RESUMEN
BACKGROUND: Asthma symptoms are often mediated by changes in immune responses to allergens measured by the levels of immunoglobulin E (IgE) and non-protein regulators such as 25-hydroxycholecalciferol (25 (OH) vitamin D3). The relationship between serum levels of IgE, 25 (OH) Vitamin D3, and asthma control in asthma patients remains unclear. OBJECTIVE: To measure the serum IgE and 25 (OH) vitamin D3 levels in asthma patients and determine their relationship with patient's asthma control. METHODS: This was a cross-sectional study of children and adults with asthma aged 5 to 60 years old; and their controls seen in a tertiary hospital in Enugu, south eastern Nigeria from October 2018 to January 2019. Serum levels of IgE, and 25 (OH) vitamin D3 were determined by sandwich enzyme-linked immunosorbent assay (ELISA); and compared between groups using the Student's t-tests. Association between IgE, 25 (OH) vitamin D3 levels, and asthma control were determined using the Chi-square. RESULTS: Sixty-five (65) asthma patients and thirty-three (36) non-asthma controls were studied. Mean serum level of IgE (411.32± 220.18 IU/ml) was significantly raised in asthma patients compared to controls (163.51 ± 186.36 lU/ml); p=0.001. There was no significant difference in mean 25 (OH) vitamin D3 levels in asthma (68.55 ± 25.91 ng/ml) compared to controls (77.25 ± 34.01 ng/ml); p=0.153. No significant association was found between patient's asthma control status, and serum IgE and 25 (OH) vitamin D3 levels. CONCLUSION: Asthma control status was not associated with Immunoglobulin E and 25 (OH) vitamin D3 levels in those studied. More robust study is required to evaluate the relationship between asthma control, IgE and vitamin D levels.
BACKGROUND: Les symptômes de l'asthme sont souvent médiés par des changements des réponses immunitaires aux allergènes, mesurées par les taux d'immunoglobuline E (IgE) et de régulateurs non protéiques tels que le 25- hydroxycholécalciférol (25 (OH) vitamine D3). La relation entre les niveaux sériques d'IgE, de 25 (OH) vitamine D3 et le contrôle de l'asthme chez les patients asthmatiques n'est pas claire. OBJECTIF: Mesurer les taux sériques d'IgE et de 25 (OH) vitamine D3 chez les patients asthmatiques et déterminer leur relation avec le contrôle de l'asthme chez les patients. MÉTHODES: Il s'agit d'une étude transversale d'enfants et d'adultes asthmatiques âgés de 5 à 60 ans; ainsi que de leurs témoins vus dans un hôpital tertiaire d'Enugu, dans le sud-est du Nigeria, d'octobre 2018 à janvier 2019. Les taux sériques d'IgE et de 25 (OH) vitamine D3 ont été déterminés par dosage immuno-enzymatique en sandwich (ELISA); et comparés entre les groupes à l'aide des tests t de Student. L'association entre les niveaux d'IgE, de 25 (OH) vitamine D3 et le contrôle de l'asthme a été déterminée à l'aide du chi carré. RÉSULTATS: Soixante-cinq (65) patients asthmatiques et trentetrois (36) témoins non asthmatiques ont été étudiés. Le taux sérique moyen d'IgE (411,32 ± 220,18 UI/ml) était significativement plus élevé chez les patients asthmatiques que chez les témoins (163,51 ± 186,5 UI/ml); p=0,001. Il n'y avait pas de différence significative dans les taux moyens de 25 (OH) vitamine D3 chez les asthmatiques (68,55 ± 25,91 ng/ml) par rapport aux témoins (77,25 ± 34,01 ng/ml); p=0.153. Aucune association significative n'a été trouvée entre le statut de contrôle de l'asthme du patient et les taux sériques d'IgE et de 25 (OH) vitamine D3. CONCLUSION: Le contrôle de l'asthme n'était pas associé aux taux d'immunoglobulines E et de 25 (OH) vitamine D3 chez les personnes étudiées. Une étude plus solide est nécessaire pour évaluer la relation entre le contrôle de l'asthme, les taux d'IgE et de vitamine D. Mots clés: 25 hydroxyl vitamine D3, Immunoglobuline E, Contrôle de l'asthme, Enfants, contrôle, Enfants.
Asunto(s)
Asma , Vitamina D , Adolescente , Adulto , Calcifediol , Niño , Preescolar , Estudios Transversales , Humanos , Inmunoglobulina E , Persona de Mediana Edad , Nigeria , Adulto JovenRESUMEN
BACKGROUND: Understanding the impact of asthma is the key to optimal care. OBJECTIVE: To determine the physical, economic, and social impact of asthma from the perspectives of individual patients in Nigeria. METHODS: This was a multicenter study of 172 adult asthma patients attending tertiary hospitals. We assessed the different impact of asthma in the preceding 12 months using a questionnaire. Physical impact (such as daily activity/chores, sport/exercise, and sleep quality), social impact (such as job loss, mental anguish, employer, and peers discrimination) and economic impact (like savings, indebtedness, mortgage/asset, and school or work absence). RESULTS: The physical, social and economic impacts were perceived by 59.3%, 47.7%, and 51.2% of patients, respectively. The physical impacts were poor sleep (44.2%), limitation of daily activity/chores (38.4%), and sporting/exercise (39.5%). The economic impacts were reduced savings (38.4%) and indebtedness (17.4%). Absence from school and work were respectively reported by 75% of students and 38.3% of workers. Socially, 34.9% reported mental torture, 10.5% changed job, 4.7% experienced discrimination and 3.5% lost their jobs due to asthma. Asthma-related emergency department visit was 42% and hospitalization was 32.6%. The physical impact was associated with non-adherence to ICS and persistent asthma symptoms. Economic impact was associated with asthma hospitalization, work absenteeism, comorbidity, and National Health Insurance (NHIS) coverage. Male sex and lack of post-secondary education were associated with social impact. CONCLUSION: Asthma causes broad and substantial physical and socioeconomic impacts in our sample of patients. Exploring these impacts and engaging the patient is imperative for holistic management and good health outcomes.
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Actividades Cotidianas , Asma/economía , Cobertura del Seguro , Programas Nacionales de Salud , Absentismo , Adulto , Asma/tratamiento farmacológico , Asma/psicología , Estatus Económico , Escolaridad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Empleo , Ejercicio Físico , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Nigeria , Examen Físico , Prejuicio , Factores Sexuales , Sueño , Encuestas y Cuestionarios , Centros de Atención Terciaria , Adulto JovenRESUMEN
AIMS AND OBJECTIVES: The objective of this study was to determine the factors that affect the interest in respiratory medicine (RM) as a subspecialty of choice among internal medicine residents in Nigeria. SUBJECTS, MATERIALS AND METHODS: This was a cross-sectional study of 136 internal medicine residents recruited from seven teaching hospitals from January 2011 to June 2011. A semi-structured questionnaire that was self administered by residents was used to obtain socio-demographic information and factors affecting residents' interest in respiratory medicine. RESULTS: Out of 136 residents that completed the study, 78 (57.4 %) were junior residents (PG year 1-3) and 58(42.6%) were senior residents (PG year >3). Thirty four (43.6%) junior residents and 21(36.2%) senior residents considered respiratory medicine as a sub-specialty of choice. Only 2(3.5%) of the senior residents were presently committed to RM. In the junior residents, interest in respiratory medicine was correlated with personal intelligence and ability (RR=2.58, ;95% confidence interval(CI): 1.16-7.07, p-0.01) , availability of respiratory physician (RR=2.42; 95% CI 1.07-7.63 ,p-0.02) and postgraduate examiners in RM in training institutions RR= (2.20; 95% CI 1.06-5.45,p-0.03), experience during rotation in medical school and residency (RR=2.11 ; 95% CI 1.11-4.21,p-0.03) and future annual income (RR=2.04;C:I1.03-4.68,p-0.04). In the senior residents, interest in RM was correlated with the availability of postgraduate examiners in RM in training institutions (RR- 6.36; 95% CI 1.16-66.80, P-<0.01), future opportunity for scholarships and travel grants (RR- 4.23; 95% CI 1.19-25.92,p-< 0.01), personal intelligence and ability (RR= 3.41; 95% CI.16-13.87,p-0.01) and prospect for rapid elevation in career (RR=2.92; 95% CI 1.03-11.91,p -0.04). Provisions of modern facilities in training institutions, mentoring by senior colleagues and promotion of subspecialty by respiratory physicians were rated by the senior residents as the most important ways of increasing interest in respiratory medicine and making it a specialty of choice. CONCLUSION: The interest in respiratory medicine among internal medicine residents is low and decline as their level of training advances. The factors affecting the interest in respiratory medicine have been highlighted and the policy makers need to understand, and if possible modify these factors by formulating appropriate changes to our training programs so as to increase future numbers of respiratory physician.
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Selección de Profesión , Internado y Residencia , Neumología , Estudiantes de Medicina/psicología , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Nigeria , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
HIV infection is a risk factor for cervical cancer and both diseases are prevalent in Nigeria. The study determined the prevalence of cervical squamous intraepithelial lesion (SIL) among HIV-positive women in Enugu state, which has the highest HIV burden in South-eastern Nigeria. Pap smear was carried out on 150 HIV-positive (HIV+ve) women and 150 HIV-negative (HIV?ve) controls at the University of Nigeria Teaching Hospital, Enugu, Nigeria from December 2007 to March 2008. The prevalence of SIL for the HIV+ve group and the control group were 12.6% and 4.6%, respectively (p = 0.014). Also, the prevalence of each category of SIL identified in the study, was higher among the HIV+ve group. There is an association between HIV infection and SIL in Enugu, South-eastern Nigeria. Cervical cancer screening should be incorporated into the antiretroviral (ARV) clinics, so as to prevent the impending surge in the burden of cervical cancer in Nigeria.
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Carcinoma de Células Escamosas/epidemiología , Infecciones por VIH/epidemiología , Neoplasias del Cuello Uterino/epidemiología , Adulto , Carcinoma de Células Escamosas/patología , Escolaridad , Femenino , Humanos , Persona de Mediana Edad , Nigeria/epidemiología , Prevalencia , Factores de Riesgo , Neoplasias del Cuello Uterino/patología , Adulto JovenRESUMEN
BACKGROUND: a major focus of attention in the efforts at controlling the spread of HIV infection has become the role of gender inequality. The objective of the study was to compare the sexual practices of HIV-positive male and female patients who received counselling and treatment at an Anti-retroviral Clinic in Enugu, South-East Nigeria. METHOD: A comparative cross-sectional descriptive study of patients attending the free anti-retroviral clinic at the University of Nigeria Teaching Hospital Enugu was done. RESULTS: A total of 146 males (30.8%) and 328 females (61.9%) were studied. Although there was no significant difference in the prevalence of sexual activity between the sexes, the reasons for sexual practices differed. Females indulged in risky sexual activity principally in obedience to the demands of their male partners and were more likely to have sexual partners who were unaware of their seropositivity than males. CONCLUSION: Risky sexual behaviour among women living with HIV/AIDS in Enugu despite exposure to intensive counselling was still mainly driven by the subordinate traditional gender roles of women in this culture.
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Infecciones por VIH/psicología , Seropositividad para VIH/psicología , Conducta Sexual , Parejas Sexuales/psicología , Adolescente , Adulto , Anciano , Análisis de Varianza , Niño , Estudios Transversales , Femenino , Infecciones por VIH/transmisión , Seropositividad para VIH/transmisión , VIH-1 , Humanos , Masculino , Persona de Mediana Edad , Nigeria , Factores de Riesgo , Asunción de Riesgos , Factores Sexuales , Factores Socioeconómicos , Encuestas y Cuestionarios , Revelación de la Verdad , Adulto JovenRESUMEN
BACKGROUND: Spirometry evaluation of ventilatory functions plays a critical role in the diagnosis, differentiation and management of respiratory illness such as asthma, chronic obstructive pulmonary disease and restrictive lung disorders. It appears to be underutilized especially by most primary care physicians. AIM: This study was aimed at determining the indications for spirometry at a tertiary health institution in Nigeria and to determine the source of referral of the patients. METHODS: Clinical and anthropometric data of all subjects who underwent spirometry at the University of Nigeria Teaching Hospital, Enugu, Nigeria over a three year period were retrieved from the records book and analyzed to determine the sex distribution, age distribution, indication for the procedure, and source of referral. RESULTS: A total of fifty two patients had the procedure over a three year period (Jan 2004-Dec 2006). The male to female ratio was 1: 1.08. Their ages ranged from 5 to 85 years of age with a mean age of 42.3 +/- 20.50 years. The commonest indication for spirometry during the study period was Bronchial asthma followed by Chronic Obstructive Pulmonary disease (COPD). Most of the patients were referred by the respiratory unit performing the procedure followed by the surgical units and no referral came from the neighbouring peripheral hospitals. CONCLUSION: Bronchial Asthma is the commonest indication for the use of spirometry. There is poor referral from the peripheral primary care centers. Primary care general physicians and surgeons should be encouraged to use of spirometry.
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Enfermedades Pulmonares/fisiopatología , Espirometría/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Asma/fisiopatología , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nigeria , Derivación y Consulta/estadística & datos numéricosRESUMEN
BACKGROUND: Tetanus has for long been an avoidable source of morbidity and mortality particularly in developing countries. The aim of this study was to review the experience with managing tetanus in a regional tertiary hospital in Nigeria. METHODS: A retrospective study of patients who were admitted with a clinical diagnosis of tetanus between January 1999 and December 2003 was done. Relevant data were extracted from the patients'case records. RESULTS: A total of 12 patients were identified within the time frame with a diagnosis of tetanus. There were more male than female patients (ratio 1.4:1) with city dwellers constituting a small majority. The mean age of the patients was 29.8 years. Lower limb injuries accounted for the portal of entry in 75% of cases while one case followed a practice of oral sex. All patients were managed in the general ward and no mortality was recorded despite the presence of dysautonomia in some patients. CONCLUSION: Despite the high rate of morbidity and mortality associated with tetanus in developing countries and despite some regional differences in presentation, careful clinical management even in resource poor countries can result in very good outcomes.
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Tétanos/diagnóstico , Adolescente , Adulto , Países en Desarrollo , Femenino , Humanos , Extremidad Inferior/lesiones , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Tétanos/epidemiología , Tétanos/transmisión , Antitoxina Tetánica , Heridas y Lesiones/complicacionesRESUMEN
BACKGROUND: Health Related Quality of Life (HRQL) measures can capture the non-respiratory effects of Chronic Obstructive Pulmonary Disease (COPD). However the relationship with Peak Expiratory Flow (PEF) is not well understood. AIM: To determine the relationship of PEF and quality of life measurements in patients with COPD. SETTINGS AND DESIGN: A cross section of consecutive patients in a university clinic. METHODS: Stable patients with COPD defined by the Global Initiative on chronic Obstructive Lung Disease (GOLD) criteria, were recruited into the study. Spirometry was done using American Thoracic Society's standards and reference equations from African American norms of the US population. Quality of life was measured with the St George's Respiratory Questionnaire (SGRQ). RESULTS: Out of 50 patients recruited for the study, 48 provided complete data with acceptable spirometry and PEF data. The mean (SD) age and body mass index was 68.4 (8.9) years and 21.4 (4.6) kg/m(2) respectively and 96% of the patients were in moderate-severe stages of COPD using the GOLD criteria. Percent predicted PEF correlated with percent predicted FEV1; r= 0.559 p<0.001 and also showed a significant, though moderate correlation between PEF readings and SGRQ scores especially in the activity (r= -0.455 p< 0.01) and total scores (r=-0.415 p<0.01) for pre bronchodilator (BD) percent predicted PEF. In regression analysis, PEF was associated with SGRQ (-0.11 95% CI -0.19, -0.03) after adjusting for age, sex, height, smoking and disease severity. CONCLUSIONS: PEF correlates with SGRQ scores and may be a useful surrogate for HRQL in patients with COPD.
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Ápice del Flujo Espiratorio , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Calidad de Vida , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Enfermedad Pulmonar Obstructiva Crónica/diagnósticoRESUMEN
BACKGROUND: The impact of the human immunodeficiency virus (HIV) infection on the respiratory system of Africans has been little studied. This study aimed to determine the pattern of respiratory symptoms and ventilatory functions in HIV infected Nigerians. METHODS: In this cross sectional study, Respiratory symptoms frequency, Forced vital capacity (FVC), Forced expiratory volume in one second (FEV(1)), FEV(1)/FVC ratio, Forced expiratory flow between 25% and 75% of FVC, were determined in 100 HIV positive subjects and compared with values in 100 HIV negative controls. RESULTS: HIV positive patients had significantly more respiratory symptoms and lower ventilatory function tests values compared to the matched controls (p<0.05). HIV patients with at least one respiratory symptom and those with CD4 count less than 200 cells/µl had lower ventilatory function values than their counterparts. 32% of the HIV patients had restrictive ventilatory functional impairment. (p<0.05). Using regression analysis, factors like HIV status, CD4 count and presence of respiratory symptoms were found to be associated with impairment in ventilatory functions. CONCLUSIONS: HIV infected patients had more frequent respiratory symptoms and lower ventilatory function values. Further lung function studies and CT scanning in HIV positive patients especially in those with respiratory symptoms are indicated.