Journal of Islamabad Medical & Dental College
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High and Low Level Mupirocin Resistance among Clinical Isolates of Methicillin Resistant Staphylococcus Aureus (MRSA)
Get PDFBackground: Staphylococcus aureus is a significant source of nosocomial infections, causing illnesses ranging from minor to life-threatening septic shock. Routine culturing and specific testing can confirm the presence of the bacteria. Antibiotic resistance is a major concern, and methicillin-resistant Staphylococcus aureus (MRSA) is particularly dangerous as it has mutations in the mecA gene, making it resistant to beta-lactam antibiotics. Mupirocin is an effective antibiotic against MRSA, binding to isoleucyl transfer-RNA synthetase to inhibit protein and RNA synthesis.
Objective: In this study, two different concentrations of mupirocin were tested against MRSA.
Material & Method: This study aimed to determine the antimicrobial susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) against two different doses of mupirocin. Clinical samples were collected in the duration of one year from different wards of Jinnah Hospital Lahore and processed in microbiology laboratory of Allama Iqbal medical college and after confirmation of Staphylococcus aureus, the modified Kirby Bauer method was used to test antimicrobial susceptibility. MRSA was confirmed by resistance to cefoxitin. High and low-level doses of mupirocin were applied, and zone sizes were measured.
Results: Total 172 isolated methicillin resistant Staphylocuccus aureus (MRSA) from all age and genders were tested against two doses of mupirocin. Both (mupriocin 5 µg and 200µg) were highly effective and MRSA were around 97% sensitive to mupirocin.
Conclusion: After the resistance of all beta lactam drugs, mupirocin can be very helpful in the treatment of MRSA infections.
Key Words:MRSA, Muprioci
Evaluation of the Occlusal Contact between the Opposing Teeth and the Cusp of Carabelli in Maxillary Permanent First Molars in Patients Visiting Peshawar Dental College
Get PDFBackground: The Cusp of Carabelli is a small additional cusp which is situated on the mesiopalatal surface of first maxillary molars. This nonfunctional cusp comes in many forms including furrows, ridges or pits and is collectively known as the Carabelli trait
Objective: To evaluate the frequency of the occlusal contacts between the accessory cusp of Carabelli and the opposing arch tooth among both genders in patients attending the out-patients department of Peshawar Dental Hospital, Peshawar
Methodology: This descriptive cross-sectional study was conducted on 300 subjects visiting the OPD of Peshawar Dental Hospital from October 2022 to December 2022. The sample size was calculated using WHO formula N=p(100-p)z2/d2 (Http://www.fao.orgThe age group selected for the participants was from 13-30 years. Consecutive sampling technique was used.). Articulating paper was used to assess the occlusal contacts caused by the cusp of Carabelli. The data were analyzed using SPSS version 20. Pearson’s chi square test was applied to analyze the data. P value of ≤ 0.05 was considered statistically significant.
Results: The results of the current study showed that 10.7% of the participants experienced occlusal contacts caused by the presence of their accessory cusp with the opposing arch tooth with no statistically significant difference between genders.
Conclusion: The cusp of Carabelli is the most prevailing variation found on the palatal aspect of mesiopalatal cusp of permanent maxillary first molars in a hospital-based inhabitants of Peshawar with rare occlusal contacts experienced by the patients.
Key words: Cusp of Carabelli, Maxillary permanent first molars, Occlusal contact
Multiple Inflammatory Fibroid Polyps in a Female; A case Report
Get PDFThe inflammatory fibroid polyp (IFP) usually presents as a solitary benign polyp that arises from the submucosa of the gastrointestinal tract. It occurs more commonly in males and stomach is the favored site followed by ileum, colon and duodenum. Multiple inflammatory fibroid polyps (IFPs) is a rare occurrence, so we thought of presenting a case of a 40 years old female with multiple inflammatory fibroid polyps (IFPs). She presented with abdominal pain and abdominal fullness. Her C.T. abdomen showed multiple lobulated soft tissue masses causing intussusception. Surgical resection was done, and histopathological examination of these polyps showed features of IFPs. A literature review of 9 cases (including ours) between 2000-2022 is also presented. To our knowledge this is the third female patient with multiple IFPs
Effect of Depression on Serum Levels of Follicular Stimulating Hormone and Luteinizing Hormone in Male Population of Military Hospital, Rawalpindi
Get PDFBackground: Depression is a psychiatric illness that affects the overall life quality of an individual. In depression along with other symptoms, one of the features affecting the personal life of individuals is loss of libido which is influenced by the hypothalamic-pituitary-testicular axis. This study was aimed to determine the serum levels of Follicular stimulating hormone (FSH) and Luteinizing hormone (LH) in depressed male patients.
Methodology: This comparative cross sectional study was done at Islamic International Medical College and Armed Forces Institute of Mental Health, Military Hospital Rawalpindi after being approved by ethical review committee. After informed consent, 96 male individuals having 18 – 60 years of age participated in the current study. Participants were segregated into groups A and B. Gender and age-matched healthy subjects in a quantity of 24 were taken in group A whereas group B consisted of 72 male depressed patients. Serum gonadotropins levels of both groups were compared by using an independent student t-test in SPSS 21.
Results: Serum FSH (2.66 ± 0.34 mIU/ml) and LH (2.67 ±0.18 mIU/ml) levels of Group A have shown no significant difference as compared to serum FSH (3.32 ± 0.43 mIU/ml) and LH (3.12 ± 0.19 mIU/ml) levels of Group B.
Conclusion: It is concluded from the study that serum FSH and LH levels were not significantly decreased in individuals with depression.
Keywords: Depression, Follicle stimulating hormone, Luteinizing hormone
 
Middle Ear Embryonal Rhabdomyosarcoma in a Five Years Old Child - A Rare Case Report
Get PDFRhabdomyosarcoma is the most common pediatric malignancy with a predilection for head and neck region. Embryonal Rhabdomyosarcoma is a variant of rhabdomyosarcoma which is extremely rare in middle ear. We present a case of middle year embryonal rhabdomyosarcoma in a five-year-old child who was treated as otitis media on first presentation and later misdiagnosed as a vascular aural polyp on histopathology
The Spectrum of Biochemical Changes in Thyroid Function Tests, Performed at Sahiwal Medical College, Sahiwal
Get PDFBackground: Thyroid disorders are among one the leading causes of endocrine problems worldwide. Hypothyroidism is very common and usually is more prevalent in females. Thyroid function tests (TFTs) play a vital role in the diagnosis and monitoring of thyroid diseases.
Methodology: This cross-sectional study was conducted at Sahiwal Medical College, Sahiwal after approval from the Institutional review board. The results of 2281 specimens tested for TFTs in the Pathology laboratory between August 2018 to December 2020 were included. Samples were analyzed by immunochemiluminescent assay method on an Access 2 analyzer by Beckman Coulter. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 25. A chi-square test was applied. P-value <0.05 was considered significant.
Results: A total of 2281 patient data was included in the study. The mean age of participants was 38.86±15.30 years and the majority were females. 64.1% of results were within the normal limit (euthyroid) while the remaining 35.9% had abnormal thyroid profiles. Hyperthyroidism was the most common abnormality (9.5%) followed by subclinical hypothyroidism (8.9%). Chi-square test revealed a statistically significant difference in age groups, with p-value of 0.004.
Conclusion: Thyroid diseases are quite common. Hyperthyroidism is slightly more prevalent than hypothyroidism in our community.
Key words: Hypothyroidism, Hyperthyroidism, Thyroid disorders, Subclinical thyroid disease
The Assessment of Self Care Practices amongst Diabetic Patients of Rawalpindi, Pakistan
Get PDFBackground: Diabetes Mellitus is a chronic disease and with rapidly increasing prevalence, it requires continuous diabetic care beyond just glycemic control. It needs continuous self-management and multi factorial risk reduction strategies. This study aims to assess the self-care practices of diabetic patients living in Rawalpindi and to determine the relationship of sociodemographic characteristics with their self-care practices.
Methodology: This cross-sectional study was conducted in two private diabetic clinics of Rawalpindi from February to July 2022. A validated structured questionnaire using Summary of Diabetes Self-Care Activities (SDSCA) scale was administered to assess self-care practices of the study participants. A total of 230 participants through convenience sampling aged 25 to 86 years were recruited in the survey. SPSS version 22 was used to carry out the statistical analysis.
Results: The current study comprised of 107(46.5%) males and 123 (53.5%) females with mean age of 54.85 ±12.41 years. Among them, 65.2% had adequate self-care practices. It was found that marital status (p=0.004), educational status (p=0.002), monthly income (p=0.001) and duration of diabetes (p=0.006) were significantly associated with self-care practices of the participants.
Conclusion: More than half of the participants had adequate self-care practices. Sociodemographic variables like marital status, education, monthly household income and duration of diabetes were significantly associated with the self-care practices of diabetic patients.
Key words: Diabetes Mellitus, Pakistan, Self-Care, Self- Management, Surve
Comparison of Wound Infection after Reversal of Loop Ileostomy in Linear versus Purse-String Skin Closure of Stoma Site
Get PDFIntroduction: Loop Ileostomy is a surgical procedure which is done to divert intestinal contents away from distal bowel to allow healing of the distal anastomosis and also for the relieve of obstruction in emergency situations. Reversal is done through local stoma site via linear closure technique as the standard procedure. Surgical site infection is the most commonly occurring & morbid complications of this technique and it can be reduced if closure is done by Purse string method. The aim of this study was to determine the more effective method of the two in terms of post-op surgical site infection.
Material & Methods: This Randomized Controlled Trial was conducted for six-month duration in Benazir Bhutto Hospital, Rawalpindi. Reversal patients presenting in outdoor-department were included and allocated randomly into either Purse-String closure group or linear skin closure group. Follow-up was done for thirty days and wound infection was identified by presence of purulent discharge from incision site. Organisms were isolated from fluid culture or tissue culture from the wound or abscess.
Results: We included a total of 90 patients in this study. 45 patients were randomly alloted to each group. The two groups were matched for various entry parameters. Wound infection was observed among 27(60%) in the linear closure group whereas 12(26.7%) in the purse-string group developed wound infection. This difference was statistically significant.
Conclusion: Given the low rate of associated wound infection, purse string closure of stoma reversal is recommended to be the preferred procedure for ileostomy reversal.
Key words: Loop Ileostomy, Linear closure, Purse string closure, Wound infectio
Genotyping of Platelet Alloantigens by DNA Sequencing in Pakistani Population
Get PDFIntroduction: Single-nucleotide polymorphism (SNP) in human platelet antigens (HPAs) glycoproteins leads to alloimmunizations and platelet disorders such as posttransfusion purpura, neonatal alloimmune thrombocytopenia, and refractoriness to platelet transfusion. To study the prevalence in a particular ethnic group, genomic DNA is used to genotype HPAs. Detection of these polymorphisms is imperative to identify the risk of alloimmunization and the provision of HPAs. Current study was planned to determine the frequency of HPAs in the Pakistani population of blood donors.
Methodology: Genomic DNA was extracted from blood samples of 300 randomly selected platelet donors from five major cities of Pakistan (Islamabad, Peshawar, Karachi, Quetta, and Mirpur). This study was approved by the ethical committee of Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan. Prior informed consent was taken from all the participants. Sequence-specific primers for platelets glycoprotein genes were designed using Primer 3 online software. The distinct targets were amplified through PCR. Amplified PCR products were eluted from the gel after electrophoresed, purified and sequenced. All the sequences and data obtained were analyzed through SPSS version 25.
Results: Genotyping of samples showed that among the subjected HPA systems, HPA-1, HPA-5, HPA-7w, HPA-19w, and HPA-21w systems were found to have both a and b alleles in the Pakistani population while only aa genotype was found in HPA-4, HPA-6w, HPA-8w, HPA-10w, HPA-11w, HPA-16w, and HPA-23w. The frequency of HPA-1a was 0.9333 and HPA-1b was 0.0666, HPA-5a was 0.8033 and HPA-5b was 0.1966, HPA-7wa was 0.98 and HPA-7wb was 0.02, HPA-19wa was 0.95 and HPA-19wb was 0.05 and HPA-21wa was 0.9866 and HPA-21wb was 0.0133. Among the analyzed HPAs, the mismatch probability was higher in HPA-5 while it was lower in HPA-21w.
Conclusion: HPA-4b, HPA-6b, HPA- 8b, HPA-10b, HPA-11b, HPA-16b and HPA-23b were absent. No homozygosity was found in the remaining genotyped HPAs. Our study suggests that it is necessary to establish HPA screening sites in blood banks to have HPA typed donor registry providing compatible therapeutic platelets to all unimmunized patients. Our data will be useful to understand and better treat the alloimmune-mediated platelet disorders.
Key words: Alloantigens, Genotyping, Sequencing, Platelets, Platelet alloantigen
Comparison of Fetal and Maternal Outcome in Active vs Conservative Management of Prelabor Premature Rupture Of Membranes (PPROM) at 34 to 37 Weeks of Gestation
Get PDFABSTRACT:
Background: The precise management of obstetrical crisis like preterm premature rupture of membrane is necessary to be designed for an optimum outcome. Both maternal and fetal morbidity and mortality rate can be decreased by accurate approach of clinical management as it is not still established yet. This study was designed to compare the maternal or fetal outcome in conservative management with active management of prelabor premature rupture of membranes at 34 – 37 weeks of gestation. STUDY DESIGN: Randomized control trial SUBJECTS & METHODS: The patient’s data was collected from the department of Gynecology and Obstetrics, F G Polyclinic Hospital and PIMS Islamabad from July 2019 to March 2020. Two groups were made and 90 cases were included in each group on the basis of active or conservative management accordingly. Fetal and maternal morbidity and mortality was judged on the basis of number of fetal distresses, chorioamnionitis and mode of delivery. RESULTS: 180 fetuses, a total of 140 survived. In group A, with conservative management, of the 17 (18.89%) mortalities, 9 (10%) developed fetal infections, 2 (2.22%) delivered prematurely, 3 (3.33%) had RDS. In group B, the active management was observed, 23 (25.55%) babies were expired, 5 (5.55%) contacted infections and died, 9 (10%) were diagnosed to have RDS, 6 (6.66%) deaths were due to prematurity with low birth weight. In conservative management group days of admission was significantly (p-value < 0.05) higher compared to active group. The duration of NICU stay was significantly (p-value < 0.05) higher in active management group (8.88% vs. 15.55%) as compared to conservative group (table 7). The rate of respiratory distress was also significantly (p-value < 0.05) in active management group (5.55% vs. 20%) as compared to conservative group. The mortality rate (25.5%) was bit higher in active management group as compare to (18.89%) in conservative management group but this difference was not statistically significant (p-value >0.05).
Conclusion: Conservative management of premature preterm rupture of membranes is more appropriate choice of management than active treatment if decided earlie