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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. Material and Methods; All the cases (n = 183) of Cirrhosis of liver with ascities, fulfilling inclusion criteria were recruited from Department of Medicine Akhtar Saeed Trust Hospital Lahore and Nishtar Hospital, Multan. All selected 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; 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. 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. Keywords; Cirrhosis, spontaneous bacterial peritonitis, E. coli. DOI: 10.7176/JMPB/67-07 Publication date: August 31 st 2020

Objective; To determine the effectiveness in terms of postoperative pain with intravenous acetaminophen versus ketamine among women undergoing abdominal hysterectomy. Material and Methods; A total of 114 women undergoing abdominal hysterectomy were taken in this study. The study was conducted at Akhtar Saeed Trust Hospital, Lahore and Nishtar Hospital Multan. Data was analyzed with statistical analysis program (SPSS version 21). Analysis was done to compare proportion of acetaminophen group and ketamine group. Chi-square test was applied to compare both groups in terms of efficacy taken p ≤0.05 as significant. Results; Our study comprised of 114 ladies undergoing abdominal hysterectomy, mean age of the study cases was 54.13 ± 6.89 years (with minimum age of the patients was 39 years while maximum age was 68 years). Majority of our study cases i.e. 92 (80.7 %) had parity more than 3 and American Society of Anesthesiology (ASA) score level 1 in 93 (81.6%). Sixty one (53.1%) belonged to rural areas, while mean duration of surgery was 72.80 ± 11.32 minutes. Mean BMI level in our study cases was noted to be 23.98 ±4.17 Kg/m 2 and obesity was present in 34 (29.8%) of our study cases. Efficacy was noted in 60 (52.6 %) of our study cases. Efficacy was 73.7% study cases in group A while 18 (31.6%) in group B (p=0.000). Conclusion; Our study results support the use of intravenous acetaminophen (IVA) for pain management in patients undergoing abdominal hysterectomy compared with ketamine. Intravenous acetaminophen is safe, reliable and effective for the pain management in postoperative abdominal hysterectomy patients which was associated with shorter hospital stay and cost effective for the suffering families. No adverse reactions were noted in this study with the use of intravenous acetaminophen. Keywords; Intravenous acetaminophen, Ketamine, Abdominal Hysterectomy. DOI: 10.7176/JMPB/67-04 Publication date: August 31 st 2020