SummaryBackgroundStaphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection.MethodsIn this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants.FindingsBetween Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18–45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference −1·4%, 95% CI −7·0 to 4·3; hazard ratio 0·96, 0·68–1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3–4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005).InterpretationAdjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia.FundingUK National Institute for Health Research Health Technology Assessment.

Background: Patients who recognize their increased risk of stroke are more likely to engage in stroke prevention practices than those who do not. Method: All patients attending medical out-patient clinic of the Federal Medical Center, Ido, Ekiti-State, Nigeria between January 2004-December 2004 were recruited into the screening process following their verbal consent. A set of questionnaire was administered to collect data. Results: A total of 155 patients were studied having satisfied the inclusion criteria. The mean age of the patients was 58.418.7 years. Majority of the patients indicated paralysis of one side of the body as the most common symptom of stroke. Patients with higher education p=0.002 and men p=0.004 were more aware of their increased risk factor for stroke than those with low education and women. Conclusion: Perception about stroke among the at risk medical out patients as found out in this study indicates that more health education both at the community and the hospital is very vital to reducing the prevalence, recurrence, disability and mortality of stroke. Health providers are enjoined to communicate information about stroke risk to their patients. Key words: Stroke, risk factorsRésumé Introduction : Des patients qui sont capable de savoir que leur risque d'une attaque augment sont très vraisemblabe d'engager des practiques de la préventions des attaques plus que ceux qui ne sont pas. Méthodes : Tous les patients qui viennent consulter au centre médical des consultations externes du centre hospitalier fédéral Ido, l'Etat d'Ekiti, Nigéria entre le janvier 2004 au décembre 2004 ont été récrutés dans un processus d'un test à la suite de leur consentement verbal. Une parure de questionnaires ont été préparé afin de collectionner des données. Résultats : Un total de 155 patients ont été étudiés après avoir satisfait des critères requis. Moyen d'âge des patients était 58,4+-18,7 ans. La plus grande partie des patients ont montré la paralysie dans un côté du corps comme un symptôme d'attaque le plus ordinaire. Des patients avec un niveau d'enseignement supérieur . p =0,002 et sexe masculin p =0,004 ont été plus conscient des facteurs ménant à l'augmentation de leur risque d'attaque plus que ceux avec un niveau d'enseignement inférieur et sexe féminin. Conclusion : La perception concernant l'attaque parmi des malades avec des risques d'attaque dans un centre hospitalier des consultation externes comme indiqué dans cette étude a montré que plus des renseingnements supplémentaires dans le domaine de la santé dans la communauté et dans l'hôpital les deux est très important afin de réduire la fréquence, récurrence, infirmité et la mortalité à travers l'attaque. Des médecins sont priés de passer des informations sur l'attaque et le risque d'attaque aux patients.

Diabetes mellitus (DM) has been considered as one of the predisposing factors for candiduria and Candida urinary tract infections. The study determined the socio-demographic characteristics, risk factors of DM patients with asymptomatic candiduria and ascertained the prevalence, virulence factors and antifungal susceptibility of Candida isolated. Socio-demographic and risk factors were obtained via questionnaires. Microscopic, macroscopic and chemical analysis of mid-stream urine (MSU) samples were determined by microbiological method and dipsticks. The characterization, virulence factors, antibiotic susceptibility of Candida isolates were determined by conventional, mycological media and disc diffusion techniques, respectively. Of the 51 MSU samples, ≥ 31.4% were amber and clear in colour, contained yeast cells and leukocytes; between 5.9 to 25.5% had hyaline casts, urobilinogen, epithelial cells, red blood cells, pus cells and nitrite, while the specific gravity was ≥ 1.015. The prevalence of candiduria among subjects with respect to age, types and duration of diabetes, gender, tobacco and alcohol consumption were not significant (p ≥ 0.005). Candida dubliniensis and C. parapsilosis prevalence was highest in subjects with random blood sugar (mg/dL) of ≥ 400 and 300-399, respectively. Of the 39 isolates, 64.1% were Fluconazole sensitive, 10.3% were dose dependent susceptible to Ketoconazole, 74.4% exhibited Voriconazole sensitivity, 100% C. dubliniensis were Clotrimazole sensitive, ≤ 28.6% C. tropicalis and C. glabrata were resistant to Amphotericin B and Itraconazole, while between 23.1% and 71.8% isolates produced hydrolytic enzymes and biofilm. This study revealed the socio-demographic characteristics and risk factors among subjects and the necessity to continuously investigate pathogenic Candida against antifungal agents for effective treatments of asymptomatic candiduria in diabetes mellitus patients.

ObjectiveCoinfection of hepatitis B virus (HBV) with hepatitis D virus (HDV) has being reported to increase severity of progression to hepatocellular carcinoma (HCC) and liver cirrhosis (LC). Beta microglobulin (2βM) which is present on the surfaces of blood cells in acceptable levels is a tumor marker which may become elevated in disease conditions. This study hence observed the prevalence of HBV and HDV coinfection in a rural population and their 2βM concentration.ResultsOf the 368 samples, 66 (17.9%) were positive to hepatitis B surface antigen (HBsAg) and 33 (50%) were coinfected with HDV, 8 (2.1%) were monoinfected with HDV. 2βM concentration increased beyond the normal level in individuals coinfected with HBV and HDV as compared with the monoinfected individuals. Coinfection resulted in the increased concentration of 2βM in HBV and HDV coinfection and the likelihood of progression to HCC and LC may not be ruled out. Monoinfection with HDV also had high 2βM concentration but this is due to having being infected with a non-detected HBV or chronic infection in which HBV is clearing.

Urinary tract infection is huge public health burden and the emergence of extended spectrum beta lactamase producing bacterial pathogens increases the burden of infectious diseases in Nigeria. This study determined the current prevalence of cephalosporin resistance among Gram-negative bacteria isolated from patients with urinary tract infections between February 2018 and June 2018. Non-repetitive Gram–negative bacteria were recovered from 106 individuals with urinary tract infections who reported at two tertiary healthcare centers in Ekiti-State, Nigeria. A total of 106 bacterial isolates were obtained which included: Klebsiella pneumoniae 34 (29.1%), Klebsiella oxytoca 17 (16.0%), Proteus vulgaris 10 (9.4%), E. coli 24 (22.6%), Proteus mirabilis 18 (16.9%) and Pseudomonas aeruginosa 3 (2.8%). Sixty five of these organisms showed resistance to ceftazidime while 76 organisms showed resistance to ceftriaxone. Forty representative organisms were selected and tested for presence of extended spectrum beta-lactamase (ESBL) genes using primers specific for different ESBL genes. A total of eight (20.0%) organisms carried the blaCTX-M gene and other variants of the ESBL genes were not detected. The organisms carrying the blaCTX-M gene included E. coli 3 (37.5%), K. pneumoniae 1(12.5%), P. mirabilis 1(12.5%),) and K. oxytoca 3(37.5%). The high prevalence of cephalosporin resistant Gram-negative bacteria among patients with UTI is a serious threat to public health and efforts must be intensified to regulate the clinical use of the cephalosporins.