Emergence and dissemination of antibiotic resistance: A global problem.

Antibiotic resistance is a major problem in clinical health settings. Interestingly the origin of many of antibiotic resistance mechanisms can be traced back to non-pathogenic environmental organisms. Important factors leading to the emergence and spread of antibiotic resistance include absence of regulation in the use of antibiotics, improper waste disposal and associated transmission of antibiotic resistance genes in the community through commensals. In this review, we discussed the impact of globalisation on the transmission of antibiotic resistance genes in bacteria through immigration and export/import of foodstuff. The significance of surveillance to define appropriate use of antibiotics in the clinic has been included as an important preventive measure.

Spontaneous rupture of spleen in falciparum malaria.

Spontaneous rupture of spleen is an extremely rare complication of falciparum malaria. We report a 3 1/2-year-old girl with splenic rupture who was managed successfully with splenectomy and antimalarials.

Neonatal disorders and obstetricians.

Neonatal disorders mean disturbance of normal state of body, organs and abnormal function of a newborn. Obstetricians play a major role to minimise the number of neonatal disorders. Prematurity, respiratory dysfunction, birth trauma, congenital malformations, neonatal infection and haemolytic disorders of the newborn are some examples of neonatal disorders commonly encountered. Preventive obstetrics is most important in reducing these disorders. Regular antenatal check-up, balanced diet, iron and folic acid tablet, avoiding repeated pregnancies are some measures which can prevent prematurity. Any factors which cause maternal hypoxia during pregnancy are responsible for foetal hypoxia. Proper antenatal care and avoidance of narcotic drugs in pregnancy are the pillars to combat respiratory dysfunction. Obstetricians play an important part to minimise birth trauma which is single handedly an important example of neonatal disorders. Proper antenatal care to detect any obstetrical anomaly reduces birth trauma to a large scale. In case of congenital anomalies, genetic counselling and early abortion in gross congenital anomaly are important aspects which can be looked after by the obstetricians. Neonatal infections can be minimised by the obstetricians themselves if they take care of any suspicious vaginal discharge in antenatal period. Dirty dressings are to be avoided in delivery time. Proper immunisation to the mother and also counselling of HIV transmission are also important. Haemolytic diseases of the newborn can be confronted by proper Rh and ABO blood groupings in antenatal period and proper intervention at the time of delivery.

Clonidine suppression test--an evaluation of its diagnostic significance in hypertensive patients.

The Clonidine Suppression Test (CST) was performed in 8 patients with Labile hypertension (Group I), 8 patients with mild and moderate Essential hypertension (Group IIa), 8 patients with severe Essential hypertension (Group IIb) and 6 patients with pheochromocytoma (Group III). The mean plasma catecholamine (CA) levels as estimated by a Spectrofluorimetric method were significantly reduced 3-4 hours after administration of clonidine (5 micrograms/kg) by mouth in Group I, IIa & IIb patients. Plasma norepinephrine levels fell from 1.82 +/- SEM 0.35 ng/ml to 1.03 +/- 0.11 ng/ml (p less than 0.05) in Group I, 1.64 +/- 0.36 ng/ml to 0.88 +/- 0.12 ng/ml (p less than 0.025) in Group IIa, 1.23 +/- 0.16 ng/ml to 0.86 +/- 0.12 ng/ml (p less than 0.005) in Group IIb patients. Plasma epinephrine levels fell from 0.35 +/- 0.06 ng/ml to 0.16 +/- 0.03 ng/ml (p less than 0.05) in Group I, 0.34 +/- 0.04 ng/ml to 0.22 +/- 0.03 ng/ml (p less than 0.01) in Group IIa, 0.33 +/- 0.06 ng/ml to 0.18 +/- 0.03 ng/ml (p less than 0.025) in Group IIb patients. The blood pressure and heart rate showed a similar response. By contrast, in patients with pheochromocytoma, the mean plasma CA levels did not show any significant fall, and even rose during the CST, but, when repeated post-operatively, showed normal suppression. No serious side effects were noticed. We conclude that the CST is a safe and reliable test for the diagnosis of pheochromocytoma.(ABSTRACT TRUNCATED AT 250 WORDS)