Spontaneous bacterial peritonitis (SBP) in cirrhotic ascites: a prospective study in a tertiary care hospital, Nepal.

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is one of the potentially lethal complications of cirrhosis and is defined as infected ascites in the absence of any recognizable secondary cause of infection. Objective was to study the occurrence of SBP, clinical and laboratory characteristics and the response to antibiotics. METHODS: We had prospectively evaluated 81 cirrhotic patients with ascites during one-year period. All SBP patients were treated with cefotaxime, 2gm IV, every 12h for 5days. RESULTS: Of these 81 patients, 24.67% of patients (n=20) had SBP and its variants (classical SBP n= 4, CNNA n=13 and bacterascites n=3). There were thirteen males and 7 females in the study.85% of the cases had Child;s class C cirrhosis. UGI bleeding and abdominal pain were the most common presenting symptoms of SBP. Culture positives were 35% (n=7). The most frequent organisms were Escherichia coli (n=3) and Streptococcus pneumoniae (n=2). 94% of the patients responded to therapy after 48 hours of treatment. Total resolution after 5 days of therapy was 73% and in-hospital mortality was 15% (n=3). CONCLUSION: SBP, if diagnosed early can be treated with very good success rate up to 73%. Appropriate treatment of SBP with cefotaxime can help in reducing mortality and morbidity in patients with chronic liver disease.

Cardiac and electrocardiographical manifestations of acute organophosphate poisoning.

INTRODUCTION: To study the extent, frequency and pathogenesis of the cardiac and electrocardiographical manifestations of acute organophosphate poisoning. METHODS: 37 adult patients admitted over a three-year period with a diagnosis of acute organophosphate or carbamate poisoning were studied prospectively. The clinical features and electrocardiographical finding were recorded. RESULTS: Cardiac complications developed in 23 patients (62.2 percent). These were: non-cardiogenic pulmonary oedema in eight cases (21.6 percent), electrocardiographical abnormalities including prolonged Q-Tc interval in 14 cases (37.8 percent), ST-T changes in 11 cases (29.7 percent), and conduction defects in two cases (5.4 percent). Sinus tachycardia occurred in 15 patients (40.5 percent) and sinus bradycardia in seven patients (18.9 percent). Hypertension developed in five patients (13.5 percent) and hypotension in four patients (10.8 percent). Five patients (13.5 percent) needed respiratory support because of respiratory depression of which two patients developed intermediate syndrome. Out of 14 patients with prolonged Q-Tc interval, only one had polymorphic ventricular tachycardia of the torsade de pointes type. Two patients died from non-cardiogenic pulmonary oedema and one from ventricular fibrillation, giving a hospital mortality of 8.1 percent. CONCLUSION: Cardiac complications usually occur during the first hour after exposure. Hypoxemia, electrolyte derangements and acidosis are major predisposing factors for the development of these complications. Intensive supportive treatment, meticulous respiratory care and administration of atropine in adequate doses vary early in the course of the illness will reduce the mortality.

Liver abscess in the tropics: an experience from Nepal.

Thirty-six consecutive cases of liver abscess seen at the BP Koirala Institute of Health Sciences Hospital, Dharan, Nepal, from 1995 to 1998, were reviewed. Twenty-one cases were male and 15 female, with a mean age of 42 years. Twenty-four cases (66.7%) were amebic, 7 (19.4%) pyogenic, 3 (8.3%) indeterminate and 2 (5.5%) tuberculous. The most frequent clinical features included fever (88%), leukocytosis (66.7%), abnormal level of serum albumin (44.4%) and alkaline phosphatase (38.9%). The liver abscess was single in 61.1%, multiple in 27.8%, and in 66.7% of cases the abscess was present in the right lobe of the liver. Ultrasonography was diagnostic in all cases. A positive culture of the abscess was obtained in 7 cases (19.4%). The most frequent bacteria found were Klebsiella pneumoniae (4;11.1%), followed by Escherichia coli (3;8.3%). Two cases were due to Mycobacterium tuberculosis and none had malignancy. Percutaneous drainage was performed in 27 patients (75%). Mortality attributable to the abscess was 5.5%. We found percutaneous needle aspiration of liver abscess helpful in confirming diagnosis, as it provides a better bacteriological culture yield, gives a good outcome, and may uncover clinically unsuspected conditions like malignancy and tuberculosis. These two conditions should certainly be considered possible causes in our part of the world when an abscess fails to respond to standard treatment. In developing countries like Nepal, the clinical presentation of liver abscess has not varied over time. At present, rapid diagnosis and image-guided percutaneous drainage offer a better prognosis for liver abscess. We also recommend routine cytological examination of aspirated abscess materials, as well as stains and cultures for acid-fast bacilli.

Histochemical enzyme pattern of microfilaria of Setaria cervi.

The present study deals with the histochemical localization of glucose-6-phosphatase, malic dehydrogenase and aldolase in the microfilaria of Setaria cervi. Marked activity of glucose-6-phosphatase was observed in the cephalic cells, excretory and anal pores, G-cells and Innenkörper. Malic dehydrogenase activity was noted throughout the body (including cuticle) of the microfilaria except for Innenkörper. Intense aldolase activity was observed in the excretory pore and G-cells only. Muscle cells and anal pore were negative for this enzyme.

Serum protein changes and their correlation with antibody production in rabbits following induced Setaria cervi infection.

The sera obtained from normal control and Setaria cervi infected rabbits were analysed weekly both qualitatively and quantitatively. Electrophoretic studies as well as biochemical estimation reveal an increase in total protein and globulin and a decrease in albumin level. The changes were more marked in the third week, followed by a declining phase reaching an almost normal level by the sixth week. The increased globulin level analysed electrophoretically also coincided with the appearance of 2 precipitin arcs in immunoelectrophoretic analysis indicating a correlation between antibody production and hyperglobulinaemia.

Effect of anthelmintics on the enzyme activities of Setaria cervi (Nematoda: Filarioidea).

The present study deals with the comparative efficacy of Hetrazan, levamisole and tetramisole on the enzyme activities of adult Setaria cervi worms. The drugs were administered orally to white rats, intraperitoneally infected with the bovine filariid, Setaria cervi. Biochemical assays revealed the decreased activities of glucose-6-phosphatase, fructose-1,6-diphosphatase, lactate dehydrogenase and adenosine triphosphatase in the drug-treated worms. Hetrazan was relatively more effective than tetramisole and levamisole. A possible role of these enzymes in the energy supply and survival of the worm has been briefly discussed.