Unmet Surgical Need among Adults in A Mixed Urban-Rural Community in Nigeria: A Survey of 1,993 Adults Using the Sosas Survey Tool.

INTRODUCTION: Community-based prevalence studies are known to be more accurate than hospital-based records. However, such community-based prevalence studies are uncommon in low- and middle-income countries including Nigeria. Allocation of resources and prioritization of health care needs by policy makers require data from such community-based studies to be meaningful and sustainable. This study aims to assess the prevalence of common surgical conditions amongst adults in Nigeria. METHODS: A descriptive cross-sectional community-based study to determine the prevalence of congenital and acquired surgical conditions in adults in a mixed rural-urban area of Lagos was conducted. The study population comprised resident members in the Ikorodu Local Government Area (LGA) of Lagos State. Data was collected using a modified version of the interviewer-administered questionnaire, the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool. Data was analysed using the REDCap analytic tool. RESULTS: Eight hundred and fifty-six households were surveyed with a yield of 1,992 adults. There were 95 adults who complained of surgical conditions giving a prevalence rate of 5%. Vast majority of reported conditions were acquired deformities (n=94) while only 1 congenital deformity was reported. Others included breast lumps, anterior neck swelling, and groin swellings. CONCLUSION: The most common surgical complaints in our setting among adults were acquired conditions of the extremities and open wounds/sores. With an estimated population of 90 million adults and approximately 1,200 orthopaedic and general surgeons respectively, the surgeon-to-affected population ratio is 1:10,000. There is a large gap to be filled in terms of surgical manpower development.

INTRODUCTION: Les études de prévalence communautaires sont connues pour être plus précises que les dossiers hospitaliers. Cependant, de telles études de prévalence communautaires sont rares dans les pays à revenu faible et intermédiaire, y compris le Nigeria. L'allocation des ressources et la priorisation des besoins de santé par les décideurs nécessitent des données issues de telles études communautaires pour être significatives et durables. Cette étude vise à évaluer la prévalence des affections chirurgicales courantes chez les adultes au Nigeria. MÉTHODES: Une étude descriptive transversale basée sur la communauté pour déterminer la prévalence des conditions chirurgicales congénitales et acquises chez les adultes dans une zone rurale-urbaine mixte de Lagos a été menée. La population étudiée comprenait des membres résidents de la zone de gouvernement local (LGA) d'Ikorodu, dans l'État de Lagos. Les données ont été collectées à l'aide d'une version modifiée du questionnaire administré par un enquêteur, l'outil d'enquête Surgeons OverSeas Assessment of Surgical Need (SOSAS). Les données ont été analysées à l'aide de l'outil analytique REDCap. RÉSULTATS: Huit cent cinquante-six ménages ont été enquêtés, ce qui a donné 1 992 adultes. Quatre-vingt-quinze adultes se sont plaints de conditions chirurgicales, donnant un taux de prévalence de 5 %. La grande majorité des conditions rapportées étaient des déformations acquises (n=94) tandis qu'une seule déformation congénitale a été signalée. Les autres incluaient des nodules mammaires, des gonflements antérieurs du cou et des gonflements inguinaux. CONCLUSION: Les plaintes chirurgicales les plus courantes dans notre cadre parmi les adultes étaient des conditions acquises des extrémités et des plaies ouvertes/ulcères. Avec une population estimée à 90 millions d'adultes et environ 1 200 chirurgiens orthopédiques et généralistes respectivement, le ratio chirurgien-population affectée est de 1:10,000. Il y a un grand écart à combler en termes de développement de la main-d'œuvre chirurgicale. MOTS CLÉS: Prévalence, Charge de morbidité, Chirurgie, Plaies.

Paediatric Trauma Presentations in a Teaching Hospital in Lagos, Nigeria: Epidemiology and Predictor of Mortality.

INTRODUCTION: Paediatric trauma remains a major health challenge worldwide. It remains a major reason for hospitalization among children and adolescents around the world, with resultant death or disability. This study was aimed to determine the epidemiology, pattern and outcomes of paediatric injuries presenting at a teaching hospital in Lagos, South-west Nigeria. PATIENTS AND METHODS: This was a prospective observational hospital based study conducted on all paediatric trauma patients below 18 years, who presented at the accident and emergency room of the Lagos University Teaching Hospital (LUTH) over a period of thirteen months. Data analysis was done with Stata v13 (StataCorp. Texas. USA). RESULTS: A total of 154 patients sustained 250 documented injuries. The mean age was 6.8 ± 4.6 years. Male to female ratio was 1.5:1. Children aged 8 years were mostly affected. There was significant statistical association between age of child at injury and the place of injury. (p = 0.021) Most injuries (51.3%) occurred at home followed by the road. Falls accounted for 72 cases (46.8%). Traumatic brain injury was the most common injury sustained. Injuries at home peaked at 5pm and extended to 7pm while injuries from road traffic accidents peaked at two periods; between 7am and 8am and 4pm. Paediatric trauma score predicted death accurately. The crude mortality rate was 5.8%. CONCLUSION: Paediatric trauma scourge is still a health concern. School age children are mostly affected by trauma. Falls were the most common cause of trauma in children and most falls occurred in the home environment. Injuries from road traffic accidents accounted for majority of deaths. The paediatric trauma score predicts mortality in injured children and should be routinely used.

INTRODUCTION: Les traumatismes pédiatriques demeurent un problème de santé majeur dans le monde entier. Il demeure une raison majeure d'hospitalisation chez les d'hospitalisation chez les enfants et les adolescents du monde entier, avec des décès ou un handicap résultant . Cette étude avait pour but de déterminer l'épidémiologie, et les résultats des blessures pédiatriques présentées dans un hôpital universitaire de Lagos, dans le sud-ouest du Nigeria. PATIENTS ET MÉTHODES: Il s'agit d'une étude prospective d'observation menée dans un hôpital sur tous les cas de blessures pédiatriques traumatisés de moins de 18 ans, qui se sont présentés au service des accidents et des urgences du accident et des urgences du Lagos University Teaching Hospital (LUTH) sur une période de treize mois. L'analyse des données a été réalisée avec Stata v13 (StataCorp. Texas. USA). RÉSULTATS: Au total, 154 patients ont subi 250 blessures documentées. L'âge moyen était de 6,8 ± 4,6 ans. Le rapport hommes/ femmes était de 1,5:1. Les enfants âgés de 8 ans étaient les plus touchés. Il existe une association statistique significative entre l'âge de l'enfant au moment de la blessure et le lieu de la blessure. (p = 0,021) La plupart des blessures (51,3 %) sont survenues à la maison, suivies par la route. Les chutes ont représenté 72 cas (46,8 %). Les traumatismes cérébraux est la blessure la plus fréquente. Les blessures à domicile ont atteint un pic à 17 heures et se prolongeant jusqu'à 19 heures, tandis que les blessures dues à des accidents de la route ont atteint un pic à deux périodes : entre 6h et 7h59 et à 16h. Le score de traumatisme pédiatrique permettait de prédire le décès avec précision. Le taux de mortalité brut était de 5,8 %. CONCLUSION: Le fléau des traumatismes pédiatriques reste un problème de santé. Les enfants d'âge scolaire sont les plus touchés par les traumatismes. Les chutes étaient la cause la plus cause la plus fréquente de traumatisme chez les enfants et la plupart des chutes se sont produites dans le environnement. Les blessures dues aux accidents de la route représentent la majorité des décès. Le score de traumatisme pédiatrique permet de prédire la mortalité chez les enfants blessés et devrait être utilisé de manière systématique. Mots clés: Traumatisme, Pédiatrie, Blessures, causes, mortalité, Enfance, Nigeria.

Mentorship in orthopaedic and trauma residency training programme in Nigeria: the residents' perspective.

Background: Mentorship is important in residency training as it is necessary for personal and professional development of the resident trainees. Objectives: This study documents mentorship in orthopaedic residency training programme in Nigeria by assessing the awareness of orthopaedic residents on the role of a mentor, willingness to be mentored and their perceived reasons for the possible lack of mentors/ participation of senior colleagues in a mentorship programme. Method: This was a descriptive cross sectional study of 37 orthopaedic residents attending a revision course of the Faculty of Orthopaedics, National Postgraduate Medical College of Nigeria. Self-administered structured questionnaires were used to collect data. Data obtained was analyzed using SPSS version 21.0. Results: The mean age of the respondent was 34.7 ± 4.7 years. The Male: Female ratio was 19:1. The average number of years already spent in the residency programme by the respondents was 2.8 ± 0.9 years. Only 27% of residents had participated in a mentorship programme since they began residency programme but only half were still being mentored at the time of the study. Sixty-five percent reported no formal mentorship programme in their institutions. However, 73% of the respondents would want a formal mentorship programme in their institution. Ninety percent of the respondents desired to be mentored. Conclusion: Most residents are willing to be mentored. Consultants and trainers should ensure that the trainees are mentored.

Prevalence of cardiovascular risk factors amongst traders in an urban market in Lagos, Nigeria.

AIMS AND OBJECTIVES: A descriptive cross-sectional study was carried out to determine the prevalence of cardiovascular risk factors amongst traders in an urban market in Lagos State. SUBJECTS AND METHODS: Tejuosho market, one of the large popular markets was selected from a list of markets that met the inclusion criteria of being major markets dealing in general goods using a simple random sampling technique by balloting. Four hundred (400) traders were selected using a systematic random sampling. Each trader was interviewed with a well-structured questionnaire and had blood pressure and anthropometric measurements (height, weight and body mass index). RESULTS: Female traders made up (74.3%) 297 of the total population. The mean age was 45.48+11.88 and 42.29+10.96 years for males and females respectively. Majority 239 (59.8%) fell within the age range of 35 - 55 years. The cardiovascular risk factors identified and their prevalence rates were hypertension (34.8%), physical inactivity (92%), previously diagnosed diabetes mellitus (0.8%), risky alcohol consumption (1%), cigarette smoking (0.3%) in females and (17.5%) in males, obesity (12.3%) and overweight (39.9%). CONCLUSION: The study recommended that any health promoting, preventive or intervention programme for this population would have to be worked into their market activities if it is to make an impact.

Sequence type ST131 and ST10 complex (ST617) predominant among CTX-M-15-producing Escherichia coli isolates from Nigeria.

Of 109 clinical Escherichia coli isolates from two major tertiary hospitals in Lagos (University Teaching Hospital and the National Orthopaedic Hospital Igbobi), 14 (12.8%) extended-spectrum beta-lactamse (ESBL) producers were characterized using PCR and sequencing, ERIC-PCR and multilocus sequence typing. All ESBL-producing isolates encoded only the CTX-M-15 gene. Clonal group ST131 (35.7%) was the predominant ST, followed by ST617 (28.6%). Isolated cases of other sequence types were also observed. Plasmid-mediated quinolone resistance genes qnrA, qnrB1 and aac-(6')-lb-cr were detected among these ESBL isolates of different clonal groups. This is the first description of the clonality of CTX-M-15-producing E. coli from Nigeria. The presence of diverse clonal lineages shows the continuing potential for genetic diversification and emergence of new epidemic strains.

Detecting Nosocomial Intrinsic Infections through Relating Bacterial Pathogens of Incision

Surgical procedures often lead to both intrinsic and extrinsic infections. In order to improve on recovery of patients; investigations were carried out on samples collected from patients during and after surgery. Laboratory analysis was performed on wound swabs from incision; colon segments; scrapes; tissues; pus and catheter specimen urine. The samples were cultured on MacConkey and Blood agar and incubated aerobically at 370C for 16-24 hours. Thereafter; isolates were identified using standard microbiological methods. Results showed that isolates from wound were also found on endogenous indicators of surgery. Klebsiella species from incision was 15 (18.75) while those from colon segment was 30(37.6); scrapes 8(16) and pus 3(7.5). Acinetobacter species found on incision was 15(7.5) and pus 7(2.3). Pseudomonas species was distributed on incision 5(2.5); colon segment 4(5); tissue 3(1.6); scrapes 5(10) and pus was 5(12.5). Staphylococcus aureus which was isolated from incision was 2(1); while scrapes and pus were 5(10) and 7(17.5) respectively. Catheter associated urinary tract infections yielded significant bacteriuria (64.7); almost twice the rate of non-significant bacteriuria (35.3); indicating the need to remove all catheters as soon as possible. Antibiogram of isolates of Klebsiella pneumoniae with resistance pattern: ApGnNaNt; Escherichia coli (ApCtNaTtCm) and S. aureus (ApChCxErPn) with plasmid sizes in the range (30.2-52.51Kb) were common to both indicators and wound; showing that the pathogens were the same clusters. This study demonstrated surgical procedures as precursory to intrinsic infections and that bacterial pathogens found on wounds and endogenous indicators of surgery are links to intrinsic infection. The study therefore emphasizes the need to culture wounds promptly to effect speedy recovery of patients who have undergone surgery

Incidence of postoperative eye infections in a private eye hospital in Lagos, Nigeria.

BACKGROUND: There is a dearth of information on postoperative eye infections in Nigeria and most hospitals do not have an infection control program in place. OBJECTIVE: This study was done to investigate the incidence of post-operative eye infections, their potential sources and the preparedness of the hospital to prevent such infections. METHODS: A microbiological survey of all eye surgical procedures between March 2004 and May 2005 was performed. Relevant samples were taken and cultured pre, intra and post operatively as required. Definitions of infections were based on the Centers for Disease Control (CDC) Criteria. In the eye clinic, and operation theatre, infection control procedures and practices were audited using a pre-designed questionnaire. RESULTS: There were 2 cases of post operative eye infections (with Haemophilus influenzae and Corynebacterium species) during the one year of survey of 339 performed surgeries. S. aureus, Coagulase negative staphylococcus (CNS), and Enterobacter spp were cultured from the aqueous humour, as well as pre and post operative conjunctivae swabs of three other patients. Eighty four (24.8%) other patients were colonized post operatively with CNS (32), S. aureus (28), Klebsiella pneumoniae (8), E. coli (5), Corynebacterium species (3), Pseudomonas aeruginosa (1) Proteus mirabilis (4), Enterobacter species alone (1) and in association with CNS on 2 occasions. Seventy eight percent of patients had contact with staff who consistently haboured Staphylococcus species in their nares. Four patients (0.11%) were exposed to surgeons whose hands were contaminated and one eye (0.003%) to contaminated antiseptic solution. Facilities for hand washing and protective clothing were adequate but staffs were observed to perform an inadequate hands scrubbing. Most items were heat sterilized. Cleaning facilities were adequate and the environment was clean. The choice of antiseptic was correct, but that of disinfectant was considered incorrect. The ophthalmic equipments except the eye occluder were appropriately disinfected. Staffs were not protected when handling linen. Infected linens were separated from soiled linens only in the theatre. They were not bagged, and were hand sluiced. The only type of waste that was properly handled was sharps. All waste types were stored together prior to final disposal away from the public. CONCLUSION: The incidence of post-operative infection was 1.69% and their sources were the patients' normal flora. Other potential sources of post-operative eye infections identified included nares of hospital staff, hands of surgeon and hospital disinfectants. Areas of deficiencies in infection control practices, which require proper infection control policies, include hand scrubbing practices, disinfection, linen management and waste handling.

Aetiology of bacteraemia among adult AIDS patients attending Lagos University Teaching Hospital (LUTH), Lagos, Nigeria.

BACKGROUND: Bacteraemia is a relatively common event in HIV-infected patients, especially in late infection. Studies in Africa have shown that more than 23% of AIDS patients have bacteraemia but there is paucity of data from Nigeria. METHODS: Blood samples from 67 consecutive patients with AIDS attending the Lagos University Teaching Hospital between April and August 2000 were cultured. Temperature, ESR, Full blood count, and where possible CD4 counts were obtained. Socio-demographic details were also recorded. Thirty apparently healthy people were randomly selected from a low-risk population to act as non-AIDS controls. The Oxoid Signal Blood Culture System was used to investigate bacteraemia. Antibiotic sensitivity tests were carried out on all isolates. RESULTS: Twenty-two (33%) of the 67 AIDS patients were culture positive. Non-typhoidal Salmonella spp (45.5%), coagulase-negative staphylococci (22.7%) and Staphylococcus aureus (18.2%) were most commonly isolated. One isolate each of Klebsiella pneumoniae, Pseudomonas aeruginosa and Bacillus spp were identified. All bacteraemic patients had temperatures above 38 degrees C and white blood cell counts ranged between 2,700-13,500/mm(3). There was a high rate of antibiotic resistance particularly to chloramphenicol, tetracyclines, cotrimoxazole and beta-lactam antibiotics. However, most isolates were still susceptible to gentamicin and the fluoroquinolones. There was no significant difference in the socio-demographics of the bacteraemic AIDS and non-bacteraemic AIDS patients. CONCLUSION: Salmonella spp. were the most common aetiological agent of bacteraemia among AIDS patients seen at the Lagos University Teaching Hospital (LUTH), Nigeria. A high temperature was a pointer to the presence of bactaeraemia while total white blood cell counts were not useful. It is recommended that blood culture should be done for AIDS patients with elevated temperature irrespective of the total white blood cell count.

Phytochemical Screening and Free Radical Scavenging Activities of the Fruits and Leaves of Allanblackia floribunda Oliv (Guttiferae)

Purpose: To compare the phytochemical constituents in the leaves and fruits of Allanblackia floribunda and determine their free radical scavenging activity. Methods: The fruit and leaves of AF collected from the uncultivated farmlands of Okeigbo; Ondo State; Nigeria; were dried; milled and extracted with methanol. Phytochemical screening was carried out according to standard procedures. Free radical scavenging activity was determined by measuring the decrease in the visible absorbance of 2;2-diphenyl-1-picrylhydrazyl (DPPH) on addition of the plant extract. The mean inhibitory concentration (IC50); which is the concentration of extract needed to decrease the initial absorbance of DPPH by 50was determined graphically. Total phenolic; flavonoids and proanthocyanidin contents were determined by spectro-photometric methods. Results: Alkaloids; anthraquinones; tannins; saponins; steroids; terpenoids; flavonoids and cardiac glycosides were found to be present in both the fruits and leaves. Only AF fruit contained phlobatannins. IC50 values of 0.01; 0.02 and 0.1 mg/ml were recorded for Vitamin E; AF leaves and AF fruits respectively. Total phenolic; total flavonoid and proanthocyanidin contents were 65; 0.07 and 2.38 mg/g of powdered plant material for AF fruits; and 12; 51.35; 19.5 mg/g of powdered plant material for AF leaves as gallic acid; rutin and catechin equivalents respectively. Conclusion: AF leaves are five times more potent as a free radical scavenger compared to the fruits though the fruit was found to contain a higher phenolic content

Phytochemical Screening and Free Radical Scavenging Activities of the Fruits and Leaves of Allanblackia floribunda Oliv (Guttiferae)

Purpose: To compare the phytochemical constituents in the leaves and fruits of Allanblackia floribunda and determine their free radical scavenging activity. Methods: The fruit and leaves of AF collected from the uncultivated farmlands of Okeigbo; Ondo State; Nigeria; were dried; milled and extracted with methanol. Phytochemical screening was carried out according to standard procedures. Free radical scavenging activity was determined by measuring the decrease in the visible absorbance of 2;2-diphenyl-1 -picrylhydrazyl (DPPH) on addition of the plant extract. The mean inhibitory concentration (IC50); which is the concentration of extract needed to decrease the initial absorbance of DPPH by 50was determined graphically. Total phenolic; flavonoids and proanthocyanidin contents were determined by spectro-photometric methods. Results: Alkaloids; anthraquinones; tannins; saponins; steroids; terpenoids; flavonoids and cardiac glycosides were found to be present in both the fruits and leaves. Only AF fruit contained phlobatannins. IC50 values of 0.01; 0.02 and 0.1 mg/ml were recorded for Vitamin E; AF leaves and AF fruits respectively. Total phenolic; total flavonoid and proanthocyanidin contents were 65; 0.07 and 2.38 mg/g of powdered plant material for AF fruits; and 12; 51.35; 19.5 mg/g of powdered plant material for AF leaves as gallic acid; rutin and catechin equivalents respectively. Conclusion: AF leaves are five times more potent as a free radical scavenger compared to the fruits though the fruit was found to contain a higher phenolic content

Infection control audit and potential sources of infection of a Nigerian eye unit.

BACKGROUND: The prevalence of post-surgical eye infections in Nigeria has not been documented. However, anecdotal reports suggest that post-operative endophthalmitis is fairly common in Lagos. OBJECTIVES: This study was done to investigate the sources of post-operative eye infections and the preparedness of the hospital to prevent such infections. METHODS: A bacteriological survey of all eye surgical procedures between September 2004 and June 2005 was performed. Relevant samples were cultured pre- intra and post operatively as required. In the eye clinic, and operation theatre, infection control procedures and practices were audited using a pre-designed questionnaire. RESULTS: Out of 207 procedures performed, there was no case of post -operative eye infection but potential sources of infections identified included nares of staff, surgical packs, theatre bed, hands of surgeons and conjunctivae of patients. Running water and soap were available for hand washing. There was no specific provision for drying hands in the clinic and staff were observed to carry out hand wash considered ineffective. Staff showed good knowledge of disinfectants and antiseptic use. In the theatre, the staff who handle the steam sterilizer were not formally trained on its use. Although sterile packs were appropriately stored they were not dated. Appropriate types of waste bins were not in use and wastes were not segregated appropriately. Ophthalmic equipment were not adequately disinfected in between patients and use of eye drops for dilatation was communal. CONCLUSION: Potential sources of post-operative eye infections were identified. Areas of deficiencies in infection control practices, which require proper infection control policies, include handwashing facilities and practices, sterilization procedures, disinfection of ophthalmic equipment, linen management and waste handling.

Medicinal Plants useful for Malaria Therapy in Okeigbo; Ondo State; Southwest Nigeria

There is increasing resistance of malaria parasites to chloroquine; the cheapest and commonly used drug for malaria in Nigeria. Artemisin; a product from medicinal plant indigenous to China; based on active principle of Artemisia annua; has been introduced into the Nigerian market. However not much has been done to project antimalaria properties of indigenous medicinal plants. This study thus; has the main objective of presenting medicinal plants used for malaria therapy in Okeigbo; Ondo State; South west Nigeria. Focus group discussions and interview were held about plants often found useful for malaria therapy in the community. Fifty species (local names) including for example: Morinda lucida (Oruwo); Enantia chlorantha (Awopa); Alstonia boonei (Ahun); Azadirachta indica (Dongoyaro)and Khaya grandifoliola (Oganwo) plants were found to be in use for malaria therapy at Okeigbo; Southwest; Nigeria . The parts of plants used could either be the barks; roots; leaves or whole plants. The recipes also; could be a combination of various species of plants or plant parts. This study highlights potential sources for the development of new antimalarial drugs from indigenous medicinal plants found in Okeigbo; Nigeria

A study on pediatric nosocomial methicillin-resistant Staphylococcus aureus in Lagos; Nigeria

This work was undertaken to determine the incidence of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infections in children at a tertiary hospital and the antibiotic susceptibility profiles of MRSA compared with methicillin-sensitive (MSSA) strains. From 1994 to 1995; 4;981 admissions in the neonatal intensive care; paediatric surgical; general paediatric; and the well-baby wards of the Lagos University Teaching Hospital were prospectively monitored for nosocomial S. aureus infections. Antibiotictesting was performed on a total of 175 isolates of S. aureus obtained from 169 patients with nosocomial infections (NI) using a disk diffusion method and by E test (AB Biodisk; Sweden). In total; nosocomial MRSA infection was identified in 96 (1.9) patients; rates recorded for patients in the various wards as stated above were 4.2; 3.2; 0.5 and 0 respectively. Correspondingly; the rate of nosocomial MRSA amongst all S. aureus infections was 63.6; 44.7; 41.7 and 0; and 54.9 overall. All MRSA and MSSA were sensitive to ciprofloxacin and vancomycin. Clindamycin and rifampin (87-98) were also highly effective against MRSA and MSSA; 78.3 of MRSA and 91.7 MSSA were sensitive to fusidic acid. Gentamicin (70.9) and erythromycin (65.8) were also active on MSSA. Cotrimoxazole had low activity against all the strains. Following the high rate and multiresistant nature of nosocomial MRSA obtained in this study; there is need for intensive surveillance of such infections and initiation of stringent control measures in Nigeria and Africa at large.; 0.5 and 0 respectively. Correspondingly; the rate of nosocomial MRSA amongst all S. aureus infections was 63.6; 44.7; 41.7 and 0; and 54.9 overall. All MRSA and MSSA were sensitive to ciprofloxacin and vancomycin. Clindamycin and rifampin (87-98) were also highly effective against MRSA and MSSA; 78.3 of MRSA and 91.7 MSSA were sensitive to fusidic acid. Gentamicin (70.9) and erythromycin (65.8) were also active on MSSA. Cotrimoxazole had low activity against all the strains. Following the high rate and multiresistant nature of nosocomial MRSA obtained in this study; there is need for intensive surveillance of such infections and initiation of stringent control measures in Nigeria and Africa at large

Comparative evaluation of direct stool smear and formol-ether concentration methods in the identification of Cryptosporidium species

Cryptosporidium is a common cause of diarrhoea in patients with Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS). Unfortunately this pathogen is not often checked for in Microbiology laboratories because the formol-ether stool concentration method for identification of Cryptosporidium is cumbersome and may not be routinely undertaken in very busy laboratories and in laboratories with inadequate personnel. This study was therefore carried out to compare the outcome of direct stool examination and formol-ether concentration method with the aim of finding a non-cumbersome method of examining for Cryptosporidiumspecies routinely in stools when it is indicated. Fresh stool specimens of 193 HIV positive and 200 HIV negative patients (control) attending clinic at the Lagos University Teaching Hospital (LUTH) were processed within two hours of collection using direct stool smear and formol-ether concentration methods. Permanently stained slides were prepared using Kinyoun acid-fast stains. Cryptosporidium oocysts were found in 35 (18.1) of HIV seropositive patients using direct stool smear method and in 36 (18.7) using formol-ether concentration method. There was no statistical difference between the two methods (p 0.05; xz = 0.012; df = 1 at 95 confidence limit critical ratio = 3.841). No Cryptosporidiumwas identified in the control (HIV negative) patients using either method. Cryptosporidium oocysts can be routinely checked for in the Microbiology laboratories using either direct stool smear or formol-ether concentration stool method with comparable sensitivity

Aerobic bacterial nosocomial infections in paediatric surgical patients at a tertiary health institution in Lagos, Nigeria.

This study was undertaken to determine nosocomial bacterial infections (NI) in surgical patients in a developing country using the detailed option of the Center for Disease Control (CDC) surgical patient surveillance technique. From 1994 - 1995. Paediatrics surgical patients at the Lagos University Teaching Hospital (LUTH) were prospectively monitored for NI at all body sites. Standard definitions of NI were used, and NI sites were categorised by type of operation. A total of 304 NI occurred in 245 out of 664 surgical patients investigated. SSI (77.3 %) and urinary tract infections (19.1%) were in preponderance. Seventy three per cent of SSI were superficial incisions, 20.5% organ/space and 6.8% deep incisions. The overall wound infection rate was 30.9%. The SSI rate for emergency surgery was 35.6% and 26.5% for elective procedures. Rates within each wound class were 20.2, 23.8, 51.9 and 52.8% respectively and 17, 37.6, 43.4 and 47. 1% for patients with ASA scores of I II III and IV in that order. The SSI rates for patients with scores of 0, 1, 2 and 3 were 20.4; 43.5, 57.1 and 75% respectively. Mean infection rates in the various wound classes were highly correlated with the number of risk factors present. Klebsiella pneumoniae (38. 7%), Escherichia coli (22.7%), Pseudomonas aeruginosa (16.8%) and Staphylococcus aureus (10. 7%) were the most common pathogens.

Diagnosis and Management of Chancroid in Nigeria.

There is a broad group of venereal disease that is referred to as the "Tropical Venereal Disease". They are so-called because they are most frequently seen in the tropical and sub-tropical areas of the world. Among them are conditions like chancroid, lymphogranuloma venereum (LGV or climatic bubo) and granuloma inguinale (chronic venereal sores). Chancroid is variously called "soft sore" or "soft chancre" because it bleeds easily and "ulcus moile".1 It is an acute infection and auto-innoculable disease. The extent of chancroid genital ulceration in Nigeria is greater in the Northern partly due to permissive sexual practices especially for men.

Extended-spectrum beta-lactamase enzymes in clinical isolates of Enterobacter species from Lagos, Nigeria.

Over a 9-month period, 8 of 40 nonduplicate isolates of Enterobacter spp. producing extended-spectrum beta-lactamase (ESBL) were detected for the first time from two hospitals in Lagos, Nigeria. Microbiologic and molecular analysis confirmed the presence of ESBL. Only four isolates transferred ESBL resistance as determined by the conjugation test, and pulsed-field gel electrophoresis showed genetically unrelated isolates.

Prevalence of methicillin-resistant Staphylococcus aureus in eight African hospitals and Malta.

Methicillin-resistant Staphylococcus aureus (MRSA) poses a serious therapeutic problem worldwide, and its frequency in most African countries has not been reported. This study was aimed at determining the prevalence and antibiotic susceptibility patterns of MRSA in eight large hospitals (>500 beds) in Africa and Malta, from 1996 to 1997. Susceptibility to methicillin (oxacillin) and to other drugs was determined by E test (AB Biodisk, Solna, Sweden) on a total of 1440 clinical isolates of S. aureus. Methicillin resistance was detected in 213 (15%) of the 1440 isolates tested. The rate of MRSA was relatively high in Nigeria, Kenya, and Cameroon (21-30%), and below 10% in Tunisia, Malta, and Algeria. All MRSA isolates were sensitive to vancomycin, with MICs 60%) of MRSA strains were multiresistant. There is a need to maintain surveillance and control of MRSA infections in Africa.

Susceptibility profile of Enterococcus faecalis isolated at the Lagos University Teaching Hospital, Nigeria.

Enterococcus faecalis is the most common of the Enterococcus genus causing infection, particularly urinary tract infections, worldwide. It is also a common cause of nosocomial infections and resistance to various antibiotics is on the increase worldwide. Thirty-five strains of E. Faecalis isolated from various clinical specimens (blood, wound swabs endocervical swabs but mostly urine) were screened for high-level aminoglycoside resistance. Their susceptibility nine antibiotics (ampicillin, gentamicin, streptomycin, vancomycin, tetracycline cotrimoxazole and chloramphenicol, ciprofloxacin and erthromycin) was also determined. All isolates were susceptible to Ampicillin and Vancomycin with MIC90 of 4microg/ml but resistant to Nalidixic acid with an MIC90>256microg/ml. Four (11%) of the isolates showed high-level resistance to Gentamicin while 11(32%) exhibited high-level resistance streptomycin after 24 hours incubation. It will appear that Ampicillin in combination with gentamicin but not streptomycin, can still be used empirically for the treatment of Enterococcal infections.