A prospective randomized comparative study of targeted versus empirical prophylactic antibiotics in the prevention of infective complications following transrectal ultrasound-guided prostate biopsy.

Background: It is established that antibiotic prophylaxis prevents infection following transrectal ultrasound-guided prostate biopsy. This study compares the infective complications in transrectal prostate biopsy (TRPB) in empirical versus targeted prophylactic antibiotics. Patients and Methods: Urine and rectal swabs were obtained prior to TRPB. They were randomized into targeted antibiotic (TA) and empirical antibiotic (EA) groups. TA had prophylactic antibiotics according to rectal swab culture, whereas EA had the standard parenteral ciprofloxacin. They were followed up weekly for 4 weeks. Chi-square or Fisher's exact tests were used to compare categorical variables, Student's "t"-test was used to compare means of numerical variables, and P < 0.05 was considered statistically significant. Results: One hundred patients were studied, fifty in each group. The mean age was 66 years, with men aged 60-69 years accounting for 50% of the study population. Providencia stuartii, Escherichia coli, and Citrobacter freundii were the most predominant bacteria identified in the prebiopsy rectal swab culture, with resistance to ciprofloxacin (57%) being much more common than that to levofloxacin (21%). Postbiopsy infection occurred in one (2%) patient in the TA group and five (10%) patients in the EA group. Difference in the infection rate between the two groups was statistically significant (P = 0.042). Three of the patients with postbiopsy infection in the EA group had urosepsis and required hospitalization. Fluoroquinolone-resistant bacteria were responsible for infection in all the six patients. TA reduced the risk of postbiopsy infection by 5.6 folds. Conclusion: TA was associated with a decreased risk of infection in TRPB.

RésuméContexte: Il est établi que la prophylaxie antibiotique prévient l'infection après une biopsie transrectale guidée par une échographie de la prostate (TRPB). Cette étude compare les complications infectieuses liées au TRPB entre antibiotiques prophylactiques empiriques et ciblés. Patients et méthodes: Des écouvillons urinaires et rectaux ont été obtenus avant le TRPB. Ils ont été randomisés en groupes d'antibiotiques ciblés (TA) et d'antibiotiques empiriques (EA). TA avait des antibiotiques prophylactiques selon la culture sur écouvillon rectal, alors que EA avait la ciprofloxacine parentérale standard. Ils ont été suivis chaque semaine pendant quatre semaines. Les tests exacts du chi carré ou de Fischer ont été utilisés pour comparer les variables qualitatives, le test de l'étudiant a été utilisé pour comparer la moyenne des variables numériques et P <-0,05 a été considéré comme statistiquement significatif. Résultats: Cent patients ont été étudiés; 50 dans chaque groupe. L'âge moyen était de 66 ans, les hommes de 60 à 69 ans représentant 50% de la population étudiée. Providencia Stuartii, Escherichia Coli et Citrobacter Freundii étaient les bactéries les plus prédominantes identifiées dans la culture du prélèvement rectal avant biopsie, la résistance à la ciprofloxacine (57%) étant beaucoup plus commune qu'à la lévofloxacine (21%). Une infection après la biopsie s'est produite chez 1 patient (2%) du groupe TA et 5 patients (10%) du groupe EA. La différence de taux d'infection entre les deux groupes était statistiquement significative (p = 0,042). Trois des patients présentant une infection post-biopsie dans le groupe EA présentaient une urosepsie et devaient être hospitalisés. Des bactéries résistantes à la fluoroquinolone étaient responsables de l'infection chez les six patients. L'AT réduit le risque d'infection après la biopsie de 5,6 fois. Conclusion: L'AT était associée à une diminution du risque d'infection dans le TRPB.

A prospective randomized comparative study of targeted versus empirical prophylactic antibiotics in the prevention of infective complications following transrectal ultrasound-guided prostate biopsy

Background: It is established that antibiotic prophylaxis prevents infection following transrectal ultrasound-guided prostate biopsy. This study compares the infective complications in transrectal prostate biopsy (TRPB) in empirical versus targeted prophylactic antibiotics. Patients and Methods: Urine and rectal swabs were obtained prior to TRPB. They were randomized into targeted antibiotic (TA) and empirical antibiotic (EA) groups. TA had prophylactic antibiotics according to rectal swab culture, whereas EA had the standard parenteral ciprofloxacin. They were followed up weekly for 4 weeks. Chi-square or Fisher's exact tests were used to compare categorical variables, Student's "t"-test was used to compare means of numerical variables, and P < 0.05 was considered statistically significant. Results: One hundred patients were studied, fifty in each group. The mean age was 66 years, with men aged 60­69 years accounting for 50% of the study population. Providencia stuartii, Escherichia coli, and Citrobacter freundii were the most predominant bacteria identified in the prebiopsy rectal swab culture, with resistance to ciprofloxacin (57%) being much more common than that to levofloxacin (21%). Postbiopsy infection occurred in one (2%) patient in the TA group and five (10%) patients in the EA group. Difference in the infection rate between the two groups was statistically significant (P = 0.042). Three of the patients with postbiopsy infection in the EA group had urosepsis and required hospitalization. Fluoroquinolone-resistant bacteria were responsible for infection in all the six patients. TA reduced the risk of postbiopsy infection by 5.6 folds. Conclusion: TA was associated with a decreased risk of infection in TRPB

Practice of first aid in burn related injuries in a developing country.

INTRODUCTION: First aid with cool running water reduces the severity of burn. Low level of knowledge of first aid in burns was shown in previous studies with few patients receiving first aid by water lavage. A study investigating the use of water lavage as first aid in patients presenting to hospital with burn in Lagos, Nigeria was carried out. METHODS: Patients admitted to a University Teaching Hospital for treatment of burns were recruited for this prospective study. Data detailing demographics, scene and aetiology of burns, material used for first aid, who administered first aid, level of education and relationship of first-aider with patients, length of hospital stay, complications and outcome of treatment were collected and statistical analysis performed. RESULTS: 168 patients; 73 (43.4%) children and 95 (56.6%) adults were seen. Burns were sustained at home in 95 (74.2%) cases and outside in 33 (25.8%). Water lavage was used in 49 (29.2%) cases, raw eggs in 21 (12.5%), pap in 16 (9.5%) and other materials in 48.8%. 40 (23.8%) patients had not received any form of first aid at presentation. Patients that received no water first aid had higher complication rate (35.3% versus 18.4%) compared with those that had water first aid. CONCLUSION AND RECOMMENDATIONS: The use of water first aid in burns was shown to reduce complication rate in this study. People should be educated on the efficacy of water first aid in pre-hospital care of burns.

Physical activity and risk of gastric cancer: a meta-analysis of observational studies.

BACKGROUND: Studies evaluating the relationship of physical activity and stomach cancer risk have yielded inconsistent and largely inconclusive results. We therefore conducted a systematic review and meta-analysis of observational studies that assessed the relationship between physical activity and risk of gastric cancer. METHODS: Following a standard protocol, we searched medical literature databases (PubMed, EMBASE, CINAHL, PsycINFO and Google Scholar) from inception to July 2012, and conducted a random effects meta-analysis. RESULTS: Seven prospective cohorts and four case-control studies of physical activity and gastric cancer risk, with 1,535,006 people and 7944 cases of gastric cancer were included. We found a modest protective association between sufficient physical activity and gastric cancer risk (relative risk: 0.81 (95% CI 0.69 to 0.96); I(2)=68.5%) in the prospective studies and (relative risk: 0.78 (95% CI 0.66 to 0.91); I(2)=0%) in case-control studies. The association appeared weaker in smokers than in non-smokers (p heterogeneity=0.035). The association may also be weaker for gastric cardia cancer relative to the distal non-cardia subtypes. Physical activity type (recreational or occupational), intake of alcohol, total energy intake, consumption of fruits and vegetables and infection with Helicobacter pylori had no influence on the association. The effect measure from cohort studies (relative risk: 0.82 (95% CI 0.70 to 0.97); I(2)=61.7%) and case-control studies (relative risk: 0.83 (95% CI 0.66 to 1.04); I(2)=49.8%) did not differ materially at higher physical activity levels. CONCLUSIONS: We conclude that a regular physical activity may be protective against stomach cancer risk.

Child pedestrian injury and fatality in a developing country.

PURPOSE: Child pedestrian injuries and fatalities in developing countries continue to increase. We examined child pedestrian injuries and fatalities in the most populated urban agglomeration in Africa in order to develop control measures. METHODS: Two-year prospective study of injured child pedestrians (≤15 years) at the Surgical Emergency Room (SER) to determine demography, vehicles involved, road location, injury mechanism, pre-hospital transport, injury-arrival time, regions injured, injury severity and fatalities was done. RESULTS: Some 226 pedestrians (114 boys and 112 girls) comprising 42 children aged ≤4 years, 91 aged 5-9 years and 93 aged 10-15 years were seen with car collisions (83 pedestrians, 36.7%), motorcycles (76, 33.6%), buses (41, 18.1%), others (15, 6.6%) and 11 undetermined vehicles. Injuries on the highways were 147 (65%); inner-city roads 77 (34.1%) and two undetermined roads. Crossing the road was responsible for 168 (74.3%) pedestrian injuries; while three other mechanisms produced 58 (25.7%) patients. Regions injured were head (42.9%), lower limbs (35.4%) and others (21.7%). Relatives, bystanders and police/ambulance brought 186 (82.3%), 31 (13.7%) and eight (3.5%) children, respectively; and within 6 h (43.4, 11.5 and 2.2%) and after (38.9, 2.2 and 1.3%). Nineteen deaths (10 brought-in-dead, nine SER deaths) occurred; 15 of them girls, 15 had severe head injury, 15 were brought by relatives. However, fatality risks were truck collisions (OR 5.97), female child (OR 4.25), head injury (OR 4.18) and age ≤4 years (OR 3.7). CONCLUSION: The equal sex incidence, worse female fatality despite similar exposure and injury severity with male, deserve further research. Improved pre-hospital and SER care is needed.

Bacteriology of infected burn wounds in the burn wards of a teaching hospital in Southwest Nigeria.

BACKGROUND: Burns are characterized by the loss of varying proportions of the protective layers of the skin, depression of immune responses, and increased wound susceptibility to infection. Wound infection is a major cause of morbidity and mortality in burn cases. This study characterizes those factors that predispose burn wounds to infection and the bacteriology of the microorganisms in our environment. PATIENTS AND METHODS: Prospective study of burns patients that were admitted and treated at the Lagos State University Teaching Hospital (LASUTH), Ikeja-Lagos, Nigeria between January 1 and May 31, 2010 was carried out. Information about the demographics, aetiology/mechanism of burns, interval between the time of injury and admission, microbial studies, and antibiotic therapy were collected and analyzed. RESULTS: A total of 74 patients consisting of 43 males and 31 females were seen. The ages range between one week and 95 ± 22.42 years. Wound infections were confirmed in 28 patients (infection rate of 37.84 per 100 patients). Delayed presentation at LASUTH and length of hospital stay were significantly related to the development of wound infection. Pseudomonas aeruginosa and Proteus mirabilis were the most common infective organisms occurring in 53.6 and 10.7 percentages respectively. The isolated organisms were resistant to the beta-lactam antibiotics and mostly sensitive to carbapenem and aztreonam preparations. CONCLUSION: Factors predisposing to invasive wound infections in our environment were highlighted and suggestions made on methods that could reduce the infections and thus reduce morbidity and mortality in burns.

Chronic ulcers in Ikeja-Lagos, Nigeria: an eighteen month review of infecting bacterial agents and susceptibility pattern.

BACKGROUND: Chronic ulcers are an important cause of morbidity among surgical and medical patients. Infection in ulcers may delay healing and cause septicemia resulting in mortality. Microbial studies are important for the appropriate management of these ulcers. OBJECTIVE: The study investigates on eighteen month review of infecting bacterial agents and susceptibility pattern in chronic ulcers in Lagos, Nigeria. METHODS: Details of all patients treated for ulcers that were investigated at the department of Medical Microbiology and Parasitology, Lagos State University Teaching Hospital, Ikeja-Lagos, Nigeria between July 1st 2009 and December 31, 2010 were retrieved from the computer database and transferred into the proforma designed for the study. Data collected were demography, date of onset of ulcer, mode of specimen collection, names of isolates and drug sensitivity patterns. RESULTS: A total of 329 cases were seen and reviewed during the study period. Males constituted 50.2%, females 38.3% and the gender of the remaining 11.6% were not indicated. There were 259 (78.7%) adults and 42 (12.8%) children. The ages of 28 cases were not indicated. Microbial growths were obtained in 217 (66.7%) patients. Gram negative (Gn) organisms were isolated in 181(83.5%) and Gram positive (Gp) in 35 (16%). The most common isolates were Pseudomonas aeruginosa (19.1%) Staphylococcus aureus (9.7%), Proteus mirabilis (7.6%) and Escherichia coil (7.3%). There were widespread resistances by the isolates to the common antibiotics in the study environment. CONCLUSION: The wide spread resistance may be due to lack of an antibiotic use policy. Certain antibiotics should be reserved for second line treatment in the emergency setting