Objective: To determine antiacanthamoebic activity of natural and marketed honey samples.
Methods: Natural honey samples were collected directly from the bee hive and marketed honey samples were purchased from the local market in Karachi, Pakistan. Both honey samples were tested for their flavonoid content (quercetin equivalent per gram of the extract) and phenolic content (gallic acid equivalent per gram). Furthermore, their anti-oxidant activity was determined by measuring 2,2-diphenyl-1-picrylhydrazyl. Using amoebistatic and amoebicidal assays, the effects of honey samples were tested against growth and viability of Acanthamoeba parasites.
Results: Natural honey exhibited potent amoebistatic and amoebicidal effects, in a concentration-dependent manner. Honey-treated Acanthamoeba castellanii showed loss of acanthopodia, following which amoebae detached, rounded up, reduced in size, decreased in cytoplasmic mass and they were observed floating in the culture medium. Importantly, honey-treated amoebae did not revive when inoculated in fresh growth medium, however, glycerol-treated amoebae exhibited viable trophozoite and active growth. In contrast, marketed honey samples varied in their efficacy against Acantha-moeba castellanii. The proportion of flavonoid, as determined by quercetin measurements and the proportion of phenolic, as determined by gallic acid measurements was higher in natural honey compared with marketed honey. Similarly, the antioxidant activity, as determined by 2,2-diphenyl-1-picrylhydrazyl scavenging activity was higher in natural honey vs. marketed honey.
Conclusions: This study shows that natural honey has antiacanthamoebic properties and possesses higher flavonoid, phenolic and antioxidant properties compared with the marketed honey. These findings are of concern to the public, health officials, and to the manufacturers regarding production of honey for medical applications.

PURPOSEFirearm injuries impose a continuous economic burden on society and hospital resources. The aim of this study was to assess the pattern of bony injuries among victims of gunshots.

METHODSA retrospective study was conducted in the Department of Orthopedics, Dow University of Health Sciences and Civil Hospital Karachi from January 2011 to December 2012. Patients with isolated bony injuries were included while patients with other systemic injuries were excluded.

RESULTSThere were 90 cases and the majority of them were male (84.4%). Mean age was (32.52 ± 10.27) years. Most of the patients (72.2%) belong to the younger age group. A low velocity weapon was used in 61 (67.8%) cases and a high velocity weapon was used in 29 (32.2%) cases. Armed robbery (64.4%) was the cause of conflict in more than half of the cases. Lower limb was involved in 72.2%. Fifty eight (64.4%) patients remained hospitalized for 15-20 days and others for more than 20 days. Internal fixation with intramedullary nailing was done in 35 patients while K-wire was used in 5 patients. Fifty patients were managed with external fixation, either uniplanar or multiplanar ilizarov. Deep wound infection and nonunion were observed more often in high velocity injuries.

CONCLUSIONArmed robbery was the leading cause of gunshot bony injuries in our hospital. Young males were victimized in a majority of cases. High velocity injuries were associated with more complications.

Adolescent ; Adult ; Bone and Bones ; injuries ; Female ; Fracture Fixation, Intramedullary ; Humans ; Male ; Middle Aged ; Pakistan ; epidemiology ; Retrospective Studies ; Tertiary Healthcare ; Wounds, Gunshot ; epidemiology

Background: Due to extensive fibrosis during revision surgery, adequate exposure is essential and it can be achieved with several extensile approach options, such as tibial tubercle osteotomy. Information regarding surgical exposure during revision arthroplasty is limited in developing countries, such as Pakistan, due to the lack of adequate data collection and follow-up. Therefore, the purpose of this study was to evaluate the impact of tibial tubercle osteotomy on final outcome of revision total knee arthroplasty (TKA). Methods: A total of 231 revision TKAs were performed between January 2008 and December 2017. Twenty-nine patients underwent tibial tubercle osteotomy for adequate exposure during revision surgery. Of these, 27 patients with complete follow-up were included in our study. Factors examined include age at the time of revision surgery, gender, comorbidities, arthroplasty site (right or left), body mass index (BMI), and primary indications for the tibial tubercle osteotomy during revision TKA. Functional outcome was measured by using Knee Society score (KSS) at 3 months and the final follow-up. All statistical analysis was done using SPSS version 20.0 with a p-value < 0.05 considered significant. Results: Out of 27 patients, 6 patients (22.2%) were men and 21 patients (77.7%) were women. Right knee revision arthroplasty was performed in 15 patients (55.5%), left knee revision arthroplasty was performed in 12 patients (44.4%), and bilateral revision surgery was performed in only 1 patient (3.7%). The mean BMI was 29.2 kg/m 2 . We used a constrained condylar knee in 20 patients (74%), a rotating hinge knee in 5 patients (18.5%), and mobile bearing tray plus metaphyseal sleeves in 2 patients (7.4%).The KSS was 52.21 ± 4.05 preoperatively, and 79.42 ± 2.2 and 80.12 ± 1.33 at 3 months and 12 months, respectively. Radiological union was achieved in all patients at 3 months. Of 27 patients, only 1 patient (3.7%) had proximal migration of the osteotomy site at 6 months: the patient was asymptomatic and union was also achieved and, therefore, no surgical intervention was performed. Conclusions Tibial tubercle osteotomy during revision TKA can be a safe and reliable technique with superior outcomes and minimal complication rates.

Uropathogenic E. coli (UPEC) is the major etiological agent of urinary tract infections. The objectives of this study were to evaluate E. coli isolates from these patients for the phenotypic pattern of antibiotic resistance and to detect the genes responsible for virulence namely fimH, hlyA and usp. A total of 110 E. coli isolates were studied and 30 antibiotics were applied for susceptibility testing. PCR detection of the genes fimH, hlyA and usp was done followed by sequencing and phylogenetic analysis. The results showed that the isolates were highly resistant to cephalaxin (100%) and cephradine (100%) but displayed high sensitivity to amikacin (96.27%), Imipenem (92.63%) and Meropenem (92.63%). The prevalence of fimH, hlyA and usp was 86%, 83% and 16%, respectively. The sequencing showed 99% similarity with previously reported sequences in NCBI GenBank database. The co-existence of multiple drug-resistant bodies and virulent genes has important implications for the treatment of patients with urinary tract infection. This study provides information about treating drug-resistant E. coli and the relationship of virulent genes with phenotypic resistance patterns.

Objective To determine antiacanthamoebic activity of natural and marketed honey samples. Methods Natural honey samples were collected directly from the bee hive and marketed honey samples were purchased from the local market in Karachi, Pakistan. Both honey samples were tested for their flavonoid content (quercetin equivalent per gram of the extract) and phenolic content (gallic acid equivalent per gram). Furthermore, their antioxidant activity was determined by measuring 2,2-diphenyl-1-picrylhydrazyl. Using amoebistatic and amoebicidal assays, the effects of honey samples were tested against growth and viability of Acanthamoeba parasites. Results Natural honey exhibited potent amoebistatic and amoebicidal effects, in a concentration-dependent manner. Honey-treated Acanthamoeba castellanii showed loss of acanthopodia, following which amoebae detached, rounded up, reduced in size, decreased in cytoplasmic mass and they were observed floating in the culture medium. Importantly, honey-treated amoebae did not revive when inoculated in fresh growth medium, however, glycerol-treated amoebae exhibited viable trophozoite and active growth. In contrast, marketed honey samples varied in their efficacy against Acanthamoeba castellanii. The proportion of flavonoid, as determined by quercetin measurements and the proportion of phenolic, as determined by gallic acid measurements was higher in natural honey compared with marketed honey. Similarly, the antioxidant activity, as determined by 2,2-diphenyl-1-picrylhydrazyl scavenging activity was higher in natural honey vs. marketed honey. Conclusions This study shows that natural honey has antiacanthamoebic properties and possesses higher flavonoid, phenolic and antioxidant properties compared with the marketed honey. These findings are of concern to the public, health officials, and to the manufacturers regarding production of honey for medical applications.

Objective: To determine the morphological and molecular characterization of Acanthamoeba isolates from contact lens paraphernalia in Malaysia and to investigate their pathogenic potential based on the physiological tolerance. Methods: One hundred and eighty contact lens wearers donated their contact lens, lens storage cases and lens solutions between 2018 and 2019. The samples were inoculated onto 1.5% non-nutrient agar plates for 14 d. Polymerase chain reaction (PCR) was performed and the amplified PCR products were sequenced and compared with the published sequences in GenBank. The pathogenic potential of positive isolates was further tested using temperature-tolerance and osmo-tolerance assays. Acanthamoeba species were categorized into three distinct morphological groups established by Pussard and Pons. Results: Acanthamoeba was successfully isolated from 14 (7.8%) culture-positive samples in which 11 belong to morphological group II and 3 belong to morphological group III, respectively. The sequencing of 18S ribosomal RNA gene led to the identification of the T4 genotype in all the isolated strains. In vitro assays revealed that 9 (64.3%) Acanthamoeba isolates were able to grow at 42 °C and 1 M mannitol and were thus considered to be highly pathogenic. Conclusions: To the best of our knowledge, this is the first report identifying the Acanthamoeba genotype and their pathogenic potential among contact lens wearers in Malaysia. The potentially pathogenic T4 genotype isolated in this study is the most predominant genotype responsible for human ocular infection worldwide. Hence, increasing attention should be aimed at the prevention of contamination by Acanthamoeba and the disinfection of contact lens paraphernalia.