Trough plasma nevirapine levels, immunologic and virologic responses in composite CYP2B6*6/*18 HIV-infected adult Nigerian patients.

The influence of composite CYP2B6*6/*18 genotype on trough plasma nevirapine levels, HIV RNA levels (virologic response) and CD4+ T lymphocyte and absolute lymphocyte counts (immunologic response) of HIV-infected patients were evaluated. Patients with records of trough plasma nevirapine levels, CD4+ T lymphocyte, absolute lymphocyte and viral load counts at baseline and months 6 and 12 after initiation of nevirapine-based antiretroviral therapy combinations were retrospectively analysed. Participants were from a cohort of 150 patients previously genotyped and with measured plasma nevirapine levels. Relationship between genotype and nevirapine levels, absolute lymphocyte and CD4+ T lymphocyte counts and viral load were explored. Composite CYP2B6*6/*18 genotype was significantly associated with trough plasma nevirapine levels (geometric mean [standard deviation]: 4482 ng/ml [1349] of normal metabolizers vs. 4632 ng/ml [1793] of intermediate metabolizers vs. 6229 ng/ml [2549] of poor metabolizers; P < 0.001), but not the plasma HIV RNA levels, absolute lymphocyte and CD4+ T lymphocyte counts. Overall, immunologic response showed improvement with approximately 61.3% and 70.4% of patients with CD4+ T lymphocyte count >350 cells/mm3 at months 6 and 12 therapy duration respectively compared to 23.1% at baseline. Composite CYP2B6*6/*18 genotype correlated with plasma nevirapine levels but not immunologic and virologic responses.

Prevalence of asthma and respiratory symptoms during pregnancy in the middle belt of Nigeria.

Background: Information about the burden of asthma during pregnancy in Africa is scarce.Objectives: To determine the prevalence of asthma and respiratory symptoms in pregnancy in Ilorin, Nigeria.Methods: This study uses the European Community Respiratory Health Survey (ECRHS) questionnaire and definitions to screen 870 pregnant women attending three hospitals for asthma.Results: The prevalence of possible asthma (i.e. awakened by shortness of breath, asthma attack(s) in the last 12 months, or currently taking asthma medication) was 2.1% (95% CI: 1.3-3.1%), physician-diagnosed asthma was 1.0% (95% CI: 0.5-1.7%), and current asthma (asthma attack in the last 12 months and currently taking asthma medication) was 0.7% (95% CI: 0.2-1.3%). The prevalence of respiratory symptoms ranged from 0.6% (95% CI: 0.1-1.1%) for wheezing without cold to 12.9% (95% CI: 10.7-15.2%) for nasal allergies. Less than 1% reported an asthma attack and using asthma medication in the last 12 months. None of the pregnant women smoked tobacco during pregnancy. Pregnant women with possible asthma experienced more respiratory symptoms and worsening symptoms than those without asthma (15.8% vs. 3.9%), and the most reported symptom was being awakened by shortness of breath. The majority (55.6%) with physician-diagnosed asthma had suffered an asthma attack in the current pregnancy with a median of two attacks.Conclusion: The prevalence of asthma and respiratory symptoms in pregnancy in this sample was low, but we observed an increase and worsening of respiratory symptoms during pregnancy in those with asthma. Hence, the priority of clinicians should be disease control to prevent feto-maternal morbidity and mortality.

Prevalence of Rifampicin-Resistant Tuberculosis among Patients Previously Treated for Pulmonary Tuberculosis in North-Western, Nigeria.

BACKGROUND: Drug-resistant tuberculosis (TB) is a significant public health problem. Greater than 90% of rifampicin (RIF)-resistant isolates were also isoniazid resistant, and hence, rifampicin resistance (RR) is frequently used as a surrogate for multidrug-resistant TB. SETTING: This study was conducted at Infectious Disease Hospital Kano in North-Western Nigeria. OBJECTIVES: The aim of this study was to determine the prevalence of RR among patients previously treated for pulmonary TB (PTB). MATERIALS AND METHODS: A total of 120 patients previously treated for PTB with current clinical features of PTB were recruited into this study. Relevant clinical information were obtained using a questionnaire. The sputum was collected and analyzed by the Gene Xpert MTB/RIF® machine to detect RR tuberculosis infection and blood screened for HIV infection. RESULTS: The mean (±standard deviation) age of the participants was 35.9 ± 14.3 years and they comprised 73 (60.8%) males and 47 (39.2%) females. HIV-seropositive rate was 11.7% among the participants. Of the 120 participants, PTB was detected in 35 (29.2%) of the participants by Gene Xpert MTB/RIF and 29 of them were cases of relapse. Five patients (4.2%) had RR tuberculosis and 80% of them were below the age of 45 years. CONCLUSION: The prevalence of RR is not high among previously treated PTB patients in this study when compared with other previous studies. This finding is a window for evaluating the efficacy of current interventions in the region and evidence for the consolidation of existing control policies.

Sero-prevalence of hepatitis B and C among mentally ill patients attending a tertiary hospital in Nigeria.

BACKGROUND: Mentally ill persons are vulnerable to sexually transmitted infections including hepatitis B and C because of their high level risky behaviors. This study is aimed at establishing the sero-prevalence of hepatitis B and C among the mentally ill individuals (MII) attending psychiatric clinic of the University of Ilorin Teaching Hospital (UITH), Nigeria since it has not been documented. METHODS: A total of 350 MII were recruited. HBsAg testing was by immunoassay test strip (Grand Medical Diagnostic R USA) while hepatitis C was tested by commercially prepared kits from ACON, R USA. Healthy adults who presented as donors in the blood bank of the hospital were used as controls. RESULTS: A total of 700 participants including 350 MII and 350 blood donors (BDs) were recruited for the study. The mean ages of MII and control participants were 36.5 ± 12.3 and 31.4 ± 8.3, respectively.The sero-prevalence of hepatitis B and C among patients with mental illness was 10.0 and 12.6%, respectively, as compared to 10.9% and 1.1% of the blood donors. There was a significant difference in the prevalence of HCV among mentally ill when compared with the blood donors (P = 0.001, χ2 = 33.97; OR (CI) =12.44 (5.33-29.03). CONCLUSION: Mentally ill patients attending UITH were significantly infected with hepatitis C virus. There is need for interventional measures to reduce the prevalence of hepatitis C among the mentally ill population such as health education and early screening of mentally ill in our setting.

Awareness of the Warning Signs, Risk Factors, and Treatment for Tuberculosis among Urban Nigerians.

Objectives. To determine the awareness of the warning signs, risk factors, and treatment of tuberculosis among urban Nigerians. Methods. This was a cross-sectional survey among 574 adults in Ilorin, Nigeria. Semistructured questionnaire was administered by trained interviewers to obtain information about awareness of tuberculosis warning signs, risk factors, and treatment. Results. Majority of the subjects (71.4%) were aware of at least one warning sign of tuberculosis. Cough (66.2%), weight loss (38.0%), and haemoptysis (30.7%) were the most identified warning signs. The predictors of awareness of warning sign were increasing age (r + 0.12), higher family income (r + 0.10), higher level of education (r + 0.10), and belonging to Christian faith (r + 0.11). Awareness of risk factors for tuberculosis was higher for tobacco smokers (77.0%) and history of contact with a case of TB (76.0%). Less than half were aware of HIV infection (49.8%), alcohol consumption (42.5%), chronic kidney disease (40.4%), extremes of ages (39.4%), cancers (36.9%), and diabetes mellitus (27.5%) as risk factors for TB. Tuberculosis was reported to be curable by 74.6% of the subjects and 67.9% knew that there are medications for treatment of tuberculosis, while 11.5% knew the duration of treatment. Conclusion. This study has revealed that the awareness of HIV and noncommunicable diseases as risk factors for TB is poor. This study has therefore demonstrated the need for health education programs that will emphasize recognition, identification, and modification of risk factor for TB.

Prevalence, intensity and complications of Microsporidium spores amongst HIV-positive hospital patients in Ilorin, Nigeria.

BACKGROUND: Microsporidiasis, which is of great concern for immunocompromised patients, is poorly studied in developing countries. OBJECTIVES: A study was carried out amongst HIV-positive hospital patients and HIV-negative hospital controls in Ilorin, Nigeria, between January 2009 and July 2010 to determine the prevalence and intensity of Microsporidium spores and the complications associated with their presence. METHOD: Stool samples from 750 HIV-positive patients and 375 HIV-negative patients were studied using the Chromotrope-2R staining technique. Determination of CD4+ count was performed on the Partec Cyflow SL-3 CD4/8 instrument. Intensity of spores was determined by counting the total number of the spores in a 10 µl stained smear of stool. Images were captured with Phenix Microimage Analysis Software and data obtained were analysed using the Statistical Package for the Social Sciences. RESULTS: The prevalence of Microsporidium isolates amongst the HIV-positive hospital patients was significantly higher (42.4%) than amongst the HIV-negative controls (19.2%) (p < 0.05). The intensity of microsporidial spores amongst HIV-positive hospital patients was also significantly higher than amongst the controls (p < 0.05). However, the difference in the intensity of spores amongst HIV-positive patients who were on antiretroviral therapy (n = 411) and those who were not (n = 339) was not significant (p = 0.236). Microsporidiasis in HIV infection infection was common amongst patients with with low CD4+ counts, diarrhoea, body rashes and cough. CONCLUSION: Both the prevalence and intensity of Microsporidiasis are high amongst HIV-positive hospital patients; campaigns to promote awareness, prevention and control are required. Laboratory testing for microsporidia in HIV patients should be performed routinely so as to identify the organism for prompt medical attention.

Assessment of the level of asthma control among adult patients in two tertiary care centers in Nigeria.

BACKGROUND: According to the Global Initiative for Asthma (GINA) guidelines, the goal of asthma management is to achieve clinical control. Uncontrolled asthma places a significant social and economic burden on patients. OBJECTIVE: The two aims of this study were to (1) assess the level of asthma control (according to the GINA definition of "control") among adult patients attending two tertiary care centers in Nigeria and (2) to determine the predictors associated with uncontrolled asthma. METHODS: This cross-sectional study was carried out from June 2009 to December 2010. The participants were all 18 years old or older with physician-diagnosed asthma. First, the participants completed an interviewer-administered questionnaire, which included items that collected their socio-demographic information and clinical data. Second, anthropometric indices were measured and spirometry was conducted to determine each participant's lung function. Finally, the researcher team members assessed each participant's inhaler device technique. The outcome measures were (1) uncontrolled asthma, (2) partly controlled asthma, and (3) controlled asthma. RESULTS: One hundred and twenty-four asthma patients participated in the study. Of these, 69.3% had uncontrolled asthma, 22.6% had partly controlled asthma, and 8.1% had controlled asthma. Multivariate analysis showed that uncontrolled asthma was strongly associated with asthma severity based on clinical features, the incorrect use of an inhaler device, the use of oral corticosteroids, an abnormal pulmonary function test, the presence of comorbidity, and the lack of adherence to inhaled corticosteroids (ICSs). The results also revealed that increasing age and a lack of tertiary education were weakly associated with asthma control. In this study, gender, marriage, smoking status, occupation, socioeconomic status, income, and the duration of the asthma were not associated with asthma control. CONCLUSION: A significant proportion of the sampled patients had uncontrolled asthma. To reduce this number, health care providers must reinforce the education of each asthma patient and promote the regular assessment of asthma control at every clinic visit, identify those with poor control, and institute the appropriate therapy needed to achieve clinical control.

Secondhand smoke exposure among nonsmoking adults in two Nigerian cities.

BACKGROUND: Tobacco control policy can only succeed if the burdens of smoking are known. The objective of this study was to determine the prevalence and correlates of secondhand smoke (SHS) exposure among nonsmoking adults in two Nigerian cities. MATERIALS AND METHODS: We carried out a cross-sectional study from October 2009 to April 2010 among adult population of two Nigerian cities: Enugu and Ilorin. A semi-structured questionnaire was administered by interviewers to obtain socio-demographic information; and information regarding pattern of SHS exposure, awareness of tobacco control policy and the harmful effects of SHS. SHS exposure was defined as regular exposure to tobacco smoke in the previous 30 days in a nonsmoking adult. RESULTS: Of the 585 nonsmoking adults that completed the study, 38.8% had regular exposure to SHS; mostly, in public places (24.4%). More men were exposed at public places when compared with women (27.0% vs. 19.5%). The strongest factor associated with exposure to SHS in women was having a smoking spouse [prevalence rate (PR) ratio-7.76; 95% confidence interval (CI), 3.08-9.42]; and in men, it was lack of home smoking restriction (PR ratio-6.35; 95% CI, 4.51-8.93). Among men, SHS exposure at any location was associated with lack of secondary school education, residing in slum apartment (house with many households), living with a smoking family member (non-spouse), lack of home smoking restriction, and alcohol intake. Among women, SHS exposure at any location was associated with having a smoking spouse, residing in slum apartment and lack of home smoking restriction. Seventy-two percent of respondents were aware of the harmful effects of SHS on their health. Lack of awareness of the harmful effects was significantly associated with increasing age (r = +0.45; P = <0.01), lack of secondary school education (r = -0.10; P = 0.04), residing in slum apartment (r = -0.12; P = 0.03) and being a widow/widower (r = +0.24; P < 0.01). Only 17.4% of the employees reported availability of outdoor smoking area at their workplaces. CONCLUSION: Our results show that prevalence of SHS exposure was the highest in public places. These findings underscore the need for enactment of comprehensive smoke-free legislation and implementation of educational strategies to reduce SHS exposure in homes.

An audit of spirometry at the University of Ilorin Teaching Hospital, Ilorin, Nigeria (2002-2009).

BACKGROUND: Spirometry is a noninvasive and cost-effective physiologic test that greatly complements other investigative procedures in evaluation of respiratory conditions. This study was aimed at auditing the spirometry performed at the University of Ilorin Teaching Hospital (UITH) Ilorin, Nigeria, and highlighting some of the challenges associated with the procedure. METHODS: We reviewed and analyzed the record of spirometry performed at the cardiopulmonary unit of the hospital from June 2002 to December 2009. RESULTS: A total of 119 patients had spirometry tests from 2002 to 2009 and their age ranged from 15 to 85 years with a mean of 47.6 +/- 14.8 years. There were 69 (58%) males and the male:female ratio was 1.4:1. More than half (65%) of the tests were in patients <50 years old. The rate of spirometry performed annually increased from 12 (10.1%) in 2002 to 31 (26.1%) in year 2009. Evaluation of bronchial asthma was the most common indication for spirometry (43 patients; 36.1%). Majority of the requests (84 patients; 70.6%) were from adult respiratory physicians. The identified challenges were lack of awareness of the range of diseases that could be investigated by spirometry, lack of skills in interpreting the results, lack of time and delays in replacing exhausted consumables and faulty components of spirometer. CONCLUSION: Gradually, the trend of spirometry request is increasing in UITH; however, a wider acceptability could be achieved for this test by raising the level of awareness and improving the skills of all doctors on the usefulness and interpretation of spirometry.

A retrospective evaluation of pretreatment and follow-up monitoring of HIV-infected adult patients in a resource-poor setting.

The rapid scale-up of antiretroviral therapy (ART) is associated with the challenges of ensuring that HIV care delivered to clients is of the highest quality. This study was designed to evaluate the pretreatment and 12 month follow-up monitoring of clinical and laboratory profiles of HIV-infected patients at the adult HIV clinic of the University of Ilorin Teaching Hospital, in Nigeria. It was a retrospective analysis of records of 440 adult patients who were on follow-up visits for 1 or more years. Two hundred two (45.9%) were male and 238 (54.1%) were female. Weight was documented at baseline in 314 (71.4%) and at month 12 of follow-up in 258 (58.6%). Baseline World Health Organization (WHO) clinical stage was documented in 269 (61.1%). Baseline CD4 count, full blood count (FBC), creatinine (Cr), liver function tests (LFT), fasting blood sugar (FBS), and fasting serum lipids (FSL) were documented in 243 (55.6%), 260 (59.1%), 143 (32.5%), 136 (30.9%), 268 (60.9%), and 161 (36.6%), respectively. At 12th month of follow-up visit, the CD4 count, FBC, Cr, LFT, FBS, and FSL were documented in 121 (27.5%), 94 (21.4%), 59 (13.4%), 77 (17.5%), 179 (40.7%), and 95 (21.6%), respectively. This report shows that the pretreatment and the 12th-month follow-up monitoring of HIV-infected adult patients in our center was less than optimal. We recommend periodic self-assessment by care providers to monitor compliance with standards.

Evaluation of current knowledge, awareness and practice of spirometry among hospital -based Nigerian doctors.

BACKGROUND: Spirometry is a cost-effective diagnostic tool for evaluation of lung function and for case-finding in a resource-limited setting. The acceptance of this test depends on the awareness of its indications and the ability to interpret the results. No studies have assessed the knowledge of spirometry among Nigerian doctors. The aim of this study was to evaluate the current knowledge, awareness and practice of spirometry among hospital-based Nigerian doctors. METHODS: We carried out a cross-sectional survey among 321 doctors working in Nigerian hospitals between March 2008 and June 2008. Information on knowledge, awareness, practice of and barriers to spirometry were obtained using a pre-tested, self-administered structured questionnaire and the data were then analysed. RESULTS: Of the 321 doctors that participated, 108 (33.6%) reported that they have good knowledge of spirometry. One hundred and ninety-five (60.7%) were aware of the importance of spirometry in aiding the diagnosis of respiratory diseases; 213(66.4%) were aware of the importance of spirometry in determining the severity of diseases. Medical school was the most common source of knowledge on spirometry (64.5%). Eighty-one (25.2%) doctors reported having a spirometer in their hospitals. Doctors having access to a spirometer used it more frequently for aiding the diagnosis of COPD (40.7% vs.27.5%) and for monitoring of asthma (18.5% vs.11.3%) than those without access to a spirometer. The doctors working in University Teaching Hospitals and Federal Medical Centres (FMC) (22.4% vs. 4.5%) and those having access to a spirometer (40.7 vs.11.3%) were very confident of interpreting spirometry results compared to those working in District and General Hospitals and without access to a spirometer. Irrespective of access to a spirometer or the type of hospital they were employed in, doctors reported that unavailability of a spirometer was the greatest barrier to its use (62.5%) followed by lack of awareness about its usefulness (17.2%). CONCLUSION: The knowledge and practice of spirometry were poor among hospital-based Nigerian doctors because of unavailability of spirometers in most hospitals. These findings have implications for further evaluation, planning and management of patient care in respiratory disease. Spirometers should be made available in all hospitals, and the knowledge of spirometry should be improved among doctors.