E. coli resistance to ciprofloxacin and common associated factors

Objective: To determine the frequency of E. coli resistance to ciprofloxacin and common factors leading to it among patients presenting with urinary tract infection

Study Design: Descriptive cross-sectional study

Place and Duration of Study: Department of Medicine, Ayub Teaching Hospital, Abbottabad, from December 2011 to June 2012

Methodology: A total of 166 patients, > 18 years of age of both gender, who presented with features of UTI and had urine culture positive for E.coli were included in the study. The urine samples were further tested for ciprofloxacin resistance and the patients were further checked for the common factors leading to E.coli resistance to ciprofloxacin

Results: Among 166 patients, 41 were male and 125 were female patients. Sixty-six [39.8%] E. coli isolates showed ciprofloxacin resistance. Male gender [p-value 0.001], previous history of recurrent UTI [p = 0.008, OR = 2.37], history of prior use of ciprofloxacin [p = 0.018, OR = 2.16] and history of catheterization [p = 0.005, OR = 4.80] were independent risk factors found in this study for the development of ciprofloxacin resistant UTIs

Conclusion: Ciprofloxacin resistance rates of E.coli were high at over 39.8%. The risk factors that affected the ciprofloxacin resistance rates of E.coli were prior use of ciprofloxacin, recurrent UTI, previous catheterization and male gender. Ciprofloxacin should be prescribed cautiously in patients with these risk factors and urine culture and sensitivity test should be performed for optimal treatment

Aetiological factors in mechanical intestinal obstruction

Background: Intestinal obstruction occurs when the normal flow of intestinal contents is interrupted. The most frequent causes of intestinal obstruction are postoperative adhesions and hernias, which cause extrinsic compression of the intestine. Less frequently, tumours or strictures of the bowel can cause intrinsic blockage. Objective of the study was to find out the various aetiological factors of mechanical intestinal obstruction and to evaluate the morbidity and mortality in adult patients presenting to Surgical 'A' unit of Ayub teaching hospital with mechanical intestinal obstruction. Methods: This cross-sectional study was conducted from March 2009 to September, 2009. All patients presenting with intestinal obstruction and were above the age of 12 years were included in the study. Patients with non-mechanical obstruction were excluded from the study and those who responded to conservative measures were also excluded. Results: A total of 36 patients with age ranging from 12 to 80 years [Mean age 37.72 +/- 19.74 years] and male to female ratio of 1.77:1, were treated for mechanical intestinal obstruction. The most common cause for mechanical intestinal obstruction was adhesions [36.1%]. Intestinal tuberculosis was the second most common cause [19.4%], while hernias and sigmoid volvulus affected 13.9% patients each. Malignancies were found in 5.6% cases. Conclusion: Adhesions and Tuberculosis are the leading causes of mechanical intestinal obstruction in Pakistan. Although some patients can be treated conservatively, a substantial portion requires immediate surgical intervention. Keywords: Intestine, Mechanical [Dynamic], Intestinal obstruction

Post operative hypothermia: incidence, relation to age and surgery

The normothermic status of the patients during anesthesia is disturbed and hypothermia is a potential problem. This study was done using Aural thermometry technique to see pattern of post operative hypothermia. Patients [n=80] core temperature measurements [using aural temperature probes after proper calibration] were obtained in the perioperative period. Sixty seven patients [83%] had temperature <36°C [mean <35.1°C +/- 0.1] on admission to the recovery room. This finding of definitive study was supported by an initial finding of the preliminary study [n=103] indicating 89% of the patients with temperature <36°C on admission to the recovery room [mean 34°C ' 0.1]. Elderly patients [> 65 years] and patients undergoing surgery of longer duration demonstrated high percentage and most marked decrease in temperature. A significant decrease in temperature, during leaving the reception area and admission to recovery room was found in all the surgical subgroups but the patients undergoing aortic reconstructive surgery showed marked decrease. Most of the patients were discharged with satisfactory rewarming while 20% of patients were discharged from the recovery room despite temperature below 36°C

Blood pressure changes during thiopentone induction

The study was carried out on total [n = 160] normotensive patients for elective surgical procedures of shorter duration to evaluate the changes in blood pressure using different concentrations and rates of administration of Thiopentone Sodium solutions as induction agent. The study demonstrated that induction with Thiopentone sodium causes a fall in blood pressure, the more concentrated the solution [5% solution] the more marked is the fall in the blood pressure as compared to the 2.5% solution. The rapid injection [administered in 30 seconds] causes a rapid and more fall in blood pressure as compared to administered in 1 minute. Atropine premixed with thiopentone causes inconsistent effect on blood pressure as compared to using plain thiopentone sodium, and there is no significant difference between the male and female in their blood pressure response to thiopentone sodium. Meticulous care is needed in the administration of thiopentone along with pre-oxygenation in the normal patients and particularly in those susceptible to its depressant effects such as those with raised blood pressure, elderly and cardiopulmonary compromised situations whereby it should be used slowly and in reduced dosage