Staphylococcus aureus is an increasing problem in clinical practice because of reduced susceptibility to available antibiotics. The objective of the study was to determine the frequency of Methicillin-resistant S. aureus (MRSA) in Peshawar, Pakistan. Clinical isolates of S. aureus were subjected to determination of antibiotic resistance, MICs and inducible clindamycin resistance (ICR). Out of total 280 S. aureus isolates, the frequency of MRSA was 36.1 % (n = 101). MRSA infection was found higher among the age group 50–59 years (60.71 %, OR 3.09), followed by 20–29 years (47.5 %, OR 1.74). Frequency of MRSA in female and male was 39.8 and 34 % respectively. MRSA was more frequent in blood specimens (48.7 %, OR 2.14). The frequency of community and hospital acquired MRSA was 42 and 34.8 % respectively. MRSA showed high resistance (100 %) to penicillin and cefoxitin followed by erythromycin (99 %). While MRSA exhibited 100 % susceptibility to vancomycin and linezolid. We have also found 7 vancomycin intermediate sensitive S. aureus (VISA) isolates. ICR was observed in 15.84 % (n = 16) of MRSA isolates. It is concluded that MRSA is potential threat to public health in Peshawar. Vancomycin and linezolid could be prescribed as a drug of choice in treating MRSA associated infections. In addition, ICR should be routinely checked to avoid clindamycin treatment failure.

Objectives: To determine bacteriological profile of ICU admitted patients with ventilator associated pneumonia.Materials and Methods: A descriptive cross-sectional study was conducted from July 2018 to April 2020 at department of Medical ICU. A total of 172 patients were observed for clinical presentation and bacteriological profile in ventilator associated pneumonia. Data were presented in form of frequency and percentages.The p-value less than 0.05 were considered as statistically significant.Results: Out of 172 patients, 24 (13.71%) and 18 (10.2%) were having Diabetes Mellitus (DM) and Hypertension (HTN), respectively. Patients who received mechanical ventilation for 0-5 days had a relatively low recovery rate of 8.8%, with the majority (91%) unfortunately expiring. In the 6–10-day category, there was a slightly higher recovery rate of 14.8%, but still, the majority (85%) of patients did not survive. Patients with >16 days of ventilation, show higher recovery rate (35.2%). The highest number of bacteria was isolated from the patients with 0-5 day’s ventilation while there was a lowest growth of bacteria in 6-10 days ventilated patients. In antibiotics susceptibility, there are variations in antibiotic eff ectiveness across different bacterial strains and antibiotics. Fosfomycin and Tigecycline show highest eff ect against all bacteria except Acinobacter baumannii while Colistin was effective against all the bacteria except Pseudomonas.Conclusion: Patients on mechanical ventilation had lower chances of recovery in the early days, but those who were ventilated longer showed better outcomes. Diabetes Mellitus and Hypertension were common comorbidities. Bacterial growth was highest in the early days of ventilation. Antibiotics like Fosfomycin and Tigecycline show highest eff ect against all bacteria except Acinobacter baumannii whereas Colistin was also eff ective against all, except for Pseudomonas.

Background: Cardiorenal Syndrome (CRS) is a complex condition characterized by the interdependence of cardiac and renal dysfunction. In diabetic patients, this syndrome is prevalent due to the multifaceted impact of diabetes on both organ systems. Effective management of CRS requires a nuanced understanding of its prevalence and the development of targeted treatment strategies. Aim: This study aims to investigate the prevalence of Cardiorenal Syndrome among diabetic patients presenting to the Nephrology Division at Khyber Teaching Hospital, Peshawar, and to evaluate the management approaches employed. Methods: A cross-sectional analysis was conducted involving diabetic patients with documented cardiac and renal conditions. Data was collected from medical records and clinical evaluations conducted between July2023 to December 2023. Inclusion criteria encompassed diabetic patients with evidence of cardiac and renal dysfunction, while exclusion criteria included patients without complete records or those with non-diabetic etiologies of cardiac or renal disease. Statistical analysis was performed to assess prevalence rates and management practices. Results: Of the 200 diabetic patients with Cardiorenal Syndrome (CRS) at Khyber Teaching Hospital, the most prevalent type was Type 2 (Chronic Cardio-Renal), affecting 60% of patients, with an average age of 68 years. This type was predominantly male (65%) and characterized by high rates of hypertension (95%) and poor glycemic control (85%). Type 4 (Chronic Reno-Cardiac) was observed in 25% of patients, often with advanced CKD stages and significant heart failure (80% in NYHA Class III/IV). Type 1 (Acute Cardio-Renal) and Type 3 (Acute Reno-Cardiac) were less common, affecting 10% and 5% of patients, respectively. Type 1 was associated with CKD Stage 3 or 4 and a substantial prevalence of low left ventricular ejection fraction (50%), while Type 3 had severe CKD with 70% having LVEF <40%. Type 5 (Secondary CRS) was not present in this cohort.Management strategies revealed that 70% of patients received ACE inhibitors, and 65% adhered to lifestyle modifications including dietary changes and exercise. The majority received coordinated care involving nephrologists and cardiologists (50%) and education on disease management (55%). Follow-up showed that 40% of patients had monthly visits to monitor their condition. Conclusion: The high prevalence of Cardiorenal Syndrome among diabetic patients underscores the need for integrated management approaches. Effective treatment strategies should address both cardiac and renal dysfunctions simultaneously. This study highlights the importance of multidisciplinary care and ongoing research to optimize outcomes for patients with Cardiorenal Syndrome.

OBJECTIVE: To determine the lipid abnormalities in patients with type 2 diabetes mellitus and correlate these to HbA1c levels. MATERIALS AND METHODS: This cross-sectional study was conducted at the Department of Medicine, Khyber Teaching Hospital Peshawar, for six months (from 1 January 2021 to 30 June 2021). The sample size calculated was 174 using the WHO software for sample size. A non-probability consecutive sampling technique was used for sample collection. All patients of both genders with established diagnoses of type 2 diabetes mellitus or newly diagnosed diabetic population who were over the age of 20 years were included in the study. Patients on lipid-lowering agents with chronic kidney disease, chronic liver disease, or congestive heart failure, pregnant women, and hypothyroid patients were excluded from the study. Data was analyzed using SPSS version 20. RESULTS: The mean age of the study sample was 50 ± 10.9 SD years. Eight-five (42.6%) were male and 115 (57.4%) were female. The mean age of males was 51.7 ± 9.8SD years and females was 48.6 ± 11.5SD years. The mean serum total cholesterol (TC) level was 183.7±51.6, the mean triglycerides (TG) level was 236.5±119SD, the mean low-density lipoprotein (LDL) level was 116±44.6SD, and the mean high-density lipoprotein (HDL) level was 38.5±9.2SD. The mean HbA1c level was 8.8±2.1SD. Mean HbA1c in both male and female populations was the same. HbA1c has a non-significant correlation with the gender of the population (P value >0.05) CONCLUSION: Gender-based differences in lipid levels were not statistically significant. Poorly controlled diabetes was associated with elevated lipid levels, but the differences were not significant. Notably, HbA1c was more closely linked to low BMI. The study found no significant correlations between HbA1c and BMI with lipid levels, while age was weakly correlated with serum cholesterol and LDL-C. KEYWORDS: Hyperglycemia, Diabetes mellitus, Dyslipidemia, HbA1c level, lipid Profile, Body mass index

Central venous lines are passed in almost all patients admitted in intensive care unit and a need still exist to look for best route for this purpose. Objective: To compare the complications in patients with central venous catheter passed via internal jugular, subclavian and femoral route at intensive care unit. Methods: A comparative cross-sectional study was conducted on 380 patients admitted in intensive care unit of Bahria International Hospital RWP from January 2022 to June 2022. Central venous catheters were passed by consultant critical care specialist on call at the time of reception of patient in unit. All the patients were observed for one week for presence of any local or systemic complications. Results: Out of 380 patients, 240 (63.2%) were male while 140 (36.8%) were female. Central venous catheter was passed via internal jugular vein in 220 (57.8%) patients, via subclavian route in 60 (15.8%) patients and via femoral route in 100 (26.3%) patients. Failed attempts were seen statistically significantly more in internal jugular route (p-value-0.041) while local cellulitis was seen more in femoral route (p-value-0.012). Conclusions: Internal Jugular vein was the route most commonly used for insertion of central venous catheter in patients admitted in our intensive care unit. Complications were seen more not very common in our setting. Failed attempts were more seen in internal jugular route while local cellulitis was seen more in femoral route.

Objectives: To determine bacteriological profi le of patients with clinical signs of sepsis admittedin Intensive care unit of a tertiary care hospital.Materials and Methods: A cross-sectional study was conducted among 220 patients having sepsisand admitted in intensive care unit of Bahria International Hospital Rawalpindi from November2021 to October 2022. Various clinical specimens including blood, urine, central venous cathetertip, and Foley catheter tip were collected from target subjects and immediately transported toPathology laboratory for microbiological analysis.Results: Out of total 220 patients,our data showed that 140 (63.6%) were male while 80 (36.4%)were female subjects with mean age of 41.623±6.782. Patients were recorded with various illnessesincluding Diabetes Mellitus (56.8%), Hypertension (25%), Asthma illness (24.5%) and end stagerenal disease (26.8%). Least cases were observed for Stroke (29.1%), Malignancy (5.4%) and otherdiseases (3.6%). Urine sample was sent for 170 (77.2%) patients while blood cultures were sentfor 110 (50%) patients. Bacteriological profi le of samples revealed that 168 (76.3%) were Gramnegative bacteria while 52 (23.7%) were Gram positive bacteria. The prevalent Gram negativebacteria was recorded as Escherichia coli45.9% (n=101) followed by Pseudomonas aeruginosa14.8% (n=25). Among the Gram bacteria, methicillin resistant Staphalococcus aureus(n=41,78.8%) was most frequent followed methicillin sensitive Staphalococcus aureus (n=8, 15.3%).