Assessment of Right Ventricular Systolic Function using Tricuspid Annular Plane Systolic Excursion (TAPSE) among HIV Patients on HAART and Its Relationship with Viral Load and CD4 Cell Count.

BACKGROUND: The introduction of highly active antiretroviral therapy (HAART) has decreased the morbidity and mortality associated with HIV infection; however, this survival advantage is not free from complications. HIV patients are more likely to develop cardiovascular disease compared with the general population, and right ventricular systolic dysfunction is said to be associated with worse outcomes. We, therefore, sought to assess right ventricular systolic function using tricuspid annular plain systolic excursion (TAPSE) among HIV patients on HAART and its relationship with viral load and CD4 cell count. METHODS: The study was a cross-sectional conducted among HIV patients receiving HAART at the Federal Medical Centre, Nguru, Yobe State, Northeastern Nigeria. Right ventricular systolic function was assessed using tricuspid annular plane systolic excursion. RESULTS: One hundred and seven (107) subjects were recruited into the study comprising thirty-seven (34.6%) males and seventy (65.4%) females. The mean CD4 cell count and viral load of the studied patients were 612.65 ± 347.62 cells/µL and 315.44±271.11copies/mL, respectively. The distribution of RVSF according to CD4 cell count showed, fifteen (14.01%) patients with CD4 cell count less than 250 had reduced right ventricular systolic function (RVSF), 30 (28.03%) patients with CD4 cell count 250 - 500 had reduced RVSF, 1 (0.93%) patient with CD4 cell count 250 - 500 had normal RVSF, 47 (43.92%) patients with CD4 cell count 501 -1,000 had normal RVSF and 14(13.08%) patients with CD4 cell count greater than 1,000 had normal RVSF. Fourteen (13.08%) patients with undetectable viral load had normal RVSF, 47(43.92%) patients with viral load 50 - 1,500 had normal RVSF, 1(0.93%) patient with viral load 1,501 - 10,000 had normal RVSF, 30(28.03%) patients with viral load 1,501 - 10,000 had reduced RVSF and 15(14.01%) patients with viral load 10,000 - 50,000 had reduced RVSF. There was a positive and significant correlation between tricuspid annular plain systolic excursion with CD4 cell count and a negative but significant correlation HIV viral load. CONCLUSION: We therefore concluded that asymptomatic right ventricular systolic dysfunction exists among patients with HIV infection and there was positive and significant correlation between tricuspid annular plain systolic excursion with CD4 cells count and a negative but significant correlation HIV viral load.

CONTEXTE: L'introduction du traitement antirétroviral hautement actif (HAART) a réduit la morbidité et la mortalité associées à l'infection par le VIH; cependant, cet avantage de survie n'est pas exempt de complications. Les patients VIH ont plus de risques de développer des maladies cardiovasculaires par rapport à la population générale, et une dysfonction systolique ventriculaire droite est dite être associée à des résultats plus graves. Nous avons donc cherché à évaluer la fonction systolique ventriculaire droite à l'aide de l'excursion systolique du plan annulaire tricuspidien (TAPSE) chez les patients VIH sous HAART et sa relation avec la charge virale et le taux de lymphocytes CD4. MÉTHODES: L'étude était une étude transversale menée auprès de patients VIH recevant le HAART au Federal Medical Centre, Nguru, État de Yobe, dans le nord-est du Nigéria. La fonction systolique ventriculaire droite a été évaluée à l'aide de l'excursion systolique du plan annulaire tricuspidien. RÉSULTATS: Cent sept (107) sujets ont été recrutés dans l'étude, dont trente-sept (34,6%) hommes et soixante-dix (65,4%) femmes. Le taux moyen de lymphocytes CD4 et la charge virale des patients étudiés étaient respectivement de 612,65 ± 347,62 cellules/µL et 315,44 ± 271,11 copies/mL. La répartition de la fonction systolique ventriculaire droite selon le taux de lymphocytes CD4 a montré que quinze (14,01%) patients ayant un taux de lymphocytes CD4 inférieur à 250 présentaient une fonction systolique ventriculaire droite réduite, 30 (28,03%) patients ayant un taux de lymphocytes CD4 de 250 à 500 avaient une fonction systolique ventriculaire droite réduite, 1 (0,93%) patient ayant un taux de lymphocytes CD4 de 250 à 500 avait une fonction systolique ventriculaire droite normale, 47 (43,92%) patients ayant un taux de lymphocytes CD4 de 501 à 1 000 avaient une fonction systolique ventriculaire droite normale et 14 (13,08%) patients ayant un taux de lymphocytes CD4 supérieur à 1 000 avaient une fonction systolique ventriculaire droite normale. Quatorze (13,08%) patients avec une charge virale indétectable avaient une fonction systolique ventriculaire droite normale, 47 (43,92%) patients avec une charge virale de 50 à 1 500 avaient une fonction systolique ventriculaire droite normale, 1 (0,93%) patient avec une charge virale de 1 501 à 10 000 avait une fonction systolique ventriculaire droite normale, 30 (28,03%) patients avec une charge virale de 1 501 à 10 000 avaient une fonction systolique ventriculaire droite réduite et 15 (14,01%) patients avec une charge virale de 10 000 à 50 000 avaient une fonction systolique ventriculaire droite réduite. Il y avait une corrélation positive et significative entre l'excursion systolique du plan annulaire tricuspidien et le taux de lymphocytes CD4 et une corrélation négative mais significative avec la charge virale du VIH. CONCLUSION: Nous concluons donc qu'une dysfonction systolique ventriculaire droite asymptomatique existe chez les patients atteints d'une infection par le VIH et qu'il existe une corrélation positive et significative entre l'excursion systolique du plan annulaire tricuspidien et le taux de lymphocytes CD4, ainsi qu'une corrélation négative mais significative avec la charge virale du VIH. MOTS CLÉS: Fonction Systolique Ventriculaire Droite, Excursion Systolique du Plan Annulaire Tricuspidien (TAPSE), CD4, Charge Virale, VIH.

Infections due to Carbapenem Resistant Enterobacteriaceae among Saudi Arabian Hospitalized Patients: A Matched Case-Control Study.

Background. We conducted this case-control study to determine the risk factors and treatment outcome of infections due to carbapenem resistant Enterobacteriaceae in our institution. Methods. This is a matched case-control study of patients with infection due to carbapenem resistant Enterobacteriaceae (CRE) and carbapenem susceptible Enterobacteriaceae (CSE), from Riyadh, Saudi Arabia, between March 2012 and December 2013. Results. During this period, 29 cases and 58 controls were studied. The mean ages of the cases (55.4 years) and controls (54.7 years) were similar (p = 0.065). Cases had higher mean Charlson comorbidity index (CCI) (3.1) than controls (1.9), p = 0.026. Several factors contributed to infection among the studied population. Prior uses of piperacillin-tazobactam, a carbapenem, a quinolone, and metronidazole were significantly associated with CRE infections. Nine of the cases died compared with 7 of the controls, p = 0.031. Mortality was associated with advanced age, the presence of comorbidities, ICU stay, and receipt of invasive procedures. Conclusions. Infections due to CRE resulted in a significantly increased mortality. Combination antibiotic therapy was associated with reduced mortality. Properly designed randomized controlled studies are required to better characterize these findings.

The usefulness of total cholesterol and high density lipoprotein--cholesterol ratio in interpreting lipid profile results of diabetes mellitus patients.

OBJECTIVE: To determine the usefulness of total cholesterol/high-density lipoprotein cholesterol and/or high-density lipoprotein cholesterol/total cholesterol ratios in the interpretation of lipid profile result in clinical practice. METHODS: This is a prospective case-control study involving 109 diabetics, 98 diabetic hypertensives, 102 hypertensives and 120 control subjects. Serum lipid profile and plasma glucose were determined using appropriate methods. RESULTS: The mean ages of the different study groups were similar. Body mass indices of diabetics with or without hypertension were significantly higher than that of the controls. The difference in the mean total cholesterol of each group was not statistically significant when compared with the controls. A significant difference existed in the mean LDL when the different study groups were compared with the controls. There was a significant difference in the mean TG of DM and DM/hypertension patients compared with that of controls. However, the mean TG of hypertensive patients was not statistically different with that of the controls. The mean HDL was lower in each group of patients compared to that of the controls however the difference was not statistically significant. The mean TC/HDL ratios were significantly higher in all groups of patients when compared to that of the controls while HDL/TC ratios were significantly lower in all categories of patients when compared to that of the controls. CONCLUSION: The ratios identified more dyslipidaemia than either of the lipid profile components. Therefore, the use of TC/HDL and or HDL/ TC ratios should be encouraged in screening for dyslipidaemia in diabetic patients with or without hypertension in clinical practice.

Should absolute lymphocyte count be used as a surrogate marker for CD4+ count in patients with HIV/AIDS?

The World Health Organization (WHO) has recommended the use of absolute lymphocyte count (ALC) as a potential marker for immunosuppression where CD4+ count is unavailable. However, there are conflicting reports on the usefulness of ALC as a surrogate marker for CD4+ counts in patients with HIV/AIDS, more so, in patients with HIV-associated tuberculosis (TB). To evaluate the usefulness of ALC as an alternative to CD4+ counts and to see whether TB affects the correlation of ALC with CD4+ counts in patients with HIV-associated TB. A total of 66 consecutive patients (33 with and 33 without TB) with a diagnosis of HIV infection were recruited into the study as cases. Another group of 66 subjects (33 subjects each) age- and sex-matched HIV-negative controls were recruited as controls and stratified in to two: a) HIV-negative PTB patients. b) apparently healthy HIV and PTB negative individuals. The age range was from 15-60 years (median: 32 years). The highest percentage (39%) of subjects fell in the age range of 25-29 years. The mean ALC for HIV-associated PTB was 3906 +/- 1092 cells/microl and for patients with HIV infection only. 4755 +/- 1049 cells/microl. There was no significant difference in mean ALC between males and females in both groups (P > 0.05). Patients with dual infection by M. tuberculosis and HIV had the lowest mean ALC (3906 +/- 1092 cells/microl). Healthy controls had mean ALC (+/- SD) of 5249 +/- 101 cells/microl. There was significant difference between the healthy controls and the other three groups. The observed difference was more in patients with HIV/ TB co-infection (P < 0.005) compared with patients with HIV alone (P < 0.05). No significant correlation was observed between CD4+ cell counts and ALC in all the age groups of the study population. When the CD4+ counts were divided into < 200 and > or = 200 cells/microl and the ALC into < 2000 and > or = 2000 cells/microl, the sensitivity, specificity and positive predictive values of the diagnostic usefulness of ALC in HIV-associated PTB were 52%. 56.3% and 78.8% while for HIV only patients the same values were 56.3%. 55.9% and 54.5%, respectively. We cannot recommend the use of ALC as a surrogate for CD4+ count in our environment as this study has clearly shown that the correlation between the two is weak. Patients with dual infection by HIV and M. tuberculosis are more likely to have lower CD4+ cell and AL counts than those with HIV infection occurring alone.

Mantoux reaction in patients with HIV-related pulmonary tuberculosis in Maiduguri, Nigeria.

Tuberculin skin testing is used for the identification of individuals with infection by Mycobacterium tuberculosis and other non-tuberculous mycobacteria. However, its value in immunosuppressed individuals due to human immunodeficiency virus (HIV) infection is controversial. This study was aimed at determining the relationship between Mantoux reaction and CD4+ cell counts; and whether the test can be used to predict CD4+ counts in patients dually infected with Human Immunodeficiency Virus and M. tuberculosis. Eighty patients, comprising 42 males (52.5%) and 38 females (47.5%) confirmed to be having antibodies to HIV who also had sputum smear positive pulmonary tuberculosis were recruited over a period of 16 months. They were Mantoux-tested with 0.1 ml of 5TU of PPD which was interpreted thus: <5 mm = negative, =5 mm = positive. CD4+ counts were determined using Dynabeads technique. The ages of all the patients ranged between 18 and 55 years (mean +/- SD: 33.9+/-8.42 years). The males had a mean age of 35.4 +/- 7.7 years while that of the females was 29.6+/-53 years (P<0.05). The CD4+ counts ranged between 73 and 512 cells/microl with a mean of 235.05 +/- 112.8 cells/microl. Fifty seven (71%) patients had negative PPD tests while 23 (29%) tested positive. Of the 37 with CD4+ counts <200 cells/microl, 32 (86.48%) had negative reaction (<5 mm) and 5 (13.51%) were positive (=5 mm) as compared to those with CD4 counts =200 cells/microl, among whom 25 (58.13%) were negative and 18 (41.86%) were positive (P<0.05). The positive predictive value was low at 56.14%. The difference in mean indurations between those with CD4+ count <200 cells/microl versus those with CD4+ count =200 cells/microl was statistically significant (P<0.05). On the whole, Mantoux indurations were noted to weakly correlate positively with CD4+ counts (Pearson's correlation, r=+0.36, P=0.001. It was concluded that there is a weak positive correlation between Mantoux reaction and CD4+ cell counts and that the Mantoux test is a poor predictor of CD4+ cell count.

A severe epidemic of meningococcal meningitis in Nigeria, 1996.

A particularly severe epidemic of meningococcal meningitis (cerebrospinal meningitis, CSM) occurred in Nigeria between January and June 1996. There were 109,580 recorded cases and 11,717 deaths, giving a case fatality rate of 10.7% overall. This is the most serious epidemic of CSM ever recorded in Nigeria, and may be the largest in Africa this century. It took over 3 months and the combined efforts of a National Task Force set up by the Federal Ministry of Health, the WHO, UNICEF, UNDP, Médecins Sans Frontières, the International Red Cross and several other non-governmental organizations to bring the epidemic under control. The main control measures centred on active treatment of infected persons, mass vaccination and health education. The exact number of persons treated cannot be ascertained, but there were treatment centres in almost every Local Government Area in the affected States. A study of 1577 patients admitted at the Infectious Diseases Hospital, Kano, showed that 84% of those infected were aged < or = 20 years and that, for the first time, infants aged < or = 2 months were affected. Despite intervention, the case fatality rate of 9.1% among this group of patients was similar to the nationwide figure of 10.7%. Long-acting oily chloramphenicol proved highly effective in the treatment of patients, and its routine use in epidemic CSM is recommended. Over 13 million persons were vaccinated in the course of the epidemic. For the first time, cases of CSM were reported from States south of the 'African meningitis belt', suggesting an extension of the belt. The severity of this epidemic yet again underscores the need for a clear policy regarding control measures aimed at forestalling future epidemics. The availability of the recently developed polysaccharide-protein conjugate vaccine should facilitate a decision on mass vaccination for the prevention of epidemic CSM in Africa.