Psychosocial health effects of Covid-19 infection on persons in treatment centers in Lagos, Nigeria

Introduction

Prior research has highlighted the psychosocial impact of infectious diseases on individuals and the community at large. However, little is known about the psychosocial implications of COVID-19. This study set out to determine the rate as well as correlates of anxiety and depressive symptoms among persons managed as in-patients for COVID-19 in Lagos, Nigeria.

Materials and methods

We conducted an online survey between April to June ending 2020 using a consecutive sampling technique of persons positive for COVID-19 and who were managed as in-patients across five (5) treatment centres in Lagos, Nigeria. The survey collected information on demographic as well as clinical data including suicidality. Anxiety and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS).

Results

There were one hundred and sixty participants in total. The mean age of respondents was 36.4 (±9.7) years with a higher proportion (56.9%) being males. With regards to diagnosis, 28.1% and 27.5% of the respondents were categorised as probable cases of depression and anxiety respectively, while 3.8% respondents reported suicidal ideation. Majority of the respondents (61.9%) reported the fear of infecting their loved ones. The variables that showed association with psychiatric morbidity were a past history of an emotional concern, employment status, guilt about infecting others and boredom.

Conclusion

This study revealed a high burden of psychological/psychiatric morbidity among persons treated for COVID-19, particularly persons who have had prior emotional concerns. The findings from this study reiterate the need to pay attention to the mental health of people during disease outbreaks and to incorporate psychosocial interventions as part of the management package.

Pattern of anxiety psychopathology experienced among postgraduate medical trainees

Objectives: Postgraduate medical training is characteristically intensive and stressful. Given that anxiety disorders are often linked with stress-related scenarios; awareness of the burden of anxiety disorders among postgraduate medical trainees and their determinants is essential for informed intervention. This study was set to investigate the pattern of anxiety psychopathology, and to determine its correlates among doctors in a Nigerian postgraduate medical training facility.Methods: The participants, made up of 204 resident doctors were administered questionnaire to elicit their socio-demographic and work related variables. Subsequently, 12- item General Health Questionnaire (GHQ-12) was used to ascertain the presence of emotional distress, and the Structured Clinical Interview for Diagnostic & Statistical Manual for Mental Disorders- fourth edition [DSM-IV] Axis-1 Disorders, Non-patient edition (SCID-1/NP) was administered to characterize anxiety related psychopathology in the participants.Results: The mean age of participants was 33.44 (±4.50). In all, 120 (58.8%) respondents reported various difficulties with their examinations, 14(8.3%) reported having physical disorder and 59(28.9%) respondents were emotionally distressed. The prevalence of anxiety psychopathology based on DSM-IV criteria was 13.2% and the pattern elicited based on recognised categories include generalized anxiety disorder (4.9%), obsessive-compulsive disorder (3.4%), specific phobia (2.4%), social phobia (1.5%) and substance induced anxiety disorders (1.0%). Having additional qualification to the medical degree seems protective against anxiety psychopathology (?2= 3.91; df=1; p<0.05), while those with emotional distress (?2=17.54; df=1; p<0.001) were more likely to experience anxiety.Conclusion: Comprehensive and need-based mental health services with psychosocial support for trainee doctors are implied. Future research focusing on modifiable predictors of mental health challenges among resident doctors and their linkage with specific aspects of training is indicated.Bangladesh Journal of Medical Science Vol.15(1) 2016 p.25-32

Characterization of Clostridium Species from Food Commodities and Faecal Specimens in Lagos State, Nigeria

BACKGROUND

Food-borne pathogens are a major public health challenge worldwide. These organisms' cause illnesses leading to time loss in the work place and reduced productivity.Clostridium species cause infections through the production of powerful toxins which are responsible for diarrhoea and cramping. Diarrhoeal diseases due to Clostridia are one of the commonest worldwide but have hardly been reported in Nigeria.

OBJECTIVE

This study characterized Clostridium species from food commodities and human faeces in Lagos State MATERIALS AND METHODS: Four hundred and twenty samples comprising food (220) and faecal (200) specimens in Lagos state were included in this study. Isolates obtained were identified using API 20-A and confirmed by Polymerase Chain Reaction assay and 16S rRNA sequencing. The food samples included meat and meat products, ready to drink traditionally prepared milk products, fresh vegetables, canned foods and local honey.

RESULTS

Seventy (16.7%) Clostridium species were identified, 50 from food and 20 from faeces. Majority of the isolates were obtained from vegetables (56%) and meat products (34%). Of the 70 Clostridial species, 38 (54.3%) were C. perfringens, 5 (7.1%) were C. difficile and 2 (2.9%) were C. botulinum. All 38 (100%) strains of C. perfringens possessed alpha (cpa) toxin gene.

CONCLUSION

Clostridium species are present in our environment and contaminate food products posing potential risks to consumers. There is therefore a need for these traditionally made street vended foods to be monitored because they are potential sources of food borne pathogens.

Arcobacter, an emerging opportunistic food borne pathogen--A review

BACKGROUND

Arcobacters, emerging aetiologic agents of food-borne diarrhoeal illness in humans and animals are more frequently isolated in meat, especially poultry meat, pork and beef. Though human infection may exist, it has not been documented in Nigeria.

AIM

This review presents an update of scientific information in Nigeria on arcobacters as an emerging food-borne pathogen of public health significance in Nigeria.

METHODS

A comprehensive reviews of literatures was adopted to give an update on scientific findings on the disease in Nigeria.

RESULTS AND CONCLUSIONS

The review revealed scientific evidences attributing the cause of human and animal illness to Arcobacter spp. It also highlights efforts towards the development of animal models where in virulence and pathogenicity of primarily A. butzleri and A. cryaerophilus isolated from human diarrhoeal stool samples were tested. This in turn elucidated the public health significance of this emerging food-borne pathogen. The review canvases for more investigation as to the role of arcobacters in food contamination and unrecognised food-borne disease in Nigeria.

Burnout among doctors in residency training in a tertiary hospital

The mental health of doctors is an issue of growing concern all over the world as it frequently interplays with their professional trainings and responsibilities. This study was done to determine the pattern and correlates of burnout among 204 doctors undergoing residency training. Eligible participants were interviewed using designed questionnaire, General Health Questionnaire (GHQ-12) and Maslach Burnout Inventory (MBI). The mean age of participants was 33.44±4.50. Ninety-three (45.6%) respondents reported burnout in the dimension of emotional exhaustion (EE), 118 (57.8%) in the dimension of depersonalization (D), and 126 (61.8%) in the dimension of reduced personal accomplishment (RPA). Factors that were significantly associated with all the dimensions of burnout were perceived heavy workload and presence of emotional distress (based on GHQ score of ≥3). The perception of call duty as being not stressful was negatively predictive of burnout in the emotional exhaustion subscale (odds ratio [OR]=0.52; 95%confidence interval [CI]=0.29-0.97; p=0.03), while emotional distress was a positive predictor (OR=6.97; 95%CI=3.28-14.81; p<0.001]. Absence of doctor-to-doctor conflict negatively predicted burnout in the depersonalization subscale (OR=0.36; 95%CI=0.17-0.76); p<0.01), while older age (OR=0.66; 95%CI=0.47-0.95; p=0.03) and adequate support from the management (OR=0.45; 95%CI=0.22-0.90; p=0.02) constituted negative predictors of burnout in the reduced personal accomplishment subscale. Burnout is highly prevalent among resident doctors. Evolvement of comprehensive mental health services, training supports, conflict de-escalation/resolution mechanisms, and periodic assessment are indicated to mitigate work related distress with burn out among resident doctors, while improving their productivity.

Serum biochemistry and heamatological changes associated with graded doses of experimental Arcobacter infection in rats

BACKGROUND; Arcobacters have unusually wide range of habitats, and some species can be human and animal pathogens

OBJECTIVE

This study was designed to assess the haematological and biochemical changes associated with experimental Arcobacter infection in adult albino rat.

METHODS

The pathogenicity of Arcobacterbutzleri and A.cryerophilus, isolated from the caecal content of healthy chicken and confirmed by multiplex PCR was tested in albino rats (Rattusnovegicus). Seventy-five healthy adult male rats, subdivided into 5 rats per group, challenged orally with a single dose of 10⁻³ - 10⁻⁹ cfu/ml of bacterial strains and another group of five uninfected rats served as control.

RESULTS

Experimental infection resulted in diarrhoea,electrolyte imbalance and alteration of heamatological values. The packed cell volume (PCV), platelets, neutrophils and lymphocytes of the experimentally infected albino rats were significantly higher than those of the control group.

CONCLUSION

This study showed that Arcobacter could be a potential pathogen in albino rats while the selected haematological and electrolyte parameters may be good diagnostic indicators of the animal response to the bacterial infections.

A study on job satisfaction among clinical and non-clinical hospital staff in a teaching hospital in Lagos, Nigeria

OBJECTIVES

Previous studies had demonstrated that continuous and effective productivity of hospital staff are linked to job satisfaction and only those who are satisfied with their job can be maximally effective and productive. This cross-sectional descriptive survey was designed to determine the levels of job satisfaction among various groups of health care professionals working in a teaching hospital in Lagos, Nigeria.

METHODS

Two hundred clinical and non-clinical hospital staff were invited to take part in the study. They completed a sociodemographic questionnaire and the Job Descriptive Index (JDI).

RESULTS

The results indicated that majority clinical and non-clinical staff were satisfied with their jobs as regards the parameters of the JDI compared with those not satisfied with their jobs.

CONCLUSION

The government and health policy makers should continue to pay attention to boost job morale and satisfaction of medical health workers to continue to make them to be satisfied with their job.

Delayed diagnosis of intersex state: surgical outcome of cases seen and review of current concepts

BACKGROUND

Sexual ambiguity is said to occur when the gender of the baby cannot be determined at birth. The gender of an individual is in question because the genitals do not appear clearly as that of male or female. It is traumatizing to the family. It also causes confusion and problems in determining the sex, in which a child would be reared. The abnormality is relatively uncommon. Disorders of sexual differentiation can arise from abnormalities in chromosomes, gonadal development or hormonal production or activity. The orderly development process may also be affected by various environmental factors. Some of these factors may ultimately lead to the development of ambiguous external genitalia.

CASE PRESENTATIONS AND MANAGEMENT

Three of such patients with ambiguous genitalia are presented, in which the initial diagnosis proved to be incorrect. The various investigations that were carried out and surgical management are discussed.

CONCLUSION

Arguments which led to the ultimate choice of the sex of a child ranged from strict medical, to psychosocial and even cultural considerations. Expert examination shortly after birth would allow an early and definite decision, avoiding more serious problems with sexual ambiguity in later life.

Isolation and molecular identification of Fusobacterium nucleatum from Nigerian patients with oro-facial infections

BACKGROUND

Fusobacterium nucleatum is one of the most common anaerobic bacteria present in the oral cavity and is often isolated from infections involving other body sites.

OBJECTIVE

To characterise F. nucleatum strains from patients attending a teaching hospital in Nigeria in order to provide information on the methods for accurate identification of anaerobes in clinical specimen.

METHODS

Fusobacterium nucleatum specie from 50 patients presenting with oro-facial infections were studied by culture on Fusobacterium selective agar and fastidious anaerobe agar. The isolates were characterised based on colonial morphology, microscopy, lipase production, susceptibility to kanamycin and colistin and resistance to vancomycin. Biochemical tests were performed using a commercial test kit. The identity of the isolates was confirmed based on molecular characterization performed using polymerase chain reaction (PCR) analysis.

RESULTS

Forty-eight (96%) F. nucleatum isolates were obtained from the 50 patients by culture and all the isolates were identified by colonial appearance and microscopy based on their unique spindle shape with tapered ends. Only 26 (54.2%) of the 48 isolates were identified by commercial API 20A test kit while PCR confirmed the identity of all the isolates.

CONCLUSION

Anaerobes are involved in human infections and their study is quite cumbersome due to tedious nature and high cost of the techniques involved. Cultural method is reliable in the isolation and identification of F. nucleatum species. PCR is a rapid and simple method that can complement the phenotypic identification of anaerobes and would assist in their full identification.

Detection of Arcobacter in feces of healthy chickens in Osogbo, Nigeria

Isolation of arcobacters in foods, with the highest prevalence reported in poultry, has underscored its importance as a potential food safety problem in recent years. To estimate its prevalence in live birds, fresh stool samples from healthy chickens were screened by enrichment and plating on Arcobacter selective medium containing cefoperazone, amphotericin B, and teicoplanin. Of 150 fecal samples, only 2 (1.3%) yielded Arcobacter. Species were identified with fluorescence resonance energy transfer PCR. Isolate no. 21 from a local flock shared 99% identity with the complete genome of A. butzleri RM4018 (CP000361.1). Isolate no. 4 from a layer hen shared 100% identity with a partial 16S rRNA gene sequence of A. cryaerophilus (EF064151.1). The low prevalence of Arcobacter in the fecal samples of healthy chickens concurs with earlier studies suggesting that Arcobacter appears to be a transient colonizer of poultry intestines and therefore might not be the major source of chicken carcass contamination.

Antibiotic susceptibility patterns in Helicobacter pylori strains from patients with upper gastrointestinal pathology in western Nigeria

A total of 186 Helicobacter pylori isolates and 532 gastric biopsies recovered from 532 patients with varying degrees of gastroduodenal pathology are subjected to in vitro antibiotic susceptibility testing using the disc-diffusion method, Etest (MIC breakpoints) and molecular testing using the polymerase chain reaction (PCR). In the isolates studied, antibiotic resistance was as follows: piperacillin (72%), amoxicillin (66%), erythromycin (78%), tetracycline (100%) and metronidazole (95%). All isolates were sensitive to ofloxacin, ciprofloxacin and norfloxacin. None of the 245 amplicons (positive for H. pylori) from the biopsies were digested with the Bbs1 and Bsal restriction enzyme used in the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique, showing sensitivity to clarithromycin. However, a 238 bp fragment from H. pylori chromosomal DNA (corresponding to the quinolone resistance determining region [QRDR]) of the gyrA gene was amplified successfully. Twelve (4.9%) of the 245 strains studied had the described mutation at position 91, from asparagine (Asn) to glycine (Gly). The study showed that all the H. pylori strains were sensitive to clarithromycin and ciprofloxacin. It also highlighted PCR as a potential tool for faster diagnosis and determination of antibiotic susceptibility (within 24 h) of H. pylori from biopsies and/or isolates recovered from peptic ulcer and gastritis patients.

Susceptibility of cariogenic Streptococcus mutans to extracts of Garcinia kola, Hibiscus sabdariffa, and Solanum americanum

BACKGROUND

The elimination of cariogenic bacteria from the oral cavity using antibacterial agents is one of the primary strategies for the prevention of dental caries. Avariety of plants with potent activity are known to be used in indigenous communities for dental hygiene worldwide.

OBJECTIVE

To determine if Hibiscus sabdariffa, Solanum americanum and Garcinia kola can inhibit the growth of cariogenic bacteria in the mouth.

METHODS

Methanol and aqueous extracts obtained from three plants, Hibiscus sabdariffa, Solanum americanum and Garcinia kola were studied for their antibacterial activity against cariogenic Streptococcus mutans obtained from patients with clinically identified carious lesions, using the agar dilution method. The sources of extracts for Garcinia, Hibiscus and Solanum were respectively fruits and leaves for the latter two.

RESULTS

The extracts (both methanol and aqueous) from Garcinia kola showed the most intensive activity and completely inhibited the growth of the primary cariogenic Streptococcus mutans at 1.25 mg/ml. Hibiscus sabdariffa was also active at a minimum inhibitory concentration (MIC) of 2.5mg/ml while Solanum americanum did not show any direct effect on S. mutans.

CONCLUSION

The result of this study showed that G. kola and H. sabdariffa have direct antibacterial effect on Streptococcus mutans.

Bacteriological and clinical evaluation of twelve cases of post-surgical sepsis of odontogenic tumours at a referral centre

OBJECTIVE

To determine the bacterial aetiology of sepsis occurring following surgery of odontogenic tumours and assess the effect of prompt and proper antibiotic usage.

DESIGN

A prospective study.

SETTING

A tertiary referral centre in Lagos, Nigeria.

SUBJECTS

Twelve patients with odontogenic tumours that developed sepsis postoperatively. Eight of the patients were referred from private hospitals, the remaining were in-patients who sought for alternative medical attention following interruption of health care services at the referral centre.

INTERVENTION

Adequate review of patient's medical history, bacteriological investigations and antibiotic therapy.

MAIN OUTCOME MEASURES

Bacteriological and clinical cure following antibiotic therapy based on susceptibility test results.

RESULTS

Two categories of patients were identified; those who completed the course of antibiotics prescribed post-surgery and patients who failed to conform to antibiotic prescription. Sepsis developed in the non-compliance group much earlier than in the group that complied (p<0.001). Infections were polybacterial with aerobes accounting for 77.4% (alpha-haemolytic streptococci 29.0%, Streptococcus pyogenes 16.1%, Staphylococcus aureus 16.1%, diphtheroids 9.7%, Klebsiella pneumoniae 6.5%) and anaerobes 22.6% (Porphyromonas gingivalis 9.7%, Peptostreptococcus spp. 6.5%, Prevotella melaninogenica 3.2%, Clostridium perfringens 3.2%). Mixed aerobic and anaerobic aetiology occurred more in osteosarcoma and fibrosarcoma. Clostridium perfringens was isolated from a case of osteosarcoma with necrotic tissues. The anaerobic bacteria were 100% sensitive to metronidazole, ciprofloxacin and augmentin, 65-85% sensitivity to ampicloxacillin, amoxicillin and erythromycin. Over 92% of the streptococci were sensitive to the beta-Lactams contrast low susceptibility with S. aureus and K. pneumoniae.

CONCLUSION

Interruption of healthcare service was the sole factor identified in the development of sepsis as the patients could not be monitored to ensure compliance to prescription.

Campylobacter enteritis in Ilorin, Nigeria

BACKGROUND

Campylobacterje junilcoli is one of the most commonly identified bacterial causes of acute gastroenteritis worldwide. In Nigeria, it has been reported in the northern part of the country, extensive work has also been done in the south-west leaving behind the middle-belt of the country.

OBJECTIVE

To determine the role of Campylobacter jejunilcoli as an agent of diarrhoea in the middle-belt of Nigeria.

DESIGN

A prospective case control study.

SETTING

University of Ilorin Teaching Hospital (UITH), private hospitals and primary health centers all in Ilorin, Nigeria.

SUBJECTS

Three hundred and six children with diarrhoea and 100 without diarrhoea were randomly selected.

MAIN OUTCOME MEASURES

Isolation of Campylobacter jejuni/coli from stool samples. Biological characteristics of the isolates.

RESULTS

Twenty five (8.2%) of the patients and none of the controls had the organism. Campylobacter jejuni and C. coli were 56% and 44% respectively. All the isolates were susceptible to erythromycin and ciprofloxacin. None of the isolates harboured plasmids.

CONCLUSION

C. jejunil coli is an important diarrhoea agent in our geographic environment, further characterisation is desired of these local strains.

Multidrug resistance in Salmonella enterica serovar typhi isolated from patients with typhoid fever complications in Lagos, Nigeria

OBJECTIVE

The aim of this study was to determine the prevalence of Salmonella enterica serovar typhi in patients with pyrexia of unknown origin (PUO), and antimicrobial resistance in strains isolated from patients with S. typhi in Lagos, Nigeria.

STUDY DESIGN

In total, 103 patients were included in this study, subdivided into two categories. Category A comprised 74 patients presenting with PUO, and Category B comprised 29 patients harbouring S. typhi who did not respond to initial treatment.

METHODS

Blood samples were cultured for bacterial isolates and identified by standard procedures. Susceptibility testing was performed according to the National Committee for Clinical Laboratory Standards. Plasmid DNA extraction was performed using the alkaline lysis method with Escherichia coli v517 used as the standard. Conjugation and transformation experiments were performed using standard methods. For the latter, E. coli K12 HB 101 (ara-14, galK2, hsd 520, lacyl, leu, mtl-1, Pro A2, rec A13, rps L20, sup E44, thii xyl-5) was used as the recipient and plasmid PBR 322 was used as the positive control.

RESULTS

The prevalence of S. typhi in PUO was 16.2% (12/74). In all, 25 of 41 (61.0%) cases were multidrug resistant (MDR) with phenotypic-resistant patterns: ACoCT, ACTCeS, ACTCoCe and ACTS were commonly encountered among the strains. Interestingly, four of the strains harbouring similar plasmid DNA were isolated from patients with hepatosplenomegaly, and a strain harbouring a large transferable plasmid of 81.2MDa was isolated from a psychosis patient.

CONCLUSIONS

Our study confirmed the circulation of MDR S. typhi in Lagos, Nigeria. Periodic review of antibiotics used in hospitals is essential as the efficacies of chloramphenicol, ampicillin and cotrimoxazole are now doubtful. Ciprofloxacin and ofloxacin are effective drugs for treatment of typhoid fever, but with current trends of drug abuse in Nigeria, resistance is likely to develop. These results, therefore, provide an early warning signal for the prudent use of fluoroquinolone antimicrobials to preserve their usefulness.

Screening of some medicinal plants used in south-west Nigerian traditional medicine for anti-Salmonella typhi activity

Ten Nigerian medicinal plants used traditionally for the treatment of several ailments of both microbial and non-microbial origins were tested on multi-drug resistant S. typhi (MDR) strains of which six of them were active. The results revealed that both the aqueous and ethanol extracts of Terminalia avicennioides, Momordica balsamina, Combretum paniculatum and Trema guineensis were effective on the MDR-S. typhi strains with minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values ranging from 9.60 to 14 mcg/ml and 24 to 33 mcg/ml, respectively. Whereas, only the aqueous extracts of Morinda lucida and Ocimum gratissimum were found to be active against this pathogen with MIC and MBC values of 9.60 and 24 mcg/ml for M. lucida, 40 and 55 mcg/ml for O. gratissimum, respectively. There was no statistical significant difference (P > 0.05) between the activity of each plant extract and the decoctions prepared from them. All the six active plants showed positive reactions to alkaloids, tannins, flavonoids and anthraquinones but in variable degrees. All but M. balsamina, indicated the presence of saponin.

Genotyping and genetic diversity of Arcobacter butzleri by amplified fragment length polymorphism (AFLP) analysis

AIMS

To investigate the potential of amplified fragment length polymorphism (AFLP) profiling for genotyping Arcobacter butzleri and to obtain further data on the genetic diversity of this organism.

METHODS AND RESULTS

Seventy-three isolates of Danish, British, Turkish, Swedish, Nigerian and North American origin from human infections, chickens, turkeys, ducks, sheep and poultry abbatoir effluent were studied by use of a protocol that involved stringent PCR amplification of fragments derived from digestion of genomic DNA with restriction enzymes BglII and Csp6I. The mean similarity value of duplicate profiles of 10 isolates was 91.15%, indicating the method to be reproducible. Numerical analysis of all 73 isolates distinguished 51 subtypes at the 91% similarity level, of which 39 comprised single strains. The remaining 34 isolates were distributed among 12 subtypes, each of which contained strains homogeneous with respect to their respective source of isolation. However, contemporaneous strains from the same source could also be distinguished.

CONCLUSIONS

AFLP profiling is an effective method for typing the genetically diverse organism A. butzleri.

SIGNIFICANCE AND IMPACT OF THE STUDY

The study represents a comprehensive analysis of the genetic diversity of A. butzleri by use of isolates from six countries spanning three continents and also shows that several distinct A. butzleri genotypes may be found in a given environment. AFLP profiling appears to have considerable potential for molecular epidemiological studies of this ubiquitous emerging pathogen that is implicated as a causative agent of both human and animal disease.