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.

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.

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.

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.

Prevalence of microalbuminuria in newly diagnosed type 2 diabetic patients in Jos Nigeria.

Diabetic nephropathy contributes significantly to end-stage renal disease in Nigeria. The earliest clinically detectable stage is that of microalbuminuria when interventions could halt or retard the progression to end-stage renal disease. To investigate the prevalence of microalbuminuria in newly diagnosed type 2 diabetic patients and its clinical correlates in Jos, consecutive patients with newly diagnosed type 2 diabetes attending two large hospitals in Jos were evaluated at three different occasions of monthly intervals for microalbuminuria using Micral test strips 11. Patients with proteinuria, positive nitrite test/ urine microbial culture, acute illnesses or cardiac decompensation were excluded. Out of a total of 99 patients recruited, only 65 completed the study. Microalbuminuria was present in 32(49.2%) of the patients, and was significantly associated with mean arterial pressure, systemic hypertension and diabetic retinopathy (P < 0.05). Microalbuminuria is common in newly diagnosed patients with type 2 diabetes mellitus. Our finding supports routine screening for microalbuminuria as part of the initial evaluation of these patients.

Comparison of pulmonary function between children living in rural and urban areas in northern Nigeria.

Children in northern Nigeria and elsewhere in the hot, arid western Sahel, are at risk of having their lung function compromised by a variety of factors, including undernutrition, environmental factors (e.g. airborne pollutants such as dust and smoke from wood fires), chronic upper-respiratory tract infections, and low socioeconomic class. We were interested in using spirometry to compare the pulmonary function of Nigerian children and adolescents aged 6-18 years who were living in urban and rural settings with the corresponding standards for African-American children. A total of 183 boys and girls in the rural village of Sabon Fobur on the Jos Plateau and another 128 boys and girls in the city of Jos were tested to determine their forced vital capacity (FVC), FVC at 1 s (FVC1), and peak expiratory flow (PEF). The nutritional status of the subjects was determined by measuring the body mass index (BMI), triceps skin-fold thickness, and mid-arm circumference, and fat-free mass (FFM) and fat mass (FM) by bioelectrical impedance analysis. According to the results of anthropometry, the subjects in Sabon Fobur and Jos were lean but generally adequately nourished. The mean FVC, FVC1 and PEF values for the rural males were 1.851,1.761, and 3.521, and for the urban males they were 1.971,1.791, and 3.471, respectively. The corresponding values for the rural females were 1.791,1.701, and 3.371, and for the urban females they were 1.761,1.671, and 3.091. These values were approximately 100 per cent of the corresponding values for African-American children. In general, strong correlations were found between each of the three lung function parameters and age, weight, height (only for the males), BMI, MAC, and FFM. These results show that: (1) the lung function of Nigerian children and adolescents living in either rural or urban areas were similar and compared favorably with African-American standards, and (2) weight was as important as height in determining pulmonary function. The inclusion of FFM as an explanatory variable did notfurther increase the accuracy of the prediction, even in a population where malnutrition may be prevalent. Therefore, we conclude that measurements of height and weight are all that are required for the assessment of lung function using spirometry in Nigerian children.

Renal disease in the acquired immunodeficiency syndrome in north central Nigeria.

BACKGROUND: The brunt of the human immunodeficiency virus infection/the acquired immunodeficiency syndrome is largely borne by communities in sub-Saharan Africa. We describe renal disease in Nigerians with the acquired immunodeficiency syndrome. METHODS: Consecutive patients with the acquired immunodeficiency syndrome (AIDS) seen in the infections unit of the Jos University Teaching Hospital and a similar group of healthy controls were evaluated for renal disease. Subjects with past history of renal disease, hypovolemia, hypertension, diabetes mellitus and/or a documented fever were excluded from the study. RESULTS: Of the 79 patients with the acquired immunodeficiency syndrome and 57 controls studied, renal disease was present in 41 (51.8%) of the patients in the AIDS group and 7 (12.2%) of controls. While 15 (19%) of the AIDS group had azotemia alone and 20 (25.3%) had proteinuria alone, 6 (7.6%) had azotemia and proteinuria. The mean protein excretion/24 hours was significantly higher in the AIDS group compared to controls, (2.99 +/- 54 g and 0.56 +/- 0.12 g respectively, p = 0.001), while the GFR was significantly higher in controls compared to the study group (103.30 +/- 37.78 and 68.03 +/- 37.55 respectively, p = 0.004). Subjects in the AIDS group with renal disease had a significantly longer duration of illness compared to those without (12.33 +/- 8.67 months and 7.28 +/- 7.78 months respectively, p = 0.008). Age and serum CD4+ cell counts were similar in patients with and without renal disease in the AIDS group. CONCLUSION: Renal disease is a common complication of acquired immunodeficiency syndrome, the duration of illness being strongly associated with its presence.