Childhood Invasive Bacterial Disease in Kathmandu, Nepal (2005-2013).

BACKGROUND: Invasive bacterial disease (IBD; including pneumonia, meningitis, sepsis) is a major cause of morbidity and mortality in children in low-income countries. METHODS: We analyzed data from a surveillance study of suspected community-acquired IBD in children <15 years of age in Kathmandu, Nepal, from 2005 to 2013 before introduction of pneumococcal conjugate vaccines (PCV). We detailed the serotype-specific distribution of invasive pneumococcal disease (IPD) and incorporated antigen and PCR testing of cerebrospinal fluid (CSF) from children with meningitis. RESULTS: Enhanced surveillance of IBD was undertaken during 2005-2006 and 2010-2013. During enhanced surveillance, a total of 7956 children were recruited of whom 7754 had blood or CSF culture results available for analysis, and 342 (4%) had a pathogen isolated. From 2007 to 2009, all 376 positive culture results were available, with 259 pathogens isolated (and 117 contaminants). Salmonella enterica serovar Typhi was the most prevalent pathogen isolated (167 cases, 28% of pathogens), followed by Streptococcus pneumoniae (98 cases, 16% pathogens). Approximately, 73% and 78% of pneumococcal serotypes were contained in 10-valent and 13-valent PCV, respectively. Most cases of invasive pneumococcal disease (IPD) were among children ≥5 years of age from 2008 onward. Antigen and PCR testing of CSF for pneumococci, Haemophilus influenzae type b and meningococci increased the number of these pathogens identified from 33 (culture) to 68 (culture/antigen/PCR testing). CONCLUSIONS: S. enterica serovar Typhi and S. pneumoniae accounted for 44% of pathogens isolated. Most pneumococcal isolates were of serotypes contained in PCVs. Antigen and PCR testing of CSF improves sensitivity for IBD pathogens.

Anesthetic and analgesic efficacy of bupivacaine in mandibular third molar surgery: a systematic review and meta-analysis.

OBJECTIVE: This study was conducted to compare the anesthetic and analgesic efficacy of bupivacaine with other local anesthetic agents routinely used for mandibular third molar surgery. METHOD AND MATERIALS: Four electronic databases (PubMed, Scopus, Cochrane, and Web of Science) were explored to isolate randomized controlled trials up to 10 February 2019. The anesthetic and analgesic efficacies were assessed using six evaluation outcomes: onset of anesthesia, success of anesthesia, duration of anesthesia, duration of analgesia, pain score on the fourth postoperative hour, and number of analgesics consumed. Stata software (version 13, StataCorp) was used to analyze the data. RESULTS: Fourteen studies met the specified criteria. The sample consisted of 1,078 mandibular third molar surgeries performed in 858 patients. Bupivacaine, lidocaine/lignocaine, articaine, etidocaine, levobupivacaine, and carbonated bupivacaine were the local anesthetics used. Compared with other anesthetic agents, bupivacaine showed longer duration of anesthesia (weighted mean difference [WMD] 123.431 minutes; 95% confidence interval [CI] 34.01 to 212.851; P = .007), lower pain score at the fourth and eighth postoperative hours (4 hr-WMD 2.757; 95% CI 0.893 to 4.62; P = .004; 8 hr-WMD 1.697; 95% CI 1.178 to 2.216; P < .001), and lower number of analgesics requirement (WMD 0.663; 95% CI 0.258 to 1.067; P = .001). The onset of anesthesia was slower for bupivacaine (WMD 0.865 minutes; 95% CI 0.799 to 0.931; P < .001). However, for success of anesthesia (risk ratio 1.003; 95% CI 0.972 to 1.035; P = .831) and duration of analgesia (WMD 45.285 minutes; 95% CI -48.021 to 138.537; P = .342), the local anesthetic agents showed no significant differences. CONCLUSIONS: Except for the onset of anesthesia, bupivacaine showed better anesthetic and analgesic properties than other local anesthetic agents for mandibular third molar surgery.