Depression amongst healthcare workers in Maiduguri, north-eastern Nigeria

Objective: Very few studies reported the high prevalence of emotional reactions amongst healthcare workers, in sub-Saharan Africa. This study aimed to assess the prevalence of depression among health care workers in two tertiary health institutions in Maiduguri, north-Eastern Nigeria.Methods: In this comparative, cross-sectional study, we used a stratified sampling technique to recruit 370 healthcare workers (clinical and non-clinical staff) from university teaching hospital, and Federal Neuro-psychiatric Hospital, Maiduguri, Borno State, north-east Nigeria. The participants completed a semi-structured socio-demographic questionnaire and Beck Depression Inventory (BDI-II).Results: Twenty (10.7%) and 14 (7.6%) clinical and non-clinical health care workers, respectively had depression (÷2 = 1.096, df = 1, ñ = 0.295). The prevalence of depression in males and females were 7.8% and 26.9%, respectively. Gender had a significant association with depression (÷2 = 3.427, df = 1, ñ =0.043).Conclusion: For an effective healthcare delivery service, the psychological well-being of hospital workers must be improved. Hospital workers require skills on stress management techniques.Keywords: Depression, healthcare workers, Maiduguri, Nigeri

Fecal Microbiota Transplant for Relapsing Clostridium difficile Infection Using a Frozen Inoculum From Unrelated Donors: A Randomized, Open-Label, Controlled Pilot Study

Fecal microbiota transplant is increasingly used to treat recurrent or relapsing Clostridium difficile infection. In this randomized controlled study, using a frozen inoculum from unrelated donors was safe and effective, whether administered by nasogastric tube or by colonoscopy. Background. Recurrent Clostridium difficile infection (CDI) with poor response to standard antimicrobial therapy is a growing medical concern. We aimed to investigate the outcomes of fecal microbiota transplant (FMT) for relapsing CDI using a frozen suspension from unrelated donors, comparing colonoscopic and nasogastric tube (NGT) administration. Methods. Healthy volunteer donors were screened and a frozen fecal suspension was generated. Patients with relapsing/refractory CDI were randomized to receive an infusion of donor stools by colonoscopy or NGT. The primary endpoint was clinical resolution of diarrhea without relapse after 8 weeks. The secondary endpoint was self-reported health score using standardized questionnaires. Results. A total of 20 patients were enrolled, 10 in each treatment arm. Patients had a median of 4 (range, 2–16) relapses prior to study enrollment, with 5 (range, 3–15) antibiotic treatment failures. Resolution of diarrhea was achieved in 14 patients (70%) after a single FMT (8 of 10 in the colonoscopy group and 6 of 10 in the NGT group). Five patients were retreated, with 4 obtaining cure, resulting in an overall cure rate of 90%. Daily number of bowel movements changed from a median of 7 (interquartile range [IQR], 5–10) the day prior to FMT to 2 (IQR, 1–2) after the infusion. Self-ranked health score improved significantly, from a median of 4 (IQR, 2–6) before transplant to 8 (IQR, 5–9) after transplant. No serious or unexpected adverse events occurred. Conclusions. In our initial feasibility study, FMT using a frozen inoculum from unrelated donors is effective in treating relapsing CDI. NGT administration appears to be as effective as colonoscopic administration. Clinical Trials Registration. NCT01704937.National Institute of Allergy and Infectious Diseases (U.S.) (HHSN272200900018C)

Lipoglycans Contribute to Innate Immune Detection of Mycobacteria

Innate immune recognition is based on the detection, by pattern recognition receptors (PRRs), of molecular structures that are unique to microorganisms. Lipoglycans are macromolecules specific to the cell envelope of mycobacteria and related genera. They have been described to be ligands, as purified molecules, of several PRRs, including the C-type lectins Mannose Receptor and DC-SIGN, as well as TLR2. However, whether they are really sensed by these receptors in the context of a bacterium infection remains unclear. To address this question, we used the model organism Mycobacterium smegmatis to generate mutants altered for the production of lipoglycans. Since their biosynthesis cannot be fully abrogated, we manipulated the biosynthesis pathway of GDP-Mannose to obtain some strains with either augmented (∼1.7 fold) or reduced (∼2 fold) production of lipoglycans. Interestingly, infection experiments demonstrated a direct correlation between the amount of lipoglycans in the bacterial cell envelope on one hand and the magnitude of innate immune signaling in TLR2 reporter cells, monocyte/macrophage THP-1 cell line and human dendritic cells, as revealed by NF-κB activation and IL-8 production, on the other hand. These data establish that lipoglycans are bona fide Microbe-Associated Molecular Patterns contributing to innate immune detection of mycobacteria, via TLR2 among other PRRs

An appraisal of clinical diagnosis and management of dementia patients in a public hospital

Background: As of 2015, 46.8 million elderly people were living with dementia, with 4.6 million new cases diagnosed every year worldwide. Comprehensive evidence and practice-based management principles with practical strategies and interventions are necessary for adequate care to be rendered.Objective: The purpose of this study was to examine clinical information, management, intervention principles and other relevant contents in the case note of dementia patients.Methodology: A retrospective study in which 42 case notes of dementia patients seen in Federal Neuro-Psychiatric Hospital, Maiduguri in 2017 were retrieved based on the register kept by health records staff. The number of dementia cases from the register showed that one hundred and fifteen (115) cases were seen in 2017. Systematic sampling was used to select client case files to be studied from a list of 115 produced using medical health record register for dementia diagnosis in the year 2017. Information sorted out included socio-demographic data, clinical information, diagnosis, management, intervention principles and other relevant contents related mostly to first visit.Results: Majority (N=27, 64.3%) were males, maximum age was 90yrs and minimum 56yrs. More than half (N=25, 59.5%) were married, a third widowed (N=15, 35.7%) and 13(31%) were unemployed. Main complaints were forgetfulness (N=36, 85.7%), irrational talks (N=29, 69%) and poor sleep (N=9, 21.4%). Information content in assessment was not comprehensive in 23 (54.8%) of case notes while 19(45.2%) were fair. Associated factors were not documented in many case notes, like smoking (N=40, 95.2%), alcohol use (N=41, 97.6%) and past psychiatric history (N=38, 90.5%). Management guidelines were sparsely used (N=24, 57.1%) or not used (N=18, 42.9%).Conclusion: Care of dementia patients need to follow adequate assessment and management based on known guidelines for it to be beneficial. A national guideline with strategies for prevention, screening and intervention will encourage early involvement in treatment and delay deterioratio

Consumer satisfaction with a federal health care service in Nigeria

No Abstrac