Bacterial isolates in severely malnourished children at Kenyatta National Hospital, Nairobi.

OBJECTIVES: To identify bacterial isolates and determine antibiotic sensitivity pattern in children with severe Protein Energy Malnutrition (PEM) presenting at the Paediatric Filter Clinic (PFC) of Kenyatta National Hospital (KNH). DESIGN: Hospital based cross-sectional survey. SETTING: Paediatric Filter Clinic of Kenyatta National Hospital (KNH), a tertiary level teaching institution for the University of Nairobi, Kenya. SUBJECTS: Children between two and sixty months presenting at the hospital outpatient filter clinic with severe malnutrition. RESULTS: Ninety-one children, forty six female and forty five males, were recruited for the study. Of these, sixty had Marasmus, twenty Kwashiorkor and eleven Marasmic-Kwashiorkor. HIV serology was positive in 43% of study subjects. There were 30 bacterial isolates from 26 subjects. Ten bacterial isolates were gram positive and twenty gram negative. Isolation rates did not vary by HIV serological status. Twenty one out of the 30 isolates were from blood culture. About 1/3 of the gram positive isolates were coagulase negative staphylococci, largely resistant to commonly used antibiotics such as Erythromycin, Ampicillin, Cotrimoxazole, Chloramphenicol and even Oxacillin. More than half demonstrated resistance to commonly used oral antibiotics while 80% of all gram positive and negative isolates were sensitive to Ciprofloxacin. Aminoglycosides, Gentamicin and Amikacin, and third generation Cephalosporins, Ceftriaxone and Ceftazidime, were found to be effective against most gram-negative isolates. CONCLUSION: Nearly a third (28.9%) of children admitted with severe malnutrition at KNH have concomitant severe bacterial infections; primarily manifesting as bacteraemia. Gram-negative agents are responsible for most severe bacterial infections in children admitted at the KNH, regardless of their HIV serological status. Whenever possible, blood culture should be included in the initial septic screening of severely malnourished children at KNH. In the absence of culture and sensitivity information, ciprofloxacin should be considered among the first line options in the empirical treatment of severe bacterial infections among these children. Clinical trials to further evaluate in-vivo effectiveness of various single or combination antibiotics are recommended.

Intratesticular varicocele: evaluation using conventional and Doppler sonography.

OBJECTIVE: The aim of this study was to describe the conventional and Doppler sonographic appearances of intratesticular varicoceles and to determine their occurrence. SUBJECTS AND METHODS: One thousand forty men with various testicular problems were examined using conventional and Doppler sonography, and the incidence of intratesticular varicocele and other conditions was recorded. Eighteen patients with intratesticular varicoceles were further examined, allowing us to study the various sonographic and Doppler parameters of this rare entity. RESULTS: Intratesticular varicocele was identified in 18 (1.7%) patients. The condition was bilateral in seven patients and unilateral in 11. Of 25 testes involved, 12 (48%) were right-sided and 14 (56%) were isolated without any ipsilateral extratesticular varicocele. The shape of the intratesticular varicocele was tubular in 21 cases and oval in five; one patient had both oval and tubular varicoceles. Diameters ranged from 2 to 8 mm (mean, 3.1 mm). Mean venous flow velocity was 2.8 cm/sec and had an inverse relationship to the diameter of the intratesticular varicocele. CONCLUSION: Intratesticular varicocele is seen in fewer than 2% of the symptomatic population. The condition has a characteristic sonographic appearance of dilated tubular intratesticular veins with a proximity to the mediastinum testis. Variations from previously published reports included presentation with an oval shape, more frequent bilateral occurrence, greater number of isolated right-sided intratesticular varicoceles, and fewer associations with an extratesticular varicocele.

Implementation of surgical audit in Pakistan.

UNLABELLED: Surgical audit, while extensively practised in the West, is still widely believed an impossible attainment in developing countries owing to the high cost and technology required to implement it. It is thus a poorly understood and rarely practised exercise in these countries. In this article we attempt to demonstrate the usefulness and feasibility of implementing audit in the setting of a developing country using personal computers (PCs) with simple, inexpensive and easily available software. We discuss the results of data analysis of 18 months of audit conducted by one general surgery team (2 consultants, 4 residents) at the Aga Khan University Hospital, Karachi. OBJECTIVE: To implement surgical audit in the setting of a developing country using microcomputers with simple, inexpensive and easily available software. DESIGN: Data analysis of inpatient audit proformas filled at weekly audit meetings from January 1989-July 1990 using Dbase III Plus. SETTING: One general surgery team (2 consultants, 4 residents) in a tertiary care hospital in Karachi. MAIN OUTCOME MEASURES: Disease patterns, caseload, complication rates. RESULTS: Conditions related to the biliary system made 26.1 per cent of the admitting diagnoses; 25.3 per cent of the patients had some co-existing medical condition as well, diabetes and hypertension being most common. The overall morbidity was 12.3 per cent and the mortality 1.5 per cent. Chest infection, wound infection and urinary retention were the most common post-operative complications. CONCLUSIONS: Results of audit data analysis initiated new research projects and development of protocols to improve patient care. Audit meetings also served as teaching sessions for residents.