[Management of patients with suspected septic arthritis admitted to Qazvin teaching hospitals [2003-2008]]

Septic arthritis is one of the most common causes of joint destruction. The aim of this study was to assess management of definitive or suspected cases of septic arthritis in educational hospitals of Qazvin University of Medical Sciences within 2003 to 2008. This was an observational study performed based on existing data. The medical files of patients with arthritis in three hospitals were assessed. Patients were hospitalized in orthopedic, rheumatology and pediatrics wards. Intravenous antibiotic receivers for arthritis [more than three days] were analyzed [174 cases] and all necessary information was collected. Data were analyzed by SPSS software using descriptive statistics. Of total study population, 57.5% of cases were males, 70.6% under the age 12 years, and 85.2% with mono-articular involvement. The most common joint involved was knee in adults [39.6%] and hip in children [47.2%]. Trauma was the most common predisposing factor [73%] whereas limitation in movement found to be the most frequent [85.6%] clinical manifestation at the time of admission. Only 57 patients underwent arthrocenthesis and positive culture results were found in 8 cases. Essential considerations such as smear, gram staining and assessing the presence of crystals in synovial fluid were not accomplished to an acceptable level yet the less important criteria such as lactate dehydrogenase, protein, and glucose concentrations of synovial fluid were tested for majority of patients. Antibiotic regimen composed of an anti-staphylococcal agent in most cases. Within the first four hours following admission, 54.6% of cases received intravenous antibiotics and 24.7% of cases received IV antibiotic therapy for longer than two weeks. According, to inappropriate management of patients with definite and suspected septic arthritis, attempts should be made to consider parameters such as careful history and physical examination, correct duration of antibiotic therapy, and the process of determining the type of microorganisms causing septic arthritis including smear and culture of synovial fluid as well as taking necessary measures to improve the current conditions

Temperature recording sites in infants, children, and adults

Axilla, mouth, and rectum are the most common sites for thermometric measurement. There is no universally accepted belief about how to predict one of them from others. In a cross-sectional hospital-based study at two educational hospitals in Qazvin Province, mercury in glass thermometers were used and then calibrated with digital thermometer within +/- 0.1°C. The axillary temperature was compared with oral or rectal ones in 50 infants, 100 children, and 100 adults. The mean difference between axillary and rectal temperature in infants was 0.366 °C [ +/- 0.21], while those between oral and axilary in children and adults were 0.667 °C [ +/- 0.37] and 0.494 °C [ +/- 0.3], respectively. Among infants, 98% of the oral and rectal readings were stabilized at 5 and 3 minutes, respectively. In children, 98% of the oral readings were stabilized at five but for axilla, 99% by 6 minutes. For adults, 95% of the oral readings were stabilized at 5 minutes while for axilla, it was 96% by 6 minutes. In less than 3 month old infants, axillary temperature accurately reflects the rectal temperature. Axillary and rectal thermometry in infants should be read after 5 and 3 minutes, while oral temperature in children and adults should be read after 6 and 5 minutes, respectively

[Ceftriaxon -resistant E.coli meningitis in a diabetic patient]

A 57-year-old Iranian woman with a 4-day history of fever, malaise, and disorientation is presented. Signs of meningeal irritation were evident on examination. The patient's medical history was remarkable for diabetes mellitus, and hypertension with several admissions to hospital. Ampicilin, ceftriaxon, and vancomycin were administered for possible bacterial meningitis. A brain CT scan without contrast was unremarkable. Analysis of CSF revealed compatible values for bacterial meningitis. Culture of urine and CSF samples led to isolation of E. coli. The patient's clinical condition showed no improvement after 3 days. Four days following hospitalization, re-culture of CSF sample again produced positive result for E. coli. Using disk diffusion method, the isolate was found to be resistant to ceftriaxone and imipenem but sensitive to ciprofloxacin. Ceftriaxone was replaced by IV ciprofloxacin plus ceftazidime. The results of repeated analyses of CSF were indicative of clinical improvement with negative result for CSF culture. Ciprofloxacin and ceftazidime were continued for a total of 21 days. The patient remained asymptomatic with no recurrence