Prevalence and Correlates of HIV-Associated Neurocognitive Disorders (HAND) in Northwestern Nigeria.

HIV-associated Neurocognitive Disorders (HAND) are common among HIV-positive individuals. This study explored the prevalence and correlates of HAND in Nigeria. 80 HIV-positive and 40 HIV-negative adults selected from Aminu Kano Teaching Hospital (AKTH) received comprehensive evaluations. A multidomain neuropsychological test (MDNPT) battery assessing 7 domains was administered to the participants and their performance was combined with measures of functional status to classify impairments into various grades of HAND. Univariate and multivariate analyses were performed to identify correlates of symptomatic HAND. Among the HIV-positive individuals, 50% were highly active antiretroviral therapy-experienced (HAART+) and 50% were highly active antiretroviral therapy naive (HAART-). Symptomatic HAND was found among 40% of the HAART- individuals and 30% of the HAART+ individuals. Respective prevalence of HIV-associated dementia (HAD) was 23% and 5%, respectively (p = 0.0002). In a binary logistic regression model, only fewer years of education independently predicted symptomatic HAND [Odds Ratio (OR) = 1.2, 95% confidence interval (CI) = 1.04-1.44, p = 0.016]. The prevalence of HAND in Nigeria is high with HAD being commoner among HAART- patients. Provision of HAART and strict monitoring of patients at risk of HAND are needed to scale down the burden of the disease.

Disease pattern and social needs of street people in the race course area of Kano, Nigeria.

PURPOSE: The study is aimed at examining street people on Race Course Street in Kano, Nigeria for prevalence of common diseases. STUDY DESIGN: Descriptive report. SUBJECTS AND METHODS: Institutional ethical approval was obtained. Information was obtained on age, sex, place of residence, drug habits, source of drinking water, toilet facility used, visual acuity, blood pressure, random blood sugar level, presence of skin diseases and physical disability. RESULTS: Sixty five subjects were examined and 7 declined. There were 16 males and 49 females (M:F=1:3). The mean age was 48 + 9.2 years. They were mainly widows, some live in the street and have no access to basic amenities and six use non-narcotic medicinal substances. Diseases observed are hypertension, visual problems, and trauma. CONCLUSION: Religious factors, socio-cultural factors, and lack of government policy leads to poor access to health care for street people.

Rationale and design of the Investigation of the Management of Pericarditis (IMPI) trial: a 2 × 2 factorial randomized double-blind multicenter trial of adjunctive prednisolone and Mycobacterium w immunotherapy in tuberculous pericarditis.

BACKGROUND: In spite of antituberculosis chemotherapy, tuberculous (TB) pericarditis causes death or disability in nearly half of those affected. Attenuation of the inflammatory response in TB pericarditis may improve outcome by reducing cardiac tamponade and pericardial constriction, but there is uncertainty as to whether adjunctive immunomodulation with corticosteroids and Mycobacterium w (M. w) can safely reduce mortality and morbidity. OBJECTIVES: The primary objective of the IMPI Trial is to assess the effectiveness and safety of prednisolone and M. w immunotherapy in reducing the composite outcome of death, constriction, or cardiac tamponade requiring pericardial drainage in 1,400 patients with TB pericardial effusion. DESIGN: The IMPI trial is a multicenter international randomized double-blind placebo-controlled 2 × 2 factorial study. Eligible patients are randomly assigned to receive oral prednisolone or placebo for 6 weeks and M. w injection or placebo for 3 months. Patients are followed up at weeks 2, 4, and 6 and months 3 and 6 during the intervention period and 6-monthly thereafter for up to 4 years. The primary outcome is the first occurrence of death, pericardial constriction, or cardiac tamponade requiring pericardiocentesis. The secondary outcome is safety of immunomodulatory treatment measured by effect on opportunistic infections (eg, herpes zoster) and malignancy (eg, Kaposi sarcoma) and impact on measures of immunosuppression and the incidence of immune reconstitution disease. CONCLUSIONS: IMPI is the largest trial yet conducted comparing adjunctive immunotherapy in pericarditis. Its results will define the role of adjunctive corticosteroids and M. w immunotherapy in patients with TB pericardial effusion.

Endomyocardial fibrosis presenting outside the tropical rain forest.

Endomyocardial fibrosis (EMF), an idiopathic cardiac disorder, occurs predominantly in the tropical and subtropical regions of the world. We present herein a report of EMF in a young man from the savannah belt of Nigeria. He was a 19-year-old young man who presented with recent onset of palpitation and dyspnea and was followed up elsewhere for 3 years as a case of chronic liver disease due to progressive abdominal distension. Clinical examination revealed an undernourished young man with atrial fibrillation and features of heart failure. His electrocardiogram showed features of atrial fibrillation, while echocardiogram showed enlarged right atrium, tricuspid incompetence, and signs of fibrosis in the ventricles. Although EMF occurs primarily in the subtropical regions of Africa in its typical manifestation, in this report it was in the savannah belt.