Frequency of urinary tract infection and antibiotic sensitivity of uropathogens in patients with diabetes.

OBJECTIVE: To determine the frequency of urinary tract infections and antibiotic sensitivity among patients with diabetes. METHODS: This observational study was carried out in Microbiology Department of Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University from April 2015 to June 2016. All patients with diabetes having symptoms of UTI attending out patients department of BIDE were analyzed. All samples received in the laboratory were processed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Antimicrobial susceptibility pattern was determined by disc diffusion method. RESULTS: A total number of 199 urine specimens, frequency of UTI were 24 (12.06%) in male and 175 (87.94%) in female. UTIs were highly found in (age group 51-60) 70 (35.18%). Escherichia coli was the most frequent pathogen (71%), followed by Klebsiellapneumoniae (7.48%), Proteus mirabilis (1.87%), Staphylococcus aureus (9.35%), Candida (5.61%) and Candidaalbicans were (2.80%). Majority of gram negative uropathogens were shown high sensitivity towards Imipenem and Piperacillin / Tazobactam followed by Nitrofurantion, Ceftriaxone, Levofloxacin, Ofloxacine, Ciprofloxacin, Norfloxacin, Cefixime, Nalidixic acid and Cephradine. Gram positive was most sensitive to Nitrofurantionand Vancomycin followed by Piperacillin / Tazobactam, Imipenem, Cephradine, Ceftriaxone, Norfloxacin and Cefixime. CONCLUSION: We observed the higher frequency of UTIs in female as compared to male participants due to poor hygiene. E.coli was the most frequent pathogen responsible for UTI in patients with diabetes, followed by Staphylococcus aureus.

Neutrophil-to-lymphocyte ratio and microvascular complications in subjects with type 2 diabetes: Pakistan's perspective

Background/aim: The aim of this study is to find the association between diabetic microvascular complications and the neutrophil-to-lymphocyte ratio (NLR) in subjects with type 2 diabetes. Materials and methods: This was a retrospective study based on hospital data records from January 2005 to May 2016 at the Baqai Institute of Diabetology and Endocrinology. The eligibility criteria included subjects with type 2 diabetes with their latest complete blood count while subjects with conditions such as chronic inflammation, cancer, heart failure, and end-stage renal disease were not eligible for inclusion. Subjects were divided into two groups: one with any microvascular complications and the other with no microvascular complications. Body mass index, anthropometric measurements, and blood pressure were measured. Results: Out of 5620 type 2 diabetic subjects, 3202 (57%) were male and (2418) 43% were female. Among these, 3374 diabetic subjects had one or more microvascular complications and 2246 had no microvascular complications. The NLR was found to be 1.14 times higher in diabetic subjects with at least one microvascular complication as compared to diabetic subjects without any complications (4.34 ± 3.32 vs. 3.36 ± 2.67; P < 0.0001). Factors likely associated with microvascular complications were high levels of NLR, HbA1c, serum creatinine, and systolic blood pressure and longer duration of diabetes. Conclusion: According to the results, the NLR is an efficient, cheaper, and readily available marker of inflammation and it is known as an important predictor for the existence of microvascular complications in subjects with type 2 diabetes.

Microbiological pattern of diabetic foot infections at a tertiary care center in a developing country.

OBJECTIVE: To determine the microbiological profile and antibiotic susceptibility patterns of organisms isolated from diabetic foot ulcers in a tertiary care hospital Karachi, Pakistan. METHODS: This descriptive study was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE), from January 2013 to March 2014. Bone, pus and tissue samples were collected from 342 patients with diabetic foot infections and inoculated on appropriate media. Antibiotic susceptibility tests were done by Kirby Bauer disk diffusion method. RESULTS: A total of 671 aerobic bacteria were isolated from 473 specimens with an average of 1.45 isolates per specimen. Poly-microbial infection was 56.87%. Gram- negative isolates were predominant 76.27%.Staphylococcus aureus was most frequent among Gram-positive 20.7% and Escherichia coli 15.72% in Gram negative isolates. MRSA was found in 26.76% Staphylococcus aureus. About 33.48% of antimicrobial resistant isolates were observed. CONCLUSIONS: In our study, Gram negative aerobes were predominant in the diabetic foot infections. A significant number of MDR isolates were also observed in this cohort. Delayed referral and inappropriate use of broad spectrum antibiotics may be the main cause of increase in the frequency of MDR isolates.

Measured versus calculated LDL-cholesterol in subjects with type 2 diabetes.

OBJECTIVE: There is a strong positive association between increased low-density lipoprotein cholesterol (LDL-C) and coronary heart disease (CHD). The accuracy of LDL-C estimation is essential and critically important. The aim of present study was to compare calculated LDL-C with direct homogeneous assay in patients with type 2 diabetes. METHODS: This observational study was carried out at Baqai Institute of Diabetology and Endocrinology (BIDE) from January 2011 to December 2013. A total of 9620 patients with type 2 diabetes were included in the study. Fasting blood glucose, total Cholesterol, triglyceride, HDL cholesterol and LDL cholesterol were obtained using standard methods. Calculated LDL-C was obtained by Friedewald formula. RESULTS: Mean difference of measured and calculated LDL-C was found to be -0.25, 6.63 and 46.55 mg/dl at triglyceride levels < 150 mg/dl, 150 - 400 mg/dl and ≥ 400 mg/dl, respectively. The result shows that the difference between measured and calculated LDL-C increases as the triglyceride level increases. CONCLUSIONS: The findings of our study suggested that calculated LDL-C was lower, as compared to measured LDL-C, which may cause misclassifications that may have an impact on therapeutic decisions in patients with diabetes. Calculated LDL-C may depend on triglyceride levels so LDL-C should be measured by direct assay in routine clinical laboratories.

Antibiogram of Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus in patients with diabetes.

OBJECTIVE: To determine the antibiogram of Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus (MRSA) in patients with diabetes. METHODS: The study was carried out in the Microbiology Department of Clinical and Research Laboratory, Baqai Institute of Diabetology and Endocrinology (BIDE) from January 2012 to December 2012. All samples received in the laboratory were processed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Identification of Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus (MRSA) was done and antimicrobial susceptibility pattern was determined by disc diffusion method. RESULTS: A total of 585 pathogens were isolated from 542 specimens of patients with diabetes. One hundred twenty one (20.68%) Pseudomonas aeruginosa and 25(4.27%) non-aeruginosa Pseudomonas were detected from 542 samples. Among 108 (18%) samples detecting the growth of Staphylococcus aureus, Methicillin-resistant Staphylococcus aureus (MRSA) were found in 42 (39%) samples. Pseudomonas aeruginosa showed marked susceptibility to imipenem (100%) followed by piperacillin / tazobactam (90.91%). All MRSA positive specimens were susceptible to vancomycin, but highly or completely resistant to the other antimicrobial drugs. Conclusion : In the present study imipenem, piperacillin/tazobactam and sulbactam-cefoperazone were found to be the most effective drugs against Pseudomonas aeruginosa. The majority of MRSA were resistant to one or more than one antimicrobial drugs. Vancomycin and imipenem were the most effective drugsagainstStaphylococcus aureus and MRSA. .

Antimicrobial susceptibility pattern of aerobic microbial isolates in a clinical laboratory in Karachi - Pakistan.

UNLABELLED: Backgroun and Objective: Resistance to multiple antimicrobials is the major cause of debility and death due to infectious diseases around the world. Our objective was to determine the frequency and antimicrobial susceptibility pattern of aerobic microbial isolates in a clinical laboratory. METHODOLOGY: All culture specimens of tissue, pus, urine, bone, blood, fluid, stool, sputum, and high vaginal swab received in the Microbiology Department of Clinical & Research Laboratory, Baqai Institute of Diabetology and Endocrinology from May 2010 to January 2011 were included in the present study. Bacterial isolates were identified and their antimicrobial susceptibility pattern was determined. RESULTS: Out of 312 cultured specimens, 272 (87.17%) were found infected with 437 microbial organisms (412 bacteria and 25 Candida isolates). A total of 90 (20.59%) multi-drug resistant (MDR) isolates were found. MDR Escherichia coli was isolated in 40 (34.19%) out of 117 culture specimens which showed the growth of Escherichia coli, Pseudomonas aeruginosa in 17 (22.08%), Methicillin-resistant Staphylococcus aureus in 13 (11.50%), Klebsiella pneumoniae in 7 (22.58%), Proteus species in 6 (31.58%), Acinetobacter species in 3 (33.33%), Enterobacter species in 2 (28.57%), Coliform (Escherichia coli) in 1 (16.67%) and Enterococcus species were isolated in 1 (50%) culture specimen. CONCLUSIONS: High prevalence of multi-drug resistant bacteria was found in the present study. Emergence of antimicrobial resistance has become a major challenge in infectious disease medicine. Antimicrobial resistance may be due to misuse of antimicrobials by physicians and self medication in Pakistan. Further large scale studies are needed to validate our findings.

Studies on lethal concentrations and toxicity stress of some xenobiotics on aquatic organisms.

Three widely used xenobiotics pentachlorophenol (PCP), 2,4-dichlorophenoxyacetic acid (2,4-D) and 2-chloro-2,6-diethyl-N-(butoxymethyl) acetanilide (Butachlor) are evaluated for acute toxicity and stress behavior on freshwater fish (Heteropneustes fossilis, Clarias batrachus, Channa punctatus) and mosquito larvae (Culex pipiens fatigans). The experiment was carried out by medium treatment using intermittent flow-through system. Median lethal concentrations (LC50) were calculated by probit analysis. The LC50 values and 95% confidence intervals showed variable range for tested chemicals. Mosquito larvae generally appeared resistant than fish, while H. fossilis was found to be most sensitive. Stress signs in the form of behavioral changes are also observed. Both types of organisms are recommended as good bioindicator for the risk assessment of aquatic environment due to chemicals tested.