Frequency of Cryptosporidiosis in Children having Persistent Diarrhea.

OBJECTIVE: Globally childhood diarrheal diseases continue to be the second leading cause of death. Cryptosporidium spp are important intestinal parasites that cause diarrhea in humans and animals particularly in developing countries. This investigation was carried out to find out the frequency of cryptosporidiosis in children presenting with persistent diarrhea. METHODS: Two hundred stool samples were collected in this descriptive cross-sectional study conducted at Microbiology Department, Combined Military Hospital, Lahore Pakistan between the months of July to Dec 2014. Children aged five years to 12 years who presented with persistent diarrhea were included in the study. Stool specimens were processed using the modified acid-fast staining method, and microscopically examined for Cryptosporidium infection. RESULTS: The average age of study participants was 7.95 with a standard deviation of 2.21 years. Among the participants 66% were males whereas 34% were females. Twenty eight percent had presence of oocysts in stool samples. CONCLUSIONS: The frequency of Cryptosporidiosis among children with persistent diarrhea was 28%. This high frequency indicates that this population is uniquely susceptible to infection. It also highlights the need for education about hygiene, accurate diagnosis, and treatment of Cryptosporidiosis. There is also a need for additional studies regarding the occurrence of this pathogen.

Challenges in Preanalytical Phase of Laboratory Medicine: Rate of Blood Sample Nonconformity in a Tertiary Care Hospital.

OBJECTIVE: To evaluate the major causes of preanalytical errors in medical laboratory of a tertiary care hospital. METHODS: It was a retrospective study in which we analyzed the sample rejection data of hematology and chemical pathology sections from January to December 2018. Number of rejected samples, reason for rejection and type of test ordered on monthly basis were recorded on a platform. RESULTS: A total of 113,817 samples were received during the study period. Preanalytical errors were found in 1,688 samples, which constitute approximately 1.48% of the total number of samples received. CONCLUSION: Our study highlights the magnitude of preanalytical errors in our setup. Preanalytical errors can lead to loss of patient trust in diagnostic services, can dent the laboratory's reputation, and lead to an increase in the overall operating expenses, both for laboratories as well as the hospitals. Compliance with good laboratory practices can significantly reduce the frequency of pre analytical errors.

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

OBJECTIVE: To study the laboratory diagnosis of tuberculosis (TB), and relate the findings to its epidemiology in Central Saudi Arabia. METHODS: 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. RESULTS: 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%. CONCLUSION: 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%.

Brucella spp isolated from respiratory sample and grown in Mycobacterium growth indicator tube (MGIT).

Brucellosis remains endemic in many countries including Saudi Arabia. The disinfection of objects and surfaces contaminated with Brucella spp is not difficult, but we encountered a situation in which the organism survived the decontamination and liquefaction procedure adopted for AFB culture. A sputum specimen from a patient was sent for TB culture and the BACTEC MGIT 960 system isolated an organism identified as Brucella spp. The blood cultures and the serological testing had confirmed this case to be brucellosis. Isolation of Brucella spp from sputum samples is rare; this case appears to be the first of its kind. As the clinical presentation of TB may mimic brucellosis and vice versa, we recommend that handling specimens from all cases of undiagnosed PUO should be done with care because of the possibility that it may contain either of these organisms.

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.

Prognostically significant fusion oncogenes in Pakistani patients with adult acute lymphoblastic leukemia and their association with disease biology and outcome.

BACKGROUND AND OBJECTIVES: Chromosomal abnormalities play an important role in genesis of acute lymphoblastic leukemia (ALL) and have prognostic implications. Five major risk stratifying fusion genes in ALL are BCR-ABL, MLL-AF4, ETV6-RUNX11, E2A-PBX1 and SIL-TAL1. This work aimed to detect common chromosomal translocations and associated fusion oncogenes in adult ALL patients and study their relationship with clinical features and treatment outcome. METHODS: We studied fusion oncogenes in 104 adult ALL patients using RT-PCR and interphase-FISH at diagnosis and their association with clinical characteristics and treatment outcome. RESULTS: Five most common fusion genes i.e. BCR-ABL (t 9; 22), TCF3-PBX1 (t 1; 19), ETV6-RUNX1 (t 12; 21), MLL-AF4 (t 4; 11) and SIL-TAL1 (Del 1p32) were found in 82/104 (79%) patients. TCF3-PBX1 fusion gene was associated with lymphadenopathy, SIL-TAL positive patients had frequent organomegaly and usually presented with a platelets count of less than 50 x10(9)/l. Survival of patients with fusion gene ETV6-RUNX1 was better when compared to patients harboring other genes. MLL-AF4 and BCR-ABL positivity characterized a subset of adult ALL patients with aggressive clinical behaviour and a poor outcome. CONCLUSIONS: This is the first study from Pakistan which investigated the frequency of 5 fusion oncogenes in adult ALL patients, and their association with clinical features, treatment response and outcome. Frequencies of some of the oncogenes were different from those reported elsewhere and they appear to be associated with distinct clinical characteristics and treatment outcome. This information will help in the prognostic stratification and risk adapted management of adult ALL patients.

Value of microbiology study in congenital nasolacrimal duct obstruction.

PURPOSE: Evaluation of the effect of different microorganisms on congenital nasolacrimal duct obstruction (CNLDO) tightness and whether probing or silastic intubation is likely to fail in a particular microorganism infection. METHODS: The culture and sensitivity results of lacrimal drainage system (LDS) discharge samples from patients with CNLDO were reviewed. Different microorganisms were correlated with the severity of nasolacrimal duct (NLD) obstruction observed during surgical intervention. The success rates of probing and silastic intubation as a primary procedure for each identifiable microorganism were documented. Statistical analysis was conducted to correlate the type of microorganism with the tightness of CNLDO and treatment failure. RESULTS: Out of 181 specimens, 22 had no growth (12.1%). LDS with positive culture had 76.6% successful probing (n = 49) and 82.1% successful silastic intubation (n = 78). Gram-positive and Gram-negative species were almost equally detected. The most prevalent organisms were Streptococcus pneumoniae and Hemophilus influenzae (48.1% and 39.2%, respectively). Tight CNLDO was more prevalent in Serratia marcescens (n = 2; 100%) and Staphylococcus aureus (n = 4; 33.3%) infections with a 7.75 Odds ratio [95% confidence interval (CI), 1.67-34.63]. Staphylococcus aureus had 37.5% successful probing; however, success was achieved in all cases with silastic intubation. Serratia marcescens infections had 100% successful silastic intubation. CONCLUSION: Microbiology study can predict tight CNLDO and helps in choosing the most successful treatment option. CNLDO with Staphylococcus infection and Serratia marcescens were likely to have tight NLD obstruction and silastic intubation had better outcomes.

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

BACKGROUND: 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. METHODS: 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. RESULTS: 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%. CONCLUSION: 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.

In vitro activity of linezolid against clinical isolates of methicillin resistant Staphylococcus.

BACKGROUND: Staphylococcus is responsible for a variety of medical problems, including skin and soft-tissue infections (SSTIs), surgical site infections (SSIs), endocarditis and hospital acquired bacteraemia. Methicillin resistance in staphylococcus has become a global problem limiting the treatment modalities to a large extent. METHODS: The aim of this study was to evaluate the in vitro activity of linezolid and other antibiotics against clinical isolates of methicillin resistant staphylococcus (n = 163); including 105 methicillin resistant Staphylococcus aureus and 58 methicillin resistant coagulase negative staphylococci. Antibiogram of these isolates was determined by the Kirby-Bauer disc diffusion method and minimum inhibitory concentration of linezolid was determined by standard agar dilution method. RESULTS: Overall methicillin resistant S. aureus showed high multi-drug resistance. ATCC 25923 Staphylococcus aureus and ATCC 29213 Staphylococcus aureus were used as the standard control strains. MIC90 of linezolid was comparable for methicillin resistant coagulase negative staphylococci and methicillin resistant S. Aureus (4.0 mg/L); however at MIC50 linezolid was two fold more active against methicillin resistant coagulase negative staphylococci (1 mg/L) than methicillin resistant S. aureus (2 mg/L). CONCLUSION: It is concluded that linezolid has excellent activity against methicillin resistant staphylococci including multidrug resistant strains.

Current radiologic interventions in hepatocellular 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.