Journal of Islamabad Medical & Dental College
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Typhoid Fever: Pakistan's Unique Challenges and Pragmatic Solutions
Get PDFTyphoid fever is a life-threatening disease caused by gram-negative bacteria Salmonella enteric serotype Typhi. Every year, this disease affects almost 21 million people worldwide, the majority of whom are from South Asia. According to the WHO, almost 11 to 21 million cases of typhoid fever and about 200,000 deaths from typhoid fever occurred all over the world. Pakistan health authorities have confirmed that from 2016 to 2020, almost 22,354 cases of typhoid fever were reported, out of which 15,717 cases were extensive drug-resistant typhoid fever reported from the different regions of Sindh. These calculations are used to measure the disease rate of typhoid fever, ratio is about 15.5/1,000, and the XDR strain of typhoid fever is highly resistant to the antibiotic, also known as extensive drug resistance. The diagnosis of typhoid fever is done by culture tests, serological test, nucleic acid assays, protein markers, and biomarkers. The proper diagnosis is very important to ensure the strain of typhoid fever, so treatment should be started accordingly
Burkholderia cepacia: Understanding Pathogenicity, Virulence Factors, and Therapeutic Strategies
Get PDFBurkholderia cepacia, formerly described as Pseudomonas cepacia, belongs to the Burkholderia cepacia complex (Bcc), a collection of closely related gram-negative bacteria that is considered a leading organism in causing pulmonary infections in humans. In healthcare settings, Burkholderia species have the ability to colonise medical equipment and surfaces, posing a threat of nosocomial infections. Moreover, they exhibit inherently resistance to various classes of antibiotics, thus being nominated as multi-drug resistant pathogens (MDR), that is why treatment of infections caused by these organisms is challenging. Enzymes such as metalloproteases, serine proteases, metalloproteases, and other extracellular lipases play a major role in its pathogenesis. In addition to this, different components, such as pili, flagella, and lipopolysaccharide (LPS), have a role in both the motility of the bacterial cell as well as its adherence to host cells. Identification is usually done with different biochemical reactions such as late oxidase activity, oxidation of glucose, variable lysine decarboxylation, maltose, mannitol, and lactose, and hydrogen sulphide gas production. Advanced techniques like semi-nested PCR, real-time PCR, or MALDI-TOF mass spectrometry enable quick and precise identification.
Key words: Multi-drug resistant, Polymerase chain reaction, Burkholderia cepacia complex, matrix assisted laser desorption ionisation, time of flight mass spectrometr
Trends in serological markers of transfusion transmissible infections among blood donors in a tertiary care hospital
Get PDFAbstract
Objective: The study aimed to determine the prevalence and trends of transfusion transmitted infections (TTIs), among blood donors in a tertiary care hospital in Pakistan.
Study Design: Cross-sectional study.
Place and Duration of Study: This was a retrospective study conducted at the Department of Microbiology and Blood Bank section, Main Pathology Laboratory, Bacha Khan Medical Complex, Swabi, from 1st of January 2022 to 1st of Jan 2024.
Material and Methods: Sample collection and processing was carried out by drawing donor’s blood in two blood collection vacutainers. One containing the anticoagulant i.e. ethylene-diamine tetra-acetic acid (EDTA) which was used to analyze the blood grouping, and to confirm the status of the donor fit for donation of blood, whereas the other vacutainer without the anticoagulant was used for screening of the serological markers for HBV, HCV, HIV, Treponema pallidum by ELISA and for Plasmodium spp. by rapid immunochromatography.
Results: According to the results obtained in our study, regarding the burden of disease, from the total of 10,939 blood donors, 844 were found positive for at least one transfusion transmitted infection i.e. an overall positivity of TTIs was 7.71%. 99.95% of the donors screened during the study period were males with 35.09% of the donors in the age group 20 to 30 years. Regarding the prevalence of the diseases, maximum prevalence observed was that of Hepatitis C virus. i.e. 4.89 %.
Conclusion: The reported prevalence of TTIs substantiates that the risk of transfusion transmitted infections is considerably high. More studies need to be conducted on regular basis, as each study shows the effectiveness and the necessity of the continuation of strict screening protocols, along with spreading awareness in order to limit the risk of transmission of TTIs in Pakistan.
Key words: Blood donor screening, ELISA, HBV, HCV, HIV, Syphilis, Malaria, TTIs
GeneXpert Assay in Detection of Pulmonary Tuberculosis and Rifampicin Tuberculosis Resistant in Tehsil Hazro Population; A Cross Sectional Study
Get PDFObjective: To determine the prevalence of Tuberculosis and MDR Tuberculosis by GeneXpert assay in Tehsil Hazro District Attock.
Study design: cross sectional study
Place and duration of study: Study was carried out at THQ hospital Hazro of District Attock from January 2019 to December 2020
Patients and Methods: Total 1460 patients of TB suspect were included in the study. First LED microscopy of all TB suspects was done. LED Microscopy positive cases along with suspects having history of HIV, close contacts of MDR TB, all TB cases of retreatment and sputum-negative cases of LED microscopy having positive clinical findings were sent for GeneXpert Assay. Results from the GeneXpert assay were categorized as GeneXpert positive, GeneXpert negative, and MDR Tuberculosis. Determinants of MDR- TB were identified using questionnaires regarding MDR –TB.
Results: Out of total 205 patients on GeneXpert Assay, 43 patients were GeneXpert positive test with no rifampicin resistance, 3 patients were GeneXpert positive with rifampicin resistance and 63 patients were GeneXpert negative but sign and symptoms, X-ray findings and laboratory tests were supporting tuberculosis and according to opinion of TB specialist they were labeled as Sputum negative Tuberculosis. Tuberculosis prevalence in Tehsil Hazro was 0.073. From the results, it was concluded that an overall MDR rate was 2.7% in our study population.
Conclusion: GeneXpert Assay is a rapid technique and reliable for Mycobacterium detection. The main determinants of MDR-TB were the patients who had contact h/o with MDR cases and those who did not follow the treatment regime in their previous Tuberculosis treatment.
Keywords: GeneXpert Assay, LED microscopy, MDR Tuberculosis, Sputum positive TB, Sputum negative TB
An Extensive Infiltrative Diffuse Tenosynovial Giant Cell Tumor in Both Compartments of the Forearm: A Case Report
Get PDFDiffuse tenosynovial giant cell tumors are relatively rare but second most common tumor effecting the synovial containing tissues. The study aim was to present a case involving a 40-year-old male patient with a complaint of a progressively enlarging swelling on the radial side of right wrist. On local examination, there was a bi-lobed swelling 7×9 and 6×5 cm on the dorsolateral and anterolateral aspect of right wrist respectively. Through Hennery’s modified approach tumor was exposed. It was extending from dorsolateral to anteromedial wrist encasing the flexors, extensor and abductor tendons of thumb and radial neurovascular bundle and adjacent wrist and finger flexors. The tumor surrounding the tendons was carefully removed, and carpal tunnel release was performed to address the tingling sensation. The patient managed was having lobulated diffuse type tumor involving the both flexor and extensor compartment. Better outcome, less morbidity and least chance of recurrence can be expected if the tumor had been operated earlier
Distribution and Antibiotic Sensitivity of Burn Wound Colonization in Referred Patients at the Burn Care Centre, PIMS, Islamabad, Pakistan
Get PDFABSTRACT
Background: Burn injuries represent a significant health challenge worldwide due to their high mortality and disability rates. These wounds often become prone to infection due to compromised immunity and disrupted blood vessels at the injury site. Timely surgical excision, coupled with topical chemotherapy, has notably reduced mortality rates in burn patients.
Objective: The objective of this study was to determine the prevalence of common bacterial infections among referred patients, with a minimum delay of one week, and to assess their bacteriological susceptibility at the Burn Care Centre, PIMS, Islamabad.
Methods: This retrospective descriptive study was conducted between March 2021 and February 2023. We reviewed wound swab culture results spanning 24 months, primarily from referred patients. Wound specimens were collected using sterile swabs and standard techniques from registered patients, then analyzed at the microbiological laboratory based on patients' culture reports.
Results: A total of 226 culture reports were assessed, comprising 95 (42.04%) male patients and 131 (57.96%) female patients, with a mean age of 21 years (range: 11 months to 65 years). Among these reports, 16 (7.08%) showed no growth. Pseudomonas aeruginosa was identified in 88 patients (38.93%), while Staphylococcus aureus (MRSA) was present in 57 (25.22%), Klebsiella pneumoniae in 36 (15.93%), and a combination of Klebsiella and Pseudomonas in 18 (7.96%) cases, as per the swab culture reports. Escherichia coli was detected in 3 (1.33%) cases and Enterobacter in 2 (0.88%) cases. Other bacteria were found in 6 (2.65%) swab culture reports. Pseudomonas and Klebsiella exhibited maximum susceptibility to Polymyxin B, at 67.04% and 61.11%, respectively, while MRSA showed the highest susceptibility to linezolid, at 89.47%.
Conclusion: Pseudomonas aeruginosa, Staphylococcus aureus, and Klebsiella pneumoniae were the most prevalent bacteria among patients referred to our Burn Care Center. Referred burn patients were found to be colonized with multi-drug resistant bacteria, compared to inpatient cases at our center.
 
Association of Microalbuminuria with Glycemic Status Among Patients with Diabetes Mellitus
Get PDFObjectives: To evaluate the association between micro-albuminuria and glycemic status among type 2 diabetic patients in Hyderabad, Sindh.
Methods: Cross Sectional study was conducted at the Medical unit of Isra University, Hyderabad from January 2019 to June 2020. All the patients aged between 30 and 50 years, of either genders, with both good controlled as well as uncontrolled diabetes mellitus type II admitted in the medicine ward were included. All the participants were divided into two groups according to their glycemic level. The Group I comprised of patients with poor glycemic control that is HbA1c >7% while Group II comprises of patients with good glycemic control that is HbA1c<7%.
Results: Majority (56.4%) of participants in the study were Male while most (31.0%) them belongs to age group 41-45 years. The mean age of all patients was 42.3 ± 4.1 years. The mean HbA1c level in group 1(poorly controlled) and 2 (good control) participants was 8.04± 0.97% and 5.87 ± 0.44%. There was a statistically significant association (p<0.05) between poorly controlled glycemic status and micro-albuminuria.
Conclusion: Micro-albuminuria is significantly associated with the poor glycemic status among type 2 diabetic patients
Diagnostic Efficacy of SOFA Score in Predicting Outcome and Mortality: An ICU Experience from Pakistan
Get PDFObjective: To determine the cut-off value of Sequential Organ Failure Assessment score at the time of admission in Intensive Care Unit to predict mortality and outcome in critically ill patients.
Materials and Methods: This cross-sectional, descriptive study was undertaken at Intensive Care Unit of Rawalpindi Teaching Hospital, Rawalpindi, Pakistan between April and August 2023. SOFA score of all critically ill patients at the time of admission in ICU and their outcome (expired or discharged) was recorded. Receiver Operator Characteristics Curve (ROC) was drawn for SOFA score and mortality. Cut off value for SOFA score was calculated. Outcome of patients above and below the cut off value for SOFA score was studied using Chi-square test.
Results: A total of 100 patients (54% females and 46% males) were included in the study with mean patient age of 68.93±11.09 years. Out of 100 patients, 48 (48%) improved and 52 (52%) expired. The Mean initial SOFA score was 5.44±3.99 in patients who improved and 9.91±4.20 in patients who expired. Coordinates of the ROC curve showed that SOFA score cut off value 7.5 had best corresponding sensitivity (0.777) and specificity (0.740). The patients were categorized to Group I (SOFA score ≤7), and Group II (SOFA score ≥8). 34.04% of the Group I and 75.47% of the Group II patients expired (p-value 0.0000001)
Conclusions: Mortality was higher in patients who had higher SOFA score at the time of admission in Intensive Care Unit. At admission SOFA scores (≤7 and >8) are best predictor of outcome in critically ill patients
Primary Cutaneous Mucinous Carcinoma: A Case Report
No full textPrimary mucinous carcinoma of the skin is an uncommon malignancy of sweat gland origin. It is usually misdiagnosed clinically because of its benign appearance. On histological examination, it should be differentiated from metastatic mucinous carcinomas arising elsewhere in the body. We present a case of a 77-year-old male presenting with a swelling on the face, which was diagnosed clinically as a benign lesion, but on histological examination, it was diagnosed as mucinous carcinoma, and after thorough investigations, it was labelled as primary mucinous carcinoma of the skin
Effect of Probiotics on Plasma Glucose Level in Obese Patients on Risk of Gestational Diabetes Mellitus
Get PDFBackground: A range of physiologic, metabolic, and gut microbial changes occur during pregnancy. Pregnancy is linked to insulin resistance and hyperinsulinemia, which increase the risk of gestational diabetes. Probiotics are being extensively examined for their potential benefits in the treatment of a variety of disorders. Moreover, there is no local study connected before on the supplementation of probiotics in such cases to find the improvement in glycemic control level and prevention of gestational diabetes (GDM), so this study was planned.
Methods: This one-year randomised control trial was conducted at PIMS Islamabad, Department of Obstetrics and Gynaecology. After receiving informed permission, 126 patients were enrolled in the trial. In group A, patients were given a standard diet plan along with a probiotic sachet daily from 20 weeks of pregnancy until 26 weeks. In group B, patients were given a standard diet plan along with routine vitamins daily for the same period. Patients were followed-up in OPD up to 26 to 28 weeks, and OGTT was done, then GDM was labelled if OGTT deranged.
Results: At the 28th week, in the probiotic group, the mean fasting blood glucose was 78.84±18.42 mg/dl, and in the control group, it was 81.25±22.49 mg/dl (p-value = 0.515). At the 28th week in the probiotic group, the GDM was noted in 12 (19%) patients, and in the control group, it was in 22 (34.9%) patients (p-value = 0.045).
Conclusion: From this study, we may conclude that there is an effective role of probiotic supplementation in the prevention of GDM among high-risk obese pregnant women