Enterobacteriaceae isolates from clinical and household tap water samples: antibiotic resistance, screening for extended-spectrum, metallo- and ampC-beta-lactamases, and detection of blaTEM,blaSHV and blaCTX-M in Uyo, Nigeria.

Introduction: Infections caused by multidrug-resistant (MDR) bacteria, extended spectrum ß-lactamase (ESBL), metallo-ß-lactamase (MBL) and AmpC-ß-lactamase (AmpC-ßL)-producers are increasing globally. This study identified bacteria in clinical and tap water samples and determined the prevalence of MDR, and ß-lactamase enzymes and genes. Methods: Isolates were identified by the Vitek 2 (bioMérieux, France) automated system. Antibiotic resistance and screening for ß-lactamase enzymes and genes was done using disc diffusion method and Vitek 2 automated system, CHROMagar-ESBL, combined double disc, inhibition-based method and multiplex polymerase chain reaction, respectively. Results: The Enterobacteriaceae isolates obtained were Escherichia coli, Klebsiella pneumoniae, Citrobacter freundii, Salmonella spp., Proteus mirabilis, Enterobacter aerogenes, Shigella sonnei, Proteus vulgaris, Enterobacter sakazakii, Klebsiella oxytoca, Citrobacter diversus, and Serratia liquefaciens. Of the 674 isolates from clinical samples, 36.5%, 28.5%, and 19.9% were ESBL, MBL, and AmpC-ßL producers, respectively. A low prevalence of AmpC-ßL and MBL producers were obtained, with no significant difference (p<0.05) between the prevalence of ESBL and non-ESBL producers. Isolates exhibited varied levels of resistance to gentamicin, amoxicillin-clavulanic acid, ciprofloxacin, and tetracycline. The results showed that 54.6% of ESBL producers, 57.9% of MBL producers, and 62.8% of AmpC-ßL producers were MDR strains. Of the 141 representative isolates tested, 36.9%, 15.6%, and 20.6% had only blaTEM, blaSHV, and blaCTX-M, respectively; 5.7% possessed both blaTEM and blaSHV; 7.1% possessed both blaTEM and blaCTX-M and 4.3% had both blaSHV and blaCTX-M. Conclusions: This study found a high prevalence of ß-lactamase producers, indicating the need for further research on the molecular epidemiology of ß-lactamase producers and their impacts in the region.

Phenotypic and molecular characterization of Staphylococcus aureus from mobile phones in Nigeria.

The presence of Staphylococcus aureus, a normal human flora on cellphones of different professionals in Ile-Ife was investigated with a view to determining their antibiotic susceptibility profile and nature of resistance and virulence genes. One hundred swab samples were collected aseptically from mobile phones of various users based on their profession. Surfaces of the mobile phones were swabbed and the streak plate method was used to isolate colonies showing characteristic golden yellow on mannitol salt agar plates. These isolates were further identified using standard microbiological methods. The antibiotic susceptibility of the isolates was determined using Kirby-Bauer's disk diffusion technique. Molecular detection of nuc, mecA and pvl genes in some isolates was carried out by polymerase chain reaction technique. All the 36 isolates obtained in this study were 100% resistant to amoxicillin and augmentin; the isolates also displayed 55.6%, 44.4% and 41.7% resistance to ceftriazone, erythromycin and chloramphenicol, respectively. Based on resistance to oxacillin, prevalence of methicillin resistant Staphylococcus aureus (MRSA) was 11.1%. Only one S. aureus was positive for plasmid analysis. MecA gene was genetically confirmed in four (4) out of the 16 suspected phenotypic MRSA strains, nuc gene was confirmed in all 28 isolates investigated, while there was no pvl gene in the strains investigated. Mobile phones harbor multiple antibiotics resistant S. aureus, which are responsible for important diseases in humans and could be difficult to manage with antibiotics thereby posing serious health risks.

Effects of maternal methyl donor on the pork characteristics of offspring pigs with prenatal exposure to bisphenol A.

To explore the effects of maternal nutrition on offspring muscle characteristics, a total of 56 sows were assigned to one of the four dietary groups during gestation: control (CON), or control diets supplemented with methyl donor (MET), bisphenol A (BPA), and combined BPA and MET (BPA+MET). Compared with CON offspring, MET offspring showed a higher meat redness value, but lower glycogen content in the longissimus thoracis (LT). Moreover, compared with CON offspring, MET offspring showed lower LT glycogen synthase (GS) mRNA levels at birth and the finishing stage, and increased methylation at the GS promoter. Prenatal BPA exposure reduced the pH and redness value of meat, but increased the lightness value, lactate content, glycolytic potential and lactate dehydrogenase (LDH) enzyme activity in the LT muscle. Prenatal BPA exposure increased LDH mRNA levels in the LT muscle at birth and the finishing stage, and reduced methylation at the LDH promoter. Thus, maternal MET affects muscle GS and LDH expression via DNA methylation, thereby resulting in persistent effects on pork quality.

The impact of a psychiatry clinical rotation on the attitude of Nigerian medical students to psychiatry.

OBJECTIVE: Undergraduate medical students have ingrained and often negative attitudes towards psychiatry as a field and as a career. This in turn has affected recruitment of graduate medical students into the specialty. Little is known about the impact of psychiatry rotations during undergraduate medical training on students' attitudes about psychiatry and eventual specialty choice in developing countries. This study examined the impact of a psychiatry clinical rotation on medical students' attitudes to psychiatry and possible career choice. METHOD: Eighty-one and one hundred and six fifth year medical students completed the ATP-30, socio-demographic and career choice questionnaires at the beginning and the end of a four week clinical rotation respectively. RESULTS: The overall attitude of the students to psychiatry was favourable at the beginning of the rotation with significant improvement following the rotation (p = 0.003). Significant improvement in attitude was observed among female and younger students. Students who indicated preference for specialties other than psychiatry showed a greater improvement in their attitude to psychiatry following the rotation (p = 0.011). The rotation however did not enhance students' preference for psychiatry as a future career. CONCLUSION: The four-week clinical rotation in psychiatry resulted in increased mean attitudinal score, but not in enhanced preference for psychiatry as a career.

Comparison of clinical profiles and treatment outcomes between vagrant and non-vagrant mentally ill patients in a specialist neuropsychiatric hospital in Nigeria.

OBJECTIVE: Vagrant mentally ill patients are a highly marginalized group that receive limited care and attention from society. There is a dearth of information on the clinical status of this group in low-income countries. The aim of this study was to compare the clinical profiles and treatment outcomes between vagrant and non-vagrant mentally ill patients admitted to Aro Psychiatric Hospital, Abeokuta, Nigeria. METHOD: We conducted a retrospective review of clinical records charting vagrant and non-vagrant mentally ill patients treated over a five year period from January 2004 to December 2008. RESULTS: The medical records of 61 vagrant and 122 non-vagrant mentally ill patients were reviewed and compared. The vagrant patients were more likely to be older, unmarried and alone, poorly educated, unemployed or performing unskilled labour, and diagnosed with schizophrenia. This cohort was also more likely to have physical co-morbidities compared with the non-vagrant mentally ill patients. The median time to improvement among the vagrants (211.0 days) was significantly longer than for the non-vagrant patients (34.0 days) suggesting more intractable illnesses. Other factors found to prolong the time to improvement among all patients were old age, education, being single, unemployment, the diagnoses of schizophrenia, and substance abuse. CONCLUSION: The clinical profiles and treatment outcomes were poorer among the vagrant mentally ill patients, underscoring a need for more comprehensive healthcare resources directed to this patient group in Nigeria.

Depression among medical outpatients with diabetes: a cross-sectional study at Jos University Teaching Hospital, Jos, Nigeria.

BACKGROUND: Clinical depression is a common problem among patients who seek medical care, and diabetic patients with comorbid depression tend to have higher health care cost. A dearth of literature exists on depression among diabetics in Nigeria. The objectives of the study were to determine the prevalence of depression among diabetic patients and to determine the sociodemographic correlates of depression among diabetics. METHODS: A cross-sectional descriptive study was conducted between December 2005 and April 2006 among patients who attend the diabetes clinic of Jos University Teaching Hospital (JUTH) with a laboratory and clinical evidence of diabetes mellitus. A semi-structured questionnaire was used to record the sociodemographic data of each consecutive patient followed by an interview by psychiatrists using the depression module of the Structured Clinical Interview for DSM-I V axis I disorder (SCID). Subsequently, the Hamilton Rating Scale for Depression (HDRS) was used to determine the severity of symptoms among subjects diagnosed with depression according to DSM-I V criteria. RESULTS: Thirty-one of the 160 subjects fulfilled the DSM-IV criteria for the diagnosis of a major depressive episode giving a 1-year prevalence rate of 19.4%. Depression was significantly correlated with sex (P=0.001) with a female-to-male ratio of 3:1 and was also significantly associated with unmarried diabetics (P=0.002) and those who had a poor relationship with their partners (P=0.04). No significant association was found between depression and the respondents' age (P=0.216), educational qualifications (P=0.268), employment status (P=0.84), place of residence (P=0.80), household composition (P=0.77), and monthly income (P=0.110). CONCLUSION: Depression is a common psychiatric disorder among diabetic subjects in this environment. It was suggested that diabetic patients be screened for depression to allow for early detection and treatment.

Beliefs and knowledge about aetiology of mental illness among Nigerian psychiatric patients and their relatives.

A survey of 70 insightful clinically stable out-patients with functional psychotic disorders and 70 accompanying relatives was carried out. They were interviewed about their beliefs concerning the cause of the illness, and their awareness of other possible aetiological factors. Relevant sociodemographic and clinical information were also elicited. Twelve (17.1%) patients and relatives, respectively, gave "medical" causal explanations; 16 (22.9%) patients and 13 (18.6%) relatives gave "psychosocial" causal explanations; 27 (38.6%) patients and 38 (54.3%) relatives were "uncertain" about the cause of their/relatives' illness (X2 = 5.08; df = 3: P = 0.16). Relatives reported a greater relevance of "heredity" (X2 = 11.58; P = 0.0006) and "supernatural" factors (X2 = 4.72: P = 0.029) as other possible causal factors, than patients. Patients with previous psychiatric hospitalisation reported higher prevalence of "psychosocial" and "supernatural" causal beliefs than those without (X2 = 9.15; P = 0.027). Also, patients with "medical" causal belief reported better treatment compliance than those with other beliefs (P = 0.031). Among relatives, "psychosocial" causal belief in comparison with other beliefs was associated with a longer duration of treatment in the hospital (h = 8.29; P = 0.04). For patients, knowledge about possible causal role of "heredity was significantly more prevalent among male than female patients (X2 = 6.55; P = 0.01) and admission of possible "supernatural" causation was associated with education below the secondary level (X2 = 6.68; P = 0.008). For relatives, knowledge about possible causal role of brain dysfunction was associated with longer duration of treatment (u = 3.93; P = 0.047), and knowledge of possible causal role of "psychosocial" stress was associated with urban place of residence rather than rural (X2 = 10.52; P = 0.0012). For both patients and relatives, the most acceptable aetiological proposition was the "supernatural" while the least was "psychosocial". Findings revealed, among others, the widespread belief in "supernatural" causation of mental illness in patients/relatives. Some identified significant findings may be relevant in mental health education programme development.