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Objective: To determine the frequency and antimicrobial susceptibility pattern of pathogens responsible for superadded bacterial infection in COVID-19 patients and correlate the association of these infections with serological markers. Study Design: Cross-sectional study. Place and Duration of study: Department of Pathology, Combined Military Hospital, Multan Pakistan, from Jan to Dec 2021. Methodology: A total of 290 patients having positive RT-PCR for SARS CoV-2 were included. All samples were processed per Clinical Laboratory Standard Institute (CLSI) protocols. API 20E and API 20NE were used for the identification of Gramnegative rods. Antimicrobial susceptibility testing was performed by the modified Kirby Bauer disc diffusion method. Serological markers, including C-reactive protein (CRP), total leucocyte count (TLC) and serum Ferritin, were determined and compared for significance in positive and negative culture cases. Results: A total of 75 patients had positive bacterial cultures. Among these, 42(56%) were blood culture, 26(35 %) were respiratory culture and 7(9%) were urine culture. Commonly isolated organisms were Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus and Pseudomonas aeruginosa, i.e., 23(31%), 20(27%), 13(17%), and 12(16%) respectively. CRP, TLC and S. ferritin were markedly raised in superadded bacterial infection compared to patients with COVID-19 infection only. Conclusion: The frequency of superadded bacterial infections in COVID-19 patients is high. The pathogens isolated in these cases were multidrug-resistant, reflecting mostly hospital-acquired flora. The association of serological markers in depicting superadded infection is statistically significant and may be used to screen for superadded bacterial infection in COVID-19 patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of Colistin agar for detection of Colistin resistance in clinical isolates of Multi- Drug Resistant Gram-Negative Bacilli. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Feb to Aug 2019. Methodology: A total of 100 Multi-Drug Resistant Gram-Negative Bacilli in clinical isolates were included. Isolates were identified using Gram stain, Catalase, Oxidase, API 20E, and API 20NE. After approval from the institutional ethical review committee, Colistin susceptibility was determined simultaneously by Colistin agar and Broth Micro Dilution Minimum Inhibitory Concentration method as per CLSI. For susceptibility criteria, EUCAST guidelines were followed. Results were validated with the gold standard test, i.e., Broth Micro Dilution. Results: Out of 100 Multi-Drug Resistant clinical isolates, the distribution was K. pneumoniae n=60, E.coli n=16, A. baumannii n=11, C. freundii n=8, and E. cloacae n=5. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of Colistin agar for detection of Colistin resistance, keeping Broth Micro Dilution Minimum Inhibitory Concentration method as the gold standard was 96.67%, 97.14%, 93.55%, 98.55%, and 97%, respectively. Conclusion: Colistin agar has excellent diagnostic accuracy for the detection of colistin resistance with standardized inoculum density. Due to its ease of use, cost-effectiveness, and accurate results, it can be used in lab setups deficient in manpower and advanced equipment for Broth Micro Dilution or genetic sequencing. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of PANBIO COVID-19 rapid antigen method in nasopharyngeal swab, for screening of COVID-19 infection in emergency cases. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Microbiology, Combined Military Hospital, Multan, from Jan to Mar 2021. Methodology: After taking approval from institutional ethical review committee, total 1539 patients were included in this study according to sample size. With informed consent, nasopharyngeal swab specimens were taken for PANBIO COVID-19 rapid antigen method from each patient presenting as emergency medical/surgical case to Combined Military Hospital Multan as well as for Polymerase Chain Reaction for SARS CoV-2 RNA. PANBIO COVID-19 rapid antigen method and polymerase chain reaction for SARS CoV-2 RNA were performed simultaneously on swabs. Polymerase chain reaction for SARS CoV-2 RNA was considered to be the gold standard for comparison with the PANBIO COVID-19 rapid antigen method. Results: A total of 21 patients had SARS CoV-2 RNA detected by polymerase chain reaction indicating COVID-19 infection. Out of polymerase chain reaction positive patients, PANBIO™ COVID-19 Ag test was able to detect 19 cases. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy was calculated and found to be 90.47%, 100%, 100%, 99.8% and 99.8% respectively. Conclusion: PANBIO™ COVID-19 rapid antigen method was found to have excellent diagnostic accuracy in detection of COVID-19 infection. It can provide as a good alternate test for screening of masses with a short turnaround time of only 15 minutes. [ABSTRACT FROM AUTHOR]

Objective: to find out the predisposing factors for the cases of mocrobial keratitis in patients with red eye reporing to the Military Hospital. Study Design: Cross-sectional study. Place and Duration of Study: Ophthalmology deparment, Military Hospital Rawalpindi during 06 months from 1st Jun 2001 to 31st Dec 2001. Methodology: This was cross-sectional study which included consecutive cases of red eye. Cases referred from other military hospitals and field medical units were also included in the study. Inclusion Criteria was serving officers and their family members including parents, wife and children, retired JCOs/NCOs/Other ranks. Exclusion criteria was all cases of cataract surgery who had transient period of red eye were excluded from the study. Results: Out of 857 patients who reported with red eye during 06 months 32 cases fulfilled the criteria for microbial keratitis. The frequency of microbial keratitis in our population sample was found to be 3.7%. Out of 32 patients of microbial keratitis predisposing factors were found in most of the cases. These included history of accidental trauma in 14 patients (43.75%), bullous keratopathy in 3 patients (9.37%), corneal exposure in 3 (9.37%), contact lens wear in 2 (6.25%), dry eyes in 2 (6.75%), and corneal graft in one patient (3.13%). Two patients had history of excessive and prolonged use of topical steroids (6.25%). Conclusion: The frequency of microbial keratitis in our population sample was quite common. Patients coming with ophthalmic problems, i.e., red eye, photophobia, irritation and watering to the general practitioner should be referred as soon as possible to the ophthalmology department. [ABSTRACT FROM AUTHOR]

Objective: To determine the status of thyroid functions in patients of β Thalassemia Major, reporting to OPD of Military Hospital, Rawalpindi. Study Design: Descriptive cross sectional study. Place and Duration of Study: Paediatric Outpatients Department of Military Hospital, Rawalpindi from 1st Jan to 30th Jun 2012. Material and Methods: After taking informed consent from the parents of all the children fulfilling the inclusion criteria, detailed history was taken and blood samples were drawn by strict aseptic means. Samples taken from these patients included complete blood and thyroid profile (serum thyroxine T4, triiodothyronine T3 and thyroid stimulating hormone TSH). These blood samples were labeled and sent to Armed Forces Institute of Pathology (AFIP), Rawalpindi for analysis by enzyme-linked immunosorbent assay (ELISA). Primary hypothyroidism was defined by TSH levels >4IU/ml. Statistical analysis was done at the end of study using SPSS version 10. Significance for association was calculated using student t-test. Results: Sixty patients fulfilled the inclusion criteria out of these sixty four patients lost the follow up while 56 patients completed the study. Out of 56 patients, 21 (37.5%) had biochemical evidence of hypothyroidism. Mean Ferritin level was 3924 ± 1247ng/ml in hypothyroid and 3136 ± 1387ng/ml in euthyroid patients indicating a significant difference in mean serum ferritin levels between hypothyroid patients and others. Conclusion: The study demonstrates hypothyroidism in a significant number of hyper transfused β-thalassemic patients, emphasizing the importance of monitoring thyroid functions in thalassemic patients, particularly in those receiving suboptimal chelation. [ABSTRACT FROM AUTHOR]

Objective: To determine the immunization status of children between 1-3 years of age, reported at children OPD; Military Hospital, Rawalpindi. Study Design: Descriptive cross sectional study. Place and Duration of Study: Paediatric outpatients department of Military Hospital, Rawalpindi from January to June 2010. Material and Methods: Vaccination data of 2200 children of 1-3 years of age coming to outpatients department, regarding seven EPI target diseases was collected using a standard proforma. Statistical analysis was done at the end of study using SPSS version 14.0. Results: Out of 2200 children, 1256 (57.1%) were completely immunized, 740 (33.6%) were partially immunized and 204 (9.3%) were unimmunized. Conclusions: This study concludes that immunization indicators have not met the expected benchmarks and achievements are inadequate as compared to the regional and global immunization level. [ABSTRACT FROM AUTHOR]