The antibiogram of pus cultures in federal tertiary care hospital, Islamabad and its utility in antimicrobial stewardship.

Background and Objectives: Antimicrobial resistance has emerged as a significant global health threat. Infections caused by Multi Drug-Resistant (MDR) bacteria pose formidable challenges in terms of treatment options and patient outcomes. Pus cultures serve as crucial diagnostic tools in identifying the agents responsible for various infections, and their antimicrobial susceptibility patterns which help in establishment of empirical therapy guidelines. This study was conducted to determine the pathogen and its susceptibility pattern from pus cultures and to generate antibiogram in our tertiary care setting. Materials and Methods: It was a cross-sectional study, conducted for a period of six months, from July 2022 to December 2022, in the Pathology Department of Pakistan Institute of Medical Sciences (PIMS). Results: Out of total 2507 samples received, 1242 (49.5%) showed positive culture. Among the 1242 positive samples, 364 were Gram positive cocci (GPCs) and 878 were Gram negative rods (GNRs). Methicillin resistant Staphylococcus aureus (MRSA) was the most common isolate (23%) followed by Klebsiella pneumoniae (22.6%), Pseudomonas aeruginosa (16.9%), Enterobacter spp. (15.5%) and Escherichia coli (14.2%). Vancomycin was found to be highly effective (100%) against MRSA. GPCs were highly susceptible to linezolid (98%) while GNRs showed high level of sensitivity to colistin (96%) and tigecycline (92%). Conclusion: The generation of a local antibiogram specific to the hospital setting is essential to effectively manage infections empirically and preserve the efficacy of existing antibiotics. By implementing antimicrobial stewardship practices based on a better understanding of antibiotic susceptibility patterns, we can contribute to the mitigation of antibiotic resistance and improve patient outcomes.

Novel Para-Aminobenzoic Acid Analogs and Their Potential Therapeutic Applications.

A "building block" is a key component that plays a substantial and critical function in the pharmaceutical research and development industry. Given its structural versatility and ability to undergo substitutions at both the amino and carboxyl groups, para-aminobenzoic acid (PABA) is a commonly used building block in pharmaceuticals. Therefore, it is great for the development of a wide range of novel molecules with potential medical applications. Anticancer, anti-Alzheimer's, antibacterial, antiviral, antioxidant, and anti-inflammatory properties have been observed in PABA compounds, suggesting their potential as therapeutic agents in future clinical trials. PABA-based therapeutic chemicals as molecular targets and their usage in biological processes are the primary focus of this review study. PABA's unique features make it a strong candidate for inclusion in a massive chemical database of molecules having drug-like effects. Based on the current literature, further investigation is needed to evaluate the safety and efficacy of PABA derivatives in clinical investigations and better understand the specific mechanism of action revealed by these compounds.

Synthesis, crystal structure, spectroscopic and computational investigations of the newly synthesized Schiff bases scaffold as enzyme inhibitor.

The current project was planned to access the enzyme inhibition potential of the synthesize imines; (E)-2-(2-hydroxy-4,5-dimethoxybenzylideneamino)benzonitrile 1 and (E)-2-(((3-hydroxy-4-methylphenyl)imino)methyl)-4-methoxyphenol 2 by the reported protocol of our continuous research and also assess their theoretical function in term of in silico action. The structural characterization of imines was done through advanced techniques i.e., FTIR, 1H NMR, 13C NMR, and UV spectroscopy. Moreover, a single X-Ray diffraction technique (SCXRD) was employed for real structural identification of imines dimensions, which revealed that compound 1 has a triclinic crystal system although 2 has a monoclinic one. A 2D fingerprint plot and Hirshfeld surface analysis (HS) was employed in the crystalline assembly of compounds to check intermolecular contacts and also their degree of contributions. Both compounds were optimized by B3LYP functional mode using a certain basis set (6-31G). The practical data (XRD) and theoretical data (DFT) of both molecules were compared and found between a sound coherence. Molecular docking studies in term of in silico assessment were conducted against enzymes of the esterase and alpha-glucosidase family. The docking outputs give a forecast about compounds that could be employed as protein inhibitors against analyzed protein surfaces.

Computational modeling of imines based anti-oxidant and anti-esterases compounds: Synthesis, single crystal and In-vitro assessment.

Molecular modeling strategy was adopted to check the biological potential of the imine based molecules against free radical, acetylcholine esterase and butyrylcholine esterase. Three Schiff based compounds as (E)-2-(((4-bromophenyl)imino)methyl)-4-methylphenol (1), (E)-2-(((3-fluorophenyl)imino)methyl)-4-methylphenol (2) and (2E,2E)-2-(2-(2-hydroxy-5-methylbenzylidene)hydrazono)-1,2-diphenylethanone (3) were synthesized with high yield. The synthesized compounds were characterized with the help of modern techniques such as UV, FTIR and NMR while exact structure was depicted with Single Crystal X-Ray diffraction technique which disclosed that compound 1 is orthorhombic, while 2 and 3 are monoclinic. A hybrid functional (B3LYP) method with general basis set of 6-31 G(d,p) were applied to optimize synthesized Schiff bases. The contribution of in-between molecular contacts within a crystalline assembly of compounds were studied using Hirshfeld surface analysis (HS). In order to check the ability of the synthesized compounds toward free radical and enzyme inhibition, in vitro models were used to assess the radical scavenging and enzyme inhibition potential which depicted that compound 3 showed highest potential (57.43 ± 1.0%; DPPH, 75.09 ± 1.0%; AChE and 64.47 ± 1.0%; BChE). The ADMET assessments suggested the drug like properties of the synthesized compounds. It was concluded from results (in vitro and in silico) that synthesized compound have ability to cure the disorder related to free radical and enzyme inhibition. Compound 3 was shown to be the most active compared to other compounds.

Typical and Atypical Presentations of Appendicitis and Their Implications for Diagnosis and Treatment: A Literature Review.

Appendicitis, an acute inflammation of the appendix, affects all demographic groups and exhibits various incidences and clinical manifestations. While acute appendicitis typically presents with colicky periumbilical abdominal pain that localizes to the right lower quadrant, atypical presentations are more common in children, geriatric, and pregnant patient populations, leading to delays in diagnosis. Clinical evaluation, clinical scoring systems, and inflammatory markers are commonly used, but their limitations have led to the increased use of diagnostic imaging in patients suspected of appendicitis. Acute appendicitis is managed by non-operative and operative management, depending on whether it is uncomplicated or complicated. Developing diagnostic pathways to improve outcomes and reduce complications is crucial. Although medical advancements have been made, diagnosing and managing appendicitis can be challenging, mainly when patients are present atypically. This literature review aims to comprehensively review typical and atypical presentations of appendicitis and their current implications for diagnosis and treatment modalities in pediatric, adult, pregnant, and geriatric patient populations.

Designing of thiazolidinones against chicken pox, monkey pox, and hepatitis viruses: A computational approach.

Computational designing of four different series (D-G) of thiazolidinone was done starting from different amines which was further condensed with various aldehydes. These underwent in silico molecular investigations for density functional theory (DFT), molecular docking, and absorption, distribution metabolism, excretion, and toxicity (ADMET) studies. The different electrochemical parameters of the compounds are predicted using quantum mechanical modeling approach with Gaussian. The docking software was used to dock the compounds against choosing PDB file for chickenpox, human immunodeficiency, hepatitis, and monkeypox virus as 1OSN, 1VZV, 6VLK, 1RTD, 3I7H, 3TYV, 4JU3, and 4QWO, respectively. The molecular interactions were visualized with discovery studio and maximum binding affinity was observed with D8 compounds against 4QWO (-13.383 kcal/mol) while for compound D5 against 1VZV which was -12.713 kcal/mol. Swiss ADME web tool was used to assess the drug-likeness of the designed compounds under consideration, and it is concluded that these molecules had a drug-like structure with almost zero violations.

COVID and Cancer: A Complete 3D Advanced Radiological CT-Based Analysis to Predict the Outcome.

BACKGROUND: Cancer patients infected with COVID-19 were shown in a multitude of studies to have poor outcomes on the basis of older age and weak immune systems from cancer as well as chemotherapy. In this study, the CT examinations of 22 confirmed COVID-19 cancer patients were analyzed. METHODOLOGY: A retrospective analysis was conducted on 28 cancer patients, of which 22 patients were COVID positive. The CT scan changes before and after treatment and the extent of structural damage to the lungs after COVID-19 infection was analyzed. Structural damage to a lung was indicated by a change in density measured in Hounsfield units (HUs) and by lung volume reduction. A 3D radiometric analysis was also performed and lung and lesion histograms were compared. RESULTS: A total of 22 cancer patients were diagnosed with COVID-19 infection. A repeat CT scan were performed in 15 patients after they recovered from infection. Most of the study patients were diagnosed with leukemia. A secondary clinical analysis was performed to show the associations of COVID treatment on the study subjects, lab data, and outcome on mortality. It was found that post COVID there was a decrease of >50% in lung volume and a higher density in the form of HUs due to scar tissue formation post infection. CONCLUSION: It was concluded that COVID-19 infection may have further detrimental effects on the lungs of cancer patients, thereby, decreasing their lung volume and increasing their lung density due to scar formation.

Reviving the role of mecillinam against extended spectrum beta-lactamase producing enterobacterales.

Background and Objectives: This study was designed to determine the in vitro efficacy of mecillinam against extended spectrum beta lactamse producing Enterobacterales. Materials and Methods: After proper permission from Ethical Review Committee of the Institute, all samples yielding growth of ESBL producing Enterobacterales were part of the study and were processed according to routine microbiological procedures. Routine antibiotic sensitivity testing was done on Muller Hinton Agar by Modified Kirby Bauer Method. All Gram negative isolates were subjected to concomitant detection of ESBL production by double disc synergy method. All ESBL producers were then subjected to the mecillinam Minimum Inhibitory Concentration (MIC) determination by E test. The results were interpreted as per CLSI Guidelines. Results: A total of 120 ESBL producing Enterobacterales isolates were included in the study. The mean age of patients with ESBL infection was 45 ± 18.7 years. There were 44% male and 55% female patients. Majority of the ESBL producing Enterobacterales were isolated from urine samples (56%), followed by pus. Among the isolated organisms, Escherichia coli (45%) was the most frequently isolated organism followed by Klebsiella spp. (22%). Overall 83% of the isolates turned out to be sensitive to mecillinam. MIC50 of mecillinam against ESBL producing Gram negative rods (GNR) turned out to be 1 ug/ml and MIC90 turned out to be 2 ug/ml. Conclusion: Mecillinam shows good in vitro efficacy against ESBL producing Enterobacterales in our study. Further studies with more sample size and from diverse areas across the country should be done to evaluate its efficacy.

Designing of Thiazolidinones for COVID-19 and its Allied Diseases: An In silico Evaluation.

In silico studies in terms of density functional theory (DFT), molecular docking, and ADMET (absorption, distribution, metabolism, excretion and toxicity) were performed for 55 thiazolidinones compounds derived from different amines and aldehydes. DFT is a computational quantum mechanical modeling method used to predict the various properties of the compounds. Different parameters such as Electronegativity (x), Chemical Hardness (ŋ), Chemical Potential (µ), Ionization potential (IP), and Electron Affinity (EA), etc. were calculated by Koopmans theorem. The compounds were docked with Molecular Operating Environment (MOE) software using already reported PDB files of BChE, AChE, and α-glucosidase. To analyze the Spike Glycoprotein of SARS-Cov-2 and heterocyclic compounds, molecular interactions study was carried out between Spike Glycoprotein of SARS-Cov-2 (6VXX) and 55 synthetic heterocyclic compounds. It was performed by the utilization of PyRx Virtual Screening Tool and AutoDock Vina based virtual environment was used in PyRx. Maximum binding affinity was observed with compound A7 which was -8.7 kcal/mol and then with A5 which was -8.5 respectively. In the case of the AChE enzyme, B5 has a maximum docking score of -12.9027 kcal/mol while C7 depicted the maximum score for the BChE enzyme with a value of -8.6971 kcal/mol. The docking studies revealed that C6 compound has maximum binding capacity toward glucosidase (-14.8735 kcal/mol). ADMET properties of under consideration compounds were determined by Swiss online-based software which concluded that these molecules have a drug-like properties and having no violation.

Heterocyclic compounds as a magic bullet for diabetes mellitus: a review.

Diabetes mellitus (DM) is a major metabolic disorder due to hyperglycemia, which is increasing all over the world. From the last two decades, the use of synthetic agents has risen due to their major involvement in curing of chronic diseases including DM. The core skeleton of drugs has been studied such as thiazolidinone, azole, chalcone, pyrrole and pyrimidine along with their derivatives. Diabetics assays have been performed in consideration of different enzymes such as α-glycosidase, α-amylase, and α-galactosidase against acarbose standard drug. The studied moieties were depicted in both models: in vivo as well as in vitro. Molecular docking of the studied compounds as antidiabetic molecules was performed with the help of Auto Dock and molecular operating environment (MOE) software. Amino acid residues Asp349, Arg312, Arg439, Asn241, Val303, Glu304, Phe158, His103, Lys422 and Thr207 that are present on the active sites of diabetic related enzymes showed interactions with ligand molecules. In this review data were organized for the synthesis of heterocyclic compounds through various routes along with their antidiabetic potential, and further studies such as pharmacokinetic and toxicology studies should be executed before going for clinical trials.

Therapeutical Potential of Imines; Synthesis, Single Crystal Structure, Computational, Molecular Modeling, and ADMET Evaluation.

Imines are multipurpose pharmacophores, simply accessible compounds, and have a broad range of usage in several areas of chemistry especially in medicine. Two novel compound imines, (E)-4-methyl-2-((o-tolylimino)methyl)phenol (1) and (E)-2-(((4-methoxybenzyl)imino)methyl)-4-methylphenol (2), were synthesized with effective product via reported protocol in the literature. Single crystal X-ray diffraction (SCXRD) was employed for structural exposition, disclosing that both compounds are orthorhombic. To optimize the newly designed imines, a B3LYP functional with a basis set 6-31G(d,p) was mainly considered. DFT results were utilized to check correlation between the data recovered from SCXRD outcomes and also to measure the energy difference. Hirshfeld surface study was done to demonstrate the intermolecular contacts along the percentage of interaction in the overall crystalline compound. Molecular operating environment program was tested against AChE and BChE enzymes to perform a modeling study of the compounds. The docking score and binding affinity of the compounds revealed that 2 showed comparatively more inhibition than 1. In silico ADMET studies exposed the physiochemical nature of these novel compounds, and it also unveiled that both compounds behaved as drug-like candidates.

Surfactant stabilized gold nanomaterials for environmental sensing applications - A review.

Surfactant stabilized Gold (Au) nanomaterials (NMs) have been documented extensively in recent years for numerous sensing applications in the academic literature. Despite the crucial role these surfactants play in the sensing applications, the comprehensive reviews that highlights the fundamentals associated with these assemblies and impact of these surfactants on the properties and sensing mechanisms are still quite scare. This review is an attempt in organizing the vast literature associated with this domain by providing critical insights into the fundamentals, preparation methodologies and sensing mechanisms of these surfactant stabilized Au NMs. For the simplification, the surfactants are divided into the typical and advanced surfactants and the Au NMs are classified into Au nanoparticles (NPs) and Au nanoclusters (NCs) depending upon the complexity in structure and size of the NMs respectively. The preparative methodologies are also elaborated for enhancing the understanding of the readers regarding such assemblies. The case studies regarding surfactant stabilized Au NMs were further divided into colorimetric sensors, surface plasmonic resonance (SPR) based sensors, luminescence-based sensors, and electrochemical/electrical sensors depending upon the property utilized by the sensor for the sensing of an analyte. Future perspectives are also discussed in detail for the researchers looking for further progress in that particular research domain.

Endogenous methicillin resistant staphylococcus aureus as a source of post-operative surgical site infections.

OBJECTIVE: To determine frequency of Endogenous Methicillin Resistant Staphylococcus aureus (MRSA) in pre-operative patients and its frequency in Surgical Site Infections (SSIs) post operatively. METHODS: It was a descriptive cross sectional conducted at Department of Microbiology, Fauji Foundation Hospital Rawalpindi (FFH), Pakistan. Samples were collected from 1st November-31st May 2018. Total 75 samples were collected during the period. Consecutive non-probability sampling technique was utilized. Specimens were collected from nose, axilla and groin of preoperative patients. Methicillin Resistant Staphylococcus aureus was identified if only isolated from these sites. Patients were followed till his/her discharge from the hospital and if they developed infection post operatively, pus specimen from infected site was also collected and identified. RESULTS: Out of 75 specimen preoperatively, 11(14.7%) were identified as endogenous MRSA. From these, 33(44%) developed Surgical site infections (SSIs), among them 19(57%) were MRSA (09 endogenous, 10 exogenous), 7(21.2%) were Escherichia coli, 3(9.1%) were Klebsiella pneumoniae, 3(9.1%) were Enterococcus faecalis and 1(3%) was Methicillin Sensitive Staphylococcus aureus. CONCLUSIONS: The results of this study determined that Endogenous Methicillin Resistant Staphylococcus aureus (MRSA) could be isolated from patients going for surgery if microbiological screening was done at the time of admission. This could prevent patients from Surgical Site Infection Post operatively by these endogenous MRSA. This search and wipe out strategy is able to curtail the events of outbreak, reduce hospital stay and decrease budget of the hospital by providing guidance in choice of empirical therapy for infection.

Level of sleep disorders among patients with chronic obstructive pulmonary disease.

OBJECTIVE: To measure the level of sleep disorders among patients with chronic obstructive pulmonary disease, and to see if there was any difference in terms of demographic variables and socioeconomic status. METHODS: The cross-sectional descriptive observational study was conducted from March to June 2017, and data was collected through purposive sampling from different tertiary health care centres of Faisalabad, Pakistan. Sleep-50-Urdu scale was used to measure sleep disorders among patients with chronic obstructive pulmonary disease. SPSS 21 was used for data analysis. RESULTS: Of the 140 respondents 70(50%) each were males and females with an overall mean age of 48.64±17.39 years. The patients had significantly high level of narcolepsy (p<0.05), but those from high socioeconomic status had relatively lower level of narcolepsy (p<0.05). Male patients and people from lower socioeconomic status also suffered from sleep apnoea and insomnia along with chronic obstructive pulmonary disease (p<0.05). CONCLUSIONS: Narcolepsy along with sleep apnoea and insomnia were significantly more prevalent among chronic obstructive pulmonary disease patients from lower socioeconomic status.

Comparison of 99mTc Injected Activity with Prescribed Activity in Four Types of Nuclear Medicine Exams.

BACKGROUND: 99mTc is a radioactive isotope that is obtained by eluting a 99Mo/99mTc generator. (PINSTECH, Islamabad) and used for radionuclide scanning. OBJECTIVES: The objective of this work is to study the uncertainties in 99mTc activity that exist due to time delay between injection preparation and administration to patients, during the process of gamma camera scanning. METHODS: Lead canisters were used for storing elution vials and dose calibrator for measuring 99mTc activity in mCi. The activity of preparing 99mTc injection and its administration to patients were compared with the prescribed values of activity recommended in the Society of Nuclear Medicine procedure guidelines. RESULTS: This study showed that uncertainty in the activity existed in one thyroid patient, 38 bone patients, 5 renal patients and 45 cardiac patients. CONCLUSION: This uncertainty in activity exists due to time delay between injection preparation and administration to patients, as well as due to residual radionuclide that is not injected into patients and remains in the syringe.

The metabolic syndrome and inflammation: role of insulin resistance and increased adiposity.

OBJECTIVES: We sought to determine the role of obesity and insulin resistance (IR) in the pathogenesis of inflammation in metabolic syndrome (MetS). METHODS: Our study included 100 patients with MetS and 100 age and gender matched control patients who attended a tertiary care laboratory in Rawalpindi, Pakistan. Anthropometric data was obtained including height and weight to calculate body mass index. A record of patient's blood pressure (BP), waist circumference (WC) and hip circumference (HC) was made. Biochemical analysis included measurements of fasting glucose, triglycerides (TG), high-density lipoprotein cholesterol (HDL-c), insulin, and high-sensitivity C reactive protein (hsCRP). IR was determined by the homeostasis mode assessment insulin resistance (HOMA-IR) method. RESULTS: The levels of hs-CRP were found to be elevated in all patients with MetS where it correlated significantly with all its components including measures of obesity, fasting insulin and glucose levels, IR, TG and HDL-c. However, on linear regression analysis only WC, fasting insulin, and HOMA-IR remained significantly correlated with hs-CRP. CONCLUSION: MetS is a condition characterized by chronic low-grade inflammation, which arises because of increased abdominal adiposity and IR. Large multicenter studies are needed to gain insight into its pathogenesis and derive treatment strategies.

Non-dermatophyte moulds as pathogens of onychomycosis.

OBJECTIVE: To determine the role and pattern of non-dermatophyte moulds as causative agents of onychomycosis. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from November 2009 to July 2010. METHODOLOGY: Nail clippings and nail scrapings were obtained from abnormal looking nails with treatment and detection failure for onychomycosis. Microscopic (40% potassium hydroxide mounts) examination and culture on Sabouraud's dextrose agar (SDA), SDA containing chloramphenicol, and SDA containing actidione and chloramphenicol were used for species identification. RESULTS: Non-dermatophyte moulds were isolated from 32 out of the total 47 culture positive cases (68%). Alternaria alternata was the commonest species (46%). Dermatophytes were isolated from only 7 patients (15%) belonging to genus Trichophyton. Yeasts were isolated in 8 (17%). There was no fungal growth in 53% of cases. CONCLUSION: The non-dermatophytes should be considered important in evaluating the culture negative cases for dermatophytes as well as those cases ending up in treatment failure after empirical treatment for dermatophyte infections.

Ambu bag as a source of Acinetobacter baumannii outbreak in an intensive care unit.

This case report describes an outbreak of multidrug resistant Acinetobacter baumannii in the intensive care unit of a tertiary care hospital. Three patients were infected on the same day from an Ambu bag which was used on all the patients. The outbreak was immediately identified and the source was traced within one week. Appropriate measures were taken and a continuous surveillance was carried out resulting in reporting of no such case from the intensive care unit in the last 6 months.