Disseminated Gonococcal Infection Caused by a Multidrug-Resistant Pathogen Presenting with Hemorrhagic Manifestation: A Case Report.

The incidence of disseminated gonococcal infection (DGI) is rising in some parts of the world, but there is paucity of data on its true incidence from sub-Saharan Africa. DGI has varied manifestations in different population group. We report a case of a 30-year-old sexually active woman presenting with hemorrhagic symptoms 2 weeks after a surgery on account of diagnosis of uterine fibroid made at a peripheral hospital. A multidrug-resistant Neisseria gonorrhoeae was isolated from the wound on her surgical site and blood sample. She was managed with intravenous meropenem, pressure dressing, and blood products, with the patient making a full recovery after a week. This case is presented because it is a rare one. Moreover, there is the need to revive the awareness of clinicians on the existence of multidrug-resistant gonococcus in our environment. We herein report a case of DGI from Nigeria.

Comparative Study of Alvarado Score and its Modifications in the Preoperative Diagnosis of Acute Appendicitis at a Tertiary Center in Sokoto, Nigeria.

BACKGROUND: Decision-making in patients suspected of having acute appendicitis has remained a diagnostic challenge worldwide despite the advances in imaging and appendiceal surgery. There have been efforts to improve the diagnosis of appendicitis using clinical scoring systems. AIM: We evaluated and compared the diagnostic accuracy and role of Alvarado score (AS) and two of its modification (Kalan and Al-Fallouji) in the preoperative diagnosis of acute appendicitis. MATERIALS AND METHODS: This was a prospective study conducted at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, of all adult patients operated for acute appendicitis from July 2014 to June 2017. The results were analyzed on computer using Statistical Package for the Social Science version 15. RESULTS: One hundred and eleven patients were studied. Sixty-six (59.5%) patients were males and 45 (40.5%) were females. The male-to-female ratio was 1.5:1. The mean age was 23.89 ± 4.93 years. The AS sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 90.3%, 83.3%, 96.6%, 62.2%, and 89.2%, respectively, were similar to the findings of Kalan score (90.3%, 83.3%, 96.6%, 62.5%, and 89.2%, respectively) and Al-Fallouji score (96.8%, 66.7%, 93.8%, 80%, and 91.9%, respectively). The receiver operating curve and area under the curve show that Alvarado, Kalan, and Al-Fallouji are accurate scores in the preoperative diagnosis of acute appendicitis with an area under the curve of 0.88, 0.86, and 0.85, respectively. CONCLUSION: Kalan and Al-Fallouji scores have comparably good diagnostic accuracy as the AS among our patients. Any of these scores can be used as an adjunct in the preoperative diagnosis of acute appendicitis.