action of citalopram, fluoxetine and paroxetine on intact frog's heart

Objective: To compare the chronotropic action of citalopram, fluoxetine and paroxetine on frog heart

Study Design: Experimental animal study

Place and Duration of Study: This study was conducted at Yusra Medical and Dental College, Islamabad from October 2015 to February 2016

Materials and Methods: Stunning and pithing of the frog was done following which the heart was exposed. The apex was attached to a force transducer. Heart rate readings were recorded on Power lab. Three groups were designed. In every set of experiments basal readings [without drug] were initially recorded that served as the control and then the tissue was treated with one antidepressant. In Group I we documented the effects of citalopram. In Group II we observed the effects of fluoxetine and in Group III we noted the effect of paroxetine. Statistical analysis was done using SPSS version 22. A p value of less than or equal to 0.05 was considered statistically significant

Results: The isolated heart tissue sample was exposed to 0.5ml of drug. Citalopram at a concentration of 1.54mM reduced the heart rate from 30 to 19 beats/min. Fluoxetine at a concentration 1.6mM brought down the heart rate from 23 to 20 beats/min. Whereas, paroxetine at a concentration of 1.3mM increased the heart rate from 21 to 23 beats/min

Conclusion: Citalopram out of the three chosen drugs caused the most marked reduction n in heart rate. Fluoxetine caused a subtle reduction in heart rate. Paroxetine on the other hand caused a mild increase in heart rate

Accuracy of non-fasting lipid profile for the assessment of lipoprotein coronary risk

Objective: To determine the diagnostic accuracy of non-fasting lipid profile in the diagnosis of hyperlipidemia, taking fasting lipid profile as gold standard, in adult population

Study Design: Cross-sectional validation study

Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from July to December 2014

Methodology: One hundred seventy-five adult patients coming for fasting lipid profile were included; their non-fasting samples were taken on the next day. Patients on anti-cholesterol treatment and indoor patients were excluded. Total cholesterol [TC], high density lipoprotein-cholestrol [HDL-C], and triglycerides were measured by direct enzymatic colorimetric method by Modular p-800[registered]. Low density lipoprotein-cholesterol [LDL-C] was calculated by Friedewald's formula, but when triglyceride was greater than 4.5 mmol/l, then LDL-C was measured directly by homogenous enzymatic colorimetric method. Non-HDL-C was calculated by simple equation, i.e. TC-HDL-C

Results: Non-fasting lipid profile had 93% specificity, 51% sensitivity, 94% positive predictive value and 49% negative predictive value; and 65% accuracy with 7.28 positive likelihood ratio and 0.52 negative likelihood ratio. Non-fasting TC and non-HDL-C were significantly higher than fasting TC and non-HDL-C by mean difference of 0.2 mmol/l each with p=0.001 and p=0.004, respectively. Fasting and non fasting HDL-C are comparable to each other with mean difference of 0.01 mmol/l [p=0.745]. Receiver operating curve [ROC] of non-fasting non-HDL-C showed 0.804 [95%CI [0.738-0.870], [p=0.000] area under the curve [AUC] indicating that it was a significant test for ruling out hyperlipidemia. Bland-Altmann plot showed a significant difference between non-fasting, non-HDL-C and fasting LDL-C and non-fasting, non-HDL-C -0.087540 with bias -0.00109; therefore, these cannot be alternative to each other

Conclusion: Diagnostic accuracy of non-fasting lipid profile was found significantly higher than fasting lipid profile [p=0.004] for the assessment of lipoprotein coronary risk on the basis of non-HDL-C, which seemed to be significant test for ruling out hyperlipidemia

Frame factors for implementation of integrated curriculum in public sector medical college - faculty's perspective

Objective: To prospectively explore the frame factors influencing the planned implementation of integrated curriculum at Allama Iqbal Medical College, Lahore from the faculty's perspective

Study Design: Qualitative exploratory phenomenological design using constructivist approach

Place and Duration of Study: Allama Iqbal Medical College Lahore from Sep to Dec 2014

Material and Methods: Purposive sampling was done and consisted of seventeen teaching faculty members of undergraduate subjects and two qualified medical educationists. Face to face semi structured in-depth interviews were carried out which were audio recorded. The interviews were then transcribed and thematic analysis carried out through manual matrix method and by using software N VIVO 1O. Triangulation of themes, subthemes and nodes was done in the content by relating to their respective frequency of quotes and word cluster. Data verification was done through member checking by second and third authors

Results: The promoting factors were political will, strong leadership, faculty training and development, ownership of new curriculum, teamwork, incentives and communication. The potential impediments to curricular change were fear of the unknown, fixed mindset, faculty resistance due to age and competing agendas. However, to address these impediments besides augmenting promoting factors, piloting of the portion of a curriculum for phase was considered essential

Conclusion: The faculty's perspective in regard to the frame factors influencing the planned implementation of integrated curriculum at public sector medical college yielded new information which will serve as a road map to the intended implementation of integrated curriculum at public sector medical colleges from the year 2017

Complications of total extraperitoneal [TEP] repair for adult inguinal hernia

Objectives: To evaluate results of laparoscopic total extra peritoneal repair for inguinal hernia in terms of complications. Setting: Surgical Unit 3, Allied Hospital, Faisalabad. Period: From March 2013 to February 2016. Study Design: Simple Descriptive Study

Patients and Methods: 114 patients over the age of 30 years underwent TEP repair for unilateral reducible inguinal hernia. Complications assessed included pain score assessment, analgesia requirement, time taken to return to normal activity and complications like intraperitoneal injury, conversion to open procedure, seroma and hematoma formation and surgical site infection

Results: Out of the 114 patients, 6 [5.26%] needed TEP converted to open and none suffered from serious complication during the procedure. 8 [7.01%] developed postoperative hematoma, 7 [6.14%] developed seroma and 5 [4.38%] developed surgical site infection. Postoperative pain assessment at 8 hours after surgery showed 42[36.8%] patients required extra analgesia while 13[11.4%] patients required extra analgesia 24 hours after surgery

Decreased serum 25-hydroxycalciferol levels in pre-diabetic adults

Objective: To determine the serum 25-hydroxycalciferol levels [25[OH]D] in adults with pre-diabetes and normoglycaemia to examine a possible association of vitamin D deficiency with pre-diabetes

Study Design: Case control study

Place and Duration of Study: Armed Forces Institute of Pathology, Rawalpindi, from November 2012 to July 2013

Methodology: A total of 272 adults including 136 pre-diabetics and 136 normoglycaemics of either gender aged 20 years and above were consecutively inducted. Patients with diabetes mellitus, pregnancy, rickets and osteomalacia, ischemic heart disease, chronic kidney disease and chronic liver disease were excluded. Fasting Plasma Glucose [FPG] was estimated with hexokinase method on Modular p800 Roche chemistry analyzer while serum 25[OH]D was measured on Diasorin Liaison immunoassay analyzer using the chemiluminescent technique. Mean 25[OH]D levels in pre-diabetic and normoglycaemic groups were compared using Mann-Whitney U test. Spearman's correlation coefficient 'r[s]' was determined between serum 25[OH]D and FPG. Odds ratio for vitamin D deficiency was also calculated

Results: Mean serum 25[OH]D level was low in pre-diabetics [23.2 nmol/L] as compared to normoglycaemics [29 nmol/L; p=0.001]. Serum 25[OH]D level had inverse correlation with FPG [r[s] = -0.448, p=0.000]. There was also significant association of vitamin D deficiency with pre-diabetes compared with normoglycaemia [OR: 2.21, p= 0.016; 95% CI: 1.15-4.27]

Conclusion: Vitamin D deficiency with pre-diabetes suggested that vitamin D may have an important role in pathogenesis of pre-diabetes

Prevalence of Ascaridia galli in white leghorn layers and Fayoumi-Rhode Island red crossbred flock at government poultry farm Dina, Punjab, Pakistan

Poultry farming not only provides high nutritious food but also creates employment opportunity for rural masses. Documented evidences elaborates that helminth parasitism is most deciduous problem of chickens especially in developing world. Ascaridia (A.) galli, a nematode of small intestine, has been considered as the most common and important parasite of chicken. The present study was carried out to investigate prevalence and severity of A. galli in White Leghorn layers (housing type: battery cage and deep litter, 50 each) and Fayoumi-Rhode Island Red crossbred (male and female: 50 each) flock rearing at Government Poultry Farm, Dina, Punjab, Pakistan. Two hundred faecal samples were examined by using standard parasitological and McMaster egg counting technique. The overall prevalence was 24.5% at farm, 13% in White leghorn layer (battery cage=2%, deep litter=24%) and 36% in Fayoumi-Rhode Island Red (male=34%, female=38%). It was also observed that White leghorn layer rearing in deep litter had more severe infection (EPG=1920) of A. galli compare with battery cages birds (EPG=500). Parasite prevalence was significantly related with sex (P<0.05) in Fayoumi-Rhode Island Red and male birds had less number of average parasites (0.34±0.47) as compared to females (0.38±0.490). Additionally, female birds were under serious threat of infection (EPG=2270) compared with its counterpart (EPG=1250). Given the high infection rates, particular attention should be paid to management and provision of feed supplement to White leghorn layer housing in deep litter and female bird of Fayoumi-Rhode Island Red crossbred.

Extensively and pre-extensively drug resistant tuberculosis in clinical isolates of multi-drug resistant tuberculosis using classical second line drugs [levofloxacin and amikacin]

To find out the frequency of Extensively Drug Resistant [XDR] and pre-XDR tuberculosis in clinical isolates of Multi-Drug Resistant [MDR] Tuberculosis [TB] by determining the susceptibilities against Levofloxacin and Amikacin [classical second line antituberculosis drugs]. A descriptive cross-sectional study. Microbiology Department, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from September 2011 to August 2013. Amikacin [AK] and Levofloxacin [LEVO] were obtained in chemically pure form from Sigma [Taufkirchen, Germany]. The breakpoint concentration used for AK was 1.0 microg/ml and for LEVO 2.0 microg/ml. Mycobacterial Growth Indicator Tube [MGIT] 960 system was used to carry out drug susceptibility testing as per recommended protocol. A total of 3 MDR-TB isolates [3%] turned out to be XDR-TB based upon simultaneous resistance to injectable second line antituberculosis drug AK and one of the fluoro-quinolones [LEVO]. A total of 24 MDR-TB isolates [24%] were found to be pre-XDR based upon resistance to LEVO alone. Treatment status record of patients with XDR and pre-XDRTB isolates revealed that majority of patients had received fluoroquinolones [FQs] during the course of treatment. XDR-TB has started to emerge in MDR-TB isolates in our set up. The worrying sign is the high frequency of pre-XDR tuberculosis. Urgent steps need to be taken to stem the tide of pre-XDR-TB in our population. It is thus recommended to develop facilities to carry out drug susceptibility testing to monitor the status of pre-XDR and XDR-TB in our population

Rapid mycobacterium tuberculosis dna detection on fine needle aspirates from extra pulmonary lymph nodes

To evaluate the diagnostic efficacy of two rapid methods i.e. Mycobacterium tuberculosis [MTB] Polymerase Chain Reaction [PCR] on Fine Needle Aspiration [FNA] samples by comparing with cytology of respective site sample. Cross-sectional comparative study. Department of Microbiology, Armed Forces Institute of Pathology [AFIP], Rawalpindi, Pakistan, from July 2010 through November 2013. A total of 105 extra pulmonary lymph nodes aspirates obtained through fine needle aspiration were processed. Cytology and PCR were done on each specimen. Cytology was taken as gold standard. Out of the total 105 samples, 71 [67.6%] were positive for the MTB PCR while 34 [32.4%] showed negative status. According to FNA cytology [FNAC] results, 72 [68.6%] cases were positive for the disease while 33 [31.4%] were negative. Sensitivity of PCR was 90.3%, specificity 81.8%, positive predictive value [PPV] 91.5%, negative predictive value [NPV] 79.4%, with diagnostic accuracy of 87.6%. Area under the curve was 0.860 [p < 0.001]. PCR is a sensitive tool for detection of MTB on FNA samples from EPTB cases. The results are available within few hours which is helpful for the clinicians to initiate therapy