Bacteriological analysis of bile in cholecystectomy patients.

Background: Cholecystectomy is currently a frequently performed operation. The presence of gallstones within either the gallbladder or biliary tree is associated with the bacterial colonization of the bile. Acute cholangitis spans a continuous clinical spectrum and can progress from a local biliary infection to advanced disease with sepsis and multiple organ dysfunction syndrome. Therefore, it is important to know the microbiological flora of the gallbladder before prophylactic antibiotics are given. Aims & objectives: To evaluate the microbiological profile of bile from gall bladder in patients undergoing cholecystectomy. To determine the appropriate antibiotic for preoperative prophylaxis in cholecystectomy patients based on the microbiological profile of bile. Methods: The study was a prospective study carried out in SSG Hospital. A total of 78 patients undergone cholecystectomy who met the inclusion criteria were included in the study. 3cc bile was aspirated from all patients, this collected bile from gallbladder before cholecystectomy was transported to the laboratory in sterile test-tube. The specimen was evaluated to find out whether it is sterile or has any bacteria present. The types of bacteria are determined and whether the amount of isolate is significant or not. And sensitivity to antibacterial agents against antibiotics was determined. Results: 19 patients showed positive bile culture in which Escherichia coli was the most common isolated bacteria (63.16% among positive bile culture and 15.38% among all patients) and bile was sterile in 59 patients (75.64%). Other organisms isolated were Pseudomonas (3.85%), Klebsiella (2.56%), coagulase negative Staphylococcus and Staphylococcus viridans (1.28%). Positive bile culture was a more common finding (50% of patients were bile culture positive) in patients with acute cholecystitis in this study. Post-operative wound infection is more common (15.79%) in group of patients with isolated organism from bile. There is a strong correlation between bile culture and wound culture (75%). Conclusions: It was found that sensitivity to third- and fourth-generation cephalosporins was higher as compared to aminoglycoside in acute as well as chronic cholecystitis. In this study levofloxacin also shows good sensitivity against isolated organism from bile. Piperacilin and tazobactum also shows good sensitivity against isolated organism from bile and they are more effective against pseudomonas. The resistance to second-generation cephalosporins and aminoglycoside has increased. For preoperative prophylaxis third and fourth-generation cephalosporins and levofloxacin show better promise and may be used as the first line of preoperative prophylaxis in operations for acute and chronic cholecystitis undergoing cholecystectomy.

A comparative study of clinical, biochemical and hematological profiles in smear positive malaria patients: at a tertiary care center located in rural part of Gujarat, India.

Background: Aims and objectives of current study were to study the clinical, biochemical and hematological profiles in smear positive malaria patients and its correlation to immediate outcome of patient. To analyze the biochemical and hematological imbalances and its correlation with clinical presentation and type of malarial parasites. To elucidate the correlation of hematological and biochemical changes in children infected with malaria and their impact on immediate outcome of patients. Methods: All patients admitted with a diagnosis of malaria in department of Pediatrics at Dhiraj Hospital, Piparia, Vadodara, during the study period of January 2013 to June 2014. Sample size was 106 cases. Inclusion criteria for the study was all children under 18 years of age with smear positive malaria cases diagnosed. The study was done after obtaining a detailed history, complete general physical examination and systemic examination. The patients were subjected to relevant investigations. The data regarding patient particulars, diagnosis and investigations is collected in a specially designed case recording form and transferred to a master chart subjected to statistical methods like mean, standard deviation, proportion, percentage calculation and wherever necessary chi square test for proportion are used. Results: Total 106 patients were enrolled in study. Complications of PF (N=31): Jaundice 16%, severe anemia 23%, thrombocytopenia 29%, leukopenia in 23%, hyponatremia in 29.1%, cerebral malaria in 16% and hyperkalemia in 17%. Complications of PV (N=65): Jaundice 20%, severe anemia 20%, thrombocytopenia 18%, leukopenia in 11%, hyponatremia in 44.6%, hyperkalemia in 9%, cerebral malaria in 12.3% and hypoglycemia in 3.77%. Conclusions: The incidence of malaria is higher in males than females. Thrombocytopenia is very common in malaria, but spontaneous bleeding is not so common finding in malaria. Mixed infections behave like falciparum malaria. P. vivax malaria though traditionally considered to be a benign entity can also have a severe and complicated course, which is usually associated with P. falciparum malaria.

Duodenal perforation: role of multi detector computed tomography (MDCT).

Perforation of peptic ulcers, more specifically; ulcers of the first part of the duodenum carry mortality up to 11 %, with a higher mortality seen in patients over the age of 50 years. Main symptoms are acute onset abdominal pain and vomiting. Guarding & rigidity is present on examination. Conventional X-ray abdomen standing is the first investigation, which shows free gas under diaphragm. MDCT scan is required for identifying the presence, site and cause of gastrointestinal tract perforation. Early diagnosis and treatment is mandatory as it is a grave emergency condition.

A Large Hepatoblastoma in an Infant.

A prematurely born, 11 month old male child presented with history of lump over right side of upper abdomen for four months. Hepatomegaly with palpable lump in right hypochondriac and epigastric region was noted. ALT, AST & alpha feto protein were elevated with anaemia. On ultrasonography, ill-defined hypo echoic densely calcified mass lesion with internal vascularity noted in right lobe of liver. CT abdomen shows enlarged liver with heterogeneously enhancing mass lesion with necrotic areas and dense calcifications. Histopathologically diagnosis of hepatoblastoma was confirmed.

Retroperitoneal fibrosis in young female.

A 26 years old female presented with dull aching flank pain with elevated ESR, C - reactive protein and positive anti-nuclear antibody (ANA). Hypo echoic thin strip was noted in bilateral perirenal region without hydronephrosis on ultrasonography. Delayed enhancing perirenal rim of hypo dense soft tissue in bilaterally perinephric space on CT abdomen. Histological diagnosis of retroperitoneal fibrosis was confirmed.