ABSTRACT
Background: Pneumococcal pneumonia is one of the major causes of mortality in children less than 5 years in Asia, especially in India. Available PCVs have less serotype coverage in India compared to western countries. Moreover, the baseline pneumococcal serotype and sequence type data is limited and available data doesn't represent the entire India. With this background we aimed to characterize invasive and carriage isolates of S. pneumoniae from a tertiary care hospital in South India. Materials and Methods: A total of 221 S. pneumoniae isolates, invasive (n=138) and carriage (n=83) between the time period of 2012-2018 were included. Isolates was identified and confirmed using standard laboratory protocols. Serotyping was performed by Customized sequential multiplex PCR and MLST as described in www.pubmlst.org. Results: The major serotypes were 19F, 6B, 14, 6A and 19A and the sequence types (ST) were ST63, 236 and 230. Predominant STs in invasive was ST 63 whereas in carriage were ST4894 and 1701. High level ST diversity in carriage was observed. Majority of the STs were SLVs or DLVs of previously reported STs or PMEN clones. Phylogenetic analyses of the STs revealed gradual expansion of three PMEN CCs CC320, 63 and 230. Conclusion: The vaccine serotypes were the predominant ones found to be associated with IPD, PMEN clones, new STs and antimicrobial resistance. Accordingly, PCV13 is expected to provide invasive serotype coverage of 75% in Indian children less than 5 years. This study provides baseline serotype and sequence type data prior to the introduction of PCV in South India.
ABSTRACT
Background: After gastrointestinal surgery like anastomosis, patients are usually not allowed to take feed orally for five days. This is to prevent post operative nausea and vomiting and also to protect the anastomotic site allowing it to heal. Aim: This randomized control study sought to compare the outcome of early Enteral feeding versus delayed feeding after gastrointestinal surgery. Materials and methods: 60 patients were randomly selected and classified into two groups, early feeding group and late feeding group and following were noted; anastomotic leak, infection (wound, intra-abdominal abscess, pulmonary complication, sepsis), length of hospital stay. Results: The mean length of hospital stay was 9.3 vs 10.90. The difference was 1.6 days (P value: 0.129). Wound infection was 20% vs 26.7%. 6.7% had intra-abdominal abscess in the early feeding group which was statistically insignificant. There were two patients (6.7%) with sepsis in late feeding group (p= 0.150). There were no anastomotic leak and no deaths in the both the groups. Conclusion: The present study indicated that there was no significant difference between the two groups. Late feeding doesn’t confer any significant advantage. There was no advantage of dietary restriction. Hence we recommend that early post-operative feeding is safer