Faculty of Basic Medical Sciences

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    Open Access
    Prevalence of in-use contamination of intravenous infusion in the paediatric wards of lagos university teaching hospital
    (1992) Ogunsola, F.T.; Rotimi, V.O.; Adenuga, A.
    The prevalence of in-use contamination of intravenous fluids on four paedatric wards (D1-D3 and the children emergency wards) was studied between January and June, 1990. A total of 118 in-use and 20 unused (controls) infusion fluids were studied. Contamination levels were high with 40 out of the 118 (33.3%) infusions contaminated while all the 20 control fluids were consistently sterile. The most isolated organisms were Corynebacterium xerosis and Bacillus subtils which from 24 out of 40 (60%) contaminated infusions, Gram-negative bacilli such as Klebsiella aeroqenes, Aerugina and Proteus mirabilis made up the remaining 40% (16 out of 40). Fourteen out of 16 (87.5%) of gram-negative isolates were isolated from ward D1 (Neonatal ward for neonates born outside the hospital). Contributory factors to the high contamination rates were found to be associated with duration of continuous infusion, use of burrettes and ward D1. On the other hand, additives did significantly correlate with contamination rates.
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    Open Access
    Hepatic neoplasms in Lagos -a 10year review of surgical biopsies
    (Nigerian Postgraduate Mededical Journal, 1993) Abdulkareem, FB; Banjo, AAF; Elesha, SO
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    Rising incidence of cerebral malaria in Lagos, Nigeria: a postmoterm study.
    (East African Medical Journal, 1993) Elesha, S O; Adepoju, FB; Banjo, AA
    One hundred and forty seven cases of acute malaria were diagnosed at autopsy between 1988 and 1991 at the Lagos University Teaching Hospital (LUTH). In 67 (46.5%) cases death was attributed to cerebral malaria (CM). There was a gradual increase in the incidence of CM during the period under review. Both sexes were affected equally but more children than adults succumbed. The highest death rate was recorded in the age group 1-5 years with a peak in the 2nd and 3rd year. There were seven adults out of which one was intenerant white lady. Only one of the six adult Nigerians had travelled outside Africa and stayed away for about four years. The commonest presenting symptoms were: fever only, fever with convulsions and/or coma and fever with gastrointestinal symptoms such as vomiting and diarrhoea. The majority of the adults were comatose (five out of seven) without fever on admission. A review of the English literature on the diagnosis, pathogenesis and management of CM is also presented. The possible reasons of the rising incidence of CM in a holoendemic region such as Nigeria are discussed.
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    Open Access
    Chloroquine reduces blood pressure and forearm vascular resistance and increases forearm blood flow in healthy young adults.
    (WILEY-BLACKWELL, 1993) Anigbogu, C.N.; Adigun, S.A.; Adegunloye, B.J.; Idong, I.
    The effects of chloroquine on resting blood pressure, forearm blood flow (FBF), and forearm vascular resistance (FVR) and on the responses to cold stimulation were studied in healthy young adults. Chloroquine sulphate (800 mg) reduced systolic pressure and increased FBF (P<0.05) but had no effect on resting FVR. Cold immersion increased systolic pressure (from 108.8 ±1.7 mmHg to 127.8 ± 6.9 mmHg; P<0.05) diastolic pressure (from 73.4 ±2.7 to 95.2 ±6.2 mmHg; P<0.01) and FVR (from 5.9±0.9 to 13.0±l.9 a.u.; P<0.001) but reduced FBF (from 14.3±1.64 to 101 ± 1.29 ml min‐1; P<0.05). Chloroquine reduced the increase in FVR reduced by cold stimulation (P<0.01), but had little effect on the BF and FBF responses to cold stimulation. The hypotensive effect of chloroquine could be attributed, at least in part, to the observed fall in vascular resistance.
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    Open Access
    Significance of antibiotics resistance amongst clinical bacterial isolates in Lagos
    (1994) Rotimi, V.O.; Onyenefa, P.I.; Banjo, T.O.; Ogunsola, F.T.; Adenuga, A.
    In vitro susceptibility of several strains or six different species or clinical facultative pathogens Involved nosocomial Infections In our hospital was Investigated by a series of disc diffusion, broth dilution and chequerboard titration testing. With disc diffusion method all the test strains, except Streptococcus pyogenes, were resistant to penicillin 46% of the Klebsiellaaerogenes and 73% of the Pseudomonasstarins were generally resistant to cefotax line. The minimum inhibit of y concentration (MIC) of the antibiotics correlated well with the results or the disc diffusion tests. Synergistic effects were demonstrated by various combinations of gentamlein, ampicilin, clindamyclin, coiistin, cefoxitin, and ceftriazone against resistant strains of S. aureus, Pseudomonas aeruginosa, Escherichia coli and Klebsiella aerogens. Against S. aureus the effect of gentamicin/CLindamyein demonstrated indifference. The need for stringent caution is strongly advocated in the selection of combination therapy for serious infections caused by some hospital bacterial strains particularly in aeutecare units. The clinical microbiologist should be consulted at all times during the precoss of selection of an appropriate combined therapy for expert guidance.
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    Open Access
    Sds-page analysis of edta-extracted cell surface antigens is a simple and reproducible typing method for clostridium difficile
    (1995) Ogunsola, F.T.; Ryley, H.C.; Duerden, B.I.
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    Open Access
    Correlation of pyrolysis mass spectrometry and outer membrane protein profiles of clostridium difficle
    (1995) Ogunsola, F.T.; Magee, J.T.; Duerden, B.I.
    To perform pyrolysis 1nas� specrrcmeuy (Pyt\olS). a small sample of colony nuucrial is thcnnally degraded in a vuc­ uum. 'thus yidJing mixed volatile products whose composi­ uon reflects that or the organism. tvt,1ss spectrometric anuly­ sis of the products yields spc1:tra that can be: cumpurcd :.tatistically; consequently. tine differences in cc\l composi­ ion can be detected [ 1 J. Typinb by PyNIS is rapi...1, inexpert­ sive. automated. and non-spccies-spccir;c un.J hus a high thruughput ( 100-150 isolates per day) [2]. ll has been used. successfully to 1yp1..· isolates recovered during nosocomial outbreaks ol' Clu:•;1ridi11111 clij}icih· infection [JJ .1nJ new is a nuniuc typing method for this organism in the UnitcJ King· dom. However. Py/\-lS is a tingcrprinting ruerhod: no p..:rn1a· ncnt 1ypc 1.h:sign;ltivn has been assigned, anJ vnriuricns between diflcrcru anulyucul batches prevent inrerbatch coin· parisons of spcctr.1. This difficulty in routine typing of C. di)ji(·i/,: is overcome by indudino rc:pn:scnt.ttiv.c isolates from any outbreak with fun her butches ofisolutcs recovered in the same hospital
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    Open Access
    Modification of pcr ribotyping method for application as a routine typing scheme for clostridium difficile
    (1996) O'neil, G.L.; Ogunsola, F.T.; Brazier, J.S.; Duerden, B.I.
    Clinically significant jsolates of Gram-negative bacilli obtained in the Lagos University Teaching Hospital Laboratory between January 1995 and June 1996 were characterised, using Analytical profile index system (APl 0 20E and API 20NE), and also by simple conventional laboratory methods. Twenty-lwo percent (163) of all clinical signifi· cant isolates were found to be non-fermenting Gram-negative bacilli. The micro-organisms identi· fied were Pseudomonas aeruginosa (55%), Acinetobacter species (29.5%). Burkholderia (Pseudononas) cepacia (9%), Pseudomonas tluorescens (2%), Pseudononas stutzeti (1 %), Stenotrophomonas (Xanthomonas) maltophi/a (0.6%), .. Chryseomonas luteola (0.6%), Ochrobacterium anthropi (0.6%), Agrobacterium radiobacter (0.6%) and Alcaligenes xylosoxidans (0.6%). Seventy percent of the isolates were obtained from specimens from hospitalised patients while 30�. were obtained from specimens from outpatient clinics. Most of the non-fermenting Gram-negative bacterial isolates were obtained from wound swabs (39%) and urinary specimens (36%). Nine percent was obtained from pulmonary specimens, 4.5% frorn eye swabs, 4.5% from ear swabs and 5.5% frorn blood. Very few (1.5%) isolates were cultured frorn the cerebrospinal fluid.
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    Open Access
    Characterization of non-fermenting gram -negative bacilli at the lagos university teaching hospital-a preliminary report
    (1996) Oduyebo, O.; Ogunsola, F.T.; Kesah, C.N.; Odugbemi, T.
    Clinically significant jsolates of Gram-negative bacilli obtained in the Lagos University Teaching Hospital Laboratory between January 1995 and June 1996 were characterised, using Analytical profile index system (APl 0 20E and API 20NE), and also by simple conventional laboratory methods. Twenty-lwo percent (163) of all clinical signifi· cant isolates were found to be non-fermenting Gram-negative bacilli. The micro-organisms identi· fied were Pseudomonas aeruginosa (55%), Acinetobacter species (29.5%). Burkholderia (Pseudononas) cepacia (9%), Pseudomonas tluorescens (2%), Pseudononas stutzeti (1 %), Stenotrophomonas (Xanthomonas) maltophi/a (0.6%), .. Chryseomonas luteola (0.6%), Ochrobacterium anthropi (0.6%), Agrobacterium radiobacter (0.6%) and Alcaligenes xylosoxidans (0.6%). Seventy percent of the isolates were obtained from specimens from hospitalised patients while 30�. were obtained from specimens from outpatient clinics. Most of the non-fermenting Gram-negative bacterial isolates were obtained from wound swabs (39%) and urinary specimens (36%). Nine percent was obtained from pulmonary specimens, 4.5% frorn eye swabs, 4.5% from ear swabs and 5.5% frorn blood. Very few (1.5%) isolates were cultured frorn the cerebrospinal fluid.
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    Open Access
    Modificaiton of a polymerase chain reaction ribotyping method for application as a routine typing scheme for clostridium difficile
    (1996) O'neil, G.L.; Ogunsola, F.T.; Brazier, J.S.; Duerden, B.I.
    A modification of a PCR ribotyping procedure based on polymorphisms in the 165-235 intergenic spacer region was evaluated for use as a typing method for Clostridium 1ifficile. This procedure depends on the variation that can occur in the intergenic space between the 165 and 235 rRNA genes of the ribosomal RNA gene complex. The primers used inthis study were chosen by examining the se'lucn<;e of the 165 gene of C. difficile and the 235 gene of C. botulinum. The primers used were: CTG GGG TGA AGT CGT AAC AAG G (positions 1445-1466 in the 165 rRNA gene) and GCG CCC TTT GTA GCT TGA CC (positions 1-20 in the 235 rRNA gene) and the PCR parameters were optimised for this primer pair. To evaluate the discriminatory "power of the method, PCR ribotyping was performed on strains of C. difficile serotyped by Delmee (serogroups A-X and sub-serogroups A2-A10). Each isolate gave multiple DNA bands in PCR ribotyping and a series of products ranging in size from 260 to 585 bp in length was obtained. All of the 19 different serogroups gave different banding patterns and these patterns were reproducible. This 'modification of PCR ribotyping offers several advantages over the original method and appears to hold much promise as a method for typinf; wild isolates of C. difficile.
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    Open Access
    Antimicrobial resistance in nigeria: an overview
    (1997) Ogunsola, F.T.; Kesah, C.N.; Odugbemi, T.
    The resistance patterns of common pathogen like · $taphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiel/a pneumoniae, Neisseria gonormoeer, Neisseria meningitidis amongst others have been reviewed in the period between 1979 and 1994. The stud· ies in general have given limited information but show a general increase in resistance to commonly used antibiotics like penicillin, cotrimoxazole, ampicillin, tetracycline, chloramphen.col, streptomycin and erythromycin. Sensitively rates to third generation cephalosporins, and quinolones are still high, thus, in life threatening infections, e. g: meningitis and septicaemia, treatment with these .igents is advocated for empiric therapy. This review emphasizes the urgent need for a good antibiotic policy to guide the therapy of infeclious diseases.
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    Open Access
    Adhesion molecules and rejection of renal allografts
    (Kidney international, 1997) Solez, K; Racusen, LC; Abdulkareem, FB; Kemeny, E; Willebrand, EV; Truong, L D
    Adhesion molecules and rejection of renal allografts. Despite an increasing amount of immunohistochemical and molecular biology data relating to the pathogenesis of kidney transplant rejection, the pathological diagnosis of this condition still rests on routine light microscopy. The detection of changes in expression and distribution of adhesion molecules in renal allograft biopsies may open a new era of increased accuracy of rejection diagnosis. Of the various adhesion molecule reactivities, peritubular capillary VCAM-1 staining appears to be the most specific rinding for chronic rejection. This same staining reaction is seen in acute rejection, but may have less specificity in that setting.
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    Open Access
    An in vitro study on methicillin and other antimicrobial agents against staphylococcus aureus, 1994 - 1996
    (1997) Kesah, C.N.; Ogunsola, F.T.; Niemogha, M.T.; Odugbemi, T.
    Staphylococcus aurous infections remain a throat lo bolh immunocompelent and imrnunosuppresscd patients despite advances in antibacterial therapy. An in virro antimicrobial susceptibility study was conducted at the Lagos University Teaching Hospital on clinical isolates of S. aureus over a period of three-years, 1994 . 1996. Beta· lactamase production was detected usina a cnrornoqenic cephalosporin method (Nitrocefin, Oxoicl) and antibiotic susceptibility testing was performed by r ' ct (AB Biodisk, Solna, Sweden) including reference sir;,, ·,. A total of 152 strains of S. aureus were analysed. Eighly-six percent of lhe 152 isolates produced B· lactamase, 50.4% were high level penicillinaso producers, while 4 7 .3°/o produced low levol penicillinasos. Approximately 52% of the strains were sonsilivo lo menucillin and 3.3% to Penicillin G. Thero was 100% suscopfibility to vancomycin over the three ye,r period, 96.5% lo rifampin, 90.2°/o to tusidic acid, 89.6°/o to ctindamycin, 71.8°/o to amoxycillin-ctavulanic acid, 7 1 . 7°/o lo crylhromycin, 64.4°/o to cotrimoxazolo, and below 50°/o lo gentamicin and tctracv: line. The MIC90 values for vancomycin, clindamycin, rifampin and fusidic acid were within tho.; susceptible breakpoints, thus these drugs could be used omp\rically. For the other antibiotics tested such as erythcomycin, tetracycline, augmentin, septrin and gentamicin, susceptibility cannot be assumed. In vitro efficacy should volioate their therapeulic option. ·
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    Open Access
    Prevalence of multi-resistant strains of pseudomonas aeruginosa isolated at the lagos university teaching hospital laboratory from 1994 to 1996
    (1997) Oduyebo, O.; Ogunsola, F.T.; Odugbemi, T.
    A total of 114 strains of Pseuaomoces aeruginosa isolated from the Lagos University Teaching Hospital (LUTH) Microbiology Laboratory, between November 1994 and Dec�mber 1996, ldentitied using analytical protite index system (API 20 NE) were checked tor susceptibility and resistance against varlous antimicrobial agents on Mueller-Hinlon agar using E test method as recommended by the National Committee on Clinical Laboratory Standards (NCCLS). Ninety-two percent, 39.7%, 21.6% and 12.5% of lsolates were found lo be resistant to arnoxycillm-clavulanate, cefotaxime, piperaciltln and imipenem respectively. Ninety-six percent, 54.2°!o, 60°/o and 95.So/o al iso- ,1' tales were susceptible to ciprolloxacin, celtazidime, gentamlcin and amikacin respectively. · Twenty-seven percent of all isolates were found to be multi-resistant and there was a gradual increase in the percentage al multi-resistant strains observed trorn 1994 to 1996. A very high percentage of isolates- resistant to piperacillin were also resistant to ticarcillin, cefotaxime and gentamicin, among olher antibiotics. Forty percent of isolates were found to be resistant to gentamicin and 86°/o of these gentamiqin resistant isolates · were multi-resistant. Forty-five percent of all isolates were found to be resistant" to celtazidime and 95.5°/o of those· celtazidime resistant strains were found to be multi-resistam. The high prevalence of multl-resistant strains in this study probably emphasizes the need for antibiotic policies in LUTH.
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    Open Access
    Penicillin - resistant pneumococcus
    (1997) Ogunsola, F.T.
    Penicillin-resistant Streptococcus pneumoniee (pneumococcus) became clinically significant in the late 1970's when reports of resistant clinical isolates, leading to treatment failure, were first reported from South Africa. Since then reports of penicillin-resistant pneumococcus (PRP) have come in from all over the world including Africa. The drugs of choice for treatment of life-threatening infections like meningitis and septicaemia were changed to cefotaxime and ceftriaxone. In recent times, there has emerged pneumococcal strains resistant to most antiblotics including the extended spectrum cephalosporins with grave implications for therapy. The penicillin resistance is not due to the production of beta-laclamases but lo changes in the penicillin binding proteins, brought about by genetic transformation. This is a review of the literature on lhe 'epidemtoloqy.' diagnosis, therapy and prevention of PRP including the problems encountered in Nigeria in isolating and identifying these strains.
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    Open Access
    EFFECT OF BRIDELIA FERRUGUBEA STEM BARK ON BLOOD CHEMISTRY AND HISTOLOGY OF SOME ORGANS IN RATS
    (Nigerian Journal of Natural Products and Medicine, 1998) Ofogba, CJ; Agbomo, FU; Abdul-Kareem, FB; Abaelu, AM; Alatishe, K
    Aqueous extract of Bridelia ferruginea stem bark caused significant increases in serum K+, creatinine, total bilirubin, GOT, GPT, HDL, Alkaline phosphate, BUN (p<0.001) and decreases in serum Na+, Cl-, CO2), cholesterol, glucose, Ca2+ (p<0.01,0.001) in rats. No changes were observed in serum triglyceride, uric acid, phosphate and total protein levels when compared with the control. The increase in some if these parameter was detected by means of PAS staining. The heart and lungs also showed adverse effects.
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    The prevalence and antibiotic susceptibility patterns of various klebsiella species in clinical samples and the implications for the control of hospital-acquired infections
    (1998) Ogunsola, F.T.; Oduyebo, O.O.; Kesah, C.N.; Odugbemi, T.O.
    One hundred and filly Klebsiel/a spp were isolated from clinical samples jn the Lagos University Teaching Hospital (LUTH) between July 1996 and February 1997. A total of 140 (93.3%) of these were K pneumoniae while K. oxytoca, K. ozaenae and K. ornithinolytica made up the remaining 7°/o. The biochemical cnnracteristics v.e re studied using the API 20E (BioMerieux, France). ',II isolates produced beta-lactarnase. Antibiotic susceptibility tests were done using tho E· Test. Moc.I isolates. 47 (33%) of 150 were from the paediatric wards while the medical wards had the lowest number, 10 (7%) of 150 isolates. The biochemical characteristics conformed with the AP\ standards, with over 50°/o of strains resistant to gentamicin, amoycillin-clavulanic acid (amoxyclav), piporucillm, co-trlmoxazote and cephalothin. About 97%;. of all lsolates were sensitive to Ciprofloxacin, Nalidixic acid and Amikacin. There was no correlation between biochemical character· istics of isolates and the site of isolation but most isolates from blood culture (mostly from the paediatric wards) were resistant to gentamicin. Multi-resistant strains would appear to be endemic in the Lagos University Teaching Hospital and there is need for a concerted infection control program and a sound antibiotic policy.
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    Open Access
    A study on prevalence of urinary tract infections in hypertensive patients attending an urban hospital in lagos, Nigeria
    (1998) Odutola, T.A.; Ogunsola, F.T.; Odugbemi, T.; Mabadeje, A.F.B.
    Three hundred und filly four hvportr.nsivo patients In the age range 20 · 80 years were studied. They included both old and new patients who were attending the clinic for the first time or had been patients for up to 27 years. The 298 age-matched non-hypertensive controls were also studied. The booking mean arterial pressure (mean arterial pressure at first attendance or at booking for lhe clinic) and the study mean arterial pressure (mean arterial pressure taken during the period of study) were recorded and patients were classified as normotensive MAP <110mmHg, mildly hypertensive 110 - 122mmHg, moderate!y hypertensive MAP 123 - 136mmHg and severely hypertensive MAP> 137mmHg. At bookinq there were significantly more male moderate and severe hypertensives than females. Symptoms of UTI were elicited by indirect questioning and midstream urine specimens collected. There was no statistically significant difference in UTI botweon malo and female patients versus controls. A total of 13 out of 116 male patients and 47 out of 178 female patients had their urine samples positive for urinary pathoqons, It was significant that most cases had asymplomatic bacteriuria. Escherichia coli was the mosl frequent organism isolated in both patients and controls hut its distribution in patients on gender basis was not siqnitlcantly different. However, in controls, the frequency in female controls was significantly higher than in male controls, but the frequency was not significantly different in all patients versus nil controls. It is concluded that the prevalence of UTI in our hypertensive population is not significantly different from that in the general population. That E. coli was the most frequent organism isolated, and that UTI occurred irrespective of the degree of hypertension nor did it affect significantly the course of lhe disease in the population studied.
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    Open Access
    A review of nosocomial infections at the lagos university teaching hospital: problems and strategies for improvement
    (1998) Ogunsola, F.T.; Oduyebo, O.; Iregbu, K.C.; Coker, A.O.; Adetunji, A.
    The infection control programme of the Lagos University Teaching Hospital was started in 1974 with an Infection Control Team reporting to an Infection Control Committee. There is currently no functioning Infection Control Committee. An analysis of data of a hospital-wide surveillance obtained between November 1993-November 1996 is presented, highlighting the problems associated with maintaining an effective infection control programme in a developing economy and discussing possible solutions. The monthly prevalence ranged between 0.11- 8.1 % for nosocomial infections with a 14: I ratio of gram-negative to gram-positive organisms. Pseudomonas aeruginosa, Klebslella pneumoniae, Proteus mirabilis and Escherichia coli were the most common pathogens accounting for 75 % of all organisms isolated. The prevalence of Staphylococcus aureus was only 4.8% of all isolates and that of hospitalacquired Plasmodium falciparum was 6.2 % . Urinary tract infections were the most common nosocomial infections and were often catheter-related. These were followed by wound infections of which 55.2% were surgical site infections. Nosocomial respiratory tract and bloodstream infections appear uncommon. Lack of an Infection Control Committee, lack of an effective antibiotic policy, poor funding, inadequate and ageing infrastructure including poor water supply and a lack of awareness of the cost benefits of an efficient programme have been identified as some of the problems mitigating against an effective infection control programme in the hospital.
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    Recurrence of anti-GBM Antibody Disease Twelve Years After Transplantation Associated With De Novo IgA Nephropathy
    (Clinical nephrology, 1998) Abdulkareem, FB; Trpkov, K; Jim, K; Solez, K
    A patient developed recurrent anti-glomerular basement membrane (GBM) antibody (ab) disease after twelve years of an uneventful posttransplant course, clinically accompanied by rapidly rising creatinine. He additionally exhibited coexisting IgA nephropathy at the time of the reappearing anti-GBM disease. Both linear IgG and mesangial IgA were detected by immunofluorescence, and electron microscopy demonstrated mesangial immune complex deposits. To our knowledge, the association of anti-GBM ab disease and IgA nephropathy has not been reported previously.