DNA microarray analysis of 'Staphylococcus aureus' from Nigeria and South Africa

'Staphylococcus aureus' is an important human pathogen with an arsenal of virulence factors and a propensity to acquire antibiotic resistance genes. The understanding of the global epidemiology of 'S. aureus' through the use of various typing methods is important in the detection and tracking of novel and epidemic clones in countries and regions. However, detailed information on antibiotic resistance and virulence genes of 'S. aureus', and its population structure is still limited in Africa. In this study, 'S. aureus' isolates collected in South Africa (n = 38) and Nigeria (n = 2) from 2001–2004 were characterized by spa typing and DNA microarray. The combination of these two methods classified the isolates into seven spa types and three clonal complexes (CCs) i.e. t064-CC8 (n = 17), t037-CC8 (n = 8), t1257-CC8 (n = 6), t045-CC5 (n = 5), t951-CC8 (n = 1), t2723-CC88 (n = 1), t6238-CC8 (n = 1), and untypeable-CC8 (n = 1). A high percentage agreement (>95%) and kappa coefficient (>0.60) was largely observed with antibiotic susceptibility testing and DNA microarray, indicating substantial agreement. Some antibiotic and virulence gene markers were associated with specific clones. The detection of the collagen-binding adhesion ('cna') gene was unique for t037-CC8-MRSA while the enterotoxin gene cluster ('egc') and staphylococcal complement inhibitor ('scn') gene were identified with t045-CC5-MRSA. Moreover, the combination of genes encoding enterotoxins ('entA', 'entB', 'entK', 'entQ') was noted with most of the CC8 isolates. The t045-CC5-MRSA clone was positive for the mercury resistance ('mer') operon. DNA microarray provides information on antibiotic resistance and virulence gene determinants and can be a useful tool to identify gene markers for specific 'S. aureus' clones in Africa

Efficacy and safety of low-intensity extracorporeal shockwave therapy for treatment of vascular erectile dysfunction in Nigerian men: Report of a study in Ibadan, south-west Nigeria

Background: Low Intensity Extracorporeal Shock Wave Therapy (LI-SWT) has been found to be effective in men with vascular erectile dysfunction (ED) but its efficacy and safety has not been investigated in a  predominantly black population so we sought to study this. Materials and Methods: Men with vascular erectile dysfunction (ED) were assessed using the five-item  International Index of Erectile Function (IIEF) score after which they were treated with 12 sessions of LI-  SWT. Treatment efficacy was evaluated immediately after treatment, at 1 month and 6 months after using  the IIEF questionnaire. 30 persons were recruited out of which 22 completed the study. Results: Mean IIEF score improved from 8.27+2.741 at baseline (pre-treatment) to 10.43 ± 8.43 one  month post treatment and was sustained six months post treatment at mean IIEF score of 10.70 + 8.84. A larger no (86.4%) had an improvement of at least 5 in the IIEF score from baseline to 6 months -post  treatment. None of the participants reported any adverse effects of treatment. Conclusion: Low intensity shock wave treatment is a useful addition to the medical armamentarium for the treatment of vascular ED

Day case endourology in surgical outpatient clinic at Ibadan: A 5 year review

Objective: To review our day case endourological practice over a five-year period. Subjects and methods: Data was obtained from the endourology day case register and these were analysed using simple statistical methods. Caudal anaesthesia and intravenous sedatives were used for the procedures. Results: A total of 559 patients underwent endoscopic procedures as day cases. Their ages ranged from 10 to 88 years, with a male to female ratio of 4 to 1. Four hundred and thirty eight (78.4%) were diagnostic and 121 (21.6%) were therapeutic. The main diagnostic procedures were urethrocystoscopy (n = 222), and cystoscopy alone (n = 116), cystoscopy and biopsy (n = 46) while the therapeutic procedures were direct visual internal urethrotomy (n = 86), endoscopic cystolitholapaxy (n = 10), and rigid retrograde endoscopic realignment (n = 7) for posterior urethral injury. The main anaesthesia was caudal block in 472 patients and topical 2% xylocaine jelly with sedation in 86 patients. Conclusions: There is a steady increase in therapeutic day case endourology. Caudal anaesthesia provides effective pain free procedure to the patient. Surgical trainees can benefit by learning the technique of caudal block anaesthesia

The UCH bladder manikin – A locally designed teaching aid for suprapubic catheterization in low-resource countries

Introduction and objectives: The ability to perform emergency open or percutaneous suprapubic catheterization (SPC) is an indispensable skill in medical practice. In Nigeria, the majority of the general medical practitioners and non-urological residents lack formal training in SPC. A low-cost manikin was designed to train such doctors. This paper describes the development of the manikin and assesses its usefulness in teaching SPC. Methods: The Ibadan PIUTA (Pan African Urological Surgeons Association [PAUSA] Initiative for Urological Training in Africa) Centre organized a workshop during which general medical practitioners and non-urological residents were taught SPC using the locally manufactured manikin. At the end, the effectiveness of the manikin in SPC training was assessed using questionnaires. Six months later, the questionnaires were distributed again to the surgical residents to evaluate the impact of the training on their practice. Results: Twenty-five medical practitioners attended the workshop. The open and closed techniques were taught using the manikin. By the end of the workshop, 100% of the participants stated that the manikin was an effective teaching aid. Six months later, 67% of the surgical residents had independently performed successful SPCs, using the percutaneous technique alone (83%) or both the open and percutaneous methods (17%). Conclusion: The UCH bladder manikin is an effective, low-cost and easily manufactured aid for teaching doctors emergency SPC. We recommend its use in centers in low-resource countries

First Report of a Methicillin-Resistant, High-Level Mupirocin-Resistant 'Staphylococcus' argenteus

We describe the identification of a methicillin-resistant, high-level mupirocin-resistant Staphylococcus argenteus. The isolate (1801221) was characterized as t6675-ST2250-SCCmecIVc, and whole-genome sequencing revealed that the isolate possessed two plasmids. One plasmid (34,870 bp), designated p1_1801221 with rep23, harboured the mupirocin resistance (mupA) gene. The second plasmid (20,644 bp), assigned as p2_1801221 with rep5a and rep16, carried the resistance determinants for penicillin (blaZ) and cadmium (cadD). Phylogenetic analysis revealed that the isolate clustered with the European ST2250 lineage. The overall high similarity of both plasmids in S. argenteus with published DNA sequences of Staphylococcus aureus plasmids strongly suggests an interspecies transfer. The pathogenic potential, community and nosocomial spread, and acquisition of antibiotic resistance gene determinants, including the mupA gene by S. argenteus, highlight its clinical significance and the need for its correct identification