Pathogens and antimicrobial resistance amongst stroke patients in the intensive care unit: A five years review from Benin City, Nigeria

Severe stroke may necessitate intensive care unit admission, but there is a heightened risk of acquiring infection with use of ICU devices. Data regarding infection, pathogens and microbial resistance amongst stroke patients admitted into the ICU is scanty in Nigeria. This study aims to describe the infections, pathogens and antibiotics resistance pattern amongst stroke patients admitted into the ICU. It was a retrospective study. The ICU admission records of all stroke patients at the University of Benin Teaching Hospital from January 2014 to September 2019 were reviewed. The data obtained were the demographics, the types of stroke, results of microbiological studies on endotracheal aspirates, urine specimen, blood specimen, wound swab, vascular catheters, urinary catheters and the antibiogram pattern. One hundred and eight stroke patients were admitted into the ICU during the 5-year under review. The mean age was 61.8 with 51% being females and 52% having ischemic stroke. Seventy-five percent of the stroke patient had hospital acquired infection. Ventilator associated pneumonia accounted for 67.1% of infections, urinary tract infection was 22.8%, and blood stream infection 6.3% while 3.7% had infected decubitus ulcers. Microbial isolates were, Enterobacter sakazakii, accounting for 43.5%, Klebsiella pneumonia 13%, Escherichia coli 11.1%, and Proteus mirabilis 7.4% while 48% had Plasmodium falciparum infection. The micro-bacteria isolates were multi-antibiotics resistant, with the highest resistance for cotrimazole, cefuroxime and ceftazidime. The stroke patient in the ICU is susceptible to developing drug resistant hospital acquired infections, which could increase mortality. Ensuring minimal cases of ICU infection with continuous antimicrobial surveillance and robust antibiotics policy should be the goal.

Clinical characteristics and correlates of patients with heart failure with mid-range ejection fraction in southwest Nigeria

A new class of Heart Failure (HF) phenotypes, HF with midrange Ejection Fraction (HFmrEF), was recently introduced, but its clinical characteristics and therapeutic distinctiveness are not yet well understood. This study aimed to describe the clinical characteristics, echocardiographic features, and other correlates of HFmrEF in southwest Nigeria. Two hundred and sixty-nine consecutive HF subjects who had echocardiography done in the cardiology clinics of two teaching hospitals were recruited for this study. Clinical parameters such as age, body mass index, waist-hip ratio, and gender were determined. The presence of comorbidities, such as hypertension and diabetes, was also assessed. Statistical analysis was done, and p <0.05 was taken as statistically significant. HFmrEF subjects constituted 27.5% of total cohort, while subjects with HF with preserved Ejection Fraction (HFpEF) and HF with reduced Ejection Fraction (HFrEF) were 29.0% and 43.5% respectively. HFmrEF was more likely to be associated with high systolic blood pressure and obesity. The clinical characteristics of HFmrEF were intermediate between those of the other two HF phenotypes. Prevalence of comorbidities, such as anaemia, iron deficiency, pulmonary hypertension, and left ventricular hypertrophy were also intermediate between HFpEF and HFrEF. Atrial fibrillation was commonest among HFmrEF subjects. There was no significant age or gender variation between the three phenotypes. Patients with HFmrEF have clinical and demographic distinctiveness that are often intermediate between HFpEF and HFrEF phenotypes. Further studies of this HF phenotype will help in understanding its therapeutic identity and its prognosis among Africans.

Clinical features, severity, and outcomes of patients with COVID-19 infection: A follow-up study

Few epidemiological investigations explored disease outcomes in patients with COVID-19 in Iraqi Kurdistan. The association of clinical and epidemiological characteristics of COVID-19 patients with outcomes was examined in this study. Patients who were diagnosed with COVID-19 from a private clinic were followed up until recovery or death between 15th August and 20th October 2020. The mean age of the COVID-19 patients was 47.12 (6-90 years). Fatigue (76.15%), myalgia (66.53%), fever (65.33%), cough (62.53%), sweating (58.52%), and headache (56.11%) were the most prevalent symptoms. Most of the patients had mild severity (350, 70.14%) followed by moderate (74, 14.83%), severe (46, 9.22%), and critical (29, 5.81%). The case fatality rate (CFR) was 5.41% (n=27) and was significantly increased with increasing severity; mild (0.0%), moderate (1.35%), severe (10.87%), and critical (72.41%; P<0.001). The patients with the critical and severe situations were significantly older; medians: 67 vs 55 years compared to those patients with moderate and mild situations; medians: 51 vs 45 years; P<0.001. The patients who died were significantly older compared to recovered patients; medians: 65 vs 46 years; P<0.001, respectively. The disease severity was the only factor to predict mortality in patients with COVID-19 disease. Concerning the severity, being older, having anorexia, fatigue, pleurisy, diarrhea, fever, sweating, shortness of breath, and being male were determined to be predictors of severity in COVID-19 patients. The incidence rate of severe/critical conditions was significantly increased with increasing age. The older age was determined to be a predictor for higher mortality.

2011 appropriate use criteria audit of an echocardiography lab in South Western Nigeria

Cardiovascular diseases are the major cause of death worldwide. Since its discovery in the 20th century, Echocardiography (ECHO) has become one of the pivotal tools in assessing cardiac structure and function. With the increase in requests for ECHO, there has risen an unwanted problem - inappropriate requests for ECHO. There has therefore arisen the need to audit ECHO labs for the appropriateness of ECHO requests. The patients referred from the outpatient clinics and in-patient wards for ECHO from June 1st, 2015 till September 30th, 2016 were recruited. Their request form data, clinical information, and ECHO results were analyzed as appropriate. The 2011 appropriate use criteria for Transthoracic ECHO was utilized. The most common indication out of the 2174 ECHOs reviewed was hypertension (16%), closely followed by hypertensive heart disease (12.4%). The percentage of appropriate, inappropriate, and uncertain indications according to the 2011 appropriate use criteria (AUC) for transthoracic echocardiography were 41.4%, 31.1%, and 0.1% respectively. Less than ten percent (9.3%) of the indications could not be classified by the 2011 AUC while 18.1% of the ECHOs had no indication. When indications of Hypertension, Hypertensive Heart Disease (HHD) and heart failure were compared, heart failure was significantly associated with eccentric Left Ventricular Hypertrophy (LVH), larger LV mass, lower BMI, larger cardiac dimensions, reduced ejection fraction, lower trans mitral A velocities than the other two indications. Concentric LVH was showed a trend towards being most in those with HHD (p= 0.072). The percentage of appropriate indications was low in this study as compared to others, largely because of large inappropriate indications. There is a need to ensure appropriate indications are filled for ECHO request forms. The 2011 AUC may need to be reviewed to expand the appropriate group of indications.

Knowledge, availability and utilization of growth monitoring facilities in urban and rural health facilities in Enugu State, South East Nigeria: A survey of nursing mothers

Sub Saharan Africa (SSA) has one of the highest rates of child mortality compared to the rest of the world’s regions. The usefulness of growth monitoring cuts across all areas of pediatric care and remains the pivot for prevention of childhood diseases and prevention untoward mortality. This study therefore aimed at determining the availability of growth monitoring facilities, and knowledge and utilization of such facilities among mothers attending rural and urban health facilities in Enugu state. This was a cross sectional descriptive survey of mothers done in selected urban and rural government health facilities using the multi-stage sampling method. Data obtained were analyzed using SPSS version 21.0. Conclusions were drawn at a level of significance, p<0.05 at 95% Confidence interval. A total of 440 mothers were recruited for the study; 330 (75%) were from urban and 110 (25%) from rural locations. Mothers in urban centers exhibited higher knowledge (84%, VHL) of growth monitoring facilities than those in rural areas, p=0.04. Growth monitoring facilities were more available in urban areas compared to rural areas, p<0.01. However, growth monitoring facilities were more utilized by mothers in rural areas than in urban locations. Although GM facilities were more available in urban health centers in Enugu state. These facilities were less utilized especially in the urban areas even though mothers demonstrated were very knowledge about these facilities.

Clinical and socio-demographic factors associated with electroencephalographic abnormalities in children with epilepsy

Electroencephalography (EEG) makes critical contribution to the management of epilepsies. Few studies have examined the clinical and socio-demographic factors that are likely to predict finding an abnormal or epileptiform EEG in children with epilepsy (CWE). Knowledge of clinical variables and socio demographic factors that determine EEG abnormalities may inform careful selection of children for EEG and improve the cost-effectiveness of this investigation. Therefore, this study was carried out to assess the relationship between the occurrence of EEG abnormalities and certain factors such as age, gender, clinical neurologic state, seizure type, anti-epileptic drug therapy, activation procedure such as sleep and etiology of epilepsy in children who had EEG in Owerri, Nigeria. The clinical and EEG records of children who had EEG at a tertiary referral center over a period of two years were retrospectively reviewed. Relevant data including demographics, clinical neurologic state, seizure type, EEG findings were extracted. Statistical analysis was used to determine association between categorical variables. The variables noted to be significantly associated with abnormal EEG recordings were the presence of abnormal neurologic findings (p=0.020) and etiology of epilepsy (p=0.045). There were no significant association between abnormal EEG findings and age (p=0.680), gender (p=0.802) and seizure types (p=0.157). The clinical neurological state and etiology of epilepsy in children were significantly associated with the occurrence of abnormalities and yield of interictal scalp EEG. Children with epilepsy who are neurologically abnormal or have multiple etiological factors could be prioritized in EEG appointments in resource-poor settings. Further research in children with epilepsy is needed to confirm these findings.

Adolescent obesity: An emerging public health crisis in an urban city in South-South Nigeria

In Nigeria, a prevalence of obesity of 4.2% has been reported among adolescents in a study in South-West Nigeria. Studies on the prevalence of obesity among adolescents have yielded different prevalence rates in different parts of the country. The present study was planned to determine the prevalence of obesity amongst apparently healthy adolescents aged 10-18 years in secondary schools in Uyo, as well as determine associated predisposing factors to obesity. This was a cross sectional school-based study of 1,701 adolescents selected by multi-stage sampling technique, carried out between December 2016 to February 2018. It involved measurement of weight, height and waist circumference of the study subjects, as well as administration of pretested questionnaires. Body Mass Index (BMI), Waist Circumference (WC) percentile and waist to height ratio of the subjects were determined. Data was analysed using SPSS version 20. Prevalence of obesity was determined and Chi Square was used to determine the relationship between qualitative variables. General obesity was defined as a BMI ≥95th percentile, while central obesity was defined as WtHR ≥0.5 or waist circumference ≥90th percentile for age and sex. Prevalence of general obesity was 5.6% while the prevalence of central obesity was 11.2% using WC percentile and 9% using WHtR. This study also revealed higher prevalence of obesity in females, adolescents from monogamous homes, as well as those whose parents are from the upper socio-class. It is recommended that routine measurement of the indices of adiposity and public health enlightenment measures aimed at reducing the burden of obesity amongst adolescents in Uyo be encouraged by public health authorities. The physicians should be encouraged to measure the indices of adiposity during consultations.

A clinico-epidemiological profile study of venereal genital dermatoses in a tertiary hospital in southern Nigeria: A 5-year review

Venereal genital dermatoses are cutaneous morbidities contracted and transmitted by sexual contact. They are caused by microorganisms that survive on the skin or mucous membranes, or that are transmitted via semen, vaginal secretions, or blood during sexual intercourse. Data on pattern of presentation and diagnoses of venereal genial dermatoses are limited in Nigeria. The aim of this study was to determine the pattern of presentation of venereal genital dermatoses over a 5-year period in the University of Benin Teaching Hospital (UBTH), Benin City, Edo State, Nigeria. Information extracted from patients’ medical records included socio-demographic data, duration of symptom, distribution of lesions, symptomatology and diagnoses of the venereal genital dermatoses. There were 121 patients with venereal genital dermatoses amongst 1600 new cases seen over the 5-year period constituting a prevalence of 7.6%. The male:female ratio of the study population was 1.5:1 and their mean age was 26.2 ± 10.5 years. The predominant symptoms at presentation were abnormal genital growth in 108 (89.3%), genital ulcer in 12 (9.9%), and genital pain in 11 (9.1%). The common venereal genital dermatoses were anogenital warts in 108 (89.3%) and genital herpes in 11 (9.1%). Venereal genital dermatoses are a relatively common dermatological presentation in UBTH and anogenital wart was the most common type. Venereal genital dermatoses were more common in the young age group and males. The most predominant site of affectation was the vulva in females and penis in males.

Metabolic changes in colorectal carcinomas are key factors for the early detection of neoplastic change

Potential metabolic biomarkers have been developed by the use of modern analytical techniques and nanotechnology in metabolomics, providing insight into the pathophysiological basis and changes, tumorigenesis, and molecular mechanisms that underpin better therapeutic, monitoring, and prognostic evaluations of colon malignancies. This would allow early detection and characterization of malignant colon tumors and could reduce the risk of mortality and morbidity of colorectal carcinomas. Based on their association with certain metabolic pathways linked to malignancies, a number of tumor markers have been designed. Whereas some have been associated with only one cancer type, while others are associated with many different forms of cancer. No tumor marker has been found to have universal application as a metabolism-related marker; although some are circulating tumor markers found in blood, urine, stool, or other body fluids, others may be found in the specific tumors themselves. This paper addresses a number of associated metabolic changes linked to colorectal cancers and potential applications for disease condition diagnosis, monitoring, treatment, and prognosis.

Mechanisms of action and adverse effects of the major therapeutic agents in trial for COVID-19 therapeutics: Review of literature

The race to find an effective cure for COVID-19 is on. Most of the candidate drugs in various clinical trials are being re-purposed but none has been approved as at date. It is pertinent for the bedside physicians to understand the mechanisms of action of these agents and their peculiar adverse effects so they are properly guided on the risk/benefit of the drugs they choose in managing COVID-19 patients. Clinicaltrials.gov, the international clinical trials platform of the WHO, the EU clinical trials register and the Cochrane Central Register of Controlled Trials were searched for registered clinical trials. Studies in therapeutic trials were considered eligible for the work. Frequency table was made for the most common trialled drugs and the mechanisms of actions and adverse effects of the selected drugs were reviewed. Ten studies were selected for review in a descending order of their frequency in different therapeutic trials and these are ritonavir, lopinavir, chloroquine/ hydroxychloroquine, interferon, remdesvir, favipravir, umifenovir, darunavir, tocilizumab and methylprednisolone. The bedside physicians need to understand the mechanisms of action of these agents and their peculiar adverse effects for proper guidance on the risk/benefit of the drugs they choose in managing COVID- 19 patients.