Health-Related Quality of Life in Patients with Osteoarthritis of the Knee attending two Outpatient Clinics in Jos, Nigeria: A Cross-Sectional Descriptive Study.

BACKGROUND: It appears particularly suitable to measure healthrelated quality of life (HRQoL) in patients with knee osteoarthritis (OA) because the chronic debilitating nature of this disease likely takes a considerable toll on HRQoL. The study aims to assess the health-related quality of life in patients with symptomatic knee osteoarthritis attending the two outpatient clinics. The study also aimed to determine factors affecting the HRQoL in patients with knee OA. METHODS: A facility based, cross sectional descriptive study using the abbreviated World Health Organisation Quality of Life (WHOQOL-BREF) (26-item) questionnaire was carried out in two out-patient (general and orthopaedic) clinics of the University Teaching Hospital, Jos, Nigeria over a period of two months. The medical assistants, record staffs and nurses were involved in recruiting the patients while the Family Physicians performed the interview. RESULTS: A total of 120 participants were recruited. The mean age was 58.41±13.03 years and the majority of the respondents were female, constituting 102 (85%) of the participants. The mean body mass index (BMI) was 30.83±7.12 kg/m2 and more than half of the participants were obese. The most common associated chronic disease was hypertension, reported by 93(77.5%). A majority, 86(72%) of the respondents reported their overall QoL and General Health (GH) as poor or fair and all the domains (physical, psychological, social relationships, and environmental) of the QoL were low. QoL scores were relatively low for domain due to psychological health and environment with that of psychological health being more severely affected. Epilepsy was found to affect QoL in patients with knee OA (p= 0.022). There was no significant effect of age, sex, educational status, employment status, marital status, and family income on QoL. CONCLUSION: This study has shown that patients with knee OA attending the outpatient clinics in JUTH, Jos have relatively poor HRQoL with the domain due to psychological health being more severely affected.

CONTEXTE: Il semble particulièrement approprié de mesurer la qualité de vie liée à la santé (QVLS) chez les patients souffrant d'arthrose du genou, car la nature chronique et débilitante de cette maladie a probablement un impact considérable sur la QVLS. L'étude vise à évaluer la qualité de vie liée à la santé des patients souffrant d'arthrose symptomatique du genou qui fréquentent les deux centres de soins ambulatoires. L'étude vise également à déterminer les facteurs affectant la QVLS chez les patients souffrant d'arthrose du genou. MÉTHODES: Une étude descriptive transversale basée sur l'établissement et utilisant le questionnaire abrégé de l'Organisation mondiale de la santé sur la qualité de vie (WHOQOL-BREF) (26 éléments) a été réalisée dans deux cliniques ambulatoires (générale et orthopédique) de l'hôpital universitaire de Jos, au Nigeria, sur une période de deux mois. Les assistants médicaux, le personnel chargé des dossiers et les infirmières ont participé au recrutement des patients, tandis que les médecins de famille ont mené les entretiens. RÉSULTATS: Au total, 120 participants ont été recrutés. L'âge moyen était de 58,41±13,03 ans et la majorité des répondants étaient des femmes, constituant 102 (85%) des participants. L'indice de masse corporelle (IMC) moyen était de 30,83±7,12 kg/m2 et plus de la moitié des participants étaient obèses. La maladie chronique associée la plus fréquente était l'hypertension, signalée par 93 (77,5 %). Une majorité, 86 (72%) des personnes interrogées ont déclaré que leur qualité de vie globale et leur état de santé général étaient mauvais ou moyens et que tous les domaines (physique, psychologique, relations sociales et environnement) de la qualité de vie étaient faibles. Les scores de qualité de vie étaient relativement bas dans les domaines de la santé psychologique et de l'environnement, la santé psychologique étant plus gravement affectée. On a constaté que l'épilepsie affectait la qualité de vie des patients souffrant d'arthrose du genou (p = 0,022). L'âge, le sexe, le niveau d'éducation, la situation professionnelle, la situation matrimoniale et le revenu familial n'avaient pas d'effet significatif sur la qualité de vie. CONCLUSION: Cette étude a montré que les patients atteints d'arthrose du genou qui fréquentent les services de consultation externe de l'hôpital JUTH de Jos ont une qualité de vie relativement médiocre, le domaine de la santé psychologique étant le plus gravement touché. Mots-clés: Qualité de vie liée à la santé, Arthrose du genou, Questionnaire WHOQOL-BREF, Consultations externes.

Sustaining tuberculosis preventive therapy scale-up through direct supportive supervision.

BACKGROUND: Tuberculosis preventive therapy (TPT) is recommended for tuberculosis (TB) prevention among people living with HIV (PLHIV) and other high-risk groups. The Nigerian Military HIV Program embarked on TPT-specific 'direct supportive supervision' (DSS) in May 2018 to increase TPT initiation and completion rates. METHODS: Interventional approaches included site visits to conduct root cause analysis, didactic teaching approach on the concepts of quality improvement and mentorship to address barriers. The DSS introduced TPT monitoring tools, sticker reminders on clients' folders, and bi-weekly data collection and review for decision making. RESULTS: TPT initiation increased from a monthly pre-intervention median of 323 clients to monthly medians of 2611 during the 'surge' and 1212 clients during the 'sustained' phases. Due to an isoniazid stock-out, a 'dip phase', with a median of 559 clients was recorded. Overall, 10 463 clients were started on TPT in fiscal year (FY) 2018 and 12 596 in FY2019, with an overall initiation rate of 79%. Completion rates were respectively 73% and 70% for FY2018 and FY2019. CONCLUSION: With the implementation of a tailored DSS, programmatic barriers to TPT were easily identified and quickly addressed to increase initiation and completion rates.

CONTEXTE: Le traitement préventif de la tuberculose (TPT) est recommandé pour la prévention de la tuberculose (TB) parmi les personnes vivant avec le VIH (PVVIH) et pour d'autres groupes à risque élevé. Le programme VIH de l'armée au Nigeria a rencontré de nombreux défis dans sa mise en œuvre. MÉTHODE: En mai 2018, le programme s'est lancé dans une « supervision directe de soutien ¼ spécifique du TPI (DSS) en vue de son expansion et de la réduction de la transmission de la TB chez les PVVIH. Les approches d'intervention mises en œuvre ont inclus des visites sur le terrain afin d'analyser les causes profondes, une approche didactique d'enseignement relatif aux concepts d'amélioration de la qualité et un tutorat afin de surmonter les obstacles. On a eu recours à l'introduction d'un outil de suivi du TPT, à des rappels sous forme de stickers sur les dossiers des clients et à un recueil de données et à une revue destinée à la prise de décisions bi hebdomadaire. RÉSULTATS: La mise en route du TPT a augmenté d'une médiane mensuelle avant l'intervention de 323 clients à 2611 et 1212 clients pendant les phases de lancement et de continuation respectivement. En raison d'une rupture de stock d'isoniazide, une phase de chute avec une médiane de 559 clients a été enregistrée. Au total, 10 463 et 12 596 clients ont débuté le TPT en FY2018 et FY2019 respectivement, avec un taux d'ensemble d'initiation de 79%. Les taux d'achèvement ont été de 73% et 70% respectivement pour FY2018 et FY2019. CONCLUSION: Grâce à une stratégie sur mesure de supervision et de soutien et en tenant compte des contextes particuliers du terrain, les obstacles programmatiques à la mise en œuvre du TPI ont été facilement identifiés et rapidement affrontés pour une meilleure prise en charge du patient.

MATERNAL AND NEONATAL OUTCOMES OF HISTOLOGICAL CHORIOAMNIONITIS.

BACKGROUND: Clinical Chorioamnionitis contributes to maternal and neonatal morbidity and mortality but the effect of histological chorioamnionitis is sparse in our environment. AIM: To determine the maternal and neonatal outcomes of histological chorioamnionitis amongst pregnant women and their babies. DESIGN OF THE STUDY: Cross sectional longitudinal study. SETTING: Jos University Teaching Hospital (JUTH), Jos, Nigeria. METHODOLOGY: Parturients were interviewed and examined as well as had their placenta examined histologically for chorioamnionitis. They and their babies were followed up for 6 weeks after delivery to monitor for any complications that may arise. RESULTS: A total of 148 parturients were enrolled from the labour ward of Jos University Teaching Hospital and of these 90 (60.8%) had histologic chorioamnionitis (HCA). As regards outcome, 9(10%) with histologic chorioamnionitis as well as 5(8.62%) of those without HCA had premature delivery. Low birth weight occurred in 12(13.33%) and 6(10.34 %) of those with HCA and without HCA respectively. In all, 1(1.47%) and 1(2.56%) of women with HCA and without HCA correspondingly had neonatal sepsis. Puerperal sepsis occurred in 2(2.94%) of those with HCA and 2(5.13%) of those without HCA. CONCLUSION: Our study has demonstrated that histological chorioamnionitis had no adverse maternal or neonatal effect. There is the need for more studies investigating the cause and the implication of histological chorioamnionitis.

A meta-analysis of the efficacy of preoperative surgical safety checklists to improve perioperative outcomes

BACKGROUND:Meta-analyses of the implementation of a surgical safety checklist (SSC) in observational studies have shown a significant decrease in mortality and surgical complications.OBJECTIVE:To determine the efficacy of the SSC using data from randomised controlled trials (RCTs). METHODS:This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO (CRD42015017546). A comprehensive search of six databases was conducted using the OvidSP search engine.RESULTS:Four hundred and sixty-four citations revealed three eligible trials conducted in tertiary hospitals and a community hospital; with a total of 6 060 patients. All trials had allocation concealment bias and a lack of blinding of participants and personnel. A single trial that contributed 5 295 of the 6 060 patients to the meta-analysis had no detection; attrition or reporting biases. The SSC was associated with significantly decreased mortality (risk ratio (RR) 0.59; 95% confidence interval (CI) 0.42 - 0.85; p=0.0004; I2=0%) and surgical complications (RR 0.64; 95% CI 0.57 - 0.71; petlt;0.00001; I2=0%). The efficacy of the SSC on specific surgical complications was as follows: respiratory complications RR 0.59; 95% CI 0.21 - 1.70; p=0.33; cardiac complications RR 0.74; 95% CI 0.28 - 1.95; p=0.54; infectious complications RR 0.61; 95% CI 0.29 - 1.27; p=0.18; and perioperative bleeding RR 0.36; 95% CI 0.23 - 0.56; petlt;0.00001.CONCLUSIONS:There is sufficient RCT evidence to suggest that SSCs decrease hospital mortality and surgical outcomes in tertiary and community hospitals. However; randomised evidence of the efficacy of the SSC at rural hospital level is absent

Treatment Discontinuation in Adult HIV-Infected Patients on First-Line Antiretroviral Therapy in Nigeria.

BACKGROUND: Retention in care and treatment services is critical to health outcomes of individuals diagnosed and living with HIV. We evaluated the incidence of and risk factors for treatment discontinuation (TD) in a large adult HIV population on ART in Nigeria. METHOD: A retrospective cohort study of adult HIV patients initiated on first-line ART between 2004 and 2011 at the Jos University Teaching Hospital (JUTH) in Nigeria. Follow up information of participants was retrieved from various sources (patient visit database, pharmacy data and patients charts) up to the end of 2012. The primary study endpoint was TD, defined as discontinuation of ART for any reason, including death or loss to follow-up (lack of pharmacy pick-up for periods≥12 months). The Incidence and hazard for TD were estimated by Kaplan-Meier and Cox proportional regression analysis, respectively. RESULT: Overall, 3,362 (28%) patients discontinued treatment during 49,436 person-years (py) of follow-up (incidence rate (IR) 6.8 TD per 100 py). The hazard of treatment discontinuation decreased with increasing age (adjusted hazard ratio (aHR 0.99; 95% CI 0.98-0.99). Other independent risk factors for treatment discontinuation were: being unmarried (aHR 1.24; 95% CI: 1.12-1.38), having primary or secondary level of education as compared to tertiary level education (aHR 1.24; 95% CI: 1.12-1.40) and average percent adherence to drug refill visits<95% (adjusted hazard ratio (aHR) 2.13; 95% CI: 1.9-2.40). Compared to tenofovir, greater hazard of TD was noted in patients initiated on ART containing didanosine (aHR) 1.73; 95% CI: 1.03-2.91), but lower in those initiated on zidovudine containing regimen (aHR 0.77; 95% CI: 0.69-0.86). CONCLUSION: Long-term treatment discontinuation rate in this study was comparable to estimates in resource-rich countries. Younger patients, as well as patients with lower educational levels and those with poor adherence had significant hazards for treatment discontinuation and should be the target of interventions to reduce treatment discontinuation and improve retention, especially within the first year of ART.

Patients who present late to HIV care and associated risk factors in Nigeria.

OBJECTIVES: Our objectives were to assess trends in late presentation and advanced HIV disease (AHD) and determine associated risk factors. METHODS: We conducted a retrospective cohort analysis of patients who had received care and treatment at the AIDS Prevention Initiative Nigeria Plus (APIN)/Harvard School of Public Health-President's Emergency Plan for AIDS Relief (PEPFAR) programme at the Jos University Teaching Hospital, Jos, Nigeria from 2005 to 2010. We used the European Consensus Definition to assess trends in late presentation (CD4 count < 350 cells/µL or AIDS-defining illness) and AHD (CD4 count < 200 cells/µL or AIDS-defining illness) and evaluated associated risk factors using logistic regression methods. RESULTS: Among 14,487 eligible patients, 12,401 (85.6%) were late presenters and 9127 (63.0%) presented with AHD. Late presentation decreased from 88.9% in 2005 to 80.1% in 2010 (P < 0.001). Similarly, AHD decreased from 67.8% in 2005 to 53.6% in 2010 (P < 0.001). In logistic regression models adjusting for sociodemographic and biological variables, male sex [adjusted odds ratio (aOR) = 1.80; 95% confidence interval (CI) 1.60-2.04], older age (aOR = 1.37; 95% CI 1.22-1.54), civil service employment (aOR = 1.48; 95% CI 1.00-2.21), referral from out-patient (aOR = 2.18; 95% CI 1.53-3.08) and in-patient (aOR = 1.55; 95% CI 1.11-2.17) services, and hepatitis B virus (aOR = 1.43; 95% CI 1.26-1.63) and hepatitis C virus (aOR = 1.18; 95% CI 1.02-1.37) coinfections were associated with late presentation. Predictors of AHD were male sex (aOR = 1.67; 95% CI 1.54-1.82), older age (aOR = 1.26; 95% CI 1.16-1.36), unemployment (aOR = 1.34; 95% CI 1.00-1.79), referral from out-patient (aOR = 2.40; 95% CI 1.84-3.14) and in-patient (aOR = 1.97; 95% CI 1.51-2.57) services and hepatitis B virus coinfection (aOR = 1.30; 95% CI 1.19-1.42). CONCLUSIONS: Efforts to reduce the proportion of patients who first seek care at late stages of disease are needed. The identified risk factors should be utilized in formulating targeted public health interventions to improve early diagnosis and presentation for HIV care.

Temporal changes in renal glomerular function associated with the use of Tenofovir Disoproxil Fumarate in HIV-infected Nigerians.

BACKGROUND: Reports of renal dysfunction in Tenofovir Disoproxil Fumarate (TDF)-treated HIV-1 infected patients have raised concerns about potential nephrotoxicity. OBJECTIVE: To compare the effects on renal function of TDF-containing highly active anti-retroviral therapy (HAART) with a non-TDF-containing HAART. METHODS: This was an observational study.Clinical and laboratory data of 186 HIV-1 infected adult Nigerians on first-line HAART for at least 48 weeks were reviewed. Eighty-four patients whose nucleos(t)ide reverse transcriptase inhibitor (NRTI) backbone included TDF were compared to 102 patients on other NRTI backbones. Creatinine clearance (CLcr) was estimated using the Cockcroft-Gault equation. Changes in serum creatinine and CLcr from the baseline for each patient were compared between the TDF-treated and the TDF-free patients. We also assessed the associations of other variables with change in CLcr... RESULTS: Baseline median serum creatinine (mmol/L) was 77 and 84 in the TDF-treated and TDF-free groups, respectively (p=0.59). Baseline median CLcr (mls/min) was 83 in the TDF-treated patients vs 78 in the TDF-free group. At 48 weeks, serum creatinine increased by 18.1% and 1.2% in the TDF-treated and TDF-free arms, respectively. There was a decrease of 4.8% in GFR in the TDF arm compared to a gain 5.1% in the TDF-free arm. CONCLUSION: Tenofovir Disoproxil Fumarate-containing HAART is associated with a slight decline in the medium term in CLcr compared with HAART regimens containing alternative Nucleosid(t) Reverse Transcriptase Inhibitors.

Frequency of cryptococcal meningitis in HIV-1 infected patients in north central Nigeria.

BACKGROUND: Cryptococcal meningitis (CM) is the most common severe life threatening fungal infection in AIDS patients. It is an important cause of morbidity and mortality There is paucity of data on the prevalence of CM in Nigeria. We aimed to determine the frequency of CM, the clinical presentation and immunological profile. METHODS: A cross sectional study was carried out at the Jos University Teaching Hospital (JUTH). A total of 100 HIV-1 infected patients suspected of having meningitis or meningoencephalitis were subjected to cerebrospinal fluid (CSF) analysis (including Indian ink preparation and fungal culture by conventional methods) and CD4 count was determined using flow cytometry (count bit Y-R 1004 Partec Muster Germany). RESULTS: The freguency of CM was 36% in our cohort. The commonest clinical presentation included headache (100.0%), neck stiffness (77.8%), fever (72.0%), vomiting 55.6%), personality changes (55.6%), photophobia (27.8%) and convulsions (27.8%). The mean duration of symptoms was 24 +/- 22 days with a median of 17 days. The mean CD4 count was 89 +/- 60 cells/mm3 with a median of 82 cells/mm3. CONCLUSION: The high prevalence of CM and the associated severe immunosuppression underscores the importance of early diagnosis of HIV infection which may reduce the incidence of CM. There is the urgent need for access to Amphotericin B and fluconazole in resource constrained settings in addition to a wide access to HAART.

Sexual behavior of medical students: A single institutional survey.

OBJECTIVE: We investigated the sexual practices of medical students as they are positioned to serve as peer educators in the fight against HIV/AIDS. METHODS: This was a cross sectional study, where self- administered questionnaires were distributed to consenting 4(th) to 6(th) year medical students in Jos, Nigeria with a view of elucidating information regarding sexual practices and condom utilization. Safe sex practice was defined as the use of condoms and being in a monogamous relationship. RESULTS: Of a total of 400 questionnaires distributed, 365 respondents (249 males and 116 females) had adequate data for analysis. A large proportion (62%) of our students have never had sex before and less than 30% of them are sexually active. Only 6.1% had multiple sexual partners and homosexuality was uncommon (1.9%). Condom utilization amongst the sexually active was high (65%) and similar among male and female students (71.3% vs. 51.9% respectively, p = 0.08). CONCLUSION: There exists safe sexual practice among medical students in our setting. This group could be recruited as peer educators in the war against HIV/AIDS.

Chronic kidney disease screening and renoprotection in type 2 diabetes.

BACKGROUND: Type 2 diabetes (T2D) is a major cause of chronic kidney disease. Control of hypertension and the use of angiotensin converting enzyme inhibitors (ACEI) and/or angiotensin II receptor blockers especially in those with proteinuria have been shown to protect against chronic kidney disease and delay its progression to kidney failure. METHODS: We reviewed the medical records of 169 patients at 12 months with a view of auditing the screening for chronic kidney disease and the use of renoprotective measures. RESULTS: Urinalysis was done in 49.1% and serum creatinine in 50.3%. No patient had glomerular filtration rate estimated. Seventy nine (67.6%) of the hypertensive patients were on anti-hypertensives. ACEI was used in 49 (45.8%) of these patients BP control was optimal in 29.1%. CONCLUSION: There is poor adherence to guidelines on chronic kidney disease screening and renoprotection in T2D.

Presentation and survival of patients with AIDS-related Kaposi's sarcoma in Jos, Nigeria.

AIDS-related Kaposi's sarcoma (AIDS-KS) remains a significant cause of morbidity and mortality. We describe the pattern of presentation and survival in Jos, Nigeria. We identified 48 HIV-positive patients with AIDS-KS and matched them for age and sex with an equal number of HIV-positive patients without AIDS-KS. We compared their clinical, immunological, virological characteristics and survival. They were similar in age and body mass index profile but patients with AIDS-KS had more tuberculosis co-infection (P, 0.02), lower median CD4 count (P, 0.003) and higher mortality (P, 0.002). Surprisingly, patients with AIDS-KS had lower levels of median viral load (29,347 copies/mL) compared with controls (80,533 copies/mL). We recommend specific AIDS-KS therapy in addition to highly active antiretroviral therapy in order to improve survival.

Chronic Kidney Disease Screening and Renoprotection in Type 2 Diabetes

Background: Type 2 diabetes (T2D) is a major cause of chronic kidney disease. Control of hypertension and the use of angiotensin converting enzyme inhibitors (ACEI) and/or angiotensin II receptor blockers especially in those with proteinuria have been shown to protect against chronic kidney disease and delay its progression to kidney failure. Methods: We reviewed the medical records of 169 patients at 12 months with a view of auditing the screening for chronic kidney disease and the use of renoprotective measures. Results: Urinalysis was done in 49.1and serum creatinine in 50.3. No patient had glomerular filtration rate estimated. Seventy nine (67.6) of the hypertensive patients were on anti-hypertensives. ACEI was used in 49 (45.8) of these patients BP control was optimal in 29.1. Conclusion: There is poor adherence to guidelines on chronic kidney disease screening and renoprotection in T2D

Willingness of Nigerian healthcare workers to donate kidneys.

BACKGROUND: The attitude of healthcare workers (HCW) towards organ donation is cardinal to the successful implementation and sustainability of transplant programs. We present the outcome of a survey among HCW in a single tertiary institution in Nigeria regarding their willingness to be living-related kidney donors. METHODS: Self-administered questionnaires were randomly distributed to HCW evaluating their attitude towards living-related kidney donation. RESULTS: Of the 650 questionnaires distributed only 502 responded (clinical medical students 51%, physicians 31.7% and nurses 17.3%); 75.6% of respondents were willing to be living donors while 5.8% were against it, and 18.5% were undecided. Multivariate analysis identified willingness to receive, perceived risk associated with kidney donation, and attitude towards cadaveric donation as independent predictors of willingness of HCW to be living donors. CONCLUSION: Nigerian HCW have a positive attitude toward kidney donation.

Direct observation therapy-highly active antiretroviral therapy in a resource-limited setting: the use of community treatment support can be effective.

This study examines the use of various direct observation therapy-HAART treatment support modalities in Jos, Nigeria. A 12-month observational study enrolling 175 antiretroviral naïve patients into four arms of direct observation therapy-HAART (highly active antiretroviral therapy); daily observed therapy (DOT), twice weekly observed therapy (TWOT), weekly observed therapy (WOT) and self-administered therapy (SAT), examined community treatment support using family and community members. Treatment outcomes were much better in the treatment-supported groups compared with the control self-therapy group. CD4 cell increases were 218/microL (DOT), 267/microL (TWOT), 205/microL (WOT) versus 224/microL (SAT), whereas plasma HIV-1 RNA reached undetectable levels (<400 copies/mL) in 91%, 88%, 84% versus 79% of patients in the DOT, TWOT, WOT versus SAT groups, respectively, at 48 weeks. We, therefore, strongly support the use of treatment support in our settings.

Does immunological status affect the prevalence of Hepatitis C virus infection among HIV/AIDS patients?

BACKGROUND: Even though HIV-HCV co-infection rates vary widely according to western reports, not so much has been documented about the situation in our environment. We determined the prevalence of HCV among our HIV cohort as well as described the relationship between the immune and virological status of the patients in this report. METHODS: Data of 1044 consenting HIV infected patients (confirmed by Western blot assay) receiving treatment at our centre between Sep 2002 and Feb 2005 were analyzed using EpiInfo 2004 retrospectively. The sera of the patients were used to determine their anti-HCVstatus by third generation ELISA (DIA.PRO Diagnostic, Bioprobes srl, Italy). HIV RNA levels and CD4 cell counts were also determined at recruitment by Roche Amplicor 1.5 and Flow Cytometry (Partec, Germany). RESULTS: Ninety out of 1044 patients (8.6%) were positive for anti-HCV The rate of co-infection was highest among the divorced (10.3%), followed by widows (9.9%) though this did not reach statistical significance. The odds of finding anti-HCV was more than twice with CD4 cell counts >600 cells/microlitre compared to below 200 cells/microlitre (p=0.026). The median HIV RNA levels of HCV co-infected individuals was 514 copies/ml, while it was 200 copies/ml for HIV monoinfected persons (p>0.05). CONCLUSION: The prevalence of HCV among this HIV cohort is high. There is also an associated higher chance of detecting anti-HCV in sera of the HIV patients whose immunological status is better than severely immunocompromised individuals.

Small bowel obstruction caused by intraluminal migration of retained percutaneous endoscopic gastrostomy internal bumper.

INTRODUCTION: Early complications associated with percutaneous endoscopic gastrostomy are well documented. Late complications associated with retained gastrostomy flange are rare. It is unclear why some patients with retained gastrostomy flange (internal bumper) develop mechanical obstruction and others do not. We report a case of mechanical obstruction with perforation occurring 6 months after the tube was cut. PATIENT AND METHODS: A 76-year-old hemiplegic patient with no swallowing reflex and who previously was on long-term percutaneous gastrostomy feeding tube underwent removal of the feeding tube but the internal bumper was left in situ due to encrustation. RESULTS: Due to migration of the retained flange, the patient developed small bowel obstruction. CONCLUSIONS: Retained internal bumper is potentially dangerous and we recommend endoscopic retrieval of such flange.

One stop rectal bleeding clinic: the coventry experience.

Among most patients attending a rectal clinic, rectal bleeding is a common presenting feature. In most patients, the cause is attributed to a benign lesion. In a small percentage, the cause is neoplastic, and for this reason, rectal bleeding merits further study. Left-sided tumors account for the majority of these tumors and are within the reach of a flexible sigmoidoscopy. This study aimed at examining the diagnostic performance of the one stop rectal clinic in Coventry. Between November 2001 and May 2002, 250 consecutive patients were seen in the one stop rectal bleeding clinic of a tertiary referral hospital. Patients were asked of the nature of rectal bleed and altered bowel habits and were examined by digital rectal examination, with a proctoscopy and rigid sigmoidoscopy before either a full colonoscopic examination or flexible sigmoidoscopy with a completion Barium enema. During the study period, colorectal cancer was detected in 4 patients (1.6%), adenomatous polyps in 36 patients (14.4%), and ulcerative colitis in 8 patients (3.2%). In 98 patients (39.2%), no abnormality was present, and in the remaining patients, diverticulosis (n = 60; 24%) and hemorrhoids were present (n = 44; 17.6%).

Antiphospholipid syndrome: a series of surgical emergencies and the current evidence for its management.

It is generally accepted that antiphospholipid syndrome remains a major medical problem characterised by hypercoagulability, arterial and venous thrombosis and thrombocytopenia. It is unclear how best to treat these patients should they require emergency surgery. If a lupus anticoagulant is present, hypercoagulability may occur de novo but surgical interventions along with sepsis are two important predisposing factors. We describe three patients with primary antiphospholipid syndrome and discuss the implications for surgery.

Use and abuse of analgesics in Nigeria: a community survey.

BACKGROUND: Chronic consumption of analgesics has been shown to increase the risk of end-stage renal disease. In Nigeria, these drugs are readily available as there is no legislation regulating their consumption. We report the use and abuse of analgesics in a Nigerian population. METHOD: Using a pre-tested questionnaire, subjects in Zawan B ward in Jos were interviewed regarding analgesic use. Cumulative lifetime dose of drugs consumed was calculated by obtaining the product of the average number of pills consumed in a week by duration of use in years. Analgesic abuse was defined as cumulative lifetime use of >5000 pills. RESULTS: Common analgesics regularly consumed were paracetamol in 58.1%, analgesic mixtures 28.9% and NSAIDS 13%. Common indications for use of these drugs were musculoskeletal pains, headache, fever and stress. Analgesic abuse was present in 22.6% of the respondents. CONCLUSION: Analgesic abuse is common in Jos, Nigeria. The sale and consumption of these drugs should be restricted by legislation.