Metabolic Syndrome in HIV: Prevalence, correlates, concordance of Diagnostic Criteria and relationship to Carotid Intimal Media Thickness in a Sub-Saharan Population.

Background: The prevalence and usefulness of MetS in determining CVD risk in at-risk populations are influenced by its definition. In a cohort of HIV-positive Nigerians, we evaluated MetS based on various defining criteria, their agreement with one another, and their association to a CVD endpoint, Carotid-Intimal-Media-Thickness (CIMT). Methodology: In this cross-sectional study, 145 HIV-positive individuals who were enrolled in HIV clinics at the Faith Alive Foundation and Jos University Teaching Hospital in Jos, Nigeria, were randomly chosen. Biophysical and anthropometric measurements including blood pressure, height, weight, waist circumference, and hip-circumference, as well as clinical records, CIMT, fasting plasma glucose, and lipid profile, were assessed. Result: The median (Interquartile range) age of the participants was 41 (35-88) years, and the majority (71.7%) were females. The prevalence of metabolic syndrome (MetS) by the Adult Treatment Panel-III (ATP), International Diabetes Federation (IDF), and Joint Interim Statement (JIS) criteria were 30.3%, 32.4%, and 35.2% respectively. MetS by all criteria was more prevalent among females and participants ≥ 40 years, p<0.05. Low HDLc (93.6-95.5%), Central obesity (86.3-95.5%), and hypertension (80.9-86.4%) were the most frequent components of MetS. HIV-related parameters were not associated with MetS. The overall agreement among MetS criteria was almost perfect between IDF and JIS criteria (k=0.94); and strong between IDF vs., ATP (k=0.82) and ATP vs. JIS (k=0.89). There was no significant difference in the median CIMT in PLHIV with and without MetS across all defining criteria. Conclusion: The prevalence of MetS in PLHIV is relatively high, particularly among females and older individuals. The correlations between the defining criteria were fairly strong and consistent across subpopulations of PLHIV. MetS based on these criteria, however, do not significantly correlate with rising CIMT.

Assessment of primary health care workers' knowledge and skill for COPD and asthma screening and diagnosis in Jos LGA of Plateau State.

Introduction: chronic obstructive pulmonary disease and asthma are the commonest of the group of Chronic Respiratory Diseases. Primary Health Care workers play a role in the prevention of these diseases. The aim of this study was to determine the knowledge and diagnostic skills of PHC workers on COPD and asthma in a local government area of Plateau State, Nigeria. Methods: it was a cross-sectional study conducted among 146 primary healthcare workers selected through a multistage sampling technique. Data was collected through a self -administered questionnaire. Data processing and analysis were done with Epi-Info epidemiological software. The categories of knowledge that were of interest were scored and graded. A confidence level of 95% was used and a p-value of <0.05 was considered significant for this study. Results: the mean age of respondents was 41.4 ± 10.1 years, junior community health extension workers made up the largest group and the mean years of service was 14.9 ± 8.9 years. The overall knowledge of COPD and asthma was fair in 68.5 % of health workers though the mean knowledge scores of asthma were statistically significantly higher than that of COPD (p = 0.000). Knowledge was found to be statistically significantly associated with age, sex and cadre. None of the respondents was able to operate a peak flow meter. Conclusion: the study concluded that though there was fair level of knowledge among the respondents on COPD and asthma, they lacked the necessary skills to screen for and diagnose these diseases.

Subclinical atherosclerosis and associated risk factors among HIV-infected adults in Jos, North Central Nigeria: a cross-sectional study.

INTRODUCTION: human immunodeficiency virus (HIV) is evolving into a leading cause of cardiovascular diseases (CVD) in sub-Saharan Africa (SSA) where the burden of HIV remains high. Atherosclerosis underlie progression to CVD. We therefore examined the prevalence of subclinical atherosclerosis and its association with traditional and non-traditional risk factors for CVD in Nigerian HIV-infected adults. METHODS: this was a cross-sectional study involving randomly selected stable HIV-infected patients with undetectable viral load attending HIV clinics at the Jos University Teaching Hospital and Faith Alive Foundation in Jos, Nigeria. Demographic data, biophysical measurements, cardiovascular risk factors and information regarding HIV-related factors, fasting serum lipid profile, fasting plasma glucose, high-sensitivity C-reactive protein and Carotid-Intima-Media-Thickness (CIMT) were assessed. Subclinical atherosclerosis was defined using a cut-off value of mean CIMT ≥ 0.78 mm. Data were analyzed with the Statistical Package for Social Sciences® (SPSS) software version 23.0 (IBM Corp., Chicago, Illinois, USA). Bivariate analysis and multivariate logistic regression were used to examine the association between risk factors of CVD and subclinical atherosclerosis. The statistical significance level was set at p ≤ 0.05. RESULTS: a total of 148 HIV adults (70.9% being females) on Anti-Retroviral Therapy (ART) were included in this study. The prevalence of subclinical atherosclerosis was 7.4%. Among subjects with subclinical atherosclerosis (SCA), 63.6% were males and 81.8% were hypertensive. Elevated blood glucose, lipids and high-sensitivity C-reactive protein, body mass index (BMI), HIV-related parameters (duration of HIV infection, antiretroviral regimen, CD4+ cell count), current smoking status, alcohol use, were not significantly associated with subclinical atherosclerosis (p>0.05). Male gender [OR(95%CI=4.91(1.36-17.77)], age [OR(95%CI)=1.14(1.06-1.23)], hypertension [OR(95%CI=14.4(3.03-71.86)] and metabolic syndrome [OR(95%CI=8.34(1.73-40.18)] were significantly associated with SCA at bivariate analysis. After adjusting for age, sex and antiretroviral regimen, only increasing age [Adjusted Odds Ratio (AOR) (95% confidence interval (CI)] = 1.12(1.01-1.25)] and hypertension [AOR (95%CI)=10.67 (1.31-87.18)], remained as independent predictors of subclinical atherosclerosis (SCA). CONCLUSION: the prevalence of subclinical atherosclerosis among HIV-infected adults is high in Nigeria. It is significantly associated with increasing age and hypertension. Traditional CVD risk factors such as dyslipidaemia, diabetes mellitus and obesity were not associated with subclinical atherosclerosis in this population.

Cardiac dysrhythmia resulting from antibiotic abuse.

Antibiotics are commonly used to combat infections and could be used in treating some connective diseases. They are not without side effects especially when used without regard to age, gender, diseases and their severity, comorbidity, and idiosyncrasies. This is more likely to occur when dispensed by unqualified persons to selves or others. Consequences of inappropriate use include various morbidities and in some instances death. This is a report of a middle-aged man with several risk factors for cardiovascular disease, who on the side had chronic osteomyelitis. Wound swab grew organisms sensitive to levofloxacin, and he had the drug prescribed to him by the attending orthopedic surgeon. With reduction in discharge to the point that he no longer bound his foot in bandage, he went on using the drug beyond the duration of prescription without reverting to his orthopedic surgeon until he developed sudden onset palpitation and shortness of breath. With this was an unusual tachyarrhythmia which defied initial measures. This prompted further review of his drug history when he admitted to taking levofloxacin for up to 3 months. Suspecting it to be the culprit, he was advised to discontinue it. With this, his symptoms started to abate, alongside gradual improvement in electrocardiograms till eventual normalization. This report is made to highlight the possibility that some antibiotics have the propensity to induce arrhythmias that can be very serious especially in cardiovascular disease-burdened patients. Such patients then go into heart failure and it becomes difficult to tell which came first, the arrhythmia or the heart failure. Resolving the order of onset assists in proper management. As a result, it is being recommended that patients with unexplained arrhythmias with or without heart failure should have their drug histories evaluated. Uncontrolled prescription and use of antibiotics should also be discouraged.