Plasmid-Mediated Fluoroquinolone Resistance among Enterobacterales in Africa: Systematic Review.

INTRODUCTION: According to the World Health Organization, antimicrobial resistance (AMR) is a silent global pandemic that plagues everyone. It makes therapy of infectious diseases more difficult and eventually increases morbidity and mortality. AIM: The purpose of this work is to examine existing data on plasmid-mediated quinolone resistance (PMQR), to assess the prevalence of PMQR genes in Enterobacterales, and to determine any knowledge gaps from sub-Saharan Africa. METHODOLOGY: The Preferred Reporting Items of Systematic Reviews and Meta-analyses (PRISMA) standard was followed when conducting this systematic review. The main internet databases examined for pertinent publications were PubMed, Google Scholar, and Ajol. A set of qualifying criteria were used to evaluate the qualified articles. Using the eligibility criteria, 56 full-text articles were chosen for screening. RESULT: Thirty-two (32) articles with the majority originating from West and North Africa and only one article reporting a study carried out in Central Africa were selected for this review. Escherichia coli and Ciprofloxacin were the most reported Enterobacterales and Quinolone respectively. The PMQR genes include qnr (qnrA,qnrB, qnrC, qnrD, and qnrS), aac (6') Ib, aac (6') Ib-cr, oqxAB and qepA gene. The most prevalent PMQR gene is the aac (6') Ib-cr gene (32%) followed by qnrS (26%). CONCLUSION: This study highlighted the requirement for an efficient antimicrobial resistance surveillance system in the continent and revealed a significant incidence of PMQR genes.

INTRODUCTION: Selon l'Organisation mondiale de la santé, la résistance aux antimicrobiens (RAM) est une pandémie mondiale silencieuse qui touche tout le monde. Elle rend le traitement des maladies infectieuses plus difficile et finit par augmenter la morbidité et la mortalité. OBJECTIF: L'objectif de ce travail est d'examiner les données existantes sur la résistance plasmidique aux quinolones (PMQR), d'évaluer la prévalence des gènes PMQR chez les Enterobacterales et de déterminer d'éventuelles lacunes de connaissances en Afrique subsaharienne. MÉTHODOLOGIE: La norme Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) a été suivie lors de la réalisation de cette revue systématique. Les principales bases de données Internet examinées pour des publications pertinentes étaient PubMed, Google Scholar et Ajol. Un ensemble de critères d'admissibilité a été utilisé pour évaluer les articles qualifiés. En utilisant les critères d'éligibilité, 56 articles en texte intégral ont été choisis pour le dépistage. RÉSULTAT: Trente-deux (32) articles, dont la majorité provient d'Afrique de l'Ouest et du Nord, et un seul article rapportant une étude menée en Afrique centrale, ont été sélectionnés pour cette revue. Escherichia coli et la ciprofloxacine étaient les Enterobacterales et les quinolones les plus signalées respectivement. Les gènes PMQR comprennent les gènes qnr (qnrA, qnrB, qnrC, qnrD et qnrS), aac (6 ') Ib, aac (6 ') Ib-cr, oqxAB et qepA. Le gène PMQR le plus prévalent est le gène aac (6 ') Ib-cr (32 %), suivi de qnrS (26 %). CONCLUSION: Cette étude a souligné la nécessité d'un système efficace de surveillance de la résistance aux antimicrobiens sur le continen`t et a révélé une incidence significative des gènes PMQR. MOTS-CLÉS: Enterobacterales, Escherichia coli, Quinolone, Ciprofloxacine, PMQR, "aac(6')-Ib", "aac(6')-Ib-cr", "qnr", "qepA", "oqxAB", "résistance aux antibiotiques".

Clinical Utility of Procalcitonin and C-Reactive Protein in the Management of Neonatal Sepsis in a Resource-Limited Nigerian Hospital.

BACKGROUND: Neonatal sepsis is an invasive infection of the bloodstream in neonates and a leading cause of morbidity and mortality among them. AIM: To investigate the role of procalcitonin (PCT) and C-reactive protein (CRP) in the management of neonatal sepsis. MATERIALS AND METHODS: This was a prospective case-control study over one-year period using convenience sampling. Blood samples for PCT and CRP were taken from all neonates, while blood culture and white blood cell count samples were additionally taken from babies with neonatal sepsis. PCT and CRP were repeated at 24 and 48 hours. The continuous variables were found to have a nonparametric distribution. They were presented as median and interquartile range, and compared using Wilcoxon signed rank and Friedman test as appropriate. RESULTS: The blood culture analysis yielded a prevalence of 12.7% with Staphylococcus aureus being the commonest organism. Baseline concentrations of PCT (1.28 ng/ml) and CRP (17.31 mg/L) in neonates with sepsis were higher than that of controls (PCT-0.63 ng/ml, CRP-5.40 mg/L). PCT concentrations decreased after two days of antibiotic treatment, while CRP concentrations decreased after a day. The concentration of both decreased to normal levels after two days of treatment. CONCLUSION: This study showed that CRP was more reliable in monitoring antibiotic therapy, unlike other studies which suggested PCT. In cases where the management of neonatal sepsis may be limited by a low blood culture yield, therapeutic monitoring may be aided by CRP and/or PCT.

Effect of an Antidepressant on Medication Adherence among Type 2 Diabetic Patients with Depression Accessing Care in GOPC of FETHI.

Comorbid depression among diabetes mellitus (DM) patients is on the increase. This has been linked with poor glycaemic control, greater risk of complications, high burden of medical cost and health care utilisation, and worsening prevalence of other comorbidities resulting in decreased life expectancy. This study determined the antidepressant effect of amitriptyline on depression and glycaemic control among the depressed type 2 DM patients attending Federal Teaching Hospital, Ido-Ekiti (FETHI), Nigeria. It was an interventional study involving 51 depressed type 2 DM patients randomly screened using Patient Health Questionnaire-9 (PHQ-9). They had health education and oral amitriptyline 50mg at night for two months. Postintervention assessment was done using the same tool. Respondents' age ranged between 44 and 78 years with a mean age of 58±8.4 years. Post-intervention assessment showed improved depressive symptoms; 50% of the respondents had significantly improved glycaemic control with a statistically significant effect on depression (the median score of PHQ-9 reduced from 6.0 to 3.0).

La dépression comorbide chez les diabétiques est en augmentation. Elle a été associée à un mauvais contrôle de la glycémie, à un risque accru de complications, à une charge élevée en termes de coûts médicaux et d'utilisation des soins de santé, ainsi qu'à un taux de mortalité plus élevé chez les personnes souffrant de comorbidité. Cette étude a déterminé l'effet de l'antidépresseur (Amitriptyline) sur la dépression et le contrôle de la glycémie chez les patients dépressifs atteints de diabète de type 2 qui fréquentent l'hôpital universitaire fédéral d'Ido-Ekiti (FETHI). Il s'agit d'une étude interventionnelle portant sur 51 patients atteints de diabète de type 2 et déprimés, sélectionnés au hasard à l'aide du questionnaire sur la santé des patients 9 (PHQ-9). Ils ont bénéficié d'une éducation à la santé et ont pris 50 mg d'amitriptyline par voie orale pendant deux mois. L'évaluation post-intervention a été réalisée à l'aide du même outil. L'âge des personnes interrogées était compris entre 44 et 78 ans, avec un âge moyen de 58± 8,4 ans. L'évaluation postintervention a montré une amélioration des symptômes dépressifs, 50% des personnes interrogées ont eu un contrôle glycémique significativement amélioré avec un effet statistiquement significatif sur la dépression (le score médian du PHQ est passé de 6,0 à 3,0). Mots clés: Diabète sucré, dépression, contrôle glycémique, observance thérapeutique.

Musculoskeletal Pain and Health-Related Quality of Life of Occupational Drivers in Southwest Nigeria.

BACKGROUND AND OBJECTIVE: Musculoskeletal pain (MSP) can be work-related and common among occupational drivers (OPDs). There is a scarcity of data on MSP among OPDs in Nigeria. This study therefore determined the 12-months prevalence and the influence of socio-demographic factors on the prevalence of MSP and health-related quality of life (HRQoL) of OPDs in Ogbomosho, Oyo State. METHODS: A total 120 occupational drivers participated in the study. The Nordic Musculoskeletal Questionnaire (NMQ) was used to measure the prevalence and pattern of MSP and the Medical Outcome Study (MOS), a 36-item short form version 1.0 of the Research and Development (RAND) to measure HRQoL. The data was analysed using descriptive statistics of mean, standard deviation, and frequency. A chi-square test with a significance level of p ≤ 0.05 was used to determine the relationship between variables. RESULTS: Mean age was 46.55±9.21 years. Musculoskeletal pain occurred in 85.8% of the drivers, with the shoulder and neck being most common. In 64.2% of the cases, the health-related quality of life score was higher than the national average. A significant association occurred between MSP and years of experience (p = 0.049). Significant associations occurred between HRQoL and age (p = 0.037), marital status (p = 0.001), and years of experience (p = 0.002). There was a significant association between MSP and HRQoL (p = 0.001). CONCLUSION: The prevalence of MSP was high among the OPDs. There was a significant association between MSP and HRQoL among OPDs. Sociodemographic factors play a significant influence on the HRQoL of drivers. Occupational drivers should be educated on the risks and dangers involved with their occupation and the steps they can take to improve their quality of life.

CONTEXTE ET OBJECTIF: Les douleurs musculo-squelettiques (DMS) peuvent être liées au travail et sont courantes chez les chauffeurs professionnels. Les données sur les douleurs musculosquelettiques chez les chauffeurs professionnels au Nigeria sont rares. Cette étude a donc déterminé la prévalence sur 12 mois et l'influence des facteurs sociodémographiques sur la prévalence des douleurs musculo-squelettiques et la qualité de vie liée à la santé (QVLS) des chauffeurs professionnels à Ogbomosho, dans l'État d'Oyo. MÉTHODES: 120 conducteurs professionnels ont participé à l'étude. Le Nordic Musculoskeletal Questionnaire (NMQ) a été utilisé pour mesurer la prévalence et l'évolution de la PSM et le Medical Outcome Study (MOS), un formulaire court de 36 items version 1.0 du Research and Development (RAND) pour mesurer la QVLS. Les données ont été analysées à l'aide de statistiques descriptives (moyenne, écart-type et fréquence). Un test de chi-deux avec un niveau de signification de p ≤ 0.05 a été utilisé pour déterminer la relation entre les variables. RÉSULTATS: L'âge moyen était de 46,55±9,21 ans. Des douleurs musculo-squelettiques sont apparues chez 85,8 % des conducteurs, l'épaule et le cou étant les plus fréquents. Une qualité de vie liée à la santé supérieure à la moyenne a été constatée chez 64,2 % des conducteurs. Une association significative est apparue entre la PSM et les années d'expérience (p=0,049). Il existe une association significative entre la QVLS et l'âge (p=0,037), l'état civil (p=0,001) et les années d'expérience (p=0,002). Il y avait une association significative entre le MSP et la QVLS (p=0,001). CONCLUSION: La prévalence de la PSM était élevée parmi les OPD. Il existe une association significative entre la PSM et la QVLS dans les services de santé publique. Les facteurs sociodémographiques ont une influence significative sur la QVLS des conducteurs. Les conducteurs professionnels devraient être sensibilisés aux risques et dangers liés à leur profession et aux mesures à prendre pour améliorer leur qualité de vie. Mots clés: Conducteurs professionnels, douleurs musculosquelettiques, qualité de vie liée à la santé.

Diabetic foot care: self reported knowledge and practice among patients attending three tertiary hospital in Nigeria.

BACKGROUND: Diabetes Mellitus (DM) foot complications are a leading cause of mortality in developing countries and the prevalence of diabetes is expected to increase in the next decades in these countries. The aim of this study was to determine the knowledge and practice of foot care among diabetes patients attending three tertiary hospitals in Nigeria. METHODS: This is a cross-sectional study carried out from November 2009 to April 2010. Pre-tested structured questionnaires were administered by medical officers to diabetes patients. The outcome variables were knowledge and practice regarding foot care. The knowledge and practice scores were classified as good if score ≥70%, satisfactory if score was 50-69% and poor if score was < 50%. RESULTS: Of 352 diabetes patients, 30.1% had good knowledge and 10.2 % had good practice of DM foot care. Majority (78.4%) of patients with poor practice had poor knowledge of foot care. With regard to knowledge, 68.8% were unaware of the first thing to do when they found redness/bleeding between their toes and 61.4% were unaware of the importance of inspecting the inside of the footwear for objects. Poor foot practices include; 89.2% not receiving advice when they bought footwear and 88.6% failing to get appropriate size footwear. Illiteracy and low socioeconomic status were significantly associated with poor knowledge and practice of foot care. CONCLUSION: This study has highlighted the gaps in the knowledge and practice of foot care in DM patients and underscores the need for an educational programme to reduce of diabetic foot complication.

Awareness and practice of safety precautions among healthcare workers in the laboratories of two public health facilities in Nigeria.

AIMS AND OBJECTIVES: To determine the level of awareness and practice of SP among laboratory workers at two tertiary public health facilities in Nigeria. METHODS: A semi-structured, self-administered questionnaire was used to assess the awareness, attitude and adherence to SP among laboratory workers. Information on the availability of safety equipment was also sought. The laboratory safety practice of respondents was assessed based on self-reported observance of basic principles of universal precautions in clinical settings. RESULTS: Study participants were 130, mean age: 28.2 years (SD±6.6), number of years in hospital employment: 3.7 years (SD±2.4) and the male to female ratio was 1.8:1. Many (41.5%) were unaware and 25.4% do not observe SP. Participants attest to availability of various safety devices and equipment including hand gloves (86.2%), disinfectants (84.6%), HBV immunisation (46.2%) and post exposure prophylaxis (PEP) for HIV and HBV (79.6%). Attitude to safety is unsatisfactory as 60.0% eat and drink in the laboratory, 50.8% recap needles and 56.9% use sharps box. Even though 83.1% are willing to take PEP, only 1.5% will present self following laboratory injury. CONCLUSION: This study shows the deficit in the awareness of SP among laboratory personnel and demonstrates that attitude and practice of safety rules are unsatisfactory. Training and re-training on SP is therefore desired. Counselling to induce a positive attitudinal change on HBV immunisation and PEP is similarly necessary.

Biochemical infertility among females attending University of Ilorin Teaching Hospital, Nigeria.

BACKGROUND: Biochemical laboratory investigations potentially contribute to the diagnosis of over 50-75% of couples being investigated for infertility. Both hormonal and anti-hormonal treatments have achieved great successes in the treatment of infertility. Our aim therefore was to investigate the pattern of biochemical abnormalities in females diagnosed as infertile form anovulation. MATERIAL AND METHODOLOGY: One hundred and twenty women diagnosed clinically as primary or secondary infertility from anovulation referred from the gynecological clinic of UITH and private hospitals in Ilorin were investigated by routine fertility test profile. RESULT: The age ranged between 20-40 years (mean = 32.9, sd +/- 4.7) for the primary infertility and 23-47 years (mean = 34.4, sd +/- 5.4) for the secondary infertility groups respectively. Ninety six (80%) subjects were found to have hormonal abnormalities. Pattern of biochemical diagnosis amongst the 33 (34.4%) primary infertility subjects included hypergonadotrophic hypogonadism 21 (63.6%), hypogonadotrophic hypogonadism 9 (27.3%), and hyperprolactinemia 3 (9.1%). Among the 63 (65.6%) cases of secondary infertility, there were 31 (49.2%) cases of hypergonadotrophic hypogonadism, 30 (47.6%) hypogonadotrophic hypogonadism, and 2 (3.2%) hyperprolactinemia. There was no statistical difference in the mean values in the various biochemical parameters. CONCLUSION: Hormonal profile should be a goal standard in the diagnosis of anovulation.

Endometrial tuberculosis in the Nigerian middle belt: an eight-year review.

Endometrial tuberculosis (TB) is a known cause of infertility in women which, because of the global increase in the spread of TB, should always be considered when investigating the cause of infertility. We undertook this review in order to determine its incidence among infertile women in the Nigerian middle belt. This is a retrospective study of all histopathological slides of infertile women seen at the University of Ilorin Teaching Hospital, Ilorin, Nigeria, between 1997 and 2004 who were evaluated for infertility by endometrial biopsy. The slides were reviewed and, where necessary, new sections were cut from tissue blocks and stained with haematoxylin and eosin. Ziehl-Neelsen stain used to demonstrate acid-fast bacilli. Clinical reports were extracted from histopathological request form. A total of 661 patients were included in the study. Primary infertility constituted 30%, secondary 69% and unspecified cases 1%. TB endometritis was seen in 0.45%. Endometrial TB is not a frequent cause of infertility in our set-up. However, with the worldwide resurgence of TB, its possible presence should always be taken into consideration.

Glycaemic Response to Different Preparations of Yam in Diabetic and Non-Diabetic Nigerians

Post-pandial glycaemic responses to food can be affected by the method involved in the preparation of the food. Dietary intervention with food modification forms the corner- stone of management of type 2 diabetes worldwide. The effect of processing on yam; a staple food in Nigeria; was studied among diabetic and non-diabetic Nigerians. Despite undergoing more processing; amala prepared from yam flour had a better post-pandial glycaemic response index (PGRI) compared to other yam preparations; and this was also significantly higher among the diabetic subjects. Yam-based products; particularly amala; should be encouraged among diabetic Nigerians

Serum uric acid level as an independent component of the metabolic syndrome in type 2 diabetic blacks.

CONTEXT: No consensus has been achieved on the components included in the definition of Metabolic Syndrome (MS). Uric acid and Gamma glutamyl transpeptidase are however newer markers not included in previous studies. OBJECTIVES: This study was carried out to determine the prevalence of MS in Diabetes Mellitus, the correlation between hyperuricaemia and MS as well as make a case for the inclusion of serum Uric acid level as a new marker for MS. METHODOLOGY: Fasting venous sample from the cubital vein of 77 females and 44 males diagnosed NIDDM patients for enzymatic determination of serum lipids, glucose and uric acid using QCA kits. The demographic records were obtained from the folders. Metabolic syndrome was diagnosed using the WHO criteria. RESULT: The prevalence of the new component hyperuricaemia among the study subjects was 10.7%. Thirty-eight (31.6%) of the subjects who had high blood pressure, hypertriglyceridemia, low HDL-C and BMI > 30 kg/m2 diagnostic of MS also had hyperuricaemia as against the 29 (23.9%) subjects who hadMS only. About 23.7% of the 38 subjects who had MS and hyperuricaemia had serum uric acid values above 0.38 mmol/l recommended as the cut off value. There was a significant correlation (r = 0.301, p < 0.01) between serum uric acid level, BMI, total cholesterol, LDL-C and HDL-C/TC, among the female subjects while the male subjects showed significant correlation (p < 0.05) between their BMI and serum HDL-C level only. There was a significant difference (p < 0.001) in the CHD risk ratio between the male and the female MS subjects. CONCLUSION: The correlation between hyperuricaemia and other components of MS as demonstrated in this study may suggest a common etiological factor between the MS components as suggested in other studies. Insulin resistance has been implicated as a common denominator. Thus a further investigation in this direction would be needed.

Permanent hypoparathyroidism developing post-thyroidectomy.

A case of permanent hypocalcaemia following a subtotal thyroidectomy for a simple multinodular goiter in a 35 year -- old married teacher is presented. This further confirms the need for utmost precaution during thyroid surgery to prevent the damage or inadvertent removal of the parathyroid glands and its consequential complications. It also throws more light on the problem faced in the management of hypocalcaemia vis a vis patient compliance and availability of proper medications in this environment.

Prevalence of coronary heart disease risk factors in Nigerians with systemic hypertension.

This study is to determine the prevalence of coronary heart disease risk factors in Nigerians with systemic hypertension. Serum lipid profile and fasting blood glucose were determined in one hundred and thirty six newly diagnosed hypertensives selected from the Medical Outpatient Department. Basic demographic data as well as medico-social history was extracted from the records. Coronary heart disease risk was calculated from the ratios of high-density lipoprotein cholesterol to total cholesterol. High risk were defined as CHD ratio <0.18, while average and low CHD risk ratio was 0.18 to 0.40 and >0.40 respectively, according to the European Athersclerosis society guidelines. There were 76 (55.9%) males and 60 (44.1 %) females aged 24-70 years (mean = 47+8.5) studied. The coronary risk ratio in the study groupts was 0.34 as against 0.57 in the controls. The prevalence of high coronary heart disease risk in newly diagnosed hypertensives was 22%. The overall prevalence rate of hypercholesterolaemia was 62.5%, with high-risk group prevalence of 70%. The high-risk group was also associated with other non-lipid factors such as overweight -54% (BMI > 25Kg/m2), glucose intolerance-55% (FBS > 6.1 mmol/L), and alcoholism (55%). The overall prevalence of hypertriglyceridaemia was 20.4%, with higher serum values amongst females, and no risk group difference. The female patients were more affected by the metabolic risk parameters especially in the high and average risk groups. There is a need therefore, for clinicians to be encouraged to investigate lipid, lipoprotein cholesterol indices and other non-lipid risk factors to calculate the risk run by hypertensive patients of developing cardiovascular complications.

Glycated haemoglobin and associated variables in diabetics: Ilorin experience.

One hundred and fifty type 2 diabetes mellitus patients were investigated to determine extent of haemoglobin glycation and factors that might influence it. Factors so considered were age, sex, disease duration, and body mass index. The mean HbA(1c) was 8.0%. Ninety-six (about 64%) of the subjects had HbA(1c) > 7.2%. Seventy-one of these were males. Sex and age did not have significant effect on HbA(1c) and so was disease duration in our center. Almost 70% of the female diabetics were overweight. Correlation was very poor between BMI and haemoglobin glycation. However, assessment of the individual group results tended to suggest that glycation decrease with increasing BMI.