Background:Immune thrombocytopenic purpura (ITP) is a rare bleeding disorder that may remit spontaneously. Life-threatening bleeding may require transfusion support, steroids, and other immunosuppressive therapy or splenectomy.Objective:To review the clinical presentation and laboratory features of ITP at Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria.Subjects and Methods:A retrospective analytic study of case notes and bone marrow (BM) records of patients diagnosed with ITP at Haematology Department, ABUTH, Zaria, from January 1, 2004, to December 31, 2012.Results:There were nine cases (six females, three males), aged 6–20 (mean 11.11) years. The presentations were epistaxis 8 (88.9%), purpura 4 (44.4%), gum bleeding 4 (44.4%), menorrhagia 2 (22.2%), and intracranial hemorrhage (ICH) 1 (11.1%). Only 1 (11.1%) had clinical splenomegaly. Platelet count of <20 × 109/L was found in 4 (44.4%) while 6 (66.7%) had packed cell volume of <25%. All the nine cases had BM megakaryocytic hyperplasia. Six patients had blood transfusion support while 7 (77.8%) patients received oral prednisolone therapy with time to cessation of bleeding of 12–16 (mean of 8) weeks. One case had spontaneous remission while another had anti-D due to relapse after steroid therapy; this resulted in transient rise in platelet counts. None had other immunosuppressive therapy or splenectomy. Six (66.7%) cases were lost to follow-up after achieving remission and one died of ICH.Conclusion:ITP is not common in our center though its clinical presentations are varied. However, prednisolone and blood transfusion therapy are central to the management of these patients with favorable outcome.
Background Coagulase-negative staphylococci (CoNS) are increasingly becoming emerging bacteria of ‘true’ clinical significance in hospital setting. We investigated an unusual rise in incidence of CoNS bacteraemia among in-patients in a private tertiary hospital, Southwest Nigeria and described ways of mitigation. Methods A descriptive epidemiology of all cases of CoNS bacteraemia reported among in-patients between April 2022 and June 2022 was conducted. Blood cultures were processed in an automated system. Phenotypic and molecular analyses of CoNS were done according to established guidelines. A multimodal infection prevention and control (IPC) approach by the World Health Organisation was implemented. Findings A total of 82 blood cultures (non-duplicate samples) were requested during the period. Of these, 30 (36.5%) were culture-positive and 10 of the isolates were CoNS (10/30, 33.3%). Cumulative incidence of CoNS bacteraemia was 12 cases per 100 patients over 90days from 1–2% in previous months. Staphylococcus haemolyticus (4/10, 40%), Staphylococcus hominis (3/10, 30%), Staphylococcus epidermidis (2/10, 20%) and Staphylococcus saccharolyticus (1/10, 10%) were identified. All isolates were resistant to ciprofloxacin, Trimethoprim-sulfamethoxazole and cefoxitin (methicillin-resistant) while they were all susceptible to both Vancomycin and linezolid. All the isolates fell into S. epidermidis and S. haemolyticus cluster groups. The rates reduced to baseline on the implementation of the IPC strategies. Conclusion The unusual rise of CoNS incidence in the hospital was caused by multi-drug resistant cluster groups of S. haemolyticus and S. epidermidis which was curtailed by the implementation of multimodal strategies.
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