Comparison of Role of Different Doses of Rectal Paracetamol with Rectal Diclofenac as Pre-emptive Analgesics for Postoperative Pain Relief in Paediatric Surgeries.

Background: Post operative pain is a major concern in children particularly in developing countries were opioids are not freely available. Use of opioids is associated with side effects increasing patient discomfort and delaying patient discharge from hospital. We conducted a study comparing the use of different doses of rectal paracetamol with rectal diclofenac when used as pre-emptive analgesics on postoperative pain and recovery in paediatric patients considering the relative risk of diclofenac to increase bleeding in surgeries like tonsillectomy, cleft lip and cleft palate. Methods: Study groups included 20 patients in each. Group P40 receiving 40 mg/kg rectal paracetamol, Group P20 receiving 20 mg/kg rectal paracetamol, Group D receiving rectal diclofenac 1 mg/kg. Pain scoring was done by TPPPS (Toddler Pre-schooler postoperative pain scale) time to first need of analgesia and total dose of analgesia was noted. The rates of recovery were evaluated by using “Modified Steward Coma Scale”at 5 and 10 minutes after extubation. Results: Time of first demand of analgesic was delayed in Group-P40 as compared to Group-D and Group-P20 and difference was statically significant. TPPPS of the three studied groups varied significantly at different time intervals in favour of Group-P40. Total duration of analgesia in Group- P40 was (646±9.94) min Group- D (501±10.63) min and in Group-P20 (294±23.17) min Total analgesic requirement was also low in Group P40 and the difference between groups was significant. Conclusion: Pre-emptive high dose rectal paracetamol appears to be more effective than rectal diclofenac sodium suppository for postoperative analgesia in children without additional risk of bleeding in surgeries like tonsillectomy and cleft lip and cleft palate repair. Hence, high dose rectal paracetamol can be used as an alternative to diclofenac sodium due to higher risks of bleeding with diclofenac sodium in surgeries with increased risk of bleeding.

Determination of lytic enzyme activities of indigenous Trichoderma isolates from Pakistan

Abstract This study investigated lytic enzyme activities in three indigenous Trichoderma strains namely, Trichoderma asperellum, Trichoderma harzianum and Trichoderma sp. Native Trichoderma strains and a virulent strain of Rhizoctonia solani isolated from infected bean plants were also included in the study. Enzyme activities were determined by measuring sugar reduction by dinitrosalicylic acid (DNS) method using suitable substrates. The antagonists were cultured in minimal salt medium with the following modifications: medium A (1 g of glucose), medium B (0.5 g of glucose + 0.5 g of deactivated R. solani mycelia), medium C (1.0 g of deactivated respective antagonist mycelium) and medium D (1 g of deactivated R. solani mycelia). T asperellum showed presence of higher amounts of chitinases, β-1, 3-glucanases and xylanases in extracellular protein extracts from medium D as compared to medium A. While, the higher activities of glucosidases and endoglucanses were shown in medium D extracts by T. harzianum. β-glucosidase activities were lower compared with other enzymes; however, activities of the extracts of medium D were significantly different. T. asperellum exhibited maximum inhibition (97.7%). On the other hand, Trichoderma sp. did not show any effect on mycelia growth of R. solani on crude extract.

Production of peptide antibiotics by Bacillus sp: GU 057 indigenously isolated from saline soil

A total of 112 soil samples were taken from differents areas of district D.I.Khan and Kohat (KPK) Pakistan and screened for production of antibiotics against the Micrococcus luteus and Staphylococcus aureus. Widest zone of inhibition (18mm) was produced by microorganism isolated from saline soil. The strain was later identified as Bacillus GU057 by standard biochemical assays. Maximum activity (18mm inhibition zone) was observed against Staphylococcus aureus after 48 hours of incubation at pH 8 and 4% concentration of glucose. The antibiotic was identified by autobiography as bacitracin. The Bacillus strain GU057 was confirmed as good peptide antibiotic producer and can effectively be indulged as biocontrol agent.

Role of brown-rot fungi in the bioremoval of azo dyes under different conditions

The present study is vital to the understanding of bioremediation of structurally different azo dyes by some unusual Brown-rot fungi. Bioremoval of each dye (20 mg l-1) was tested in two different culture media under static and shaking conditions by taking inocula from different fungi. Fungal strains showed varying dyes removal abilities, though considerable high in case of Acid Red (AR) 151(di-azo) as compared to Orange (Or) II (mono-azo). With an exception of Aspergillus tereus SA3, all the fungal isolates showed higher removal of dyes in SDB. Under static condition, the maximum decolorizing fungal strains were; Aspergillus flavus SA2 (67 percent) and Alternaria spp. SA4 (57 percent) in AR 151, while Penicillium spp. (34 and 33 percent) in Orange II, in SDB and STE, respectively. Bioremoval of dyes was considerably increased when experiments were shifted from static to shaking mode. It was specifically increased ( percent) in; AR 151 (255) with Penicillium spp., Or II with A. flavus SA2 (112) and Alternaria spp. (111). The primary mechanism of dyes removal proved to be fungal biosorption. However, reduction of dyes (onto fungal) with formation of their products (α. naphthol, sulphalinic acid and aniline) furthermore revealed that dyes (specifically azo) were actually biodegraded.

Ethambutol resistance of indigenous Mycobacterium tuberculosis isolated from human patients

The present study was conducted to find out the ethambutol resistance pattern of indigenous isolates of Mycobacterium tuberculosis from Tuberculosis diagnosed human patients. A total of 172 specimens were collected from six different sources and comprised of 84.9 percent sputum, 10.5 percent pus and 4.7 percent bronchial washings. There were 70.9 percent males and 29.1 percent females with 84.30 percent pulmonary and 15.69 percent extra-pulmonary tuberculosis. The Mycobacterium tuberculosis isolates collected from primary culture were further studied to determine their pattern and level of resistance. The inoculums were prepared using 0.5 Mac Farland turbidity standards. Five different concentration of ethambutol were used in Lowenstein Jensen (LJ) medium i.e. 2μg/ml, 4μg/ml, 6μg/ml, 8μg/ml and 10μg/ml for sensitivity testing. Data showed 10 (5.8 percent) resistant and 162 (94.2 percent) sensitive Mycobacterium tuberculosis out of total 172 clinical isolates. The growth was not inhibited at 1st (2μg/ml) and 2nd (4μg/ml) drug levels, while growth of 50 percent isolates inhibited at 3rd level (6μg/ml), 30 percent inhibited at 4th level (8μg/ml) and 20 percent at 5th level (10μg/ml). The last three levels are above the therapeutic index and not recommended in actual clinical practice. It is thus conceivable to explore some other more effective chemotherapeutic agents, modify combinations or find more effective procedures to stop morbidity and mortality due to ethambutol resistant Mycobacterium tuberculosis.

Bilateral suppurative parotitis in a newborn

Suppuration occurring in inflamed parotid glands is an uncommon observation in the neonatal age group. This case report describes a male neonate, 12 days of age, who presented with high grade fever, irritability, poor feeding and bilateral swelling in the parotid region. Workup showed bilateral suppurative parotitis. Abscess developed despite antibiotic therapy requiring surgical drainage before final recovery

Bone mineral density in patients with pemphigus vulgaris on long term steroid therapy

Osteoporosis is a common side-effect seen with long term steroid therapy. Patients at increased risk are over 50 years of age, postmenopausal, or have restricted mobility. To assess the bone mineral density [BMD] in patients with pemphigus vulgaris [PV] on long term steroid therapy. All patients with pemphigus vulgaris on oral/parenteral steroid therapy at the Department of Dermatology, Unit I, Mayo Hospital, Lahore were enrolled. Their BMD was measured at the heel with a quantitative ultrasound device. A control group comprising of 20 patients was also taken within the same time period that suffered from skin diseases other than pemphigus vulgaris and were not taking steroids in any form. There were 25 patients, 14 males and 11 females, with an average age of 33.8 years [range 12-60 years]. The average duration of PV was 24 months [6 months to 12 years]. The steroids used by these patients included prednisolone, betamethasone and dexamethasone. The duration of intake ranged from 2 months to 36 months. The highest dose was 120 mg and lowest was 10 mg. The mean BMD score of the patients was 0.39244 g/cm2 and 0.45773 g/cm2 for the control group. The mean T-score of the patients was -2.31, score was -2.61in female patients and -2.08 in males. The score was -1.74 in the control group. All patients requiring long-term glucocorticoid therapy are candidates for osteoporosis prevention