Molecular diagnosis of urinary Mycobacterium tuberculosis among patients attending urology clinic in Aminu Kano Teaching Hospital, Kano, Nigeria

Background: Tuberculosis, a communicable disease with significant morbidity and mortality. It is still among the top killers of infectious diseases; Mycobacterium tuberculosis is a successful pathogen that has evolved several mechanisms to manipulate the host immune response. Objective of the study: The objective of this study was to determine the prevalence of urinary tuberculosis among patients attending urology clinic in Aminu Kano Teaching Hospital, Kano, Nigeria. Materials and Methods: A prospective cross-sectional laboratory based study that involved the use of questionnaire and consent/assent form prior to sample collection. Xpert MTB/Rif assay was used to analyze the urine samples. Results: The results of this study shows that, out of 71 samples analyzed along with positive control (H37RV) and molecular grade water was used as negative control. The results showed that, 2 (2.8 %) were from urine samples. Data generated were analyzed using descriptive statistics and results were presented in tables and charts. Conclusion: The study confirmed the presence of urinary tuberculosis in the study area, with prevalence of 2.8%. The pattern of tuberculosis was susceptible Mycobacterium tuberculosis. Therefore, there is need to introduce a routine screening of urinary tuberculosis among patients presenting sign and symptoms of urinary tract infection using Gene Xpert. This will be achieved through the engagement and enlightenment of the clinicians, strengthening the laboratory capacity for diagnosis and make the services available and accessible to the patients who need them. Keywords: Mycobacterium tuberculosis; Extra-Pulmonary Tuberculosis; Prevalence and Gene Xpert

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this