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BackgroundSepsis is a life-threatening infection that can lead to organ failure and death. We aim to assess predictors of mortality among children admitted with Septicemia at a referral health facility in Northwestern Nigeria.MethodsWe conducted a prospective cross-sectional study of children aged 0-14 years admitted to various units of the pediatrics department of the health facilities. Children were recruited between September 2018 and November 2019. All recruited children were followed up on clinical progress until either discharge, abscondment, or death. We assessed the children clinically daily and collected whole-blood samples for laboratory tests. We conducted a univariate and multivariable analysis using STATA-16 to assess identified predictive factors with our outcome variable.ResultsA total of 326 children were recruited, median age: 2-years. About 54.0% of the children were boys, and 53.1% were within 1-5 years age-group. Predominant organisms cultured from the blood of the children were Salmonella typhi (5.7%), Klebsiella pneumoniae (2.3%), and Staphylococcus aureus (2.0%). A total of 35 deaths were recorded with a case fatality rate (CFR) of 10.7%. CFR is highest in children Child’s vaccination status, mother’s education level as well as blood lactate levels, GCS, qSOFA score and positive blood culture were significantly associated with child’s mortality. Factors associated with increase mortality include; children with incomplete vaccination history [OR=1.72, 95%CI: 2.74–15.53] versus those with full vaccination; children whose mothers had no formal education [OR=14.39, 95%CI: 3.24–63.99] when compared to those children whose mothers have tertiary level of education. Furthermore, children with whole blood lactate level between 4-8mmol/l [OR=3.23, 95%CI: 1.15–9.07], or greater than 8mmol/l [OR=10.54, 95%CI: 3.68–30.14] versus children with whole blood lactate level less than 4mmol/l; children with qSOFA score of 3 [OR=15.62, 95%CI: 3.31–73.60] versus children with qSOFA score of 1; and children who had a positive blood culture [OR=6.90, 95%CI: 3.04–15.64].ConclusionWe found a high prevalence of severe sepsis at pediatrics department of AKTH. Serum lactate levels, GCS, and qSOFA scores were predictive of mortality. Routine measurement and monitoring of these parameters will improve case management and reduce sepsis related mortality in the hospital.

Supplemental Digital Content is available in the text., IMPORTANCE: At the start of the coronavirus disease 2019 pandemic, medications repurposed for management of coronavirus disease 2019 were used in the absence of clinical trial evidence. OBJECTIVES: To describe the variation and evolution in use of repurposed medications for coronavirus disease 2019. DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study of adults hospitalized with coronavirus disease 2019 between February 15, 2020, and April 12, 2021, across 76 United States and international hospitals within the Society of Critical Care Medicine’s Discovery Viral Infection and Respiratory Illness Universal Study coronavirus disease 2019 registry. MAIN OUTCOMES AND MEASURES: Hospital variation was quantified using multivariable adjusted random effects logistic regression models and unsupervised clustering. Repurposed medications included antivirals, corticosteroids, hydroxychloroquine, immunomodulators, and therapeutic dose anticoagulants. RESULTS: Among 7,069 adults hospitalized with coronavirus disease 2019, 1,979 (28%) received antivirals, 2,876 (41%) received corticosteroids, 1,779 (25%) received hydroxychloroquine, 620 (9%) received immunomodulators, and 2,154 (31%) received therapeutic dose anticoagulants. Contribution of hospital site to risk-adjusted variation was 46% for antivirals, 30% for corticosteroids, 48% for hydroxychloroquine, 46% for immunomodulators, and 52% for therapeutic dose anticoagulants. Compared with the early pandemic, the later pandemic practice phenotypes converged with increased use of antivirals (odds ratio, 3.14; 95% CI, 2.40–4.10) and corticosteroids (odds ratio, 5.43; 95% CI, 4.23–6.97), with decreased use of hydroxychloroquine (odds ratio, 0.02; 95% CI, 0.01–0.04) and immunomodulators (odds ratio, 0.49; 95% CI, 0.34–0.70). There was no clinically significant change in the use of therapeutic dose anticoagulants (odds ratio, 1.01; 95% CI, 1.01–1.02). There were no differences in risk-adjusted mortality between hospitals with high rates of repurposed medication use compared with hospitals with low rates of use. CONCLUSIONS AND RELEVANCE: Hospital variation in the use of repurposed medications varied widely across hospitals early in the pandemic and later converged with the emergence of randomized clinical trials. Platforms developed for rapid activation and enrollment in clinical trials of repurposed medications are needed prior to the next pandemic to expedite effective, evidence-based practice.

Malignant histiocytosis is a rare condition with variable clinical presentation and prognosis. Its diagnosis requires high index of suspicion and further evaluation. Thus, it poses a diagnostic as well as management challenges especially in resource poor setting. The objective is to highlight the diagnosis and treatment challenges in the management of malignant histiocytosis so that physicians can diagnose it early and initiate appropriate treatment. Our patient is a 35-year-old man who presented with chest wall mass, dyspnoea and right cervical lymphadenopathy He was initially being evaluated for lymphoma. Biopsy of the lymph nodes was done twice in different hospitals and that of the chest wall mass done once. Histological diagnosis was arrived at with the aid of immunohistochemistry three months after his first presentation to the hospital. The patient was then commenced on chemotherapy and showed remarkable improvement on the short-term basis. Malignant histiocytosis is a rare disease laden with management challenges. Despite that, its diagnosis and treatment can be achieved even in resource poor setting with high index of suspicion, team work and good laboratory support.

Introduction: Painful crisis is the most common manifestation of sickle cell anemia (scA), hence rapid pain control and analgesia should be provided [1, 2]. Pentazocine is a narcotic agonist/ antagonist analgesic commonly used in Nigeria for pain management in both medical and surgical conditions. reports on opioid abuse/dependence amongst scA patients are not commonly published, we report on a young scA lady with pentazocine dependence seen at a psychiatric clinic. case report: We report a case of a 17-yearold known scA female with a six-month history of excessive use of pentazocine. she started selfinjection of pentazocine 18 months ago following a bone pain crisis and is said to have a strong desire to use the drug which she uses on daily basis. Initially, she started with 30 mg daily but currently injects 60 mg bd. she has developed hyperpigmented macules with indurations and scarification marks on both forearms. A diagnosis of pentazocine dependence with mild depression in a sickle cell anemia patient was made. she was admitted at the drug unit and managed accordingly. conclusion: Health care Aishatu Yusha’u Armiya’u1, Bilkisu Ilah Garba2, Dalha Gwarzo Haliru3 Affiliations: 1MBBS, MWACP, FMCPsych, Department of Psychiatry, Jos University Teaching Hospital, Jos. Plateau State, Nigeria; 2MBBS; Dip Allerg; MSc Med; FMCPaed, Department of Paediatrics, Yariman Bakura Specialist Hospital Gusau. Zamfara State, Nigeria; 3MBBS, FMCPath, Department of Haematology and blood transfusion, Bayero University Kano. Kano State, Nigeria. Corresponding Author: Dr Armiya’u Aishatu Yusha’u, MBBS, MWACP, FMCPsych, Department of Psychiatry, Jos University Teaching Hospital, Jos. Plateau State, Nigeria; Email: aarmiyau@gmail.com Received: 07 November 2015 Accepted: 08 January 2016 Published: 04 March 2016 workers should be sensitized on the dangers of analgesic abuse especially in patients with sickle cell anemia. All patients with chronic pain that require long duration of analgesic drugs should be counseled on the symptoms of dependence and informed to report immediately to their doctors.