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Objective: To determine important errors in initial Gram staining of clinical specimens and evaluate the types of Gram-stain errors. Study Design: Cross-sectional study. Place and Duration of Study: Microbiology Department, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Aug 2018 to Feb 2019. Methodology: Gram staining and culture inoculation of all specimens were performed per recommended guidelines. The Gram stain results on day-0 were compared with the results of the culture on day-2. There was no discrepancy if similar organisms were obtained on culture as on Gram stain. Nevertheless, if the Gram stain and culture results were not similar, it was termed a discrepancy. The consultant microbiologist reviewed all discrepant slides, and if not resolved, possible causes of error were sought, and the results documented. Results: Of the total 300 clinical specimens, errors were observed in the initial gram staining of 29 specimens (9.7%), whereas 271(90.3%) specimens were error-free. Upon evaluating these 29 errors, 11(38.0%) were observer errors which were resolved when reviewed by a consultant microbiologist. 14(48.0%) were technical errors, and 4(14.0%) results were discrepant due to the presence of anaerobic organisms, missed on initial aerobic cultures. Conclusion: The frequency of Gram stain errors in our study (9.7%) is not very high; nevertheless, it can have severe consequences in critical samples from seriously ill patients if wrong empirical antimicrobial treatment is begun based on a wrong initial Gram stain result.

Objective: To determine the molecular strain typing and drug resistance pattern of Salmonella enterica serovar Typhi prevalent in Northwest Pakistan. Methodology: A total of 2,138 blood samples of ...

Objective: To discover the frequency of vancomycin resistant enterococci (VRE) fecal colonization and subsequent bacteremia in patients with hematological diseases in a bone marrow transplant center. Study Design: Cross-sectional study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology (AFIP), in collaboration with Armed Forces Bone Marrow Transplant Center, Rawalpindi, from Jan 2016 to Dec 2019. Methodology: Stool specimens/anal swabs from all enrolled patients were collected aseptically and transported to the laboratory without delay. Blood cultures were collected aseptically from only those enrolled patients who developed signs and symptoms of bacteremia. Stool and blood cultures were processed as per standard microbiological protocols. Enterococci were identified to species level by colony morphology and biochemical tests. Modified Kirby Bauer disc diffusion method and VITEK-2 system (Version-8.01 bio Merieux, France) were used to perform antimicrobial sensitivity of each isolate. Results: A total number of 246 patients were studied. Among them, 67 (27%) patients had fecal colonization by vancomycin resistant enterococci. We report a statistically significant association of recent hospitalization, prolonged exposure to antimicrobial therapy, chemotherapy exposure and use of indwelling devices during the hospital stay with vancomycin resistant enterococci colonization. Vancomycin resistant enterococci bacteremia was detected in 57 (23%) patients. Among these 57 patients, 53 (93%) were vancomycin resistant enterococci colonizers. Vancomycin resistant enterococci colonization was significantly associated with vancomycin resistant enterococci bacteremia. Conclusion: A considerable burden of vancomycin resistant enterococci fecal colonization exists among patients with hematological diseases. vancomycin resistant enterococci colonization poses a considerable risk of vancomycin........

Objective: To evaluate the cytospin slide microscopy method for detection of acid fast bacilli (AFB) in bronchoalveolar lavage (BAL) fluid comparing it with concentrated smear microscopy. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from Dec 2016 to Sep 2018. Methodology: BAL specimens from suspected tuberculosis patients who were sputum smear negative, submitted to AFIP for diagnosis were included in the study. Smears for microscopy were prepared with the modified cytospin method as well as the standard concentrated technique. The prepared smears from both methods were stained with Ziehl–Neelsen (ZN) staining method and examined under 100 × oil immersion lens. TB culture performed on BACTEC MGIT 960 automated culture system (Becton Dickinson, USA) was taken as gold standard for TB diagnosis. The two methods were compared in terms of sensitivity, specificity, positive predictive value and negative predictive value. Results: Out of the 130 samples tested, 62 (47.7%) were positive on culture using MGIT 960 system. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the modified cytospin method for pulmonary TB diagnosis was found to be 68.3%, 100%, 100%, 77% and 84.6%, respectively. Conclusion: The sensitivity of the modified cytopsin smear method was significantly higher than that of the concentrated method. The study concludes that this is a simpler and more accurate method for BAL fluid microscopy.

Objective: To determine the diagnostic accuracy of in-house biochemical testing for identification of enterococcus species isolated from various clinical specimens against gold standard i.e., automated Vitek 2 system. This study also includes the antimicrobial susceptibility testing of enterococci against various antimicrobials. Study Design: Cross-sectional comparative study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi,from Apr 2017 to Mar 2018. Methodology: A total of 218 isolates from various clinical specimens suspected to be Enterococcus spp. werechecked by in-house biochemical testing including bile esculin, 6.5% NaCl and 1% arabinose and results werecompared with Vitek 2 compact system. The frequencies were determined by both systems and antimicrobial susceptibility testing was performed by disk diffusion as per clinical and laboratory standards institute guidelines. Results: Comparing the results of in-house testing with gold standard i.e., Vitek 2 system, the statistical data was calculated. Sensitivity turned out to be 100%, Specificity was found to be 68.75%. Positive and negative predictive values were 97.58% and 100% respectively. Accuracy turned out to be 97.71%. Conclusion: The in-house biochemical testing can be quite a useful method for identification of enterococci inresource-limited settings. However, it requires overight incubation and cannot identify other enterococcal species and non-enterococcal species. Vitek 2 is an automated system that is easy-to-handle, provides a rapid and reasonably accurate identification of enterococci alongwith accurate AST results. Enterococcal isolates from various clinical specimens in our setup showed least resistance to linezolid, followed by teicoplanin and vancomycin. Nitrofurantoin and.............

Automatic information extraction from online published scientific documents is useful in various applications such as tagging, web indexing and search engine optimization. As a result, automatic information extraction has become among the hottest areas of research in text mining. Although various information extraction techniques have been proposed in the literature, their efficiency demands domain specific documents with static and well-defined format. Furthermore, their accuracy is challenged with a slight modification in the format. To overcome these issues, a novel ontological framework for information extraction (OFIE) using fuzzy rule-base (FRB) and word sense disambiguation (WSD) is proposed. The proposed approach is validated with a significantly wider document domains sourced from well-known publishing services such as IEEE, ACM, Elsevier, and Springer. We have also compared the proposed information extraction approach against state-of-the-art techniques. The results of the experiment show that the proposed approach is less sensitive to changes in the document format and has a significantly better average accuracy of 89.14% and F-score as 89%.

Objective: To evaluate the epidemiology of clostridioides difficile infections and colonisation in a tertiary-care setting. Method: The cross-sectional study was conducted at the Combined Military Hospital, Rawalpindi, Pakistan, from June 1, 2017, to October 31, 2019, and comprised adult patients admitted in high-risk units of the hospital for any disease experiencing watery stools after 48 hours of hospital admission and passing more than 3 stools per day with no other recognised aetiology. Stool samples of the participants, diagnosed with antibiotic associated diarrhoea, were submitted forglutamate dehydrogenase antigen assay and clostridioides toxin A/B assay detected by enzyme-linked immunosorbent assay and clostridioides difficile toxin gene detection by polymerase chain reaction. Clostridium difficile-associated diarrhoea was diagnosed by a positive toxin assay or polymerase chain reaction. Data was analysed using SPSS25. Results: Of the 715 subjects, 322(45%) were males and 393(55%) were females. The overall mean age was 56.64±8.57 years, and 488(68.3%) were aged 60 years. The incidence of clostridioides difficile-associated diarrhoea was found in 10(1.4%) patients and was highest in oncology unit 3(4.3%). No positive case was detected from the high dependency unit and the surgical ward. All the10(1.4%) positive cases were on >2 antibiotics with a combination of oral vancomycin and intravenous metronidazole. Mortality rate was significantly higher in the positive cases compared to those with clostridioides difficile colonisation (p

Objective: To evaluate Gene Xpert MTB/RIF and Multiplex PCRfor detection of Mycobacterium tuberculosis and Rifampicin resistance comparing with gold standard MGIT 960. It was cross sectional validation study. Methods: This study had been carried out at Department of Microbiology Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan from March 2018 to October 2018.MGIT 960 culture system MTB positive Rifampicin (RIF) resistant and RIF susceptible (negative control) samples were taken. Gene Xpert MTB / RIF assay and Multiplex PCR were applied simultaneously and compared with gold standard MGIT 960. Results: Out of 192 samples evaluated, 84(44%) were culture positive RIF resistant and 108(56%) were culture positive RIF susceptible as negative control. Out of total culture positive RIF resistant, all 84 were found positive for MTB by Gene Xpert MTB /RIF assay and Multiplex PCR method. Gene Xpert MTB/RIF assay detected all 84 RIF culture resistant samples for Rif resistance. Multiplex PCR detected only 44 RIF culture resistant, while remaining 40 did not showed resistance to rpoB gene codon 531 region. Sensitivity, Specificity, PPV and NPV of Gene Xpert MTB/RIF were 100% each respectively. Sensitivity, Specificity, PPV and NPV of Multiplex PCR for detection of RIF resistance were 52%, 100%, 100%, 72% respectively. Conclusion: Molecular detection of MTB and RIF resistant by Gene Xpert MTB/ RIF and Multiplex PCR simultaneously is rapid and cost effective method. Both methods can help clinician to initiate early empirical therapy to patient in resource limited region. Keywords: RIF, Gene Xpert MTB/ RIF, Multiplex PCR.

Polymyxins play a significant role against carbapenem-resistant Enterobacteriaceae (CRE). A total of 121 clinical samples yielded growth of CRE that were included in the study. Rapid Polymyxin NP test was performed on all the isolates as described by Nordmann P et al. and results were compared with broth microdilution method. Majority of the isolates were Klebsiella pneumoniae (70.2%) followed by Escherichia coli (17.4%). A total of 71 isolates were found resistant and 50 as susceptible by broth microdilution. Sensitivity and specificity of rapid polymyxin NP test were found to be 97.2% and 100%, respectively. Our study concluded that rapid polymyxin NP test is reliable and can be used as an alternative to broth microdilution in resource limited settings.

Solid waste management and soil degradation are the two main issues faced by the developing countries. The present study is the first effort to use bio-municipal solid waste (MSW) for the ameliorat...

Acinetobacter baumannii has emerged as one of the leading causes of multidrug resistant nosocomial infections worldwide. It is able to survive in hospital environment and build up diverse resistance mechanisms making it difficult to treat with current antibiotics. Objective: It was to determine the frequency and patterns of Acinetobacter baumannii in intensive care units (ICU) settings.A cross sectional study was carried out in the Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from 1st July 2017 to 30th June 2019. A total of 603 non-duplicate clinical specimens were received from intensive care units. Specimens yielding growth of multidrug resistant Acinetobacter baumannii, were evaluated as per standard protocol. The antimicrobial sensitivity testing was performed as per Clinical and Laboratory Standard Institute guidelines (2017-2018).Among Acinetobacter baumannii (310 isolates), 5% were multidrug resistant, 93% extensively drug resistant and 1% pan drug resistant. Percentage of carbapenem resistant strains was 92%. In drugs like tigecycline and polymyxin, resistance was noted as 73% and 1% respectively. High yield of this superbug was mainly obtained from respiratory specimens (43.5%), whereas 24% were detected from wound infections and 29% from other samples. .This study showed a rapidly increasing resistance in Acinetobacter baumannii. Therefore, polymyxin remains the only option in our intensive care units, but its usage as empirical therapy in our setting has led to the emergence of resistance to this drug. Implementing infection control practices, antimicrobial stewardship and restricted use of polymyxin can play a significant role in reducing health care burden.

Alkene is an attractive substrate for chemists due to its easy availability and reactivity towards large number of reactants affording diverse range of organic compounds. It reacts under ionic and free radical mechanisms including single electron transfer (SET). In this review, strategies used for C–C and C-heteroatom functionalization of alkene has been discussed with emphasis on the regio, stereoselectivity, mechanistic detail and sustainability aspects. These strategies mainly follow the free radical mechanism, and the highly reactive carbon radicals show uncontrollable regio- and stereoselectivities. Thus these strategies still need to be focused; especially in the asymmetric versions. The regio- and stereoselectivities of functionalization of alkenes have been highlighted and debated. In addition, the hazardous reagents such as Cl2, Br2 I2, CO, peroxides, and benzene have also been discussed with the emphasis on their impact on the environment. Their plausible green alternatives have also been suggested, such as MX as halogen replacement; CO surrogates (formaldehyde etc.); sustainable aromatic solvents as benzene replacement. The non-green strategies relying on pre-formed silyl hydride and their green alternative strategies such as transfer hydrogenations have also been indicated. The applications of the functionalization of alkenes for the total synthesis of bioactive compounds have also been discussed in detail. In addition, future perspectives are also highlighted for further developments in the functionalization of alkenes.

Objective To evaluate performance of thin layer agar (TLA) 7H11 method for detection of ofloxacin (OFX) and kanamycin (KM) resistance in smear positive clinical specimens of patients with tuberculosis comparing the results with gold standard MGIT 960 system. Study design Cross-sectional validation study. Place and duration of study Department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from April to September 2017. Methodology Acid fast bacilli (AFB) smear positive specimens submitted at the study place, were inoculated on TLA 7H11 agar. Growth was examined along with susceptibility of OFX and KM and compared with gold standard MGIT 960 system. Results One hundred and sixty specimens were evaluated. Sensitivity and specificity of TLA for OFX was found to be 100% and 99.3%, respectively; and PPV and NPV was found to be 90.9% and 100%, respectively. Overall diagnostic accuracy was 99.38%. Sensitivity and specificity of TLA for KM was found to be 80% and 100%, respectively. PPV and NPV was found to be 100% and 99.36%, respectively. Overall diagnostic accuracy was 99.38%. Conclusion Thin layer agar is reliable, easy to perform and cost effective technique not only for rapid detection of MTB but also for drug susceptibility (DST) of second line anti TB agents. It is a suitable alternative to culture on LJ medium and can also be alternative to MGIT 960 system in resource-poor settings.

Quinoline derivatives have interesting biological profile. In continuation for the comprehensive evaluations of substituted quinoline derivatives against human nucleoside triphosphate diphosphohydrolases (h-NTPDases) a series of substituted quinoline derivatives (2a-g, 3a-f, 4, 5a-c, 6) was synthesized. The inhibitory activities of the synthesized compounds were evaluated against four isoenzymes of human nucleoside triphosphate diphosphohydrolases (h-NTPDases). These quinoline derivatives had IC50 (µM) values in the range of 0.20–1.75, 0.77–2.20, 0.36–5.50 and 0.90–1.82 for NTPDase1, NTPDase2, NTPDase3 and NTPDase8, respectively. The derivative 3f was the most active compound against NTPDase1 (IC50, 0.20 ± 0.02 µM) that also possessed selectivity towards NTPDase1. Similarly, derivative 3b (IC50, 0.77 ± 0.06), 2h (IC50, 0.36 ± 0.01) and 2c (IC50, 0.90 ± 0.08) displayed excellent activity corresponding to NTPDase2, NTPDase3 and NTPdase8. The compound 5c emerged as a selective inhibitor of NTPDase8. The most active compounds were then investigated to determine their mode of inhibition and finally binding interactions of the active compounds were analyzed through molecular docking studies. The obtained results strongly support the quinoline scaffold’s potential as potent and selective NTPDase inhibitor.

Objective To evaluate a direct antibiotic susceptibility testing method for blood culture.. Methods The cross-sectional comparative study was conducted at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from December 2016 to October 2017. Direct antimicrobial susceptibility testing was performed from positive blood culture bottles. Bacterial identification was done by using API 10S. Different antimicrobial panels were employed for Gram-negative rods (GNRs), gram-positive cocci (like suspected Staphylococci and Enterococci). Results were compared with conventional disk diffusion testing and very major, major and minor errors were calculated. Result agreement and kappa coefficient scores were generated for categorical agreement. SPSS 24 was used for data analysis. Results Of the 101 bacterial isolates, 82(81.2%) were Gram negative rods and 19(18.8%) were Grampositive cocci. Among 781 bacteria-antibiotic comparisons, the number of very major errors was 3(0.4%), major errors were 7(0.9%) and minor errors were 12(1.5%), while, 759(97.2%) comparisons yielded the same results. The kappa coefficient was 0.946, showing almost perfect agreement. Direct identification of Gram negative rods was successful in 53(64.6%) cases. Conclusions Direct susceptibility testing of blood culture produced reliable results for majority of the antimicrobials.

Introduction:Tuberculosis is an infectious disease with a high prevalence of about 9 million cases occurring annually. Ziehl Neelsen microscopy is the most widely used technique to detect Acid Fast Bacilli, but it is less sensitive. However, fluorescent microscopy is more helpful with simple diagnostic criteria. Gene Xpert®MTB/RIF assay is a rapid molecular assay that enables diagnosis of Tuberculosis with simultaneous detection of rifampicin resistance. Owing to this fact, we aimed at evaluating the diagnostic accuracy of Ziehl Neelsen microscopy, fluorescent microscopy and Xpert MTB/RIF keeping MTB culture (Mycobacterial Growth Indicator Tube) as a gold standard for the diagnosis of tuberculosis.Methodology:This study was carried out at a tertiary care hospital of Rawalpindi in the year 2016. Patients aged 18 to 70 years irrespective of gender with suspected TB based on history, clinical and radiological examination were included in the study. Respiratory clinical specimens including sputum, Broncho-Alveolar Lavage (BAL), and endobronchial washings were collected. Specimens were processed by MGIT (MTB culture), ZN microscopy, fluorescent microscopy and Gene Xpert MTB/RIF assay.Results:A total of 352 respiratory specimens were tested among which 160 (45%) samples were positive by culture. Out of culture positive samples, 158 samples (98.7%) were GeneXpert TB positive while 2 were negative. While only 49 (30.6%) were positive on ZN microscopy and 89 (55%) were positive on fluorescent microscopy. Out of the culture negative samples, 2 were positive with ZN microscopy, one was positive with fluorescent microscopy and 3 were positive on Gene Xpert. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and diagnostic accuracy of ZN Smear microscopy was 39%, 99.5%, 96%, 63% and 14.5% respectively. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of fluorescent smear microscopy was 55% and 99.5%, 98%, 72% and 79% respectively. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of Gene XPERT was 98% and 99%, 98%, 99% and 98% respectively.Conclusion:In countries like Pakistan where Tuberculosis is endemic, the diagnostic accuracy with highest sensitivity and specificity was Gene Xpert Polymerase Chain Reaction (PCR) MTB/RIF assay which can help in well-timed diagnosis of the disease.

In this study, solar light responsive Bi3+ and Fe2+ doped ZnO were synthesized and used for photocatalytic degradation of norfloxacin (NOR), an emerging water pollutant. Analysis with Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), field emission scanning electron microscopy (FESEM), transmission electron microscopy (TEM), high-resolution transmission electron microscopy (HRTEM), selected area electron diffraction (SAED), and UV–vis diffuse reflectance spectroscopy (DRS) confirmed coupling of dopants (i.e., Bi3+ and Fe2+) or co-dopants (Bi3+/Fe2+) with ZnO and suggested small narrow size as well as highly crystalline and porous nature of the doped ZnO. Metal ions doping lowered band gap energy and inhibited recombination of electron-hole pair in the as-synthesized ZnO. Consequently, BiFe-ZnO showed enhanced photocatalytic activity and reusability, giving 80% removal of NOR as compared to 36% by un-doped ZnO at a reaction time of 120 min. The analysis with photoluminescence (PL) technique verified high yield of OH from solar light activation of BiFe-ZnO compared to Bi-ZnO, Fe-ZnO and ZnO. Performance of the as-prepared photocatalysts was promoted with the added HSO5− and increased with increasing [HSO5−]0. Degradation of NOR by BiFe-ZnO with the added HSO5− was due to OH and SO4 − and NOR showed high reactivity with OH and SO4 −. The removal efficiency of NOR was inhibited using OH and SO4 − scavengers. Photocatalytic activity of the as-synthesized photocatalysts with the added HSO5− was highly dependent on [NOR]0, [pH]0, co-existing ions, and natural organic matter. Degradation pathways were suggested from the pattern of NOR degradation and identified transformation products. The mineralization of NOR as well as formation of non-toxic end product suggests co-doped ZnO with added HSO5− to be a potential technology for treating antibiotics contaminated water.

Purpose- The present study was an attempt to enhance the understanding on the competitiveness of business schools (Bschools) and identify the most influential determinants that affect competitiveness of Bschools in Khyber Pakhtunkhwa from faculty’s perspective. Methodology- The current study followed the quantitative approach. The sample size was 261 determined by formula of Yamane (1967) and respondents were selected using stratified probability sampling technique. Data was collected through questionnaire using 5-point Likert scale. Principal Component Analysis was applied to assess unifactoriality of the constructs. Hypothesis of study assuming relationship between independent and dependent variables were tested using SEM. Findings- Findings of the study suggests that Teaching staff, Employment prospects, Gender diversity, Leadership and management significantly and positively affect the Competitiveness of Bschools (P< 0.05). On other hand, Industry and Internationalization aspects were found to have significant negative effect on competitiveness of Bschools (P

Ciprofloxacin (CIP) is a widespread emerging water pollutant and thus its removal from aquatic environment is vital. The use of Fe3+/H2O2 and Fe2+/H2O2 resulted in 38 and 64% removal of CIP (8.0 ppm), respectively, within 80 min reaction time (pH 5.8, [H2O2]0 = 80 ppm, and [iron]0 = 20 ppm). Low pH, high temperature, high dose of H2O2 and Fe2+, and low CIP concentration facilitated removal of CIP. The radical scavenger studies proved in situ generated OH to be involved primarily in the removal of CIP. The effect of temperature was used to estimate enthalpy and activation energies of the removal of CIP. At 800 min reaction time, the Fe2+/H2O2 resulted in 54% mineralization of CIP using 16.0 ppm [CIP]0, 320.0 ppm [H2O2]0, and 40.0 ppm [Fe2+]0. The potential degradation pathways of CIP established from the degradation of CIP by OH and products evolved was found to be initiated at C6 through the loss of fluoride ion. The acute and chronic toxicities of CIP and its degradation products were estimated with the final product found to be non-toxic. The results suggest that Fe2+/H2O2-mediated AOPs have high potential for degradation as well as toxicity elimination of CIP and its degradation products.

Objective To evaluate the performance of nitrate reductase assay on smear positive pulmonary specimens for detection of multi and extensively drug resistant tuberculosis simultaneously. Study design Cross-sectional analytical study. Place and duration of study Microbiology Department, Armed Forces Institute of Pathology, Rawalpindi from June to December 2016. Methodology Smear positive pulmonary samples were processed both by nitrate reductase method on Lowenstein Jenson medium and also inoculated on gold standard Bactec MGIT 960 TB system. All the specimens were first digested and decontaminated according to standard protocol before inoculation. Results Out of total 76 samples, three did not give color and, therefore, were excluded from the final data analysis. Among the remaining 73 samples, mycobacterial index was: 28 specimens were having 1+ (1-9 bacilli/100 fields), 26 samples were 2+ (1-9 bacilli/ field), and 19 samples were having 3+ index (>9 bacilli/field). The respective sensitivity and specificity were 84% and 100% for isoniazid (INH); 82% and 100% for rifampin (RIF); 67% and 100% for amikacin (AK); and both 100% for ofloxacin (OFX). Overall agreement in case of INH, RIF, AK, and OFX was 94.5%, 97.2%, 98.6% and100%, respectively. Overall average agreement was 97.5%. Conclusion Nitrate reductase assay is a reliable, low cost and accurate method that can be used for early for diagnosis of multi and extensively drug resistant tuberculosis.

Background We sought to determine the incidence of bacterial biofilm-based catheter-associated urinary tract infections, identify variables affecting biofilm formation, and identify etiologic bacterial pathogens and antibiotic-resistance patterns associated with biofilm-based catheter-associated urinary tract infections (CAUTIs) in our setup. Methods Patients who developed at least 2 symptoms of urinary tract infection after at least 2 days of indwelling urinary catheters were included. Urine was collected aseptically from catheter tubing and processed per standard microbiologic practices. Bacterial pathogens were identified on the basis of gram staining, colony morphology, and biochemical reactions. The detection of the biofilm was done using the tube adherence method. Drug susceptibility testing was done using the Kirby-Bauer disc diffusion method. Findings Biofilm was detected in 73.4% isolates, whereas 26.6% of isolates were nonbiofilm producers. Mean duration of catheterization after which biofilm was detected was 5.01 ± 1.31 days. A latex catheter was used in 69.5% of patients, whereas a silicone catheter was used in 30.4% of patients. Escherichia coli was found to be the most common pathogen isolated (52.3%), whereas Enterobacter cloacae exhibited the highest biofilm production (87.5%) among isolated pathogens. Among biofilm producers, the highest resistance was observed with ampicillin (100%). Fosfomycin exhibited the lowest resistance (17.2%). Significant association with biofilm was detected for gender, duration of catheterization, and type of catheter. Conclusion Biofilm-based CAUTI is an emerging problem. E coli was the most frequent isolate. High antibiotic resistance was observed in biofilm-producing strains. Using the variables affecting biofilm formation, tailored intervention strategies can be implemented to reduce biofilm-based CAUTIs.

Pauciflorol F and isopaucifloral F are very important polyphenolic natural products and exhibit a variety of biological activities such as antibiotic, anticancer, anti-HIV, antioxidant, antifungal, and anti-inflammatory activities. These important molecules have gained significant attraction of medicinal chemists and several new strategies have been developed toward the synthesis of pauciflorol F and isopaucifloral F. This review article summarizes the major synthetic approaches adopted for the synthesis of these two indanone-based compounds.

Purpose: The present study was intended to find out the impact of three important components of marketing mix for tourism i.e. People, Process and Physical Evidence on Satisfaction of Sikh Pilgrims visiting Pakistan and the moderating role of Personal Perceived Risk of Terrorism in the relationship between the aforementioned independent variables and Pilgrims Satisfaction. Design/Methodology/Approach: The present research is based on the philosophy of positivism and it is descriptive and deductive in approach. Data was collected from a sample of 357 Sikh Pilgrims. Multiple linear regression analysis was carried out to test the hypothesized effect of People, Process and Physical Evidence on satisfaction of Sikh Pilgrims and the moderating effect of Personal Perceived Risk of Terrorism. Findings: Findings of the study showed that Physical Evidence and People have a significant positive effect whereas Process has a significant negative effect on satisfaction of Sikh Pilgrims. Personal Perceived Risk of Terrorism was found to have an insignificant moderating effect on the relationship of Process, People and Physical Evidence with Satisfaction. Implications/Originality/Value: The study might help uplift the tourism sector of Pakistan and enhance the relationship between people of different religions of the region.

A 61 year male, admitted in Combined Military Hospital Rawlpindi on 12th March 2017, operated for diverticulitis became colonized with Staphylococcus haemolyticus. Patient suffered repeated septic episodes caused by the same organism during his stay in hospital. The strain was identified as methicillin resistant Staphylococcus haemolyticus (MRSH) also resistant to Linezolid by analytical profile index for Staphylococcus (API Staph) and VITEK 2 Gram positive cocci panel. The isolate was cultured from blood cultures, Central Venous Catheter (CVC) tip and skin swabs. Patient was successfully treated with injectable vancomycin and skin decolonization was acheived with chlorhexidine bath after which no episode of MRSH infection occurred. Patient had an uneventful recovery and was discharged on 21st June. His follow up visit showed clinical improvement.

A pot experiment was conducted in sandy clay loam saline-sodic soil to assess the effects of farm yard manure (FYM), municipal solid waste (MSW) composts and gypsum application on nitrate leaching, soil chemical properties and crop productivity under rice-wheat cropping system. It also aims at establishing the correlation between soil phsico-chemical properties and yield response using principle component analysis and Pearson correlation analysis. The MSW was decomposed aerobically, an-aerobically and co-composted. Maximum nitrate leaching was observed during rice (75.9 mg L−1) and wheat (37.2 mg L−1) with an-aerobically decomposed MSW as compared with control treatment. Results revealed a decrease in soil pH (−6.95% and −8.77%), electrical conductivity (EC) (−48.13% and −51.04%), calcium carbonate (CaCO3) (−40.30% and −48.96%), and sodium adsorption ratio (SAR) (−40.27% and −45.98%) with an-aerobically decomposed MSW compost during rice and wheat, respectively. In this treatment, organic matter (OM) (93.55% and 121.51%) and cation exchange capacity (CEC) (19.31% and 31.79%) were the highest as compared with control treatment during rice and wheat, respectively. Rice and wheat growth were significantly (p≤ 0.05) increased by an-aerobically decomposed MSW followed by co-compost, aerobically decomposed MSW, FYM, gypsum and control. Furthermore, Pearson correlation coefficients predicted significant positive correlation of yield with soil OM, and CEC while inverse relationship was observed with EC, pH, CaCO3, and nitrogen use efficiency. Soil amelioration with organic and gypsum amendments was further confirmed with principal component analysis. This study has proved an-aerobically decomposed MSW as an effective solution for MSW disposal, thereby improving soil chemical properties and crop productivity from sandy clay loam saline-sodic soil.

Objective: We conducted this study to investigate the epidemiology of candidemia in our setting and to quantify the risk factors associated with disease, overall outcome, and mortality associated with candidemia. Methods: In this prospective observational study, we conducted lab-based surveillance with clinical correlation of all cases of candidemia within our ICUs during the period (2016–2018). Clinical assessment was done on day 5 and day 30, and comorbidities, clinical features, and outcome were observed within 30 days after the diagnosis. The diagnosis was made on the basis of positive blood culture for Candida spp and a compatible clinical picture. The demographic characteristics, sequential organ failure assessment (SOFA) scores, comorbidities, use of invasive devices, antibiotics administered were observed, and antifungal susceptibility testing was performed according to CLSI guidelines. Type and duration of antifungal administered and outcomes were noted. Results: In total, 48 episodes of candidemia, with 29 (60%) males and 19 (40%) females, were identified during the study period. C. albicans was the most common specie responsible for candidemia, causing 17 of the cases (~35%), whereas rest of the cases were caused by non–albicans spp, which included C. auris, accounting for 9 (19%) C. parapsilosis and C. tropicalis 7 (15%) each, C. glabrata and C. famata 2 (6%), and C. krusei was isolated in only 2 cases (4%). Among modifiable risk factors, CVC insertion and antibiotic exposure were the leading factors, seen in 100% of patient. Candida colonization was observed in 26 patients (28%), of whom 2 (4%) had multifocal Candida colonization. Among evaluable patients, 17 (35%) died within 30 days of the onset of candidemia. C. tropicalis was associated with the highest mortality rate, 27% (n = 4) in this cohort. Regarding the crude mortality in the different units, patients in medical ICU had the highest mortality rate (54%). In vitro activity of 3 systemically active antifungal agents was tested against 48 isolates of Candida spp. Based on CLSI break points, the susceptibility to voriconazole was 98%; only 1 isolate was resistant to voriconazole. Among candidemia-positive cases, 28 patients (58%) had taken the antifungals for >14 days, whereas 18 (37.5%) were treated for Conclusions: In our study, C. albicans was the most common specie responsible for candidemia, but non–albicans spp are also emerging, with higher in vitro resistance to antifungals.Funding: NoneDisclosures: None

Objective To assess the utility of galactomannan and beta-D-glucan assays in the diagnosis of invasive aspergillosis in clinically suspected cases, and to compare their diagnostic potential to determine whether a combination of the two may result in an early and specific diagnosis. Methods The descriptive cross-sectional case-control study was conducted at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from April 1, 2017, to March 31, 2018, and comprised serum samples from clinically suspected invasive aspergillosis patients and healthy controls. The sera were tested for galactomannan and beta-D-glucan detection. Proven, probable and possible categories of invasive aspergillosis according to European Organisation for Research and Treatment of Cancer / Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria. Galactomannan antigen was detected using a one-stage immunoenzymatic sandwich microplate assay. Beta-D-Glucan antigen was detected using a protease zymogen-based colorimetric assay. Sensitivity and positive / negative likelihood ratio of both the cases and the controls were calculated and compared. Results Of the 178 subjects, 119(67%) were cases and 59(33%) were controls. Beta-D-glucan assay was more sensitive than galactomannan assay (91.6% versus 80.67%) whereas galactomannan assay was more specific than beta-D-glucan assay (86.44% versus 76.27%) in the diagnosis of invasive aspergillosis. The sensitivities of both assays decreased with decreasing probability of invasive aspergillosis, i.e., maximum sensitivities of both beta-D-glucan and galactomannan assays were for proven cases (100% versus 87.5%), followed by probable cases (89.29% versus 85.71%), and possible cases (91.57% versus 78.31%). Conclusions Both beta-D-glucan and galactomannan assays seemed to play an encouraging role in the diagnosis of invasive aspergillosis in high-risk clinically suspected cases, with the former assay being more sensitive and the latter assay being more specific.

Background: Effective control of tuberculosis is achieved by early diagnosis and drug susceptibility testing for initiation of appropriate treatment. The performance of crystal violet decolorization assay (CVDA) for susceptibility testing of Mycobacterium tuberculosis to isoniazid (INH) and rifampicin (RIF) was compared in a multicenter study. Methods: Seventy-two M. tuberculosis isolates were tested in two phases by CVDA. Results: In Phase I, the specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), and agreement for INH were 100%, respectively. Specificity, sensitivity, PPV, NPV, and agreement for RIF were 98.2%, 100%, 94.1%, 100%, and 98.6%, respectively. In Phase II, specificity, sensitivity, PPV, NPV, and agreement were 98%, 100%, 95.4%, 100%, and 98.6% for INH, respectively. Specificity, sensitivity, PPV, NPV, and agreement for RIF were 96.3%, 88.2%, 88.2%, 96.3%, and 94.4%, respectively. Results in the study were obtained on average 10.9 ± 3.1 days in Phase I and 9.8 ± 2.2 days in Phase II. Conclusion: CVDA can be performed for drug susceptibility testing in developed and developing countries. In addition, further studies with larger sample size are needed for evaluation of this method. Fil: Coban, Ahmet Yilmaz. Akdeniz Üniversitesi; Turquía Fil: Alakbarova, Gumral. Medical Microbiology Laboratory. Thalassemia Center; Azerbaiyán Fil: Satti, Luqman. Armed Forces Institute of Pathology; Pakistán Fil: Tayyab, Nadia. Armed Forces Institute of Pathology; Pakistán Fil: Zaman, Gohar. Armed Forces Institute of Pathology; Pakistán Fil: Morcillo, Nora Susana. Provincia de Buenos Aires. Ministerio de Salud. Hospital "Dr. Antonio A. Cetrángolo"; Argentina Fil: Imperiale, Belén Rocío. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentina Fil: Wainmayer, Ingrid. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud “Dr. C. G. Malbrán”; Argentina Fil: Símboli, Norberto Fabián. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud “Dr. C. G. Malbrán”; Argentina