Bacterial etiology and antibiotic resistance pattern of neonatal sepsis: a study in a tertiary care hospital, in Bangladesh

Background: Neonatal sepsis is a leading cause of neonatal mortality and morbidity. The objective of the study was to detect causative microorganisms of neonatal sepsis and their antimicrobial resistance patterns.Methods: This prospective cross-sectional study was conducted from July 2017 to June 2018 in the Department of Neonatal Medicine and NICU of Dhaka Shishu (Children) Hospital (DSH). Neonates diagnosed with probable sepsis were studied. After enrollment, 1 mL blood was taken and sent to Microbiology department of DSH for culture and sensitivity. With baseline characteristics, clinical examination findings and outcome, were also recorded.Results: Rate of isolation of single organism was 9.2% (84/913). Out of 84 isolates, gram negative bacteria were 77.4% with Klebsiella pneumonae being the commonest (35, 41.7%), gram positive bacteria were 11.9% with Staphylococcus aureus and Streptococcus were equal (5, 5.95% each) and the remaining (9, 10.7%) isolated organism was Candida. Most of the isolated gram-negative bacteria were resistant to ampicillin, gentamicin, and ceftazidime; but gram-positive bacteria preserved 20-80% sensitivity. Klebsiella was more resistant than Acinetobacter to amikacin, netilmicin, ciprofloxacin and levofloxacin. Around 45-65% of gram-negative bacteria were resistant to imipenem and meropenem but gram-positive bacteria showed lesser resistance. Among the gram-negative bacteria, Klebsiella and Acinetobacter were resistant to piperacillin as same as carbapenem group, but gram-positive bacteria were 100% sensitive to piperacillin. All the gram-negative bacteria showed more resistance to 4th generation cephalosporin, cefepime than carbapenem. Out of culture positive 84 neonates, 63 (75.0%) were cured but 21 (25.0%) died. Among the 21 expired neonates, 47.6% (10/21) were infected with Klebsiella.Conclusion: This study observed that gram-negative bacteria causing neonatal sepsis predominantly, with emergence of Candida. All the isolated gram-positive and gram-negative organisms were mostly resistant to available antibiotics

Evaluation of the Treatment of GustiloIiia Open Tibial Shaft Fracture TransosseousOsteosynthesis Technique with Ilizarov External Fixator

Background: Fractures of the tibial shaft are important for tworeasons. The first is that they are common, the second is thatthey are controversial - and anything that is both common andcontroversial must be important. Fractures of the shaft of thetibia cannot be treated by following simple sets of rules.Because of its location tibia is exposed to frequent injury and itis the most commonly fractured long bone.Objective: To evaluate the treatment of open tibial shaftfracture of Gustilo IIIA grade by Trans osseous osteosynthesistechnique with Illizarov External Fixator as a primary anddefinite mode of treatment.Methods: Clinical trial (Quasi Experimental study) fromJanuary 2009 to June 2010 (18 months) at National Institute ofTraumatology and Orthopaedic Rehabilitation Purposivesampling was done according to availability of the patients andstrictly considering the inclusion and exclusion criteria andsample size was 17 no of cases.Results: 14 male and 1 female patient between 17 and 51years were studied. Most common age group in this serieswere 26-35 year age group ((53.33%) and average age of thepatients was 30 years with SD of ±8.67. Most of the patientswere male and road traffic accident was the leading cause ofinjury (70.58%). Left side involved in (58.82%) most of thecases and 2 patients had bilateral fractures. Commonest site ofthe fractures were middle third (58.82%) of the tibia. Most ofthe fractures were comminuted type of fractures (47.05%).Most of the patients were operated on the day of admissionand in some cases within 4 - 7 days of admission. Averageduration of hospital stay was 8.06 days ranging from 1 day to28 days. Total duration of treatment was average 186.66 days(26 weeks) highest 291 days (42 weeks) and lowest 140 days(20 weeks). Most of the patient had soft tissue healing bygranulation tissue formation (35.29%). Others were treated byprimary closure, Delayed primary closure, secondary closure,partial thickness skin grafting.Conclusion: In this study the results of open tibia fracture(Gustilo IIIA) by Transosseous osteosynthesis technique withIlizarov External Fixator has been found to be satisfactory.Though there were a few minor complications with the fixatorthe dynamisation and compressing ability of this stable frameprovided good union without any second surgical procedure orbone grafting and prevented any malunion.

Evaluation of Madigan Procedure in the Treatment of Habitual Dislocation of Patella

This was a clinical trial (quasi experimental) study carried outat the National Institute of Traumatology and OrthopedicRehabilitation (NITOR), Dhaka, between July 2004 to June2006, involving 16 patients with habitual dislocation of thepatella. All these cases were managed by Madigan operativeprocedure. Aim of this study was to evaluate the effectivenessof the madigan procedure in the treatment of habitualdislocation of the patella. Out of these 16 patients 2 weresubsequently lost from follow up. So, the study finally consistedof 14 patients. In this study non-random purposive techniqueas per inclusion and exclusion criteria was followed irrespectiveof sex. Most common age group in this study was 6-10 years(62.5%). The mean age of occurrence was 8.25 years.Repeated intramuscular injection on the thigh was thecommonest cause of dislocation found in 37.5% cases. Thesecond most common cause of dislocation was history of boil.Abscess or cellulitis on the thigh followed by contracture of thequadriceps muscles. Various postoperative complications likehypertrophic scar constituted (18.75%), stitch granuloma(6.25%), restriction of knee motion (6.25%) and re-dislocationoccurred in (6.25%) cases. Functional outcome in themanagement of habitual dislocation of the patella wasanalyzed by using the Hospital for Special Surgery (HSS) kneescore. Regarding the final or overall results in this series, therewere 71.43% cases were found satisfactory and the remaining28-57% were found unsatisfactory result.

Diagnosis and Management of Isolated Superior Mesenteric Artery Dissection: A Systematic Review and Meta-Analysis

The objective of this study was to analyze the three different management modalities for isolated superior mesenteric artery (SMA) dissection. We did a comprehensive literature search and found 703 articles on the initial search, out of which 111 articles consisting of 145 patients were selected for analysis. The mean age was 55.7 years (standard deviation,9.7;33–85) and 80.6% were male. These patients were managed conservatively (41.3%), endovascularly (28.1%) or surgically (30%). The median follow-up was 10 months (interquartile range [IQR], 4–18 months), 12 months (IQR, 6–19 months) and 14 months (IQR, 6–20 months) respectively. Contrast-enhanced computed tomography (CT) was the most commonly used diagnostic tool in the conservative group (43.8%), while conventional CT scan was the most widely used in endovascular (58.1%) and surgical group (50%). 17% percent of the conservative group had SMA angiography for diagnosis, while this was less than 3% in the other groups. Of these patients, 96.7%, 97.4%, and 100.0% recovered successfully in the conservative, endovascular, and surgical groups respectively. There was no significant difference in the mortality between the three groups (Pearson χ²=0.482). This suggests a conservative and endovascular approach could be used in most patients, which can reduce costs and surgery-related morbidity and mortality. Surgical management should be reserved for cases having infarction or widespread bowel ischemia and in cases where other treatment modalities fail.

Diagnosis and Management of Isolated Superior Mesenteric Artery Dissection: A Systematic Review and Meta-Analysis

The objective of this study was to analyze the three different management modalities for isolated superior mesenteric artery (SMA) dissection. We did a comprehensive literature search and found 703 articles on the initial search, out of which 111 articles consisting of 145 patients were selected for analysis. The mean age was 55.7 years (standard deviation,9.7;33–85) and 80.6% were male. These patients were managed conservatively (41.3%), endovascularly (28.1%) or surgically (30%). The median follow-up was 10 months (interquartile range [IQR], 4–18 months), 12 months (IQR, 6–19 months) and 14 months (IQR, 6–20 months) respectively. Contrast-enhanced computed tomography (CT) was the most commonly used diagnostic tool in the conservative group (43.8%), while conventional CT scan was the most widely used in endovascular (58.1%) and surgical group (50%). 17% percent of the conservative group had SMA angiography for diagnosis, while this was less than 3% in the other groups. Of these patients, 96.7%, 97.4%, and 100.0% recovered successfully in the conservative, endovascular, and surgical groups respectively. There was no significant difference in the mortality between the three groups (Pearson χ²=0.482). This suggests a conservative and endovascular approach could be used in most patients, which can reduce costs and surgery-related morbidity and mortality. Surgical management should be reserved for cases having infarction or widespread bowel ischemia and in cases where other treatment modalities fail.

Mitomycin-C induced genetoxic effect in lymphocytes and histological alterations in testes of male albino mice

Background: mitomycin-C [MC] is an anti-cancer drug against several tumor types, including colon, breast and head and neck. In this demonstration, the genotoxic effects of mitomycin-C on DNA content and testicular tissue of male albino mice Mus musculus were studied.

Materials and Methods: mitomycin-C treated animal was injected intrapretonialy with tested doses of mitomycin-C single time at the first day of the experiment. Comet assay was used to detect the DNA damage in mice lymphocytes and the mean of total comet score was increased by dose and time among all treated groups

Results: The histological alterations caused in the testis of mice after mitomycin-C treatment displayed variable changes in both the seminiferous tubules and the interstitial tissue. Changes in seminiferous tubules were represented by hypoplasia of the germinal epithelium and spermatogenic arrest at various stages of spermatogenesis. The most prominent changes reported in the intertubular tissue were represented by the presence of a homogeneous and intensely eosinophilic ground substance in the interstitial areas, congestion of blood vessels as well as haemorrhage. The histological changes were also significantly increased by time and dose

A case of subretinal tubercular abscess presenting as disc edema.

We report a case of ocular tuberculosis (TB) which initially presented with disc edema and was mistaken for optic neuritis. With no definite pathology being identified, the patient was treated on the lines of optic neuritis with intravenous (IV) steroid with beneficial effect. Ocular TB was suspected when he presented later with a subretinal abscess. Based on positive Mantoux, QuantiFERON TB gold results and radiographic findings, a diagnosis of subretinal abscess of presumed tubercular etiology was made. The patient was successfully treated with anti‑tubercular therapy. To the best of our knowledge, this is the first case report of ocular TB presenting as disc edema followed by subretinal abscess.

Comparison of ABO and Rh-D Blood Group Systems between the Garo Tribal People of Mymensingh and General People of Dhaka City.

Background: The distribution pattern of ABO and Rh-D blood group in our country including the tribal people is not fully established as elaborated and large scale studies have not been carried out on it. Therefore this study was designed to observe the distribution pattern of ABO and Rh-D blood groups among the Garo tribes of Mymensingh and general people of Dhaka city. Objectives: To determine and to compare the distribution pattern of ABO and Rh-D blood groups among the Garo tribal people of Mymensingh and general people of Dhaka city and to compare this distribution between this two groups. Materials and Methods: This observational study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka from July 2008 to June 2009. After proper ethical consideration total 900 Garo people of Mymensingh and 784 general people of Dhaka city were included in this study. The Garo localities and the general people of Dhaka city were selected by systematic random sampling. ABO and Rh-D blood groups were determined by the antigen antibody agglutination test of slide method. Chi square statistical analyses were done to compare the results of ABO blood group systems between the Garo people and general people of Dhaka city. Results: This study revealed that there are significant variations in the distribution of ABO and Rh-D blood groups between the Garo tribal people of Mymensingh and the general people of Dhaka city. In this study it was observed that blood group ‘A’ was apparently predominant in Garo population, while blood group ‘B’ was predominant in general population (p<0.001), blood group ‘AB’ and ‘O’ were almost similar in both groups. Rh typing of the participants reveals that majorities of both groups were Rh positive. Rh negative persons are rare in both populations, but it is extremely rare in the Garo population (0.9%). Conclusion: From the findings of the present study it can be concluded that distribution of ABO and Rh-D blood groups varies between the Garo tribal people and the general people of Dhaka city.

Emerging Antimicrobial Resistance of Klebsiella pneumoniae strains Isolated from Pediatric Patients in Jordan

Bacterial resistance has been emerging and become major public health problem worldwide. The present study was conducted to investigate antimicrobial resistant pattern of Klebsiella pneumoniae strains isolated from clinical specimens of Jordanian pediatric patients during the period from January to December 2008. A total of 166 Klebsiella pneumoniae strains were isolated from clinical specimens and tested for their susceptibility to different antimicrobial drugs. Overall, high resistance rate was recorded for ampicillin [91.3%], followed by imipenem [90.9%], pipracillin [86.3%], ceftriaxone [83.8%], aztreonam [83.3%] and vancomycin [80.6%]. Lower relatively resistance rate was recorded for ciprofloxacin [6.9%], followed by norfloxacin [15.1%], nalidixic acid [33.6%], and gentamicin [39.7%]. beta-lactam antibiotics as well as imipenem, aztreonam, and vancomycin should not be used in treating infections caused by pathogenic K. pneumoniae and other related bacteria in Jordan. However, quinolone compounds and gentamicin seem to be effective in treatment of infections caused by pathogenic K. pneumoniae

Kikuchi disease with associated systemic lupus erythematosus: a case report

This case report describes a 28 year old male patient presenting with low-grad fever, symmetrical polyarthritis, rash on palms, neck and trunk, oral ulcers and cervical, axillary and hilar lymphadenopathy. Other systemicexamination was unremarkable. Patient was diagnosed as Kikuchi-Fujimoto's disease on the basis of lymph node histopathology, which showed the pathognomonic [Acute Histiocytic Necrotizing Lymphadenitis]. Concurrently diagnosis of systemic lupus erythematosus [SLE] was also made because of the presence of five out of eleven criteria for the diagnosis of SLE. The five criteria which were present in this patient were oral ulcers, arthritis, proteinuria of 1295 mg/24 hrs, positive Antinuclear Antibody and positive anti-double stranded DNA

pattern of dysphagia in children

Difficulty in swallowing is not uncommon among children and yet little information is available in the literature. We report our experience on the pattern of this condition. We extracted data from the medical records of 42 children with dysphagia on age at presentation, nationality, gender, and final diagnosis. From 1993 to 2002, 96% of 42 children presenting with dysphagia were Saudi nationals, ranging in age from 3 months to 18 years, with a male to female ratio of 1:0.6. An etiologic diagnosis was found in 30 children [72%]. Esophagitis, esophageal strictures and motility disorders were the most common causes of dysphagia, occurring in 16 [38%], 7 [17%], and 4 [10%] children, respectively. Two children had esophageal webs and one had an esophageal ring. Age-related analysis indicated that most of the cases of esophagitis [11/16, 69%] and strictures [5/7, 71%] occurred in young children whereas most nondemonstrable causes occurred in older children [9/12, 75%]. This report documents a pattern of dysphagia in Saudi Arab children that is similar to descriptions from other countries

Colonoscopy in children

Pediatric colonoscopy is routinely performed in most hospitals in Saudi Arabia and yet published data are scarce. The objective of this report is to describe our experience in the practice of pediatric colonoscopy in Saudi Arabia. Retrospective analysis of data of all patients below 18 years of age who underwent colonoscopy over a 10-year period. From 1414 H [1993 G] to 1423 H [2002 G], two hundred and seventeen colonoscopies, of which 183 diagnostic procedures, were performed on 183 children. The majority [94%] were Saudi nationals, the age range was between 5 months and 18 years, and the female to male ratio was 1: 0.8. Colonoscopy was total in 58 [32%] and limited in 125 patients [68%]. The commonest reason for not completing the procedure was securing the diagnosis in 45/125 patients [36%]. The commonest indication was rectal bleeding [35%]. The highest yield was in children with bloody diarrhea [91%] and the lowest in those with abdominal pain [27%] with an overall yield of 44%. Colitis was the most common diagnosis occurring in 66% of the children this report highlights the role of colonoscopy in the recognition of diseases of the colon in our community and identifies some of the problems areas associated with the performance of this procedure in our institution

Gammaglutamyl transpeptidase activity in patients with schistosomiasis

Schistosoma mansoni infestation may induce liver fibrosis and portal hypertension, with possible elevation of liver enzymes. Aim of the study: The aim of this study was to evaluate the serum gammaglutamyl transpeptidase [GGT] activity in a group of non- alcoholic and non-obese patients with hepatointestinal schistosomiasis. Patients and methods: Medical records of 174 patients diagnosed to have hepatointestinal schistosomiasis on the basis of clinical and laboratory data patients diagnosed to have hepatointestinal schistosomiasis on the basis of clinical and laboratory data were reviewed. Body mass index [BMI] was calculated for all patients. Direct stool smear and formol-ether concentration [FEC] methods and hematological and biochemical blood tests were performed. Other studies including abdominal ultrasonography, upper and lower gastrointestinal endoscopy was also performed when feasible. All [174] patients were adults with male to female ratio of 3.8:1. BMI was similar in both groups. Patients were divided into two groups: group 1 [57] with elevated GGT and group 2 [117] patients with normal GGT. Both groups had positive indirect hemagglutination test [IHA] for schistosomiasis. Other causes of liver disease were excluded. Group 1 had significant elevation of alanine aminotransferase [ALT], alkaline phosphatase [ALP] and reduction in platelets [P<0.001], low albumin and high globulin levels [P>0.01] compared to group 2. Abnormal ultrasonographic findings were more frequently encountered in group 1 [P<0.001]. The above data indicated that GGT elevation was most likely secondary to hepatobiliary involvement by Schistosoma mansoni and may indicate chronicity. There fore schistoromiasis has to be cousidered in our bcomunity when even GGT is elevated in non-Al coholi population Alcoholic pouplation

Etiology and outcome of come - a hospital based study

To identify various etiologies of nontraumatic coma and its outcome. Design: This was a hospital-based prospective study. Place and Duration of Study: It was conducted from June, 1996 to December 1997 at Civil Hospital, Karachi. Subjects and A 100 consecutive patients hospitalized with nontraumatic coma were included in the study. They were thoroughly examined and investigated to reach at a diagnosis. They were closely followed for outcome till their discharge or expiry. The highest number of patients i.e., 23% was in the 41-50 years age group and worst prognosis in 52% i.e. mortality. The causes were grouped into twelve categories, out of which leading cause for coma was found to be cerebrovascular diseases followed by metabolic and infectious diseases. Worst prognosis was seen in undiagnosed patients, patients with viral encephalitis and poisoning. Favourable outcome was seen in patients with electrolyte disturbance and diabetic ketoacidosis. Recovery was 100% with Glasgow Coma Scale [GCS] level > 11 while it was 34.5% in those having GCS < 5. Etiology and GCS level have a significant effect on the outcome of patients with nontraumatic coma

Incidence of cancer in cold thyroid nodules

In 160 clinically solitary sold thyroid nodules incidence of cancer was 17.5%. Papillary carcinoma, consituted 57.14% of the malignant cases, most of them were young females, 37.5% cases of papillary carcinoma had unilateral cervical lymph node metastasis. The incidence of other malignancies were follicular carcinoma [14.28%], medullary carcinoma [7.14%], undifferentiated carcinoma [14.28%], malignant lymphoma [7.14%] malignancy was found in 19.67% sold cold nodules, 12.5% mixed and 9.09% cystic nodules. 31.81% males reporting with cold thyroid nodules were found to have malignancy compared to 13.06% females. 42.85% of malignant cases were in the third decade of life and more than half were below 30 years but relative frequency was more in the elderly age group. 50% of the nodules found in cases over 50 years of age were malignant compared to 17.02% in the younger [below 30 years] and 11.11% in middle aged [30 to 50 years] groups. Cold thryoid nodules are important for their malignant potential and incidence of malignancy in cold thyroid nodule in our country is not insignificant, this fact should be kept in mind during management of these cases and special attention should be given to all the elderly patients, men of all ages and women of younger age group. FNAC may add substantially in the management of the cases and should be called for wherever the facility is available. In absence of the procedure, surgery is indicated for all the cold thyroid nodules. The ideal procedure would be a:lobectomy and excision of the isthmus i.e. a hemithyroidectomy rather than a nodulectomy. This will suffice for all the benign lesions as well as intrathyroidal papillary carcinoma especially in the younger age group. The excised specimen should be routinely sent for histopathological examination