Purpose:To evaluate the resistance or susceptibility of Pseudomonas aeruginosa, the most common pathogen in contact lens keratitis and corneal ulcer, to different antibiotic regimens.Materials and Methods:This cross-sectional study included all patients with recently diagnosed contact lens corneal ulcer whose culture results were positive for P. aeruginosa, from March 2009 to March 2010. The empirical antibiotic therapy was changed to appropriate antibiotics according to the culture results, provided that satisfactory clinical improvement was not achieved with the initial antibiotic regimen. The overall sensitivity or resistance of P. aeruginosa to the most commonly used antibiotics was assessed based on the results of the antibiograms.Results:Fifty-two patients (43 females and 9 males) were included. Forty-five patients (86%) were wearing cosmetic contact lenses, while 7 patients (14%) were using therapeutic contact lenses. Thirty-nine patients (75%) were hospitalized and13 patients (25%) were followed up through an outpatient clinic. Thirty patients (58%) had central ulcers, whereas 22 patients (42%) had peripheral ulcers. Twelve patients (23%) had hypopyon in their first exam. The mean time to diagnose the ulcer after the last time wearing was 2 days (range: 12 hours to 5 days). AMT was required for 10 patients (19%). Based on the antibiograms, PA was shown to be sensitive in 100% of cases to ceftazidime and ciprofloxacin. Amikacin, imipenem, and gentamicin were the second most effective antibiotics.Conclusion:P. aeruginosa was highly sensitive to ceftazidime, ciprofloxacin, and amikacin. All cases were resistant to cefazolin. Resistance to multiple antibiotics might be a significant concern in patients with corneal ulcers. In referral centers dealing with corneal ulcers, the initial antibiotic regimens should be changed from time to time to prevent this phenomenon.
Aim: Residual leg pain makes the outcome in lumbar discectomy unfavorable. The aim of this study was to compare gabapentin with placebo in terms of reduced remaining postoperative leg pain and morphine consumption after single level lumbar laminectomy and discectomy.Methods: We conducted a randomized parallel group, doubleblind, placebo-controlled clinical trial. Two hundred and six patients were randomly assigned into 2 groups. Each group received preanesthesia identical capsules containing gabapentin or placebo. Similar anesthesia protocol was performed. One hundred thirty patients were excluded secondarily and a total of 76 patients with residual, but less degree postoperative leg pain remained in the study. Postoperative visual analog scale and morphine consumption via patient-controlled analgesia pumps were recorded and statistically compared at 6-hour intervals for 24 hours.Results: No statistical significance was found between the 2 groups in terms of reduced postoperative leg pain or morphine consumption (P >0/0.05). No clinical evidence to prove synergism between gabapentin and morphine in discectomy patients was found. Conclusions:The results of this clinical trial failed to show that preemptive gabapentin is more effective than placebo with regard to leg pain reduction and morphine consumption during the acute stage after single level lumbar laminectomey and discectomy. However the possibility remains that multiple dose regimens of gabapentin would be beneficial.
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