Gut fermentation syndrome

Fungi have not been recognized to cause such notable syndromes until very recently. It has been documented among few individuals who became intoxicated after consuming carbohydrates, which became fermented in the gastrointestinal tract. These claims of intoxication without drinking alcohol, and the findings on endogenous alcohol fermentation are now called Gut Fermentation Syndrome. This review will concentrate on understanding the aetiology, clinical manifestations, laboratory diagnostic options and treatment of the syndrome.Keywords: Gut Fermentation Syndrome, Fungi, Yeast, Saccharomyces cerevisiae

Pattern of asymptomatic sexually transmitted infections in women undergoing hysterosalpingography for infertility evaluation in Ibadan Nigeria.

The roles of gonorrhea and non-gonococcal urethritis due to Chlamydia trachomatis in the etiology of infertility due to tubal occlusion have been established by various studies. Hysterosalphingography (HSG) is done to investigate tubal patency. This study was aimed at finding the prevalence of asymptomatic sexually transmitted infections (STIs) in women being investigated for infertility in a tertiary institution.Methods: This was a cross-sectional study of asymptomatic infertile women referred for pre-HSG screening. Detailed medical history, Endocervical and high vaginal swabs were collected to establish diagnosis of STIs following clinical examination and informed consent. These specimens were evaluated microscopically for Chlamydia trachomatis and bacterial vaginosis. Endocervical secretions were Gram-stained for intracellular Gram – Negative diplococci and suspected isolates were confirmed as Neisseria gonorrhoeae by standard laboratory methods.Results: There were 250 participants with a mean age of 34.6 years (SD = 5.4, range = 25 -49). The mean age of sexual debut of participants was 21.5 years (SD = 4.3). Fifty-six (22.5%) of the women engaged in oral sex while 53 (21.2 %) shared their spouses with other sexual partners. 17.7% had previous PID, 43.1% of them has vaginal discharge syndrome. The commonest STI was Vulvo- vaginal candidiasis (24.4%) and others were bacterial vaginosis (18.4%), Chlamydia cervicitis ( 17.6% ), trichomoniasis (11.2% ), and gonorrhea ( 2.4 % ).Conclusion: The procedure of HSG is invasive and asymptomatic infections in the cervix can be dislodged and propagated by injection of contrast to the fallopian tubes thus causing tubal blockage. Routine Pre-HSG screening for occult STIs is encouraged to avoid iatrogenic Pelvic Inflammatory Disease.Keywords: Hysterosalpingography, Sexually Transmitted Infections, Infertility

Molluscum contagiosum virus infection amongst plwha in ibadan, Nigeria

Background: Molluscum contagiosum (MC) infection is caused by a pox virus and the virus is probably passed on by direct skinto- skin contact which may affect any part of the body. There is anecdotal evidence associating facial lesions with HIV-related immunodeficiency. This study was aimed to determine the prevalence and associated risk factors of Molluscum contagiosum infection among PLWHAs attending ART clinic at the University College Hospital, Ibadan, Nigeria. Methods: This is a descriptive cross-sectional survey of 5,207 patients (3519 female and 1688 males) attending ART clinic between January 2006 and December 2007. Physicians performed complete physical and pelvic examinations. Diagnosis of Molluscum Contagiosum infection was based on the clinical findings of typical lesions on the external genitalia, perianal, trunk, abdominal and facial regions.Results: The mean age of the patients was 34.67 yrs. ± 9.16). About 10% (542) had various sexually transmitted infections (STIs). The male to female ratio was 1: 4.2. One hundred and twenty seven subjects (23.4%) had no formal or primary education with 247 (45.6 %) beingtreatment naïve while 295 (54.4 %) were treatment experienced. Of the 542 PLWHAs with STIs, 3.3 % had undetectable viral load (< 200 copies/ ml) while 272 (50.1 %) had low CD4 count (< 200 cells / mm3.) and The Mean log10 viral load was 5.02 + 0.94. Molluscum Contagiosum infection was diagnosed in 13 patients (0.024%; 8 females and 5 males). Vaginal Candidiasis was the commonest genital infection diagnosed in 223 (41.1%) of the patients with STIs. MC patients had higher viral load, lower CD4 count and more likely to be treatment experienced”.Conclusions: Molluscum Contagiosum infection is not uncommon among the HIV-infected patients, but underreported. Awareness of this cutaneous manifestation should be known to Physicians in AIDS care.Key Words: Molluscum contagiosum, HIV, Sexually Transmitted Infectio

Diverse genetic subtypes of HIV-1 among female sex workers in Ibadan, Nigeria

Genetic diversity is the hallmark of HIV-1 infection. It differs among geographical regions throughout the world. This study was undertaken to identify the predominant HIV-1 subtypes among infected female sex workers (FSWs) in Nigeria. Methods: Two hundred and fifty FSWs from brothels in Ibadan Nigeria were screened for HIV antibody using ELISA. All reactive samples were further tested by the Western Blot Techniques. Peripheral Blood Mononuclear Cells (PBMCs) were separated from the blood samples of each subject. Fragments of HIV Proviral DNA was amplified and genetic subtypes of HIV-1 was determined by direct sequencing of the env and gag genes of the viral genome followed by phylogenetic analysis . Results: The age of the FSWs ranged from 15 to 55 years old (Mean = 25.8years, SD =3.74). Majority were Nigerians while others (1.6 %) were from neighboring West Africa countries. Four ( 1.6% ) of the FSWs were active for less than one year as sex workers, and the mean length of sex work was 2.80 years ( Range = 1.0 – 15.0 years ). Sixty-four (25.6%) of the 250 CSWs were positive for HIV-1 while 7 (2-8%) had dual infections to HIV-1 / HIV-2. Among the 34 HIV-1 strains  characterized by sequencing, 19 (55-9%) were subtype G, 9 (26.5%) CRF02_A/G, 3 (8.8%) CRF06_cpx while 1 (2.9%) each were identified as subtype C, CRF01_A/E and CRF09_cpx respectively. Nineteen (55.9%) of the FSWs with subtype G had been active in the sex work for between one to five years. The youngest of the HIV -1 infected FSWs with sexual activity of less than a year had subtype G strain. There is a significant probability that infection with this subtype occurred with a short incubation period (p< 0.05). Conclusion: This study showed a wide range of HIV- 1 subtypes among FSWs in Nigeria. The situation poses serious challenge for the design of HIV vaccine candidate for use in Nigeria.Keywords: Diverse, HIV, subtypes, Female Sex workers and Vaccin

Obstetric and newborn outcomes and risk factors for low birth weight and preterm delivery among HIV-infected pregnant women at the university college hospital Ibadan

There remains uncertainty about the impact of HIV on pregnancy outcomes and effects of highly active antiretroviral therapy on fetal development. This study describes obstetric outcomes among HIV positive parturients at the University College Hospital, Ibadan. HIV positive parturients were identified in the birth register. During the 30-month period, 318 of 6203 deliveries were HIV positive (5.1%) with 97.6% record retrieval. The mean age of the HIV positive parturients was 31.66 years (± 4.66); the mean gestational age at delivery was 38.02 weeks (± 2.75) and the mean birth weight 2.85kg (±0.59). There were 35.8% (109) preterm births, 2.9% stillbirths and 21.5% low birth weights. The regimen most commonly (198, 64.5%) used was a non-nucleoside reverse transcriptase (NNRTI) based HAART. Preterm births were similar following spontaneous vaginal delivery (31.5%) and elective section (31%) but higher (41.3%) with emergency section (ñ=0.4).On univariate analysis, the preterm infants had lower mean birth weights (2.46±0.61 vs 2.96±0.44; ñ=0.000). The proportion of preterm births was higher among Low birth weight infants (71.9% vs 28.1%; ñ=0.00). Variables with more preterm births were age >35 years (51.6%), ≤6years of schooling (51.5% vs 48.4%) and being on combination ARV (PI, 37.5% or non-PI, 36.2%). However, these differences did not attain statistical significance. Low birth weight infants had mothers who had higher mean ages (33.28 years ± 4.59 vs 31.28 years ± 4.59, ñ= 0.02), lower mean gestational age at delivery (35.72 weeks ± 3.16 vs 38.49 weeks ± 2.1, ñ= 0.00). Variables with more low birth weight include <12years of schooling and being on mono/ dual therapy (31.8%). These differences were not statistically significant. On logistic regression, factors that retained an association with low birth weight were mean maternal age at delivery (ñ= 0.002; â= 0.904; 95% CI, 0.848 – 0.966) and being on mono/ dual therapy (ñ= 0.039; â= 3.042; 95% CI, 1.055 – 8.768). The only factor that retained an association with preterm birth was mean maternal age at delivery (ñ= 0.015; â= 0.935; 95% CI, 0.886 – 0.987). HIV positive (especially older) women, have high rates of preterm deliveries and low birth weights. The beneficial effects of HAART on mother-to-child transmission are indisputable but monitoring antiretroviral therapy in pregnancy remains a priority and antenatal surveillance should include fetal growth assessment.

Evaluation of the reliability of Levine method of wound swab for microbiological studies in chronic wounds: a pilot study

Background: All chronic wounds habour microorganisms which may stall spontaneous healing of the wounds or impair success of wound closure. Wound biopsy for microscopy, culture and sensitivity is the preferred method of isolating microorganisms present in a wound but the procedure is resource intensive and unpleasant to patients. The aim of this paper is to evaluate the reliability of Levine swab in accurate identification of microorganisms present in a wound and identify the necessity for further studies in this regard. Methods: A semi structured questionnaire was administered and physical examination was performed on patients with chronic wounds who meet the inclusion criteria for the study. Full thickness wound biopsy and wound swab using the Levine method were taken from the wound of each patient. The data generated was analysed using Statistical Package for Social Sciences (SPSS) version 20. Results: There were 21 ulcers from 19 patients but only nineteen ulcers were suitable for analysis. The mean age of the patients was 42 years (range 13-69 years). There were nine males and 10 females. Most of the ulcers were posttraumatic (67%), were located on the right side of the body and the commonest site was the right leg (24%). More than half of the ulcers had at least moderate discharge. Only one species of microorganism was isolated per wound swab or wound biopsy specimen. Comparison of results from wound swabs with wound biopsy from each of the patients revealed that isolated microorganisms were similar in 60% of cases. Conclusion: Wound swab by the Levine method may be as reliable as wound biopsy specimens for microbiological studies in chronic wounds due to certain causes. Larger studies that evaluate wounds due to different causes separately will be required to validate this observation.Keywords: Levine swab, chronic cutaneous ulcer, microbiology, wound samplingNigerian Journal of Plastic Surgery, Vol. 9, No 2, September 201