Résumé
BACKGROUND: Neonatal sepsis is one of the commonest causes of neonatal mortality in the developing world. The neonatal intensive care units (NICUs) today face one common problem of tackling sepsis and neonatologists remain constantly baffled by the changing patterns of microbial flora and their sensitivity patterns. With the neonatal services coming of age in Nepal this retrospective analysis spread over a period of six years has become very pertinent. MATERIALS AND METHODS: We conducted a retrospective study over a period of six years to study the prevalence of different organisms causing septicaemia in the community and at our hospital and the antibiotic susceptibility pattern. In all 265 cases of suspected sepsis were screened using a panel consisting of CRP, ANC and I/T ratio and subsequently confirmed by cultures. The cases were early onset (n=44), late onset (n=56) and nosocomial groups (n=40). The data for the intramural (n=32) and extramural (n=68) cases was analysed separately. RESULTS: One hundred nineteen cultures out of the 131 positives were obtained from blood (44.92%) and the remaining were isolated from urine (6.11 %) and CSF (4.58 %). The most common organism to be isolated was staphylococcus aureus (42.75%) followed by klebsiella pneumoniae (18.32%)and escherechia coli (12.21%). Staphylococcus was isolated from 36.84%, 45.16% and 31.81% of the cultures obtained from neonates in the in-born, out-born and the nosocomial groups respectively while klebsiella pneumoniae [18.32 %] was seen in 21.05 %, 17.39 % and 36.36 % in each of the three groups. Pseudomonas aeruginosa [6.11 %] was isolated from 13.64 % of the nosocomial cultures compared to 8.7 % of the out-borns while it was not seen in the in-borns. Other organisms isolated were much less in number, included - pathogenic streptococci, acinetobacter and enterobacter species. Coagulase negative staphylococci (CoNS) was seen in 4.39 % [n=4] and 9.09 % [n=4] of the same groups respectively. The gram positive organisms displayed a high degree of resistance to most penicillins and cephalosporins but glycopeptides and monobactams were effective in them. There was a high incidence of resistance noted with most third generation cephalosporins and aminoglycosides amongst most gram negative organisms where-in cefepime and imepenem were effective in most cases. CONCLUSIONS: Staphylococcal sepsis is not only common in community acquired infections but also in nosocomial sepsis. There is an emerging resistance to cephalosposrins probably attributable to extended spectrum betalactamases. Further large-scale multicentre studies are required to generalise the data for the whole country.
Résumé
BACKGROUND: Down syndrome is associated with various forms of thyroid dysfunction, hypothyroidism being the most common. The additive effects of both co-morbid conditions lead to further amplification of the clinical problems in these children with Down syndrome. OBJECTIVE: The purpose of this prospective study was to know the prevalence of thyroid dysfunction in Down Syndrome children below the age of 14 years and to correlate the features of Down Syndrome with those of thyroid dysfunction. METHODS: In all 32 Down syndrome children were grouped as euthyroid, compensated and uncompensated hypothyroidism on the basis of their T3, T4 and TSH levels and the features of were compared using the student's t-test. RESULTS: Hypothyroidism was seen in 5 out of 32 cases (15.6%) of which 1 (3.1%) had uncompensated while the other 4 (12.5%) had a compensated hypothyroidism. Hyperthyroidism was not observed in any of the cases. The prevalence of hypothyroidism of 16.7% on the age group 0-1 year could well be a reflection of congenital hypothyroidism while 20% prevalence in the age group 9-12 could imply acquired hypothyroidism. The mean values of the developmental quotient (D.Q.) and the Rao's index in Down syndrome cases with hypothyroidism was 49 5.1 and 0.15 0.06 respectively while that of euthyroid Down syndrome patients were 52 5.54 and 0.17 0.04 respectively ('p' value > 0.05), the differences though obvious yet not statistically significant. CONCLUSION: It thus seems necessary to screen all Down syndrome children for thyroid dysfunction.