Salmonella Typhi Infections and Effect of Fluroquinolones and Third Generation Cephalosporins in Clinical Outcome.

Background: Enteric fever is a common public health problem in Nepal. The emerging fluoroquinolone resistance to Salmonella typhi is a major concern in every hospital and is a public health problem these days. Continuous antibiotic susceptibility patterns surveillance and standard treatment policies need to be established to control MDR typhoid. Objective: To detect the increasing pattern of fluoroquinolone resistant Salmonella typhi and to correlate its clinical response to third generation cephalosporins. Materials and Method: This is a cross- sectional prospective study conducted in the pediatric ward of Birendra Hospital, Kathmandu, from September 2009 to August 2010. Forty seven children aged between 3-14 years with the diagnosis of suspected, probable and confirmed cases of Enteric fever were enrolled in the study. Data was collected and statistical analysis was done using SPSS program. Result: Culture positive enteric fever was found in 21 cases (44.68%) and positive Widal test in 18 (38.29%). Among the culture positive cases, antibiotic sensitivity was highest for Ofloxacin (95.23%), followed by third generation Cephalosporins (Ceftriaxone, Cefixime) (90.47%). A significant number of isolates were resistant to Nalidixic acid (71.42%). All cases were successfully treated with parenteral antibiotics followed by oral third generation cephalosporins without any complications and/or mortality. Conclusion: There is an increasing trend to fluoroquinolone resistant Salmonella typhi. Third generation cephalosporin can be the appropriate antibiotic for treatment.of clinically suspected cases of Enteric fever and to minimize the risk of increasing emergence of MDR enteric fever including Nalidixic acid resistant Typhoid.(NARST).

Successful management of infantile hypertrophic pyloric stenosis with atropine sulfate.

OBJECTIVE: To evaluate the effectiveness of atropine sulfate in management of infantile hypertrophic pyloric stenosis (IHPS). DESIGN: Prospective observational. SUBJECT: Patients attending the hospital with complaints of persistent vomiting and later clinically and sonographically diagnosed as cases of IHPS were selected for the trial. METHODS: Atropine was initially administered intravenously in a dose of 0.06 mg/kg/day in eight divided doses, increased by 0.15 mg/kg/day till vomiting ceased and remained so for a period of 24 hours at a stretch and ultrasonography showed a transit time (of gastric contents through pyloric canal) of less than 1 minute. Intravenous atropine was then substituted by oral atropine at double the effective IV dose for 3 weeks. Ultrasonographic evaluation of pyloric muscle thickness and length was done at the commencement of IV treatment, after completion of oral treatment and at 3,6,9,12 and 15 months follows up. Transit time of gastric contents was measured at the commencement of intravenous treatment and then daily after the vomiting stopped for more than 24 h at a stretch. RESULTS: Medical treatment of IHPS with atropine was successful in 50/52 (96.2%) cases. Vomiting ceased in 1-3 days in all patients with mild hypertrophy and in 4-7 days in all the cases with moderate hypertrophy. In all except 2 patients with severe hypertrophy, vomiting ceased in 8-12 days. These two cases continued to vomit at least once daily even after 2 weeks of IV treatment and ultimately opted out for pyloromyotomy. All the 50 medically treated children made uneventful recovery during oral therapy except 3 cases (6%) in whom vomiting recurred during the follow-up. These 3 children later responded by increasing the dose of oral atropine. All of them began to gain weight by the time oral therapy was commenced and ultrasonographic evidence of normalization of pylorus was observed in all these children 3-15 months after completion of oral therapy. CONCLUSION: Atropine sulfate proved to be an effective and safe treatment option for IHPS.

Ciprofloxacin in children: is arthropathy a limitation?

Two hundred and nineteen children treated with Ciprofloxacin were observed for drug related adverse reactions (ADR). ADR was observed in 35/219 (15.98%) children, arthropathy in 2/219 (0.9%) children only. All the ADR were reversible even on continuation of therapy except one child with arthropathy and no permanent sequele or death occurred as a drug related ADR.

C-reactive protein as an indicator of complications in bacterial meningitis.

OBJECTIVE: To determine the value of serum C-reactive protein (CRP) estimation in the follow-up of bacterial meningitis (BM). DESIGN: Longitudinal follow-up. SETTING: Urban hospital. METHODS: Sequential serum CRP estimation was done in 50 healthy children and in 100 children with BM. Serial serum CRP value was correlated with the clinical picture in BM. RESULTS: Serial serum CRP in 14 patients with complicated BM was significantly different than the 72 uncomplicated BM cases. CONCLUSIONS: Serial determination of serum CRP may be a cheap, simple and reliable prognostic indicator in BM.

Fulminant hepatitis in Kala-azar.

One hundred and fifty cases of Kala-azar were studied for evidence of hepatic involvement. The hepatic function was mildly affected in 25 cases and 3 cases had fulminate hepatitis. Most of the cases were cured after anti-Kala-azar therapy except 2 cases, who died of hepatic failure. This study suggests that fulminant hepatitis may be the outcome of Kala-azar, itself.

Cerebrospinal fluid C-reactive protein in the diagnosis of meningitis in children.

C-reactive protein was evaluated in the cerebrospinal fluid of 250 patients to determine if its measurement is of any clinical value in the diagnosis of bacterial meningitis. The C-reactive protein was found to be significant in the diagnosis of bacterial meningitis.

Plasma prolactin in epilepsy and pseudoseizures.

Postictal values of plasma prolactin levels were measured in 15 children with generalized seizures, 8 children with pseudoseizures and 6 control subjects. In patients with generalized seizure, the mean plasma prolactin level was 28.6 +/- 2.3 ng/ml, whereas in patients with pseudoseizures and in controls, its mean values were 10.4 +/- 3.8 ng/ml and 9.8 +/- 2.6 ng/ml, respectively. Thus, prolactin levels were significantly (p < 0.001) elevated following generalized seizures but were almost normal following pseudoseizures. Plasma prolactin levels may, therefore, be helpful in differentiating between generalized seizures and pseudoseizures.