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Background. The routine use of empiric antibiotics in neonates born to mothers with prolonged rupture of membranes (PROM) iscontroversial.Objectives. To determine the incidence of probable and proven sepsis in such neonates and identify risk factors for sepsis and theiroutcomes.Methods. This was a retrospective chart review conducted at King Edward VIII Hospital over two years. Study participants included 200neonates and 181 mothers. Data were captured onto Microsoft Excel, collated and analysed using descriptive statistics and comparative data utilising the R Core Team’s R Statistical Computing Software, 2020.Results. Seven neonates (3.5%) had proven sepsis, 58 (29%) had probable sepsis, and 135 (67.5%) were without sepsis. Two (1.0%) neonates died and 188 (94.0%) received antibiotics. White cell count was normal in all cases without sepsis and abnormal in 65.5% and 28.6% of cases with probable and proven sepsis, respectively. A raised C-reactive protein was observed in only 22.4% and 14.3% of neonates with probable and proven sepsis, respectively. One hundred and sixty-seven (83.5%) mothers had no Group B Streptococcus (GBS) screening. Of those screened, three had GBS infection, but two did not receive antibiotics.Conclusions. The incidence of sepsis following PROM is low. Identifying neonates at risk is challenging, but the absence of clinical features and normal rapidly obtained supportive laboratory markers of sepsis provides reassurance that antibiotics could be temporarily withheld. Better GBS screening programmes and appropriate antibiotic responses for pregnant women should be implemented rigorously.

Tugaksheeri is an important drug that has been widely used in the preparation of various ayurvedic formulations. The plant is botanically identified as Maranta arundinaceaLinn. of marantaceae family and has a nutrient dense starchy rhizome which has very low glycemic index, easy to digest and ideal for meeting the nutritional demands of sick. As per Samhithasand nighantusit is used in the treatment of kshaya(tuberculosis), swasa(dyspnoea), kasa(cough), daha(burning sensation), raktha dosha(disorders of blood), kamala(jaundice), pandu (anaemia)and mutrakruchra(dysuria). In folklore practices it is widely used in the treatment of diarrhea, dysentery and colitis. In order to validate these traditional claims scientifically and also to determine the quality and purity preliminary phytochemical evaluation of the drug was carried out. It revealed the presence of variable phytoconstituents suchas alkaloids, phenol, flavonoids, steroid, carbohydrate etc which are responsible for the therapeutic potential of the drug. Values of total ash, acid insoluble ash, moisture content, alcohol and water-soluble extractives were comparable with the available references. Apart from the findings of previous research works, in the present study water insoluble ash value, quantitative estimation of fibre, tannin, total sugar, reducing sugar, qualitative analysis of ash for acid and basic radicals, successive solvent extraction in various solvents like petroleum ether, cyclohexane, acetone and alcohol, qualitative analysis of successive solvent extractives were carried out for the first time. All these findings will help to ensure the quality and purity of the drug.

Nocardiosis is a rare opportunistic bacterial infection. We describe an 8-year-old immunocompetent patient who presented with constitutional symptoms suggestive of probable tuberculosis (TB) in whom we confirmed a diagnosis of nocardiosis. Nocardia is a Gram-positive bacterium that is ubiquitous in soil and decaying vegetable matter. N. asteroides is the most common species. Despite the traditional description of nocardiosis as an opportunistic infection, case reports and case series of pulmonary nocardiosis have recently been reported in immunocompetent patients. Three clinical presentations of nocardiosis have been described; acute, subacute and chronic suppurative infections with episodes of exacerbations and remissions. We describe the presentation, diagnosis, management and prognosis of a rare case of disseminated nocardiosis managed initially as disseminated TB with no improvement.

International multicentric study at nine tertiary care centres.The World Health Organization (WHO) currently does not recommend chest radiographs (CXRs) for routine management of pneumonia. We evaluated the use of CXR for the prediction of treatment failure in children with severe pneumonia.We used WHO vaccine trials radiographic assessment, clinical and nasopharyngeal microbiological data from 1121 3-59-month-old children recruited using the WHO definition of severe pneumonia in the Amoxicillin Penicillin Pneumonia International Study (APPIS). Using Poisson regression, we estimated the relative risk of developing clinical treatment failure and predictive preventive benefit of the CXR and examined the concordance of the CXR findings with the nasopharyngeal microbiological data.A CXR with 'significant pathology' (defined by the WHO algorithm as end-point consolidation, pleural fluid and other infiltrates) was associated with a high risk of treatment failure, especially in children who received penicillin as compared to oral amoxicillin. Significant pathology was also associated with nasopharyngeal isolation of penicillin-resistant Streptococcus pneumoniae. Children with a normal CXR had a reduced risk of clinical treatment failure.CXR with significant pathology independently and additively predicts clinical treatment failure. If CXR and the WHO tool are available, they can be used in the management of severe pneumonia.

OBJECTIVE: Ventilator-associated pneumonia (VAP) has been poorly studied in South Africa, but is likely to be a significant problem, with resulting increased morbidity and mortality in the paediatric intensive care unit population. This guideline is intended to review the evidence and recommendations for prevention and management of VAP in children and to provide, where possible, clear advice to aid the care of these children, to limit costly and unnecessary therapies and - importantly - limit inappropriate use of antimicrobial agents. EVIDENCE: The Working Group was constituted. Literature on the aetiology, prevention and management of paediatric VAP is reviewed. RECOMMENDATIONS: Evidence-based clinical practice guidelines are provided for VAP diagnosis and prevention in South Africa. In addition, the current status of antimicrobial use has been reviewed and clear recommendations are set out.