Doctors' attitudes to patient occupation information in four hospital specialties.

BACKGROUND: Although we do not know how often doctors enquire about their patients' work, evidence suggests that occupation is often not recorded in clinical notes. There is a lack of research into doctors' views on the importance of patient occupation or their educational needs in this area. AIMS: To assess doctors' attitudes to using patient occupation information for care-planning and to determine doctors' need for specific training in occupational health. METHODS: We undertook a cross-sectional survey of doctors in cardiology, obstetrics and gynaecology, oncology and orthopaedics. Our questionnaire explored attitudes of the doctors to asking patients about their occupational status, their training and competency to do so, and their training needs in occupational health. RESULTS: The response rate was 42/46 (91%). Obstetrics and gynaecology 6/9 (67%) and oncology doctors 3/6 (50%) reported enquiring about the nature of patients' occupations' 'most of the time'/'always' and that it rarely influenced clinical decisions. This contrasted with orthopaedic doctors 12/12 (100%) and cardiology doctors 14/15 (93%). Although 19/42 (45%) participants felt it was important to ask patients their occupation, only 10/42 (24%) 'always' asked patients about their work. The majority of participants 29/41 (71%) reported receiving no training in occupational health, but 37/42 (88%) considered that some training would be useful. CONCLUSIONS: Training on the importance of occupation and its' role as a clinical outcome in care-planning, might help doctors feel more competent in discussing the impact of health on work with patients.

Vaginal candidiasis and its risk factors among women attending a Nigerian teaching hospital.

AIMS AND OBJECTIVES: The study was set to detect Candida species in female genital discharge and validate the associated risk factors. MATERIALS AND METHODS: A prospective study of female genital swabs collected from women with abnormal vaginal discharge (test group) and a control group who were attending gynaecology, family planning, antenatal care or HIV/STI clinics of Aminu Kano Teaching Hospital, Kano Nigeria and analysed for microscopy and culture in microbiology laboratory from December 2008 to December 2009. Data on epidemiologic indices were collected from the patients, using structured interviewer- administered questionnaires. RESULTS: Candida species were detected in the test group in 60% (n=600/1000) cases of infective vaginal discharge while 12% (120/1000) in the control group. The isolation rate of Candida albicans was 69% more than the non- albicans. Distribution of vaginal candidiasis in the test group, was prevalent in young adults age group of 21 to 30 years with 50% (n=300/600), in patients with pregnancy 38% (n=225/600) and patients with chronically debilitating illnesses 26% (n=157/600). CONCLUSION: The result shows that vaginal candidiasis is quite common and Candida albicans is the most prevalent species. We therefore recommend early diagnosis and prompt treatment of vaginal candidiasis in all women clinics especially among the patients with chronic debilitating illness, pregnancy and young adults in order to avert the complications of vaginal candidiasis and reduce HIV transmission.

Bacterial isolates from cerebrospinal fluid of children with suspected acute meningitis in a Nigerian tertiary hospital.

AIMS AND OBJECTIVES: To determine the common aetiolog of acute bacterial meningitis in children and their antibiotic susceptibility pattern. MATERIALS AND METHODS: A retrospective study with a review of cerebrospinal fluid culture reports of paediatric patients aged 0-15 years, suspected of acute meningitis in the Medical Microbiology Department of Aminu Kano Teaching Hospital, Kano, Nigeria from October 2006 to October 2009 from October 2006 to October 2009. RESULTS: A positive culture bacterial isolation rate of 3.3% (n=50/1500) with prevalence of Streptococcus pneumoniae (24%), Neisseria meningitidis (22%), Escherichia coli (16%), Haemophilus influenzae (14%), Group B streptococci (8%) and Enterococci (8%) which were susceptible to ceftriaxone (96%), cefotaxime (95%) and ciprofloxacin (93%) across the bacterial isolates. Neonates were 55% (n=6.8/12.4) most at risk. CONCLUSION: Neonates are the most at risk of acute bacterial meningitis. In the absence of antibiotic susceptibility report, ceftriaxone should be considered as a first choice reliable antibiotic for empirical treatment of meningitis in children, in this environment.

Seroprevalence of hepatitis B surface antigen among patients attending Aminu Kano Teaching Hospital, Kano.

OBJECTIVE: To study the seroprevalence of Hepatitis B viral (HBV), infection among patients attending Aminu Kano Teaching Hospital in Kano metropolis. PATIENTS AND METHOD: This is a retrospective study in which patients tested for hepatitis B virus using hepatitis B surface antigen (HBsAg) as a marker were reviewed over 3 years. A total of 6,395 patients comprising of 4,040 males and 2,355 females including adults and children were tested for HBsAg from January 2004 to December 2006. Over this period, 1509 sera were tested in 2004, 2,322 in 2005 and 2,564 in 2006. RESULTS: Among the 6,395 patients, 703 (11.4%) comprising of 240 (10.2%) females and 490 (12.1%) males were positive for HBsAg. The highest prevalence was seen at the extremes of life in which 19.4% and 16.9% were seen among patients below 10 years and above 50 years respectively. The yearly trend of HBV surface antigenemia was 220 (14.6%) in 2004, 235 (10.1%) in 2005 and 275 (10.7%) in 2006. CONCLUSION: We conclude that the prevalence of HBsAg among patients attending Aminu Kano Teaching Hospital, Kano is high and highest prevalence is seen at the extremes of life.

Seroprevalence of hepatitis B surface antigen among patients attending Aminu Kano Teaching Hospital, Kano.

BACKGROUND: Hepatitis B virus infection has become a global public health problem. In Nigeria, several studies from different parts of the country have confirmed the endemicity of the infection. This study seeks examine the seroprevalence of Hepatitis B viral infection among patients attending Aminu Kano Teaching Hospital in Kano metropolis. METHOD: This is a retrospective study in which patients tested for hepatitis B virus using hepatitis B surface antigen (HBsAg) as a marker were reviewed over 3 years. A total of 6,395 patients comprising of 4,040 males and 2,355 females including adults and children were tested for HBsAg from January 2004 to December 2006. Over this period, 1,509 sera were tested in 2004, 2,322 in 2005 and 2,564 in 2006. RESULTS: Among the 6,395 patients, 703 (11.4%) comprising of 240 (10.2%) females and 490 (12.1%) males were positive for HBsAg. The highest prevalence was seen at the extremes of life in which 19.4% and 16.9% were seen among patients below 10 years and above 50 years respectively. The yearly trend of HBV surface antigenemia was 220 (14.6%) in 2004, 235 (10.1%) in 2005 and 275 (10.7%) in 2006. CONCLUSION: We conclude that the prevalence of HBsAg among patients attending Aminu Kano Teaching Hospital, Kano is high and highest prevalence is seen at the extremes of life.

The trend of HIV infection in Kano, Nigeria--a seven-year study of adult attendees of Aminu Kano Teaching Hospital.

BACKGROUND: Human immunodeficiency virus (HIV) infection is a huge concern with increasing epidemic proportions The consequences are devastating in developing countries particularly in large areas of southeast Asia and sub Saharan Africa including decrease in life-expectancy, huge loss of manpower and a heavy economic and social burden. Sub-Saharan Africa has been hit harder by HIV/AIDS pandemic than any other region of the world At the end of 2006, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that, globally 39.5 million people were living with HIV/AIDS, out of which 24.7 million were in sub-Saharan Africa. To determine the annual trend of HIV infection in Kano as well as the seroprevalence rates over the years. METHOD: This retrospective study includes all adults that are 15years and above, who are also AKTH attendees and. patients referred from other hospitals in Kano, who, based on clinical suspicion, were sent to the serology laboratory of the hospital for HIV screening and confirmation between January, 1997 and December, 2003. It however, excludes all pediatrics, antenatal care clinic attendees and all blood donors screened for HIV antibodies within the period. These have been collated under various risk groups elsewhere. RESULTS: Of 9241 subjects tested, 3217 (34.8%) were confirmed seropositive for HIV antibodies consisting of 1908 (36.7%) and 1441 (35.7%) males and females respectively Analysis of results on yearly basis shows prevalence rates of 37.1% in 1997, 40% in 1998 and 47.9% in 1999. However, the HIV seroprevalence rates declined to 22.6% among these subjects in 2000 before rising to the peak (48.8%) in 2002 from 30% seroprevalence of the previous year, 2001. The prevalence rate for 2003 was 32.1%. effective control strategies aimed at curbing the spread of HIV infection.

Human immunodeficiency virus and hepatitis B virus co-infection among patients in Kano Nigeria.

BACKGROUND: Human immunodeficiency virus and hepatitis B virus are widespread in the developing countries and patients with dual infection of HIV and HBV are increasingly being diagnosed among hospital patients. Reports have indicated that hepatitis will contribute significantly to morbidity and mortality in HIV infected patients because of increased use and accessibility of highly active antiretroviral therapy (HAART). The objective of this study is to determine the prevalence of HIV and HBV co-infection in patients in Kano Nigeria and to highlight the reciprocal interactions between the HIVand HBV. METHODS: Three hundred patients consisting of 152 males and 148 females were recruited into the study at the Aminu Kano Teaching Hospital Kano, Nigeria between February 2002 and March 2003. RESULTS: Out of a total of three hundred HIV positive patients, two hundred and eleven (70.3%) were HBV positive. Of the 152 males that are HIV positive, 102 (67.1%) were HBVpositive while out of 148 females that are HIVpositive, 109 (73.6%) were HBV positive. CONCLUSION: A co-infection rate of 70.5% was observed in this study. Since HIV infected patients with HBV co-infection respond less to HAART additional concern and care must be taken in order to minimize the complications associated with the increasing use of HAART The testing of HIV positive patients for HBV will help in the choice of therapy in these patients's.

Effect of supplemental dietary glutamine on methotrexate concentrations in tumors.

This study evaluated the effects of supplemental dietary glutamine (GLN) on methotrexate sodium concentrations in tumors and serum of sarcoma-bearing rats following the initiation of methotrexate. After randomization to a GLN diet (+GLN) or GLN-free diet (-GLN), tumor-bearing rats received 20 mg/kg of methotrexate sodium by intraperitoneal injection. The provision of supplemental GLN in the diet increased methotrexate concentrations in tumor tissues at 24 and 48 hours (38.0 +/- 0.20 nmol/g for the +GLN group vs 28.8 +/- 0.10 nmol/g for the -GLN group and 35.6 +/- 0.18 nmol/g for the +GLN group vs 32.5 +/- 0.16 nmol/g for the -GLN group, respectively). Arterial methotrexate levels were elevated only at 48 hours (0.147 +/- 0.007 microns/L for the +GLN group vs 0.120 +/- 0.006 microns/L for the -GLN group). Tumor morphometrics were not different between the groups but significantly greater tumor volume loss was seen even at 24 hours (-2.41 +/- 1.3 cm3 for the +GLN group vs -0.016 +/- 0.9 cm3 for the -GLN group). Tumor glutaminase activity was suppressed in both groups at 48 hours, but more so in the +GLN group (0.94 +/- 0.13 mumol/g per hour for the +GLN group vs 1.47 +/- 0.22 mumol/g per hour for the -GLN group). This study suggests that GLN may have therapeutic as well as nutritional benefit in oncology patients.

Glutamine facilitates chemotherapy while reducing toxicity.

Dose intensification of chemotherapy is thought to increase survival. With recent advances in hemopoietic cell modulators such as granulocyte colony stimulating factor, the limiting toxicity of intensifying chemotherapeutic regimens has become the severity of the associated enterocolitis. In animal models, glutamine protects the host from methotrexate-induced enterocolitis. This study evaluates the effects of a glutamine-supplemented diet on the tumoricidal effectiveness of methotrexate. Sarcoma-bearing Fisher 344 rats (n = 30) were pair-fed an isocaloric elemental diet containing 1% glutamine or an isonitrogenous amount of glycine beginning on day 25 of the study. Rats from each group received two intraperitoneal injections of methotrexate (5 mg/kg) or saline on days 26 and 33 of the study. On day 40, rats were killed, tumor volume and weight were recorded, and tumor glutaminase activity and tumor morphometrics were measured. Blood was taken for arterial glutamine content, complete blood count, and blood culture. The gut was processed for glutaminase activity and synthesis phase of the deoxyribonucleic acid. In rats receiving methotrexate, the tumor volume loss was nearly doubled when glutamine was added to the diet. Significant differences in tumor glutaminase activity and morphometrics were not detected. The toxicity to the host was ameliorated. Significantly increased synthesis phase of deoxyribonucleic acid of the whole jejunum, decreased bacteremia, "sepsis," and mortality were demonstrated. Glutamine supplementation enhances the tumoricidal effectiveness of methotrexate while reducing its morbidity and mortality in this sarcoma rat model.

Bladder cancer in Kano--a histopathological review.

Malignant tumours of the bladder have been observed to be quite common in Kano but there has been no formal study. This four-year (1998-2001) retrospective review sought to document the pattern of these neoplasms. Vesical malignancies constituted 6.4% of all cancers in Kano with squamous (53%) and transitional (35%) carcinomas as the most common histological types. Males outnumbered females more than five times (M:F = 5.2.:1). Cancer of the bladder was most prevalent in the 5th and 6th decades with a mean age of 48.8 years. In general our findings are similar to bladder cancer in other schistosomal endemic regions of Africa.

Widespread antibiotic resistance in savannah Nigeria.

There is minimal data on antibiotic resistance from savannah northern Nigeria. A retrospective study of 438 patients seen in 12 months (2000) with microbial pathogens from urinary and respiratory tracts was undertaken. Antibiotic susceptibilities were determined using stokes disc diffusion technique. Resistance in Escherichia coli (E. coli) reached 91-96% to cotrimoxazole, tetracycline and ampicillin but was 11%, 17% and 28% to colistin, nitrofurantoin and nalidixic acid. Resistance of other uropathogens (Klebsiella and Proteus spp) reached 83-99% to cotrimoxazole, tetracycline and ampicillin but was 14-40% to colistin, nitrofurantoin and nalidixic acid. Pneumococci were non-susceptible to penicillin (93%), cotrimoxazole (92%), tetracycline (84%), ampicillin (53%), chloramphenicol (21%) and cefazolin (8%). Antibiotic resistance is widespread in savannah northern Nigeria. Resistance is less to chloramphenicol, colistin, nalidixic acid, nitrofurantoin and the latter generation cephalosporins and quinolones than to penicillin, ampicillin, cotrimoxazole and tetracycline.

A review of medico-legal deaths in Kano.

Medicolegal death (MLD) is a relatively uncommon subject of study in Nigeria. This prospective review of 200 cases in Kano found the commonest cause to be road traffic accidents (48.5%) followed by homicides (34%) and natural deaths (5%). Gang violence among local youths with blunt and sharp weapons accounted for most of the homicides. MLDs most frequently (60.5%) occurred in the 3rd to 5th decades of life and males were predominant (M:F = 3.5:1). Our findings differed significantly from MLDs in the developed world where natural deaths were overwhelmingly preponderant. The prevalence of MLDs in Kano can be substantially reduced if the recommendations of this study are implemented.

Glutamine enhances selectivity of chemotherapy through changes in glutathione metabolism.

OBJECTIVE: Chemotherapy doses are limited by toxicity to normal tissues. Intravenous glutamine protects liver cells from oxidant injury by increasing intracellular glutathione (GSH) content. The authors hypothesized that supplemental oral glutamine (GLN) would increase the therapeutic index of methotrexate (MTX) by improving host tolerance through changes in glutathione metabolism. The authors examined the effects of oral glutamine on tumor and host glutathione metabolism and response to methotrexate. METHODS: Thirty-six 300-g Fischer 344 rats were implanted with fibrosarcomas. On day 21 after implantation, rats were randomized to receive isonitrogenous isocaloric diets containing 1 g/kg/day glutamine or glycine (GLY) by gavage. On day 23 after 2 days of prefeeding, rats were randomized to one of the following four groups receiving an intraperitoneal injection of methotrexate (20 mg/kg) or saline (CON): GLN+MTX, GLY+MTX, GLN-CON, or GLY-CON. On day 24, rats were killed and studied for arterial glutamine concentration, tumor volume, kidney and gut glutaminase activity, and glutathione content (tumor, gut, heart, liver, muscle, kidney, and lung). RESULTS: Provision of the glutamine-enriched diets to rats receiving MTX decreased tumor glutathione (2.38 +/- 0.17 in GLN+MTX vs. 2.92 +/- 0.20 in GLY+MTX, p < 0.05), whereas increasing or maintaining host glutathione stores (in gut, 2.60 +/- 0.28 in GLN+MTX vs. 1.93 +/- 0.18; in GLY+MTX, p < 0.05). Depressed glutathione levels in tumor cells increases susceptibility to chemotherapy. Significantly decreased glutathione content in tumor cells in the GLN+MTX group correlated with enhanced tumor volume loss (-0.8 +/- 1.0 mL in GLN+MTX vs. +9.5 +/- 2.0 mL in GLY+MTX, p < 0.05). CONCLUSION: These data suggest that oral glutamine supplementation will enhance the selectivity of antitumor drugs by protecting normal tissues from and possibly sensitizing tumor cells to chemotherapy treatment-related injury.

Prevention of chronic radiation enteropathy by dietary glutamine.

BACKGROUND: Nearly 50% of all cancer patients receive therapeutic radiation during the course of their disease. The risk of late complications is the main dose-limiting factor in the delivery of radiation therapy. The small intestine, the major site of chronic radiation enteropathy, is also the principal organ of glutamine consumption. We therefore hypothesized that the provision of supplemental glutamine may have a protective effect on the development of chronic radiation enteropathy. METHODS: This study evaluated the effects of supplemental oral glutamine on the development of chronic radiation (XRT) enteropathy. After scrotalization of a loop of small intestine, rats were randomized to receive 1 g/kg/day glutamine (GLN) or glycine (GLY) by gavage. After 2 days of prefeeding, rats were randomized to 1 of 4 groups: GLN + XRT (n = 10), GLY + XRT (n = 10), GLN only (n = 10), GLY only (n = 10). Twenty Gy was delivered to the scrotalized bowel in the GLN + XRT and GLY + XRT groups via a collimated beam. Gavage was continued for 10 days. Animals were then pair-fed chow. Rats were killed at 2 months postirradiation. Chronic radiation injury was assessed microscopically. RESULTS: Injury scores in GLN + XRT were similar to those of unirradiated bowel and significantly different from GLY + XRT (1.89 +/- 0.48 in XRT + GLN vs. 6.42 +/- 1.55 in the XRT + GLY, p < 0.01). Elevated Injury Scores in the XRT + GLY group correlated with gross thickening and fibrosis, a 10-fold decrease in gut GLN extraction (1.40 +/- 4.3% in GLY + XRT vs. 16.0 +/- 5.1% in GLN + XRT, p < 0.05), and a 30% decrease in glutathione content (2.46 +/- 0.19 and GLY + XRT vs. 3.17 +/- 0.17 GLN + XRT, p < 0.05). CONCLUSIONS: Provision of GLN during abdominal/pelvic XRT may prevent XRT injury and decrease the long-term complications of radiation enteropathy.