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Background. Beta hemolytic streptococcus (BHS) represents a worldwide health problem because of the complications that can occur. Thus, it is important to identify the presence and type of BHS in time to start treatment if needed, avoiding the complications.

Aim. Our aim was to identify the prevalence of Beta Hemolytic Streptococcus in a Children’s Tertiary Care Hospital in Timisoara.

Methods. A cross-sectional study was conducted from April-June 2018 in Emergency Hospital for Children Timisoara. The study lot consists from 1100 children, ages between 0-18 years, which were not given, in the preceding two weeks, any antibiotics. We compared the study with two studies from different cities in Nepal, with the same subject as ours. Group A and Group C Streptococci were identified by beta hemolytic colonies, bacitracin sensitivity, catalase negativity test and latex agglutination test (Oxoid Streptococcal Grouping kit). ASO (Antistreptolysin O) test was also performed from serum samples, for patients with positive cultures. We also tested the antibiotic sensitivity to: Cefepime, Clindamycin, Erythromycin, Tetracycline.

Results. The prevalence of BHS (Beta Hemolytic Streptococcus), especially GABHS (Group A Beta Hemolytic Streptococcus) was 4%, in children from a tertiary care hospital in Timisoara, Romania; which is comparable to the findings of similar studies. In the first study, the prevalence of GABHS was 7.2%, and in the second study was 9%. The patients with positive cultures were also tested for ASO, 28 patients (52%) had high levels, while 26 (48%) had normal levels. On all positive patients an antibiogram was made and we observed that most of the isolates were sensitive to the antibiotics used. A few isolates in Group A were resistant.

Conclusions. Considering the limited data found on our subject, further epidemiological studies on streptococcal disease complex are needed.

intervention [ 11 ]. This study aimed to determine the prevalence of atypical presentations among older Thai patients with infectious diseases presenting at the ED of a tertiary care hospital and identification of factors associated with these presentations. Materials and methods Study participants This is secondary analysis of a retrospective cohort observational study of atypical presentations of older adults at an ED first reported in the Archives of Gerontology and Geriatrics in 2015 [ 12 ]. We analyzed a subset of data from patients diagnosed as having infectious


Background: Dengue virus infection has been a public health concern in Thailand. In the past decades, there has been recent interest concerning unusual clinical manifestations in both dengue fever (DF) and dengue hemorrhagic fever (DHF).

Objective: We described the unusual clinical manifestations and outcomes of children with dengue admitted to a tertiary care hospital in northeast Thailand.

Materials and Methods: A study was conducted on the 73 patients with serologically confirmed dengue infection admitted to Srinagarind Hospital, a tertiary care facility in northeast Thailand between January 2007 and August 2011.

Results: Of the 73 children examined, 42 (57%) were boys and 31 were girls. Their age ranged from 8 months to 14 years (median 11 years). Nine patients developed neurological symptoms, 6 patients had altered consciousness, and 3 patients convulsion. Among 9 patients with neurological symptoms, 1 patient had acute kidney injury, 1 had hepatic failure, and 1 had kidney and liver involvement, mostly associated with fluid resuscitation or prolonged shock. Apart from neurological symptoms, one patient developed infection associated hemophagocytic syndrome and was treated with intravenous immunoglobulin. Two patients died from multiple organ failure, and 1 patient was brought back home in a moribund condition. The other patients recovered completely.

Conclusion: Altered consciousness was the most commonly observed unusual neurological manifestation. Patients who did not develop acute kidney injury or liver failure had mild clinical courses and recovered from neurological symptoms without sequelae. Acute kidney injury was associated with fluid overload and/or prolonged shock. Careful fluid management and close monitoring for complications resulted in favorable outcomes.

(Indonesia 29.6%, Malaysia 19.1%, the Philippines 22.7% and Thailand 34.8%) [ 16 ] and 27% rate from the Asia Global Survey [ 17 ]. This could be due to the fact that KCMH is a tertiary-care hospital with a high volume of complicated pregnancies. Despite a high rate of cesarean section, our results corroborated with a recent report from Siriraj by Chotigavanichaya et al. [ 5 ]. By contrast, another report from Siriraj by Ariyawatkul et al. [ 8 ] demonstrated that a high Apgar score at 1 min and cesarean section were linked to lower risk of birth-related fracture. This

tertiary care hospital. The incidence of ALI/ARDS according to the AECC definition in a general SICU in our hospital was low, but the mortality rate was high. ALI/ARDS developed early in the SICU, and the most common causes were sepsis and pneumonia. A study with a larger sample size should be conducted to identify independent risk factors for the development of ALI/ ARDS. Conflict of interest statement : The author declares that there is no conflict of interest in this research. References 1 The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal


In our centre, among 1965 registered cancer patients between May 2011 and December 2013, we report three cases with multiple primary malignant neoplasms. One of them was excluded due to lack of data, and so we present the remaining two cases. The first case is an 82-year-old female patient with colon and thyroid cancer and the second case is a 61-year-old female patient with colon and breast cancer. Both cases were metachronous and discovered accidently during the regular follow up, and managed with a curative intent. Conclusion: It is important for the clinicians to keep in mind that individuals with cancer are at increased risk for subsequent primary malignancies, which must be differentiated from recurrent or metastatic disease.


Multidrug-resistant (MDR) enterococci are a growing threat. The aim of this study was to determine the species distribution and prevalence of multidrug resistance among 100 enterococcal strains, isolated from patients treated in the University Hospital in Pleven, Bulgaria. Susceptibility to 11 antimicrobial agents was determined, using the disc diffusion method according to the performance standards of Clinical Laboratory Standards Institute (CLS1), 2012. All isolates were screened for high-level aminoglycoside resistance and resistance to vancomycin according to the recommendations of CLS1, 2012. For strains with reduced susceptibility to vancomycin, minimal inhibitory concentrations (MIC) of glycopeptides were determined by Etest (Liofilchem, Italy) and by Vitek 2 automated system. Our results demonstrated decreased susceptibility of enterococci to almost all intensively used anti-enterococcal drugs. Resistance to both penicillins (ampicillin and penicillin) among E.faecium strains was significantly higher (83-87%) than among E.faecalis isolates (4-27%). HLGR was detected in 70% of E.faecium and 38% of E.faecalis isolates. All HLGR strains were foundtobemultiple-drug resistant. Of particular note was the emergence of concomitant resistance to 6 antimicrobials in almost 50% of E.faecium isolates. Despite the wide dissemination of MDR E.faecium strains penicillins in our hospital, acquired resistance to vancomycin was not found.


We reviewed medical records of cases of liver abscesses (LA) registered in Rīga East University Hospital clinical centre “Gaiïezers” from January 2012 to October 2018 to assess sociodemo-graphic factors, clinical, laboratory, microbiological and radiological findings, as well as therapeutic modalities and their efficacy associated with LA. A total of 95, including five recurrent, cases were included in this study. No statistically significant differences in gender distribution were found. Mean patient’s age was 64.5 ± 15.9. The most common documented risk factors for the development of LA were underlying biliary tract abnormalities (37.9% of cases), and diabetes mellitus (12.7%), while in 21.1% of cases, LA were defined as cryptogenic. Most patients presented with fever (70.5%); right upper abdominal pain was reported in 61.1%, while vomiting and / or nausea — in 25.3% of cases. The most common isolates identified from LA were Klebsiella pneumonia (40.3% of cases), mainly in monomicrobial LA, and Escherichia coli (22.6% of cases), predominantly in polymicrobial LA. Ceftriaxone and metronidazole intravenous formulations were used in 35.5% cases as the principal antimicrobial combination at hospital. Median overall expected duration of antimicrobial treatment was 15 days. LA drainage was performed in 87.4% of cases for the median duration of seven days. In 86.3% of cases both approaches were combined.


Background: Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome can affect the natural course of tuberculosis (TB) and pose diagnostic difficulties and may negatively affect the treatment due to frequent drug interactions in the advanced state of disease. Targeted tuberculin skin testing (TST) for latent tuberculosis infection (LTBI) identifies persons at high risk for TB who would benefit by treatment of LTBI, if detected. Materials and Methods: A prospective observational study conducted at the Department of Pulmonary Medicine and Department of Internal Medicine, MIMSR Medical College, Latur, India from November 2012 to October 2013 included all HIV-positive patients attending the outdoor department. A total of 100 HIV-positive patients subjected to TST were studied. The clinical presentation, CD4 count and tuberculin test result were studied. Chi-square test was applied to know the test of significance. Results: In this study of 100 patients, 48 were male, 52 were female and the male to female ratio was 0.92:1, with majority of the cases in the age group of 31-40 years. The mean age of the patients was 35.89 years. The most common mode of transmission of HIV infection was heterosexual in 93 patients (93%), blood transfusion in four patients (4%) and injections in three patients (3%). Of the 100 patients studied, 56 patients were TST negative (56%), whereas 44 patients were TST positive (44%). Of the 100 patients studied, 48 patients had a CD4 count of <200 cells/mm3; of these 48 patients, 37 patients were TST negative and 11 patients were TST positive. Conclusion: TST reactivity varied directly and that of anergy inversely with absolute CD4 counts. TST should be correlated with CD4 count as indurations to protein purified derivative depend on CD4 count. TST in asymptomatic HIV cases, irrespective of CD4 count, would definitely guide regarding decision of chemoprophylaxis in LTBI. The role of TST in the decision to start chemoprophylaxis in LTBI should be considered cautiously in India, as the prevalence of both HIV and TB is high.


Objective: To evaluate the clinical presentation, possible etiological factors, management and outcome of patients in our hospital with extrahepatic portal vein obstruction (EHPVO). Materials and Methods: This study included patients with EHPVO followed up in our department during last 10 years. Patients of cirrhosis with EHPVO were excluded. Patients’ clinical presentation, etiology of EHPVO, management and outcome results were analyzed. Results: Of 30 patients, 19 (67.9%) were males. Median age was 12 years. Of 14 patients who underwent liver biopsy 9 had histological activity index stage of 1/6. History of omphalitis and pulmonary tuberculosis was present in one case each. Of 22 patients with the available thrombophilia profile, nine patients had a deficiency of protein C, five patients had a deficiency of protein S, one each had reduced level S of anti-thrombin III and factor V mutation. The predominant presenting symptom was hematemesis (15 patients, 53.6%). Seven patients (25%) had splenomegaly. Three patients (10.7%) had no esophageal varices on endoscopy. Three patients underwent splenectomy due to severe pancytopenia. Endoscopic retrograde cholangipancreatography was performed in four patients (14.3%) due to portal biliopathy. Common bile duct stenting was performed in all four patients. Of them, one patient underwent splenorenal shunt operation for indication of hemobilia. One patient died at the age of 40 years, due to cholangitis and sepsis. Conclusions: Results from this study show that the anticoagulant deficiency is a common cause of EHPVO in our setup. Hematemesis is a common presenting symptom. Some of these patients have symptomatic portal biliopathy.