Pattern of nosocomial infections in the special care baby unit of the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria

Background: Sepsis contributes significantly to newborn deaths in Nigeria. A significant proportion of severe infections in the newborn may be health care-related.Objective: To determine the prevalence, types and risk factors for nosocomial infections in the Special Care Baby Unit of a Nigerian Tertiary Hospital.Method: A cross-sectional survey of consecutively admitted infants aged 0 to 28 days with signs of infections or who developed signs of infection following admission. Infants with or without nosocomial infections were compared for the clinical and laboratory details.Results: Out of 356 infants, 32 (8.9%) had between 1 and 3 nosocomial infections while 48 (13.5%) had community-acquired infections. Half of babies with nosocomial infections were preterm and weighed less than 2kg. A significantly higher proportion of babies with nosocomial infections were inborn (p < 0.000) and stayed longer than 7 days on admission (p = 0.034). Bacteraemia was significantly more frequent among babies with nosocomial infections (p = 0.014) while superficial skin and mucosal infections occurred to similar extents in both groups. Klebsiella and Proteus species were the leading isolates among babies with nosocomial infections. Nasogastric intubation was significantly more frequently performed among babies with nosocomial infections (p = 0.045).Conclusion: The present study revealed that hospital acquired infection is an important cause of morbidity in the newborn unit.Keywords: Bacteraemia; Hospital-acquired infections; invasive procedures;newborn

Characteristics of clients accessing HIV counseling and testing services in a tertiary hospital in Sagamu, Southwestern Nigeria

Introduction: Client-initiated HIV testing and counseling has helped millions of people learn their HIV status. Nevertheless, global coverage of HIV testing and counseling programs remains low. This study describes the characteristics of clients who accessed HIV counseling and testing (HCT) services in Olabisi Onabanjo University Teaching Hospital, (OOUTH)Sagamu.Materials and Methods: A retrospective study of the clients accessing HCT services in OOUTH. Data was collected from clients using a client intake form. Pre-test counseling, HIV screening and post-test counseling were carried out. Informed consent and confidentiality were ensured. Data obtained were analyzed using SPSS 10.0.Results: A total of 2607 clients accessed our HCT services between May 1st 2008 and April 30th 2010. The clients were between the ages of 1 year and 90 years. The mean age was 33.3 ± 15.26. The median age was found to be 32.0 years, with the modal age being 30.0 years. 73.7% (1828) were non-reactive (negative result), 25.9% (643) were reactive (positive result), while 0.3% (8) were indeterminate. Among the reactive results, 9.3% (242) were males while 15.1% (394) were females.Conclusion: A fair uptake of HCT services was noted. More females accessed services than males. More positive results were seen among females than males (P<0.05).Recommendations: Upscale of HCT services to involve Sexually transmitted infections clinics and free-standing, client-initiated testing centers is necessary. Continuous AIDS education and risk reduction should be promoted

Seroprevalence and risk factors of Herpes Simplex Virus Type 2 amongst patients’ attending retroviral clinic in Federal Medical Center Abeokuta, south-west Nigeria

Herpes simplex virus type 2 (HSV-2) is the primary cause of genital herpes worldwide and also has a role in facilitating human  immunodeficiency virus (HIV) transmission. The aim of the study was to determine seroprevalence of HSV-2 among the subjectsand associated risk factors. In this cross-sectional study, 207 HIV Positive subjects attending a retroviral Clinic in Federal Medical Center, Abeokuta, Ogun state were interviewed and had blood samples taken. The patients were interviewed using a structured questionnaire and their serum samples were tested for HSV-2 specific immunoglobulin G (IgG) antibodies using enzyme-linked immunosorbent assay (ELISA) for consented participation. Prevalence of HSV-2 antibodies was ascertained and related to demographics and behavioral variables.  A total of 207 participants were recruited for this study comprising of Sixty-three (30.4%) male and 144 (69.6%) female HIV positive  subjects. Seroprevalence of HSV-2 was 70.0%. Only 58(28%) had current history of genital ulcer. Logistic regression revealed a history of multiple sexual partners (P value=0.003), oral sex (P value=0.02) were found to be associated with HSV-2 acquisition in HIV patients.All other risk factors such as history of transactional sex, age at sexual debut and condom use were not significant. The results highlight the potential public health impact of HSV-2 particularly in a developing country like Nigeria where HSV-2 testing is not included in our testing and treatment protocol for HIV. This result should lead to commencement of HSV type-specific serological testing in the HIV infected population and also high risk groups should be targeted for behavioral modification messages. Keywords: Seroprevalence, Risks, Factors, Herpes simplex, HIV

Bacterial vaginosis in pregnancy and early labour using Nugent scoring and the implication on foetal outcome

Background: To compare the pattern of vaginal microflora during pregnancy with pattern in early labour using Nugent scoring and determine the effect of these changes on fetal outcome. Design: A prospective longitudinal study. Setting and Population: Pregnant women attending antenatal clinics of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria between June 2017 and May 2018. Methods: Consenting pregnant women who attended antenatal clinics were recruited. Vaginal secretions were obtained for Nugent scoring during pregnancy and at presentation in labour. Main Outcome Measures: Prevalence of abnormal vaginal flora in pregnancy and early labour, birth outcome, birth weight, gestational age at delivery, APGAR scores, need for neonatal ward admission. Results: Sixty-seven (33.3%) of pregnant women had abnormal flora which was consistent with bacterial vaginosis.At the presentation of these women in labour, 14.4% of them had bacterial vaginosis thus indicating a significant reduction in abnormal vaginal flora in labour compared to the proportion of abnormal flora in antenatal period(P<0.001). There were no significant differences in the fetal outcomes of mothers with bacterial vaginosis when compared with those with normal vaginal flora (P-value >0.05). Conclusions: Persistence of abnormal vaginal microflora from pregnancy till early labour did not seem to be associated with poorer foetal outcomes when compared with women with normal vaginal microflora in labour. The possibility of persistent infection or re-infection before labour may justify the need for re-evaluation of vaginal smears in the late third trimester to allow for prompt treatment before the onset of labour. Keywords: Bacterial vaginosis, foetal outcome, Lactobacillus, pregnancy, vaginal microflora. Funding: This research work was sponsored by the Tertiary Education Trust Fund, Nigeria (TETFund) with referencenumber OOU/IBR/010

Vaginal Candida infection in pregnancy and its implications for fetal well-being

Vaginal Candida infection is one of the most common genital tract infections reported in pregnant women. This study was designed to determine the prevalence of vaginal Candida infection and pattern of Candida species isolates in the genital tract of pregnant women during antenatal period and in early labour; and the associated fetal outcome. The study was conducted at the antenatal clinic and labor ward of Olabisi Onabanjo University Teaching Hospital Sagamu, Ogun State, Nigeria. High vaginal swabs were collected from 408 pregnant women at the antenatal clinic and repeated in early labour. The samples were processed to isolate Candida species. Data were analysed using Statistical Package for Social Science (SPSS) windows version 21.0 (IBM Corp., Armonk, NY, USA). Prevalence of Candida infection was significantly higher in early labour (46%) than during antenatal period (38%) (P=0.02). Candida albicans was the predominant isolate, followed by Candida glabrata and Candida tropicalis. Candida infection was associated with increased likelihood of low birth weight babies (AOR 2.8, CI: 1.1-6.8; P= 0.03). However there was no statistically significant effect of Candida infection on the likelihood of preterm delivery (AOR 1.4, CI: 0.7-2.6; P= 0.35). Routine screening and prompt treatment of women at risk of delivering low birth weight babies is advocated. Keywords: Candida; Pregnancy; Preterm birth; Prevalence   L'infection vaginale à Candida est l'une des infections des voies génitales les plus courantes signalées chez les femmes enceintes. Cette étude a été conçue pour déterminer la prévalence de l'infection vaginale à Candida et le profil des isolats d'espèces de Candida dans le tractus génital des femmes enceintes pendant la période prénatale et au début du travail; et l'issue foetale associée. L'étude a été menée à la clinique prénatale et au service d'accouchement de l'hôpital universitaire Olabisi Onabanjo de Sagamu, dans l'État d'Ogun, au Nigéria. Des écouvillons vaginaux élevés ont été prélevés sur 408 femmes enceintes à la clinique prénatale et répétés au début du travail. Les échantillons ont été traités pour isoler les espèces de Candida. Les données ont été analysées à l'aide de la version 21.0 de Windows Package for Social Science (SPSS) (IBM Corp., Armonk, NY, USA). La prévalence de l'infection à Candida était significativement plus élevée au début du travail (46%) qu'au cours de la période prénatale (38%) (P = 0,02). Candida albicans était l'isolat prédominant, suivi de Candida glabrata et Candida tropicalis. L'infection à Candida était associée à une probabilité accrue de bébés de faible poids à la naissance (AOR 2,8, IC: 1,1-6,8; P = 0,03). Cependant, il n'y avait aucun effet statistiquement significatif de l'infection à Candida sur la probabilité d'accouchement prématuré (AOR 1,4, IC: 0,7-2,6; P = 0,35). Le dépistage systématique et le traitement rapide des femmes à risque d'accoucher de bébés de faible poids à la naissance sont recommandés. Mots-clés: Candidose; Grossesse; Naissance prématurée; Prévalenc

Pattern of completion of Laboratory Request Forms in a tertiary health facility

Background: Laboratory request form is an important means of interaction between clinicians and laboratory service providers. The omission of information on the request form may result in laboratory errors which may have a negative impact on patients’ outcome. Objective: To assess the pattern of completion of laboratory request forms in a tertiary facility. Methods: Two thousand, two hundred and forty-one laboratory request forms sent to the laboratory over a period of two months were assessed for their level of completeness. Results: Out of 2241 laboratory request forms, only 5 (0.2%) was fully completed. The most complete information on the forms included types of investigation required (98.9%), the gender of the patient (97.8%), the identity of consultant-in-charge of the patient (95.3%) and the referring physician's name and signature (93.8%). The least provided information was the time of collection of the specimen (0.7%). Conclusion: This study shows that laboratory request forms are frequently incompletely and inadequately completed. Continuous medical education of clinicians on the need for adequate completion of request forms is required

Failure to heal of thyroidectomy wound due to gossypiboma and stitch sinus: Report of two cases

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Prevalence and Antifungal Susceptibility Pattern of Candida species Isolated from Patients with Urinary Tract Infections

Background: The presence of Candida species in the urine is termed candiduria, and it is a common form of urinary tract infection (UTI). Many other species of Candida organism apart from Candida albicans are known with increasing the occurrence of resistance to available antifungal agents. Objectives: To determine the prevalence and sensitivity pattern of Candida isolates obtained from urine samples of diagnosed urinary tract infections. Methods: Midstream urine of patients attending the Lagos University Teaching Hospital, Ikeja Lagos, were collected and inoculated on Sabouraud Dextrose Agar (SDA). Microbiological processing was done with Gram reaction, germ tube test, CHROME agar TM and sugar fermentation test using API 32C system. Antifungal susceptibility tests were done using the agar disc diffusion method. Results: Candida species were obtained from 36 (12.9%) of 280 patients with UTI. Candida albicans (CA) had the highest frequency (12; 33.3%) compared to 24 (66.7%) for Non-albicans Candida (NAC). The speciation of Candida using Chrome Agar showed some misidentification from the API32C identification, but there was a significant correlation between API32C and Chrome Agar methods (r = 0. 9793). Half of the C. albicans species were sensitive to fluconazole while C. hellenica was only sensitive to Nystatin. The C. parapsilopsis had the highest susceptibility pattern, with 86% and 71% for fluconazole and ketoconazole, respectively. Generally, ketoconazole had the highest effectiveness on Candida species. Conclusion: This study demonstrated the role of Candida species in UTIs and their high susceptibility to ketoconazole

Typhoid Intestinal Perforations in a Tropical Tertiary Health Facility: A Prospective Study.

Background: Despite decades of improvement in patient care globally, typhoid intestinal perforation remains a frequently fatal illness in the developing world. This study aimed at determining the factors that influenced the outcome of surgical management of typhoid intestinal perforation in Sagamu, South-West Nigeria. Methods: Twenty-three consecutive adult cases managed between January 2006 and December 2008 at the surgical department of Olabisi Onabanjo University Teaching Hospital Sagamu were studied prospectively. Patients received parental ciprofloxacin or ceftriaxone in addition to metronidazole. They all had laparotomy after adequate resuscitation. Patients in American Society of Anesthesiologists (ASA) class VE were operated upon under local anaesthesia, intravenous ketamine and diazepam. Results: There were 13 males and 10 females with a male to female sex ratio of 1.3:1. The ages ranged from 19 to 51 years. Seventeen (73.9%) patients were aged between 20 and 34years.Two patients, one each from ASA grades IVE and VE, died on 1st and 2nd postoperative days respectively. The mortality of 8.7% was significantly associated with ASA class (P= 0.040). ASA class was strongly associated with severity of peritonitis (P=0.021). Complications occurred in 11 (47.8%) patients. Ten (43.5%) developed wound infection and one (4.3%) an entercutaenous fecal fistula. Wound infection was significantly associated with method of closure of perforation (P=0.034), and number of perforations (P=0.007). Conclusion: This study has shown that ASA class is a significant predictor of mortality in patients treated for typhoid intestinal perforation in our centre. We recommend that patients in ASA classes IV and V should have post-operative intensive care to reduce the risk of death

In Vitro Antimicrobial Studies of Plait Aqueous Extracts of Some Nigerian Medicinal Plants

Medicinal plants have been used by man to treat various kinds of infections without scientfic pror of their efficacy. The Antimicrobial activities of aqueous extracts of four Nigerian medicinal plants namely: Solanum americanum, Euphorbia hirta, Cassia occidentalis and Telfaria occidentalis were investigated against a wide range of isolated strains of bacteria by the disc diffusion method. The Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) of the extracts were also determined on the susceptible organisms. These plant extracts are used in Nigeria folklore medicine to treat infections of microbial origin. Aqueous extracts of the investigated plants showed antibacterial activities against different pathogenic bacteria. Among the pathogenic organisms  used, Staphylococcus  aureus, Pseudomonas aeruginosa, Klebsiella  pneumoniae and Escherichia coli were susceptible to three of the aqueous extracts used at concentrations of 100μg/ml. The plant  extracts demonstrated broadspectrum antibacterial activity against the microorganisms tested. The Minimum Inhibitory Concentration (MIC) of Solanum americanum was between 6.3μg/ml to 25μg/ml against these test organisms while MIC of Cassia occidental is ranged between 12.5μg/ml to 25μg/ml, while that of Eurporbia hirta ranged between 25μg/ml and 50μg/ml. The Minimum Bactericidal Concentration (MBC) of Cassia occidentalis and Euphorbia hirta was 25μg/ml for all the bacterial isolates, while that for Solanum americanum was 12.5μg/ml for Pseudomonas aemginosa and Staphlococcus aureus and 25μg/ml for E. coli and Klebsiella pneumoniae. Keywords: Antimicrobial activity, Medicinal plants, Minimum Bactericidal Concentration, Minimum Inhibitory Concentratio