Nonspecific Interstitial Pneumonia in a 28-Year-Old Nigerian Female: Challenges in Diagnosis and Management in Resource-Constrained Setting.

BACKGROUND: Nonspecific interstitial pneumonia is a rare clinical condition and usually precedes the full manifestation of connective tissue disorders, drug-induced interstitial lung disease or chronic hypersensitivity pneumonitis. OBJECTIVE: This article reports a twenty-eight (28)-year-old Nigerian female with nonspecific interstitial pneumonia (NSIP) complicated by Cor pulmonale. The unusual characteristics of our index case favors NSIP rather than idiopathic pulmonary fibrosis (age of 28 years, female, chest high-resolution computerized tomographic features and response to glucocorticoids). RESULTS: High-resolution computerized tomography scan of the chest showed honeycombing in the apical lobes and a mixture of reticular changes, ground-glass appearance and fibrotic changes in basal lobes. Echocardiography revealed features of right chamber enlargement with pulmonary hypertension. Due to financial constraint, serological tests for CTDs and lung biopsy could not be done. CONCLUSION: Being a rare condition, a high index of suspicion with full investigative workup to make early diagnosis and effect prompt treatment is important.

CONTEXTE: La pneumonie interstitielle non spécifique est un état clinique rare qui précède habituellement la manifestation complète de troubles du tissu conjonctif, de pneumopathie interstitielle d'origine médicamenteuse ou de pneumonie d'hypersensibilité chronique. OBJECTIF: Cet article présente le cas d'une Nigériane de vingt-huit (28) ans atteinte d'une pneumonie interstitielle non spécifique (PINS) compliquée d'un cor pulmonaire. Les caractéristiques inhabituelles de notre cas d'index favorisent la PINS plutôt que la fibrose pulmonaire idiopathique (âge de 28 ans, femme, caractéristiques de la tomographie informatisée à haute résolution du thorax et réponse aux glucocorticoïdes). RÉSULTATS: La tomographie informatisée à haute résolution du thorax a montré des alvéoles dans les lobes apicaux et un mélange de changements réticulaires, d'aspect en verre dépoli et de changements fibrotiques dans les lobes basaux. L'échocardiographie a révélé des caractéristiques d'élargissement de la chambre droite avec hypertension pulmonaire. En raison de contraintes financières, les tests sérologiques pour les CTD et la biopsie pulmonaire n'ont pas pu être effectués. CONCLUSION: Comme il s'agit d'une maladie rare, il est important d'avoir un indice de suspicion élevé et de procéder à un bilan d'investigation complet afin de poser un diagnostic précoce et d'appliquer un traitement rapide. Mots clés: Pneumonie interstitielle, pneumopathie interstitielle, maladie du tissu conjonctif, cor pulmonaire, contraintes de ressources, jeune femme.

The use of highly active antiretroviral therapy for the prevention of mother-to-child transmission of the human immunodeficiency virus in Nigeria.

Mother-to-child transmission of HIV accounts for 90% of paediatric HIV. The objective of this paper is to assess the outcome of preventing mother-to-child transmission of the human immunodeficiency virus (HIV), using highly active antiretroviral therapy (HAART). All pregnant women booking for antenatal care at the university of Maiduguri teaching hospital received voluntary counselling and testing for HIV. All HIV-positive mothers were placed on HAART for the prevention of mother-to-child transmission of HIV. All exposed babies received single dose nevirapine within 72 h of birth and zidovudine syrup for 6 weeks. The babies were then tested for viral DNA using the polymerase chain reaction (PCR) at 6 and 12 weeks of age. Among 5,461 mothers screened for HIV during the study period, 695 (12.7%) were confirmed HIV-positive. Out of 446 mother-baby pairs followed up to a minimum period of 6 months postpartum, only five (1.1%) babies were HIV-positive.

Salivary gland tumours: is colour Doppler imaging of added value in their preoperative assessment?

Using a Toshiba SSA-270A Colour Duplex Scanner, 15 patients with suspected parotid and submandibular gland tumours had preoperative duplex scanning done. Peak systolic doppler shifts (fmax) were recorded and their vascularity was also subjectively scored. There were no arteries identified within the substance of contralateral normal glands. All recordings were analysed retrospectively and an independent histological assessment of tumours was made. Pleomorphic adenomas (n = 9) had a median peak systolic frequency (fmax) of 0.8 kHz, while adenolymphomas (n = 4) had a fmax of 1.65 and the two malignant tumours had fmax of 4.5 (P = 0.007 Kruskal-Wallis test). There appears to be a strong correlation between the fmax and the subjective vascular score (Corr 0.92). Colour duplex scanning is a non-invasive procedure which may be of help in the preoperative assessment of salivary gland tumours.