Hepatitis C Virus (HCV) Prevalence in Special Populations and Associated Risk Factors: A Report From a Tertiary Hospital.

BACKGROUND: With the advent of highly effective anti-hepatitis C virus (HCV) drugs, efforts to identify infected cases, high-risk groups, and associated risk factors have become the focus of current control measures. OBJECTIVES: To determine the prevalence of the HCV antibody among diabetics and patients with lymphoproliferative disorders (LPD) who presented to the outpatient clinics of a university hospital and its associated risk factors. PATIENTS AND METHODS: Consecutively consenting patients who had been previously diagnosed with diabetes mellitus and LPD at the outpatient department of the Lagos State University teaching hospital were recruited. A case record form was used to extract their demographics and physical examination findings as well as any risk factors for HCV infection; blood was also drawn to run a serological assay for the HCV antibody. All data were collated and analyzed using the Statistical Package for the Social Sciences version 20. Student T-test, Chi square, and logistic regression were some of the inferential statistics used in addition to descriptive statistics. RESULTS: In all, 438 patients (405 diabetics and 33 patients with LPD) were recruited. Their ages ranged from 17 - 87 years with a mean + Standard deviation of 59.61 + 11.859 years. The prevalence of hepatitis C among the diabetic subgroup was 0.7%, while the antibody was present in 9.1% of the LPD patients. The occurrence of the HCV antibody was, however, not significantly associated with age, sex, educational level, or marital status (P > 0.05). Having multiple sexual partners was identified as the only significant risk factor for hepatitis C (OR = 9.148; P = 0.017). CONCLUSIONS: This survey suggested that a higher HCV prevalence exists in this population than is currently reported in the general population, and having sex with multiple partners was a risk factor for HCV infection.

Effect of sub-clinical hypothyroidism on clinical severity in first-ever acute ischemic stroke.

BACKGROUND: Subclinical hypothyroidism has been documented to have a positive effect on the clinical presentation and outcome in acute ischemic stroke. OBJECTIVE: To determine the prevalence of subclinical hypothyroidism in first ever ischemic strokes and to evaluate its effect on the clinical presentation. METHODS: Using a cross-sectional study design, 138 patients diagnosed with first ever ischemic stroke within 7 days of onset were included in the study. Each participant had documentation of demographic data, followed by a detailed neurological examination. Stroke severity on admission was recorded using the National Institute of Health Stroke Scale (NIHSS) and blood samples for free thyroxine (T4) and thyroid stimulating hormone (TSH) were taken within 24h of onset of symptoms. For analysis, the patients were divided into two groups: those who had elevated TSH level (> 2.5 mlU/L) with normal FT4 level were assigned to the sub-clinical hypothyroidism group whilst those with normal thyroid function were assigned to the control group. All values were compared between the two groups. RESULTS: The study population comprised of a total number of 138 participants with mean age of 63.4 +/- 12.9 years. The females were 56 (40.6%) and the males were 82 (59.4%). A total number of 11 (7.9%) had subclinical hypothyroidism whilst 127 participants (92%) had normal thyroid functions. The mean NIHSS score of cases with SCH on admission was significantly lower than that of those with normal thyroid functions (6.73 +/- 3.6 vs. 11.1 +/- 6.3, p=0.025). A significantly higher proportion of patients in the SCH group had mild neurologic deficits on admission compared with the group with normal thyroid functions (81.8% vs 24.4%, p < 0.001). CONCLUSION: Our study has suggested that subclinical hypothyroidism appears to confer a neuroprotective effect in acute ischemic stroke.

Primary headache disorders at a tertiary health facility in Lagos, Nigeria: prevalence and consultation patterns.

BACKGROUND: Primary headaches are underdiagnosed and undertreated, with a significant impact on social activities and work. AIM: To determine the last-year prevalence and health care utilization pattern of primary headaches at a tertiary centre. METHODS: A cross-sectional study was carried out amongst staff of the Lagos State University Teaching Hospital in Lagos, Nigeria. 402 staff members were selected by simple random sampling and administered a detailed structured headache assessment questionnaire. Migraine and tension-type headache were diagnosed according to the criteria of the International Headache Society (2004). RESULTS: The participants comprised 168 males and 234 females. The mean age was 36.9 ± 7.9 years. The overall headache prevalence was 39.3% with female predominance (P < 0.0001). Tension-type headache was the most prevalent at 72.8% and migraine at 18.9%. Unclassifiable headache constituted 8.2%. Migraine headache showed female preponderance (P = 0.000). 80.4% of participants did not seek medical consultation compared with 19.6% who did (P = 0.000). Of the latter, 83.9% consulted the general practitioner (GP), whilst 16.1% consulted the neurologist. CONCLUSIONS: Primary headache prevalence is high in our population. It is not recognised as that requiring care by most of the staff of this tertiary health facility; thus education is required to increase health care utilization.

Quality of Sleep in an HIV Population on Antiretroviral Therapy at an Urban Tertiary Centre in Lagos, Nigeria.

Aim. To determine the prevalence of sleep disturbance and its associated characteristics in HIV-positive outpatients on HAART using the PSQI. Methods. Using a cross-sectional design, 300 patients attending the outpatient HIV/AIDS clinic at the Lagos State University Teaching Hospital were recruited. Baseline data obtained included the participants' demographic data, educational qualification, and marital status. Their treatment history, including duration since HIV diagnosis, the most recent CD4 cell count, and current antiretroviral therapies, was obtained from their case records. Each participant completed the PSQI questionnaire and those with scores ≥5 were diagnosed with poor sleep quality. Results. The participants were made up of 70.7% females and 29.3% males. Their ages ranged between 18 and 74 years with a mean of 38.9 ± 10.3 years. According to the PSQI, 59.3% reported poor sleep quality. The mean score of those with poor quality sleep (9.2 ± 3.3) was comparable to that of those with good quality sleep (1.26 ± 1.4). P < 0.001. Significant differences were observed in all the individual components of the PSQI (P < 0.001). On multivariate analyses, the independent associations with sleep quality were the duration since HIV diagnosis (P = 0.29), efavirenz based regimen (P < 0.001), and lower CD4 cell count (P < 0.001). Conclusions. Sleep disturbances are quite common in the HIV population even in the era of HAART. Early recognition via routine assessment and effective treatments could prevent the resultant complications and improve quality of life.

Seroprevalence of human T lymphotropic virus antibodies among healthy blood donors at a tertiary centre in Lagos, Nigeria.

INTRODUCTION: Transmission of human T-lymphotropic viruses (HTLV) occurs from mother to child, by sexual contact and blood transfusion. Presently, in most centres in Nigeria, there is no routine pre-transfusion screening for HTLV. The study aims to determine the prevalence of HTLV-1 and HTLV-2 among healthy blood donors at a tertiary centre in Lagos. METHODS: A cross-sectional study was carried out at the blood donor clinic of the Lagos State University Teaching Hospital (LASUTH), Ikeja. About 5 mls of venous blood was collected from each subject into a sterile plain bottle after obtaining subject's consent. The serum separated and stored at -200C. Sera were assayed for HTLV by an enzyme-linked immunoassay (ELISA) for the determination of antibodies to HTLV 1 and HTLV -2. Western blot confirmatory testing was done on reactive samples. All donors were also screened for HIV, HBsAg and HCV by rapid kits. RESULTS: The seroprevalence of HTLV -1 by ELISA was 1.0% and 0.5% by Western Blot among blood donors. A total of 210 healthy blood donors were enrolled. Only 2 (1.0%) blood donors were repeatedly reactive with ELISA test. On confirmatory testing with Western Blot, 1 (0.5%) blood donor was positive for HTLV. All the healthy blood donors were negative for HIV, HbsAg and HCV. None of the 210 blood donors had been previously transfused; as such no association could be established between transfusion history and HTLV positivity among the blood donors. CONCLUSION: The seroprevalence of HTLV in this environment is low among healthy blood donors.

Seroprevalence of human T-lymphotropic virus antibodies among patients with lymphoid malignancies at a tertiary center in Lagos, Nigeria.

BACKGROUND: There is a significant association of human T-lymphotropic viruses (HTLV) with lymphoid malignancies. HTLV causes a lymphoproliferative malignancy of CD4-activated cells called adult T-cell leukemia/lymphoma (ATL) and a chronic myelopathy called tropical spastic paraparesis/HTLV-1-associated myelopathy (TSP/HAM). This study aims to determine the prevalence of HTLV among patients with lymphoid malignancies at a tertiary center in Lagos. METHODS: A cross-sectional study was carried out at the hematology clinic of the Lagos State University Teaching Hospital. After obtaining consent, approximately 5 mL of venous blood was collected from each subject. The serum was separated and stored at -20°C. Sera were assayed for HTLV by an enzyme-linked immunoassay (ELISA) for the determination of antibodies to HTLV-1 and -2. Western blot confirmatory testing was done on reactive samples. All patients were also screened for human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) by rapid kits. RESULTS: A total of 39 patients with lymphoid malignancies were enrolled, consisting of 24 (61.5%) with solid malignancies, while 15 (38.5%) had leukemia. Only two patients (5.1%) with lymphoid malignancies were reactive on the ELISA test. On confirmatory testing with Western blot, two patients (5.1%) with lymphoid malignancies were also positive for HTLV. All patients were HIV negative, but four were positive to HBsAg and HCV. There was no association between history of previous blood transfusion and positivity to HTLV (P=0.544). CONCLUSION: A prevalence of 5.1% of HTLV among patients with lymphoid malignancies was found in this study, and previous history of blood transfusion was not found to be a significant cause of HTLV infection.

The kikuchi-fujimoto disease in Nigeria: a case report and literature review.

The Kikuchi-Fujimoto is a rare, self-limiting disease, which is characterized by regional lymphadenopathy. It occurs worldwide with a higher prevalence among Asians and women below the age of forty years. We present 41-year-old Nigerian woman who was investigated extensively for unilateral left cervical lymphadenopathy. She was eventually diagnosed as having the Kikuchi-Fujimoto disease and was managed conservatively thereafter. We describe a case report and review of literature for better awareness of the disease amongst medical practitioners and pathologists in Africa.

Mycosis fungoides: case report and literature review.

Mycosis fungoides (MF), also known as Alibert-Bazin syndrome or granuloma fungoides, is the most common form of cutaneous T-cell lymphoma. Cutaneous lymphomas are an uncommon, heterogeneous group of non-Hodgkin lymphomas (NHLs) of T- and B-cell origin where the skin is the primary organ of involvement. This is a case of a 60-year-old Nigerian woman, who was diagnosed and managed as a case of chronic dermatitis but further investigations confirmed a diagnosis of MF; she was thereafter managed with topical glucocorticoids/chemotherapy and improved on these treatments. We make a plea for better awareness of the disease among physicians and pathologists in Africa.

Latent Autoimmune Diabetes Mellitus in Adults (LADA) and it's characteristics in a subset of Nigerians initially managed for type 2 diabetes.

INTRODUCTION: Latent autoimmune diabetes in adults (LADA) is an entity characterized by the presence of GAD autoantibodies. LADA is largely understudied and underreported amongst Nigerians with Diabetes Mellitus (DM). We undertook to document the Prevalence, clinical and biochemical characteristics of LADA in a subset of Nigerians who hitherto had been treated for type 2 DM. METHODS: This is a cross-sectional study conducted on 235 patients being managed for type 2 DM. The diagnosis of LADA was made in the presence of Glutamic Acid Decarboxylase autoantibody (GADA) positivity in the study subjects. Thereafter persons with LADA were compared with those without LADA. Clinical parameters such as demographic data, history of diabetes mellitus (DM) and its complications were obtained, biochemical parameters including Fasting blood glucose (FBG), C-peptide, glycated haemoglobin (HbA1c) and lipid parameters were compared in both groups of Study subject. Test statistics used were Student t- test and χ 2. SPSS was used for data analysis. RESULTS: Thirty three out of 235 of the Study subjects were GADA positive, giving a prevalence of 14%. The mean age (SD) of the subjects with LADA is 53.24(7.22) with an age range of 30-63 years. Majority (48%) of LADA subjects were in the 50-59 age category. There was no significant difference in the proportion of males and females with LADA (p = 0.3). 37% of patients with LADA were on insulin for glycaemic control. Three (3) LADA subjects had history/clinical evidence of autoimmune thyroid disease. 66% of LADA were in the overweight/obese category. LADA subjects had significant poor long term glycaemic control compared with anti-GAD negative subjects (p = 0.026). About half of LADA subjects were insulinopaenic. LADA subjects had lower levels of total cholesterol than GADA-ve subjects (p = 0.03). A higher proportion of LADA had evidence of microvascular complications of DM compared with antiGAD negative individuals. CONCLUSION: The diagnosis of LADA should be entertained in overweight/obese persons from the fourth decade of life presenting with DM. Pharmacotherapy with insulin is a potential means of managing hyperglycaemia in this group of patients especially since a significant proportion are insulinopaenic. The Prevalence of LADA in our patients is comparable to what obtains in Ghanaian and Caucasian populations.