Body composition markers are associated with changes in inflammatory markers but not vice versa: A bi-directional longitudinal analysis in a population-based sample.

BACKGROUND AND AIM: Growing body of evidence consistently link obesity and inflammation, Although the direction of the association is still unclear. We aimed to investigate longitudinal associations of body anthropometric, composition and fat distribution parameters with inflammatory markers and vice versa. METHOD AND RESULTS: We used data from 2464 individuals of the SHIP-TREND cohort with a median follow-up of 7 years. Linear regression models adjusted for confounders were used to analyze associations of standardized body composition markers derived from classic anthropometry, bioelectrical impedance analysis (BIA) and magnetic resonance imaging (MRI) at baseline with changes in inflammatory markers (C-reactive protein (CRP), white blood cell (WBC), fibrinogen) and vice versa. Higher level of anthropometric markers at baseline were associated with an increase in the change of inflammatory markers. A 13.5 cm higher waist circumference (WC), 16.0 kg body weight and 7.76 % relative fat mass (FM) at baseline was associated with a change in CRP of 0.52 mg/L (95 % confidence interval [CI]: 0.29 to 0.74), 0.51 mg/L (95 % CI: 0.29; 0.74) and 0.58 mg/L (95 % CI: 0.34; 0.82) respectively. Absolute FM showed the strongest association with changes in serum fibrinogen levels (ß for 8.69 kg higher FM: 0.07 g/L; 95 % CI: 0.05; 0.09). Baseline inflammatory markers were only associated with changes in hip circumference. CONCLUSION: Our study indicates the importance of anthropometric, body composition and fat distribution markers as a risk factor for the development of inflammation. To prevent inflammatory-related complications, important is to take measures against the development of obesity.

Biosynthesized silver nanoparticles enhanced wheat resistance to Bipolaris sorokiniana.

Agronomic crops can benefit from the application of nanoscale materials in order to control phytopathogens and improve plant growth. Bipolaris sorokiniana, a soil- and seed-borne fungus, causes severe yield losses in wheat. In order to determine the physio-chemical changes in wheat under biotic stress of B. sorokiniana, the current study aimed to synthesis silver nanoparticles (AgNPs) using Allium sativum bulb extract. Herein, we applied the silver nanoparticles (AgNPs) as a foliar spray on two wheat varieties (Pakistan-2013, and NARC-2011) at the concentrations of 10, 20, 30, and 40 mg/L to suppress B. sorokiniana. Among all the applied concentrations of AgNPs, the 40 mg/L concentration demonstrated the most effective outcome in reduction of the intensity of spot blotch and improved the morphological, physiological, biochemical parameters, as well as antioxidant activity in wheat plant. Foliar application of AgNPs at 40 mg/L Pakistan-2013 and NARC-2011 wheat varieties significantly increased chlorophyll a 84.8% and 53.4%, chlorophyll b 28.9% and 84.3%, total chlorophyll content 294.3% and 241.2%, membrane stability index 7.5% and 6.1%, relative water contents 25.4% and 10.5%, proline content 320.5% and 609.9%, and soluble sugar content 120% and 259.4%, respectively, compared to control and diseased plant. This is the first study provides important insights into the role of phyto-mediated AgNPs in increasing resistant of wheat infected with B. sorokiniana. These findings offers valuable new insights that may be useful for reducing disease incidence in wheat fields.

Body composition markers from classic anthropometry, bioelectrical impedance analysis, and magnetic resonance imaging are associated with inflammatory markers in the general population.

BACKGROUND AND AIM: The associations of body composition markers derived from different modalities with inflammatory markers are unclear. The aim of this study was to determine associations of the body composition markers from different modalities with inflammatory markers in a population-based study. METHODS AND RESULTS: We analyzed data from 4048 participants (2081 women, 51.4%) aged 20-84 years. Linear regression models adjusted for confounding were used to analyze the association of classic anthropometry markers, absolute and relative fat mass, absolute fat-free mass (FFM), and body cell mass (BCM) assessed by bioelectrical impedance analysis, subcutaneous, visceral, and liver fat from magnetic resonance imaging (MRI), with markers of inflammation. We found positive associations of classic anthropometry markers, total body fat, subcutaneous, visceral, and liver fat, with all inflammatory markers. Waist circumference (WC) showed the strongest association with high-sensitivity C-reactive protein (hsCRP) (ß: 1.39; 95% confidence interval [CI]: 1.22 to 1.56) and white blood cell (WBC) (0.39; 0.29 to 0.48), whereas visceral fat showed the strongest association with ferritin (41.9; 34.7 to 49.0). Relative body fat was strongly associated with hsCRP (1.39; 1.20 to 1.58), fibrinogen (0.29; 0.27 to 0.32), and WBC (0.35; 0.25 to 0.46). Conversely, we found inverse associations of body height, FFM, and BCM with hsCRP, fibrinogen, and WBC. CONCLUSIONS: Our study indicates the importance of WC as an easily measured marker for early inflammation. MRI-assessed markers of central obesity seem to be most strongly related to ferritin.

Extensively Drug-Resistant Enteric Fever In Children: Surging Threats Of Antimicrobial Resistance And Possible Solutions.

BACKGROUND: Enteric fever is an infectious disease caused by Salmonella enterica including Salmonella Typhi and Paratyphi A and is associated with potentially serious outcomes, especially in developing countries. The study was conducted with the aim to present the clinical features, laboratory characteristics and antibiotic susceptibility in patients with culture-proven extensively drug-resistant (XDR) enteric fever and to explore drug combinations as a possible solution for the growing problem of antimicrobial resistance. METHODS: This descriptive cross-sectional study was conducted in the Paediatric unit of Ayub teaching hospital. Patients admitted with culture-proven XDR enteric fever were included. Patient characteristics were documented on a predesigned proforma. Response to antimicrobial agents including ceftriaxone and levofloxacin, azithromycin and meropenem and meropenem alone was assessed. Data was entered and analyzed using SPSS version 26. RESULTS: A total of 53 patients participated in this study. The majority of patients 36 (67.9%) were male and above 5 years of age(n=38,71.7%). The mean age of the participants was 7.08±3.02 years. The major presenting features included fever, anorexia and pain abdomen in 53 (100%), 51 (96.2%) and 41 (77.4%) respectively. The mean duration of symptoms prior to hospitalization was 8.92±3.361 days. Of the total patients, 32(60.4%) responded to the initial therapy with ceftriaxone and levofloxacin, 11(20.8%) patients responded to meropenem alone and 10 (18.9%) patients responded to meropenem and azithromycin in combination. There was no statistically significant difference in mean duration to show response in patients receiving either of the treatments (p=0.484). CONCLUSIONS: Paediatric patients with XDR enteric fever mainly presented with fever, anorexia and pain abdomen and showed good response to therapy with the combination of ceftriaxone and levofloxacin inspite of the apparent resistance on blood culture and sensitivity.

High Genetic Diversity in the Himalayan Common Bean (Phaseolus vulgaris) Germplasm with Divergence from Its Center of Origin in the Mesoamerica and Andes.

The common bean is found in the Himalayan region of Pakistan with substantial morphological variability. Genetic diversity within any crop species is a precursor for genetic improvement; however, little is known about common bean genetic diversity in this region. We explored the genetic diversity in the common bean from the Himalayan region (Khyber Pakhtunkhwa, Gilgit-Baltistan, Kashmir) of Pakistan. Microsatellite genotyping was carried out for 147 samples with 40 simple sequence repeat (SSR) markers. The results revealed a clear divergence of the Pakistani population from the primary gene pool (with FST values of 0.2 with Andes and 0.27 with Mesoamerica). However, within the Himalayan germplasm, no clear evidence of spatial structure was observed (with the maximum FST values of only 0.025), probably due to the dispersal of seeds by human activity within the region. This was further elucidated by the discriminant analyses of principal components. Considering the diversity parameters, high genotypic diversity was observed for the indigenous lines (0.990), comparable to the primary gene pool (0.976 for Mesoamerica and 0.976 for Andes populations). A high genotypic diversity was observed within the Himalayan population (ranging from 0.500 for Upper Dir to 0.952 for Mansehra). Gene diversity across loci varied between 0.28 for Chitral to 0.38 for Kurram. Our results suggested a divergent and independent evolution of the Himalayan population, which might have led to the diversification of the common bean germplasm in the region postintroduction into the region. The diversity observed could also be exploited in future breeding programs for the development and introduction of climate-resilient varieties.

Meningococcaemia In Children-An Under Recognized Public Health Problem In Pakistan.

Background: Meningococcaemia is a serious bacterial disease caused by Neisseria meningitidis resulting in septicaemia and meningitis in previously well individuals and is associated with serious consequences including mortality. As the data from our region is scarce, the study was conducted with an aim to highlight the disease manifestations and outcomes so that appropriate interventions are devised. Method: A descriptive study was conducted in Paediatrics A Unit from 1st March 2020 to 30th September 2021 after approval of institutional review board. Children admitted with features of meningococcaemia in the form of fever and typical petechial purpuric rash were included in the study. Results: A total of 46 patients with meningococcaemia were included in the study. Of these, 24 (52.2%) were male. Majority of the patients 22 (47.8%) were in the age group of 1 year to five years, Major complications were meningitis in 39 (84.8%), septic shock in 26 (56.5%) and purpura fulminans in 12 (26.1%) patients. Mortality was documented in 6 (13%) patients. Outcome was associated with age. (p= 0.039). There was a significant difference in outcome in patients with prolonged PT/APTT (p=0.031), purpura fulminans (p=0.000) and septic shock (p=0.021). Conclusion: Meningococcaemia is prevalent in our region in paediatric population. The disease has a fulminant course with a myriad of complications and potentially fatal outcomes especially in children under one year of age.

Recovering phosphate and energy from anaerobic sludge digested wastewater with iron-air fuel cells: Two-chamber cell versus one-chamber cell.

Anaerobic sludge digested (ASD) wastewater is widespread in wastewater treatment plants. Recovering phosphate from ASD wastewater not only removes pollutants but also solves the phosphorus deficiency problem. Iron-air fuel cells were chosen to recover phosphate and generate electricity from ASD wastewater. To optimize cell configuration, a two-chamber and a one-chamber iron-air fuel cell were set up. The phosphate removal efficiency, the vivianite yield and the electricity generation efficiency of the two fuel cells were evaluated. It turned out that the volumetric removal rate (VRR) of phosphate of the two-chamber cell was 11.60 mg P·L-1·h-1, which was about five times of that in the one-chamber cell. The phosphate recovery product vivianite was detected on the surface of the iron anodes and the calculated purities of the two-chamber fuel cell and one-chamber fuel cell were 90.6% and 58.7%, respectively. Considering the content and purity, the iron anode surface in the two-chamber fuel cell was the best point to recover phosphate. The proton exchange membrane (PEM) in the two-chamber fuel cell provided low pH conditions suitable for vivianite formation. Moreover, under the low pH condition, metal ions of Fe2+, Ca2+, Al3+ and so on were kept soluble, leading to a high conductivity. The high conductivity caused low internal resistance, which benefited the electricity generation. The total output electric power of the two-chamber fuel cell was 2.4 times that of the one-chamber fuel cell when treating 25 mL ASD wastewater (0.62 vs. 0.26 mW·h). Overall, the two-chamber fuel cell was the better choice for phosphate recovery and electricity generation from ASD wastewater. Further studies on the long-term operation of two-chamber fuel cells should be carried out.

Burden And Spectrum Of Respiratory Ailments In Paediatric Tertiary Care Setting.

BACKGROUND: Respiratory tract infections are a significant cause of mortality and morbidity in paediatric age group all over the world and especially in under developed regions. The present study was conducted with an aim to assess the burden and the types of respiratory illnesses in our region. METHODS: The study was a cross sectional study conducted at Paediatric A unit of Ayub teaching hospital from 1st October, 2018 to 31st March, 2019. All patients aged 1 month and above who required admission for various respiratory ailments were included in the study. RESULTS: A total of 2255 patients were admitted in Paediatric A unit over a six months period. Of these, 603 (26.74%) patients were admitted with various respiratory problems and were included in the study. Among these, 389 (64.5%) patients were male and 214 (35.5%) were female. Mean age of the participants was 18.77±30.87 months. The major disease categories were bronchopneumonia in 189 (31.3%), bronchiolitis in 176 (29.2%), measles pneumonia in 60 (10%), lobar pneumonia in 52 (8.6%) and upper RTI in 32 (5.3%). Mean duration of stay was 3.13±2.08 days. Majority of the patients 482 (79.9%) were up to 24 months of age, followed by 77 (12.8%) patients in 25-60 months age and 44 (7.3%) patients more than 60 months of age. A total 295 (48.92%) patients were vaccinated while 308 (51.07%) patients were either partially vaccinated 116 (19.2%) or unvaccinated 192 (31.8%). A total of 576 (95.5%) patients were discharged, 17 (2.8%) patients expired and 5 (0.8%) were referred to higher specialty. Bronchopneumonia was the leading cause of mortality in this study. CONCLUSIONS: Respiratory tract infections constitute a major threat to the health of paediatric patients especially in the first two years of life. Improvement in vaccination coverage is essential in reducing the burden of a majority of respiratory ailments along with health education.

COVID 19 In Children: An Experience From A Paediatric Tertiary Care Setting.

BACKGROUND: The pandemic of COVID 19 has affected a number of people around the globe. The data from paediatric population is scarce. The present study is aimed to present the paediatric perspective of the disease in terms of different clinical presentations, laboratory parameters, complications, and outcomes so as to develop an insight into disease manifestations in children. METHODS: This descriptive case series was conducted in the department of Paediatrics after approval of institutional review board. All children admitted in paediatric unit with confirmed SARS-COV-2 infection either by PCR or antibody test were included in the study. Patients' characteristics were documented on a predesigned proforma and analysed using SPSS 26.0. RESULTS: A total of 17 patients comprising 13 (76.5%) male and 4(23.5%) female were included in the study. The major clinical features were fever, cough and shortness of breath documented in 15 (88.2 %) patients. Major complications were shock in 13 (76.5%), respiratory complications in 16 (94.11%), CNS complications in 4 (23.5%), cardiac complications in 5 (29.4%), hepatic involvement in 3 (17.6%) Acute Kidney Injury in 4 (23.5%) patients and 9 (52.9 %) patients were labelled as having Multisystem Inflammatory Syndrome in Children (MIS-C). A total of 7 (41.2%) patients had coexistent comorbid diseases. A total of 13 (76.47%) patients were discharged, 2 (11.8%) patients expired and 2 (11.8%) left against medical advice. CONCLUSION: The clinical presentation of paediatric patients with SARS-COV-2 infection is highly variable. Multisystem inflammatory syndrome associated with SARS-COV-2 must be considered in the differential diagnosis of children presenting with multiorgan dysfunction.

A Rare Case Of Berardinelli Seip Syndrome.

Berardinelli Seip Syndrome is a rare disorder associated with loss of adipose tissue leading to a myriad of findings owing to derangements of carbohydrate and lipid metabolism. There is no cure and the management comprising low fat diet, metformin and leptin replacement is aimed at preventing complications. We report this syndrome in a male child from Afghanistan.

Corrigendum to "Combined Industrial Wastewater Treatment in Anaerobic Bioreactor Post-Treated in Constructed Wetland".

[This corrects the article DOI: 10.1155/2013/957853.].

Validity Of Grayscale Ultrasound And Resistive Index In The Detection Of Nature Of Ovarian Neoplasms By Taking Histopathology As A Gold Standard.

BACKGROUND: The utility of ultrasound has long been established in the diagnosis of benign and malignant ovarian neoplasms. Ultrasound is a safe and non-invasive imaging modality that has a high sensitivity and specificity. The objective was to determine the validity of grayscale ultrasound and resistive index in the detection of nature of ovarian neoplasms by taking histopathology as a gold standard. METHODS: It was Cross-sectional study conducted in department of Radiology, Ayub Teaching Hospital Abbottabad from May 16 to November 30, 2014. Twohundred- twenty-one female patients in whom an adnexal mass was noted on pelvic ultrasound were included in the study. RESULTS: Out of these 221 patients, malignant ovarian masses were present in 50 (22.62%) patients on grayscale ultrasound. While a resistive index ≤0.6 was found in 56 (25.34%) patients. Over all the sensitivity of grayscale ultrasound was 95% and the specificity was 93.37%. Likewise, the sensitivity and specificity of resistive index were 95% and 90.06% respectively. CONCLUSIONS: This study showed the grayscale ultrasound is a sensitive imaging modality for differentiation of benign and malignant ovarian masses.

Improvement of ferrous ion-dependent nitrate removal (FeNiR) process with chelating ferrous ion as substrate.

In order to improve the ferrous ion-dependent nitrate removal (FeNiR) process, hexametaphosphate chelated ferrous ion was used as substrate to replace the free ferrous ion. With hexametaphosphate chelated ferrous ion as substrate, the influent pH was adjusted to 6.8, and as a result a higher effluent pH (7.2) was detected. The volumetric removal rate (VRR) of nitrate kept at 0.42 ± 0.03 kg-N/(m3∙d) for 48 days and the corresponding nitrogen removal efficiency was 94.39 ± 4.57%. After 88 days of cultivation, FeNiR granules became small because of the oligotrophic substrate. The transmission electron microscope (TEM) analysis showed that less iron encrustation was formed on the surface or in the periplasm of FeNiR cells. The linear curve of the living cell percentage versus time showed that the death rate of FeNiR cells with chelated ferrous ion as substrate was much lower than that with free ferrous ion as substrate (0.4210 vs 0.9221). Without iron encrustation, both the FeNiR activity and alkaline phosphatase (ALP) activity of FeNiR cells kept at high level and thus the efficiency of the FeNiR reactor kept stable and high. With hexametaphosphate chelated ferrous ion as substrate, the pH in bulk liquid was high (pH = 7.2) resulting in the high FeNiR rate, and less iron encrustation was formed around cells ensuring the stability of high FeNiR rate. Therefore, using hexametaphosphate chelated ferrous ion as substrate was an efficient way to improve the FeNiR process.

Obesity And Diabetes As Determinants Of Vitamin D Deficiency.

BACKGROUND: Vitamin D has been the focus of attention in the recent past owing to its multitude of effects on various organ systems including immune system, endocrine, cardiovascular etc. Diabetes mellitus and obesity are widely prevalent in our region. The present study was designed with an objective to determine the vitamin D status in relation to diabetes mellitus and obesity in our area. METHODS: This cross-sectional study was conducted at the Medical C Unit of Department of Medicine, Ayub Teaching Hospital from January to December 2017. Approval of ethical committee was taken. A total of 117 patients were enrolled in this study of which 109 were finalized for analysis owing to incomplete data in 8 cases. Patients' characteristics were recorded on a structured proforma. Type 2 diabetes was confirmed using HbA1C Levels. Using ADA 2016 criteria. Vitamin D status was assessed using 25-OH-Vit D levels from the same laboratory. Height and weight of the patients were recorded to obtain BMI. Data was entered and analysed using SPSS version 20. RESULTS: Of the total sample, 69 (63.3%) were females and 40 (36.7%) were males. Mean age of the participants was 44.13±15.777. Mean vitamin D levels were 26.35±18.72. A total of 83 (76.14%) patients were either vitamin D deficient 66 (60.6%) or insufficient 17 (15.6%) while 26 (23.9%) were sufficient in vitamin D. There was statistically significant difference in vitamin D status in diabetic versus non diabetic patients (p=0.015). As regards BMI and vitamin D status, the difference was also statistically significant (p=0.018). CONCLUSIONS: Vitamin D deficiency is widely prevalent in our region. There is also a high prevalence of obesity and diabetes mellitus and they are inversely related to low vitamin D levels.

Industrial wastewater treatment in internal circulation bioreactor followed by wetlands containing emergent plants and algae.

Wastewater treatment based on ecological principles is a low cost and highly desirable solution for the developing countries like Pakistan. The present study evaluated the effectiveness of biological treatment systems including Internal Circulation (IC) anaerobic bioreactor and constructed wetlands (CWs) containing macrophytes and mixed algal cultures for industrial wastewater treatment. The IC bioreactor reduced COD (52%), turbidity (89%), EC (24%) of the industrial wastewater. However, the effluents of IC bioreactor did not comply with National Environmental Quality Standards (NEQS) of Pakistan. Post-treatment of IC bioreactor effluents was accomplished in CW containing macrophytes (Arundo donax and Eichhornia crassipes) and mixed algal culture. The CWs planted with macrophytes lowered the concentrations of COD (89%) and turbidity (99%). CWs with algal biomass were not effective in further polishing the effluent. Inhibition of algal biomass growth was observed due to physicochemical characteristics of wastewater. The integrated treatment system consisting of IC bioreactor and macrophytes was found more suitable option for industrial wastewater treatment.

Assessment of antimicrobial, antioxidant and cytotoxicity properties of Camellia sinensis L.

The phytochemical screening, antimicrobial, antioxidant and cytotoxic properties of Camellia sinensis were evaluated in the present study. The phytochemical screening revealed the presence of an applicable amount of lycopene, ß-carotenes, flavonoids and tannins in C. sinensis. Among the phytochemicals, tannin was found to be significantly higher in tea plant. The antimicrobial activity of plant extracts against selected bacterial strains namely, Escherichia coli, Staphylococcus aurous, Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, Marginella morganii and Haemophilus influenzae was investigated. The results showed that the stem part of C. sinensis presented greater antimicrobial potential than the leaf and root. Antioxidant activity (assessed through % inhibition of linoleic acid per oxidation test) was the highest (89.22%) in n-hexane extract of root part as compared to other extracts. Finally, the cytotoxicity analysis (haemolytic activity against human erythrocytes) of plant extract showed the negligible (%) lysis of RBCs ranging from 1.73 to 4.01%. In conclusion, it can be suggested that C. sinensis is the potential source to obtain bioactive phenolic compounds with high antimicrobial and antioxidant properties, which could possibly be exploited for the treatment of various infectious diseases.

Corrigendum to "Natural Treatment Systems as Sustainable Ecotechnologies for the Developing Countries".

[This corrects the article DOI: 10.1155/2013/796373.].

Spectrum Of Congenital Heart Disease In Full Term Neonates.

BACKGROUND: Congenital heart disease is a significant problem world over especially in neonates. Early diagnosis and prompt interventions in neonatal period precludes the mortality associated with this disorder. The objective of this study was to highlight the diversity of congenital cardiac defects in our region so that appropriate interventions are devised to minimize significant morbidity and mortality associated with this disorder. METHODS: This descriptive cross-sectional study was conducted at the Neonatology Unit of Department of Paediatrics, Ayub Teaching Hospital from January 2015 to December 2016. Approval of ethical committee was taken. All fullterm neonates of either gender who presented in department of neonatology including those delivered in hospital or received from other sources (private settings, home deliveries), diagnosed as having congenital heart disease on echocardiography were included in the study. Preterm neonates of either gender were excluded from the study. Patient characteristics were recorded in a designed proforma. Data was entered in SPSS version 20 and analysed. RESULTS: A total of 89 neonates were included in the study. Mean age of presentation was 6.34±7.058 days and range of 1-28 days. There was a male preponderance with 57 (64%) male patients as compared to 32 (36%) female patients. Ventricular septal defect (VSD) was the commonest cardiac lesion being present in 34 (38.2%) patients. Other defects included complex congenital heart disease in 8 (9%), atrial septal defect (ASD) and transposition of great arteries (TGA) in 7 (7.9%) each, atrioventricular septal defect (AVSD) in 6 (6.7%) and Fallots's tetralogy (TOF) and hypoplastic left heart syndrome in 5 (5.6%) each.. CONCLUSIONS: Congenital heart disease is a problem of profound importance. It constitutes approximately one third of the total major congenital malformations. There is a diversity of cardiac lesions in our region that warrant early and prompt interventions so that the disease is recognized and treated at the earliest to reduce morbidity and mortality.

Role Of Tuberculin Test As A Diagnostic Tool For Tuberculosis.

BACKGROUND: Childhood Tuberculosis remains one of the major public health concerns in developing countries like Pakistan and is responsible for high rates of morbidity and mortality in children. Although tuberculin skin test is very commonly used by physicians all over the world, its interpretation always remains difficult and challenging. The objective of this study was to determine the frequency of positive tuberculin skin test in vaccinated and unvaccinated children suffering from tuberculosis. METHODS: This Cross-sectional study was conducted in the department of Paediatric Ayub Teaching Hospital, Abbottabad from 1st February 2015 to 30th April 2016. A total of 150 patients were observed in this study. Children of either gender who were aged 1-15 years admitted in ward with tuberculosis were included in the study by using nonprobability convenient sampling technique. We injected 0.1 ml (10 units) of tuberculin purified protein derivative (PPD) into the anterior surface of the forearm and induration was read at 72 hours after administration. Data was entered and analysed using SPSS version 10. RESULTS: Out of 150 children, 84 (56%) were males and 66 (44%) were females. The mean age was 7.8±3.84 years. Of these 75 (50%) were vaccinated and 75 (50%) were unvaccinated. In vaccinated Group 5.3% children had positive tuberculin skin test while in unvaccinated Group 2.7% children had positive tuberculin skin test and this difference was found statistically insignificant (pvalue= 0.40). Pulmonary TB was the diagnosis in 67 (44.7%), TBM in 65 (43.3%), abdominal TB in 7 (4.7%), disseminated TB in 4 (2.7%) and military TB in 7 (4.7%) patients. CONCLUSIONS: The positivity of tuberculin skin test in vaccinated and unvaccinated children suffering from tuberculosis was found to be insignificant in our study. We conclude that Tuberculin Skin Test should not be used as a sole diagnostic tool for diagnosing the disease in children of our region..

Antimicrobial Resistance Patterns In Community Acquired Urinary Tract Infections.

BACKGROUND: Urinary tract infection (UTI) is the most frequent disease for which patients seek medical care. The antimicrobial agents causing UTI and their sensitivity patterns have remarkably changed throughout the world over the past few years. Hence, the present study was designed to explore the uropathogens and their susceptibility to various molecules in our region. METHODS: This descriptive cross sectional study was conducted at Medical C Unit of Ayub Teaching Hospital, Abbottabad from January 2015 to January 2016. Patients with clinical features of UTI were evaluated using Urine R/E and Urine culture and sensitivity. Ten antibiotics were checked for susceptibility. Results were analysed using SPSS 17. RESULTS: A total of 630 patients presented with urinary complaints. Of these, 236 patients had more than 8-10 pus cells on urine R/E. They were further evaluated using culture and sensitivity and positive culture was obtained in 75 patients. Of these 34 (45.3%) were males and 41 (54.7%) were females. E Coli was the predominant isolate being present in 49 (65.3%) patients. This was followed by Klebsiella in 9 (12%) patients. Tazobactam-piperacillin and cefoperazone-sulbactam were the most sensitive drugs having overall sensitivity of 96% and 93.3% respectively. The isolates were highly resistant to Fluoroquinolones 77.3% followed by Penicillins 72% and TMP-SMX 69.3%. CONCLUSIONS: Antibiotic sensitivity patterns have enormously changed over the past decade. Newer agents are quite efficacious but their use should be highly judicious to prevent the development of resistance to these molecules.