Bone marrow involvement in metastatic pediatric ewing sarcoma

Objective: To evaluate the frequency of bone marrow involvement with metastatic lung and bone sites in newly-diagnosed pediatric patients with Ewing sarcoma [ES]

Study Design: An observational study

Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, from January 2010 to October 2015

Methodology: Newly-diagnosed pediatric-age patients with ES were inducted. Ten patients were excluded because bone marrow aspiration/biopsy [BMAB] was not done. Patients' medical records were reviewed for data collection of age, diagnosis, tumor volume, bone marrow diagnosis, metastatic work-up and outcomes

Results: A total of 139 patients with median age of 12 years were identified. The median volume of tumors was 529 ml. Eleven patients had bone marrow [BM] disease involvement. Five [45.5%] had bone metastatic disease and 1 [9%] had both pulmonary and bone metastases. Four patients [31.1%] with positive BM had primary limb disease

Conclusion: Ewing sarcoma patients with bone metastatic disease have a higher frequency of BM involvement. However, BM can be involved without metastatic disease. BMAB should still be considered at staging for newly diagnosed pediatric patients with localized ES

Extensively and pre-extensively drug resistant tuberculosis in clinical isolates of multi-drug resistant tuberculosis using classical second line drugs [levofloxacin and amikacin]

To find out the frequency of Extensively Drug Resistant [XDR] and pre-XDR tuberculosis in clinical isolates of Multi-Drug Resistant [MDR] Tuberculosis [TB] by determining the susceptibilities against Levofloxacin and Amikacin [classical second line antituberculosis drugs]. A descriptive cross-sectional study. Microbiology Department, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from September 2011 to August 2013. Amikacin [AK] and Levofloxacin [LEVO] were obtained in chemically pure form from Sigma [Taufkirchen, Germany]. The breakpoint concentration used for AK was 1.0 microg/ml and for LEVO 2.0 microg/ml. Mycobacterial Growth Indicator Tube [MGIT] 960 system was used to carry out drug susceptibility testing as per recommended protocol. A total of 3 MDR-TB isolates [3%] turned out to be XDR-TB based upon simultaneous resistance to injectable second line antituberculosis drug AK and one of the fluoro-quinolones [LEVO]. A total of 24 MDR-TB isolates [24%] were found to be pre-XDR based upon resistance to LEVO alone. Treatment status record of patients with XDR and pre-XDRTB isolates revealed that majority of patients had received fluoroquinolones [FQs] during the course of treatment. XDR-TB has started to emerge in MDR-TB isolates in our set up. The worrying sign is the high frequency of pre-XDR tuberculosis. Urgent steps need to be taken to stem the tide of pre-XDR-TB in our population. It is thus recommended to develop facilities to carry out drug susceptibility testing to monitor the status of pre-XDR and XDR-TB in our population

Frequency and antimicrobial susceptibility pattern of Acinetobacter species isolated from pus and pus swab specimens

To evaluate the frequency and antimicrobial susceptibility pattern of Acinetobacter species isolated from pus and pus swab specimens at a tertiary care setting. Cross-sectional observational study. Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from July 2008 to July 2012. Data regarding positive culture and antimicrobial sensitivity pattern was retrieved from the pus and pus swab culture records of the Microbiology Department, AFIP, Rawalpindi. Only those pus and pus swab specimens which yielded the growth of Acinetobacter species were included in the study. Out of 2781, 1848 were of pure pus while 933 were pus swab specimens. Out of 2538 culture positive isolates, 276 [10.9%] were identified as Acinetobacter species. Among 276 Acinetobacterspp., 245 [88.8%] were Acinetobacter baumannii and 31 [11.2%] were Acinetobacter johnsonii. Male/female ratio of the affected patients was 5.6:1. Doxycycline was the most sensitive antibiotic to which 45% of the tested isolates were sensitive. Sensitivity to all other antimicrobials was 15% or less. About 11% of soft tissue and wound infections are caused by Acinetobacter species in our set up particularly in male. Doxycycline was the most sensitive antibiotic. Sensitivity to all other antimicrobials was 15% or less. In vitro sensitivity to carbapenems is very low

Quality evaluation and in vitro interaction studies between levofloxacin 250mg and diclofenac sodium 50mg tablets

Fluoroquinolones are broad-spectrum antibiotics, work against Gram-positive and Gram-negative bacteria and are a clinically proven option for many resistant infections. Among fluoroquinolones Levofloxacin works best against acute sinusitis, inflammation of the lower airways, acute exacerbation of chronic bronchitis, community acquired pneumonia, complicated urinary tract infection including Pyelonephritis, chronic bacterial prostatitis and skin and soft tissue infection. Levofloxacin is a frequently prescribed antibacterial agent with Diclofenac Sodium for pain management in infectious conditions. The objective of the present work is to evaluate the level of interaction between Levofloxacin and Diclofenac Sodium. In this work market available brands of both drugs were also evaluated for quality. The physiochemical parameters like weight variation, thickness variation, and mechanical strength were determined. Similarly the percentage drug release and content uniformity test were also analyzed; the tested quality attributes were found within the recommended pharmacopeia ranges except brand L6 that had high drug content 124.629 +/- 3.614 while brand L[4] and L[5] were not found similar in pH 1.2. When subjected to model dependent analysis Levofloxacin showed compliance with [first order, Higuchi, Hixson Crowell and Weibull] at pH [1.2, 4.5 and 6.8]. However Diclofenac Sodium showed adherence with [first order, Hixson Crowell and Weibull] at pH [1.2, 4.5 and 6.8] but following Higuchi at pH 1.2 and 4.5 only. The interaction studies were also performed spectrophotometrically and simultaneous equation was used to estimate the percentage availability of both the drugs at pH 4.5, 6.8, FaSSGF and FaSSIF. The studies showed that the percent availability of Levofloxacin was increased significantly in FaSSIF i.e. 129.173 +/- 0.323 at 45 minutes in the presence of Diclofenac Sodium

Immunomodulatory effects of Pimpinella anisum L. (Aniseed) in Broiler Chicks against Newcastle disease and infectious bursal disease viruses / Efecto inmunomodulador de Pimpinella anisum L. (anís) en pollos de engorde contra la enfermedad de Newcastley la enfermedad viral de la bursitis infecciosa

Pimpinella anisum L. (Aniseed) is mostly used as an immune stimulant, growth promoter, antifungal, antibacterial in many countries for centuries. The aim of this study was to determine the immunomodulatory effect of aniseed against Newcastle Disease (ND) and infectious bursal disease (IBD) viruses. The immunomodulatory effect of aniseed against ND and IBD viruses were determined by modifying splenic cell migration inhibition assay and differential leukocyte count for cellular immunity. Haemagglutination inhibition and indirect haemagglutination were used for measurement of humoral immune response against ND and IBD viruses, respectively. The present study suggests that the aniseed addition to basal diet at the rate of 0.5 g/kg and 1 g/kg of feed had best immunomodulatory activity both for humoral and cellular immune responses. However, at higher doses aniseed had adverse effects. Aniseed possesses significant immunomodulatory activity when it is added at lower doses i.e., 0.5 g/kg and 1 g/kg.

Pimpinella anisum L. (Anís) se utiliza principalmente como un estimulante inmunológico, promotor del crecimiento, antifúngico, y antibacteriano, en muchos países durante siglos. El objetivo de este estudio fue determinar el efecto inmunomodulador de anís contra la enfermedad de Newcastle (ND) y la enfermedad de la bursitis infecciosa (IBD). El efecto inmunomodulador de anís contra los virus ND y e IBD se determinaron mediante la modificación del ensayo de inhibición de la migración de células del bazo y recuento diferencial de leucocitos de la inmunidad celular. La inhibición de la hemaglutinación y hemaglutinación indirecta se utilizaron para la medición de la respuesta inmune humoral contra el virus de ND e IBD, respectivamente. El presente estudio sugiere que la adición de anís a la dieta basal a la tasa de 0,5 g/kg y 1 g/kg de alimentación tuvo una mejor actividad inmunomoduladora tanto para las respuestas inmunes humorales como celulares. Sin embargo, a dosis más altas de anís tuvo efectos adversos. El anís posee una importante actividad inmunomoduladora cuando se añade en dosis más bajas, es decir, 0,5 g/kg y 1 g/kg.

Growth promoting effect of Pimpinella anisum (Aniseed) in broiler chickens / Efecto promotor del crecimiento de Pimpinella anisum (semilla de anis) en pollos broiler

The present study was conducted to evaluate growth promoting effect of Pimpinella anisum L. (aniseed) in broiler chickens in terms of body weight gain, organ weights, feed intake and feed conversion ratio (FCR). For this purpose, four levels (0.5, 1.0, 1.5 and 2.0 grams per kg feed) of aniseed powder were administered in feed from day 0 till the end of experiment (42 days of age). The body weight gain, feed intake and FCR were recorded on weekly basis. The birds showed good performance (better weight gain, better feed intake and FCR) when aniseed was fed in lower doses however, birds showed poor performance at higher levels of aniseed. Likewise, almost same pattern was observed for organ weights. This study suggests the good effect of aniseed on performance of broiler chickens at lower doses which suggests the further need of series experiments to find out the minimum safe levels of aniseed to be incorporated in broiler ration to get desirable results.

Se realizó el presente estudio para evaluar el efecto promotor del crecimiento de Pimpinella anisum L. (anís) en pollos de engorde en términos de ganancia de peso corporal, peso de los órganos, el consumo de alimento y conversión alimenticia (FCR). Para este propósito, cuatro niveles (0,5, 1,0, 1,5 y 2,0 gramos por kg de alimento) de anís en polvo se administraron en el pienso desde el día 0 hasta el final del experimento (42 días de edad). La ganancia de peso corporal, consumo de alimento y FCR fueron registrados en forma semanal. Las aves mostraron un buen rendimiento (mejor ganancia de peso, un mejor consumo de alimento y FCR) cuando el anís se alimentó en dosis más bajas, sin embargo, las aves mostraron malos resultados en los niveles más altos de anís. Del mismo modo, se observó casi el mismo patrón de peso de los órganos. Este estudio sugiere que el buen efecto del anís en el rendimiento de pollos de engorde en dosis más bajas que sugiere la necesidad adicional de experimentos de la serie para conocer los niveles de seguridad mínimos de anís que se incorporarán en la ración de pollos de engorde para obtener los resultados deseados.

Antimicrobial susceptibility pattern of bacteria isolated from patients with urinary tract infection

To determine the antimicrobial susceptibility pattern of bacterial pathogens in the patients of urinary tract infection reporting at a tertiary care hospital. Laboratory based study. Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from January to December 2012. A total of 440 culture positive bacterial isolates from 1110 urine samples; submitted over a period of one year were included in this study. Identification of bacterial isolates was done by standard biochemical profile of the organisms. The antimicrobial susceptibility of culture positive bacterial isolates was performed by disk diffusion method as recommended by Clinical Laboratory Standard Institute guidelines [CLSI]. Out of the 440 culture positive urine samples, 152 [34.6%] were from indoor patients whereas 288 [65.4%] from outdoor patients. Gram negative bacteria accounted for 414 [94%] of the total isolates while rest of the 26 [6%] were Gram positive bacteria. The most prevalent bacterial isolate was Escherichia [E.] coli 270 [61.3%] followed by Pseudomonas [P.] aeruginosa 52 [12%] and Klebsiella [K.] pneumoniae 42 [9.5%]. The susceptibility pattern of E. coli showed that 96.2% of the bacterial isolates were sensitive to imipenem, 85.1% to amikacin, 80.7% to piperacillin/tazobactam and 72.6% to nitrofurantoin. In case of P. aeruginsosa, 73% bacterial isolates were sensitive to tazobactam/piperacillin, 69.2% to sulbactam/cefoperazone and 65.38% to imipenem. The antibiogram of K. pneumoniae has revealed that 76.1% of the bacterial isolates were sensitive to imipenem and 52.3% to piperacillin/tazobactam. Nitrofurantoin and imipenem were the most effective antimicrobials amongst the Enterococcus spp. as 92.3% showed susceptibility to this bacterial isolate. Majority of the bacterial isolates were sensitive to imipenem and piperacillin/tazobactam while susceptibility to most of the commonly used oral antibiotics was very low. Among the oral antimicrobials, nitrofurantoin showed good susceptibility against Enterobacteriaceae family and Gram positive organisms

In vitro susceptibility of chloramphenicol against methicillin-resistant staphylococcus aureus

To determine the in vitro susceptibility of chloramphenicol against methicillin-resistant Staphylococcus aureus. Cross-sectional study. Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from January to June 2012. One hundred and seventy four isolates of methicillin-resistant Staphylococcus aureus were included in this study using cefoxitin [30 microg] disc for detection. Minimum inhibitory concentration [MIC] of chloramphenicol against MRSA was determined by using E-strip [AB BIO DISK]. The susceptibility was determined by swabbing the Mueller-Hinton agar [MHA] plates with the resultant saline suspension of MRSA and applying E-strip of chloramphenicol from AB Biodisk Sweden and determining the MIC of chloramphenicol [in microg/ml]. Clinical and Laboratory Standards Institute [CLSI] recommendations of /= 32 microg/ml as resistant were followed in interpreting the results. Out of the 174 MRSA isolates, 132 [75.86%] isolates were susceptible to chloramphenicol with MICs of A[2] 8 microg/ml, 38 [21.84%] were resistant >/= 32 microg/ml while 4 [2.30%] were in intermediate range with MIC of 16 microg/ml. Chloramphenicol has shown good in vitro activity against MRSA and is likely to have a key role in the treatment of MRSA infections providing us a good alternative to newer expensive antimicrobials in resource limited countries

Pathogens causing blood stream infections and their drug susceptibility profile in immunocompromised patients

To determine the types of pathogens causing blood stream infections and their drug susceptibility profile in immunocompromised patients. Cross-sectional, observational study. Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from January to September 2012. Blood culture bottles received from immunocompromised patients were dealt by two methods, brain heart infusion [BHI] broth based manual method and automated BACTEC system. The samples yielding positive growth from either of two methods were further analyzed. The identification of isolates was done with the help of biochemical reactions and rapid tests. Antimicrobial susceptibility of the isolates was carried out as per recommendations of Clinical and Laboratory Standards Institute [CLSI]. Out of the 938 blood culture specimens received from immunocompromised patients, 188 [20%] yielded positive growth. Out of these, 89 [47.3%] isolates were Gram positive and Gram negative each, while 10 [5.3%] isolates were fungi [Candida spp.]. In case of Gram positive isolates, 75 [84.3%] were Staphylococcus spp. and 51 [67%] were Methicillin resistant. Amongst Gram negative group 49 [55.1%] isolates were of enterobacteriaceae family, while 40 [44.9%] were non-lactose fermenters [NLF]. In vitro antimicrobial susceptibility of Staphylococci revealed 100% susceptibility to vancomycin and linezolid. The enterobacteriaceae isolates had better susceptibility against amikacin 85.7% compared to tigecycline 61.2% and imipenem 59.2%. For NLF, the in vitro efficacy of aminoglycosides was 72.5%.The frequency of Gram positive and Gram negative organisms causing blood stream infections in immunocompromised patients was equal. Vancomycin in case of Gram positive and amikacin for Gram negative organisms revealed better in vitro efficacy as compared to other antibiotics.

Frequency of ocular manifestations of chronic graft versus host disease

With the advancement of techniques for haematopoietic cell transplantation, the number of transplant survivors is increasing rapidly and so are the chances of chronic graft versus host disease [cGVHD]. The ocular manifestations of this disease have not been explored in our local population. This study was conducted to determine the frequency of ocular complications in cases of cGVHD following successful bone marrow transplantation. Twelve diagnosed cases of cGVHD were evaluated from June 2008 to March 2009 and there ocular manifestations were noted especially the ocular surface disorders, using double staining method with fluorescein and rose-bengal. Nine patients [75%] were having dry eyes, 7 [58.3%] with mebomian glands dysfunction, 4 [33%] with acute conjunctivitis, 2 [16.7%] with bilateral lacrimal canalicular occlusion, and 1 [8.3%] each of bilateral posterior subcapsular cataract, unilateral sterile corneal epithelial defect, anterior uveitis, retinal haemorrhages and disc oedema. The higher frequency of dry eyes along with other ocular manifestations in patients of cGVHD suggests the need of close ophthalmic monitoring in all such cases

Posterior capsule tear in phacoemulsification of posterior polar cataracts and uncomplicated cataracts

The aim of our study was to document the difference in the incidence of posterior capsule tear in phacosurgery of the posterior polar cataract and uncomplicated cataract and to report the visual outcomes of these cases. A quasi-experimental study. CMH Rawalpindi, from Mar 2004 to Mar 2007. The medical records of all patients who had Phacoemulsification surgery during the study period were retrospectively analyzed. Only patients with posterior polar cataracts and uncomplicated cataracts were included. The data of eyes, which developed posterior capsule tear, were further analyzed. Hydrodissection was not done in the eyes with posterior polar cataracts instead gentle hydrodileneation and viscodissection was done. The incidence of posterior capsule tear and the visual outcome were recorded in the two groups. Out of the 2110 eyes of 1750 patients included in the study, 1735 patients [99.16%] had uncomplicated cataracts [2089 eyes/ 99.001%] and 15 patients [0.86%] posterior polar cataract [21 eyes/ 0.99%]. Posterior capsule rupture occurred in 33 eyes [1.56%] of all study patients. It was significantly high in patients with posterior polar cataract 7 cases [PP group] out of 21 eyes [33.33%] than in eyes with uncomplicated cataract 26 [UC group] out of 2089 eyes [1.24%] [P value <0.001]. The corrected visual acuity significantly improved inpatients of both groups; 6/12 or better in 21 eyes [80.76%] of 26 eyes in UC group and 5 eyes [71.4%] of 7 eyes in PP group postoperatively. Posterior capsule rupture occurred more frequently in posterior polar cataract than uncomplicated cataract. If managed by experienced surgeon, the visual outcome is good in both the groups