Management of severe tetanus using magnesium sulfate – The experience in a tertiary health institution in Southern Nigeria

Tetanus is a vaccine-preventable disease caused by the neurotoxin of Clostridium tetani: A motile, Gram-positive, sporeforming obligate anaerobe commonly found in the soil, dust, and alimentary canals of various animals. It remains a public health challenge in the developing countries as the morbidity and mortality rates remain high unlike in the developed world where the incidence is markedly low and no longer contributory to significant mortality. We report two male adolescents admitted in the pediatric department of a tertiary medical center of Nigeria for severe tetanus following an open injury to the limbs. Due to poor response to initial management with the combination of chlorpromazine, phenobarbitone, and diazepam, the latter was replaced with continuous infusion of magnesium sulfate after a loading dose was administered. Both the patients recovered without any prevailing complications and were discharged after 26 and 50 days of hospitalization, respectively, after receiving tetanus toxoid and were subsequently followed up. Successful severe tetanus management without the use of sophisticated medical gadgets and expensive treatment in a resource-poor economy is achievable as demonstrated by our study with the use of magnesium sulfate infusion

The voices of children and young people during COVID-19: A critical review of methods

Aim: Critically review research methods used to elicit children and young people's views and experiences in the first year of COVID-19, using an ethical and child rights lens.Methods: A systematic search of peer- reviewed literature on children and young peo-ple's perspectives and experiences of COVID-19. LEGEND (Let Evidence Guide Every New Decision) tools were applied to assess the quality of included studies. The critical review methodology addressed four ethical parameters: (1) Duty of care; (2) Children and young people's consent; (3) Communication of findings; and (4) Reflexivity.Results: Two phases of searches identified 8131 studies; 27 studies were included for final analysis, representing 43,877 children and young people's views. Most studies were from high-income countries. Three major themes emerged: (a) Whose voices are heard; (b) How are children and young people heard; and (c) How do research-ers engage in reflexivity and ethical practice? Online surveys of children and young people from middle-class backgrounds dominated the research during COVID-19. Three studies actively involved children and young people in the research process; two documented a rights- based framework. There was limited attention paid to some ethical issues, particularly the lack of inclusion of children and young people in re-search processes.Conclusion: There are equity gaps in accessing the experiences of children and young people from disadvantaged settings. Most children and young people were not in-volved in shaping research methods by soliciting their voicesThe Icelandic Research Fund, grant no. 217579-051Pre-print (óritrýnt handrit

Newborn resuscitation practices and paucity of resuscitative devices in Nigeria; a call to action

Background: Neonatal resuscitation is a method of preventing morbidities & mortality from asphyxia. Up to 85% of facilities in sub-Saharan Africa lack supplies or skilled personnel for neonatal resuscitation. Relative to the place of birth and the skill of the birth attendant, a variety of resuscitative practice are employed to make babies cry instead of helping the baby breathe. Many painful procedures are applied when the baby is unable to cry after birth in the absence of a health care worker trained in bag-mask ventilation. Objectives: To ascertain the resuscitation practices in communities lacking bag-mask-valve devices Methods: Surveys on the resuscitation practices during NISONM annual community outreach and mENCC trainings for four consecutive years in different geopolitical zones of the country. Results: Spanking of the baby usually in the upside down position (>90%), body massage with hot compress or salicylate containing balms, herbal concoctions, injection hydrocortisone or crystalline penicillin were used. Conclusion: There is an urgent need to address the issue of training on bag-mask ventilation and provision for frontline healthcare workers in Nigeria as a neonatal mortality reduction strategy. DOI: https://dx.doi.org/10.4314/ahs.v19i1.30 Cite as: Okonkwo IR, Ezeaka VC, Mustapha B, Ezeanosike O, Tongo O, Okolo AA, et al. Newborn resuscitation practices and paucity of resuscitative devices in Nigeria; a call to action. Afri Health Sci. 2019;19(1). 1563-1565. https://dx.doi.org/10.4314/ahs.v19i1.3

Neonatal hyperbilirubinemia and Rhesus disease of the newborn: incidence and impairment estimates for 2010 at regional and global levels.

BACKGROUND: Rhesus (Rh) disease and extreme hyperbilirubinemia (EHB) result in neonatal mortality and long-term neurodevelopmental impairment, yet there are no estimates of their burden. METHODS: Systematic reviews and meta-analyses were undertaken of national prevalence, mortality, and kernicterus due to Rh disease and EHB. We applied a compartmental model to estimate neonatal survivors and impairment cases for 2010. RESULTS: Twenty-four million (18% of 134 million live births ≥ 32 wk gestational age from 184 countries; uncertainty range: 23-26 million) were at risk for neonatal hyperbilirubinemia-related adverse outcomes. Of these, 480,700 (0.36%) had either Rh disease (373,300; uncertainty range: 271,800-477,500) or developed EHB from other causes (107,400; uncertainty range: 57,000-131,000), with a 24% risk for death (114,100; uncertainty range: 59,700-172,000), 13% for kernicterus (75,400), and 11% for stillbirths. Three-quarters of mortality occurred in sub-Saharan Africa and South Asia. Kernicterus with Rh disease ranged from 38, 28, 28, and 25/100,000 live births for Eastern Europe/Central Asian, sub-Saharan African, South Asian, and Latin American regions, respectively. More than 83% of survivors with kernicterus had one or more impairments. CONCLUSION: Failure to prevent Rh sensitization and manage neonatal hyperbilirubinemia results in 114,100 avoidable neonatal deaths and many children grow up with disabilities. Proven solutions remain underused, especially in low-income countries

Carbapenem resistance expressed by Gram-negative bacilli isolated from a cohort of Libyan patients

Background and objectives: Carbapenem-resistant Enterobacteriaceae (CRE) and other Gram-negative bacteria are among the most common pathogens responsible for both community and hospital acquired infection. The global spread of cephalosporinases in Enterobacteriaceae has led to the increased use of carbapenems resulting in the emergence and rapid spread of CRE. This has become an alarming public health concern, yet the condition in Libya remains unclear. The aim of this study was to obtain a better understanding of CRE strains prevalent in Libyan patients by investigating their phenotypic characteristics and antibiograms. Methods: Gram-negative bacterial species were collected from Misrata Central Hospital, Misrata Cancer Centre and Privet Pathology Laboratories. Clinical samples and swabs were obtained from hospitalised and non-hospitalised patients and from mechanical ventilation and suction machines. Patients who had received antibiotic therapy for at least three days prior to the study were excluded. The identification and characterization of the isolated species were achieved using the growth characteristics on MacConkey and blood agar, spot tests and API 20E or API 20NE biochemical testing systems. Screening for carbapenem resistance was performed using the disk diffusion method with carbapenem 10 μg and cephalosporin 30 μg disks and minimum inhibitory concentrations (MIC) determined using the Sensititre Gram-negative Xtra plate format (GNX2F). All strains demonstrating resistance or reduced susceptibility to one of the four carbapenems were subjected to carbapenememase activity detection using the RAPIDEC CARBA NP test, Modified Hodge test and carbapenem inactivation methods. Results: A total of one hundred and forty isolates representing fourteen bacterial species were isolated from 140 non-duplicated specimens. Clinical specimens included urine samples (96/140, 68.57%), sputum (15/140, 10.71%), surgical wound swabs (18/140, 12.85%), foot swabs from diabetes mellitus (DM) patients (6/140, 4.29%), ear swabs (3/140, 2.14%) and wound swabs (2/140, 1.43%). Thirty-four (24.29%) isolates demonstrated resistance to at least one of the four carbapenems with Klebsiella pneumoniae representing 73.53% (25 isolates) of all carbapenem resistant species, followed by 8.82% for Pseudomonas aeruginosa (3 isolates), 5.88% for both Proteus mirabilis (2 isolates) and Escherichia coli (2 isolates) and 2.94% for both Citrobacter koseri (1 isolate) and Rahnella aquatilis (1 isolate). The other isolates were either susceptible or cephalosporinase producers. Conclusion: This study has revealed the high rate of carbapenem resistance amongst Libyan patients and emphasizes the crucial need for accurate screening, identification and susceptibility testing to prevent further spread of nosocomial and community acquired resistance. This may be achieved through the establishment of antibiotic stewardship programmes along with firm infection control practices.National Research Foundation of South Africa; Libyan GovernmentWeb of Scienc

Perinatal Outcome in Patients With Pre-Eclampsia in Benin City, Nigeria

Objective: To determine the prevalence of pre-eclampsia and examine its influence on perinatal outcome among Nigerian women. Methods: Among 3780 deliveries over a two-and-half year period, 212 singleton infants were born after preeclamptic pregnancies. We compared the perinatal outcome with those of 636 control infants. Pre-eclampsia was defined as (1) an increase in either systolic or diastolic blood preasure (BP) greater than 30mm Hg or 15mmHg respectively above the booking BP plus proteinuria ( > 1+) without simultaneous urinary tract infection. (2) an intrapartum BP > 140 /90mmHg obtained on at least two occasions not less than 6 hours apart during delivery plus presence of proteinuria as indicated in (1) above. Results: The prevalence of pre-eclampsia was 5.6%; corresponding to 77.9% of all cases of hypertensive disorders in pregnancy. Pre-eclampsia occurred most frequently among women aged 20-24 years (2.7%); corresponding to 48.6% of all cases and whose parity were zero (3.6%); corresponding to 64.2% of all cases. The perinatal mortality rate, the preterm delivery rate and the incidence of birth asphyxia were separately significantly higher in mothers with pre-eclamptic pregnancies than in controls. Mean birth weight was significantly lower in infants delivered after pre-eclamptic pregnancies (2995 + 340g) than after control pregnancies (3105 + 301g). Presence of heavy proteinuria (= 3+) potentiated the adverse effects of pre-eclampsia on perinatal outcome. Conclusion: Pre-eclampsia commonly complicates pregnancy in young primiparous women. It affects the fetus adversely resulting in fetal growth restriction, preterm delivery, birth asphyxia and sometimes, fetal demise. Key Words: Pre-Eclampsia, Hypertension, Pregnancy, Proteinuria [Trop J Obstet Gynaecol, 2004; 21:148-152

State-of-the-art : plenary session transcript

Meeting: International Conference on AIDS, 5th, 4-9 June, 1989, Montreal, QC, CAPlenary speakers: Catherine Hankins, Angela A. Okolo, Roel A. Coutinho, Samuel Broder, Gilles BibeauFrench portions of session omitted from the transcrip