Asymptomatic Bacteriuria in a University Teaching Hospital in Southern Nigeria: Prevalence, Uropathogens, and Antibiotic Susceptibility

Background: Asymptomatic bacteriuria (ASB) has been documented as the main risk factor for the development of symptomatic urinary tract infection in pregnancy and is associated with maternal and fetal complications. Objective: To determine the ASB prevalence, the causative microorganisms, their drug sensitivity patterns, and the factors associated with its occurrence in pregnant women in the Uyo, Nigeria. Methodology: Three hundred and twenty women were recruited during their first antenatal visit over a period of 13 weeks. A midstream urine specimen was obtained from each patient, cultured, isolates identified and antimicrobial sensitivity done. Data were analyzed using the Statistical Package for the Social Sciences version 20.  Results: The ASB prevalence was 9.1% with the two commonest identified isolates being Escherichia coli (41.4%) and Klebsiella pneumoniae (24.1%). Imipenem(100.0%) and gentamycin (37.9%) were the two most sensitive drugs. The association between respondents’ educational level and the occurrence of ASB was significant statistically. Conclusion: The prevalence of ASB was relatively high among the respondents. This, therefore, emphasizes the need for routine  screening  of our antenatal female population for ASB in all our health facilities

A giant ectopic hidradenoma papilliferum in a Niger delta region of Nigeria

Hidradenoma papilliferum is a known example of adnexal skin tumours with apocrine differentiation. It is a rare benign tumour which tends to arise from areas with rich concentration of aporine glands such as anogenital region, vulval, perineal, axillae, and periumbilical areas. In this report, the tumour was found in the upper outer quadrant of left breast, being one of the ectopic sites for this tumour. Contrary to most reports where male preponderance was popular for ectopic hidradenoma papilliferum, the patient in this report is a 71-year-old female. Considering the location of this tumour in this report, the likely histopathological differential diagnoses such as tubular apocrine adenoma, clear cell (apocrine) adenoma, lipoma, intraductal papilloma and papillary carcinoma of the breast should be considered for exclusion. This is the first reported case of a giant ectopic hidradenoma papilliferum of the breast in a Niger Delta region of Nigeria which also highlights the role of fine needle aspiration and cytology in the diagnosis of breast lesions

Resterilized Polypropylene Mesh for Inguinal Hernia Repair

Purpose: The use of prosthetic biomaterials for reconstructing and reinforcing the posterior wall of the inguinal canal reduces the incidence of hernia recurrence. Cost, availability of mesh, and perhaps reluctance to adopt a new technique are factors which prevent widespread practice of hernioplasty in low-resource settings. Use of resterilized mesh significantly reduces the cost of hernioplasty and is safe. Patients and Methods: Sheets of 30 cm × 30 cm polypropylene mesh were cut into 16 cm × 8 cm to produce mesh strips which were repackaged into SELFSEAL® (Medical Action Industries Inc., USA) sterilizing pouches measuring 90 mm × 230 mm and autoclaved. At repair, the strips are shaped to fit the anatomy of the posterior wall of the inguinal canal, a slit created at one end and applied in Lichtenstein repair of inguinal hernias. Patients were monitored for seroma collection and wound infection up to 2 weeks postoperative period. Results: Sixty inguinal hernia repairs were done in 58 patients using the resterilized mesh; two cases being bilateral. One patient (1.7%) had seroma collection at 2 weeks which was aseptically aspirated. We did not record any case of wound infection. Conclusion: The use of sterilized polypropylene mesh for the repair of inguinal hernias is safe and reduced the cost of hernioplasty by reducing the cost of polypropylene mesh. This technique is recommended in low-resource settings

Feasibility and cost analysis of programmatic implementation of Microscopic-Observation Drug Susceptibility (MODS) assay in Nigeria

Objectives: Detection of Multi-drug resistant tuberculosis in Nigeria still remains a challenge. We evaluated the feasibility of programmatic implementation of the Microscopic-Observation Drug Susceptibility (MODS) assay, a rapid culture and drug susceptibility testing technique for drug susceptibility testing in a low resource setting.Method: In a novel laboratory setting in Nigeria, we obtained data from the market on the cost of materials necessary for MODS assay. Three routinely collected sputum specimens from 160 tuberculosis suspects were evaluated by smear microscopy while only the early morning specimen was used for MODS culture.Results: MODS assay detected M. tuberculosis in 97.7% (42/43) of smear positive and 6.0% (7/117) of smear negative TB suspects. There was a statistically significant advantage of a single MODS culture over 3 smear microscopies (P=0.019). The modal time from culture of specimen to detection of M. tuberculosis and availability of drug susceptibility result for MODS was 7days with a mean of 8.4 days (Range= 5-13 days). Culture and susceptibility result was available in 18.4% (9/49) of patients within 5days of culture. Turnaround time for smear microscopy in the centers was 3 days. Cost of processing one specimen by MODS assay in the study was USD2.65. Multi-Drug resistant tuberculosis (MDR-TB) was detected in 4.1% (2/49) while Isoniazid mono-resistance was detected in 2.0% (1/49) of the culture positive cases. All the drug resistant isolates were from re-treatment cases with a statistically significant association (P=0.005).Conclusion: The MODS technique is simple, and its implementation in this novel setting was feasible. MODS can be scaled up to meet the demand for MDR-TB confirmation in XpertMTB/Rif deployed sites in Nigeria.Keywords: Tuberculosis, MDR-TB, Mycobacterium tuberculosi

Nugent Score and Candida Colonization Among Women in Uyo, Nigeria

Background: Bacterial vaginosis are among the most common causes of abnormal vaginal discharges and both represent consequences of imbalance in normal vaginal flora and pH.Objective: The aim of this study was to determine and compare the prevalence of Bacterial vaginosis (BV) and colonization with Candida among women attending Obstetrics and Gynecology clinics in a tertiary hospital.Methodology: This was a hospital based cross-sectional study. Pregnant and non-pregnant women attending Obstetrics and Gynaecology clinics in Uyo, Nigeria were interviewed using a structured questionnaire and self-administered vaginal swabs were collected by each participant. Nugent score was determined by Gram stain of smears of vaginal swabs while colonization by Candida was determined by inoculating each swab onto Saboraud’s agar and checking for growth of characteristic colonies after overnight incubation at 37°C. Chi square test was used to determine associations between variables.Results: Nugent score was positive for bacterial vaginosis in 40% of participants and Candida colonization was present in 49.52% of participants. There was significant association between BV status and colonization with Candida spp.Conclusion: There is an inverse relationship between BV and Candida colonization among participants in this study. Keywords: Bacterial vaginosis, Candidiasis, Vaginal discharge, Uyo