Antimicrobial resistance among aerobic biofilm producing bacteria isolated from chronic wounds in the tertiary care hospitals of Peshawar, Pakistan.

OBJECTIVE: Chronic wound infections impose major medical and economic costs on health-care systems, cause significant morbidity, mortality and prolonged hospitalisation. The presence of biofilm producing bacteria in these wounds is considered as an important virulence factor that leads to chronic implications including ulceration. The undertaken study aimed to isolate and identify the biofilm aerobic bacterial pathogens from patients with chronic wound infections, and determine their antibiotics resistance profiles Method: During this study, swab specimens were collected from patients with chronic wounds at teaching hospitals of Peshawar, Pakistan between May 2013 and June 2014. The isolated aerobic bacterial pathogens were identified on the basis of standard cultural characteristics and biochemical tests. Antibiotics resistance profiles of biofilm producing bacteria against selected antibiotics were then determined. RESULTS: Among the chronic wound infections, diabetic foot ulcers were most common 37 (37%), followed by surgical ulcers 27 (27%). Chronic wounds were common in male patients older than 40 years. Among the total 163 isolated bacterial pathogens the most prevalent bacterial species were Pseudomonas aeruginosa 44 (27%), Klebsiella pneumoniae 26 (16%), Staphylococcus species 22 (14%) and Streptococcus spp. 21 (13%). The isolation rate of bacterial pathogens was high among patients with diabetic foot ulcers 83 (50.9%). Among bacterial isolates, 108 (66.2%) were observed as biofilm producers while 55 (33.8%) did not form biofilm in our model. The investigated biofilm producing bacterial isolates showed comparatively high resistance against tested antibiotics compared to non-biofilm producing bacterial isolates. The most effective antibiotics were amikacine and cefepime against all isolates. CONCLUSION: Increased multidrug resistance in biofilm producing bacteria associated with chronic wounds was observed in this study. Judicious use of antibiotics is needed to control the wound associated biofilm associated pathogens.

A prospective cohort study on the effect of various risk factors on hypoglycaemia in diabetics who fast during Ramadan.

Muslim diabetics who fast during Ramadan are at risk of hypoglycaemia, and previous consensus guidelines have highlighted certain risk factors. This prospective cohort study aims to determine the relative risk (RR) of hypoglycaemia during Ramadan fasting compared with a non-fasting period of equivalent length, and to ascertain which risk factors are clinically significant. From the results, Ramadan fasting carries a RR of hypoglycaemia of 1.60 (95% CI 1.05 to 2.43). Good metabolic control (HbAlc < 8%) and old age (> 60 years) increased RR more than twice, while taking breakfast prior to fasting reduces RR to less than half.

Antioxidant levels and activities of selected seeds of malaysian tropical fruits.

The aims of this study are to determine and compare the antioxidant levels and activities (i.e. primary and secondary) between selected seeds of Malaysian tropical fruits - guava (Psidium guajava), mango (Mangifera indica L.) and papaya (Carica papaya L.). Seeds are among byproducts from the processing of fruitsbased products. Instead of discarding seeds as waste, seeds with high potential as antioxidants could be utilised for commercial purposes. Accordingly, the selected seeds of Malaysian tropical fruits were tested in this study for total phenolic content (TPC), free radical scavenging activity by 1, 1- diphenyl-2-picrylhydrazyl (DPPH) assay and metal ion chelating effect by ferrous ion chelating (FIC) assay. Extraction of antioxidant compounds from sample was done with 70% ethanol. TPCs of the seeds were expressed as gallic acid equivalents (GAE) in mg per 100 g fresh seed weight. TPC assay showed that mango seeds had the highest TPC (i.e. 32 ± 0.001 mg GAE) followed by guava seeds (i.e. 20 ± 0.001 mg GAE) and papaya seeds (8 ± 0.003 mg GAE). For DPPH assay, IC50 data showed that mango seed extract scavenged 50% DPPH radicals at the lowest concentration (0.11 ± 0.01 mg/mL) followed by the positive control BHA (0.13 ± 0.01 mg/mL), guava seed extract (0.26 ± 0.01 mg/mL) and papaya seed extract (0.34 ± 0.01 mg/mL). Interestingly, all seed extracts showed higher free radical scavenging activities than BHA after sample concentration of 0.60 mg/mL. However, FIC assay indicated that metal ion chelating effects of all seed extracts were weaker than BHA suggesting that the fruit seeds are not sources of good metal ion chelators. Overall, present results suggest that TPC of the seeds show strong negative correlation with their primary antioxidant activity (r= -0.985, R2= 0.970), and not all compounds in extracts which could scavenge DPPH radicals are good metal ion chelators. Mango seeds relatively showed the highest antioxidant level and primary antioxidant activity followed by guava seeds and papaya seeds.

Incidence of skin cancers in 3867 patients treated with narrow-band ultraviolet B phototherapy.

BACKGROUND: Narrow-band ultraviolet B (NB-UVB) phototherapy is a widely used treatment. Psoralen-UVA photochemotherapy (PUVA) increases skin cancer risk and some animal studies have raised the possibility of an increased risk with NB-UVB. The risk of skin cancer in humans following treatment with NB-UVB is unknown. OBJECTIVES: This current analysis forms part of an ongoing study ultimately aiming to define the long-term carcinogenic risk of NB-UVB treatment in humans. METHODS: Details of all patients receiving NB-UVB treatment until 31/12/2002 in Tayside, Scotland, were accessed from a treatment database and linked to the Scottish Cancer Registry. Indirect standardization was used to compare skin cancer incidence in the study population with age and sex matched cancer registry data for the Tayside population. We also assessed the effect of NB-UVB exposure treatment numbers on the risk of developing skin cancer. RESULTS: Of 4690 records reviewed, 4665 were suitable for analysis with 3886 records linked with the cancer registry and 3867 followed-up for at least 6 months before 31/12/02 (the date at which cancer registration was deemed to be complete). The median number of NB-UVB treatments was 29 with 352 patients receiving > or = 100 treatments. The study gave 24,753 person-years of follow up. First skin cancers recorded in study patients were 27 basal cell carcinomas (BCC), seven squamous cell carcinomas (SCC) and six melanomas. No association was found between NB-UVB exposure alone (without PUVA) and any skin cancer. For NB-UVB and PUVA treated patients there was an association with BCC, with 27 BCCs found compared with 14.1 expected in the matched population. CONCLUSION: We found no significant association between NB-UVB treatment and BCC, SCC or melanoma. There was a small increase in BCCs amongst those also treated with PUVA. These reassuring results do not demonstrate the early increase in skin cancers that was found associated with PUVA treatment. However, cautious interpretation is required as the cohort contained relatively few patients who had a high treatment number and because the slow evolution of skin cancers may result in a delayed incidence peak. Ongoing risk assessment is therefore essential.

Prevalence of beta-thalassaemia and sickle cell traits in premarital screening in Al-Qassim, Saudi Arabia.

To study the prevalence of beta-thalassaemia and sickle cell traits in the Al-Qassim region, Saudi Arabia. The Ministry of Health of Saudi Arabia launched a countrywide programme in February 2004 to allow all Saudis planning marriage to screen their carrier status for beta-thalassaemia and sickle cell traits. This population survey of mandatory premarital screening for beta-thalassaemia and sickle cell heterozygotes provided an opportunity to estimate the prevalence of these traits in the Al-Qassim region. From February 2004 to October 2006 all individuals attending for premarital screening in that region were screened. For each subject, venous blood was taken to determine complete blood count, red cell indices and hemoglobin electrophoresis. Subjects were considered to have beta-thalassaemia trait if mean corpuscular volume was <79 fl, mean corpuscular haemoglobin <27 pg and haemoglobin A2 level >3.5%; and sickle cell trait if sickle cell haemoglobin amounted to 35 to 45% and sickling test was positive. Totally 38,153 individuals were screened during the study period. The prevalence rates of beta-thalassaemia and sickle cell traits were 0.165% (63/38,153) and 0.252% (96/38,153) respectively. Compared with results of previous studies carried out in this region on the same issue, the prevalence of sickle cell heterozygotes seems to be the same but the frequency of beta-thalassaemia carriers is substantially higher. Screening for carriers both of beta-thalassaemia and sickle cell traits is important to prevent at risk marriages through genetic counseling.

Prevalence of hepatitis B and C and blood donors.

OBJECTIVE: Screening for hepatitis B and C is routinely carried out in the blood banks. The purpose of this study is to compare the prevalence of hepatitis B surface antigen and anti hepatitis C among Saudi and non-Saudi blood donors. METHODS: All the blood donors visiting King Fahad Specialist Hospital were screened by Enzyme Linked Immunosorbent Assay technique for hepatitis B surface antigen and anti hepatitis C. Donors with any history of jaundice in the past were eliminated from the study. RESULTS: Egyptians showed a very high prevalence of Hepatitis C. Saudis had a higher prevalence of hepatitis B compared to hepatitis C. CONCLUSION: The prevalence of hepatitis B and C among Saudis of Qaseem region is low, while for Egyptians the results correspond to previous studies.

Radiographic evaluation of the degenerative cervical spine.

Despite some claims to the contrary, the use of plain film radiography can be an inexpensive initial means of evaluating the degenerative cervical spine if viewed in the context of the patient's clinical history and physical examination and may serve as a guide for further imaging techniques. This article presents a systematic approach for evaluating cervical spine radiographs for the spectrum of degenerative changes, followed by a brief discussion of differential diagnoses.

Specificity, inhibitory studies, and oligosaccharide formation by beta-galactosidase from psychrotrophic Bacillus subtilis KL88.

beta-Galactosidase from psychotrophic Bacillus subtilis KL88 was specific to the beta-D-glycosidic linkage normally present in lactose. The enzyme was completely inhibited by transition metal ions (Cu2+, Fe3+, Fe2+, Zn2+) and partially inhibited by high concentrations of glucose and galactose as well as Ca2+. It was activated by most of the alkaline earth metal ions (NA+, K+, Li+). Oligosaccharides were formed at the different levels of lactose concentrations reaching more than 20% for high lactose concentration (20%). Three types of oligosaccharides were formed in significant concentrations detected by HPLC analysis.