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Histoplasmosis, an invasive fungal infection endemic in the Americas, Africa, and Asia, with a few cases reported among immigrants to Europe, was classified as an AIDS-defining disease in 1987 (1,2). [...]

IntroductionFever is both a sign of various diseases (chief of which are infectious in nature) and an adverse effect of certain interventions (e.g. vaccines, drugs) in the pediatric population. It elicits anxiety among caregivers and healthcare professionals alike resulting in non-evidence based practices, adverse medication administration events, waste of scarce resources and overutilization of health facilities. The determinants of these practices among caregivers in the domiciliary contexts have not been well characterized in developing settings.MethodsWe assessed the knowledge and practices of childhood fever and their determinants among caregivers in domiciliary settings in Northern Nigeria using a 41-item questionnaire between August 2020 and February 2021.ResultsThe questionnaire is reliable (knowledge: Cronbach's Alpha = 0.689; practice: Cronbach's Alpha = 0.814) and collected data on a total of 2,400 caregiver-child pairs, who participated in the study. Over two-third (68.3%; 1,640) of the caregivers expressed fever phobic tendencies. Paracetamol was the most commonly used medication and constituted 31.3% of medication administration adverse events reported by the caregivers. Only one out of every six knowledgeable caregivers engaged in evidence-based home childhood fever management practices (7% vs. 41.6%) with being a primary caregiver [Knowledge: odd ratio (OR): 2.81, 95% CI: 0.38; 5.68; p value: 0.04; Practice: OR: 1.65, 95% CI: 0.09; 7.33; 0.02] and having a child/children aged ≤3 years (knowledge: OR: 7.03, 95% CI: 4.89; 9.67, p value: 0.003; practice OR: 3.11, 95% CI: 1.27; 8.59, 0.007) determining both the knowledge and practices of childhood fever management in a household.ConclusionsThe knowledge and practice of childhood fever management among caregivers were sub-optimal with being a primary caregiver and having a child/children aged ≤3 years being the significant determinants of each domain. These gaps underscore the dire need for targeted strategies aimed at improving childhood fever management by educating caregivers.

Sources of healthcare financing especially among surgical patients in Nasarawa state is presently unknown. Sub-Saharan African countries have introduced a number of methods to funding healthcare system. The Nigerian government commenced implementation of a social health insurance scheme (National Health Insurance Scheme; NHIS) so as to improve on healthcare funding for its citizens. This study determined the sources of financing surgical cases, type of surgeries and compared the cost of treatment among patients attending the Dalhatu Araf Specialist Hospital and other Health Centers in Nasarawa State. It was a hospital based cross-sectional descriptive study among 420 adults aged 18 years to 75 years in a study that lasted for two years. The data collected was analyzed using Statistical package for the Social Science (SPSS) version 20.0. Significant p was < 0.05. The average age of patient was 28.6 ± 11.9 years. There were more females (75.5%) with most (73.8) of our participants living in rural areas. Majority (60.0%) had Caesarean Section and one-sixth had exploratory laparotomy respectively. Most spending for healthcare needs was Out-Of-Pocket (OOP) with only a handful (6.7%) enjoying insurance coverage. The average cost of surgery was 41,337.73 Naira and 28,426.47 Naira among the low and high socio-economic class respectively. Most of the participants in this study were on Out-Of[1]Pocket healthcare financing with only one out of fifteen having health insurance coverage of the NHIS. Most of the surgical patients are from the rural areas, are females, do not attend tertiary level of education and are of low socio-economic status. Caesarean section and exploratory laparatomy were the predominant indications for surgeries. Those from the lower socio-economic status pay more for surgeries even though they earn less. We recommended that the state consider State health insurance agency and this should cater for people in both the formal ana the non-formal sectors. In addition, rural dwellers and surgeries such as caesarean section and emergency laparatomies should not be left out.

Background Fungal lung diseases are global in distribution and require specific tests for diagnosis. We report a survey of diagnostic service provision in Africa. Methods A written questionnaire was followed by a video conference call with each respondent(s) and external validation. To disseminate the questionnaire, a snowball sample was used. Results Data were successfully collected from 50 of 51 African countries with populations >1 million. The questionnaire was completed by respondents affiliated with 72 health facilities. Of these 72 respondents, 33 (45.8%) reported data for the whole country while others reported data for a specific region/province within their country. In the public sector, chest X-ray and computed tomography are performed often in 49 countries (98%) and occasionally in 37 countries (74%), and less often in the private sector. Bronchoscopy and spirometry were done often in 28 countries (56%) and occasionally in 18 countries (36%) in the tertiary health facilities of public sector. The most conducted laboratory diagnostic assay was fungal culture (often or occasionally) in 29 countries (58%). In collaboration with the Africa Centre for Disease Control and Prevention, regional webinars and individual country profiles provided further data validation. Conclusion This survey has found a huge disparity of diagnostic test capability across the African continent. Some good examples of good diagnostic provision and very high-quality care were seen, but this was unusual. The unavailability of essential testing such as spirometry was noted, which has a high impact in the diagnosis of lung diseases. It is important for countries to implement tests based on the World Health Organization Essential Diagnostics List.

Abstract Background Human Immuno-Deficiency Virus (HIV) remains one of the world’s significant public health challenges. Viral suppression is the key indicator for treatment success in People living with HIV (PLHIV). We determined the level of viral suppression, and its associated factors among PLHIV attending Federal Medical Centre Katsina (FMC Katsina), Nigeria. Methods This retrospective descriptive cross-sectional study was conducted on 913 HIV positive adults enrolled in care between January 2009 and December 2019. Information on socio-demographics, clinical, immunological, Viral load (VL), and other relevant parameters were extracted from the patients’ care records. The primary outcome was the proportion of patients that achieved viral suppression. We also analyzed variables that were associated with VL suppression. Results Of 913, records of 831 (91.0%) registered patients were analyzed. During the period, 751 (90.4%) achieved viral suppression, 427 (51.4%) had CD4 counts ≥ 500 and 477 (57.4%) were on HAART for ≥ 5 years. Majority, 793 (95.4%) were on first-line HAART regimen (Tenofovir-Lamivudine-Dolutegravir or Abacavir-Lamivudine-Dolutegravir), and 809 (97.4%) in the non-advanced stage (WHO stages 1 and 2). The median (interquartile range) of viral load was 20 (20–40) vs 19,989 (3311–110,340) cp/ml in virally suppressed, and unsuppressed respectively. Factors associated with viral suppression included being unemployed (Adjusted OR [AOR] 4.9, 95% CI 2.771, 8.539), educated (AOR 4.2, 95% CI 1.098, 16.223), having a baseline CD4 count ≥ 500 cells/µl (AOR 2.7, 95% CI 1.588, 4.625), and being on first line HAART regimen [AOR 7.0, 95% CI 3.220, 15.648]. Conclusions Our study demonstrated a good viral suppression among PLHIV on HAART. Variables associated with viral suppression included unemployment, formal education, high baseline CD4 count, and first line HAART regimen.

Background: Globally, intensive care units (ICUs) are encountering emergence and spread of antibiotic-resistant pathogens, and for some pathogens, there are few therapeutic options available. Objectives: The study assessed prevalence, susceptibility pattern, and risk factors of carbapenem-resistant Enterobacteriaceae (CRE) infections among ICU patients in Kano, Nigeria. Materials and Methods: A descriptive cross-sectional study was used to study 190 patients admitted to the ICUs of two tertiary hospitals in Kano. Antibiotic susceptibility of isolated organisms was determined by disc diffusion technique. Suspected carbapenemase producers were further subjected to the modified Hodge test (MHT) method for confirmation. Results: A total of 76 out of the 190 samples yielded clinical isolates of Enterobacteriaceae as follows: 34 (44.7%) Escherichia coli, 19 (25%) Klebsiella pneumoniae, 3 (3.9%) Proteus mirabilis, 4 (5.3%) Enterobacter aerogenes, 3 (3.9%) Proteus vulgaris, 2 (2.6%) Citrobacter freundii, 2 (2.6%) Klebsiella ozaenae, 2 (2.6%) Klebsiella oxytoca, 2 (2.6%) Salmonella subsp. 3b, 2 (2.6%) Enterobacter agglomerans, 2 (2.6%) Enterobacter cloacae, and 1 (1.3%) Serratia odorifera. Screening the Enterobacteriaceae-positive samples for carbapenem resistance using ertapenem disc (10 μg) showed 8 samples (10.5%) as resistant while MHT gave a carbapenem resistance prevalence of 7.9% (6 out of 76). Based on multiplex polymerase chain reaction; the distributions of genotypes of the carbapenemase producers were as follows: Verona Integron Metallo-beta-lactamase (VIM) genes only (4 [50%]) New Delhi Metallo-beta-lactamase (NDM) genes only (2 [25%]), and 1 (12.5%) had Klebsiella pneumoniae carbapenemase (KPC) and VIM gene coexisting. Surgical procedure (P = 0.009) and history of recent admission (P = 0.001) were found to be risk factors for CRE. Conclusion: The study provided evidence of the presence of CRE infections among patients admitted to ICUs in the study centers. This underscores the need for effective infection prevention and control measures to avoid the spread of CRE in hospital setting.

BackgroundThe year 2020 Lassa fever (LF) outbreak had the greatest disease burden and this can place an enormous strain on the already overstretched healthcare system and can potentially increase morbidity and mortality due to infectious diseases. Therefore, having a knowledgeable healthcare workforce with appropriate skills and competencies to prevent and manage outbreaks of a neglected infectious disease such as LF in Nigeria will potentially enhance public health. Thus, this survey assessed the level of knowledge of LF and its prevention and control (PC) measures amongst the healthcare workers (HCWs) during a LF outbreak in Katsina state, Nigeria.Methodology/principal findingsDuring this cross-sectional survey, HCWs complete a validated 29-item questionnaire comprising 18 items on the knowledge of LF and its PC measures and an item on global self-evaluation of their LF knowledge. Psychometric properties of the questionnaire were evaluated. Chi-square and binary logistic regression analyses were conducted. Out of 435 HCWs invited, a total of 400 participated in the study (92% response rate). The majority of participants (51.8%) demonstrated inadequate LF knowledge, with 62.9% of those scoring low having a high self-perception of their LF knowledge with the global scale. This LF knowledge over-estimation was predicted by LF training status (odds ratio (OR) 2.53; 95% CI: 1.49-4.30; p = 0.001). The level of LF knowledge and its PC measures among the study participants was low (11.60±8.14, 64.4%) and predicted by participants' LF training status (OR 2.06; 95% CI: 1.19-3.57; p = 0.009), place of work (OR 1.82; 95% CI: 1.07-3.08; p = 0.03) and their designations (OR 2.40; 95% CI: 1.10-5.22; p = 0.03).ConclusionThe level of knowledge of LF and its PC measures among the HCWs surveyed was suboptimal and participants' LF training status, place of work and occupational category were the significant predictors. In addition, LF knowledge overestimation on a global scale was observed among a majority of HCWs and this was also predicted by LF training status. Therefore, there is a critical need for health authorities in Nigeria to prioritize continuous on-the-job training of HCWs on priority neglected tropical diseases such as Lassa fever.

Introduction and objective Infections due to multidrug-resistant (MDR) Enterobacteriaceae are an ongoing global threat in their management. The aim of the study was to investigate the antiimicrobial resistance (AMR) and virulence gene profiles of MDR Gram-negative isolates in Sokoto, north-west Nigeria. Material and methods A total of 578 clinical samples were collected from patients. Suspected Gram-negative bacteria were isolated from these clinical samples: vaginal swab, pus, stool, blood, wound swab and urine, using Gram-staining and conventional biochemical reactions. These isolates were further identified with an identification kit (Microgen-GN-A), and tested against a panel of 11 antibiotics. A single polymerase chain reaction (PCR) assay targeting 13 virulence gene related to adhesion ( fim H, pap C, and sfa S), iron chelation ( iut A, and fyu A), toxins ( ast A, stx 1, stx 2, and eae A), biofilm ( bss S), and serum resistance ( tra T, iss , and kaps MTII) encoding genes were evaluated. Results A total of 276 Gram-negative isolates were identified using the Gram stain and biochemical reactions. These organisms were further confirmed with identification kit. Of the 276 isolates, 36 organisms of interest (23 Escherichia coli , 4 Klebsiella pneumoniae and 9 Proteus mirabilis ) were identified. Other Gram-negative isolates accounted for the remaining 86.9%. The majority of the isolates were resistant to cefixime (100%) and partially resistant to amikacin (19.4%).The virulence genes bssS (58.3%), fim H (44.4%), and iut A (44.4%) were the most prevalent, whereas kaps MTII (5.6%) and stx 2 (2.8%) were least detected, while ast A was not detected in any of the isolates. Conclusions The study elucidated the prevalence of antibiotic resistance and virulence genes in Gram-negative bacteria from clinical isolates in Sokoto, north-western Nigeria. The majority of the isolates were MDR, thereby posing a public health risk.

Abstract Background The advent of Highly Active Antiretroviral Therapy (HAART) is associated with improved clinical and laboratory outcomes resulting in prolonged life and well-being of people living with Human Immunodeficiency Virus (PLHIV). However, the needs for life-long therapy, medications’ side effects and stigma have raised concerns about their quality of life (QOL). This study assessed the determinants of Health-related quality of life (HRQOL) among HIV-positive patients at Ahmadu Bello University Teaching Hospital (ABUTH) Zaria. Methods We conducted a cross-sectional study of 353 HIV-positive adults on HAART attending the HIV clinic of ABUTH, Zaria. The participants were recruited into the study using a systematic sampling technique. Data on socio-demographics, medical parameters, QOL and family functionality were collected using structured, interviewer-administered questionnaire. The World Health Organization (WHO) Quality of Life HIV short form instrument (WHOQOL-HIV BREF) item and Family APGAR tool were respectively used in assessing the QOL and family functionality of the participants. We performed univariate, bivariate and multivariate analysis. Results Mean age was 39.1(±10.9) years, 239 (67.7%) were females, 208 (58.9%) were Hausa-Fulani, 240 (68.2%) married and up to 210 (59.4%) had at least a secondary education. The overall mean scores on the scale of 4–20 for HRQOL were similar in three domains: environment domain 14.5(±2.8); social relationship 14.4(±3.1) and level of independence 14.4(±2.5). Lower scores were recorded in spirituality/religion/personal beliefs 12.3(±4.3). Identified determinants of HRQOL were spousal HIV- positive status (AOR = 3.37; CI; 1.46–7.74) and high family function (AOR = 2.57; CI: 1.51–4.39). Conclusion Having highly functional family and having HIV-positive partner were the major determinants of HRQOL. Routine family counselling and strengthening the HIV social-support network should be incorporated into the routine patients’ care in HIV treatment centers.

The characteristics of the emulsified fuel is largely influenced by the production methods of the emulsion. Although, blending by means of mechanical blender is widely used, the efficacy of using direct ultrasonic homogenizer in producing emulsified fuels has not been explored extensively. Mechanical blender uses metal blades to shear and mix the liquids and the produced emulsion quality would depend on the blade design, rotating speed and mixing duration. Hence, the homogeneity of emulsions produced by different blenders is not consistent. On the hand, ultrasonic homogenizer utilized direct ultrasonic force to produce high frequency vibrating waves to disrupt the immiscible liquid layers and mixed the liquids. Consistency and homogeneity of the emulsion produced by any direct ultrasonic homogenizer can be realized by changing the ultrasonic power, frequency and mixing duration. The current work describes the vital characteristics of water-in-biodiesel emulsions (WiBE) produced by direct ultrasonic homogenization and subsequently, ascertaining the optimum emulsion blends that meet the recommended international fuel specifications for a diesel engine. A total of 48 WiBE samples were prepared and their properties were characterized. The variable parameters for the blends are water content varying from 9% to 15%, three surfactant dosages of 5%, 7% and 9%, and hydrophilic-lipophilic balance (HLB) values ranging from 6 to 9. The results showed that the water particles in the emulsion were uniformly distributed within the continuous phase (biodiesel) and the sauter mean diameter (SMD) values of the water particles were generally small at a mean value of 2.25 µm. Emulsions with 7% and 9% surfactant dosages were observed to have lower SMD values for HLB 7 and HLB 8 respectively. 33 out of 48 samples were found to be stable emulsions. Emulsion with 11% water had the lowest mean density. The viscosity of all samples increased as water contents and surfactant dosages increase. Two samples were found to be the optimum WiBEs which are, 11% water content at HLB 7 with 9% surfactant dosage, and 11% water content at HLB 8 with 7% surfactant dosage. Keywords: Palm oil, Physicochemical properties, Sonication method, Emulsified fuel, Surfactant, Droplet size

This paper presents the study of water-in-biodiesel emulsions (WiBE) stabilized by surfactants with different hydrophiliclipophilic balance (HLB) on a single-cylinder diesel engine. The engine performance and exhaust emissions were compared against the base fuel biodiesel (B5 diesel) which contained 5% palm oil methyl ester (POME) in the diesel fuel, at a constant engine speed of 2000 rpm with different engine loads. 36 emulsion blends of B5 diesel mixed with 9%, 12% and 15% volume of water, HLB values of 6, 7, 8 and 9, and surfactant dosage of 5%, 10% or 15% by percentage volume of water added. The results exhibited 11.7% lower engine power with WiBE as compared to B5 diesel. It was also observed that WiBE produced higher in-cylinder pressure and heat release rate. WiBE with higher water content at high load condition produced up to 15.2% higher peak pressure with a significant reduction in both NOx and smoke opacity, while a moderate decrease in the exhaust temperature was recorded for WiBE. The research work proved that WiBE with 15% water content with optimum HLB value is capable of reducing up to 79% NOx and 23% smoke opacity simultaneously, due to the heat sink effect during combustion.

ALTHOUGH MOBILE BANKING HAS GAINED POPULARITY ALL OVER THE WORLD, BOTH IN RICH AND EMERGING NATIONS, ITS FULL POTENTIAL HAS NOT YET BEEN REALIZED. UNDERSTANDING THE VARIABLES DRIVING ITS UPTAKE AND EFFECTIVENESS IS CRUCIAL GIVEN THE EASE OF 24/7 ACCESS TO FINANCIAL SERVICES AND THE ABILITY TO INVOLVE UNDERSERVED PEOPLE. THE PURPOSE OF THIS STUDY IS TO EVALUATE THE EFFECTIVENESS OF THE MOBILE BANKING SERVICES PROVIDED BY GCB BANK PLC. THE ADANSI SOUTH DISTRICT OF GHANA IS THE SUBJECT OF THIS STUDY BECAUSE IT IS A PROMISING AREA FOR MOBILE BANKING TO CHANGE HOW PEOPLE INTERACT WITH MONEY. DESPITE THE POSSIBILITIES, OBSTACLES INCLUDING UNSTABLE NETWORKS, SECURITY ISSUES, AND LOW CUSTOMER KNOWLEDGE PREVENT BROAD USE. [ABSTRACT FROM AUTHOR]

INTRODUCTION: A typical presentation of Mycetoma is not uncommon although clinical manifestations might be misleading leading to delay in diagnosis, treatment and consequently leading to poor prognosis. Mycetoma can have a fungal or bacterial etiology and manifestation is usually that of a disfiguring subcutaneous infection that can affect any part of the exposed body. We are reporting a case of Mycetoma in an eleven years old girl that occurred in parts of the lower abdomen, perineum and gluteal region that was initially thought to be a soft tissue sarcoma or disseminated tuberculosis. CASE PRESENTATION: An eleven years old girl presented to Usmanu Danfodiyo University Teaching Hospital, Sokoto with lower abdominal mass and multiple nodular masses with discharging sinuses on the upper part of the right thigh, perineum and gluteal region of six months duration. Swellings started as multiple small boils that subsequently started discharging from various points. Patient usually fetches firewood in the forest for her parents as her routine house chores and she remembered an incident where she had pricks from thorns in the bush around her lower thigh and perineum. On examination she was chronically ill looking, in painful distress, with bilateral inguinal lymphadenopathy. She had nodular lesions of varying sizes ranging from 1x1cm to 4x4cm, tender, involving the upper part of the thigh bilaterally, but more on the right, lower abdomen, labia and gluteal region. Some of the lesions had hyper-pigmented sinuses discharging mucopurulent fluid, with areas of soft tissue swelling around the lower abdomen and upper right thigh extending to the leg. Patient was observed to walk with a limp gait. MANAGEMENT AND OUTCOME: An initial diagnosis of soft tissue infection to rule out soft tissue sarcoma and disseminated tuberculosis (abdomen and lymph nodes) and deep tissue mycosis was made. However, with further investigations and reviews by the medical microbiologist and anatomic pathologist, along with bacteriologic, and mycologic studies of swab samples and aspirate and tissue biopsy for Histology revealed an eumycotic mycetoma. She received Ketoconazole and Trimetoprim-sulphametoxazole. She responded significantly as lesions reduced in sizes, abdominal swelling and leg swelling reduced with closure of discharging sinuses. Patient could walk with some resolution of the limp. Repeat abdominal ultrasound scan showed resolution of initial findings. She spent four weeks in the hospital and was discharged. On subsequent follow-up; she was walking without any limp and lesions were healed with some scar and few areas left to dry up. Further follow-up visits after one month and three month showed progressive healing and complete resolution of lesion respectively. However. Patient was however lost to further follow-up which would have enabled monitoring as to any reoccurrence or not. CONCLUSION: We presented a case of a young girl with an abnormal presentation of eumycotic mycetoma. Patient achieved near cure on medications without the need of surgery due to an excellent multidisciplinary approach between pediatricians, clinicians, clinical microbiologists and anatomic pathologists.

The objective of this work was to upgrade bio-oil from bagasse by pyrolysis using catalyst/biomass of three different compositions (5, 15 and 20 wt% HZSM-5 loadings). The thermal analysis and product distribution experiments were carried out in a thermogravimetric analyzer (TGA) and a fixed bed reactor, respectively. In TGA, the pyrolysis of catalytic runs shifted the thermograph curves to the lower temperatures and generated high yield residues compared to that obtained from non-catalytic run. From a fixed-bed condition, the maximum bio-oil yield from non-catalytic and catalytic runs at a temperature of 500 °C at 15% ZSM-5 catalyst concentration were 49.4% and 21.1 wt% respectively. Aromatics, phenols and oleic acids are the main chemical components deduced from gas chromatography/mass spectrometry (GC–MS) analysis of the bio-oil. Bio-oil from catalytic pyrolysis had more aromatics (desirable component) and less oleic acid (undesirable component) than the bio-oil from non-catalytic pyrolysis. The study of bio-oil from catalytic bagasse pyrolysis enhances desirable component when used as transportation fuel. Besides addition of catalyst improving the degradation mechanism of biomass also alters the product composition closer to the aromatic range hydrocarbon. Keywords: Bagasse, Pyrolysis, TGA, Fixed bed reactor, Catalytic, Bio-oil

INTRODUCTION: The most recently discovered severe acute respiratory syndrome Coronavirus 2 (SARS-COV-2) that causes COVID-19, subjected the entire world in turmoil health-wise and economically. With higher burden of malaria in Nigeria and other Sub-Saharan African countries coupled with fragile healthcare system and delivery, these may pose a threat in the diagnosis and management of COVID-19 patients co-infected with malaria. Free radicals have been implicated in the progression and pathogenesis of malaria and COVID-19 through Fenton’s reaction and cytokine storm respectively. METHODS: the current research comprises of seventy-four (74) participants; 20 apparently healthy controls and 54 COVID-19 patients (20 among which were co-infected with malaria). Serum levels of 8-iso PGF2α and Alphatocopherol were determined among the study participants using ELISA technique and colorimetric assay, respectively. RESULTS: results revealed statistically significant elevation of 8-iso PGF2α in COVID-19 patients co-infected with malaria compared to COVID-19 patients only, and this may be due to increase production of free radicals. Furthermore, a significant decrease of Alphatocopherol was observed in COVID-19 co-infected with malaria compared to COVID-19 patients due to increase utilization of antioxidants in counterbalancing the negative effect of free radicals generated. CONCLUSION: conclusively, SARS-COV-2 patients co-infected with malaria might be predisposed to oxidative stress and low Alphatocopherol. The increase in oxidative stress is proportional to malaria parasite density and inversely related to Alphatocopherol levels. This implies that oxidative stress is notably higher and such patients may have a severer form of the COVID-19. Increased 8-iso-PGF2α in co-infection and decreased alphatocopherol levels can reflect the severity and adverse outcomes compared to COVID-19 naïve because of their tremendous involvement in the pathogenesis and progression of diseases.

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. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Cholera is an acute gastrointestinal infection caused by Vibrio cholerae, which may lead to severe dehydration and death if not treated. This analysis is aimed at highlighting the magnitude, pattern and trend of cholera outbreak that occurred in Kaduna State in 2014. METHODS: we obtained the 2014 cholera line-list from the Kaduna State Disease Surveillance and Notification officer (DSNO). We described the outbreaks in time, place and person using Epi-info 7 and Health Mapper. RESULTS: a total of 1468 case-patients and 54 deaths were recorded, giving a case fatality rate (CFR) of 3.68%. Female case-patients were 809(55.08%). The median age for case-patients was 15 years, with an age range of 0.04-90 years. Age specific case fatality rate (ASCFR) is highest among the 60 years. Seven (30%) out of the 23 local government areas (LGAs) in Kaduna State were affected by the cholera outbreak in 2014. Igabi LGA has the highest attack rate (150.46 per 100,000 population) while Chikun LGA has the lowest attack rate (12.22 per 100,000 population). Chikun LGA records the highest CFR (17.54%). Cholera infection spread across LGAs sharing the same borders. The outbreak started from the first epidemic week of 2014 and lasted over 33 weeks. CONCLUSION: our analysis revealed a protracted cholera outbreak that gradually increases in magnitude throughout the first half of 2014 and spread within contiguous LGAs. We recommended the strengthening of the state's diseases surveillance system towards timely detection and early response to disease outbreaks in the future.