Open Access Original Research Article

Spectrum and Antimicrobial Susceptibility Pattern of Uropathogens: Indoor Versus Outdoor Isolates

Meghna Palewar, Swati Mudshingkar, Vaishali Dohe, Renu Bharadwaj

International Journal of TROPICAL DISEASE & Health, Page 1-7
DOI: 10.9734/IJTDH/2017/36611

Background and Objectives: The resistance of uropathogens to commonly prescribed antimicrobials is increasing globally. As the susceptibility of uropathogens varies according to place and time, the present study was undertaken to know the local epidemiology and antimicrobial susceptibility patterns (AMSP) of common bacterial uropathogens. This helps in formulating effective empirical treatment.

Methods: This is a prospective observational study, where a total of 3353 consecutive urine specimens over a period of one year in a tertiary care hospital were cultured by semiquantitative method. The pathogens isolated were identified by standard methods and their antimicrobial susceptibility was done by Kirby Bauer disk diffusion method as per Clinical Laboratory Standards Institute (CLSI) guidelines. The data was analyzed by using WHONET 5.6 software.

Results: Of the total 3353 samples, 63% were sterile, 24% showed significant growth, 5.27% showed insignificant growth and 7.45% were collection contaminants. The 812 samples with significant growth yielded 988 bacterial isolates with 814 (82%) gram negative bacilli (GNB) and 174 (18%) gram positive cocci (GPC). Gram negative uropathogens had low susceptibility to ampicillin, cotrimoxazole, norfloxacin and cephalosporins. They had good susceptibility to nitrofurantoin and aminoglycosides like amikacin, gentamicin followed by piperacillin-tazobactam and meropenem.  ESBL production was observed amongst 40% of Escherichia coli and 60% of Klebiella pneumoniae isolates. Similarly gram positive uropathogens had low susceptibility to fluoroquinolones like norfloxacin, ciprofloxacin and tetracycline. They had good susceptibility to vancomycin, teicoplanin, linezolid and nitrofurantoin. Amongst the isolates from In Patient department (IPD) 36% of Staphylococcus aureus were MRSA and 2% of Enterococcus were Vancomycin Resistant Entercoccus (VRE).

Conclusion: Local epidemiology and susceptibility pattern of uropathogens should be studied to formulate effective empirical treatment regimen. Our study recommends use of Nitrofurantoin as best antimicrobial for UTI in uncomplicated, non-hospitalised patients. And use of aminoglycosides, or β lactam - βlactamase inhibitor combination agents like piperacillin/tazobactum and cefaperazone-sulbactam in complicated and serious hospitalized patients.

Open Access Original Research Article

Prevalence of Mutant Plasmodium falciparum Chloroquine Resistance Transport Gene (PFCRT) in Human Immune Deficiency Virus Patients Attending University of Uyo Teaching Hospital, Uyo-Nigeria

Amadi Chijioke Patrick, Inyang Udoinyang Clement

International Journal of TROPICAL DISEASE & Health, Page 1-9
DOI: 10.9734/IJTDH/2017/36827

In this study, the prevalence of mutant Plasmodium falciparum chloroquine resistant transport gene in HIV positive patients attending University of Uyo Teaching Hospital, Uyo was evaluated. The risk factors associated with HIV was evaluated by testing for the significant difference between Genders, Ages, CD4 count level in association with malaria parasite. Blood samples were collected from 67 participants attending the HIV adult Clinic, University of Uyo Teaching Hospital, Uyo. Of the 67 cases, 35 were HIV +ve adult patients while 32 were HIV –ve (Controls). Twenty-one percent of subjects admitted that they took Anti-malaria drugs every three months. Upon microscopic examination, 2(5.7%) of falciparum malaria was detected, while Nested PCR Assay detected 3(8.7%) falciparum malaria in the DNA sample extracts of HIV patients. All 32 HIV negative subjects had no falciparum malaria. Five HIV positive patients were infected with falciparum malaria; the prevalence rate of Pfcrt in HIV patients was 14.2%. There was no significant difference of malaria parasite infection by gender (P = 0.88), age group (P = 0.17), and CD4+ count (O.R:1.0, P = 0.81). There is an urgent need to administer effective anti-malaria drug to HIV patients infected with falciparum malaria.

Open Access Original Research Article

Plain Radiographic Patterns of Pelvic Fractures in Public Hospitals in South West Nigeria

A. O. Adebola Yusuf, A. P. Adefalujo, A. O. Akanji, Z. A. Awoyemi, R. A. Akinola

International Journal of TROPICAL DISEASE & Health, Page 1-12
DOI: 10.9734/IJTDH/2017/36368

Aim and Objectives:  The purpose of this study was to evaluate the various pelvic fracture types seen in Lagos and its environs, with their accompanying lesions, and compare them to previous works done in literature.

Study Design:  Prospective, Cross Sectional, Descriptive Study.

Place and Duration of Study: Lagos State Accident and Emergency Services hospitals. {LASEMS}, Lagos University Teaching Hospital (LUTH) and National Orthopaedics Hospital, Igbobi (NOH), Nigeria.

Duration: January to December 2009.

Materials and Methods: Study was carried out in the Radiology departments of three public hospital in South west Nigeria from January to December 2009.

Methodology: Ethical approval was obtained from the Research and Ethics committee of the Lagos State Health Service Commission. The x-rays of one hundred consecutive patients admitted in three tertiary hospitals in Lagos metropolis, diagnosed as traumatic pelvic injuries were documented, analyzed and reported. Statistical analysis was done using Epi Info Version 6 Statistical Software on an IBM- Compatible computer

Results: Out of the One hundred (100) patients recruited, the age ranged from 6 to 69 years with a mean of 31.5 +2 SD years. Females were slightly more than males, with a M: F ratio of 1.04:1.00. Generally, various types of pelvic ring fractures were seen and they included, Lateral compression fracture (LCF) 45.22%, Anterioposterior compression fracture (APCF) 26.96%, Vertical shear fracture (VSF) 13.04%, Combined / Complex fracture (CCF) 11.30%, and Avulsion fracture (AF) 3.48% in that order.

The acetabular fractures that also occurred included; Central / Combined 38.4%, equal Anterior and Posterior columns 23.1% each and Transverse Acetabular fracture 15.4%.

The appreciable concomitant lesions found in the patients were: soft tissue clinical complications; vascular (28), urogenital (23), neurological (18), infective (6), skeletal (42), degenerative (3) and morphological / structural (11).

Conclusion: In a limited resource country like Nigeria, with limited availability of high end functional imaging facilities, plain radiography as diagnostic imaging tool produced favorably comparable results as found by previous workers in classifying pelvic ring fractures. Its utilization afforded clinically valuable results sparing the patients additional radiation, exorbitant costs and contributed immensely to the early and prompt diagnoses of these fractures.

Open Access Original Research Article

Epidemiological Profile of Tuberculosis and Investigation of Some Risk Factors in the Province of Larache, Morocco (2000-2012)

A. Sbayi, A. Arfaoui, N. Ait Ouaaziz, S. El Koraichi, H. Janah, A. Quyou

International Journal of TROPICAL DISEASE & Health, Page 1-9
DOI: 10.9734/IJTDH/2017/37194

Aim: Tuberculosis (TB) remains a topical health issue all over the world. The present work aims to bring out the epidemiological profile of TB and to investigate some risk factors associated with this pathology in the province of Larache, Morocco.

Methodology: It consists in a retrospective study based on 7671 cases of tuberculosis, all forms combined, reported to the Centre for Diagnosis and Treatment of Respiratory Diseases of Larache during a period of 13 years from January 2000 to December 2012.

Results: The results showed that pulmonary tuberculosis represents two thirds of all cases (58%), Pleural TB comes second and Ganglionic TB comes third with 18% and 12% respectively. Moreover, 45% of patients completed their treatment and 34% are cured (smear negative). We reported 89 cases of death during the period of study. The evolution of the annual rate of success knew a remarkable increase from 95.6% in 2000 to 98.4% in 2012.

On the other hand, we demonstrated that death occurs preferentially in older patients (55.9 ±19.7 years old). Ganglionic and cerebral TB occur preferentially in younger patients (26.6 ± 17.7 years old) whereas urogenital and pericardial TB occur in older patients especially (45.7 ± 18.8 years old).

As for localization, we found that patients suffering from pulmonary TB display a significantly higher risk of death compared to other patients (RR = 1.58; CI95%= 1.01 - 2.467). In contrast, the risk of death is significantly lower in patients with ganglionic TB (RR= 0.08; CI95%= 0.01- 0.56).

Furthermore, females present a significantly higher risk to contract ganglionic, peritoneo-intestinal and pericardial TB compared to males. In contrast, the risk of contracting pulmonary TB is almost two times higher in males compared to females.

Conclusion: In conclusion, much effort should be made to fight against tuberculosis in Morocco.

Open Access Original Research Article

Spatial and Temporal Variations of Maternal Deaths in Borno State of Nigeria: An Institutional Based Study

Mustapha A. Kolo, Yusuf M. Adamu, Abdulkarim G. Mairiga, Muhammad Chutiyami

International Journal of TROPICAL DISEASE & Health, Page 1-14
DOI: 10.9734/IJTDH/2017/36007

Aim: The aim of the study is to describe and explain the spatial and temporal variations of maternal mortality between different regions of Borno State, Nigeria.

Method: This is a retrospective patient record study, which included antenatal attendance, hospital deliveries and maternal deaths over a ten year period (2001-2010). The data was collected from the Health Information Management System (HIMS) unit of the Borno State Ministry of Health and at the record departments of thirty one (31) selected general hospitals across Borno state. The state was stratified into three senatorial zones for the purpose of data collection, namely Central Borno, Northern Borno and Southern Borno,

Results: It was identified that Central Borno in comparison to the other zones recorded the highest antenatal care attendance and hospital delivery because of the high concentration of health facilities and easy accessibility. Over the 10 year period, more antenatal care visits were recorded in 2008, while hospital deliveries were highest in 2004. Maternal Mortality Ratios (MMR) computed over the 10year period indicated 1630 maternal deaths in 146,829 deliveries, yielding an MMR of 1110/100,000. The spatial pattern of MMR observed revealed that Northern Borno had the highest MMR of 1373/100,000, suggestive of the extent to which maternal mortality is a major health problem in the state.

Conclusion: The study concluded that maternal deaths remained one of the major health challenges in the state. It is thus recommended that both government and international agencies should put more effort in the underserved areas of the state.Maternal