Phenotypic Characterisation of Staphylococcus aureus Isolated from Patients in Healthcare Institutions in Zaria Metropolis, Kaduna State, Nigeria

BACKGROUND: Staphylococcus aureus is a cosmopolitan and pathogenic microorganism associated with various diseases spectra and antimicrobial resistance of public health importance.Aim: This study determined the phenotypic characteristics of S. aureus isolated from patients in healthcare institutions in Zaria metropolis.STUDY DESIGN: A cross-sectional hospital-based study was carried out in 5 healthcare institutions. Four hundred and twenty clinical samples were collected and analyzed. RESULTS: Majority of the patients (54.3%) were within the age range 21­40 years and mean age of 26.04 ± 12 years. Approximately, 70% of the respondents had history of antibiotic use prior to consultation in the hospitals and wereselfprescribed, and 91.2% were outpatients. The most commonly abused antibiotics were ampicillin-cloxacillin (19.5%) and cotrimoxazole (10.0%), and the mean duration of their use was 3.5 ± 1.3 days. The detection rate for S. aureus was 10% and 5.2% for MRSA. The S. aureus isolates showed the highest frequency of resistance against ampicillin 42 (100%), followed by penicillin G 39 (92.9%) and least was to gentamicin 5 (11.9%). The frequency of resistance for the MRSA were ampicillin 22 (100%), penicillin G 21(95.5%) and least was to gentamicin 2 (9.1%). The minimum inhibitory concentrations of oxacillin were greater than 128 µg /ml. CONCLUSION: The detection rate of S. aureus and MRSA strains are of great public health concern which requires continuous health education on rational use of antibiotics among others

Formes familiales du syndrome de Gougerot-Sjögren : étude de 22 familles multiplex

Introduction : Les facteurs génétiques du SGS, outre les modèles animaux, sont déterminés par le biais de leurs formes familiales. L'objectif de ce travail était d'étudier les aspects phénotypiques des formes familiales du SGS. Patients et méthodes : Etude réalisée dans le service de Rhumatologie du CHU Aristide Le Dantec de Dakar entre Janvier 2013 et Mars 2016, où nous avons colligé les observations de familles multiplex de SGS répondant aux critères de consensus de 2002.Résultats : Vingt-deux familles ont été colligées à partir de 22 propositus (17 femmes et 5 hommes), d'âge moyen de 31,5 ans au début apparent de la maladie. Le SGS chez ces propositus était primitif dans 8 cas et secondaire à une PR dans 14 cas. Les familles totalisaient 921 membres. Soixante- quinze (54 femmes et 21 hommes), y compris les cas index présentaient un SGS (54 primitifs et 21 secondaires), soit une prévalence de 8,14 %. Les apparentés de premiers degré atteints étaient au nombre de 46 (85%). Les autres maladies auto- immunes associées étaient une PR (16 cas), un lupus systémique (1 cas), une polymyosite (1 cas), une sclérodermie systémique (1 cas), un vitiligo (1 cas) et une maladie de Basedow (1 cas). Les autres affections répertoriées étaient : lymphome oculaire (1 cas), cancer du col de l'utérus (1 cas). L'évolution sous traitement fut favorable, sauf chez 1 cas décédé. Conclusion : Le caractère familial du SGS chez nos malades plaide en faveur de l'implication de facteurs génétiques dans le déterminisme de la maladie

Fanconi Anaemia in South African Patients with Afrikaner Ancestry

Background. Fanconi anaemia (FA) is a rare genetic disorder of impaired DNA repair that results in physical and haematological consequences in affected individuals. In South Africa (SA), individuals with Afrikaner ancestry are at an increased risk of inheriting disease-causing FA mutations, owing to the three common FANCA (FA, complementation group A) founder mutations present in this population subgroup.Objectives. To describe the physical phenotype of SA patients with FANCA mutations for the purpose of recommending appropriate care for affected individuals.Methods. A structured clinical examination and file-based review were used to evaluate the physical phenotype of 7 patients with compound heterozygous and homozygous FANCA founder mutations, and 1 patient with confirmed FANCA complementation analysis. Descriptive statistical analysis was used to determine the frequency of physical anomalies in Afrikaner patients and to compare the described phenotype to other FA cohorts, including a previously clinically characterised black SA FA cohort.Results. An earlier age of diagnosis of FA in Afrikaner patients, a high frequency of somatic anomalies and a higher-than-expected incidence of the VACTERL/H phenotype were noted.Conclusions. Based on our findings, recommendations for the care of FA patients with Afrikaner ancestry are made, including renal ultrasound evaluation at diagnosis and hearing screening

Burden, genotype and phenotype profiles of adult patients with sickle cell disease in Cape Town, South Africa

Background. An exponential increase in the number of sickle cell disease (SCD) patients in paediatric services in Cape Town, South Africa, has been reported. The trend in adult/adolescent services has not been investigated. Objectives. To evaluate epidemiological trends of SCD and the profile of patients affected by SCD attending the Haematology Clinic at Groote Schuur Hospital (GSH), Cape Town.Methods. (i) A retrospective review of the number of SCD patients over the past 20 years; (ii) a cross-sectional analysis of clinical and haematological characteristics of SCD patients; and (iii) molecular analysis of the haemoglobin S mutation, the haplotype in the ß-globin-like genes cluster, the 3.7 kb α-thalassaemia gene deletion and 19 selected single-nucleotide polymorphisms (SNPs) associated with fetal haemoglobin (HbF) levels.Results. From 1995 to 2016, 81 adolescent/adult patients with SCD were registered, mostly originating from other African countries (n=61, 75.3%). There was an increase of over 200% in new cases (n=47) during the last quarter of the two decades investigated. Data from 34 of 58 regular attendees (58.6%) were analysed. The mean age of the patients was 26.1 years (standard deviation (SD) 9.8), and 70.6% were male. With the exception of four patients with sickle/ß-thalassaemia, all the patients had SCD (haemoglobin SS). The co-inheritance of a single 3.7 kb α-globin deletion was found in 42.3% of cases (n=11). The Bantu haplotype was the most observed (65.4% of chromosomes). Most HbF-promoting SNPs were not associated with variable levels of haematological indices.Conclusions. There is an increasing burden of adult SCD patients at GSH. National health and academic institutions need to adapt policies and healthcare professional training accordingly

Caracterisation phénotypique des souches de pseudomonas aeruginosa isolées dans la ville de Yaoundé (Cameroun)

Introduction. L'objectif etait de determiner la proportion de souches de Pseudomonas aeruginosa (P. aeruginosa) exprimant des mecanismes de resistance dans la ville de Yaounde. Methode. Il s'agissait d'une etude prospective et descriptive realisee du 02 janvier au 30 juin 2012. Des souches de P. aeruginosa provenant de divers produits pathologiques de patients ont ete identifiees a l'aide de la galerie API 20NE (Biomerieux). Pour les prelevements urinaires; une cytologie etait faite pour verifier l'absence de cancer. La lecture interpretative de l'antibiogramme a ete faite par diffusion sur gelose Mueller-Hinton selon CA-SFM 2011. Resultats. Au total 34 souches de P. aeruginosa ont ete isolees dont 85;3?% chez patients hospitalises. Parmi ces souches; 41;2?% etaient isolees des urines; 23;5?% des hemocultures et 17;6?% des suppurations. Les urines montraient a l'examen cytologique des modifications inflammatoires aigues et l'absence de cancer. Le profil de resistance aux antibiotiques a montre une resistance elevee preferentielle des Beta-lactamines notamment a la ticarcilline (35;29?%). Concernant les Beta-lactamines; les phenotypes les plus observes ont ete pour les 2/3 sauvages et 26;5?% pour les penicillinases ; quant aux aminosides 94;1?% etaient de phenotype sauvage; tandis que 2/3 etaient de type sauvage pour les fluoroquinolones. Conclusion. Une association Beta-lactamines/aminosides ou Beta-lactamines/fluoroquinolones pourrait etre preconisee afin de lutter contre toute infection a P. aeruginosa

Angiotensin II Type 1 Receptor Antagonists and their Combinations in the Treatment of Hypertension

The pathophysiology of hypertension is not multifactorial in nature; and there is a complex interplay of mechanisms of control and counter-regulatory responses activated by drugs. The problem for clinicians is that it is not really possible to recognise the various clinical phenotypes of hypertension. In other words; the heterogeneity of hypertension remains a clinical problem.1 Current overwhelming evidence is that the most important treatment concept in the management of hypertension is that treatment should reduce blood pressure to goal levels.2 The majority of hypertensive patients will need two or more antihypertensive drugs to control their blood pressure at goal. Conceptually; a strong case can be made for the early use of combination therapy in the treatment of hypertension.3

"The ""Ten Commandments"" of Treating Preschool Children who Wheeze"

"Wheezing in young children is problematic for most practitioners. Difficulties arise in both the diagnosis and management of this clinical phenotype. Not all preschool children who wheeze have asthma. Therefore; we suggest that the ""Ten Commandments"" of managing preschool wheezing include thinking that in very young infants ( 1 year) wheezing is likely to be viral in origin; realising that allergy testing is mandatory to diagnose the cause of early wheezing; taking a history of asthma and allergy in family members; noting that chronic coughing is a pointer to asthma; using the term ""asthma"" if that is the diagnosis; ensuring that the environmental avoidance of triggers is addressed; using a short course of montelukast for virus-induced wheezing episodes; avoiding steroids to treat virus-induced wheezing; treating associated nasal symptoms; and making sure that the follow-up of children addresses the issue of stopping therapy if it is not working."

The variable African diabetic phenotype: tales from the north and the south

Although most African diabetic patients are clearly phenotypically type 1 or 2, some do not easily fit into these categories. Examples are malnutrition-related diabetes mellitus (MRDM) and atypical ketosis-prone type 2 diabetes. To explore this problem we have compared two cohorts of diabetic patients from very different parts of Africa ­ rural KwazuluNatal in South Africa, and Mekelle District in northern Ethiopia. Basic demographic data were collected as well as measurements of blood pressure (BP) and glycated haemoglobin (HbA1c). South African patients were older (56±11 vs 41±16 years, p<0.001) than Ethiopian patients, and more were female (70% vs 30%, p< 0.001). Body mass index (BMI) was higher in South African patients (31.5±6.3 v 20.6±5.4, p<0.001) and 56% were obese (BMI >30.0) compared with 4% in Ethiopia (p<0.001). Hypertension (BP >140/80) affected 80% of South African patients but only 4% of the Ethiopian cohort (p<0.001). Insulin treatment was more common in the Ethiopian patients compared with South Africans (66% vs 25%, p<0.001). Duration of diabetes and HbA1c were similar in both groups. Phenotypically, 96% of the South Africans had typical type 2 diabetes, whereas only 42% of the Ethiopians had such type 2 characteristics (p<0.001). The high occurrence of apparent type 1 diabetes (42%) in the Ethiopian patients, in conjunction with their very low BMI levels and local chronic food shortages, raises the possibility as to whether at least some of this group may have MRDM

Extended Spectrum Beta-Lactamases among Gram-negative bacteria from an Egyptian Pediatric Hospital: a Two-Year Experience

Background Knowledge of the anti-microbial susceptibility pattern of common pathogens in a given area helps to inform the choice of empirical antibiotic therapy. The aim of this study was to determine the existence and to describe the characteristics of extended spectrum a-lactamase (ESBLs) in a pediatric hospital in Mansoura University; Egypt; to aid in the choice of empirical antibiotic therapy. Method: Between January 2005 and December 2006; blood samples were collected from children suspected to have nosocomial infections in a pediatric hospital in Mansoura. The gram negative isolates were identified; tested for antimicrobial susceptibility and analyzed for presence of ESBL. Results: A total of 1;600 children with suspected septicemia were studied. Gram negative septicemia was identified in 816 cases (45). The commonest isolated gram negative bacilli was Klebsiella species (38.2) followed by Enterobacter species (32.4); Serratia species (16.2) and Burkholderia cepacia (10.3). The highest susceptibility was for imipenem (74.3) followed by gentamicin (70.8); cefoperazone (64.5) and cefotaxime (63.2). The highest resistant rate was for cefazolin and ampicillin/sulbactam (75.5for each); followed by cefuroxime 70.3and ceftriaxone (63.5). The ESBL was found in 44.5for cefotaxime and 50for ceftazidime by double discs method. Conclusion: This study highlights the emergence of antibiotic resistant gram negative bacilli in a pediatric hospital with special emphasis on extended a-lactamase resistant strains. Our results show that the most appropriate antibiotics to be used for empirical therapy are amikacin and gentamicin

The Prevalence and Clinical Significance of Du Phenotype in Rhesus D Negative Pregnant Women in Maiduguri; Nigeria

To determine the prevalence and clinical significance of Du phenotype in Rhesus D negative pregnant women in Maiduguri; Nigeria; samples from 800 pregnant women who attended routine antenatal clinic from January 2004 to March 2005 were analyzed prospectively with respect to their ABO and Rhesus Blood group system. All Rhesus D negative women had elaborate indirect antiglobulin test to detect the presence of Du phenotype. The commonest ABO blood group system was group O. The prevalence's of Rhesus D positive and Rhesus D negative was 90.3