>Modern Contraception: Uptake and Correlates among Women of Reproductive Age-Group in a Rural Community of Osun State,Nigeria

BackgroundUniversal contraceptive access is one of the key strategies for achieving sustainable developments in any country. Yet, uptake has remained low in most developing nations like Nigeria. The reasons for low use must be contextually understood to aid effective contraceptive programming. This study assessed contraceptive use and its determinants among reproductive aged women in Ejigbo, Osun State, Nigeria.MethodsA quantitative study involving 405 participants which were recruited using multi-stage sampling method was carried out. Data were collected using pretested semi-structured, interviewer-administered questionnaire. Chi-Square test and binary logistic regression analysis were used for inferential statistics.ResultThe mean age of the respondents was 28±6. The majority (92.8%) of the respondents were aware of family planning, 68.9% of them possessed good knowledge but only 53% of them demonstrated favorable contraceptive attitude. Less than half (33.0%) of those who had heard about contraception were current users of modern methods. Injectables (45.0%) and male condoms (30.0%) were the most prevalent contraceptive methods among the respondents. The main determinants of contraceptive uptake were respondents’ educational status (AOR=0.525, 95%CI=0.284-0.972), contraceptive knowledge (OR=0.512, 95%CI=1.242-1.968) and attitude (OR=0.512, 95%CI=1.2421.968). Fear of perceived side effects (45.2%), low pregnancy risk perception (35.7%) and spousal refusal (12.5%) were the main reasons for non-contraceptive use among non-users.ConclusionContraceptive demand in the study population was low in spite of high awareness level. There is a need to increase contraceptive literacy in the study population and make the services more acceptable to rural dwellers so as to meet the SDG-3 target in Nigeria.     

Detecting Staphylococcus aureus Virulence and Resistance Genes: a Comparison of Whole-Genome Sequencing and DNA Microarray Technology

Staphylococcus aureus is a major bacterial pathogen causing a variety of diseases ranging from wound infections to severe bacteremia or intoxications. Besides host factors, the course and severity of disease is also widely dependent on the genotype of the bacterium. Whole-genome sequencing (WGS), followed by bioinformatic sequence analysis, is currently the most extensive genotyping method available. To identify clinically relevant staphylococcal virulence and resistance genes in WGS data, we developed an in silico typing scheme for the software SeqSphere⁺ (Ridom GmbH, Münster, Germany). The implemented target genes (n = 182) correspond to those queried by the Identibac S. aureus Genotyping DNA microarray (Alere Technologies, Jena, Germany). The in silico scheme was evaluated by comparing the typing results of microarray and of WGS for 154 human S. aureus isolates. A total of 96.8% (n = 27,119) of all typing results were equally identified with microarray and WGS (40.6% present and 56.2% absent). Discrepancies (3.2% in total) were caused by WGS errors (1.7%), microarray hybridization failures (1.3%), wrong prediction of ambiguous microarray results (0.1%), or unknown causes (0.1%). Superior to the microarray, WGS enabled the distinction of allelic variants, which may be essential for the prediction of bacterial virulence and resistance phenotypes. Multilocus sequence typing clonal complexes and staphylococcal cassette chromosome mec element types inferred from microarray hybridization patterns were equally determined by WGS. In conclusion, WGS may substitute array-based methods due to its universal methodology, open and expandable nature, and rapid parallel analysis capacity for different characteristics in once-generated sequences.     

The role of laparoscopic surgery in the management of a malfunctioning peritoneal catheter

IntroductionPeritoneal catheter malfunction is a common complication of peritoneal dialysis (PD). It has a high failure rate with conservative management. Catheter replacement was historically the standard surgical treatment of choice. Nowadays, laparoscopy has been introduced as an alternative surgical modality to rescue the malfunctioning peritoneal catheter and also offers the possibility of replacement if indicated. The aim of this study was to compare the outcomes of these two surgical modalities.MethodsThe medical records of consecutive patients who underwent surgical treatment for malfunctioning PD catheters (between January 2010 and April 2013) were analysed. The primary outcome included successful return to adequate PD. The secondary endpoint was length of catheter patency and the cause of catheter failure.ResultsA total of 32 cases were identified, of which 8 had open catheter replacement and 24 had a laparoscopic intervention. The overall median follow-up duration was 12.5 months. The success rate for laparoscopic surgery in terms of functioning catheter at 12 months was 62.5% but only 37.5% for open surgery. The mean length of catheter patency after laparoscopic intervention was 31.6 months compared with only 13.6 months for the open surgery group. The most common cause of catheter failure diagnosed during laparoscopic intervention was catheter migration (33.0%), followed by omental wrap and catheter blockage by fibrin/blood plug (25.0% each). Open surgery did not have any diagnostic potential.ConclusionsLaparoscopy is the treatment of choice for malfunctioning PD. Its proven benefit includes simultaneous identification of the aetiological cause of malfunction together with direct correction of this problem, thereby maximising outcome. It also allows for rapid recommencement of PD and avoidance of haemodialysis, saving cost and resources.     

Carriage of encapsulated bacteria in Gabonese children with sickle cell anaemia

Sickle cell anaemia (SCA) is a haemoglobin disorder that alters the deformability of erythrocytes through abnormal polymerization of haemoglobin. Children with SCA have an increased risk of infections with encapsulated bacteria. To guide the antibiotic prophylaxis and vaccinations in children with SCA in Gabon, we characterized Streptococcus pneumoniae, Staphylococcus aureus and Haemophilus influenzae from children with and without SCA. We performed a cross-sectional study and compared nasal and pharyngeal S. pneumoniae, Staph. aureus and H. influenzae isolates from SCA children (n = 73) with comparators matched for age, residence and sex (n = 143) in a matched-comparison analysis. The resistance pattern and capsular type were identified for each isolate. The total carriage rate for S. pneumoniae, Staph. aureus and H. influenzae was 13.8%, 46.7% and 12.5%, respectively, and did not differ between groups (p >0.05). The mean number of days under antibiotic treatment in the past year was higher in children with SCA than in controls (penicillin: 70.1 vs 0.1 days, p 0.00002). The total non-susceptibility rate was 30% for oral and parenteral (meningitis) penicillin in S. pneumoniae, resistance rates were 1.6% for oxacillin in Staph. aureus and 14.8% for ampicillin in H. influenzae. Susceptibility to antibiotic agents and distribution of capsular types did not differ significantly between both groups. In conclusion, carriage and resistance rates are similar in children with and without SCA. Our data provide the basis to guide empiric therapy of invasive diseases caused by S. pneumoniae, Staph. aureus and H. influenza in children in Gabon.     

Minimally invasive video-assisted parathyroidectomy is a safe procedure to treat primary hyperparathyroidism

IntroductionCervical exploration to identify the four parathyroid glands was considered to be the gold standard for management of primary hyperparathyroidism. In recent years, advances in preoperative localizing techniques have led to the use of more targeted, minimally invasive procedures to remove parathyroid glands. We present our series of patients who underwent Minimally Invasive Video-Assisted Parathyroidectomy (MIVAP) procedures and our results in treating primary hyperparathyroidism.MethodsPatients who underwent video-assisted parathyroidectomy were identified from a prospectively maintained database. Clinico-pathological data including indications for surgery, complications, conversion to open procedure and success of surgery were obtained from clinical notes.ResultsA total of 56 patients underwent MIVAP between 2002 and 2010 at a district general hospital setup. The clinical indication was diagnosed primary hyperparathyroidism. Preoperative localization was attempted in all patients by sestamibi and high resolution ultrasound scans. The median age of patients was 65 years (32–82) and the median operating time was 78 min (20–168). Conversion to open procedure was done in 8/56 (14%) cases. The reason for conversion was failed exploration in 5 patients, inability to retrieve a very large friable adenoma in one patient, lipo-adenoma in one patient and very small parathyroid adenoma in one patient. Postoperative complications happened in one patient (2%) who developed postoperative sepsis resulting in temporary recurrent laryngeal nerve (RLN) palsy. All but 5 patients became normo-calcaemic following surgery.ConclusionMIVAP is a safe and effective procedure for treating patients with primary hyperparathyroidism. It also allows classical 4 gland exploration, whenever necessary.     

A survey of eye safety practices among welders in Nigeria

Background : Welding is a common occupation in both developed and developing countries. The occupation is potentially vision-threatening if adequate safety measures are not taken to protect the eyes. Safety standards which guide such occupations are lacking in many developing countries including Nigeria. Therefore, it was considered of interest to study the welders in Nigeria in order to establish the current level of eye safety practice. Method : Questionnaires were administered to welders in Lagos area of Nigeria. Data from 339 completed questionnaires were analysed. Results : Less than half (43.7 per cent) of the welders used welding goggles when welding. Another 45.4 per cent used sun glasses, while others (10.9 per cent) did not use any device. In the week preceding the survey, 65.3 per cent of respondents reported having welded for a period without eye protection. About half (47.7 per cent) reported frequent exposure to nearby flashes when not welding. A majority of the welders reported that their eyes were sometimes or frequently irritated by fumes from welding. Conclusion : This study reveals that a large proportion of welders in Nigeria did not take adequate precautions to protect their eyes from hazards associated with welding. This finding is attributed to absence of ocular health safety standards in the country and inadequate knowledge of the potential occupational hazards by the welders. These results will be a strong tool in persuading the health authorities of the need to establish a committee to set safety standards, monitor compliance and to educate the welders and allied workers about the occupational hazards associated with the profession, and the need to take adequate safety precautions.     

Combined Administration of l-Carnitine and Ascorbic Acid Ameliorates Cisplatin-Induced Nephrotoxicity in Rats

Objectives: Cisplatin (CIS) is an effective antitumor drug. However, its clinical use is limited due to nephrotoxicity. l-Carnitine and vitamin C are both natural antioxidant that can be obtained from diets. This study investigated the effects of l-carnitine and/or vitamin C in rats against cisplatin-induced nephrotoxicity.

Methods: Twenty-five male Wistar rats were divided into 5 groups of 5 rats each. Group 1, normal control. Group 2, positive control, received cisplatin (10 mg/kg/day intraperitoneally [i.p.]) for 3 days. Groups 3, 4, and 5 received cisplatin for 3 days and thereafter l-carnitine (50 mg/kg/day), vitamin C (100 mg/kg/day), or their combination, respectively, for 28 days. At the end of the study, a biochemical study was carried out in which nephrotoxicity markers, electrolytes, hematological indices, oxidative stress biomarkers, and renal histopathological alterations were evaluated.

Results: CIS-treated rats developed significant polyuria, increase in the plasma levels of creatinine, urea, and inorganic phosphate (P_i), alteration in hematological parameters, and decrease in plasma levels of Na⁺, Cl^?, K⁺, Ca²⁺, and Mg²⁺. Measurements of 24-hour urine output demonstrated markedly decreased creatinine and urea and increased Na⁺, Cl^?, K⁺, Ca²⁺, and Mg²⁺ levels in the CIS-treated group, whereas P_i levels were not changed. It also caused significantly decreased catalase (CAT), superoxide dismutase (SOD), and reduced glutathione (GSH) levels in the rats' kidneys. Histopathological scores revealed renal tubular damage in CIS-treated rats. However, l-carnitine, vitamin C, or their combination significantly attenuated the alterations caused by CIS in the plasma and kidneys of the rats.

Conclusion: l-Carnitine and vitamin C administration ameliorated CIS-induced nephrotoxicity due to their antioxidant and anti-inflammatory effects.