Prevalence, distribution and antibiotic resistance of emergent Arcobacter spp. from clinically healthy cattle and goats.

Prevalence, distribution and antibiotic resistance of Arcobacter spp. were investigated in cattle, goats, floor and treated water samples in this study. The prevalence of Arcobacter in adult and young was recorded as 8/110 (7.27%) and 4/83 (4.81%), respectively, which showed insignificant difference (P = 0.3503) in detection rates between adult and young cattle. A total of 33.33% of the floor samples and 11.11% of the treated water samples analysed were determined as positive for Arcobacter. Among the species isolated, over all, A. butzleri (45%) was the most frequently detected species, followed by A. skirrowii (5%). A. butzleri was isolated from adult cattle, floor and water samples at the rates of 75.0%, 33.4% and 50%, respectively. Co-colonization of species was not uncommon, and 50% of the samples were carrying more than one Arcobacter species. Only 12.5% sample from cattle (adult) was detected positive for only A. skirrowii. All samples from young animals, floor and water contained mixed isolates. None of the samples from goat farm was found to be carrying Arcobacter species. On profiling of antimicrobial resistance patterns, it was found that only one A. butzleri isolate (3.7%) was sensitive to all nine antibiotics tested. A. butzleri was found highly resistant to ampicillin (55.6%), followed by cefotaxime (33.4%) and ciprofloxacin (33.4%). Overall, 20% of the isolates showed multidrug resistance (resistant ≥4 antibiotics). Gentamicin and enrofloxacin can be used as drugs of choice for the treatment for Arcobacter infections.

Low prevalence of the intact cag pathogenicity island in clinical isolates of Helicobacter pylori in Karachi, Pakistan.

Clinical diseases that follow Helicobacter pylori infection are associated with expression of the cagA gene, a part of cytotoxin-associated gene pathogenicity island (cag-PAI). This study aims to determined whether or not the presence of cagA is associated with the presence of complete cag-PAI and to evaluate inflammatory changes associated with the five loci in the cag-PAI of H. pylori comprising cagA, cagA promoter region (cagAP), cagE, cagT and the left end of the cagA gene (LEC). H. pylori isolates were obtained from patients with dyspeptic symptoms. Clinical strains of H. pylori were screened by the polymerase chain reaction (PCR) for respective genes of the cag-PAI. Of 115 H. pylori isolates, 31 (28%) were positive for the five cag-PAI loci. H. pylori isolates with intact cag-PAI were associated with gastric carcinoma (GC; n=9 [60%]) and gastric ulcer (GU; n=5 [45%]) compared to non-ulcer dyspepsia (NUD; n=14 [18%]) (P=0.001 and P=0.049, respectively). In patients with intact cag-PAI, acute on chronic inflammation was present in 25 (81%) and was more common than chronic inflammation (P=0.013). The cagE and cagAP had deletions in 25 (37%) and 23 (35%) cases, respectively. The cagAP region was significantly associated with GC (n=12 [80%], P<0.001) and GU (n=9 [82%], P=0.001) compared to NUD (n=24 [30%] and with significant acute on chronic inflammation (n=40 [80%], P=0.007). The distribution of vacAs1a with intact cag-PAI in GC was 9 (60%) and in NUD was 10 (13%) (P<0.001). The presence of the cagA gene does not signify presence of an intact cag-PAI. Most of the H. pylori isolates studied had partial cag-PAI with missing cagE and cagA promoter regions.

Meta-analysis: antibiotic prophylaxis to prevent peristomal infection following percutaneous endoscopic gastrostomy.

BACKGROUND: Despite numerous guidelines recommending prophylactic antibiotics prior to percutaneous endoscopic gastrostomy, their use remains controversial. AIM: To conduct a systematic literature review and performed meta-analyses to determine the benefit of antibiotic prophylaxis for percutaneous endoscopic gastrostomy placement. METHODS: We performed a systematic literature review by searching healthcare databases and grey literature for randomized-controlled trials of antibiotic prophylaxis against wound infection after percutaneous endoscopic gastrostomy. Relative risks were calculated for individual trials and data pooled using fixed-effects model. Relative risk reduction, absolute risk reduction and number needed to treat were calculated and are reported with 95% confidence intervals. RESULTS: Ten randomized-controlled trials met the inclusion criteria and 1059 cases were pooled. Overall findings indicated that antibiotic prophylaxis resulted in a relative risk reduction of 64% and an absolute risk reduction of 15%. Number needed to treat to prevent one wound infection was 8. Cephalosporin prophylaxis was associated with a relative risk reduction of 64%, absolute risk reduction of 10% and number needed to treat of 10, whereas penicillin-based prophylaxis was associated with a relative risk reduction of 62%, absolute risk reduction of 13% and number needed to treat of 8. CONCLUSIONS: Antibiotic prophylaxis prior to percutaneous endoscopic gastrostomy is effective in reducing the incidence of percutaneous endoscopic gastrostomy site wound infection. Based on sensitivity analyses, penicillin-based prophylaxis should be the prophylaxis of choice.

Outcome of pregnancy in renal allograft recipients: SIUT experience.

The course of pregnancy and its outcome was studied in renal allograft recipients. Between November 1985 and November 2005, a total of 1481 renal transplants were carried out at the Sindh Institute of Urology and Transplantation (SIUT); among them were 348 females, with 73 potential females for pregnancy. All patients received cyclosporine and prednisolone, with 82% also receiving azathioprine and 4 patients mycophenolate mofetil as a third immunosuppressant drug. We evaluated incidence of hypertension, diabetes, pre-eclampsia, urinary tract infection (UTI), rejection during pregnancy and during 3 months' postdelivery as well as outcomes of pregnancy. Among 73 potential candidates, 31 had 47 pregnancies, after an average of 31 months (8-86 months). Of 31 subjects, 21 subjects were hypertensive on one or two drugs prior to conception. A rise in blood pressure during pregnancy was noticed in 7 patients. Albuminuria from trace to 3+ appeared in 13 patients and glycosuria in one other. Blood sugar levels remained within normal range in all subjects. UTIs occurred during pregnancy in 7 patients. Among 47 pregnancies, 9 had abortions (7 spontaneous, 2 therapeutic) and 6 had preterm deliveries. The others were full-term deliveries: 12 via a lower segment caesarean section and 20 were normal vaginal deliveries. Average birth weight was 4.8 lbs. At an average follow-up of 38 months the serum creatinine values ranged from 0.94 to 2.3 mg %. One patient developed acute irreversible graft dysfunction soon after delivery. Our study demonstrated that pregnancy did not reduce renal graft survival, but newborns are at greater risk of premature birth and low birth weight.

In vitro susceptibility of Blastocystis hominis isolated from patients with irritable bowel syndrome.

This study aims to determine the growth pattern and in vitro susceptibility of clinical isolates of Blastocystis hominis to different concentrations of metronidazole, furazolidone and ciprofloxacin. Stool specimens from 25 consecutive patients with irritable bowel syndrome presenting to the gastroenterology department of Aga Khan University Hospital between January and May 2003 are examined by microscopy and cultured for B. hominis. Drug susceptibility assays are performed for metronidazole, furazolidone, and ciprofloxacin using final concentrations of 0.01 mg/mL and 0.1 mg/mL. The effect of the drugs is assessed after B. hominis culture for 48 h. With furazolidone and metronidazole, 68% (17/25) and 60% (15/25) of B. hominis isolates, respectively, failed to grow at drug concentrations of both 0.01 mg/mL and 0.1 mg/mL. However, ciprofloxacin failed to suppress growth completely at both concentrations. B. hominis resistance to furazolidone, metronidazole and ciprofloxacin at 0.01 mg/mL was 32% (8/25), 40% (10/25) and 100% (25/25), respectively. B. hominis isolates varied in their degree of susceptibility to the three drugs studied, being greater with furazolidone than with metronidazole, and complete resistance with ciprofloxacin.

Biology and novel therapeutics for neuroendocrine tumors of the lung.

Neuroendocrine (NE) tumors of the lung are a special class of tumors that include large cell neuroendocrine carcinoma (LCNEC), typical carcinoid (TC) tumor, atypical carcinoid (AC) tumor, and small cell lung cancer (SCLC). Even though they all have the same NE phenotype, these tumors can differ in their pathological characteristics, immunohistochemical patterns, molecular and cellular biology, clinical characteristics, response to various therapeutic modalities, and finally the ability to be molecularly targeted by novel therapeutics. In this review article, we will summarize the various characteristics of these specialized NE tumors, with particular emphasis on the biology with the potential for novel targeted therapies. As an example, SCLC is characterized by overexpression of receptor tyrosine kinases such as c-Kit, c-MET and Ret, and these can be targeted with small molecule inhibitors and various antibodies. Many of NE tumors are quite aggressive and arriving at targeted therapies would be a useful venue to pursue for a potential cure.

Irritable bowel syndrome in health care professionals in Pakistan.

OBJECTIVE: To evaluate the symptomatology of irritable bowel syndrome (IBS) among health care professionals attending an IBS symposium in a tertiary care university hospital. METHOD: A questionnaire designed to incorporate Manning and Rome II criteria was distributed among participants of an IBS symposium, most of them were health care professionals. A total of 100 questionnaires were distributed, 41 had symptoms fulfilling criteria of IBS. In these patients male: female ratio was 28:13 with age range 18-68. RESULTS: The predominant symptom was abdominal pain 87.8 % (36/41) which was aggravated post-prandially 72.2% (29/41), relieved following defecation in 87% (35/41) with a sense of incomplete evacuation 85.3% (35/41) and distention after defecation in 80.4% (33/41). Anxiety and depression was present in 80% (33/41) as an extraintestinal symptom. CONCLUSION: Irritable bowel syndrome is common in health care workers with intestinal and extraintestinal manifestations being equally common.

Open label trial of the efficacy and tolerability of Lamisil (Terbinafine) 500 mg once daily in the treatment of onychomycosis due to candida.

An open label trial of Lamisil (Terbinafine) 500 mg daily for 16 weeks was conducted on 20 patients with Onychomycosis due to candida. Of these, 15 patients could complete the trial. Total number of target nails infected was 21. The follow-up period was from 16 to 52 weeks. At 16 weeks, 71% cases showed clinical improvement and 67% had mycological cure. Thirty-three percent had complete cure at 52 weeks. The results show that Terbinafine is effective against candida but requires a longer duration of treatment. The drug was well tolerated.

Endometriosis with myxoid change simulating mucinous adenocarcinoma and pseudomyxoma peritonei.

A case of endometriosis with myxoid change is presented here which raised concern for metastatic adenocarcinoma and pseudomyxoma peritonei. This is the second case similar to the one described previously in the literature. A 51-year-old woman underwent repair for an umbilical hernia. The tissue sections of the hernia specimen contained isolated pools of mucin surrounded focally by cuboidal-type epithelium. Subsequent CT scan of the abdomen and pelvis revealed a large right adenexal mass. These clinicopathologic findings raised strong suspicion for adenocarcinoma and pseudomyxoma peritonei. Intraoperative frozen section of the right ovary showed an endometriotic cyst. She underwent hysterectomy, bilateral salpingoophrectomy, partial omentectomy, and lysis of adhesions. Permanent sections revealed foci of endometriosis in both ovaries and cervix. Pools of acellular mucin were present in the omentum and bladder peritoneum. There was no evidence of malignancy in any of the specimen. The case illustrates that endometriosis with myxoid change can simulate with mucinous adenocarcinoma and pseudomyxoma peritonei.

Piezogenic papules--a study of 100 cases.

Hundred people were examined for piezogenic papules (cutaneous hernia). Of these 80 had pedal papules, 86 wrist papules and 74 both pedal and wrist papules. Most of these papules were bilateral and multiple. All cases examined were painless. Biopsy showed fragmentation of dermal elastic tissue and herniation of subcutaneous fat into the dermis. Histology was similar for both pedal and wrist papules.