Search

Byline: R. Ghazala, A. B. Tabinda, and A. Yasar - Email: yasar.abdullah@gmail.com ABSTRACT Sixty days feeding experiment was conducted on grass carp fry fed isocaloric diets with variable protein levels [...]

Background: Patients associated with VAP having mortality rates range from 20 to 50% and this may extend up to 70% when multi-resistant and invasive pathogens accountable for infection, however, VAP is also interrelated with noteworthy rate of morbidity, extended period of stay in ICU, protracted MV, and augmented hospitalization cost. Objectives: To review the risk factors, incidence and transience rate of mortality for ventilator-associated pneumonia. Design: Prospective and cross sectional way. Period: From April 2016 to December 2016. Setting: Different Tertiary Care Institutes of Karachi, Pakistan. Method: A structured data collection form was prepared to record the information and validated using spearman correlation coefficient and Cronbach's α value. Value of α = 0.902 and p = 0.913 have revealed the suitable degree of reliability and uniformity. Data was collected with respect to gender, age, antibiotic utilization record, and main diagnosis outcomes. Microbiological basis of ventilator-associated pneumonia was assessed using patient lab record for rate and seclusion of organism. Results: In this study a detail of significant virulence factor articulated by these microorganisms has been depicted. Statistically insignificant differences were observed among the groups with respect to clinical and demographic characteristics like mean age, gender, infection severity scores (SOFA, MODS, CPIS and APACHE II), immune status of patients and type of the cases including surgical or clinical scenario. 39.3% patients developed early onset while 60.6% of cohort was observed with late onset of VAP. Conclusion: The precise microbial source of VAP are numerous and diverse. The realistic challenge at the present time is to portray the authentic approximate of the clinical consequences associated with VAP. Henceforth such investigations may be supportive in origination of the most favorable institutional antimicrobial strategy to reduce the associated complications of this threat. [ABSTRACT FROM AUTHOR]

Irrational, over and misuse of antibiotics arise as global concern in both hospital and community settings and lead to adverse events including antimicrobial resistance, associated health problems, amplified hospitalization stay and cost. Hence, Drug Utilization Evaluation (DUE) studies are designed to evaluate and improve the prescribing, administration and the rational use of medications. The present study was designed to assess the pattern of antimicrobial drug utilization in in-patients cohort of tertiary care setup in Karachi, Pakistan. This cross sectional observational study was conducted in retrospective manner. World health organization (WHO) guidelines and criteria are considered to evaluate the appropriateness of drug use in various disease conditions. ATC/DDD system was applied to determine the study outcome. High frequency of antibiotics utilization found in respiratory tract infections of both lower (LRTI) 16.8% (n=42) and upper (UTI) 13.2% (n=33). The estimated total number of drug units administered per month was greater with cefixime (46) and ciprofloxacin (45) both. DDD/100 bed days drug utilization of antibiotics was higher with ciprofloxacin, cefexime and meropenem (47, 46 and 29.25) correspondingly. In conclusion, the current investigation signifies extensive scope for progress in prescribing trend. Drug adherence to customary guidelines of disease management and constraint policies to endorse judicious drug use may be considered vital in healthcare setup. [ABSTRACT FROM AUTHOR]

Drug-drug interactions (DDIs) are extremely significant concern, particularly in sensitive population including pediatric and geriatric. Propensity for the development of DDIs is high in patients admitted at intensive care units (ICU). This study was conducted to evaluate the DDIs incidence, facts and measures in ICU. From a total of 150 cases studied for ICU patients, with the mean age of 56.37±12.45 years, 55.33% were male and the rest were female 44.66%. The demographic information like age, gender and main diagnosis details of study participants that were extracted from the patients' clinical record. A statistically significant association between the drug interaction and the number of drugs prescribed per prescription was observed (p<0.0001). Concerning the onset of outcome, 52% of DDIs distinguished as delayed onset of effect (past 24 hours) and 35% were categorized as rapid onset (within 24 hours). Despite the facts regarding patient safety and minimizing DIs error, polypharmacy is still frequent in critically ill patients admitted in ICU attributed high risk of adverse reactions due to use of multiple interventions to treat severity of disease condition. Such studies may be used to develop an effective tool for the diagnosis and management of DDIs. [ABSTRACT FROM AUTHOR]

Among the well-known Health care-associated infections (HAIs), surgical site infections (SSIs) contribute to considerable high mortality and morbidity rate, substantial prolongation in hospitalization period and extra expenses in terms of treatment cost. This study was aimed to evaluate the predictive variables associated with surgical site infections, and their clinical consequences. This was a prospective, cross sectional study conducted in the surgical department of tertiary care setting in Karachi, Pakistan. Each patient was followed up from the time of admission until time of the discharge postoperatively for 30 days. A total of 554 surgical procedures were performed and 81 SSIs were identified. The predictor variable/risk factors significantly associated with the presence of SSI were age, gender, BMI, ASA score, co-morbid condition, surgical wound class, emergency surgeries, duration of surgery, type of anesthesia, prosthetic implant, pre operative length of stay and pre operative blood transfusion. Outcomes of such studies may be utilized in the design of a multi factorial practice to get better patient's safety and clinical outcomes. [ABSTRACT FROM AUTHOR]

Suitability of chicken intestine as an alternate protein source was evaluated for the diet of Cirrhinus mirigala fingerlings. Percentage protein, fat, ash, fiber, moisture and available energy (Kcal/100g) for the experimental diets were analyzed. Five experimental diets were formulated with chicken intestine meal 0% (FM[sub 100] Control), 25% (FM75), 50% (FM50), 75% (FM25) and 100% (FM0) substituting 0, 25, 50, 75, and 100% of the fish meal (FM) respectively. FM100 served as control diet. Experimental diets were iso-nitrogenous, iso-lipidic and iso-energic with 40% protein, 7.7-8.7% lipid and 425-446kcal energy per 100g diet. Sixtey days feeding trial experiment was performed in static indoor conditions. FM75 had almost similar growth as compared to control (FM100) in Cirrhinus mirigala fingerlings diets. Significantly higher growth was recorded in FM50 as compared to FM100 (control) and FM75. Present study showed overall significantly higher growth in FM25 (P<0.01) and FM0 (P<0.05) as compared to the control. Lowest feed conversion ratio was observed in higher growth dietary treatments and vice versa. The results of the present study concluded that although best growth was achieved in the dietary treatment FM25 but without compromising growth 100% chicken intestine could be substituted for fish meal without addition of amino acids in Cirrhinus mirigala fingerlings diet. [ABSTRACT FROM AUTHOR]

ABSTRACT Background. Intramedullary neurosarcoidosis may be the first manifestation of the disease and may mimic a tumor clinically and radiographically. Two patients who presented with cervical intramedullary lesions on magnetic resonance imaging (MRI) scans were found to have neurosarcoidosis. Clinical presentation. Two patients with negative past medical history presented with progressive myelopathic features, and intramedullary cervical lesions were detected on MRI scan; the diagnosis was made on biopsy of the lesions. Early therapeutic intervention led to a favorable outcome. Conclusion. Intramedullary neurosarcoidosis, especially in the cervical cord, can be the initial presentation of the disease, mimicking a tumor. MRI scan, biopsy, and, in fewer cases, angiotensin-converting enzyme levels can help with the diagnosis and may lead to a favorable outcome. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine if the interval between onset of symptoms to initial electrodiagnostic studies indicates disease progression in amyotrophic lateral sclerosis (ALS). Fifty consecutive patients referred to our neurophysiology laboratory with clinical evidence of ALS were divided into two groups by outcome scores on the ALS Functional Rating Scale (ALSFRS) using 26 as a cut-off. Our results, which showed a median of four months (range 2-24 months) duration to initial electrodiagnostics for Group I (ALSFRS scores below 26) versus 10 months (range 1-24 months) for Group II (p = 0.02), suggest this measure is a marker of disease progression in ALS. [ABSTRACT FROM AUTHOR]