Frequency and Antibiotics Sensitivity Pattern of Culture-Positive Salmonella Typhi in Children.

OBJECTIVE: To calculate the frequency of positive blood culture in clinically diagnosed cases of enteric fever and antibiotic sensitivity patterns in culture-positive cases of S.typhi Study Design: Observational Study. Place and Duration of the Study: Department of Paediatrics Medicine, Services Hospital Lahore, from November 15th 2020 to May 15th 2021. METHODOLOGY: A total of 246 patients, fulfilling the definition of a suspected case of enteric fever were enrolled. Blood cultures were drawn on the spot. Antimicrobial sensitivity for 8 antimicrobial agents-Ampicillin, amoxicillin, chloramphenicol, cefixime, ceftriaxone, cefotaxime, ciprofloxacin, meropenem, and Azithromycin, were performed. A p-value of <0.05 was considered statistically significant. RESULTS: Blood cultures were positive in 62 (25.2%), patients out of which 34 (54.9%) were females and 28 (45.1%) were males, of which, 58 were S. typhi and 4 were S. Paratyphi A or B. Cefixime was sensitive in 27.4% of patients and intermediate sensitivity was found in 3.2% of cases and 69.4% of cases were resistant, ceftriaxone was sensitive in 38.7% of cases and Azithromycin was sensitive in 96.7% of cases, whereas meropenem showed 100% sensitivity. Chloramphenicol and Ciprofloxacin were resistant in 80.6% and 27.3% of the cases respectively. Among isolates, 32.3% (20) were categorised as sensitive enteric fever; 64.5% (40) as MDR, and 3.2% (2) as XDR enteric fever. CONCLUSION: MDR and XDR enteric fever are a major concern. For such cases, Azithromycin remains the best oral antibiotic with a sensitivity of up to 96.7%. Meropenem was sensitive in 100% of cases and was the only antibiotic with no documented resistance in this study. KEY WORDS: Enteric fever, Salmonella, Antibiotic sensitivity, Blood culture, MDR, XDR, Azithromycin, Meropenem.

Role of Intravenous Magnesium Sulphate in Term Neonates with Hypoxic Ischemic Encephalopathy (HIE) in a Low-income Country: A Randomised Clinical Trial.

OBJECTIVE: To determine the effects of magnesium sulphate in term neonates with hypoxic ischemic encephalopathy (HIE) in reducing mortality and morbidity. STUDY DESIGN: Randomised clinical trial. PLACE AND DURATION OF STUDY: Department of Neonatology, Services Hospital, Lahore, Pakistan from April to December 2019. METHODOLOGY: Term babies (inborn or outborn), fulfilling the operational definition of hypoxic ischemic encephalopathy, reaching within 6 hours of delivery in Nursery Department of Pediatric Medicine Unit-II, Services Hospital, Lahore, were included. Sarnat score was used for staging the severity of HIE. Cases were administered magnesium sulphate (MgSO4) as intravenous infusion. Rest of the management was similar for cases and controls. Mortality was defined as death due to birth asphyxia; whereas, morbidity was assessed by comparing the following at discharge: the grade of hypoxic ischemic encephalopathy, presence and frequency of seizures, duration of seizures, ability to suck feed and neurological problems such as abnormalities of muscle tone and neonatal reflexes. Babies with prematurity, dysmorphism comorbidities or arriving after 6 hours of birth, were excluded. Chi-square test was used for comparison; and p value <0.05 was considered significant. RESULTS: Gender, mode of delivery, mode of resuscitation at birth, major risk factors (prolonged labour, premature rupture of membranes, presence of meconium-stained amniotic fluid) were comparable in both groups. The duration of seizures, ability to suck feed and presence of neurological problems at discharge were significantly better in magnesium sulphate group as compared to control group. CONCLUSION: Magnesium sulphate is better in establishing earlier suck feed and reducing the duration of seizures and neurological problems in babies with birth asphyxia. Key Words: Hypoxic ischemic encephalopathy, Magnesium sulphate, Outcome, Term, Low income country.