Background. Neonatal sepsis remains one of the leading causes of mortality and morbidity in developing countries. With a dearth of data on neonatal sepsis in our country, this study was conducted to determine the incidence of clinical neonatal sepsis and evaluate the clinical, bacteriological, and antimicrobial susceptibility profile of organisms. Material and Methods. A prospective cross-sectional study was conducted in the Neonatal Unit of the National Hospital from 1st January to 31st December 2016. All neonates admitted with suspected clinical sepsis were included. Sepsis screens and cultures were sent under aseptic conditions. Data was analyzed using STATA™ version 12. Clinical features and neonatal and maternal risk factors were analyzed using chi-squared test. Bacteriological profile was analyzed with descriptive statistics. Results. During the study period, incidence of culture positive neonatal sepsis was 19 per 1000 admissions with a blood culture positivity rate of 14%. 54.5% had culture-positive early-onset sepsis (EOS). Prematurity (p=0.012), APGAR<6 (p=0.018), low birth weight (p<0.001), and maternal intrapartum antibiotics (p=0.031) significantly increased risk for culture-positive EOS. Prematurity (p<0.001), low birth weight (p=0.001), and parental nutrition (p=0.007) were significantly associated with increased risk of culture-positive late-onset sepsis. A positive screen had sensitivity of 81.8% and negative predictive value of 87.7%. Gram-negative organisms were most commonly isolated (64.6%). Coagulase-negative Staphylococci (31%) were the commonest isolate followed by Klebsiella pneumoniae (27%) and Acinetobacter (18.8%). Ninety percent of Acinetobacter were carbapenem resistant. Gram-negative sepsis had mortality of 88.9%. Conclusion. Preterm, low birth weight, low APGAR scores, intrapartum antibiotics, and parental nutrition were significantly associated with neonatal sepsis. Coagulase-negative Staphylococci, Klebsiella pneumoniae, and Acinetobacter were the principal causative organisms. Gram-negative organisms had high resistance to commonly used antibiotics.
Introduction: Peripheral neuropathy outbreaks have been a common occurrence amongst boarding schoolchildren from seven districts in Bhutan. Thiamin deficiency has always been suspected to be the cause but the status of the vitamin has never been established. This study aims to find the status of thiamin and dietary intake of micronutrients in boarding schoolchildren from seven districts with previous history of peripheral neuropathy outbreaks. Methods: Whole blood thiamin and dietary intake of micronutrients were assessed in 448 school children for four study periods (SP). Baseline data (SP1) was collected when the school children just joined the school at the start of the school academic year. SP2 was the first half of the school year and the data was collected just before the midterm break. SP3 was the short summer break and SP4 the second half of the school academic year. Results: 50.58% of the school children were found to be thiamin deficient at baseline which increased to 90.1% in SP2. The percentage of thiamin deficient school children increased to 91.8% in SP3 and then decreased to 79.82% in SP4. The requirements for vitamin B1, B12, vitamin A and iron were never met by dietary intakes in all the study periods. Conclusions: In conclusion, this study found a high prevalence of Thiamin deficiency in schoolchildren at baseline and the number of school children with Thiamin deficiency increased when in schools. The school children also had inadequate dietary intake of many micronutrients.
Introduction: Bhutanese school children are vulnerable to vitamin B12 deficiency as outbreaks of micronutrient deficiency diseases have been a common occurrence. The study presents the status of vitamin B12 deficiency among boarding school children from those seven districts. Methods: A cross-sectional study was conducted to determine serum vitamin B12 level. Data and blood samples were collected from 448 boarding school children from the seven districts of Bhutan. Serum cobalamin levels were assessed and relationship between factors analyzed. Results: The study found that 64 % of the school children were found to have vitamin B12 deficiency. Adjusted Odds Ratio for the vitamin deficiency among boarding school children from lower secondary and higher secondary schools were 4.05 and 3.3 respectively, when compared to those from the primary school. Starches were the most commonly served foods in boarding schools, while the animal source foods were served twice or less in a month. Conclusion: The study found a high prevalence of Vitamin B12 deficiency among boarding school children from seven districts. Boarding school meals had very less frequency of animal source foods.
Introduction: The Widal test is widely used in hospitals in Bhutan for diagnosis of typhoid fever. The right test with high sensitivity and specificity supplements clinical judgement and contributes to correct diagnosis of disease. This study focuses on the contribution of the Widal test in the diagnosis of typhoid fever. Methods: Data was collected from records of patients who presented to Damphu hospital from March 2011 to June 2012 with clinical suspicion of typhoid fever. Blood samples were collected from patients and tested at Damphu Hospital, Tsirang and the Royal Centre for Disease Control, Thimphu. Seventy records were used for the study. Results: There was no growth of Salmonella typhi on blood cultures from patients who had tested positive in the Widal test. There were 20 (28.57%) samples which tested positive for scrub typhus; among these Widal test was positive in 10 (50%) samples. Thirty four out of 36 (94.44%) patients had duration of illness less than seven days and among them 26 (74.47%) had positive Widal test results. Conclusion: None of the samples that tested positive by Widal test gave a definite diagnosis of typhoid fever with blood culture. Clinical judgement may be more challenging because patients with other febrile illnesses like Scrub typhus also have positive Widal test result. We conclude that it is best not to rely on the Widal test alone for the diagnosis of typhoid fever and this test should be replaced by more accurate ones.
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