Beruflich Dokumente
Kultur Dokumente
Authors resort to plagiarism for various reasons, the most important being to increase the number of publications in a short time.
As demanded in Pakistan, doctors serving in the government teaching institutions require a fairly large number of research
publications in indexed journals for promotion. Being busy practitioners, these professionals at times resort to easy and unfair
means for writing articles. Secondly, in this part of the world, most authors do not have a good command over English language
and copying verbatim from the net is simple and saves time and energy. At times the author is ignorant about the wrong doing,
which is not an acceptable excuse. An important reason is lack of appropriate training. This is because the senior faculty, universities
and governing bodies that are responsible for providing the correct guidance, lack expertise, time and funding resources to conduct
required training/workshops for the junior doctors.
Another reason commonly encountered is the desire to become eminent. Scientists want to have a large number of publications
to their credit, so that they can be quoted all over the world. Low moral values are the most important factor, an honest individual
would never resort to unfair means. “Ethical writing is a reflection of ethical practice”3.
Whatever the reason, plagiarism is stealing of intellectual property and when detected has to be penalized. It not only brings
disgrace to the author besides losing the published material, promotions may be stopped or even services terminated. Some
institutions may impose a monitory penalty.
Ethics, trust and honesty are the basis of research and publication. Research is essential for the progress of science as the results
obtained should be published for the benefit of others. The American College of Physicians in their Ethics Manual have stated
that, “Dishonesty should not be tolerated - it should be investigated and punished, researchers should be careful, impartial, unbiased
and open to investigation and purpose of scientific research should not be self-promotion, personal publicity and financial gain”4.
Ethics took shape with the Nuremberg Code formed in 1946, The Helsinki Declaration in 1964, and The Belmont Report of 19795.
All these have formed a base for important guidelines on Ethics in Research and have been adopted by the World Association
of Medical Editors (WAME)6, International Committee of Medical Journal Editors (ICMJE)7 and Committee on Publication Ethics
(COPE)8. These guidelines on ethics are followed by most scientific journals.
Despite the guidelines from international authorities which have been adopted by most journals and institutions, the act of
plagiarism is being detected and reported from all over the world. This dishonesty may start from school and continue to the
professional colleges and university. A study on cheating from Croatia which included students in four medical universities,
reported more than 99 percent to have admitted to at least one form of educational dishonesty and 78 percent reported to some
form of cheating. The study concluded that “Academic dishonesty of university students does not begin in higher education;
students come in medical schools ready to cheat”9.
Another questionnaire based study on Plagiarism by Shirazi et al included fourth year medical students and faculty members10.
The results revealed that 19% and 22% of students and faculty knew about referencing material from other sources. Surprisingly,
74% students and 69% faculty had observed that colleagues indulge in plagiarizing and were not reported. The study concluded
that there was a general lack of information regarding plagiarism among medical students and faculty members.
A third cross sectional questionnaire based study conducted by the editorial section of the Journal of Pakistan Medical Association
(JPMA) included all authors who submitted their manuscripts for publication in 2010. This study was planned to score the level
of perception and practices regarding plagiarism. In this study of JPMA, only 22% of the participants could define plagiarism
correctly. The level of perception and practices regarding plagiarism of authors submitting to JPMA was 30% above the 75th
Percentile. The study concluded that the authors submitting to JPMA had inadequate knowledge on plagiarism 11 .
Plagiarism has been reported earlier from Pakistan. “In Pakistan, this problem is not uncommon and many such cases are brought
to the notice of editors of medical journals. Surprisingly, the people involved in this matter are usually from a higher academic
echelon who had published a similar paper of their own in a local prestigious journal, which was earlier, published in an international
journal”12. Preventive strategies regarding plagiarism have been advised by Hashim et al, ”Local literature has advocated using
reference managers to prevent plagiarism” 13.
Detecting plagiarism is not difficult with the availability of the internet and numerous software. Hence, every journal should have
a regular screening system. More than this, there is a dire need to root out plagiarism from our teaching institutions. For this,
awareness has to be created to consider plagiarism a fraudulent act and which can have drastic and damaging consequences if
224 . Infectious Diseases Journal of Pakistan
detected. Faculty members have to acquaint themselves with the rules and teach their students. Workshops and hands-on training
would be an added advantage for the purpose. It is also essential for all institutions, journals and health policy makers to have
definite guidelines on plagiarism which will promote ethical research and publication.
Fatema Jawad
Editor-in-chief
Journal of Pakistan Medical Association
Email: jpma_jpma@hotmail.com
References
1. www.merriam-webster.com/dictionary/plagiarized. Cited 26 December Overlapping Publications. www.rin.ac.uk/policy/committee-publication
2010. ethics-cope-guidel.
2. Pechenik A. A short guide to writing about biology. 4th Edition. New York: 9. Taradi SK, Taradi M, Knezevic T, Dogas Z. Students come to medical
Addison Wesley Longman. 2001; p.10. schools prepared to cheat: a multi-campus investigation. J Med Ethics doi
3. Kolin F C. Successful writing at Work. 6th Edition. Houghton Mifflin. 10.1136/jma.2010.035410.
2002. 10. Shirazi B, Jafarey AM, Moazam F. Plagiarism and the medical fraternity:
4. American College of Physicians Ethics Manual. American College of A study of knowledge and attitudes. J Pak Med Assoc 2010; 60:269-73.
Physicians. Ann Intern Med 2005; 101: 263-74. 11. Jawad F, Ejaz K, Riaz M K, Jafary A, Shirazi B. What is plagiarism and
5. Summary from the Nuremberg Code. Trials of War Criminals before the how much authors know about it? Oral presentation at 5th Regional
Nuremberg Military Tribunals. Under Control Council Law 10, Volume 2, Conference on Medical Journals in the Eastern Mediterranean Region,
Nuremberg, October 1946 - April 1949. Washington DC, US Government Karachi-Pakistan, December 2-5, 2010 Abstract Book, page 71.
Printing Office, 1949; pp. 181-2. 12. Gadit AA. Plagiarism: how serious is this problem in Pakistan? J Pak
6. WAME http://www.wame.org/resources. Med Assoc 2006; 56: 618.
7. www.icjme.org. Uniform Requirements for Manuscripts Submitted to 13. Hashim MJ, Rahim MF, Alam AY. Training in reference management
Biomedical Journals. software - a part of new medical informatics workshops in Pakistan. J Ayub
8. Publishing and Editorial issues related to Publication in Biomedical Journals: Med Coll Abbottabad 2007; 19: 70-1.
Abstract
Objective knowledge and hence reduce the disease burden and development
To assess the knowledge gaps regarding tuberculosis in general of multi drug resistant tuberculosis.
practitioners of Karachi registered for attending the continuous
medical education programme. Key Words
CME, General Physicians, Tuberculosis.
Methods
This was a cross sectional survey targeting General Practitioners Introduction
of Karachi attending the continuous medical education Tuberculosis (TB) is an important cause of morbidity and
programme organized by the College of Family Medicine, mortality in the developing world. One third of the world’s
through non-probability purposive sampling. For analysis, they population, approximately two billion people are infected with
were arbitrarily divided into two groups on the basis of clinical Mycobacterium tuberculosis1. In 2006, 1.7 million people died
experience; group 1 with less than 5 years and group 2 with from tuberculosis worldwide, majority from developing countries
more than 5 years of experience. with more than half of these deaths occurring in Asia. Pakistan,
being a third world country ranks eighth in prevalence of
Results tuberculosis2.
A total of 120 general practitioners (GPs) attended the CME
programme, out of which 109 completed the questionnaire. According to WHO estimated TB burden in 2004, its incidence
71 (65.13%) were males and 38 (34.86%) were females. Mean in Pakistan is 181/100,000 and prevalence is 329/100,000
age of general practitioners was 37.7 ± 9.9 years and mean people3. Tuberculosis has been regarded primarily as a disease
duration of their practice was 10.6 ± 8.7 years. The overall of poverty and overcrowding4. Factors contributing to persistent
knowledge score was found to be slightly higher among general prevalence of this devastating illness in the community include
practitioners in group 1. The most common symptom for inadequate knowledge of health care professionals, lack of
diagnosis of tuberculosis identified by 38% general practitioners diagnostic tools in health care setup, non-availability of anti-
in group 1 was chronic cough, whereas 42% general practitioners tuberculous drugs and poor patient compliance5. WHO declared
in group 2 recognized low grade fever with night sweats. Most tuberculosis as a global emergency in 1993, thus national TB
general practitioners in both groups, 59% versus 46% identified guidelines were launched with a revision in 19986. Although
sputum for acid fast bacillus (AFB) smear as investigation of evidence based guideline is available, yet health care
choice. Only 21% GPs in group 1 versus 37% in group 2 knew professionals lack knowledge for appropriate management of
about the correct duration of therapy for pulmonary tuberculosis, TB. A number of local studies have shown that private
and 12% group 1 versus 15% group 2 general practitioners practitioners are not compliant with the treatment guidelines7,10.
knew about the duration of treatment for extra pulmonary A study done on family physicians in Pakistan targeting
tuberculosis. Drugs for initial phase were correctly identified knowledge regarding Mantoux test, revealed an overall
by 55% general practitioners in group 1 and 54% in group 2. inadequacy in knowledge; only 18.8% family physicians scored
The drugs for continuation phase were correctly identified by >80% correct responses11.
10% general practitioners in group 1 and 20% from group 2.
An international study assessed knowledge of health care
Conclusion professionals and community health workers. Although doctors
The study identified gaps in knowledge regarding tuberculosis and nurses had better mean scores than non-professionals, yet
among general practitioners from Karachi. Their active an overall knowledge gap existed12. A few other international
engagement in educational activities could enhance their studies also revealed lower levels of knowledge regarding the
Corresponding Author: Fauzia Haji Mohammad, symptoms and diagnostic procedures for TB among doctors in
Department of Family Medicine, Ziauddin University, private practice and primary care physicians13,14. The literature
Clifton, Karachi. search in the area has suggested updating knowledge of general
Email: fauziaakhtar@yahoo.com practitioners (GPs) to improve the scenario for early detection
with findings in a study conducted in Oman18. This may lead identified by almost half of GPs in both the groups. These
to delay in the diagnosis of disease with increasing spread of figures were almost similar to another study done in Karachi
disease as well as complications. The gold standard test for the (58.3 %)10. The overall reason for these results is that GPs
diagnosis of pulmonary TB is sputum smear for AFB; correctly consider this test to be unreliable and inconvenient in outpatient
Validation of BBL CHROMagar Candida Medium (BD Diagnostics) in Isolating and Differentiating
Candida Species in Clinical Specimens
Abstract
Objective incidence has risen five fold during this decade and is currently
To determine the diagnostic efficacy of BBL CHROMagar between fourth and sixth most common nosocomial blood
Candida (BD Diagnostics) in isolating and differentiating various isolate in America and Europe2,3. A tilt towards non-albicans
Candida species using API 20 C AUX (BioMerieux) as gold Candida has been reported especially in hematological and
standard. transplant patients4. Moreover fungemia/colonization ratio of
non-albicans Candida has also been found to be more than that
Methods of Candida albicans 5. Identification of different Candida species
One hundred and six isolates of yeasts isolated from various has important therapeutic implication as C. glabrata is less
clinical specimens were studied from March 2007 through sensitive to ketoconazole and fluconazole than other species
September 2007. All suspected Candida colonies were and C. krusei displays innate resistance to fluconazole 6 .
presumptively identified on Gram staining and tested up to
species level by simultaneous inoculation on CHROMagar Presumptive identification of C. albicans is usually done through
Candida medium and API 20 C AUX test strips followed by testing for germ-tube formation7. However, C. tropicalis, C.
recommended incubation. parapsilosis and Cryptococcus gastricum also have resembling
structures8. Therefore it should not be used as a sole criterion
Results for identification of C. albicans. Reference identification
Out of the total, 52.8% were identified as C. albicans. High procedures using biochemical and morphological studies and
sensitivities (98.2%-100%) and specificities (95%-96.8%) were conventional methods of yeast identification mainly consisting
shown by CHROMagar Candida medium for most commonly of assimilation / fermentation characteristics are difficult and
isolated Candida species of C. albicans, C. krusei, C. tropicalis require expertise7. Packaged kit and automated systems are
and C. glabrata. expensive and limited by the size of their database 10 .
Chromogenic agar media like BBL CHROMagar Candida are
Conclusion easy to use and interpret due to formation of distinct color and
CHROMagar Candida medium was easy to use, cost effective morphologies resulting from cleavage of chromogenic substrates
and reliable agar medium for isolation and differentiation of by species specific enzymes10. The rationale of the study is to
most frequently occurring yeast species in the clinical specimens evaluate the diagnostic efficacy of CHROMagar Candida for
and is recommended for use in peripheral labs. identification and differentiation of various yeast species in
clinical samples as it is now direly needed to precisely identify
Key words the pathogen not only at the reference laboratories but also at
API 20C AUX Medium, Candida Infections, CHROMagar the peripheral diagnostic facilities.
Candida medium, non-albicans Candida species.
Material and methods
Introduction This study was conducted at Department of Microbiology,
The incidence of fungal infections is rising with increasing Armed Forces Institute of Pathology, Rawalpindi, from March
number of immunocompromised patients, widespread use of 2007 through September 2007. One hundred and six yeast
broad spectrum antibiotics and invasive procedures1. Candida isolates yielded from various clinical specimens including blood,
species are important cause of local and blood stream infections high vaginal swabs, urine, sputum, stool and tissues sent for
causing significant mortality and morbidity especially in critically culture and sensitivity to the department of microbiology were
ill patients, immunocompromized population and infants. Overall included in the study irrespective of age and gender of patients.
Upon isolation of a yeast colony, 0.5 MacFarland suspension
Corresponding Author: Ashraf Hussain, was prepared in normal saline and 100 uL of the suspension
Pathology Department, Combined Military Hospital, was dispensed on CHROMagar (BD Diagnostics) plate and
Chhor. spread with wire loop. The plates were incubated at 370C for
Email: hussainashraf78@yahoo.com 48 hrs. Identification of Candida species was made according
Red Cell Distribution Width in the Diagnosis of Iron Deficiency Anemia and Thalassemia Trait
Malik Muhammad Adil, Ayesha Junaid, Iffat Zaman, Zeshan Bin Ishtiaque
Abstract
Percentage
levels > 3.5% were taken as thalassemia trait. 30
The proposal was reviewed by internal review board and the
study was approved by the Ethics Committee of Shifa College 20
of Medicine. All data was entered in to Statistical package for
Social Sciences (SPSS version 10.0). The data was re-validated 18
and later analyzed.
10
Results 8
RDW value in 50 patients with iron deficiency anemia and 50
patients with thalassemia trait are depicted in table 1. Mean 0
RDW in patients with iron deficiency anemia was 44.1±4.1 % 35.1-40 40.1-45 45.1-50 50.1-56
(Range 36.2-55.2%). Elevated RDW was found in all 50 cases Iron deficiency anemia (RDW)
none of them were with normal RDW. Mean RDW in patients
with thalassemia trait was 18±1.8 % (Range14.7-24.9 %).
Fig 1: Distribution of iron deficiency anemia by RDW.
Elevated RDW was found in all 50 cases none of them were
with normal RDW. Table 2 shows comparison of our results
100
Table 1: RDW values in different types of anemia.
Anemia No. of RDW % Elevated pvalue
cases RDW 80 86
Mean Range Cases %
Iron
deficiency 50 44.1±4.1 36.2-55.2 50 100 0.001 60
Percentage
Thalassemia
trait 50 18±1.8 14.7-24.9 50 100
40
Abstract
Objective hospital and being given for the treatment of acute diarrhoea.
To determine the frequency of prescription of flagyl by general Appropriate measures need to be taken and importance of better
practitioners in outpatient clinics in order to limit its use for prescribing habits should be highlighted during clinical meetings
treatment of acute diarrhoea and other GIT symptoms. and discussions.
*Department of Clinical Sciences, Faculty of Eastern Medicine, Hamdard University Karachi, Pakistan
**College of Conventional Medicine, Faculty of Eastern Medicine, The Islamia University Bahawalpur
Abstract
Background estimated rates are around 25% 5-6. Infections are usually acquired
Helicobacter pylori induces chronic inflammation of the in early childhood. In developed nations it is currently uncommon
underlying gastric mucosa and is strongly linked to the to find infected children. The percentage of infected people
development of duodenal and gastric carcinoma. increases with age; about 50% infected over the age of 60 years
as compared to around 10% between 18 and 30 years.7-8
Methods
A study was conducted to evaluate the efficacy of Pylorex, a Coded herbal formulation Pylorex contains Curcuma longa,
herbal formulation, for treatment of H. pylori infection as Mallotus philippinensis and Glycyrrhiza glabra. These medicinal
compared to triple allopathic therapy (Omeprazole, Amoxicillin, herbs used in this study were selected on the basis of their
Metronidazole). The therapeutic evaluations of these medicines traditional use in Greek system of medicine, especially for
were conducted on 97 clinically and immunologically diagnosed treatment of H. pylori infection9.
cases of H. pylori infection.
This study was conducted to evaluate the efficacy of Pylorex
Results for treatment of H. pylori infection as compared to triple
H. pylori was eradicated in 16 (32.6%) out of 49 patients by allopathic therapy (Omeprazol, Amoxicillin, Metronidazole)
the use of triple allopathic therapy (Control drugs), and in 9 among the population living in Gadap Town.
(18.7%) out of 48 patients by the use of Pylorex (Test drug).
Materials and methods
Conclusion The therapeutic evaluations of these medicines were conducted
Pylorex possesses a therapeutic value for the treatment of H. on clinically and immunologically diagnosed cases of H. pylori
pylori associated symptoms but the eradication rate is superior infection at Shifa-ul-Mulk Memorial Hospital, for Eastern
in triple allopathic therapy. Medicine, Hamdard University Karachi, from June 2007 to July
2009. All selected patients (n=97) were thoroughly examined.
Introduction Participants who were willing to undergo treatment and to attend
Helicobacter pylori, gram-negative bacterium, is found on the all the follow up visits during the clinical trial were selected.
luminal surface of the gastric epithelium. It contains a
hydrogenase which produces energy by oxidizing molecular The therapeutic evaluation of the drug was made on the basic
(H2) that is produced by intestinal bacteria. It produces catalase, improvement in the subjective signs and symptoms, clinical
urease and oxidase. It is capable of forming biofilms and can observations and laboratory investigations at periodic intervals
convert from spiral to a possibly coccoid form. The coccoid during the course of treatment. Patients were randomly assigned
form can adhere to gastric epithelial cells in vitro1- 4. Half of to receive triple allopathic therapy (Omeprazole 20 mg twice
the world's population is infected by this bacterium. Actual daily 15 minutes before meal, Amoxicillin 500 mg twice daily
infection rates vary; people in under developed countries have and Metronidazole 500 mg twice daily after meal; and 500 mg
much higher infection rates than the developed countries where Pylorex twice daily. The duration of treatment was 15 days with
a window for follow up visit of 15-30 days for periodic
Corresponding Author: Muhammad Akram, assessment.
Department of Basic Medical Sciences,
Faculty of Eastern Medicine, Hamdard University, Primary analysis was based on antigen test that uses enzyme
Madinat-al-Hikmah, Muhammad Bin Qasim Avenue, immunoassay to detect the presence of H. pylori antigen in
Karachi, Pakistan. stool specimens. The samples were tested at Aga Khan
Email: makram0451@hotmail.com Laboratories Karachi. Weekly record of sign and symptoms
ng
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(32.6%) out of 49 patients by the use of triple allopathic therapy
Re
bd
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s
es
au
A
ln
(Control drug), and in 9 patients (18.7%) out of 48 patients by N
l
Fu
the use of Pylorex (Table 2). All differences that were equal to Figure 1: Improvement response in symptoms after treatment
or more than the set cut-off values were considered clinically
significant. Results of stool antigens before and after both the
treatments are shown in table 1 and 2. The evaluation of H. than synthetic antibiotics, some patients prefer to use herbal
pylori eradication was significantly high in the control group medicines. Thus healthcare professionals should be aware of
as compared with test group. But there was a significant the available evidence for herbal antibiotics.
difference in H. pylori associated symptoms as observed between
two treated groups at the end of therapy (fig 1). It has been previously reported that Curcuma longa, Mallotus
philippinensis and Glycyrrhiza glabra have anti-H. pylori effects
commonly used for the treatment of this infection10-12. In a recent
Discussion study, anti-H. pylori activity of 50 commonly used Unani
Hundreds of plants worldwide are used in traditional medicine (traditional) medicinal plants from Pakistan, extensively utilized
as treatment for bacterial infections. Some of these have also for the cure of gastrointestinal disorders, were explored as
been subjected to in vitro screening but the efficacy of such natural source compounds against H. pylori13.
herbal medicines has seldom been rigorously tested in controlled
clinical trials. Conventional drugs usually provide effective Curcumin is the substance that gives the spice turmeric its
antibiotic therapy for bacterial infections but there is an increasing yellow color. Dozens of studies have shown that it is chemo-
problem of antibiotic resistance and a continuing need for new preventative, and recently it has been shown to have a strong
solutions. Although natural products are not necessarily safer antibacterial effect against H. pylori. Studies have indicated
that curcumin could be considered as a valuable support in the
treatment of infections14-15.
Table 1: Baseline stool antigen in patients
Treatment group Total In a recent study, researchers found that licorice extract produced
(n) a potent effect against clarithromycin-resistant H. pylori strains.
Baseline Test (Pylorex) Control The authors concluded that licorice extract could form the basis
(Triple allopathic for alternative H. pylori therapeutic agent. Licorice extracts are
therapy)
also effective against H. pylori strains resistant to both amoxicillin
Positive and clarithromycin10 .
stool 48 49 97
antigen Mallotus philippinensis (Kameela) also has activity against
H. Pylori especially against clarithromycin and metronidazole
In recent weeks several young women, mostly peripartum, and a young male have been admitted to three Karachi
hospitals with acute lung injury (ARDS) and suspected or confirmed H1N1 influenza pneumonia. They all required
ventilatory support.
IDSP strongly recommends influenza vaccination, especially in pregnant women, and vigilance for lower respiratory
involvement in all patients with influenza-like illness.
Early diagnosis and treatment with oseltamivir or zanamivir is known to improve outcome.
*Student, Army Medical College, National University of Sciences and Technology (NUST), Rawalpindi, Pakistan.
**Professor and Head of Department of Microbiology, Army Medical College, National University of Sciences and
Technology (NUST), Rawalpindi, Pakistan.
Abstract
Introduction Introduction
Typhoid fever is an important public health issue in developing Typhoid is one of the major health problems of the developing
countries like Pakistan due to overcrowding and poor sanitary world where it is responsible for serious morbidity1. Moreover,
conditions. Moreover, development of antibiotic resistance has the widespread acquisition of plasmid mediated resistance
added to the problems. against the conventional anti-typhoid drugs has added to the
problem2.
Objectives
To study the current trends of typhoidal salmonellae susceptibility The resistance to chloramphenicol emerged in 1970s and the
to the conventional anti-typhoid drugs. multidrug resistant strains came to notice in the late 1980s and
early 1990s 3. In Pakistan, the first multi-drug resistant S. typhi
Material & Methods was isolated in 1987 and by the end of 1990s isolation rates
A descriptive cross-sectional study was carried out at the reached epidemic proportions leaving fluoroquinolones and the
Microbiology Department of Army Medical College (National 3rd generation cephalosporins as the only treatment options 4, 5.
University of Sciences and Technology), Rawalpindi from Injudicious use of these drugs has lead to the emergence of
January 2006 to December 2009. All the isolates were dealt resistance against quinolones as well 6-9.
with standard microbiological procedures. The antimicrobial
sensitivity against the conventional anti-typhoid drugs was In recent years, there have been increasing reports of reversal
determined using Kirby-Bauer disc diffusion method as per the towards sensitivity to the conventional anti-typhoid drugs from
guidelines of Clinical and Laboratory Standards Institute. various parts of the world10,11. Such observations prompted us
to conduct a study at our institute to determine the trend of
Results susceptibility of typhoidal Salmonellae against the conventional
Out of 240 typhoidal Salmonellae isolated, 111 were Salmonella drugs and help local therapeutic recommendations.
typhi and 129 were Salmonella paratyphi A. An increase in the
percentage of multi-drug resistant isolates of typhoidal Methods
Salmonellae was found. This study was carried out on typhoidal Salmonellae isolated
from blood during January 2006 to December 2009 at the
Conclusion Department of Microbiology of Army Medical College, National
The susceptibility of typhoidal Salmonellae to the conventional University of Sciences and Technology (NUST), Rawalpindi.
anti-typhoid drugs has not improved.
The blood culture samples were received from the wards of
Key words
Military Hospital (MH), Rawalpindi; 1100-bedded tertiary care
Antibiotic Sensitivity, Anti-typhoid Drugs, Typhoid, Typhoidal
hospital. Five mL of venous blood was collected aseptically
Salmonellae.
using a disposable syringe and added to 50mL of sterile Brain
Heart Infusion broth (BHI) (Merck) from adults and 3mL blood
Corresponding Author: Anam Imtiaz, in 30mL BHI from children. The top of the culture bottle was
Army Medical College, National University of Sciences and cleaned with iodine immediately before the addition of blood.
Technology (NUST), The subcultures were done on MacConkey’s agar (Oxoid,
Rawalpindi, Pakistan. Basingstoke, UK) at 24 hr, 48 hr, and 5th and 7th days. Cultures
E-mail: anam_ib@hotmail.com showing no growth till seven days were considered as negative.
Chloramphenicol 40.5 51.7 57.1 66.7 In a study conducted in United States in 2009, only 13% of the
Ampicillin 42.9 51.7 46.4 75 2016 isolates studied were found to be resistant to ampicillin,
chloramphenicol and cotrimoxazole, which is in sharp contrast
Cotrimoxazole 45.2 51.7 57.1 66.7
to our results 17.
Central Nervous System ring enhancing lesions in an Immunocompromised Child with Status
Epilepticus: A Case Report and Literature Review
Abstract otitis media, and skin infections and was treated for pulmonary
In some developing countries like Pakistan the incidence of tuberculosis two years ago. His previous immune workup for
Human Immunodeficiency Virus infection in children is unknown recurrent infections had revealed IgG level of greater than 25
and probably underreported . Children usually get HIV infection g/L on two occasions. There was no known history of previous
through vertical transmission and have progressively impaired transfusions or exposures to animals or birds. He was living in
cellular and humoral immunity. Children can have variable Pakistan with his grandparents since age of ten months and his
presentation from being asymptomatic to severe symptoms with parents were in South Africa. His father, a businessman, was
any organ involvement. Central nervous system involvement of Pakistani origin and his mother was of African origin. No
is commonly seen in children with HIV infection and has a poor illnesses were reported in his parents except that his mother
prognosis. Encephalopathy, seizures, status epilepticus, spastic was being treated for tuberculosis for last two years in South
weakness of extremities, microcephaly, developmental delay Africa.
or regression, can be the presenting CNS features. We present
case of a HIV child with status epilepticus history of recurrent On examination, he was a sick looking, frail child. His heart
infections and had ring enhancing brain lesions. rate was 100/minute, respiratory rate 20/minute, blood pressure
100/60 mmHg and he was afebrile. His weight and height were
Key words: Brain Lesions, Encephalopathy, HIV Infection, at the 5th percentile. Neurological examination showed Glasgow
Status Epilepticus Coma Scale of 4/15 and no signs of meningeal irritation. He
was having generalized tonic clonic seizures on presentation.
Introduction He had no lymphadenopathy and had only mild hepatomegaly.
Global burden of HIV infection in children is substantial because The skin showed multiple hyperpigmented macules, few scabbed
of increasing number of infected women1-4. In Pakistan much lesions along with few round blisters and erythematous lesions
lower number of cases are reported5-8. Vertical transmission is on face, upper trunk and lower extremities (Fig 1). Rest of the
the most common route of acquiring infection in children. systemic examination was unremarkable. His seizures were
controlled using intravenous midazolam and phenytoin.
HIV infected children can have a diverse presentation with
involvement of any system of the body. CNS involvement is The initial laboratory investigations showed white blood cell
quite common in children. Seizure or status epilepticus can be count of 12,800/µL, hemoglobin 13 g/dL (polymorphs 86%,
the presenting feature with or without CNS lesions with diverse
etiology. CNS involvement is associated with a poor prognosis.
We will review here CNS involvement in a case of pediatric
HIV infection focusing on mass lesions.
Case report
A six-year-old boy presented with generalized tonic-clonic
seizures and loss of consciousness for 5 hours. He received
blood transfusion prior to referral from a local hospital where
he had presented with lethargy, generalized weakness and
anemia. Over the past few years, the child had multiple severe
bacterial infections including recurrent pneumonias, suppurative
Corresponding Author: Amna Batool, Figure 1: Patient’s skin showing multiple hyperpigmented
Chief Resident, Department of Pediatrics, macules, few scabbed lesions along with few round blisters
Shifa International Hospital, Sector H-8/4, Islamabad. and erythematous lesions
Email: dramnabatool@yahoo.com
Globally the number of children (<15 years) living with HIV The neurological manifestations of HIV infection include:
was estimated to be more than 2,000,000 in 2007, new infections progressive encephalopathy, static encephalopathy, seizures,
>350,000, and 270,000 deaths; more than 90% occurring in strokes, HIV myopathy and myelopathy, peripheral neuropathy,
Sub-Saharan Africa1,2. Importantly, global estimates of HIV in developmental delay or regression, psychiatric manifestations
children continues to steadily increase as compared to adults. and sleep problems.
It is estimated that 90% children acquire the infection during Our patient presented with status epilepticus, encephalopathy
pregnancy period, delivery or breastfeeding with transmission and CNS enhancing lesions, which probably implied severe
Salman Saleem*, Mehreen Ali Khan**, Ayesha Hafeez**, Aamer Ikram**, Usman Rathore**
“Update on Infectious Diseases for the Practicing Clinician” Emergency Room Conference (ERCON)
October 18th to 23rd 2010 October 30, 2010: Islamabad
IDSP conducted a course “Update on Infectious Diseases for Emergency Room Conference (ERCON) was arranged by
Practicing Clinician”, in Karachi. Dr Farheen Ali was Convenor Organization of ER Physicians. Members of IDSP participated
and Dr Fatima Noman Co-Convenor. This is a brief report in the conference. Dr. A. Salam Khan, Convenor of the ERCON
regarding the feedback that we received from the participants introduced and welcomed participants.
and the issues we came across during the course.
Dr. Naseem Salahuddin explained why she believed that rabies
Feedback from participants was an “orphan disease” in Pakistan. Rabies is a common but
1. Overall the course was very much appreciated. Most fatal disease that has never been given its due importance by
participants agreed that the knowledge they gained was the health authorities and no attempt has ever been focused on
valuable in daily practice. its preventive aspect. The obsolete nerve tissue vaccine continues
2. Most requested and stressed that IDSP must continue such to be produced and distributed to Government run centers and
courses and make it an annual event. results in rabies deaths. Dr Seemin Jamali, Director of Emergency
3. There was a request to include and emphasize emerging Services at JPMC, Karachi, spoke on prevention and treatment
infections. of animal bites. Despite JPMC being a Federal Government
4. There were suggestions to include: institute, it has for over a decade obtained modern tissue culture
a. Nosocomial infections vaccine rather than the NIH provided sheep brain vaccine. Thai
b. TB in pediatric patients Red Cross intradermal regimen is both economical and effective
c. HIV in rabies prophylaxis.
d. Bedside/hands-on session for certain topics
5. There were requests to distribute “Antibiotic Guidelines”. Dr Mehmood Javed, ID Consultant at Shifa International Hospital
6. The participants appreciated the handouts given; CDs presented a concise lecture on Viral Hemorrhagic Fever and
were requested by a few. Influenza, and emphasized their preventive aspects.
7. Most were comfortable with afternoon timings. Dr Altaf Ahmad, President IDSP and Director of Lab Services
8. The evaluation sheet was not properly understood by at The Indus Hospital, Karachi, expounded on the importance
many. (We should make it simpler in future and in place of Biosafety and Biosecurity measures as being essential
of 1-5 ranking give actual levels “Unsatisfactory to procedures in the laboratory for protection of personnel as well
Excellent”). as for the environment and community.
Overall the program was well received. We should be able to - Antibiotic resistance
make this a yearly event. - Viral Hemorrhagic fevers
- Disaster related infections
Dr. Farheen Ali - MDR Tuberculosis
- HIV/AIDS threats
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Application for member as
Full Member (Annual/ Life) Overseas Member Associate Member
Rs.500 for 1 yr, Rs.3000/- for life US$.100/- for Life Rs.500 for 1 yr, Rs.3000/- for life
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FULL MEMBERSHIP:
Should be at least medical graduates registered with PMDC and having postgraduate qualification in any field.
Full member may be
1. Life: with payment of Rs.3000/- 2. Annual: with 1 year fee of Rs.500/-
ASSOCIATE MEMBERSHIP:
Ph. D, Master degree & M. Phill in biological sciences, BSc in Nursing & allied medical science with 1 yearly fee of Rs.500/-
PRIVILEGES OF MEMBERSHIP:
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All the members shall have the right to:
1. Participate in all activities of the society.
2. Receive all publication including quarterly ID Journal free of cost.
3. Vote according to constitution of the society.
ASSOCIATE MEMBERS:
All the members shall have the right to:
1. Participate in programs of the society.
2. Receive all publication including quarterly ID Journal free of cost.
Please send your Application form by hand or by mail only.
Membership fee will only be received in cash/ cross cheque/ pay order or bank draft made out to Infectious Disease Society of Pakistan.
Mailing Address and Contact Nos:
Infectious Diseases Society of Pakistan
A-53, Block-2, Gulshan-e-Iqbal, Karachi. Ph: 0333-3977011
E-mail: idsp123@yahoo.com