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    James Damen

    Background: Vaginal candidiasis is the most common opportunistic mucosal infection that affects large numbers of healthy women of childbearing age. Candida is capable of causing various clinical manifestations ranging from mucocutaneous... more
    Background: Vaginal candidiasis is the most common opportunistic mucosal infection that affects large numbers of healthy women of childbearing age. Candida is capable of causing various clinical manifestations ranging from mucocutaneous overgrowth to disseminated infection. This was a cross-sectional study conducted between September to December 2015. Aim of the study: To determine the prevalence and antifungal susceptibility of Candida isolates of vaginal swab among reproductive age women. Materials and Methods: Women within the age group of 15 to 45 years formed the population of this study. Socio-demographics information, were gotten through a standard questionnaire. Vaginal swabs were collected from each participant and cultured on Sabouraud dextrose agar supplemented with chloramphenicol. Identification of the isolates were based on morphological appearance, germ tube and chlamydospore formation. Antifungal susceptibility testing was performed by using the CLSI guidelines (CLSI, 2012). Results: Of the 246 participants who submitted vaginal swabs, yeasts was isolated in 47 (19.1%). Out of 47 yeasts isolates, 28 (11.4%) were Candida albicans while 19 (7.7%) were nonalbicans Candida species (NAC). Antifungal susceptibility testing performed on C. albicans showed a high susceptibility to fluconazole 23/28 (82.1%) and nystatin 15/28 (53.6%) while NAC exhibited high resistance 4/19(21.1) and 2/19(10.5) to fluconazole and nystatin respectively. Conclusion: Hence, there is need to understand the pattern of antifungal susceptibility in our community in order to adequately check the spread of resistant species in this population.
    Majority of clinical decisions are said to be based on laboratory test results. Therefore, discrepant and unreliable laboratory results may cause serious consequences for the health of individuals and the society. This study is designed... more
    Majority of clinical decisions are said to be based on laboratory test results. Therefore, discrepant and unreliable laboratory results may cause serious consequences for the health of individuals and the society. This study is designed to evaluate the degree of accuracy and precision of laboratory test results from different laboratories. Fifty blood samples were collected from apparently healthy subjects and sent to 3 different participating hospital laboratories designated as A, B and C within northern Nigeria over a ten-week period. The laboratories, all using standard hematology techniques, undertook Hb estimation, total WBC counts and PCV measurements in an inter-laboratory quality control assessment. The study revealed that laboratories B and C obtained significantly lower mean values of 13.20 g/dl and 13.80 g/dl for hemoglobin respectively compared to 14.60 g/dl from the originating laboratory (p<0.01). Meanwhile, the mean WBC values for laboratories B and C appeared significantly higher than the accurate mean. Two laboratories (B and C) also obtained mean values of PCV slightly different from the accurate one while laboratory A had similar mean PCV value to the accurate one. Generally, higher variance ratios between laboratories than between samples (P<0.01) was observed in hemoglobin estimation and WBC count, while PCV showed a high variance ratio between samples than laboratories. However, the reproducibility of test results of participating laboratories was good. With the increasing reliance on laboratory test results for the diagnosis of diseases, clinical laboratories must embark on regular intra- and inter-laboratory quality evaluations to minimize misdiagnosis.
    Community awareness and participation in mass screening is critical for schistosomiasis control. This study assessed the impact of sharing anonymized image-based positive test results on the uptake of screening during community... more
    Community awareness and participation in mass screening is critical for schistosomiasis control. This study assessed the impact of sharing anonymized image-based positive test results on the uptake of screening during community mobilization outreach. We conducted an observational study to compare the population response to standard and image-based strategies in 14 communities in Abuja, Nigeria. Six hundred and ninety-one (341 females, 350 males) individuals participated in this study. We analyzed the response ratio, relative increase, and sample collection time. The potential treatment uptake and change in social behavior were determined based on a semi-structured questionnaire. The mean response ratio of the image-based strategy was 89.7% representing a significantly higher ratio than the 27.8%, which was observed under the standard mobilization approach (p ≤ 0.001). The image-based method was associated with 100% of the participants agreeing to provide urine samples, 94% willing t...
    Due to the increase in population and the demand for food supply there has been an increase in irrigation and construction of dams, these have aided the spread of schistosomiasis. Aim: This study was conducted to determine the prevalence... more
    Due to the increase in population and the demand for food supply there has been an increase in irrigation and construction of dams, these have aided the spread of schistosomiasis. Aim: This study was conducted to determine the prevalence of urinary schistosomiasis among irrigation farmers in Jos South Local Government Area of Plateau state, North central Nigeria. Materials and Method: A total of 150 specimens were collected within the periods of October to December 2010. Urine specimens were examined for eggs of Schistosoma haematobium by sedimentation technique. Participant’s demographic information was obtained by questionnaires. Data obtained were age and gender. Results: Out of 150 urine specimens examined 28 (18.7%) were positive for Schistosomiasis haematobium. The highest prevalence of infections were recorded among participants within the age group of 21-30; 11 (19.0%), There was no significance difference in the occurrence of infection in relation to age group (P>0.05). ...
    Background and Aims: The current pandemic known as Coronavirus Disease-19 (COVID-19) is a significant public health menace. Currently, there is no specific treatment for this disease, although some medicinal agents are under... more
    Background and Aims: The current pandemic known as Coronavirus Disease-19 (COVID-19) is a significant public health menace. Currently, there is no specific treatment for this disease, although some medicinal agents are under investigation. Some published articles have reported Severe Acute Respiratory Distress Syndrome Coronavirus-2 (SARS CoV-2) involvement in other organs, including the liver and kidneys, which can impair the metabolism and excretion of the medications taken to treat the disease. This study evaluated the effects of 3 herbal mixtures on some biochemical parameters of the liver and kidney of laboratory animals. Methods: Liver enzymes such as serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, albumin and total serum protein were quantified. Urea, creatinine and bilirubin (total and direct) were also evaluated. These parameters were determined for all three polyherbal combinations (CoV Pla-1, CoV Pla-2, CoV Pla-3). Results: The extracts d...
    Transmission of COVID-19 is facilitated by uptake of droplets containing coronavirus from the breath, sneeze or cough of infected persons. This represents the commonest mode of coronavirus infection and spread to mucous membranes of the... more
    Transmission of COVID-19 is facilitated by uptake of droplets containing coronavirus from the breath, sneeze or cough of infected persons. This represents the commonest mode of coronavirus infection and spread to mucous membranes of the respiratory system. The virus rapidly replicates in alveolar cells, triggering a strong immune response, resulting in cytokine storm syndromes and pulmonary tissue damage. These pathologic processes contribute to a compromised pulmonary function. Thus, evaluation of pulmonary function would give insights into modulatory effect of agents that may be beneficial in ameliorating this pathology. The study evaluated effects of Cov-Pla1 and Cov-Pla3 (polyherbal products of the research team, positioned for treatment of Covid-19) on pulmonary function in bleomycin-induced lung injury in rabbits. Rabbits of both sexes were divided into six groups and treated with the extracts alone or the extract following pre-treatment with bleomycin. Targeted respiratory fu...
    Background: Staphylococcus aureus (S. aureus) nasal carriage is potential source for their continuous spread as well as risk factor for subsequent infections. Studies on S. aureus nasal carriage are important in determining the... more
    Background: Staphylococcus aureus (S. aureus) nasal carriage is potential source for their continuous spread as well as risk factor for subsequent infections. Studies on S. aureus nasal carriage are important in determining the epidemiology of staphylococcal infections and a guide to infection control and preventive measures. Aim of the study: The present study was conducted to investigate the carriage prevalence and antibiotic susceptibility of S. aureus among students studying Medical Laboratory Science at the University of Jos. Materials and methods: Two hundred and forty one (241) nasal swab specimens were obtained from Medical laboratory science students of the University of Jos. Swabs were plated on Mannitol salt agar (MSA), culture plates were incubated at 37C for 18-24hours. After incubation S. aureus isolates were identified by their characteristic yellowish colony on MSA. Standard inocula were prepared by adjusting density of saline suspension of S.aureus to 0.5 McFarland’...
    ABSTRACT<br> Background: It is logical to assume that HIV positive subjects are more at risk to malaria infection than HIV negative subjects.<br> Objective: The objective of this comparative cross-sectional study is to... more
    ABSTRACT<br> Background: It is logical to assume that HIV positive subjects are more at risk to malaria infection than HIV negative subjects.<br> Objective: The objective of this comparative cross-sectional study is to determine malaria infection in HIV positive and HIV negative subjects, and relate malaria infection to differential CD4 T cell counts in subjects who are infected with HIV.<br> Method: Giemsa staining technique was used to stain thin and thick blood film of consenting HIV positive and HIV negative controlled subjects, and observed under the microscope for the presence of malaria parasites. A positive test to malaria was defined as the presence of malaria parasites irrespective of species and density. CD4 T cell analysis was carried out on HIV positive subjects, using the Partec cyflow machine following the standard operating procedure.<br> Result: Among the two hundred and ten (210) HIV positive subjects, 10(4.8%) were positive for malaria. Out...
    Malaria infection during pregnancy is a major public health problem in tropical and subtropical regions throughout the world. The study was designed to determine the prevalent of malaria parasitaemia among pregnant women who attended... more
    Malaria infection during pregnancy is a major public health problem in tropical and subtropical regions throughout the world. The study was designed to determine the prevalent of malaria parasitaemia among pregnant women who attended general hospital in shendam, Jos, Plateau State of Nigeria between the period of January and March, 2016. Participation was voluntary, pregnant women who gave consent to be part of the study were randomly selected. Questionnaires were distributed to the subjects to obtained demographic data. Blood samples were collected; thin and thick blood films were made and stained using Giemsa stain. The blood films were examined using oil immersion objective. The study revealed that an overall 5.6% of the 250 pregnant women were found to have malaria infections. It was found that women between the ages of 20-23 years had the highest prevalence of 2.0%. Highest prevalence of 3.6% was also recorded in non-formal education women. The results also showed that pregnant...
    Majority of clinical decisions are said to be based on laboratory test results. Therefore, discrepant and unreliable laboratory results may cause serious consequences for the health of individuals and the society. This study is designed... more
    Majority of clinical decisions are said to be based on laboratory test results. Therefore, discrepant and unreliable laboratory results may cause serious consequences for the health of individuals and the society. This study is designed to evaluate the degree of accuracy and precision of laboratory test results from different laboratories. Fifty blood samples were collected from apparently healthy subjects and sent to 3 different participating hospital laboratories designated as A, B and C within northern Nigeria over a ten-week period. The laboratories, all using standard hematology techniques, undertook Hb estimation, total WBC counts and PCV measurements in an inter-laboratory quality control assessment. The study revealed that laboratories B and C obtained significantly lower mean values of 13.20 g/dl and 13.80 g/dl for hemoglobin respectively compared to 14.60 g/dl from the originating laboratory (p<0.01). Meanwhile, the mean WBC values for laboratories B and C appeared sign...
    Sandwich ELISA is a modified form of the standard ELISA technique used by researchers and in routine laboratories for detecting and quantifying specific analytes in samples. This study is designed to evaluate the impact offreeze-thaw... more
    Sandwich ELISA is a modified form of the standard ELISA technique used by researchers and in routine laboratories for detecting and quantifying specific analytes in samples. This study is designed to evaluate the impact offreeze-thaw cycles on the results of serum cytokine measurement by sandwich ELISA technique. Serum samples were collected from four healthy donors and stored in 3 aliquots at -80C for three days per thaw-freeze cycle. The concentrations of IL-4, IL-6, IL-8 and IL-9 in the aliquots of serum samples exposed to one, two and three freeze-thaw cycles respectively were determined. Data shows an increase in the cytokine levels following two and three freeze-thaw cycles compared to the expression levels obtained after one freeze-thaw cycle (baseline). The increases reported are as follows: IL-4; 6.56pg/ml (19%) and 3.52pg/ml (10%), IL-6; 103pg/ml (20.9%) and 24.6pg/ml (5%), IL-8; 105.05pg/ml (14%) and 102.76pg/ml (11%) and IL-9; 117pg/ml (17.77%) and as high as 312pg/ml (4...
    Background The change in epidemiology and antifungal susceptibility has generated interest among clinical microbiologists in the identification of Candida up to species level along with antifungal susceptibility patterns. Objectives This... more
    Background The change in epidemiology and antifungal susceptibility has generated interest among clinical microbiologists in the identification of Candida up to species level along with antifungal susceptibility patterns. Objectives This study was undertaken to investigate the prevalence of Candida spp and its antifungal susceptibility from the various clinical samples. Materials and Methods Total of 317 clinical samples from various suspected fungal infections were received in the Department of Microbiology to investigate suspected Candidal infections. Isolation, identification and antifungal susceptibility were done by standard conventional methods. Results A total of 104 non-duplicate Candida species were isolated, out of which 37 (35.6%) were C. albicans and 67 (64.4) were non-C. albicans, and the remaining were C. tropicalis 35 (33.7%), C. glabrata 18 (17.3%) and C. parapsilosis 6 (5.8%). Maximum isolates were from sputum as well as body fluids followed by pus, tissue and urine...
    Background: Late December 2019, an unknown incidence of Pneumonia was observed among some residents of Wuhan city, China. The disease named coronavirus disease 2019 (COVID-19) and declared as a pandemic by the WHO on the March 11th, 2020... more
    Background: Late December 2019, an unknown incidence of Pneumonia was observed among some residents of Wuhan city, China. The disease named coronavirus disease 2019 (COVID-19) and declared as a pandemic by the WHO on the March 11th, 2020 by the World Health Organization (WHO) has resulted to the death of million people across the globe. Prior to the current COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), two other outbreaks of coronaviruses namely severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) have been experienced within the last few decades. This review looks at the unique characteristics of SARS-CoV-2 to the other coronaviruses (SARS-CoV and MERS-CoV) and its significance(s) in the control strategies including diagnostics. Materials and Methods: Using the keywords “coronavirus mutation”, “nucleotide substitution”, “coronavirus evolution”, “SARS-CoV-2”, “COVID-19” publis...
    Background: Malaria is endemic in Nigeria and sickle cell disease is very common in Nigeria and it is believed that malaria is the common cause of morbidity and mortality in children with sickle cell disease (SCD) in our environment as a... more
    Background: Malaria is endemic in Nigeria and sickle cell disease is very common in Nigeria and it is believed that malaria is the common cause of morbidity and mortality in children with sickle cell disease (SCD) in our environment as a result malaria prophylaxis is always recommended for them. The study was meant to determine the prevalence, risk factors and effect of malaria in sickle cell disease children. Methods: We recruited 200 febrile children with sickle cell disease and another 200 febrile non sickle cell disease children as control into the study. Two miles of their blood were collected and both thin and thick blood films were made on the same slide, stained by Giemsa methods and examined microscopically. Parasite densities were also determined and packed cell volume (PCV) were enumerated. Results: The study showed that the prevalence of malaria in febrile SCD was 49.0% and 61.0% in non SCD. The PCV of ≤20% recorded the highest prevalence of 66.7% while the least prevale...
    Article history: Received:14 July Received in revised form: 28 July Accepted: 28 July Available online: August Back ground of the study: Intestinal parasitic infection remains an important public health problem in developing countries;... more
    Article history: Received:14 July Received in revised form: 28 July Accepted: 28 July Available online: August Back ground of the study: Intestinal parasitic infection remains an important public health problem in developing countries; they are associated with abdominal pain, mal absorption, diarrhea, weight loss, nausea and vomiting. They are transmitted to humans through consumption of food, water and vegetable contaminated with the infective form of the parasites. Food handlers therefore play an importance role in the transmission of these parasites to their customers. Objectives of the study: The study was aimed at accessing the demographic paramenters and intestinal parasitosis among foodlers in Jos metropolis. Methods. A cross section of 212 stool specimen were randomly collected in a clean universal container from food handlers in Jos metropolis from June to December, 2014 and transported to the Faith Medical and Diagnostic Laboratory and were examined by Macroscopy, Direct m...
    The development of manpower for the tertiary level of health care services in developing countries is inadequate resulting in the establishment of a new centre as soon as the specialist is available. This is usually met by the high health... more
    The development of manpower for the tertiary level of health care services in developing countries is inadequate resulting in the establishment of a new centre as soon as the specialist is available. This is usually met by the high health demands from the community in the face of near lack of modern technological diagnostic advancement in the health sector. There is great need to study the morphologic outcome of bone marrow aspiration done in our centre for generation of baseline data and planning. Records of bone marrow Aspiration cytology done in Plateau State Specialist Hospital, Jos, Nigeria between January 2007 and June 2012 were studied. A total of 97 bone marrow aspiration were requested for and done in the Plateau State Specialist Hospital, Jos, within the study period. 55(56.8%) were males while 42(43.2%) were females. Eighty four (87.6%) had pathologic outcome while 13(13.4%) had normal or reactive marrow appearance. Pathologic marrow outcome were 28.6% leukaemias, 33.3% n...
    The coronavirus disease COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) has presented unprecedented challenges to the healthcare systems in the world. There are no definite effective therapeutic... more
    The coronavirus disease COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) has presented unprecedented challenges to the healthcare systems in the world. There are no definite effective therapeutic agents or vaccines against the virus currently. However clinical management of the infection includes prevention, control measures, supportive care and repurposed drug therapy based on pathophysiology of the virus and manifestation of the disease condition thereby using antiviral agents such as remdesivir, lopinavir and favipiravir. Herbal preparations are being promoted for the management of Covid-19. Some selected Nigerian medicinal plants are hereby investigated by In-silico studies of the plant constituents. When compared with the listed therapeutic agents, the phytochemical constituents of the selected plants have better binding affinity to several Covid-19 viral target proteins. Also they were found to be safe for human use with LD50 of >2000 ...
    Symptoms of Coronavirus Disease-2019 include pulmonary hyper-inflammation; managing local and systemic inflammatory responses may be key in treatment. This study evaluated the anti-inflammatory, analgesic and antipyretic effects of a... more
    Symptoms of Coronavirus Disease-2019 include pulmonary hyper-inflammation; managing local and systemic inflammatory responses may be key in treatment. This study evaluated the anti-inflammatory, analgesic and antipyretic effects of a mixture (Cov-Pla 2) containing five medicinal plants in laboratory animals. The antinociceptive activity of Cov-Pla 2 was evaluated using acetic acid-induced writhing, Brewer’s Yeast Pyrexia test in rats and hot plate tests in mice. The egg albumin-induced rat paw oedema test was employed to evaluate the extract’s anti-inflammatory activity. The extract produced a dose-dependent (125-500 mg/kg, p.o.) inhibition of pain response elicited by acetic acid, compared to normal saline and increased reaction latency in the hot plate test. The antiinflammatory test showed a significant (P<0.05) reduction in paw size diameter at 125 mg/kg from 2 hours, compared to control. In the antipyretic test, the extract produced a significant (P<0.05) time-dependent d...
    Background and Aims: The current pandemic known as Coronavirus Disease-19 (COVID-19) is a significant public health menace. Currently, there is no specific treatment for this disease, although some medicinal agents are under... more
    Background and Aims: The current pandemic known as Coronavirus Disease-19 (COVID-19) is a significant public health menace. Currently, there is no specific treatment for this disease, although some medicinal agents are under investigation. Some published articles have reported Severe Acute Respiratory Distress Syndrome Coronavirus-2 (SARS CoV-2) involvement in other organs, including the liver and kidneys, which can impair the metabolism and excretion of the medications taken to treat the disease. This study evaluated the effects of 3 herbal mixtures on some biochemical parameters of the liver and kidney of laboratory animals. Methods: Liver enzymes such as serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, albumin and total serum protein were quantified. Urea, creatinine and bilirubin (total and direct) were also evaluated. These parameters were determined for all three polyherbal combinations (CoV Pla-1, CoV Pla-2, CoV Pla-3). Results: The extracts d...
    Coronavirus Disease-19 (COVID-19) has today become a major public health threat. Despite several ongoing clinical trials, there is as yet no specific treatment for this disease. This study evaluated the effects of 3 polyherbal mixtures... more
    Coronavirus Disease-19 (COVID-19) has today become a major public health threat. Despite several ongoing clinical trials, there is as yet no specific treatment for this disease. This study evaluated the effects of 3 polyherbal mixtures (CoV-1, CoV Pla-2 and CoV Pla-3) on some electrolyte and haematological parameters in laboratory animals. The parameters evaluated were PCV, HGB, MCV, MCH, MCHC, RBC, WBC, neutrophils and lymphocytes counts, including Na+, Cl-, HCO3-, K+.  Treatment was per oral with doses of 100, 200 and 400 mg/kg for the 3 polyherbal mixtures. Control group had 0.1 mL of distilled water per oral. The extract was safe up to 5000 mg/kg. An insignificant (P>0.05) decrease in RBC was observed at all doses except for 200 mg/kg for CoV Pla-3 which was significant (P<0.05) compared to control. When compared to control, an insignificant increase in the mean lymphocyte values in all extracts was observed. WBC in CoV Pla-1 and CoV Pla-3 increased, compared to control, a...
    The coronavirus disease COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) has presented unprecedented challenges to the healthcare systems in the world. There are no definite effective therapeutic... more
    The coronavirus disease COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) has presented unprecedented challenges to the healthcare systems in the world. There are no definite effective therapeutic agents or vaccines against the virus currently. However clinical management of the infection includes prevention, control measures, supportive care and repurposed drug therapy based on pathophysiology of the virus and manifestation of the disease condition thereby using antiviral agents such as remdesivir, lopinavir and favipiravir. Herbal preparations are being promoted for the management of Covid-19. Some selected Nigerian medicinal plants are hereby investigated by In-silico studies of the plant constituents. When compared with the listed therapeutic agents, the phytochemical constituents of the selected plants have better binding affinity to several Covid-19 viral target proteins. Also they were found to be safe for human use with LD50 of >2000 ...
    To determine the prevalence of transmissible malaria in apparently healthy blood donors in the city of Jos in north-central Nigeria. We collected blood specimens from individuals who had passed the screening criteria for blood donation.... more
    To determine the prevalence of transmissible malaria in apparently healthy blood donors in the city of Jos in north-central Nigeria. We collected blood specimens from individuals who had passed the screening criteria for blood donation. We created thin and thick blood films using the blood film template provided by the World Health Organization (WHO). The films were allowed to air dry; then, we stained them using a 3% Giemsa solution and examined them microscopically. In specimens that tested positive the malaria species was identified. The highest prevalence of malaria was in donors aged between 31 and 40 years (65.1%), whereas the lowest prevalence was in donors aged 20 years or younger (25.0%). Plasmodium falciparum was the predominant species (98.0%); the least prevalent was Plasmodium malariae (2.0%). In male donors the prevalence of malaria parasitemia was 62.0%; the prevalence in female donors was 62.5%. Among paid donors the malaria parasitemia rate was 82.3%, compared with ...
    A semi-quantitative screening for asymptomatic bacteriuria was carried out in the first trimester of 500 consecutive pregnant women in Benin City. The purpose was to provide baseline data and rational therapy for asymptomatic bacteriuria... more
    A semi-quantitative screening for asymptomatic bacteriuria was carried out in the first trimester of 500 consecutive pregnant women in Benin City. The purpose was to provide baseline data and rational therapy for asymptomatic bacteriuria in pregnant women. Of the 500 women screened, 433 clinical specimens showed significant bacteriuria, representing an incidence of 86.6%. Of this number, 38 (7.4%) were of mixed bacterial colonies while 395 (91%) were of single bacterial colonies. Staphylococcus aureus (29.8%), Escherichia coli (29.1%) and Klebsiella pneumoniae (21.5%) were the most frequently isolated pathogens. The high incidence of asymptomatic bacteriuria in pregnancy correlated significantly (P < 0.05) with the observed high proportion of pyuria. On average, sensitivity of the pathogens was ciprofloxacin 99.7%; ceftazidime 81.6%; co-trimoxazole 79.4%; augmentin 71.4%; nalidixic acid 61.7%; nitrofurantoin 61.%; gentamycin 56.9% and ampicillin 25.4%. S. aureus was most sensitive, while Proteus mirabilis was least sensitive among the pathogens. Rational therapy of asymptomatic bacteriuria in pregnant women may prevent associated risks such as pyelonephritis and pre-eclampsia.