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

HIV status of partners of HIV positive pregnant women in different regions of Nigeria: matters arising.

This study was conducted to determine the pattern of HIV sero-status of Partners of HIV Positive Pregnant Women in three different regions of Nigeria and to explore the implications for HIV prevention interventions. The Site Coordinators of PMTCT programs in three Nigerian cities obtained data of the HIV status of the partners of HIV positive pregnant women. The selection of Benin City, Jos and Kano was made after consideration of their ethnic, religious and cultural representation of Nigeria. Benin City represents a traditional southern Nigeria city, Kano a traditional northern city and Jos, a middle-belt, ethnically diverse cosmopolitan setting. The data were analyzed using frequencies. A total of 500 partners of HIV infected pregnant women were tested for HIV using Determine Abbott test kits. Positive results were confirmed using Western blot or a second rapid test kit. The city-by-city results showed that in Benin City (Southern Nigeria), 78.8% (104/132) of the partners were HIV negative (sero-discordant), Jos (Middle-Belt) had 48.4% (103/213) sero-discordance while Kano (Northern Nigeria) recorded a sero-discordance rate of only 7.7% (12/155). These results indicate that the dynamics of HIV transmission in marital settings in Nigeria are different in the various regions of the country. Socio-cultural and religious settings play a significant role in HIV transmission among couples. These findings should guide prevention interventions in order to achieve maximal impact.

Gossypol blood levels and inhibition of spermatogenesis in men taking gossypol as a contraceptive. A multicenter, international, dose-finding study.

The safety and efficacy of gossypol continues to be controversial. The aim of this study was to evaluate gossypol as a contraceptive pill for men at doses lower than those previously prescribed and in men from various ethnic origin. A total of 151 men from Brazil, Nigeria, Kenya, and China were divided into two groups. Both groups received 15 mg gossypol/day for 12 or 16 weeks to reach spermatogenesis suppression. Subjects were then randomized to either 7.5 or 10 mg/day for 40 weeks. In addition, 51 men were enrolled as a control group. In all, 81 subjects attained spermatogenesis suppression. Only one man discontinued treatment because of tiredness. Potassium levels fluctuated within the normal range. FSH increased consistently. Testicular volume decreased, but after discontinuation, values returned to levels not statistically different from admission. Of 19 subjects on the 7.5 mg/day dose group, 12 recovered sperm counts >20 million/mL within 12 months of discontinuing gossypol. In the 10 mg/day group, sperm counts recovered in only 10 of 24 subjects. Eight of the 43 patients remained azoospermic 1 year after stopping gossypol. All men diagnosed with varicocele failed to reverse spermatogenesis suppression. Gossypol blood levels indicated that sperm suppression occurs independently of concentration, whereas spermatogenesis recovery appears to be concentration-dependent. Gossypol may become a medical alternative to surgical vasectomy when the delay in onset of infertility is acceptable. When taken for 1 year, gossypol causes no reduction in sexual desire or frequency of intercourse. The possibility of reversal, occurring in 51% of the men on this regimen within 1 year after stopping gossypol, is an advantage of this compound as compared with surgical sterilization in many parts of the world.

PIP: The safety and efficacy of gossypol continues to be controversial. The aim of this study was to evaluate gossypol as a contraceptive pill for men at doses lower than those previously prescribed and in men from various ethnic origin. A total of 151 men from Brazil, Nigeria, Kenya, and China were divided into two groups. Both groups received 15 mg gossypol/day for 12 or 16 weeks to reach spermatogenesis suppression. Subjects were then randomized to either 7.5 or 10 mg/day for 40 weeks. In addition, 51 men were enrolled as a control group. In all, 81 subjects attained spermatogenesis suppression. Only 1 man discontinued treatment because of tiredness. Potassium levels fluctuated within the normal range. FSH increased consistently. Testicular volume decreased, but after discontinuation, values returned to levels not statistically different from admission. Of 19 subjects in the 7.5 mg/day dose group, 12 recovered sperm counts higher than 20 million/ml within 12 months of discontinuing gossypol. In the 10 mg/day group, sperm counts recovered in only 10 of 24 subjects. 8 of the 43 patients remained azoospermic 1 year after stopping gossypol. All men diagnosed with varicocele failed to reverse spermatogenesis suppression. Gossypol blood levels indicated that sperm suppression occurs independently of concentration, whereas spermatogenesis recovery appears to be concentration-dependent. Gossypol may become a medical alternative to surgical vasectomy when the delay in onset of infertility is acceptable. When taken for 1 year, gossypol causes no reduction in sexual desire or frequency of intercourse. The possibility of reversal, occurring in 51% of the men on this regimen within 1 year after stopping gossypol, is an advantage of this compound as compared with surgical sterilization in many parts of the world.

Application of polymerase chain reaction to the prenatal diagnosis of sickle cell anaemia in Nigeria.

Although sickle-cell disease is very common in Nigeria, control by prenatal testing is lacking. The polymerase chain reaction-based technology combined with chorionic villi sampling has enabled us to offer prenatal diagnosis of sickle cell disease to 50 pregnant women who were at risk of bearing children with sickle cell anaemia. DNA was extracted from the villus and subjected to either PCR and restriction enzyme (Dde I) analysis (36 samples) or to PCR-ARMS procedure (12 samples) or to both procedures when the results by the first procedure were equivocal (2 samples). The genotypic distribution was 13AA, 25AS and 11SS. In one case, it was not possible to determine the genotype of the villi by both methods. A post delivery genotype analysis confirms the correctness of prenatal diagnosis in all the 42 subjects that has so far reported. The results clearly demonstrate the usefulness of the PCR method in the prenatal diagnosis of sickle-cell anaemia in this environment.

Initiation of prenatal diagnosis of sickle-cell disorders in Africa.

We introduced prenatal diagnosis of SCD in Nigeria in order to meet a rising demand. Our approach and experience are documented as a guide to others in countries with similar problems. A cost-recovery fee charged only to sustain the service predictably limited access to it. Ultrasound-guided transcervical (TC) or transabdominal (TA) sampling of 124 chorionic villi was done from nine weeks' gestation. All couples carried the sickle trait (AS) and 52 (51 per cent) women had previously had children with sickle-cell anaemia. 72 samples were obtained by the TA and 52 by the TC route. 7.2 per cent miscarried after CVS but the miscarriage rate was significantly higher (p=0.023) after TC CVS (13.5 per cent) than after TA CVS (2.8 per cent) and also higher in the first 62 (11.3 per cent) than after the last 62 CVS (3.2 per cent). DNA analysis of CVS indicated Hb AA in 29 (23.4 per cent), AS in 67 (54 per cent) and SS in 23 (18.5 per cent). No result was obtainable in five subjects for technical reasons. 96 per cent of the women with SS fetuses terminated the pregnancies. The need for a standby source of electricity where supply is unreliable and for providing an equitable service to all couples at risk are highlighted.

Results of a user satisfaction study carried out in women using Uniplant contraceptive implant.

A study of the acceptability of Uniplant, a 12-month single implant of nomegestrol acetate, included 819 women from Africa, Latin America, and China, participating in a clinical trial of Uniplant. A standard, pre-coded questionnaire was specially designed for this purpose and applied at the moment of removal of implant, either at the end of 12 months of use or at the time of discontinuation for whatever reason. The level of satisfaction proved high when users' comparison with their previous contraceptive method, users' recommendation of Uniplant to others, users' intention to use the method in the future, and service satisfaction were taken into consideration. Uniplant was considered easy to use, safe (low risk of pregnancy), and also to cause fewer side effects than other methods. When asked about the least liked feature of Uniplant, almost half the respondents said that there was nothing that they disliked and about one-third mentioned the changes in their menstrual pattern. However, according to the clinical trial, over half of the Uniplant users have bleeding patterns similar to untreated cycles. The majority of respondents did not feel any discomfort during the procedure of insertion and removal of the implant. About 70% of patients in the study stated that they required contraception for more than one year and most of these women said that they did not mind having to change the implant every year.

Profile of abortion in Nigeria.

PIP: This article offers insights on the profile of abortion in Nigeria. The first section of the paper analyzes the legal context of abortion in the country, which is governed by the provisions of the Criminal Penal Codes. Sections 228, 229, 230 and 297 of the Criminal Code and Sections 232 and 234 of the Penal Code define the specific offenses and stipulate the punishment for them. The second section examines the proposed legislation, the ¿Termination of Pregnancy Bill,¿ which was modeled after the English Abortion Act of 1967. Despite the indications that the proposed reforms in the Bill were widely accepted, groups of religious leaders and conservative women's societies pitted themselves against it. The third section provides information on the dimension of the problem in Nigeria based on findings of the different studies on abortion conducted in the region. It is generally estimated that 3 million abortions take place annually in Africa; 700,000 of these abortions may occur in Nigeria. The final section presents a study that utilizes focus group discussions to explore the knowledge, attitudes, beliefs, motives, and behaviors of women towards reproductive health and abortion. In light of the findings presented, the paper outlines policy changes that are needed, advocacy activities to facilitate such changes and areas of further research.^ieng

Multicenter clinical trial on the efficacy and acceptability of a single contraceptive implant of nomegestrol acetate, Uniplant.

Uniplant, a single Silastic implant containing nomegestrol acetate, provides contraceptive efficacy for one year. Uniplant use for one year was studied in 1,803 healthy women of reproductive age, enrolled from 10 centers in 9 countries, after informed consent. Implants were placed subdermally either in the upper arm or in the gluteal region. Two-hundred-seventy-six subjects discontinued prior to completing one year of study. Cumulative discontinuation rate at 12 months was 15.72%. Medical reasons for discontinuation were principally menstrual-related. Fifteen pregnancies occurred during the one year study period, resulting in a 12-month net cumulative pregnancy rate of 0.94%. Approximately 56% of subjects using Uniplant had bleeding patterns similar to normal menstruation. Results from this study confirm that Uniplant is an efficient, well tolerated, 12-month contraceptive implant, with the advantage of easier insertion and removal of the single implant compared to other multiple implant methods.

Differences in serum potassium concentrations in normal men in different geographic locations.

Hypokalemia has been associated with the taking of gossypol, a potential oral antifertility drug for men. Because the frequency of this response differed in different parts of the world, this study was done to learn if "normal" serum [K+] also differed. [K+] was measured by flame photometry in serum from apparently normal men from Austria (n = 30), China (53), Brazil (100), the Dominican Republic (38), and the US (103), and in plasma from Nigerian men (82). The mean (SD) for [K+] in Chinese men, 3.82 (0.27) mmol/L, was lower than that in Brazilians [4.06 (0.29) mmol/L], Austrians [4.14 (0.44) mmol/L], Dominicans [4.37 (0.33) mmol/L], or Americans [4.38 (0.37) mmol/L]. Apparently there are regional differences in average serum [K+], with men in China having lower serum [K+] than men elsewhere. This may predispose them to hypokalemia.

Mortality in eclampsia in the Lagos University Teaching Hospital (LUTH); comparison of the recent 10-year period (1977-1986) with the previous 10 year period (1967-1976).

Over a 10-year period, between 1st January 1977 and 31st December 1986, a total of 572 eclamptic patients were treated in the Lagos University Teaching Hospital (LUTH). Three hundred and eighty-four of these patients (66.4%) were pre-delivery eclamptics, while 188 (33.6%) were post-partum eclamptics. The great majority of these cases (448) (98.3%) were unbooked patients. The overall maternal deaths from eclampsia or its complications during the period were 62 (108 per 1000) while the known perinatal deaths associated with the condition was 100 (240 per 1000). The mean Caesarean Section (C/S) rate in the pre-delivery eclamptics was 30.22 +/- SD 19.62%, while the mean C/S rate in all eclamptic patients treated in LUTH during this period was 22.20 +/- SD 15.04%. Comparison of the data from the recent decade to that of the previous decade (1966-1976), shows that the number of eclamptic patients treated in the LUTH, over the recent decade (1977-1986) more than doubled the number of eclamptics treated in the previous decade (1967-1976) (572 as compared with 273 for the previous decade). The overall maternal mortality rate remained unchanged (106 to 108 per 1000), while the perinatal mortality rate increased from 117 per 1000 to 240 per 1000 in the recent decade respectively. The C/S rate in the pre-delivery eclamptics increased during the period from 21.3% in the previous decade to 30.2% in the recent decade. The unbooked eclamptic patients remain the dominant group in the two studies.

Contraceptive choice in Lagos, Nigeria.

Among 1266 contraceptive acceptors (median age 30 years, median parity 4.5) attending a family planning clinic, mostly after referral from the post-natal clinic, two thirds chose the intrauterine device, almost all the remainder choosing oral contraception. Oral contraception was, however, the main choice among women parity 0 or 1. A definite intention to have no more children was given by none of the women of parity 3 or under, and only by 15% of those of parity 8 or more, so that child spacing was the main reason for accepting contraception. By 12 months, the discontinuation rate among oral contraceptive users was 17% (IUD 11%) of which 11% (IUD 6%) was for personal reasons or to plan pregnancy, 4% (IUD 5%) through adverse effects and 0.6% (IUD 0.8%) through accidental pregnancy.

PIP: Among 1266 contraceptive acceptors (median age=30 years, median parity=4.5) attending a family planning clinic, largely because of referrals from a postnatal clinic, 2/3 selected the IUD and almost all the remainder selected oral contraceptives (OCs). OCs were the main choice for women with parity 0 or 1. No women with parity 3 or less claimed that they intended to have no more children; only 15% of those with parity 8 or more made the same claim. Child spacing was thus the main reason for accepting contraception. At the end of 12 months, the discontinuation rate for OC users was 17% (IUD=11%) of which 11% (IUD=6%) was for personal reasons or to plan a pregnancy, 4% (IUD=5%) because of adverse effects, and 0.6% (IUD=0.8%) because of accidental pregnancy. (author's modified)

Implications of pattern of tubal disease for microsurgery or in vitro fertilization in Lagos.

Tubal disease was found in 78 of 100 consecutive Nigerian patients who had laparoscopy for infertility, while 22 patients had patent tubes. Forty-two patients had bilateral tubal occlusion; 18 had unilateral occlusion, while 18 had gross pelvic adhesions. Forty-one patients had cornual block, and 10 had hydrosalpinges. Multiparas were more prone to unilateral tubal occlusion or gross pelvic adhesions compared with nulliparas. In 27 (35 percent) patients with tubal disease in vitro fertilization (IVF) would be the only suitable treatment, while in another 10 (12 percent) patients with hydrosalpinges, IVF probably offers a better prognosis than microsurgery.

Etiologic classification and sociomedical characteristics of infertility in 250 couples.

Two hundred fifty infertile couples were studied during a 30-month period. Of these, 77 couples (30.8%) were polygamous. Tubal disease was the commonest etiologic factor, being the sole factor in 24% and a factor in 41.2%. Oligo-azoospermia was the sole factor in 20.8% and a factor in 34.4%. Anovulation was the sole factor in 16.8%. Female factors were the sole findings in 129 patients (51.6%), while male factors were the sole findings in 54 (21.6%). In 36 (14.4%), combined factors were present. There were 56 (22.4%) pregnancies including 27 (63%) pregnancies in 43 patients who were treated for anovulation. There were five pregnancies in 103 patients with tubal disease. Thirty-five (62.5%) pregnancies ended in live births, while eight (14.3%) were abortions or ectopic gestations.