T-cell responses to MERS coronavirus infection in people with occupational exposure to dromedary camels in Nigeria: an observational cohort study.

BACKGROUND: Middle East respiratory syndrome (MERS) remains of global public health concern. Dromedary camels are the source of zoonotic infection. Over 70% of MERS coronavirus (MERS-CoV)-infected dromedaries are found in Africa but no zoonotic disease has been reported in Africa. We aimed to understand whether individuals with exposure to dromedaries in Africa had been infected by MERS-CoV. METHODS: Workers slaughtering dromedaries in an abattoir in Kano, Nigeria, were compared with abattoir workers without direct dromedary contact, non-abattoir workers from Kano, and controls from Guangzhou, China. Exposure to dromedaries was ascertained using a questionnaire. Serum and peripheral blood mononuclear cells (PBMCs) were tested for MERS-CoV specific neutralising antibody and T-cell responses. FINDINGS: None of the participants from Nigeria or Guangdong were MERS-CoV seropositive. 18 (30%) of 61 abattoir workers with exposure to dromedaries, but none of 20 abattoir workers without exposure (p=0·0042), ten non-abattoir workers or 24 controls from Guangzhou (p=0·0002) had evidence of MERS-CoV-specific CD4+ or CD8+ T cells in PBMC. T-cell responses to other endemic human coronaviruses (229E, OC43, HKU-1, and NL-63) were observed in all groups with no association with dromedary exposure. Drinking both unpasteurised camel milk and camel urine was significantly and negatively associated with T-cell positivity (odds ratio 0·07, 95% CI 0·01-0·54). INTERPRETATION: Zoonotic infection of dromedary-exposed individuals is taking place in Nigeria and suggests that the extent of MERS-CoV infections in Africa is underestimated. MERS-CoV could therefore adapt to human transmission in Africa rather than the Arabian Peninsula, where attention is currently focused. FUNDING: The National Science and Technology Major Project, National Institutes of Health.

Sonographic assessment of postvoid residual urine volumes in patients with benign prostatic hyperplasia.

OBJECTIVE: To derive a formula that defines the postvoid residual (PVR) urine volume more accurately in patients with prostatic gland enlargement. DESIGN: Prospective. SETTING: Department of Radiology, University of Ilorin Teaching Hospital, Ilorin. SUBJECT: Fifty-two consecutive patients with benign prostatic hyperplasia. The mean age was 64.98+/-9.57 years. METHOD: PVR urine was evaluated by ultrasonography. Each patient had two examinations, the first of which was with a full bladder and the second of which was immediately after voiding. Two orthogonal diameters were measured on each bladder section (longitudinal and transverse) in the supine position. Fifty-two paired sets of ultrasonic measurements were thus obtained. Catheterized postvoid urine residue was regarded as the gold standard. RESULTS: Using these measurements, an equation--[PVR(CUBIC)=374.057+(-196.94+V1)+(32.5539+V1(2))+(-1.1480+V1(3)) where V1=average of the length (L), width (T), and the anteroposterior distance on transverse section (Dt) of the postvoid urinary bladder]--more accurate than previously existing ones was obtained by cubic regression analysis. Mean ultrasound estimated volume was 220.51 ml as against 220.76 ml after catheterization. The mean difference was 0.25 ml (not significant, p<0.01) with 95% confidence interval of +/-10 ml. With this equation, the ultrasonographic residual urine volume showed a higher correlation coefficient with the catheterized volume at p<0.01 (Pearson r=0.982, r2=0.96) than previously defined formulas. The standard error of the mean was 5.11 ml (mean=220.5+/-190.4 ml). CONCLUSION: With the above equation, we consider conventional transabdominal ultrasonography a reliable method for assessing the residual urine volume in patients with benign prostatic hyperplasia. This equation, though complex when compared to some of the pre-existing formulas, can be integrated into the memory of modern ultrasound machines for easy and faster computation.