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Background: The emergence and spread of antibiotic resistant bacteria causing infection is a great health issue for clinicians. The problem of multidrug resistant (i.e. resistant to at least three groups of antimicrobial) is becoming more and more threatening. The rate of resistance among Gram negative bacteria especially non fermenters are increasing to all available antibiotic groups. Objectives: The aim of study was to detect the pattern of antimicrobial susceptibility in non-fermenter Gram negative bacilli (NFGNB) in a tertiary care hospital (Postgraduate Medical Institute, Lahore). Study Design: Descriptive study. Settings: The study was conducted in Pathology Department, Postgraduate medical institute (PGMI), Lahore. Study Period: Six months from August 2014 to December 2014. Material and Methods: Non-fermenter Gram negative bacteria were collected from various clinical specimen including blood, pus, urine, fluid aspirates and respiratory tract in a period of six months in pathology department, PGMI. All non-fermenter Gram negative isolates were identified up to species level by standard laboratory procedures using API (Analytical profile index) 20 NE (nonenterobacteriaceae). Antimicrobial susceptibility testing of non-fermenter Gram negative isolates were performed by modified Kirby Bauer disk diffusion method as recommended in CLSI. Results: Out of the total 51 samples the most commonly isolated NFGNB were Acinetobacter baumanni and Burkholderia cepacia (16 each) followed by Pseudomonas aeruginosa (7), Pseudomonas luteola (5), Stenotrophomonas maltophilia (4), Pseudomonas fluorescens (2) and Pseudomonas stutzeri (1). Conclusion: The study showed that rate of multidrug resistance increased in non-fermenter Gram negative organisms. [ABSTRACT FROM AUTHOR]

Objectives: To study the frequency of acute myocardial infarction (AMI) and its types in patients admitted in CCU of Divisional Headquarter Hospital (DHQ), Faisalabad Institute of Cardiology (FIC) Faisalabad and to investigate associated risk factors. Methodology: It was an observational hospital based study conducted at Cardiac Care Centre, DHQ Hospital Faisalabad and FIC from 30th March 2009 to 30th June 2009. One hundred patients were included in the study at both centers. A Performa was filled with tabulated questions and information was recorded. The data was analyzed on SPSS version 13. Results: It revealed statistically significant difference by patient's age and sex. AMI was higher in males (CI = 75 - 91%) than females (CI = 9 - 25%). Types of infarction including inferior and anteroseptal were observed in significantly higher number of patients, while extensive anterior, non-STEMI and lateral infarction was observed in significantly less number of patients. Results showed significant association (P<0.05) of fat sources in diet with types of AMI. Hypertension (CI = 36-56), smoking (CI = 30-50), family history of IHD (CI = 26-45) were stronger risk factors than others and 19% patients admitted with AMI had Diabetes Mellitus. Conclusion: AMI was significantly higher in patients between 40 and 50 years of age. Age and sex and fat sources in the diet showed significant association with AMI, while family history of IHD, hypertension and smoking were other stronger risk factors. [ABSTRACT FROM AUTHOR]

Objective: To determine the attitude and factors leading to decision regarding the mode of delivery in women with previous experience of C-section., Methods: The cross-sectional study was conducted at Maternity Unit of Jinnah Postgraduate Medical Centre, Karachi, from January to August 2008, and involved 150 women with one previous C-section without any recurrent cause. All women had a parity of two or more. Women with more than one caesarean section and women who lost contact were excluded. The women were recruited from antenatal clinic and were briefed by medical professionals before the questionnaire was filled out. SPSS version 10 and Chi square test were used for statistical analysis., Results: Of the total 29 (19.3%) preferred a repeat caesarean section, and 121 (80.7%) opted for the trial of scar. No significant difference was seen in the mode of delivery when the decision was taken by women alone or when it was taken jointly by doctors and women. When the decision was taken by doctors, there was significant difference in the mode of deliveries. The patients expressed satisfaction towards the information received. Previous associated factors, like negative birth experience, had an influence on decision-making regarding the mode of delivery., Conclusion: Decision by women is extremely important regarding their mode of delivery and should be respected. Psychological support during pregnancy may provide an alternative to caesarean section for women with previous negative experience.

Objective: To determine the efficacy of single dose of magnesium sulphate versus the standard Pritchard regime in the management of pre-eclampsia., Study Design: Quasi-experimental study., Place and Duration of Study: Jinnah Postgraduate Medical Centre, Karachi, from January 2004 to January 2006., Methodology: All women with severe pre-eclampsia and impending eclampsia were included in the study. Patients with pregnancy induced hypertension and mild to moderate pre-eclampsia were excluded. From the 100 women included in the study, after matching for age, parity and gestational age, 50 were given only bolus dose of magnesium sulphate and 50 were given the standard regime. They were observed for one week for the number of convulsions. Fisher's exact test and Chi-square test were used to analyze results., Results: There was no significant difference in the two groups in term of occurrence of seizures, one patient developed fit with Pritchard regimen. The rate of caesarean section was lower in group A, 12% versus 30% in group B (p=0.05). There was no significant difference in perinatal outcome in either group (82% live births in group A versus 72% amongst group B (p=0.2). Few side effects like vomiting, dizziness and irritation at the site of injection were observed when standard treatment was used. Single dose treatment was also found to be cost-effective costing Pak Rs. 45 (US $ 0.56) as compared to Pak Rs. 195 (US $ 2.4) in control group. No maternal death was observed in either group., Conclusion: Having the equal effectiveness, ease of monitoring and cost-effectiveness, single loading dose of magnesium sulphate is preferable over the standard regime in the management of pre-eclampsia as a prophylactic measure for prevention of seizure.

Objective: To determine the effect of partogram on the frequency of prolonged labour, augmented labour, operative deliveries and whether appropriate interventions based on the partogram will reduce maternal and perinatal complications., Method: A case controlled, prospective and interventional study on 1000 women in labour was carried out in the obstetric unit of Jinnah Post graduate medical center, Karachi, from 1st July to 30th December, 2002. Five hundred women were studied before and after the introduction of partogram. Duration of labour, mode of delivery, number of cases augmented and neonatal outcome were noted, Results: Labour was shorter than 12 hours in 80.8% primigravida, 18.4% had labour shorter than 24 hours and only 0.8% had labour longer than 24 hours. After introduction of partogram 91.6% delivered within 12 hours and rest (8.4%) delivered within 24 hours. Normal vaginal delivery was had in 88%, 5.6% had operative vaginal delivery and 6.4% had caesarean section. Introduction of partogram showed significant impact on duration of labour (p < 0.001) as well as on mode of delivery (p < 0.01). In multigravidae 94.4% delivered within 12 hours and rest 5.6% delivered within 24 hours when partogram was used while 88.4% delivered within 12 hours and the rest 11.6%) within 24 hours before the use of partogram. Partogram showed significant reduction in duration of labour (p < 0.01). Results also showed significant reduction in number of augmented labour (p < 0.001) and vaginal examinations (p < 0.001)., Conclusion: By using partogram, frequency of prolonged and augmented labour, postpartum haemorrhage, ruptured uterus, puerperal sepsis and perinatal morbidity and mortality was reduced.

Objective: To determine the effectiveness of 50 microg misoprostol for midtrimester termination of pregnancies., Design: Experimental, cross-sectional study., Place and Duration of Study: Department of Gynaecology and Obstetrics, Unit II, Jinnah Postgraduate Medical Centre, Karachi, a tertiary care centre, from 1st Jan 2003 to 30th June 2005., Patients and Methods: The study subjects were 54 pregnant women admitted during the 2nd trimester (14-26 weeks) of gestation, willing or requiring termination of pregnancy. Those patients were included in the study who were admitted with closed cervical os, either had intrauterine death, fetal anomaly, medical disorder (hypertension or diabetes) or history of previous ceasrean section. Cases of placenta previa, acute asthma, glaucoma, cardiac diseases and allergy to prostaglandins were excluded. Each patient received 50 microg misoprostol intravaginally. Maximum 4 doses were given at 4 hours interval and state of cervical os was assessed by vaginal examination before insertion of next dose or at the onset of uterine contractions. After 4 doses of misoprostol, patients were kept under observation and watched for uterine contractions to start or for expulsion of products. Syntocinon infusion was started to augment labour where products of conception failed to expel out inspite of open os. Outcome measures include success rate of termination within 12, 24, 36 and 48 hours, mean induction - abortion time interval and maternal side effects., Results: The success rate of termination within 12, 24, 36 and 48 hours were 27.7%, 83.3%, 94.4% and 96.3% respectively. Mean induction to abortion time interval, in case of abortion within 48 hours, was found to be 18.9 +/- 11.58 (range 4 - 48 hours). Dead fetuses were aborted earlier than alive fetuses. The mean induction abortion time interval was 17.01 +/- 8.7 hours in dead and 23.4+/-15.9 hours in alive fetuses (t -value:1.9, p: 0.05). Two patients failed to deliver within 48 hours of induction. Two patients suffered from febrile illness., Conclusion: Vaginal administration of 50 microg misoprostol every 4 hourly is an effective and safe agent for ripening of cervix and convenient way of inducing abortion during 2nd trimester of pregnancy in a women either with alive or dead fetus. It is associated with a low frequency of side effect.