RESUMEN
A mobile colistin resistance gene mcr was first reported in 2016 in China and has since been found with increasing prevalence across South-East Asia. Here we survey the presence of mcr genes in 4907 rectal swabs from mothers and neonates from three hospital sites across Nigeria; a country with limited availability or history of colistin use clinically. Forty mother and seven neonatal swabs carried mcr genes in a range of bacterial species: 46 Enterobacter spp. and single isolates of; Shigella, E. coli and Klebsiella quasipneumoniae. Ninety percent of the genes were mcr-10 (n = 45) we also found mcr-1 (n = 3) and mcr-9 (n = 1). While the prevalence during this collection (2015-2016) was low, the widespread diversity of mcr-gene type and range of bacterial species in this sentinel population sampling is concerning. It suggests that agricultural colistin use was likely encouraging sustainment of mcr-positive isolates in the community and implementation of medical colistin use will rapidly select and expand resistant isolates.
Asunto(s)
Colistina , Proteínas de Escherichia coli , Embarazo , Recién Nacido , Femenino , Humanos , Colistina/farmacología , Escherichia coli/genética , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Mujeres Embarazadas , Nigeria/epidemiología , Farmacorresistencia Bacteriana/genética , Proteínas de Escherichia coli/genética , Pruebas de Sensibilidad Microbiana , PlásmidosRESUMEN
Early development of the microbiome has been shown to affect general health and physical development of the infant and, although some studies have been undertaken in high-income countries, there are few studies from low- and middle-income countries. As part of the BARNARDS study, we examined the rectal microbiota of 2,931 neonates (term used up to 60 d) with clinical signs of sepsis and of 15,217 mothers screening for blaCTX-M-15, blaNDM, blaKPC and blaOXA-48-like genes, which were detected in 56.1%, 18.5%, 0% and 4.1% of neonates' rectal swabs and 47.1%, 4.6%, 0% and 1.6% of mothers' rectal swabs, respectively. Carbapenemase-positive bacteria were identified by MALDI-TOF MS and showed a high diversity of bacterial species (57 distinct species/genera) which exhibited resistance to most of the antibiotics tested. Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae/E. cloacae complex, the most commonly found isolates, were subjected to whole-genome sequencing analysis and revealed close relationships between isolates from different samples, suggesting transmission of bacteria between neonates, and between neonates and mothers. Associations between the carriage of antimicrobial resistance genes (ARGs) and healthcare/environmental factors were identified, and the presence of ARGs was a predictor of neonatal sepsis and adverse birth outcomes.
Asunto(s)
Microbioma Gastrointestinal , Sepsis , Antibacterianos , Países en Desarrollo , Farmacorresistencia Microbiana , Escherichia coli , Femenino , Humanos , Lactante , Recién Nacido , Pruebas de Sensibilidad Microbiana , MadresRESUMEN
OBJECTIVES: Elevated waist circumference results from an excessive accumulation of visceral fat, causing an impairment of health. Waist circumference is highly correlated with diabetes, cardiovascular disease, and all-cause mortality. This study aimed to estimate the overall, sex-specific, and region-specific prevalence rates of central obesity in Nigeria. STUDY DESIGN: Systematic review and meta-analysis. METHODS: Online searches of Google Scholar, PubMed, and Scopus were conducted, and studies were selected based on predefined criteria. Random effects model was fitted using inverse variance method with correction using Sidik-Jonkman's estimator. RESULTS: Eighteen studies consisting of 21,859 individuals conducted between 1996 and 2021 were included in the meta-analysis. Thirty-nine percent (95% confidence interval [CI]: 25%-54%, I2 = 99.3%) of adult Nigerians are centrally obese (by International Diabetes Federation criteria). This translates to estimated 46.8 million centrally obese adult Nigerians. More than half (54% [95% CI: 39%-68%]) of adult females are centrally obese. This is four times the prevalence in males (13% [95% CI: 5%-24%]). Southern regions have higher prevalence of central obesity than northern regions (48% vs 18%). The overall mean waist circumference in Nigeria is 83.8 cm (95% CI: 80.8-86.8 cm, I2 = 99.8%, P value is <0.001). CONCLUSIONS: Females, urban residents, and individuals living in the northern part of Nigeria have a high burden of central obesity. Public health measures for halting the epidemic of obesity should be targeted at these high-risk groups.
Asunto(s)
Diabetes Mellitus , Obesidad Abdominal , Adulto , Índice de Masa Corporal , Diabetes Mellitus/epidemiología , Femenino , Humanos , Masculino , Nigeria/epidemiología , Obesidad/epidemiología , Obesidad Abdominal/epidemiología , Prevalencia , Circunferencia de la CinturaRESUMEN
OBJECTIVE: To compare suxamethonium with atracurium using the priming principle, for rapid sequence orotracheal intubation assessing onset time, time to successful laryngoscopy and intubation and quality of intubating conditions. PATIENTS AND METHODS: A prospective double-blind, randomised study was performed in 90 ASA physical status I and II patients aged between 18 and 64 years undergoing elective surgery requiring endotracheal intubation between October 2002 and June 2003 in a university teaching hospital . All patients were premedicated with 5-10mg oral diazepam and randomly assigned to one of two groups to receive either suxamethonium as a bolus dose (group A) or atracurium (priming with 0.05 mg/kg followed by 0.55 mg/kg after induction of anaesthesia) (group B). In both groups, the trachea was intubated when there was maximal muscle relaxation, determined clinically by jaw muscle relaxation. Muscle paralysis using a PNS, quality of intubating conditions, and occurrence of muscle weakness due to the priming dose of atracurium, time to laryngoscopy and onset time were all noted. RESULTS: Onset time was 87.1 +/- 25.60s and 135.8 +/- 46.23s in groups A and B respectively (P < 0.05). Group A had a laryngoscopy time of 73.6 +/- 25.22s compared to 107.7 +/- 41.32s in group B (P < 0.05). Intubating conditions were significantly better in group A compared to group B (P < 0.05). The frequency of muscle weakness from the priming dose of atracurium was 6.6%. CONCLUSION: Atracurium, using the priming principle, is an option in our environment for modified rapid sequence induction when suxamethonium is contraindicated.