Picture Cards Versus Physical Examination: A Proof-of-Concept Study to Improve the SOSAS Survey Tool

INTRODUCTION

The Surgeons OverSeas Assessment of Surgical Needs (SOSAS) survey tool is used to determine the unmet surgical needs in the community and has been validated in several countries. A major weakness is the absence of an objective assessment to verify patient-reported surgically treatable conditions. The goal of this study was to determine whether a picture portfolio, a tool previously shown to improve parental recognition of their child's congenital deformity, could improve the accuracy of the SOSAS tool by how it compares with physical examination. This study focused on children as many surgical conditions in them require prompt treatment but are often not promptly diagnosed.

METHODS

We conducted a descriptive cross-sectional community-based study to determine the prevalence of congenital and acquired surgical conditions among children and adults in a mixed rural-urban area of Lagos, Southwest Nigeria. The picture portfolio was administered only to children and the surgical conditions to be assessed were predetermined using an e-Delphi process among pediatric surgeons. The modified The Surgeons OverSeas Assessment of Surgical Needs-Nigeria Survey Tool (SOSAS-NST) was administered to household members to collect other relevant data. Data were analyzed using the REDCap analytic tool.

RESULTS

Eight hundred and fifty-six households were surveyed. There were 1984 adults (49.5%) and 2027 children (50.5%). Thirty-six children met the predetermined criteria for the picture portfolio-hydrocephalus (n = 1); lymphatic malformation (n = 1); umbilical hernia (n = 14); Hydrocele (n = 5); inguinal hernia (n = 10) and undescended testes (n = 5). The picture portfolio predicted all correctly except a case of undescended testis that was mistaken for a hernia. The sensitivity of the picture portfolio was therefore 35/36 or 97.2%.

CONCLUSIONS

The SOSAS-NST has improved on the original SOSAS tool and within the limits of the small numbers, the picture portfolio has a high accuracy in predicting diagnosis in children in lieu of physical examination.

Paediatric Trauma Presentations in a Teaching Hospital in Lagos, Nigeria: Epidemiology and Predictor of Mortality

INTRODUCTION

Paediatric trauma remains a major health challenge worldwide. It remains a major reason for hospitalization among children and adolescents around the world, with resultant death or disability. This study was aimed to determine the epidemiology, pattern and outcomes of paediatric injuries presenting at a teaching hospital in Lagos, South-west Nigeria.

PATIENTS AND METHODS

This was a prospective observational hospital based study conducted on all paediatric trauma patients below 18 years, who presented at the accident and emergency room of the Lagos University Teaching Hospital (LUTH) over a period of thirteen months. Data analysis was done with Stata v13 (StataCorp. Texas. USA).

RESULTS

A total of 154 patients sustained 250 documented injuries. The mean age was 6.8 ± 4.6 years. Male to female ratio was 1.5:1. Children aged 8 years were mostly affected. There was significant statistical association between age of child at injury and the place of injury. (p = 0.021) Most injuries (51.3%) occurred at home followed by the road. Falls accounted for 72 cases (46.8%). Traumatic brain injury was the most common injury sustained. Injuries at home peaked at 5pm and extended to 7pm while injuries from road traffic accidents peaked at two periods; between 7am and 8am and 4pm. Paediatric trauma score predicted death accurately. The crude mortality rate was 5.8%.

CONCLUSION

Paediatric trauma scourge is still a health concern. School age children are mostly affected by trauma. Falls were the most common cause of trauma in children and most falls occurred in the home environment. Injuries from road traffic accidents accounted for majority of deaths. The paediatric trauma score predicts mortality in injured children and should be routinely used.

COVID-19: A review of the effectiveness of non-pharmacological interventions

COVID-19, a highly infectious disease, caused by a novel virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has brought about an unprecedented threat to global health. First reported in Wuhan, China, in December 2019, it has now spread to all continents of the world becoming a pandemic. There is no known treatment or vaccine for it although many candidate drugs and vaccines are in various clinical trial phases. For now, non-pharmacological interventions (NPIs) have become the mainstay of response for COVID-19 and are being used across the world to flatten the epidemiologic curve with some success. This review focussed on identifying which NPIs have been effective. NPIs that are effective include isolation and quarantine, physical distancing, use of face masks and hand hygiene. These measures are best used in combination and simultaneously. The evidence is that they should be instituted early in the pandemic and for sustained periods. They should also be implemented in the context of the cultural and socioeconomic conditions of the populace. Ineffective NPIs include ultraviolet irradiation and spraying of outdoor spaces and individuals. We recommend that decision makers weigh the evidence carefully, as it applies to the local setting to inform public health decisions.

Prevalence of surgically correctable conditions among children in a mixed urban-rural community in Nigeria using the SOSAS survey tool: Implications for paediatric surgical capacity-building

Background

In many low- and middle-income countries, data on the prevalence of surgical diseases have been derived primarily from hospital-based studies, which may lead to an underestimation of disease burden within the community. Community-based prevalence studies may provide better estimates of surgical need to enable proper resource allocation and prioritization of needs. This study aims to assess the prevalence of common surgical conditions among children in a diverse rural and urban population in Nigeria.

Methods

Descriptive cross-sectional, community-based study to determine the prevalence of congenital and acquired surgical conditions among children in a diverse rural-urban area of Nigeria was conducted. Households, defined as one or more persons ‘who eat from the same pot’ or slept under the same roof the night before the interview, were randomized for inclusion in the study. Data was collected using an adapted and modified version of the interviewer-administered questionnaire—Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool and analysed using the REDCap web-based analytic application.

Main results

Eight-hundred-and-fifty-six households were surveyed, comprising 1,883 children. Eighty-one conditions were identified, the most common being umbilical hernias (20), inguinal hernias (13), and wound injuries to the extremities (9). The prevalence per 10,000 children was 85 for umbilical hernias (95% CI: 47, 123), and 61 for inguinal hernias (95% CI: 34, 88). The prevalence of hydroceles and undescended testes was comparable at 22 and 26 per 10,000 children, respectively. Children with surgical conditions had similar sociodemographic characteristics to healthy children in the study population.

Conclusion

The most common congenital surgical conditions in our setting were umbilical hernias, while injuries were the most common acquired conditions. From our study, it is estimated that there will be about 2.9 million children with surgically correctable conditions in the nation. This suggests an acute need for training more paediatric surgeons.

A malariometric survey of under-fives residing in indoor residual spraying-implementing and non-implementing communities of Lagos, Nigeria

Background

Indoor residual spraying (IRS) is used as part of the integrated vector management strategy for the control of malaria in Lagos, Nigeria. The purpose of this study was to compare the malariometric indices of children under 5 years old living in IRS-implementing and non-IRS-implementing communities of Lagos, Nigeria.

Methods

The study was a community-based, comparative, cross-sectional study of 480 children under five recruited using a multi-stage sampling method. Data on each child were collected using a household questionnaire administered to the consenting care-giver of each selected child. Each child underwent a comprehensive physical examination. On-the-spot malaria rapid diagnostic testing and haemoglobin estimation to assess parasitaemia and anaemia, respectively, were also carried out. Risk factors for parasitaemia and anaemia were identified using multivariate logistic regression.

Results

A total of 238 children were studied in the IRS-implementing group while 242 children were studied in the non-IRS-implementing group. The IRS -implementing community had a lower level of parasitaemia (1.3 %) compared to the non-IRS-implementing community (5.8 %) (p < 0.001). There was no significant difference in anaemia, spleen rate and fever in the IRS-implementing group (10.9, 9.7 and 5 %) and the non-IRS-implementing group (9.9, 8.8 and 8.7 %), respectively. Residing in an IRS-implementing community was associated with lower odds of parasitaemia (OR 0.17, p < 0.01). Sleeping under a bed net was the only factor associated with anaemia (p < 0.01).

Conclusion

IRS has led to a reduction in the level of parasitaemia in the under-fives in the study areas.

Mentorship in orthopaedic and trauma residency training programme in Nigeria: the residents' perspective

BACKGROUND

Mentorship is important in residency training as it is necessary for personal and professional development of the resident trainees.

OBJECTIVES

This study documents mentorship in orthopaedic residency training programme in Nigeria by assessing the awareness of orthopaedic residents on the role of a mentor, willingness to be mentored and their perceived reasons for the possible lack of mentors/ participation of senior colleagues in a mentorship programme.

METHOD

This was a descriptive cross sectional study of 37 orthopaedic residents attending a revision course of the Faculty of Orthopaedics, National Postgraduate Medical College of Nigeria. Self-administered structured questionnaires were used to collect data. Data obtained was analyzed using SPSS version 21.0.

RESULTS

The mean age of the respondent was 34.7 ± 4.7 years. The Male: Female ratio was 19:1. The average number of years already spent in the residency programme by the respondents was 2.8 ± 0.9 years. Only 27% of residents had participated in a mentorship programme since they began residency programme but only half were still being mentored at the time of the study. Sixty-five percent reported no formal mentorship programme in their institutions. However, 73% of the respondents would want a formal mentorship programme in their institution. Ninety percent of the respondents desired to be mentored.

CONCLUSION

Most residents are willing to be mentored. Consultants and trainers should ensure that the trainees are mentored.

Prevalence of cardiovascular risk factors amongst traders in an urban market in Lagos, Nigeria

AIMS AND OBJECTIVES

A descriptive cross-sectional study was carried out to determine the prevalence of cardiovascular risk factors amongst traders in an urban market in Lagos State.

SUBJECTS AND METHODS

Tejuosho market, one of the large popular markets was selected from a list of markets that met the inclusion criteria of being major markets dealing in general goods using a simple random sampling technique by balloting. Four hundred (400) traders were selected using a systematic random sampling. Each trader was interviewed with a well-structured questionnaire and had blood pressure and anthropometric measurements (height, weight and body mass index).

RESULTS

Female traders made up (74.3%) 297 of the total population. The mean age was 45.48+11.88 and 42.29+10.96 years for males and females respectively. Majority 239 (59.8%) fell within the age range of 35 - 55 years. The cardiovascular risk factors identified and their prevalence rates were hypertension (34.8%), physical inactivity (92%), previously diagnosed diabetes mellitus (0.8%), risky alcohol consumption (1%), cigarette smoking (0.3%) in females and (17.5%) in males, obesity (12.3%) and overweight (39.9%).

CONCLUSION

The study recommended that any health promoting, preventive or intervention programme for this population would have to be worked into their market activities if it is to make an impact.

Incidence of postoperative eye infections in a private eye hospital in Lagos, Nigeria

BACKGROUND

There is a dearth of information on postoperative eye infections in Nigeria and most hospitals do not have an infection control program in place.

OBJECTIVE

This study was done to investigate the incidence of post-operative eye infections, their potential sources and the preparedness of the hospital to prevent such infections.

METHODS

A microbiological survey of all eye surgical procedures between March 2004 and May 2005 was performed. Relevant samples were taken and cultured pre, intra and post operatively as required. Definitions of infections were based on the Centers for Disease Control (CDC) Criteria. In the eye clinic, and operation theatre, infection control procedures and practices were audited using a pre-designed questionnaire.

RESULTS

There were 2 cases of post operative eye infections (with Haemophilus influenzae and Corynebacterium species) during the one year of survey of 339 performed surgeries. S. aureus, Coagulase negative staphylococcus (CNS), and Enterobacter spp were cultured from the aqueous humour, as well as pre and post operative conjunctivae swabs of three other patients. Eighty four (24.8%) other patients were colonized post operatively with CNS (32), S. aureus (28), Klebsiella pneumoniae (8), E. coli (5), Corynebacterium species (3), Pseudomonas aeruginosa (1) Proteus mirabilis (4), Enterobacter species alone (1) and in association with CNS on 2 occasions. Seventy eight percent of patients had contact with staff who consistently haboured Staphylococcus species in their nares. Four patients (0.11%) were exposed to surgeons whose hands were contaminated and one eye (0.003%) to contaminated antiseptic solution. Facilities for hand washing and protective clothing were adequate but staffs were observed to perform an inadequate hands scrubbing. Most items were heat sterilized. Cleaning facilities were adequate and the environment was clean. The choice of antiseptic was correct, but that of disinfectant was considered incorrect. The ophthalmic equipments except the eye occluder were appropriately disinfected. Staffs were not protected when handling linen. Infected linens were separated from soiled linens only in the theatre. They were not bagged, and were hand sluiced. The only type of waste that was properly handled was sharps. All waste types were stored together prior to final disposal away from the public.

CONCLUSION

The incidence of post-operative infection was 1.69% and their sources were the patients' normal flora. Other potential sources of post-operative eye infections identified included nares of hospital staff, hands of surgeon and hospital disinfectants. Areas of deficiencies in infection control practices, which require proper infection control policies, include hand scrubbing practices, disinfection, linen management and waste handling.

Aetiology of bacteraemia among adult AIDS patients attending Lagos University Teaching Hospital (LUTH), Lagos, Nigeria

BACKGROUND

Bacteraemia is a relatively common event in HIV-infected patients, especially in late infection. Studies in Africa have shown that more than 23% of AIDS patients have bacteraemia but there is paucity of data from Nigeria.

METHODS

Blood samples from 67 consecutive patients with AIDS attending the Lagos University Teaching Hospital between April and August 2000 were cultured. Temperature, ESR, Full blood count, and where possible CD4 counts were obtained. Socio-demographic details were also recorded. Thirty apparently healthy people were randomly selected from a low-risk population to act as non-AIDS controls. The Oxoid Signal Blood Culture System was used to investigate bacteraemia. Antibiotic sensitivity tests were carried out on all isolates.

RESULTS

Twenty-two (33%) of the 67 AIDS patients were culture positive. Non-typhoidal Salmonella spp (45.5%), coagulase-negative staphylococci (22.7%) and Staphylococcus aureus (18.2%) were most commonly isolated. One isolate each of Klebsiella pneumoniae, Pseudomonas aeruginosa and Bacillus spp were identified. All bacteraemic patients had temperatures above 38 degrees C and white blood cell counts ranged between 2,700-13,500/mm(3). There was a high rate of antibiotic resistance particularly to chloramphenicol, tetracyclines, cotrimoxazole and beta-lactam antibiotics. However, most isolates were still susceptible to gentamicin and the fluoroquinolones. There was no significant difference in the socio-demographics of the bacteraemic AIDS and non-bacteraemic AIDS patients.

CONCLUSION

Salmonella spp. were the most common aetiological agent of bacteraemia among AIDS patients seen at the Lagos University Teaching Hospital (LUTH), Nigeria. A high temperature was a pointer to the presence of bactaeraemia while total white blood cell counts were not useful. It is recommended that blood culture should be done for AIDS patients with elevated temperature irrespective of the total white blood cell count.

Diagnosis and Management of Chancroid in Nigeria

There is a broad group of venereal disease that is referred to as the "Tropical Venereal Disease". They are so-called because they are most frequently seen in the tropical and sub-tropical areas of the world. Among them are conditions like chancroid, lymphogranuloma venereum (LGV or climatic bubo) and granuloma inguinale (chronic venereal sores). Chancroid is variously called "soft sore" or "soft chancre" because it bleeds easily and "ulcus moile".1 It is an acute infection and auto-innoculable disease. The extent of chancroid genital ulceration in Nigeria is greater in the Northern partly due to permissive sexual practices especially for men.

Aerobic bacterial nosocomial infections in paediatric surgical patients at a tertiary health institution in Lagos, Nigeria

This study was undertaken to determine nosocomial bacterial infections (NI) in surgical patients in a developing country using the detailed option of the Center for Disease Control (CDC) surgical patient surveillance technique. From 1994 - 1995. Paediatrics surgical patients at the Lagos University Teaching Hospital (LUTH) were prospectively monitored for NI at all body sites. Standard definitions of NI were used, and NI sites were categorised by type of operation. A total of 304 NI occurred in 245 out of 664 surgical patients investigated. SSI (77.3 %) and urinary tract infections (19.1%) were in preponderance. Seventy three per cent of SSI were superficial incisions, 20.5% organ/space and 6.8% deep incisions. The overall wound infection rate was 30.9%. The SSI rate for emergency surgery was 35.6% and 26.5% for elective procedures. Rates within each wound class were 20.2, 23.8, 51.9 and 52.8% respectively and 17, 37.6, 43.4 and 47. 1% for patients with ASA scores of I II III and IV in that order. The SSI rates for patients with scores of 0, 1, 2 and 3 were 20.4; 43.5, 57.1 and 75% respectively. Mean infection rates in the various wound classes were highly correlated with the number of risk factors present. Klebsiella pneumoniae (38. 7%), Escherichia coli (22.7%), Pseudomonas aeruginosa (16.8%) and Staphylococcus aureus (10. 7%) were the most common pathogens.

Extended-spectrum beta-lactamase enzymes in clinical isolates of Enterobacter species from Lagos, Nigeria

Over a 9-month period, 8 of 40 nonduplicate isolates of Enterobacter spp. producing extended-spectrum beta-lactamase (ESBL) were detected for the first time from two hospitals in Lagos, Nigeria. Microbiologic and molecular analysis confirmed the presence of ESBL. Only four isolates transferred ESBL resistance as determined by the conjugation test, and pulsed-field gel electrophoresis showed genetically unrelated isolates.

Prevalence of methicillin-resistant Staphylococcus aureus in eight African hospitals and Malta

Methicillin-resistant Staphylococcus aureus (MRSA) poses a serious therapeutic problem worldwide, and its frequency in most African countries has not been reported. This study was aimed at determining the prevalence and antibiotic susceptibility patterns of MRSA in eight large hospitals (>500 beds) in Africa and Malta, from 1996 to 1997. Susceptibility to methicillin (oxacillin) and to other drugs was determined by E test (AB Biodisk, Solna, Sweden) on a total of 1440 clinical isolates of S. aureus. Methicillin resistance was detected in 213 (15%) of the 1440 isolates tested. The rate of MRSA was relatively high in Nigeria, Kenya, and Cameroon (21-30%), and below 10% in Tunisia, Malta, and Algeria. All MRSA isolates were sensitive to vancomycin, with MICs <or= 4 mg/L. The isolates were also highly sensitive to ciprofloxacin, except in Kenya, Morocco, and Tunisia, where relative resistance to this drug was noted. Susceptibility to rifampin and fusidic acid seems to be correlated with the clinical use of these compounds. Only 46% of 59 MRSA strains analyzed were susceptible to rifampin, fusidic acid, and ciprofloxacin. The majority (> 60%) of MRSA strains were multiresistant. There is a need to maintain surveillance and control of MRSA infections in Africa.

Beta-lactamase detection in nosocomial bacterial pathogens in Lagos, Nigeria

Beta-lactamase production was investigated in 1033 bacterial pathogens--262 gram-positive bacteria, 482 Enterobacteriaceae, 289 non-fermenting bacilli. These were isolated from nosocomial infections in paediatric patients. Beta-lactamase was detected using chromogenic cephalosporin and starch paper methods. More than 80% of the isolates produced the enzyme, which was not detected in enterococci and streptococci. There was no appreciable difference ([symbol: see text] 2 = 5.31, P > 0.05) in the number of Beta-lactamase producers obtained using the two methods. Great caution must be exercised in the therapeutic use of Beta-lactam drugs for nosocomial bacterial infections.

Susceptibility profile of Enterococcus faecalis isolated at the Lagos University Teaching Hospital, Nigeria

Enterococcus faecalis is the most common of the Enterococcus genus causing infection, particularly urinary tract infections, worldwide. It is also a common cause of nosocomial infections and resistance to various antibiotics is on the increase worldwide. Thirty-five strains of E. Faecalis isolated from various clinical specimens (blood, wound swabs endocervical swabs but mostly urine) were screened for high-level aminoglycoside resistance. Their susceptibility nine antibiotics (ampicillin, gentamicin, streptomycin, vancomycin, tetracycline cotrimoxazole and chloramphenicol, ciprofloxacin and erthromycin) was also determined. All isolates were susceptible to Ampicillin and Vancomycin with MIC90 of 4microg/ml but resistant to Nalidixic acid with an MIC90>256microg/ml. Four (11%) of the isolates showed high-level resistance to Gentamicin while 11(32%) exhibited high-level resistance streptomycin after 24 hours incubation. It will appear that Ampicillin in combination with gentamicin but not streptomycin, can still be used empirically for the treatment of Enterococcal infections.

Infections caused by Acinetobacter species and their susceptibility to 14 antibiotics in Lagos University Teaching Hospital, Lagos

Acinetobacter spp are well recognised as causes of nosocomial infections particularly in patients with immature or defective body defence system. Information concerning these organisms are lacking in this environment. For this reason the pattern of infection and the antimicrobial susceptibility profiles of these organisms isolated over a one-year period were studied. A total of 58 (3%) of the 2001 isolates from all clinical specimens received in the laboratory during the year were Acinetobacter spp. The 58 Acinetobacter spp constituted 5.5% of all the 1051 NLF-GNB isolated, and caused 4.6% of all the 1261 nosocomial infections. Thirty-seven (63%) and 17 (30%) of the Acinetobacter isolates were from wound infections and UTI respectively. All the infections were nosocomially acquired and were associated with compromised host immunity, defective body defence, surgery or urinary catheterization; with Acinetobacter baumannii being the predominant species. There was an apparent male predominance over females by a ratio of 1. 9:1 in the infections, particularly from 45 years and above. One hundred percent and 96.6% of the isolates were susceptible to cefoperazone-sulbactam and travofloxacin respectively. Forty-five (77.6%) were susceptible to cefotaxime, 49 (84.5%) to ampicillin-sulbactam, 34 (58.6%) to ceftazidime, 38 (65.6%) to ticarcillin-clavulanic acid and 41 (70.7%) to ciprofloxacin. Generally the Acinetobacter spp showed multiple resistance to the range of antibiotics tested. All the isolates produced beta-lactamase.

Bacteria causing septicaemia in neonates with tetanus

105 consecutively admitted neonates with tetanus were screened for sepsis to determine the prevalence of sepsis in neonatal Tetanus (NNT) patients and identify the bacterial pathogens causing septicaemia in them. The presence of omphalitis, poor colour, hypothermia and hyperthermia were found to be sensitive predictors of septicaemia in NNT patients. 50 bacterial pathogens were isolated from 50 babies. Klebsiella pneumoniae (20.7%), and Enterobacter cloacae (19.0%) were the leading gram negatives, while staphylococcus aureus (19.2%) was the prevalent gram positive organism isolated. Antimicrobial susceptibility profile heavily favours ofloxacin but a combination of cloxacillin and gentamicin is recommended as first line. Ceftazidime with about 60% susceptibility across board is the favoured cephalosporin.

Bacterial eye infection in neonates, a prospective study in a neonatal unit

One hundred and fifty five neonates with conjunctivitis admitted into the neonatal unit at the Lagos University Teaching Hospital were microbiologically investigated. This was to determine the bacterial aetiologic agent(s) in neonatal eye infection and highlight some risk factors. Antimicrobial susceptibility testing was done on the pathogens isolated using the diskagar diffusion method. The incidence of conjuctivitis in the newborn was 18 per 1000 live births. Predisposing factor noted were vaginal delivery, asphyxia neonatorum and prolonged rupture of membrane. Pathogens predominantly isolated were Staphylococcus aureus (37.4%), Coagilase negative Staphylococci (12.3%), Klebsiella pneumoniae (12.9%) and Pseudomonas aeruginosa (8.2%). Antimicrobial suscepibility results revealed varied degrees of susceptibility to ofloxacin (75%), Cloxacillin, erythromycin, Gentamicin and augumentin (30%) by the gram positive bacteria while most of the gram negative were susceptible to colistin and ofloxacin (above 90%). The high incidence of bacterial eye infection should be minimized by the elimination of the risk factors and adoption of stringent aseptic measures in the care of the neonate.

Adherence of Candida albicans to human vaginal epithelial cells

The adherence capacity of Candida species to female vaginal epithelial cells was examined. The results showed that in four groups of patients studied, the highest adherence was with epithelial cells collected from pregnant diabetic women (47% adherence, and 1,700 adherent yeasts). Pregnant or diabetic women had 39% each of adherence to epithelial cells but differed in the number of adherent yeasts (1,400 and 1,000 respectively). The diabetic and pregnant women therefore appeared differential attachment to epithelial cells from different physiologically adapted women.

Disease in children due to serogroup W-135 Neisseria meningitidis

Two cases of meningococcal disease due to serogroup W-135 Neisseria meningitidis are presented. One died from fulminating meningococcaemia and the other had severe meningoencephalitis with acute septic arthritis. Serogroup W-135 N. meningitidis is pathogenic for man, and laboratories should attempt to identify and serotype the organism so that more data about the disease it causes can be obtained.

Effects of saliva and alpha-amylase on antibiotic sensitivity of bacteria

Two hundred and ninety-six bacterial isolates were investigated for the effects of saliva and alpha-amylase on their susceptibility to ampicillin, tetracycline, chloramphenicol and gentamicin. When the test organisms were primed with normal and 'diseased' saliva there were no observable differences in the MICs of ampicillin and chloramphenicol for group-A streptococci, but alpha-amylase significantly reduced the MIC of tetracycline from 2 to 0.25 mg/1. With Staphyloccus aureus, priming with saliva and alpha-amylase had no effect on the MICs of gentamicin and ampicillin, whereas the MICs of tetracycline and chloramphenicol were increased. The effect of saliva on the susceptibility of E. coli to tetracycline was also significant; MIC50 and MIC90 were reduced from 128 to 8 and 32 mg/1 respectively. Chloramphenicol was however increased from less than 0.125 to 1 and 2 mg/1 when E. coli was primed with amylase and saliva respectively. The general significance of these observations is discussed.

Differentiation of gram-positive and gram-negative bacteria and yeasts using a modification of the "string" test

Solutions of potassium hydroxide and sodium hydroxide with concentrations between 0.5% and 4% were found to produce mucoid and sticky suspensions when added in drops, using a bacteriological loop, to smears of 609 strains of gram-negative bacteria on glass slides. A total of 461 strains of gram-positive bacteria and yeasts did not produce any mucoid or "string" formation when treated with the same solutions. It was concluded that this modified test could aid in differentiating gram-positive from gram-negative organisms.

Isolation of species of Yersinia from patients with gastroenteritis in Nigeria

From patients in Nigeria with acute gastroenteritis, strains of Yersinia were isolated from 14 (1.3%) of 1082 specimens of faeces examined specifically for yersiniae by direct plating and after cold enrichment. Clinical significance was ascribed to six isolates of Y. enterocolitica (serotypes 03, 05,27 and 09) but not to seven isolates of Y. intermedia or one isolate of Y. frederikseni.

Plasmid profile, serogrouping, and auxotyping of Neisseria gonorrhoeae isolates from Africa

The plasmid patterns of 90 isolates of Neisseria gonorrhoeae (including 39 penicillinase-producing strains) originating from various countries in Africa were determined. Serogrouping by coagglutination and auxotyping were used to characterise the isolates. The 4.4-megadalton plasmid was present in seven isolates out of 39 penicillinase-producing strains, two of which occurred with a conjugative 24.5-megadalton plasmid. The African strains were predominantly serogroup WI and wild type. Arginine-dependent isolates were as common as proline-dependent types.

Enteropathogenic, enterotoxigenic and enteroinvasive Escherichia coli isolated from acute gastroenteritis patients in Lagos, Nigeria

Enteropathogenic, enterotoxigenic and enteroinvasive Escherichia coli were isolated from 52 (4.8%) of 1,082 patients with acute gastroenteritis reporting at the Lagos University Teaching Hospital, Lagos, Nigeria between October 1979 and March, 1981. Of the 52 strains of E. coli isolated, 35 (67.3%) were enteropathogenic, 12 (23.1%) were enterotoxigenic and five (9.6%) were enteroinvasive. E. coli 0111 (25.7%) was the most predominant among the serotypes of the "classical" enteropathogenic strains found in this study. Diarrhoea associated with enteropathogenic E. coli occurred only in children aged less than five years, whereas enterotoxigenic and enteroinvasive E. coli were found primarily in adults. The study has highlighted for the first time the important role that enterotoxigenic and enteroinvasive E. coli strains could play in acute diarrhoeal diseases in Lagos, Nigeria.

Bacterial flora of the parturient vagina--implications for neonatal sepsis

A bacteriological study of vaginal swabs taken from 78 parturient women at Lagos University Teaching Hospital (L.U.T.H.) is presented. 26.83% of the vaginal cultures were sterile. The most frequently isolated bacteria were Staphylococcus spp. 21.4%, followed by beta hemolytic streptococci 16.65%, of which approximately a half belonged to Lancefield group B. Escherichia coli was isolated in 11.1% of the cases. The implications for neonatal and puerperal sepsis are discussed.

A simple manganous chloride and Congo red disc method for differentiating Neisseria gonorrhoeae from Neisseria meningitidis

Manganous chloride and Congo red incorporated into blotting paper discs have been used to differentiate gonococci from meningococci. The new technique is simple and reliable; the materials for the test are inexpensive. The method will increase the efficiency of distinguishing between the pathogenic Neisseria in any clinical bacteriology laboratory and especially in those in the tropical areas.

Identification of Neisseria gonorrhoeae by carbohydrate disc reactions on a modified fermentation medium

The identification of Neisseria gonorrhoeae by the use of a carbohydrate disc reaction on a modified fermentation medium is described. 70 out of the 71 strains tested produced detectable acid in 18--24 hours from the dextrose disc and no acid from Maltose, sucrose or lactose discs. One strain required 48 hours for good growth and acid production from dextrose disc only. The carbohydrate disc method was compared with a standard fermentation method using sugars incorporated in serum-free medium, 64 out of 71 strains of gonococci tested were identified after 18--24 hours incubation. All the strains gave clear-cut confirmatory results after 48 hours incubation. The importance of serum-free fermentation media in the identification of gonococci in tropical areas where meningococcal infections are also prevalent is discussed.

Staphylococcal scalded skin syndrome in Nigerian children: a report of three cases

Three cases of staphylococcal scalded skin syndrome in Nigerian children are reported. The clinical features and bacteriological findings are discussed. It is suggested that the clinical condition is not as rare in our community as absence of reports on African children in the literature may suggest. A reference centre for phage typing of staphylococci from suspected cases in a developing country like our own is recommended.

Counter immunoelectrophoresis technique in laboratory diagnosis of bacterial meningitis

Fifty cerebrospinal fluid specimens were studied by counter-immunoelectrophoresis (CIE), Gram's staining and culture techniques. Out of 33 test cases of pneumococcal, meningococcal and Haemophilus influenzae meningitides, 31 cases, were CIE positive, 24 were detected by Gram's staining while 27 were positive by culture. The 17 cases which served as controls did not give false positive results. The CIE is recommeded as an adjunct to bacterial culture in laboratory diagnosis of bacterial meningitis especially in areas where there is poor control of drug usage by people with resultant self antibiotic medication which makes definite bacterial meningitis specimens "sterile" on culture.