Histologic Analysis of Gynaecologic Lesions in Nigerians

Background: Gynaecological neoplasms are a cause of significant morbidity and mortality in females all over the world.Objective: To determine the pattern of gynaecological lesions seen in Me Cure Healthcare, Lagos  Nigeria.Design: A descriptive retrospective study.Setting: Histopathology section of Me Cure Healthcare Limited from August 2009 to August 2014.Subjects: Histopathological reports and paraffin sections of gynaecologic lesions/ specimens which were diagnosed by Me Cure Healthcare.Results: A total of 691 gynaecologic specimens were received. The youngest patient was 14 years, while the oldest patient was 79 years with a mean age of 40.47 years and Std of ± 10.59. Eighty three percent  of specimens were benign neoplastic lesions, while 5.9% of specimens were malignant neoplastic   lesions. Uterine leiomyomas were the most common lesions and majority of them were seen in age  groups 30-39 and 40-49 years. Simple endometrial hyperplasia without atypia accounted for most   endometrial lesions (52,3%) and were seen more in age groups 30-39 and 40-49 years. Most ovarian  lesions (45.9%) were non neoplastic cysts and seen more in age groups 20-29 and 30-39 years. The  cancers seen were those of the cervix (56.1%), endometrium (22%), ovary (14.6%), uterus (4.9%) and choriocarcinoma (2.4%) in that order. Cervical cancer was seen in 36.5% of cervical lesions and involved mainly age groups; 30-39 years, 50-59 years and 60-69 years (each of these age groups had five cases). The mean age for cases of cancer of the cervix was 50 years Std ± 13.0 and all the age groups except 10-19 years were involved.Conclusion: Benign lesions were the most common with uterine leiomyoma accounting for most of them, while cervical carcinoma was the the common gynaecological cancer. Endometrial cancer cases were noted to be on the rise

Prevalence and risk factors of acute gastroenteritis caused by Rotavirus among children in tertiary hospitals, southeastern Nigeria

Background: Diarrhea is a worldwide problem and rotavirus is the commonest viral etiologic agent. In Nigeria, diarrhea causes more than 315,000 deaths of preschool-age children annually. In Ebonyi State, it is among the leading causes of pediatric emergency visits and one of the major causes of infant morbidity and mortality. This study was aimed at determining the prevalence and associated risk factors of acute gastroenteritis due to rotavirus infection among under-five children in Abakaliki, Ebonyi state. Methodology: This was a cross-sectional study of 275 children under 5 years of age hospitalized for acute watery diarrhea, who were consecutively recruited into the study. Stool samples were collected from each child for rotavirus antigen detection using an enzyme-linked immunosorbent assay (ELISA). Socio-demographic information of each child and selected risk factors were collected using structured questionnaire. Data analysis was done on SPSS software version 20.0, and association of demographic characteristics and risk factors with rotavirus diarrhoea was measured using Chi-square test, odds ratio (and 95% confidence interval). Significant value was set at p < 0.05. Results: The prevalence of rotavirus diarrhea among children under 5 years of age in this study was 26.5% (73/275). Aside from educational level of the mothers, there was no significant association between any of the sociodemographic characteristics and prevalence of rotavirus diarrhoea (p>0.05). Although the prevalence of diarrhoea in the children was lower with the use of maize gruel (pap) as weaning feed (26.3%, 71/270) compared to the use of other complementary feeding such as ‘Cerelac’ and ‘NAN’ (40%, 2/5), this association did not reach a significant level(OR=0.5352, 95% CI=0.0875-0.3270, p=0.6110), probably due to the small number of children weaned using other complementary feeds. Conclusion: The relatively high prevalence of rotavirus diarrhea in children under 5 years of age in this study is an indication of the need for the parents/guardians of these children to improve child feeding hygiene

Evaluation of procalcitonin as a biomarker of bacterial sepsis in adult population in a tertiary healthcare facility in Lagos, Nigeria

Background: Prompt antibiotic treatment of sepsis improves the outcome, but dependence on clinical diagnosis for empiric therapy leads to overuse of antibiotics which in turn promotes the emergence of antibiotic resistance. Blood culture takes time and molecular diagnosis may not be available or affordable. The use of procalcitonin (PCT) as a biomarker to guide antibiotic therapy in adults is less established compared to children. This study was therefore designed to evaluate the usefulness of PCT as a biomarker to aid early commencement of antibiotics among adult patients with sepsis in a tertiary healthcare facility in Lagos, Nigeria. Methodology: Three hundred patients with clinical diagnosis of sepsis made by the managing physicians were recruited for the study. Criteria used for clinical diagnosis of sepsis include tachycardia, tachypnea, fever or hypothermia and presence of leukocytosis, bandemia or leucopenia. The patients were selected using systematic consecutive sampling methods. A sepsis work-up including quick sequential organ failure assessment (qSOFA), white blood cell count (WCC), aerobic blood culture and estimation of serum PCT levels were done for all the participants. Data were analysed using the Statistical Package for Social Sciences (SPSS) for windows version 25.0. Sensitivity, specificity, positive, and negative predictive values, accuracy and likelihood ratio of PCT against blood culture, WCC and qSOFA score were determined. Association between variables was measured using Fisher exact test (with Odds ratio and 95% confidence interval). P-value ˂0.05 was considered statistically significant. Results: There were 127 (42.3%) males and 173 (53.7%) females with the mean age of 44.9±14.5 years. Majority (96.2%, n=75/78) of the patients who were culture positive for bacterial pathogens had PCT level ≥10ng/ml, which showed statistically significant association of bacteraemia with PCT level (OR=1362.5, 95% CI=297.9-6230.5, p˂0.0001). At PCT cut-off value of 0.5ng/ml, the negative predictive value of 100% almost confirms absence of systemic bacterial infection. The high sensitivity, specificity, positive predictive value, negative predictive value,accuracy and likelihood ratio of 94.9%, 98.6%, 96.2%, 98.2%, 97.7%, and 69.9 respectively recorded at PCT level of 10ng/ml indicates that this cut-off level is strongly diagnostic of systemic bacterial infection. Conclusion: In this study, we observed that PCT levels were significantly higher in patients with positive culture (bacteraemia) and PCT was able to differentiate bacterial sepsis from non-bacterial infections. The findings of this study support the usefulness of PCT as a biomarker for early diagnosis of systemic bacterial infections in adult patients.   French title: Évaluation de la procalcitonine en tant que biomarqueur de la septicémie bactérienne chez la population adulte dans un établissement de soins de santé tertiaires à Lagos, au Nigeria Contexte: Un traitement antibiotique rapide de la septicémie améliore les résultats, mais la dépendance au diagnostic clinique pour le traitement empirique conduit à une surutilisation des antibiotiques qui à son tour favorise l'émergence de la résistance aux antibiotiques. L'hémoculture prend du temps et le diagnostic moléculaire peut ne pas être disponible ou abordable. L'utilisation de la procalcitonine (PCT) comme biomarqueur pour guider l'antibiothérapie chez l'adulte est moins établie que chez l'enfant. Cette étude a donc été conçue pour évaluer l'utilité de la PCT en tant que biomarqueur pour faciliter le début précoce des antibiotiques chez les patients adultes atteints de septicémie dans un établissement de soins de santé tertiaire à Lagos, au Nigeria. Méthodologie: Trois cents patients avec un diagnostic clinique de septicémie posé par les médecins traitants ont été recrutés pour l'étude. Les critères utilisés pour le diagnostic clinique du sepsis comprennent la tachycardie, la tachypnée, la fièvre ou l'hypothermie et la présence d'une leucocytose, d'une bandémie ou d'une leucopénie. Les patients ont été sélectionnés à l'aide de méthodes d'échantillonnage consécutifs systématiques. Un bilan de septicémie comprenant une évaluation séquentielle rapide des défaillances d'organes (qSOFA), une numération des globules blancs (WCC), une hémoculture aérobie et une estimation des taux sériques de PCT a été effectué pour tous les participants. Les données ont été analysées à l'aide du package statistique pour les sciences sociales (SPSS) pour Windows version 25.0. La sensibilité, la spécificité, les valeurs prédictives positives et négatives, la précision et le rapport de vraisemblance de la PCT par rapport à l'hémoculture, le WCC et le score qSOFA ont été déterminés. L'association entre les variables a été mesurée à l'aide du test exact de Fisher (avec rapport de cotes et intervalle de confiance à 95 %). La valeur P ˂0,05 a été considérée comme statistiquement significative. Résultats: Il y avait 127 (42,3%) hommes et 173 (53,7%) femmes avec un âge moyen de 44,9±14,5 ans. La majorité (96,2%, n=75/78) des patients dont la culture était positive pour les agents pathogènes bactériens avaient un taux de PCT ≥ 10ng/ml, ce qui a montré une association statistiquement significative de la bactériémie avec le taux de PCT (OR=1 362,5, IC à 95%=297,9-6230.5, p˂0.0001). À la valeur seuil PCT de 0,5ng/ml, la valeur prédictive négative de 100% confirme presque l'absence d'infection bactérienne systémique. La sensibilité élevée, la spécificité, la valeur prédictive positive, la valeur prédictive négative, l'exactitude et le rapport de vraisemblance de 94,9%, 98,6%, 96,2%, 98,2%, 97,7% et 69,9 respectivement enregistrés au niveau PCT de 10 ng/ml indiquent que cette réduction- hors niveau est fortement le diagnostic d'une infection bactérienne systémique. Conclusion: Dans cette étude, nous avons observé que les taux de PCT étaient significativement plus élevés chez les patients ayant une culture positive (bactériémie) et que la PCT était capable de différencier la septicémie bactérienne des infections non bactériennes. Les résultats de cette étude confirment l'utilité de la PCT en tant que biomarqueur pour le diagnostic précoce des infections bactériennes systémiques chez les patients adultes

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

Stable-isotope techniques to investigate sources of plant water

Stable isotopologues of water (mainly 1H216O, HD16O and 1H218O) have been used for decades as tracers of the Earth's water cycle. In this chapter, we briefly describe the theoretical background and state-of-the-art techniques of the use of water stable isotopes to investigate the sources of plant water. We aim to provide the basic understanding of stable isotope fractionation within the Earth's critical zone that is relevant for studies of plant water sources. We then present a practical guide of their most common applications in field studies and the most common and up-to-date laboratory procedures. We finally introduce the existing statistical approaches for estimating the relative contributions of water sources to plant transpiration. By acknowledging the advantages and limitations of each approach, we aim to provide an overview of the current techniques to researchers in the fields of plant ecophysiology, ecohydrology and forest ecology, so that they can make informed decisions when designing their experiments

Poor utilization of medical microbiology laboratory by clinicians in a tertiary hospital in Lagos State Nigeria

Background: The clinical diagnosis of infection without laboratory confirmation leads to overprescription of antimicrobials and the resultant antimicrobial resistance. Global point prevalence survey done in Lagos University Teaching Hospital showed low targeted antimicrobial therapy meaning poor utilization of Medical Microbiology laboratory for the diagnosis of infections This study is aimed at finding the reasons for poor utilization of the Medical Microbiology laboratory for the diagnosis of infectionsMethods: A cross sectional survey of clinicians in Lagos University Teaching Hospital was conducted using self-administered structured questionnaire to obtain information on utilization of the medical microbiology laboratory for diagnosis of infections.Result: Two hundred and four doctors from various departments responded to our questionnaire amongst whom were: houseofficers (13.7%), junior registrars (36.3%), senior registrars (34.3%), consultant (11.3%) and medical officers (4.4%). The years of practice were: 1 – 10years (77.3%), 11 – 20 years (14.8%), 21 – 30 years (4.4%), >30 years (3.5%). One hundred and forty four participants (70.6%) reported good use of Microbiology laboratory for the diagnosis of infection. Of 60 participants (29.4%) that reported poor use of Medical Microbiology laboratory, only 41 gave reasons. The main reason for poor utilization was that “Clinical diagnosis is sufficient” (56.1%), followed by” Results are often delayed and end up being irrelevant to patient management” (22.0%). Only 7.3% reported that their reason for poor use of the Microbiology laboratory was that their patient cannot afford the cost. Other reasons were: 'No access to Medical Microbiology Laboratory” (4.9%), 'No confidence in the accuracy of laboratory result” (4.9%) “Already know potent antibiotics, so there's no need for laboratory test”. None of the participants gave the following reasons: “No pathologist to ensure the quality of laboratory services” and “Don't need Medical Microbiology laboratory to manage patients with infection”. Microscopy, culture and sensitivity was the investigation most often requested for (63.7%) participants) while antigen detection was the Two hundred and four doctors from various departments responded to our questionnaire amongst whom were: house least (6.4 %) participants. Of all the variables assessed, only being a senior registrar was associated with good use of medical microbiology laboratory.Conclusion:This result showed poor utilization of the laboratory (29.2%) and the main reason for this poor utilization is the presumption by prescribers that clinical diagnosis is sufficient for the diagnosis of infection (56.1%). Prescribers should be educated on the use of the Medical Microbiology for targeted antimicrobial therapy

Species differences in the seasonality of evergreen tree transpiration in a Mediterranean climate: Analysis of multiyear, half-hourly sap flow observations

In Mediterranean climates, the season of water availability (winter) is out of phase with the season of light availability and atmospheric moisture demand (summer). We investigate the seasonality of evergreen tree transpiration in a Mediterranean climate, using observations from a small (4000 m2), forested, steep (32) hillslope, in the northern California Coast Range. We analyze 3 years of half-hourly measurements from 39 sap flow sensors in 26 trees, six depth profiles of soil moisture measured by TDR, and spatially distributed measurements of micrometeorology from five locations. The sap flow measurements show that two common evergreen tree species have different seasons of peak transpiration. Douglas-firs (Pseudotsuga menziesii) maintain significant transpiration through the winter rainy season and transpire maximally in the spring, followed by a sharp decline in transpiration in the summer dry season. Pacific madrones (Arbutus menziesii), and to a lesser extent other broadleaf evergreen species (Quercus wislizeni, Notholithocarpus densiflorus, Umbellularia californica), in contrast, transpire maximally in the summer dry season. The seasonal patterns are quantified using principal component analysis. Markov chain Monte Carlo estimation of response to environmental variables shows that the difference in transpiration seasonality arises from different sensitivities to atmospheric evaporative demand and root-zone moisture. The different sensitivities to atmospheric evaporative demand also create species differences in transpiration variability at synoptic time scales. Using the sap flow measurements and a regional forest inventory, a bottom-up regional transpiration estimate is constructed. The estimate suggests that sensitivity of Douglas-fir transpiration to water stress suppresses dry season evapotranspiration at the regional scale. Key Points Three year, half-hourly record of sap flow, micrometeorology, and soil moisture PCA shows offset in peak transpiration season between needleleaf and broadleaf species Douglas-fir water stress response could reduce dry season transpiration at large scale © 2014. American Geophysical Union. All Rights Reserved

Species differences in the seasonality of evergreen tree transpiration in a Mediterranean climate: Analysis of multiyear, half-hourly sap flow observations

In Mediterranean climates, the season of water availability (winter) is out of phase with the season of light availability and atmospheric moisture demand (summer). We investigate the seasonality of evergreen tree transpiration in a Mediterranean climate, using observations from a small (4000 m2), forested, steep (32) hillslope, in the northern California Coast Range. We analyze 3 years of half-hourly measurements from 39 sap flow sensors in 26 trees, six depth profiles of soil moisture measured by TDR, and spatially distributed measurements of micrometeorology from five locations. The sap flow measurements show that two common evergreen tree species have different seasons of peak transpiration. Douglas-firs (Pseudotsuga menziesii) maintain significant transpiration through the winter rainy season and transpire maximally in the spring, followed by a sharp decline in transpiration in the summer dry season. Pacific madrones (Arbutus menziesii), and to a lesser extent other broadleaf evergreen species (Quercus wislizeni, Notholithocarpus densiflorus, Umbellularia californica), in contrast, transpire maximally in the summer dry season. The seasonal patterns are quantified using principal component analysis. Markov chain Monte Carlo estimation of response to environmental variables shows that the difference in transpiration seasonality arises from different sensitivities to atmospheric evaporative demand and root-zone moisture. The different sensitivities to atmospheric evaporative demand also create species differences in transpiration variability at synoptic time scales. Using the sap flow measurements and a regional forest inventory, a bottom-up regional transpiration estimate is constructed. The estimate suggests that sensitivity of Douglas-fir transpiration to water stress suppresses dry season evapotranspiration at the regional scale. Key Points Three year, half-hourly record of sap flow, micrometeorology, and soil moisture PCA shows offset in peak transpiration season between needleleaf and broadleaf species Douglas-fir water stress response could reduce dry season transpiration at large scale © 2014. American Geophysical Union. All Rights Reserved

Vegetation induced changes in the stable isotope composition of near surface humidity

Obtaining the d-excess parameter from oxygen and hydrogen stable isotope composition of meteoric waters has the potential power to reconstruct changes in atmospheric water pools (e,g. sources, origins and overall balance) and the climatic conditions that prevail during surface evaporation. Recently, plant and ecosystem scientists turned their attention using d-excess information to inform questions at these scales. Here, we use the d-excess parameter to evaluate the influence of forest canopies on atmospheric humidity within a mixed evergreen forest in coastal California. We found that during the day, when transpiration was at a maximum, the d-excess of atmospheric water vapour exceeded model predictions for the background atmosphere into which the ecosystem evapotranspiration mixes. At night when transpiration was minor, the d-excess of atmospheric water vapour was on average less than model predictions for an ocean derived water vapour source. The observed diurnal fluctuations around the d-excess of the modelled background water vapour provided a strong evidence that during the day as the land surface warms and the boundary layer grows plants alter the isotope composition of atmospheric humidity via non-steady state isotope effects. In contrast, at night equilibrium isotope effects dominate as the atmosphere stabilizes. These day and nighttime fluctuations around the d-excess of ocean derived water vapour highlight the importance of plant transpiration for the isotope hydrology of near surface humidity and subsequently for the isotope composition of condensate like dew, an important water input to this ecosystem. © 2013 John Wiley & Sons, Ltd