Emphysematous Cystitis along with Emphysematous Pyelonephritis in Type II Diabetes: A Case Report

Emphysematous urinary tract infections (UTIs) are infections of the lower or upper urinary tract associated with gas formation. They may manifest as cystitis, pyelitis, or pyelonephritis. Diabetes mellitus is a major risk factor for these infections. The diagnosis of gas-forming UTI is usually made by plain films of the abdomen and/or computed tomography (CT). Escherichia coli and Klebsiella pneumonia are the predominant etiologic organisms. We present a rare case of emphysematous cystitis along with emphysematous pyelonephritis in a patient with poorly controlled diabetes. This patient underwent nephrectomy and 500 ml of puss was drained before nephrectomy. Puss C/S showed growth of Escherichia coli which was sensitive to pipercillin/tazobactam. We conclude that all female diabetic patients more than 60 years of age presenting with urinary symptoms, abdominal pain, fever and evidence of UTI on urine routine examination should have at-least an ultrasound abdomen and kidney ureter bladder (KUB) done and if presence of air is suspected, these patients should get CT scan KUB done so that diagnosis of emphysematous UTI be made and managed accordingly

Acute Appendicitis: Relationship of Total Leucocyte Count with Per-Operative Stage

Objective: To correlate total leucocyte count(TLC) with per-operative stage of acute appendicitis. Patients and Methods: This cross sectional study was conducted in department of surgery, Pakistan Institute of Medical Sciences (PIMS) from June 2016 to June 2017. A total 77 patients were included through consecutive sampling technique. Statistical Package for Social Sciences (SPSS) version 20 was used to analyze data. Results: A total of 77 patients were included in the study, among them 47 (61%) were males, and 30(39%) were females. Mean age was 22.25 ± 5.19 years. Mean TLC was 12,900 ± 4087 cells/µL Patients having acute appendicitis were labeled as, acute appendicitis stage I which included 59 (76.6%) patients, Gangrenous appendicitis was named as stage II which included 11 (14.3%) patients. Perforated appendicitis was labeled as Stage III in which 7 (9.1%) patients were inducted. In stage I, mean age was 21.89 ± 5.50 years and mean TLC was 12,344 ± 4162 cells/µl. In stage II, mean age was 22.36 ± 3.90 years and mean of total leukocyte count was 15,072 ± 3497 cells/µl. In stage III, mean age was 25.57 ± 3.50 years and mean leukocyte count was 14,214 ± 4141cells/µl (p-value >0.05). Conclusion: Significant statistical association was not found in patients in different stages of appendicitis with respect to TLC (p value >0.05), although patients in all stages had raised mean TLC with mean TLC highest in patients having stage II (Gangrenous appendicitis)

Commonly Occurring Bacteria in Diabetic Foot Infections and their Sensitivity to various Antibiotics

Background: Diabetic foot infections are a common cause of morbidity in type 1 & 2 Diabetes mellitus. The selection of appropriate empirical treatment is thus essential while treating such patients. The main objective of this study was to find out most prevalent bacteria and their sensitivity to various antibiotics in patients with diabetic foot infections.Material and Methods: This cross-sectional study was conducted in the Department of Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from January 2017 to December 2017. A total 118 patients were included through consecutive sampling technique. Samples were collected in the form of swab, pus or tissue material and were cultured on blood agar and microorganisms were identified using standard microbiological methods. Antimicrobial sensitivity was also checked. StatisticalPackage for Social Sciences (SPSS) version 22 was used to analyze data.Results: Out of 118 patients, 72% (n=85) were males while 28% (n=33) were females. Cultures of 105 patients were positive and most common organisms isolated were S. aureus (32.4%; n=34), E. coli (17.1%; n=18), P. aeruginosa (14.3%; n=15), Polymicrobials (14.3%; n=15) and K. pneumoniae (7.6%; n=8). Antibiotics to which organisms were most sensitive included Piperacillin/Tazobactam (69.5%; n=73), Imipenem (55.2%; n=58), Amikacin (43.8%; n=46), Vancomycin (40%; n=42) and Levofloxacin (38.1%; n=40).Conclusion: Most common organisms causing diabetic foot infections in our study were S. aureus, E. coli, P. aeruginosa, Polymicrobial and Klebsiella. Overall most sensitive antibiotics to these organisms included Piperacillin/Tazobactam, Imipenem,Amikacin, Vancomycin and Levofloxacin

Capacity Dimensioning of HSDPA Urban Network

To launch a cellular network, prelaunch capacity dimensioning is performed which includes coverage estimation and throughput prediction. Cellular companies in developing countries like Pakistan are only providing 2G services, while 3G services are yet to be launched. Although a lot of research has been done on 3G services in developed countries but there is very little knowledge regarding practical aspects of planning and optimization of 3G networks in third world countries like Pakistan. This research paper includes a thorough analysis of factors that affect capacity of 3G networks, including radio propagation models. Various propagation models are studied and propagation constants of Standard Propagation Model are tuned according to topography of Islamabad. The performance analysis of these propagation models is done using Matlab and results are verified through planning tool Atoll and field measurements. Based on analysis of these results capacity dimensioning, in terms of number of sites, is carried out for an urban network of Islamabad

Role of heat stress in migration decisions : a case study of Faisalabad

This study explores the relation between migration decisions and heat stress, its impact on livelihoods and thermal comfort levels both at home and at work. Many developing countries face declining worker productivity due to heat stress. Migration provides an opportunity to reduce risk and diversify livelihoods. Extreme heat stress is associated with migration because it affects livelihood and reduces farm and non-farm income. The paper is based on a household survey using a structured questionnaire to compare two study sites 1) Rural areas of Faisalabad district 2) Peri-urban areas of Faisalabad city.UK Government’s Department for International Development (DfID)International Development Research Centre (IDRC

A COMPARISON OF PACING STRATEGY BETWEEN INTERNATIONAL AND PAKISTANI 100-M SWIMMERS

The purpose of this study was to determine, based on the stroking time recorded in a 100-m swimming competition, whether elite international 100-m swimmers have the same pacing strategy as the Pakistani swimmers or not. Based on a video data, three different levels of performance were analyzed i.e. Finalists (G1, n=32) from the European Championship, 2012; Medalists (G2, n=12) and Non-medalists (G3, n=20) from the Pakistan National Swimming Championship, 2014. For the current analysis each stroking distance was divided into two sections (i.e. before and after the 25m mark). The average speed of each section (ST1, ST2, ST3 and ST4) was quantified in order to depict pacing strategy. Results showed even-positive pacing (1.75 ± 0.17 m/s) towards the end of the race in G1; whereas, variable speed pacing was observed in both G2 (1.42 ± 0.26 m/s) and G3 (1.21 ± 0.28 m/s). Based on these findings it is proposed to encourage an efficient pace strategy for 100-m swimmers

Variability of breast density assessment and the need for additional imaging: A comparison between computed mammography and digital mammography

Objective: To determine the variability of breast density assessment and the need for additional imaging using computed radiography (CR) mammography versus digital radiography (DR) mammography.Study design: Cohort study.Place and duration of study: Department of Radiology, The Aga Khan University Hospital, Karachi from March to June 2018.Methodology: Patients who underwent screening CR mammography, followed by DR mammography a year later, were selected. Only disease-free individuals were included in the study. Evaluation of breast density was done subjectively, using the breast imaging reporting and data system (BI-RADS) by two independent experienced radiologists. Statistical analysis was performed using the Wilcox Signed Rank-sum test to compare both modalities. Fisher Exact method was used to compare the need for ultrasound imaging.Results: A total of 295 patients were included in the study. The mean age of the patients was 52.76 ± 0.64 years. There was a significant difference in the change of breast density when comparing both modalities (Z= -11.839, p \u3c0.001). A statistically significant reduction in the need for further breast ultrasound was observed after DR mammography than with CR mammography (p \u3c0.001).Conclusion: Use of DR mammography, especially in patients with dense breast parenchyma, is a better screening tool overall. It translates to better feasibility for the radiologist and is more economical for the patient. DR mammography decreases unnecessary imaging and leads to better visualisation, thus providing a more accurate categorisation of breast density. Key Word: Computed radiography mammography, Breast density, Screening, Breast cancer, Digital mammography, Ultrasound

ANALYSIS OF MORTALITY IN PATIENTS ADMITTED IN MEDICAL INTENSIVE CARE UNIT OF KHAN RESEARCH LABORATORIES HOSPITAL, ISLAMABAD, PAKISTAN

OBJECTIVE: This study was conducted to ascertain the causes of death and mortality rate in patients admitted to medical intensive care unit (ICU) of Khan Research Laboratories (KRL) Hospital, Islamabad, Pakistan. METHODS: Current study enrolled 775 patients admitted in Medical ICU of KRL Hospital, Islamabad, Pakistan from April 16, 2016 till April 16 2017. KRL Hospital is a 350 bedded hospital and has a 13-beded level II ICU. This was a descriptive study involving non-probability consecutive sampling. Statistical analysis was done using statistical package for social sciences (SPSS version 20). RESULTS: Out of 775 patients, 125 (16.1%) patients died. Out of these 125 patients, 68 (54.4%) were males and 57 (45.6%) were females. Majority of patients (n=69; 55.2 %) were ranging in age from 71-100 years of age, while 37 (29.6%) patients were ranging in age from 56-70 years and 19 (15.2%) were less than 55 years of age. Among the deceased, pneumonia was the most common reason (n=49; 39.2 %) for admission followed by urinary tract infection (n=16; 12.8%) and septicemia (n=14; 11.2%). Hypertension (n=33; 26.4%) was the most common co-morbid followed by diabetes mellitus (n=24; 19.2 %) and ischemic heart disease (n=18; 14.4 %). CONCLUSION: More than half of deceased patients admitted to ICU had age more than seventy years. Sepsis related conditions were responsible for death in more than sixty percent of patients. Majority of patients had diabetes mellitus, hypertension or ischemic heart disease as co-morbid conditions

Pattern of Antimicrobial Sensitivity and Resistance in Large Series of Indoor Patients at a Tertiary Care Hospital

Objective: In the era of increasing antibiotic resistance, associated with increasing hospital stay and morbidity, the purpose was to define guidelines for antibiotics in different clinical situations. Patients and Methods: This study was conducted at Khan Research Laboratories Hospital, Islamabad, Pakistan, from July 2014 to December 2016. 3277 patients admitted in Medical, Surgical, Gynaecology & Obstetrics, ENT, Eye and Dental departments were included. Positive cultures from different sources including blood, urine, pus, central venous lines, bronchial washings and cervical swabs were taken. Age, gender, common pathogens, their sensitivity and resistance to 27 antimicrobial drugs were taken into account. Statistical Package for Social Sciences (SPSS) version 20 was used for data analysis. Results: 53.1% (n=1738) were females while 46.9% (n=1539) were males.2800 samples were available for analysis. Majority of the patients belonged to Medical ward, 56.9% (n=1864). Major source of culture was urine, 38.3% (n=1073). Escherichia coli (E. coli) was the most common isolate 51.3% (n=1436) followed by Staphylococcus aureus 19.9% (n=558). E. coli showed maximum sensitivity to Imipenem i.e. 94% (n=1349) followed by Amikacin, 93% (n=1335). It was resistant to ceftriaxone (77%).Staphylococcus aureus showed maximum sensitivity to Linezolid and Vancomycin i.e. 98% (n=548) followed by Chloramphenicol 84% (n=470), while being resistant to ciprofloxacin and levofloxacin (54%). Klebsiella pneumoniae showed maximum sensitivity to Imipenem i.e. 75%, while showing resistance to Amoxicillin/Clavulanic Acid (95%) and Ceftriaxone (80%).Staphylococcus epidermidis showed maximum sensitivity to Linezolid i.e.99%. Pseudomonas aeruginosa showed maximum sensitivity to Piperacillin and Tazobactam i.e. 76% . Acinetobacter baumannii showed maximum sensitivity to Colistin i.e. 91%.Salmonella typhi showed maximum sensitivity to Ceftriaxone i.e. 99% while resistance to Ciprofloxacin (94%).Enterococcus faecalis showed maximum sensitivity to Linezolid i.e.100% and Salmonella Paratyphi A showed maximum sensitivities to Cefixime and Ceftriaxone i.e 100% Conclusion: Antibiotic resistance is emerging. Rationale use of antibiotics is required to curtail the surge of antibiotic resistance. There is also a need to modify treatment guidelines in different clinical situations based on local sensitivity and resistance patterns in order to reduce hospital stay, morbidity and mortality.&nbsp