Diversity of Urinary Tract Pathogens and Drug Resistant Isolates of Escherichia coli in different age and gender Groups of Pakistanis

Purpose: This paper was mainly aimed to investigate drug resistance of the various urinary tract infection (UTI) pathogens from patients of different gender and age groups of Pakistanis. Method: For these purposes, urine samples of 109 patients were analyzed. Samples were screened on CLED agar. Antimicrobial susceptibility testing was performed by Kirby Bauer\'s disc diffusion method. Isolated colonies were processed for biochemical characterization and antibiotic sensitivity to ampicillin, amikacin, augmentin, ceftazidime, ceftriaxone, cefuroxime, cotrimoxazole, ciprofloxin, imipenem, meropenem, tazocine, trimethoprim, gentamicin and nitrofuratoin. Result: E.Coli was found to be the most frequent causative agent of UTIs (66%) followed by Enterococci (8.3%), Candida spp. and Pseodomonas spp. (7.3% each), Klebsiella spp. (5.5%) and Enterobacter spp. (2.7%). Proteus. and Morgenella species were found in less than 1% of the cases. E.coli showed variable antimicrobial resistance to different antibiotics as 92%, 86%, 80%, 62%, 47%, 20% and 4% of the isolates were found to be resistant to ampicillin, cotrimoxazole, ciprofloxin, gentamicin, nitrofuratoin and amikacin, respectively. Conclusion: The most effective in vitro agents were found to be amikacin followed by gentamicin (among the parenterals), and ciprofloxin among the orally administratered ones. A higher prevalence of UTIs was observed in the female population and E.coli showed no resistance to nitrofuratoin in age groups of 50+ and 70+ in both genders. Keywords: Urinary tract infections, Age, Gender, Resistant microbes, E.coli. Tropical Journal of Pharmaceutical Research Vol. 7 (3) 2008: pp. 1025-103

Hypothyroidism conversion to hyperthyroidism: it's never too late.

Primary hypothyroidism is a common endocrine condition, most commonly caused by autoimmune thyroiditis (Hashimoto's disease) while Graves' disease is the most common cause of hyperthyroidism. Hypothyroidism is usually a permanent condition in most patients requiring lifelong levothyroxine treatment. Transformation from Hashimoto's disease to Graves' disease is considered rare but recently been increasingly recognised. We describe a case of a 61-year-old lady who was diagnosed with hypothyroidism approximately three decades ago and treated with levothyroxine replacement therapy. Approximately 27 years after the initial diagnosis of hypothyroidism, she started to become biochemically and clinically hyperthyroid. This was initially managed with gradual reduction in the dose of levothyroxine, followed by complete cessation of the medication, but she remained hyperthyroid, ultimately requiring anti-thyroid treatment with Carbimazole. This case highlights that there should be a high index of suspicion for a possible conversion of hypothyroidism to hyperthyroidism, even many years after the initial diagnosis of hypothyroidism. To our knowledge, this case illustrates the longest reported time interval between the diagnosis of hypothyroidism until the conversion to hyperthyroidism. Learning points: Occurrence of Graves' disease after primary hypothyroidism is uncommon but possible.In this case, there was a time-lapse of almost 28 years and therefore this entity may not be as rare as previously thought.Diagnosis requires careful clinical and biochemical assessment. Otherwise, the case can be easily confused for over-replacement of levothyroxine.We suggest measuring both anti-thyroid peroxidase (TPO) antibodies and TSH receptor antibodies (TRAB) in suspected cases.The underlying aetiology for the conversion is not exactly known but probably involves autoimmune switch by an external stimulus in genetically susceptible individuals

Role of Liposuction Combined with Subcutaneous Mastectomy in the Surgical Treatment of Gynecomastia

Background: Gynecomastia is one of the common benign male breast diseases, surgical treatment of which remains a controversial issue. Here, we describe successful combined use of liposuction and subcutaneous mastectomy in the treatment of gynecomastia. Aim: To evaluate the effectiveness of the liposuction combined with subcutaneous mastectomy in the treatment of gynecomastia. Materials and Methods: In this retrospective study, a total of 28 patients were included. All the patients had undergone detailed clinical evaluation and appropriate investigations. Information regarding age of onset, etiology, laterality, nipple discharge was collected from patient’s medical records. Twenty of 28 patients had unilateral gynecomastia whereas 8 patients had bilateral gynecomastia. Based on the clinical evaluation and investigations, secondary causes of gynecomastia were ruled out. Subcutaneous mastectomy using infraareolar skin incision combined with liposuction was performed on 26 patients. Two patients underwent only liposuction. Results: Twenty‑four patients (86%) were satisfied with the results of the operative intervention. In 24/28 patients (86%), the indication of surgery was cosmetic reasons and in 4/28 patients (14%), the indication was failure to treatment with danazol. Average age of the patients was 24 (6) years and most of the patients were between 20 and 30 years of their age. The postoperative complications include infection in two patients and contour deformity in two other patients. Conclusions: Liposuction combined with subcutaneous mastectomy is a reliable, versatile, less time consuming and valid procedure for the treatment of gynecomastia. This procedure provides satisfactory aesthetic results.Keywords: Gynecomastia, liposuction, subcutaneous mastectom

Biological activities of Rumex dentatus L: Evaluation of methanol and hexane extracts

Rumex dentatus L. (Plygonaceae) extracts were evaluated for antibacterial, antifungal, cytotoxic, antitumor and allopathic potential. The leaf, stem and root extracts were prepared in methanol and hexane by simple maceration. The methanol extracts of root and shoot were found effective against all the bacterial strains tested. Zone of inhibition ranged between 9.7 to 12.1 mm. While the hexane extracts inhibited fungal growth (up to 80%) more efficiently than the methanol extracts. Concentration of different the extracts of R. dentatus effectively inhibited tumor induction on the potato discs produced by wild type Agrobacterium strains At10 and At6. The root extracts either in methanol or hexane showed LD50 values below 1000 ppm in brine shrimp mortality assay. The methanol extracts of leaf and stem inhibited radish seed germination (70 and 61% respectively) and root length more than the hexane extracts. The R. dentatus methanol extract showed presence of alkaloids, saponins, anthraquinones and tannins while flavonoids were also found in both methanol as well as hexane extract

A rare association of crossed fused renal ectopia

BACKGROUND: Thrombocytopenia and absent radius syndrome (TAR) is a rare genetic disorder. It is an autosomal recessive disorder characterised by radial aplasia and thrombocytopenia that may have additional anomalies. We report a case of TAR syndrome with crossed fused renal ectopia. This anomaly has not been previously reported in association with TAR syndrome. CASE PRESENTATION: A 24 years old female with Thrombocytopenia and absent radius syndrome admitted with pelvic fracture was investigated for recurrent urinary tract infections. Abdominal ultrasonography could not visualise the kidney on right side. Further extensive investigations in the form of intravenous urography (IVU), Magnetic resonance imaging (MRI) and renal isotope scans revealed a crossed fused renal ectopia. CONCLUSION: This report describes the new finding of a crossed fused renal ectopia associated with TAR syndrome that has not been reported before in the literature. Ectopic kidneys have increased susceptibility to develop complications like urinary infections, urolithiasis, and abdominal mass. There is a reported case of TAR syndrome with renal anomaly that developed Wilm's tumor. Finding of crossed fused renal ectopia warrants complete urologic investigation to rule out surgically correctable pathology in the urinary tract

Mapping the disease-specific LupusQoL to the SF-6D

Purpose To derive a mapping algorithm to predict SF-6D utility scores from the non-preference-based LupusQoL and test the performance of the developed algorithm on a separate independent validation data set. Method LupusQoL and SF-6D data were collected from 320 patients with systemic lupus erythematosus (SLE) attending routine rheumatology outpatient appointments at seven centres in the UK. Ordinary least squares (OLS) regression was used to estimate models of increasing complexity in order to predict individuals’ SF-6D utility scores from their responses to the LupusQoL questionnaire. Model performance was judged on predictive ability through the size and pattern of prediction errors generated. The performance of the selected model was externally validated on an independent data set containing 113 female SLE patients who had again completed both the LupusQoL and SF-36 questionnaires. Results Four of the eight LupusQoL domains (physical health, pain, emotional health, and fatigue) were selected as dependent variables in the final model. Overall model fit was good, with R2 0.7219, MAE 0.0557, and RMSE 0.0706 when applied to the estimation data set, and R2 0.7431, MAE 0.0528, and RMSE 0.0663 when applied to the validation sample. Conclusion This study provides a method by which health state utility values can be estimated from patient responses to the non-preference-based LupusQoL, generalisable beyond the data set upon which it was estimated. Despite concerns over the use of OLS to develop mapping algorithms, we find this method to be suitable in this case due to the normality of the SF-6D data

Negotiating professional and social voices in research principles and practice

This paper draws on work conducted for a qualitative interview based study which explores the gendered racialised and professional identifications of health and social care professionals. Participants for the project were drawn from the professional executive committees of recently formed Primary Care Trusts. The paper discusses how the feminist psychosocial methodological approach developed for the project is theoretically, practically and ethically useful in exploring the voices of those in positions of relative power in relation to both health and social care services and the social relations of gender and ethnicity. The approach draws on psychodynamic accounts of (defended) subjectivity and the feminist work of Carol Gilligan on a voice-centred relational methodology. Coupling the feminist with the psychosocial facilitates an emphasis on voice and dialogic communication between participant and researcher not always captured in psychosocial approaches which tend towards favouring the interviewer as ‘good listener’. This emphasis on dialogue is important in research contexts where prior and ongoing relationships with professional participants make it difficult and indeed undesirable for researchers to maintain silence

Modulation of Sn concentration in ZnO nanorod array: intensification on the conductivity and humidity sensing properties

Tin (Sn)-doped zinc oxide (ZnO) nanorod arrays (TZO) were synthesized onto aluminum-doped ZnO-coated glass substrate via a facile sonicated sol–gel immersion method for humidity sensor applications. These nanorod arrays were grown at different Sn concentrations ranging from 0.6 to 3 at.%. X-ray diffraction patterns showed that the deposited TZO arrays exhibited a wurtzite structure. The stress/strain condition of the ZnO film metamorphosed from tensile strain/compressive stress to compressive strain/tensile stress when the Sn concentrations increased. Results indicated that 1 at.% Sn doping of TZO, which has the lowest tensile stress of 0.14 GPa, generated the highest conductivity of 1.31 S cm− 1. In addition, 1 at.% Sn doping of TZO possessed superior sensitivity to a humidity of 3.36. These results revealed that the optimum performance of a humidity-sensing device can be obtained mainly by controlling the amount of extrinsic element in a ZnO film