Bacteriological Spectrum and Sensitivity Pattern in Culture Proven Urinary Tract Infection in Children

To determine the different types of organisms causing urinary tract infections in children and their sensitivity to antibiotics.Methods: This cross sectional study was conducted at Children Hospital, PIMS Islamabad and consisted of 117 patients of either gender between age of 03 months to 12 years.Results: Mean age of children enrolled in our study was 4.4 (± 2.6) years. Out of 117 patients, 63 (54 %) were girls. The most common isolate was E. coli (57.3%) percent, followed by Klebsiella (18.8 %), Staphylococcus aureus (13.7 %), Pseudomonas (5.1 %) and Proteus (3.4 %) children. All isolates were sensitive to ciprofloxacin, of loxacin, amikacin, cefixime and imepenem. Only 38.5% E coli and 37.5% Klebsiella were sensitive to Ampicillin, and 14.3% E coli and 9.1% Klebsiella were sensitive to Trimethoprim-sulphamethoxazole.Conclusion: The most common isolate was E. coli, followed by Klebsiella, Staphylococcus aureus, Pseudomonas and Proteus. Most antibiotics tested for the E. coli, Klebsiella, Staphylococcus, Pseudomonas and Proteus are effective except Cotrimoxazole, Ampicillin, and Gentamicin which show high resistanc

Comparative analysis of leaf spot disease in Rice Belt of Punjab, Pakistan

Background: Brown leaf spot (BLS) caused by Bipolaris oryzae (Breda de Haan) Shoemaker, is a chronic disease of rice that infects millions of hectares worldwide each year. In this study, a total of 18 rice growing districts of Punjab, Pakistan were surveyed during cropping season in 2014-17 for the incidence of BLS disease. Methods: The survey method was used to gather the data of BLS incidence during 2014-2017 in 18 districts of rice growing areas of Punjab, Pakistan. Meteorological data was collected from the weather stations of each surveyed district and co-related with BLS incidence. Results: The findings of the study revealed that quantitative relationship exists between meteorological variables and BLS incidence. The incidence of disease in the field was at peak during the month of October. The disease incidence varied from 1.12% to 14.37% over a period of study i.e. from 2014-2017. However, the role of relative humidity (RH) was highly positively correlated with the incidence of disease. Relative humidity showed a positive correlation with the incidence of disease as indicated by the year in which it was towards the high values. The highest disease incidence was observed in district Sargodha whereas the minimum in district Okara. The highest incidence of BLS disease was found in variety Basmati Super (51.43%) and the minimum in Basmati 386 (6.57%). Conclusion: Our study revealed that the fluctuations in temperature did not depict an appreciable impact on the incidence of BLS as indicated by the statistical coefficient, whereas RH strongly influenced the incidence of BLS incidence.

A conceptual framework of the way forward to a community pharmacist- general practitioner collaborative medication therapy management model for chronic diseases in Malaysian primary care: a qualitative study

Background There is a growing global interest in interprofessional collaboration between community pharmacist (CP) and general practitioner (GP) in primary care. Objective To conceptualize a stakeholder driven framework to improve collaboration between the CP and the GP in Malaysian primary care to effectively manage medicines in chronic diseases. Design and Setting A qualitative study that involved individual semi structured interviews of the leadership of various associations, guilds, and societies representing CPs, GPs, and Nurses in Malaysia. Method This study collected and reported data in accordance with the Consolidated Criteria for Reporting of Qualitative Studies guidelines. Key informants were recruited based on purposive (expert) sampling. Interviews were transcribed verbatim and data were coded in NVivo based on the principles of thematic analysis. Result A total of twelve interviews (5 CPs, 5 GPs and 2 Nurses) were conducted. Five themes emerged: Theme-1 highlighted comparison of community pharmacy practice in Malaysia and developed countries; Theme-2 involved the current practices in Malaysian primary care; Theme- 3 encompassed the advantages of CP-GP collaboration in chronic diseases; Theme-4 highlighted the barriers which impede collaboration in Malaysian primary care; and, Theme-5 delineated the way forward for CP-GP collaboration in Malaysia. Conclusion The actionable insights obtained from the Malaysian stakeholders offered an outline of a framework to enhance collaboration between CP and GP in primary care. Generally, stakeholders were interested in CP-GP collaboration in primary care and viewed many positive roles of CPs including prescription review, adherence support and patient education. The framework of the way forward includes: separation of roles of the CP and the GP through a holistic revision of relevant legislation to grant an active role to the CPs in chronic care; definition of protocols for collaborative practices; incentivization of both stakeholders (CP and GP) and, Design and implementation of an effective regulatory mechanism where the Malaysian Ministry of Health may take a leading role

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

First report of Xiphinema diffusum from Pakistan

The population of Xiphinema americanum species group was detected from the soil surronding the roots of peach (Prunus persica) during a survey of plant-parasitic nematodes in Gilgit-Baltistan, Pakistan. From the results of the morphological study, the species was identified as X. diffusum. Morphometrics of X. diffusum generally agree with those of the type species and the topotype specimens. Molecular analysis of 18S rDNA of X. diffusum from Pakistan indicated two nucleotide differences and 99 % similarity with the Chinese (AM086669) and the Australian (AM086685) population of X. diffusum. Phylogenetic analysis of 18S rDNA placed the Pakistanis population close to X. diffusum from China and Australia. This species is reported for the first time from Pakista