Adherence to anti retroviral therapy (ART) during Muslim Ramadan fasting.

Annual fasting during the month of Ramadan is observed in Muslim countries, some of which have widespread HIV infection. We studied treatment adherence and customary practices among 142 fasting 'FT' and 101 non-fasting 'NFT' patients on anti-retroviral therapy (ART) in Nigeria. Adherence on ART among FT and NFT patients was similar during Ramadan, 96% and 98%, and ever since commencement of ART, 80% and 88%, respectively. FT patients altered their typical daily behaviors by advancing morning and delaying evening doses thereby prolonging dosing intervals, eating heavier meals pre-dawn and on breakfast at sunset (78%), and changing or reducing their sleeping and waking times (40%). This preliminary study suggests that adherence and drug taking frequency appear uncompromised in FT HIV infected patients on ARVs.

Snake bite in Nigeria.

Four families of venomous snakes are found in Nigeria--Viperidae, Elapidae, Colubridae and Actraspididae but three species carpet viper (Echis ocellatus), black-necked spitting cobra (Naja nigricollis) and puff adder (Bitis arietans), belonging to the first two families, are the most important snakes associated with envenoming in Nigeria. The incidence of bites has been reported as 497 per 100,000 population per year with a 12 percent natural mortality, with Echis ocellatus accounting for at least 66 percent in certain foci. Bites occur more often while victims were farming, herding or walking although the spitting cobra may bite victims who roll upon it in their sleep. Carpet viper venom contains a prothrombin activating procoagulant, haemorrhagin and cytolytic fractions which cause haemorrhage, incoagulable blood, shock and local reactions/ necrosis. The spitting cobra bite manifests with local tissue reaction and occassionally with bleeding from the site of bite, but no classic neurotoxic feature has been observed except following Egyptian cobra (N. haje) bites. Cardiotoxicity and renal failure may occassionally occur following bites by the carpet viper and the puff adder. In the laboratory, haematological and other features are noted and immunodiagnosis has a role in species identification. Immobilisation of the bitten limb is probably the single most important first aid measure. Antivenom should be used cautiously when indicated. As only 8.5 percent of snake bite victims attend hospitals in Nigeria, health education should be the main preventive measure, mean-while, the study of immunisation of occupationally predisposed individuals in endemic areas should be intensified. A new Fab fragment antivenom specific to Nigerian Echis ocellatus was investigated clinically, just as the local herbs-Aristolochia spp, Guiera spp and Schummaniophyton spp are investigated experimentally.