What after ciprofloxacin and ceftriaxone in treatment of salmonella typhi

To determine resistance pattern of Salmonella typhi in blood cultures. Laboratory-based observational study. Blood samples processed during the period of one and half year in the laboratory of Fatima Memorial Hospital for culture sensitivity were followed. Sensitivity of Salmonella typhi isolates was checked to 20 different antibiotics. Report of culture and sensitivity pattern was recorded. Amongst the 86 isolate 45 were found to be resistant to 2 or more first line anti-salmonella drugs. Eighteen multi-drug resistant Salmonella typhi [MDRST], isolates were detected. Four of the MDRST isolates were resistant to each of ciprofloxacin and ceftriaxone, and two were resistant to both of these drugs. Resistance was 19.2% to ciprofloxacin and 17.5% to ceftriaxone. Sensitivity to meropenem was 100% and to imipenem 98.6%. Pattern of S. typhi resistance is changing rapidly. MDRST and strains resistant to ciprofloxacin and ceftriaxone are a major threat in developing world. Proper steps must be taken to avoid emergence of Salmonella typhi strains resistant to most of the pertinent antibiotics

treatment of hyperkalemia with salbutamol and insulin

To see the potassium lowering effect of salbutamol and insulin in hyperkalemia, and to compare this hypokalemic effect when these drugs are administered alone or in combination. This interventional study was conducted in Services Hospital Lahore, for a period of one year. Fifteen patients with hyperkalemia were divided into three groups. Group A, Band C received 0.5 mg salbutamol diluted in 100 ml 5% water, glucose 25 gm diluted in 100 ml of water plus 10 units of regular insulin and both salbutamol 0.5 mg diluted in 100 ml of water with 25 grams of glucose plus 10 units of regular insulin respectively. Dextrose was given as infusion over 30 minutes and insulin as iv bolus. Blood samples were drawn at 0, 30, 60, 180 and 360 minutes. Blood pressure, pulse, temperature, respiratory rate and ECG were also recorded. Base line serum potassium levels fell from 6.4 +/- 0.3mmol/L, 6.5 +/- 0.3 mmol/L and 6.5 +/- 0.2 mmol /L, to 5.5 +/- 0.2 mmol/L, 5.7 +/- 0.2mmol/L and 5.4 +/- 0.3 mmol /L for groups A, B, and C respectively at 60 minutes. These levels started to creep up again at 180 minutes to 5.7 +/- 0.1 mmol /L, 5.9 +/- 0.2 mmol /L and 5.5 +/- 0.4 mmol /L for groups A, B and C respectively. According to the preliminary report Salbutamol is slightly more effective then insulin in the treatment of hyperkalemia. When administered simultaneously their effect is additive and prolong then administered alone. The number of patients in each group was too small, hence it needs to be studied further

Study of insulin injection technique amongst the nursing staff

To assess the knowledge and technique of insulin injection amongst the nursing staff. A total of 272 nurses working in three different hospitals [one private and two public] of Lahore, Pakistan were assessed regarding timing with meals, knowledge of site of insulin injection, tissue of injection, and technique of injection. Observations were recorded in Proforma and results were analyzed. Out of these 272 nurses only 40 knew all the steps regarding the insulin injection technique. The fact that insulin should be injected 30 minutes before meal was known to 57.4% and 66.2% had the idea of injecting insulin in subcutaneous tissue. Sixty-four percent knew about injecting insulin in upper arm, 75% knew about upper thigh as site of injection and 89.7% of the nurses knew that this has to be given in the abdomen. Technique of pinching skin was right in 64% nurses, 56.6% knew that cleaning the skin with spirit is not required. While assessing the technique of injection 72.8% of the nurses gave it correctly at an angle of 900. Nurses an integral part of health care providing team are not themselves properly trained to administer insulin injection in a developing country like Pakistan. Therefore for better health care provision their training has to be improved generally in all the fields and especially in the field of diabetes mellitus. The authorities responsible for their training should realize these facts and take effective measures