Diphtheria in a 7-year-old child in north-eastern Nigeria - management in a resource-poor setting.

We report a case of a 7-year-old unimmunized child who presented with a 2 week history of nasal quality speech, hoarseness of the voice, regurgitation of feeds, and unstable gait. He had a previous history of fever, severe sore throat and bloody nasal discharge. A throat swab was negative for Corynebacterium diphtheria; however, he had received antibiotics at a primary care clinic prior to presentation. A clinical diagnosis of diphtheria with neurologic complication was made and the child was started on oral erythromycin, nasogastric tube feeding and daily physiotherapy, following which he improved. We did not prescribe diphtheria anti-toxin because of its unavailability.

Musculoskeletal evaluation in severe haemophilia A patients from Latin America.

There is a paucity of literature on haemophilia treatment in Latin American countries, a region characterized by rapidly improving systems of care, but with substantial disparities in treatment between countries. The aim of this study was to evaluate the musculoskeletal status of haemophilia patients from Latin America and to examine the relationship between musculoskeletal status and treatment practices across countries. The Committee of Latin America on the Therapeutics of Inhibitor Groups conducted a survey of its member country representatives on key aspects of haemophilia treatment in 10 countries. Musculoskeletal status of patients was obtained during routine comprehensive evaluations between March 2009 and March 2011. Eligible patients had severe haemophilia A (factor VIII <1%) without inhibitors (<0.6 BU mL(-1) ) and were ≥5 years of age. Musculoskeletal status was compared between three groups of countries, based primarily on differences in the availability of long-term prophylaxis. Overall, 143 patients (5-66 years of age) were enrolled from nine countries. In countries where long-term prophylaxis had been available for at least 10 years (Group A), patients aged 5-10 years had significantly better mean World Federation of Hemophilia clinical scores, fewer target joints and fewer affected joints than patients from countries where long-term prophylaxis has been available for about 5 years (Group B) or was not available (Group C). In Latin America, the musculoskeletal status of patients with severe haemophilia without inhibitors has improved significantly in association with the provision of long-term prophylaxis. As more countries in Latin America institute this practice, further improvements are anticipated.

Isolation and characterization of halophilic Archaea able to produce biosurfactants.

Halotolerant microorganisms able to live in saline environments offer a multitude of actual or potential applications in various fields of biotechnology. This is why some strains of Halobacteria from an Algerian culture collection were screened for biosurfactant production in a standard medium using the qualitative drop-collapse test and emulsification activity assay. Five of the Halobacteria strains reduced the growth medium surface tension below 40 mN m(-1), and two of them exhibited high emulsion-stabilizing capacity. Diesel oil-in-water emulsions were stabilized over a broad range of conditions, from pH 2 to 11, with up to 35% sodium chloride or up to 25% ethanol in the aqueous phase. Emulsions were stable to three cycles of freezing and thawing. The components of the biosurfactant were determined; it contained sugar, protein and lipid. The two Halobacteria strains with enhanced biosurfactant producers, designated strain A21 and strain D21, were selected to identify by phenotypic, biochemical characteristics and by partial 16S rRNA gene sequencing. The strains have Mg(2+), and salt growth requirements are always above 15% (w/v) salts with an optimal concentration of 15-25%. Analyses of partial 16S rRNA gene sequences of the two strains suggested that they were halophiles belonging to genera of the family Halobacteriaceae, Halovivax (strain A21) and Haloarcula (strain D21). To our knowledge, this is the first report of biosurfactant production at such a high salt concentration.

Misoprostol use for cervical ripening and induction of labour in a Nigerian teaching hospital.

CONTEXT: Induction of labor is always a challenge to many an obstetrician more so when the cervix is unfavorable. OBJECTIVES: To determine the efficacy and safety ofmisoprostol in cervical ripening and labour induction. MATERIALS AND METHOD: Aprospective study spanning 2 years and involving 151 patients admitted for cervical ripening and induction of labor at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. 50 microgram (mcg) ofmisoprostol was inserted vaginally every 4 hours until cervix became favorable or onset of labor. RESULTS: Main indications for induction of labour were prolonged pregnancy and hypertensive diseases of pregnancy. An average of 2 insertions of 50 mcg tablet was used to achieve cervical ripening in 107 patients (71%) and 80% (120) had spontaneous labor within 10 hours of insertion. The mean insertion-labor interval was 7.86 hours (SD +/- 2.5). The average duration of labour was 9.36 hours (SD +/- 2.9). Vaginal delivery was achieved in 96% of the patients. Uterine hyperstimulation occurred in 9 patients but there was no case of uterine rupture. CONCLUSION: Misoprostol was effective and safe in cervical ripening and induction of labor with a vaginal delivery rate of 96%. It should be an essential drug in obstetric practice especially in low resource settings.

Spontaneous liver rupture in pre-eclampsia.

Spontaneous liver rupture is a rare complication of pre-eclampsia. A booked, 30-year old woman with pre-eclampsia and twin gestation developed severe abdominal pains 10 hours after a supervised, vaginal delivery. On examination she was in hypovolemic shock with abdominal distension from hemoperitoneum. Uterine rupture was suspected and she had a laparotomy after resuscitation. But at surgery the uterus was intact and instead liver rupture was found which was managed by omental packing after evacuating the clots. Postoperatively, the patient developed acute renal failure that responded well to treatment. The mother and her babies were discharged in good health after 15 days of multidisciplinary management.

Kinetics of the acidic and enzymatic hydrolysis of benazepril HCl studied by LC.

A reversed-phase high-performance liquid chromatographic (HPLC) method was developed and validated for the kinetic investigation of the chemical and enzymatic hydrolysis of benazepril hydrochloride. Kinetic studies on the acidic hydrolysis of benazepril hydrochloride were carried out in 0.1 M hydrochloric acid solution at 50, 53, 58 and 63 degrees C. Benazepril hydrochloride appeared stable in a pH 7.4 phosphate buffered solution at 37 degrees C and showed susceptibility to undergoing in vitro enzymatic hydrolysis with porcine liver esterase (PLE) in a pH 7.4 buffered solution at 37 degrees C. Benazeprilat appeared to be the major degradation product in both (chemical and enzymatic) studies of hydrolysis. Statistical evaluation of the proposed HPLC methods revealed their good linearity and reproducibility. Relative standard deviation (R.S.D.) was less than 4.76, while detection limits for benazepril hydrochloride and benazeprilat were 13.0 x 10(-7) and 9.0 x 10(-7) M, respectively. Treatment of the kinetic data of the acidic hydrolysis was carried out by non-linear regression analysis and k values were determined. The kinetic parameters of the enzymatic hydrolysis were determined by non-linear regression analysis of the data using the equation of Michaelis-Menten.