Global trend of Methicillin-resistant Staphlococcus aureus and emerging challenges for control

Background: Following its first recognition in early 1960s, the increasing incidence of nosocomial and community-acquired methicillin resistant Staphylococcus aureus (MRSA) infections has become a global problem. The emergence of multiple-drug resistant MRSA strains and dissemination of epidemic antibiotic clones including presence of wide spectrum of virulence and predisposing risk factors complicate diagnosis, chemotherapy and control causing significant morbidity and mortality. Detection of MRSA strains in domestic animals and protozoan has widened the epidemiologic characters of the organism and may influence infection control policies. Objectives: To review the emergence and epidemiologic spread of resistant strains of MRSA, molecular/genetic basis of resistance in the organism and challenges facing control strategies worldwide. It also aims to suggest intervention strategies so as to checkmate the spread of MRSA infections.Methods: By reviewing local and international literatures on MRSA infections coupled with practical experience in the field of this endeavour. Result/Conclusion: MRSA has shown increasing endemic and epidemic spread in the last four decades causing serious medical and socio-economic difficulties. Routine and regular surveillance (uncommon in poor-resourced developing areas of especially sub-Saharan Africa), good hospital practices and personal hygiene, public enlightenment, development of effective therapeutic agents and rational administration of antibiotics based on reliable test results will limit the spread of MRSA infections.Key words: MRSA, incidence, morbidity, mortality, surveillance, control

Review of Lassa fever, an emerging old world haemorrhagic viral disease in sub-Saharan Africa

Lassa fever is an acute immunosuppressive illness of increasing public health concern causing severe morbidity and significant mortality (Case fatality rate (CFR) ≥ 50%) especially in epidemic cases. Although Lassa fever has emerged (following its first detection (1969) in Lassa town, Nigeria) as one of the most prevalent and debilitating viral haemorrhagic fevers endemic in West Africa region (Nigeria inclusive), yet, the control/prevention of the regular outbreak of the disease has become an herculean task in the areas affected; there is inadequate healthcare facility (including Laboratory/diagnostic and care centres), poor socioeconomic environment, lack of awareness among the populace and presence of favourable ecologic niche for the survival and propagation of the natural host and reservoir mouse (Mastomys natalensis) of Lassa virus . Lassa fever is mainly transmitted by contact with excretions and secretions of infected rats via foods and water as well as exposure to other contaminated items. Lassa virus is a member of an Old World Arenariruses, of family Arenaviridae. It is an enveloped, single-stranded (SS) bisegmented RNA virus with ability to replicate very rapidly. It consists of 4 lineages; 3 members are identified as ancenstral strains found in Nigeria, while the fourth is domiciled in other West Africa Countries. Lassa virus infects almost every tissue in human body resulting in multisystemic dysfunction. The incubation period is generally between 6 to 21 days resulting in 3 stages of clinical manifestation viz: Acute phase characterized by flu-like, non-specific illness; haemorrhagic phase accompanied with gastrointestinal symptoms and cardiovascular/neurologic complications. Currently, there is no clinically certified Lassa fever vaccine thus complicating deterrent or preventive measures. Hence, there is need for intensification of educational programs for the populace on the useful control measures against Lassa fever. The stakeholders need to prioritize intervention and support program and also speed up the processes leading to the production of effective vaccine to limit the menace of Lassa fever outbreak and associated morbidity, fatality and high socio-economic cost.Keywords: Lassa fever, endemic, epidemic, reservoir rodent, West Afric

Emerging and re-emerging infectious agents of nosocomial diseases – The need for review of hospital policy and control strategies

Nosocomial infections (NIs, now referred to as Healthcare-associated infections, HCAIs) are diseases that essentially originate from the hospital and may be disseminated via biologic or inanimate agents in the healthcare center. They occur globally and constitute major hazards inhealthcare institutions resulting in significant morbidity, mortality and increased hospital stay, and high socio-economic cost. Between 3 and 21 percent (average range, 5 – 9%) of all hospitalized patients are affected by HCAIs each year in various communities worldwide; while critically ill,trauma or immunocompromised patients (e.g. those requiring multiple life – saving invasive procedures or immunosuppressive therapy) are hardest hit. The increasing involvement of multiple drug-resistant strains of a large spectrum of emerging and re-emerging infectious agents of NIscomplicate morbidity, management and impose serious burden on the patients and relations. Hospital workers, patients, materials or equipments and hospital procedures constitute major factors of transmission mechanism of HCAIs. However, the incidence and socioeconomic impact ofNIs (though estimated to be high) are rarely investigated in sub-Saharan Africa (including Nigeria) due to poor healthcare facility and low capacity. There is need for increased awareness on HCAIs and adoption of enduring hospital policy and effective control measures that will take cognizanceof emerging trends of nosocomial agents and transmission mechanism to reduce morbidity, mortality and socio-economic impact associated with HCAIs.Keywords: Healthcare – associated infections, hazards, morbidity, mortality, control measures

Emergence of ebola virus disease and its devastating impact in poor-resourced areas of sub-Saharan Africa

Ebola virus disease (EVD) is an unusual infection, and one of the most virulent emerging viral diseases known causing severe morbidity and significant mortality. In recent epidemic outbreak of EVD in West African countries of Guinea, Sierra Leone and Liberia (the 3 nations epi-centre of the epidemic), the disease has affected over 25,000 people resulting in more than 10,000 deaths, (Case Fatality Rate, CFR>40%; i.e. from December, 2013-March, 2015). Following the first outbreak of EVD in Sudan and Democratic Republic of Congo (DRC) in 1976, several epidemics (>20 outbreaks) of the disease have been recorded particularly in poor-resourced areas of the East, Central and West-Africa resulting in significant mortality. CFR of EVD is 25-90 percent. Ebola virus is transmitted to humans by wild animals (mainly non-human primates) and spreads in human population via close contact with blood, body fluids and secretions of infected patients. EVD can also be acquired through direct contact with infected corpses. It is characterized (at initial stage) by non-specific flu-like symptoms including headache, fever, myalgia and malaise following incubation period of 2-21 days. This may terminate into severe systemic manifestations including diffuse internal and external bleeding, shock and death if untreated early. Non recognition of the specific natural host of Ebola virus and rapid progression of infection including slow mounting of acquired immunity against EVD by infected host complicate control measures. The socio-economic cost of EVD epidemic outbreak is colossal. Despite notable advances in healthcare-related technology enhancing the diagnosis, treatment / management and prevention / control of infectious or viral diseases, the response of the stakeholders over the years geared toward controlling the spread of the disease left much to be desired. No clinically certified drugs or vaccines against EVD are yet available. There is the urgent need by stakeholders to device appropriate preventive / control measures including development of effective drugs and vaccines to checkmate the spread of EVD and associated severe morbidity, high mortality and devastating socio-economic impact.Key Words: Ebola virus disease, severe morbidity, mortality, socio-economic impact, checkmate

Alcohol Consumption and Marijuana Use Interaction with Metabolic Syndrome among United States Adults: Analysis of NHANES 2013-2014.

INTRODUCTION: The relationship between alcohol, marijuana and metabolic syndrome remains controversial. Marijuana has been found to be a commonly used drug among those who drink alcohol, yet little is known about the effect of using both substances concurrently with metabolic syndrome. With decriminalization of marijuana across different states in the United States, it is expected that the prevalence of marijuana use will increase. Therefore, it is of utmost importance to understand the adverse impact of these drugs on metabolic syndrome. AIM: This study aims to understand (a) the relationship between alcohol and marijuana use and metabolic syndrome (b) the association between concurrent use of alcohol and marijuana and metabolic syndrome, and (c) the statistical interaction of alcohol and marijuana use on metabolic syndrome using the National Health and Nutrition Examination Survey data. METHODS: A cross-sectional analysis of 2013-2014 National Health and Nutrition Examination survey data was conducted. Participants aged ≥20 years were eligible. Metabolic syndrome was defined by the International Diabetes Federation criteria. The adjusted odds ratio of metabolic syndrome was calculated controlling for variables fitted using stepwise logistic regression model selection. RESULTS: After adjusting for age, race, educational level, marital status, poverty, and cigarette smoking status; current drinkers showed a significant inverse association with metabolic syndrome (aOR, 0.69 95% CI, 0.49-0.99). The odds of metabolic syndrome in concurrent users (aOR 0.53 95% CI, 0.28-0.99) was less than the odds among non-concurrent users. Compared with young adults, middle-aged and older adults had increased odds of metabolic syndrome. DISCUSSION: This data indicates that alcohol consumption and co-use of alcohol and marijuana is associated with a lower prevalence of metabolic syndrome. Longitudinal studies are needed to confirm these findings. Notably, age and smoking are significant predictors of metabolic syndrome

Ifa Divination Trays from Isale-Oyo

This paper is a study of the images and patterns on ifa divination trays from Isale-Oyo. The paper also explains some ifa paraphernalia. The paper establishes that ifa trays from Isale-Oyo bear distinctive features when compared with other ifa trays in Yorubaland such as those of Ijebu and Osogbo. Central to this study is the iconographic description and interpretations of Isale-Oyo divination trays. Data were collected through direct interviews with divination tray owners. Photographs of the trays were also taken. The investigation revealed that: • Divination trays from Isale-Oyo combine features found on both Ijebu and Osogbo trays. • The Esu figure continues to occupy the top central position on Oyo divination trays, even though with representational variations elsewhere in Yorubaland. • Some divination trays in Oyo carry no decorations on their borders, and in some recent cases, ceramic plates are now used for divination.Este artigo trata dos padrões e imagens dos tabuleiros de adivinhação ifa usados em Isale-Oyo (Nigéria), bem como de outros objectos religiosos associados. Argumenta-se que os tabuleiros ifa de Isale-Oyo têm características que os distinguem de outros tabuleiros ifa da região yoruba, como os de Ijebu e Osogbo. A descrição e a interpretação da iconografia dos tabuleiros de adivinhação constituem o foco deste estudo. Os dados discutidos foram recolhidos através de entrevistas a proprietários de tabuleiros de adivinhação e fotografias de tabuleiros. Conclui-se que: • Os tabuleiros de adivinhação de Isale-Oyo combinam traços dos tabuleiros de Ijebu • e dos tabuleiros de Osogbo. • A figura de Esu continua a ocupar a posição central superior nos tabuleiros de adivinhação de Oyo, embora se registem variações na sua representação noutras zonas do território yoruba. • Alguns tabuleiros de adivinhação de Oyo não possuem qualquer decoração nos frisos, e nalguns casos recentes vêm sendo utilizados na adivinhação pratos de cerâmica