Ralstonia pickettii Bacteremia: An Emerging Infection in a Tertiary Care Hospital Setting

Ralstonia species are Gram-negative bacilli that have increasingly been recognized as emerging nosocomial pathogens, particularly in immunocompromised hosts. Ralstonia pickettii is the most clinically important pathogen from the Ralstonia genus. Nosocomial outbreaks of Ralstonia pickettii infections brought about by the use of contaminated medical solutions, including saline, sterile water, as well as disinfectants, have been reported. There have been case reports of invasive infections with variable presentations. Here, we describe three cases of Ralstonia pickettii bacteremia during a period of one year in a tertiary care hospital in Karachi, Pakistan. The first case was a 76-year-old male, known case of type 2 diabetes mellitus (DM), hypertension, and amyotrophic lateral sclerosis, who presented with complaints of burning micturition, hematuria, and fever. The patient had a history of multiple hospital admissions in the recent past. His blood culture was found to be positive for Ralstonia pickettii. A computed tomography scan of the kidneys, ureter, and bladder (CT KUB) was suggestive of pyelonephritis. The patient improved on intravenous meropenem. The second case was a 47-year-old man, who was admitted with a gunshot injury to the neck, resulting in complete cervical cord resection and mild hydrocephalus with intraventricular hemorrhage. The patient had a prolonged intensive care unit (ICU) stay, which was complicated by ventilator-associated pneumonia with Acinetobacter and central line-associated bloodstream infection (CLABSI) with Ralstonia pickettii. He was treated with meropenem and colistin but continued to deteriorate and expired. The third case was a 46-year-old lady, known case of end-stage renal disease (ESRD), who was admitted with prosthetic valve endocarditis. She had a prolonged hospital stay complicated by CLABSI with Ralstonia pickettii, improved on meropenem, but later died due to fungemia. Ralstonia pickettii is an emerging cause of nosocomial infection in patients, particularly those with a prolonged hospital stay, and can cause invasive and severe infections

Stigma towards people with mental illness and community mental health ideology among university students: A comparative study

The study examines the difference between the stigma among psychology and non-psychology students towards people with mental illness and to find out their ideology towards community mental health services. A cross-sectional study was conducted among university students. All together (N= 300) participants were recruited through the quota convenient sampling. CAMI (Community Attitude towards the Mentally Ill) scale was used in this research, assess four types of attitudes towards mental illness (i.e., Authoritarianism, Benevolence, Social restrictiveness, and Community mental health ideology). The findings of this study show a significant difference between the attitudes of psychology and non-psychology students. Both the subscales, authoritarianism and social restrictiveness conclude that non-psychology students showed more authoritative and restrictive behavior towards mentally ill people and are less oriented towards community mental health ideology as compared to psychology students. However, psychology students showed less benevolence as compared to non-psychology students towards mentally ill people. Additional findings indicated that the level of authoritarianism, social restrictiveness, and benevolence is high among males as compared to females. The study highlights the need for society to develop a plan and action to change stigma attached to mental illness at both institutional and community levels

Molecular characterization, cloning and sequencing of coat protein gene of a Pakistani potato leaf roll virus isolate and its phylogenetic analysis

Total RNA was extracted from potato leaf roll virus (PLRV) positive potato plants and complementary DNA were synthesized. Reverse transcriptase polymerase chain reaction (RT-PCR) based detection conditions were optimized by using coat protein (CP) gene specific primers. A 346 bp amplicon of PLRV- coat protein (CP) gene was amplified. Amplified CP-gene of PLRV was cloned in TA cloning vector, PCR ® 2.1. The clone was confirmed subsequently through restriction digestion analysis. PCR amplification used cDNA clone as a template and nucleotide sequencing. Expected nucleotide sequence of amplified PLRV-CP gene show homology of 94 to 97% when compared to the sequences already reported in GenBank database. This explored novel PLRV-CP gene was submitted at NCBI GenBank for characterization of PLRV Pakistani isolate (Accession No. JN039286). Phylogenetic analysis was also carried out and tree was made by using MEGA 4.0.Key words: Potato, potato leaf roll virus (PLRV), coat protein (CP) gene, reverse transcriptase polymerase chain reaction (RT-PCR), PLRV-CP Pakistani isolate

Population study of 1311 C/T polymorphism of Glucose 6 Phosphate Dehydrogenase gene in Pakistan – an analysis of 715 X-chromosomes

<p>Abstract</p> <p>Background</p> <p>Nucleotide 1311 polymorphism at exon 11 of G6PD gene is widely prevalent in various populations of the world. The aim of the study was to evaluate 1311 polymorphism in subjects carrying G6PD Mediterranean gene and in general population living in Pakistan.</p> <p>Results</p> <p>Patients already known to be G6PD deficient were tested for 563C-T (G6PD Mediterranean) and 1311 C-T mutation through RFLP based PCR and gene sequencing. A control group not known to be G6PD deficient was tested for 1311C/T only.</p> <p>C-T transition at nt 1311 was detected in 60/234 X-chromosomes with 563 C-T mutation (gene frequency of 0.26) while in 130 of normal 402 X-chromosomes (gene frequency of 0.32).</p> <p>Conclusion</p> <p>We conclude that 1311 T is a frequent polymorphism both in general populations and in subjects with G6PD Mediterranean gene in Pakistan. The prevalence is higher compared to most of the populations of the world. The present study will help in understanding genetic basis of G6PD deficiency in Pakistani population and in developing ancestral links of its various ethnic groups.</p

Sclerosing Mesenteritis as a Cause of Abdominal Mass and Discomfort in an Elderly Patient: A Case Report and Literature Review

Sclerosing mesenteritis is a rare benign process that involves inflammation, fat necrosis, and fibrosis of the mesentery. The disease poses great diagnostic challenge due to its nonspecific clinical and diagnostic findings. We report the case of a 75-year-old man who presented with vague abdominal discomfort associated with an intra-abdominal mass. With suspicion of a bowel carcinoid tumor on computed tomography scans, the patient underwent diagnostic laparoscopy. A diagnosis of sclerosing mesenteritis was made on histological examination. The patient's symptoms responded to a combination of immunosuppressive drugs, with no interval change in the size of the mass on radiological examination after fifteen months

Neonatal hyperbilirubinemia in infants with G6PD c563C \u3e T variant

Background: 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. G6PD c.563C \u3e T 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 G6PD c.563C \u3e T. Methods: 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]. G6PDgenotype was analyzed in 32 deficient infants through PCR-RFLP analysis and gene sequencing. Results: G6PD variants c.563C \u3e T and c.131 C \u3e G 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 c.563C \u3e T variant had significantly lower enzyme activity (mean ± 1SD; 0.3±0.2 U/gHb vs. 14.0±4.5 U/gHb, p\u3c0.001) experienced higher peak levels of total serum bilirubin (mean ± 1SD; 16.8±5.4 mg/dl vs. 13.8±4.6 mg/dl, p=0.008) which peaked earlier after birth (mean ± 1SD 2.9±1.6 vs. 4.3±2.3 days, p=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. Conclusions: We concluded that infants with G6PD c.563C \u3e T variant developed jaundice earlier than infants with normal G6PD enzyme levels. Compared to G6PD normal infants, G6PD c.563C \u3e T carrying infants had significantly low G6PD activity