October 1988, Volume 38, Issue 10

Special Communication


Fatema Jawad  ( 7/6, Rimpa Plaza, M.A. Jinnah Road, Karachi. )

ISOLATION OF SALMONELLA ORGANISM FROM STOOL CULTURE OF APPARENTLY HEALTHY PERSONS. Chaudhry, F.M., Haque, A., Chaudhry, N.A., Mahmood, F, Pak. J. Med. Res., 1986; 25: 182 - 184.
One hundred and twenty five apparently healthy food handlers including kitchen staff of various student hostels were studied to check the prevalence of carrier state of Salmonella Typhi. It is an established fact that many patients become carriers• after recovery from Typhoid and paraty­phoid fevers and act as continuous sources of infection. The individuals included in the study were hostel kitchen employees and housewives. All volunteers belonged to the lower socioecono­mic group. Faecal and urine specimens were col. lected from each subject. The faecal material was transported in glycerol saline and cultivated according to the recommendations of Harvey and Price.
The results obtained revealed 15 cases to be Salmonella carriers. Salmonella paratyphi A constituted 53.33 percent of the total isolates with Salmonella paratyphi B being 20 percent and Salmonella typhi 26.67 percent. The male to female ratio was 11.24 percent and 13.88 percent respectively. 15 percent of the carriers were between the age group of 10 and 30 years, The incidence of Salmonella carriers determined in this study (12%) is much higher than the statistics from abroad. The cause could be attributed to poor hygienic conditions, underdosage of anti­biotics during the disease with early discóntinua­tion of the drug. Salmonella paratyphi A being the main organism is due to the fact that paratyphoid fever giving milder symptoms escapes attention and proper treatment.
Only one urinary carrier was detected. The high percentage of Salmonella carriers is alarming and requires immediate attention. All food handlers should be checked ever six months to eliminate typhoid carriers.
A SEROEPIDEMIOLOGY OF HEPATITiS - B IN HAEMODIALYSIS UNITS. Akbar, M., Hafiz, A.     Pak. J. Med. Res., 1986; 25: 192 — 196. A seroepidemiologic study for hepatitis —B virus markers in 64 chronic renal failure patients from four haemodialysis units of Karachi was conducted. Viral hepatitis has been recognized as a major complication of haemodialysis. It has been observed that the patients and staff of these units are at increased risk of infection because trans­mission of the disease is besides the parenteral route is via the intramural environment and opera­tional procedures. 64 haemodialysis patients, 27 family members , six staff members and 56 volunteer blood donors acting as controls, were screened for HBsAg and anti-HBs. Environmental samples from the dialysis machines, fluid, floors of the unit, wash basin taps, doors and lavatory chain handles were also screened for HbsAg. The direct passive haemagglutination technique was used for the test.
Eleven of the 64 patients were found positive for HBsAg and 14 for anti HBs. The control group showed 5.4% to be HBsAg positive and 3.6% anti HBs positive. 74% of the family members had HBsAg positive. One staff member became HBsAg positive whereas two were anti.HBs positive. The females showed a higher incidence of HBsAg positive while males had a higher prevalence of anti HBs.
The dialysis Machine samples revealed 11% to be positive whereas floor samples were 40% positive.
The detection of antigen positive patients in dialysis units in an incidence of 39% is a serious matter. Also the follow up of the seronega­tive cases revealed 20.5% to have developed HBV infection.
The recommendations forwarded by the
study were:
-  Regular screening of patients for HBsAg.
-  Strict screening of blood for HBsAg before transfusion.
-  Proper precautions to avoid contamination of animate and unanimate objects with patients blood.
- Seropositive patients should be dialyzed separately.
STUDY OF PRIMARY OPEN ANGLE GLAUCOMA IN NJSHTAR HOSPITAL, MULTAN. Sheikh, S.A., Sahi, T., Bodla, M.A., Akram, M., Tayyab, A.A. Pak.J.Med.Res., 1986; 25:122 - 125.
A study to detect open angle glaucoma was carried out in the Eye Department of Nishtar Hospital, Multan between July 1981 and June 1984. Of the 1366 glaucoma patients admitted, 265 were labelled as open angle glaucoma. The criteria for diagnosis were raised intra-ocular pressure, open angle of the anterior chamber, visual field defects, increased cup/disc ratio and glaucomatous optic cupping. As 80 patients dropped out the study was conducted on 185 individuals. Majority of the cases were between 40 — 50 years of age, 60.54% were males and 39.36% were females. All the patients complained of diminished vision, 26 had coloured halos, 23 had pain in the eyes. 24 had headache and two cases gave a history of nausea and vomiting. 19 cases had a positive family history of glaucoma.
The examination on 281 eyes showed mild congestion in 40 eyes, shallow anterior chamber in 80 eyes, dilated pupil in 106 eyes, sluggish pupil reaction in 204 eyes and 74 eyes had an atrophic iris. The disc was cupped in 238 eyes.
Appanation tonometry revealed an intra­ocular pressure between 20 - 30 mmHg in 75 eyes, 30 - 40 mmHg in 87 eyes, 40 - 50 mmHg in 61 eyes, 50 - 60 mmHg in 38 eyes and over 60 mmHg in 18 eyes.
Visual field defects were present in 180 eyes. 38 eyes had no defects and 63 eyes could not be tested.
it is an established fact that increased intra. ocular pressure leads to damage of the optic disc. In this study 64% eyes had a defect in the visual field. Glaucoma is a common cause of blindness in our country and early detection and treatment can prevent it.
A STUDY OF THE BACTERIOLOGICAL PATTERN IN GALL BLADDER DISEASE. Baqai, R., Banatwalla, N.S., Zuberi, S.J., Ashraf, S. Pak. J. Med. Res., 1986; 25:61-63.
The results of the culture and sensitivity of seventy seven specimens of bile, gall stone and gall bladder tissue are presented. Aseptic col­lection was done during surgery and the specimens were incubated for 24 — 48 hours at 37°C. Bacteria were identified and antibiotic sensitivity was determined by the disc diffusion method.
Twenty seven bile specimens and one stone gave a positive growth. Gram positive bacteria were isolated in 25% and gram negative in 75% of the cultures. E. Coil were found in 53% of the specimens followed by pseudomonas and staph. albus. Antibiotic sensitivity was done for Esch. Coli only and Kanamycin was found to be the most effective drug followed by Gentamycin and Fosfomycin.
Infected bile can be responsible for post­operative wound infections. The appropriate antibiotic in the post-operative period can prevent wound infections.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: