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Professor, Consultant Pathologist, American Board Certified Pathologist, Fellow College of American Pathologists. Areas of interest Fine Needle Aspiration Cytology, Cytology, Cancer, Ethics, Islam, Humanity

Editorial: Good Medical Research

Doing good medical research is not that difficult. However, it does require some planning and a little bit hard work. You may need a team of dedicated colleagues to work with you.

The research must be carefully planned. It must answer some specific scientific question and should add something new to the already existent body of scientific knowledge and better understanding of the subject matter. It should not be mere replica of some old research. The aim should be well thought of. The research ought to bring some benefits in terms of improvement in medical care and management! The research must be repeatable and replicable with methods described in sufficient details! Mere data collection from registers do not constitute genuine research; such research could be carried out by even  an 8 grader!

Plasmid-Borne Drug Resistance Elimination Potential of Ethidium Bromide and Acridine Orange in Multidrug Resistant and Extensive Drug Resistant Escherichia Coli

Muhammad Akbar Hassan1, Muhammad Salman Rasool2, Fasihuddin Ahmed Ansari1 and Shahana Urooj Kazmi1

1 Department of Microbiology, University of Karachi, 2 Department of Microbiology, D. J. Sindh Govt. Science College, Karachi, 3Department of Microbiology, University of Karachi, 4Department of Microbiology, University of Karachi, Women University, Sawabi

ABSTRACT: Multidrug resistant (MDR) and extensively drug resistant (XDR) E. coli strains generate diverse and severe infections like bacteremia and urinary tract infections (UTIs) worldwide. They mostly carry antibiotic resistance markers or genes on mobile plasmids making the treatment and eradication of such infections more problematic. Plasmid eliminating agents (Ethidium bromide and Acridine orange) could be advantageous in the expulsion of resistance bearing plasmids and eventually helpful in extermination of MDR and XDR-E. Coli.

Objective: This study was designed to determine the antibiotic resistance patterns of Escherichia coli isolates from patients with urinary tract infections and bacteremia. We also detected the antibiotics resistance profiles and compared the potential of curing agents in eliminating plasmid mediated antibiotic resistance.

Methods: Three hundred and fifty (350) E. coli isolates from patients diagnosed with urinary tract infections and bacteremia were taken. Antibiotic sensitivity testing was accomplished by following CLSI (2015) protocol. Sub- minimum inhibitory concentrations (SICs) of Ethidium bromide and Acridine orange were determined by broth dilution method in Luria Britani (LB) broth to find curing concentrations for resistance plasmids.

Results: E. coli which were (100%) resistant to Amoxicillin-clavulanate, Cefaclor, Cefuroxime, Cefixime, Ceftazidime, Cefepime, Cefotaxime, Ceftriaxone, Ciprofloxacin and Pipidemic acid (urine only) and were selected for curing analysis. About 46%, 16%, 14% and 14% of E. coli (blood isolates) were resistant to Cefoperazone- sulbactam, Imipenem, Meropenem and Amikacin, respectively. About 34%, 13%, 12%, 10%, 9% and 6% of E. coli from urine were resistant to Cefoperazone-sulbactam, Amikacin, Nitrofurantoin, Meropenem, Imipenem and Fosfomycin, respectively. Sub-minimum inhibitory concentrations (SICs) of Ethidium bromide and Acridine orange were effective between 125µg/ml to 1000µg/ml for both curing agent but the most impressive resistance plasmid curing concentrations were 500-1000µg/ml and 500µg/ml of EthBr and AO, respectively. These both curing agents were able to displace Imipenem, Meropenem, Cefoperazone-sulbactam, Nitrofurantoin,  Fosfomycin, Amikacin, Cefotaxime, Ceftazidime, Ceftriaxone, Ciprofloxacin and Cefepime resistance in E. coli. The most prevailing eliminated resistance was of Imipenem and Meropenem. The study proposes that Ethidium bromide and Acridine orange are pivotal in eradication of plasmid mediated antibiotic resistance in MDR and XDR-E. coli.

Smear-positivity of Tuberculosis in in-door patients of DHQ hospital, Swabi, Pakistan

Farooq Ali1, Syeda Shahdana Zia2, Qismat Shakeela1, Shehzad Ahmed1*

1 Department of Microbiology, Hazara University Mansehra, KPK, Pakistan, 2National Institute for Genomics and Advanced Biotechnology, National Agricultural Research Centre, Islamabad, Pakistan

ABSTRACT

Background: Tuberculosis is an infectious disease with a historical background caused by acid fast bacillus bacterium, Mycobacterium tuberculosis which is transferred by droplets.It contributes to affect about one-third population globally. Tuberculosis has a wide prevalence and death rate just second to the HIV infection.

Materials and methods: The study was conducted during a year from January-December 2018 to observe the infected rate of tuberculosis in district Swabi. The aim of the study is to pinpoint the prevalence rate of the infection to speed up the access of health care programs to the infected people for effective treatment in the population. The suspected patients were belonging to district Swabi. The sputum was sampled, covered and labelled carefully from all the suspected patients. Each sample was smeared, stained on slid and was examined carefully for acid fast bacilli.

Results: The overall result examined was 18.15% in which male contributed 53.81% and female 46.18%. The highest prevalence rate, 26.27%, was observed in the age group 16-30. The highest frequency rate in male was observed in the age group 61-75 while in female in the age group 16-30. Moreover, the farmer occupation was more infective in comparison to others.

Conclusion: Results concluded that, the prevalence rate of tuberculosis is quite high in the study area which is due to the lake of health education, awareness and medical care.

Hypoglycemic and Hypotriglyceridemic Effects of Aloe Vera Whole Leaf and Sitagliptin in Diabetic Rats

Sobia Javaid and Akbar Waheed

Department of Pharmacology Riphah University, Almeezan Campus, Rawalpindi

ABSTRACT

Background:. Aloe Vera with excellent metabolic properties is playing wonders in diabetes treatment.

Objective: “To compare the hypoglycemic and hypotriglyeridemic effects of Aloe Vera whole leaf and Sitagliptin on Streptozotocin induced diabetic rats”

Methodology: Randomized Control Trial, conducted at Department of Pharmacology, Riphah University, in collaboration with NIH, Islamabad, Pakistan, from September 2019 to August 2020. Healthy, 40, albino rats were randomly divided into Groups A and B. Group B was further subdivided into:  GroupB1  (Diabetic  Control), Group B2 (Aloe Vera whole Leaf treated), GROUP B3 (Sitagliptin treated), n=10 each, (after diabetes induction). At Day 60, FBS and serum triglycerides were measured in all rats. SPSS version 25 was applied for statistical analysis. One-way ANOVA test was used for assessing any difference in the mean values. Post-hoc  Turkey  analysis was done to compare inter-group mean differences. P value of <0.05 was considered significant.

Results: On terminal sampling, mean FBS of Rats in Group A was 82.40 mg/dl, Group B1 498.40mg/dl, Group B2 89.30mg/dl and Group B3 93.00mg/dl; Serum Triglycerides for Group A 125.40mg/dl, B1 221.00mg/dl, B2 112.50mg/dl, B3 125.00mg/dl respectively. In Group B2 and Group B3 significant reduction in fasting blood glucose and triglycerides is observed, compared to Group B1, with no statistically significant intergroup differences in results of Group B2 and B3.

Conclusion: Aloe Vera whole leaf extract significantly decreased fasting blood glucose and triglyceride levels with nearly similar efficacy to Sitagliptin in diabetic rats.

Clinicopathological Features of Dengue Fever–a Single Center Study

Aliya Batool1, Bushra Anwar2, Amina Rasul3, Sadaf Khalid4, Naghmi Asif5 and Hijab Shah6.

1Bone marrow transplant unit/department of Pathology  Islamabad Medical and Dental College, 2 Department of Pathology Fazaia Medical College,  3Department of Physiology Watim  Medical and Dental College. 4 Department of Community Medicine Islamabad Medical and Dental college. 5 Department of Pathology

Department of Community Medicine Islamabad Medical and Dental college. 6 Department of Pathology Department of Community Medicine Islamabad Medical and Dental college

ABSTRACT

Background: Dengue viral infection is an important and rapidly spreading mosquito borne infection of humans worldwide.

Objective: To evaluate the clinicopathological features of patients with dengue fever.

Methodology: A descriptive cross sectional study was conducted to evaluate the clinicopathological features of patients with dengue viral infection in Pakistan Atomic Energy Commission General Hospital, Islamabad. A total of 62 patients of Dengue infection were followed and documented in this study. A detailed clinical history, physical examination, and investigations were noted using a structured Performa. Tests included complete blood count (CBC), serum Aminotransferases including Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), and dengue serology.Results: Out of 62 patients with diagnosis of Dengue viral infection through Dengue serology test, 59 cases fulfilled the WHO diagnostic criteria of probable Dengue fever and 3 cases fulfilled the diagnostic criteria of Dengue Hemorrhagic Fever (DHF), including Dengue Shock Syndrome (DSS). Male to female ratio was 5׃1 and median age of the patients was 34 years (ranged from 4 to 70 years). Fever was the main symptom (100% of cases), followed by generalized body aches and pains (in 73% of cases), at the time of presentation. Mean hemoglobin level was 14 ± 1.8 gm/dl, while total leukocyte count (TLC) was <4000/µl in 84%, and platelets were <150,000/µl in 100% of the cases. Serum aminotransferases (AST, ALT) were deranged in 70% of the cases. Conclusion: This study shows slight difference in clinicopathological features of patients with dengue infection compared to those in other parts of the world, which can help the clinicians in early detection of dengue infection and on those basis further workup and management can be planned

Microbial Contamination of White Coats, Hands and Mobile Phones of Health Care Workers

Muhammed Irfan Khan1,Mehwash Kashif2 , Roohi Ehsan3,  Muhammad Faizuddin1, Sana Iqbal 2 and Hiba Jamil 4

1Pathology Department, Karachi Medical & Dental College, 2Department of Oral Pathology, Karachi Medical & Dental College, 3Department of Forensic Medicine, Karachi Medical & Dental College, 4 Karachi Medical & Dental College

ABSTRACT

Background: Microbial contamination as the name suggests is the infiltration of pathogenic microbes into any living body. It increases the burden of disease and results in many fatal infections. The commonest reason behind microbial contamination in the health care system is health care workers. The risk of infections in tertiary care centers increases magnanimously despite a near-constant disinfection regimen being followed daily. Aside from the usual surfaces and equipment, infective agents are most commonly present on the hands of hospital staff, their mobile phones, and their clothing, specifically their lab coats.

Objective: This study was planned to evaluate the microbial contamination of white coats, hands, and mobile phones of health care workers.

Methods: This study, conducted in a tertiary care hospital in Karachi, estimates the percentage of microbial colonization on the white coats, mobile phones, and hands of health care workers. A total of 114 individuals were asked to obtain samples and a convenience sampling technique was used. Data were analyzed on SPSS version 17.0.

Result: Lab coat contaminants were found to be Staphylococcus aureus (70%), Staphylococcus epidermidis (15.71%), and Escherichia coli (5.71%), Methicillin-Resistant Staphylococcus aureus MRSA (4.2%), Klebsiella (2.85%), and Pseudomonas (1.42%). The hands of observed health care workers mostly contained MRSA (32.32%) Staphylococcus aureus (29.29%), Staphylococcus epidermidis (29.29%), and Pseudomonas (9.09%). Mobile phones majorly held MRSA (37%), Staphylococcus epidermidis (36%), Staphylococcus aureus (21%), and Pseudomonas (6%).

Conclusion: This cross-sectional study shows that a huge extent of health care worker’s apparel and belongings were tarnished with various types of microorganisms that can bring about nosocomial contaminations.

FIP1L1-PDGFRA-Gene Fusion in Patients with Eosinophilia and Spinal Manifestation

Feroz Ali Khan1 and Qazi Muhammad Jamal2

1Demonstrator at Khyber Medical College, Peshawar, 2Casualty Medical Officer at Qazi Hussain Ahmad Medical Complex, Nowshera

ABSTRACT:

The rapid proliferation of progenitors of blood cells increases the chances of mutations and production of dysfunctional cells that often suppress the normal hematopoietic system. Chronic eosinophilic leukemia, characterized by elevated levels of pink-staining bilobed eosinophils, is one of the known pathological  presentation of unregulated proliferation of dysplastic blood cells. Tissue infiltration of heart, lungs, skin, gut and other organs has been observed previously but the formation of a mass, comprising of myeloid and eosinophilic infiltrates, around the spinal cord has rarely been seen. With the spinal mass removed, our reported patient’s eosinophilia responded to short course of imatinib however, left him bed bound due to lower limbs paralysis.