Clinical observations and haematological changes following subchronic administration of methanolic leaf extract of Crotalaria lachnosema Stapf. (Fabaceae) in male Wistar rats

The aim of this study was to determine the Clinical observations (Visually and via Laboratory analysis) and haematological changes induced by subchronic administration of methanolic leaf extract of Crotalaria lachnosema (C. lachnosema) leaf (MLECL) on male Wistar rats. Four groups designated as Groups 1(control), 2, 3 and 4, of ten rats each, which were exposed to the extract in feed at dose levels of 0, 40, 200 and 1000 mg/kg for 42 days respectively. The clinical observations were recorded. At the end of the study period, the surviving rats were sacrificed following light ether anaesthesia and blood was collected from each rat via jugular venesection. The extract was found to cause impairment in both the body weight and relative organ weights of the exposed rats at termination of the experiment (P < 0.05) compared to the control group. The extract was found to affect the erythron only in group 2 with total red blood cell count (7.72 ± 0.25 × 1012/L), haemoglobin concentration (127.00 ± 2.66 g/L) and packed cell volume (48.44 ± 2.11 %) being significantly (P < 0.05 ) lower relative to those of the control (8.86 ± 0.32 × 1012/L, 150.80 ± 6.03 g/L and 48.44 ± 2.11 %, respectively). It was concluded from these studies that exposure to MLECL caused toxic effects in male Wistar rats (toxic effect like the decreased erythron; haematopoietic system is one of the most sensitive targets of toxic compounds, and thus considered an important index in pathophysiological status in man and animal). Human food or animal feed products contaminated with the plant C. lachnosema, even at very low concentrations, with the LD50 of 1300 mg/kg should be discouraged.Keywords: Crotalaria lachnosema, Haematology, LD50, Toxicity, Weight change

The in vitro and in vivo biological activities of antifungal compounds isolated from Loxostylis alata A.Spreng. ex Rchb. leaf extracts

The main aim of this study was to find a plant extract or isolated compound that could be used to combat aspergillosis in animals. Aspergillus fumigatus is one of the most common pathogenic fungal species in humans and animals. A. fumigatus is also an economically important fungus in the poultry industry. Current treatment of the disease is hampered by drug resistance of the organism to conventional antifungals and also its widespread toxicity to the animals. Seven tree species that had good antifungal activity against Cryptococcus neoformans in the Phytomedicine Programme database were selected for further work. These tree species were: Combretum vendae A.E. van Wyk (Combretaceae), Commiphora harveyi (Engl.) Engl. (Burseraceae), Khaya anthotheca (Welm.) C.DC (Meliaceae), Kirkia wilmsii Engl. (Kirkiaceae), Loxostylis alata A. Spreng. ex Rchb. (Anacardiaceae), Ochna natalitia (Meisn.) Walp. (Ochnaceae) and Protorhus longifolia (Bernh. Ex C. Krauss) Engl. (Anacardiaceae). The antimicrobial activity of leaf extracts of the selected plant species were determined against four important nosocomial bacteria (Staphylococcus aureus, Enterococcus faecalis, Escherichia coli and Pseudomonas aeruginosa) and five important animal fungi (Aspergillus fumigatus, Candida albicans, Cryptococcus neoformans, Microsporum canis and Sporothrix schenckii) using a serial microplate dilution method. The minimal inhibitory concentrations (MIC), of an acetone extract of Loxostylis alata was the lowest against Aspergillus fumigatus with an MIC value of 0.05 mg/ml. The number of antifungal compounds in extracts was determined by bioautography. The acetone extract of L. alata had the most active zones (10). The antioxidant, antiplatelet and cytotoxic effects of the seven plant species were evaluated using established in vitro assays. All the extracts had comparably low toxicity except for the extract of C. harveyi that had high haemagluttination assay titre value, which indicates toxicity. The extracts of P. longifolia, K. wilmsii, O. natalitia, L. alata, C. harveyi and C. vendae contained antioxidant compounds in the qualitative assay using DPPH. In the quantification of antioxidation using ABTS, only the extracts of P. longifolia, L. alata, and C. vendae had substantial antioxidant activity with respective TEAC value of 1.39, 1.94 and 2.08. Similarly, in the quantitative DPPH assay, L. alata. (EC50, 3.58 ± 0.23 μg/ml) and K. wilmsii (EC50, 3.57 ± 0.41 μg/ml) did not differ significantly (p ≤ 0.05) from the positive control (L-ascorbic acid). K. anthotheca had a much lower antioxidant activity (EC50 176.40 ± 26.56 μg/ml), and differed significantly (p ≤ 0.05) from all the other extracts and control. In addition, the extract of C. vendae and C. harveyi had significant (p ≤ 0.05) antiplatelet activity and did not differ from the control (aspirin) with EC50 of 0.06 ± 0.01 μg/ml, 0.19 ± 0.00 μg/ml, respectively. Lower EC50 values in the antioxidant and antiplatelet studies are indicative of superior activity of the plant extract against oxidation and platelet aggregation. Based on the results obtained L. alata was selected for further examination. To simplify the isolation of the antifungal compounds from the L. alata fractions the acetone extract was first separated into six different fractions based on polarity in a mild solvent-solvent fractionation process. The fractions were aqueous methanol, butanol, carbon tetrachloride, chloroform, hexane and water fractions. The antimicrobial activities of the fractions as well as other relevant pharmacological tests on the different fractions were carried out. The number of antimicrobial compounds present in the aqueous methanol (AM), butanol (BT), carbon tetrachloride (CCl4), chloroform (CC), hexane and water fractions was determined by bioautography. The CCl4 extract was active against six out of the 9 microbial strains used and was particularly active against S. aureus, E. faecalis, A. fumigatus, C. albicans, C. neoformans and M. canis with MIC of 0.04, 0.04, 0.1, 0.1, 0.06 and 0.03 mg/ml, respectively. Microsporum canis was the most sensitive organism with the lowest average MIC of 0.16 mg/ml. Qualitative antioxidation using DPPH and quantitative assay using both ABTS and DPPH radicals revealed the presence of several antioxidant compounds in the AM, BT and water fractions of Loxostylis alata. This supported the usefulness of L. alata in treating fungal diseases, as aspergillosis and most fungal infections are associated with immune depression of the host. Antioxidants may reverse several conditions associated with immune deficiencies, resulting in increased levels of interleukin-2, elevated numbers of total lymphocytes and T-cell subsets. Loxostylis alata is used in southern African traditional medicine to control labour pain and to boost the immune system. Extracts and compounds isolated from leaves of Loxostylis alata were therefore also evaluated for their in vitro antimicrobial, anti-inflammatory (cyclooxygenase-1 and -2) activities and evaluated for their potential toxic effects using 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide (MTT) and Salmonella typhimurium tester strains TA98 and TA100. Antimicrobial activity was evaluated using a serial microdilution assay. The bacterial strains used were Staphylococcus aureus (ATCC29213), Enterococcus faecalis (ATCC 29212), Pseudomonas aeruginosa (ATCC 27853) and Escherichia coli (ATCC 25922). The fungal strains used were Cryptococcus neoformans, Sporothrix schenckii, Aspergillus fumigatus, Microsporum canis and Candida albicans. A bioassay guided fractionation of the crude extract yielded two antimicrobial compounds namely, Lupeol and μ-sitosterol Lupeol had the most pronounced zone of inhibition against S. aureus and A. fumigatus., When MICs of the 2 compounds were determined, only lupeol had relatively good activity with MICs values ≤ 100 μg/ml against 8 out of 10 of the tested pathogens. However, β-sitosterol had activity against only S. aureus and E. coli with MICs values of 90 and 110 μg/ml, respectively. In addition β-sitosterol had selective inhibition of COX-1 (IC50 = 55.3 ± 2) None of the compounds isolated were toxic in the Salmonella typhimurium/microsome assay and MTT cytotoxicity test. The isolation of these two compounds is reported for the first time from Loxostylis alata. It was disappointing that the two antifungal compounds isolated from L. alata had such a low activity against Aspergillus fumigatus. This inhibits the development of a single compound that can be used therapeutically. Because the crude extract had very good activity we decided to investigate the safety and potential use of this extract in target animal species. At a dose of 300 mg/kg, the chicks had some signs of intoxication, but not at a dose of 200 mg/kg. Aspergillosis was induced experimentally, in broiler chicks. The degree of infection was assessed by comparing degree and severity of clinical signs, lesion scores and fungal re-isolation from treated chicks with those from infected chicks not treated with the extract. The extract at a dose of 100 and 200 mg/kg reduced significantly (p ≤ 0.05) the lesions due to aspergillosis and the amount of Aspergillus fumigatus isolated from infected chicks in an excellent dose related response.. The crude extract of L. alata leaves was as active as the commercially used ketoconazole against avian aspergillosis. It appears likely that the crude acetone extract could be produced at a much lower cost than ketoconazole or other chemical antimicrobial products. If these results can be confirmed in larger studies and if the crude extract does not have a negative effect on the production of the poultry the crude extract of L. alata may prove to be a viable and cost effective alternative to using current antimicrobial products. This study proves that it may be worthwhile to invest human and financial resources in searching for plant related products than can increase animal health and productivity. CopyrightThesis (PhD)--University of Pretoria, 2009.Paraclinical Sciencesunrestricte

Nitric oxide inhibitory activity of Strychnos spinosa (loganiaceae) leaf extracts and fractions

Background: The study was aimed at determining the anti-inflammatory activity of fractions and extracts obtained from Strychnos spinosa leaves on a mediator of inflammation nitric oxide (NO).Materials and Methods: Leaves were extracted with acetone and separated into fractions with different polarities by solventsolvent fractionation. The Griess assay was used to determine the nitric oxide (NO) inhibitory activity. Cellular toxicity was determined by "using the MTT reduction assay".Results: With the exception of the ethyl acetate fraction which had an IC50 >750 μg/mL, all extracts and fractions had significant nitric oxide-inhibitory activity. The most active being the water fraction, chloroform fraction and the dichloromethane/methanol extracts with IC50 values of 88.43 μg/mL, 96.72 μg/mL and 115.62 μg/mL, respectively. The extracts and fractions had low cytotoxicity on macrophage U937 cell lines.Conclusion: Extracts and fractions of Strychnos spinosa leaves may be promising sources of natural anti-inflammatory agents. Findings obtained from this study showed that Strychnos spinosa leaves possess promising anti-inflammatory action and could be used in the treatment of inflammation-related conditions.Keywords: Strychnos spinosa, inflammation, nitric oxide, cytotoxicit

Characterization of bacteria isolates colonizing the throat of hospitalized patients at Sobi Specialist Hospital, Ilorin, Nigeria and in vitro antimicrobial effects of Citrus aurantifolia and Alum on the isolates

Background: Antibiotic resistance in microorganisms implicated in nosocomial respiratory infections is a major reason for prolonged hospital stay and increased cost of therapeutic treatment of hospital acquired pneumonia (HAP). This study was designed to isolate bacterial pathogens  colonizing the throat of hospitalized patients at the Sobi Specialist Hospital, Ilorin, and to evaluate antibacterial effects of extracts of Citrus  aurantifolia peel and Alum against these bacterial isolates. Methodology: This was a cross sectional study of 100 randomly recruited hospitalized patients at the Sobi Specialist Hospital, Ilorin, Nigeria. Throat  samples collected from consenting participants were cultured on selective agar media (MacConkey, Eosin-Methylene blue and Mannitol salt) for  isolation of bacteria. Identification of isolates from culture plates was done by Gram reaction and conventional biochemical tests while confirmation  of the isolates was done by the polymerase chain reaction (PCR) assay. Antibiotic susceptibility test for each isolate to selected antibiotics (ampicillin,  amoxicillin-clavulanate, cefuroxime, ceftazidime, gentamicin, nitrofuran, ofloxacin and ciprofloxacin) was done by the Kirby Buer disc  diffusion method. Aqueous extract of Alum ([KAl(SO4).12H2O]) was done to produce concentrations of 10, 20, 30, 40 and 50% (w/v) at pH 3.6 and  tested on the bacterial isolates using agar diffusion method. Citrus aurantifolia peel was extracted using methanol and hexane solvents to produce  extract concentrations of 500mg/ml, 250mg/ml and 150mg/ml, and tested on the isolates by agar diffusion, and by the broth dilution method to  obtain minimum inhibitory (MIC) and minimum bactericidal concentrations (MBC) of C. aurantifolia. Results: A total of 14 bacterial isolates were recovered from throat samples of 100 hospitalized patients with Staphylococcus aureus (43%, n=6) being  the most frequent while Escherichia coli (14.5%, n=2) was the least frequent. The isolates were generally resistant to penicillin, aminoglycoside and  fluoroquinolone groups of antibiotics tested. The zone of inhibition for hexane and methanol extracts of C. aurantifolia and aqueous extract of alum  on the bacterial isolates ranged from 11.5-19.2mm, 9.8-15.8mm, and 9.3-21.2mm respectively while those of selected antibiotics ranged from  7.0-25.0mm. The MICs of hexane and methanol extracts of C. aurantifolia against S. aureus were 10mg/ml and 25mg/ml, while the MBCs were 50  and 100mg/ml respectively. Conclusion: Findings from this study showed the presence of resistant pathogenic bacteria colonizing the throat of hospitalized patients receiving care at the Sobi Specialist Hospital, Ilorin, Nigeria. The crude extracts of C. aurantifolia and Alum in this study showed inhibitory effects (albeit at  higher concentrations) on the bacterial isolates comparable to the standard antibiotics. We posit that based on the inhibition capacity, further  studies to characterize, purify and isolate the active anti-bacterial components in the extracts should be considered for novelty.&nbsp

Preliminary screening of some fractions of Loxostylis alata (Anacardiaceae) for antimicrobial and antioxidant activities

An acetone extract of Loxostylis alata was separated into six fractions based on polarity by a solventsolvent fractionation procedure and the different fractions were screened for antimicrobial and antioxidant activities. The number of antimicrobial compounds in the carbon tetrachloride (CCl4), chloroform (CC), aqueous methanol (AM) and butanol (BT) fractions were determined by bioautography. Each fraction was loaded onto thin layer chromatography (TLC) plates and eluted using two different mobile solvent systems, namely chloroform/ethyl acetate/formic acid (5:4:1): (CEF) and ethyl acetate/methanol/water (40:5.4:5) (EMW). Relative front (Rf) values of active compounds against bacteria ranged from 0.4 - 0.9 in CEF and EMW solvent system. Similarly, the Rf values of compounds active against fungi were in the range of 0.7 - 0.9. Hexane, carbon tetrachloride, chloroform, aqueous methanol and butanol fractions showed areas of inhibition against bacterial organisms, while only hexane and carbon tetrachloride fractions depicted areas of fungal growth inhibition on their chromatograms. The CCl4 extract was active against six out of the nine microbial strains used and was particularly active against Staphylococcus aureus, Enterococcus faecalis, Aspergillus fumigatus, Candida albicans, Cryptococcus neoformans and Microsporum canis with minimum inhibitory concentration (MIC) of 0.04, 0.04, 0.1, 0.1, 0.06 and 0.03 mg/ml, respectively. M. canis was the most sensitive organism with the lowest average MIC of 0.16 mg/ml. Qualitative antioxidation using diphenylpicryl- hydrazyl (DPPH) and qualitative assay using both 2,2'-azinobis-3-ethylbenzothiazoline-6- sulfonate (ABTS) and DPPH radicals revealed the presence of three antioxidant compounds in the AM and BT fractions, while the water fraction had only one antioxidant compound. However, the concentration of the antioxidant compounds was more in the AM and BT fractions as revealed by their pronounced colour intensity on the TLC plates. The water fraction had more free radical scavenging effect against DPPH with EC50 value of 0.62 ± 0.03 μg/ml. The lower the EC50 value of an extract, the more effective its antioxidant activity. In a similar manner, TEAC value of water fraction was 2.97, which further indicates superior free radical scavenging effect of the fraction against ABTS radical. The greatest reduction of reactive oxygen species (ROS) production induced by diclofenac was also achieved by the water fraction which on overall shows that the water fraction contains more antioxidants. The presence of antimicrobial and antioxidant activities in the fractions of L. alata suggests that this plant may be a source of pharmacologically active substances with beneficial actions towards disease control and treatment in animals and humans.The South African National Research Foundation and the Research Committee, Faculty of Veterinary Science, University of Pretoria, South Africa.http://www.academicjournals.org/AJB/mn201

Knowledge of Factors Contributing to Child Malnutrition among Mothers of Under-five Children in Sokoto Metropolis, North-West Nigeria

Background: Malnutrition remains a killer of children, especially in Sub-Saharan Africa. In Nigeria, malnutrition is among the top five killers of children under five years of age. This study aimed to assess the knowledge of factors contributing to child malnutrition among mothers of under-fives.Methods: A cross-sectional study was conducted among 347 mothers of under-five children who were selected using a multistage sampling technique from January to March 2018. Data were collected using an interviewer-administered questionnaire. Data were analysed using IBM SPSS® version 20.0. Descriptive statistics, crude and adjusted Odds Ratio (OR) with 95% Confidence Interval (CI) in cross-tabulation and binary logistic regression analysis, respectively, were estimated.Results: More than half, 198 (57.0%) were aged 40 years and below. Most, 324 (93.4%) of the respondents were Hausas, with only 45 (13.0%) having tertiary education. Majority of the respondents, 326 (93.9%) knew that diarrhoea-causing diseases could lead to malnutrition. About two-thirds, 222 (64.0%) knew that deworming could protect a child from malnutrition. Less than half, 169 (48.7%) did not know that overeating starchy food can cause malnutrition. Overall, majority 216 [62.2% (95% CI = 56.9% - 67.4%)] of the respondents had good knowledge of factors associated with malnutrition. There were no statistically significant predictors of knowledge of factors contributing to malnutrition.Conclusion: Mothers of under-five children in Sokoto metropolis had a high level of knowledge of the factors contributing to child malnutrition. However, there is still a need to continue educating mothers of under-five children on the importance of maintaining proper nutrition for their children. Keywords: Awareness; Factors; Knowledge; Malnutrition; Mothers; Under-fiv

NITRIC OXIDE INHIBITORY ACTIVITY OF STRYCHNOS SPINOSA (LOGANIACEAE) LEAF EXTRACTS AND FRACTIONS

Background: The study was aimed at determining the anti-inflammatory activity of fractions and extracts obtained from Strychnos spinosa leaves on a mediator of inflammation nitric oxide (NO). Materials and Methods: Leaves were extracted with acetone and separated into fractions with different polarities by solventsolvent fractionation. The Griess assay was used to determine the nitric oxide (NO) inhibitory activity. Cellular toxicity was determined by "using the MTT reduction assay". Results: With the exception of the ethyl acetate fraction which had an IC50 >750 μg/mL, all extracts and fractions had significant nitric oxide-inhibitory activity. The most active being the water fraction, chloroform fraction and the dichloromethane/methanol extracts with IC50 values of 88.43 μg/mL, 96.72 μg/mL and 115.62 μg/mL, respectively. The extracts and fractions had low cytotoxicity on macrophage U937 cell lines. Conclusion: Extracts and fractions of Strychnos spinosa leaves may be promising sources of natural anti-inflammatory agents. Findings obtained from this study showed that Strychnos spinosa leaves possess promising anti-inflammatory action and could be used in the treatment of inflammation-related conditions

A controlled study to determine the efficacy of Loxostylis alata (Anacardiaceae) in the treatment of aspergillus in a chicken (Gallus domesticus) model in comparison to ketoconazole

BACKGROUND: The poultry industry due to intensive methods of farming is burdened with losses from numerous infectious agents, of which one is the fungus Aspergillus fumigatus. In a preliminary study, the extracts of Loxostylis alata A. Spreng, ex Rchb. showed good activity in vitro against A. fumigatus with a minimum inhibitory concentration of 0.07 mg/ml. For this study crude, a crude acetone extract of L. alata leaves was evaluated for its acute toxicity in a healthy chicken model and for efficacy in an infectious model of aspergillosis (A. fumigatus). RESULTS: At a dose of 300 mg/kg, the extract induced some toxicity characterised by decreased feed intake and weight loss. Consequently, 100 and 200 mg/kg were used to ascertain efficacy in the infectious model. The plant extract significantly reduced clinical disease in comparison to the control in a dose dependant manner. The extract was as effective as the positive control ketoconazole dosed at 60 mg/kg. CONCLUSIONS: The results indicate that a crude extract of L. alata leaves has potential as an antifungal agent to protect poultry against avian aspergillosis.The South African National Research Foundation and the Research Committee of the Faculty of Veterinary Science, University of Pretoriahttp://www.biomedcentral.com/1746-6148/8/210am2013mn201

Antimicrobial Stewardship Implementation in Nigerian Hospitals: Gaps and Challenges

Background: Antimicrobial resistance (AMR) is a major clinical challenge globally. It is mainly a consequence of inappropriate prescribing and use of antibiotics. Antimicrobial stewardship (AMS) ensures that antibiotics are prescribed and used appropriately. This study assessed AMS practice in selected Nigerian hospitals.Methodology: This was a cross sectional survey of 20 Federal, State and Private tertiary hospitals randomly selected from the six geopolitical zones of Nigeria. Using an adapted WHO tool on AMS, data were collected from each hospital as regard the existence of AMS committee, Accountability and Responsibility, AMS actions, Education and Training, Monitoring and Evaluation, Infection Prevention and Control (IPC) practice, facilities to support AMS, and challenges to AMS implementation. Gaps and challenges to the implementation of the AMS among the hospitals were identified.Results: Only 6 (30%) of the 20 hospitals had AMS committees while 2 (10%) had any evidence of leadership commitment to AMS. All the hospitals had laboratory facilities to support culture and sensitivity testing. There were no regular AMS-related education or training, monitoring, evaluation or reporting activities in the hospitals, except in 7 (25%) that had participated in the global point prevalence survey (Global-PPS) of antimicrobial use and resistance being hosted by the University of Antwerp, Belgium. Challenges impeding AMS activities included lack of human and financial resources, prescribers’ opposition, lack of awareness and absence of AMS committees. Most of the gaps and challenges bordered on seeming lack of knowledge and inadequate communication among prescribers and other stakeholders.Conclusion: There is need for intense education and training activities for prescribers and other stakeholders, including but not limited to hospital administrators. Keywords: Survey, Antimicrobial Stewardship, Antimicrobial Resistance; Nigeria   French title: Mise en œuvre de la gestion des antimicrobiens dans les hôpitaux Nigérians: lacunes et défis Contexte: La résistance aux antimicrobiens (RAM) est un défi clinique majeur à l'échelle mondiale. C'estprincipalement une conséquence d'une prescription et d'une utilisation inappropriées d'antibiotiques. La gestion des antimicrobiens (AMS) garantit que les antibiotiques sont prescrits et utilisés de manière appropriée. Cette étude a évalué la pratique de l'AMS dans certains hôpitaux Nigérians. Méthodologie: Il s'agissait d'une enquête transversale de 20 hôpitaux tertiaires fédéraux, d'État et privéssélectionnés au hasard dans les six zones géopolitiques du Nigéria. À l'aide d'un outil OMS adapté sur l'AMS, des données ont été collectées auprès de chaque hôpital en ce qui concerne l'existence d'un comité AMS, la responsabilité et la responsabilité, les actions AMS, l'éducation et la formation, le suivi et l'évaluation, la  pratique de prévention et de contrôle des infections (IPC), les installations pour soutenir l'AMS. et les défis de la mise en œuvre de l'AMS. Les lacunes et les défis liés à la mise en œuvre de l'AMS parmi les hôpitaux ont été identifiés. Résultats: Seuls 6 (30%) des 20 hôpitaux avaient des comités AMS tandis que 2 (10%) avaient des preuves d'engagement du leadership envers l'AMS. Tous les hôpitaux disposaient d'installations de laboratoire pour soutenir la culture et les tests de sensibilité. Il n'y avait pas d'activités régulières d'éducation ou de formation, de suivi, d'évaluation ou de rapportage liées à la MGS dans les hôpitaux, sauf dans 7 (25%) qui avaient participé à l'enquête mondiale sur la prévalence ponctuelle (Global-PPS) de l'utilisation et de la résistance aux  antimicrobiens organisée par l'Université d'Anvers, Belgique. Les défis entravant les activités de l'AMS  comprenaient le manque de ressources humaines et financières, l'opposition des prescripteurs, le manque de sensibilisation et l'absence de comités AMS. La plupart des lacunes et des défis se limitaient à un manque apparent de connaissances et à une communication inadéquate entre les prescripteurs et les autres intervenants.Conclusion: Des activités d'éducation et de formation intensives sont nécessaires pour les prescripteurs et autres intervenants, y compris, mais sans s'y limiter, les administrateurs d'hôpitaux. Mots clés: enquête, gestion des antimicrobiens, résistance aux antimicrobiens; Nigeria   &nbsp

Corrigendum: Antimicrobial Stewardship Implementation in Nigerian Hospitals: Gaps and Challenges

No Abstract