Molecular Detection of Chlamydia Trachomatis in Patients with Pelvic Inflammatory Disease Visiting a Tertiary Care Hospital in Pakistan

Objective: To detect the frequency of Chlamydia trachomatis in urine samples of women with Pelvic Inflammatory Disease visiting a tertiary care hospital using a Polymerase Chain Reaction assay and find an association between different risk factors. Study Design: Cross-sectional study. Place and Duration of Study: Department of Microbiology, Army Medical College/National University of Medical Sciences Rawalpindi Pakistan, from Mar 2018 to Jan 2019. Methodology: Over eleven months, 60 diagnosed urine samples of married females with pelvic inflammatory disease between the ages of 14-49 years were included in the study. DNA of Chlamydia trachomatis from urine samples was extracted manually using the commercially available kit. It was detected by performing a real-time Polymerase Chain Reaction assay using a forward primer (5’-CATGAAAACTCGTTCCGAAATAGAA-3’) and a reverse primer (5’-TCAGAGCTTTACCTAACAACGCATA-3’) of sequence mentioned above for amplification of target sequences, of the Chlamydia trachomatis. Results: Out of sixty cases included in this study, Chlamydia trachomatis DNA was detected in 12 cases (20%), and 48 cases (80%) were negative. So, the frequency of Chlamydia trachomatis in our study population was estimated at 20%. In addition, age, socioeconomic status, education and no of sexual partners were all risk factors were evaluated for their role in acquiring infection. Conclusion: Females having Chlamydia trachomatis infection and other sexually transmitted infections are at an increased risk of developing Pelvic Inflammatory disease due to the presence of risk factors and the asymptomatic nature of the disease.

PCR to CRISPR: Role of Nucleic Acid Tests (NAT) in detection of COVID-19

COVID-19 infection has emerged as an unparalleled pandemic with morbidity and mortality tolls challenging diagnostic approaches and therapeutic interventions, and raising serious questions for healthcare policy-makers. From the diagnostic perspective, Reverse transcriptase polymerase chain reaction remains the gold standard. However, issues associated with gene primer variation in different countries, low analytical sensitivity, cross-reactivity with certain human coronaviruses have raised serious concerned within the scientific community. Alongside longer turnaround times, requirements of sophisticated equipment and trained technicians are the other challenges for conventional reverse transcriptase polymerase chain reaction testing. The recent biotechnological boom has now allowed newer nucleic acid testing options for diagnosing severe acute respiratory syndrome coronovairus 2 with much better diagnostic efficiency, reduced turnaround times and possible benefit for use as a point-of-care test. ---Continue

HOST GENOME INTERACTIONS IN COVID-19: DIFFICULTIES IN PATIENT MANAGEMENT AND HEALTHCARE POLICY MANAGEMENT

Mankind during current pandemic has displayed the best possible responses utilizing researched knowledge base, cutting edge biotechnology and most importantly the will to take down tis mammoth menace of our times. Though mixed sorrows and failures progress towards the “war on COVID-19” without doubt outshined against the challenger from the development of timely diagnostics and prognostics to novel therapeutics and vaccinations. The more we explore the delicate & detailed intricacies surrounding the ongoing pandemic, there remains questions still to be answered. Rather, a reply most of the time in itself opens up newer Pandora boxes and it seems like an ongoing unlimited brawl with few troughs in between. While targeting statistical exactness among Homo Sapien’s response to COVID-19 infection, we remain less educated to decide for nature's defined hostgenome variability about disease pathogenesis. While we all humans are the same genetically, but then weare not that same again genetically.

MULTIPLEX POLYMERASE CHAIN REACTION (PCR) FOR THE DETECTION OF NEISSERIA GONORRHOEAE AND THE QUINOLONE RESISTANCE GENE IN PAKISTAN

Objective: To detect Neisseria gonorrhoeae from the urine of male patients reporting with active urethral discharge using multiplex polymerase chain reaction (PCR). And the simultaneous detection of the quinolone resistance determining region (QRDR) on the Neisseria gonorrhoeae gene using multiplex polymerase chain reaction. Study Design: Cross sectional study. Place and Duration of Study: Microbiology department, Army Medical College Rawalpindi Pakistan, from Mar to Dec 2018. Methodology: Male patients with active urethral discharge with no past history of antibiotic use for urethral discharge were included in study and patients without active urethral discharge and history of antibiotic use for urethral discharge were excluded. Urine of patients of active urethral discharge was collected and multiplex polymerase chain reaction was done by using two forward primers along with common reverse primer. Results: In this study 24 (40%) of patients who presented with active urethral discharge were positive for gonorrhea. However Quinolone Resistance Determining Region is detected in 17 (70.83%) of cases and only 7 (29.17%) were sensitive to ciprofloxacin. Conclusion: The multiplex polymerase chain reaction is very efficient and effective method for the simultaneous detection of Neisseria gonorrhoeae and status of isolate susceptibility to ciprofloxacin. And in Pakistan ciprofloxacin cannot be used as first line drug for the treatment of gonorrhea.

COMPARATIVE IN- VITRO EVALUATION OF VANCOMYCIN MINIMUM INHIBITORY CONCENTRATIONBY AGAR DILUTION AND E-STRIP IN METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS

Objective: To compare the in-vitro efficacy by determining Minimum Inhibitory Concentration of Vancomycinusing the reference Agar Dilution to the E-Strip in Methicillin Resistant Staphylococcus aureus isolates. Study Design: Validation study. Place and Duration of Study: The department of Microbiology Army Medical College/National University ofMedical Sciences in collaboration with Pak Emirates Military Hospital Rawalpindi, from Dec 2016 to Dec 2017. Methodology: Non-duplicate 84 isolates of Methicillin resistant Staphylococcus aureus from various clinical specimens were included in the study. All these isolates were screened for susceptibility to glycopeptide by E-strips method (Bio mérieux) as well as Agar Dilution method, using vancomycin concentrations of 0.25, 0.50, 1.00, 2.00, 4.00 and 8.00µgm/ml respectively in two fold serial dilutions. Results: There was an overall agreement on 83 samples by both the methods i.e. 83 were Vancomycin SensitiveStaphylococcus aureus by both methods while one isolate with intermediate resistance to Vancomycin was onlydetected by Agar Dilution. The sensitivity of the E–strips compared to Agar Dilution was found to be 100%. Thepositive predictive value was 98.8% with a diagnostic accuracy of 98.8%. Specificity and negative predictive valuecould not be ascertained for E-strips because of the limitation of the method to detect the Vancomycin Intermediate Staphylococcus aureus isolates. Conclusion: E-strip can be a convenient alternative to the gold standard Agar Dilution but its inability to identifyVISA challenges its reliability in determining the Vancomycin resistance in MRSA isolates.

Comparative Fluoride Release and Antimicrobial Analysis of Commercial and Experimental Bioactive Glass/Nano-Oxide-Based Dentifrices

OBJECTIVES

 The objectives were to measure fluoride release and assess the antimicrobial behavior of fluoride-doped nano bioactive glass (F-nBG) and nano zinc oxide (ZnO)-enriched novel dentifrices.

MATERIALS AND METHODS

 Experimental dentifrices were synthesized by incorporating ZnO nanoparticles and F-nBG (1.5 wt% and 4 wt%) as active ingredients. The fluoride release behavior of suspensions and elutes of samples were analyzed by ion selective electrode. Antimicrobial activity and minimum bactericidal concentration against Streptococcus mutans and Lactobacillus casei were evaluated. Microbial stability against contamination was also assessed by a challenge test.

RESULTS

 The fluoride release behavior of experimental dentifrices was higher than that of commercial dentifrices and was dependent on filler loading. The fluoride release was more from suspensions than elutes. Zones of inhibition (ZOIs) and minimum bactericidal concentration values for novel dentifrices showed direct proportionality with filler loading, and effectiveness was exhibited against both strains. Experimental dentifrices exhibited effective antibacterial potential, which could possibly be due to release of sufficient fluoride and zinc ions in aqueous media from F-nBG and ZnO present in their formulations.

CONCLUSION

 Combination of F-nBG and ZnO may provide a multi-benefit approach for simultaneously treating early white spot lesions, reducing bacterial growth, and providing core plaque control.

Efficacy of Antimicrobials Against Multidrug-Resistant Acinetobacter baumannii from Patients in a Tertiary Care Hospital

Introduction: In just two decades Acinetobacter baumannii has attained considerable importance, evolving from an insignificant organism to a leading pathogen especially in intensive care unit settings globally. Treatment options are already very limited and have almost run out due to the rapid emergence of antimicrobial resistance. Evaluation of antimicrobials that are currently in use to determine their effectiveness against multidrug-resistant (MDR) strains and developing newer options is of utmost importance. We thus set out to determine the efficacy of routinely used antibiotics against MDR A. baumannii. Materials and Methods: This was a cross-sectional study conducted at the Department of Microbiology, Army Medical College, National University of Medical Sciences (Rawalpindi, Pakistan) from December 2015 to June 2016. The organisms were identified on the basis of colony morphology, gram staining, catalase, oxidase, motility test, and API (analytical profile index) 20NE. The organisms were considered to be MDR when the isolate was found to be resistant to at least one agent in more than three antimicrobial groups. Antibiotic sensitivity was determined using the modified Kirby-Bauer disc diffusion method according to Clinical Laboratory Standards Institute (CLSI) guidelines. Results: The 77 isolates were found to have good sensitivity to tigecycline (94.8%) and minocycline (80.5%). Most of the isolates were resistant to other routinely used antibiotics. Conclusion: A few antibiotics, tigecycline and minocycline, are still effective against these MDR A. baumannii. We need to remain up to date regarding the efficacy of antibiotics to effectively treat patients with these MDR bacteria.

Determination of reference intervals of thyroid markers during pregnancy in Urban area of District Rawalpindi Pakistan

OBJECTIVE

To determine the reference values for thyroid stimulating hormone, free tetra-iodothyronine and total tri-iodothyronine for healthy pregnant women.

METHODS

This cross sectional study was conducted at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from January 2016 to June 2017. Pregnant women with normal, single intrauterine, uncomplicated pregnancy were recruited from the local population. Blood sample was taken to analyse thyroid stimulating hormone, free tetra-iodothyronine and total tri-iodothyronine using chemiluminescence immunoassay. For thyroid hormone levels during each trimester 5th and 95th percentiles were calculated as reference intervals. Data was analysed using SPSS 24.

RESULTS

Out of 384 subjects, 188(48.95%) were in their first trimester and 196(51.04 %) females were in their second trimester. There were 109(57.97%) primigravida in the first trimester and 137(69.9%) in the second trimester. Mean age of subjects presenting in the first and second trimester was 25.37±3.78 years and 26.54±4.65 years respectively. Reference intervals for those in the first trimester for thyroid stimulating hormone was 0.05-2.8uIU/ml, for free tetra-iodothyronine14.4-22.7pmol/l and total tri-iodothyronine1.5-3.3nmol/l. For those in second trimester the corresponding values were 0.16-3.3 uIU/ml, 14.2-24.6.0 pmol/l and 1.6-3.1nmol/l.

CONCLUSIONS

Laboratories should adopt trimester-specific reference intervals for thyroid function tests in pregnancy..

Spectrum of renin angiotensin aldosterone system disorders in young hypertensives

OBJECTIVE

To analyse the spectrum of renin angiotensin aldosterone system disorders in young hypertensive patients in hospital settings.

METHODS

This cross-sectional study was conducted at the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from January to December, 2016. It comprised hypertensive subjects aged 17-40 years of either gender presenting in the outpatient department. All subjects were having blood pressure more than 140/90mmHg and were not on any anti-hypertensive medicine. Blood sample was taken from each patient to analyse arterial blood gases, plasma renin, serum aldosterone and electrolytes. Association of qualitative variables like age, systolic and diastolic blood pressure with essential hypertension and primary hyperaldosteronism was explored.

RESULTS

Of the 80 patients, 72(90%) were diagnosed with essential hypertension and 8(10%) with primary hyperaldosteronism. None of the patients had Liddle syndrome, apparent mineralocorticoid excess or Gordon syndrome. Mean age of patients having essential hypertension was 30.97±7.1 years, whereas, for those with primary hyperaldosteronism it was 29.25±7.1 years. Systolic blood pressure was significantly higher (p = 0.000) among all patients. No statistically significant association was found between age, systolic and diastolic blood pressure (p<0.05).

CONCLUSIONS

Primary hyperaldosteronism as compared to other renin angiotensin aldosterone system disorders was found to be the leading cause of hypertension in young population.

Comparison of urine dipstick test with conventional urine culture in diagnosis of urinary tract infection

OBJECTIVE

To determine the sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of Urine Nitrite (NIT) and Leukocyte Esterase (LE) test compared with urine culture for diagnosis of UTI.

STUDY DESIGN

Validation study.

PLACE AND DURATION OF STUDY

Department of Microbiology, Army Medical College, Rawalpindi, from January 2013 to December 2013.

METHODOLOGY

Three hundred fresh uncentrifuged urine samples with suspicion of UTI, were collected and tested for LE and NIT by using (COMBI-10SL, UK) strip. Nitrite was considered as positive if there was a change in color of dipstick from colorless towards pink within 60 seconds. Leukocyte esterase was considered as positive if there was a change in color from off-white towards purple within 2 minutes. Quantitative urine culture was performed by using the strips calibrated to deliver 0.02 ul of urine on Cystine Lactose Electrolyte Deficient (CLED) medium agar. All plates were incubated at 37°C and read after 24 and 48 hours. Culture was considered as gold standard to evaluate the performance of dipstick test.

RESULTS

Out of 300 samples, 136 were culture positive and 164 were culture negative. Out of 136 positive culture results, 103 were dipstick positive and 33 were negative. Sensitivity, specificity, positive predictive value and negative predictive value of both nitrite and leukocyte esterase were 75.74%, 68.90%, 66.66% and 77.40% respectively considering culture as gold standard.

CONCLUSION

Dipstick test for the detection of leukocyte esterase and nitrite in urine are sensitive and specific and can be used reliably for the detection of UTI in resource limited setup.

ICU Pathogens: A Continuous Challenge

OBJECTIVE

To determine the frequency and antibiogram of pathogens in an intensive care unit (ICU).

STUDY DESIGN

Cross-sectional, observational study.

PLACE AND DURATION OF STUDY

Department of Microbiology, Army Medical College, National University of Science and Technology, Islamabad, from January 2013 to January 2014.

METHODOLOGY

Clinical samples, received from patients admitted in ICU, were inoculated on various medias like blood agar, chocolate agar, MacConkey agar and urine samples on CLED. These were then incubated at 37°C for 24 hours. Isolates were identified by colony morphology, Gram reaction, catalase test, oxidase test. Species identification in case of Gram Negative Rods was done by using API 20E (BioMérieux). Antibiotic susceptibility was done by using modified KirbyBauer disc diffusion technique. Bacterial isolates were prepared and inoculated on Mueller-Hinton agar plates followed by application of various antibiotic disc (Oxoid, UK) as per manufacturer's instructions. The plates were then incubated at 37°C aerobically for 18 - 24 hours. Zone diameters were measured and interpreted as sensitive and resistant, according to Clinical and Laboratory Standards Institute (CLSI) guidelines.

RESULTS

Out of the 367 positive cultures, 116 (31.08%) were Acinetobacter baumanniisusceptible to minocycline and tigecycline followed by Klebsiella pneumoniae (n=71, 16%) susceptible to tigecycline and meropenem. Others were Pseudomonas aeruginosa, Escherichia coli,Coagulase Negative Staphylococcus, Staphylococcus aureus, Enterococcus spp., Streptococcus spp., Klebsiella oxytoca, Stenotrophomonas maltophilia,and Candida spp.

CONCLUSION

Acinetobacter baumanniiwas the most frequently isolated pathogen. Most of the cultures yielding pathogens were from respiratory tract samples. Gram negative isolates were multidrug resistant but most were tigecycline and susceptible to meropenem.

Methicillin resistant coagulase negative staphylococcus: From colonizer to a pathogen

The objective of our study was to determine the frequency of methicillin resistance in coagulase negative Staphylococcus (CoNS) and to determine its in-vitro antimicrobial susceptibility to various other routinely used antibiotics. It was a cross sectional study conducted at the department of Microbiology, Army Medical College, Rawalpindi, Pakistan from June 2011 to May 2012. The organisms were identified on the basis of colony morphology, Gram staining, catalase, DNAase and slide/tube coagulase tests. The organisms were considered to be methicillin resistant when the diameter of zone of inhibition was less than 25mm around 30μg cefoxitin disc. Antibiotic sensitivity was determined using the Modified Kirby-Bauer disc diffusion method. From a total of 337 CoNS, 201 were methicillin resistant and were included in the study. All were resistant to Penicillin, followed by Erythromycin (93•1%), Ciprofloxacin (77%), Co-trimoxazole (74•8%), Gentamicin (68•3%), Clindamycin (51•06%), Tetracycline (44•6%), Fusidic acid (40%), Rifampicin (39•5%), Chloramphenicol (19•3%), Linezolid (2%), Minocycline (1•1%), and Vancomycin (0%). More than half of CoNS were methicillin resistant. Vancomycin is the only drug to which all of the MRCoNS were sensitive, with more than 98% of the isolates being sensitive to Linezolid and Minocycline.

Evaluation of phenotypic tests for detection of Amp C beta-lactamases in clinical isolates from a tertiary care hospital of Rawalpindi, Pakistan

OBJECTIVE

To evaluate sensitivity and specificity of disc approximation test compared to three-dimensional extract test as a phenotypic gold standard test for detection of AmpC beta-lactamase producing Escherichia coli and Klebsiella pneumoniae.

METHODS

The cross-sectional validation study was conducted from November 2014 to April 2015 at Army Medical College, Rawalpindi, Pakistan. Extended spectrum beta lactamases (ESBLs) were isolated from various clinical specimens. Screening for AmpC beta-lactamases was done by using cefoxitin disc (30µg) showing inhibition zone diameter of <18mm. Screen-positive isolates were subjected to disc approximation test (DAT) and three-dimensional extract test(3-DET).SPSS 20 was used for statistical analysis.

RESULTS

A total of 120 ESBL producing Gram negative rods were included in the study. Out of these 120, 82(68.33%) were found to be AmpC beta-lactamase producing on screening with cefoxitin disc. Amongst these 82 isolates, Escherichia coli were identified in 57(69.51%) and Klebsiella pneumoniae in 25 (30.48%). Phenotypic confirmation by disc approximation test (DAT) identified 43(52.43%). AmpC beta-lactamase producing isolates, whereas gold standard 3-DET showed 38(46.34%) of AmpC beta-lactamase producing isolates. Hence, sensitivity of disc approximation test (DAT) was found to be 88%, specificity was 92%, positive predictive value was 92.68%, negative predictive value was 87.80% and diagnostic accuracy was 90.24%.

CONCLUSIONS

Implementation of disc approximation test in the laboratories can help in identifying AmpC beta-lactamase harbouring organisms.

In Vitro Efficacy of Doripenem against Pseudomonas aeruginosa and Acinetobacter baumannii by E-Test

OBJECTIVE

To assess the in vitro efficacy of doripenem against Pseudomonas aeruginosa and Acinetobacter baumannii using Epsilometer strips.

STUDY DESIGN

Cross-sectional study.

PLACE AND DURATION OF STUDY

Department of Microbiology, Army Medical College, Rawalpindi and National University of Sciences and Technology, Islamabad, from May 2014 to September 2014.

METHODOLOGY

A total of 60 isolates of Acinetobacter baumannii and Pseudomonas aeruginosa collected from various clinical samples received from Military Hospital were included in the study. The specimens were inoculated onto blood, MacConkey and chocolate agars. The isolates were identified using Gram staining, motility, catalase test, oxidase test and API 20NE (Biomeriux, France). Organisms identified as Acinetobacter baumannii and Pseudomonas aeruginosa were included in the study. Bacterial suspensions equivalent to 0.5 McFarland turbidity standard of the isolates were prepared and applied on Mueller Hinton agar. Epsilometer strip was placed in the center of the plate and incubated for 18-24 hours. Minimum Inhibitory Concentration (MIC) was taken to be the point where the epsilon intersected the E-strip. MIC of all the isolates was noted.

RESULTS

For Pseudomonas aeruginosa isolates, MIC(50) was 12 µg/mL and MIC(90) was 32 µg/mL. For Acinetobacter baumannii MIC(50) and MIC(90) was 32 µg/mL.

CONCLUSION

Doripenem is no more effective against Pseudomonas aeruginosa and Acinetobacter baumannii in our setting.

Comparative Efficacy of Ceftaroline with Linezolid against Staphylococcus aureus and Methicillin Resistant Staphylococcus aureus

OBJECTIVE

To compare the in vitro antimicrobial efficacy of ceftaroline with linezolid against Staphylococcus aureus and methicillin resistant Staphylococcus aureus.

STUDY DESIGN

Quasi-experimental study.

PLACE AND DURATION OF STUDY

Microbiology Department, Army Medical College, Rawalpindi, from January to December 2013.

METHODOLOGY

Clinical samples from respiratory tract, blood, pus and various catheter tips routinely received in the Department of Microbiology, Army Medical College, Rawalpindi were innoculated on blood and MacConkey agar. Staphylococcus aureus was identified by colony morphology, Gram reaction, catalase test and coagulase test. Methicillin resistant Staphylococcus aureus detection was done by modified Kirby Bauer disc diffusion method using cefoxitin disc (30 μg) and the isolates were considered methicillin resistant if the zone of inhibition around cefoxitin disc was ≤ 21 mm. Bacterial suspensions of 56 Staphylococcus aureus isolates and 50 MRSA isolates were prepared, which were standardized equal to 0.5 McFarland's turbidity standard and inoculated on Mueller-Hinton agar plates followed by application of ceftaroline and linezolid disc (Oxoid, UK), according to manufacturer's instructions. The plates were then incubated at 37 °C aerobically for 18 - 24 hours. Diameters of inhibition zone were measured and interpretated as per Clinical and Laboratory Standards Institute (CLSI) guidelines.

RESULTS

Out of 106 isolates all of the 56 Staphylococcus aureus (100%) were sensitive to ceftaroline and linezolid. However, out of 50 methicillin resistant Staphylococcus aureus, 48 (96%) were sensitive to ceftaroline whereas, 49 (98%) were sensitive to linezolid.

CONCLUSION

Ceftaroline is equally effective as linezolid against Staphylococcus aureus and methicillin resistant Staphylococcus aureus.

Coagulase negative staphylococci - a fast emerging threat

OBJECTIVE

To determine the frequency of isolation of coagulase-negative staphylococci and their resistance to methicillin over a period of time.

METHODS

The descriptive cross-sectional study was carried out at Army Medical College, Rawalpindi, from June 2009 to May 2012, and comprised clinical samples mostly from patients admitted to the intensive care unit. They were inoculated onto appropriate culture media depending upon the specimen. After 24-hour incubation at 35°C, coagulase-negative staphylococci were identified on the basis of colony morphology, gram staining, a positive catalase and a negative tube coagulase test.Methicillin resistance among the isolated staphylococci was determined using a 30µg Cefoxitin disc as per the Clinical and Laboratory Standards Institute protocol. Number of coagulase-negative staphylococci for each year and their methicillin resistance rates were calculated. A comparison was made with methicillin resistant staphylococcus aureus) isolated during the same period.

RESULTS

Of the total 1331 specimens studies over three years, 581(43.65%) were coagulase-negative staphylococci. The rate of coagulase-negative staphylococci and methicillin resistance was higher each year; 110(26.6%) in May 2009-Jun 2010, 134(36.5%) in 2011, and 337(61%) in 2012. Methicillin resistance rates also increased from 25(22.7%) to 46(34.3%) and then to 201(59.6%) in 2012.Maximum isolated specimens came from blood 311(53.5%), followed by pus/swabs 204(35.1%).

CONCLUSIONS

The frequency of isolation of coagulase-negative staphylococci and its methicillin resistance among hospitalised patients is on the rise.

Frequency and antibiogram of vancomycin resistant enterococcus in a tertiary care hospital

OBJECTIVE

To determine the frequency of Vancomycin Resistant Enterococcus (VRE) in a tertiary care hospital of Rawalpindi, Pakistan.

STUDY DESIGN

Observational, cross-sectional study.

PLACE AND DURATION OF STUDY

Department of Microbiology, Army Medical College, Rawalpindi, from May 2011 to May 2012.

METHODOLOGY

Vancomycin resistant Enterococcus isolated from the clinical specimens including blood, pus, double lumen tip, ascitic fluid, tracheal aspirate, non-directed bronchial lavage (NBL), cerebrospinal fluid (CSF), high vaginal swab (HVS) and catheter tips were cultured on blood agar and MacConkey agar, while the urine samples were grown on cystine lactose electrolyte deficient agar. Later the antimicrobial susceptibility testing of the isolates was carried out using the modified Kirby-Bauer disc diffusion method on Mueller Hinton agar.

RESULTS

A total of 190 enterococci were isolated. Of these, 22 (11.57%) were found to be resistant to vancomycin. The antimicrobial sensitivity pattern revealed maximum resistance against ampicillin (86.36%) followed by erythromycin (81.81%) and gentamicin (68.18%) while all the isolates were 100% susceptible to chloramphenicol and linezolid.

CONCLUSION

The frequency of VRE was 11.57% with the highest susceptibility to linezolid and chloramphenicol.

Role of appropriate surgery in survival of patients with epithelial ovarian cancer

OBJECTIVE

Management of epithelial ovarian cancer (EOC) patients is largely based on appropriate surgery. The principle treatment of early stage is competence of surgical staging surgery and surgical management of all patients with advance EOC is approach in a similar manner with cytoreduction surgery. We decided to evaluate the impact of appropriate surgery as a scale on 2 and 5-year survival in EOC patients.

METHODS

In a descriptive analytic study a total 186 patients were divided into 62 with early stage of EOC equivocal FIGO stage I and 124 with advanced disease at Vali-e-Asr Hospital affiliated with Tehran University of Medical Science, Iran, from 1998 to 2008. Two and 5-year disease free survival (DFS) and overall survival rates were determined and compared between the two groups using chi-squared test' Kaplan Meier and Cox regression.

RESULTS

Five-year DFS in patients with early stage of disease was 85% for the surgical staging group and 38% for non-surgical staging group (P = 0.037). Two-year DFS and overall survival did not differ between the groups. Also 5-year survival rates in subjects with surgical staging surgery were 42% and 40% for non staging group. For patients assigned to advanced disease group, 5-year DFS in subjects with cytoreductive surgery was 73% and the figure for the remainder was 58%. Five-year overall survival rate in cytoreductive surgery group was 43% in comparison to 38% in the second group.

CONCLUSION

Maximal effort for appropriate surgery appears to be a corner stone for optimal survival.

Nutritive value of human milk and nutritional status of wives of army personnel of low income from Rawalpindi

The nutritional status and proximate composition, fatty acid profile and mineral composition of milk from 26 wives of army personnel of low income group from Rawalpindi was investigated. The body mass index ranged from 13.5 to 23.7, hemoglobin from 8.6 to 14.8 G/dl, serum protein from 4.8 to 7.5 G and serum albumin from 3.3 to 4.8 G%. Milk protein content varied from 0.6 to 2.4%, fat from 1.0 to 3.7% [corrected]. Palmitic acid was the major fatty acid in milk whose concentration ranged from 34.4 to 47.1% [corrected] and the linoleic acid from 6.9-15.4% [corrected]. The calcium content of milk varied from 7.9-87.1 mg%, iron from traces to 0.44 mg% and zinc from 0.02-1.28 mg%.