Summary Information about community-acquired bacteraemia in developing countries in south and southeast Asia is scarce. We aimed to establish the case fraction of bacteraemia in febrile patients admitted to hospital. We searched four databases and identified studies of south and southeast Asia published between 1990 and 2010 that prospectively assessed patients admitted to hospital and from whom a blood culture was taken. We reviewed 17 eligible studies describing 40 644 patients. Pathogenic organisms were isolated from 3506 patients (9%; range 1–51%); 1784 (12%) of 14 386 adults and 1722 (7%) of 26 258 children. Salmonella enterica serotype Typhi was the most common bacterial pathogen, accounting for 532 of 1798 (30%) isolates in adults and 432 of 1723 (25%) in children. Other commonly isolated organisms in adults were Staphylococcus aureus , Escherichia coli , and other Gram-negative organisms, and in children were Streptococcus pneumoniae and Haemophilus influenzae . A substantial case fraction of bacteraemia occurs in patients admitted to hospital with fever in this region. Management could be improved if diagnostic microbiology facilities were more widely available. The prevailing organisms causing bacteraemia and their susceptibility patterns could inform empirical treatment regimens and prevention strategies.

https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(12)70028-2.pdf

Community-acquired bacterial bloodstream infections in developing countries in south and southeast Asia: a systematic review

THE recent completion of this work, of which the first volume was published in 1904, marks an epoch in the literature of the pathology of the eye. In his preface the author states that “the object of this treatise is to give as complete an account of the pathology of the eye as is possible in the present state of our knowledge.”The Pathology of the Eye.By J. Herbert Parsons. 4 vols. Vol. i., pp. xiii+388; vol. ii., pp. viii+389–770; vol. iii., pp. x+771–1128; vol. iv., pp. ix+1129–1427. (London: H. Frowde and Hodder and Stoughton, 1908.)

Pathology of the eye

Bacterial bloodstream infections are a major public health problem, which leads to high morbidity and mortality of patients. On time diagnosis and appropriate medication will be the best way to save the lives of affected ones. The aim of the present study was to determine the bacterial profile of bloodstream infections and their antibiotic susceptibility pattern in Mekelle Hospital. Cross sectional study method was carried out in 514 (269 females and 245 males) febrile patients in Mekelle hospital from March to October 2014. Standard bacteriological methods were used for blood collection, bacterial isolation and antimicrobial susceptibility pattern. Out of the total 514 febrile patients, 144 (28%) culture positive were isolated. Staphylococcus aureus 54 (37.5%), Coagulase-negative staphylococci 44 (30.6%), Escherichia coli 16 (3.1%), Citrobacter spp. 9 (1.7%) and Salmonella typhi 8 (1.6%) were the most dominant isolates, collectively accounting for >90% of the isolates. Antimicrobial resistance pattern for gram positive and gram negative bacteria was 0–83.3% and 0–100%, respectively. High resistance was seen to Trimethoprim-sulphamethoxazole 101 (70.1%), Oxacillin 65 (62.5%), Ceftriaxone 79 (58.9%) and Doxycycline 71 (49.3%). Fifty-nine percent of the isolated bacteria in this study were multi drug resistant. Most bacterial isolates were sensitive to Gentamicin, Ciprofloxacin and Amoxicillin clavulanic acid. All gram positive isolates in this current study were sensitive to vancomycin. Prevalence of bacterial isolates in blood was high. It also reveals isolated bacteria species developed multi drug resistance to most of the antibiotics tested, which highlights for periodic surveillance of etiologic agent, antibiotic susceptibility to prevent further emergence and spread of resistant bacterial pathogens.

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Bacteriological profile and antimicrobial susceptibility patterns of blood culture isolates among febrile patients in Mekelle Hospital, Northern Ethiopia.

Pelvic fracture urethral injury (PFUI) management in male adults and children is controversial The jury is still out on the best way to manage these injuries in the short and long-term to minimise complications and optimise outcomes There is also little in the urological literature about pelvic fractures themselves, their causes, grading systems, associated injuries and the mechanism of PFUI A review of pelvic fracture and male PFUI literature since 1757 was performed to determine pelvic fracture classification, associated injuries and, PFUI classification and management The outcomes of; suprapubic catheter (SPC) insertion alone, primary open surgical repair (POSR), delayed primary open surgical repair (DPOSR), primary open realignment (POR), primary endoscopic realignment (PER), delayed endoscopic treatment (DET) and delayed urethroplasty (DU) in male adults and children in all major series have been reviewed and collated for rates of restricture (RS), erectile dysfunction (ED) and urinary incontinence (UI) For SPC, POSR, DPOSR, POR, PER, DET and DU; (I) mean RS rate was 979%, 539%, 18%, 583%, 620%, 802%, 144%; (II) mean ED rate was 256%, 225%, 71%, 372%, 236%, 319%, 127%; (III) mean UI rate was 67%, 136%, 0%, 145%, 41%, 41%, 68%; (IV) mean FU in months was 463, 294, 12, 61, 314, 318, 549 For males with PFUI restricture and new onset ED is lowest following DU whilst UI is lowest following DPOSR On balance DU offers the best overall outcomes and should be the treatment of choice for PFUI

Pelvic fracture urethral injury in males-mechanisms of injury, management options and outcomes.

BACKGROUND: Presence of microorganisms in the circulating blood whether continuously or intermittently is a threat to every organ in the body. Approximately 200,000 cases of bacteraemia occur annually with mortality rates ranging from 20-50%. Early diagnosis and appropriate treatment of these infections can make the difference between life and death. The aim of the present study was to determine the bacterial flora of the blood stream infections and their antibiotic susceptibility pattern.
METHODS: A cross sectional study was conducted on 260 adult febrile patients in Jimma University Specialized Hospital from 27 October 2009 to 26 March 2010. The positive blood cultures were examined and the organisms were identified as per standard procedures. Antimicrobial testing was performed for all isolates by disk diffusion techniques, according to Clinical Laboratory Standards Institute guide lines. The data was analyzed using SPSS for windows version 16 and Microsoft Office Excel.
RESULTS: From the total of two hundred sixty blood specimens only 23(8.8%) were positive to seven different types of bacteria. The isolated bacteria were: Coagulase negative staphylococci 6(26.1%), S. aureus 5 (21.7%), S. pyogens 3 (13.0%), E. coli 4(17.4%), K. pneumoniae 3(13.0%), Salmonella spp. 1(4.3%), and Citrobacter spp. 1(4.3%). The isolates showed high rates of resistance to most antibiotics tested. The range of resistance for gram positive bacteria were 0% to 85.7%, and for gram negative from 0% to 100%. None of the isolates were resistance to ciprofloxacin and ceftriaxone.
CONCLUSION: Our study result showed the presence of invasive bacterial pathogens with high rate of resistance to most commonly used antibiotics used to treat bacterial infections. Therefore, timely investigation of bacterial flora of the blood stream infections and monitoring of their antibiotic resistance pattern plays an important role in reduction of the incidence of blood stream infections.

 KEYWORDS: invasive bacteria, antimicrobial resistance, Jimma, Ethiopia

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Invasive Bacterial Pathogens and their Antibiotic Susceptibility Patterns in Jimma University Specialized Hospital, Jimma, Southwest Ethiopia

The presence of bacteria in blood is simply known as bacteraemia. The main aim of this study is to determine the bacteraemia in patients visiting Kathmandu Model Hospital and antibiotic susceptibility pattern of isolates with special interest on ciprofloxacin. This prospective study was carried out in microbiology laboratory, Kathmandu Model Hospital from April 2005 to June 2005. Standard procedure was followed for blood sample collection. The bacteria were isolated and identified by standard microbiological procedure. Further, antibiotic susceptibility test was determined by NCCLS recommended Kirby-Bauer disc diffusion method. Out of 532 culture requests, 123 samples showed evidential microbial growth. The number of isolate of Salmonella typhi, Salmonella paratyphi A and Escherichia coli were 78, 44 and one respectively. The antibiotic susceptibility test demonstrated that chloramphenicol was the foremost drug of choice among the tested antibiotics with its sensitive rate of 98.4%. All the isolates of Salmonella typhi were susceptible to ceftriaxone and all isolates of Salmonella paratyphi A were susceptible to chloramphenicol, cotrimoxazole and amoxycillin. Ciprofloxacin resistant serotype of Salmonella was not isolated but out of 16 isolated serovar of Typhi and 10 serovar of Paratyphi A screened with nalidixic acid, 10 serovar of Typhi and all serovar of Paratyphi A were found to be resistant. Three isolates of Salmonella typhi were found as multidrug resistant (MDR) whereas no MDR was found in Salmonella paratyphi A. From this it can be concluded that Salmonella bacteraemia is more than other. Although nalidixic acid resistant serovars were isolated, ciprofloxacin resistant serovar were not present.

Etiological agents of bacteraemia and antibiotic susceptibility pattern in Kathmandu Model Hospital.

Background: Nutritional status is a prime indicator of health. Generally, three anthropometric indicators are often used to assess nutritional status during childhood and adolescence: underweight (weight-for-age), stunting (heightfor-age) and thinness (BMI-for-age). Malnutrition in children is a major public health problem in many developing countries. This study was conducted to assess nutritional status among children attending health camps in two mountainous districts in Nepal. Methods: Five hundred and seventy five children below 15 years of age attending the medical camp in Humla and Mugu districts in October 2011 were assessed for nutritional status. For children less than five years, weight for age, weight for height and height for age as per WHO classification, and for children between five to 15 years age specific values of height, weight and Body Mass Index (BMI) were calculated. Results: In Humla district, 28.2% children were undernourished, 8.8% wasted and 22.4% stunted in less than five years. In the same age group, 31.7% children were undernourished, 9.4% wasted and 29.4% stunted in Mugu district. In the age group five to 15 years, thinness was seen in 22.4% and 29.4% children in Humla and Mugu

Nutritional status of children in two districts of the mountain region of Nepal.

This is a retrospective study of fine needle aspiration cytology of breast lesionsperformed between May 1998 and April 2000. During this period, a total of 2001 fineneedle aspirations were done in the Tribhuvan Universtiy Teaching Hospital (TUTH),of which 470 (23.48 %) were of the breast. Fibrocystic disease found to be the mostfrequent and was diagnosed in 183 cases (38.9%). Fibroadenoma was the third commonpathological condition, numbering 61 (12.9%). Malignant conditions of the breastwere 72 cases (15.3%).During these two years, histological diagnosis was available in 154 cases. Histologicalexamination revealed benign conditions in 74 cases (48%), malignancy in 59 cases(38.3%) and inflammatory & lactational changes in 21 cases (13.7%). Out of these154 cases, 71 cases had also undergone fine needle aspiration cytology. The 36 casesdiagnosed as benign cytologically, 34 cases were also benign histologically, whereas 2cases turned out to be malignant. Out of 37 cases that were histologically malignant,on cytology 35 cases were diagnosed as malignant. The sensitivity and specificity ofcytopathological diagnosis for breast lesions was 100% and 94.6% respectively.Inflammatory lesions correlated well cytologically and histolgically.FNAC is a safe and rapid diagnostic method for evaluation of various lesions. However,there are possibilities of false negative and false positive results because of wide rangeof appearance of breast lesions.Key Words: Breast lumps, Fine Needle Aspiration Cytology, Benign Lesions,Malignant Lesions, Histopathology and Correlation.

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Fine needle aspiration cytology of breast lump in t.u. teaching hospital

Background Posterior urethral injury requires meticulous tertiary care and optimum expertise to manage successfully. The aim of our study is to describe our experiences with pelvic injuries involving posterior urethra and their outcome after early endoscopic realignment. Methods A prospective study was carried out in 20 patients with complete posterior urethral rupture, from November 2007 till October 2010. They presented with blunt traumatic pelvic fracture and underwent primary realignment of posterior urethra in our institute. The definitive diagnosis of urethral rupture was made after retrograde urethrography and antegrade urethrography where applicable. The initial management was suprapubic catheter insertion after primary trauma management in casualty. After a week of conservative management with intravenous antibiotics and pain management, patients were subjected to the endoscopic realignment. The follow up period was at least six months. The results were analyzed with SPSS software. Results After endoscopic realignment, all patients were advised CISC for the initial 3 months. All patients voided well after three months of CISC. However, 12 patients were lost to follow up by the end of 6 postoperative months. Out of eight remaining patients, two had features of restricture and were managed with DVU followed by CISC again. One patient with restricture had some degree of erectile dysfunction who improved significantly after phospodiesterase inhibitors. None of the patients had features of incontinence. Conclusions Early endoscopic realignment of posterior urethra is a minimally invasive modality in the management of complete posterior urethral injury with low rates of incontinence and impotency.

Early endoscopic realignment in posterior urethral injuries.

Dr. Bishwo Man Singh Shrestha, Dr. Bhagwan Koirala, Dr. Purna Raj Joshi, Dr. Mod Nath Marahatta, Mr. Mahendra Bhatta, Dr. Rabindra Timila, Dr. Uttam Shrestha, Dr. Jyotendra Sharma, Dr. Paleswan Lakhey, Dr. Sidhartha Pradhan, Prof. Govind Prasad Sharma*

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B Shrestha

Papers

Etiological agents of bacteraemia and antibiotic susceptibility pattern in Kathmandu Model Hospital.

Nutritional status of children in two districts of the mountain region of Nepal.

Fine needle aspiration cytology of breast lump in t.u. teaching hospital

Early endoscopic realignment in posterior urethral injuries.

Begining open heart surgery in Nepal: Our experience and three years audit at Tribhuvan University Teaching Hospital