Typhoid fever in children: Clinical presentation and risk factors

Objective: The diagnosis of typhoid fever based on widal test is on the rise despite its set back. We prospectively reviewed over one year period, cases of typhoid fever admitted in our centre to document the pattern of clinical presentation, risk factors and the reliability of Widal test in its diagnosis.Methods: This was a prospective study carried out in a NigerianTeaching Hospital. All children, whose parents consented, admittedwith a diagnosis of typhoid fever using the Centre for Disease Controland prevention (CDC) case definition for typhoid fever, between 1stJanuary and 31st December 2010, were consecutively reviewed using astructured questionnaire.Results: A total of 42 patients were admitted out of which 35 were analysed, the remaining 7 were excluded because consent was notobtained. The disease was more common in males than females withM: F ratio of 3:2. The study gives the incidence of suspected typhoidof 30.5 per 1000 admission. The age range of the study population was 6months to 15 years with cases being common among the age group fiveto nine years 13(37.1%). It has a bimodal peak of occurrence as itoccurs commonly in April/May and in August/September. The diseasewas common in the low socioeconomic classes. All the 35 patientshad fever (100%), vomiting 25 (71.4%), typhoid psychosis 3 (8.6%) and 4 (11.4%) had intestinal perforation. Culture was positive in 8 (22.9%) of the patients. Widal test were significant in 20 (57.1%) with a sensitivity of 62.5%, specificity 44.4%, positive predictive value 25%, negative predictive value 80% and the efficiency of the test was 48.6%.Conclusion: The incidence of typhoid fever in this study is 30.5 per 1000 admission, it is common during rainy and harmattan period. The use of Widal test is not too helpful in diagnosis of typhoid fever. Therefore, culture samples should be done in all cases of suspected typhoid fever

Caecal duplication in a neonate causing intestinal obstruction

Intestinal duplication is one of the rare congenital abnormalitiesencountered. Duplications found on the small intestine aremore commonly encountered in clinical practice than the large intestineand majority of these occurs in the ileum. We present a three-weekold neonate with features of intestinal obstruction a presumptive diagnosisof intususception with presumed sepsis was made. Intraoperative findings revealed caecal duplication causing the intestinal obstruction. Limited excisionand ileo-ascending colic anastomosis was carried out. Patient respondedwell and was discharged on follow-up

The Influence of Gestational Age on the Loss of Maternal Measles Antibodies in Newborn Infants in North-Eastern Nigeria: A Call for a Review of Measles Immunization Schedule

Background: Maternal measles antibodies (MMA) are actively transferred in mother-infant pairs during third trimester of pregnancy. Gestational age (GA) affects the levels of MMA such that longer GA may result in infants starting out with high levels of MMA.Objective: To determine the influence of GA on the loss of MMA in newborn infants in North-Eastern Nigeria.Method: A prospective study was conducted on newborn infants at Maiduguri; sera were collected at birth and at six months of age. Enzyme linked immunosorbent assay (ELISA) was used to measure MMA while GA was determined using the last menstrual period, ultrasound scan reports and the Dubowitz criteria.Results: Seventy eight newborn infants were enrolled. Seventeen (89.5 %) preterm, 43 (95.6 %) term and 14 (100 %) postterm had protective levels of MMA at birth. Two (10.5 %) preterm, nine (20.0%) term and two (14.3 %) postterm had protective MMA at six months of age. Comparison of mean MMA at birth and at six months of age was significant (p = 0.005), however, it was independent of GA of the newborn infants.Conclusion: Significant decline of mean MMA levels was seen in these infants at six months of age, which was independent of their GA. These infants may be prone to measles at an earlier age (less than six months). Therefore, the current recommendation of measles immunization to infants at nine months of age may require reconsideration

Dexamethasone reduces acrosin activity of ram spermatozoa

The aim of this study was to investigate the effect of dexamethasone on acrosin activity of spermatozoa in Chios rams during autumn (breeding season for sheep in Greece), in correlation with possible changes in blood testosterone. Dexamethasone was administered in four equal consecutive intramuscular injections, one every four hours (total dose: 3 mg kg(-1)). Total acrosin activity was determined in semen samples collected 48 before and on the 4th and 7th day and thereafter once every week until the 77th day after dexamethasone administration. Blood samples for testosterone radio-immunoassays were collected 24 h before, during dexamethasone administration and on the 4th, 7th 14th and 21st day after administration. Total acrosin activity in spermatozoa was reduced between days 7-28 after dexamethasone administration. Dexamethasone also induced a reduction in mean value and basal level of blood testosterone and inhibited its episodic secretion between 1 and 4 days after administration. As the reduction of acrosin activity appeared relatively soon after dexamethasone administration (7th day), it is likely that the increased amount of dexamethasone did not influence tire synthesis of proacrosin in the late spermatids. As glucocorticoid receptors exist in the epididymis and accessory glands in various species, dexamethasone may have a direct influence on the synthesis and/or release of acrosin inhibitors in epididymal fluid or seminal plasma. These changes in acrosin activity in ovine spermatozoa mediated by dexamethasone may be of importance regarding the role of stress in the reduction of sperm fertilizing ability