Atorvastatin improves sputum conversion and chest X-ray severity score.

BACKGROUND: We report the results of a phase IIB study investigating the safety and effectiveness of atorvastatin use with standard anti-TB drugs.METHODS: In this multicentre, open-labelled study, we recruited treatment-naÏve patients with uncomplicated pulmonary TB aged at least 18 years. Participants were randomly assigned to standard-of-care or standard-of-care plus oral dose of atorvastatin (40 mg) daily for 2 months. Primary end points were safety measured by the number of participants with severe adverse events and effectiveness measured by the number of participants with negative sputum culture. Secondary endpoint was chest X-ray (CXR) severity score.RESULTS: Of the 185 participants screened, 150 were enrolled and equally assigned to the standard-of-care and atorvastatin groups. Adverse event severity was similar in the two groups. There was increased frequency of muscle pain in the trial group (12/75, 16% vs. 4/75, 5%). For efficacy analysis, respectively 64 (97%) and 57 (85.1%) patients in the trial and control groups had culture-negative results (P = 0.02) and experienced a reduction in CXR severity score of respectively 37% and 22%, with a mean difference of 1.4-4.9%.CONCLUSION: Atorvastatin is safe and associated with improved microbiological and radiological outcomes in TB.

Clinical Profile and Outcome of COVID-19 Cases Admitted at a Tertiary Health Facility In South-West Nigeria.

BACKGROUND: Coronavirus Disease 2019 (COVID-19) is anemerging disease with a global spread that has affected millions of lives. In Nigeria, the third wave of the outbreak is being experienced with many patients requiring hospitalization. Being a novel disease, we characterized the clinical profile and outcomes of patients admitted into our isolation centre. METHODS: A case series of 65 COVID-19 patients admitted at theIsolation Centre of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, from June 2020 to March 2021 is presented. Information on demographic characteristics, medical history, symptoms, treatment and outcomes was obtained. Data were analysed using SPSS version 25. RESULTS: Most (47; 72.3%) patients were less than 65 years old and 39 (60.0%) were males. The commonest symptoms were cough (42; 64.6%), breathlessness (41; 63.1%), fever (40; 61.5%), muscle aches (40; 61.5%), and anosmia (16; 24.6%). Hypertension (41; 63.1%) and diabetes (18; 27.7%) were the most predominant comorbidities. Forty-three patients (66.2%) had supplemental oxygen therapy. The majority (44; 70%) of patients were admitted for 10 days or less and 58 (89.3%) patients were discharged home. However, 6 deaths (9.2%) were recorded among patients with advanced comorbidities and severe sepsis with all deaths occuring within 5 days of admission. CONCLUSION: There was a male predominance among patients admitted at the Isolation Centre and all mortalities occurred within five days of admission. Early detection, prompt management of cases with hypoxaemia and optimal treatment of comorbidities are recommended for good outcomes in COVID-19 patients.

CONTEXTE: La maladie de la coronavirus 2019 (COVID-19) est une maladie émergente dont la propagation mondiale a affecté des millions de vies. Au Nigéria, la troisième vague de l'épidémie est en train de se produire avec de nombreux patients nécessitant une hospitalisation. S'agissant d'une nouvelle maladie, nous avons caractérisé le profil clinique et les résultats des patients admis dans notre centre d'isolement. MÉTHODES: Une série de cas de 65 patients atteints de COVID-19 au Centre d'isolement de l'Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, de juin 2020 à mars 2021 est présentée. Des informations sur les caractéristiques démographiques, les antécédents médicaux, symptômes, le traitement et les résultats ont été obtenus. Les données ont été à l'aide de SPSS version 25. RÉSULTATS: La plupart des patients (47 ; 72,3 %) étaient âgés de moins de 65 ans et 39 (60,0 %) étaient des hommes. Les symptômes les plus fréquents étaient la toux (42 ; 64,6%), l'essoufflement (41 ; 63,1%), la fièvre (40 ; 61,5%), les douleurs musculaires (40; 61,5%) et l'anosmie (16 ; 24,6 %). L'hypertension artérielle (41; 63,1%) et le diabète (18 ; 27,7%) étaient les comorbidités les plus prédominantes. Quarante-trois patients (66,2 %) avaient une oxygénothérapie complémentaire. La majorité (44 ; 70%) des patients ont été admis pour 10 jours ou moins et 58 (89,3%) ont été renvoyés chez eux. Cependant, 6 décès (9,2 %) ont été enregistrés parmi les patients présentant des comorbidités avancées et une septicémie grave, tous les décès étant survenus dans les 5 jours suivant l'admission. CONCLUSION: Il y avait une prédominance masculine parmi les patients admis au centre d'isolement et tous les décès sont survenus dans les cinq jours cinq jours après l'admission. La détection précoce, la prise en charge rapide des cas l'hypoxémie et le traitement optimal des comorbidités sont recommandées recommandés pour obtenir de bons résultats chez les patients atteints de COVID-19. Mots clés: COVID-19, Profil clinique, Résultat, Gestion des cas, Centre d'isolement.

PREVALENCE AND PREDICTORS OF EXCLUSIVE BREASTFEEDING AMONG MOTHERS IN A SEMI-URBAN NIGERIAN COMMUNITY: A CROSS-SECTIONAL STUDY.

Background: The uptake of exclusive breastfeeding (EBF) is low globally including Nigeria despite its benefits and interventions. This study aimed to assess the prevalence and predictors of EBF among mothers in a semiurban Nigerian community. Methods: We conducted a cross-sectional study among nursing mothers attending the immunization clinic at the Federal Medical Centre, Owo, Ondo State. A semi-structured questionnaire containing the World Health Organization's indicators for assessing breastfeeding practices was used for data collection. Results: A total of 386 mothers were recruited with a mean age of 30.8 ± 5.0 years. Among them, 149 (36.8%) were below 30 years, 345 (89.4%) have had ANC visit at least four times, and 259 (67.1%) had initiated breastfeeding immediately after delivery. The prevalence of EBF was 52.6%. Natural feeds were the common feeds introduced after 6 months among 159 (78.3%) mothers. One hundred and forty-four (62.1%) nursing mothers aged 30 years or older practiced EBF compared to 72 (48.3%) persons below 30 years (X2 = 6.290, p = 0.012). Also, 38 (70.3%) mothers who have delivered four or more children practiced EBF compared to 180 (54.2%) with fewer children (X2 = 5.437, p = 0.020). Nursing mothers aged 30 years or older had 36% higher odds of practicing EBF compared to younger persons (Adjusted Odds Ratio = 1.358, 95%CI = 0.886 - 2.081, p = 0.160). Conclusion: To achieve the WHO recommended target of ensuring that 90% of nursing mothers practice EBF, advocacy and health education must be intensified.

Efficacy of newer versus older antihypertensive drugs in black patients living in sub-Saharan Africa.

To address the epidemic of hypertension in blacks born and living in sub-Saharan Africa, we compared in a randomised clinical trial (NCT01030458) single-pill combinations of old and new antihypertensive drugs in patients (30-69 years) with uncomplicated hypertension (140-179/90-109 mm Hg). After ≥4 weeks off treatment, 183 of 294 screened patients were assigned to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg (n=89; R) or amlodipine/valsartan 5/160 mg (n=94; E) and followed up for 6 months. To control blood pressure (<140/<90 mm Hg), bisoprolol and amlodipine could be doubled (10 mg per day) and α-methyldopa (0.5-2 g per day) added. Sitting blood pressure fell by 19.5/12.0 mm Hg in R patients and by 24.8/13.2 mm Hg in E patients and heart rate decreased by 9.7 beats per minute in R patients with no change in E patients (-0.2 beats per minute). The between-group differences (R minus E) were 5.2 mm Hg (P<0.0001) systolic, 1.3 mm Hg (P=0.12) diastolic, and 9.6 beats per minute (P<0.0001). In 57 R and 67 E patients with data available at all visits, these estimates were 5.5 mm Hg (P<0.0001) systolic, 1.8 mm Hg (P=0.07) diastolic and 9.8 beats per minute (P<0.0001). In R compared with E patients, 45 vs 37% (P=0.13) proceeded to the higher dose of randomised treatment and 33 vs 9% (P<0.0001) had α-methyldopa added. There were no between-group differences in symptoms except for ankle oedema in E patients (P=0.012). In conclusion, new compared with old drugs lowered systolic blood pressure more and therefore controlled hypertension better in native African black patients.