Effect of cellulose acetate phthalate and polyethylene glycol on physical properties and release of theophylline from microcapsules

ABSTRACT The present study describes the development of theophylline microcapsules by a non-solvent addition method and the effect of plasticizer addition on microencapsulation. The release was studied in distilled water and the data were analysed by various mathematical models for determining the mechanism of release. Prepared microcapsules were found to be spherical, free flowing and having more than 80% entrapped drug. The polymer - cellulose acetate phthalate and plasticizer - polyethylene glycol was considered to be affecting the properties of microcapsules including drug release (time for 50% drug release, T50). The formulation with the highest proportion of polymer and without plasticizer (F3) showed the slowest release with T50 = 4.3 h, while the formulation with lower proportion of polymer and 20% (w/w) plasticizer (F13 &14) showed the fastest release of drug with T50 values of 1.2 h and 1.3 h, respectively. The drug release from most of the formulations was found to be following Higuchi model. It is concluded from the results of the present study that cellulose acetate phthalate significantly affects the sustained release of the drug in water, whereas the addition of polyethylene glycol slightly enhances the drug release.

RESUMO O presente estudo descreve o desenvolvimento de microcápsulas de teofilina pelo método sem adição de solvente e o efeito da adição de plastificante na microencapsulação. A liberação foi estudada em água destilada e os dados foram analisados por vários modelos matemáticos para determinação do mecanismo de liberação. As microcápsulas preparadas mostraram-se esféricas, livres de corrente e com mais de 80% de fármaco encapsulado. O polímero - ftalato de acetato de celulose e o plastificante - polietileno glicol - afetaram as propriedades das microcápsulas, incluindo a liberação do fármaco (tempo para liberação de 50% do fármaco, T50). A formulação com a maior proporção de polímero e sem plastificante (F3) se mostrou como a de liberação mais lenta, com T50 = 4,3 h, enquanto as formulações com menor proporção de polímero e 20% de plastificante (m/m) (F13 &14) apresentaram a liberação mais rápida do fármaco, com T50 de 1,2 h e 1,3 h, respectivamente. A liberação do fármaco para a maioria das formulações seguiu o modelo de Higuchi. Concluiu-se, dos resultados do presente estudo, que o ftalato do acetato de celulose afeta significativamente a liberação controlada do fármaco em água, enquanto que a adição de polietileno glicol aumenta ligeiramente a liberação do fármaco.

Isolation and purification of heparin from bovine pancreas by different methods

Background: Different methods of heparin extraction are being used

Objective: To compare heparin extraction from bovine pancreas by using three different methods including method of Charles and Scott, Max and Volpi

Methodology: Design: Comparative Study. Setting: The University of Lahore with three month's duration starting from 1[st] July 2013. Fresh twenty samples of bovine pancreas samples were collected from the slaughterhouse of Lahore Pakistan and immediately placed in the ice buckets. The isolated heparin samples were separated into two species, slow moving and fast moving heparin by agarose gel electrophoresis. The anticoagulant activity of heparin samples was determined by using assay of Mitali et al [1982]

Results: The percentage yield of heparin extracted by Volpi method was significantly higher [P<0.001] i.e. 0.446% with the anticoagulant activity of 19 IU/ mg for bovine pancreas

Conclusion: Heparins are important in the field of medicine and pharmaceuticals. The results of our study showed that heparin isolated by the method of Volpi was significantly higher for bovine pancreas

Anaesthesia perspective of combat injuries at South Waziristan agency-a field experience of war on terrorism

To determine the presentation form of combat injuries, different aspects of anaesthesia management and methods of effective pain control inside the field hospital. A descriptive study. South Waziristan Scouts Hospital, South Waziristan Agency, Iltiana, Khyber Pakhtun Khawa province from March 2007 to August 2009. A descriptive review of the type of injuries sustained by the troops including local civil population reporting to South Waziristan Scouts [SWS] Hospital from March 2007 to Aug 2009. All patients of combat related injuries reporting to SWS Hospital were included in this study excluding elective surgical cases, gynaecological cases and routine medical patients. Initial anaesthesia management, pain control in anaesthetized patients or analgesia provided without anaesthesia in injured patients and evacuation process of emergencies to tertiary care hospital are discussed. The data was collected from hospital records including operation theatre and was analyzed in the SPSS version 14 for windows in the form of frequency of patients. A total of 149 male [age 30 +/- 15] patients were managed at SWS hospital after sustaining combat related injuries. General anaesthesia was given to 61% patients whereas 26% were operated under spinal anaesthesia. Deaths reported were 12.75% comprising 1.3% brought in dead during combat, 2.68% after cardiopulmonary resuscitation inside the hospital, 2.68% homicides by miscreants, 0.67% suicide, 0.67% of bomb disposal squad during mines search operation and 4.69% due to helicopter crash due to snow fall. Firearm and splinter injuries were the commonest in active encounter followed by IED linked injuries. Stray bullets injured a soldier in the chest causing pneumothorax and minor injuries to other 2%. Suicide 0.67% of permanent residing troop and homicides of 2.68% soldiers by the miscreants were documented. The time for casualty arrival in the hospital was 15 min to 10 hours depending upon the distance of incidence from the hospital. Ketamine was the drug of choice for induction and pain management followed by thiopentone either alone or in combination with ketamine. nalbuphine IV and diclofenac sodium IM were given to all patients for analgesia. Full stomach and lower limb emergent cases were operated under spinal anaesthesia using hyperbaric 7.5% bupivacaine. Poor supply of medicines, deficient staff and skilled workers, inefficient chain of evacuation and geographical problems were the major difficulties in that area. Active initial management and team work in a fully equipped setup have the added advantage. Extreme cold, poor team work, hitches in the evacuation, support and supplies were the major problems which if covered can possibly help to manage wounded persons at source

Finding effectiveness of teaching basic life support to paramedics

To determine the impact of single setting basic life support courses to paramedics by analyzing their responses. Cross sectional analytical study. Combined Military Hospital Gujranwala and PNS Rahat Hospital, Karachi, Pakistan from Jan 2010 to Jan 2013. This study consisted of printed questionnaire of 10 questions from cardiopulmonary resuscitation [CPR] basics prepared according to latest guidelines of American Heart Association [AHA] given to paramedics of two hospitals participating in basic life support [BLS] course from Jan 2010 to Jan 2013. The courses were run by a single person while distributing questionnaire to all participants of both genders performing duties at different departments of the hospital on rotation. Groups of similar education level were selected for these courses. The assessment of all participants was done after each course completion as per the questionnaire and data was collected for statistical analysis. In a study of 300 individuals the consistent response of performing chest compression was seen in a large no of participants [97.3%] which was followed by checking responsiveness [75%], checking carotid pulse [66.6%], effective chest compressions [76.6%], mask ventilation first attempt was successful in [33.3%], and second attempt [96.6%]. Only 45 [15%] out of 300 had seen all types of available defibrillators [monophasic, biphasic, automated external defibrillator], monophasic defibrillator was seen by majority [83.3%] followed by biphasic [23.3%]. Automated external defibrillator [AED] was seen by few [16.6%] out of 300. Mouth to mask ventilations was difficult in first attempt for majority with small success rate [33.3%] and improved in second attempt [290%]. Checking responsiveness [75%] and feeling carotid pulse was poor in first attempt [33.3%]; however it improved following practice [83.3%]. Defibrillator paddle placement was easily mastered after practice. The defibrillation skills and knowledge of abbreviations taken from CPR guidelines was easily remembered by many participants. BLS is simple to teach but mastering skills is difficult for everyone. The outcomes of training sessions over the time can be improved with customized repeated courses to maximum individuals while stressing on practical application. Furthermore prevalent teaching methods of this skill in our hospitals need purposeful modification keeping in view the participant's capacity

Histopathological patterns of testicular biopsies in male infertility

To evaluate histopathological patterns of testicular biopsy specimens from infertile males and to categorize each case according to Modified Johnson scoring system. Male infertility contributes to about 20% of infertility cases. Testicular biopsy is important in categorizing patients with Azoospermia and provides useful information and guidelines for further treatment. Histopathological findings of testicular biopsies are of significant importance in making decision for selection of cases for Intracytoplasmic sperm injection [ICSI] in patients with non obstructive azoospermia. Testicular biopsies from male patients with history of infertility and azoospermia were included in this study. All biopsies were received in 10% formalin fixative and routinely processed and stained with Hematoxylin and Eosin [H and E]. Clinical data was obtained and recorded on a proforma. All cases were examined microscopically and various histological patterns were evaluated and categorized according to the histopathological patterns and Modified Johnson scoring was performed. A total 53 cases of testicular biopsies from azoospermic males were evaluated. Mean age was 28 years and range was from 24-56 years. Most frequent pattern was of Sertoli cell only syndrome [30.18%], further categorized as Johnson score 2. The second most frequent was hypospermatogenesis [18.86%], further categorized as Johnson score 7. There were 5 cases that showed mixed pattern and 1 case showed discordant pattern. This study outlines the different histopathological patterns of testicular biopsies in cases of male infertility in our setup and identifies Sertoli cell only syndrome as the most common pathological finding amongst various histopathological patterns

Extended Spectrum beta-lactamases in pyogenic gram-negative bacilli

To determine the frequency, distribution and sensitivity pattern of extended spectrum beta-lactamases producing Gram-negative bacilli from pus samples. Cross Sectional Comparative Study Study, place and duration: This study was conducted at the Microbiology Department, Fauji Foundation Hospital, Rawalpindi over a period of two years from 04/ 2004 to 03 / 2006 Inclusion criteria: All pus samples were included. Exclusion criteria: Dried pus swabs were not included in the study. Multidrug resistance and ESBLs-production were studied in a total of 138 Enteric Gram-negative Rods [GNR] obtained from pus specimens by the help of double disc diffusion technique. Susceptibility testing was done to various groups of antimicrobials. Frequency of ESBLs-production was 56.5%. ESBLs-positivity was highest at 61-70 years of age group [24.3%], followed by 11-20 yrs [17.5%]. ESBLs-positivity in females versus males was 58.2%: 54.2% and highest in indoor patients [92.3%]. ESBLs-production was highest amongst Escherichia coli [55.1%] followed by Klebsiella pneumoniae, [29.5%], Pseudomonas aeruginosa [9.0%], Aeromonas spp [2.6%]. The antibiotics showing best activity against ESBLs-producing K pneumoniae and E coli were beta lactam beta -lactamase inhibitors [piperacillin /tazobactam 100% and 80%-] and carbapenems [imipenem 100% each and meropenem 75% and 100%] respectively. ESBLs producing GNRs had a more antibiotic-resistant profile than non- ESBLs producers. They were not only resistant to beta-lactams but showed cross-resistance towards a wide variety of commonly used other antimicrobials. ESBLs producers are more resistant as compared to non-ESBLs producers. Considering the high prevalence of ESBLs in Enteric Gram-negative rods, it is suggested that all such isolates should be tested for the production of ESBLs in the routine microbiology laboratory

Frequency of enteric gram negative rods isolated from various clinical samples

To determine the frequency of gram negative rods in both nosocomial and community acquired infections in our setting. This descriptive study was conducted at the Microbiology Department of Fauji Foundation Hospital, Rawalpindi over a period of two years [April 2004 to March 2006]. All pus, urine, blood and HVS received during the study period were included. Samples without properly filled forms, dried swabs and improperly transported samples were excluded. Two thousand and ninety one Enteric Gram Negative Rods [EGNR] were isolated over a period of two years, They were most commonly found in urine samples [40.7%], followed by pus [37.1%], HVS [12.0%], sputum [6.12%] and blood [3.92%] samples. The most common EGNR isolated was Escherichia coli [49.7%] followed by Klebsiella pneumoniae [23.4%], Pseudomonas aeruginosa [19.5%] and Proteus species [1.81%]. The most commonly isolated Enteric Gram negative rod from urine samples [n 852] was E. coli [622] followed by Klebsiella pneumonia [189], Providentia [18] and Enterobacter species [13]. The most commonly isolated Gram negative rod from pus samples [n 852] was Pseudomonas aeruginosa [290] followed by E. coli [227], Klebsiella pneumoniae [18] and Proteus species. The most commonly isolated EGNR from HVS samples was E. coli [130] followed by Klebsiella pneumoniae [68] and Pseudomonas aeruginosa [51]. The most common EGNR found in sputum [n 128] was Klebsiella pneumoniae [56] followed by Pseudomonas aeruginosa [40] and E. coli [30]. In blood samples the most common organism isolated was E. coli, followed by Pseudomonas and Klebsiella.

Multiple myeloma presenting at unusual sites

To report unusual presentations of multiple myeloma and to highlight that early detection of these unusual features will encourage early investigation, diagnosis and appropriate management and consequently better prognosis of this difficult disease. Three consecutive cases of plasmacytoma reported at histopathology department of Foundation University Medical College which were later on diagnosed as multiple myeloma are presented. The clinical features and lab investigations were extracted from the patients' files. The hematoxylin and eosin stained slides were retrieved and reviewed. Three cases comprising a surgically excised chest wall mass [presternal], trucut biopsy of a mediastinal mass and a surgically excised extra dural mass along D7-D8 vertebrae were received in histopathology lab. All the patients were females. The ages of the patients were 63, 55 and 47 years respectively. On initial view of slides the diagnosis of plasma cell tumor, plasmacytoma and non-Hodgkin's lymphoma [lymphoplasmacytic type] was made respectively although the differential of large cell lymphoma with plasmacytic differentiation was also kepi in mind. Surprisingly all three cases turned out to be multiple myeloma after bone marrow aspiration, serum protein electrophoresis and skeletal x- rays. Plasmacytoma with coexistent multiple myeloma must be kept in the differential of mediastinal and vertebral masses and further lab and radiologic assessment must be done before starting the treatment.

Incidental appendectomy benefits at the time of total abdominal hysterectomy

To determine the benefits of incidental appendectomy during abdominal hysterectomy in terms of post-operative complications and cost of operation. [5 years] 2003 to 2008. Retrospective study. 171patients who did [n: 73] or did not [n: 98] undergo elective incidental appendectomy at the time of uncomplicated total abdominal hysterectomy from 2003 to 2008 at three different hospitals by a single surgeon. The data was obtained about age, operation time, hospital stay, postoperative complications like [fever, wound infection, abscess formation, wound collection, wound dehiscence]. Post-operative follow up was done for 5 years. Data was analyzed with chi square test using SPSS 16. Seventy three incidental appendectomies were performed in this study of 171 patients [43%]. The procedure was most commonly performed with total abdominal hysterectomy. Bilateral salpingo oophorectomy was performed in 27 [16%] while unilateral in 13 cases [7.6%]. Histopathology was done in 114 cases of uterus [70%], all the ovarian samples [100%], and 14 of appendixes [19%]. Only 06 appendixes out of 14 were reported inflamed [42.8%]. Sixteen patients [16.3%] out of remaining 98 patients reported for appendectomy within 3 to 5 years following TAH. P value <0.05 was considered significant and results of both groups were compared with mean and P value. The data from current study and review of literature affirms incidental removal of the appendix. The two groups are comparable to each other in all parameters and perforation. The decision to perform an elective coincidental appendectomy at the time of an unrelated gynecologic surgical procedure should be based on individual clinical scenarios and patient characteristics and preferences

Testicular torsion of undescended testis in a child

The children presenting with acute scrotum have many diseases in differential diagnosis and testicular torsion in undescended testis and normal testis is an important consideration. Torsion of the testis, or more correctly, torsion of the spermatic cord, is a surgical emergency because it causes strangulation of gonadal blood supply with subsequent testicular necrosis and atrophy. In most of cases history and physical examination are sufficient to make an accurate diagnosis. While other causes may require simple treatment but torsion require immediate exploration to save the testis. Early diagnosis and prompt treatment is essential to help such children

Removal of a large hydatid cyst in spleen

Hydatid disease is caused by the infestation of larvae of Taenia Echinococcus [TE]. Humans are infected through faeco-oral route by the ingestion of food and milk, contaminated by dog faeces containing the ova of parasite or direct contact with dogs. After coming out of eggs in the gut, larvae get into the portal circulation and pass through the liver which acts as the first filter. Most of the larvae settle in the liver and lungs, rarely passing to other organ like brain, spleen and mesentery. We describe an incidental finding of huge hydatid cyst spleen in an old lady who presented with long standing generalized vague complaints. The complete removal of cyst was performed with partial splenectomy

Role of plain X-Ray KUB and renal ultrasound in evaluation of renal colic

Objectives: The purpose of the study was to determine the role of plain x-ray abdomen KUB and renal ultrasound in evaluation of patients with renal colic

Methods: This study was conducted in the Urology Unit of surgical department at District Headquarter Hospital Rawalpindi from January to March 2009. A total of 76 patients with the clinical diagnosis of renal colic were included in this study. All these patients initially presented in emergency with renal colic and then followed up in outdoor. After complete history and clinical examination they were investigated with, plain x-ray KUB and renal ultrasound. Findings were noted and compared with each other

Results: Out of 76 patients 57 patients [75%] were male and 19 patients [25%] were female. Male to female ratio was 3:1.Sixty three patients[83%] presented between 3rd to 5th decades of life. Forty three patients [57%] presented with left renal colic while 33 patients [43%] presented with right renal colic. Thirty patients [40%] were diagnosed by plain x-ray KUB while 37 patients [47%] were diagnosed by renal ultrasound. When xray KUB and renal ultrasound were combined, diagnosis was possible in 46 patients [60%]. Urolithiasis in 46 patients [60%] out of 76 patients with renal colic was diagnosed by performing x-ray KUB and renal ultrasound

Conclusion: Urolithiasis, the most common cause of renal colic can be effectively diagnosed with x-ray KUB and renal ultrasound

Lumbar Discitis; prevalence and management after lumbar disc surgery

To study the occurrence of discitis after lumber disc surgery and its management. Observational study. Department of Neurosurgery QAMC/ BVH Bahawalpur. April 2006 to May 2009. This study includes 400 patients who underwent standard laminectomy procedure for disc excision. Patients presenting with backache and leg pain were thoroughly investigated. For the confirmation of herniated disc MRI or lumber route myelography were performed. All patients underwent either fenestration, hemilaminectomy or complete laminectomy for disc excision. Patients were followed for two weeks to three years after surgery. The diagnosis of discitis was on clinical grounds but this condition was confirmed by heamatological examination i.e. ESR, complete blood count, C-reactive protein and radiological examination i.e. MRI, CT and plain X-rays. Eighteen [4.5%] patients out of four hundred patients developed dicitis after surgery. Initially all patients were managed conservatively i-e. with complete bed rest and antibiotics .Fifteen [83.33%] patients responded well to this treatment but three [16.67%] patients did not improve and were subjected to surgery. Discitis after lumber disc surgery is rare. Discitis should be considered in any patient who develops severe backacheleg pain and muscles spasms after one to four weeks of lumber disc surgery especially accompanied with fever, raised ESR and elevated C-reactive proteins. A definitive diagnosis is essential for appropriate therapy of discitis

Morphological spectrum of chronic hepatitis [C] infection: experience at foundation university medical college and Fauji foundation hospital Rawalpindi

To determine the morphological patterns of HCV related liver disease in our set up. 164 routinely processed liver biopsies were assessed and scored for grading [necro-inflammatory changes] and staging [fibrosis] using modified Knodell HAI scoring system. Our patients were mostly females and maximum cases were in 4[th] and 5[th] decades. Mild portal inflammation was seen in 78% and moderate in 20% cases. Piecemeal necrosis was mild in 76% while moderate in 15% cases. HAI grades ranged from mild [161 cases] to moderate [03 cases]. Fibrous portal expansion/short fibrous septae were seen in 35[21.3%] cases. HCV related lived disease is mild in our set up and a long term follow up of these cases is required to assess the progression of disease

Aerobic vaginal pathogens and their sensitivity pattern

The vaginal flora is a complicated environment, containing dozens of microbiological species in variable quantities and relative proportions. The frequent cause of vaginal discharge is an infection or colonization with different microorganisms. Some pathologic conditions causing vaginitis are well defined yet, 7-72% of women with vaginitis may remain undiagnosed and such forms of abnormal vaginal flora neither considered as normal, nor can be called bacterial vaginosis have been termed as 'intermediate flora' and its management probably differ from that of bacterial vaginosis. It is of crucial importance in pregnant females at risk of preterm delivery. The present study has been conducted especially to elucidate this type of aerobic vaginal isolates and their culture and sensitivity towards currently used antibiotics. This study was conducted at the Microbiology Department of Fauji Foundation Hospital, Rawalpindi over a period of two years [April 2004-March 2006]. One thousand, nine hundred and twenty three high vaginal swabs, both from indoor and outdoor patients were collected, cultured and their susceptibility to various antibiotics was determined. Significant growth was obtained in 731 samples. The highest frequency of infection [39.5%] was observed at 31-40 years followed by 41-50 years [35.8%]. About 76% were from outdoor and 24% were from indoor patients. Staphylococcus aureus was the most prevalent vaginal pathogen at 11-60 yrs and with highest prevalence at 31-40 years followed by 41-50 years. It was a predominant pathogen in both indoor [35%] as well as outdoor [41.6%] patients, followed by enteric gram-negative bacilli and other gram-positive cocci. There were very few antibiotics among the conventionally available aminoglycosides, third generation cephalosporins, penicillin, quinolones, sulfonamides and tetracyclines possessing good sensitivity [>80%] against any one the common aerobic vaginal pathogens. The effective chemotherapeutics agents belong to the groups of carbapenems and beta-lactams beta-lactamase inhibitor combinations. The high prevalence of gynaecological infections demands that the patients with gynaecological symptoms be investigated thoroughly. Culture must invariably be done. Currently the antibiotics showing good sensitivity are very expensive. So there is a need for an effective antimicrobial policy. Effective drug should be reserved for the treatment of serious life threatening situations only

Morbidity and mortality of firearm injury in Peshawar region

Firearm injuries cause significant morbidity and mortality among its victims. The present study, carried out at a major tertiary care hospital of Peshawar, Pakistan was aimed at highlighting the extent and severity of firearm-related morbidity and resultant mortality despite expert medical care. All victims of firearm injury brought to the Lady Reading Hospital Peshawar Emergency Department and thereafter admitted to hospital wards during the period mid-2006 to mid-2007 were included in the study prospectively regardless of age, gender or socio-economic status. Data relevant to the background of firearm use, type of firearm used, types and extents of injuries, clinical condition of the patients and final outcome were collected on performas and entered into SPSS 15.0 for analysis. Seventy-four cases of firearm injury were recorded during the study period, with a predominant male to female ratio [9.6:1]. Most victims [79.7%] were in the age group of 15-35 years. Although there were more cases from Peshawar [28.4%], there was no major referral pattern noted. High velocity weapons were used in 95.9% of cases and homicide was the main motive for injury [60.8%]. Injuries were sustained most frequently in the abdomen and pelvis [44.6%] and 67.6% of victims sustained internal injuries. There were only 5 [6.8%] deaths from firearm injuries. It is concluded, the young males of the population must be targeted for lifestyle adjustments such as training to refrain from anger or disputes [usually over petty things] and to prevent the easy access of firearms as a weapon to settle disputes

Low-level quinolone-resistance in multi-drug resistant typhoid

To find out the frequency of low-level quinolone-resistance in Multi-Drug Resistant [MDR] typhoid using nalidixic acid screening disc. Descriptive study. Armed Forces Institute of Pathology, Rawalpindi, from January 2005 to December 2005. Blood was obtained from suspected cases of typhoid fever and cultured in to BacT/ALERT. The positive blood cultures bottles were subcultured. The isolates were identified by colony morphology and biochemical tests using API-20E galleries. Susceptibility testing of isolates was done by modified Kirby-Bauer disc diffusion method on Muellar Hinton Agar. For the isolates, which were resistant to nalidixic acid by disc diffusion method, Minimal Inhibitory Concentrations [MICs] of ciprofloxacin and nalidixic acid were determined by using the E-test strips. Disc diffusion susceptibility tests and MICs were interpreted according to the guidelines provided by National Committee for Control Laboratory Standard [NCCLS]. A total of 21[65.5%] out of 32 isolates of Salmonellae were nalidixic acid-resistant by disk diffusion method. All the nalidixic acid-resistant isolates by disc diffusion method were confirmed by MICs for both ciprofloxacin and nalidixic acid. All the nalidixic acid-resistant isolates had a ciprofloxacin MIC of 0.25-1Mu g/ml [reduced susceptibility] and nalidixic acid MICs = 32 Mu g [resistant]. Out of all Salmonella isolates, 24 [75%] were found to be MDR, and all were S. typhi. Low-level quinolone-resistance in typhoid was high in this small series. Screening for nalidixic acid resistance with a 30 Mu g nalidixic acid disk is a reliable and cost-effective method to detect low-level fluoroquinolone resistance, especially in the developing countries

Histopathological study of benign Melanocytic naevi

To study the histological spectrum and types of benign melanocytic naevi and to observe unusual/atypical histological features in these lesions. An observational study with prospective data. 1st June 1997 to 30th June 1998 at department of Pathology PNS Shifa, Karachi. A total of 50 consecutive cases of melanocytic naevi were studied. Skin biopsies were taken by the Dermatologist from the patients with a primary clinical diagnosis of naevus/mole. Relevant data was recorded. Majority of cases 24[48%] were in the third decade with female preponderance [56%]. Commonest site was the face [66%]. Thirty percent cases showed lentiginous proliferation. Acanthosis was observed in 26% cases and effacement in 12%. Twelve percent cases showed mild patchy infiltration by the inflammatory cells. Foreign body reaction along with inflammation was seen in 8% cases. Nuclear pleomorphism with slight variation in size, shape and staining was observed in 8% of the lesions. No architectural disarray or other atypical histological features fulfilling the criteria of dysplastic naevus or malignancy were observed. Face was the most common site and intradermal naevus was the commonest lesion. Few histological features like lentiginous proliferation, multinucleated naevus cells, foreign body reaction, fatty infiltration, linear fibrosis and acanthosis were observed. However no cytological features for dysplasia or malignancy were present

Extended spectrum beta-lactamases in urinary gram -negative bacilli and their susceptibility pattern

Beta-lactamases of Gram-negative bacteria are the most important mechanism of resistance against beta-lactams. Two types of beta-lactamases can confer resistance against third generation cephalosporins; inducible chromosomal beta-lactamases, and extended-spectrum beta-lactamases. The extended-spectrum beta-lactamases producing strains of Enterobacteriaceae have emerged as a major problem in hospitalized as well as community based infections resulting in range of infections from uncomplicated urinary tract infection to life threatening sepsis. To find out the prevalence of extended-spectrum beta-lactamases producing Gram- negative bacilli among urinary isolates and their sensitivity pattern. The study was conducted at the Microbiology Department of Fauji Foundation Hospital, Rawalpindi over a period of two years [April 2004-March 2006]. Multidrug resistance and extended-spectrum beta-lactamases production was studied in 111 enteric Gram-negative bacilli isolated from urine of symptomatic patients [1-70 years] including males and females from indoor and outdoor patients by using double disc diffusion technique. Prevalence of extended-spectrum beta-lactamases production was seen in 71 [61.2%] enteric gram-negative organisms, the most prevalent gram-negative organism was Klebsiella pneumoniae 40 [71.4%] followed by Escherichia coli 27 [62.8%] and Pseudomonas aeruginosa 3 [25%]. The extended-spectrum beta-lactamases producers were more prevalent in indoor patients 63 [88.7%] compared to outdoor patients 8 [11.3%], more in females 43 [60.6%] than males, 28 [39.4%]. The extended-spectrum beta-lactamases producing gram-negative rods had more antibiotic-resistant profile than non-producers. All enteric gram negative rods should be tested for the production of extended-spectrum beta-lactamases in routine microbiology laboratory

Extended Spectrum beta-Lactamases in enteric gram-negative bacilli: Related to age and gender

Extended Spectrum beta-Lactamases [ESBLs]-producing strains of Enterobacteriaceae have emerged as a major problem in hospitalized as well as community based patients. Infections due to ESBLs-producers range from uncomplicated urinary tract infection to life threatening sepsis. The objective of this study was to find out the prevalence of ESBLs-producing Gram- negative bacilli among clinical isolates. This descriptive study was conducted at the Microbiology department of Fauji Foundation Hospital, Rawalpindi over a period of two years [March 2004-April 2006]. Six hundred and nine isolates of Enteric Gram-negative rods from various samples were tested for ESBLs- production by double disc synergy test. In 176 ESBLs-producing isolates, source of samples in term of indoor/outdoor was analyzed. In 165 ESBLs-producing isolates, patients' gender and age was analysed from 3 months to 70 years. The ESBLs-producing isolates were more commonly isolated from indoor patients [88.1%] as compared to outdoor patients [11.9%]. Escherichia coli was found to be most prevalent organism in indoor patients while Klebsiella pneumoniae, was the most prevalent organism in outdoor patients. ESBLs were most commonly isolated from female patients [64.3%] suffering from urinary tract infections [[41.5%], as compared to male patients [35.7%] in which the organisms were most commonly isolated from pus samples [54.2%]. ESBLs-producing Enteric Gram-Negative rods were most frequent at later part of life where they were most common [27.9%] at 61-70 years, followed by 41-50 years of age group [20.0%]. Another peak [13.3%] was also seen at younger age group [11-20 years]. The least prevalence [5.5%] was seen in two age groups [0-10 and 31-40 yrs]. In case of female patients, ESBLs-producing EGNR were most frequently [29.2%] isolated from middle age group [41-50 years] followed by later age groups [51-60 and 61-70 years, [15.1% and 25.5%]. Considering the high prevalence of ESBLs in Enteric Gram-negative rods, it is suggested that all such isolates should be tested for the production of ESBLs in the routine microbiology laboratory