European Journal of Molecular & Clinical Medicine

Background: Many anesthetic pre-medications are used to relieve this stress response. Of these premedications,
midazolam and dexmedetomidine are effectively used as sedatives. The present study was
planned to compare intranasal dexmedetomidine with intranasal midazolam as a pre-anesthetic
medication in children. Many anaesthetic pre-medications are used to relieve this stress response. Of
these pre-medications, midazolam and dexmedetomidine are effectively used as sedatives. The present
study was planned to compare intranasal dexmedetomidine with intranasal midazolam as a pre-anesthetic
medication in children. Fear of unpleasant and painful procedures, separation from parents and
unwillingness to breathe through an anaesthesia face mask may produce stormy anaesthetic induction in
unpremeditated patients. Because of this premedication should be an integral part of paediatric
anaesthetic practice.

Aims: To study the surgical outcome in paediatric patients presenting with spinal dysraphism
in our institution.
Materials and Method: 78 paediatric cases presented between 2014 to 2019 with
myelomeningocele to the neurosurgical OPD in Vijayanagara Institute of Medical Sciences,
Ballari which caters to mainly rural and semi urban population. Initial clinical assessment,
followed by operative work up was done. MRI Brain and spine was done as a prep operative
evaluation. Post-operative outcome was noted and Post-operative regular follow up after
discharge for at least 6 months.
Results: 78 patients were operated upon at our centre. The mean age of presentation of the
cases 5 months +/- 6 days, ranging from 8days to 24months. Post-operative average hospital
stay was 14 days. The mean post-operative follow up period was 36 months. Hydrocephalus
was associated with meningomyelocele in 30 cases, but VP shunting required in same sitting
in 9 cases only. Six patients found to have CSF leak and only 1 required reexploration and
Dural repair.
Conclusion: The clinical profile of patients presenting to us mirror the General profile across
India. Surgical outcomes at our center are on par with the standard results seen across the
country. Early and prompt surgical intervention is the key in management of spinal
dysraphism. The MOMS study comparing surgical outcomes with pre natal surgery shows
equivalent outcomes with post natal surgery

Background: The broad spectrum ß-lactam antibiotics are commonly used empirically for the treatment of gram negative sepsis. But the emergence of ESBL producing organisms has posed a serious threat for their continuing use. Present study was undertaken to find out the magnitude of the problem of infections due to extended spectrum β-lactamase producing organisms.
Material and Methods: Present study was a descriptive & observational study, conducted in patients < 18 years age, all cultures showing a significant growth of ESBL producing organisms from any of the clinical specimens, as per CLSI guidelines.
Results: Infections by ESBL producing organisms were found more common in 13-18 years of age group (36.25%) & males (71.25%). K. pneumoniae has been found to be the most commonly isolated ESBL producing organism (56.25%) followed by E. coli (38.75%). ESBL producing organisms were most commonly grown in urine samples (51.25%) followed by pus culture (11.25%) and blood (10%). All were sensitive to tigecycline and colistin (100%). In the carbapenem group, sensitivity to imipenem was highest (93.75%) followed by ertapenem (66.25%), doripenem (65%) and meropenem (53.75%). Among the 45 isolates of ESBL K. pneumoniae, all were sensitive to tigecycline and colistin. Sensitivity to imipenem is 93.33% while that to meropenem, doripenem and ertapenem were 46.66%, 62.22% and 64.44% respectively. Out of the 31 isolates of ESBL producing E. coli, all were sensitive to tigecycline and colistin. Sensitivity to Imipenem was 96.77% while that to meropenem, doripenem and ertapenem were 64.71%, 70.96% and 70.96% respectively. Sensitivity to meropenem has gone down dramatically from 71.42% to 22.22%, which is significant.
Conclusion: A growing resistance in the ESBL producing organisms is noted which is very alarming. A limited number of drugs are available against these ESBL producing organisms and the drug of choice is carbapenem.