ABSTRACT
Background: Typhoid fever is classically caused by Salmonella enterica serotype typhi.Recently the frequency of isolation of S. paratyphi A (SPA) has been increased in comparison to S. typhi in Indian scenario. Aim: To observe the rate of isolation and antimicrobial susceptibility pattern of SPA from suspected enteric fever cases attending tertiary care centres of Eastern Orissa. Settings and Design: Retrospective study Materials and Methods: 1488 blood samples were collected during different duration of fever and cultured in BACTEC blood culture system and bottles showing signal for growth were subcultured and identified as Salmonella spp. by standard procedure and mini API (Biomeriux) and antimicrobial susceptibility by disc diffusion method. Statistical Analysis: Chi square test. Results: 167 Salmonella spp. were isolated including 83.8% Salmonella paratyphi A and 16.6% S. typhi. Among them 102 were males and 65 were females with mean age of 22.7 yrs. S. paratyphi A was the predominant spp. each year but during 2008 – 2011, there was a dramatic rise (significant P value‑ 0.034). Multidrug resistance was noticed in 10.2% of the isolates. 98% of S. paratyphi A were resistant to nalidixic acid and 41% to ciprofloxacin, but the MIC of ciprofloxacin was raised between 1‑2 μgm/dl showing the relation between nalidixic acid resistance and raised MIC of ciprofloxacin. Conclusion: Nalidixic acid should be tested along with ciprofloxacin disc while testing for susceptibility and MIC of ciprofloxacin is mandatory before advocating therapy to prevent treatment failure.
ABSTRACT
Background: Cholecystolithiasis and choledocholithiasis combinedly known as or simply cholelithiases is of common occurrence with a worldwide incidence of about 10%. Though numerous treatment options are available but with the advent of minimally invasive techniques and endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic cholecystectomy (LC) with intraoperative ERCP (IO-ERCP) are the most recent researched technique so far. Objective: This study was done to assess the efficacy of LC with IO-ERCP for the management of cholecysto-choledocholithiases under protocolized balanced anesthesia. Methods: This retrospective study was conducted at a tertiary level hospital on 400 patients from 2008 to 2014. The patient selection was based on clinical presentations, laboratory investigations, and ultrasonography and magnetic resonance cholangiopancreatography imaging with positive evidence of gall bladder stones along with common bile duct (CBD) stones. Under general anesthesia as per standardized hospital protocol in all cases by conventional 4 port laparoscopic approach CBD was accessed, transcystically cannulated followed by IO-ERCP and completion of cholecystectomy. Results: Out of 400 patients, LC + IO-ERCP was successful in 304 cases. Neither the post-operative (PO) recovery was delayed nor was eventful. PO complications were also insignificant though we encountered a single case of post-ERCP pancreatitis, but that was one of those cases where we failed to accomplish IO-ERCP, instead had to settle with post-LC ERCP in the same setting. Average operation time was 116.84 ± 14.46, and the average duration of hospital stay was 2.15 ± 0.54. Conclusion: The combo procedure of LC IO-ERCP was found to be very efficacious owing to less number of hospitalizations, shortened hospital stay, reduced chances of PO complication, decreased risks of anesthesia hence, both times saving, as well as cost effective with overall patient satisfaction.