Journal of the College of Physicians and Surgeons--Pakistan: JCPSP (JCPSP-J COLL PHYSICI)

Publications in this journal

• Article: Genomic Organization of a Vancomycin-Resistant Staphylococcus aureus.

  Zulfiqar Ali Mirani, Nusrat Jamil
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  ABSTRACT: Objective: To study the genomic organization of vancomycin resistance in a local isolate of vancomycin resistant Staphylococcus aureus (VRSA). Study Design: Experimental study. Place and Duration of Study: Department of Microbiology, University of Karachi, January 2008 through December 2010. Methodology: A vancomycin-resistant Staphylococcus aureus (VRSA-CP2) isolate (MIC 16 μg/ml) was isolated from a local hospital of Karachi. Species identification was confirmed by Gram staining, standard biochemical tests and PCR amplification of the nuc gene. The vancomycin MIC was re-confirmed by E-test. For the genetic determination of vancomycin resistance, in-vitro amplification of vanA cassette was performed by using plasmid DNA of CP2, CP2's transformant as template on MWG Thermo-Cycler. Amplified products of vanR, vanS, vanH, vanA, vanY, orf2, orf1D, orf2E, orf-Rev and IS element genes were subjected to Sanger's electrophoresis based sequence determination using specific primers. The Basic Local Alignment Search Tool (BLAST) algorithm was used to identify sequences in GenBank with similarities to the vanA cassette genes. Results: The vancomycin-resistant isolate CP2 was found to be resistant to oxacillin, chloramphenicol, erythromycin, rifampicin, gentamicin, tetracycline and ciprofloxacin, as well. The isolate CP2 revealed four bands: one of large molecular size ~56.4 kb and three of small size ~6.5 kb, ~6.1 kb and ~1.5 kb by agarose gel electrophoresis indicating the presence of 3 plasmids. The plasmid DNA of isolate CP2 was analyzed by PCR for the presence of the van cassettes with each of the vanA , vanB and vanC specific primers. It carried vanA cassette, which comprises of vanR, vanS, vanH, vanA, vanY, and orf2. The vanA cassette of isolate CP2 also carried an insertion element (IS). However, it did not show the PCR product for orf1. Vancomycin resistance was successfully transferred from the donor CP2 to a vancomycin-sensitive recipient S. aureus. The MIC of vancomycin for the transformant was 16 μg/ml, similar to the parent isolate CP2. Nucleotide sequencing of the PCR product showed similarity with van genes of enterococci and other VRSA reported from different parts of the world. Conclusion: Sequence of vanA cassette of CP2 showed partial homology with vancomycin resistant enterococci, VRSA vanA cassette element recorded in gene bank NCBI.
  Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 02/2013; 23(2):107-111.
• Article: Need for Provision of Voluntary HIV Counselling and Testing (VCT) to Injecting Drug Users (IDUs)

  Naeem Aslam
  Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 01/2013; 23(5):378-380.
• Article: Mortality in meconium aspiration syndrome in hospitalized babies.

  Zahid Anwar, Tayyaba Khawar Butt, Fariha Anjum, Muhammad Yaqub Kazi
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  ABSTRACT: Objective: To determine the outcome of the babies in terms of mortality with the diagnosis of Meconium Aspiration Syndrome (MAS). Study Design: An observational study. Place and Duration of Study: The Neonatal Unit of Services Institute of Medical Sciences and Services Hospital, Lahore, Pakistan, from February 2008 to January 2009. Methodology: All the babies admitted to the neonatal unit during the period of study with the diagnosis of MAS were included. At admission, demographic, maternal, antenatal and natal data were recorded on a specific form. The progress of the baby, including need for ventilation, medications, complications and outcome were also followed and documented. Results: One hundred and nine babies admitted with MAS, 32% died. Most of the babies (n=73) were admitted from our obstetrical unit and the rest through the emergency department. Majority (60 of 109) were admitted within the 1st hour of life. Most (14 of 15) of the newborns requiring intubation within 1st hour of life, died. Forty four babies were ventilated and 35 of these babies succumbed. Of ventilated babies, 11 developed pneumothoraces. Seventy two percent (13 out of 18) of expired babies stayed for less than 24 hours. Conclusion: Mortality rate for MAS was higher in the study group as compared to international figures. It was especially high in babies requiring mechanical ventilation in 1st hour of life or with co-existing severe hypoxic ischemic encephalopathy.
  Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 12/2012; 21(11):695-9.
• Article: Frequency of HBsAg Positivity: A Laboratory Data Analysis

  Farhan Essa Abdullah, Akhtar Amin Memon, Ammara Mushtaq, Syeda Ezz-e-Rukhshan Adil, Shahana Urooj Kazmi
  Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 11/2012; 22(11):742-743.
• Article: Utility of Polymerase Chain Reaction in Diagnosis of Tuberculosisin Our Setup: A Ten Years Experience

  Faisal Hanif, Aamer Ikram, Luqman Satti, Muhammad Roshan, Shahid Ahmed Abbasi
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  ABSTRACT: Objective: To evaluate the yield of polymerase chain reaction (PCR) for detection of Mycobacterium tuberculosis from different clinical specimens. Study Design: Observational study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from January 2001 to December 2010. Methodology: Different clinical specimens received for Mycobacterium tuberculosis PCR were dealt during the study period. Contaminated samples like sputum were processed by the standard N-acetyl L-cysteine (NALC)-NaOH method. PCR protocols were followed as per manufacturer's manual. PCR was performed using a Thermal Cycler (Master Cycler, Eppendorf, Germany): an initial denaturation step at 94°C for 3 minutes was followed by 40 cycles of denaturation at 94°C for 30 seconds, annealing at 60°C for 30 seconds and extension at 72°C for 30 seconds and a final extension at 72°C for 7 minutes. The products were held at 4°C and later run on 1% agarose gel, stained with Ethidium bromide and visualized in ultraviolet (UV) transilluminator. Results: Out of a total 4620 samples for PCR, 299 were positive for Mycobacterium tuberculosis (6.5%). The percentage of samples from male patients were 63.2%. The mean age of patients was 38+11.5 years. Blood was the most frequent specimen received for PCR (46.66%), followed by body fluids (18.41%) and CSF (10.64%). Yield for different clinical samples was 63/471 for sputum (13.4%), 3/29 for endobronchial washings (10.3%), 59/851 for body fluids (6.9%) and 24/400 for urine (6%). Positive yield from blood was the lowest (101/2156, 4.7%). Conclusion: PCR for Mycobacterium tuberculosis is a rapid and reliable method for the diagnosis of both pulmonary and extrapulmonary tuberculosis. The highest positive yield was obtained from sputum and lowest from blood specimens.
  Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 05/2012; 22(5):298-201.
• Article: Current pattern of antibiotic resistance in Staphylococcus aureus clinical isolates and the emergence of vancomycin resistance.

  Irfan Ali Mirza, Muhammad Roshan, Umme Farwa
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  ABSTRACT: The lettter to editor points the salient mistakes in carrying out antimicrobial susceptibilities of Staphylococus aureus and MRSA. This letter refersto the recommended CLSI methods in carrying out antimicrobial susceptibilities in this regard.
  Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 04/2012; 22(04):269-272.
• Article: Forensic Odontology

  Thorakkal Shamim
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  ABSTRACT: Forensic odontology is a specialized field of dentistry which analyses dental evidence in the interest of justice. Forensic odontology embraces all dental specialities and it is almost impossible to segregate this branch from other dental specialities. This review aims to discuss the utility of various dental specialities with forensic odontology.
  Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 04/2012; 22(4):240-245.
• Article: hypermetropia as a presentation of diffuse choroidal heamangioma in sturge-weber syndrome

  farah akhtar, mahmood ali, naima zaheer, ayisha kausar
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  ABSTRACT: A 16 years old male patient of Sturge-Weber syndrome was referred to glaucoma clinic for the management of unilateral glaucoma. There was also an ipsilateral hypermetropic shift. On detailed investigations, a diffuse choroidal haemangioma was diagnosed which induced this hypermetropic shift. Anisometropia in Sturge-Weber syndrome can give us clue regarding some underlying pathology, so unilateral myopia or hypermetropia should be thoroughly evaluated in such patients.
  Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 01/2012; 22:53-55.
• Article: 16. Obstetrical Trauma to the Genital Tract Following Vaginal Delivery Journal of the college of physicians and surgeons Pakistan 2012,vol.22(2):95-97 1st Author.

  Dr Meharunnissa khaskheli
  Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 01/2012; 22(2):95-97.
• Article: http://www.jcpsp.pk/archive/2011/Nov2011/07.pdf

  Mahmood Ali, Farah Akhtar
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  ABSTRACT: Ocular digital massage for the management of post- trabeculectomy underfiltering blebs. Mahmood Ali, Farah Akhtar Department of Ophthalmology, Pakistan Institute of Ophthalmology, Al-Shifa Trust Eye Hospital, Rawalpindi. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP 11/2011; 21(11):676-9. DOI:11.2011/JCPSP.676679 pp.676-9 Source: PubMed Edit ABSTRACT To evaluate the efficacy and safety of ocular digital massage (ODM) in the management of underfiltering blebs after trabeculectomy. Quasi experimental study. Place and Duration of Study: Glaucoma Clinic of Al-Shifa Trust Eye Hospital, Rawalpindi, from January 2007 to November 2008. ODM was performed 3-4 times daily in 20 eyes having intraocular pressure (IOP) above the target level after trabeculectomy. Equal number of eyes with satisfactory IOP after trabeculectomy were taken as controls. Both groups were evaluated at 1 week, 3 weeks, 6 weeks, 3 months, 6 months and 9 months. Mean IOP, frequency of complications and required number of IOP lowering medicines in both groups were compared using 't' test. Massage group had a significantly higher mean IOP than the control group before the initiation of massage (p < 0.001). After initiating ODM, there were no significant differences in the mean IOP of two groups at 1 week (p = 0.421), 3 weeks (p = 0.073), 6 weeks (p = 0.575), 3 months (p = 0.071), 6 months (p = 0.085) and 9 months (p = 0.369). The difference in terms of required number of IOP lowering medicines (p = 0.075) and complication rates (p = 0.411) was also not significant. ODM is an effective method for controlling IOP after trabeculectomy, and thus contributes to long-term surgical success with an acceptable risk / benefit ratio.
  Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 11/2011;