Colorectal cancer (CRC) is the third most prevalent cause of tumorigenesis and several pathogenic bacteria have been correlated with aggressive cases of cancer i.e., genotoxin (colibactin) producing Escherichia coli (E. coli). This study was designed to investigate the genetic diversity of clb+clb+ E. coli strains and their association with CRC. Pathogenic E. coli isolates from colorectal biopsies were characterized based on phylotypes, antibiotic resistance pattern, and (Enterobacterial Repetitive Intergenic Consensus Sequence-based Polymerase Chain Reaction) ERIC-PCR. Furthermore, isolates were screened for the presence of the Pks (polyketide synthase) Island specifically targeting colibactin genes A and Q. The selective clb+clb+ isolates were subjected to cytotoxicity assay using Human embryonic kidney (HEK) cell lines. We revealed that 43.47% of the cancer-associated E. coli isolates were from phylogroup B2 comparatively more pathogenic than rest while in the case of healthy controls no isolate was found from B2. Moreover, 90% were found positive for colibactin and pks (polyketide synthase) island, while none of the healthy controls were found positive for colibactin genes. All healthy and cancer-associated isolates were tested against 15 antibiotic agents, we observed that cancer-associated isolates showed a wide range of resistance from 96% against Nalidixic acid to 48% against Doxycycline. Moreover, E. coli isolates were further genotyped using ERIC-PCR, and selected clb+clb+ E. coli isolates were subjected to cytotoxicity assay. We recorded the significant cytotoxic activity of clb+clb+ E. coli phylogroup B2 isolates that might have contributed towards the progression of CRC or dysbiosis of healthy gut microbiota protecting against CRC pathogenesis. Our results revealed a significant p<0.023 association of dietary habits and hygiene p<0.001with CRC. This is the first study to report the prevalence of E. coli phylogroups and the role of colibactin most virulent phylogroup B2 among Pakistani individuals from low socioeconomic setup.

Background: Hirsutism is an important array of clinical syndrome that ranges from various dermatological to gynecological concerns. This is characterized by growth terminal hairs in women in male-pattern. Aim: To compare the efficacy of Nd-YAG laser with adjuvant eflornithine cream versus Nd-YAG laser treatment alone for facial hirsutism in women. Methods: It was a Randomized Controlled Trial conducted in the Department of Dermatology, Shalamar Hospital, Lahore from 25th February, 2020 to 25th October, 2020. Sampling technique used was probability consecutive sampling. In this study female cases with age 18-40 years with Fitzpatrick type III-IV were enrolled having facial hirsutism for > 6 months and were randomly allocated in two groups A and B. In group A, cases were provided with eflornithine cream to apply on face after cleaning and drying in the form of a thin film only on the treatment area every night. Results: A total 162 cases (81 in each group) were enrolled in this study. Mean age of the subjects in group B and A was 30.23±5.43 vs 30.94±4.88 years. Efficacy was observed in 64(79.01%) cases in group B managed with ND-Yag laser alone and 78(96.30%) cases in group A managed with ND-Yag laser along with Eflornithine with p=0.001. For age group 30-40 years efficacy in group B was 41(80.39%) cases and in all the 49(100%) cases in group A with p= 0.001.In cases with BMI up to 25 kg/m2 efficacy in group B and A was observed in 44(88%) vs 49(100%) cases (p=0.03) and those with BMI more than this, this efficacy was found in 20(64.52%) and 29(90.63%) cases respectively with p=0.02. Conclusion: Efficacy in facial hirsutism is significantly better in ND-Yag laser combined with Eflornithine as compared to ND-Yag laser alone and this difference is also significantly better for combination group in terms of age group 30-40 years, BMI up to 25mg/m2 and in those with duration of complaint upto 2 years. Keywords: Hirsutism, Efficacy, Eflornithine, Nd-YAG laser