Phenotypic and genotypic characterization of plasmid-mediated AmpC beta-lactamases in enteric Gram-negative bacteria from patients with lower respiratory tract infections in a tertiary hospital, southwest Nigeria

Background: AmpC or class C or group 1 beta lactamases are class C cephalosporinases that hydrolyse a wide variety of beta-lactam antibiotics including alpha methoxy beta-lactams (cefoxitin), narrow and broad spectrum cephalosporins. This study was conducted to characterize plasmid-mediated AmpC producing enteric Gram- negative bacteria from patients with lower respiratory tract infections in Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) Ile Ife, Osun State, Nigeria Methodology: A total of 149 patients with clinical features of lower respiratory tract infections (LRTI) were selected by simple random sampling for the study. All Gram-negative isolates recovered from standard microbiological cultures of respiratory specimens of these patients were tested against cefoxitin, third generation cephalosporins (3GCs), and other antibiotics using the disc diffusion AST method, and also screened for production of AmpC beta-lactamases phenotypically by the CLSI method. Plasmid DNA extraction was carried out on twenty-nine cefoxitin-resistant selected isolates using the Kado and Lin method, while genotypic detection of plasmid-mediated AmpC gene was carried out by the polymerase chain reaction (PCR) assay. Results: The results showed that 204 (43.3%) of 471 isolates recovered from the 149 selected patients were resistant to 3GC in the AST assay, among which 121 (59.3%) were resistant to cefoxitin, and 189 of the 471 isolates (40.1%) were AmpC producers. The AmpC producers concurrently showed multiple resistance pattern to other antibiotics tested in this study. Ninety six percent of the 29 selected isolates for plasmid analysis contained plasmids, 45% of which amplified positive on PCR for CMY, 38% for FOX, and 31% for ACC types of AmpC genes. Conclusion: This study showed a high degree of antibiotic resistance among enteric Gram-negative bacteria recovered from patients with LRTIs, as well as high degree of plasmid-encoded AmpC genes responsible for this high antibiotic resistance among the isolates. Proper antibiotic policy and regulation are required to limit the spread of plasmid mediated AmpC ß-lactamase

Health-related quality of life among patients with bronchial asthma in Ile-Ife, Nigeria

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Exercise-induced asthma in adult Nigerian asthma patients: a comparison of step test, free running, and bicycle ergometer

Exercise is not only a very common precipitant of acute asthmatic episodes but also a potent non-pharmacological test for diagnosis of asthma. Different exercise protocols have been used; however a simple exercise test would be valuable and helpful for detecting exerciseinduced asthma (EIA). The main goal of this study was to compare the exercise-inducing capacity of free running; step test; and cycle ergometer. Forty-eight asthma patients performed and completed the exercise tests reaching at least 80-85of the predicted maximal heat rate. The peak expiratory flow (PEF) values and heart rate (HR) were used to monitor pulmonary function post-exercise and the intensity of the exercise respectively. The PEF values were measured at baseline; immediately after the exercise then at 5-minute intervals up to 30 minutes. Subjects who reached the percentage fall in PEF 15were considered positive for EIA. Free running was found to be the most asthmagenic exercise followed by the step test and cycle ergometer: 36 subjects (75) for free running versus 27 subjects (56) for step test; versus 24 subjects (50) for cycle ergometer. There is a strong and significant correlation between the percentage fall in PEF of cycle ergometer and step test (r=0.61; p0.001). Free running produced the most positive result. However; the step test is a safe; simple; portable; and readily available instrument which compares well with laboratory-based cycle ergometer. We conclude that the step-test is an inexpensive and responsive exercise protocol for assessing and evaluating asthmatics in low-income countries

Secondhand Smoke Exposure among Nonsmoking Adults in two Nigerian Cities

Background: Tobacco control policy can only succeed if the burdens of smoking are known. The objective of this study was to determine the prevalence and correlates of secondhand smoke (SHS) exposure among nonsmoking adults in two Nigerian cities. Materials and Methods: We carried out a cross-sectional study from October 2009 to April 2010 among adult population of two Nigerian cities: Enugu and Ilorin. A semi-structured questionnaire was administered by interviewers to obtain socio-demographic information; and information regarding pattern of SHS exposure; wareness of tobacco control policy and the harmful effects of SHS. SHS exposure was defined as regular exposure to tobacco smoke in the previous 30 days in a nonsmoking adult. Results: Of the 585 nonsmoking adults that completed the study; 38.8had regular exposure to SHS; mostly; in public places (24.4). More men were exposed at public places when compared with women (27.0vs. 19.5). The strongest factor associated with exposure to SHS in women was having a smoking spouse [prevalence rate (PR) ratio-7.76; 95confidence interval (CI); 3.08-9.42]; and in men; it was lack of home smoking restriction (PR ratio-6.35; 95CI; 4.51-8.93). Among men; SHS exposure at any location was associated with lack of secondary school education; residing in slum apartment (house with many households); living with a smoking family member (non-spouse); lack of home smoking restriction; and alcohol intake. Among women; SHS exposure at any location was associated with having a smoking spouse; residing in slum apartment and lack of home smoking restriction. Seventy-two percent of respondents were aware of the harmful effects of SHS on their health. Lack of awareness of the harmful effects was significantly associated with increasing age (r= +0.45; P = 0.01); lack of secondary school education (rof the employees reported availability of outdoor smoking area at their workplaces. Conclusion: Our results show that prevalence of SHS exposure was the highest in public places. These findings underscore the need for enactment of comprehensive smoke-free legislation and implementation of educational strategies to reduce SHS exposure in homes

Lipid profile in HIV/AIDS patients in Nigeria

Introduction: Alterations of serum lipid profiles have been reported widely among Human Immuno deficiency Virus (HIV) positive patients on Highly Active Anti Retroviral Therapy (HAART). However; there are few data on serum lipid profile among treatment na?ve HIV positive patients in our environment. Objectives: To describe the pattern of lipid profile among treatment na?ve HIV positive patients and changes following HAART initiation. Methods: One hundred and thirty HIV positive patients seen in HIV center in an urban area in Nigeria and 44 matched individuals were recruited. Data were collected on socio demographic characters; baseline lipid profiles and CD4 count. Values of lipid parameters were retrieved after 12 months on HAART. Results: The mean Low density lipoprotein(LDL) was 2.26+ 0.9 mmol/l among the test group compared with 0.96+0.39mmol/L among the control ;p value =0.000 .The mean High density lipoprotein (HDL) was also significantly lower;0.8+ 0.6mmol/L reaching a dyslipidemic level; in the HIV positive group than the control; p value = 0.00. Tuberculosis /HIV co infected patients had a significantly elevated mean LDL; p=0.002. Conclusion: Abnormality of serum lipid is common among treatment na?ve HIV patients seen in Nigeria. The NNRTI regimen is associated with elevation of HDL and some stabilization of TC and TG

Occupational Asthma: a Review of Current Concept

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