Emerging resistance of van genotype in enterococci: A potential menace for therapeutic failure

Objectives: Emerging cases of vancomycin-resistant enterococci (VRE) are detrimental for the patients. The current study aimed to ascertain the occurrence of VRE, their antibiogram and the van genotype responsible for vancomycin resistance. Methods: A total number of 2,958 clinical specimens were processed at Microbiology Department of the Alrazi Health Care, Lahore during the one year (2016-2017) using microbiological culture media, biochemical and serology. Antibiogram of enterococcal strains was performed using disc diffusion and E-test. ATCC Enterococcus faecalis 29212 was used as a quality control strain. The detection of van genotypes was accomplished by multiplex PCR assay. Results: Out of the 147 enterococci, 139 (94.6%) were E. faecalis, and 8 (5.4%) were E. faecium. Statistically significant associations of urine (p < 0.001), pus (p < 0.001) and wound swabs (p = 0.001) were observed with E. faecalis. A significant correlation of enterococcal infections (p = 0.05) was seen with female patients. Four (2.9%) strains of E. faecalis found to be VRE with vanB (75%) and vanA (25%) genotypes. Conclusion: The emerging strains of VRE (vanB and vanA genotype) in the current study are a potential menace for therapeutic failure, which left the physicians with only linezolid as a therapeutic option. doi: https://doi.org/10.12669/pjms.35.6.1145 How to cite this:Ejaz H. Emerging resistance of van genotype in enterococci: A potential menace for therapeutic failure. Pak J Med Sci. 2019;35(6):1659-1663. doi: https://doi.org/10.12669/pjms.35.6.1145 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Comparison of Caffeine versus Theophylline for apnea of prematurity

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.1.94 ◽

2019 ◽

Vol 35 (1) ◽

Cited By ~ 2

Author(s):

Arif Zulqarnain ◽

Muddasser Hussain ◽

Khalid Munir Suleri ◽

Zafar Ali Ch.

Keyword(s):

Numerical Data ◽

Study Data ◽

T Test ◽

P Value ◽

Medical College ◽

Creative Commons ◽

Hospital Ethics ◽

One Year ◽

Apnea Of Prematurity ◽

Open Access Article

Objective: To make a comparison between standard doses of theophylline and caffeine for the treatment of apnea of prematurity. Methods: A randomised control trail was conducted in Department of Pediatrics Medicine Govt. Khawaja Muhammad Safdar Medical College and Govt. Allama Iqbal Memorial Teaching Hospital, Sialkot over duration of one year from August 2017 to August 2018 after approval from the hospital ethics committee. An informed consent in the form of written document was also taken from the parents of each infant participating in the study. Data was analyzed by using SPSS version 24. Mean and SD was calculated for numerical data like gestational age and mean concentration of caffeine and theophylline. Frequency and percentages were calculated for categorical data like nasal continuous positive airway pressure (CPAP), supplemental oxyen and intrventricular hemorrhage (IVH) grade I. Student t-test was applied in order to determine the significance of results. P value ≤ 0.05 was considered significant. Results: A total of 100 infants were enrolled in this study. This study was further divided into two equal groups by lottery method i.e. 50% in each, treated with Theophylline and Caffeine respectively. Mean apnea events/day in neonates administrated by theophylline was 1±0.1, 2±0.12, 2±1.1, 1±0.10 and 2±o.12 for 0, 1-3, 4-7, 8-14 and 15-21 days respectively. While, the mean apnea events/day in neonates administrated by Caffeine was 2±0.3, 1±0.22, 2±1.5, 1±0.13 and 2±0.14 for 0, 1-3, 4-7, 8-14 and 15-21 days respectively. The differences were statistically significant for 1-3 days and 4-7 days p<0.05 according to student t test. Conclusion: Results of our study revealed that caffeine being more effective than Theophylline for treating apnea of prematurity. How to cite this:Zulqarnain A, Hussain M, Suleri KM, Ali Ch. Z. Comparison of Caffeine versus Theophylline for apnea of prematurity. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.94 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Outcome of modified interlaminar decompression: A conservative decompressive surgery for lumbar spine stenosis

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.4.1170 ◽

2020 ◽

Vol 36 (4) ◽

Author(s):

Farooq Azam ◽

Seema Sharafat ◽

Zahid Khan ◽

Mumtaz Ali

Keyword(s):

Lumbar Spine ◽

Decompressive Surgery ◽

Degenerative Lumbar Spinal Stenosis ◽

Creative Commons ◽

One Year ◽

Complication Of Surgery ◽

Lumbar Spinal ◽

Open Access Article ◽

Structured Questionnaire

Objective: To evaluate the outcomes of modified interlaminar decompression in patients with degenerative lumbar spinal stenosis (LSS). Methods: This descriptive observational study was conducted at the Department of Neurosurgery, Lady Reading Hospital Peshawar from July 2014 to June 2018. All patients with degenerative LSS who underwent modified interlaminar decompression during the study period were included in the study. The patients were followed up to one year after surgery. The data was entered into a structured questionnaire designed according to the study which was then analyzed using SPSS version 21. Results: A total of 182 LSS cases were included in the study and 236 levels were operated during the study period. According to the records increased prevalence of LSS was found among males i.e. 58.8%. The common level with degenerative stenosis involved was L4-5. Good to excellent outcomes were observed in 93.9% patients in the 1st follow-up visit. The most common complication of surgery was dural tear followed by wound infection. Conclusion: Modified interlaminar decompression is a conservative surgical technique, proved to be a potential approach with acceptable complications, satisfactory outcomes and it is easy to learn. doi: https://doi.org/10.12669/pjms.36.4.1170 How to cite this:Azam F, Sharafat S, Khan Z, Ali M. Outcome of modified interlaminar decompression: A conservative decompressive surgery for lumbar spine stenosis. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.1170 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Analysis of Eradication, Recurrence and Levels of 25-hydroxyvitamin D3 and Interleukin-1β in paediatric patients with Helicobacter Pylori Infection-related Gastritis

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.6.2292 ◽

2020 ◽

Vol 36 (6) ◽

Author(s):

Yuanda Zhang ◽

Binbin Bi ◽

Xu Guo ◽

Shaohui Zhang

Keyword(s):

Helicobacter Pylori ◽

Helicobacter Pylori Infection ◽

Interleukin 1Β ◽

Control Group ◽

Creative Commons ◽

Paediatric Patients ◽

One Year ◽

Recurrence Group ◽

Open Access Article

Objective: To study whether the levels of 25-hydroxyvitamin D3 (25-(OH)D3) and Interleukin-1β (IL-1β) are correlated to the eradication and recurrence of helicobacter pylori (Hp) in paediatric patients with Hp infection-related gastritis. Methods: A total of 142 paediatric patients with Hp infection-related gastritis from November 2017 to March 2018 in Baoding Children’s Hospital were selected as study subjectswere selected as study subjects and were followed up for one year. Paediatric patients were grouped and analyzed according to the effect of follow-up treatment and recurrence. Results: The levels of 25-(OH) D3 in the non-eradication group were lower than those in the eradication group and the control group (F=27.087, P<0.05); the levels of IL-1β were higher than those in the eradication group and the control group (F=16.610, P<0.05). Recurrence during follow-up visits: The levels of 25-(OH) D3 in the recurrence group were lower than those in the non-recurrence group and the control group (F=33.837, P<0.05); the levels of IL-1β in the recurrence group were higher than those in the non-recurrence group and the control group (F=7.896, P<0.05). Correlation analysis showed the levels of 25-(OH) D3 and IL-1β in the eradication group and the non-eradication group were negatively correlated (r=-0.232, P<0.05); the levels of 25-(OH) D3 and IL-1β in the recurrence group and the non-recurrence group were negatively correlated (r=-0.225, P<0.05). Conclusion: Relatively high levels of IL-1β may be correlated to the difficulty in eradicating the Hp infection in paediatric patients. Relatively low levels of 25-(OH) D3 may be correlated to the difficulty in eradicating the Hp infection and recurrence in paediatric patients. doi: https://doi.org/10.12669/pjms.36.6.2292 How to cite this:Zhang Y, Bi B, Guo X, Zhang S. Analysis of Eradication, Recurrence and Levels of 25-hydroxyvitamin D3 and Interleukin-1β in paediatric patients with Helicobacter Pylori Infection-related Gastritis. Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2292 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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In vitro efficacy of vancomycin combined with fosfomycin against Vancomycin-Resistant Enterococci strains

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.2.1347 ◽

2019 ◽

Vol 36 (2) ◽

Author(s):

Gulseren Aktas

Keyword(s):

Inhibitory Concentration ◽

Distinct Advantage ◽

Creative Commons ◽

Microdilution Method ◽

Vancomycin Resistant Enterococci ◽

Broth Microdilution Method ◽

Vancomycin Resistant ◽

Time Kill ◽

Open Access Article

Objective: Enterococci have been isolated frequently worldwide and have difficulties in the treatment. Combination antibiotherapies have a distinct advantage over monotherapies in terms of their synergistic effect. In the study, it was aimed to investigate in vitro activity of vancomycin combined with fosfomycin against VRE strains. Methods: A total of 30 VRE strains were included in the study. Bacterial identifications of the strains were undertaken using conventional routine methods. The resistance to agents tested was investigated by using the broth microdilution method. Glucose-6-phosphate (25 mcg/mL) for fosfomycin were used in all experiments. The activity of antibiotics in combination was assessed using a broth microcheckerboard. The fractional inhibitory concentration index (FICI) was interpreted as follows: synergism, FICI ≤0.5. Additionally, two strains in 30 VRE were studied to determine the time-kill curves to verify the synergistic results. For each strain, antibiotics were studied alone and in combination at the minimum inhibitory concentration (1xMIC) values. Results: Susceptibility rate to fosfomycin was found at 26.6 % (8/30). The MIC50, MIC90 and MIC interval values of antimicrobials were 512, 512, and 512 - 1024 mcg/mL for vancomycin, and 128, 160, and 64 - 224 mcg/mL for fosfomycin, respectively. The rate of synergism was found as 100 % by both checkerboard and time-kill methods. Conclusion: The result shows that the combination of vancomycin with fosfomycin could be an alternative in the treatment of infections caused by VRE. doi: https://doi.org/10.12669/pjms.36.2.1347 How to cite this:Aktas G. In vitro efficacy of vancomycin combined with fosfomycin against Vancomycin-Resistant Enterococci strains. Pak J Med Sci. 2020;36(2):281-285. doi: https://doi.org/10.12669/pjms.36.2.1347 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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ZnO Nanoparticles in Bettering The Color Uniformity of Phosphor-Converted White Led Lights

Journal of Advanced Engineering and Computation ◽

10.25073/jaec.202043.280 ◽

2020 ◽

Vol 4 (3) ◽

pp. 173

Author(s):

Ming-Jui Chen ◽

Van Tho Le ◽

Doan Quoc Anh Nguyen ◽

Thinh Cong Tran

Keyword(s):

Particle Size ◽

Mie Scattering ◽

Phosphor Layer ◽

Creative Commons ◽

Color Uniformity ◽

Theoretical Application ◽

The One ◽

The Right ◽

Led Lights ◽

Open Access Article

To make further improvements in future WLED generation, bettering color uniformity is an important goal manufacturers desire to accomplish. One of the most common and effective methods to enhance the color homogeneity is the one focusing on improving scattering in phosphor layer which can be achieved by adding ZnO into the phosphor layer. Based on theoretical application of Mie-scattering, we compute and analyze the scattering characteristics of the diffusor particles. From the results, the ZnO particles are proven to have positive influences on the development of lighting quality. Additionally, the article analyzed and presented the effects of ZnO concentration which fluctuates from 2% to 22% on the color homogeneity. Thus, the color uniformity is influenced not only by the particle size but also by the concentration of the added ZnO. Hence, managing the color uniformity of WLEDs means controlling the size and concentration of ZnO. With the concentration of 10% ZnO, the lumen output of LEDs reaches the highest values. Meanwhile, when the concentration and size of ZnO are 14% and 500 nm respectively, ∆CCT is reduced to the lowest value. Based on the manufacturers' requirements, the most appropriate ZnO concentration and particle size can be determined. However, if requirements include both lumen and color uniformity, the right choice is 14% concentration with 500 nm particle size of ZnO. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.

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Fusing Detected Humans in Multiple Perception Sensors Network

Journal of Advanced Engineering and Computation ◽

10.25073/jaec.201712.61 ◽

2017 ◽

Vol 1 (2) ◽

pp. 114

Author(s):

Hoang Quang Minh Tran ◽

Anh Vu Le

Keyword(s):

Original Work ◽

Region Of Interest ◽

Field Of View ◽

Robot Operating System ◽

Creative Commons ◽

Parallel Configuration ◽

The One ◽

Top View ◽

Open Access Article ◽

Euclidian Distances

A fusion method is proposed to keep a correct number of humans from all humans detected by the robot operating system based perception sensor network (PSN) which includes multiple partially overlapped field of view (FOV) Kinects. To this end, the fusion rules are based on the parallel and orthogonal configurations of Kinects in PSN system. For the parallel configuration, the system will decide whether the detected humans staying in FOV of single Kinect or in overlapped FOV of multiple Kinects by evaluating the angles formed between their locations and Kinect original point on top view (x, z plane) of 3D coordination. Then, basing on the angles, the PSN system will keep the person stay in only one FOV or keep the one with biggest ROI if they stay in overlapped FOV of Kinects. In the case of Kinects with orthogonal configuration, 3D Euclidian distances between detected humans are used to determine the group of humans supported to be same human but detected by different Kinects. Then the system, keep the human with a bigger region of interest (ROI) among this group. The experimental results demonstrate the outperforming of the proposed method in various scenarios. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Az angiotenzinkonvertálóenzim-gátló/kalciumcsatorna-blokkoló fix gyógyszer-kombinációk egyéves perzisztenciája hypertoniában

Orvosi Hetilap ◽

10.1556/650.2019.31355 ◽

2019 ◽

Vol 160 (9) ◽

pp. 343-348

Author(s):

Gábor Simonyi ◽

Tamás Ferenci ◽

Ervin Finta ◽

Iván Igaz ◽

Sándor Balogh ◽

...

Keyword(s):

Enzyme Inhibitor ◽

Patient Adherence ◽

Therapeutic Option ◽

Fixed Dose ◽

Insurance Fund ◽

Channel Blockers ◽

Prescription Database ◽

Hypertensive Patients ◽

One Year ◽

The One

Abstract: Introduction: The most recent European guidelines for the treatment of hypertension suggest the use of renin-angiotensin-aldosterone system antagonists (RAAS inhibitors) and calcium channel blockers (CCBs) or diuretics fixed-dose combinations (FDCs) as the first therapeutic option. In antihypertensive therapy, the patient’s adherence is one of the most important factors in reducing unwanted cardiovascular events. Aim: Our aim was to assess the one-year persistence of angiotensin-converting enzyme inhibitor (ACEI) and CCB FDCs in hypertensive patients. Method: Authors have analysed the prescription database of the National Health Insurance Fund in Hungary on pharmacy claims between October 1, 2012 and September 30, 2013. Those patients were identified who filled prescriptions for FDCs of ACEI and CCBs prescribed for the first time for hypertensive patients and who had not received similar drugs during the year before. Apparatus of survival analysis was used, where ‘survival’ was the time to abandon the medication. Results: 124 388 patients met the inclusion criteria. One-year persistence rate and hazard ratio (HR) of discontinuation in patients with ramipril/amlodipine FDC was 54% (HR = 1.00, reference), perindopril/amlodipine 47% (HR = 1.30, p<0.0001), lisinopril/amlodipine 36% (HR = 1.79, p<0.0001), ramipril/felodipine 26% (HR = 2.28, p<0.0001) and trandolapril/verapamil 12% (HR = 4.13, p<0.0001). The average survival time of drug limited to 360 days was 270.2 days for ramipril/amlodipine FDC, 242.7 days for perindopril/amlodipine FDC, 211.2 days for lisinopril/amlodipine FDC, 186.3 days for ramipril/felodipine FDC and 125.7 days for trandolapril/verapamil FDC. Conclusions: The authors demonstrated that the one-year persistence of ACEI/CCB FDCs was significantly different in hypertensive patients. Ramipril/amlodipine FDC was more advantageous for patient adherence. Orv Hetil. 2019; 160(9): 343–348.

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Frequency of autoimmune thyroiditis in children with Celiac disease and effect of gluten free diet

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.6.2226 ◽

2020 ◽

Vol 36 (6) ◽

Author(s):

Javaria Rasheed ◽

Rushan Hassan ◽

Muhammad Khalid ◽

Fauzia Zafar

Keyword(s):

Celiac Disease ◽

Autoimmune Thyroiditis ◽

Prospective Observational Study ◽

Gluten Free Diet ◽

Gluten Free ◽

Creative Commons ◽

Euthyroid Status ◽

One Year ◽

Open Access Article

Objective: To determine the frequency of autoimmune thyroiditis in children with Celiac disease and the effect of gluten free diet on autoimmune thyroiditis. Methods: We enrolled 100 patients, age 1-12 years of either gender diagnosed as Celiac disease (CD) in this prospective observational study in the Department of Pediatric Medicine, from 1st January 2018 to 30th June 2019. Diagnosis of autoimmune thyroiditis was made if anti–thyroperoxidase >35 iu/ml or anti–thyroglobulin >20 iu/ml at diagnosis of CD and then at one year on gluten free diet (GFD) in all cases. Children with repeat anti-tTG levels > 10 times upper limit normal at 6-months after enrollment were labelled as non-compliant to GFD. Descriptive statistics were used to analyze the data. Results: Mean age of the participants was 5.94±3.16 years and 53% were females. Fourteen cases of autoimmune thyroiditis were detected at enrollment and six (7%, n/N = 6/86) were later diagnosed on follow-up who were initially negative. Seven hypothyroid cases among the autoimmune thyroiditis were treated with thyroxine and became euthyroid on follow-up testing. Compliance to GFD was 52%. Autoimmune thyroiditis improved on gluten free diet in four cases (28.6%). Of the six euthyroid cases at diagnosis three cases became hypothyroid and all were non-compliant. Conclusion: Frequency of autoimmune thyroiditis was 20% over a follow-up period of one year. Good compliance with the GFD has some effect on improving autoimmune thyroiditis and maintaining euthyroid status of CD patients. doi: https://doi.org/10.12669/pjms.36.6.2226 How to cite this:Rasheed J, Hassan R, Khalid M, Zafar F. Frequency of autoimmune thyroiditis in children with Celiac disease and effect of gluten free diet . Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2226 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Conservative treatment of Fibrous Dysplasia

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.3.14 ◽

2019 ◽

Vol 35 (3) ◽

Author(s):

Besime Ahu Kaynak

Keyword(s):

Conservative Treatment ◽

Fibrous Dysplasia ◽

Developmental Disorder ◽

Unusual Case ◽

Histopathological Examination ◽

Facial Bones ◽

Creative Commons ◽

One Year ◽

Bony Enlargement ◽

Open Access Article

Fibrous Dysplasia (FD) is a developmental disorder of bone that can affect one bone (monostotic type) or multiple bones (polyostotic type). The disease can be associated with hyperpigmentation and endocrinological disorders. In general, FD is found in teenagers, in the second decade of life. It often involves the long bones, craniofacial bones, ribs and pelvis. Approximately 30% of monostotic FD (MFD) lesions are found in the cranial, rather facial bones. It frequently appears in the posterior region of the jaw bone and is usually unilateral. The etiology of FD is not clear but even so genetic predisposition is suspected. The diagnosis is based on radiological and histopathological examination. We present an unusual case of symptomatic FD. A 15-year-old female patient was admitted to the clinic, complaining gradually increased swelling on her left side of the mandible one year ego with severe and unusual pain at related region. The bony enlargement was extending from median mandible to the crestal marginal level. Surgical shaving and recountering of mandible through the delicate preservation of the mental nerve in the left side of mandible was carried out. The aim of this report is to present the conservative treatment as sufficient treatment modality for the treatment of FD during puberty. doi: https://doi.org/10.12669/pjms.35.3.14 How to cite this:Kaynak BA. Conservative treatment of Fibrous Dysplasia. Pak J Med Sci. 2019;35(3):---------. doi: https://doi.org/10.12669/pjms.35.3.14 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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