艾滋病合并肺结核X线表现特征

目的：探讨艾滋病合并肺结核X线表现特征,以减少误诊。方法回顾分析28例经临床检验证实的艾滋病合并肺结核X线表现。结果病灶累及单个肺野5例,两个肺野10例,两侧全肺野13例。治疗后复查,大部分病例经单纯抗结核治疗,不能有效遏制病灶的进展。结论艾滋病合并肺结核X线表现病变范围广、发病部位无规律、类型不典型,还具有反复性、变化快,常合并有其它机遇性感染的特点。     

Prevalence of EHEC O157:H7 in patients with diarrhoea in Lagos, Nigeria

The prevalence of sorbitol-nonfermenting Escherichia coli O157:H7 (EHEC) was assessed in 100 patients with diarrhoea by stool culture on sorbitol MacConkey agar. The cytotoxicity of the EHEC strains was analysed by Vero cell assay and the antimicrobial susceptibility pattern of the isolates was determined. Detection rate of EHEC O157:H7 was 6%. Five of the six patients were males. Three of the isolates were from children and one was from a teenager. All strains induced cytotoxic effects in the Vero cell assay. All isolates were susceptible to most of the antimicrobials tested. The results showed that diarrhoea caused by EHEC O157:H7, a potentially life-threatening pathogen, has remained common particularly among the child population of Lagos during the past 10 years (5). There must therefore be adequate meat and food inspection to improve the general hygiene of local fast food restaurants, so-called 'bukkas', which are regarded as likely sources of infection.     

Antibiotic susceptibility of microorganisms at a general hospital in Lagos,Nigeria

OBJECTIVE: To determine susceptibility patterns of microorganisms to antibiotics in a large general hospital in Lagos, Nigeria. METHODS: Clinical samples received in the laboratory were processed according to standard methods. Susceptibility to antibiotics was done using a disk diffusion technique. RESULTS: Five hundred and fifty-one samples from urine, wound, reproductive tract and other body fluids were analysed. The most frequently isolated pathogens (n=586) were Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae. Most of the organisms were sensitive to ciprofloxacin, perfloxacin, cefuroxime, ceftriaxone and azithromycin but were resistant to ampicillin, cotrimoxazole and penicillin. Pseudomonas aeruginosa was multi-resistant. The susceptibility pattern obtained at this hospital is similar to what obtains in teaching hospitals in Nigeria. CONCLUSION: Microorganisms isolated at this hospital are more sensitive to newer antibiotics.     

Genotypic Characterisation of Mycobacterium tuberculosis Isolates from Tuberculous Meningitis Patients at a Tertiary Neurocare Centre in Southern India

Aims: Specific genotypes of Mycobacterium tuberculosis (MTB) have been reported to cause outbreaks of pulmonary tuberculosis (TB) in geographical areas that are endemic to TB. However, since there is little epidemiological evidence on the association of particular genotypes that cause tuberculous meningitis (TBM), we sought to investigate the association of specific MTB strains with infection of the central nervous system (CNS). Materials and Methods: We carried out a genetic characterisation of 89 MTB isolates from TBM patients at a Southern Indian tertiary neurocare centre and compared the genotypes with strains of pulmonary TB isolated from Indian immigrants in New York City. We applied the standard methods of genotyping of MTB, namely, IS6110-based restriction fragment length polymorphism and spoligotyping for strain identification, along with principal genetic grouping and single-nucleotide polymorphism cluster analysis. Results: The analysis revealed a high-level of diversity amongst the strain population. The genotypes of the isolates from TBM patients paralleled the pulmonary TB strain population recovered from the Indian immigrants in NYC. Conclusions: We conclude that there is no apparent association between genotypes of MTB and propensity to infect CNS tissue.     

Utility of GeneXpert in the Diagnosis,Reliance on Urine Microscopy and Clinical Characteristics of Genitourinary Tuberculosis at a Tertiary Care Hospital

Background: One-third of the world’s population is infected with tuberculosis (TB) with new infection occurring every second. In humans, TB is primarily caused by Mycobacterium tuberculosis (MTB). Genitourinary TB (GUTB) is still a major health problem in many developing countries including India and had been declared by the World Health Organisation as ‘public health emergency’ in 1993. Materials and Methods: This is a prospective study conducted at a tertiary care hospital involving 46 patients who presented with clinical feature suggestive of GUTB – urine specimens of these 46 patients were analysed for acid–fast bacilli (AFB), AFB culture, GeneXpert, and other relevant investigations were done to reach the diagnosis. Majority of patients were female (65.25%). This is especially relevant to rural and low socioeconomic areas in developing countries where women’s health is worse than men’s (in terms of nutrition); women’s risk of disease may be increased. Most of our patients were above 30 years of age and exhibited nonspecific symptoms such as dysuria, haematuria and frequency. All patients were put on antitubercular drugs and followed as per the guidelines. Conclusion: The sample size in the present study is small to arrive at a brisk inference, but it may safely be postulated that yield of detection for GeneXpert may be improved using multiple sampling, especially the early morning ones. It is also pertinent to mention here that GeneXpert may not be able to pick up mutant genomes.     

Pattern and outcome of childhood intestinal obstruction at a Tertiary Hospital in Nigeria

Background

Intestinal obstruction is a common cause of pediatric surgical emergency with a high morbidity and mortality in Africa.

Methods

A retrospective review of cases managed from January 1996 to December 2005 at a teaching hospital in Southwestern, Nigeria was done to examine the pattern of causes of intestinal obstruction in children and the management outcome.

Results

One hundred and thirty cases were seen over the study period with an age range of 2 hours to 14 years. Majority (61.24%) were infants, while 18.46% were neonates.Fifty-five cases (42.31%) were due to congenital causes while the rest were of acquired causes. The major causes of intestinal obstruction in the study were intussusception (29.23%), anorectal malformations (22.31%), obstructed inguinoscrotal hernia (16.92%) and Hirschsprung''s disease (13.85%). Surgical site infection and sepsis were the commonest complications observed with an overall complication rate of 60.78%. The mortality rate was 3.08% and most (75%) occurred in neonates.

Conclusion

While mortality as an outcome of management is low, the morbidity was very high in this study.     

Clinical and Laboratory Characteristics of Patients with Toxocariasis Encountered at a Tertiary Care Centre in North India

Toxocariasis is a neglected soil-transmitted helminthic infection caused by either Toxocara canis or Toxocara cati where humans get infected by accidental ingestion of embryonated eggs, and the definitive hosts are dogs and cats. This study aims to analyse the clinical and laboratory characteristics of Toxocara-infected patients and assessment of response to standard treatment with review of literature. The clinical details of patients with Toxocara serology positive for IgG antibodies by ELISA in 5 years (2013–2017) were retrospectively analysed. A total of 29 patients with clinical features and serology suggestive of Toxocara infection were evaluated. A complete history of 14 patients was available for the analysis. Majority (13/14; 96.5%) of cases were children <15 years, males (79%) and belonged to lower socioeconomic status (64.3%). The most common clinical presentation was fever (78.5%) with respiratory symptoms (57%) followed by gastrointestinal features (35.7%). All the patients had eosinophilia (range 8.3%–85%) and raised total IgE levels. Toxocariasis is more common in children, and the true prevalence may be underestimated. In endemic areas, Toxocara workup should be considered in patients with eosinophilia presenting with respiratory and gastrointestinal features.     

Gender-based violence during COVID-19 lockdown: case study of a community in Lagos,Nigeria

BackgroundGender-based violence (GBV) has been identified to be one of the ripple effects of the global pandemic. In countries like Nigeria, the situation is hypothesized to be worse because of widespread poverty and gender inequalities.ObjectiveTo examine the exposure of females to GBV during the first 3 months of the COVID-19 lockdown.MethodThis cross-sectional study was conducted in a low-income community in Lagos. Semi-structured questionnaires were administered to 130 respondents selected via systematic random sampling.ResultsThe mean age of the respondents was 26.89 ± 8.67 years. Majority worked informal jobs, while only 50% had attained beyond primary education. Within the period, the respondents had been subjected to sexual (54.6%), physical (52.3%), verbal assault (41.5%), and online sexual harassment (45.4%); of which only 30% reported to the police. Furthermore, respondents subjected to sexual (p=0.004) and physical assault (p=0.032) during the period earned significantly less money than other respondents.ConclusionThe fact that over 1 out of every 2 females was subjected to at least one form of GBV within the short timeframe shows how unsafe girls and women in low-income communities are. This calls for proactive community-level interventions to curb the GBV menace.     

Caesarean delivery rate and indications at a secondary healthcare Facility in Ibadan,South Western Nigeria: a five-year review

BackgroundCaesarean delivery is an essential surgical skill within the primary care setting aimed at reducing maternal morbidity and mortality.ObjectivesTo determine the rate and indications for caesarean deliveries with a view to improving on the service delivery in the study area.MethodsA retrospective review of all caesarean deliveries over a five-year period, January 1^st, 2012 to December 31^st, 2016.ResultsA total of 2321 deliveries were recorded during the study duration and 481 of them were through caesarean section (CS) giving a caesarean section rate of 20.4%. The rate was higher in the multigravida 255 (53.1%). The commonest indication for caesarean section was previous caesarean section 131 (27.2%). Emergency caesarean delivery accounted for 278 (57.8%). Only 16 (3.3%) stayed more than five days postoperatively while the rest, 465 (96.7%), stayed less than five days. There was a gradual yearly increase in rate from 12.1% in 2012 to 19.5% in 2016.ConclusionThe rate of CS in this study has shown a gradual yearly increase with emergency CS having a higher percentage. Early diagnosis and referral of high-risk pregnancies from peripheral hospitals could reduce emergency CS among the study population.     

A possible model for estimating birth length of babies from common parental variables using a sample of families in Lagos,Nigeria

BackgroundLength at birth is important for evaluating childhood growth and development. It is of interest in Pediatrics because of its implications for perinatal and postnatal morbidity and mortality. Predicting birth length will be useful in anticipating and managing possible complications associated with pregnancy and birth of babies with abnormal birth length.ObjectiveThe aim was to identify easily accessible parental determinants of baby''s birth length in Lagos, Nigeria, using a sample of patients attending a government hospital.MethodsParental anthropometrics and other data were obtained from 250 couples by actual measurements, oral interviews and questionnaires. Baby''s birth length was measured immediately after delivery by qualified, a well-trained obstetric nurse, and association between parental and offspring parameters were assessed.ResultsWeight gain, maternal weight, parity and mid-parental height were the significant parental explanatory variables of offspring birth length. They were the most suitable variables for a generated model for predicting babies'' birth length from parental variables in the study.ConclusionA model that might be useful for predicting babies'' birth length from easily accessible parental variables was produced. This model may complement ultrasonographic data for predicting baby''s birth length with a view to achieving better perinatal and postnatal care.     

Characteristics and Prognosis of Hospitalized Patients at High Risk of Deterioration Identified by the Rapid Response System: a Multicenter Cohort Study

We aimed to investigate the characteristics and prognosis of high risk hospitalized patients identified by the rapid response system (RRS). A multicentered retrospective cohort study was conducted from June 2019 to December 2020. The National Early Warning Score (NEWS) was used for RRS activation. The outcome was unexpected intensive care unit (ICU) admission within 24 hours after RRS activation. The 11,459 patients with RRS activations were included. We found distinct clinical characteristics in patients who underwent ICU admission. All NEWS parameters were associated with the risk of unexpected ICU admission except body temperature. Body mass index, pulmonary disease, and cancer are related to the decreased risk of unexpected ICU admission. In conclusion, there were differences in clinical characteristics among high risk patients, and those differences were associated with unexpected ICU admissions. Clinicians should consider factors relating to unexpected ICU admission in the management of high risk patients identified by RRS.     

Analysis of Characteristics and Mortality in Cardiac Arrest Patients by Hospital Level: a Nationwide Population-based Study

BackgroundSurvival and post-cardiac arrest care vary considerably by hospital, region, and country. In the current study, we aimed to analyze mortality in patients who underwent cardiac arrest by hospital level, and to reveal differences in patient characteristics and hospital factors, including post-cardiac arrest care, hospital costs, and adherence to changes in resuscitation guidelines.MethodsWe enrolled adult patients (≥ 20 years) who suffered non-traumatic cardiac arrest from 2006 to 2015. Patient demographics, insurance type, admission route, comorbidities, treatments, and hospital costs were extracted from the National Health Insurance Service database. We categorized patients into tertiary hospital, general hospital, and hospital groups according to the level of the hospital where they were treated. We analyzed the patients'' characteristics, hospital factors, and mortalities among the three groups. We also analyzed post-cardiac arrest care before and after the 2010 guideline changes. The primary end-point was 30 days and 1 year mortality rates.ResultsThe tertiary hospital, general hospital, and hospital groups represented 32.6%, 49.6%, and 17.8% of 337,042 patients, respectively. The tertiary and general hospital groups were younger, had a lower proportion of medical aid coverage, and fewer comorbidities, compared to the hospital group. Post-cardiac arrest care, such as percutaneous coronary intervention, targeted temperature management, and extracorporeal membrane oxygenation, were provided more frequently in the tertiary and general hospital groups. After adjusting for age, sex, insurance type, urbanization level, admission route, comorbidities, defibrillation, resuscitation medications, angiography, and guideline changes, the tertiary and general hospital groups showed lower 1-year mortality (tertiary hospital vs. general hospital vs. hospital, adjusted odds ratios, 0.538 vs. 0.604 vs. 1; P < 0.001). After 2010 guideline changes, a marked decline in atropine use and an increase in post-cardiac arrest care were observed in the tertiary and general hospital groups.ConclusionThe tertiary and general hospital groups showed lower 30 days and 1 year mortality rates than the hospital group, after adjusting for patient characteristics and hospital factors. Higher-level hospitals provided more post-cardiac arrest care, which led to high hospital costs, and showed good adherence to the guideline change after 2010.     

Predictors of exclusive breastfeeding practice among nursing mothers attending a health care facility in a peri-urban setting in Lagos State,Nigeria

BackgroundThe Nigerian government initiated various national infant and young child feeding programmes (1992–2005) to improve juveniles well-being. Despite these efforts, under-five children feeding related diseases and mortality still escalate. Investigating the drivers of exclusive breastfeeding (EBF) is exigent in tackling this menace.ObjectiveTo investigate maternal socio-demographic and index child variables that serve as predictors of EBF practice among nursing mother attending a healthcare facility in Lagos, western Nigeria.MethodsOne hundred and twenty (N=120) consenting nursing mothers (15–49 years) with infants between 0–24 months completed a structured, self-administered questionnaire. Scores of current practice level for EBF was computed and adjusted odd ratios (aORs) generated from a logistic regression model.ResultsRespondents mean age was 28.7 ± 2.3 years. Of 120 respondents, 82(68.3%) and 38(31.7%) had good and poor EBF practice respectively. Having an index child <6months age (aOR=5.02, 95% confidence intervalCI=1.28–15.43), being in monogamy (aOR=3.0, 95% CI=1.80–6.73), having tertiary education (aOR=3.12, 95% CI=1.39–8.96), being married (aOR=2.0, 95% CI=0.1–0.8) and vaginal delivery (aOR=2.96, 95% CI=1.75–7.48) increased the odds of EBF practice.ConclusionAge of index child, marriage type, maternal education, marital status and nature of delivery independently predicted EBF practice.     

Pattern of Palliative Care, Pain Management and Referral Trends in Patients Receiving Radiotherapy at a Tertiary Cancer Center

Background:

Pain is a common primary symptom of advanced cancer and metastatic disease, occurring in 50-75% of all patients. Although palliative care and pain management are essential components in oncology practice, studies show that these areas are often inadequately addressed.

Materials and Methods:

We randomly selected 152 patients receiving palliative radiotherapy (PRT) from October 2006 to August 2008, excluding metastatic bone lesions. Patients'' records were studied retrospectively.

Results:

A median follow-up of 21 weeks was available for 119 males and 33 females with a median age of 55 years. Maximum (60%) patients were of head and neck cancers followed by esophagus (14%), lung (10%) and others. Dysphagia, growth/ulcer and pain were the chief indications for PRT. Pain was present in 93 (61%) cases out of which, 56 (60%) were referred to pain clinic. All except one consulted pain clinic with a median pain score of 8 (0-10 point scale). Fifty-three of these 56 patients (96%) received opioid-based treatment with adequate pain relief in 33% cases and loss of follow-up in 40% cases. Only five (3%) cases were referred to a hospice. Twenty-two (14%) cases were considered for radical treatment following excellent response to PRT.

Conclusion:

In this selective sample, the standard of analgesic treatment was found to be satisfactory. However, there is a lot of scope for improvement regarding referral to pain clinic and later to the hospice. Patients'' follow-up needs to be improved along with future studies evaluating those patients who were considered for further RT till radical dose. Programs to change the patients'' attitude towards palliative care, physicians'' (residents'') training to improve communication skills, and institutional policies may be promising strategies.     

Molecular Characterisation of Methicillin-Resistant Staphylococcus aureus Isolated from Patients at a Tertiary Care Hospital in Hyderabad,South India

Context: Infections with methicillin-resistant Staphylococcus aureus (MRSA) greatly influence clinical outcome. Molecular characterisation of MRSA can help to predict their spread and to institute treatment and hospital protocols. Aim: The aim of this study is to understand the diversity of MRSA in a tertiary care hospital in Hyderabad, India. Settings and Design: Samples collected at Gandhi Medical College, Hyderabad, and designed to assess hospital-or community-associated MRSA (HA-MRSA or CA-MRSA). Subjects and Methods: MRSA were subjected to antibiotic susceptibility testing, pulsed-field gel electrophoresis (PFGE), spa typing, multi-locus sequence typing and staphylococcal cassette chromosome–mec (SCCmec) typing. Statistical Analysis Used: Discriminatory index and 95% confidence interval. Results: Of the 30 MRSA, (a) 18 and 12 were HA-MRSA and CA-MRSA, respectively, and (b) 23.3% and 6.6% displayed induced clindamycin and intermediate vancomycin resistance, respectively. Genetic diversity was evident from the presence of (a) 20 pulsotypes, (b) eight spa types, with the predominance of t064 (n = 9) and (c) seven sequence types (ST), with the preponderance of ST22 and ST8 (9 each). ST22 and ST8 were the most prevalent among HA-MRSA and CA-MRSA, respectively. SCCmec type IV was the most frequent (n = 8). 44.4% of HA-MRSA belonged to SCCmec IV and V, whereas 33.3% of CA-MRSA belonged to SCCmec I and III; 33.3% (5/15) of the isolates harbouring the pvl gene belonged to SCCmec IVC/H. Conclusions: ST8 was a dominant type along with other previously reported types ST22, ST239, and ST772 from India. The observations highlight the prevalence of genetically diverse clonal populations of MRSA, suggesting potential multiple origins.     

Cost-of-Illness and Quality of Life in Patients with Ankylosing Spondylitis at a Tertiary Hospital in Korea

The objectives of this study were to estimate the cost-of-illness (COI) and health-related quality of life (HRQOL) in patients with ankylosing spondylitis (AS) in Korea and to evaluate the effects of socio-demographic and clinical factors on the COI and the HRQOL. Face-to-face interview surveys were taken from patients with AS at the Rheumatology Clinic of Seoul National University Hospital. Direct medical and non-medical costs, indirect costs (productivity loss due to job loss and sick leave), and deterioration of HRQOL in patients with AS were measured. Factors associated with COI and HRQOL were analyzed with multiple regression and multivariate logistic regression. A total of 191 patients with AS was enrolled in the study. The COI in patients with AS amounted to 11,646,180 Korean Won (KRW) per patient, and their HRQOL was 0.62. As functional severity worsened, the total costs increased (class I, KRW 7.7 million; class II, KRW 12.9 million; classes III & IV, KRW 25.2 million) and the HRQOL scores decreased (class I, 0.72; class II, 0.61; classes III & IV, 0.24). Functional severity is the major determinant of the COI and HRQOL in patients with AS.

Graphical Abstract

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Regulatory Role of Vitamin D Receptor Gene Variants of BsmI, ApaI, TaqI, and FokI Polymorphisms on Macrophage Phagocytosis and Lymphoproliferative Response to Mycobacterium tuberculosis Antigen in Pulmonary Tuberculosis

The regulatory role of vitamin D receptor (VDR) gene variants of Bsm I, Apa I, Taq I, and Fok I polymorphisms on vitamin D(3)-modulated macrophage phagocytosis with live Mycobacterium tuberculosis and lymphoproliferative response to M. tuberculosis culture filtrate antigen (CFA) was studied in patients with pulmonary tuberculosis (n = 46) and in normal healthy subjects (NHS) (n = 64). Vitamin D(3) at a concentration of 1 x 10(-7) M enhanced the phagocytic potential of normal subjects who had a phagocytic index of less than 20%. This increase was seen in subjects with the genotypes BB (p = 0.017), AA (p = 0.016), tt (p = 0.034), and FF (p = 0.013) and the extended genotype BBAAtt (p = 0.034). Normal subjects with BBAAtt performed better phagocytosis than individuals with bbaaTT genotype (p = 0.034). Vitamin D(3) at 10(-9), 10(-8), and 10(-7) M concentrations suppressed the lymphoproliferative response to CFA antigen in normal subjects. This decreased lymphocyte response was observed in normal individuals with the genotypes BB (p = 0.0009), tt (p = 0.016), and FF (p = 0.008) and the extended genotype BBAAtt (p = 0.02). Addition of vitamin D(3) had no significant effect on macrophage phagocytosis and lymphoproliferative response to CFA in pulmonary TB patients. This may be due to the unresponsive nature of the cells to the action of vitamin D(3) or the downregulated VDR expression by virtue of the disease, which renders them inactive. The genotypes BB, tt, and the extended genotype BBAAtt may be associated with increased expression of VDR which in turn regulate the action of vitamin D(3) and modulate the immune functions to M. tuberculosis in NHS.     

Overexpression of a Novel Lymphocyte Population, Positive for an Intracellular CD14-Like Antigen, in Patients Positive for Human Immunodeficiency Virus Type 1

CD14, originally recognized as a lipopolysaccharide (LPS) receptor, has recently been implicated in the process of T-cell suppression and apoptosis. Its soluble form has been shown to bind, in vitro, to human T cells, a process that may carry a negative signal onto these cells. We recently described a novel lymphocyte population in human peripheral blood, a population that expresses an intracellular CD14-like antigen. This novel T-cell population, composed mainly of CD8 cells and of very few CD4 cells, was found to be greatly enhanced in asymptomatic, untreated human immunodeficiency virus (HIV)-positive individuals. In the present study, we further characterized this cell population and found that it differed from other CD8 subpopulations associated with HIV infection such as CD8/CD38. In addition, we followed HIV patients under conditions of highly active antiretroviral therapy (HAART) and observed two groups of patients: patients in whom the CD14-like positive-testing T cells returned to normal within 1 to 3 months, and patients in whom it did not, in spite of a significant plasma HIV-RNA viral load decrease. Thus, this new CD14-like positive-testing lymphocyte population may represent an interesting and important component of the cellular events associated with HIV infection. On the basis of its modulation following HAART, we speculate that it may be used, in the future, as a drug-monitoring cellular marker in antiretroviral treatment.