Resistance to carbapenems is a global threat, especially in developing countries with limited health resources. Prevalence, antibiogram, PCR detection of antibiotic resistance genes, and potency of Silver Nanoparticles (AgNPs) against multidrug-resistant (MDR) Pseudomonas aeruginosa were studied. Kirby-Bauer disc method and PCR were used to study antibiogram and drug resistance genes respectively in 255 isolates of Pseudomonas aeruginosa obtained from a tertiary care hospital. Silver nitrate (AgNO3) precursor salts were reacted with Aspergillus flavus culture filtrate to trigger the extracellular mycosynthesis of AgNPs. Mycosynthesis was first monitored regularly by visible ultraviolet spectroscopy that recorded AgNP peaks of approximately 400–470 nm. Confirmation by Transmission electron micrographs provided confirmation of AgNPs formed within a range of 5–30 nm. Individual and combined antibacterial activity of ten antibiotics and AgNPs was analyzed. Pearson correlation coefficients (r) were calculated for phenotypic and genotypic multidrug resistance. Data were evaluated using SPSS version 20. p-value < 0.05 was considered statistically significant. 61.5% were carbapenemase producers (p < 0.01). The recorded frequency of blaIMP-1, blaSHV, blaVIM, blaOXA, and blaTEM were 13%, 32%, 15%, 21%, and 43%, respectively. The reducing order of antimicrobial activity of antibiotics and AgNPs was piperacillin/tazobactam + AgNPs (31 mm), cefoxitin + AgNPs (30 mm) > amikacin + AgNPs (25 mm) > aztreonam + AgNPs (23 mm) > meropenem + AgNPs (22 mm) > imipenem + AgNPs (20 mm) > gentamycin + AgNPs (17 mm) > ciprofloxacin + AgNPs (16 mm) > cefoperazone/sulbactam + AgNPs (14 mm) ≥ ceftazidime + AgNPs (14 mm). The conjugated effect of AgNPs plus antibiotics showed a 0.15–3.51 (average of 2.09) fold-area augmentation of antimicrobial activity. AgNPs conjugated with antibiotics effectively inhibited MDR Pseudomonas aeruginosa. To the best of our understanding, this is an inaugural report from Punjab Pakistan enlisting co-expression of Metallo-β-lactamases, extended-spectrum β-lactamases, and AmpC-β-lactamase plus activity of antibiotic-AgNPs.

Objective: To find the incidence of urethrocutaneous fistula after Tubularized Incised Plate Urethroplasty (TIPU) and Urethral Advancement and Glanuloplasty Incorporated (URAGPI) repairs in children presenting with coronal hypospadias. Study Design: Randomized Prospective Study. Setting: Department of Paediatric Surgery, Pak Emirates Military Hospital, Rawalpindi. Period: 10th March 2022 to 10th November 2022. Material & Methods: A total of 40 children were enrolled in the study. Patients were randomly allocated to receive either TIPU (n=20) or URAGPI (n=20) technique after approval of hospital ethical review committee. Data was collected on a specifically designed proforma. Outcome was measured in terms of incidence of urethrocutaneous fistula in the two study groups. Results: Average age of patients was 28.2 ± 9.7 (months) in TIPU and 29.6 ± 9.9 months in URAGPI group. Frequency of fistula was 4 (20.0%) in TIPU repair compared to none 0 (0.0%) in the URAGPI repair. Difference in proportions of urethrocutaneous fistula was found statistically significant between the two groups (p-value = 0.03). Conclusion: Incidence of urethrocutaneous fistula was found greater in TIPU technique when compared with URAGPI technique.

Objective: To compare operative time, hospital stay and post-operative complications between laparoscopic and open pyloromyotomy. Study Design: Randomized Prospective study. Setting: Department of Paediatric Surgery, Pak Emirates Military Hospital, Rawalpindi. Period: 7th May 2022 to 7th November 2022. Material & Methods: This study included 20 patients each in the two groups. Group A underwent laparoscopic whereas group B underwent open pyloromyotomy. Both groups were compared regarding operative time (OT), hospital stay (HS) and post-operative complications. Results: OT ranged from 20 to 70 min with a mean of 15.4 min in group A. In group B, the mean OT was 25.6 min (range, 25–60 min). HS ranged from 14 to 58 hours with a mean of 16.8 hours in group A. In group B, it ranged from 19 to 30 hours, and the mean was 24.2 hours. One case in group A was converted to open approach (conversion rate 5%) because of mucosal perforation while one case of incomplete pyloromyotomy was found. Conclusion: Laparoscopic technique has shorter operative time and hospital stay than open surgery. Complication like mucosal perforation were seen in laparoscopy group, however, it was not found statistically significant.