ABSTRACT
Lower gastrointestinal bleeding and rectal prolapse in children have a broad differential diagnosis influenced by age, nutritional status, comorbidities, and geographical exposure. In endemic regions, intestinal schistosomiasis should be considered among infectious causes of chronic gastrointestinal blood loss and inflammatory colorectal disease. Rectal prolapse secondary to schistosomiasis is rare, and operative intervention is infrequently required. A 5-year-old girl presented with a six-month history of intermittent rectal bleeding and full-thickness rectal prolapse, accompanied by progressive weakness and abdominal distension. Severe microcytic hypochromic anaemia was identified, with a haemoglobin level of 2.7 g/dL. After blood transfusion and clinical stabilisation, open abdominal sacral rectopexy was performed because of persistent, ulcerated prolapse with ongoing bleeding and failure of conservative management. Intraoperative findings included thickening of the sigmoid colon, whitish serosal patches, enlarged mesenteric lymph nodes, and hepatomegaly. Stool ova testing was requested but unavailable. Histopathological examination of biopsied tissue revealed active Schistosoma eggs within granulomas, confirming the diagnosis. This case illustrates an advanced presentation of intestinal schistosomiasis in a young child, complicated by life-threatening anaemia and full-thickness rectal prolapse requiring surgical correction. In endemic settings, children with chronic rectal bleeding, anaemia, abdominal symptoms, or prolapse should undergo targeted evaluation for schistosomiasis. When stool microscopy is unavailable or inconclusive, histopathology can provide definitive confirmation. Earlier recognition, guided by exposure history, appropriate ova testing, and haemoglobin assessment, may reduce the risk of progression to severe complications.

ABSTRACT
Carbapenem-resistant Enterobacterales (CRE) infections, which are associated with high morbidity and mortality, are increasingly reported worldwide, particularly in healthcare settings. This observational study investigated patients with CRE infections at an Indian tertiary care hospital. The infections predominantly affected elderly individuals: the 61–80 age group accounted for 59.4% of cases, while the 71–80 subgroup alone comprised 38.6% of patients. Regarding hospital stay duration, nearly half of the patients (48.3%) were hospitalized for 0–10 days, whereas 31.0% remained hospitalized for 31 days or more. The most frequently utilized indwelling devices were Foley catheters, followed by nebulizers, nasogastric (NG) tubes, and ventilators. Microbiologically, Klebsiella pneumoniae was the primary isolate (58.6%), followed by Escherichia coli (27.3%), Pseudomonas aeruginosa (6.1%), Acinetobacter baumannii (2.0%), non-lactose fermenters (2.0%), and Providencia rettgeri, Enterobacter cloacae, and Aspergillus spp. (2.0% each). This study highlights the clinical and microbiological characteristics of CRE isolated from hospitalized patients. Genetic analysis revealed that blaNDM and blaOXA-48 were the most prevalent carbapenemase genes, while blaKPC and blaIMP occurred less frequently. Notably, several isolates co-harbored multiple resistance genes (such as blaNDM and blaOXA-48, suggesting the emergence of multidrug-resistant variants with complex resistance determinants.

ABSTRACT
Background: Infectious diarrhea remains a significant global health concern, especially in less developed regions. The disease's impact on children under five years old is particularly severe, causing a high mortality rates in Low- and Middle-income Countries (LMICs). Objectives: The study aimed to investigate to characterize bacterial causative agents of diarrhea among children below 5 years attending Kiandutu Health care center in Thika, Kiambu County. It also sought to determine the antibiotic susceptibility testing of the isolated bacteria among children below 5 years attending Kiandutu Health care center in Thika, Kiambu County. Materials and Methods: The study utilized an exploratory descriptive approach because it will look at the many aspects of the disease incidence, including the onset of disease and treatment for the children attending Kiandutu Health Centre. Results: In characterizing the bacterial causative agents of diarrhea, Escherichia coli was isolated in 45.1%. In the remaining cases, in 54.9%, there was no growth or no pathogen isolated. In addition, MDR, which was defined as resistance to at least one agent in three different antimicrobial categories, was highly prevalent; it was identified in 78.3% (36/46) of the isolates. By stratification according to their ESBL status, all the ESBL-positive isolates showed MDR at 100% (23/23), compared to 56.5% (13/23) among the ESBL-negative isolates. The most sensitive antibiotic was chloramphenicol: 40 isolates were found to be sensitive and 6 resistants, giving a 13% resistance rate. Second to this was Amoxyclav, with 37 sensitive and 8 resistant. moderately effective antibiotic was ciprofloxacin, with 28 sensitive, 13 resistant, and 5 intermediates, yielding a 28.3% resistance rate. Conclusions and Recommendations: Resistance is ubiquitous, even among infections acquired within communities. Empiric antibiotic treatment is increasingly ineffective, with most first-line drugs failing against common pathoge

ABSTRACT
Retail medicine outlets serve as the first point of contact for most Ghanaians seeking treatment for common ailments. However, weak regulation has led to the widespread dispensing of antimicrobials without a prescription in community pharmacies and over-the-counter medicine shops (OTCMS), fueling antimicrobial resistance (AMR). This cross-sectional study assessed the sale of prescription-only antimicrobials for common self-limiting conditions that do not require antimicrobial therapy in Tamale, northern Ghana. Using the simulated patient (SP) method, adult male actors presented with symptoms of urinary tract infection, upper respiratory tract infection, and acute diarrhoea. Three escalating levels of demand were employed to evaluate dispensing practices without a prescription. A total of 35 community pharmacies and 25 OTCMS were visited three times each, resulting in 180 SP visits. In community pharmacies, pharmacists were the most frequently encountered staff (34.3%), while medicine counter assistants predominated in OTCMS (44.0%). The overall prevalence of dispensing antimicrobials without a prescription was alarmingly high at 91.7% (165/180). Antimicrobials were commonly sold at the first level of demand, 64.8% in community pharmacies and 86.7% in OTCMS. Watch group antibiotics were more frequently dispensed in pharmacies (45.8%), whereas Access antibiotics dominated in OTCMS (47.3%). The most dispensed agents were ciprofloxacin (19.6%), amoxicillin-clavulanic acid (14.4%), and doxycycline (11.0%). This study reveals widespread violations of national regulations governing antimicrobial sales, particularly in OTCMS where such sales are illegal. Urgent implementation of antimicrobial stewardship programmes, stricter enforcement of regulations, and targeted staff training are recommended to curb irrational antimicrobial use and combat AMR in Ghana.