Choice of Antimicrobials in Surgical Prophylaxis - Overuse and Surgical Site Infection Outcomes from a Tertiary-Level Care Hospital.

Background: This study was aimed to describe the choice of Surgical Antimicrobial Prophylaxis at a tertiary-level care hospital in United Arab Emirates. It also associated the choice between two leading antimicrobials for the SAP to the site of surgery. Methods: A descriptive drug use evaluation was performed retrospectively to study choices of antimicrobials in surgical antibiotic prophylaxis. An analytical cross-sectional study design was used to develop a hypothesis regarding the choice of ceftriaxone. Data were collected from the medical records of Hospital from July 2020 to December 2020. Results were presented in numbers and percentages. Results: SAP data were collected from 199 patients, of which 159 were clean or clean-contaminated. Dirty surgeries (18) needed a higher level of antimicrobials as there were infections to be treated. For other surgeries with no infection, overuse of antimicrobials was found regarding the choice of antimicrobials. Surgical antibiotic Prophylaxis was administered within the recommended time prior to surgeries. Ceftriaxone was preferred over cefuroxime in all types of surgeries based on the timing of Surgical Antibiotic Prophylaxis, wound classification, and the surgical site. A statistically significant association for choice of ceftriaxone over cefuroxime was found regarding surgical sites (p-value <0.05). About 99% of the patients were prescribed discharge antimicrobials when 158 (80%) surgeries were clean or clean-contaminated. Conclusion: Overuse of antimicrobials was found in surgical antimicrobial prophylaxis. Ceftriaxone was preferred more than cefuroxime in all types of surgeries. No surgical site infections were reported. A follow-up comparative study is recommended to decrease antimicrobial use without increasing risk of surgical site infection.

Visceral Leishmaniasis In Adults.

Visceral Leishmaniasis (also known as Kala Azar) is a parasitic infection caused by Leishmania Donovani in the East and Leishmania Infantum in the west. It is prevalent in many countries including India, Bangladesh, Nepal, Africa and part of America. The disease follows chronic course and is usually lethal if left untreated. It has also been reported from different parts of Pakistan, including Northern areas, Districts Mansehra & Abbottabad and Hilly areas of Khyber Pukhtoonkhawah. Most the cases have been reported in paediatric population. Except one case, reported previously from Abbottabad. The present two cases were also seen in adults.

IMMUNOEXPRESSION OF TWIST IN DIFFERENT MORPHOLOGICAL VARIANTS OF AMELOBLASTOMAS.

BACKGROUND: Ameloblastoma is the most common and a clinically significant odontogenic tumour. The diagnosis and sub classification of ameloblastoma have been traditionally relied on histological assessment, but it is still a subject of debate. The aim of this study was to evaluate the immuno-expression of Twist in various subtypes of ameloblastomas and their corelation with various histological variants. METHODS: This cross-sectional study was conducted in the Department of Pathology, Post Graduate Medical Institute, Lahore between June to December 2013. Thirty cases of various types of Ameloblastomas were included in this study. Histological sub-classification of the tumours was performed based on WHO classification. Twist expression of these tumours was estimated by immunohistochemistry, performed on paraffin sections. RESULTS: Out of these thirty cases, 22 (73%) were newly diagnosed typical solid/multicystic intraosseous ameloblastoma, 2 (7%) cases belonged to recurrent ameloblastoma, and 3 (10%) each were diagnosed as peripheral/extraosseous ameloblastoma and ameloblastic carcinoma. On histopathological sub-classification of the newly diagnosed solid ameloblastoma, 8 cases were diagnosed as follicular ameloblastoma in which 3 cases (37.5%) were negatively stained, 4 cases (50%) were mild positive and 1 case (12.5%) was moderate positive with Twist immunostaining. Out of 5 cases of plexiform ameloblastoma 3 cases (60%) were mild positive. Out of 4 cases of acanthomatous ameloblastoma 2 (50%) were moderate positive and 2 cases (50%) were strong positive. All granular cell ameloblastoma stained positive. The only case of desmoplastic ameloblastoma was moderately positive. Both the cases of recurrent ameloblastoma were strongly positive. All 3 cases of peripheral ameloblastoma stained negatively. All ameloblastic carcinoma were strongly positive. CONCLUSION: Twist immunohistochemical analysis can be used as an adjuvant to H&E histopathological findings for proper categorization and grading of ameloblastoma especially in the clinically aggressive tumours.