Management of community acquired pneumonia (CAP) in children: Clinical practice guidelines by the Paediatric Association of Nigeria (PAN

The Paediatric Association of Nigeria first published management guideline for community-acquired pneumonia in 2015 and covered available evidence at that time. This update represents a review of available recent evidence statements regarding the management of pneumonia in children, while at the same time incorporating relevant materials from the first edition of the guideline. The guideline is developed to assist clinicians in the care of children with CAP. The recommendations provided in this guideline may not be the only approach to management, since there are considerable variations among children in the clinical course of CAP.The goal of this guideline is to reduce morbidity and mortality rate of CAP in children by providing recommendations that may be relevant in assisting clinicians to make timely diagnosis and institute appropriate antibiotic therapy of children with CAP. Summarized below are recommendations made in the new 2021 CAP guideline. As part of the recommendations, the quality of the evidence is provided and the grade of the recommendation indicated.The details of the background, methods and evidence summaries that support each of these recommendations can be found in the full text of the guideline.

Prevalence and outcome of pregnancy among elderly primigravida in Aminu Kano teaching hospital, Kano: a 5 year review

Background: As women increasingly delay child bearing, the proportion of women having their first delivery at ''advanced maternal age'' is expected to rise. These elderly primigravidae have traditionally been considered to be at increased risk of adverse maternal and perinatal outcomes compared to their younger counterparts, because of associated pregnancy and labour complications. Objectives: To determine the prevalence of elderly primigravidae and compare their pregnancy outcome with that of younger primigravidae in Aminu Kano Teaching Hospital, Kano. Materials And Methods: This was a retrospective case control study comparing the pregnancy outcome of primigravid mothers aged 35 years and above (elderly primigravidae) with those of younger primigravidae aged 20-25 years, who delivered at Aminu Kano Teaching Hospital between January 2009 and December 2013. Results: There were 18,452 deliveries during the period under review, out of which 295 were primigravidae aged 35 years or above giving a prevalence of 1.6%. There was statistically significant higher preterm delivery rate ( X2= 10.30, P= 0.001) and caesarean delivery rate (X2= 12.15, P= 0.0001) among the elderly primigravidae compared to younger primigravidae. The elderly primigravidae were more prone to hypertensive disorders in pregnancy (X2=23.96, P=0.0001) and diabetes (X2=4.689, P=0.030) compared to the younger primigravidae. The prevalence of antepartum haemorrhage (X2=6.434, P=0.011) and uterine fibroids (X2=5.549, P=0.019) were also statistically significant among the elderly primigravidae compared to the younger primigravidae. There was no significant difference in the other maternal and foetal outcome measures. Conclusion: The prevalence of elderly primigravidae in this study was 1.6%. The prevalence of obstetric complications such as preterm delivery, antepartum haemorrhage, uterine fibroids coexisting with pregnancy and medical conditions like hypertensive disorders in pregnancy and diabetes mellitus are higher among elderly primigravidae compared to younger primigravidae. The elderly primigravidae were also more liable to have caesarean deliveries than the younger primigravidae. However there was no difference in the fetal outcome in the two groups

Surgical-Site Infection Following Cesarean Section in Kano; Nigeria

Objectives: To determine the prevalence, risk factors and common bacterial pathogens for surgical site infection (SSI), following cesarean section (CS). Materials and Methods: A retrospective case-control study of patients delivered by CS in Aminu Kano Teaching Hospital, Kano, Nigeria. The cases were the patients whose CS was complicated by SSI; they were matched by other patients delivered by CS who had had no SSI as controls. Hospital records of cases and controls were compared.Results: Four hundred and eighty five hospital records were available for review, 44 (9.1%) had SSI. Statistically significant determinants of infection are: Long duration of labor before CS (P<0.001), Long operation time (P=0.009), heavy intraoperative blood loss and blood transfusion (P<0.001). Eleven (25%) of the cases had CS due to obstructed labor compared to 15.3% of controls. Staphylococcus aureus was isolated in 31.8% of the cases. Cephalosporins and quinolones were the most sensitive antibiotics.Conclusion: The incidence of SSI following CS in our unit was 9.1%. Most cases followed prolonged obstructed labor, with long operation time and heavy blood loss. Staphylococcus aureus sensitive to cephalosporins was the most frequently isolated pathogen. Strategies for preventing prolonged obstructed labor and appropriate antibiotic prophylaxis may prove effective

The modulatory effect of cochlospermum tinctorium a rich aqueous root extract on liver damage induced by carbon tetrachloride in rats

The aqueous root extract of Cochlospermum tinctorium (CTR) was investigated for its phytochemical composition; acute oral toxicity and hepatoprotective effect on carbon tetrachloride (CCl4) induced liver damage in rats. Phytochemical screening indicates the presence of alkaloids; tannins; cardiac glycosides; saponins; flavonoids; triterpenes; cyanogenic glycosides and volatile oils while steroids and anthraquinones were absent. Administration of 5000 mg/kg (body weight) of the extract orally did not produce any death in the rats within the observable period. The extract at 100 - 300 mg/kg (body weight) significantly and dose dependently reduced the levels of Alanine aminotransferase (ALT); Aspartate aminotransferase (AST) and Alkaline phosphatase (ALP) enzymes levels in the CCl4 -treated rats. The values of serum albumin; serum total protein and reduced glutathione in the extract treated groups of rats remained comparatively higher than its values in the CCl4 - treated group. The pretreatment of the rats with the extract produced a significant (P 0.05) reduction in blood clotting time. The histopathological findings were in support of the biochemical changes recorded during the study. These results suggest that aqueous root extract of CTR possess hepatoprotective effect against CCl4- induced liver damage in rats and the extract at 5000 mg/kg body weight appeared to be safe when administered orally