Health professionals' knowledge about relative prevalence of hospital-acquired infections in Delta State of Nigeria.

INTRODUCTION: Hospital-acquired infections (HAIs) constitute a serious global public health challenge, causing great suffering to many people across the globe at any given time. This study ascertains the knowledge of health professionals on the challenge and their compliance with infection control measures. METHODS: Validated questionnaires were administered to 660 health professionals and supported with face-to-face interview. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 16.0 (SPSS Inc, USA). Chi-square was used to test association between the independent and the outcome variables. Cut-off point for statistical significance was 5% (p value<0.05). RESULTS: UTIs (61.4%) followed by Hospital-acquired Pneumonia (55.6%) were known to be the most prevalent HAIs in government hospitals while Staphylococcus aureus (54.4%) was reported the most microbial agent. In private health facilities, Hospital-acquired Pneumonia was known to be the most common (66.1%) while Pseudomonas aeruginosa was the most reported culprit. HAIs were reported to have occurred more in government hospitals and catheterization was the commonest modes of transmission in both health facilities. CONCLUSION: The prevalence of HAIs in this state was reported to be high. Although health-care professionals have good knowledge of HAIs, active effort is not always made to identify and resolve them. Standardized surveillance of HAIs is urgently needed.

Guillain-Barré syndrome as a paraneoplastic manifestation of small-cell carcinoma of lung.

Guillain-Barré syndrome (GBS) encompasses the variants of acute immune-mediated polyneuropathies usually preceded by an infection. A few case reports have associated GBS to neoplastic diseases. It remains unclear whether these are merely coincidental or represent paraneoplastic phenomena. The clinical features of GBS associated with oncological cases do not appear to differ from post-infectious GBS. We report a 74-year-old man in whom small cell carcinoma of lung (SCLC) was diagnosed during a presentation with GBS. Treatment with chemotherapy for SCLC and intravenous immunoglobulins led to complete neurological recovery and tumor regression.

Microscopic polyangiitis triggered by recurrent methicillin-resistant Staphylococcus aureus bacteremia.

Most of the purported links between microbial agents and primary small-vessel anti-neutrophilic antibody-positive (ANCA) vasculitides remain speculative. There is strong circumstantial evidence for the role of Staphylococcus aureus in the development of Wegener's granulomatosis, but its role in other ANCA-positive vasculitis syndromes is less clear. We describe a patient who developed a non-granulomatous, necrotizing small-vessel vasculitis with a positive anti-neutrophil cytoplasmic antibody of a perinuclear type (p-ANCA), along with anti-myeloperoxidase antibodies after recurrent episodes of methicillin-resistant Staphylococcus aureus bacteremia.

Multiple myeloma and systemic lupus erythematosus in a young woman.

Although systemic lupus erythematosus (SLE) is associated with lymphoid malignancies, concurrent multiple myeloma and SLE are rare. We report a 28-year-old black woman with SLE who developed smoldering IgA kappa multiple myeloma. The coexistence of these conditions in this age and race has not been previously reported. A literature search was conducted and all 12 previously reported cases of concurrent SLE and multiple myeloma were reviewed. The demographic and clinical features of multiple myeloma in SLE are summarized. Possible mechanisms underlying this association are also discussed. In the appropriate clinical context, multiple myeloma should be considered in SLE patients irrespective of young age, race, SLE disease activity, or duration.

Recurrent symptomatic pleural effusion due to a ventriculopleural shunt.

Ventriculopleural shunts are uncommonly used for the treatment of normal pressure hydrocephalus in adults. Pleural effusion has been reported to complicate the course of these ventriculopleural shunts in children. The pleural effusion should typically resemble the cerebrospinal fluid unless frankly infected. There are few good data on the nature of the pleural effusion. We, report a case of recurrent right-sided pleural effusion, 2 years after a ventriculopleural shunt insertion, for normal pressure hydrocephalus with no evidence of an underlying infection. The effusion abated after ligation of the shunt. We discuss the possible mechanisms in the development of the effusion. It is important to be aware of this unlikely complication of an uncommon procedure. Recognizing the origin of the pleural effusion can help in instituting close follow-up and early referral for revision of the ventriculopleural shunt.

Immune thrombocytopenia associated with Mycoplasma pneumoniae infection: a case report and review of literature.

Although extra-pulmonary manifestations of Mycoplasma pneumoniae are well described, immune thrombocytopenia associated with M. pneumoniae is rarely reported. We describe a woman who developed immune thrombocytopenic purpura during an acute mycoplasma infection. The clinical features and outcomes of all previously reported cases are reviewed, and possible mechanisms underlying this association are discussed. Immune thrombocytopenic purpura should be considered early in patients with thrombocytopenia and mycoplasma infections, with the institution of usual therapy for immune thrombocytopenic purpura.

Transient left bundle branch block: an unusual electrocardiogram in acute pulmonary embolism.

Pulmonary embolism may result in permanent or transient electrocardiographic abnormalities. New onset left bundle branch block (LBBB) is usually associated with myocardial ischemia. However, nonischemic mechanisms are also known to account for some cases of LBBB. Tachycardia, a common finding in pulmonary embolism, is one such mechanism. This is illustrated by our case, and possible mechanisms for tachycardia-dependent LBBB are discussed. It is important to recognize and interpret the conditions that precipitate it, thereby avoiding inappropriate interventions.

Pathophysiologic considerations for the interactions between obstructive sleep apnea and sickle hemoglobinopathies.

There are contradictory reports about the effects of obstructive sleep apnea (OSA) on clinical vaso-occlusive events in sickle hemoglobinopathies. The discourse has focused on the possible effects of OSA-associated hypoxemia on hemoglobin S (HbS) polymerization. Advances in understanding the pathogenesis of sickle vaso-occlusion and the physiologic consequences of OSA suggest that the potential for interaction exceeds simple hypoxemia. HbS polymerization, red cell-endothelial cell interactions, hypercoagulability, neutrophil activation and vasoactive factors constitute the multi-pathway model of sickle cell vaso-occlusion. These processes are abnormal in OSA and theoretically these abnormalities may initiate or potentiate vaso-occlusion. If this hypothesis is correct, OSA may convert the clinically benign genetic carrier state of sickle cell trait to a clinically overt disease. Reported clinical events in sickle cell trait are usually related to exposure to relative hypoxia, and are limited to the spleen and renal medulla. Studies to compare the prevalence of events (splenic infarction and hematuria) in sickle cell trait with and without OSA, as well as their relationship to exposure to environmental hypoxia will be a first step in verifying this hypothesis.

Right atrial foreign body: transvenous migration of Greenfield filter.

Migration of an inferior vena cava filter to the heart is a rare occurrence. Migration is usually to the right cardiac chambers, and is mostly detected incidentally. We report a 65-year-old woman with transvenous migration of an inferior vena caval filter to the right atrium in whom retrieval of the filter was not feasible due to prohibitive surgical risk. On subsequent follow-up at 10 months, the filter remains in the right atrium without complications.

Pulmonary actinomycosis: the great masquerader.

Actinomycosis is a rare but treatable disease. Thoracic manifestations are varied and can mimic malignancy or tuberculosis. We report the case of a 54-year-old man who presented with a persistent cough and radiological evidence of right upper lobe lung mass. Conventional computed tomography guided biopsy and bronchoscopy proved to be non-diagnostic. Thoracotomy and histopathologic examination of the tissue confirmed actinomycosis infection. Excellent clinical and radiologic responses were noted following treatment with penicillin V. Despite a high clinical suspicion, the diagnosis can prove to be challenging.