The etiology and antimicrobial susceptibility patterns of urinary tract infections at a private Nigerian teaching hospital in South West Nigeria

Background: Urinary tract infections (UTI’s) are among the commonest bacterial infectious disease in clinical practice with a wide range of etiologic agents. It frequently occurs in both the hospital and the community.Aims/Objectives: To determine the etiology of UTI at BUTH and obtain data on their susceptibility and resistance patterns.Methods: This was a prospective analysis of data on patients with UTI obtained from in and outpatients over a six month period. Samples had been obtained by clean catch mid-stream urine or suprapubic aspiration. The organisms had beenidentified by biochemical methods with susceptibility and resistance testing performed. Data analysis was with EPI-INFO version 3.5.1Results: There were a total of 200 urine samples that had positive growth. Prevalent organisms were Escherichia coli (48%) and Klebsiella spp (24%), followed by Staphylococcus aureus (10%) and Coagulase Negative Staphylococci (6.5%). The risk factors for UTI were female gender (p = 0.00), Diabetes mellitus (p = 0.03) and genitourinary surgery (p = 0.04). Effective antibiotics in-vitro to Escherichia coli were Nitrofurantoin and Cefepime at 84.8% and 92.3% respectively; while Cotrimoxazole performed poorly (32.5% susceptibility).Conclusion: Urinary tract infections are an important cause of morbidity in our environment and inaccuracies in diagnosis will prolong morbidity and may lead to costly and unsafe treatments.The prevalent pathogens in our environment are the Gram negative bacilli, Escherichia coli and Klebsiella pneumoneae. Nitrofurantoin retains efficacy to both urinary pathogens.Keywords: Urinary Tract Infection, Catheterization, Escherichia coli, Risk factors, Nitrofurantoi

Toluene Poisoning (Accidental Ingestion of Evostik)

Introduction: Childhood poisoning is one of the causes of high morbidity and mortality especially among under-five children in low income  countries. The home and its surroundings may harbour poisonous substances which might be ingested by adventurous children. Evo-stik glue is a modified silane (MS) polymer based high performance adhesive. It contains toluene, a colourless, sweet-smelling liquid with detrimental effects on virtually every organ in the body especially brain and kidneys. Toluene is a component of household items such as gasoline, shoe and nail polish.Aim / Objectives: From a few reported cases of toluene poisoning worldwide there was need to create awareness on the possibility of toluene poisoning as well as its deleterious effects. This is a case report on exposure to the effects of toluene by accidental ingestion that set the platform toemphasize the importance of prompt and appropriate management of toluene poisoning.Methodology: This case report is about a 2year old girl who accidentally ingested 15-20ml evostik glue stored in an attractive container in the  home. QH was presented at the Lagos State University Teaching Hospital Paediatric Emergency Unit with a one day history of persistent  spontaneous, non-projectile and non-bilous vomiting. On admission, she was conscious, moderately dehydrated with dry buccal mucosa. (38.2ºC)febrile, but not pale, icteric, or cyanosed. She developed seizures, recurrent hypoglycaemia, generalized peripheral edema and Anurias. On the second day of admission a renal challenge was performed to which the kidneys were unresponsive. Intravenous fluid was then restricted in line with conservative management of acute kidney injury when renal challenge fails. Deranged electrolytes and hypoglycaemia were corrected. She was also placed on an antihypertensive (Amlodipine). In addition, she received intravenous Omeprazole and Ranitidine on account of upper gastrointestinal bleeding. Haemodialysis and upper gastrointestinal endoscopy could however not be done on the second day of admission due to logistic reasons.On the third day she slipped into unconsciousness and her Glasgow coma scale had dropped to 8/15. A double volume exchange blood transfusion was commenced. The patient’s clinical state suddenly deteriorated during the procedure and she succumbed despite all efforts at resuscitation.Results: She developed persistent vomiting, altered sensorium and acute kidney injury within 48 hours of presentation. The case was 100% fatal. Toluene significantly inhibits the N-Methyl-D aspartic acid (NMDA) subtype of glutamate-activated ion channel. It remarkably reduces metabolicfunction in the brain increases dopamine release and the activity of dopaminergic neurons.Conclusion: Toluene poisoning is associated with high mortality. Early presentation and prompt intervention may lead to a good outcome.  Prevention of accidental ingestion of toxic substances at home is key in averting mortality associated with childhood poisoning. Keywords: Toluene Poisoning, Evostik, Nigeria

Acute kidney injury and necrotizing enterocolitis complicating sever perinatal asphyxia - Case Report

No Abstract

Nephrotic syndrome in an urban south african paediatric population: a fifteen-year retrospective study of clinical, histopathologic pattern and treatment outcomes

Background: Nephrotic syndrome (NS) is the commonest mode of presentation of glomerular disease in Africa. There is no single histological entity that underlies NS in Africa. Objectives: To determine the clinicopathological patterns, and the outcome of nephrotic syndrome Methods: Medical records of children with NS were reviewed. Results: There were 147 children studied and 112(76.2%) were males. The mean age at presentation was 5.73±3.69 years. 134(91.2%) had idiopathic nephrotic syndrome. Majority were of the mixed race 124(84.4%). 119(83.8%) were steroid sensitive and 23(16.2%) were primary steroid resistant. Secondary steroid resistance was seen in 20(17.7%).The black race had higher rates of steroid resistance 8(66.7%) whereas the white 10(90.9%) and the mixed race 104 (88%) were more steroid sensitive. Minimal change disease (MCD) was commonest histological presentation 33(34.0%).The whites (4/8,50%) and the mixed race(28/84,33.3%) had high rates of minimal change. The black children had the highest proportions of mesangioproliferative GN (MesPGN) (5/7(57.1%) and similar rates of MCD and focal segmental glomerulosclerosis (FSGS) 14.3%. The mixed race had the highest proportion of FSGS 17/84(20.2%) Overall mortality was 3.4% and 6.3% had undergone transplantation. Conclusion: MCD is the predominant pattern among the white and mixed race. FSGS is seen across all the races. Steroid resistance remains high among the black population Keywords: Nephrotic syndrome, steroid sensitive, steroid resistant, childre

Incidence and determinants of mortality of paediatric acute kidney injury in Lagos State University Teaching Hospital, Ikeja

Background: Acute Kidney Injury (AKI) is common and very often under-recognised especially in the developing nations. The disorder imposes a severe burden of morbidity and mortality in all regions of the world. Aims/Objectives:  To determine the incidence of AKI, aetiological patterns and the outcome of AKI in our institution which is a major referral centre in a megacity in Nigeria. We also determined the factors that majorly contributed to mortality. Methods: A prospective cohort study was carried out between August 2016 and September 2018. Acute kidney injury was defined using the KDIGO guideline. The severity of AKI was determined using serum creatinine or urine output criterion of the KDIGO guideline. Result: AKI was documented in one hundred and two subjects with an incidence of 29/1000 admissions. The median age was 36.0months (IQR 3.75-84.0). Majority of the subjects 80 (78.4%) were older than 60 months and 13(12.8%) were between 0 and 12 months. Fifty-six (54.9%) were males. Majority of the AKI were community-acquired 84(82.4%). Sepsis was the leading cause of AKI (79.4%) and most of the subjects presented in KDIGO stage 3. Majority were managed conservatively 63(61.8%). Peritoneal dialysis was done on 11(10.8%), haemodialysis on 25(24.5%) and 3(2.9%) had initial PD but subsequently changed to HD. Majority of the children survived 75(74.3%), and 18(17.8%) died. Over 85% of those managed conservatively were discharged and mortality was seen only in those in KDIGO stage 3. Major determinants of outcome included level of consciousness, KDIGO stage 3, platelet level less than 100,000/mm3, acidosis and sodium level. Five (4.9%) progressed to chronic kidney disease and of this 2(1.9%) have progressed to end stage renal disease requiring transplantation. Conclusion: Sepsis is the leading cause of AKI in our setting. Although majority of our subjects presented in the most severe form of AKI, conservative management was effective in a large proportion. Mortality was seen only in KDIGO stage 3 and the major factors associated with mortality were acidosis, thrombocytopenia, unconscious state and abnormal sodium level

Acute Kidney Injury and Intravascular Haemolysis Complicating Multiple Bee Stings in a Nigerian Child: A Case Report and Review of the Literature

The honey bee is a winged insect of the genus Apis known for its role in pollination and more importantly in the production of honey. However, stings from bees are not uncommon in our environment. A myriad of complications can arise from bee sting which increase in severity, with prognosis proportionate to an increase in the dose of inoculated venom. The complication of the stings ranges from local skin reaction and anaphylaxis to multiple organ failure including acute kidney injury (AKI). Bee sting has been identified as a causative agent of nephrotoxic acute tubular necrosis which may lead to AKI. We report a 3-year-old boy with AKI and features of intravascular haemolysis following multiple bee stings who recovered well with conservative management