Serotonin syndrome and liver failure with duloxetine overdose

We present a unique case of serotonin syndrome and acute liver failure associated with Duloxetine overdose in a young female. This pathological combination has not been reported previously with this medication and in our opinion deserves attention of medical community. Duloxetine use has increased exponentially over the years, putting significant patient population at risk of side effects from this drug

Chronic suppurative otitis media; empiric quinolones in children

The aim of the study was to determine the most prevalent organisms in chronic otitis media in children and their susceptibility to various antibimicrobials so that an appropriate empiric antibiotic can be started promptly while awaiting the results of the culture and sensitivity. Prospective observational study. The study was conducted at Combined Military Hospital Lahore from Jan 2006 to Dec 2007. A total of 156 patients less than 15 years of age who were having discharge from one or both ears for at least 1 week with tympanic membrane perforation were included in the study. A sample of the ear discharge was collected on the swab and cultured on appropriate media. The Gram positive organisms were identified on the basis of Gram staining, catalase and coagulase test, the Gram negative organisms were identified by API 20e. A total of 156 patients were included in the study of which 96 [61.5%] were males and 59 [37.8%] were females. The organisms isolated were Staphylococcus aureus in 79 [50.6%], Pseudomonas-aeruginosa in 45 [28.8%] patients and Proteus mirabilis 17 [10.9%], Escherichia coli, Acinetobacter sp and streptococi were isolated in occasional patients. Staphylococcus aureus was the commonest organism isolated followed by Pseudomonas aeruginosa and Proteus mirabilis fifty four. [34.6%] of Staphylococcus aureus were sensitive to gentamicin, fifty two [33.3%] to ciprofloxacin and 42 [26.9%]% to both ciprofloxacin and gentamicin. Among the Pseudomonas aeruginosa isolates 40 [25.6%] were sensitive to gentamicin, 27 [17.3%] to ciprofloxacin and 22 [14.1%] to both ciprofloxacin and gentamicin. Out of 156 patients 91 [58.3%] had isolates which were sensitive to ciprofloxacin and 62 [39.7%] were resistant to it. One hundred fourteen patients [73.1%] had isolates which were sensitive to gentamicin whereas 33 [21.2%] were resistant. Similarly 35 isolates [22.4%] were sensitive to sulphamethoxazole/trimethoprim whereas 66 [42.3%] were resistant. Among Proteus mirabilis isolates 12 were sensitive to gentamicin, 11 were sensitive to ciprofloxacin and 11 were sensitive to both ciprofloxacin and gentamicin. Ciprofloxacin ear drops can be recommended to be given empirically in children with chronic discharging ears. The initial therapy can be modified and appropriate therapy started if the result of the culture and sensitivity report shows the isolate to be resistant to the antibiotic started empirically