ROLE OF PROBIOTICS IN PREVENTION OF NECROTIZING ENTEROCOLITIS AMONG PRETERM NEONATES.

Background; Necrotising enterocolitis (NEC) is the most commonly occurring gastrointestinal emergency in preterm infants. This study was conducted to determine frequency of necrotizing enterocolitis (NEC) in preterm infants less 1.5 Kg taking probiotics at a tertiary care hospital. Material and Methods; Consecutive 270 preterm neonates having weight less than 1.5 Kg was taken in this descriptive case – series study. Once registered, the study cases were fed with Infloran (Lactobacillus acidophilus) and Bifidobacterium infants, 125 mg/kg per dose was given twice daily with breast milk until discharged and were followed for two weeks to see NEC. The amount of feeding was advanced slowly if tolerated, with no more than 20 mL/kg per day increment per day. These study cases were followed for 15 days to record outcome variable i.e. NEC. Data was analyzed by using SPSS Version 20. Results; Of these 270 study cases, 139 (51.5%) were boys while 131 (48.5%) were girls. Mean gestational age of our study cases was 29.61 ± 2.66 weeks (with minimum gestational age was 24 weeks while maximum gestational age was 34 weeks). Of these 270 study cases, 147 belonged to urban areas and most of our study cases i.e. 179 (66.3%) were poor, 79 (29.3%) were from middle income families and only 12 (4.4%) belonged to rich families. Mean weight of our study cases was 1312.85 ± 78.66 grams. Mean maternal age was noted to 27.91 ± 4.24 years, 170 (62.96 %) mothers were less than 30 years of age and most of these mothers were illiterate i.e. 191 (70.7%). Majority of these mothers i.e. 170 (62.96 %) had parity less than 3. Mean duration on probiotics was noted to be 14.88 ± 1.38 days. Necrotizing enterocolitis was noted in 15 (5.6%) of our study cases. Conclusion; Our study results have shown that frequency of necrotizing enterocolitis (NEC) was low in preterm infants using probiotics. The use of probiotics was effective in the prevention of NEC and our study results support the use of probiotics in these infants. Probiotics were found to be safe, reliable and efficacious in our study. NEC was significantly associated with gender, gestational age, residential status, poor socioeconomic status, increasing maternal age and parity and duration on probiotics. Keywords; Probiotics, necrotizing enterocolitis, preterm infants

IDENTIFICATION OF PATTERN AND BURDEN OF CAUSATIVE AGENTS OF SPONTANEOUS BACTERIAL PERITONITIS AMONG CIRRHOTIC PATIENTS.

Background; Spontaneous bacterial peritonitis is a common bacterial infection in patients with cirrhosis and ascities with in-hospital mortality rates ranging from 20 to 30%. Early diagnosis and a prompt antibiotic therapy have considerably decreased the mortality rate and this study was done to determine drug resistance pattern among causative organisms of SBP. Objective; To determine the frequency of different causative organisms of spontaneous bacterial peritonitis (SBP) and their sensitivity pattern in patients with liver cirrhosis. Material and Methods; A total of 183 patients with liver cirrhosis having SBP were included in this descriptive cross-sectional study. The study was conducted at department of Medicine. Patients were subjected to ascitic fluid tap, under aseptic measures by inserting a needle of 22 / 18 gauge in the left flank of abdomen. Ten ml of ascitic fluid was aspirated in a heparinised disposable syringe; which was immediately inoculated into blood culture bottle at bedside and send for bacterial culture and causative organisms was tested for their antibiotic drug resistance pattern. Data was entered and analyzed by computer program SPSS-18. Results; Of these 183 study cases, 103 (56.3%) were male patients while 80 (43.7%) were female patients. Mean age of our study cases was 51.73 ± 9.28 years. Previous history of use of antibiotics before 72 hours was noted in 103 (56.3%), anti – HCV was positive in 103 (56.3%) while HBs Ag was positive in 13.7% of our study cases. Among these study cases, E.coli was noted in 135 (73.8%), Staph. Aureus in 17.5% and Klebsiella was noted in 8.7%. Chloramphenicol was resistant in 24 (13.1%), ampicillin was resistant in 143 (78.1%), co – trimoxazole in 61.2%, ciprofloxacin in 55.7%, Ofloxacin in 56.3%, Cefotaxime was resistant in 78.1% and amoxicillin was resistant in 74.9%. Conclusion; Our study results have indicated that E.coli was major causative organisms among patients with spontaneous bacterial peritonitis having cirrhosis of liver followed by staphylococcus aureus and klebsiella. High degree of drug resistance was observed among  these strains in our study which points towards well directed efforts of our health policy makers to adopt certain guidelines regarding use of these drugs in our population. Keywords; Cirrhosis, spontaneous bacterial peritonitis, E. coli

Efek Penambahan Fraksi Polar F29-F32 Ekstak Metanolik Meniran (Phyllanthus niruri L.) terhadap Daya Hambat Chloramphenicol dan Amoxicillin pada Staphylococcus aureus dan Escherichia coli

ABSTRACTIntroduction: One solution to overcome antibiotic resistance is addition of adjuvants from herbs. Previous study found the extract of stonebreaker (Phyllanthus niruri, L.) works synergistically with Amoxicillin against E.coli. However, the active compound that interacts with these antibiotics are not yet known. This study separates active compounds with polar fraction and  examines the combination of stonebreaker with antibiotics in inhibiting the development of S. aureus and E. coli.Method: Fractionation was carried out on methanolic simplisia extract of Phyllanthun niruri L. using silica resin with an eluent of 100% methanol. The fractionation results were tested by Thin Layer Chromatography (TLC) using Dragendroff, FeCl3, and Formaldehyde reagents. Single (fraction) and combination (fraction and antibiotic) inhibition was measured using Kirby-Bauer method, and the interaction analysis based on AZDAST (Ameri-Ziaei Double Antibiotic Synergism Test). Statistical tests were used Mann-Whitney with was significance of P<0.05.Result Fractination produced 4 fractions (F29-F32). The results of fractions 29-32 were found to contain phenol compounds, but other staining reagents did not found positive result. Fractions 29, 31 and 32 in stonebreaker had a single inhibitory activity against S. aureus. Fractions 30 and 32 in stonebreaker had a single inhibitory activity against E. coli. The combination of fraction 29 and Amoxicillin (10.6±1.1 mm) had a smaller ZOI than a single fraction ZOI (13.6 ± 1.5 mm). The combination of fraction 30 and Cholamphenicol (17.3±0.57 mm) had a smaller ZOI than a single ZOI Chloramphenicol (19.6±0.57 mm).Conclusion fractions 29-32 were found to contain phenol compounds. Combination of fraction 29 and Amoxicillin are antagonistic to S. aureus and combination of fraction 30 and Chloramphenicol are antagonistic to E.coli. (p<0.05)Keywords: Phyllanthus niruri, L., Polar Fraction, Staphylococcus aureus, Escherichia col

A compact and lightweight microstrip antenna array with Wilkinson power divider for X-band application at 9.5 GHz

In this paper, a two-element microstrip antenna array with a compatible 1:2 Wilkinson Power Divider operating at 9.5 GHz for X-band application is presented. The design, simulation and optimization of this work are performed using Computer Simulation Technology (CST) Microwave Studio. The proposed design is shown to exhibit good simulation performances with return loss of -38.21 dB, bandwidth of 493 MHz, and gain of 7.08 dB. Coupled with the antenna array, a 1:2 Wilkinson Power Divider is then designed, simulated and optimized. The simulation result of the power divider exhibits three modes of resonance at 8.0-8.5 GHz, 9.09-10.28 GHz and 11.2-11.5 GHz. The operating frequency at 9.5 GHz resulted an equal power division with insertion loss less than 3.68 dB and less mutual coupling as the isolation factor is at 16.23 dB. The antenna array and Wilkinson Power Divider configuration produced an overall dimension of 83.14 mm 67.34 mm, which realized a portable solution for the parabolic reflector antenna

Knowledge, attitude and perceptions of Muslim cancer patients regarding cancer treatment during Ramadan: Results from a tertiary care hospital Karachi

Objective: To assess the knowledge and attitude of Muslim cancer patients regarding cancer treatment during Ramadan.Methods: This cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from July to August 2015, and comprised cancer patients. .Adult Muslim cancer patients receiving active oncological treatment or on surveillance were included. Patients on only supportive treatment were excluded. SPSS 19 was used for data analysis.Results: Of the 265 patients, 87(32.8%) were males and 178(67.2%) were females. The overall mean age was 49±13.87 years. Besides, 184(70.9%) patients belonged to the middle class. Breast cancer was the most common cancer 106(40.6%). Overall, 153(57.9%) patients had stage II disease. Further, 201(80%) patients had 0-1 performance status. Moreover, 180(72%) patients were receiving different forms of chemotherapeutic agents. It was found that 113(54.3%) patients sought advice regarding fasting. Most of the patients who observed fast, i.e. 214(81%), had an early stage disease and 19(7.1%) were on hormonal therapy. Patients who did not fast mostly attributed this to fatigue 69(26.3%). Conclusion: Only half of the patients sought advice on fasting and those having early disease more.Conclusions: Only half of the patients sought advice on fasting and those having early disease more frequently observed fast

Factors associated with the risk of type 2 Diabetes in women of childbearing age in a selected community in Malaysia

Women of childbearing age are at increased risk of type 2 diabetes (T2D), possibly due to metabolic alterations during pregnancy that contributes towards insulin resistance. However, limited studies assessed T2D risk specifically in Malaysian women of childbearing age. Hence, this study was conducted to determine factors associated with T2D risk in women of childbearing age at a selected public university in Malaysia. This cross-sectional study involved 83 childbearing-age women in Universiti Putra Malaysia (mean age: 37.7 ± 5.7 years; BMI: 26.6 ± 6.0 kg/m2). Weight, height and waist circumference were measured, and body mass index was calculated. Dietary intake and diabetes knowledge were assessed using a food frequency questionnaire and Diabetes Knowledge Questionnaire (DKQ-24), respectively. The Finnish Diabetes Risk Score (FINDRISC) tool predicted T2D risk within 10 years. A total of 66.3% (n = 55) respondents were at risk of T2D. The majority of the subjects (74%) had poor diabetes knowledge scores. Fibre intake was inadequate compared to the recommended range. Waist circumference, first- and second-degree family history of diabetes was significantly associated with increased T2D risk (p = 0.016, 0.001 and 0.009, respectively), whereas a daily consumption of fruits and vegetables was associated with reduced T2D risk (p = 0.024). The findings highlight the importance of public health action, including nutrition education, after delivery to prevent or delay their progression towards T2D

Epidemiology of Methicillin-resistant and Methicillin-sensitive Staphylococcus aureus infections in Lebanon

Background. Methicillin-resistant Staphylococcus aureus (MRSA) is a prevalent pathogen associated with significant morbidity and mortality. In Lebanon, MRSA rates have recently started to rise. We aimed to determine risk factors for acquiring MRSA and Methicillin-sensitive Staphylococcus aureus (MSSA) infections and identify independent risk factors for in-hospital mortality among patients with S. aureus infection. Methods. We used a case-case-control study design that included patients with infections and compared them to uninfected controls. Two multivariable regression models were constructed to determine variables associated with acquiring MRSA and MSSA infections. We explored independent predictors of mortality in the overall population compared with the MRSA subgroup. Results. 356 patients with S. aureus infections were identified and compared to 208 uninfected controls. A recent history of surgery and underlying diabetes were independent risk factors for acquiring both infections. Having a urinary catheter for more than 6 days and steroid therapy were unique risk factors for MRSA infection (aOR 28.1, 95% CI 3.5-223.6 and 3.7, 95% CI 1.6-8.7, respectively). Risk factors exclusively associated with MRSA infection included ICU admission, acute renal failure, and malignancy. Conclusions. Risk factors associated with MRSA infection are distinct from those associated with MSSA infection. This can be used to risk stratify patients and will aid in choosing empirical antibiotic therapy

Accuracy of procalcitonin levels for diagnosis of culture-positive sepsis in critically ill trauma patients: A retrospective analysis

Background: Abdominal trauma and intra-abdominal sepsis are associated with significant morbidity and mortality. Microcirculation in the gut is disrupted in hemorrhagic and septic shock leading to tissue hypoxia, and the damaged gut acts as a reservoir rich in inflammatory mediators and provides a continual source of inflammation to the systemic circulation leading to sepsis. Sepsis is defined as the presence (probable or documented) of infection together with a systemic inflammatory response to infection. Blood culture is commonly considered to be the preferred approach for diagnosing sepsis, although it is time-consuming, that is, reports are normally available only after 12-48 hours. Procalcitonin levels (PCT) have recently emerged as a promising biomarker in the diagnosis of sepsis. The aim of the present study is to determine the diagnostic accuracy of PCT levels in predicting sepsis in critically ill trauma patients.Methodology: This was designed as a validation study conducted in the Indoor Department of General Surgery, Liaquat National Hospital, Karachi. The sample size was calculated by taking the estimated frequency of sepsis in suspected patients at 62.13%, expected sensitivity of PCT at 70.83%, and specificity at 84.21% and the desired precision level of 12% for sensitivity; the calculated sample size was 96. The non-probability consecutive sampling method was used to recruit participants who were diagnosed with sepsis on clinical assessment. Blood culture samples were sent for the enrolled patients and a final diagnosis was made on the blood culture report. PCT levels were measured in these suspected patients on the same day of sending blood culture. Diagnostic accuracy of PCT size was measured using the receiver operating characteristic (ROC) curve. ROC curve was formulated for PCT levels against culture-proven sepsis to determine the ideal cut-off value of PCT levels. Two different cut-offs were determined to obtain the highest sensitivity and highest specificity accordingly.Results: A total of 97 individuals met the inclusion criteria with a mean age of 34.89 ± 10.52 years. Mean PCT levels were 0.96 ± 0.59, with a gender predilection towards females (p \u3c 0.001). No age difference was documented among gender (p = 0.655). The mean duration of intensive care unit stay was 11.73 ± 3.56 days. Culture-proven sepsis was identified in 67.0% of the study participants with a higher PCT level (p \u3c 0.001). Among the 52.6% males included in the study, half were reported to have culture-positive sepsis, but among the 47.4% females culture was positive in 87% (p \u3c 0.001). ROC revealed PCT was predictive for culture-positive sepsis at a cut-off value 0.47 ng/mL (p \u3c 0.001), with a sensitivity of 92.3%, specificity of 68.7%, positive predictive value (PPV) of 85.7%, and negative predictive value (NPV) of 81.5%. By increasing the cut-off value to 0.90 ng/mL at area under the curve of 0.816, the specificity increased to 81.3% and sensitivity became 66.2%, with a PPV of 87.8% and NPV of 54.2%.Conclusion: Our study determined two cut-values for PCT to predict sepsis, one with the highest sensitivity and the other with better specificity. Other than that, higher PCT levels were significant in female trauma patients. We conclude that PCT is a reliable marker for culture-proven diagnosis of sepsis and may aid physicians/surgeons to promptly manage patients accordingly