Bacterial profile and antimicrobial susceptibility pattern of neonatal sepsis in Felege-Hiwot Referral Hospital, Bahir Dar, northwest Ethiopia: A cross-sectional study design

AbstractBackground: Neonatal sepsis is a life-threatening medical condition that occurs when host and pathogen interaction leads to organ/tissue damage. Determining the bacterial profile and the antimicrobial susceptibility pattern, and associated factors, in certain geographic regions is vital for rapid empirical medical decisions.Objective: To assess the bacterial profile, antimicrobial susceptibility pattern, and factors associated with neonatal sepsis, in Felege-Hiwot Referral Hospital, Ethiopia.Methods: A facility-based cross-sectional study was conducted from April 2018 to July 2018. A total of 412 neonates were included in the study. Socio-demographic and clinical data were collected using a structured and pre-tested questionnaire. About 2ml of blood sample was withdrawn from each participant, and processed for bacterial identification and susceptibility testing, following 2017 Clinical and Laboratory Standards Institute guidelines. Data were analysed using Statistical Package for the Social Sciences version 23. Logistic regressions were used to determine the association between independent variables and dependent variables in relation to bacterial profiles and antimicrobial susceptibility patterns. Odds ratios, and their 95% confidence intervals, were calculated, and the results were considered statistically significant at a p-value less than 0.05.Results: Of the 412 neonates who were enrolled, 41.3% (170/412) were positive for blood culture. Klebsiella pneumoniae, 28.2% (48/170) was the predominant isolate, followed by Staphylococcus aureus, 24.7% (42/170). The majority of the isolates developed resistance to ampicillin and penicillin. The overall proportion of multidrug resistance was 78.2% (133/170). Preterm (<37 weeks) [AOR = 2.049; 95% CI: 1.151, 3.647], low birth weight (<2,500gm) [AOR = 2.357; 95% CI: 1.352, 4.109], prolonged rupture of membrane (≥18 hours) [AOR = 4.282; 95% CIL: 1.615, 11.354], and caesarean section modes of delivery [AOR = 2.826; 95% CI: 1.618, 4.936] showed statistical association with bacteriologically confirmed neonatal sepsis.Conclusions: The majority (78.2%) of presumptive neonatal sepsis cases tested positive for blood culture. Klebsiella pneumoniae and Staphylococcus aureus were the leading isolates recovered from neonatal sepsis cases. Most of the bacterial isolates from NS cases were resistant to multiple classes of antibiotic. Auspiciously, majority of these isolates were susceptible to ciprofloxacin; as such this replication inhibitor antibiotic could be a choice of physicians for empirical treatment decision. Since it is a single facility based study, further study is recommended. [Ethiop. J. Health Dev. 2021; 35(1):18-28]Key words: Bacteria; neonate; early-onset neonatal sepsis; late-onset neonatal sepsi

High resolution ultrasonography of thyroid nodules: can ultrasonographic assessment obviate the need for invasive aspiration cytology in ultrasonographically benign lesions?

The use of high-resolution ultrasound (HRUS) thyroid imaging has resulted in a significant revolution in the treatment of thyroid nodules. The enigma of thyroid nodules has been a blind spot for radiologists for a long period. Reporting a thyroid nodule as benign or malignant is quite difficult and many times not accurate. The American Collage of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS) 2017 classification has solved this problem to a large extent. However, the classification needed pathological confirmation for it to be highly accurate. We compared our HRUS-based TIRADS labeling of thyroid nodules with thyroid cytopathology using revised Bethesda classification system. Patients detected with thyroid nodules by HRUS were categorized using ACR-TIRADS and further were taken for fine needle aspiration cytology (FNAC) in our department. The pathological results were compared with the initial TIRADS category of the nodule and the effectiveness of the TIRADS classification in categorizing nodules into benign and malignant was assessed using various statistical variables. The initial USG and the FNAC were performed by a single radiologist with over 10 years of experience. A total of 201 patients underwent HRUS followed by FNAC after obtaining written consent in our department. The thyroid nodules labeled as true benign on ACR-TIRADS (TIRADS 2) were all true benign on Bethesda cytopathology (less than Bethesda III), confirming the high accuracy of HRUS. The diagnostic accuracy of HRUS in cases of ACR-TIRADS 3 nodules was approximately 90.6% with an error rate of 9.4%. Nodules labeled as ACR-TIRADS 4 and 5 had error rates of 47% and 10% in labeling nodules as malignant. The ultrasound-based ACR-TIRADS system can accurately predict the likelihood of specific nodules being benign. There is a strong concordance between Bethesda cytology and ACR-TIRADS classification, particularly for benign nodules. In resource-constrained system like ours, patients with TIRADS 2 and 3 nodules can be safely followed obviating the need for an invasive procedure like FNAC

Sheehan syndrome: Cardiovascular and metabolic comorbidities

Sheehan syndrome (SS) caused by postpartum hemorrhage leads to partial or complete pituitary hormone deficiency. In addition to lipid and glucose abnormalities, patients with SS have increased body fat, insulin resistance (IR), coagulation abnormalities, increased leptin concentration, low-grade inflammation, and endothelial dysfunction that predispose them to cardiovascular diseases. Untreated growth hormone (GH) deficiency, hypogonadism, and excess glucocorticoid use are considered risk factors for these abnormalities. Compared to other hypopituitary subjects, patients with SS are younger and have a longer duration of disease and severe GH deficiency. Replacement with GH in addition to standard hormone replacement improves their cardiometabolic profile

Prevalence of ultrasonography proved polycystic ovaries in North Indian women with type 2 diabetes mellitus

BACKGROUND: Polycystic ovaries (PCO) and their clinical expression (the polycystic ovary syndrome [PCOS]) as well as type 2 diabetes mellitus (T2DM) are common medical conditions linked through insulin resistance. We studied the prevalence of PCO and PCOS in women with diet and/or oral hypoglycemic treated T2DM and non-diabetic control women. DESIGN: Prospective study. METHODS: One hundred and five reproductive age group women with diet and /or oral hypoglycemic treated T2DM were the subjects of the study. Sixty age-matched non-diabetic women served as controls. Transabdominal ultrasonographic assessment of the ovaries was used to diagnose PCO. Clinical, biochemical and hormonal parameters were also noted. RESULTS: Ultrasonographic prevalence of PCO was higher in women with diabetes than in non-diabetic subjects (61.0% vs. 36.7%, P < 0.003) whereas that of PCOS was 37.1% in diabetic subjects and 25% in non-diabetic controls (P > 0.1). Diabetic women with PCO had diabetes of significantly longer duration than those without PCO (4.19±2.0 versus 2.9±1.6 yrs; p < 0.05). Among both diabetic and non-diabetic women, those with PCO had significantly higher plasma LH, LH/FSH ratio, total testosterone and androstenedione levels. CONCLUSION: This study demonstrates a higher prevalence of PCO in women with T2DM as compared to non-diabetic subjects

Adrenal morphology and cortical function in patients with extrapulmonary tuberculosis: response to antituberculosis treatment

ABSTRACT Objective: Enlargement of the adrenal glands and variable adrenocortical function have been reported in patients with pulmonary tuberculosis and, in a few studies, in patients with extrapulmonary tuberculosis (EPTB). However, none of the studies have evaluated the course of the adrenal morphology in these patients. Subjects and methods: Prospective study including 37 patients with EPTB and 37 healthy age- and sex-matched controls. The adrenal function was evaluated by measurement of cortisol levels at baseline and after stimulation with ACTH (Acton Prolongatum) before and 6 months after antituberculosis treatment. The size of both adrenal glands was evaluated using 64-slice computed tomography (CT) scanning before and 6 months after treatment. The findings were compared with those in a group of healthy matched controls. Results: Clinical and biochemical parameters were comparable between groups. The mean baseline serum cortisol level was significantly lower in the EPTB group (397.1 ± 184.9 nmol/L) compared with the control group (696.3 ± 101.8 nmol/L). Compared with controls, patients with EPTB had significantly lower mean cortisol levels at baseline and 1 hour after ACTH, both before (397 ± 184.9 nmol/L and 750.7 ± 176.8 nmol/L, respectively) and after (529.7 ± 100.4 nmol/L and 1017.2 ± 119.7 nmol/L, respectively) antituberculosis treatment. Both the length and thickness of the right and left adrenal glands were greater in patients with EPTB than in controls but became comparable to those in controls after treatment completion. Conclusions: Patients with EPTB have an enlarged adrenal size and low baseline and stimulated serum cortisol levels. After treatment completion, cortisol levels increased significantly, and the adrenal size normalized in these patients

Murder in a Nutshell: A Teaching Tool in Criminal Justice

Nutshell crime scenes have been around to teach investigators how to spot important details in crime scenes since the 1940s. NMU is fortunate enough to have a few nutshells in the criminal justice department to use in criminal investigation classes. The purpose of these models is to train the eye on how to observe a scene and understand the evidence that investigators are looking at. For my project, I researched a closed justifiable homicide case that took place in the Upper Peninsula. I was able to read the police and lab reports as well as interview an evidence technician who worked the case. The purpose of my research was to form a presentation to be used as a teaching tool in future criminal justice classes to go along with the nutshell model that was developed with this project. This presentation will go through the case that I researched and also explain why teaching with nutshells is important in the field of criminal justice

Laporan survey kawasan desa di hulu DAS Malinau, kecamatan Malinau (19 Pebruari s/d 4 Maret 1999)

This report is the first of two survey reports. The survey was undertaken at Malinau Watershed area from 19 February -4 March 1999. Although this is not a full report, the information and its reviews are relevant for discussion and follow up. The objectives of the survey carried out by relevant institutions are to: (1) seek preliminary information on villages, their communities, history and adat forests along the Malinau watershed; (2) collect preliminary data on forest and natural forest management systems carried out by adat communities and their adat law; (3) have general picture of conflicts and potential conflicts in villages along the Malinau watershed and local institution readiness in solving the existing conflicts; (4) obtain preliminary information on communities' and local institutions' preparedness in mapping their adat forests; and (5) promote and encourage participatory mapping activities