Culture-Based Identification of Causative Organisms in Ascitic Fluids of Patients with Spontaneous Bacterial Peritonitis Secondary to Decompensated Liver Disease and their Sensitivities to Ceftriaxone as an Empiric Therapy

OBJECTIVES To identify the pathogens in the ascitic fluids of patients with spontaneous bacterial peritonitis and then to determine their sensitivity pattern to ceftriaxone. METHODOLOGY The cross-sectional study was conducted at the Medical Unit-A, Department of Medicine, Hayatabad Medical Complex, Peshawar, from November 2021 to April 2022. Before ceftriaxone treatment was started, a minimum of 10 ml of ascitic fluid was introduced into a blood culture vial. Only patients with a positive culture were registered, and their information was gathered using a proforma. For statistical analysis, SPSS version 23 was used. RESULTSA total of 96 patients were enrolled in our study. There were 62 (59.52%) male and 34 (40.48%) female patients. Based on the isolation and identification of bacteria, the most prevalent bacteria isolated was Escherichia coli in 36 (37.5%) patients, followed by Acinetobacter Spp in 13 (13.54%) patients, Streptococcus spp in 14 (14.58%), Enterococcus spp in 11 (11.45%), Staphylococcus aureus in 9 (9.39%), MRSA in 8(8.33%) and K. Pneumonia in  5(5.21%) patients. The overall sensitivity of ceftriaxone to gram-positive bacteria was observed in 12 (42.85%) isolates, whereas the overall sensitivity of ceftriaxone to gram-negative bacteria was observed in 25 (36.76%) isolates. (p=0.091) (Figure 6). CONCLUSION Our study concludes that gram-negative bacteria were more prevalent than gram-positive bacteria in ascitic fluids of patients with spontaneous bacterial peritonitis. The most common isolated pathogen was E.coli. Gram-negative was more resistant to ceftriaxone as compared to gram-positive bacteria

Emerging Threat: First Case of West Nile Virus Encephalitis in Peshawar, Pakistan

West Nile Virus (WNV), once confined primarily to Africa, is now an emerging communicable disease in Pakistan. Clinical cases and serological evidence of WNV infection have been documented in both human and animal populations in the Punjab and Sindh provinces of Pakistan. We report the first case of WNV encephalitis in an 80-year-old hypertensive and diabetic lady from district Peshawar. Sadly, the patient did not survive. This case highlights the importance of thinking of zebras in addition to horses when confronted with the sound of hoofbeats, as ‘zebra diagnoses’ do exist. Clinicians shall consider novel infections when evaluating patients with fever and altered mental status

Malnutrition levels among type-2 diabetes mellitus patients in Pakistani a multi center study

Objective: To determine the frequency of malnutrition among T2DM patients in tertiary care. Place and Duration of Study: Departments of Medicine Hayatabad medical complex peshawar Pakistan from jan 2020 to July 2021. Methodology: this Multi-center study conducted in department of medicine hmc hospital Peshawar from jan 2020 to July 2021.  total of 130 T2DM patients were assessed for nutritional evaluation with the assistance of a nurse and supporting staff. With the use of a questionnaire and a Subjective Global Assessment form, the data was collected (SGA). With the aid of MS Excel and SPSS, the nutritional risk factors and malnutrition status were determined, and the data was statistically examined. Results: The results of our recent study showed that, of the 130 patients, 62 48% were at intermediate risk of malnutrition and 68/52% were at high risk. Similar to this, 48 individuals had severe malnutrition, while 80 patients were classified as having moderate malnutrition. Obese Class-I, with the greatest risk of malnutrition and the highest frequency of severe malnutrition, has been proven to have the highest incidence among the different BMI categories. 0.920 is the correlation coefficient R2.&nbsp

Deficiency of vitamin D in patients with chronic liver disease at department of medicine HMC Peshawar a multi center study

Background: Multiple nutrients are deficient in people with chronic liver disease (CLD), but vitamin D insufficiency is more prevalent in CLD patients than in patients with other deficiencies. As a result of liver fibrosis, the liver's synthetic abilities are diminished, and this compromises activation through a decrease in vitamin D Binding Protein, which results in vitamin D insufficiency. The situation is further complicated by a decline in performance and nutritional deficiencies. The research examined the prevalence of vitamin D insufficiency in people with chronic liver disease and its relationship to the severity of the condition. Methodology: The Multi center study conducted in department of Medicine at the Hayatabad Medical Complex in Peshawar carried out this. 71 CLD patients who satisfied the criteria were included in the research. Three groups of patients were divided based on their Child-Pugh scores. The patient's vitamin D levels were examined by hospital laboratories. Serum (26,OH)D concentrations below 30 nmol/L were considered to represent [vitamin D] insufficiency levels. The data were examined using SPSS version 22. Results: 71 CLD patients were assessed. In this study the (mean age) was 52.43 ± 12.190.years. The (male-to-female ratio) was 02.04:01.&nbsp

Finding strongly linked between anemia and diabetic foot ulcers: A multi center study

Objective: Diabetic foot ulcers and anemia are two typical complications of diabetes. For this reason, we set out to gather data on the prevalence of anemia in persons with and without diabetic foot ulcers (DFUs) of similar ages and sex. Method: The Department of Medicine HMC hospital Peshawar conducted this multi-center study from October 2020 to October 2021 in their interdisciplinary diabetic foot clinic. Those who took part in the study were split into two groups: those with DFUs (the Case group) and those without (the Control group) (people without DFUs). Biochemical and hematological markers, as well as demographic data, were collected from the outset. DFU in the case group was categorized and staged using the UT system. Anemic subjects with other obvious explanations were not included. Controls were recruited from a diabetes clinic that offered presentations during the same time frame. SPSS version 24 was used for the statistical analysis of the data. Results: A total of  80 people were studied, split evenly between the case and control groups regarding age and gender. Men made up the majority of the 60 participants (74%).&nbsp

Comparison of lipid profiles and hypertension in type 02 diabetes mellitus patients with and without hypertension a multi center study

Introduction: Persistent hyperglycemia and anomalies in the metabolism of proteins, lipids, and carbohydrates are hallmarks of diabetes mellitus, which is brought on by insufficient insulin synthesis or action. Other associated systemic problems, such dyslipidemia and hypertension, may result from this. Dyslipidemia increases cardiovascular events such persistent high blood pressure by raising serum triglycerides, free fatty acids, and HDL cholesterol and lowering it. This research examined hyperlipidemia. Type 2 diabetics, regardless of hypertension. Objective: to compare T2DM with and without hypertension, the present study evaluated the blood lipid profiles of both groups. Layout of the study An experimental research approach is used, along with a comparative study methodology. Methodology: the multi-center study conducted in department of medicine HMC hospital Peshawar OPDs and Out Door Patients hosted the research. From January 2021 to January 2022, performed lab tests. The Multi center study achieved our aim. The study comprised 100 type 2 diabetics divided into cases and controls. Cases had type 02 diabetes and hypertension, but controls did not. Both groups estimated cholesterol, triglycerides, LDL, and HDL levels. The statistical analysis uses SPSS version 28. Mean values and an independent student T-test were used to compare groups

Neonatal Hyperbilirubinemia in infants with <it>G6PD c.563C > T</it><it>Variant</it>

<p>Abstract</p> <p>Background</p> <p>There is a strong correlation between glucose-6-phosphate dehydrogenase (G6PD) deficiency and neonatal hyperbilirubinemia with a rare but potential threat of devastating acute bilirubin encephalopathy. G6PD deficiency was observed in 4–14% of hospitalized icteric neonates in Pakistan. <it>G6PD c.563C > T</it> is the most frequently reported variant in this population. The present study was aimed at evaluating the time to onset of hyperbilirubinemia and the postnatal bilirubin trajectory in infants having <it>G6PD c.563C > T.</it></p> <p>Methods</p> <p>This was a case–control study conducted at The Aga Khan University, Pakistan during the year 2008. We studied 216 icteric male neonates who were re-admitted for phototherapy during the study period. No selection was exercised. Medical records showed that 32 were G6PD deficient while 184 were G6PD normal. Each infant was studied for birth weight, gestational age, age at the time of presentation, presence of cephalhematoma, sepsis and neurological signs, peak bilirubin level, age at peak bilirubin level, days of hospitalization, whether phototherapy or exchange blood transfusion was initiated, and the outcome. During hospital stay, each baby was tested for complete blood count, reticulocyte count, ABO and Rh blood type, direct antiglobulin test and quantitative G6PD estimation [by kinetic determination of G6PDH]. <it>G6PDgenotype</it> was analyzed in 32 deficient infants through PCR-RFLP analysis and gene sequencing.</p> <p>Results</p> <p><it>G6PD variants c.563C > T</it> and <it>c.131 C > G</it> were observed in 21 (65%) and three (9%) of the 32 G6PD deficient infants, respectively. DNA of eight (25%) newborns remained uncharacterized. In contrast to G6PD normal neonates, infants with <it>c.563C > T</it> variant had significantly lower enzyme activity (mean ± 1SD; 0.3 ± 0.2 U/gHb vs. 14.0 ± 4.5 U/gHb, <it>p</it> < 0.001) experienced higher peak levels of total serum bilirubin (mean ± 1SD; 16.8 ± 5.4 mg/dl vs. 13.8 ± 4.6 mg/dl, <it>p =</it> 0.008) which peaked earlier after birth (mean ± 1SD 2.9 ± 1.6 vs. 4.3 ± 2.3 days, <it>p =</it> 0.007). No statistically significant difference was observed in mean weight, age at presentation, hemoglobin, reticulocyte count, TSH level, hospital stay or in the frequency of initiation of phototherapy or blood exchange between the two groups.</p> <p>Conclusions</p> <p>We concluded that infants with <it>G6PD c.563C > T</it> variant developed jaundice earlier than infants with normal G6PD enzyme levels. Compared to G6PD normal infants, <it>G6PD c.563C > T</it> carrying infants had significantly low G6PD activity.</p