Effect of Fascia Closure with Triclosan-Coated Polydioxanone Suture on Surgical Site Infection in Open Appendectomy Wounds: A Comparative Study.

Background: Interest in surgical site infections (SSI) has been sustained over the years because its occurrence may be ruinous to the overall success of surgical operations. The use of antimicrobial suture has been associated with a reduction in SSI, but its role in open appendectomy has not been evaluated. Objective: This study compared the effect of fascia closure with triclosan-coated polydioxanone (PDS) with plain PDS on SSI in appendectomy wounds. Materials and Methods: Ninety-three consecutive patients who had open appendectomy for uncomplicated acute appendicitis were randomised to either have fascia closure with triclosan-coated PDS (TCS) or plain PDS. Post-operative wound infection rates were compared. Results: SSI occurred in three of the 93 patients (3.2%), two of these occurred in the plain suture group, while one occurred in the TCS group (4.2% vs. 2.2%, P = 0.6). All three SSIs were superficial. Staphylococcus aureus was the predominant organism isolated in the infected wounds. Conclusion: The use of triclosan-coated polydioxanone for fascia closure in open appendectomy did not significantly affect the rate or severity of SSI. Further studies, perhaps evaluating the use of TCS in a different anatomical plane or complicated appendicitis are recommended.

Local Epidemiology of Nosocomial Staphylococcus aureus Infection in a Nigerian University Teaching Hospital.

Population-based studies of Staphylococcus aureus contribute to understanding the epidemiology of S. aureus infection. We enrolled surgical inpatients admitted to an African tertiary-care hospital in order to prospectively analyze the nosocomial impact of S. aureus. Data collection included an active sampling of the anterior nares and infectious foci within 48 h after admission and subsequently when clinically indicated. All S. aureus isolates were spa and agr genotyped. Possession of Panton-Valentine leukocidin (PVL) and other toxin genes was determined. We analyzed antibiotic susceptibility profiles by VITEK 2 systems and verified methicillin-resistant S. aureus (MRSA) by mecA/C PCR. Among 325 patients, 15.4% carried methicillin-susceptible S. aureus (MSSA) at admission, while 3.7% carried MRSA. The incidence densities of nosocomial infections due to MSSA and MRSA were 35.4 and 6.2 infections per 10,000 patient-days, respectively. Among all 47 nosocomial infections, skin and soft-tissue (40.4%) and bones or joints' (25.5%) infections predominated. Six (12.7%) infection-related S. aureus isolates harbored PVL genes including two (4.2%) MRSA: overall, seventeen (36.2%) isolates carried pyrogenic toxin superantigens or other toxin genes. This study illustrates the considerable nosocomial impact of S. aureus in a Nigerian University hospital. Furthermore, they indicate a need for effective approaches to curtail nosocomial acquisition of multidrug-resistant S. aureus.

Contemporary management of breast cancer in Nigeria: Insights from an institutional database.

High-quality data are needed to guide interventions aimed at improving breast cancer outcomes in sub-Saharan Africa. We present data from an institutional breast cancer database to create a framework for cancer policy and development in Nigeria. An institutional database was queried for consecutive patients diagnosed with breast cancer between January 2010 and December 2018. Sociodemographic, diagnostic, histopathologic, treatment and outcome variables were analyzed. Of 607 patients, there were 597 females with a mean age of 49.8 ± 12.2 years. Most patients presented with a palpable mass (97%) and advanced disease (80.2% ≥ Stage III). Immunohistochemistry was performed on 21.6% (131/607) of specimens. Forty percent were estrogen receptor positive, 32.8% were positive for HER-2 and 43.5% were triple negative. Surgery was performed on 49.9% (303/607) of patients, while 72% received chemotherapy and 7.9% had radiotherapy. At a median follow-up period of 20.5 months, the overall survival was 43.6% (95% CI -37.7 to 49.5). Among patients with resectable disease, 18.8% (57/303) experienced a recurrence. Survival was significantly better for early-stage disease (I and II) compared to late-stage disease (III or IV) (78.6% vs 33.3%, P < .001). Receipt of adjuvant radiotherapy after systemic chemotherapy was associated with improved survival in patients with locally advanced disease (68.5%, CI -46.3 to 86 vs 51%, CI 38.6 to 61.9, P < .001). This large cohort highlights the dual burden of advanced disease and inadequate access to comprehensive breast cancer care in Nigeria. There is a significant potential for improving outcomes by promoting early diagnosis and facilitating access to multimodality treatment.

Safety and feasibility of early postmastectomy discharge and home drain care in a low resource setting.

BACKGROUND: Early postmastectomy discharge with a drain in place is standard practice in most developed countries. Its feasibility has not been evaluated in low resource settings like Nigeria. METHODS: Consenting patients undergoing mastectomy were discharged on the third postoperative day and assessed as outpatients for wound complications as well as their experience at home. Wound outcomes were compared with patients who had traditional long stay. RESULTS: Forty-five of the 58 patients who had a mastectomy during the study period participated in the early discharge program (77.6%). Of these, four patients (8.9%) had drain malfunction, seroma occurred in eight patients (17.8%), eight patients (17.8%) had wound infection, and six patients (13.3%) had flap necrosis. There was no readmission. Compared with long stay patients, postoperative stay was significantly shorter (3 vs 11 days; P < 0.01) with significant cost savings, while complication rates were not statistically different. All the patients in the early discharge group were confident operating their drains and preferred early discharge. Being around relatives, reduced cost, and fear of the hospital environment were common reasons cited for their preference. CONCLUSION: Our results support the implementation of an early postmastectomy discharge program in a low resource setting.

Trend Over Time for Cholecystectomy following the Introduction of Laparoscopy in a Nigerian Tertiary Hospital.

BACKGROUND: There still exist some concerns about the desirability of laparoscopic surgery in lower-middle income countries. We recently adopted laparoscopy for common general surgical procedures and observed many benefits. This study aims to describe the changing rate of cholecystectomy before and after the introduction of laparoscopy in our hospital. METHODS: We reviewed the records of cholecystectomies performed before and after the introduction of laparoscopic cholecystectomy (LC) in 2009 in a single general surgery unit of the Ife Hospital Unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Cholecystectomy was reviewed as a percentage of general procedures performed, and postoperative length of stay was calculated. RESULTS: A total of 173 cholecystectomies were performed in the hospital between January 2005 and December 2015. The yearly number rose from 7 in 2005 to 31 in 2015 corresponding to 2.7% of total elective major general surgery procedures in 2005 and 9.1% in 2015. A marked progressive increase was observed in the number and rate of cholecystectomies from 2009 following introduction of LC. From 0% in 2005, LC rose to 90% of all cholecystectomies in 2015. The mean postoperative length of stay of patients undergoing cholecystectomy declined from 5.2 days in 2005 to 3 days in 2009 and 1.8 days in 2015. CONCLUSION: This study demonstrates an increased rate of cholecystectomy following the introduction of LC in our setting. We recommend increased adoption of laparoscopy and other forms of minimally invasive surgery across the country.

Developing a Breast Cancer Screening Program in Nigeria: Evaluating Current Practices, Perceptions, and Possible Barriers.

PURPOSE: In low- and middle-income countries like Nigeria, women present with advanced breast cancer at an earlier age. Given the limited resources, development of screening programs that parallel resource capabilities of low- and middle-income countries is imperative. The objective of this study was to evaluate the perceptions, practices, and barriers regarding clinical breast examination (CBE) screening in a low-income community in Nigeria. MATERIALS AND METHODS: A cross-sectional survey of women age 40 years or older in Ife, Nigeria, using multistaged sampling was performed. Information on sociodemographics, knowledge of breast cancer, screening practices, and willingness to participate in CBE screening was obtained using an interviewer-administered questionnaire. RESULTS: A total of 1,169 women whose ages ranged from 40 to 86 years (mean age, 47.7 years; standard deviation, 8.79 years) were interviewed. The majority of women (94%) knew about breast cancer, whereas 27.5% knew someone who had had breast cancer, the majority of whom (64.5%) had died of the disease. Of the 36% of women who had breast screening recommended to them, only 19.7% had an actual CBE. Of these, only 6% had it in the last year. The majority of women (65.4%) were willing to have regular CBEs and did not care about the sex of the examiner in most instances. Lack of perceived need was the reason cited by women unwilling to participate. CONCLUSION: The majority of women were aware of breast cancer and knew it as a fatal disease. With the relatively encouraging number of those willing to be examined, a carefully designed CBE program coupled with advocacy to correct uneducated beliefs seems promising.

Impact of introduction of laparoscopic surgery on management of unresolved intra-abdominal malignancies in a West African hospital.

BACKGROUND: Intra-abdominal malignancies often pose diagnostic problems to surgeons in resource-challenged centers such as ours due to limitations in modern imaging and other facilities. This prompted the adoption of laparoscopy in our hospital as an adjunctive tool in diagnosing these conditions. METHOD: Pre- and per-operative data of consecutive cases of clinically unresolved advanced intra-abdominal tumors subjected to laparoscopy from January 2009 through June 2013 were reviewed. Anatomic diagnosis and tissue biopsies were carried out during the procedures. RESULTS: Of the 152 patients seen with intra-abdominal tumors, 74 (48.7 %) had advanced conditions that could not be resolved clinically. Of these, 33 (44.6 %) were able to afford and had computed tomography (CT), scan while the remaining (N = 41; 55.4 %) less endowed only had an ultrasound scan. This cohort underwent laparoscopic evaluation, and biopsies confirmed the following: 27 (36.5 %) metastatic adenocarcinomas, 12 (16.2 %) primary hepatic malignancies, 11 (14.9 %) cases each of lymphomas and colonic adenocarcinomas, 4 (5.4 %) gastrointestinal stromal tumors, 3 (4.1 %) pancreatic carcinomas, 2 (2.7 %) cases each of carcinoid tumors and abdominal tuberculosis, and one case each of schistosomiasis and HIV-related Kaposi's sarcoma. Additionally, 26 (35.1 %) had ascites, while 29 (39.1 %) had peritoneal surface malignancies. With local adaptations and improvisations, laparoscopy was cheaper than an abdominal CT scan in our setting, with the additional benefit of obtaining tissue diagnosis to institute treatment. CONCLUSION: Although laparoscopy is commonly used for staging intra-abdominal tumors, we found it useful in complementing clinical diagnosis and attaining histopathological confirmation in a setting where access to and funding of modern imaging is limited.

Characterization of colonizing Staphylococcus aureus isolated from surgical wards' patients in a Nigerian university hospital.

In contrast to developed countries, only limited data on the prevalence, resistance and clonal structure of Staphylococcus aureus are available for African countries. Since S. aureus carriage is a risk factor for postoperative wound infection, patients who had been hospitalized in surgical wards in a Nigerian University Teaching Hospital were screened for S. aureus carriage. All S. aureus isolates were genotyped (spa, agr) and assigned to multilocus sequence types (MLST). Species affiliation, methicillin-resistance, and the possession of pyrogenic toxin superantigens (PTSAg), exfoliative toxins (ETs) and Panton-Valentine Leukocidin (PVL) were analyzed. Of 192 patients screened, the S. aureus carrier rate was 31.8 % (n = 61). Of these isolates, 7 (11.5%) were methicillin-resistant (MRSA). The isolates comprised 24 spa types. The most frequent spa types were t064, t084, t311, and t1931, while the most prevalent MLST clonal complexes were CC5 and CC15. The most frequent PTSAg genes detected were seg/sei (41.0%) followed by seb (29.5%), sea (19.7%), seh (14.7%) and sec (11.5). The difference between the possession of classical and newly described PTSAg genes was not significant (63.9% versus 59.0% respectively; P = 0.602). PVL encoding genes were found in 39.3% isolates. All MRSA isolates were PVL negative, SCCmec types I and VI in MLST CC 5 and CC 30, respectively. Typing of the accessory gene regulator (agr) showed the following distribution: agr group 1 (n = 20), group II (n = 17), group III (n = 14) and group IV (n = 10). Compared to European data, enterotoxin gene seb and PVL-encoding genes were more prevalent in Nigerian methicillin-susceptible S. aureus isolates, which may therefore act as potential reservoir for PVL and PTSAg genes.

Local adaptations aid establishment of laparoscopic surgery in a semiurban Nigerian hospital.

BACKGROUND: Establishing and sustaining the routine practice of laparoscopy in resource-limited settings is extremely challenging. We present our experience implementing laparoscopic surgery at the Obafemi Awolowo University Teaching Hospital in Western Nigeria and the associated modifications that were necessary for success. METHODS: We reviewed all laparoscopic cases performed at our institution from January 2009 through December 2011. Operating surgeons were trained locally. Laparoscopic equipment and instrumentation was procured by both local and foreign sources. RESULTS: One hundred eighty-one procedures were performed in 175 patients whose ages ranged between 18 and 72 years. The procedures included cholecystectomies (n = 48, 24.5 %), appendectomies (n = 36, 20 %), diagnostic laparoscopies for staging and biopsy of intra-abdominal masses (n = 53, 30.9 %), adhesiolyses (n = 18, 11.6 %), hernia repairs (n = 6, 3.2 %), colorectal surgeries (n = 2, 1.3 %), and others (n = 18, 8.4 %). Diagnostic procedures were performed as day cases. Duration of stay for hospital admissions was 1-3 days. There were four conversions to open operation due to technical difficulties with equipment. No deaths were recorded. Local adaptation techniques facilitated cost reduction. Overall, there was improvement in the acceptance of the laparoscopic procedures among our patients and coworkers. CONCLUSION: Our local institution has successfully adopted laparoscopic techniques to treat surgical diseases. Specific improvisations have helped establish and sustain this technology. We advocate similar local adaptations to increase the use of laparoscopic surgery in hospitals located in limited resource settings.

Laparoscopic appendectomy in a Nigerian teaching hospital.

OBJECTIVE: Laparoscopic appendectomy in a setting where resources are poor is still controversial. This study evaluates the impact of laparoscopy on the early outcome of acute appendicitis in a developing country. METHODS: All patients who underwent appendectomy from January 2010 through June 2011 at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria were recruited for this study. RESULTS: Of the 139 patients with acute appendicitis within the study period, 83 (59.7%) had open appendectomy (OA), 19 (13.7%) whose clinical and radiological findings suggested complicated appendicitis at presentation had laparotomy, while 37 (26.6%) had laparoscopic procedures. In the laparoscopy group, initial diagnostic laparoscopy in 4 (10.8%) patients revealed a normal appendix along with other findings that precluded appendectomy. Laparoscopic appendectomy (LA) was then performed in 33 (23.7%) patients with 2 of these (6.1%) requiring conversion to open laparotomy. Mean time for the LA procedure was higher than that observed for OA (56.2 vs 38.9 min). Patients in the LA group had a shorter mean postoperative stay (1.8 vs 3.0). Wound infection occurred in 2 (6.5%) patients from the LA group and 8 (9.6%) from OA. CONCLUSION: Laparoscopic appendectomy reduced the rate of unnecessary appendectomy and postoperative hospital stay in our patients, potentially reducing crowding in our surgical wards. We advocate increased use of laparoscopy especially in young women.

The impact of neoadjuvant chemotherapy on patients with locally advanced breast cancer in a Nigerian semiurban teaching hospital: a single-center descriptive study.

BACKGROUND: There is a paucity of data on the response of breast cancer to neoadjuvant c in low-resources developing African countries such as Nigeria. We therefore decided to study the impact of neoadjuvant chemotherapy on breast cancer patients in Nigeria in the light of constrained resources. METHODS: This was a single-center retrospective descriptive study. Sixty-two patients with locally advanced breast cancer treated with neoadjuvant chemotherapy in the last 24 years in Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria, constituted the study population. The outcome measures were clinical tumor response, disease-free survival, overall survival, and chemotherapy toxicity profile. RESULTS: Patients ranged in age from 30 to 85 years (mean = 49.1 +/- SD 12.7 years) and included one male. After three cycles of chemotherapy, complete clinical response was observed in 4 patients (6.5%), partial clinical response in 28 patients (45.2%), no clinically measurable response in 24 patients (38.7%), and progressive disease in 6 patients (9.7%). Forty-one patients completed six cycles, of which 9 patients (22.0%) had complete clinical response and 12 patients (29.3%) had partial clinical response. Four of 30 patients (13.3%) with tumor size of 6-10 cm had complete clinical response, while no patient with a tumor bigger than 10 cm had complete clinical response. Of the 62 patients, 42 were followed up for more than 1 year. The 1-, 2-, and 5-year survival rates of this cohort were 66.7, 42.9, and 11.9%, respectively The median follow-up period was 9 months and the disease-free survival and overall survival rates at median follow-up period were 45 and 37%, respectively. CONCLUSION: There was a poor overall clinical response rate to neoadjuvant chemotherapy in the Black population studied. Late presentation with large tumor mass may be accountable for this.

Challenges unique to the design of a comprehensive questionnaire assessing breast cancer risk factors among women in sub-Saharan Africa.

We assessed the efficacy of a pilot questionnaire designed to elicit information about external risk factors for breast cancer in sub-Saharan African women. Preliminary analysis identified areas of the questionnaire and interviewing process that required modification, as well as socioeconomic factors that contribute to reduced participation among these understudied populations.

Particle-induced X-ray emission (PIXE) analysis of minor and trace elements in gallstones of Nigerian patients.

Gallstone disease is a major health problem in many parts of the world. In Nigeria, however, only a few cases of gallstone disease are reported. Minor/trace elements are reported to play a significant role in the formation of gallstones. This study was conducted to assess the minor elements in gallstone of Nigerian patients who had cholecystectomy in our institution using particle-induced X-ray emission (PIXE) technique. We also compare the findings with previous reports from outside Nigeria. Fourteen patients who had cholecystectomy for calculous cholecystitis at Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria, between March 2006 and July 2008, had the stone retrieved. The stones were analyzed for trace elements at the Center for Energy Research and Developments of the University using PIXE experiments. Certified standard reference material, NIST 1577a (bovine liver), was equally analyzed to confirm the accuracy of the experimental procedure. Computer code GUPIXWIN was used to analyze the data. Fourteen elements, phosphorus, sulfur, chlorine, potassium, calcium, manganese, iron, copper, zinc, bromide, lead, titanium, rubidium, and strontium, were detected in most of the samples. The concentrations of the elements varied in the different samples, ranging from a few parts per million to a few percent. Ca was the major constituent of all samples. The black sand-like samples had very high levels of P, S, K, and Pb, which were different from a previous report. The distribution of trace elements in stones in Nigeria patients is different from previous report outside Nigeria, and this may have some role in the occurrence of gallstones in the black African.

A middle aged woman presenting with massive empyema of the gallbladder: a case report.

Empyema of gallbladder is generally a rare disease and it is even rarer in the traditional African population where incidence of cholelithiasis is much lower compared with the Caucasian population. This is a presentation to highlight massive empyema of the gallbladder in a 58 year old woman who had no prior history of gallstone disease and who was treated with open cholecystectomy. The outcome was successful and she was followed up for a year.

Endoscopic hemorrhoidal sclerotherapy using 50% dextrose water: a preliminary report.

Injection sclerotherapy has a prominent role in the treatment of bleeding hemorrhoids. The commonly used sclerosants are not available or very expensive in Nigeria. We prospectively evaluated 50% dextrose water, used as a nonallergenic sclerosant, in the treatment of bleeding internal hemorrhoids. Forty consenting adult patients (median age 50 years [range 35-67]; 22 women) with bleeding hemorrhoids, seen over a 2-year period, were offered injection sclerotherapy with 50% dextrose water. They were assessed for response, tolerance and complications. The duration of symptoms before presentation was 3 months to 15 years. The bleeding stopped after the injection in all patients. No patient needed a repeat procedure. No complication was recorded during follow up which ranged from 2 months to 12 months. We conclude that endoscopic hemorrhoidal sclerotherapy using 50% dextrose water offers a simple, safe and effective modality of treatment if properly utilized.

Surgical outcome of abdominoperineal resection for low rectal cancer in a Nigerian tertiary institution.

BACKGROUND: Rectal cancer is a lifestyle-related illness with an increasing incidence in all developing countries in the last decade. Abdominoperineal resection (APR) offers a good oncologic clearance for low rectal cancer. The remaining controversies surrounding APR, as it is performed in a tertiary center in Nigeria, involve defining the role the operation plays in the management of existing rectal problems and determining what outcomes can be expected. The present study was aimed at examining the surgical outcomes of APR for low rectal cancers in a Nigerian tertiary institution. MATERIALS AND METHODS: This single-institution, retrospective, descriptive study analyzed APR rate, patient sex and age, subsite involvement, the diagnostic process, follow-up, and survival patterns after treatment of low rectal cancers. The study was conducted at Obafemi Awolowo University Teaching Hospital Complex Ile-Ife, Nigeria, between January 1989 and December 2007. RESULTS: During the 18-year period, 36 patients underwent APR. This accounts for 24.0% of all patients that had low rectal cancer. The age of the patients ranged from 29 years to 74 years (median: 58.9 years). Most of the patients were 60 years of age or older, and the majority were women (55.9%). The median duration of symptoms was 12 months, and all patients sought medical care for bleeding per rectum. Close to 80% of patients had advanced disease at presentation. Postoperatively, 17 patients (50%) had at least one complication and one patient (2.9%) died. Four (11.8%) patients had recurrence of the tumor, and in every case, recurrence occurred within the first year after operation. Operative blood loss (p = 0.006), degree of differentiation of the tumor (p = 0.011), distance from the anal verge (p = 0.033), and operative stage (p = 0.005) were found to significantly affect the outcome of treatment for the patients who underwent APR. The operative stage similarly affected the survival of patients (Mantel Cox = 0.026). CONCLUSIONS: Despite the advanced disease of our patients, the outcome of management appears to be comparable with results reported from other centers.

Paradox of wellness and nonadherence among Nigerian women on breast cancer chemotherapy.

CONTEXT: Intentional nonadherence among cancer patients is rare and may occur only when the benefits of treatment are not obvious to the patient. AIMS: To highlight a group of women on chemotherapy for breast cancer who defaulted from their medications because they were improving. SETTINGS AND DESIGN: A study was carried out of the reasons for nonadherence to medications among women receiving chemotherapy for breast cancer at a Nigerian teaching hospital between January 1993 and December 2002. MATERIALS AND METHODS: A retrospective review of patients' records was done. RESULTS: Of the 188 women who received chemotherapy during the study period, 152 (80.9%) defaulted from treatment at one point or another. The reasons for nonadherence were available in 101 patients. Among these, 18 (18.0%) reported nonadherence because they felt better after commencing chemotherapy. They were aged 31-50 years (Mean = 35.6 (SD3.2)). Six (33.3%) of them presented in AJCC Stage I, and 10 (55.6%) in stage II. Age and disease stage at presentation were found to have significant influence on their reason for nonadherence. Of the nine women on neo-adjuvant chemotherapy, six (66.7%) had complete response but defaulted and five (55.6%) re-presented within a year with metastatic disease. Three of the patients receiving systemic post-surgery chemotherapy presented within a year with local recurrence. Most of the other patients were subsequently lost to follow-up. CONCLUSIONS: Nonadherence due to wellness among breast cancer patients is associated with poor outcome. We propose a detailed prospective study to establish factors that may influence such behavior.

Antibiotic resistance of Helicobacter pylori from patients in Ile-Ife, South-west, Nigeria.

BACKGROUND: Helicobacter pylori has become recognized as a major cause of gastroduodenal diseases in man. Evidence indicates that once acquired, H. pylori persists, usually for life unless eradicated by antimicrobial therapy. Over the past few years, we have accumulated some knowledge of the epidemiology of H. pylori in Ile-Ife, South-West Nigeria. In one collaborative study, we detected H. pylori in 195 (73%) patients referred for endoscopy at Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). Furthermore we have observed a variegated gastric inflammatory response and atrophy including atrophic pangastritis but are yet to demonstrate MALToma in any of our patients. In addition we have demonstrated that dental plaque is a possible source of gastric H. pylori infection and such an endogenous source could account for difficulty in eradication leading to re-infection. Presently, infected patients are treated with standard combination therapy made up of amoxycilin and ciprofloxacin with a proton pump inhibitor/bismuth. Reports however have shown that the incidence of antimicrobial resistance in Helicobacter pylori is a growing problem and which has been linked with failures in treatment and eradication. Given this situation it has become necessary to have information about the susceptibility of isolates to particular antimicrobial agents before the selection of an appropriate treatment regimen. OBJECTIVES: More recently, we sought to study antimicrobial susceptibility of locally isolated H. pylori strains. METHODS: We subjected 32 isolates to antimicrobial susceptibility testing against seven agents. RESULTS: All the isolates showed multiple acquired antimicrobial resistance as they were all resistant to amoxicillin, clarithromycin, metronidazole, while 29/31, 27/31 showed resistance to rifampicin and tetracycline respectively. Five (15.6%) of these isolates showed resistance to ciprofloxacin. CONCLUSIONS: Our findings suggest that H. pylori strains isolated within our study environment have acquired resistance to all the commonly prescribed antibiotics. On the basis of the findings it would be necessary to re-evaluate the eradication treatment regime in our setting.

Helicobacter pylori in gastroduodenal diseases.

OBJECTIVE: To determine the prevalence and disease association of Helicobacter pylori (H. pylori) in dyspeptic patients in southwest Nigeria. SETTING: Obafemi Awolowo University Teaching Hospitals Complex, Ile-lfe, Nigeria. METHODS: Consecutive dyspeptic patients for upper gastrointestinal endoscopy from January 1996 to March 1997 were investigated for H. pylori in gastric biopsy by histopathology and culture. Patients without gastroduodenal ulcerations or neoplastic lesions constituted the nonulcer dyspeptic (NUD) group. RESULTS: 138 (92 males, 46 females) patients aged 4.5-85 years [mean (7) = 45+/-SD 17.8 years] who had upper gastrointestinal endoscopy were analyzed for presence of H. pylori. Eighty-three had histopathology alone, while 55 others had both histology and culture. Endoscopic diagnosis included duodenal ulcer (DU) (n=35, 23%); gastric ulcer (n=4, 3%); gastric cancer (n=14, 9%); NUD, including gastritis (n=49, 32%); duodenitis (n=47, 31%); and normal (n=16, 11%). Overall, H. pylori was positive in 107 of 138 (77.5%) patients. There was a significant association of H. pylori with DU and NUD (p<0.000). Three-quarters of cases of normal endoscopy harbored H. pylori. The finding of 80% and 85% H. pylori in gastritis and duodenitis, respectively, was of interest. CONCLUSIONS: These findings suggest that DU and NUD were the main clinical expressions of H. pylori infection in southwest Nigerian dyspeptic patients similar to what is found in developed nations. Of note is the high incidence of H. pylori in endoscopically normal patients.