IDENTIFICATION OF PATTERN AND BURDEN OF CAUSATIVE AGENTS OF SPONTANEOUS BACTERIAL PERITONITIS AMONG CIRRHOTIC PATIENTS.

Background; Spontaneous bacterial peritonitis is a common bacterial infection in patients with cirrhosis and ascities with in-hospital mortality rates ranging from 20 to 30%. Early diagnosis and a prompt antibiotic therapy have considerably decreased the mortality rate and this study was done to determine drug resistance pattern among causative organisms of SBP. Objective; To determine the frequency of different causative organisms of spontaneous bacterial peritonitis (SBP) and their sensitivity pattern in patients with liver cirrhosis. Material and Methods; A total of 183 patients with liver cirrhosis having SBP were included in this descriptive cross-sectional study. The study was conducted at department of Medicine. Patients were subjected to ascitic fluid tap, under aseptic measures by inserting a needle of 22 / 18 gauge in the left flank of abdomen. Ten ml of ascitic fluid was aspirated in a heparinised disposable syringe; which was immediately inoculated into blood culture bottle at bedside and send for bacterial culture and causative organisms was tested for their antibiotic drug resistance pattern. Data was entered and analyzed by computer program SPSS-18. Results; Of these 183 study cases, 103 (56.3%) were male patients while 80 (43.7%) were female patients. Mean age of our study cases was 51.73 ± 9.28 years. Previous history of use of antibiotics before 72 hours was noted in 103 (56.3%), anti – HCV was positive in 103 (56.3%) while HBs Ag was positive in 13.7% of our study cases. Among these study cases, E.coli was noted in 135 (73.8%), Staph. Aureus in 17.5% and Klebsiella was noted in 8.7%. Chloramphenicol was resistant in 24 (13.1%), ampicillin was resistant in 143 (78.1%), co – trimoxazole in 61.2%, ciprofloxacin in 55.7%, Ofloxacin in 56.3%, Cefotaxime was resistant in 78.1% and amoxicillin was resistant in 74.9%. Conclusion; Our study results have indicated that E.coli was major causative organisms among patients with spontaneous bacterial peritonitis having cirrhosis of liver followed by staphylococcus aureus and klebsiella. High degree of drug resistance was observed among  these strains in our study which points towards well directed efforts of our health policy makers to adopt certain guidelines regarding use of these drugs in our population. Keywords; Cirrhosis, spontaneous bacterial peritonitis, E. coli

Probing Stochastic Gravitational Wave Background from SU(5)×U(1)χSU(5) \times U(1)_{\chi} Strings in Light of NANOGrav 15-Year Data

A realistic model of $SU(5) \times U(1)_{\chi}$, embedded in $SO(10)$ supersymmetric grand unified theory, is investigated for the emergence of a metastable cosmic string network. This network eventually decays via the Schwinger production of monopole-antimonopole pairs, subsequently generating a stochastic gravitational wave background that is compatible with the NANOGrav 15-year data. In order to avoid the monopole problem in the breaking of both $SO(10)$ and $SU(5)$, a non-minimal Higgs inflation scenario is incorporated. The radiative breaking of the $U(1)_{\chi}$ symmetry at a slightly lower scale plays a pivotal role in aligning the string tension parameter with the observable range. The resultant gravitational wave spectrum not only accounts for the signal observed in the most recent pulsar timing array (PTA) experiments but is also accessible to both current and future ground-based and space-based experiments.Comment: 22 pages and5 figures

ROLE OF PROBIOTICS IN PREVENTION OF NECROTIZING ENTEROCOLITIS AMONG PRETERM NEONATES.

Background; Necrotising enterocolitis (NEC) is the most commonly occurring gastrointestinal emergency in preterm infants. This study was conducted to determine frequency of necrotizing enterocolitis (NEC) in preterm infants less 1.5 Kg taking probiotics at a tertiary care hospital. Material and Methods; Consecutive 270 preterm neonates having weight less than 1.5 Kg was taken in this descriptive case – series study. Once registered, the study cases were fed with Infloran (Lactobacillus acidophilus) and Bifidobacterium infants, 125 mg/kg per dose was given twice daily with breast milk until discharged and were followed for two weeks to see NEC. The amount of feeding was advanced slowly if tolerated, with no more than 20 mL/kg per day increment per day. These study cases were followed for 15 days to record outcome variable i.e. NEC. Data was analyzed by using SPSS Version 20. Results; Of these 270 study cases, 139 (51.5%) were boys while 131 (48.5%) were girls. Mean gestational age of our study cases was 29.61 ± 2.66 weeks (with minimum gestational age was 24 weeks while maximum gestational age was 34 weeks). Of these 270 study cases, 147 belonged to urban areas and most of our study cases i.e. 179 (66.3%) were poor, 79 (29.3%) were from middle income families and only 12 (4.4%) belonged to rich families. Mean weight of our study cases was 1312.85 ± 78.66 grams. Mean maternal age was noted to 27.91 ± 4.24 years, 170 (62.96 %) mothers were less than 30 years of age and most of these mothers were illiterate i.e. 191 (70.7%). Majority of these mothers i.e. 170 (62.96 %) had parity less than 3. Mean duration on probiotics was noted to be 14.88 ± 1.38 days. Necrotizing enterocolitis was noted in 15 (5.6%) of our study cases. Conclusion; Our study results have shown that frequency of necrotizing enterocolitis (NEC) was low in preterm infants using probiotics. The use of probiotics was effective in the prevention of NEC and our study results support the use of probiotics in these infants. Probiotics were found to be safe, reliable and efficacious in our study. NEC was significantly associated with gender, gestational age, residential status, poor socioeconomic status, increasing maternal age and parity and duration on probiotics. Keywords; Probiotics, necrotizing enterocolitis, preterm infants

Bacterobilia in acute cholecystitis: bile cultures\u27 isolates, antibiotic sensitivities and antibiotic usage. a study on a Pakistani population.

Abstract Acute cholecystitis is one of the most common acute surgical conditions. Laparoscopic cholecystectomy remains the mainstay of treatment. In patients managed non-operatively, antibiotics play an important role in the treatment of cholecystitis. The current retrospective observational study was conducted at a tertiary care hospital in Karachi, and comprised medical records of patients admitted between 2008 and 2014with acute cholecystitis and in whom bile cultures were obtained. Of the 509 patients with a mean age of 51.15 ± 13.4years, early laparoscopic cholecystectomy (within 72hours) was performed on 473(92.9%) cases, while the rest underwent percutaneous cholecystostomy. Bile cultureswere positive in 171(33.6%) patients. Predominantly gram-negative organisms were isolated among a total of 137(27%), with E.coli 63(46%) being the most commonly isolated organism. Of the gram-positive organism, enterococcus 11(8%) was the most common. Antibiotic sensitivities were determined.Based on our findings gram-negative coverage alone should be sufficient in our segment of the population

Bacterobilia in acute cholecystitis: bile cultures\u27 isolates

Abstract Acute cholecystitis is one of the most common acute surgical conditions. Laparoscopic cholecystectomy remains the mainstay of treatment. In patients managed non-operatively, antibiotics play an important role in the treatment of cholecystitis. The current retrospective observational study was conducted at a tertiary care hospital in Karachi, and comprised medical records of patients admitted between 2008 and 2014with acute cholecystitis and in whom bile cultures were obtained. Of the 509 patients with a mean age of 51.15 ± 13.4years, early laparoscopic cholecystectomy (within 72hours) was performed on 473(92.9%) cases, while the rest underwent percutaneous cholecystostomy. Bile cultureswere positive in 171(33.6%) patients. Predominantly gram-negative organisms were isolated among a total of 137(27%), with E.coli 63(46%) being the most commonly isolated organism. Of the gram-positive organism, enterococcus 11(8%) was the most common. Antibiotic sensitivities were determined.Based on our findings gram-negative coverage alone should be sufficient in our segment of the populatio

Anti-counterfeit technologies

  Corresponding arrangement that covers and safeguards the unit dose of drug is called packaging .One of main reason of deaths , treatment failure , un cure cases and failure of health care set up is counterfeit drugs. Renowned medicines brands in addition to sky-scraping cost of medicine make pharmaceutical ideal for counterfeit medicines and in top of list include medicine for most commonly use disease and high price like medicine use in dyslipidemia, anticancer antihypertensive and other antidiabetic agents. This review article focus on the perfect ways and features present existing anti counterfeit technologies and various other parameters in upcoming and how to remove draw backs in existing technologies during packaging in pharmaceutical industry

Synthesis, in-vitro inhibition of cyclooxygenases and in silico studies of new isoxazole derivatives

Isoxazole belongs to the class of five-membered heterocyclic compounds. The process of developing new drugs has significantly gained attention due to inadequate pharmacokinetic and safety attributes of the available drugs. This study aimed to design a new diverse array of ten novel isoxazole derivatives via Claisen Schmidt condensation reaction. In vitro COX-1/2 anti-inflammatory assay, in silico molecular docking of potent compounds, Molecular docking simulation, and SwissADME pharmacokinetic profile were investigated in this research. The in vitro COX-1 and COX-2 enzyme inhibitory assay showed that almost all the tested compounds exhibited anti-inflammatory effects whereas C6, C5, and C3 were found to be the most potent COX-2 enzyme inhibitors among the tested compounds and are good candidates for selective COX-2 inhibitors. In silico molecular docking studies coupled with molecular dynamic simulation has been done to rationalize the time-evolved mode of interaction of selected inhibitor inside the active pockets of target COX-2. The binding orientations and binding energy results also showed the selectivity of compounds towards COX-2. Physicochemical properties, pharmacokinetic profile, lipophilicity, water solubility, drug metabolism, drug-likeness properties, and medicinal chemistry of the synthesized isoxazole derivatives were assessed. The SwissADME (absorption, distribution, metabolism, and excretion) database was used to assess the physicochemical properties and drug-likeness properties of the synthesized isoxazole derivatives. All the compounds were shown high GI absorption except Compound 7 (C7). Compound 1 (C1) and Compound 2 (C2) were found to cross the blood-brain barrier (BBB). Lipinski’s rule of five is not violated by any of the ten synthesized isoxazole derivatives. It was predicted with the SwissADME database that C2, C5, C6, C7, and C8 are potent inhibitors of cytochrome (CYP) subtype CYP-2C19. A subtype of CYP-2C9 was inhibited by C4 and C7. The medicinal chemistry of all the compounds C1-C10 showed no PAIN (Pan assay interference compounds) alerts. The improved gastrointestinal (GI) absorption and BBB permeability of C1 and C2 can provide a future prospective for new researchers in the medicinal field to investigate the compounds for the management of chronic diseases. The synthesized isoxazole compounds showed excellent in vitro COX-1/2 enzymes anti-inflammatory investigations, in silico studies, good physicochemical properties, and improved pharmacokinetic profile which will be further investigated via in vivo anti-inflammatory activities. Moreover, to further support our findings of the computational research and in vitro studies, an in-vivo pharmacokinetic profile is suggested in the future

UV-Light Mediated Biosynthesis of Silver Nanowires; Characterization, Dye Degradation Potential and Kinetic Studies

Herrin, a simple and eco-friendly method for the synthesis of silver nanowires (Ag-NWs) has been reported. Silver nanowires were synthesized using Psidium guajava seed extract that acted as a reducing agent as well as a stabilizing agent for silver nitrate solution. Synthesis was carried out at 50 °C temperature under continuous UV-irradiation. Silver nanowires were initially characterized by a UV-visible and FTIR spectrophotometer. In addition, morphology and particle size of synthesized Ag-NWs were determined using Field Emission Scanning Electron Microscopy and X-ray diffraction (XRD) techniques. Nanowires were found to have 12.8 μm length and 200–500 nm diameter and cubic phase morphology. Furthermore, the catalytic potential of Ag-NWs for the degradation of methyl orange dye (MO) was determined. The selected dye was degraded successfully that confirmed the catalytic potential of Ag-NWs. The authors concluded that Ag-NWs can be synthesized using plant extract having excellent morphological features as well as impressive catalytic potential