localized outbreak of cholera due to vibrio cholerae 01, ogawa resistant to tetracyclines

To study the clinical and laboratory parameters of a localized Cholera outbreak and determine the sensitivity pattern of the subtype involved. A descriptive study. Combined Military Hospital, Lahore. Two weeks. The study is about a localized outbreak of cholera in a group of soldiers, who consumed water from a single contaminated source of water. We are presenting here an account of the clinical and laboratory parameters of 39 hospitalized cases of cholera, who presented with profuse watery diarrhoea and vomiting. There vital signs, hydration status and systemic examination findings were recorded. Stool samples were sent for routine and microscopic examination and bacteriological culture. Blood samples were taken for complete blood count, serum sodium, potassium, urea and creatinine examination. SPSS 18 was used for statistical analysis of the results. The average age of thirty nine men studied in this outbreak was 24.9 +/- 6.9 years. There was no statistically significant difference between confirmed and suspected cholera cases on descriptive analysis of the clinical and laboratory parameters. Majority of patients showed pre-renal azotemia which improved within 48 to 72 hours of hospitalization. Stool cultures isolated Vibrio cholerae O1, subtype Ogawa, which was resistant to tetracyclines, cotrimoxazole and nalidixic acid but sensitive to fluoroquinolones and third generation cephalosporins. The outbreak was controlled when the contaminated water source was sealed and rectified. Multiple drug resistance strains of Vibrio cholera are causing large outbreaks which should be controlled by prevention of the disease and avoiding inappropriate use of antibiotics

Interactive lectures: a perspective of students and lecturers

To evaluate usefulness of lectures in learning of basic science subjects by students and lecturers. It was a survey carried out in Bahria University Medical and Dental College after completion of six modules of teaching in Basic Sciences from January 2009 till December 2010. Response on usefulness of interactive lectures [IL] was acquired by a questionnaire designed separately for students and lecturers. The data was interpreted by soft ware "Statistical Software for Social sciences" [SPSS] version15. The perception of 97 students and 15 lecturers indicated usefulness of IL in better understanding of subject content. Majority of lecturers [93%] were convinced with its role in concept visualization. They were however not convinced with its role in persistence of interest and student's interaction [33%]. Majority of students [84%] were satisfied with delivery of content [p<0.005], 89% understood structural and functional relationship by the teaching methodology however felt need of its improvement in terms of relevance of knowledge in applied sciences. The lecturers and students agreed upon usefulness of IL and its continuation as part of core curriculum in teaching of basic science subjects

2011 dengue haemorrhagic fever outbreak in Lahore - an account of clinical parameters and pattern of haemorrhagic complications

To describe the frequency and outcome of dengue haemorrhagic fever [DHF] cases and determine the association of clinical and laboratory parameters with haemorrhagic complications. A descriptive study. Combined Military Hospital, Lahore, from August to November 2011. Clinical profile and outcome of 640 adult patients hospitalized with a strong clinical suspicion of dengue fever [DF] was evaluated. Based on serological confirmation, these patients were divided into confirmed DF and probable DF cases. They were also categorized according to severity into dengue fever [DF], dengue haemorrhagic fever [DHF] and dengue shock syndrome [DSS] cases according to WHO guidelines. After detailed clinical evaluation, blood samples were taken for a complete blood count, urea, creatinine, sodium, potassium, bilirubin, alanine aminotransferase [ALT], prothrombin time [PT] and activated partial thromboplastin time [APTT]. Patients were managed according to standard protocols with intravenous fluids and symptomatic treatment. SPSS 18 was used for statistical analysis of clinical data. Comparison of features among the groups was made using chi-square or t-test with significance at p < 0.05. There was 359 probable DF and 281 confirmed DF cases. The development of DHF, neurological manifestations and overall mortality was more frequent in confirmed DF group. Comparison between DHF/DSS and DF cases revealed a significant difference in vomiting [p = 0.04], purpuric rash [p < 0.001], systolic blood pressure [p = 0.002], serum ALT [p < 0.001], hospital stay [p < 0.001], neurological involvement [p < 0.001] and coagulopathy [p < 0.001] between the two groups. Among 159 DHF patients, 108 [67.9%] had bleeding from gums and oral cavity, 73 [45.9%] had haemetemesis and 82 [51.5%] malaena, 41 [25.8%] had epistaxis, 12 [7.5%] developed intracranial bleeding, 18 [11%] had hematuria, 12 [7.5%] had fresh bleeding per rectum and 37 [23%] developed haemoptysis. Overall mortality was 3%, but mortality in DHF/DSS cases was 6% and 41.6% for DSS cases. Logistic regression analysis showed that abdominal pain, purpuric rash, ascites, thrombocytopenia, coagulopathy and raised ALT had a statistically significant predictability for developing DHF. A variety of manifestations including that abdominal pain, purpuric rash, ascites, thrombocytopenia, coagulopathy and raised ALT had a statistically significant predictability for developing DHF. A knowledge and understanging of these complictions would be useful for the management of patients if such outbreaks of DHF are encountered again

Uric Acid, creatinine and proteinuria: do they have any relationship with leptin during pre-eclampsia?

To determine the relationship between serum leptin, uric acid, creatinine and proteinuria during pre-eclampsia. Comparative cross-sectional study. This study was carried out in the department of physiology, Basic Medical Sciences Institute, JPMC, in collaboration with the department of Gynaecology and Obstetric, JPMC from Jan 2007 to Dec 2007. For this purpose 45 primigravidas with normal pregnancy and 45 primigravidas with pre-eclamptic pregnancy were selected who were in their third trimester. All the subjects were of the same maternal age, gestational age, height and weight. Serum leptin levels were determined by immunoenzymometric assay and total lipid profile was determined by enzymatic colorimetric method. Serum uric acid and serum creatinine were determined by uricase method and jaffe's method by photometric system. To perform the dipstick urine analysis, multistix URS-10 test strips were used. The study included 90 patients, divided into two groups. Serum uric acid was found to be significant in pre-eclamptic group [p<0.001] but there was no difference between serum creatinine of the two groups. No significant correlation was found between serum leptin, uric acid and creatinine. It was found that the level of leptin rises with the level of proteinuria. From this study, it was concluded that serum leptin levels during pre-eclampsia were not strongly associated with serum uric acid and creatinine but relation with proteinuria was found to be significant

Perception and preferences of undergraduate medical students regarding the use of contemporary teaching aids at Dow International Medical College, Karachi

In this study, perception and preferences of the medical students' studying at Dow International Medical College have been described about the use of different teaching aids. Cross sectional survey was conducted on a stratified random sample of 200 undergraduate medical students during the month of October 2010 at Dow International Medical College, Karachi, Pakistan. 80% of the students responded to the questions asked. Over all 40% of the students chose powerpoint presentations as a reliable mode of teaching and favoured it as interesting and interactive teaching aid over problem based learning [28.8%], audio visual aid [18.6%] and white board [12%]. They believe that powerpoint provides a better learning experience as compared to other teaching tools. Projectors as a teaching tool was rejected by the students. This article serves as a source of valuable information for the faculty members. Students have chosen powerpoint presentations as the best teaching aid and have preferred the integration of different teaching tools for better understanding. Teachers will be able to use this information to develops better understanding about the subject matter among students by considering their learning style preferences. It will also facilitate them in developing interest and active participation of students in the classroom

Validity of nalidixic acid screening in fluoroquinolone-resistant typhoid salmonellae

To validate the screening of low-level fluoroquinolone resistance in typhoid salmonellae by using nalidixic acid [30mg] disk providing an acceptable zone of inhibition. Quasi-experimental study. The Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan from July 2002 to June 2003. Antimicrobial susceptibility of 225 clinical isolates of S. typhi [n=126] and S. paratyphi A [n=99] against nalidixic acid and ciprofloxacin was determined by the modified Kirby-Bauer disk diffusion and agar dilution techniques of NCCLS. The relationship between the zone sizes and the MICs of the two quinolones was plotted in the form of scattergrams and nalidixic acid MICs and zone of inhibition sizes were correlated with those of ciprofloxacin by regression analysis. One hundred and ninety-five isolates were nalidixic acid-susceptible [MIC <16 Mug/mL] and 30 were nalidixic acid-resistant [MIC >32 Mug/mL]. All the nalidixic acid-susceptible isolates had ciprofloxacin MIC of <0.064 Mug/mL. Among the nalidixic acid-resistant isolates 20 had ciprofloxacin MIC > 0.125 Mug/mL and 10 had ciprofloxacin MIC < 0.03- 0.064 Mug/mL. The diameter of inhibition zone around a 30 mg nalidixic acid disk of nalidixic acid-resistant isolates was <13 mm [range 6-16 mm, mean 10.3 mm + SD 3.5 mm], while among nalidixic acid-susceptible isolates it ranged from 14 to 30 mm [mean 23.8 mm + SD 2.2 mm]. The diameter of inhibition zone around a 5mg ciprofloxacin disk of nalidixic acidresistant isolates ranged from 26 to 35 mm [mean 29.8 mm + SD 3.1 mm], while in nalidixic acid-susceptible isolates it ranged from 32 to 42 mm [mean 36.6 mm + SD 1.9 mm]. With ciprofloxacin MIC Z WITH CARON0.125 mg/mL taken as a breakpoint, a zone of <33mm around a 5mg ciprofloxacin disk to detect low susceptibility strains had a sensitivity of 100% and a specificity of 82%. Screening for nalidixic acid resistance [inhibition zone diameter of <13 mm] in isolates with ciprofloxacin MIC Z WITH CARON 0.125 mg/mL using a 30 mg nalidixic acid disk yielded a sensitivity of 100% and a specificity of 95%. Screening for nalidixic acid resistance with a 30mg nalidixic acid disk is a reliable and cost-effective method for detection of low-level fluoroquinolone resistance in typhoid salmonellae

update on the diagnosis of tuberculosis

Tuberculosis [TB] continues to be the bane of mankind. Early diagnosis is the cornerstone of tuberculosis control strategies. Recent years have seen major advances in the fields of biotechnology and molecular biology with introduction of several new diagnostic techniques for tuberculosis and improvement in the existing ones. The new automated culture techniques have appreciably reduced the time required for detection and antimicrobial susceptibility testing. The molecular amplification techniques like the Polymerase Chain Reaction [PCR] have made the same-day diagnosis a reality. Improvements in serology and introduction of novel new techniques like the bacteriophage assays have also shown a lot of promise. However, most of these new techniques are too expensive and sophisticated to be of any practical benefit to the vast majority of TB patients living in underdeveloped countries like Pakistan for whom an early and inexpensive diagnosis remains as elusive as ever. In this article various existing modalities as well as the new advances in TB diagnostics are reviewed