Occurrence of multidrug resistant and extended spectrum β-lactamase (ESBL) - producing Escherichia coli in wastewater of two healthcare facilities in Ibadan, Nigeria

Most industries in developing countries of the world, especially hospitals and other clinical settings, lack wastewater treatment facilities, and as such, untreated wastewater from their operations are discharged into water bodies without any form of treatment. This study aimed at the antibiotic sensitivity profile and ESBL production in E. coli isolated from untreated hospital wastewater before discharge into the environment. Untreated wastewater from two hospitals, a State Government-owned hospital (SGH) and a privately-owned hospital (POH) with no wastewater treatment facilities were sampled for a period of four months. Isolation of E. coli was carried out using the pour plate technique on Eosin Methylene Blue agar, while identification was carried out using conventional methods. Determination of ESBL production was done by means of the Double Disc Synergy Technique and antibiotic sensitivity testing was carried out by employing the disc diffusion method. A total of fifty-eight (58) E. coli were obtained: SGH at 55 and POH at 3. Herein, in 100% of the total count, resistance was indicated for ampicillin and ertapenem, while 14%, 11%, 16% and 57% of the total count were resistant to ceftazidime, cefpodoxime, cefotaxime and amoxicillin-clavulanate, respectively. In addition, 94.8% showed resistance to tetracycline, 19% to ciprofloxacin, 6.9% to gentamycin, 39.7% to chloramphenicol and 55% and 47% to sulfamethoxazole-trimethoprim and nalidixic acid, respectively. Furthermore, 94.8% of all the isolates were multidrug resistant (MDR), while 29.3% were ESBL positive. Wastewater from the two hospitals under study contained ESBL positive and MDR E. coli, suggesting a need to forestall a potential threat to public health by treating the wastewater generated by both hospitals before discharge into the environment

Complications of Transverse Distal Penile Island Flap: Urethroplasty of Complex Anterior Urethral Stricture

PURPOSE: To report the complications of transverse distal penile island flap urethroplasty for urethral reconstruction in adult patients with long/ multiple segments anterior urethral stricture. MATERIALS AND METHODS: This prospective study was carried out on 55 patients with complex anterior urethral stricture to study complications of transverse distal penile island flap urethroplasty in two teaching hospitals between June 2002 and December 2008. Pre-, intra- and postoperativeinformation were collected on a pro forma to generate data, which was analyzed. RESULTS: The patients’ mean age was 43.83 years (range, 19 to 73 years). The leading etiology of the stricture was urethral inflammation (76.4%) with the commonest complication being infection: wound infection in 9.1%, urosepsis in 3.6%, and epididymo-orchitis in 1.8% of the subjects. CONCLUSION: Transverse distal penile island flap urethroplasty has a remarkable outcome in treatment of a long/multiple segment urethral stricture with few manageable complications

A comparative study of the relevance of digital rectal examination, transrectal ultrasound, and prostate-specific antigen in the diagnostic evaluation of patients with advanced carcinoma of the prostate in a resource poor environment

Aims: To compare the diagnostic yield of digital rectal examination (DRE), transrectal ultrasound (TRUS) scan, and prostate-specific antigen (PSA) in diagnostic evaluation of advanced carcinoma of the prostate (CAP). Subjects and Methods: A comparative study of sensitivity and specificity of DRE, TRUS, and PSA in the evaluation of advanced CAP. This was done over a 3-year period (January 2010 to December 2012) in a tertiary health institution in Sub-Saharan Africa. All patients presenting with symptoms of prostatic enlargement were recruited, DRE, TRUS, and PSA findings were compared to the histological diagnosis. Statistical Analysis Used: SPSS version 16.0. Results: One hundred and eight cases were analyzed. Histological diagnosis revealed that 52 (48.1%) were CAP whereas 56 (51.9%) were benign. All the patients presented with lower urinary tract symptoms. Surprisingly, some patients with advanced CAP had PSA values in the normal range (0-4 ng/ml) while some with the benign disease also had PSA values above 50 ng/ml. PSA was noted to have the highest sensitivity but lowest specificity. Conclusions: Limitations of PSA are not only seen in screening for early disease, but also in the diagnosis of advanced CAP, and no value of PSA can be considered safe to declare a patient CAP free

FREE RANGE AND DEEP LITTER HOUSING SYSTEMS: EFFECT ON PERFORMANCE AND BLOOD PROFILE OF TWO STRAINS OF COCKEREL CHICKENS

This study was conducted to determine the performance and blood profile of one hundred and fifty cockerel chickens each of Harco Black and Novogen strains raised on deep litter and free range production systems. Each production system was allotted 150 chicks in three replications of 25 chicks per strain. The birds on deep litter production system were fed ad libitum while each of the birds on free range was fed 50 % of its daily feed requirement. The birds were weighed weekly. Blood plasma and serum were collected at the 4th and 12th weeks for laboratory analyses. Data generated were subjected to analysis of variance in a 2×2 factorial arrangement. Novogen strain consumed less feed (

Changes in growth, digestibility and gut anatomy by broilers fed diets containing ethanol-treated castor oil seed (Ricinus communis L.) meal

Un ensayo de alimentación de ocho semanas se realizó para investigar la composición química, la respuesta del crecimiento, la digestibilidad aparente de nutrimentos, las características y la morfología intestinal de pollos de engorde alimentados con dietas que contienen harina de semillas de ricino tratada con etanol (HSRTE). Doscientos pollos de engorde Anak 2000 de un día de edad se asignaron a cuatro dietas experimentales que contienen HSRTE a 0, 100, 150 y 200 g/kg, respectivamente. Cada tratamiento se repitió cinco veces con 10 aves por repetición. El peso vivo final, la ganancia de peso y el consumo de alimento se redujo (P < 0,01) con la inclusión cada vez mayor de la dieta de HSRTE. Los pollos de engorde alimentados con el control y aquellos alimentados con dietas que contenían 100 y 150 g/kg de HSRTE tuvieron una relación alimento:ganancia similar. Los pollos de engorde alimentados con dietas que contenían 200g/kg de HSRTE registraron la menor proteína cruda y digestibilidad de fibra cruda (Contrastes lineal y cuadrático, P < 0,05) y la relación alimento:ganancia más pobre (Contraste lineal, P < 0,05). Se notó un mejoramiento similar en la relación alimento:ganacia y digestibilidad aparente de fibra cruda, grasa y cenizas con aves alimentadas con la dieta control, dietas que contenían 100 y 150 g/kg de HSRTE, respectivamente. El peso relativo de la molleja se incrementó (P < 0,05) con el aumento de los niveles de inclusión en la dieta de HSRTE. Los pollos alimentados con 200 g/kg de HSRTE registraron el mayor peso relativo de la molleja, el páncreas y el duodeno (P < 0,05) y la mayor longitud relativa del yeyuno y el íleon (P < 0,05). La longitud de las vellosidades y la profundidad de las criptas del duodeno se redujeron (P < 0,05) con un incremento de la inclusión en las dietas de HSRTE. En conclusión, la harina de semillas de ricino tratada con etanol puede ser incluida hasta 150 g/kg en dietas para raciones para pollos de engorde, sin perjudicar el crecimiento y la digestibilidad de los nutrimentos.Eight weeks feeding trial was conducted to investigate the chemical composition, growth response, apparent nutrient digestibility, gut characteristics and morphology of broiler chickens fed four diets containing ethanol-treated castor oil seed meal (ECAM). Two hundred day-old Anak 2000 broiler chicks were then allotted to the four experimental diets containing ECAM at 0, 100, 150 and 200 g/kg, respectively. Each treatment was replicated five times with 10 birds per replicate. The final live weight, weight gain and feed intake reduced (P < 0.01) with increasing dietary inclusion of ECAM. Control fed broilers and those fed diets containing 100 g/kg and 150 g/kg ECAM had similar feed to gain ratio. Broilers fed diets containing 200 g/kg ECAM recorded the least (Linear and quadratic contrast, P < 0.05) crude protein and crude fibre digestibility, and the poorest (Linear contrast, P < 0.05) feed to gain ratio. Similar improved feed to gain ratio, apparent crude fibre, fat and ash digestibility were noticed with birds fed the control diet, diets containing 100 g/kg and 150 g/kg ECAM, respectively. Relative gizzard weight increased (P < 0.05) with increasing dietary inclusion levels of ECAM. Broilers fed with 200 g/kg ECAM recorded the heaviest (P < 0.05) relative gizzard, pancreas, duodenum weight and the longest (P < 0.05) relative jejunum and ileum length. Villi length and crypt depth of the duodenum reduced (P < 0.05) with increasing dietary inclusion of ECAM. In conclusion, ethanol-treated castor seed oil meal can be included up to 150 g/kg diet in broiler ration without impairing growth and nutrient digestibility

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population