ABSTRACT
Background: UTI constitute a major public health problem in India accounting 2nd most common infection next to respiratory tract infection. They are responsible for increasing treatment cost and significant morbidity.Aim:-To determine the incidence of UTI, evaluation of pathogens responsible and their antimicrobial susceptibility pattern in the population.Methods:Urine samples were collected from 300 patients attending the OPD Patna medical college, Patna during the period of 18 months (January 2017 to June 2018) Antimicrobial sensitivity testing was done for the bacterial isolates present in the sample by Kirby- Bauer disc diffusion method. Only those samples were taken into consideration which develops count equal to or greater than 1*105CFU/ml as indicated by Kass.Results:Out of 300 samples collected 146 (48.66%)) yielded bacterial growth. Out of 146 culture isolates E.Coli was the most common pathogen followed by klebsiella, CoNS and staphylococcus. Antibiotic sensitivity was performed on all the isolates. It was observed that highest sensitivity was 49.31% to amikacin, gentamycin (45.89%), nitrofurantoin (38.35%) meropenem (27.39%).Conclusions:It was observed that high grade of resistance to ampicillin, cotrimoxazole, ciprofloxacin, cefuroxime, chloramphenicol, cefotaxime, cefazolin, amoxicillin + clavulanic acid and gentamycin is present as a result of misuse or improper use of antibiotic in the community. Hence urine culture is necessary for the diagnostic screening of UTI before the treatment.
ABSTRACT
Parathyroid carcinoma is a rare disease. It accounts for lessthan 1% of all case of primary hyperparathyroidism and isusually not detected until the time of surgery or thereafter.Preoperative staging is not available for most patients. Hence aradical excision remains the standard management. Usuallythe disease has an indolent but slowly progressive course.Most of the patients suffer due to complications ofhypercalcemia, rather than direct tumor invasion ormetastases. The management of PC is difficult in terms ofdiagnosis, treatment and follow up. Here is a case report thatproves a diagnostic challenge to both the clinicians andpathologists and is discussed below
ABSTRACT
Quality of anaesthetic care can be improved only after identifying the factors contributing to patients' discomforts and dissatisfaction. The purpose of this prospective observational study was to assess the quality of central neural blocks in terms of physiological alterations and undesired events and to find out modifiable factors associated with patients' discomforts and dissatisfaction. Total 204 female patients (ASA I and II) undergoing gynaecological surgeries received either of the subarachnoid block (SAB), combined spinal epidural anaesthesia (CSEA) or lumbar epidural anaesthesia (LEA) depending on the nature of the procedure. Intra-operative and immediate post-operative physiologic alterations and undesired effects, surgeons' rating of the operation condition and patient satisfaction (using 10 cm visual analogue scale) and acceptability of the technique were analyzed. Out of 204 patients, hypotension, bradycardia and nausea occurred in 45.1%, 17.6% and 14.7% respectively. Fifty-six (27.4%) patients experienced discomforts whereas 10.8% had tolerable pain and 4.9% patients required conversion to general anaesthesia. The main causes of discomfort in these patients were inability to move lower limbs in 35.7% and discomfort in the upper limbs in 32.1% of patients. Operating conditions were suboptimal and unacceptable in 3.9% and 4.3% of patients respectively. The mean patient satisfaction VAS score was 8.2 +/- 1.3 and patient acceptability was 90.2%. Significant failure or unacceptability (approximately in 10.0%) along with a high incidence of preventable discomforts demand improvement in preoperative patient education, intra-operative care and liberal uses of sedation to improve the quality to bring the acceptability closer to 100.0%.