Dairy Staphylococcus aureus: Epidemiology, Drug Susceptibilities, Drug Modulation, and Preventive Measures

Staphylococcus aureus is an emerging pathogen from dairy animals’ mammary glands. Among various risk factors associated with this pathogen are unhygienic milking procedures, improper preventive techniques, and lack of germicidal teat dipping before and after milking. Methicillin-resistant S. aureus, coagulase positive S. aureus, vancomycin-resistant S. aureus, and biofilm-producing S. aureus are common strains of S. aureus being isolated from dairy milk these days. They have huge economic and public health concerns. Trials of antibiotic susceptibility proposed variable responses, while drug modulation and drug synergistic proved to be hope for its treatment. Some of the plant derivative, phages, and nanoparticles are non-antibiotic sources to treat S. aureus. Various attempts to treat S. aureus at the world level have been carried out but require more researches to be undertaken in order to prevent it. The chapter concludes that S. aureus from dairy needs equal attention as is given to S. aureus from the human origin, and researches are required to probe solutions

Microbiological and clinical profile of infective endocarditis patients: an observational study experience from tertiary care center Karachi Pakistan

Background: The study analyzed microbiological and antimicrobial susceptibility profile of organisms isolated from patients with infective endocarditis (2015–17) and compared disease outcomes in cohorts of endocarditis patient with history of prior invasive vascular intervention (high risk group) vs those without (native valve group). We hypothesized that high risk group would be more likely to have severe disease outcomes. Methods: This was a prospective cohort study (2015–17). All blood and cardiac tissue samples of enrolled patients suspected of endocarditis according to modified Duke’s criteria were followed for microbiological and antimicrobial susceptibility profile. The high risk group was compared with the native valve group with 90 day follow up to determine difference in clinical course and outcome in terms of disease severity (defined as any patient with endocarditis undergoing surgical management, readmission or dying). The data was analyzed using SPSS 21.0 software and chi-square test. 90 day mortality was calculated using Kaplan Meier survival curves. Results: Total 104 patients with endocarditis were enrolled. Overall culture positivity rate was 71.2%. Streptococcus species were the most common isolate (36.7%), followed by S. aureus (17.3%) cases. In Streptococcus species, 14.2% showed intermediate susceptibility to penicillin. Thirty six patients were included in the cohort analysis. A poor outcome was seen in 85.7% high risk group as compared to 50% of native valve group. The overall mortality rate was 19.4%. Conclusions: We found Streptococcus species to be the predominant pathogen for endocarditis overall. However Staphylococcus aureus predominated native valve group. High risk group showed more complicated clinical cours

Respiratory pathogens in patients with acute exacerbation of non-cystic fibrosis bronchiectasis from a developing country

Bronchiectasis unrelated to cystic fibrosis (non-CF bronchiectasis) has become a major respiratory disease in developing nations. The dilated mucus filled airways promote bacterial overgrowth followed by chronic infection, bronchial inflammation, lung injury and re-infection Accurate pathogen identification and antimicrobial susceptibility allowing appropriate treatment, in turn, may break this vicious cycle. To study the spectrum and antimicrobial spectrum of pathogen yielded from respiratory specimens in adult patients with acute exacerbation of non-cystic fibrosis (CF) bronchiectasis. This cross-sectional study was performed at the pulmonology clinics of the Aga Khan University, Karachi, Pakistan from 2016-2019. Respiratory specimens were collected from adult patients with acute exacerbation of non-CF bronchiectasis presenting in pulmonology clinics. Microbial cultures were performed using standard methodology. Susceptibility testing was performed and interpreted using Clinical Laboratory Standard Institute criteria. A total of 345 positive cultures from 160 patients presenting with acute exacerbation were evaluated. The most frequent organisms were Pseudomonas aeruginosa (n=209) followed by Hemophilus influenzae (n=40) and Staphylococcus aureus (n=24). High rates of antimicrobial resistance were found in all these pathogens. Proportion of Pseudomonas aeruginosa strains resistant to ciprofloxacin, imipenem, ceftazidime and piperacillin-tazobactam were 27.1%, 16.8%, 14.8% and 13.1% respectively. 65% of Hemophilus influenzae strains were resistant to cotrimoxazole and ciprofloxacin and 66.7% of Staphylococcus aureus strains were resistant to methicillin. High antimicrobial resistance in non-CF bronchiectasis patients against commonly used antimicrobials is a concern and highlight need for urgent community level interventions to improve clinical outcome in these patients

Reconnoitering Milk Constituents of Different Species, Probing and Soliciting Factors to Its Soundness

Milk composition and production varies from species to species, reflecting its diversified benefits on health. Lipids from caprine and ovine milk are anti-obesity and anti-atherogenic while prebiotic in the case of caprine. Higher contents of selenium from caprine and iron from camel milk play a role in immune system and oxygen transport system, respectively, whereas enriched vitamins like riboflavin, folic acid, B6, vitamin A of bovine, and foliate of cattle are effective in the synthesis of hemoglobin, and high niacin content of caprine is anti-cancerous. Camel milk is found to have characteristics of anti-carcinogenic, antidiabetic, and autoimmune therapeutic. Various processing techniques like pasteurization, skim milk powder processing, and ultra-high temperature processing are necessary for safe provision of milk to meet consumers’ demand. Change in flavor, loss of micronutrients, biofilm production, and spore-forming bacteria are prominent challenges during processing. Antimicrobial resistance and disease conditions are exaggerating factors of milk deterioration with respect to quality and quantity. Preclinical trials like somatic cell count, California mastitis test, proteomic analysis, Raman spectroscopy-based analysis, and X-ray fluorescence analysis are helpful in avoiding the spread of disease and controlling of economic losses. This chapter focuses differential functions of bioactive of milk, issues arising during processing techniques, and preclinical studies of milk for safer production and consumption of milk

Diagnostic accuracy of different cut-off values of adenosine deaminase levels in tuberculous pleural effusion

Objective: To assess the diagnostic accuracy of different cut-off values of pleural fluid adenosine deaminase levels as a diagnostic method for tuberculous pleural effusion. Method: The prospective study was conducted from 2014 to 2016 at the Aga Khan University Hospital, Karachi, and comprised pleural fluid samples of adult patients with and without tuberculosis which were tested for adenosine deaminase levels, and divided into tuberculosis group A and non-tuberculosis group B. Sensitivity, specificity, negative predictive value and positive predictive value were calculated using different cut-offs. Data was analysed using IBM SPSS (Statistical Package for Social Sciences) version 21.0 (IBM Corp., Armonk, NY). Results: Of 155 patients, 46(29.7%) had tuberculosis; 30(65.2%) males and 16(34.8%) females. Those who did not have tuberculosis were 109(70.3%); 69(63.3%) males and 40(36.7%) females. The adenosine deaminase levels were elevated in group A compared to group B (p\u3c0.001). The cut-off of 30U/L showed the highest sensitivity (71.7%) and negative predictive value (87.4%), and a specificity of 82.6%. The cut-off of 50U/L showed the highest specificity (89.9%) with sensitivity 52.2%, and the cut-off of 40U/L showed the highest positive predictive value of 68.9% with sensitivity 67.4% and specificity 87.2%. Conclusion: Pleural fluid adenosine deaminase testing for diagnosing tuberculosis pleuritis revealed highest sensitivity and moderate specificity for cut-off value of 30U/

The Point Prevalence, Etiological and Hemato-Biochemical Investigations of Post-Parturient Haemoglobinuria (PPHU) in Buffalo Population in Tehsil Bhalwal, Pakistan

The current study was designed to explore all possible etiological features including mineral composition of soil and their effects on hemato-biochemical profile in buffaloes suffering from post-parturient hemoglobinuria. The total 384 buffaloes were randomly selected from Tehsil Bhalwal, District Sargodha, Pakistan. The post parturient hemoglobinuria was observed during the period of four months, from November 2016 to February 2017. The parameters including point prevalence of PPHU and hemato-biochemical profile were investigated. The data was analyzed using T-test and regression analysis through SPSS software. Out of 384 animals, 40 (10.4%) were confirmed with PPHU. All hemato-biochemical profile showed significant difference between healthy and affected groups instead mean corpuscular hemoglobin concentration (MCHC), serum calcium and glucose, which were not significant. Vital signs including pulse and respiration showed significant difference but heart rate was found non-significant between both groups. The results regarding mineral analysis of the soil showed significant difference in phosphorus and copper and non-significant difference in calcium and molybdenum. Moreover, strong positive correlation was associated with phosphorus and molybdenum level while moderate positive correlation was attributed to the calcium and copper level in the soil. It is concluded that post parturient hemoglobinuria in buffaloes of Tehsil Bhalwal was associated with variation of soil composition, particularly the deficiency of phosphorus which is main cause of hemoglobinuria. It is necessary to fulfill the minerals requirement of soil and animal’s feed to overcome the problems of PPHU in affected areas.

Comparison of clinical presentation and out-comes of chikungunya and dengue virus infections in patients with acute undifferentiated febrile illness from the Sindh region of Pakistan

Background: Arboviruses are a cause of acute febrile illness and outbreaks worldwide. Recent outbreaks of Chikungunya virus (CHIKV) in dengue endemic areas have alarmed clinicians as unique clinical features differentiating CHIKV from Dengue virus (DENV) are limited. This has complicated diagnostic efforts especially in resource limited countries where lab testing is not easily available. Therefore, it is essential to analyse and compare clinical features of laboratory confirmed cases to assist clinicians in suspecting possible CHIKV infection at time of clinical presentation.Methodology: A prospective point prevalence study was conducted, with the hypothesis that not all patients presenting with clinical suspicion of dengue infections at local hospitals are suffering from dengue and that other arboviruses such as Chikungunya, West Nile viruses, Japanese Encephalitis virus and Zika virus are co-circulating in the Sindh region of Pakistan. Out-patients and hospitalized (in-patients) of selected district hospitals in different parts of Sindh province of Pakistan were recruited. Patients with presumptive dengue like illness (Syndromic diagnosis) by the treating physicians were enrolled between 2015 and 2017. Current study is a subset of larger study mentioned above. Here-in we compared laboratory confirmed cases of CHIKV and DENV to assess clinical features and laboratory findings that may help differentiate CHIKV from DENV infection at the time of clinical presentation.Results: Ninety-eight (n = 98) cases tested positive for CHIKV, by IgM and PCR and these were selected for comparative analysis with DENV confirmed cases (n = 171). On multivariable analysis, presence of musculoskeletal [OR = 2.5 (95% CI:1.6-4.0)] and neurological symptoms [OR = 4.4 (95% CI:1.9-10.2)], and thrombocytosis [OR = 2.2 (95% CI:1.1-4.0)] were associated with CHIKV infection, while atypical lymphocytes [OR = 8.3 (95% CI:4.2-16.7)] and thrombocytopenia [OR = 8.1 (95% CI:1.7-38.8)] were associated with DENV cases at time of presentation. These findings may help clinicians in differentiating CHIKV from DENV infection.Conclusion: CHIKV is an important cause of illness amongst patients presenting with acute febrile illness in Sindh region of Pakistan. Arthralgia and encephalitis at time of presentation among patients with dengue-like illness should prompt suspicion of CHIKV infection, and laboratory confirmation must be sought

Leptospirosis: Rising Nuisance for Cattle and Threat to Public Health

Leptospirosis is a communicable disease at farms that results in abortion and pathological changes in animals and human respectively. Disease is majorly spreading through indirect contact with contaminated urine material. The causative agent belongs to Leptospira genus having 21 species, 25 serogroups, and 250 serovars. The prevalence noted at world level is counted to be 41.39% with 30.11% in Asia, 25.62% in Africa, and 46.42% in South Africa. The virulence is attributed to Loa22 protein which is the first protein identified as essential virulence factor. Pathogenesis involves vasculitis following which are direct cytotoxicity and immunological injury resulting in renal failure. Direct examination, PCR, isothermal methods, microscopic agglutination test (MAT) and IgM enzyme-linked immunosorbent assay (ELISA) are diagnostic approaches for leptospirosis. The MAT is a gold standard test for leptospirosis identification. Doxycycline and azithromycin were used as drugs against leptospirosis in mild and severe cases of leptospirosis. Further studies are needed regarding identification, treatment, and effective vaccination

Principles of Anesthesia and Airway Management in Head and Neck Surgery

This topic aims to discuss key aspects of anesthetic and airway management for head and neck surgery. Airway management is a central part of patient care and management in Head and Neck Surgery. Common challenges in Head and Neck surgery are shared airway, distorted airway anatomy due to existing pathology; risk of airway obstruction, disconnection or loss of airway intra-operatively; risk of soiling of the airway due to bleeding and surgical debris; and the potential for airway compromise post-operatively. The option for airway management technique is influenced by patient’s factors, anesthetic needs, and surgical requirements. Intubation technique necessitating either a small or large cuffed tracheal tube with a throat pack provides the highest level of airway protection Non-intubation or open airway techniques involve mask ventilation, apneic techniques, and insufflation techniques, or the use of a laryngeal mask airway. Lastly, jet ventilation techniques may be conducted via a supraglottic, subglottic or transtracheal routes. It is essential to have clear airway management plans including rescue airway strategies that should be communicated with the surgeons and patients at the earliest opportunity

Laser based study of interacting autoionising reonances in the spectra of calcium, barium and strontium

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