Application of Artificial Intelligence in the Management of Drinking Water: A Narrative Review.

Waterborne illnesses are a significant concern worldwide. The management of water resources can be facilitated by artificial intelligence (AI) with the help of data analytics, regression models, and algorithms. Achieving the Sustainable Development Goals (SDGs) of the 2030 Agenda for Sustainable Development of the United Nations depends on understanding, communicating, and measuring the value of water and incorporating it into decision-making. Various barriers are used from the source to the consumer to prevent microbiological contamination of drinking water sources or reduce contamination to levels safe for human health. Infrastructure development and capacity-building policies should be integrated with guidelines on applying AI to problems relating to water to ensure good development outcomes. Communities can live healthily with such technology if they can provide clean, economical, and sustainable water to the ecosystem as a whole. Quick and accurate identification of waterborne pathogens in drinking and recreational water sources is essential for treating and controlling the spread of water-related diseases, especially in resource-constrained situations. To ensure successful development outcomes, policies on infrastructure development and capacity building should be combined with those on applying AI to water-related problems. The primary focus of this study is the use of AI in managing drinking water and preventing waterborne illness.

Role of Telemedicine and Digital Technology in Public Health in India: A Narrative Review.

There are still many areas of India without proper medical facilities. In such a setting, technology can play a facilitating role, particularly in reaching out to remote locations and offering a greater standard of care at a lower cost. The method of treating and diagnosing patients remotely through communication networks is known as telemedicine. When more patients get access to telemedicine, payers take more notice of how much less expensive it is than traditional medicine, and doctors are aware of its benefits. Telemedicine is a more beneficial technology that can expand access to preventive treatment and may lead to long-term health. Telemedicine has the potential to greatly affect public health. This paper reviews the current state of the art of telemedicine in India. Nearly 50 years ago, telemedicine was shrugged off as a complicated, expensive, and inefficient technology. Because of how quickly the information technology and telecommunications disciplines are advancing, telemedicine is today a viable, dependable, and useful technique. Practitioners and medical experts from a variety of fields have experienced success with telemedicine. The COVID-19 pandemic highlighted the need for strong primary healthcare networks for a more effective public health response during health emergencies and exposed the fragmentation of healthcare delivery systems. Although primary care is the first point of contact between the general public and the healthcare system, it has not recently grown much focus or funding. Even in the post-COVID-19 environment, telemedicine offers the potential to get through enduring barriers to primary care in India, such as a shortage of qualified medical professionals, issues with access, and the cost of in-person care. Telemedicine has the power to speed up the delivery of universal health coverage while strengthening primary care. There is a widening gap between people and those who offer basic health services as the population in India has grown, and the average lifespan has increased. Telemedicine helps with palliative care, early identification, a better cure, prevention, and rehabilitation in the treatment of cancer. Due to a shortage of primary care delivery networks and referral units, secondary and tertiary care facilities' health systems are overworked. To successfully use telemedicine, proper planning and operating processes are required. Thus, the development and implementation of telemedicine will improve patient care and India's primary healthcare system in the future. Finally, telemedicine's cost-effectiveness will likely be its most significant outcome.

Greater efficiency of polyherbal drug encapsulated biosynthesized chitosan nano-biopolymer on diabetes and its complications.

Diabetes is a highly complex disease that has an adverse impact on the lives of individuals, and the current medicines used to manage diabetes have obvious side effects. Medicinal plants, on the other hand, may serve as an alternate source of anti-diabetic drugs. A polyherbal combination has a higher and more extensive therapeutic potential than a single herb. Yet, due to deterioration during the absorption process, the usage of this drug still yields inadequate results. Encapsulation of polyherbal drug with chitosan nanoparticles is one of the key ways to solve this problem due to its biocombatibilty, slow and targeted drug delivery characteristics. In the present study, the chitosan was derived from prawn shell and the chitosan nanoparticles had been prepared by ionic-gelation method. The anti-diabetic polyherbal drug (Andrographis paniculata, Andrographis alata, Adhatoda zeylanica, Gymnema sylvestre, Syzygium cumini, and Justicia glabra) was encapsulated with a bio-derived chitosan biopolymer. The drug loading efficiency was about 85 %. The chemical and physical properties of the chitosan and drug-loaded chitosan nanoparticles had been analyzed by FT-IR absorption, XRD, SEM, TEM and EDAX analysis. The antidiabetic efficiency, hepatoprotective activity and antihyperlipedimic activity of the chitosan nanoparticles, polyherbal drug and polyherbal drug encapsulated with chitosan nanoparticles were assessed in a group of rats. The polyherbal drug reduced the serum glucose level from 306.4 mg/dL to 134.47 mg/dL, while the polyherbal drug encapsulated with chitosan nanoparticles reduced to 127.017 mg/dL. This was very close to the serum glucose level of non-diabetic rat (124.65 mg/dL). Further, it considerably increased the insulin level close to that of non-diabetic rat. Thus, the polyherbal drug encapsulated with chitosan nanoparticles showed superior efficiency in antidiabetic and also diabetic complications.

Laparoscopic management of type VI choledochal cyst with common bile duct stone: report of a case and review of literature.

A young adult male presented with biliary colic and intermittent jaundice for 1 year. Abdomen findings were unremarkable. Routine investigations revealed a raised total bilirubin. On abdominal ultrasonography, common bile duct (CBD) dilatation with multiple stones was noted. On further imaging with magnetic resonance cholangiopancreatography, type I choledochal cyst (CDC) was suspected. A laparoscopic approach was planned. Intraoperatively, dilatation of cystic duct was noted which constitute type VI CDC. Partial malrotation of the gut and accessory right hepatic artery were also noted as incidental finding. Laparoscopic cholecystectomy with CBD exploration and removal of stones, biliary stent placement, cystic duct cyst excision and primary repair of CBD was done. Postoperatively, the patient improved symptomatically with a fall in bilirubin to normal range. We are describing the laparoscopic management of a rare case of type IV CDC which was diagnosed intraoperatively.

Results from the Survey of Antibiotic Resistance (SOAR) 2015-18 in Tunisia, Kenya and Morocco: data based on CLSI, EUCAST (dose-specific) and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints.

OBJECTIVES: To determine antibiotic susceptibility of community-acquired respiratory tract infection (CA-RTI) isolates of Streptococcus pneumoniae and Haemophilus influenzae collected in 2015-18 from Tunisia, Kenya and Morocco. METHODS: MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST (dose-specific) and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. RESULTS: S. pneumoniae isolates from Tunisia (n = 79), Kenya (n = 44) and Morocco (n = 19) and H. influenzae isolates (n = 74) from Tunisia only were collected and analysed. Low antibiotic susceptibility was observed in S. pneumoniae from Tunisia, with >90% susceptible only to the fluoroquinolones (all breakpoints), penicillin (CLSI IV and EUCAST high-dose) and ceftriaxone (CLSI, EUCAST high-dose and PK/PD breakpoints). In addition, isolate susceptibility in Kenya was >90% to amoxicillin and amoxicillin/clavulanic acid (CLSI and PK/PD breakpoints). Antibiotic activity was highest in Morocco, where ≥89.5% of pneumococci were susceptible to most antibiotics, excluding trimethoprim/sulfamethoxazole (68.4% by CLSI or PK/PD and 79%-84.2% by EUCAST), macrolides (79%-84.2% by all breakpoints) and cefaclor (0% by EUCAST and 52.6% by PK/PD). The majority (≥86.5%) of H. influenzae isolates from Tunisia were susceptible to most antibiotics by all available breakpoints, except ampicillin and amoxicillin (almost one-third were ß-lactamase positive), trimethoprim/sulfamethoxazole (51.4%-56.8%), cefaclor (1.4% by PK/PD), cefuroxime (4.1% by EUCAST), macrolides (1.4%-2.7% by PK/PD) and cefdinir (66.2% by PK/PD). The application of different EUCAST breakpoints for low and higher doses for some of the antibiotics (amoxicillin, amoxicillin/clavulanic acid, ampicillin, penicillin, ceftriaxone, clarithromycin, erythromycin, levofloxacin and trimethoprim/sulfamethoxazole) allowed, for the first time in a SOAR study, the effect of raising the dosage on susceptibility to be quantified. CONCLUSIONS: Low antibiotic susceptibility was observed in S. pneumoniae from Tunisia, but susceptibility was higher in isolates from Kenya and highest in those from Morocco. H. influenzae from Tunisia were highly susceptible to most antibiotics. These factors are important in decision making for empirical therapy of CA-RTIs.

Acinetobacter infections: a retrospective study to determine inhospital mortality rate and clinical factors associated with mortality.

A retrospective case series of acinetobacter infections at a tertiary hospital in Nairobi was conducted to determine the mortality rate and factors associated with mortality. Over an eight-year period, 80 clinically significant infections were identified. The majority of infections were ventilator-associated pneumonia (40%) and bloodstream infections (30%). Eighty-six percent of the isolates were multi-drug resistant. The mortality rate in the study cohort was 45%. Twelve patients grew Acinetobacter spp. within 48 h of hospitalization, and three of these patients had no prior healthcare contact. The mean Sequential Organ Failure Assessment score was associated with mortality from acinetobacter infections.

Results from the Survey of Antibiotic Resistance (SOAR) 2011-14 in the Democratic Republic of Congo, Ivory Coast, Republic of Senegal and Kenya.

OBJECTIVES: To assess antibiotic susceptibility of community-acquired respiratory tract isolates from Ivory Coast, Kenya, Democratic Republic of Congo (DRC) and Senegal in 2011-14. METHODS: Bacterial isolates were collected and MICs determined using Etest(®) for all antibiotics except erythromycin, for which testing was by disc diffusion. Susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. For macrolide interpretation, CLSI breakpoints were adjusted for incubation in CO2. RESULTS: Susceptibility to penicillin (using CLSI oral or EUCAST breakpoints) was low among isolates of Streptococcus pneumoniae from the DRC and Kenya (17.4% and 19%, respectively) but higher among isolates from the Ivory Coast (70%) and Senegal (85.7%). Penicillin susceptibility using CLSI iv breakpoints was higher in all countries, but still only 69.6% in the DRC. Macrolide susceptibility (based on CLSI erythromycin disc diffusion breakpoints) was also low in Kenya (∼65%) but 87%-100% elsewhere. Haemophilus influenzae were only collected in the DRC and Senegal, with ß-lactamase prevalence of 39% and 4%, respectively. Furthermore, ß-lactamase-negative ampicillin-resistant (BLNAR) isolates were found in DRC (four isolates, 17%), but only two isolates were found in Senegal (by EUCAST definition). Amoxicillin/clavulanic acid in vitro susceptibility was 73.9% in the DRC and 100% in Senegal based on CLSI breakpoints, but this reduced to 65.2% in the DRC when BLNAR rates were considered. Clarithromycin susceptibility was >95% in both countries. CONCLUSIONS: There was considerable variability in antibiotic susceptibility among the African countries participating in the surveillance programme. Thus, continued surveillance is necessary to track future changes in antibiotic resistance. Use of EUCAST versus CLSI breakpoints showed profound differences for cefaclor and ofloxacin against S. pneumoniae, with EUCAST showing lower susceptibility.

A FIVE YEAR REVIEW OF API20E BACTERIA IDENTIFICATION SYSTEM'S PERFORMANCE AT A TEACHING HOSPITAL.

OBJECTIVES: To assess the performance of the API20E bacteria identification system at a teaching hospital in Kenya. DESIGN: Retrospective study. SETTING: The microbiology laboratoryoratory of the Aga Khan University teaching Hospital. SUBJECTS: One thousand six hundred and fifty eight API20E records. MAIN OUTCOME MEASURES: The accuracy in identifying the bacteria species. RESULTS: One thousand four hundred and forty two (87.6%) isolates had the exact identity, 199 (12%) nearest identity, and seven (0.4%) no identity. The performance varied among the species; Acinetobacter baumanii had 140 (99.3%) isolates with the exact identity and only one (0.7%) with the nearest identity compared with Aeromonas hydrophila which had five (17.2%) with exact and 24 (82.8%) with nearest. CONCLUSIONS: The API20E system is a robust bacteria identification method which can serve small and medium clinical microbiology laboratories that may not afford automated systems. Adhering to the manufacturer's instructions and good.

Unexpected absence of meticillin-resistant Staphylococcus aureus nasal carriage by healthcare workers in a tertiary hospital in Kenya.

Healthcare workers (HCWs) are a major reservoir of meticillin-resistant Staphylococcus aureus (MRSA). A cross-sectional study was conducted between July and December 2010 to determine the prevalence of nasal carriage of MRSA at the Aga Khan University Hospital Nairobi. Nasal swabs were taken from 246 randomly selected HCWs. MRSA was identified using both phenotypic and genotypic methods. The prevalence of MRSA carriage was 0% [95% confidence interval (CI): 0-1.5%] whereas that of meticillin-susceptible Staphylococcus aureus was 18.3% (95% CI: 14.0-23.6%). Given the absence of MRSA in our hospital, screening HCWs should be limited to an outbreak setting.

URINARY TRACT INFECTIONS AT AGA KHAN UNIVERSITY HOSPITAL NAIROBI - A ONE YEAR EXPERIENCE.

BACKGROUND: In developing countries,most of these patients with urinary tract infections (UTI) are normally treated empirically and urine culture is usual ordered for as a last resort in patients refractory to antibiotic treatment. OBJECTIVE: To explore the possibility of designing empiric antibiotic therapy for symptomatic UTI in patients at Aga Khan University Hospital by looking at the trends of UTI, common pathogens isolated and their antibiotic susceptibility pattern. DESIGN: A retrospective clinical-laboratory study. SETTING: Aga Kahn University Hospital- Nairobi. SUBJECTS: Allpositive urine cultures between January and December 2008 were included in the study. RESULTS: A total of 409 urine specimens were retrieved and analysed and 100 cases had negative cultures. Three hundred and nine cases had positive cultures. Sixty eight point seven percent were females while 31.3% were males with a mean age of 31 years. One hundred and thirty five out of 409 patients (33%) had classical signs and symptoms. In 143 (35%) cases E. coli was isolated. The other cultures were organisms other than E. coli. There was a higher resistance to clotrimazole in E. coli (71%) as compared to non-E. coli organisms (23%. There was a higher resistance rate to Nalidixic acid in non-E. Coli organisms (35%) and higher resistance rate to Augmentin in E. Coli 43 versus 18% (c/f non-E.Coli. Forty patients in the study had predisposing factors for UTI. CONCLUSIONS: It is sometimes warranted to start the patient on empiric antibiotic treatmentbefore culture results are available. Nitrofurantoin, Cefuroxime, Ciprofloxacin have good sensitively rates and are therefore drugs of first choice for the treatment of uncomplicated urinary tract infection provided that the contraindications and specific precautions are noted.

IL-17A and IL-17F gene expression is strongly induced in the mucosa of H. pylori-infected subjects from Kenya and Germany.

Helicobacter pylori infection is the major cause of gastritis. Immunologically, H. pylori gastritis is associated with an infiltration of immune cells into gastric mucosa and the upregulation of various cytokines. Here, we analysed the gene expression of IL-1- and IL-17-related cytokines in regard to H. pylori infection in 85 German and 51 Kenyan patients with reflux-related or dyspeptic symptoms, respectively. Degree of gastritis and density of colonization were assessed histologically in accordance with the updated Sydney classification. Gene expression levels of cytokines IL-1ß, IL-8, IL-18, IL-33, IL-17A, IL-17F and IL-23 as well as IL-23R were analysed by real-time RT-PCR. In both populations, H. pylori-infected individuals had significant higher inflammatory scores for activity and chronicity than H. pylori-negative subjects (P values between 0.006 and <0.0001). IL-8 mRNA was induced up to 6-fold in H. pylori-infected patients (P < 0.05), while the expression levels of IL-1ß, IL-18, IL-23, IL-33 and IL-23R did not differ with respect to the H. pylori status in both groups. Most strikingly, a significant induction of both IL-17A and IL-17F was noted in H. pylori-infected individuals of both ethnic groups. Almost all IL-17F-positive samples revealed co-expression of IL-17A (40/42, 95.2%). Analysing IL-17A and IL-17F transcript levels of these 40 'double-positive' samples, a highly significant positive correlation between both genes was identified (P < 0.001). Taken together, H. pylori infection leads to a strong upregulation of both IL-17A and IL-17F in the gastric mucosa suggesting a regulatory link between both genes.

Antibacterial susceptibility patterns of blood stream isolates in patients investigated at the Aga Khan University Hospital, Nairobi.

BACKGROUND: Microbial invasion of the blood stream can have serious immediate consequences and are a threat to every organ in the body. Timely detection and treatment is vital and necessitates hospital admission and immediate intervention. OBJECTIVES: To investigate aetiology and anti-microbial resistance patterns of bacterial isolates in blood stream infections. DESIGN: A retrospective clinical-laboratory study carried over a five year period January 2003 to April 2008. SETTING: The Aga Khan University Hospital, Nairobi, Department of Pathology, Division of Microbiology. SUBJECTS: All blood culture specimens received from both in and out-patients' at the Aga Khan University Hospital's laboratory. RESULTS: Rates of oxacillin resistance for Staphylococcus aureus were 21%. Streptococci were generally susceptible to beta-lactams. High-level gentamicin resistance was seen in 12% of Enterococci. Vancomycin resistance was conspicuously absent. Resistance rates of Pseudomonas aeruginosa to ciprofloxacin, gentamicin, amikacin, imipenem were between 11% and 23%. Salmonella spp. showed multiple resistant patterns to co-trimoxazole, chloramphenicol and ampicillin with resistance rates of greater than 35%. One hundred and twenty three patients (11%) tested positive for HIV. Unlike in HIV negative individuals, Cryptococcus neoformans was an important isolate, positive in 5%. A number of HIV positive patients had Staphylococcus aureus and coagulase negative staphylococcus isolates in their blood cultures. In such clinical circumstances it is difficult to determine the clinical significance of these isolates. CONCLUSION: Antimicrobial susceptibility patterns revealed high level resistance among the gram positive organisms and also amongst extended spectrum beta lactamase (ESBL) producing E.coli and Klebsiella spp. This study highlights the challenges of deriving empiric drug regimens in the current clinical scenario. However, we do know it is important to cover adequately for gram positive organisms.

Validation of c-reactive protein in the early diagnosis of neonatal sepsis in a tertiary care hospital in Kenya.

OBJECTIVE: To evaluate utility of C-reactive protein (CRP) in the early diagnosis of neonatal sepsis in a tertiary care Newborn Unit in Kenya. DESIGN: Cross-sectional study. SETTING: Newborn Unit, Kenyatta National Hospital. SUBJECTS: All neonates admitted to Newborn Unit, Kenyatta National Hospital during the study period with suspected sepsis based on specified clinical criteria. RESULTS: Of the 310 infants, there were 83 episodes of proven sepsis and 94 episodes of probable sepsis. Using the standard CRP cut-off value of 5 mg/dl, a sensitivity of 95.2% in proven sepsis and 98.9% for probable septic episodes were noted. In proven sepsis, a specificity of 85.3%, positive predictive value of 80.6%, and a negative predictive value of 96.5% were noted. In probable sepsis, a specificity of 83.3%, positive predictive value of 80.9% and a negative predictive value of 99.1% were noted. The overall accuracy in proven sepsis was 96.5%, and in probable sepsis was noted to be 99.1%. Sub-analysis showed a lower positive predictive value (61.5%) for early onset sepsis compared to 93% for late onset sepsis. Repeat CRP tests were done in 33 babies. Twenty two of the 29 with proven/probable infection had a ten-fold increase in CRP levels, but levels were noted to be low or reducing in seven (24.1%) babies showing signs of improvement clinically. Using a receiver operator characteristic curve, the optimal cut-off point for CRP was found to be 5 mg/dl. CONCLUSIONS: Serum CRP is an accurate indicator of neonatal sepsis, with high sensitivity, specificity and predictive values, at the standard cut-off of 5. CRP is a better screening test for late-onset than early-onset neonatal sepsis. The standard recommended CRP cut -off point of 5 is appropriate for local use.

Species distribution and antifungal sensitivity patterns of vaginal yeasts.

OBJECTIVES: To identify yeastisolates in vaginal specimens to species level and determine their antifungal susceptibility patterns. DESIGN: Cross-sectional laboratory-based study. SETTING: The Aga Khan University Hospital (AKUH), Nairobi. SUBJECTS: Yeast isolates from high vaginal swabs presented to the laboratory for culture and sensitivity were identified to species level using the API Candida system and subjected to broth microdilution susceptibility testing. MAIN OUTCOME MEASURES: Frequency tables and graphs were used to summarise the data. Susceptibility data was analysed by the non-parametric Fisher's exact test. P < 0.05 was considered statistically significant. RESULTS: A total of 101 yeasts were studied. C. albicans was the prominent species (69.3%) followed by C. glabrata (12.9%), C. famata (5.0%), C. krusei (3.0%), Trichosporon species (3.0%) and S.cerevisiae (3.0%), C.parapsilosis (1.0%). Three (3.0%) of the isolates had profiles that fell between C. glabrata and C. famata. The percentages of C. albicans susceptible to flucytosine, amphotericin B, fluconazole and itraconazole were 94.3, 92.9, 100 and 90 respectively; that of non-albicans isolates were 93.5, 80.6, 77.4 and 29 respectively. There was no significant difference (p > 0.05) between the susceptibility of C. albicans and non-albicans isolates to flucytosine and amphotericin B, however there was a significant difference (p < 0.05) to fluconazole and itraconazole. CONCLUSIONS: C. albicans was the predominant cause of vulvovaginal candidiasis in this study, and demonstrated good susceptibility to antifungal agents tested. A significant number of non-albicans yeasts were identified; these demonstrated reduced susceptibility to all drugs, in particular to the azoles which are commonly used for treatment of vaginal candidiasis. The isolation of non-albicans yeasts may have clinical implication given their reduced susceptibility to antifungals.

Metallo-beta-lactamase-producing Pseudomonas aeruginosa isolated from a large tertiary centre in Kenya.

This study was designed to characterize the beta-lactamase content of carbapenem-resistant Pseudomonas aeruginosa isolates recovered during 2006 and 2007 in a large tertiary-care centre in Nairobi, Kenya. Molecular characterization was done using PCR and sequencing, and typing was performed using pulsed-field gel electrophoresis (PFGE). In total, 416 P. aeruginosa isolates were obtained during that period, of which 57 (13.7%) were resistant to carbapenems. All carbapenem-resistant isolates tested positive for metallo-beta-lactamase (MBL) production. All MBL isolates produced VIM-2 with two types of integron structures. PFGE identified three clonally related groups of VIM-2-producing P. aeruginosa, including a pan-resistant clone that was responsible for nosocomial outbreaks during 2006 and 2007 in the intensive-care unit. These findings suggest that continuous molecular surveillance needs to be performed to monitor the spread within the hospital of this pan-resistant strain. This study is the first report of VIM-2-producing P. aeruginosa from the African continent.

Enumeration, isolation and identification of diazotrophs from Korean wetland rice varieties grown with long-term application of N and compost and their short-term inoculation effect on rice plants.

AIM: This study has been aimed (i) to isolate and identify diazotrophs from Korean rice varieties; (ii) to examine the long-term effect of N and compost on the population dynamics of diazotrophs and (iii) to realize the shot-term inoculation effect of these diazotrophs on rice seedlings. METHODS AND RESULTS: Diazotrophic and heterotrophic bacterial numbers were enumerated by most probable number method and the isolates were identified based on morphological, physiological, biochemical and 16s rDNA sequence analysis. Long-term application of fertilizer N with compost enhanced both these numbers in rice plants and its environment. Bacteria were high in numbers when malate and azelaic acids were used as carbon source, but less when sucrose was used as a carbon substrate. The combined application promoted the association of diazotrophic bacteria like Azospirillum spp., Herbaspirillum spp., Burkholderia spp., Gluconacetobacter diazotrophicus and Pseudomonas spp. in wetland rice plants. Detection of nifD genes from different diazotrophic isolates indicated their nitrogen fixing ability. Inoculation of a representative isolate from each group onto rice seedlings of the variety IR 36 grown in test tubes indicated the positive effect of these diazotrophs on the growth of rice seedlings though the percentage of N present in the plants did not differ much. CONCLUSIONS: Application of compost with fertilizer N promoted the diazotrophic and heterotrophic bacterial numbers and their association with wetland rice and its environment. Compost application in high N fertilized fields would avert the reduction of N(2)-fixing bacterial numbers and their association was beneficial to the growth of rice plants. SIGNIFICANCE AND IMPACT OF THE STUDY: The inhibitory effect of high N fertilization on diazotrophic bacterial numbers could be reduced by the application of compost and this observation would encourage more usage of organic manure. This study has also thrown light on the wider geographic distribution of G. diazotrophicus with wetland rice in temperate region where sugarcane (from which this bacterium was first reported to be associating and thereon from other plant species) is not cultivated.

Bronchoscopic study on aetiology of chronic cough in HIV-infected adults with negative sputum smears for Mycobacterium tuberculosis at Kenyatta National Hospital, Nairobi.

OBJECTIVE: To establish the aetiology of chronic cough in HIV-infected patients with negative sputum smears for Acid Fast Bacilli (AFB). DESIGN: A cross-sectional descriptive study. SETTING: Kenyatta National Hospital, a tertiary referral centre in Kenya SUBJECTS: Sixty five HIV-infected adults presenting with chronic cough and negative sputum smears for AFBs. RESULTS: Sixty-two patients were included in the final analysis. Aetiology of chronic cough was established in 42 (68%) patients. Pneumocystis jiroveci, bacterial pneumonia and Mycobacterium tuberculosis were diagnosed in 22 (35.5%), 17 (27.4%) and 14 (22.5%) patients respectively. Majority (98%) of patients with a diagnosis had multiple causes established in them. Ciprofloxacin had activity against 91% of the isolated organisms while Penicillin was active against 35% only. CONCLUSION: This study documents Pneumocystis jiroveci pneumonia as a common cause of morbidity in a subset of HIV infected patients with chronic cough and negative sputum smears for AFB in Kenya.

Bacterial isolates in severely malnourished children at Kenyatta National Hospital, Nairobi.

OBJECTIVES: To identify bacterial isolates and determine antibiotic sensitivity pattern in children with severe Protein Energy Malnutrition (PEM) presenting at the Paediatric Filter Clinic (PFC) of Kenyatta National Hospital (KNH). DESIGN: Hospital based cross-sectional survey. SETTING: Paediatric Filter Clinic of Kenyatta National Hospital (KNH), a tertiary level teaching institution for the University of Nairobi, Kenya. SUBJECTS: Children between two and sixty months presenting at the hospital outpatient filter clinic with severe malnutrition. RESULTS: Ninety-one children, forty six female and forty five males, were recruited for the study. Of these, sixty had Marasmus, twenty Kwashiorkor and eleven Marasmic-Kwashiorkor. HIV serology was positive in 43% of study subjects. There were 30 bacterial isolates from 26 subjects. Ten bacterial isolates were gram positive and twenty gram negative. Isolation rates did not vary by HIV serological status. Twenty one out of the 30 isolates were from blood culture. About 1/3 of the gram positive isolates were coagulase negative staphylococci, largely resistant to commonly used antibiotics such as Erythromycin, Ampicillin, Cotrimoxazole, Chloramphenicol and even Oxacillin. More than half demonstrated resistance to commonly used oral antibiotics while 80% of all gram positive and negative isolates were sensitive to Ciprofloxacin. Aminoglycosides, Gentamicin and Amikacin, and third generation Cephalosporins, Ceftriaxone and Ceftazidime, were found to be effective against most gram-negative isolates. CONCLUSION: Nearly a third (28.9%) of children admitted with severe malnutrition at KNH have concomitant severe bacterial infections; primarily manifesting as bacteraemia. Gram-negative agents are responsible for most severe bacterial infections in children admitted at the KNH, regardless of their HIV serological status. Whenever possible, blood culture should be included in the initial septic screening of severely malnourished children at KNH. In the absence of culture and sensitivity information, ciprofloxacin should be considered among the first line options in the empirical treatment of severe bacterial infections among these children. Clinical trials to further evaluate in-vivo effectiveness of various single or combination antibiotics are recommended.

Neonatal bacterial meningitis at the newborn unit of Kenyatta National Hospital.

BACKGROUND: Meningitis occurs in up to one third of neonates with septicaemia. Diagnosis is difficult due to its non-specificity of signs and symptoms. While neonatal septicaemia is a common problem at Kenyatta National Hospital (KNH), there are no recent data on the incidence and clinical characteristics of neonatal meningitis at the hospital. OBJECTIVE: To evaluate the prevalence and the bacterial aetiology of meningitis in neonates at the Newborn Unit (NBU) of KNH. DESIGN: Descriptive cross-sectional study. SETTING: Newborn Unit of Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS AND METHODS: Lumbar punctures were performed on eighty-four neonates with suspected sepsis based on specified clinical criteria. Cases were defined as meningitis if the cerebrospinal fluid (CSF) was positive for bacteria by Gram stain, aerobic bacterial culture or latex particle agglutination assay. RESULTS: The prevalence of meningitis amongst cases of suspected sepsis was 17.9%. The male:female ratio was 1.5:1 mean birth weight 2116.7 grams (1682.2-2551.2) mean gestational age 35.7 weeks (32.6-38.8) and the mean postnatal age was 4.1 days (2.7-5.4) with none of the parameters being significantly different from those without meningitis. Feed intolerance and lethargy were the most common clinical features, present in 73.3% and 60% of patients with meningitis respectively. Neonates with meningitis had a higher mean CSF protein value (2.67 g/L vs 1.97 g/L, p=0.367) and a significantly higher mean CSF white cell count (21 cells/mL vs 7 cells/mL, p=0.001). The most common aetiological agents were Escherichia coli (46.7%). Group B. Streptococci (26.7%) and Klebsiella pneumoniae (13.3%). Most blood and CSF isolates were resistant to ampicillin and gentamicin but showed good in-vitro sensitivities to amikacin, cefuroxime and the third generation cephalosporins (ceftriaxone, ceftazidime and cefotaxime). Blood cultures were positive in only 53.3% of neonates with meningitis. CONCLUSION: Neonatal bacterial meningitis is an important clinical problem at KNH with a prevalence of 17.9% amongst cases of suspected sepsis. E. coli and Group B Streptococci were the most common aetiological pathogens. Blood cultures were negative in almost half of the patients with meningitis. Resistance to the commonly employed first-line antibiotics (penicillin and gentamicin) is high and a change of empirical antibiotic use for neonates with suspected sepsis is recommended.