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Dissociative Identity Disorder (DID) is diagnosed if an individual has at least two different identities that alternately control a person's actions with no memory of the incidents. We hereby describe a case of a 21-year-old student with a history of clinical depression, false claims of being raped, getting pregnant and often neglected by her parents. Cultural issues regarding DID were also discussed. DID should be closely monitored for suicidal behaviour. Dissociative identity disorders are rarely reported in Africa. She was admitted into the psychiatric ward where her diagnosis was confirmed through a structured interview for dissociative disorders and differential diagnoses were ruled out by psychological, and laboratory investigations. Socio-c Possible abuse in her childhood might have contributed to her condition. Individuals with DID should be closely monitored for suicidal behaviour.&nbsp

Objectives: The Human Immunodeficiency virus causes an infection of public health importance with about 71% of the global burden in Sub-Saharan Africa. In Nigeria, 3.2 million people are living with HIV, and 838,000 - 1.3 million of the cases are found among youths. Although Non- Occupational Human Immunodeficiency Virus (HIV) post-exposure prophylaxis (nPEP) is a safe and efficacious method of HIV prevention, it remains an underutilized prevention strategy in Nigeria. This study aimed to determine the awareness level of nPEP after sexual and other non-occupational exposure to HIV among undergraduate students of a private University. Methods: A descriptive cross-sectional survey was conducted among 395 undergraduates’ students. Data was collected by pre-tested structured self-administered questionnaires. Data obtained from the study were analyzed using the IBM SPSS Statistics version 20 software program and Frequency distribution tables with percentages and cross-tables were used for data description. Results: About 42.8% were aware of nPEP. Most of the respondents 361 (91.4%) knew that PEP is to be given after HIV exposure risk following sexual intercourse. Although 79.5% of the respondents indicated that they will see their physician after unprotected sexual intercourse and other non-occupational exposure to HIV, the majority neither knows about nPEP initiation time, 247 (62.5%) nor its duration, 286 (72.4%). Conclusions: A low level of awareness was observed among our study participants, therefore, consistent health education and promotion of nPEP will improve its awareness, uptake, and possibly reduce the prevalence of HIV among our youths.

Background and Purpose: The significant association between dermatological disorders and psychopathology has been established globally. However, little work has been documented about this relationship in sub-Saharan Africa. The objective of this study was to determine the prevalence of psychiatric morbidity and its correlation with age, gender and marital status among adult patients attending the dermatology outpatient clinic in Lagos, Nigeria. Methodology: Seven hundred and nine consecutive new adult patients attending the dermatology outpatients’ clinic at the Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria were recruited and invited to complete the Hospital Anxiety and Depression Scale. Results: There were 305 (43.0%) males and 404 (57.0%) females. Of the total number of participants, 33.9% and 15.6% had various degrees of probable anxiety and depression respectively with an overall prevalence of 9.0%. There were no significant associations between the psychometric and sociodemographic variables. Conclusion and Recommendation: This study also demonstrated that dermatological diseases can comorbid with psychiatric disorders. Therefore, early detection and psychological intervention of identified and diagnosed of psychiatric symptoms or disorders in dermatological patients is of significant therapeutic importance.

Antibiotic resistance has become a global concern as the clinical efficacy of many existing antibiotics is being threatened by the emergence of multidrug resistance pathogens. Phyllantusamarus has been showing to possess various properties including antibacterial property by many authors. This study was therefore designed to investigate the antibacterial effects of aqueous and methanolic extract of Phyllantusamarus on urinary tract pathogens. 10g of the concentrated extract from methanol and aqueous was simultaneously dissolved in 100ml of water and used to make two-fold dilutions, to give100, 50, 25, 12.5, 6.3, 3.2, 1.6 and 0.8mg/ml as extract concentrations. 10 different concentrations, 12.5, 6.3, 3.2, 1.6, 0.8, 0.4, 0.2, 0.1, 0.05mg/ml and 5µg/ml, of the control drug ciprofloxacin were also prepared. The phytochemical constituents of both methanolic and aqueous extract were also investigated. Fourteen isolates from urine sample were identified. These isolates, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Klesiella pneumonia, Enteroccocusfeacalis, Proteus mirabillis, Staphylococcus saprophytic sand Control standard Escherichia coli ATCC 25922 were subjected to antibacterial effect of varying concentration of these methanolic and aqueous extract of phyllantusamarus and standard drug ciprofloxacin using agar well diffusion method. The diameter in millmiters of the inhibition zones was measured, the Minimum Inhibitory Concentration and Minimum Bactericidal Concentration were also determined. The data obtained were analysed using SPSS version 17. The extract was found to containsaponins, flavonoids, alkaloids, tannins, phlobatanins and terpenoids. Both aqueous and methanolic extract of P. amarus caused a concentration dependent increase in zones of inhibition of the growth of the isolates. The MIC and MBC values were however found to be high compare to the standard. There was no significant different between Agar well diffusion method and disc diffusion method. The study clearly showed that P. amarus has appreciable antibacterial properties. However, there is need for improvement in approaches for natural product isolation and characterization so that the bioactivity and potency of the drug can be improved upon.

Small and Medium Size Enterprises (SMEs) are encouraged by Nigerian Government to develop and sustain the economy and promote employment. They range from process industries, fabrication workshops, service centres, food and drink premises, and several others. A majority of these sprawled up in urban areas though they are also seen in peripheral and rural areas. These centres play significant role in the national economy. At the same time, they also produce a variety of end products and byproducts in solid, liquid or gaseous forms which affect the environment negatively by polluting air, water and soil. This has resulted in eutrophication of water bodies, contamination of groundwater, soil and affected quality of life in the cities. There are well laid out pollution control regulations and guidelines in the country. The Federal Ministry of Environment, The National Environmental Standards and Regulations Enforcement Agency (NESREA) with five Zonal offices implement these regulations. But in spite of these, SMEs sector which is mostly private driven escapes from being questioned on their poor environmental upkeep and disposal of untreated waste products. This paper has drawn examples from selected major urban areas in Nigeria and highlights some of the issues, challenges and possible mitigation measures to safeguard the fragile Nigerian environment.

This document is one important step in a process for improving access to quality of care in family planning by reviewing the medical eligibility criteria for selecting methods of contraception. It updates the third edition of Medical eligibility criteria for contraceptive use published in 2004 and summarizes the main recommendations of an expert Working Group meeting held at the World Health Organization Geneva 1-4 April 2008. (Please see Annex 2 for the list of participants.) The Working Group brought together 43 participants from 23 countries including nine agency representatives. The document provides recommendations for appropriate medical eligibility criteria based on the latest clinical and epidemiological data and is intended to be used by policy-makers family planning programme managers and the scientific community. It aims to provide guidance to national family planning/reproductive health programmes in the preparation of guidelines for service delivery of contraceptives. It should not be seen or used as the actual guidelines but rather as a reference. The document covers the following family planning methods: low-dose combined oral contraceptives (COCs) combined patch (P) combined vaginal ring (R) combined injectable contraceptives (CICs) progestogen-only pills (POPs) depot medroxyprogesterone acetate (DMPA) norethisterone enantate (NET-EN) levonorgestrel (LNG) and etonogestrel (ETG) implants emergency contraceptive pills (ECPs) copper-bearing intrauterine devices (Cu-IUDs) levonorgestrel-releasing IUDs (LNG-IUDs) copper-IUD for emergency contraception (E-IUD) barrier methods (BARR) fertility awareness-based methods (FAB) lactational amenorrhoea method (LAM) coitus interruptus (CI) and female and male sterilization (STER). WHO will update and add to the recommendations in this document at appropriate intervals through expert Working Group meetings every three to four years and through input from its family planning Guidelines Steering Group on an as-needed basis. These recommendations will be made available on the WHO web site (www.who.int/reproductivehealth). The web site will also provide additional information determined by WHO to be relevant to these recommendations pending the next formal consensus Working Group meeting. Such updates may be particularly warranted for issues where the evidence base may change rapidly. WHO encourages research to address key unresolved issues for establishing medical eligibility criteria for contraceptive use. WHO also invites comments and suggestions for improving this guidance.

Background: The study was carried out to investigate the manifestations of psychological distress and symptoms among individuals receiving treatment for sexually transmitted diseases and to compare them with individuals who were not suffering from sexually transmitted diseases.Methods: Patients attending the sexually transmitted disease clinic of the Lagos State University Teaching Hospital, Ikeja, Lagos were recruited for this study; while the comparison group (n=50) was made up of participants attending the outpatient clinic of the University of Lagos Medical Centre, Akoka, Lagos. The participants completed the Symptoms Distress Checklist-90 (SLC-90) and Psychophysiological Symptoms Checklist (PSC).Results: The findings showed that 80% were males. The ages of the respondents ranged from 22 to 52 years, with a mean of 31.4 years. The participants in the study group obtained higher mean scores on interpersonal sensitivity (C), depression (D), anxiety (E) and hostility (F). The participants in the study group also had higher mean score in the PSC than those in the control group. Significant differences were found in SLC-(B) obsessive-compulsive, (E) anxiety and (F) Hostility. Of the total participants, 15 (30%) of the study group had previous STI infections when compared to 3 (6%) of the comparison group.Conclusion: It is suggested that clinicians running the sexually transmitted diseases should screen their patients for psychological disturbances and also work with mental health experts to provide psychological services for identified patients suffering from psychological distress among those attending the STI clinic.Keywords: Psychological reactions, sexually transmitted infections, Lagos, Nigeria

Objective: Biosafety is an important element of quality management systems in laboratory practice as it is a measuring tool for compliance with accreditation and certification standards. Our aim was to assess the practices of laboratory personnel towards biosafety measures in their respective laboratories. Methods: The study design was a quantitative and qualitative cross sectional prospective one obtained with the use of a structured questionnaire. Data analysis was done with Epi Info version 3.4.1 and was presented using frequency tables with chi square calculated for different variables with the significant p value set at ≤ 0.05. Results: There were 63 respondents in the study. Private laboratories fared better in an assessment of their biosafety practices. Comparative variables identified as unsafe biosafety practices between public and private laboratories were non availability of Hepatitis B virus antibody testing, p value 0.01, odds ratio 5.4, consuming food in the laboratory, p value 0.00, odds ratio 0.2., non-use of N95 masks p value 0.04, O.R 3.9 and biosafety cabinet use p value 0.05, O.R 2.8. Discussion: Biosafety practices in Nigeria need to be streamlined in accordance with good laboratory practices in order to forestall workplace accidents and promote a safe environment for testing of clinical human samples. Conclusion: The absence of appropriate biosafety policies and practices is one of the challenges facing health care workers in sub Saharan Africa. There is the need for biosafety to be placed in the front burner of issues in laboratory practice in our respective facilities.

Background: The aim of the study was to determine the lifestyle and cardiovascular risk factors among hypertensives and the use of antihypertensive medication in Lagos, Nigeria.Methods: Two hundred and fifty consecutive patients who were attending the outpatients' clinic cardiology unit of the medical department of Lagos University Teaching Hospital, Lagos, Nigeria were recruited into the study. Self-administered questionnaire was used to collect data from the participants.Results: The mean age of the respondents was 53.9 +12.1 years. Forty-six percent were males and 54% females. Some of the participants indulged in unhealthy lifestyle such as daily smoking of cigarettes (5.0%) and alcohol consumption (10.8%). Some of the participants (45.3%) carry out physical exercises such as walking (71.0%). A large number of the participants (84.0%) believed that hypertension can be controlled. Half of the respondents (50%) had used medication for one to five years. Close to half of the participants (48.2%) stopped taking their medication because they experienced side effects in the past while 24.8% claimed they stopped their use of medication because they could not afford the drugs.Conclusion: There is a need for public health experts to carry out educational campaigns to increase awareness on the implications of negative lifestyle and cardiovascular risks factors of hypertension, compliance and complications of hypertension. Clinicians should also consider the financial status of their patients in prescribing antihypertensive drugs to enable affordability.Keywords: Lifestyle, cardiovascular, risk factors, hypertension, antihypertensive Lagos, Nigeria.

Aim: The aim of this study was to determine the relationship between interpersonal relationship in family structures and manifestations of symptoms of anxiety and depression in adolescent from different family structures.Methods: Two hundred and fortyseven students attending a Federal Technical College in Lagos were randomly selected to participate in this study. The participants were classified and divided into four different family structures such as single-parent family, two-parent family, polygamous and extended family structures. The participants completed a demographic form, Index of Family Relations (IFR), State Trait Anxiety Inventory (STAIY2) and Self-Rating Depression Scale (SDS).Results: There were 127 males and 120 females and their ages ranged from 17 to 22 years. The findings showed a significant relationship between family relationship and anxiety and depression (r =0.371, df 246, P< .05). The participants had certain degrees of anxiety but less of depres s i ve s ymptoms . The differences in family relations among the different family structures was were found not to be significant at F3,228=.650, P>.05.Conclusion: This study also demonstrated that there was a relat ionship between family structure, adolescent and young adult psychopathology particularly with regards to symptoms of anxiety but less of symptoms of depression.Key Words: Family structure, interpersonal relat ionship, anxiety, depression, adolescents, young adults, Nigeria

Dental anxiety has been reported to be of global public health concern. In Nigeria, not much work has been documented on dental anxiety. The objectives of this study were to estimate the prevalence of dental anxiety and determine the reliability and validity of the Modified Dental Anxiety Scale (MDAS) in screening for dental anxiety among Nigerian adult dental patients. One hundred and ninety adult participants were invited to complete a sociodemographic questionnaire, Modified Dental Anxiety Scale and Hamilton Anxiety Rating Scale in order to determine the prevalence, internal consistency and concurrent validity of the Modified Dental Anxiety Scale. The mean score of the MDAS was 11.0 (SD = 6.1) and the scores ranged from 5-25. Of the total 190 participants, 60 (48.6%) scored above the cut-off score of 11. The internal consistency of the MDAS was 0.90 (95% CI = 0.94-0.97). The MDAS correlated well with HARS; the concurrent validity coefficient of 0.58 was obtained. (r = 0.90, p

Objective: Dental practitioners frequently encounter individuals who suffer from psychological pain at the dental clinics. Most dentists do not have the training or the instrument to recognise and manage psychological pain associated with dental treatment. This study was carried out to determine the level of psychological pain among dental patients visiting the dental clinic of the Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria. Method: One hundred and twenty five patients who attended the dental clinic of the Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria were invited to take part in the study. They completed a sociodemographic questionnaire, Psychache Scale (PAS) and the Hamilton Anxiety Rating Scale (HARS) in order to determine their levels of psychological pain and anxiety. Result: Of the total respondents, 43% were males and 57% females, mean age 30.2 years (SD=10.7, ranging from 15-80), 74.2% were married and 22.5% single. With regards to psychological pain and anxiety, 31.9% scored high in the PAS, indicating probable psychological pain while 25.8%, 19.4% and 54.8% were detected to suffer from mild, moderate and severe anxiety as detected by HARS. Conclusion: The finding from this study demonstrated that Nigerian dental patients also suffer from psychological pain and various degrees of dental anxiety. Therefore there is a need for Nigerian dental surgeons to acquire some knowledge of mental health in order to recognise these psychopathologies among their patients.Keywords: Psychological pain, anxiety, dental patients, NigeriaNig Dent J Vol 20 No. 1 Jan - June 2012

The association between tuberculosis and psychopathology had been variously reported. Despite the observed high global prevalence of tuberculosis, there are very few studies on its psychiatric complications in Nigeria. The study was conducted to determine the prevalence of psychological distress and psychiatric symptoms among tuberculosis patients in a teaching hospital in Lagos, Nigeria. Method: The study was a cross-sectional descriptive survey. It was carried out among patients attending the chest clinic of the Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria. One hundred and nine consecutive patients attending the clinic were administered with the General Health Questionnaire 12th version and the Symptoms Check List (SCL-90). Results: A large number of the respondents (40.7%) were between the ages 21 and 30 years old. About half of the participants suffered from somatisation, neuroticism, depression and anxiety and as regards GHQ scores, more than half (51.9%) indicated psychological distress. Likewise, the mean scores on the SCL did not differ significantly by age group of participants. There was no correlation observed between GHQ-12 score and duration of illness. Conclusion: Clinicians managing patients with tuberculosis need to be aware of symptoms of psychopathology among their patients which informs the need to screen them for psycho-pathology at the commencement of anti-tuberculosis therapy. It was however suggested that psycho-education and psychotherapy should also be carried out by clinicians managing tuberculosis patients as part of their holistic management.Journal of Community Medicine & Primary Health vol 23 (1-2) 2011 , MAR/SEPT. 2011

Background: The burnout syndrome has been associated with decreased job performance and low career satisfaction. There are many studies on surgeon burnout and globally but none has been carried out in Nigeria to address the issue of burnout among orthopaedic surgeons. This study aimed at assessing the rate of burnout syndrome among orthopaedic surgeons working in an orthopaedic hospital in Lagos State,Nigeria. Methods: The study was a questionnaire-based cross-sectional survey. It took place at the National Orthopaedic Hospital, Igbobi, Lagos, Nigeria. All the doctors working at the specialist hospital were invited to complete a questionnaire on their demographic details and the Maslach Burnout Inventory which was used to measure burnout among the participants. Results: Twenty-nine doctors took part in the study, 28 (96.5%) were males and 1 (3.5%) female, their mean age was 35. 52 years (SD 5.55) with a range of 28- 57 years. Of the total participants, 7 (24.1%) consultant surgeons and 21 (27.5%) were resident doctors. As regards burnout, 4 (13.8%) scored high on the emotional exhaustion subscale, 11 (37.9%) scored high on the depersonalisation subscale while 21 (72%) scored high on the personal achievement subscale. On the overall burnout rate, 15(51.7%) experienced burnout. Conclusions: The findings of this study showed that orthopaedic surgeons working in Lagos State, Nigeria also experience certain degrees of burnout. There is a need for orthopaedic surgeons to acquire the skills of stress management to prevent burnout and also enhance quality service delivery in their various hospitals.

No Abstract.

Nigerians who suffer from severe mental illness also need psychiatricpsychosocial rehabilitation. Despite the availability of a wide range of mental health services in Nigeria, majority of Nigerians with mental health relatively have their needs unmet. To fill this unmet gap, Nigerian psychiatrists should also make psychiatric psychosocial interventions available at the primary health care centres and in the rural communities. When these services are available in the community, Nigerians with mental health disorders can easily acquire the available social, emotional and intellectual skills provided by mental health experts to enable them live and work with minimal supervision from clinicians. The aim of this paper is therefore to further sensitize Nigeria mental health care providers on the need to make psychiatric psychosocial services available at the primary health care centres and rural communities for every Nigerian with mental illness.Key words: psychosocial, rehabilitation, psychiatry, Nigeria

Psychological debriefing is widely applied for victims who encounter overwhelming trauma. This study aimed at assessing the anxiety levels and psychiatric morbidity of class mates of the victims of a plane crash and also to carry out bereavement-oriented group psychotherapy to alleviate observed psychopathology in the study group. Participants were assessed with Hamilton anxiety rating scale and the 12th version of the general health questionnaire before and after the application of one single bereavement-oriented group psychotherapy. The pre-application of the Hamilton anxiety rating scale and general health questionnaire had significantly elevated scores as compared to the post psychotherapy scores. Bereavement-oriented group psychotherapy was found to be effective in lowering psychopathology associated with bereavement and may further prevent post traumatic stress disorder.

Background: Though Campylobacter enteritis is a self-limiting disease, antimicrobial agents are recommended for extraintestinal infections and for treating immunocompromised persons. Erythromycin and ciprofloxacin are drugs of choice. The rate of resistance to these drugs is increasing in both developed and developing countries thus compromising their use in therapy. Continued surveillance of resistance pattern is necessary to guide rational use of antimicrobial agents in therapy when such are indicated. Objective: This study aims at determining the resistance of Campylobacter jejuni/coli to common antimicrobial agents. Methods: Campylobacter jejuni/coli recovered from cases of childhood diarrhoea in Ilorin, Nigeria were studied. All the organisms were isolated by standard techniques using the Butzler-type medium and they were preserved in 15% glycerol cryopreserve medium. The in-vitro antibiotic susceptibility testing for all organisms was performed by employing the Kirby- Bauer disc diffusion method. Production of beta-lactamase by the isolates was determined by the starch paper technique. Results: High level resistance to cotrimoxazole, ceftriaxone, and ampicillin were 96%, 84% and 68% respectively. On the other hand none of the isolates had any evidence of resistance to erythromycin and ciprofloxacin. Only one of the 25 isolates tested produced beta-lactamase. Conclusion: Campylobacter jejuni/coli are susceptible to firstline dugs, ery thromycin and ciprofloxacin. However high level resistance to other agents portends a possibility of transfer of acquired resistance and the need for continuous surveillance of resistance pattern Keywords: Campylobacter enteritis, Antimicrobial agents, Resistance, Surveillance. Nigerian Medical Journal Vol. 48 (3) 2007: pp. 75-77

Nigerian Journal of Biomedical Sciences Vol.3(2) 2004: The study was to determine the antibiotic susceptibility patterns and beta-lactamase production of Campylobacter jejuni/coli isolates obtained from stool specimens from children with diarrhoea at the Obafemi Awolowo University Teaching Hospital Complex (O.A.U.T.H.C.), Ile-Ife. Thirty strains of Campylabacter jejuni/coli were isolated from children with diarrhoea in the clinical laboratory of the department of Medical Microbiology and Parasitology of O.A.U.T.H.C. The antimicrobial susceptibility test was carried out according to the method described by Bauer et al, 1966. All isolates were tested for evidence of beta-lactamase activity by the starch paper technique (Odugbemi et al 1977). All isolates tested were sensitive to erythromycin, gentamicin, tetracycline and ciprofloxacin whereas only one strain was sensitive to cotrimoxazole. None of the isolates produced beta-lactamase. In this environment, the clinical use of erythromycin, tetracycline, gentamicin and ciprofloxacin is recommended for the treatment of Campylobacter enteritis. KEY WORDS: Campylobacter jejuni/coli; beta-lactamase; antibiotics; susceptibility. Nigerian Journal of Biomedical Sciences Vol.3(2) 2004: 61-64

Objective:To investigate the prevalence, species distribution and genetic diversity of zoonotic Arcobacter species. Design: Prospective study. Setting: Drainage system of a cosmopolitan chicken abattoir in Lagos, Nigeria. Methods : One hundred and fifity drainage water samples were enriched in a minimal antibiotics-containing medium at room temperature and bacteria then isolated by use of a membrane filtration method. Results: Twenty six (14%) of samples were positive for Arcobacter spp. Of these, 20 were examined by a comprehensive probabilistic identification scheme for Epsilobacteria and all strains identified as A. butzleri. AFLP analysis of these strains revealed considerable genetic diversity among the strains, with 12 genotypes defined at the 90% similarity level. Conclusion: The prevalence of A. butzleri in Nigerian poultry abattoir effluent indicates this species may constitute a public health problem in this country. AFLP profiling could be a useful tool for molecular epidemiological and population genetic studies of this organism. This is the first known report of A. butzleri in Nigeria, and first application of AFLP analysis for genotyping the species. (E Afr Med J:2003 80(4): 218-222)

A total of 101 Campylobacter isolates from Nigerian children with or without gastroenteritis were biotyped and serogrouped by using the Lior typing schemes (H. Lior, J. Clin. Microbiol. 20:636-640, 1984; H. Lior, D. L. Woodward, J. A. Edgar, L. J. Laroche, and P. Gill, J. Clin. Microbiol. 15:761-768, 1982). Fifty-three (52.5%) of the isolates were Campylobacter jejuni biotype I, 29 (28.7%) were C. jejuni biotype II, 10 (9.9%) were Campylobacter coli biotype I, and 9 (8.9%) were C. coli biotype II. Serogroup 36 was the most common (20.7%) in this study, in contrast with serogroup 1 (18.5%) earlier reported from Canada (Lior et al., J. Clin. Microbiol. 15:761-768, 1982).

In an epidemiological study of enteropathogenic Escherichia coli, 102 strains were isolated from patients seen at the University Teaching Hospital in Lagos. The most common serotype encountered was 055 followed by 026. Antimicrobial susceptibility testing and plasmid profiling of the strains were done. All the strains were sensitive to colistin, nalidixic acid, nitrofurantoin, cefotaxime, amikacin, and augmentin. Of the 102 strains, 47 (46%) were resistant to one or more of the following antimicrobial agents: Co-trimoxazole, tetracycline, ampicillin, streptomycin, sulphonamide and a combination of ampicillin with sulbactam. All the strains that were resistant to any antimicrobial agents were also resistant to tetracycline. Seventy-two strains (70.6%) harbored plasmid whose molecular weights ranged from 0.8 to 120 x 10(6) daltons. The majority of the plasmid were smaller than 6 x 10(6); 90% of strains carrying plasmid ranging in size from 2 to 6 x 10(6) daltons and 50 to 70 x 10(6) daltons were resistant to one or more antimicrobial agents. Transformation and conjugation experiment showed that about 57% of the resistant strains carried R plasmid. Plasmid-determined resistance to tetracycline, ampicillin, streptomycin and sulphonamide was found.

Ninety-two children with rheumatic heart disease were studied clinically, and through a post-diagnosis surveillance period of varying duration over a 10-year period. The logistics and effectiveness of secondary penicillin prophylaxis, administered monthly, were assessed during the surveillance period. Eighty-one (88%) of the 92 children were seen for the first time with already established rheumatic heart disease. Mitral insufficiency was the major functional defect in these children whose mean age was 8.6 years. There was a high default rate of just under 50% among children referred to the surveillance clinic. Socio-economic inadequacies were found to be major factors in the high default rate. Regular monthly parenteral penicillin was found to be effective in reducing recurrence of rheumatic fever and maintaining good health in these children.