Changing epidemiology of tuberculosis detected by an 8-year retrospective laboratory study in a tertiary teaching hospital in central Saudi Arabia

To study the laboratory diagnosis of tuberculosis [TB], and relate the findings to its epidemiology in Central Saudi Arabia. This retrospective study was carried out at the Department of Pathology/Microbiology, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between January 2003 and December 2010. Data were retrieved from the hospital information system on laboratory findings. After adjustment, 9,405 specimens were studied. The specimens were stained by Ziehl-Neelsen [ZN], auramine-rhodamine, and cultured in Bactec alert 960, and Lowenstein-Jensen media. Mycobacterium tuberculosis [M. tuberculosis] complex and non-tuberculous mycobacteria were differentiated by ProbTec system and p-nitrobenzoate medium. The BACTEC MGIT 960 SIRE kit was used for susceptibility testing. A total of 568 [6%] specimens grew M. tuberculosis complex, and 87% were from Saudis with an incidence rate of 55.6/100,000 of TB. Time to positive growth in the Bactec liquid medium was directly related to the acid fast bacilli smear load. Most of the positive patients were from the 18-35 years age group. The percentage of multidrug resistance was 0.7%. Most patients [87%] were Saudis showing an incident rate of 55.6/100,000. An increase of TB cases was noticed in the 18-35 age group. Resistance to isoniazid was 10.6%, 1% to Rifampicin, 2-8% to Ethambutol, and streptomycin was 6%

Effect of different factors; interferon alpha plus ribavirin combination therapy

To determine the effect of different factors on the efficacy of treatment in Hepatitis C patients. Descriptive, analytical study. Shalamar hospital Lahore. October 2010 to May 2013. A total of 254 Hepatitis C patients infected with different genotypes of Hepatitis C virus [HCV] were treated with Interferon alpha 2b plus Ribavirin [IFN alpha-2b+RBV] for 6-12 months according to viral genotype. Before starting the treatment, the presence of HCV and its quantity in the patient was done by real-time PCR. HCV Genotyping was done by multiplex PCR. The patients with <40 years of age or had less than 2 million international units per milliliter basic viral load [<2 MIU/ml] showed better end of therapy [EOT] and sustained virological response [SVR] than >/=40 years of age or >/=2 MIU/mL basic viral load. The response of males to Interferon therapy was better than females. The patients infected with HCV genotype 1 or 4 exhibited lower response than those infected with other than 1 or 4 genotype. The affect of other variables like alcohol, diabetes, hypertension, smoking, injection brand change or missing the injection during therapy were also remarkable in the present study. With proper management of the factors mentioned in the present study efficacy of the treatment can be improved

Antibacterial effect of mango [mangifera indica Linn.] leaf extract against antibiotic sensitive and multi-drug resistant Salmonella typhi

Alternative herbal medicine has been used to treat various infections from centuries. Natural plants contain phytoconstituents having similar chemical properties as of synthetic antibiotics. Typhoid fever is a serious infection and failure of its treatment emerged multi-drug resistant [MDR] bugs of Salmonella typhi. Due to multiple and repeated issues with antibiotics efficacy, it became essential to evaluate biological properties of plants from different geographical origins. Mango leaves have been reported for various medicinal effects like antioxidant, antimicrobial, antihelminthic, antidiabetic and antiallergic etc. Objective of present study was to investigate anti-typhoid properties of acetone mango leaf extract [AMLE] against antibiotic sensitive and MDR S. typhi isolates. A total of 50 isolates of S. typhi including MDR [n=30] and antibiotic sensitive [n=20] were investigated. Staphylococcus aureus [ATCC 25923] and Salmonella typhimurium [ATCC14028] were used as quality control strains. AMLE was prepared and its antibacterial activity was evaluated by agar well diffusion screening method and minimum inhibitory concentration [MIC], by agar dilution technique. Zone of inhibition [mm] of AMLE against MDR and antibiotic sensitive isolates was 18 +/- 1.5mm [Mean +/- S.D]. Zone of S. aureus [ATCC 25923] and S. typhimurium [ATCC14028] was 20 +/- 1.5mm [Mean +/- S.D]. MIC of AMLE was reported in range from 10-50 mg/ml. The present study described the inhibitory effects of mango leaves against S. typhi

Histopathological spectrum of gastric biopsies in a tertiary care hospital

This study was carried out to determine the histopathological spectrum of gastric lesions at a tertiary care hospital. A retrospective study. This study was conducted at Dr. Tahir Laboratory from Gastroenterology unit of Hamdard University Hospital Karachi from July 2009 to August 2012. The gastric mucosal biopsies of 280 patients received at Dr. Tahir Laboratory from Gastroenterology unit of Hamdard University Hospital Karachi. A slight higher frequency of gastric disease seen in females with age range of 17 years to 78 years was observed. The clinical presentations mostly seen were abdominal pain, dyspepsia, vomiting, diarrhea, decreased appetite and weight loss. The histopathology revealed chronic active gastritis [H Pylori positive and negative] followed by malignant gastric ulcer. A number of biopsies were unremarkable histologically. The more prevalent lesions in this series were chronic active gastritis. H. pylori associated gastritis was seen in majority of the patients. Thus gastric biopsy is an essential tool for diagnosis and confirmation of clinically suspected cases

Antibiotic resistance among clinical isolates of stenotrophomonas maltophilia at a teaching hospital in Riyadh, Saudi Arabia

Stenotrophomonas maltophilia has emerged as a significant pathogen in compromised patients, causing infections which are difficult to treat. This study was carried out to comprehend the recent trend of antimicrobial resistance among clinical isolates of S. maltophilia and suggest management guidance for patients in general and in our region in particular. A total of 222 clinical isolates were tested between Jan 2003 to Jun 2009 at King Khalid University Hospital, College of Medicine, King Saud University, Riyadh Saudi Arabia. The organisms were identified as per standard guidelines. Final identification and minimum inhibitory concentration [MIC] was determined by using Microscan[registered]. S. maltophilia showed absolute resistance to Imipenem. In vitro, least resistance was observed against Cotrimoxazole [9.45%] followed by Ceftazidime [57.21%], Piperacillin/Tazobactam [60.82%], Ciprofloxacin [77.03%], Aztreonam [86.03%]. Gentamicin showed overall highest resistance [87.39%]. The crude mortality rate was 47%.Cotrimoxazole is still the most effective agent against S. maltophilia but, keeping in view the increasing resistance to first and second line drugs, there is an urgent need for an effective surveillance system. To discourage development of resistance and devise an effective empirical therapy, large scale study should be considered.

Report of a recurrent mutation in ARS [component B] gene with severe Mal de Meleda in a large consanguineous Pakistani family

To characterize the disease causing mutation in a large consanguineous Pakistani family with severe Mal de Meleda [MDM] or keratosis palmoplantaris transgrediens, a rare autosomal recessive skin disorder. Single nucleotide polymorphism [SNPs] genotyping was performed using the GeneChip Mapping 250K array [Affymetrix]. Homozygosity mapping and sorting of genomic regions were performed with dedicated software called AutoSNPa. Selected regions were further investigated by genotyping with microsatellite markers derived from known and novel polymorphic repeats. Two-point LOD score calculation was performed by using the MLINK of Fastlink computer package. All three coding exons of ARS [component B] gene were amplified by PCR and sequenced. Sequencing of all the coding exons of ARS [component B] gene in the affected individuals revealed a recurrent missense mutation in exon 3 at base pair 256 from Guanine to Alanine [256G>A] and as a result the amino acid Glycine is replaced by Arginine at position 86 [G86R]. This finding will facilitate control of affected MDM births in the Pakistani families

Carbapenemase intrudes K. pneumoniae in local clinical isolates

To determine the sensitivity pattern of the isolates under study against commonly used antimicrobials. The study was carried out at the Department of Microbiology, University of Health Sciences Lahore. Two hundred Clinical isolates [n=200] of Enterobacteriaceae were collected from various tertiary care hospitals of Lahore. The isolates were identified by their morphology and cultural characteristics. API 20E was used for their biochemical profile. Kirby-Bauer disk diffusion method was employed for their susceptibility according to CLSI 2009 guidelines. Modified Hodge Test was used for testing carbapenemase production. Further confirmation was done using EDTA disk potentiation method. Susceptibility pattern of two hundred isolates showed multidrug resistance pattern. All the isolates showed least resistance to Imipenem and Meropenem [0.5%] followed by Amikacin [24%] and Tetracycline [61%]. Only one strain of K. pneumoniae was found to be resistant to carbapenems and it was confirmed to be carbapenemase producer by Modified Hodge Test, and metallo [3-lactamase producer by EDTA disk potentiation method. Carbapenemase has intruded local isolates of K. pnuemoniae. It can result in outbreak of carbapenem resistant strains as it can spread through vertical as well as horizontal transmission. The carbapenem resistant isolates must be contained in order to prevent its further spread among other members of Enterobacteriaceae and other bacteria

Current radiologic interventions in hepatocelluar carcinoma

With the rising incidence of chronic liver disease caused by viral hepatitis, hepatocellular carcinoma is showing a corresponding rise worldwide. Surgery remains the mainstay of treatment, but patients unfit for surgery or liver transplantation form the bulk of those presenting with this disease. Palliative treatments are being used to treat those and radiological modalities form the mainstay of the treatment. Radiology plays a major role in the diagnosis, treatment and follow-up of hepatocellular carcinoma. Current radiological treatment modalities include percutaneous ethanol ablation, radiofrequency ablation and trans-arterial chemoembolization. This update highlights the recent advancements in the field and compares their relative merits and demerits