Antimicrobial sensitivity pattern of organisms causing urinary tract infection in children with sickle cell anemia in Maiduguri, Nigeria

Background: Patients with sickle cell disease have increased tendency to develop frequent and severe infections, especially of bones and urinary tract.Objective: The knowledge of antimicrobial sensitivity pattern of common etiological agents will serve as a guide to empiric treatment while results of urine culture and sensitivity are being awaited.Materials and Methods: Antimicrobial sensitivity test was carried out on bacterial isolates from the urine of febrile children with sickle cell anemia (SCA) and children with HbAA in Maiduguri. Urine specimens were collected and cultured by standard methods. Sensitivity to 15 antimicrobials (based on availability of sensitivity disc) was tested using the disc.diffusion technique of stokes.Results: Significant bacteriuria was obtained from 65 (26%) of the 250 children with SCA and 51 (20.4%) of the 250 controls. The isolates were E. coli, Klebsiella, Coliforms, Proteus, Staph aureus and Salmonella. Sensitivity was highest to 3rd generation cephalosporins, followed by the quinolones: ciprofloxacin (86.2%), ofloxacin (83.1%), and peflacine(73.8%). Sensitivity of the organisms to some of the commonly used antibiotics like ampicillin, cotrimoxazole, and nalidixic acid was generally low. In general, the pattern of bacteriuria and their sensitivity in the SCA group was similar to the pattern in the control group.Conclusion: Etiological agents of childhood urinary tract infections (UTI) in this environment are resistant to most of the drugs commonly recommended for its treatment. Amoxicillin/clavulanic acid, cefuroxime, and gentamicin, are recommended as first.line drugs for treatment of UTI while awaiting results of culture and sensitivity. Ceftriaxone andceftazidime should be reserved for case of non response to first.line drugs and severe infections

Effects of crop rotation and tillage system on the control of ryegrass (lolium multiflorum X perenne) in wheat (triticum aestivum) in the Swartland production area of South Africa's Western Cape Province

A major challenge facing agriculture today is to sustain the productivity of agricultural systems with the reduction of weed invasion. The Swartland region in the Western Cape (South Africa) is intensively cropped, producing wheat (Triticum aestivum) as the major crop. As a result of the weedy ryegrass invasion the wheat yield is reduced. In addition, ryegrass has developed resistance to grass herbicides (graminicides). This situation has increased the need to use alternative practices for controlling the invasion of ryegrass in wheat fields. In this regard, crop rotation and tillage systems were proposed as techniques to suppress the ryegrass invasion. This could thus maintain a sustainable long-term wheat production system with less application of herbicides, decreased input costs and increased total grain yield. Against this background, the effects of crop rotation and tillage were determined on ryegrass seedling emergence in a field and shade netting experiment, while seed dormancy was determined in the laboratory. The objectives were to compare the wheat production of two crop rotations with mono-cropped wheat and assess the impact on the ryegrass population in no-till and minimum tillage systems. Analyses of variance on data sets of ryegrass seeds from 2009, 2010 and 2011 were used to determine germination and dormancy percentages in laboratory experiments. The performance of laboratory treatments was evaluated on the basis of germination percentage of seeds. In the field and shade netting experiments, analyses of variance for data from 2007, 2011 and 2012 were used to determine crop rotation x tillage system response. Field and shade netting performance were evaluated on the basis of ryegrass population inhibition and stimulation respectively. Ryegrass seeds from 2009 and 2010 showed higher germination percentages (80 per cent and 73 per cent) than 2011 (42 per cent). Primary dormancy prevented high germination of newly harvested seeds as dormancy release increase with age of the seed. Results of field and shade netting experiments showed stimulation of the ryegrass weed population in wheat monoculture under minimum tillage. However, when wheat was rotated with leguminous crops under both tillage systems (minimum-till and no-till) ryegrass was significantly inhibited. It was concluded that the critical period for weed competition is the first six weeks after planting. Results from this study provide a basis for producers of cereals to make good decisions with regards to timing weed control measures. It is essential to use competitive crop sequences which will inhibit weeds. The challenge is getting this practice adopted and implemented by producers as it will promote conservation agriculture within the region. This study promotes long-term sustainable wheat production systems with an efficient weed management programme that is environmentally friendly using less herbicides within the Swartland region

Significance of Pyuria in the Diagnosis of Urinary Tract Infection in Children with Sickle Cell Anaemia in Maiduguri, Nigeria

Urinary tract infection (UTI) is a significant cause of morbidity and mortality in children, especially in those with sickle cell disease, who are at higher risk of infections. It will be useful to have a simple test which can be used in resource limited health facilities as a means of screening such children for UTI with the view to instituting prompt treatment. This study is carried out to determine the usefulness of significant pyuria in detecting UTI in febrile children with sickle cell anaemia (SCA). Two hundred and fifty febrile children with sickle cell anaemia that attended State Specialist Hospital and University of Maiduguri Teaching Hospital (UMTH) were prospectively studied with their consent. Urine sample was collected using standard procedure, examined for pus cells and was cultured at the Microbiology laboratory of UMTH. The study showed UTI prevalence of 26%. Significant pyuria was found to have sensitivity of 55.4%, specificity of 77.8%, the efficacy of the test was 72.0% and the test has low positive predictive value of 46.8% in detecting bacteriuria in SCA patients. The significant pyuria observed in this study support its usefulness in the diagnosis of UTI among children with SCA especially in communities having limited facilities or personnel for carrying out urine culture.Keywords: Sickle Cell Anaemia, Bacteriuria, Pyuri

Childhood ovarian juvenile granulosa cell tumour: a case report and review of literature

Juvenile granulosa cell tumour (JGCT) is very uncommon gynecological malignancy that occurs more commonly in under five years old of age. We describe a case of JGCT in a 4-years old girl. The malignancy is assigned to International Federation of Gynecology and Obstetric staging system (FIGO stage I). Treated with complete excision only, the patient showed no evidence of relapse one year after surgery. Findings in this case are discussed and histological examination confirmed the diagnosis. The natural history of JGCT, epidemiology, histology, treatment and prognosis are reviewed along with the case presentation.Key words: Childhood, Juvenile Granulosa Cell, Tumour, Ovar

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

An Online Community for Computer Technology Support and Training for College Office Support Staff

Educational institutions strive to stay on the edge of technological advances in response to stakeholders\u27 desire to receive value for their investment. Rapid changes in computer technology present a dilemma to colleges and universities in the support and training arena. An important segment of the institutional population, office support staff are vital to the everyday running of departments with extremely diverse responsibilities critical to the institutional mission. Office support staff seem to be left out when support and training programs for new technology are being planned. With technology changing so quickly it is vital that organizations have support and training programs in place that will continually provide office support staff with updated skills. The developmental study used an implementation analysis method to develop an online support community (OSC) to provide a central location to find and contribute support for computer technology issues that affected productivity. A needs assessment comprised of literature reports, focus group feedback, and historical records as well as the results of a pre-survey and inventory ensured data triangulation and was used to define content areas for technology support and training. A Learning Management System was used to plan and design the OSC in the initial treatment and workplace software, SharePoint, for the second treatment. Discussion forums and content areas were created using the defined technology content areas. Office support staff participated in the study and data were collected using surveys, content postings, interviews and electronic reporting. The OSC was evaluated after the first and second treatments using an evaluation model of reaction, learning, behavior, and results. The results indicated that an OSC can be effectively used to provide technology support for office support staff. Elements necessary for design include: long-term documentation, content matter experts, medium that allows for open-ended login, evidence of knowledgeable participants sharing useful data, participant leaders, and IM for immediate answers. The need for support and training for office support staff is ongoing and necessary for the productive and efficient completion of their job and work responsibilities. The results will be useful in designing online support communities and for planning support and training events

Blackwater fever (BWF)? a case report from the semi-arid northeastern Nigeria

Black Water Fever is an uncommon complication of P. falciparum malaria in our environment. The overall incidence in Nigeria is unknown but the frequency may be more than is reported. It is commonly associated with administration of suboptimal doses of quinine and development of acute renal failure.We present a case of BWF having occurred after the administration of quinine,whichwe treated successfullywith artemether.

Factors infleuncing neonatal septicaemia in Maiduguri, north-eastern Nigeria

BACKGROUND: Neonatal septicaemia is a leading cause of morbidity and mortality worldwide, especially in the tropics. The risk factors vary, and the clinical features of neonatal septicaemia may be vague and nonspecific, therefore a high index of suspicion is vital to early diagnosis and treatment. The aetiological agents and their antibiotic sensitivity pattern have continued to change (in the same centre over time), hence the need to have undertaken this study.AIMS AND OBJECTIVES: The primary objective of the study was to determine the risk factors influencing the aetiology of neonatal septicaemia at the University of Maiduguri Teaching Hospital.PATIENTS AND METHODS: The study was prospective and all the newborn that had clinical diagnosis of septicaemia were consecutively enrolled and admitted to the Special Care Baby Unit of the Department of Paediatrics of University of Maiduguri Teaching Hospital (UMTH). The patients were appropriately investigated including blood cultures, cerebrospinal fluid cultures and urine culture among others.RESULTS: One hundred and ten neonates were studied, of these 46(42.0%) had positive blood culture, while 64 (58.0%) were blood culture negative. Eighteen (39.1%) of the septicaemic neonates were inborn, while 28 (60.9%) were out born. The incidence of neonatal septicaemia among babies delivered at UMTH was 5.9/1000 live births and the male to female ratio among septicaemic neonates was 1.9:1. The common risk factors for NNS were prolonged rupture of membrane (PROM), prematurity and low socioeconomic status of parents among others. Fever was the commonest clinical feature at presentation (87%), others include: poor feeding (64 %), excessive crying (33%), tachypnoea, hepatomegaly were some of the common examination findings. Staphylococcus aureus 16(69.6%) and Streptococcus pyogenes 5(21.8%) were the predominant Gram positive organisms isolated while Escherichia coli 9(39.1%) and Klebsiella Pneumoniae 7(30.4%) were the predominant Gram negative organisms isolated.CONCLUSION: Mortality was high in infection associated with Gram negative organisms and in the presence of conditions/complications like urinary tract infections, tetanus and meningit

Post-neonatal tetanus in University of Maiduguri Teaching Hospital, North-eastern Nigeria

Background: Tetanus is a public health problem in Nigeria. This study examines the demographic and clinical profile of postneonatal tetanus (PNT) seen in University of Maiduguri Teaching Hospital (UMTH), North- eastern Nigeria.Methods: This is a hospital-based prospective study of PNT. All childrenbeyond the neonatal period to 14 years of age admitted into the Paediatrics unit of UMTH, Maiduguri from June 2009 to July2011 with the diagnosis of PNT were studied.Results: A total of 39 cases of PNT were admitted over the period underreview. The male: female ratio was 2.3:1.0. Their ages at presentationranged between 16 months and 14 years, with mean +SD of 6.9+3.87 years. Over 90 percent of the children were either not immunizedagainst tetanus or their immunization status was unknown and onlytwo of the children were fully immunized. No booster immunizationwas received by any of the eligible children. The portal of entry of the infection was injury to the lower limbs and otogenic route in 53.9% and 33.3% respectively. Majority of patients were of low socioeconomicstatus. The duration of hospital stay ranged between 1-50 days with mean + SD (18.68+ 11.51).The mortality rate was (7)18 %.Conclusion: Tetanus still remains a major cause of childhood morbidityand mortality in Nigeria. Severe disease and the first one week of admission are the main variables identified to influence outcome.Therefore, there is need to strengthen routine immunization and booster doses of tetanus toxoid (TT) should be mandatory at primary and secondary school entry. Close monitoring of patients with severe tetanus during the critical period is imperative for successful management

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