Both methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) are rapidly overcoming the current array of drugs. One hundred and fifty isolates from a hospital were studied for resistance towards linezolid and vancomycin. Fifty-four (36.0 %) isolates were MRSA. Both MRSA and MSSA showed high resistance towards linezolid when using the disc diffusion method, with the figures being 48.1 and 29.2 %, respectively. The figures for the E-test were 46.3 and 27.0 %, respectively. The vancomycin resistance was remarkable in MRSA (14.8 %), but relatively low in MSSA (3.1 %). The E-test results were 13.0 and 4.16 %, respectively. The cfr gene was detected in 78 % of linezolid-resistant isolates and the vanA operon was detected in 74 % of vancomycin-resistant isolates. This level of resistance against linezolid and vancomycin is unprecedented. These results are alarming and highlight the threat of non-treatable S. aureus strains.

Chronic lymphocytic leukemia (CLL) is the most common form of leukemia in the western adult population; it is also prevalent worldwide. The B cell lymphoma-2 (BCL-2) family proteins play a key role in regulating intrinsic apoptosis and, in many cancers, are the main culprits behind tumor survival and therapy resistance. Hence, the role of BCL-2 inhibitors is very beneficial in the treatment of CLL. Venetoclax is the first selective, orally bioavailable BCL-2 inhibitor. This review article discusses factors such as the pharmacokinetics, pharmacodynamics, acquired resistance to venetoclax, responders vs. non-responders in venetoclax monotherapy, and the synergistic role of venetoclax with other drugs in detail. Venetoclax is the first BH3 mimetic drug and selective BCL-2 inhibitor that has received FDA approval. This drug has proved to provide good therapeutic responses in CLL patients irrespective of the presence of adverse clinical or genetic features, including in patients with relapsed or refractory forms of CLL. We anticipate that novel combination therapies, including venetoclax and immunotherapy, will further alter the treatment landscape for patients with relapsed CLL, particularly for those with deletion 17p (del 17p) CLL, which carries a very poor prognosis.

Objectives: The objective of the current study was to find prevalence of relevant ESBL and carbapenemase producing genes in nosocomial E. coli and K. pneumoniae isolates and to check phenotypic susceptibility of all ESBL positive isolates to carbapenems. Methods: Forty ESBL producing clinical isolates of Escherichia coli (n=33) and Klebsiella pneumoniae (n=7) were examined for the presence of β-lactamase genes (CTX-M, CTX-M-1, 2, 3, 4 and TEM). Carbapenem resistance was checked phenotypically and by presence of blaNDM-1 gene. Results: Nine (27%) were positive for CTX-M genes, and 10 (30%) for TEM among E. coli isolates. Importantly, six isolates showed co-existence of CTX-M and TEM genes. In K. pneumoniae, two (28%) isolates were positive for CTX-M and one (14%) for TEM genes. Eight (24%) E. coli and one (14%) K. pneumoniae isolates were positive for CTX-M-1. Respective figures for CTX-M-4 were three (10%) and one (14%). CTX-M-2 and CTX-M-3 groups were not represented. Twenty (50%) isolates were resistant to both imipenem and meropenem out of which only four isolates expressed blaNDM-1 gene. Conclusions: The significant presence of both ESBL and carbapenemase producers and co-existence of ESBL and carbapenemases in the same isolates is worrisome. Abbreviations: ESBL: Extended spectrum β-lactamase. MBL: Metallo-betlactamase. PCR: Polymerase chain reaction. doi: https://doi.org/10.12669/pjms.37.1.3192 How to cite this:Irfan S, Azhar A, Bashir A, Ahmed S, Haque A. High frequency of simultaneous presence of ESBL and carbapenemase producers among nosocomial coliform isolates in Faisalabad, Pakistan. Pak J Med Sci. 2021;37(1):34-39.  doi: https://doi.org/10.12669/pjms.37.1.3192 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Matrix metalloproteinases (MMPs) play significant part in the tumor development, metastasis and invasion by proteolytic degradation of basement membrane and extracellular matrix. Hence MMPs can serve as good biomarkers for carcinoma breast particularly MMP-2 in our population. Objectives: To measure the concentrations of MMP-2 in plasma of breast cancer patients and establishing their correlation with stage and grade of the disease. Study Design: Comparative cross sectional. Setting: Surgery department Madinah Teaching Hospital (MTH) and the Pathology department, The University of Faisalabad (TUF), Faisalabad. Period: 1st August, 2017 to 31st December, 2017. Material & Methods: Only females with diagnosed breast cancer disease along with staging and grading were included in the study. Females with incomplete reports, on chemotherapy or radiotherapy or having other diseases like oral squamous cell carcinoma, rheumatoid arthritis etc were excluded. ELISA kit was applied to measure the concentrations of MMP-2 in plasma of the participants. OD values were calculated at 450 nm by ELISA reader placed at Post Graduate Research Laboratory, The University of Faisalabad, Faisalabad. Data was gathered and results were finalized by using SPSS 22 for statistical assessment. Results: Age of 64(72%) breast cancer patients was within range of 30-76yrs and age for 25(28%) healthy females as controls range was 18-70yrs. Difference between ages of cases and controls using t-test was statistically highly significant. Ninety five percent cases showed invasive ductal carcinoma (IDC) as histological type. Range of MMP-2 levels in cases was 80-690 ng/mL with mean 451.02 while range of MMP-2 levels in controls was 65-830ng/mL with mean 329.72 showing statistically significant difference. Relationship of different groups of MMP-2 levels in cases with stages of breast cancer was established using chi-square test which was statistically significant, stage IIB (37.5%) and IIIA (34.4%) tumors showed higher values of MMP-2. Relationship between MMP-2 levels, grade, tumor size and node invasion was nonsignificant statistically. Conclusion: MMP-2 levels were raised in cases in comparison to healthy controls. Age of majority patients was > 45 yrs while the invasive ductal carcinoma was the main histological type. MMP-2 levels were associated with stage of the disease.

Objectives:Emergence of methicillin resistant Staphylococcus aureus (MRSA) is a major medical problem of current era. These bacteria are resistant to most drugs and rapid diagnosis can provide a clear guideline to clinicians. They possess specific virulence factors and relevant information can be very useful. We designed this study to develop multiplex PCRs to provide rapid information.Methods:We studied 60 Staphylococcus aureus isolates and detected methicillin resistance by cefoxitin sensitivity and targeting of mecA gene. After initial studies with uniplex PCRs we optimized two multiplex PCRs with highly reproducible results. The first multiplex PCR was developed to confirm genus, species and methicillin resistance simultaneously, and the second multiplex PCR was for screening of virulence factors.Results:We found 38.33% isolates as methicillin resistant. α -toxin, the major cytotoxic factor, was detected in 40% whereas β-hemolysin was found in 25% cases. Panton Valentine leucocidin was detected in 8.33% and toxic shock syndrome toxin in5% cases. The results of uniplex and multiplex PCRs were highly compatible.Conclusions:These two multiplex PCRs when run simultaneously can provide vital information about methicillin resistance and virulence status of the isolate within a few hours as compared to several days needed by routine procedures.

Objective: To calculate the incidence of PMS (premenstrual syndrome) in young medical female students. To check relation of serum 17β estradiol with affective symptoms of PMS. Study Design: Cross sectional study. Settings: The Department of Biochemistry, The University of Faisalabad (TUF). Duration: 3 months from September 2017 to November 2017. Methodology: The study groups included 50 controls and 31 patients of the age group 18-28 years. Their symptoms of PMS were noted by questionnaire. Blood sampling of participants was performed in luteal phase of cycle. Serum 17β estradiol was estimated with the help of ELISA. Results: The T-test was used to consider a comparison between the affective symptoms of PMS in patients and controls and for comparison of estradiol between the both groups. While comparing estradiol between the both groups, P value is non-significant. For the symptoms of PMS, P value was significant between patients and control group. Conclusion: It suggests that the fluctuations in serum estradiol level are not the only cause of affective symptoms of PMS in this study. There may be other factors responsible for the symptoms in selected subjects such as life style, dietary habits or genetics.