While antimicrobial resistance (AMR) continues to be a major public health problem in Pakistan, data regarding trends of resistance among pathogenic bacteria remains scarce, with few studies presenting long-term trends in AMR. This study was therefore designed to analyze long-term AMR trends at a national level in Pakistan. We report here results of a comprehensive analysis of resistance, among pathogens isolated from blood and cerebrospinal fluid (CSF), between 2011 and 2015. Susceptibility data was obtained from a local laboratory with collection points all across Pakistan (Chughtai Laboratory). Resistance proportions to most commonly used antimicrobials were calculated for each pathogen over a period of five years. While Acinetobacter species demonstrated highest resistance rates to all tested antimicrobials, a sharp increase in carbapenem resistance was the most noticeable (50%-95%) between 2011–2015. Our results also highlight the presence of third and fourth generation cephalosporins resistance in Salmonella enterica serovar Typhi in Pakistan. Interestingly, where rise in AMR was being observed in some major invasive pathogens, decreasing resistance trends were observed in Staphylococcus aureus, against commonly used antimicrobials. Overall pathogens isolated from blood and CSF between 2011–2015, showed an increase in resistance towards commonly used antimicrobials.
The COVID-19 pandemic caused by SARS-CoV-2 spread across many countries between 2020 and 2022. The similarities in clinical presentation with other endemic diseases pose a challenge to physicians in effectively diagnosing and treating the infection. Approximately 129 nations have a risk of dengue infection, and more than 100 of those are endemic to dengue. During the COVID-19 pandemic, the number of dengue cases decreased in many countries owing to the isolation measures followed. However, the common clinical presentation between them has led to misdiagnosis. Both COVID-19 and dengue fever cause a surge in proinflammatory cytokines and chemokines, thus sharing a common pathophysiology. False positive serological test results also posed difficulty differentiating between COVID-19 and dengue fever. This review aims to compare the clinical features, pathophysiology, and immune response between dengue and COVID-19, to benefit public health management during the pandemic.
To the best of our knowledge, Non-O1 Vibrio cholerae (NOVC) bacteremia has never been documented in Pakistan. This case report is the first reported case of bacteremia in an infant due to NOVC in Pakistan. A neonate was admitted to a hospital with fever and no history of diarrhea. The isolate was identified biochemically and serologically and was sensitive to all the drugs tested as per CLSI 2014 guidelines.
| Bacteremia is associated with high rates of morbidity and mortality. For early diagnosis of bacteremia; prior use of antibiotics, suboptimal volume of blood sample and improper microbiological techniques are strongly condemned. In time-diagnosis of bacteremia can reduce the antibiotic resistance, hospital stay and cost to the treatment. Blood samples from patients with history of fever in conjunction with clinical signs and symptoms of bacteremia (from July 2013 to July 2014) were processed using BACTEC 9050 automated system. ESR (erythrocyte sedimentation rate), CRP (C-reactive protein) and TLC (total leukocyte count) were also measured, respectively. Out of 3559 samples, 525 (14.75%) samples were positive for bacterial growth. Among positive blood cultures, the pathogens isolated were coagulase negative Staphylococcus aureus (36.38 %), E. coli (18.28%), Methicillin sensitive Staphylococcus aureus (MSSA) (7.04%), Strept. fecalis (5.9%), Salmonella typhi (6.09%), Candida species (4.95%), Pseudomonas species (4.38%), Klebsiella pneumonia (4%), Acinetobacter species (3.42%), Salmonella paratyphi A (2.85%), Methicillin resistant Staphylococcus aureus (MRSA) (2.67%), Citrobacter species (2.47%), Streptococcus species other than Strept. faecalis (1.52%), Xanthomonas maltophilia (0.57%), Vibrio species (0.19%), Yersinia species (0.19%) and Klebsiella oxytoca (0.19%). ESR, CRP and TLC showed poor correlation with bacteremic patients. In addition, increased antimicrobial resistance was observed in all pathogens isolated. ESR, CRP and TLC were considered as preliminary indicator of infections having low specificity and sensitivity in blood stream infections. Keywords
This review focuses on neuroendocrine neoplasms (NENs), which represent a heterogeneous group of relatively uncommon tumors that arise from cells of the endocrine and nervous systems. Although diverse, these tumors share common features, such as an alike histological appearance, the presence of secretory granules and, often, the generation and release of hormones or biogenic amines. NENs have been categorized based on their clinical behavior, histology, anatomic location and proliferation rate—factors relevant to their treatment and prognosis. Previously, chiefly diagnosed by their clinical features, their presence incidental to widespread imaging techniques appears to be on the rise in the US and several other countries. In this light, this article summarizes their pathophysiology, staging and recent changes to clinical practice pertinent to their diagnosis and treatment. Neuroendocrine neoplasms (NENs) are a group of heterogeneous tumors with neuroendocrine differentiation that can arise from any organ. They account for 2% of all malignancies in the United States. A significant proportion of NEN patients experience endocrine imbalances consequent to increased amine or peptide hormone secretion, impacting their quality of life and prognosis. Over the last decade, pathologic categorization, diagnostic techniques and therapeutic choices for NENs—both well-differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinomas (NECs)—have appreciably evolved. Diagnosis of NEN mostly follows a suspicion from clinical features or incidental imaging findings. Hormonal or non-hormonal biomarkers (like serum serotonin, urine 5-HIAA, gastrin and VIP) and histology of a suspected NEN is, therefore, critical for both confirmation of the diagnosis and classification as an NET or NEC. Therapy for NENs has progressed recently based on a better molecular understanding, including the involvement of mTOR, VEGF and peptide receptor radionuclide therapy (PRRT), which add to the growing evidence supporting the possibility of treatment beyond complete resection. As the incidence of NENs is on the rise in the United States and several other countries, physicians are more likely to see these cases, and their better understanding may support earlier diagnosis and tailoring treatment to the patient. We have compiled clinically significant evidence for NENs, including relevant changes to clinical practice that have greatly updated our diagnostic and therapeutic approach for NEN patients.
Background: Only a few studies have presented long-term trends in antimicrobial resistance (AMR) at a nationwide level in Pakistan. This study presents a comprehensive situational analysis of AMR trends among pathogens isolated from blood and cerebrospinal fluid (CSF) cultures, between 2011 and 2015, in Pakistan. Methods: A retrospective analysis of AMR data on pathogens isolated from Blood and CSF over a five year period was carried out. Susceptibility data on these pathogens was obtained from Chughtai Laboratory (CL). Then, proportion of the resistant pathogens were calculated and analyzed. Results: Our results show that highest resistance rates against all tested antimicrobials were observed in Acinetobacter species. We observed a steep rise in carbapenem resistant Acinetobacter species from 50 to 95.5% between 2011 and 2015. Our results also highlight the emergence of third and fourth generation cephalosporins resistance in Salmonella enterica serovar Typhi in Pakistan. While we observed a rise in AMR in other major pathogens, we unexpectedly found decreasing resistance trends in Staphylococcus aureus. Conclusions: Taken together, our results show an overall increase in AMR in pathogens isolated from blood and CSF cultures in Pakistan between 2011 and 2015.
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