Clinical Utility of Procalcitonin and C-Reactive Protein in the Management of Neonatal Sepsis in a Resource-Limited Nigerian Hospital.

BACKGROUND: Neonatal sepsis is an invasive infection of the bloodstream in neonates and a leading cause of morbidity and mortality among them. AIM: To investigate the role of procalcitonin (PCT) and C-reactive protein (CRP) in the management of neonatal sepsis. MATERIALS AND METHODS: This was a prospective case-control study over one-year period using convenience sampling. Blood samples for PCT and CRP were taken from all neonates, while blood culture and white blood cell count samples were additionally taken from babies with neonatal sepsis. PCT and CRP were repeated at 24 and 48 hours. The continuous variables were found to have a nonparametric distribution. They were presented as median and interquartile range, and compared using Wilcoxon signed rank and Friedman test as appropriate. RESULTS: The blood culture analysis yielded a prevalence of 12.7% with Staphylococcus aureus being the commonest organism. Baseline concentrations of PCT (1.28 ng/ml) and CRP (17.31 mg/L) in neonates with sepsis were higher than that of controls (PCT-0.63 ng/ml, CRP-5.40 mg/L). PCT concentrations decreased after two days of antibiotic treatment, while CRP concentrations decreased after a day. The concentration of both decreased to normal levels after two days of treatment. CONCLUSION: This study showed that CRP was more reliable in monitoring antibiotic therapy, unlike other studies which suggested PCT. In cases where the management of neonatal sepsis may be limited by a low blood culture yield, therapeutic monitoring may be aided by CRP and/or PCT.

Epidemiology and risk factors of brucellosis in Alexandria governorate.

This study aimed to describe the trend and to identify possible risk factors for brucellosis in Alexandria in northern Egypt. We enrolled 72 confirmed cases of brucellosis and 144 age-matched controls in this study. Participants were interviewed at home using a structured questionnaire. Working with animals, breeding goats and eating ice cream bought from street vendors were significantly associated (P < 0.05) with brucellosis by univariate and multivariate analysis. Contact with infected animals and their products was the most important method of transmission.

Thyroid dysfunction in type 2 diabetics seen at the University College Hospital, Ibadan, Nigeria.

Thyroid dysfunction complicates the metabolic derangement observed in Diabetes Mellitus (DM). It is necessary to recognize and treat it when present in order to achieve stability of metabolic control in these patients. The prevalence of thyroid dysfunction in type-2 diabetics in our environment is not known. This study was therefore designed to determine the prevalence of thyroid dysfunction in Type 2 diabetics seen at the Metabolic Research Unit of University College Hospital, Ibadan, Nigeria. Serum TSH, Free T3 and Free T4 assays were performed using Automated Enzyme Immunoassay platform on fresh sera from volunteers comprising 64 adult type 2 diabetics and 36, age matched, non diabetic controls; weight, height and blood pressures were measured in all subjects. In addition, past lipid profile results of type 2 diabetics were retrieved from medical records. Thyroid dysfunction was present in 19 (29.7%) of 64 type 2 diabetics and 1 (2.8%) of 36 non diabetic controls.The prevalence of thyroid dysfunction is 32.4% in females and 25.9% in males. Secondary hypothyroidism was seen in 78.9%, sub-clinical hypothyroidism in 15.8%, and sub-clinical hyperthyroidism 5.2% of subjects with thyroid dysfunction. Abnormal lipid profiles were seen in 35.4% of euthyroid type 2 diabetics and 100% of hypothyroid type 2 diabetics. 87.5% of type 2 diabetics and 38.8% of controls were hypertensive. 7.8% of type 2 diabetics and 50% of controls were obese. The prevalence of thyroid dysfunction in type 2 is higher in type 2 diabetics than in controls. More of Type 2 diabetics were obese and more of them were hypertensive compared to controls. The approach of using TSH first in screening for thyroid dysfunction is not sufficient in type 2 diabetics. Routine screening for thyroid dysfunction should be carried out in type 2 diabetics.

Waist circumference, waist to hip ratio, and body mass index in the diagnosis of metabolic syndrome in Nigerian subjects.

Metabolic syndrome is the commonest controllable precursor of cardiovascular and end stage renal diseases. While central obesity is recognized universally as its strongest component, there is the need for an accurate and affordable tool to screen for the presence of metabolic syndrome in every community. The easiest and cheapest measures of obesity are the body mass index (BMI), waist circumference (WC) and waist to hip ratio (WHR). This study investigated the potential of BMI, WHR and WC in diagnosis of metabolic syndrome (MS) in Nigerian subjects.This cross sectional study involved three hundred and thirty eight apparently healthy adult Nigerians recruited within the University College Hospital and its environs were evaluated for the features of metabolic syndrome using the World Health Organisation and the NCEP ATP 111 criteria. BMI, WC, WHR, Blood Pressure, Fasting Lipid Profile and Fasting Plasma Glucose were measured in each participant. Correlation between BMI, WC, WHR and Blood Pressure, Fasting Lipid Profile and Fasting Plasma Glucose which are other components of MS was determined and empirical Receiver Operating Characteristics (ROC) analysis was used to evaluate each of them as predictors of MS. The prevalence of MS in the studied population was significantly higher (36.7%) using NCEP definition than (23.7%) using WHO definition. By both definitions, this prevalence was higher in females than in males. WC was positively correlated with FPG and TG (r=0.560 and 0.436 respectively; P=0.000) in the NCEP category while WC was positively correlated with FPG, SBP and DBP (r=0.254, 0.480, and 0.490 respectively; P>0.05) in the WHO category. ROC Analysis shows WC having the highest AUC (0.785) hence diagnoses MS more accurately than both BMI (0.733) and WHR (0.783) using in the NCEP ATP 111 criteria. The highest Area Under Curve (AUC) was observed in WHR (0.837) followed by WC (0.799) in the WHO category. Both WC and WHR are shown to be good predictors of the presence of MS. It will be appropriate to incorporate WC measurement into routine general physical examination in our clinics.

A four years old girl with phthiriasis pubis infestation.

A four years old girl had Phthirus pubis infestation in the scalp, eyelids, eyelashes, neck and shoulders. She had fever, severe itching, allergic reaction and anxiety. The girl was successfully treated with 2.5% permethrin cream. The risk of lice infestation as a community health problem was discussed.

Epidemiology and risk factors of brucellosis in Alexandria governorate

This study aimed to describe the trend and to identify possible risk factors for brucellosis in Alexandria in northern Egypt. We enrolled 72 confirmed cases of brucellosis and 144 age-matched controls in this study. Participants were interviewed at home using a structured questionnaire. Working with animals, breeding goats and eating ice cream bought from street vendors were significantly associated [P < 0.05] with brucellosis by univariate and multivariate analysis. Contact with infected animals and their products was the most important method of transmission