School based mass de-worming initiative in south-west Nigeria

Background: The public health implications of helmintic infection in developing countries were generally agreed by many researchers to include poor growth and poor school performance among others. But the role of school based mass de-worming in combating the menace of helminthiasis remains controversial. Several studies have assessed the impacts of mass de-worming with conflicting results. This study was designed to evaluate the impact of antihelminthic mass chemotherapy on changes in growth indices and school absenteeism.Materials and methods: Albendazole tablets were administered by school teachers to pupils after data and stool sample collection. Follow up data were collected 6 months later for impact assessment. Ponderal growth retardation was defined as BMI under 5-percentile.Results: Overall helminth infection rate was 373/1442 (39%) of the pupils before the intervention. Ascaris lumbricoides (n=247; 25.8%) and hookworm (n=89; 9.3%) were the most common. At enrolment 19.6% of children with and 11.8% without helminth infections had BMI below the 5-percentile. These figures were reduced to 9.2% and 8.8% after de-worming respectively. No effect of de-worming was seen on longitudinal growth. The number of helminth infected children with >25% absenteeism reduced by 12.5%, while the reduction rate was 6.8% in the uninfected group.Discussion: The difference in response to de-worming between infected and uninfected children strongly support the beneficial effect of de-worming on growth and school absenteeism. The intervention could be administered by school teachers without formal healthcare training, thus allowing integration of the programme into existing structures.Keywords: Helminthes, Absenteeism, Preventive Chemotherap

Hookworm presenting as acute febrile illness and surgical abdomen

Hookworm is estimated to infect about 500 million people worldwide. It is usually associated with diarrhoea, abdominal pain and iron deficiency anaemia, but diagnosis can be missed because it sometimes presents unusually or mimics other diseases. We present in this report the case of an 18-year-old asthmatic medical student who was referred to a general surgeon on account of abdominal pain of 8 days duration. His problem started initially with fever, chills and rigor which was managed as malaria but no improvement. The diagnosis shifted from enteric fever to peptic ulcer disease, and his worsening condition was later reviewed as acute abdomen. Abdominal X-ray and ultrasound were normal. Stool microscopy showed numerous ova of hookworm. He was then treated with albendazole leading to full recovery on subsequent follow up. Hookworm disease can mimic a lot of other clinical conditions. A careful review of literature is a reminder that the clinical presentation of hookworm can be diverse and misleading. The current report emphasizes the fact that hookworm should always be considered a possible differential in endemic regions when clinicians are confronted with acute non-malaria febrile illnesses or cases of acute surgical abdomen. Keywords: acute abdomen, fever, hookworm

Evaluation of procalcitonin as a biomarker of bacterial sepsis in adult population in a tertiary healthcare facility in Lagos, Nigeria

Background: Prompt antibiotic treatment of sepsis improves the outcome, but dependence on clinical diagnosis for empiric therapy leads to overuse of antibiotics which in turn promotes the emergence of antibiotic resistance. Blood culture takes time and molecular diagnosis may not be available or affordable. The use of procalcitonin (PCT) as a biomarker to guide antibiotic therapy in adults is less established compared to children. This study was therefore designed to evaluate the usefulness of PCT as a biomarker to aid early commencement of antibiotics among adult patients with sepsis in a tertiary healthcare facility in Lagos, Nigeria. Methodology: Three hundred patients with clinical diagnosis of sepsis made by the managing physicians were recruited for the study. Criteria used for clinical diagnosis of sepsis include tachycardia, tachypnea, fever or hypothermia and presence of leukocytosis, bandemia or leucopenia. The patients were selected using systematic consecutive sampling methods. A sepsis work-up including quick sequential organ failure assessment (qSOFA), white blood cell count (WCC), aerobic blood culture and estimation of serum PCT levels were done for all the participants. Data were analysed using the Statistical Package for Social Sciences (SPSS) for windows version 25.0. Sensitivity, specificity, positive, and negative predictive values, accuracy and likelihood ratio of PCT against blood culture, WCC and qSOFA score were determined. Association between variables was measured using Fisher exact test (with Odds ratio and 95% confidence interval). P-value ˂0.05 was considered statistically significant. Results: There were 127 (42.3%) males and 173 (53.7%) females with the mean age of 44.9±14.5 years. Majority (96.2%, n=75/78) of the patients who were culture positive for bacterial pathogens had PCT level ≥10ng/ml, which showed statistically significant association of bacteraemia with PCT level (OR=1362.5, 95% CI=297.9-6230.5, p˂0.0001). At PCT cut-off value of 0.5ng/ml, the negative predictive value of 100% almost confirms absence of systemic bacterial infection. The high sensitivity, specificity, positive predictive value, negative predictive value,accuracy and likelihood ratio of 94.9%, 98.6%, 96.2%, 98.2%, 97.7%, and 69.9 respectively recorded at PCT level of 10ng/ml indicates that this cut-off level is strongly diagnostic of systemic bacterial infection. Conclusion: In this study, we observed that PCT levels were significantly higher in patients with positive culture (bacteraemia) and PCT was able to differentiate bacterial sepsis from non-bacterial infections. The findings of this study support the usefulness of PCT as a biomarker for early diagnosis of systemic bacterial infections in adult patients.   French title: Évaluation de la procalcitonine en tant que biomarqueur de la septicémie bactérienne chez la population adulte dans un établissement de soins de santé tertiaires à Lagos, au Nigeria Contexte: Un traitement antibiotique rapide de la septicémie améliore les résultats, mais la dépendance au diagnostic clinique pour le traitement empirique conduit à une surutilisation des antibiotiques qui à son tour favorise l'émergence de la résistance aux antibiotiques. L'hémoculture prend du temps et le diagnostic moléculaire peut ne pas être disponible ou abordable. L'utilisation de la procalcitonine (PCT) comme biomarqueur pour guider l'antibiothérapie chez l'adulte est moins établie que chez l'enfant. Cette étude a donc été conçue pour évaluer l'utilité de la PCT en tant que biomarqueur pour faciliter le début précoce des antibiotiques chez les patients adultes atteints de septicémie dans un établissement de soins de santé tertiaire à Lagos, au Nigeria. Méthodologie: Trois cents patients avec un diagnostic clinique de septicémie posé par les médecins traitants ont été recrutés pour l'étude. Les critères utilisés pour le diagnostic clinique du sepsis comprennent la tachycardie, la tachypnée, la fièvre ou l'hypothermie et la présence d'une leucocytose, d'une bandémie ou d'une leucopénie. Les patients ont été sélectionnés à l'aide de méthodes d'échantillonnage consécutifs systématiques. Un bilan de septicémie comprenant une évaluation séquentielle rapide des défaillances d'organes (qSOFA), une numération des globules blancs (WCC), une hémoculture aérobie et une estimation des taux sériques de PCT a été effectué pour tous les participants. Les données ont été analysées à l'aide du package statistique pour les sciences sociales (SPSS) pour Windows version 25.0. La sensibilité, la spécificité, les valeurs prédictives positives et négatives, la précision et le rapport de vraisemblance de la PCT par rapport à l'hémoculture, le WCC et le score qSOFA ont été déterminés. L'association entre les variables a été mesurée à l'aide du test exact de Fisher (avec rapport de cotes et intervalle de confiance à 95 %). La valeur P ˂0,05 a été considérée comme statistiquement significative. Résultats: Il y avait 127 (42,3%) hommes et 173 (53,7%) femmes avec un âge moyen de 44,9±14,5 ans. La majorité (96,2%, n=75/78) des patients dont la culture était positive pour les agents pathogènes bactériens avaient un taux de PCT ≥ 10ng/ml, ce qui a montré une association statistiquement significative de la bactériémie avec le taux de PCT (OR=1 362,5, IC à 95%=297,9-6230.5, p˂0.0001). À la valeur seuil PCT de 0,5ng/ml, la valeur prédictive négative de 100% confirme presque l'absence d'infection bactérienne systémique. La sensibilité élevée, la spécificité, la valeur prédictive positive, la valeur prédictive négative, l'exactitude et le rapport de vraisemblance de 94,9%, 98,6%, 96,2%, 98,2%, 97,7% et 69,9 respectivement enregistrés au niveau PCT de 10 ng/ml indiquent que cette réduction- hors niveau est fortement le diagnostic d'une infection bactérienne systémique. Conclusion: Dans cette étude, nous avons observé que les taux de PCT étaient significativement plus élevés chez les patients ayant une culture positive (bactériémie) et que la PCT était capable de différencier la septicémie bactérienne des infections non bactériennes. Les résultats de cette étude confirment l'utilité de la PCT en tant que biomarqueur pour le diagnostic précoce des infections bactériennes systémiques chez les patients adultes

Malaria rapid diagnostic test positivity rate among febrile patients seen at the Paediatric emergency unit of a tertiary care facility

Background: Malaria, a life-threatening parasitic disease transmitted to humans by the female Anopheles mosquito is one of the infectious causes of fever in children. In Nigeria, malaria remains one of the most important health problems, accounting for 25% of infants and 30% of under-five mortalities. The objective of this study was to determine the prevalence of malaria among febrile children presenting at the children's emergency room (CHER) of a tertiary health facility in Abakaliki using a malaria rapid diagnostic test (mRDT). Methodology: This was a retrospective study that involved children presenting with fever in CHER over a 3-year period. A total of 1,273 febrile children below 18 years of age were tested with a malaria rapid diagnostic test (mRDT) kit during this period. Medical records of the patients were assessed to retrieve information such as age, gender, and clinical diagnoses. Data were analyzed using SPSS version 25. Results: A total of 707 (55.5%) were males and 883 (69.4%) were below 5 years of age. The overall prevalence of malaria by the mRDT test was 26% (n=331). Uncomplicated malaria, 283 (22.2%) was the commonest clinical diagnosis made while the least was malnutrition 3 (0.2%). Children aged 10-<18 years were predominantly affected as mRDT positivity rate was significantly higher in children age group 10-<18 years (40.4% 76/189) than other age groups (X2=44.76, p<0.001). Similarly, the rate was significantly higher (OR 9.625, 95% CI 7.233-12.808, p<0.0001) in children with the clinical diagnosis of malaria (55.2%, 235/426) than those with the clinical diagnosis of other illnesses (11.3%, 96/847), and significantly higher (OR 0.19, 95% CI 0.1186-0.3043, p<0.0001) among those clinically diagnosed with complicated (79.7%, 114/143) than those with uncomplicated malaria (42.8%, 121/283). Conclusion: There is a high prevalence of malaria among febrile children presenting at the CHER of Alex Ekwueme Federal University Teaching Hospital Abakaliki. Children age group 10-<18 years were predominantly affected. The use of mRDT should be encouraged both as a screening and diagnostic tool with a protocol such that febrile children who have positive results are confirmed as having malaria while those with negative results are further evaluated with microscopy

Correlation of candida carriage, nugent score and outcome in pregnant women in a Nigerian Teaching Hospital

No AbstractKeywords: Candida, Nugent score, pregnant wome

Histopathological study of soft tissue malignancies in a teaching hospital, Sagamu, South-West Nigeria.

No Abstract

Vasoformative Neoplasms in a Teaching Hospital, Sagamu, Ogun State: A Histopathological Review.

Objective: To determine the pattern of occurrence and histopathologic characteristics of vasoformative tumours in Sagamu, South- West Nigeria, over a period of four years. Design: A cross-sectional retrospective study from January 2003 to December 2006. Setting: Department of Morbid Anatomy & Histopathology of Olabisi Onabanjo University Teaching Hospital, Sagamu with efficient laboratory services. Methods: All the pathological reports and slides of submitted vasoformative tumour biopsies were retrieved and reviewed. The relevant clinical information from the case notes, histopathology registers and reports included biodata of the patients, site of the lesions, and histological types were retrieved and analyzed. Results: Vasoformative tumours constituted 1.4% of all surgical biopsies and 37.7 % of all soft tissue tumours. Among the vasoformative tumours, 90.0% were benign and 20.0% malignant tumours. The male to female sex distribution was 0.8:1 for benign tumours with slight female preponderance whilst male preponderance existed in malignant vasoformative tumours. The age of patient ranged from 11days to 60years with peak age incidence in the age group 0-10 years. The mean ages for benign and malignant neoplasms were 18.0 years and 41.5 years respectively. Haemangiomas were the predominating benign vasoformative tumours (94.4%), of which the majority is capillary haemangioma. Angiofibroma was also seen in 5.5 % cases and located in the nasopharynx. Malignant vasoformative tumours accounted for 20.0% of vasoformative tumours, of which all were angiosarcomas. However, there was no case of Kaposi , sarcoma. Head and neck region are the most vulnerable anatomic sites for both benign and malignant vasoformative tumours in 70.0% and 50.0% cases respectively. No multicentric tumours were found in this series. Conclusion: Vasoformative tumours were common soft tissue tumours of childhood in Sagamu, South –West Nigeria. Haemangiomas were the most common vasoformative tumours and they share similar characteristics with those seen elsewhere. Also, there seems to be no relationship between malignant vascular tumours and AIDS infection but further future investigations will unravel this misery.KEY WORDS: Histopathological review, Haemangioma, Angiosarcoma