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INTRODUCTION: Antibiotic overprescribing is associated with antibiotic resistance worldwide but worst in developing nations. Minimal information exists on the antibiotic prescribing habits of essentially all cadres of healthcare workers in Nigeria, but particularly primary healthcare (PHC) workers. Our aim was to explore antibiotic prescribing habits of Nigerian primary healthcare workers in the context of increasing antibiotic resistance which has a direct effect on healthcare associated infections (HCAIs) and patient safety worldwide. METHODS: a questionnaire-based cross-sectional study was conducted among 442 primary healthcare workers across three Northern Nigerian states of Gombe, Sokoto and Kwara. Data obtained was analysed using SPSS version 20. RESULTS: antibiotic prescription rate was 98.2%. The most commonly prescribed antibiotics were amoxicillin (71.7%) and ampicillin/cloxacillin (70.1%) while the least was meropenem (4.1%). Major indicators of antibiotics abuse include unconfirmed typhoid fever (96.1%), non-specific vaginal discharge (95.4%), fresh trauma wound (91.3%), non-specific diarrhoea (87.1%) and common cold (85.9%). Additionally, about one-third of the respondents also routinely prescribe antibiotics to healthy birds (31.5%) and animals (18.3%). Identified reasons attributed to antibiotic overprescribing from the participants´ perspectives include lack of awareness (87.0%), lack of penalty (79.4%), desire to help patients (76.5%), pressure from sales representatives (61.0%) and patients´ pressure (58.3%). Overall, majority (85.8%) of respondents agrees that overprescribing is a cause of antimicrobial resistance. CONCLUSION: overprescribing of antibiotics is common among PHC workers and could contribute significantly to the rising scourge of antimicrobial resistance and poses a threat to patient safety and associated increased burden of HCAIs.

Background: Post burn digital contractures account for 30% of new outpatient clinic visits but 25% of elective surgery load in our practice. There is a lot of backlog and pressure to operate particularly in the pediatric age group. We were able to demonstrate in this series that irrespective of the duration, uncomplicated post burn contractures are usually not complicated by ankylosis and a single stage complete release is possible. Aims and Objectives: 1. To determine if multiplicity of joint involvement and duration between burn and corrective surgery affect outcome. 2. To determine the range of complications after post burn digital contracture release. 3. To determine if preoperative plain radiographs are necessary in uncomplicated post burn digital contractures. Materials and Methods: Retrospective analysis of the records of 33 patients. Data collected included socio demographic and disease characteristics, etiology of burns, duration of burns before corrective surgery, complications after corrective surgery. Data was analyzed using SPSS version 16.0. All patients with contractures in other joint other than digits and from other causes other than burns, or burns associated with mechanical trauma were excluded. Results: Mean age 8 yrs, nearly equal sex distribution. Scald 48.5%, flame 21.2%, contact burn 9.1%, others 21.2%. Mean duration between burn and contracture release 40months. Overall, 172 joints were involved in 33 patients, 69.7% had incision ,+ FTSG, 3% had incision+ STSG, 6.1% had Z plasty only and 21.2% had Z plasty + FTSG. In 32 patients (97%) complete intra op contracture release was achieved. Twenty patients (60.6%) healed without complications, recorded complications post op were wound infection (30%), graft shift and digital tip gangrence. Conclusion: Prolonged duration between burn and eventual contracture release does not affect achieving complete contracture release, neither does multiplicity of joint involvement.

This is a case report to highlight the atypical presentation of hand ulcers caused by herpes simplex virus (HSV) in immunocompromised patients. We report a case of a 43-year-old right-handed female who developed a nonhealing and progressive ulcer involving the left middle finger and extending to the palm for which she was referred to our facility. Initial clinical diagnosis following examination was squamous cell carcinoma. However, carefully observed similar new lesions she developed while being investigated was in favour of HSV infection. She had remarkable response on acyclovir which substantiated the diagnosis. Awareness and a high index of clinical suspicion are required of physicians who may come across similar lesions.

Background: The burn unit, like any high dependency, unit is awash with multi-antibiotic resistant microbes, and the clinician is in a constant battle to prevent such infections from becoming established. After the elimination of hypovolemic shock as a cause of death, infections constitute the leading cause of morbidity and mortality in burn patients. Aims and Objectives: This study aimed to determine the incidence of infection in our burn unit and to demonstrate how our burn unit routine leads to a low incidence of infection in our setting. Materials and Methods: This is a retrospective review of the records of patients attended to between 2009 and 2013 in the burn unit of Federal Teaching Hospital, Gombe, Nigeria. Details of the treatment and follow-up data were obtained from patients' case files using a predesigned pro forma. All patients were within 24 h of burn and had wounds cleaned under general anesthesia before admission to the unit. In addition, all patients with major burns received infusion of glucose, potassium, and insulin (GKI). Antibiotics use was strictly regulated and was guided by known antimicrobial and sensitivity patterns. Results: Thirty-three patients were admitted within the study period, of whom 27 patients had complete information and were analyzed. The mean age of the burn patients was 11 ± 16.7 (SD) years. There were 16 (59.3%) males and 11 (40.7%) females. Scalding and flame burns accounted for 20 (74.1%) and seven (25.9%) patients, respectively. Only four (14.8%) patients developed wound infection on admission (three were in the age range of 11 years and below, while one was 57 years old) and one patient had gastrointestinal tract (GIT) infection. One patient died from suspected thromboembolism within 24 h of burn, and 14 (51.8%) and 12 (44.4%) patients were discharged with and without residual burn wounds, respectively. The average burn surface area was 18.9%. The average length of stay (LOS) was 18.65 days and the average LOS per patient per percentage burn surface was 0.98 days. On follow-up at 2 weeks after discharge, four (14.8%) patients had delayed wound healing and seven (25.9%) patients developed hypertrophic scars. Conclusion: Our findings indicate a low incidence of infection related complications and it appears that our burn unit routine may play a significant role.

Common features of Van der Woude syndrome include pits and or sinuses of the lower lip, cleft lip with or without cleft palate, isolated cleft palate, bifid uvula, and hypodontia. When associated with a web of the popliteal region, it is called popliteal pterygium syndrome. Here we present a case of popliteal pterygium syndrome with incidental finding of membranous type choanal atresia on attempt at nasotracheal intubation for general anesthesia.