Causative agents of urinary tract infections in children and their antibiotic sensitivity pattern: a hospital based study.

A retrospective study was conducted to find out the causative agents of urinary tract infection (UTI) in children and their antibiotic sensitivity pattern among Nepalese children. This was done at Kanti Children's Hospital in Kathmandu (Nepal) by analyzing the records of urine samples collected for culture and sensitivity tests over a period of six months (April to November, 2007). Of the total 1878 mid-stream urine samples collected from suspected cases of UTI, 538 (28.6%) were positive for pathogenic organisms. There was no significant difference in growth positive rate in two genders (M: 51.7% and F: 48.3%). Of the various pathogenic organisms isolated, Escherichia coli constituted for 93.3% followed by Proteus sp, Klebsiella sp, Citrobacter sp, Staphylococcus aureus and others. E. coli was found to be most sensitive to amikacin, chloramphenicol, nitrofurantoin and ofloxacin and least sensitive to most commonly used drugs like cephalexin, nalidixic acid, cotrimoxazole and norfloxacin.

Automated analytical systems for drug development studies. 3. Multivessel dissolution testing system based on microdialysis sampling.

An automated system consisting of a six-vessel dissolution apparatus, microdialysis sampling, STT E6 multiposition switching valve and a liquid chromatograph was assembled to measure dissolution profiles of immediate and sustained-release tablets. A DL-5 microdialysis loop probe (BAS, Inc.) was immersed in each dissolution vessel and perfused with a suitable medium for sampling. The dialystate from each vessel was injected sequentially onto an on-line liquid chromatography (LC) system for automated analysis. The STT E6 multiposition switching valve was used to sample up to six vessels simultaneously. After addressing issues related to sample carry-over and between-probe variability, the automated system was used in a reproducible manner (RSD < 3%) to measure the dissolution of immediate-release acetaminophen tablets and Accutrim (containing 75 mg phenylpropanolamine HCl) 16 h Precision Release tablets. An uneven injection time sequence was used to monitor three acetaminophen tablets per dissolution run using the automated system and each vessel was sampled about every 6.5 min. However, with Accutrim 16 h Precision Release tablets, a longer sampling interval (10 min) was used, the six tablets could be tested in each dissolution run. The dissolution profiles of acetaminophen and Accutrim tablets measured using the automated multivessel dissolution system compared well with manual and automated single-vessel dissolution systems.

Automated analytical systems for drug development studies. II--A system for dissolution testing.

Microdialysis is a non-equilibrium dynamic sampling method in which the analytes diffuse across a semipermeable membrane due to a concentration gradient and are carried away by the constantly pumping perfusion medium for on-line analysis. A BAS, Inc. microinfusion pump/injector and an on-line LC system were interfaced with a dissolution apparatus to automate dissolution testing of tablets. A DL-5 microdialysis loop probe was suspended in the dissolution medium for sampling. The automated system was used reproducibly (RSD < 2%) to measure the dissolution of acetaminophen and Sulfatrim tablets. Drug recovery from the microdialysis probe was a function of the perfusion rate at constant temperature. However, microdialysis recovery was independent of drug concentration over the linear ranges of the assays for the analytes of interest. Dissolution profiles determined by microdialysis sampling were compared with manual sampling. Identical profiles were obtained for acetaminophen tablets in water at 37 degrees C and 50 rpm by both sampling methods. Dissolution of Sulfatrim tablets was determined in 0.1 M hydrochloride acid at 37 degrees C and 75 rpm. Microdialysis sampling permitted the use of a specially designed perfusion medium to buffer the acidic samples before injecting onto the LC column. Dissolution profiles of sulphamethoxazole were comparable for both sampling methods; however, microdialysis sampling indicated slightly higher release of trimethoprim from the Sulfatrim tablets, which was attributed to release of adsorbed drug from the connecting tubing.

Automated analytical systems for drug development studies. I--A system for the determination of drug stability.

An automated system consisting of a pH-stat, microdialysis sampling and a liquid chromatograph was assembled to measure the rate of rapid chemical reactions. 2',3',5'-Triacetyl-6-azauridine was used as a model compound to validate the performance of the automated system. Buffer catalysis was minimized by using a non-catalytic concentration of borate buffer along with a pH-stat to maintain the pH during the kinetic run. The microdialysis sampling technique permitted sample quenching and buffering of the solutions to a pH compatible with the LC column materials. The combination of microdialysis sampling and rapid LC analysis allowed reactions with a half-life of approximately 1 min to be sampled every 30 s. The rates of hydrolysis of the drug, measured at different conditions of temperature (37-70 degrees C) and pH (9.0-10.5) using the automated system, compared well with the previously determined values.

Stability of diltiazem in acid solution.

A brief study of the stability of diltiazem was conducted at 70 degrees C in the pH range of 0.45 to 6.1 using polarimetry. Racemization did not occur. The hydrolysis rate of the acetate ester moiety was found to be slow, with a minimum in the pH-rate catenary at approximately pH 3.5. Where reaction products are known, photoelectric polarimetry has great advantages in speed, convenience, and cost compared with chromatographic methods for measuring rates of reaction of optically active analytes.

Risk factors for birth asphyxia and brain damage in pregnancy and labour.

In this review the patho-physiology and risk factors of birth asphyxia are discussed. Simple and appropriate, but scientifically sound, technology for the prevention of birth asphyxia is described. This can be used at home, in the community, in health sub-centres and health centres to identify and assess risk factors so that appropriate referral can be made. Based on experience in developing countries, actions which can be performed by the mother, relatives, neighbours, traditional birth attendants and nurses and midwives are described.

The home-based maternal record: a tool for family involvement in health care.

PIP: The home-based maternal record offers an opportunity for family involvement in health care. Home-based records of maternal health have been used in several developing countries, and have led to increased detection and monitoring of women at high risk for complications during pregnancy. Home-based cards that include menstrual information remind health workers to educate and motivate women for family planning, and serve as a source of health statistics. Records that use pictures and symbols have been used by illiterate traditional birth attendants, and had an accurate completion rate of over 90%. The WHO has prepared a prototype record and guidelines for local adaptation. The objectives were to provide continuity of care throughout pregnancy, ensure recognition of at-risk women, encourage family participation in health care, an provide data on maternal health, breastfeeding, and family planning. The guidelines have been evaluated and results show that the records have improved the coverage, acceptability, and quality of MCH/FP care. The records have also led to an increase in diagnosis and referral of at-risk women and newborns, and the use of family planning and tetanus toxoid immunization has increased in the 13 centers where the reports are being used. Focus group discussions have shown that mothers, community members, primary health workers, and doctors and nurses liked the records. It is important to adapt criteria for high-risk conditions to the local areas where the records will be used to ensure the relevance of risk diagnosis. The evidence shows that home-based maternal and child records can be an important tool in the promotion of self-reliance and family participation in health care. In addition, home-based records can be used for the implementation of primary health care at the local level, and serve as a resource for data collection.^ieng

Immunization glossary.

PIP: This immunization glossary defines the following terms: antibody; maternal antibodies; antigen; antitoxin; booster dose; control of a disease; droplet infection; endemic; epidemic; eradication of a disease; gamma globulin; immunity; active immunity; passive immunity; herd immunity; incidence; jet injector; prevalence; seroconversion; toxoid; live attenuated vaccines; whole inactivated vaccines; inactivated bacterial toxins/toxoid vaccines; and vaccine efficacy. Antibodies are special proteins in the blood which inhibit the organisms or toxins causing the disease. Those antibodies which inhibit the action of toxins are called antitoxins. The sites of maximum antibody formation are the lymph nodes and spleen. Immunity is the state of resistance of the body to agents foreign to it. Active immunity is acquired by contracting an infection or by administration of vaccines either singly or in suitable combination. The person who contracts the infection or is immunized makes his/her own antibodies which remain in the body for a long time. This is the most desirable form of immunity. In the case of passive immunity, ready-made antibodies are acquired by infection or injection. Live vaccines contain live bacteria or viruses. These organisms are treated in the laboratory to minimize their harmful effects while retaining their ability to stimulate the production of protective antibodies. Vaccine stability can be improved by freeze-drying, a process in which the vaccine is reduced to a powder by freezing and removing water vapor under vacuum. Dead or killed vaccines are made from killed bacteria or viruses. Examples of inactivated bacterial toxins/toxoid vaccines are the diptheria and tetanus toxoids. Vaccine efficacy is a measure of the degree to which a vaccine protects the members of the community in which it is used.^ieng

Maternal nutrition in deprived populations.

PIP: In deprived populations, a large proportion of women are chronically undernourished, the chances being therefore great that their infants will be undernourished in utero and present a low birth weight. Their children thus have a poor start in life, for which even breastmilk with its special protective and nutritive qualities cannot completely compensate, especially if the mothers continue to be chronically malnourished while subject to heavy workloads and repeated pregnancies. The supplementary feeding of pregnant and lactating women can to some extent offset these negative effects on both mother and child, but constitute a late intervention. Current literature on these issues is reviewed, and areas of action to improve women's nutritional status are indicated. In order to ensure that those most in need are reached at the grass roots level, the actions undertaken should be based on community participation, within the context of a multisectoral approach and a primary health care strategy.^ieng

The mother's card: a simplified aid for primary health workers.

PIP: The Mother's Card and its use are described. The card is filled out by the health worker and provides data on the mother concerning family planning, menstrual cycles, pregnancy period (including whether at risk, state of nutrition, immunization against tetanus, and expected date of birth), and breastfeeding. The card is kept by the mother, and the health worker keeps a copy. Each card has space for 10 years and up to 4 pregnancies. The cards have been used successfully in India since 1976 and in Somalia since early 1980, and were useful in strengthening family planning programs as well as identifying pregnancies at risk for special attention.^ieng

Appropriate technology in primary health care for better midwifery services.

PIP: Focus is on the various improvised techinques devised for better delivery of midwifery services for an entire community. The various technological devices described were worked out for the 1st time and subsequently implemented in the entire area of 60 program villages of Primary Health Center, Kasa in India during 1974-1976. The Integrated Mother-Child Health-Nutrition Project, Kasa had a population of 56,364 in the program villages. About 19% of the population were women in the reproductive age group of 15-45 years. The following improvised and simplified field techniques assisted the health workers in the maintenance of surveillance, community diagnosis and community management including a diferrent system of referral: 1) a mother's card which provided menstrual registry, information on pregnancies and their outcome, and help in identifying cases for family planning; 2) tri-colored arm tape for assessing nutritional status of women; 3) surveillance system on at-risk pregnant women; 4) anemiometer for identification of mild or severe anemia without pricking for blood; and 5) a very small midwife's kit for conducting safe deliveries. These techniques have been tried out in a wider area, and the results have been promising.^ieng