Urine examination has been employed in clinical practice as the most common screening laboratory method for early detection of urinary tract infections (UTIs) or renal disorder. This study was undertaken to ascertain the usefulness of urine macroscopy and microscopy as vital screening procedure for diagnosing UTI among antenatal patients in a teaching hospital in Awka, Nigeria. Freshly voided midstream urine specimens of 269 pregnant women were collected and examined using macroscopic, microscopic and culture methods. The sensitivity, specificity, positive predictive value and negative predictive value of urine colour, and microscopic features were compared with urine culture in diagnosis of UTI. Statistical analysis was done using SPSS and Epi info® and P-value was set at <0.05 significant level. One hundred and seven specimens showed positive urine cultures. Out of these 107 specimens, 60 (56.1%) also had deviation from normal urine colour and 77(72%) were positive on urine microscopy. Macroscopic examination showed that a significant relationship exists between urine colour and positive urine culture (p=0.0001). The sensitivity and specificity of urine colour with respect to UTI were 56.7% and 67.9% respectively. Urine microscopy revealed that the positive features had a significant relationship with positive urine culture (p= 0.000). Pyuria alone showed the specificity and positive predictive value of 100% each. The sensitivity, specificity, positive predictive value and the negative predictive value of combination of positive microscopic features were 72%, 64.8%, 57.5% and 77.8% respectively. Examination of colours and microscopic features of urine are therefore vital in predicting urinary tract infection.

There is an increase in non-albicans Candida (NAC) vulvovaginal candidiasis which is attributed to overuse of antifungal therapy and this has led to antifungal resistance. This study was aimed at determining the antifungal resistance pattern of some clinical isolates of Candida species. Eighty-eight (88) isolates were used which included Candida tropicalis (34), Candida Parapsilosis (21), Candida albicans (20), Candida krusei (7) and Candida glabrata (6). The drugs used were Fluconazole (25µg), Ketoconazole (10µg), Voriconazole (1µg), Nystatin (100Units), Amphotericin B (20µg), Flucytosine (1µg), Clotrimazole (10µg) and Itraconazole (50µg). The susceptibility testing was carried out using the M44-A standard method for yeast disk diffusion testing. Results showed that the percentages of Candida species resistant to Fluconazole, Ketoconazole, Voriconazole, Amphotericin B, Flucytosine, Clotrimazole and Itraconazole and Nystatin were 52.3%, 61.9%, 35.2%, 19.3%, 86.4%, 34.1%,  45.5% and 44.3%,  with inhibition zone diameters ≤14mm, ≤20mm, ≤13mm, <10mm, ≤11mm, ≤11mm, ≤13mm and no inhibition zone diameter respectively. Candida krusei was the most resistant species with 100% resistance to each of Fluconazole, Ketoconazole and Flucytosine. Candida tropicalis was the species with the highest susceptibility (79.4%) to Amphotericin B followed by Candida parapsilosis with inhibition zone diameters ≥15mm. While Candida glabrata showed 100% resistance to each of Flucytosine and Itraconazole, Candida albicans showed 100% resistance to Flucytosine only. Candida glabrata was the only Candida species with 0% resistance to Amphotericin B. The drug to which most of the Candida species were susceptible was Amphotericin B followed by Voriconazole while Flucytosine was the drug with the highest resistance followed by Ketoconazole and Fluconazole. The highest number of susceptible-dose dependent Candida isolates was observed with Ketoconazole (25%), followed by Clotrimazole and Itraconazole, each recording 23.9%. Based on the findings of the present study, Voriconazole is recommended for vaginal candidiasis especially in the study area and also especially for infections caused by Fluconazole-resistant Candida species. This suggests that routine sensitivity testing is pertinent to guiding the choice of antifungal therapy. Thus, indiscriminate use of antifungal drugs should be avoided to reduce the development and spread of resistance.