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Aimen Fatima,1 Bushra Aslam,1 Maryam Zaid,1 Muska Khattak,1 Sidra Bashir,1 Safia Masood,1 Zara Rafaque,2 Javid Iqbal Dasti11Lab of Microbial Genomics and Epidemiology, Department of Microbiology, Quaid-I-Azam University, Islamabad, 45320, Pakistan; 2Department of Microbiology Hazara University Mansehra, Mansehra 21120, PakistanCorrespondence: Javid Iqbal Dasti, Lab of Microbial Genomics and Epidemiology, Department of Microbiology, Quaid-I-Azam University, Islamabad, 45320, Pakistan, Tel +92-5190644175, Email [email protected] Background:Pseudomonas aeruginosa is an opportunistic pathogen involved in number of hospital-acquired infections such as catheter-associated urinary tract infections, bacteremia, septicemia, skin infections, and ventilator-associated pneumoniae. Biofilm formation is an important trait implicated in chronic infections, such as cystic fibrosis and chronic pulmonary obstruction. We evaluated effects of gentamicin, cefepime, and ciprofloxacin on biofilm of P. aeruginosa.Materials and Methods: A total of 266 isolates were collected from the Armed Forces Institute of Pathology (AFIP). Antibiotic susceptibility was assessed by double disk synergy testing. ESBL and carbapenemase detection was performed by phenotypic testing. Molecular screening of the genes was done by PCR. Micro-dilution broth method was used to determine minimum inhibitory concentrations of antibiotics. Biofilm formation was done by micro-titer plate assay.Results: Overall, 20% of the P. aeruginosa isolates were extensively drug-resistant (XDR-PA), and 25% were multi-drug-resistant (MDR-PA). Likewise, 43% of the isolates were ESBL producers, and carbapenemase production was detected in 40% of the isolates. Molecular analysis confirmed occurrence of different resistant factors in ESBL-positive isolates; 67% carried blaTEM, 62% blaCTXM-15, 41% blaSHV, 34% blaCTXM-14, and 33% blaOXA-1. In addition, 68% of the carbapenem-resistant isolates were positive for blaNDM-1, 25% for blaOXA-48, and 22% for blaKPC-2. Biofilm formation was assessed for 234 isolates, out of which 28% were strong biofilm formers. Moderate and weak biofilm formers constituted 46% and 23%, respectively. Overall, ciprofloxacin, levofloxacin, and cefepime showed inhibitory effects on P. aeruginosa biofilms. Antibiotics in combination showed strong synergistic effects (ciprofloxacin and cefepime), while gentamicin and cefepime resulted in complete eradication of P. aeruginosa biofilm.Conclusion: We confirm strong synergistic effects of gentamicin and cefepime that completely eradicated P. aeruginosa biofilm. We further confirm inhibitory effects of ciprofloxacin, levofloxacin, and cefepime on P. aeruginosa biofilms. Hence, combination therapy can be more effective against biofilm-associated infections. [ABSTRACT FROM AUTHOR]

Sustainable maritime development needs coherent governance, particularly for the shipping sector, to ensure a stable maritime economy. However, maritime governance in Pakistan is considered inadequate and incoherent and thus poses a serious challenge to sustainability. The National Maritime Policy (NMP) was launched two decades ago, in 2002, to provide an overarching governance framework for long-term benefits, but it is now outdated. This study aimed at analyzing the extent to which the NMP of 2002 is coherent with provincial, national, and international obligations and addresses emerging requirements for the development of a sustainable shipping sector in Pakistan. An analytical framework based on three (03) guiding principles, seven (07) criteria, and twenty-eight (28) indicators was employed using a combination of qualitative and quantitative methods. Coherence across twenty-one (21) governing instruments was analyzed, scored (0–5), and rated on a ratio scale to represent the coherence index for each indicator. Thus, a matrix representing the coherence index score for each indicator individually and in pairwise comparison with the NMP was developed. An overall coherence index was calculated as 2.1, which shows poor coherence across governing instruments. This indicates that the NMP 2002 is unable to address emerging governance needs for sustainability issues such as climate response, pollution control, ballast water management, ecosystem conservation, social well-being, stakeholder engagement, and economic diversification, thus requiring revision to meet the challenges created by incoherent governing instruments at all levels and among segments of the maritime economy. [ABSTRACT FROM AUTHOR]

Objective: To compare efficacy of methyl prednisolone acetate injection with and without thumb spica cast for the treatment of de-Quervain tenosynovitis. Study Design: Randomized Controlled Trial. Setting: Orthopedic Unit, Allied Hospital, Faisalabad. Period: April 2016 to September 2016. Material & Methods: In each group 41 patients were included with non-probability consecutive sampling. Results: Eighty two patients were enrolled in the study. Out of 82 patients in the study, 3 (3.7%) were males and 79 (96.3%) were females. There were 10 (12.20%) pateints with age >40 years, and 36 (43.90%) patient in each of age group 21-30 and 31-40 years. The proportions of cured persons between two groups i.e., treated with corticosteroid injection and those treated with combination of injection and thumb Spica splint were found same with p-value 0.19 for Z=1.31. The efficacy was independent of treatment methods with Χ2=1.10 (p-value = 0.30). The same independence pattern was also observed in different age groups. Age range was between 18 and 70 years. Statistical analysis was performed using chi-square test. Six weeks following treatment, 29 (35.37%) patients from group A and 34 (41.46%) patients from group B showed relief of pain, swelling and tenderness and a negative Finkelstein test (p-value 0.295). post stratification of gender showed no significant association (p-value 0.388 and 0.328 in groups A and B respectively). Conclusion: It has been concluded that use of corticosteroid injection alone is sufficient to treat de-Quervain syndrome as compared to the use of thumb Spica splint with corticosteroid injection. It is therefore recommended that in patients suffering from de-Quervain syndrome, corticosteroid injection may be the choice of treatment. [ABSTRACT FROM AUTHOR]

Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal problems in newborns. It occurs in 1in 1000 live births affecting girls more than boys and more associated with breech presentation and positive family history. Objectives: To evaluate the effectiveness of arthrography in assessing the closed reduction of DDH. Study Design: Observational. Setting: This study was conducted at Allied Hospital, Faisalabad, Pakistan, Period: From December 2013 to January 2016 and comprised patients of either gender. Material & Methods: DDH was diagnosed with help of clinical examination and radiological investigations. Arthrography was performed and images were taken in different positions of the hip which were evaluated and findings noted. Results: Out of 50 hips, 34 had normal looking head of femur while 16 patients had head of femur which was either smaller than normal or of abnormal shape. Shape of acetabulum was found normal in 41 hips. Normal labrum was present in 44, inverted in 4 and everted in 2 patients. Ligamentum teres was found hypertrophic in 6 patients. Normal head coverage was present in 40 while in 10 hips head of femur was lateralized = 4 mm. No external obstruction to reduction was encountered. In 44 cases reduction was concentric and eccentric reduction was noted in 6 patients. Conclusion: Arthrography is of special help in assessing the reduction of hip in DDH as it provides information about shape of head of femur, shape of acetabulum, labrum, ligamentum teres, containment of the hip, coverage of head and external obstacles to reduction. [ABSTRACT FROM AUTHOR]

Objectives: Assessment of upstream levels of lipid peroxidation and DNA damage regulating the development of rheumatoid arthritis. Data Source: All the samples were collected from Jinnah Hospital Lahore. Study Design: Comparative cross sectional study. Period: Two years from 18-09-2014 to 24-10-2016. Setting: The Institute of Molecular Biology and Biotechnology (IMBB) in The University of Lahore-Pakistan. Material and Methods: Blood, saliva and synovial fluid of fifty (n=50) individuals diagnosed with Rheumatoid Arthritis and fifty (n=50) age-sex matched controls were added in current study. Levels of MDA were determined spectrophotometrically while the concentrations of isoprostanes, 8-OHdG and 4-HNE were measured by the help of commercially available Elisa Kit. Results: Levels of lipid peroxidation products including MDA (μmol/ml), isoprostanes (pg/ml), 4-HNE (μmol/ml) and DNA damage in the form of 8-OHdG (pg/ml) were significantly high (p<0.015, p<0.022, p<0.004 and p<0.036) in patients as relative to normal individuals. Levels of MDA in serum (1.95±0.094 vs. 0.95±0.019), saliva (0.012±0.0034 vs. 0.056±0.0056) and synovial fluid (3.26±0.65 vs. 0.019±0.0016) were differed significantly in each groups. Level of isoprostanes in serum (12.26±5.26 vs. 1.26±0.015), saliva (2.16±0.019 vs. 0.816±0.017) and synovial fluid (34.26±4.26 vs. 0.136±0.019) were recorded higher in RA patients as compared to control. Concentrations of 8-OHdG in serum (0.945±0.014 vs. 0.019±0.0035) saliva (0.0024±0.0003/ 0.0029±0.00017) and synovial fluid (1.33±0.451 vs. 0.055±0.0016) were recorded high in RA patients. Significantly higher concentration of 4-HNE in serum (4.265±1.25 vs. 1.99±0.016), saliva (1.26±0.15 vs. 0.191±0.0091) and synovial fluid (6.35±1.16 vs. 0.094±0.00165) were recorded in patients with RA. Conclusion: Present study concluded the role of oxidative biomarkers and their differential expression in the onset of autoimmunity in patients with RA. Increased stress is involved in the DNA damage and increased lipid peroxidation in the synovial fluid. Therefore, antioxidant therapy may have some prognostic role in the patients with RA by decreasing the intensity of oxidative stress and DNA damage. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the management of tibial diaphyseal fractures treated by POP cast versus intramedullary nailing in terms of time of union. Design of study: Randomized controlled trials. Setting: Department of Orthopaedic, Allied / DHQ Hospital, Faisalabad. Duration of Study: Six months (01-08-2013 to 31-01-2014). Materials and Methods: 80 patients fulfilling the inclusion and exclusion criteria were included in the study. After laboratory and radiological assessment, the patients in Group 1 were treated by long leg cast. The patients in Group 2 were treated with intramedullary interlocking nail. The patients were followed on OPD basis. Results: 80 patients divided into 2 groups. Each group had 40 patients. Mean age of patients was 30.99 ±8.092 years. There were total of 65% males and 35% females in this study. According to geometry of fractures simple transverse fractures were 47.5%, spiral fractures were 17.5%, oblique fractures were 25% and segmental fractures were 10%. There were 71.25% closed fracture and 28.75% type l open fractures. Mean time of union was 23.86 ± 5.48 weeks in group 1 while in group 2, mean time of union was 18.35 ± 4.12 weeks. P-value was 0.001 which is statistically significant. Conclusion: It is concluded that reamed intramedullary interlocking nailing is a good mode of internal fixation comparing with conservative management of close reduction and POP cast in both close and type I open fractures in terms of union. [ABSTRACT FROM AUTHOR]