Molecular detection and characterization of ovine herpesvirus-2 using heminested PCR in Pakistan

Background@#Malignant catarrhal fever (MCF) is a highly fatal lymphoproliferative disease of cattle, deer, bison, water buffalo, and pigs caused by the gamma-herpesviruses alcelaphine herpesvirus-1 (AlHV-1) and ovine herpesvirus-2 (OvHV-2). @*Objectives@#This study aimed to determine the prevalence of OvHV-2 in sheep, goats, cattle, and buffalo in Rawalpindi and Islamabad, Pakistan, by applying molecular and phylogenetic methods. @*Methods@#Blood samples were aspirated from sheep (n = 54), goat (n = 50), cattle (n = 46) and buffalo (n= 50) at a slaughterhouse and several farms. The samples were subjected to heminested polymerase chain reaction (PCR), followed by sequencing and phylogenetic analysis of the OvHV-2 POL gene and the OvHV-2 ORF75 tegument protein gene. @*Results@#The highest percentage of MCF positive samples was in sheep (13%), whereas goat, cattle, and buffalo had lower positive percentages, 11%, 9%, and 6.5%, respectively. Four OvHV-2-positive PCR products obtained from sheep samples were sequenced. The sequences obtained were submitted to the NCBI GenBank database (MK852173 for the POL gene;MK840962, MK852171, and MK852172 for the ORF75 tegument protein gene). Phylogenetic analysis revealed a close similarity of study sequences with those of worldwide samples. @*Conclusions@#This study is the first cross-sectional study on the prevalence and molecular detection of OvHV-2 in apparently healthy cattle and buffalo that could be carrying OvHV-2 acquired from OvHV-2-positive sheep and goats. The results indicate that OvHV-2 is circulating in Pakistan. Further studies are needed to characterize OvHV-2 and elucidate further its prevalence.

Molecular detection and characterization of ovine herpesvirus-2 using heminested PCR in Pakistan

Background@#Malignant catarrhal fever (MCF) is a highly fatal lymphoproliferative disease of cattle, deer, bison, water buffalo, and pigs caused by the gamma-herpesviruses alcelaphine herpesvirus-1 (AlHV-1) and ovine herpesvirus-2 (OvHV-2). @*Objectives@#This study aimed to determine the prevalence of OvHV-2 in sheep, goats, cattle, and buffalo in Rawalpindi and Islamabad, Pakistan, by applying molecular and phylogenetic methods. @*Methods@#Blood samples were aspirated from sheep (n = 54), goat (n = 50), cattle (n = 46) and buffalo (n= 50) at a slaughterhouse and several farms. The samples were subjected to heminested polymerase chain reaction (PCR), followed by sequencing and phylogenetic analysis of the OvHV-2 POL gene and the OvHV-2 ORF75 tegument protein gene. @*Results@#The highest percentage of MCF positive samples was in sheep (13%), whereas goat, cattle, and buffalo had lower positive percentages, 11%, 9%, and 6.5%, respectively. Four OvHV-2-positive PCR products obtained from sheep samples were sequenced. The sequences obtained were submitted to the NCBI GenBank database (MK852173 for the POL gene;MK840962, MK852171, and MK852172 for the ORF75 tegument protein gene). Phylogenetic analysis revealed a close similarity of study sequences with those of worldwide samples. @*Conclusions@#This study is the first cross-sectional study on the prevalence and molecular detection of OvHV-2 in apparently healthy cattle and buffalo that could be carrying OvHV-2 acquired from OvHV-2-positive sheep and goats. The results indicate that OvHV-2 is circulating in Pakistan. Further studies are needed to characterize OvHV-2 and elucidate further its prevalence.

Sentinel lymph node identification by blue dye in patients with breast carcinoma

Objective: To determine the diagnostic accuracy of methylene blue dye to detect axillary lymph node metastases in patients with breast carcinoma by taking histopathology as gold standard

Methods: This quasi experimental study was done at Department of Surgery of Dow University Hospital Karachi during January 2013 to September 2015 after the approval of Hospital Ethical Committee. A total number of 85 patients with biopsy proven carcinoma were included in the study. 1% methylene blue dye was infiltrated in the peri tumoural area of the diseased breast. The blue stained node called sentinel lymph node [SLN] was recognized and carefully dissected out. SLN and mastectomy with axillary clearance specimen was sent for histopathology in two separate bottles and the report of the histopathology was compared

Results: The axillary lymph nodes were positive for carcinoma in 61 cases out of 85[71.7%].Two of the patients had negative sentinel lymph node but positive non sentinel lymph node [false negative], and in three cases sentinel lymph node were involved only but not the rest of the axilla [False positive]. The sensitivity, specificity and accuracy were 96.8%, 86.36% and 94.1% respectively

Conclusion: Methylene blue dye technique is a reliable and safe diagnostic modality for detection of Sentinel lymph node in breast cancer patient because of its high accuracy

Comparison of hemorrhoidectomy by ligasure with conventional Milligan Morgan's hemorrhoidectomy

Objective: To compare the efficacy of haemorrhoidectomy done by using LigaSure with conventional Milligan Morgan haemorrhoidectomy

Methods: This randomized controlled trial was done at Department of Surgery Dow University Hospital Karachi during January 2013 to September 2015. A total of 55 patients were included in the study. Patients were randomly allocated to group A [Haemorrhoidectomy by Ligasure] and group B [Milligan Morgan Haemorrhoiectomy]. Efficacies of both procedures were compared by operative time, Blood loss, wound healing, and pain score on immediate, 1st and 7th post operative day

Results: Out of total 55 patients 23 were male and 32 were females. The most common group of age involved was between 40 - 60 years. Third degree Heamorrhoids were present in 37 [67.3%] of patients while remaining 18 [32.7%] had fourth degree Heamorrhoids. Group A included 29 cases while Group B included 26 cases. The mean operating time of Group A was 52.5 with standard deviation of 11.9 while it was 36.6 +/- 9.8 in the other group. The mean blood loss in group A was 51.92 with standard deviation of 15.68 while it was 70.34 +/- 25.59 in group B. Overall pain score was less in those patients who underwent Heamorrhoidectomy by Ligasure method

Conclusion: The efficacy of Heamorrhoidectomy by Ligasure is better than the traditional Milligan Morgan Heamorrhoidectomy but we need more clinical trials with large sample size and long term follow ups

Types of traumatic lens dislocations at Larkana

The objective of this study was to determine the pattern of traumatic lens dislocations presenting at our institute. This may help develop the preventive strategies. The number of cases of traumatic lens dislocations, presented at the Department of Ophthalmology, Chandka Medical College, Larkana, Pakistan, from January 2002 to June 2015, were 59 including 61.02% [n=36] males and 38.98% [n=23] females. Cause of trauma was wood or plant impalement in 35.6% [n=21] cases, cracker blast in 13.55% [n=8] cases, fall on ground in 11.86% [n=7] cases, penetrating injuries with needle, scissors or knife in 10.16% [n=6] cases, road traffic accidents in 10.16% [n=6] cases, sports injuries [cricket ball and gulle danda] in 8.47% [n=5] cases, firearm injuries in 5.1% [n=3] cases, and fist hitting in 5.1% [n=3] cases. Lens was dislocated posteriorly in 33.90% [n=20] cases, anteriorly in 25.42% [n=15] cases, inferiorly in 11.86% [n=7] cases, medially in 10.17% [n=6] cases, laterally in 10.17% [n=6] cases, superiorly in 6.78% [n=4] cases, and a single [1.69%] case of lenticele was seen

Morbidity and mortality of corrosive injury of esophagus: a study of 50 cases

Objective: To evaluate the morbidity and mortality of corrosive injury of esophagus. Introduction: Corrosive ingestion, mostly accidental in children and with suicidal or deliberate self-harm intention in adults, still remains a prevalent condition in developing countries. It is relatively common among the illiterate people having poor socioeconomic condition residing in the rural areas. It poses a great challenge to the otorhinolaryngologist from management point of view. Study design: Descriptive study. Place and duration of study: This study was conducted in the department of ENT and Head and Neck Surgery, Allied Hospital [PMC] Faisalabad during a period of two years from November 2013 to October 2015

Patients and Methods: Fifty patients with history of corrosive ingestion were included in the study. All patients were admitted in the ENT department and thoroughly investigated regarding history, physical examination and investigations according to a written proforma. Inclusion criteria: The patients of either sex ranging from 3 years to 60 years, having history of corrosive ingestion and giving written consent for any surgical intervention and regular follow up were included in the study. Exclusion criteria: Patients having age below 3 years and above 60 years, patients with malignant stricture, peptic stricture and not giving written consent for surgical intervention and regular follow up were excluded. Data analysis: SPSS software version 20 was used to analyze the data

Results: Out of 50 patients, 16% were males and 84% were females ranging from 3 years to 60 years. Thirty one patients [62%] were from rural areas while 19 patients [38%] were urban dwellers. Forty one patients [82%] took acid whereas 9 patients [18%] took alkali. Eleven patients [22%] reported early within first three days of corrosive intake while 39 patients [78%] reported late. Two patients out of 50 were received in very serious condition with respiratory distress and shock who died despite of emergency treatment. Endoscopic examination of 48 survivors showed grade I corrosive injury in 6 patients [12.5%], grade II injury in 30 patients [62.5%] and grade III injury in 12 patients [25%]. Forty two patients were found to develop esophageal strictures. Thirty four patients [81%] out of 42 had single stricture while 08 patients [19%] had multiple strictures who were referred to general surgery for further management. Treatment: Patients having minor burns were successfully managed conservatively and no stricture was found in 6 months follow up period. Patients with single stricture were managed with endoscopic dilation with good results while patients having multiple strictures of esophagus were referred to general surgery for further management

Conclusion: Stricture formation in the esophagus and resulting dysphagia is more frequently seen in those patients who present late after corrosive ingestion. Moreover endoscopic dilatation of corrosive induced strictures with gum elastic bougies is quite safe and effective procedure to relive dysphagia although repeated sessions of endoscopic dilatations are often required

Head and neck infections; secondary to dental causes; diagnosis and treatment

To analyse the risk factors responsible for different head and neck infections secondary to dental causes. DESIGN: Retrospective study. Department of ENT and Head and Neck Surgery, Allied Hospital, Punjab Medical College, Faisalabad. October 2011 to September 2014. The study consisted of 50 patients who presented with history of head and neck infections secondary to dental causes in the department of ENT and Head and Neck Surgery at Allied Hospital Faisalabad. Patients of head and neck infections of either sex ranging from 12 to 57 years of age and having history of dental infections / extractions were included in the study. Patients having head and neck infections secondary to some other cause other than dental etiology were excluded from the study. SPSS software, version 10 was used to analyse the data. Chi square test was applied to analyse the data. In our study 62% patients with head and neck infections were males while 38% patients were females. Age ranged from 12 years to 57 years with mean age 33.68 years. 96% of our patients presented with deep neck abscesses while only 02% of the patients had osteomyelitis of maxilla and further 02% of the patients presented with necrotizing fasciitis of the submandibular region. 58% of the patients had dental infections whereas 42% patients were having dental extraction as the root cause responsible for these head and neck infections. Moreover, all the patients had poor oro-dental hygiene. It was also observed that 76% of the patients, having history of dental extraction, were treated by unqualified dental practitioners without adequate aseptic conditions. Twelve patients out of fifty [24%] were found to have diabetes mellitus and one patient each was suffering from malignancy and chronic renal failure. 10 [20%] of our patients were smokers. Some of the patients [16%] were having anemia. Two patients out of fifty [04%] were suffering from pulmonary tuberculosis. All these patients were managed with adequate parentral antibiotics and surgical interventions. We had to perform an emergency tracheostomy in one patient. All the patients had good response to the management without any complication. Dental infections and dental extractions are still an important cause for potentially life threatening head and neck infections in developing countries like Pakistan. Unhygienic dental practices and lack of proper dental care facilities along with immunocompromizing conditions such as diabetes mellitus are most common risk factors for these avoidable head and neck infections. Therefore it is necessary that unhygienic dental practices as well as practices by unqualified dental practitioners should be strictly banned

Seroprevalence of dengue fever [IgG] in adults of rawalpindi district

Objective: The objectives of current study were to find out the prevalence of Dengue viral infection [DVI] IgG amongst the adult population residing in urban/ rural areas of Rawalpindi in order to assess that in which specific population it is more prevalent. The hypothesis of the study was that DVI is more prevalent in urban areas of Rawalpindi district

Study Design: Descriptive Cross Sectional Comparative Study

Place And Duration: It was carried out at Microbiology Department of Benazir Bhutto Hospital Affiliated with Rawalpindi Medical College, Rawalpindi. It was carried out from March to September 2010

Methodology: Stratified random sampling procedure was adopted for 240 healthy adults, 144 urban residents and 96 rural residents of Rawalpindi. The clotted blood samples were used for the detection of anti-dengue Ab [IgG] by 3[rd] generation ELISAmethod

Results: The results were in favor of the hypothesis showing 34.7 % prevalence of DF in urban areas when compared to 19.7% prevalence in rural areas of Rawalpindi

Conclusion: Dengue fever is more prevalent in urban areas of Rawalpindi

In vitro synergistic effect of ciprofloxacin with aminoglycosides against multidrug resistant-Pseudomonas aeruginosa

Pseudomonas aeruginosa is an increasingly prevalent nosocomial human pathogen. Infections with multidrugresistant [MDR] P. aeruginosa are currently a treatment challenge and requires search for better treatment options. Purpose of study: To determine in vitro synergistic effect of ciprofloxacin in combination with amikacin and gentamicin against MDR P. aeruginosa clinical isolates. Antibiotic resistance pattern of 100 identified clinical isolates of P. aeruginosa was determined against eight antibiotics by disc diffusion method at Microbiology Laboratory, Holy Family Hospital, Rawalpindi. For 30 selected MDR isolates, minimum inhibitory concentrations [MICs] of amikacin and gentamicin were determined separately by agar diffusion method followed by combined activity of ciprofloxacin with amikacin and gentamicin by checkerboard agar dilution technique. Antibiotic resistance pattern of P. aeruginosa isolates was; gentamicin and carbenicillin [94%], amikacin and piperacillin [92%], ceftazidime [90%], colistin [87%], ciprofloxacin [79%] and imipenem [72%]. MICs against 30 selected MDR isolates ranged from 32 to >/= 128 micro g/ml for amikacin, and >/= 128 micro g/ml for gentamicin. Synergistic effect was observed in 12/30[40%] isolates for AK+CIP and in 05/30 [16.7%] for CN+CIP. Ciprofloxacin in combination with amikacin and gentamicin showed synergistic effect and no antagonistic effect against MDR P. aeruginosa

Comparison of heparin and low dose aspirin with low dose aspirin alone in improving theperinatal outcome in pregnancies with recurrent pregnancy losses

To compare the perinatal outcome of low dose Aspirin [LDA] alone and low dose Aspirin with Heparin in pregnancies with recurrent pregnancy loss [RPL] with or without positive antiphospholipid antibodies [aPL]. Randomized controlled trial. Departments of Obstetrics and Gynaecology Combined Military Hospital [CMH] Quetta, Lahore and Rawalpindi. 30 April 2009 to 30 April 2011. 60 women with recurrent pregnancy losses [RPL] fulfilling clinical criteria of antiphospholipid syndrome [APS] with or without aPL antibodies positive reporting to the antenatal clinic at the three hospitals were included. Convenience sampling was done and subjects were randomly allocated into groups A and B using random numbers table. GroupA received low dose Aspirin[LDA] 75 mg once daily starting from first trimester and GroupB received unfractioned Heparin [UH] 5000IU SC BD or low molecular weight Heparin [LMWH] 40mg subcutaneous along with LDA. In group A 26[86.7%] and in group B 25[83.3%] live births were attained. Significant side-effects were observed in groupB including bruising and injection site pain. Cost of drug for treatment over 28 weeks in groupA was Rs 300 and in groupB was Rs 6300. LDA alone have comparable perinatal outcomes with Heparin in cases of RPL, with an added benefit of no pain and bruising, low cost and more convenience of administration.

cross sectional study to assess the association between pyrexia of unknown origin and primary dengue infection [SEROTYPE II] amongst < 18 years of age group

AIMS AND OBJECTIVES: To highlight one of the presentation of primary Dengue Viral Infection [DVI] as Pyrexia of Unknown Origin [PUO] in less than 18 years of age group

MATERIALS AND METHODS: It was a Descriptive cross sectional study carried out in the Department of Microbiology, Rawalpindi Medical College and Allied Teaching Hospitals, Rawalpindi. A Simple Random Sampling procedure was adopted to collect the samples from Pediatric and Medicine Departments of RMC and Allied Teaching Hospitals, RWP. The sample size was 117 Samples based upon inclusion and exclusion criteria of study. The data was recorded on the bio data proformas and finally analyzed by SPSS version 16

The frequency of positive cases was calculated in terms of percentages. 3 Generation ELISA was used to assess the presence of anti- Dengue IgG antibodies

RESULTS: Out of total 117 PUO patients, 41 [35%] were found positive for IgG DEN 2 antibodies

CONCLUSION: Dengue viral infection can present as PUO. The results of this study will be helpful for the clinicians to consider DVI in their list of differential diagnosis of PUO

Vaginal carriage rate of Group B Streptococcus in pregnant women and its transmission to neonates

Maternal vaginal colonisation with Group B Streptococcus [GBS, Streptococcus agalactiae] at the time of delivery can cause vertical transmission to the neonate. GBS is the leading cause of sepsis, meningitis and pneumonia in the infants. Asymptomatic colonisation of the vagina with GBS varies with the geographical location. This was a cross-sectional study conducted in 2009 at Benazir Bhutto Hospital, Rawalpindi, Pakistan. Lower vaginal swabs were obtained from 200 pregnant women at the time of admission in the Gynaecology and Obstetrics Department for term, normal vaginal delivery and swabs from the skin of abdomen and ear canals of their respective neonates immediately after delivery were collected. Swabs were inoculated on blood agar and incubated aerobically and on Group B Streptococcus agar [GBS agar] and incubated anaerobically in an anaerobic jar. Identification of GBS was made on the basis of colonial morphology [beta-haemolytic colonies on blood agar and orange pigmented colonies on GBS agar], Gram stain, catalase test and conformation was done by means of latex agglutination tests. A GBS carriage rate of 8.5% among pregnant women before delivery and an acquisition rate of 53% on the abdominal skin and 18% in the ear canals by the neonates of colonised mothers were found. GBS colonisation in pregnant women and its transmission to the neonates is present in our population so GBS infections in the prenatal and neonatal period might not be uncommon in Pakistan, so routine screening should be carried out

Staphylococcal nasal carriage of health care workers

To determine the frequency of staphylococcal nasal carriage of health care workers [HCWs] and antimicrobial susceptibility profile of the isolates for appropriate decolonization therapy. An observational study. The study was conducted at Holy Family Hospital, Rawalpindi, during the period from May 2007 to April 2008. Nasal swabs from anterior nares of HCWs were cultured and identified as Staphylococcus aureus, coagulasenegative staphylococci [CoNS], methicillin-resistant S. aureus [MRSA], methicillin-resistant CoNS [MRCoNS] by using standard methods. Antimicrobial susceptibility testing was performed on Muller Hinton Agar using disc diffusion method. Of the 468 HCWs, 213 [45.5%] participants were men and 255 [54.5%] were women. Eighty five [18.2%] were nasal carriers of S. aureus, 07 [1.5%] for MRSA, 343 [73.3%] for CoNS and 10 [2.1%] for MRCoNS. The highest carriage rate for S. aureus was in midwives [30%] followed by maintenance staff [28.6%], security guards [25%], technicians [23.5%], staff nurses [22.7%] and<20% in house physicians and nursing students. Carriage rate in HCWs from different departments was: surgical ICU [40%], gynaecology [34.9%], delivery room [30%], gynaecology operation rooms [25%], medicine [22.7%] and<20% in pediatrics and surgery. All isolates were susceptible to vancomycin, imipenem and levofloxacin and>90% of S. aureus and CoNS were susceptible to amikacin, gentamicin and fluoroquinolones tested. Fluoroquinolones, preferably oral levofloxacin in combination with topical gentamicin ointment, in places like Pakistan where mupirocin is not routinely available, can be used for decolonization of nasal staphylococcal carriage

Seroprevalence of dengue viral infection in healthy population residing in rural areas of district Rawalpindi

This current study is perhaps the first study of its type in any rural area of Pakistan. It was carried out on healthy population resident of different villages of Tehsil Kahutta, District Rawalpindi. Although Dengue Viral Infection was believed to be only present in urban and semi urban areas. Dengue viral infection is prevalent in rural areas of District Rawalpindi. 1. To find out the prevalence of Dengue viral infection [lgG] in rural areas. 2. To highlight subclinical cases of Dengue Viral Infection. Pathology [Microbiology] Department, Benazir Bhutto Hospital, Rawalpindi. Descriptive Cross Sectional Study. 7 Months. 96 Samples. 1. Individuals who have never suffered from Dengue infection. 2. Both male and female population of any age group. 3. Must be the resident of rural area. 1. Individuals who have a strong history of Dengue infection. 2. Individuals who have a strong history of immunization for Japanese encephalitis, Yellow fever, and Tick borne encephalitis. Thus to prevent erroneous results because of cross reacting antibody formation. A Systematic Random Sampling procedure was adopted. A written informed consent form and bio data proforma filling were the pre requisites of study. Than 3ml of venous blood sample was drawn from every participant. Finally ELISA test was done to detect the presence of lgG Anti Dengue Antibodies. Out of 96 participants, 13 [13.5%] were found to be positive for IgG Anti Dengue Antibodies presence. Dengue viral infection is prevalent in rural areas of District Rawalpindi

Evaluation of resistance to fluoroquinolones in clinical isolates of escherichia coli

The evaluation of resistance to ciprofloxacin [CIP] in Escherichia coli [n=1112] isolated from clinical specimens including urine, pus, high vaginal swabs, etc. was carried out at Rawalpindi General Hospital, Rawalpindi during the years 2002- 2005. The isolates were identified by colonial morphology, gram staining, and biochemical tests like indole, citrate and TSI. The antibiotic susceptibility of these isolates was determined by Kirby-Bauer disk diffusion method according to the standard guidelines of Clinical Laboratory Standards Institute [CLSI]. During the year 2002 resistance to ciprofloxacin was 49.19% [n=187], in the year 2003 it was 47.5% [n=297], in year 2004 was 59.03% [n=332], in year 2005 was 46.28% [n=296]. When resistant isolates from different sources were compared E. coli uropathogens varied between 45.2 to 58.53% during the four year. While pus isolates in 2003 were highly resistant [69% resistance] and isolates from high vaginal swab showed peak resistance in 2004 [66%] Fig. 3 table 4. In the year 2002, four fluoroquinolones [FQs] i.e. ofloxacin [OFX], ciprofloxacin [CIP], enoxacin [ENX] and sparfloxacin [SPX] were included in the study while norfloxacin [NOR] was tested against urinary isolates only. During that year 203 isolates were identified as E. coli; 124 from urine, 45 from pus, 21 from high vaginal swabs, and 13 from other sources. Highest resistance was seen in isolates from urine ranging from 54-68% against these FQs

Hospital acquired infections in a medical intensive care unit

To determine the frequency of nosocomial infections and causative organisms in medical intensive care unit [ICU] patients and antimicrobial susceptibility pattern of the isolates. A cross-sectional study. The Holy Family Hospital, Rawalpindi, during the period of May 2007 to April 2008. Clinical samples from patients having any signs of site-specific infections or fever appearing anytime after 48 hours of admission into ICU were collected. The samples were cultured onto suitable culture media and bacterial isolates were identified using standard biochemical methods. Antimicrobial susceptibility testing to conventional and newer antibiotics was performed on Mueller Hinton agar using disc diffusion method. Frequency percentages were determined. Bacteria or Candida spp. were isolated from 269/440 [60.1%] samples. The most frequent site of infection was respiratory tract [47.95%] followed by urinary tract [25.3%]. Pseudomonas [P.] aeruginosa, Klebsiella [K.] pneumoniae, Escherichia [E.] coli and Candida spp. were the commonest organisms. The isolation rate of Gram-positive bacteria was relatively low. Majority [>50%] of the Gram-negative isolates were resistant to many of the antibiotics tested. Relatively low resistance was only observed against amikacin [21.3%] and imipenem [26.1%]. Majority [>60%] of Gram-negative isolates were resistant to cefotaxime, ceftriaxone and ceftazidime. The isolates showed high resistance to ofloxacin [65.9%] and ciprofloxacin [73.9%]. The high frequency of HAIs and antibiotic resistance rate, suggests that more strict infection control practices along with prescription of antibiotics after antibiotic susceptibility testing should be implemented to limit the emergence of antibiotic resistant organisms

Multi-resistant gram negative bacterial infections in a surgical intensive care unit at Rawalpindi

Hospital-acquired infections encompass almost all clinically evident infections that do not originate from a patient's original admitting diagnosis. Nosocomial infections are one of the major causes of morbidity and mortality in Pakistan. This study was conducted to determine the frequency of hospital-acquired infections and its causative organisms in patients admitted to a surgical intensive care unit. A prospective observational study was carried out at Holy Family Hospital, Rawalpindi from July 2007 to April 2008. Clinical samples of tracheal aspirates, sputum, urine, blood, body fluids, pus and others were collected from patients admitted to intensive care unit and cultured. Bacterial isolates were identified along with their antimicrobial susceptibility. A total of 156 samples were collected. Bacteria or candida species were isolated in 89[57.1%] samples. Highest infection was seen in respiratory tract followed by surgical sites. Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli and candida spp. were the commonest organisms. The isolation rate of gram-positive bacteria was relatively low. Resistance pattern of gram-negative isolates was: ampicillin, 67[90.5%]; co-trimoxazole, 67[90.5%]; cefaclor, 66[89.2%]; co-amoxyclav, 64[86.5%]; tetracycline, 61[82.4%]; rifampicin, 59[79.7%] cephradine, 58[78.4%]; ceftriaxone, 58[78.4%], ceftazidime, 57[77.0%], lincomicin, 53[71.6%]; ofloxacin, 50[67.6%]; ciprofloxacin, 50[67.6%]; cefotaxime, 49[66.2%]; gentamicin, 47[63.5%]; chloramphenicol, 45[60.8%]; levofloxacin, 41[55.4%]; fosfomycin, 37[50%];sparfloxacin, 35[47.3%]; enoxacin, 29[39.2%]; imipenem, 27[36.5%]; moxifloxacin, 21[28.4%], amikacin, 21[28.4%]; and aztreonam, 14[18.9%]. The high frequency of hospital acquired infections suggests that infection control practices are not strictly observed along with indiscriminate prescription of antibiotics that are causing emergence of antimicrobial resistant organisms. Guide lines to control facility based transmission of infections should be strictly followed

Frequency of different presentations and surgical management of ectopic pregnancy at combined Military Hospital Lahore

To determine frequency of different presentations of ectopic pregnancy presenting at Combined Military Hospital Lahore and types of surgical management offered. Descriptive study Department of Gynaecology and Obstetric Combined Military Hospital, Lahore from1-06-2006 to 31-12-07. Fifty women with ectopic pregnancy whether booked or unbooked were treated at CMH, Lahore, during study period were included. Diagnosis was made from history, clinical examination and confirmed by ultrasonography, serum beta-hCG or laparoscopy. The mean age of patients was 23.6 +/- 5.0. The commnest presentation was with pain lower abdomen 92.0%. Eighty two percent of patient presented with amenorrhea. Vaginal bleeding/spotting was present in 76.0% while 18.0% presented with shock and fainting attacks were the presenting feature in 14.0% of cases. Regarding surgical management salpingectomy was performed in 84.0% of cases. Linear salpingostomy in 6.0% of patients. Segmental resection with reanastomosis in 4.0% of cases, salpingoophrectomy in 4.0% and partial oophrectomy in 2.0% of cases. Ectopic pregnancy is still a major obstetric and gynaecological emergency. As majority of patients present at late stage with either ruptured ectopic pregnancy or irrepairable damage to tube and ovary so management by laparotomy is more practicable in developing countries like ours

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

Impaction of a seed in the oesophagus ; Prolongeal dysphagia and vomiting for 3.5 [three and half years] in a 5 years old child - A diagnostic challenge

Dysphagia in children due to ingestion of foreign body is quite common. We report a case of dysphagia and vomiting in a 5 years old boy who presented in ENT OPD Allied Hospital Faisalabad. Our case is an unusual one with respect to the duration of symptoms which last for 3,1/2 years. The case was misdiagnosed as a case of stricture of oesophagus on a number of occasions. The foreign body seed was removed per orally with the help of rigid Oesophagoscope. Literature review has been done and discussed