Oxidative stress responses as a marker of toxicity in mice exposed to polluted groundwater from an automobile junk market in South-Western Nigeria

The global trade in used vehicles and their components generates huge financial benefits but leads to detrimental environmental consequences including groundwater pollution and potential adverse health effects mediated by free-radical processes such as lipid peroxidation. We investigated oxidative stress responses in thirty-six, female mice orally exposed (via drinking) to graded concentrations (0%, 50%, and 100%) of groundwater from a well located within a major automobile junk market in SW-Nigeria containing extremely high levels of arsenic (0.332 ± 0.089 mg/l) and seventeen PAHs, which serves as domestic water supply. Blood samples from the mice were assayed for selected biochemical parameters at intervals of 7, 14, and 28 days. A significant dose- and duration-dependent increase in malondialdehyde (MDA) and Myeloperoxidase (MPO) confirmed oxidative stress onset due to exposure to the polluted well-water, while a significant decline in nitric oxide (NO-) levels may suggest impaired endothelial smooth-muscle relaxation which may lead to the development of metabolic diseases over time. Superoxide dismutase (SOD) and reduced glutathione (GSH) showed a contrasting trend with Glutathione peroxidase (GPx), while Glutathione-S-Transferase (GST) declined significantly by the 28th day. Two clusters were identified by principal component analysis-one involving MDA, SOD, and GSH suggesting that antioxidant responses driven mainly by SOD and GSH proved insufficient in scavenging the free radicals generated by lipid peroxidation. NO- and total protein clustered together possibly due to the significant declines in both over the study period. Histological examination of liver tissue of exposed mice corroborated the above findings and highlights the need for urgent remedial action.

Drug resistance profiles of new- and previously treated patients with pulmonary tuberculosis in Ibadan, Nigeria

BACKGROUND

Information on TB drug resistance profiles and its' associated risk factors are scarce in Nigeria despite the large burden of disease in the country. The study was designed to report drug resistance profiles of new- and previously treated patients with pulmonary tuberculosis (TB) in Ibadan, Nigeria.

METHOD

Sputum from consenting pulmonary TB patients were collected and cultured for Mycobacterium tuberculosis (Mtb) at the TB laboratory of the University College Hospital, Ibadan, Nigeria using standard method. Mtb were stored and sent for drug susceptibility testing against first and second-line anti-TB drugs at the MRC Unit, The Gambia and at the Institute of Tropical Medicine, Antwerp, Belgium using BACTEC MGIT 960 and proportion method on solid medium respectively.

RESULTS

Of 238 Mtb collected, 124 (52.1%) were viable, 102 (59.65%) non-viable while 12 (7.02%) were contaminated. About half (58.87%) of the Mtb were from previously treated patients, 40 (32.26%) were from new patients while treatment history of 1.1 (8.87%) were unknown. Forty-seven (37.90%) of the 124 Mtb. tested were multidrug resistant (MDR) out of which, 40 (85.10%) were from previously treated patients.. HIV prevalence was 8.69%. Of the 17 MDR-TB from previously treated cases tested for second-line drugs, four (23.53%) were resistant to fluoroquinolones or injectable agents, 13 (76.47%) were susceptible while none was resistant to both of these classes of drugs.

CONCLUSION

MDR-TB in Ibadan already demonstrates resistance to second line anti-TB drugs hence management of MDR-TB patients should be strengthened to prevent emergence of extensively drug-resistant TB (XDR-TB).

Outbreaks-of Ebola virus disease in the West African sub-region

BACKGROUND

Five West African countries, including Nigeria are currently experiencing the largest, most severe, most complex outbreak of Ebola virus disease in history. This paper provided a chronology of outbreaks of Ebola virus disease in the West African sub-region and provided an update on efforts at containing the present outbreak.

METHODS

Literature from Pubmed (MEDLINE), AJOL, Google Scholar and Cochrane database were reviewed.

RESULTS

Outbreaks of Ebola, virus disease had frequently occurred mainly in Central and East African countries. Occasional outbreaks reported from outside of Africa were due to laboratory contamination and imported monkeys in quarantine facilities. The ongoing outbreak in West Africa is the largest and first in the sub-region; the number of suspected cases and deaths from this single current outbreak is already about three times the total of all cases and deaths from previous known outbreaks in 40 years. Prevention and control efforts are hindered not only by lack of a known vaccine and virus-specific treatment, but also by weak health systems, poor sanitation, poor personal hygiene and cultural beliefs and practices, including myths and misconceptions about Ebola virus disease--all of which are prevalent in affected countries. Constrained by this situation, the World Health Organisation departed from the global standard and recommended the use of not yet proven treatments to treat or prevent the disease in humans on ethical and evidential grounds.

CONCLUSION

The large number of people affected by the present outbreak in West Africa and the high case-fatality rate calls for accelerated evaluation and development of the investigational medical interventions for life saving and curbing the epidemic. Meanwhile, existing interventions such as early detection and isolation, contact tracing and monitoring, and adherence to rigorous procedures of infection prevention and control should be intensified.

Chlamydial infection, plasma peroxidation and obesity in tubal infertility

BACKGROUND

Genital tract infections and obesity are both sources of oxidative stress. Alterations in immune and antioxidant parameters may arise from this or from an indeterminate autoimmune mechanism.

OBJECTIVE

This study aimed to investigate the association of Chlamydial infection, obesity and oxidative response with tubal infertility in Nigerian women.

METHODS

It was a case-control study of 40 women with tubal infertility and 32 fertile women, respectively, recruited from the Infertility and Family Planning Clinics respectively, of the University College Hospital, Ibadan, Nigeria. Anthropometric indices were measured in each subject and endocervical swabs were taken to screen for current genital tract infection. Antioxidant, hormonal and immunologic analysis were performed on serum.

RESULTS

None of the subjects had current genital tract infections. Chlamydia trachomatis IgG positivity was significantly higher in infertile than in fertile subjects [OR 4.33; 95%CI (0.078-0.681)]. No significant variations were observed in the anthropometric indices, antioxidant parameters and hormones between infertile and the fertile women. Body mass index correlated positively with oxidative stress in infertile subjects. Waist and hip circumferences correlated negatively with oestradiol in women with tubal infertility.

CONCLUSION

Chlamydial infection is associated with tubal factor infertility, however, obesity seems to increase oxidative stress and reduce fertility potential in women with tubal factor infertility.

Genital ulcer diseases among HIV-infected female commercial sex workers in Ibadan, Nigeria

We evaluated the prevalence and association of Genital Ulcer Diseases (GUDs) among HIV-1 infected female commercial sex workers (FCSWs) in Ibadan, Nigeria. A total of 250 FCSWs from brothels in Ibadan were tested for presence of antibodies to HIV and Syphilis. Pelvic examinations for signs of sexually transmitted infections (STIs) were carried out on the subjects. Endocervical and high vaginal swabs were collected from each of the subjects to establish laboratory diagnosis of STIs. Their age ranged from 15 to 55 years (Mean = 25.8 yrs; SD = 3.74). Majority (246/250) were Nigerians, while 1.6% were from neighboring West African countries. Sixty four (25.6%) of the subjects were positive for HIV-1 while seven (2.8%) had dual HIV-1/2 infection. Analysis of the STIs showed that 49 (19.6%) of the CSWs had GUDs. Herpes genitalis was the commonest GUDs as it occurred in 25 (10%) of the subjects. Other STIs identified were chancroid (5.6%), syphilis (4.0%) and lymphogranuloma venerum (LGV) (4%). Sixteen (64.0%) of the CSWs with herpes genitalis had HIV-1 infection. The risk ratio of herpes genitalis for HIV acquisition was 3.0 (95% CI: 2.0 - 4.4). Syphilis and chancroid were also found tobe significantly associated with increased risk of HIV infection (p < 0.0001). The adjusted odd ratios for Herpes genitalis, chancroid, and syphilis were 3.7 (1-13.0, p < 0.05), 19.8 (2.7-13.0, p < 0.05) and 19.1 (1-231.0, p < 0.05) respectively. There is need to educate FCSWs continually to adopt safer sexual behaviours, seek early diagnosis and treatment of GUDs to reduce their risk of transmitting HIV infection.

In vitro antimicrobial properties of coconut oil on Candida species in Ibadan, Nigeria

The emergence of antimicrobial resistance, coupled with the availability of fewer antifungal agents with fungicidal actions, prompted this present study to characterize Candida species in our environment and determine the effectiveness of virgin coconut oil as an antifungal agent on these species. In 2004, 52 recent isolates of Candida species were obtained from clinical specimens sent to the Medical Microbiology Laboratory, University College Hospital, Ibadan, Nigeria. Their susceptibilities to virgin coconut oil and fluconazole were studied by using the agar-well diffusion technique. Candida albicans was the most common isolate from clinical specimens (17); others were Candida glabrata (nine), Candida tropicalis (seven), Candida parapsilosis (seven), Candida stellatoidea (six), and Candida krusei (six). C. albicans had the highest susceptibility to coconut oil (100%), with a minimum inhibitory concentration (MIC) of 25% (1:4 dilution), while fluconazole had 100% susceptibility at an MIC of 64 microg/mL (1:2 dilution). C. krusei showed the highest resistance to coconut oil with an MIC of 100% (undiluted), while fluconazole had an MIC of > 128 microg/mL. It is noteworthy that coconut oil was active against species of Candida at 100% concentration compared to fluconazole. Coconut oil should be used in the treatment of fungal infections in view of emerging drug-resistant Candida species.

Internal hernia through the broad ligament presenting with acute on chronic intestinal obstruction: A case report

BACKGROUND

Internal hernias are rare. Their occurrence through the broad ligament is one of the rarest forms. We present a report of a 45 year Nigerian female with acute on chronic intestinal obstruction due to an internal hernia of the broad ligament.

METHODS

Patients case notes and a review of relevant literature using manual library and Medline search was used.

RESULTS

A 45-year-old multiparous woman presented with a ten-year history of features of partial intestinal obstruction, and no previous abdominal surgery. Examination revealed right iliac fossa tenderness and a plain abdominal radiograph showed air fluid levels. Conservative management was not successful and laparatomy confirmed an internal hernia of the right broad ligament which was repaired with satisfactory outcome.

CONCLUSION

This report is to highlight the fact that though rare, internal hernia should be considered in the differential diagnosis of intestinal obstruction.

Photochemical behavior of benzo[a]pyrene on soil surfaces under UV light irradiation

The rates of photodegradation and photocatalysis of benzo[a]pyrene (BaP) on soil surfaces under UV light have been studied. Different parameters such as temperature, soil particle sizes, and soil depth responsible for photodegradation, catalyst loads and wavelength of UV irradiation blamed for photocatalysis have been monitored. The results obtained indicated that BaP photodegradation follows pseudo-first-order kinetics. BaP photodegradation was the fastest at 30 degrees C . The rates of BaP photodegradation at different soil particle size followed the order: less than 1 mm>less than 0.45 mm>less than 0.25 mm. When the soil depth increased from 1 mm to 4 mm, the half-life increased from 13.23 d to 17.73 d. The additions of TiO2 or Fe2O3 accelerated the photodegradation of BaP, and the photocatalysis of BaP follows pseudo-first-order kinetics. Changes in catalyst loads of TiO2 (0.5%, 1%, 2%, and 3% (wt)) or Fe2O3 (2%, 5%, 7%, and 10% (wt)) did not significantly affect the degradation rates. Both BaP photocatalysis in the presence of TiO2 and Fe2O3 were the fastest at 254 nm UV irradiation.

Hepatitis B surface antigen (HbsAg) in blood and genital secretions of patients with sexually transmitted diseases in Ibadan, Nigeria

A total of 100 patients attending the Special Treatment Clinic of the University Teaching Hospital (UCH), Ibadan between October, 1998 and April, 1999 were studied to detect Hepatitis B surface antigen (HbsAg) in the blood and genital discharges. This was with a view of establishing whether infected persons (positive by blood test) also excrete the antigen, HbsAg, in their genital secretions. Urethral swabs were collected from 63 male patients, while High Vaginal and Endocervical swabs were collected from 37 female patients. Blood samples were collected from all the patients. HbsAg was tested for by Enzyme immunoassay technique with Wellcozyme HbsAg kit. Of the 63 male patients, 10 (15.9%) had HbsAg in the urethral secretion while 22 (34.9%) had it in their blood, 70% of these male patients were within the age range 11-30 years. Of the 37 female patients, 34 (92%) had HbsAg in the Endocervical secretions, 6 (16.2%) of them had HbsAg in their blood. Eighty percent of the female patients with positive HbsAg in the genital secretions were within age range 21-40 years. This study documents that Hepatitis B virus can be transmitted sexually in this environment.

Laparoscopic and microbiological features of acute salpingitis in developing countries

One hundred and twenty-four out of 198 consecutive women who underwent diagnostic lasparoscopy for clinical symptoms and signs of acute salpingitis at the University College Hospital, Ibadan, Nigeria had acute salpingitis. These were slightly younger than those without acute salpingitis, otherwise there were no differences in the sociodemographic characteristics of the two groups. Urinary and gastrointestinal symptoms, abnormal vaginal discharge, fever (> 38 degrees C) and sexually transmitted organisms were significantly more in women with acute salpingitis. Ninety-five per cent of the Neisseria gonorrhoea cultured were of the PPNG strain. Pelvic adhesions were present in 69.4% of the women with acute salpingitis. Forty-one per cent of the women had tubal occlusion. It was concluded that laparoscopy rather than clinical findings alone would determine the severity of acute salpingitis. This should be performed along with culture of genital discharges and peritoneal fluid for optimum management. The use of a single dose broad spectrum antibiotics active against both PPNG and non-PPNG strains, and chlamydial infections is advocated for treatment in developing countries.

Ureaplasma urealyticum as a cause of non-gonococcal urethritis: the Ibadan experience

Two hundred and eighteen men with confirmed urethritis were investigated for Ureaplasma urealyticum at the Special Treatment Clinic, University College Hospital, Ibadan between 5th January and 28th December 2000. Sixty-four (29.35%) of the 218 patients had gonococcal urethritis whilst 154 (70.65%) had non-gonococcal urethritis (NGU) out of which 22 (14.3%) had U. urealyticum urethritis and 10(6.5%) had Trichomonal urethritis. The difference in the occurrence of U. urealyticum between the patients and the control group was highly statistically significant (p<0.001). The age range of peak incidence among the patients investigated was 20-29 years. There was evidence of urethritis in all the 22 U. urealyticum positive cases as shown by the presence of increase in the number of polymorphonuclear leucocytes in the specimens collected. A significant difference in the nature of the urethral discharge in men with gonorrhoeae compared with U. urealyticum positive NGU patients was also demonstrated. Treatment of those patients found to be positive for U. urealyticum with a course of oral Tetracyline was successful but then the problems posed by the asymptomatic Ureaplasma urethritis still remained unanswered.

Pattern of sexually transmitted diseases among commercial sex workers (CSWs) in Ibadan, Nigeria

The purpose of this study was to determine the pattern of STDs among commercial sex workers (CSWs) in Ibadan, Nigeria. The subjects were 169 CSWs randomly selected from 18 brothels, majority of who were examined and investigated in their rooms. Another 136 women without symptoms who visited the special treatment clinic, University College Hospital, Ibadan were selected as a normal control group. Vaginal candidiasis was the most common STD diagnosed in both CSWs and the control group. The other STDs in their order of frequency were HIV infection 34.3%, non-specific vaginosis 24.9%, trichomoniasis 21.9% and gonorrhoea and "genital ulcers" had an incidence of 16.6% each. Other important conditions were tinea cruris 18.9%, scabies 7.7% genital warts 6.5% and 4.1% of them had syphilis sero-positivity. All the 13 CSWs that had scabies, the 4 (36.4%) with genital warts and the 19 (67.9%) with "genital ulcers" had HIV infection. While there was no significant difference between the CSWs with vaginal candidiasis, gonorrhoea, trichomoniasis and the control group, the HIV positivity was significantly higher (P < 0.001) in CSWs than in the control subjects. These findings suggest that women who exchange sexual services for money can no longer be ignored, and should therefore be identified and made to participate in STD prevention and control programmes.

Penicillinase producing Neisseria gonnorhoeae: the review of the present situation in Ibadan, Nigeria

All the isolates of Neisseria gonorrhoeae from patients that attended special treatment Clinic, University College Hospital, Ibadan, Nigeria between 15th January 1997 and 15th December 1999 were studied so as to review the present prevalence rate of penicillinase producing Neisseria gonorrhoeae (PPNG) in Ibadan. Of the 214 patients that had gonococcal infections, 161 were male (75.2%) and 53 (24.8%) were female. Ninety-two (57.1%) of the male and 28(52.8%) of the female were aged between 20- 29 years while 19.9% of the male and 15.1 % of the female were in the age of 40 and above. The sex difference is not statistically significant (chi2=2.19, df=3, p=0.53). The present study revealed that PPNG strains have increased dramatically to 98.6 per cent. This has posed a great threat to the usefulness of penicillin and ampicillin as the drugs of choice in gonococcal therapy in Nigeria.

Non-gonococcal urethritis due to Chlamydia trachomatis: the Ibadan experience

Using a qualitative amplified enzyme-linked immunoassay, two hundred and eighty-nine male patients with symptoms and signs suggestive of urethritis were investigated for Chlamydia trachomatis as a cause of non-gonococcal urethritis (NGU). Ninety-one (31.49%) of the 289 male patients investigated had gonococcal urethritis whilst 198 (68.51%) had NGU out of which 112 (56.60%) had chlamydial urethritis and 14 (7.1%) had Trichomonal urethritis. Two (6.7%) of the control subjects had C. trachomatis in their urethral swabs. The difference in the occurrence of C. trachomatis between the patients and the controls was highly statistically significant (P<0.001). The age range of peak incidence among the patients investigated was 20-29 years. Thirteen of the men treated for gonorrhoea still had watery urethral discharge and irritation and were diagnosed as having post-gonococcal urethritis (PGU), eleven (84.6%) of whom had C. trachomatis demonstrated in their urethral swabs. We were able to demonstrate a significant difference in clinical symptoms in men with gonorrhoea and NGU but only a slight difference between men with chlamydia-positive NGU and chlamydia-negative NGU.

Childhood gastroenteritis due to Aeromonas hydrophila in Ibadan, Nigeria

This is a prospective study spanning a period of six months where stools of 400 diarrhoeic children and 100 non-diarrhoeic children aged 0-5 years were screened for Aeromonas hydrophila and other enteric pathogens. Out of the 400 diarrhoeic stools only three (0.75%) were positive for Aeromonas hydrophila while none was positive in the control group. No other enteric pathogen was isolated from these positive samples, indicating that Aeromonas hydrophila is responsible for their diarrhoea. Continuous surveillance of this agent of diarrhoea in this environment will further reveal any threat the organism may poise in the nearest future.

Review of cases of children with gonorrhoea--source of infection

This is a retrospective study to determine what effort was put into identifying the source of infection in children with gonorrhoea in Ibadan. The case files of eighty-four children aged 1 to 10 years who had gonococcal genital infections between 1983 and 1998 and presented at the Special Treatment Clinic of the University College Hospital, Ibadan were studied. Clinical manifestations of the 84 children include vaginal discharge (97.6%), urethritis (2.4%) and combined genital and eye infection (8.3%). A total of 103 relatives of 61 index subjects were examined. Of those in whom specimens were collected for microscopy culture and sensitivity, 27 (26.2%) had gonorrhoea. A history of sexual contact in the children studied was recorded in only (10.7%) cases, while four (4.7%) others without history of sexual intercourse had torn hymen. Sexual abuse or child neglect was suspected in this group. None of the named contacts was traceable by the health visitors. The recognition of a child with gonococcal infection identifies a cluster of family members who are at increased risk of having gonorrhoea. This study indicates that more effort will be required to find the source and mode of transmission of gonorrhoea in children.

Non-penicillinase producing Neisseria gonnorhoeae: are they still in existence in Ibadan, Nigeria?

In an attempt to evaluate the current prevalence rate of penicillinase producing Neisseria gonorrhoeae (PPNG) and whether non-PPNG strains are still in existence in Ibadan, Nigeria, all isolates of Neisseria gonorrhoeae from patients that attended our clinic between January and December 1997 were studied. Of the 155 patients that had gonococcal infections, 118 were male (76.1%) and 37 (23.9%) were female with 31 (83.8%) being the partners of infected men. Sixty-four (54.2%) of the male and 19 (51.4%) of the female were aged between 20 and29 years while 21.2% of the male and 16.2% of the female were in the age of 40 and above. The sex difference is not statistically significant (chi2=1.47,P=-0.69). The present study revealed that non-PPNG strains have reduced considerably to 5.4% from 100% in 1977. This has posed a great threat to the usefulness of penicillin and ampicillin as the drugs of choice in gonococcal therapy in Nigeria.

Bacterial agents of discharging ears and antimicrobial sensitivity patterns in children in Ibadan, Nigeria

Bacteriological studies were carried out on ear swabs from 361 cases of children with discharging ears at the Microbiology Department of the University College Hospital, Ibadan between March 1995 and February 1997. 308 (85.3%) had positive cultures. 78.6% of these yielded one isolate, 19.2% yielded two isolates while 2.2% had three isolates. Pseudomonas spp. Was the predominant agent of CSOM and ASOM. This was followed by Staphylococcus aureus. Other commonly isolated organisms were Proteus and Klebsiella species. Ofloxacin and ciprofloxacin showed the highest activity to all isolates, while two third of the isolates were sensitive to azithromycin, cefuroxime, ceftriazone and gentimicin.

Comparative in-vitro activities of commonly available quinolones and other antibiotics on bacterial isolates in Ibadan, Nigeria

The 4-quinolones, many of which are now available in Nigeria under different trade names, have a broad spectrum of activity. An evaluation is made of the comparative in-vitro activities of these quinolones and other antibiotics against 125 strains of bacteria commonly isolated from clinical specimens in University College Hospital, Ibadan, by using the Stroke's disc sensitivity method, and MIC estimation. The quinolones showed greater activity than the cephalosprins against Klebsiella spp., Proteus spp. and Escherichia coli, but were found to be equipotent against Pseudomonas spp. the MIC results revealed ciprofloxacin (Ciprotap) as the most active of the quinolones. Though some strains of Klebsiella spp. and Pseudomonas spp. were found to be resistant to all the antibiotics tested, majority of the strains of the gram-negative bacilli from clinical specimens were highly susceptible to all the quinolones. This emphasizes the need to monitor regularly the emergence of resistance associated with the use of antibiotics in the developing countries.

Pattern of gram negative rods bacteraemia in diabetic patients in Ibadan, Nigeria

In a study of 100 patients in Ibadan between July and December 1995 to evaluate bacteraemia due to gram-negative bacilli, 64% were culture positive, 44 (68.8%) of these yielded gram-negative rods. The isolates were Klebsiella species (43.2%), Escherichia coli (27.3%), Pseudomonas aeruginosa (13.6%), Proteus species (11.4%) and Bacteroides melaninogenious (4.15%) by standard bacteriological methods. Antimicrobial sensitivity results suggested ofloxacin or ceftriaxone with metronidazole as empirical antibiotic therapy.

Efficacy of pefloxacin in the treatment of postoperative sepsis in gynaecology

Twenty four women with postoperative sepsis following gynaecological surgery were recruited into a study designed to determine the efficacy of Pefloxacin. With the standard oral dose of Pefloxacin, clinical cure or improvement occurred in 98% of the patients. In-vitro, 90% of bacterial isolates were sensitive to Pefloxacin. No adverse effect was encountered in any of the patients. We concluded that Pefloxacin is effective in the treatment of postoperative bacterial infections following gynaecological surgery.

Socio-demographic characteristics and sexual behaviour of adolescents attending the STC, UCH, Ibadan: a 5 year review

As a continuation of the on-going efforts to prevent and control the spread of sexually transmitted diseases (STDs) and the Acquired Immunodeficiency Syndrome (AIDS) in adolescents, this retrospective clinic-based study identifies the socio- demographic characteristics, describes the sexual practices, identifies the common STDs, including drug utilization patterns in this risk group at the special treatment clinic of the University College Hospital, Ibadan. Results reveal that adolescents constituted between 3.3% and 4.8% of the total number of patients seen each year. The characteristics of the subjects were as follows: 54 (38.3%) were aged 19 years, 133 (94.3%) were single, 79 (53.2%) were females and 103 (73.0%) were students. As regards sexual behaviour, 22 (15.71%) denied previous history of sexual intercourse. Vaginal intercourse was reported in all the sexually active youth, 2(1.71%) reported oral sex, while 10 (8.41%) admitted that they had multiple sexual partners. Gonorrhoea was diagnosed in 23 (21.51%) of sexually active youths. Among those who had used drugs before presentation ampicillin was the common drug used for treatment by 14 (26.4%). The importance of encouraging adolescents to present at STD clinics is highlighted. Health workers need to have a sympathetic attitude and assure them of confidentiality. The need for more community-based education is shown, including the importance of proper and complete documentation of hospital records.

Nosocomial infections: methicillin resistant Staphylococcus auerus in wound infection in Ibadan, Nigeria

In a study of 188 cases of wound infection seen in the University College Hospital, Ibadan, between December 1994 and April 1995, 78 strains of Staphylococcus aureus were methicilin resistant (MRSA). The disc sensitivity pattern of the MRSA was determined using the method of Kirby et al., and the MICs of common antibacterial agents to the MRSA were determined by agar dilution method. Vancomycin, ofloxacin and ciprofloxacin offered the best effective treatment for MRSA wound infections, and are recommended as reserved drugs while gentamicin and cotrimoxazole are first line drugs.

Non-gonococcal urethritis (NGU) due to trichomonas vaginalis in Ibadan

Two hundred and sixty two male patients attending the Special Treatment Clinic (STC) of the University College Hospital, Ibadan between July and December 1989, were examined for Trichomonas vaginalis as a cause of non-gonococcal urethritis using both microscopic and culture methods. Thirteen of the 262 male patients were the sexual partners of trichomonas vaginalis infected women. While 47(17.9) percent of the 262 men investigated had gonococcal urethritis, 215(82.1 percent) had non-gonococcal urethritis out of whom 18(8.4 percent) had trichomonal urethritis. The age range of peak incidence among the patients investigated is 20-29 years. A significant difference (P < 0.001) between the number of male sexual contacts that were positive for trichomoniasis (38 percent) and other male patients included in this study (8.4 percent) was demonstrated. Culture of the samples from the male patients investigated gave the highest proportion (100 percent) of positive results. This indicates the superiority of culture methods over other methods of diagnosing trichomoniasis such as microscopic method routinely used in our centre.

Pattern of bacterial pathogens in surgical wound infections

Wound swabs from surgical patients were studied from 1989 to 1991 to review the pattern of nosocomial infection in the University College Hospital, Ibadan, Nigeria. The prevalence rate of nosocomial infection was 4.9%. The ratio of gram-negative to gram-positive organisms in wound infection was 3:1 with klebsiella species and Pseudomonas species emerging as the most important gram-negative organisms. Staphylococcus aureus was the single most prevalent organisms in surgical would infections. Recommendations on control measures are given.

Efficacy of pefloxacin in acute gonococcal urethritis

A clinical trial of pefloxacin as a single oral regimen in the treatment of acute uncomplicated gonococcal infection was evaluated in sixty-four male patients with clinical and laboratory diagnosis of gonococcal urethritis using a single dose of 800 mg pefloxacin. Of the 64 men, 59 (92.2%) were infected by (penicillinase producing Neisseria gonorrhoeae (PPNG) strains, while 5 (7.8%) had non-PPNG strains. The cumulative percentage cure for all infections was 84.4%. Pefloxacin is effective as a single dose therapy for acute gonococcal urethritis in males infected by penicillinase producing and non-penicillinase producing Neisseria gonorrhea in our area of study.

Herpetic urethritis in male patients in Ibadan

In a study of 151 male patients attending a sexually transmitted disease clinic, 40 (26.4%) had non-gonococcal urethritis. Herpes simplex virus was isolated in tissue culture of HEp-2 cell line from 10 of the patients with non-gonococcal urethritis, and identified by complement fixation and indirect immunofluorescent anti body tests. Of the isolates, 30% were Herpes simplex virus type 1 (HSV-1), while 70% were Herpes simplex virus types (HSV-2).

Genital herpes simplex virus infection in females in Ibadan Nigeria

In a study of female patients attending the Sexually Transmitted Diseases Clinic of the University College Hospital Ibadan, Nigeria, Herpes simplex virus was isolated from the cervix of 5 of 117 patients, a prevalence rate of 4.3%. Two (1.7%) of these patients had HSV in the vagina. The viruses were identified by culture in HEp-2 cell line, chloroform sensitivity test, complement fixation test and indirect immuno-fluorescent antibody technique. Only one (20%) of the five patients has HSV-1 in the endocervix.

Clinico-epidemiological patterns of HIV infection in STD patients in Ibadan

The HIV-seropositive subjects identified among the STD Clinic patients seen at a Special Treatment Clinic between 1989 and 1990 were studied to determine the epidemiological and clinical trends of HIV infection in these patients, and to demonstrate any association between the STDs and HIV- seropositivity. Thirty-seven out of the 581 patients investigated have been confirmed HIV-seropositive by Western bolt. The prevalence of HIV infection was 6.4%. Anti-HIV-1 antibody prevalence (3.6%) was higher than that of anti-HIV-2 antibody (2.8%). The age-range of the patients investigated was from 2 weeks to 49 years, and the HIV-seropositive cases were in the age-range 15-49 years, with peak incidence of HIV infection in the 21-30 years age-bracket. The male: female ratio of HIV-seropositive subjects was practically the same (1.01:1). HIV antibody-positive cases consisted of residents from towns in both Northern and Southern Nigeria. Only one of the HIV antibody-positive cases has developed clinical AIDS-progressive weight loss fourteen months after he was found positive for HIV antibody.

Isolation of herpes simplex virus from sexually transmitted disease patients in Ibadan, Nigeria

BACKGROUND AND OBJECTIVES

Despite the public health importance of herpes simplex virus infection in Nigeria, attempts have not been made to isolate and identify the virus.

GOAL OF THE STUDY

To isolate, identify, and type the virus from patients attending a sexually transmitted disease (STD) clinic in Ibadan, Nigeria.

STUDY DESIGN

One hundred fifty-three clinical samples from 116 patients were taken and inoculated into tissue culture for virus isolation. The isolates were identified and typed using chloroform sensitivity test, histocytological study, Complement Fixation Test (CFT), and indirect immunofluorescent antibody technique (IFAT).

RESULT

Virus was isolated from seven of the 153 samples. Two of the seven were HSV-1, and five were HSV-2.

CONCLUSION

This is the first documented isolation of the herpes simplex virus in Nigeria. The study has provided baseline data for future studies on genital herpes in Nigeria. These results may have interesting implications with respect of HIV transmission and other related sexually transmitted diseases in Nigeria.

Coronary venous intimal thickening in explanted cardiac allografts. Evidence demonstrating that transplant coronary artery disease is a manifestation of a diffuse allograft vasculopathy

The accelerated coronary artery disease occurring in cardiac allografts is thought to be a form of chronic rejection directed against allogeneic vascular endothelium. If this hypothesis is correct, one would anticipate disease not only in the arteries but in venous structures as well. Accordingly, the degree of myointimal proliferation of both coronary arteries and coronary veins was assessed in 22 explanted or autopsied cardiac allografts by light microscopy. Other factors assessed included clinical cause of death/retransplantation, time posttransplantation, underlying cardiac disease, donor and recipient age, and ischemic time. Thirteen of the 22 hearts had either moderate or severe arterial myointimal thickening. Of these, 10 hearts had associated coronary venous thickening. Of the 9 remaining hearts with either mild or no arterial myointimal thickening, none had venous involvement. The overall correlation between the presence and degree of allograft coronary artery and allograft coronary vein thickening was high (r = 0.80, P = 0.0014). Of the other demographic factors investigated, only length of time posttransplant had a weak correlation with arterial or venous myointimal thickening (r = 0.46, P = 0.045 and r = 0.48, P = 0.039, respectively. These data demonstrate that the usually termed "accelerated transplant atherosclerosis" in the cardiac allograft is a true vasculopathy and involves both the arterial and venous systems.

Recurrence of sarcoidosis in a cardiac allograft: control with augmented corticosteroids

Sarcoidosis of the heart is an unusual but previously reported indication for heart transplantation. It is clear that sarcoidosis is a systemic disease, but in spite of this, recurrence in the cardiac allograft has not been previously noted. The case presented here is that of a 34-year-old male in whom cardiac sarcoidosis recurred in the allograft 6 months after heart transplantation.