Background: Acute bacterial meningitis is a medical emergency which warrants early diagnosis and aggressive therapy. It is important to know the regional bacterial etiology in semitropical countries like India along with their sensitivity profi le to allow optimum management of such patients with least possible mortality. This study was undertaken to study the trends in etiology and the antimicrobial resistance pattern of the pathogens prevalent in North India over a period of 8 years. Methods: The study was performed from June 2001 to June 2009. CSF and blood samples were collected from all patients suspected of meningitis and inoculated on chocolate agar, blood agar and MacConkey agar. Antimicrobial susceptibility testing was done using Kirby Bauer disc diffusion method. Detection of methicillin resistant Staphylococcus aureus (MRSA), high level aminoglycoside resistance (HLAR) in Enterococcus species, extended spectrum β lactamases (ESBL), Amp C and metallo-betalactamases was also done. Results: 403 samples were positive on culture. S. aureus was the most common pathogen. Among the gram positive cocci as well as the gram negative bacilli, a gradual decline in the antimicrobial susceptibility was seen. The aminoglycosides had the best spectrum of antimicrobial activity. Towards the end of the study, an alarming rise of MRSA to 69.4%, HLAR among the Enterococci to 60% was noted. Among the Enterobacteriaceae, ESBL and Amp C production was found to be 16.7% and 42% respectively. No vancomycin and imipenem resistance was observed. Conclusion: An entirely different trend in etiology in bacterial meningitis was observed in the semitropical region of North India. The high prevalence of drug resistant pathogens is a cause for worry and should be dealt with by rational use of antimicrobials. Frequent revision in drug policy may be necessitated for optimum management of patients.

BACKGROUND: Oral submucous fibrosis (OSMF) is a chronic, premalignant condition of the oral mucosa and one of the commonest potentially malignant disorders amongst the Asian population. The objective of this study was to investigate the association of etiologic factors with: age, frequency, duration of consumption of areca nut and its derivatives, and the severity of clinical manifestations. METHODS: A cross-sectional, multi centric study was conducted over 8 years on clinically diagnosed OSMF cases (n = 765) from both public and private tertiary care centers. Sample size was determined by World Health Organization sample size calculator. Consumption of areca nut in different forms, frequency of daily usage, years of chewing, degree of mouth opening and duration of the condition were recorded. Level of significance was kept at P < or = 0.05. RESULTS: A total of 765 patients of OSMF were examined, of whom 396 (51.8%) were male and 369 (48.2%) female with a mean age of 29.17 years. Mild OSMF was seen in 61 cases (8.0%), moderate OSMF in 353 (46.1%) and severe OSMF in 417 (54.5%) subjects. Areca nut and other derivatives were most frequently consumed and showed significant risk in the severity of OSMF (P < or = 0.0001). Age of the sample and duration of chewing years were also significant (P = 0.012). CONCLUSIONS: The relative risk of OSMF increased with duration and frequency of areca nut consumption especially from an early age of onset.
Age of Onset ; Areca* ; Asian Continental Ancestry Group ; Female ; Humans ; Male ; Mastication ; Mouth ; Mouth Mucosa ; Nuts* ; Oral Submucous Fibrosis* ; Pakistan* ; Sample Size ; Tertiary Care Centers ; World Health Organization

COVID-19 has swept globally and Pakistan is no exception.To investigate the initial introductions and transmissions of the SARS-CoV-2 in Pakistan,we performed the largest genomic epidemiology study of COVID-19 in Pakistan and generated 150 complete SARS-CoV-2 genome sequences from samples collected from March 16 to June 1,2020.We identified a total of 347 mutated positions,31 of which were over-represented in Pakistan.Meanwhile,we found over 1000 intra-host single-nucleotide variants(iSNVs).Several of them occurred concurrently,indicating possible interactions among them or coevolution.Some of the high-frequency iSNVs in Pakistan were not observed in the global population,suggesting strong purifying selections.The genomic epidemiology revealed five distinctive spreading clusters.The largest cluster consisted of 74 viruses which were derived from different geographic locations of Pakistan and formed a deep hierarchical structure,indicating an extensive and persistent nation-wide transmission of the virus that was probably attributed to a signature mutation(G8371T in ORF 1ab)of this cluster.Further-more,28 putative international introductions were identified,several of which are consistent with the epidemiological investigations.In all,this study has inferred the possible pathways of introduc-tions and transmissions of SARS-CoV-2 in Pakistan,which could aid ongoing and future viral surveillance and COVID-19 control.