Isolation of pathogenic bacteria from hospital staff apparel in Nigeria

A survey of bacteria contamination of hospital staff apparel in use in Anambra State, Nigeria, was carried out to determine the extent of contamination by clinically important bacteria. Of a total of 125 swab samples of hospital staff apparel, 72 (58%) showed bacterial contamination including 32 (70%) of 46 samples from hand gloves, 28 of 45 (62%) samples from protective gowns, and 12 of 34 (35%) samples from face-shields. The potentially pathogenic bacteria isolated were Salmonella spp, Proteus vulgaris, Shigella dysenteriae, Pseudomonas aeruginosa and Staphylococcus aureus. The isolation of clinically important bacteria from the apparel suggests the need for improved infection control measures.     

Psychiatric morbidity in stroke patients attending a neurology clinic in Nigeria

Back ground

Stroke produces a wide range of mental and emotional disorders. Neuropsychiatric complications associated with stroke may have negative effects on the social functioning, overall quality of life and the recovery of motor functioning of stroke survivors.

Objective

To determine the prevalence and nature of psychiatric morbidity among stroke patients attending neurology outpatient clinic of the University of Ilorin Teaching Hospital (UITH), Ilorin-Nigeria.

Methods

All patients with stroke aged 18 years and above at an outpatient neurology clinic in Ilorin, Nigeria were assessed for mental and emotional disorders using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) over one year (March 2009 to February 2010).

Results

Overall prevalence of psychiatric morbidity was 36.0% (30/83) among 83 patients who constituted the study population. Specific diagnoses recorded were depression (19.2%), generalised anxiety disorder (9.6%), harmful alcohol use (2.4%); dementia, somatoform disorder, phobia and delusional disorder each had a prevalence of 1.2%. Clinical and sociodemographic variables were not significantly associated with psychiatric morbidity.

Conclusion

Psychiatric disorders are often associated with stroke. Identifying and treating stroke patients with these psychiatric co-morbidities could thus help to improve the overall quality of life of these patients.     

Determinants of spontaneous healing in traumatic perforations of the tympanic membrane

Objectives: To analyse the various factors influencing spontaneous healing of traumatic tympanic membrane perforation in West Africa. Study design: Prospective clinical study. Setting: Tertiary referral centre. Participants: Consecutive patients with traumatic tympanic membrane perforations without history of previous middle ear disease. Main outcome measures: Healing outcome at 4, 8, 12 weeks; effects of perforation size, location, and mode of injury, active intervention and ear discharge on healing outcome. Results: Fifty‐three patients, 32 (60%) men and 21 (40%) women, aged 2–86 years, with traumatic tympanic membrane perforation who met our inclusion criteria were analysed. Ninety‐four percent of the perforations healed spontaneously. Spontaneous healing was significantly correlated with age (P < 0.05). It was significantly delayed by large perforations estimated at 50% or more of entire tympanic membrane, ear discharge, wrong intervention on acute perforation by ear syringing, and by penetrating injuries sustained through the ear canal (P < 0.05, P < 0.01, P < 0.01 and P < 0.01 respectively). Perforations in the anterior versus posterior quadrants showed no significant difference in the healing rate (P > 0.05). Non‐healing of the traumatic perforation was significantly associated with the large perforations, ear discharge and wrong intervention by ear syringing in chi‐square test (P = 0.01, P = 0.02 and P < 0.001 respectively), but only with penetrating injuries sustained through the ear canal and the ear syringing intervention in logistic regression test (P = 0.02 and P = 0.04 respectively). Conclusion: The rate of spontaneous healing of traumatic tympanic membrane perforation varied inversely with age of patient and size of perforation. It was delayed by middle‐ear infection, as well as in ears that sustain direct injuries and in ears that had wrong interventions. However, it was not dependent on whether the perforation was in the anterior or posterior location. Logistic regression analysis revealed that penetrating injuries sustained through the ear canal and the ear syringing intervention were the only risk factors important in predicting the non‐healing of traumatic tympanic membrane perforation.     

Controlled trial of continuous inflating pressure for hyaline membrane disease

A controlled trial of elective intervention with continuous inflating pressure (CIP) was performed in infants with severe hyaline membrane disease who weighed more than 1000 g at birth. Infants entered the trial if their arterial oxygen tension (PaO2) fell below 60 mmHg while breathing a fractional inspired oxygen concentration (F1O2) greater than 0-95. 11 out of 12 infants in the CIP-treated group and 10 out of 12 in the control group survived. 7 treated and 6 control infants required mechanical ventilation. When CIP was started the Pao2 of the treated infants increased, and they breathed high concentrations of oxygen for a significantly shorter period than the control infants. During the 31-month duration of the trial 107 other infants with severe hyaline membrane disease were admitted who did not meet the criteria for entry to the trial. 37 survived after breathing high concentrations of oxygen (F1O2 greater than 0-60) spontaneously without any ventilatory assistance, and the remaining 70 infants were already being ventilated on their arrival in the unit, usually because they had required mechanical ventilation during transfer from other hospitals. The neonatal survival rate for those infants born in this hospital during the study period was 88% (50 out of 57 infants) and for those referred from other hospitals it was 69% (51 out of 74 infants). The maximum further increase in overall survival rate that might have been achieved in our population of infants if CIP had been initiated very early in the course of the illness was 5%--i.e. from 77% (101/131) to 82% (107/131).     

Thrombosis at venous insertion sites after inferior vena caval filter placement

Color Doppler flow imaging or compression ultrasound (US) was used to prospectively determine frequency of thrombosis at 54 venous insertion sites (47 in common femoral veins, seven in right internal jugular veins) after percutaneous placement of Greenfield filters for interruption of the inferior vena cava. Fifty-one filters were successfully placed in 51 patients with a dilator set or a balloon angioplasty catheter. Nine focal thrombi were detected in the common femoral vein (19%) and one in the right internal jugular vein (14%). Use of dilators induced eight thrombi (24%), compared with two (10%) from balloon catheters. The left common femoral vein had a high frequency of thrombosis, regardless of dilation technique (five of nine). Of nine patients with acute common femoral vein thrombosis, four became symptomatic within 10 days after the procedure. Patients may remain asymptomatic or have delayed symptoms; thus, US is valuable for determining patients at risk of thrombosis of the common femoral vein.