Doctors' and Nurses' Knowledge and Perceived Barriers Regarding Acute Oxygen Therapy in a Tertiary Care Hospital in Nigeria.

Purpose: Oxygen may cause serious consequences when administered wrongly. This study aimed to assess doctors' and nurses' knowledge of acute oxygen therapy and perceived delivery barriers. Participants and Methods: We conducted a cross sectional study among 202 healthcare providers (134 doctors and 68 nurses) in a Nigerian hospital. The validated Acute Oxygen Therapy Questionnaire (AOTQ), which consisted of 21 knowledge assessment questions, was self administered by participants. Provider's knowledge was classified as good if the score was≥80% and poor if < 60%. Results: Overall, 26.7% (37.3% doctors and 5.9% nurses) had good knowledge of acute oxygen therapy (AOT), 35.9% were aware, and 19.3% used the AOT guidelines. The commonest source of knowledge on oxygen therapy was medical /nursing school (75.2%). The participants' mean knowledge score was 14.75 ± 2.83(possible score of 0-21). Doctors in postgraduate (PG) training obtained the highest score (15.96±2.48) among the participants (F=12.45, df=4, p<0.001). Most doctors (62%) and 23.5% of nurses considered oxygen as a drug. More doctors (52.2%) than nurses (14.7%) believed that a doctor's order was mandatory before oxygen administration, contrary to guidelines recommendations. Most nurses did not know that breathlessness does not always signify hypoxemia and that asymptomatic anemia was not an indication for oxygen. Concerning oxygen prescription, 39.7% of nurses and 64.2% of doctors knew that it should be prescribed to achieve a target saturation range rather than a fixed dose. In acute oxygen delivery in COPD, doctors and nurses exhibited poor knowledge of the appropriate device and flow rate. The reported barriers to oxygen delivery were: a shortage of oxygen supply, inadequate delivery devices, power outages and out of pocket costs. Conclusion: A significant proportion of doctors and nurses had poor knowledge of acute oxygen therapy, poor awareness and infrequently used AOT guidelines, and reported pertinent delivery barriers that warrant educational and administrative interventions.

Diagnosis of latent tuberculosis among HIV infected patients in Ilorin, Nigeria using tuberculin skin test and interferon gamma release assay.

INTRODUCTION: Latent Tuberculosis Infection (LTBI) screening is recommended for individuals with a known risk factor for progression to active disease especially in the setting of HIV infection. This will ensure early diagnosis and prompt treatment. The purpose of our study was to compare tuberculin skin test (TST) with Interferon Gamma Release Assay (IGRA) in the diagnosis of LTBI among patients with known HIV infection at University of Ilorin Teaching Hospital (UITH), Ilorin. METHODS: this was a hospital based cross-sectional study at the Highly Active Antiretroviral therapy (HAART) Clinic and medical wards of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. A total of 282 consenting patients with HIV infection were recruited. Sociodemographic and clinical information was obtained using a well-structured questionnaire. The screening for LTBI was done using Tuberculin skin test (TST) and Interferon Gamma release assay (IGRA). RESULTS: the prevalence of LTBI among HIV infected patients was 40.6% and 53.1% using TST and QFT-IT respectively, while the overall prevalence considering positivity to either of the test was 66%. There was mild agreement (κ: 0.218) between TST and QFT-IT in the diagnosis of LTBI among patients with HIV infection. The association between CD4 count and TST was not statistically significant (p value = 0.388) but there was strong association between CD4 cell count and QFT results (p = 0.001). CONCLUSION: the prevalence of LTBI is quite high among patients with HIV infection in our locality. There is a need to encourage screening of at-risk individuals to forestall the morbidity and mortality associated with TB in this population.

Spirometric abnormalities following treatment for pulmonary tuberculosis in Ilorin, Nigeria.

BACKGROUND: Pulmonary tuberculosis (PTB) contributes significantly to morbidity and mortality worldwide, and despite microbiological cure for the disease, many patients still demonstrate residual respiratory symptoms and spirometric abnormalities. AIM AND OBJECTIVES: The study aimed at identifying the prevalence, pattern and factors associated with spirometric abnormalities in patients successfully treated for PTB in Ilorin, Nigeria. MATERIALS AND METHODS: This was a hospital-based cross-sectional study at the pulmonary outpatient clinics of the University of Ilorin Teaching Hospital and Kwara State Specialist Hospital, Sobi, Ilorin. A total of 308 consenting patients who had been certified microbiologically cured for bacteriologically confirmed PTB in the preceding 3 years had assessment of residual pulmonary symptoms, spirometry and plain chest radiograph. RESULTS: The prevalence of abnormal spirometry following treatment for PTB was 72.1% (confidence interval: 0.6682-0.7695), with restrictive pattern being the predominant abnormality (42.2%). Over half of the patients (56.5%) had at least one residual respiratory symptom. The significant predictors of abnormal spirometry were PTB retreatment (adjusted odds ratio [aOR] = 6.918; P = 0.012), increasing modified Medical Research Council dyspnoea scores (aOR = 7.935; P = 0.008) and increasing radiologic scores (aOR = 4.679; P ≤ 0.001) after treatment. CONCLUSION: There is significant residual lung function impairment in majority of the individuals successfully treated for PTB in Ilorin. This highlights the need for spirometric assessment and follow-up after treatment.

Clinical and microbiological profile of adult inpatients with community acquired pneumonia in Ilorin, North Central, Nigeria.

BACKGROUND: The optimal management of community acquired pneumonia (CAP) depends on the clinical and microbiological profile in the locality. OBJECTIVES: To determine the clinical and microbiological profile of patients admitted with CAP in Ilorin, Nigeria. METHODS: One hundred and two consenting consecutively selected patients with clinical and radiologic confirmation of CAP were recruited in 12 months. The socio-demographic, physical examination and laboratory/radiologic parameters were documented in a questionnaire. Microbiological evaluation of their sputum was done and blood samples were taken for complete blood count, culture, serum urea and serological evaluation for atypical bacteria and some viral pathogens. RESULTS: CAP constituted 5.9% of the total medical admissions during the one-year study period. The mean age of the patients was 49 ± 22 years with the largest frequency in those aged 65 years and above. The commonest symptoms were shortness of breath (96.1%) and cough (94.1%), with a median duration of 3 days from symptom onset to admission. Systemic hypertension was the commonest comorbid illness (25/102; 24.5%). Klebsiella pneumoniae was the predominant pathogen isolated (20/102; 28.1%). The susceptible antibiotics were Imipenem, Ceftazidime and Ceftriaxone. Intra-hospital mortality was 17.6%. CURB - 65 score of ≥ 2 and the presence of complications of CAP were the independent predictors of mortality. CONCLUSION: CAP constitutes a significant disease burden in Ilorin, Nigeria. Typical bacteria accounted for over half of the pathogens isolated from the patients with gram negative agents predominating. This highlights a possible shift in the microbiological profile which could guide empirical treatment.

When nuisance is nice: ignored erythema nodosa heralding the Löfgren's syndrome in a Nigerian woman.

Löfgren's syndrome (LS) is a variant of sarcoidosis characterised by the triad of erythema nodosum (EN), radiographic bilateral hilar adenopathy, and arthralgia/arthritis. Like all cases of sarcoidosis, it is of unknown aetiology and may constitute a diagnostic difficulty in the ambiguous phenotype. Löfgren's syndrome is associated with a good prognosis and commonly undergoes spontaneous remission within four months. However, the co-existence of multiple good and adverse prognostic factors in a patient may call for guarded expectation. Sarcoidosis is generally more prevalent among people of African descent, but the vast majority of the literature on sarcoidosis are from the western hemisphere. Löfgren's syndrome has been rarely documented in West Africans despite the availability of some reports of sarcoidosis in the region. We present a case of a Nigerian woman with LS that started out as isolated EN, which was ignored for months until the onset of florid pulmonary and systemic symptoms.