Evaluation of multiple risk factors involved in the development of diabetic Retinopathy

Objective: To determine the role of hypertension, hyperlipidemia, smoking and positive family history of diabetes and hypertension in the development of diabetic retinopathy

Methods: This prospective cohort study was conducted at the Department of Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi over 2 years period from June 2014 to June 2016. One hundred consecutive diabetic patients with no signs of diabetic retinopathy and good glycemic control [HbA1c<6.5%] were registered by non-probability convenient sampling after taking written informed consent. They were evaluated for hypertension, hyperlipidemia and smoking status. These patients were then followed 6 monthly for 2 years to look for the development of diabetic retinopathy

Results: The mean age of the patients was 50.72+/-9.29 years and there were 57 [57%] male and 43 [43%] female patients. Majority [82%] of the patients had NIDDM. The mean duration of diabetes was 8.31+/-6.83 years. 11% of the patients were smoker, 37% were hypertensive, 6% had hyperlipidaemia, 62% had family history of diabetes and 30% had family history of hypertension. At the end of follow-up, 9 [9.0%] patients had diabetic retinopathy. The frequency of diabetic retinopathy increased with increasing age of the patient; however, the difference was statistically insignificant. A comparatively higher frequency of diabetic retinopathy was also seen in patients with IDDM and those with positive family history of diabetes and hypertension yet again, the difference was statistically insignificant. Also, no significant difference was noted among male and female genders and smokers vs. non-smoker. However, the frequency of diabetic retinopathy increased significantly with increasing duration of diabetes. It was also higher among those with hypertension and hyperlipidemia

Conclusion: Higher patient age [>/=50 years], increasing duration of diabetes [>/=20 years], insulin dependent diabetes mellitus, hypertension, hyperlipidemia, and positive family history of diabetes and hypertension were found to be associated with increased frequency of diabetic retinopathy

Evaluation of 99mTc-sulfadiazine as Bacillus microorganisms infection imaging agent using animal model

Bacterial infection is one of the vital sources of morbidity and mortality. The development of single photon emission computed tomography [SPECT] radiotracer agents using antibiotics, for targeting in-vivo bacteria, helps in antibiotic dose calibration, targeted infection therapy and reduction in mortality rate. The aim of this study was to appraised [99m]Tc-labeling sulfadiazine as a radiopharmaceutical for bacillus infections imaging. Radiolabeling of sulfadiazine with technetium-99m was carried out by subsequent addition of 1.5 mL aqueous solution of sulfadiazine [1mg/mL], 120Mug stannous tartrate, gentistic acid as stabilizing agent and 185 MBq normal saline solution of 99mTcO4 -1 [pertechnetate] at pH = 5. The reaction mixture was incubated for 40 min at room temperature with light stirring. The quality control analysis [ITLC-SG and paper chromatography analysis] revealed 98% labeling yield. Biodistribution and scintigraphic study was carried using bacillus bacterial infection induced New Zealand white rabbits. Due to the ease of [99m]Tc-sulfadiazine conjugation method, high labeling efficiency, shelf stability [>95% up to 6h], blood serum stability [90% up to 6h] and high uptake in the infected muscle [T/NT =2.21 at 1h], [99m]Tc-SDZ could be used as radiopharmaceutical of choice for further pre-clinical and clinical studies

Post interferon therapy decreases male fertility through gonadotoxic effect

Prevalence of hepatitis C virus [HCV] has been seen in more than 15% of Pakistani population. For the treatment of this infection, only two medicines, interferon, and ribavirin were approved in 1998. The concerned physicians evaluate side effects of these two antiviral drugs only during the treatment period. The long-term extra hepatic side effects are being neglected. This retrospective study was conducted with reference to induced infertility in HCV treated 40 male patients from the period 2008-2015. Possible effects of interferon therapy on fertility hormones and seminal parameters were assessed. Level of fertility hormones like serum Follicle Stimulating Hormone [FSH], Luteinizing Hormone [LH], and testosterone was measured. For seminal parameters, guidelines from World Health Organization [WHO] were followed. Among forty cases of HCV patients who received interferon, only 14 [35%] have children and 26 [65%] could not conceive [p = 0.0372]. After HCV treatment, HCV positive patients showed a significant change in the level of FSH, LH [p<0.05]. Especially, it decreased testosterone level [p=0.0096]. Similarly, HCV treatment significantly decreased sperm count [p = 0.001] and motility [p = 0.0005]

Assessment of killing kinetics assay and bactericidal mechanism of crude methanolic bark extract of Casuarina equisetifolia

Casuarina equisetifolia L. is an important medicinal plant widely used to treat various diseases particularly ulcers, diabetes, cough, diarrhea and many infectious and skin diseases. The aim of this research study was to examine the killing mechanism and killing kinetics assay of methanolic bark extract of C. equisetifolia against some highly resistant human pathogens. The comparison on antibacterial activity of extract was firstly done with six different well reputed antibiotics using disk diffusion method. The broth dilution method was used to measure the MIC and MBC values. The mechanism of killing was identified by scanning electron microscopy [SEM] technique. Results showed that higher inhibitory zones were produced by methanolic plant extract than that of some tested antibiotics. The lower MIC and MBC values indicated the antibacterial potency of plant extract. The extract of C. equisetifolia produced a more drop in optical density of S. aureus, MRSA B. subtilis and S. epidermidis up to 12 hrs. The complete destruction of the cell membrane of MRSA was observed after 12 h treatment with plant extract. It is concluded that crude bark extract of C. equisetifolia is potent antimicrobial agent and produced both bacteriostatic and bactericidal effects. Its killing time was extremely faster especially against MRSA. The cell membrane rapturing is a suggested killing mechanism of plant extract

Biowaiver studies of metronidazole tablets [400mg]: an alternative to In-vivo bioequivalence studies

The aim of the study was to investigate the dissolution behavior of commercially available brands of metronidazole and to provide basic tool to evaluate the comparative effectiveness and interchangeability of generic brands under biowaiver conditions. The dissolution test for six brands of metronidazole 400mg tablets was performed and physical controls were analyzed. Basket Rack methods at 100rpm were used to estimate release pattern of drug. Pharmaceutical parameters of tablets were analyzed. In order to evaluate dissolution profiles, multiple point dissolution were performed and calculated 85.96 +/- 0.41 to 90.56 +/- 0.93 % within 15 minutes in pH 1.2,85.50 +/- 1.40 to 88.99 +/- 0.80% in pH 4.5 and 85.37 +/- 1.94 to 92.79 +/- 0.89% in pH 6.8 dissolution medium respectively. Five different kinetics have been studied to predict and evaluate the acceptability level of drug release. The results show that Hixson-Crowell, first-order and Weibull demonstrated the drug release with R2

Enzymatic degradation study of 111In-labeled minigastrin peptides using cathepsin B enzyme and AR42J cancer cell line for the development of neuroendocrine tumor imaging radiopharmaceuticals

Neuroendocrine tumors [NET] are the rare tumors which often impose graveyard threat. These tumors are characterized by the overexpression of various G-protein coupled receptors including cholecystokinin [CCK] receptors-1 and 2 [A or B]. Minigastrin peptides are being investigated for theranostic purposes of CCK-2 receptor positive NET. The minigastrin analogue [APHO70] was modified by engineering enzyme susceptible tetrapeptide sequence into APHO70 peptide to reduce the random degradation by lysosome enzymes which pave the way to random trafficking in patient's body and dipeptide addition at c-terminus. All the four modified minigastrin peptides [MG-CL1-4] were investigated for lysosome cathepsin B [catB] enzyme susceptibility and fate into AR42J cancer cell line. The indium-111 labeled MG-CL1-4 peptides were also studied for target [tumor] and non-target saccumulation by using tumor induced mice. The RP-HPLC analysis result showed nonspecific cleavage of standard 111In-APH070 and 111In-MGCL1 while specific cleavage was noted in case of 111In-MGCL [2-4]. The effect of specific and non-specific cleavage on biodistribution in tumor induced nude mice model indicates the promising accumulation of 111In-MGCL2, 111In-MGCL3, and 111In-MGCL4 radiotracers while 111In-MGCL1 showed less accumulation. 111In-MGCL2 and 111In-MGCL3 showed highest target-to-kidney ratio [T/K] i.e. 1.71 and 1.72, respectively whereas standard compound showed T/K 1.13. In conclusion, the two indium-111 labeled analogues i.e. 111In-MGCL2 and 111In-MGCL3 showed promising sensitivity for tumor and could be tested for further investigation to reach pre-clinical studies

Phenolic acid profiling and antiglycation studies of leaf and fruit extracts of tyrosine primed Momordica charantia seeds for possible treatment of diabetes mellitus

The increasing risk of variety of fatal diseases including diabetes mellitus is imposing serious challenge to chemist, biologists and clinicians. Due to the side effects of the chemotherapy, worldwide it is thinking that phytomedicine are more effective to cope continuously increasing risk of fatal diseases without any side effect. Seed priming is a strategic pre-sowing semi-bioengineering technique which has ability to improve the growth rate and biologically active compounds in short time. Among seed priming techniques, tyrosine seed priming most frequently used because amino acids provide best growth media for nutritional food crops. Seeds of Momordica charantia were subjected to the pre-sowing tyrosine solution. Different growth parameters including growth emergence rate, seedling vigor, growth and weight of root, shoot and leaf were studied. The results showed positive effect on Momordica charantia seed growth and phenolic acids production i.e. ferulic acid - 43.95 ppm and sinapic acid - 18.39 ppm. The antiglycation assay showed 23.45 +/- 1.23% antiglycation activity of primed-seed fruit extract as compare to control seed fruit extract [0.87 +/- 0.03%]. On the basis of the results, it is concluded that tyrosine primed seed fruit extract could effectively be further tested for pre-clinical and clinical studies to manage diabetes mellitus disease

Frequency of Laryngospasm in awake Versus deep Extubation after Intranasal surgery

Objective: To compare the frequency of laryngospasm in awake versus deep extubation after intranasal surgery

Study Design: Randomized controlled trial

Place and Duration of Study: The study was carried out at Combined Military Hospital Rawalpindi which is a tertiary care hospital, after seeking permission from Hospital Ethics Committee. Study was carried out for six months, from Feb 2013 till Aug 2013

Material and Methods: Two hundred and fifty patients fulfilling the inclusion criteria were selected for this study and divided into two groups of 125 each. Patients of group A were extubated fully awake while the patients assigned to group B were extubated during deep anaesthesia. Patients were then monitored closely for 30 minutes to assess whether they developed laryngospasm or not

Results: The mean age in group-A was 23.92 +/- 5.01 years and in group-B was 24.16 +/- 5.56 years. The mean height in group-A was 169.53 +/- 4.74cm and in group-B was 170.42 +/- 4.34 cm. The mean weight in group-A was 66.18 +/- 6.31 kg and in group-B was 65.67 +/- 6.00 kg. In group-A 72 percent patients were male and 28 percent were female while in group-B 76 percent patients were male and 24 percent patients were female. In group-A 9 [7.2 percent] patients developed laryngospasm and in group B 6 [4.8 percent] patients developed laryngospasm

Conclusion: There is no difference in frequency of laryngospasm in awake versus deep extubation after intranasal surgery

Biosurfactants production potential of native strains of bacillus cereus and their antimicrobial, cytotoxic and antioxidant activities

Present study was designed to evaluate the biosurfactant production potential by native strains of Bacillus cereus as well as determine their antimicrobial and antioxidant activities. The strains isolated from garden soil were characterized as B. cereus MMIC 1, MMIC 2 and MMIC 3. Biosurfactants were extracted as grey white precipitates. Optimum conditions for biosurfactant production were 37°C, the 7[th] day of incubation, 0.5% NaCl, pH 7.0. Moreover, corn steep liquor was the best carbon source. Biuret test, Thin Layer Chromatography [TLC], agar double diffusion and Fourier Transform Infrared Spectroscopy [FTIR] characterized the biosurfactants as cationic lipopeptides. Biosurfactants exhibited significant antibacterial and antifungal activity against S. aureus, E. coli, P. aeruginosa, K. pneumoniae, A. niger and C. albicans at 30 mg/ml. Moreover, they also possessed antiviral activity against NDV at 10 mg/ml. Cytotoxicity assay in BHK-21 cell lines revealed 63% cell survival at 10 mg/ml of biosurfactants and thus considered as safe. They also showed very good antioxidant activity by ferric-reducing activity and DPPH scavenging activity at 2 mg/ml. Consequently, the study offers an insight for the exploration of new bioactive molecules from the soil. It was concluded that lipopeptide biosurfactants produced from native strains of B. cereus may be recommended as safe antimicrobial, emulsifier and antioxidant agent

Designing and molecular docking of cyclic peptides against HCV NS3 protease

Hepatitis C Virus [HCV] infection is a worldwide serious health issue which contributes towards most of the hepatic morbidities. So far no prophylaxis is available to prevent this virus; therefore, development of antiviral compounds to fight HCV infection is the need of time. Chemically synthesized peptides that are potent immunogenic antigens are being pursued as candidate vaccines against HCV. The present study was planned to identify peptide inhibitors having potential to block the activity of NS3 protein of HCV that will ultimately arrest HCV multiplication. Docking of NS3 with peptides revealed that the majority of the peptides have strong binding affinity for active sites of NS3. Peptide 1, 2, 3 and 6 were found interactive with NS3 active residues while the active sites of NS3 had hydrophobic contact with the rest of peptides. Thus, these peptides bear therapeutic potential of a candidate drug for the prevention of HCV replication. Post docking analysis revealed important binding abilities of peptides with the active sites of NS3 protein, showing the efficiency of peptides as potential peptide inhibitors against HCV. The study revealed that HCV replication can be inhibited by these peptides. HCV replication inhibition potential of these peptides can contribute in reducing the burden of HCV infection and its associated complications worldwide

Radiolabeling of benzylpenicillin with lutetium-177: quality control and biodistribution study to develop theranostic infection imaging agent

Benzylpenicillin acts through binding with beta-lactamase enzyme and inhibiting the bacterial cell wall biosynthesis. Therefore, the radiolabeling of benzylpenicillin with lutetium-177 is expected to serve as a theranostic agent for deep-seated bacterial infections. The radiolabeling of benzylpenicillin resulted tilde 93% radiochemical yield at optimized reaction conditions. Radiochemical purity analysis was tested with the help of Whatman No. 2 paper and instant thin layer chromatography. Biodistribution study with healthy New Zeeland white rabbit revealed moderate accumulation in different organs. Kidneys are the major organs, showed not more than 4.57+/-0.89% injected dose per gram organ [ID/gm organ] at 1 h time point and 3.48+/-1.11% ID/gm organ at 6 h time point. The accumulation of tracer agent in liver was found in the range of 7.42+/-2.42% to 9.09+/-2.76 ID/gm organ. The glomerular filtration rate studies revealed rapid clearance - omitting the chance of nephrotoxicity. The radiolabeling yield, biodistribution and glomerular filtration rate results revealed [177]Lu-benzylpencillin could be a potential candidate to diagnose the deep-seated bacterial infection

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

Antioxidant, antibacterial and antiproliferative activities of pumpkin (cucurbit) peel and puree extracts - an in vitro study

Natural resources right from the beginning of the human civilization has paved the way to human being to combat different challenges. The big challenge was to safe the human being from diseases and shortage of food. Plants helped the man in both areas very efficiently. No doubt when plants are used as food actually we are also taking lot of compounds of medicinal values in an excellent combination which naturally reduce the risk of diseases. Extraction and purification of several medicinally important compounds also gave the way to develop pharmaceutical industry in addition to its own therapeutic effects against different lethal diseases. Pumpkin is one of the several medicinal important vegetables used in different way on the behalf of its admirable power to combat different diseases. Antioxidant and biological studies showed very important results. A good coherence was found among extraction yield [10.52 to 18.45%], total phenolics [1.13 to 6.78 mg GAE/l00g], total flavonoids [0.23 to 0.72mg CE/l00g] and antioxidant potential [-70%]. Antibacterial assays of peel and puree extracts advocated good potential to stop the growth and division of pathogenic bacteria. Further biological activity study was carried out using MDBK cancer cell line. The growth inhibitory effect on cancer cell line using MTT assay showed methanol extracts of peel and puree both remained efficient to inhibit growth [-35%] and cell division of cancer cells. Our results showed that extracts of pumpkin puree and its waste, peel, may be utilize to prepare functional food against pathogenic born diseases and most active compounds may also be extracted, concentrated and converted into tablets or suspension form for therapeutic purposes

In vitro bactericidal activity of cefepime and cefpirome against clinical isolates at Karachi

Antibiotics not only support to alleviate the infections but also facilitate to avert the multiplication of microbes. Due to the irrational use of antibiotics, the resistance of antibiotics has been augmented which results may increase in morbidity and mortality with the span of time. World renowned regulatory bodies like Food and Drug Administration [FDA], Center of Disease Control and Prevention [CDC], and World Health Organization [WHO] vigorously advocate the surveillance of the resistance of antibiotics. During the present study by Kirby-Bauer disk diffusion method 141 clinical isolates of Staphylococcus aureus [n=47, 33.34%], Escherichia coli [n=54, 38.3%], Proteus species [n=26, 18.4%], and Klebsiella pneumoniae [n=14, 9.92%] are evaluated against cefepime and cefpirome which comes of fourth generation cephalosporin. It has been found that cefpirome has better bactericidal activity than cefepime against E. coli and K. pneumoniae while cefepime has been possessed better antibacterial activity against S. aureus and Proteus species which were isolated from respiratory tract infections, blood stream infection, intra-abdominal and urinary tract infections, and skin and soft tissue infections. K. pneumoniae, E. coli, Proteus species, and S. aureuswere 34.8%, 26.3%, 11.3%, and 37.7% resistance against cefepime respectively. S. aureus, E. coli, K. pneumoniae, Proteus species has shown 41.4%, 21.7%, 17.6%, and 8.9% resistance against cefpirome correspondingly.

Disintegrants combination: Development and optimization of a cefadroxil fast disintegrating tablet

Fast Disintegrating Tablets [FDTs] is a rapidly growing dosage form preferred for special population (pediatric, geriatric and psychotic patients]

It is also developed with the aim of improving bioavailability and patient compliance

During the present study, cefadroxil fast disintegrating tablets formulations [n=9] were designed and optimized by central composite design with two independent variables [croscarmellose and crospovidone] using design expert® software

The effects of independent variables on formulation properties such as friability, hardness, in vitro dispersion and disintegration were assessed by drawing response surface graphs with design expert® software. Tablets were assessed for pharmacopeial and non-pharmacopeial parameters to ensure the quality of compressed tablets

Among all formulations, F3, F8 and F9 have shown better results. The formulation F9 containing 15mg croscarmellose and !l075mg crospovidone showed good pharmacotechnical attributes as well as shelf life. F 9 showed improved dissolution with t90o/0 of> 2 min and will lead to better bioavailability

Chronic hepatitis; HCV genotypes in correlation with alanine aminotransferase level in patients in interior of Sindh

Objective: To determine the correlation between HCV genotypes and serum ALT levels in various patients of chronic hepatitis induced by hepatitis C virus, in our setup. Design: A prospective study carried out from August 2006 to December 2009. Setting: Research Medical Center LUMHS Jamshoro, Pathology Department Peoples University of Medical and Health Sciences Nawabshah and Biotechnology Department University of Karachi

Patients: A total of 344 HCV-PCR positive patients with different genotypes were evaluated 239 men and 105 women with ages between 18-55 years of age years were included in the study

Methodology: All the patients went for ELISA test for the presence of HCV antibodies by ELISA kit of Biokit Spain, then a 10.0 ml sample of blood was collected in a tube with separating gel, to obtain serum, which was O stored at -80°C, for the determination of HCV RNA by RT- PCR [Real time cephid smart cycler] and for determination of HCV-RNA genotypes by comparison in sizes of the products amplified by RTPCR using HCV genotype- specific primers, then subjecting the product to electrophoresis by Anagen kit. 5.0 ml of blood was also collected in a tube with separating gel, to obtain serum, which was stored at room temperature for the determination alanine aminotransferase by using UV enzymatic kinetic method

Results: when HCV genotypes were correlated with serum ALT levels, 09 cases were found < 50 mg % and among these 06 cases were of genotype 1a, 02 cases were of genotype 2a and one case of untyped. 55 cases shows serum ALT level between 50-100 mg % and among this majority of cases belongs to untyped category. 209 cases shows serum ALT level between 100-200 mg % and among this majority of cases belongs to genotype 3a. 71 cases shows serum ALT level >200 mg % and among this majority of cases belongs to genotype 3a

Conclusions: The data in the current study indicates the strong correlation between HCV genotypes and serum ALT levels. The genotypes 3a, 3b and 2 were found associated with high serum ALT levels and the genotype 1 was found associated with low levels of serum ALT

Novel indium-111 labeled gastrin peptide analogues [MG-CL1-4]: synthesis and quality control

Radiolabeled neuropeptides are widely investigated to diagnose and therapy of tumors. These peptides get internalization after binding with particular receptors at the surface of cells and finally move to lysosome. Internalization into tumor cells helps in mapping the infected site. Minigastrin peptide analogues [MG-CL1-4] were synthesised and labeled with 111-In radioisotope under different sets of conditions for imaging CCk-2 receptor bearing tumors. Different parameters such as temperature [80-100[degree]C], pH [4-12], incubation time [5-30 minutes] and dilution effect were investigated to get the maximum labeling yield and stability. The results indicated that MG-CL1-4 is successfully labeled with indium-111 at pH 4.5 with heating at 98[degree]C for 15 minute. At these conditions i.e. heating, pH and incubation minimum oxidized and maximum labeling yield, more than 94 %, was obtained. The labeling stability was studied by incubating the radiolabeled complex for predefined time points in PBSA and blood serum. Results show that more than 90% radiolabeled MG-CL1-4 remained intact

Design and development of insulin emulgel formulation for transdermal drug delivery and its evaluation

The objective of the present study was to formulate an insulin emulgel, selection of an optimize formulation through in vitro drug release kinetics and finally evaluate its hypoglycemic activity in animal model. Insulin emulgel was prepared using Emu Oil as penetration enhancer with the combination of Carbomer or Hydroxypropyl Methylcellulose [HPMC] as gelling agent and Polysorbate 80 as emulsifier. The response of gelling agent type [Carbomer or HPMC] and concentration of other two variables penetration enhancer and emulsifier were studied using 2[3] factorial design during in vitro drug release through excised rat skin. Biological activity of emulgel formulation was also investigated using Albino rabbits alone and in combination with iontophoresis. The in vivo efficacy of insulin emulgel was assessed by measuring the blood glucose level at start of the experiment and after every 15 minutes interval for 120 minutes. Total eight formulations were studied. F4 formulation showed maximum insulin permeation flux [4.88+/-0.09 micro g/cm[2]/hour] through excised rat skin. Insulin permeation from these formulations was found to follow the Korsmeyer-Peppas model [r[2] =0.975 to 0.998] during 24 hour with non-Fickian mechanism. Formulation F4 was further investigated in Albino rabbits. For the first group [treated with insulin emulgel alone] the blood glucose level decreased from initial value 250+/-10mg/dl to 185+/-7mg/dl at 120 minutes and for the second group [treated with insulin emulgel plus iontophoresis] the blood glucose level decreased to 125+/-5mg/dl in 120 minutes [P<0.05]. It was observed that absorption of insulin through transdermal emulgel was greater in combination with iontophoresis to decrease blood glucose level. On the basis of this study, it has been shown that application of insulin emulgel iontophoretically can be used as alternative [acceptable and painless] to injectable insulin subject to further studies on large animals

Comparative study on resistant pattern of clinical isolates against Levofloxacin and Cefepime

The aim of this study is to evaluate the susceptibility and resistance pattern of clinical isolates causing different types of infections and to compare the efficacy of antibiotics namely Levofloxacin and Cefepime. The in-vitro antibacterial activity and resistance patterns of these two well known antibiotics were studied and compared using disk diffusion method. For this, one hundred clinical isolates comprising of Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas aeruginosa were collected from different local pathological laboratories and hospitals. Escherichia coli [17.95% against cefepime and 30.77% against levofloxacin], Staphylococcus aureus [30% against cefepime and 46.66% against levofloxacin] and Pseudomonas aeruginosa [23.53% against cefepime and 35.29% against levofloxacin] were found resistant against the studied antibiotics which show that cefepime is more effective than levofloxacin. In case of Klebsiella pneumoniae, resistance was 42.85% against cefepime and 35.71% against levofloxacin thereby showing that levofloxacin is more effective than cefepime. Concluded that the clinical isolates collected were susceptible to both the antibiotics but the microbial resistance against these antibiotics is increasing in our population which is alarming. Therefore, it is recommended the physicians may prescribe these antibiotics unless no other substitute is available in clinical practice

Hyperhomocysteiniemia leading to ischemic stroke in a 32 year old male

Homocysteinemia is an independent risk factor for stroke. It may be inherited or acquired. Low B12 and folate levels are associated with hyperhomocysteinemia. We report a case of a 32 years old male who developed left MCA ischemic stroke with right hemiplegia on 4th admission day after attempted suicide with benzodiazepines. His MCV was raised and macroovalocytes were present on peripheral film

His serum B12 and red cell folate levels were markedly reduced and homocysteine levels were markedly raised. This led to hypercoagulable state in this patient which resulted in left internal artery occlusion by a large thrombus leading to stroke. Other factors for hypercoagulability were found negative. Patient's clinical status and MCV improved on replacement therapy with B12, B6 and folic acid