Enhancing Effect on Alkalinization of the Medium
|
|
- Jody Golden
- 5 years ago
- Views:
Transcription
1 Appum MICROBIOLOGY, Sept. 968, p American Society for Microbiology Vol. 6, No. 9 Printed in U.S.A. Enhancing Effect on Alkalinization of the Medium on the Activity of Erythromycin Against Gram-negative Bacteria LEON D. SABATH,' VICTOR LORIAN, DEBORAH GERSTEIN, P. BRONWEN LODER, AND MAXWELL FINLAND Thorndike Memorial Laboratory, Second and Fourth (Harvard) Medical Services, Boston City Hospital; Department ofmedicine, Harvard Medical School; and Mattapan Chronic Diseases Hospital, Boston, Massachusetts 8 Received for publication 5 June 968 The antibacterial activity of erythromycin was markedly enhanced by alkalinization of the culture medium or urine within the clinical range (ph 6. to 8.). This effect was demonstrated against recent isolates of Escherichia coli, Klebsiella pneumoniae, Enterobacter sp., and Pseudomonas aeruginosa, as well as against Staphylococcus aureus and Streptococcus faecalis. The urine of normal volunteers was made alkaline by ingestion of sodium bicarbonate or acetazolamide (Diamox) during administration of. g of erythromycin every 8 hr; such urine was capable of inhibiting E. coli and K. pneumoniae even when diluted up to (in one instance) 8 times with broth of the same ph as the urine. Undiluted urine of the same subjects, without alkalinization, was seldom capable of inhibiting these organisms. The range of ph (6.6 to. 8.6) over which the antibacterial effect was enhanced coincided with that over which there was decreasing ionization of a basic group. Studies on erythromycin in 95 (6) and later (, ) indicated that its activity is much greater in an alkaline than in an acid medium. The test organisms upon which this observation was originally based were Streptococcus hemolyticus and Sarcina lutea (and later also Staphylococcus aureus). Zagar (5) and later J. C. Sylvester (personal communication) suggested that the susceptibility of gram-negative bacilli to erythromycin might be similarly affected by changes in ph. Subsequently, Sylvester (unpublished data) reported strains of three different gram-negative bacilli, Escherichia coli, Proteus vulgaris, and Pseudomonas aeruginosa, for which the minimal inhibiting concentration (MIC) of erythromycin was.5,.5, and.5,ug/ml, respectively, at ph 8.; at ph 6., the MIC for each was,ug/ml. The present study was designed to explore the clinical potential of this phenomenon. Urine from seven normal volunteers receiving erythromycin with and without alkalinizing medication was studied for activity against some pathogenic gramnegative bacilli in vitro. The pharmacological effects of sodium bicarbonate and acetazolamide ' Recipient of a Career Development Award, National Institute of Allergy and Infectious Diseases. Present address: Bronx-Lebanon Hospital, Fulton Avenue, Bronx, N.Y. 56. on the concentration and antibacterial activity of erythromycin in serum and urine will be reported separately (L. D. Sabath et al., submitted for publication). MATERIALS AND METHODS Organisms. Eighteen clinical isolates of gram-negative bacilli from patients with urinary-tract infections, three clinical isolates of gram-positive cocci, and a laboratory strain of Staphylococcus aureus were studied. The clinical strains were isolated and identified at the Mattapan Chronic Diseases Hospital. Sensitivity testing. Twofold dilutions of erythromycin base (supplied by Abbott Laboratories) were made in -ml amounts of Difco Nutrient Broth (NB) that had been adjusted to various levels of ph (6. to 8.) with dibasic sodium phosphate, sodium hydroxide, and (or) citric acid. One drop of a : dilution of a -hr culture (about, viable units) of the organism to be tested was then added to each tube and incubated at C. The lowest concentration of erythromycin that prevented visible growth after hr was taken as the MIC for that ph. Subcultures were made by withdrawing. ml of culture from each of the tubes showing no growth at hr and flooding it over the surface of antibioticfree nutrient agar, which was then incubated for 8 hr. The surviving cell count was calculated on the basis of the number of colonies appearing; the lowest concentration of erythromycin that produced a 88 Downloaded from on November, 8 by guest
2 VOL. 6, 968 ENHANCING ERYTHROMYCIN ACTIVITY BY ALKALINIZATION % or greater reduction in bacterial cell count was considered the minimum bactericidal concentration (MBC). Activity oferythromycin in urine. Seven adult volunteers took erythromycin estolate (kindly supplied by R. S. Griffith of Lilly Laboratories for Clinical Research),. g orally every 8 hr for four doses on two separate occasions, week apart, once with and once without alkalinizing treatment (NaHCO or acetazolamide). Each specimen of urine was tested for activity against E. coli 5 and Klebsiella pneumoniae. The ph of the urine was measured (Radiometer ph meter) at the end of each collection period. In the tests of antibacterial activity, the urine was diluted in NB that had been adjusted to the same ph as that of the voided urine. One drop of a : dilution of a -hr culture was inoculated into each tube of diluted urine, and the maximum dilution of urine that prevented growth after hr of incubation at C was noted. Ionization of erythromycin. The titration curve of erythromycin base (Upjohn) was determined by using a Radiometer Titrator and Titrigraph (type SBRc; Copenhagen), correcting for a water blank. RESULTS All strains tested except those of Proteus showed moderate to marked increases in susceptibility to erythromycin at ph 8. when compared with their susceptibility at more acidic ph levels (Table ). Erythromycin also decreased the number of viable cells, the MBC generally being to 6 times the corresponding MIC. In some instances, there was a -fold or greater increase in activity over the range of ph tested. Urine from subjects receiving erythromycin without alkalinizing medication failed to inhibit the test strain of K. pneumoniae in every instance and rarely inhibited E. coli 5. Identical doses of erythromycin given with NaHCO or acetazolamide produced urine that inhibited the two test organisms in all samples (Table ). The increase in activity produced with alkalinization was highly significant (P <.). The extent to which the urines could be diluted and still inhibit the test organisms was clearly related to the degree of alkalinization achieved. Urine from subject, at ph 8., inhibited the test E. coli even at a dilution of :8, whereas the second specimens from subjects 6 and, with a ph of, inhibited the strain only at dilutions of : and :, respectively. The titration curve of the erythromycin base (Fig. ) shows one basic group titrating between ph 6 and with apparentpk of 8.6, as previously reported (). DIscussIoN The fact that some antibiotics show changes in antibacterial activity at different hydrogen ion Downloaded from TABLE. Changes in minimal inhibiting concentration (MIC) and minimal bactericidal concentration (MBC) of erythromycin with increasing ph Organism MIC (MBC)a ph 6. ph. ph. ph.8 ph 8. Escherichia coli.. > 5 ().5 (>) 6. (5). (.5) E. coli (5).5 (.5). (.).6 (.6) E. coli 8.> 5 (> ). (6.) E. coli 9.> 5 ().6 (.) E. coli. > >.5 (5) E. coli. > 5 ().5 (5). (.). (.) E. colil9... > 5 (>). (> ) E. coli 5... > 5 (5).5 (5). (.5).8 (6.) Klebsiella pneumoniae > 5 ().5 (6.) K. pneumoniae. > (>) 5 (>) 6. (.5) 6. (.5) Enterobacter.> >.5 (5) Enterobacter 5.> 5 (>) 6. (5) Enterobacter. 5 (>).5 (5) 6. (.5). (.5) Proteus sp.. > 5 (>) P. mirabilis 9. > > 5 (>) P. vulgaris. > > (>) > Pseudomonas aeruginosa. > > 5 (5) P. aeruginosa. > (>) 5 (5) Staphylococcus aureus A.... (6.). (.8). (.) S. aureus9... (6.). (.6). (.) Streptococcus faecalis... 5 (5). (6.).6 (.). (.8). (.) S. faecalis....5 (.5).6 (.6). (.6) In nutrient broth; expressed as micrograms per milliliter. on November, 8 by guest
3 9 SABATH ET AL. APPiL. MICROBIOL. TABLE. Effect ofalkalinizing medication on antibacterial activity ofurine from normal subjects receiving erythromycin estolate Erythromycin alone Erythromycin and alkalinization Period of urine collection (hr after Subject MID (MBD)- MID (MBD) first dose) ph of urine ph of urine E. coli 5 K. pneumoniae E. coli 5 K. pneumoniae All periods J9b < (<) () < (). () (.9) (6) 6 (8) 6 (6) 6 (6) () 8. (6.) 8 (6) (6) (6) 6 () 9. (.9).5 (.). (.). (8.) () () (). (.6) 8 () () 8 () (). (.6) (8) 8 () () (.8).8 (.). (.8).6 (.9) a Reciprocals of maximal inhibiting dilution (maximal bactericidal dilution) : = growth in undiluted serum; = no growth in undiluted sera only; etc. b Number of urine collections at all periods; the ph of these specimens and the geometric means of the MID (MBD) are shown in the other columns. concentrations has been known for over years (). The general principle appears to be that some acidic antibiotics are more active at acidic ph levels, whereas the reverse is true with some basic antibiotics. Although erythromycin, a weekly basic substance, showed profound changes in antibacterial activity with both gram-positive and gram-negative bacteria, over the range from ph 6 to 8, not all acidic and basic antibiotics show such effects. Benzylpenicillin, an acidic substance, shows only minimal changes in antibacterial activity in this range (). A currently popular explanation for the effect of changes in ph on antibacterial activity is that change in ionization of the antibiotic is the crucial factor, and the supposition is made that, as more of the antibiotic becomes ionized (as with erythromycin at progressively more acidic ph levels), it becomes increasingly difficult for it to permeate the bacterial cytoplasmic membrane or cell wall; this results in an apparent decrease in antibacterial activity. This could explain the striking ph effect shown by streptomycin (, ), since the marked (> -fold) increase in activity betweenph 5 and 8 coincides with the decrease in ionization of one of its guanido groups (8). However, the concurrence of such changes in ionization and in biological effects has not been demonstrated in all instances. Furthermore, Tallgren and von Bonsdorf () reported strains of urinary- Downloaded from on November, 8 by guest
4 VOL. 6,968 ENHANCING ERYTHROMYCIN ACTIVITY BY ALKALINIZATION 9 z w ceptibility testing was in medium that was much more alkaline (ph.) than that of normal urine (ph 5-6), in which the erythromycin activity would have been considerably lower. In the present study, the subjects receiving erythromycin alone had acid urines (ph <6.) which failed to inhibit the test organisms (Table ); with alkalinization, all samples contained from to 8 times the MIC of erythromycin when tested at the ph of the urine. Although, with usual dosage regimens, concentrations of erythromycin achieved in serum and tissues will rarely inhibit the common urinary pathogens, the urine, if alkalinized, certainly will. Other studies (, 9) have shown that favorable results were usually obtained in treating bac-.- o.5- >.5- a.s - pk 8.6 TABLE. Comparative effects ofph on activity of total (T) and un-ionized (U) erythromycin against three organisms MIC (Ag/mI) ph % Ua E. coli 5 Enterobacter S. faccalis T Ub T U T U 6#. 5.5, a Estimated from Fig.. p H b MIC of un-ionized erythromycin is product of FIG.. Ionization oferythromycin. %U X MIC of T. tract pathogens that failed to show an effect of ph on activity over ranges in which other strains of the same species had shown profound effects with the same antibiotics. Some strongly basic acridines are fully ionized throughout a ph range over which they show marked changes in antibacterial effect, indicating that a change in ionization of the acridine cannot account for the change in antibacterial effect (). Other suggested explanations are that a receptor on the bacterial cell may be changing its charge and, therefore, its affinity for the antibacterial substance, over the critical ph range (), or that charged acidic antibiotics compete with hydroxyl ions for a receptor and have fewer hydroxyl ions for competition at the more acidic ph. Similarly, ionized basic antibacterial substances may compete with hydrogen ions (). However, convincing experimental documentation of a single mechanism for the ph effect is lacking. Two pieces of evidence from the present study are consistent with the hypothesis and it is the neutral or un-ionized molecules that exert the antibacterial effect: (i) a decrease in ionization (Fig. ) occurred over the same ph range in which there was a striking increase in antibacterial activity; and (ii) the amount of un-ionized erythromycin required to inhibit three of the organisms (Table ) varied only three- to five-fold between ph 6 and 8, whereas the amount of total (ionized plus un-ionized) erythromycin required to inhibit the same organisms at the same range of ph varied 5- to -fold, suggesting that the increasing amount of ionized erythromycin at the more acid ph is without antibacterial effect. However, these observations do not exclude the other two possible mechanisms cited. The in vitro effect of changes in ph activity of erythromycin indicated that antibiotic concentrations effective against many gram-negative bacilli should be achievable in human urine providing that the usually reported (5) fraction ( to 5%) of ingested erythromycin appears in the urine of subjects who are also taking alkalinizing medication. The present study shows that up to 8 times the concentration of erythromycin required to inhibit the test E. coli appeared in the urine of the subjects receiving both erythromycin and NaHCO or acetazolamide. In fact, more than % of ingested erythromycin may appear in the urine after repeated doses; this was confirmed in concurrent studies in the present subjects (Sabath et al., submittedfor publication). Although a significant portion of urinary pathogens are reported as being susceptible to erythromycin (, ), it should be noted that the sus- Downloaded from on November, 8 by guest
5 9 SABATH ET AL. APPL. MICROBIOL. teriuria when adequate antibacterial activity has been achieved in the urine, though not in the serum. It therefore seems desirable to investigate the possibility of using erythromycin along with alkalinization for the treatment of bacteriuria, particularly when alternative therapy requires the use of more toxic antibiotics. ACKNOWLEDGMENTS This investigation was supported by Public Health Service research grants AI- and TOI-AI-86 from the National Institute of Allergy and Infectious Diseases. LITERATURE CITED. Abraham, E. P., and E. S. Duthie. 96. Effect of ph of the medium on activity of streptomycin and penicillin and other chemotherapeutic substances. Lancet : Albert, A Selective toxicity. Methuen and Co., Ltd., London, p Flynn, E. H., M. V. Segal, P. F. Wiley, and K. Gerzon. 95. Erythromycin. I. Properties and degradation studies. J. Am. Chem. Soc. 6:-.. Garrod, L. P., and P. M. Waterworth Behavior in vitro of some new antistaphylococcal antibiotics. Brit. Med. J. : Griffith, R. S Laboratory and clinical studies with erythromycin propionate. Antibiotics Ann , p Haight, T. H. and M. Finland. 95. Observations on mode of action of erythromycin. Proc. Soc. Exptl. Biol. Med. 8: McCabe, W. R., and G. G. Jackson Treatment of pyelonephritis: bacterial, drug, and host factors in success and failure among 5 patients. New Engl. J. Med. :-. 8. Sabath, L. D Synergy of antibacterial substances by apparently known mechanisms. Antimicrobial Agents and Chemotherapy- 96, p Sabath, L. D., H. A. Elder, C. E. McCall, and M. Finland. 96. Synergistic combinations of penicillins in the treatment of bacteriuria. New Engl. J. Med. :-8.. Tallgren, L. G., and C. H. von Bonsdorf The effect of varying the ph level upon the sensitivity of urinary bacteria to antibiotics. Acta Med. Scand. 8: Tunevall, G., and P. Hedenius. 95. Laboratory and clinical studies with erythromycin. Antibiot. Chemotherapy : Waterworth, P. M. 96. The antibacterial properties of leucomycin. Antibiot. Chemotherapy :-8.. Williamson, G. M., and K. Zinnemann. 96. The susceptibility of coliform bacilli to erythromycin. Antibiot. Chemotherapy :69-.. Wolinsky, E., and W. Steenken, Jr. 96. Streptomycin and penicillin resistant staphylococci. I. Influence of ph body fluids on streptomycin action. Proc. Soc. Exptl. Biol. Med. 6: Zagar, Z. 96. Sensitivity of E. coli, Ps. aeruginosa, and B. proteus to erythromycin in various ph culture media. Chemotherapia 6:8-89. Downloaded from on November, 8 by guest
Sensitivity of Gram-negative bacilli to ampicillin
J. clin. Path. (1969), 22, 644-648 Sensitivity of Gram-negative bacilli to ampicillin after six years' clinical use B. SLOCOMBE AND R. SUTHERLAND From Beecham Research Laboratories, Brockham Park, Betchworth,
More informationA new selective blood agar medium for Streptococcus pyogenes and other haemolytic streptococci
J. clin. Path. (1964), 17, 231 A new selective blood agar medium for Streptococcus pyogenes and other haemolytic streptococci E. J. L. LOWBURY, A. KIDSON, AND H. A. LILLY From the Medical Research Council
More informationTHE "REVERSAL," NEUTRALIZATION, AND SELECTIVITY
THE "REVERSAL," NEUTRALIZATION, AND SELECTIVITY OF GERMICIDAL CATIONIC DETERGENTS' MORTON KLEIN AND ZELMA G. KARDON Department of Bacteriology, School of Medicine, University of Pennsylvania, Philadelphia
More informationAgainst Aerobic Gram-Negative Bacilli
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Dec. 1979, p. 6-6 0066-0/79/1-06/05$0.00/0 Vol., No. 6 In Vitro Activity of LY17935, a New 1-Oxa Cephalosporin, Against Aerobic Gram-Negative Bacilli DENNIS G. DELGADO,
More informationAffinity of Doripenem and Comparators to Penicillin-Binding Proteins in Escherichia coli and ACCEPTED
AAC Accepts, published online ahead of print on February 00 Antimicrob. Agents Chemother. doi:./aac.01-0 Copyright 00, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights
More informationLaboratory assessment of physical and chemical methods of preserving urine specimens
J. clin. Path., 1977, 30, 532-536 Laboratory assessment of physical and chemical methods of preserving urine specimens P. G. WATSON AND B. I. DUERDEN' From the Department of Bacteriology, Edinburgh University
More informationCOAGULATION OF HUMAN PLASMA BY PASTEURELLA PESTIS'
COAGULATION OF HUMAN PLASMA BY PASTEURELLA PESTIS' DANIEL M. EISLER Naval Biological Laboratory, School of Public Health, University of California, Berkeley, California Received for publication June 27,
More informationCHAPTER 8 ANTIBACTERIAL ACTIVITY OF THE CRUDE ETHANOLIC EXTRACT AND THE ISOLATED COMPOUNDS FROM THE STEM OF COSTUS IGNEUS
CHAPTER 8 ANTIBACTERIAL ACTIVITY OF THE CRUDE ETHANOLIC EXTRACT AND THE ISOLATED COMPOUNDS FROM THE STEM OF COSTUS IGNEUS 8.1 INTRODUCTION Medicinal plants are the backbone of traditional medicine and
More informationClinical experience with ceftazidime in urology in Japan
Journal of Antimicrobial Chemotherapy (98), Suppl. A, 6- Clinical experience with ceftazidime in urology in Japan Noboo Kawamura Department of Urology, Tokai University, School of Medicine, Bosei-dai,
More informationUrinary tract infection, Urinary pathogens.
Kay words: Urinary tract infection, Urinary pathogens. Fig. 1 Organisms commonly isolated and their incidence in the U.T.I. with bacterial TOTAL(NUMBER=1396) MALE(NUMBER=707) FEMALE(NUMBER=689) Fig. 2
More information320 MBIO Microbial Diagnosis. Aljawharah F. Alabbad Noorah A. Alkubaisi 2017
320 MBIO Microbial Diagnosis Aljawharah F. Alabbad Noorah A. Alkubaisi 2017 Pathogens of the Urinary tract The urinary system is composed of organs that regulate the chemical composition and volume of
More informationPhiladelphia 4, Pa. (ST). With E. coli, one molecule of PABA neutralized 2,000 molecules
THE MECHANISM OF RESISTANCE TO SULFONAMIDES II. ABSENCE OF CORRELATION BETWEEN RESISTANCE AND THE FORMATION OF ARYLAMINE BY STAPHYLOCOCCUS AUREUS. NONINTERFERENCE WITH THE UTILIZATION OF GLUCOSE AS A CRITICAL
More informationReceived 30 March 2005; returned 16 June 2005; revised 8 September 2005; accepted 12 September 2005
Journal of Antimicrobial Chemotherapy (2005) 56, 1047 1052 doi:10.1093/jac/dki362 Advance Access publication 20 October 2005 Evaluation of PPI-0903M (T91825), a novel cephalosporin: bactericidal activity,
More informationRifampin Resistance. Charlottesville, Virginia i0w organisms in Trypticase soy broth (BBL Microbiology
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Apr. 1980, p. 658-662 0066-4804/80/04-0658/05$02.00/0 Vol. 17, No. 14 Treatment of Experimental Staphylococcal Infections: Effect of Rifampin Alone and in Combination
More informationSt. Joseph's Journal of Humanities and Science ISSN:
M. Parimala Celia et al. / St. Joseph s Journal of Humanities and Science (Volume 4 Issue 1 January 2017) 23-28 33 St. Joseph s Journal of Humanities and Science (Volume 4 Issue 2 August 2015) 33-38 St.
More informationRELATIONSHIP TO RESISTANCE IN KLEBSIELLA PNEUMONIAE
THE SIGNIFICANCE OF LACTOSE FERMENTATION AND ITS RELATIONSHIP TO RESISTANCE IN KLEBSIELLA PNEUMONIAE VICTOR J. CABELLI' AND M. J. PICKETT Department of Bacteriology, University of California, Los Angeles,
More informationAdenium Biotech. Management: - Peter Nordkild, MD, CEO, ex Novo Nordisk, Ferring, Egalet - Søren Neve, PhD, project director, ex Lundbeck, Novozymes
Adenium Biotech Management: - Peter Nordkild, MD, CEO, ex Novo Nordisk, Ferring, Egalet - Søren Neve, PhD, project director, ex Lundbeck, Novozymes Board of Directors: - Stephan Christgau, PhD, chairman,
More informationTHE SENSITIVITY OF STAPHYLOCOCCI AND OTHER WOUND BACTERIA TO ERYTHROMYCIN, OLEANDOMYCIN, AND SPIRAMYCIN
J. clin. Path. (1959), 12, 163. THE SENSITIVITY OF STAPHYLOCOCCI AND OTHER WOUND BACTERIA TO ERYTHROMYCIN, OLEANDOMYCIN, AND SPIRAMYCIN BY E. J. L. LOWBURY AND L. HURST From the Medical Research Council
More informationCharacterization of Bacteria by Their Degradation of Amino Acids
APPLIED MICROBIOLOGY, Oct. 1968, P. 1591-1595 Copyright 1968 American Society for Microbiology Vol. 16, No. 10 Printed in U.S.A. Characterization of Bacteria by Their Degradation of Amino Acids M. J. PICKETT
More informationEvaluation of Antibacterial Effect of Odor Eliminating Compounds
Evaluation of Antibacterial Effect of Odor Eliminating Compounds Yuan Zeng, Bingyu Li, Anwar Kalalah, Sang-Jin Suh, and S.S. Ditchkoff Summary Antibiotic activity of ten commercially available odor eliminating
More informationRoula M. Abdel-Massih Dept. of Biology, University of Balamand, Lebanon
http://skinnywithfiber.org Roula M. Abdel-Massih Dept. of Biology, University of Balamand, Lebanon Ilex paraguariensis Classification and characteristics Family Aquifoliaceae Found mainly in South America
More informationChapter 4. Anti-bacterial studies of PUFA extracts from Sardinella longiceps and Sardinella fimbriata. 4.1 Introduction
Anti-bacterial studies of PUFA extracts from Sardinella longiceps and Sardinella fimbriata C o n t e n t s 4.1 Introduction 4.2 Materials and Methods 4.2.1 Extract Preparation and Determination of PUFA
More informationCefuroxime iv Rationale for the EUCAST clinical breakpoints, version th September 2010
Cefuroxime iv Rationale for the EUCAST clinical breakpoints, version 1.0 26 th September 2010 Foreword EUCAST The European Committee on Antimicrobial Susceptibility Testing (EUCAST) is organised by the
More informationPathogenic organisms in the sputum of patients
Thorax (1967), 22, 265. Pathogenic organisms in the sputum of patients with chronic bronchitis 0. L. WADE, P. C. ELMES, AND EILEEN BARTLEY From the Department of Therapeutics and Pharmacology and the Department
More informationThe action of light on culture media
The action of light on culture media PAMELA M. WATERWORTH J. clin. Path. (16), 22, 27-2'77 From the Department of Bacteriology, Royal Postgraduate Medical School, London SYNOPSIS Failure of growth of staphylococci
More informationLeukopenic and Lethal Effects of Slime from Acinetobacter calcoaceticus
Leukopenic and Lethal Effects of Slime from Acinetobacter calcoaceticus Yoshiki OBANA and Takeshi NISHINO Department of Microbiology, Kyoto Pharmaceutical University Key words: A.calcoaceticus, slime,
More informationSynergism of Fosfomycin-Ampicillin and Fosfomycin-
ANTIMICROBiAL AGENTS AND CHEMoTHERAPY, May 1978, p. 75-79 66-484/78/13-75$2./ Copyright 1978 American Society for Microbiology Vol. 13, No. 5 Printed in U.S.A. Synergism of Fosfomycin-Ampicillin and Fosfomycin-
More informationDetermination of MIC & MBC
1 Determination of MIC & MBC Minimum inhibitory concentrations (MICs) are defined as the lowest concentration of an antimicrobial that will inhibit the visible growth of a microorganism after overnight
More informationClinical and In Vitro Evaluation of Cefazolin, a New Cephalosporin Antibiotic
ANTMICROBIAL AGZNTS AND CHEMOTHERPY, Feb. 1973, p. 168174 Copyright 1973 American Society for Microbiology Vol. 3, No. 2 Printed in U.S.A. Clinical and In Vitro Evaluation of Cefazolin, a New Cephalosporin
More informationInfectious Disease Testing. UriSelect 4 Medium. Direct Identification Visibly Reliable
Infectious Disease Testing Urielect 4 Medium Direct Identification Visibly Reliable Urielect 4 Non selective chromogenic medium for the isolation, differentiation and enumeration of urinary tract infections
More informationUTI : A NEW APPROACH TO ITS DIAGNOSIS
Abstract UTI : A NEW APPROACH TO ITS DIAGNOSIS Pages with reference to book, From 126 To 129 S. Hafiz, N. Lyall ( Department of Microbiology, The Aga Khan University Hospital, Karachi. ) The incidence
More informationBacteraemia in patients receiving human cadaveric
J. clin. Path., 1971, 24, 295-299 Bacteraemia in patients receiving human cadaveric renal transplants D. A. LEIGH1 From the Department of Bacteriology, The Wright-Fleming Institute, St Mary's Hospital,
More informationAerobic bacteria isolated from diabetic septic wounds
Aerobic bacteria isolated from diabetic septic wounds Eithar Mohammed Mahgoub*, Mohammed Elfatih A. Omer Faculty of Pharmacy, Omdurman Islamic University Department of Pharmaceutical Microbiology, Omdurman
More informationCephalosporin, Against Cephalosporin-Resistant Bacteria, and
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Nov. 1979, P. 59-553 Vol. 16, No. 5 66-/79/11-59/$2./ Antibacterial Activity of Ceftizoxime (FK 79), a New Cephalosporin, Against Cephalosporin-Resistant Bacteria,
More informationChanges in the Microflora of Bovine Colostrum During Natural Fermentation
27 f. Milk Food Techno/. Vol. 39. No. I, Pages 27-31!January, 1976) Copyright 1976, International Association of Milk, Food, and Environmental Sanitarians Changes in the Microflora of Bovine Colostrum
More informationURINARY TRACT INFECTIONS 3 rd Y Med Students. Prof. Dr. Asem Shehabi Faculty of Medicine, University of Jordan
URINARY TRACT INFECTIONS 3 rd Y Med Students Prof. Dr. Asem Shehabi Faculty of Medicine, University of Jordan Urinary Tract Infections-1 Normal urine is sterile.. It contains fluids, salts, and waste products,
More informationCeftizoxime in the treatment of infections in patients with cancer
Journal of Antimicrobial Chemotherapy (98), Suppl. C, 67-73 Ceftizoxime in the treatment of infections in patients with cancer V. Fainstein, R. Bolivar,. Elting, M. Valdivieso and G. P. Bodey Department
More informationUrinary Tract Infection at a University Hospital in Saudi Arabia: Incidence, Microbiology, and Antimicrobial Susceptibility
Urinary Tract Infection at a University Hospital in Saudi Arabia: Incidence, Microbiology, and Antimicrobial Susceptibility Ahmed T. Eltahawy, MB, BCh, DipBact, PhD; Ragaa M. F. Khalaf, MB, BCh, DipBact,
More informationInfluence of Water Diuresis on Antimicrobial
Influence of Water Diuresis on Antimicrobial Treatment of Enterococcal Pyelonephritis SANDRA P. LEVISON and DONALD KAYE From the Department of Medicine, The Medical College of Pennsylvania, Philadelphia,
More informationNEOSPORIN G.U. Irrigant Sterile (neomycin sulfate polymyxin B sulfate solution for irrigation)
NEOSPORIN G.U. Irrigant Sterile (neomycin sulfate polymyxin B sulfate solution for irrigation) NEOSPORIN G.U.SOLUTION NOT FOR INJECTION DESCRIPTION NEOSPORIN G.U. Irrigant is a concentrated sterile antibiotic
More informationPrevalence of asymptomatic bacteriuria in elderly referred to outpatient clinics in Talegani hospital, Abadan, Iran
Farajzadeh Sheikh et al. 147 Original article Prevalence of asymptomatic bacteriuria in elderly referred to outpatient clinics in Talegani hospital, Abadan, Iran Ahmad Farajzadeh Sheikh, PhD 1 Nabi Jomehzadeh,
More informationTHE USE OF THE PENICILLINASE-RESISTANT
Therapeutic problems THE USE OF THE PENICILLINASE-RESISTANT PENICILLIN IN THE PNEUMONIAS OF CHILDREN MARTHA D. Yow, MARY A. SOUTH AND CHARLES G. HESS From the Department of Pediatrics, Baylor University
More informationURINARY TRACT INFECTIONS
URINARY TRACT INFECTIONS Learning Objectives Identify signs and symptoms that may indicate presence of UTI (both complicated and uncomplicated) List common causative organisms and risk factors for UTIs
More informationEXERCISE. Proteins,Amino Acids, and Enzymes VII: Oxidase Test. Suggested Reading in Textbook. Pronunciation Guide. Materials per Student
EXERCISE 30 Proteins,Amino Acids, SAFETY CONSIDERATIONS Be careful with the Bunsen burner flame. No mouth pipetting. The oxidase reagent is caustic. Avoid contact with eyes and skin. In case of contact,
More informationKyabaggu D, 2 Ejobi F 3* Olila D
The sensitivities to first-line antibiotic therapy of the common urinary tract bacterial infections detected in urine samples at a hospital in metropolitan Kampala (Uganda) 1 Kyabaggu D, 2 Ejobi F 3* Olila
More informationAXITAB-CV TAB. COMPOSITION :
AXITAB-CV TAB. COMPOSITION : Each film coated tablet contains: Cefuroxime Axetil I.P. Eq. to Anhydrous 500mg. Potassium Clavulanate Diluted I.P. Eq. to Clavulanic Acid 125mg DESCRIPTION : Cefuroxime Axetil
More informationSCREENING THE BIOACTIVE POTENTIAL OF PROTEIN ISOLATED FROM CYPRINUS CARPIO. Iyyanuchamy, S.K and A. Periyanayagasamy*
Research Paper: Iyyanuchamy and Periyanayagasamy., 2011: Pp.6-10 SCREENING THE BIOACTIVE POTENTIAL OF PROTEIN ISOLATED FROM CYPRINUS CARPIO Iyyanuchamy, K and A. Periyanayagasamy* Department of Microbiology,
More informationExperimental Endocarditis Caused by Streptococcus sanguis:
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, July 1981, p. 1-14 66-484/81/71-5$2./ Vol. 2, No. 1 Experimental Endocarditis Caused by Streptococcus sanguis: Single and Combined Antibiotic Therapy MARIA V. VICENTE,
More informationDiscrepancies in the recovery of bacteria from multiple sinuses in acute and chronic sinusitis
Journal of Medical Microbiology (2004), 53, 879 885 DOI 10.1099/jmm.0.45655-0 Short Communication Correspondence Itzhak Brook ib6@georgetown.edu Received 1 March 2004 Accepted 18 May 2004 Discrepancies
More informationTreatment of serious Pseudomonas infections with azlocillin
Journal of Antimicrobial Chemotherapy (983), Suppl. B, 53-58 Treatment of serious Pseudomonas infections with azlocillin S. Olive, W. J. Mogabgab, B. Holmes, B. Pollock, B. Pauling and R. Beville Tulane
More informationComparative Evaluation of the Limulus Assay and the Direct Gram Stain for Detection of Significant Bacteriuria
Comparative Evaluation of the Limulus Assay and the Direct for Detection of Significant Bacteriuria JAMES H. JORGENSEN, PH.D., AND PAMELA M. JONES, M.T. (ASCP) Departments of Pathology and Microbiology,
More informationPRODUCT INFORMATION. Colistin Link. Colistin 150 mg/2 ml (as colistimethate sodium) powder for injection vial
PRODUCT INFORMATION Colistin Link Colistin 150 mg/2 ml (as colistimethate sodium) powder for injection vial For Intramuscular and Intravenous use. NAME OF THE MEDICINE Colistimethate sodium for injection,
More informationCefotaxime Rationale for the EUCAST clinical breakpoints, version th September 2010
Cefotaxime Rationale for the EUCAST clinical breakpoints, version 1.0 26 th September 2010 Foreword EUCAST The European Committee on Antimicrobial Susceptibility Testing (EUCAST) is organised by the European
More informationTHE BACTERIA RESPONSIBLE FOR APOCRINE ODOR*
THE BACTERIA RESPONSIBLE FOR APOCRINE ODOR* JOHN S. STRAUSS, M.D.f AND ALBERT M. KLIGMAN, M.D., PH.D. Shelley, et at. (), have shown that apocrine sweat is non-odorous when delivered to the surface but
More informationVolatile Fatty Acids and the Inhibition of Escherichia
APPuan MICROBIOLOGY, Jan. 1969, p. 83-87 Copyright 1969 American Society for Microbiology Vol. 17, No. 1 Printed in U.S.A Volatile Fatty Acids and the of Escherichia coli Growth by Rumen Fluid1 MEYER J.
More informationFactors Affecting the Antimicrobial Activity of Vitamin K
APPLIED MICROBIOLOGY, Sept., 1965 Copyright @ 1965 American Society for Microbiology Vol. 13, No. 5 Printed in U.S.A. Factors Affecting the Antimicrobial Activity of Vitamin K LARRY S. MERRIFIELD2 AND
More informationNatural History of Aortic Valve Endocarditis in Rats
INFECTION AND IMMUNITY, JUlY 192, p. 127-131 19-9567/2/7127-5$2./ Vol. 37, No. 1 Natural History of Aortic Valve Endocarditis in Rats ERIC HtRAIEF, MICHEL P. GLAUSER,* AND LAWRENCE R. FREEDMANt Division
More informationAsian Journal of Pharmaceutical Analysis and Medicinal Chemistry Journal home page:
Research Article CODEN: AJPAD7 ISSN: 2321-0923 Asian Journal of Pharmaceutical Analysis and Medicinal Chemistry Journal home page: www.ajpamc.com FORMULATION AND EVALUATION OF HERBAL WASH FOR NASAL HEALTH
More informationORIGINAL ARTICLE SUSCEPTIBILITY PATTERNS IN GRAM NEGATIVE URINARY ISOLATES TO CIPROFLOXACIN, CO-TRIMOXAZOLE AND NITROFURANTOIN
SUSCEPTIBILITY PATTERNS IN GRAM NEGATIVE URINARY ISOLATES TO CIPROFLOXACIN, CO-TRIMOXAZOLE AND NITROFURANTOIN Anoop Sinha 1, Benny P V 2 HOW TO CITE THIS ARTICLE: Anoop Sinha, Benny PV. Susceptibility
More informationCulturing Procedure. THOMAS R. NEBLETT Henry Ford Hospital, Detroit, Michigan Received for publication 29 March years.
JOURNAL OF CLINICAL MICROBIOLOGY, Sept. 1976, p. 296-35 Copyright 3 1976 American Society for Microbiology Vol. 4, No. 3 Printed in U.S.A. Use of Droplet Plating Method and Cystine-Lactose Electrolyte-Deficient
More informationAntibiotic Resistance Pattern of Blood and CSF Culture Isolates At NHLS Academic Laboratories (2005)
Antibiotic Resistance Pattern of Blood and CSF Culture Isolates At NHLS Academic Laboratories (2005) Streptococcus pneumoniae (SP) Blood Culture Isolates Penicillin intermediate Penicillin Cefotaxime 336
More information1430 West McCoy Lane Santa Maria, CA p:
091217TR HardyCHROM BluEcoli 1 HardyCHROM Candida 2 HardyCHROM ECC 3 HardyCHROM ESBL 4 HardyCHROM Listeria 5 HardyCHROM MRSA 6 HardyCHROM O157 7 HardyCHROM Salmonella 8 HardyCHROM SS NoPRO 9 HardyCHROM
More informationCeftomax TM S (Cefoperazone Sodium plus Sulbactam Sodium Injection)
COMPOSITION Ceftomax TM S (Cefoperazone Sodium plus Sulbactam Sodium Injection) CEFTOMAX - S Injection 1.5 gm Each vial contains: Cefoperazone Sodium equivalent to Cefoperazone IP. 1,000 mg Sulbactam Sodium
More informationHealthcare-associated infections acquired in intensive care units
SURVEILLANCE REPORT Annual Epidemiological Report for 2015 Healthcare-associated infections acquired in intensive care units Key facts In 2015, 11 788 (8.3%) of patients staying in an intensive care unit
More informationComparative Activity of Cefotaxime and Selected f3-lactam Antibiotics Against Haemophilus Influenzae and Aerobic Gram-Negative Bacilli
REVIEWS OF INFECTIOUS DISEASES VOL. 4, SUPPLEMENT SEPTEMBER-OCTOBER 1982 1982 by The University of Chicago. All rights reserved. 0162-0886/82/0405-0015$02.00 Comparative Activity of Cefotaxime and Selected
More informationCONSIDERATIONS IN UTI DETECTION AND POTENTIAL IMPACT ON ANTIBIOTIC STEWARDSHIP
CONSIDERATIONS IN UTI DETECTION AND POTENTIAL IMPACT ON ANTIBIOTIC STEWARDSHIP ERIN H. GRAF, PHD, D(ABMM) Director, Infectious Disease Diagnostics Laboratory Assistant Professor, Clinical Pathology and
More informationSerotyping and the Dienes reaction on Proteus
J. clin. Path. (199), 22, 2-28 Serotyping and the Dienes reaction on Proteus mirabilis from hospital infections J. de LOUVOIS1 From the Department ofpathology, Midland Centre for Neurosurgery and Neurology,
More informationInvestigators Meeting
Outcomes of Urinary Tract Infection Management by Pharmacists (R x OUTMAP) Investigators Meeting June 11, 2017 Overview 1. Introductions and Opening Remarks 2. Epidemiology and Definitions 3. UTI Assessment
More informationSections 11 & 12: Isolation and Identification of Enterobacteriaceae
Sections 11 & 12: Isolation and Identification of Enterobacteriaceae The family Enterobacteriaceae includes many genera and species. The last edition of Bergey s Manual of Systematic Bacteriology (Vol.
More informationURINARY TRACT INFECTIONS IN DIABETIC PATIENTS ATTENDING OUTPATIENT DEPARTMENTS AT KASTURBA MEDICAL COLLEGE TEACHING HOSPITAL, MANIPAL, INDIA
WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Gautam R. et al. Volume 2, Issue 3, 1141-1146. Research Article ISSN 2278 4357 URINARY TRACT INFECTIONS IN DIABETIC PATIENTS ATTENDING OUTPATIENT DEPARTMENTS
More informationJAC Efficacy and tolerance of roxithromycin versus clarithromycin in the treatment of lower respiratory tract infections
Journal of Antimicrobial Chemotherapy (1998) 41, Suppl. B, 69 73 JAC Efficacy and tolerance of roxithromycin versus clarithromycin in the treatment of lower respiratory tract infections G. Tatsis*, G.
More informationClinical Comparison of Cefotaxime with Gentamicin plus Clindamycin in the Treatment of Peritonitis and Other Soft-Tissue Infections
REVIEWS OF INFECTIOUS DISEASES. VOL. 4, SUPPLEMENT. SEPTEMBER-OCTOBER 982 982 by The University of Chicago. All rights reserved. 062-0886/82/0405-022$02.00 Clinical Comparison of with Gentamicin plus Clindamycin
More informationComparison of Anti- Vibrio Activities of Potassium Sorbate, Sodium Benzoate, and Glycerol and Sucrose Esters of Fatty
APPLIED AND ENVIRONMENTAL MICROBIOLOGY, June 1980, p. 1178-1182 0099-2240/80/06-1178/05$02.00/0 Vol. 39, No. 6 Comparison of Anti- Vibrio Activities of Potassium Sorbate, Sodium Benzoate, and Glycerol
More informationDetection of Bacteriuria and Pyuria by URISCREEN, a Rapid Enzymatic Screening Test
JOURNAL OF CLINICAL MICROBIOLOGY, Mar. 1992, p. 680-684 0095-1137/92/03680-05$02.00/0 Copyright 1992, American Society for Microbiology Vol. 30, No. 3 Detection of Bacteriuria and Pyuria by URISCREEN,
More informationWhen should UTIs be treated in the Elderly? Shelby L. Wentworth, MS4 University of Florida College of Medicine 29 AUG 2018
When should UTIs be treated in the Elderly? Shelby L. Wentworth, MS4 University of Florida College of Medicine 29 AUG 2018 UTIs in Patients >/ 65 yo - Most common infectious illness [1]. - Urinary tract
More informationAbstract. J Pak Med Assoc
Intraprostatic Tissue Infection in Catheterised Patients in comparison to Controls A. N. Talpur, A. T. Hasan, M. A. Sheikh Department of Urological Surgery and Transplantation, Jinnah Postraduate Medical
More informationEfficacy of Ceftriaxone in Serious Bacterial Infections
ANTIMIROBIAL AGENTS AND HEMOTHERAPY, Mar 1982, p 402-406 0066-4804/82/030402-05$0200/0 Vol 21, No 3 Efficacy of eftriaxone in Serious Bacterial Infections JAY S EPSTEIN, SUSAN M HASSELQUIST, AND GARY L
More informationFactors Affecting the Activity of Phenolic Disinfectants
Factors Affecting the Activity of Phenolic Disinfectants Bacteriological Section, Pesticides Regulation Branch, Plant Pest Control Division, Agricultural Research Service, U. S. Department of Agriculture,
More informationSensitivity of Surveillance Testing for Multidrug-Resistant Gram-Negative Bacteria in the
JCM Accepts, published online ahead of print on 20 August 2014 J. Clin. Microbiol. doi:10.1128/jcm.02369-14 Copyright 2014, American Society for Microbiology. All Rights Reserved. 1 2 Sensitivity of Surveillance
More informationDiagnostic Considerations and Interpretation of Microbiological Findings for Evaluation of Chronic Prostatitis
JOURNAL OF CLINICAL MICROBIOLOGY, Oct. 1989, p. 2240-2244 0095-1137/89/102240-05$02.00/0 Copyright C 1989, American Society for Microbiology Vol. 27, No. 10 Diagnostic Considerations and Interpretation
More informationGram-negative rods. Enterobacteriaceae. Biochemical Reactions. Manal AL khulaifi
Gram-negative rods Enterobacteriaceae Biochemical Reactions Bacteria Gram positive Gram negative Cocci Bacilli Cocci Rods Characters of Enterobacteriaceae All Enterobacteriaciae Gram-negative rods Reduce
More informationSpinal Cord Injuries
JOURNAL OF CLINICAL MICROBIOLOGY, OCt 1983, p 844-848 95-1 137/83/1844-5$2/ Copyright 1983, American Society for Microbiology Vol 18, No 4 ph and Water Content of Pseudomonas aeruginosa- and Klebsiella
More informationAsyntomatic bacteriuria, Urinary Tract Infection
Asyntomatic bacteriuria, Urinary Tract Infection C. Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asyntomatic Bacteriuria in Adults (2005) Pyuria accompanying asymptomatic
More informationCefadroxil for Oral Suspension USP 250 mg/5 ml and 500 mg/5 ml
Cefadroxil for Oral Suspension USP 250 mg/5 ml and 500 mg/5 ml Rx only To reduce the development of drug-resistant bacteria and maintain the effectiveness of cefadroxil for oral suspension and other antibacterial
More informationUTI IN ELDERLY. Zeinab Naderpour
UTI IN ELDERLY Zeinab Naderpour Urinary tract infection (UTI) is the most frequent bacterial infection in elderly populations. While urinary infection in the elderly person is usually asymptomatic, symptomatic
More informationCommercial in Confidence
Determination of Bactericidal Activity of Zwiteck Sanitizer using the European Standard Method BS EN 1276:2009 ~ Project Report Prepared for Zwiteck BV Inspiring tomorrow s professionals Determination
More informationAntibacterial Activity of Human Urine
Downloaded from http://www.jci.org on November 3, 217. https://doi.org/1.1172/jc15921 Antibacterial Activity of Human Urine DONALD KAYE From the Department of Medicine, The New York Hospital-Cornell Medical
More informationV. Reporting UNIVERSITY HEALTH NETWORK/MOUNT SINAI HOSPITAL, DEPARTMENT OF MICROBIOLOGY
Version: 1.0 CURRENT 1 of 26 TABLE OF CONTENTS Urinary Tract Infection Workup I. Introduction... 3 II. Specimen Collection and Transplant... 4 III. Reagents/Materials/Media... 4 IV. Procedure... 4 Asymptomatic
More informationConsultation on the Revision of Carbapenem Breakpoints
Consultation on the Revision of Carbapenem Breakpoints July 2018 Please send comments to the EUCAST Scientific Secretary at jturnidge@gmail.com by September 15. EUCAST revision of carbapenem breakpoints
More informationAntibacterial activities of extracts and their fractions of leaves of Tridax procumbens Linn
Antibacterial activities of extracts and their fractions of leaves of Tridax procumbens Linn Dhasarathan. P 1, Hemalatha. N 2, Theriappan. P 1 and Ranjitsingh, A.J.A 3 1 Department of Biotechnology, Prathyusha
More informationBacterial Infections of the Urinary System *
OpenStax-CNX module: m64804 1 Bacterial Infections of the Urinary System * Douglas Risser This work is produced by OpenStax-CNX and licensed under the Creative Commons Attribution License 4.0 1 Learning
More informationReceived for publication 11 April 1975
JOURNAL OF CLINICAL MICROBIOLOGY, Sept. 1975, p. 186-192 Copyright ) 1975 American Society for Microbiology Vol. 2, No. 3 Printed in U.S.A. Evaluation of the Enteric Analyzer for Identification of Enterobacteriaceae
More informationThe characteristics of bacterial pathogens in cases of children with respiratory tract infection in Eastern area.
Biomedical Research 2018; 29 (5): 1008-1013 ISSN 0970-938X www.biomedres.info The characteristics of bacterial pathogens in 15000 cases of children with respiratory tract infection in Eastern area. Guiting
More informationZINEX. Composition Each tablet contains Cefuroxime (as axetil) 250 or 500 mg
ZINEX Composition Each tablet contains Cefuroxime (as axetil) 250 or 500 mg Tablets Action Cefuroxime axetil owes its bactericidal activity to the parent compound cefuroxime. Cefuroxime is a well-characterized
More informationEffect of glucose and ph on uropathogenic and non-uropathogenic Escherichia coli: studies with urine from diabetic and non-diabetic individuals
J. Med. Microbiol. - Vol. 48 (1999), 535-539 0 1999 The athological Society of Great Britain and Ireland BACTERIAL ATHOGEN I CITY Effect of glucose and ph on uropathogenic and non-uropathogenic Escherichia
More informationQuantitation of Microorganisms in Sputum
APPTED MICROBIOLOGY, Aug. 1969, p. 214-22 VoL 18, No. 2 Copyright 1969 American Society for Microbiology Printed in U.S.A. Quantitation of Microorganisms in Sputum P. W. MONROE, H. G. MUCHMORE, F. G. FELTON,
More informationStudies on Bacteria Isolated from Catheter Edges and Urine in Short and Long-Term Urethral Catheterization
Acta Medica et Biologica Vol. 40, No.3, 123-127, 1992 Studies on Bacteria Isolated from Catheter Edges and Urine in Short and Long-Term Urethral Catheterization Hideo MORISHITA Yuichi NAKAJIMA Tetsu TORII
More informationEnterobacter aerogenes
Enterobacter aerogenes Piagnerelli M 1, Carlier E 1, Deplano A 3, Lejeune P 1, Govaerts D 2 1 Departments of Intensive Care and 2 Microbiology, A. Vésale Hospital. 6110 Montigny-le-Tilleul. 3 Department
More informationGASTRIC FLORA OF FASTING HEALTHY SUBJECTS AND ITS RELATIONS TO ph
GASTRIC FLORA OF FASTING HEALTHY SUBJECTS AND ITS RELATIONS TO ph Pages with reference to book, From 113 To 116 Rakhshanda Baqai, Sarwar J. Zuberi, Pirzada M.A. Siddiqui ( PMRC Research Centre, Jinnah
More information