A study of culture positive multidrug resistant enteric fever--changing pattern and emerging resistance to ciprofloxacin

The present prospective study was carried out to observe the changing trends in the clinical pattern and multidrug resistance in typhoid fever. Fever was the main presenting feature. Other associated features were headache, vomiting, diarrhoea, altered sensorium and jaundice. Out of 78 patients, one patient died due to enteric encephalopathy and other due to septicaemia with peripheral circulatory failure. 12 patients responded to chloramphenicol and gentamycin. 51 patients responded to ciprofloxacin, while remaining 9 patients responded to combination of cefotaxime and amikacin. Three patients showed in vitro resistance to ciprofloxacin and two out of these also showed no response in vivo. This study re-emphasises the changing pattern, prolonged course and role of quinolones especially ciprofloxacin in the management of drug resistant typhoid fever, but at the same time indicates that ciprofloxacin is not the drug of choice in all cases of typhoid fever and resistance to it may be seen in some cases, where other drugs have to be used.

Comparison of Siriraj and Guy's Hospital score to differentiate supratentorial ischaemic and haemorrhagic strokes in the Indian population

In India, 70% of the population does not have access to computerised brain scanning. Siriraj score is a safe and reliable clinical method to asses acute stroke syndrome. 160 patients with acute stroke were analysed by Siriraj and Guy's hospital stroke score simultaneously. CT Scan was performed in all and subarachnoid haemorrhage was excluded. Ninety two patients (57.5%) had infarction and 68 (42.5%) had haemorrhage. Siriraj score formula revealed haemorrhage in 53 (80%) and infarction in 78 (83%), while in the rest the results were equivocal or incorrect. Guy's hospital score revealed haemorrhage in 45 (66%) and infarction in 59 (69%). Clinical features are also helpful in differentiating infarction from haemorrhage, but the accuracy is not as high as with Siriraj score and secondly Siriraj score is a very simple formula in comparison to Guy's score.