The present study was undertaken to compare the changing trends of antibiograms of Salmonella enterica serovar Typhi and Salmonella enterica serovar Paratyphi A isolates. A total of 80 isolates of salmonella obtained from blood cultures between 2001-2004 were included in the study. Identification and antibiotic sensitivities of the isolates were performed by using mini API (bio Merieux, France). Sixty isolates were identified as Salmonella enterica serovar Typhi and 20 were identified as Salmonella enterica serovar Paratyphi A. More than 67% of S.typhi and 80% of S.paratyphi A isolates were sensitive to chloramphenicol. Sensitivity of S.typhi isolates to cephalosporins was found to have increased from [2001][2002][2003][2004] while that of S.paratyphi A showed a decline. With increasing resistance to ciprofloxacin and the possibility of re-emergence of sensitivity to chloramphenicol, the policy of empirical treatment of enteric fever needs to be rationalized.

Abstract. Antimicrobial resistance (AMR) is a global public health threat. There is limited information from Rwanda on AMR trends. This longitudinal study aimed to describe temporal trends of antibiotic susceptibility among common bacteria. We collated the antimicrobial susceptibility results of bacteria cultured from clinical specimens collected from inpatients and outpatients and submitted to the microbiology laboratory at King Faisal Hospital, Kigali, Rwanda, from January 1, 2009, to December 31, 2013. Differences in antimicrobial susceptibility between the first and fifth year of the study for each bacterial species was assessed using χ 2 test. Of 5,296 isolates collected, 46.7% were Escherichia coli, 18.4% were Klebsiella spp., 5.9% were Acinetobacter spp., 7.1% were Pseudomonas spp., 11.7% were Staphylococcus aureus, and 10.3% were Enterococcus spp. Colistin and imipenem had greatest activity against gramnegative bacteria. Acinetobacter spp. showed the greatest resistance profile to antimicrobials tested, relative to other gram-negative bacteria. Vancomycin retained excellent activity against S. aureus and Enterococcus species (average susceptibility was 100% and 99.4%, respectively). Trend analysis determined that resistance to imipenem increased significantly among Klebsiella, E. coli, Pseudomonas, and Acinetobacter isolates; there was also rising resistance to colistin among E. coli and Pseudomonas species. Only E. coli demonstrated increased resistance to gentamicin. For gram-positive pathogens, vancomycin susceptibility increased over time for Enterococcus species, but was unchanged for S. aureus. Our data suggest that resistance to imipenem and colistin are rising among gram-negative bacteria in Rwanda. Proper infection control practices and antimicrobial stewardship will be important to address this emerging threat.

Background:The public health impact of parasitic infection has been consistently underestimated in the past, but there is now a general consensus that diseases caused by intestinal parasites represent an important public health problem, especially children. Recent studies suggest that even moderate intensity of infection may have adverse effects on growth, iron deficiency anemia and cognitive function, practically for children of school age. Objective: Aim of the present study was to determine the intestinal parasitic infection in school going children. Materials and Methods:The stool samples were collected from different municipal school in and around Amalapuram according to the standard procedures between June 2006 to August 2006. All the stool samples were examined by the direct microscopic examination and by the formalin-ether concentration methods. Analysis of the data was carried out by using Epi info software. Results: A total 208 stool specimen were collected. The mean age group was 8.8 ± 2.11. 133 (63.9%) were infected with one or more intestinal parasites. 95 (71.4%) of the students were infected with single parasite, 38 (28.6%) with two or more parasites. The most common was Entamoeba histolytica (E.histolytica) with 41 (30.8%) single and 26 (19.54%) with multiple infections. The second most common was Giardia intestinalis (G.intestinalis) with 25 (18.8%) single and 25 (18.8%) with multiple infections. The third one was Entamoeba coli (E.coli) with 15 (11.3%) single and 17 (12.78%) with multiple infections. E.histolytica and G.intestinalis were the most commonly found parasite in multiple infections. 1.5% of Ascaris lumbricoides, 5.3% Hookworm, 0.8% Enterobius vermicularis and 0.8% of Trichuris trichuria were found in the stool sample. Conclusions: Intestinal parasitic infection is an important public health problem in Andhra Pradesh, India. Rural residence, mother education less than primary school and no hand wash with soap after toilets were the significant risk factors. Interventions including health education on personal hygiene, appropriate water management like boiling and use of latrines to the school children and to the parents.The public health impact of parasitic infection has been consistently underestimated in the past, but there is now a general consensus that diseases caused by intestinal parasites represent an important public health problem, especially children. Recent studies suggest that even moderate intensity of infection may have adverse effects on growth, iron deficiency anemia and cognitive function, practically for children of school age.

Background: No dose-finding trials are available for rituximab that could guide dosing in non-malignant diseases. We hypothesized that currently used doses (≥ 375mg/m 2) exceed several hundred-fold the half-maximal effective dose, which is most sensitive for detecting putative differences between biosimilars and important for dosefinding. Methods: In an exploratory, dose-finding, trial healthy volunteers received single infusions of 0.1 (n= 4), 0.3 (n= 4) and 1 mg/m 2 (n= 8) rituximab. Subsequently, in a randomized, double-blind trial, healthy volunteers received single infusions of 0.1 (n= 24) or 0.3 mg/ m 2 (n= 12) of two rituximab products. CD19/20+ cell counts were measured, pharmacokinetics and, immunogenicity were assessed. Results: Single infusions of 0.1, 0.3 and 1 mg/m 2 rituximab transiently depleted CD20+ cells by a mean 68% (95%CI: 24-100%), 74% (95%CI: 59-84%) and 97% (95%CI: 95-99%), respectively. In the randomized trial infusion of 0.1mg/m 2 or 0.3mg/m 2 proposed biosimilar or reference rituximab decreased CD20+cells by 45% (95%CI: 32-58%)-55% (95%CI: 45-66%) and 81 (95%CI: 73-87%)-87% (95%CI: 74-100%), respectively. In the randomized trial, 26 of 36 patients developed human anti-chimeric antibodies and 9 of 36 patients developed neutralizing anti-drug antibodies. Pharmacokinetic analyses were limited by the assay sensitivity and the very low rituximab doses. However, there was a clear pharmacokinetic signal during the first 24 hours in the 1mg/m 2 group. Conclusions: It is important to understand that < 1% of the authorized rituximab doses depletes all circulating B lymphocytes in healthy volunteers. This will help particularly countries struggling to meet the financial burden of therapy with biologics.

This case illustrates the fact that cholecystectomy with bile spillage is a definite risk factor for SSI. Although controversial, isolation of the pathogen from the bile and the surgical site must be made to allow this rare pathogen to be identified. Appropriate antibiotic could then be directed against the pathogen.