Serum Immunoglobulin E and Vitamin D Levels in Asthma Patients in Enugu, Nigeria: Association with Asthma Control.

BACKGROUND: Asthma symptoms are often mediated by changes in immune responses to allergens measured by the levels of immunoglobulin E (IgE) and non-protein regulators such as 25-hydroxycholecalciferol (25 (OH) vitamin D3). The relationship between serum levels of IgE, 25 (OH) Vitamin D3, and asthma control in asthma patients remains unclear. OBJECTIVE: To measure the serum IgE and 25 (OH) vitamin D3 levels in asthma patients and determine their relationship with patient's asthma control. METHODS: This was a cross-sectional study of children and adults with asthma aged 5 to 60 years old; and their controls seen in a tertiary hospital in Enugu, south eastern Nigeria from October 2018 to January 2019. Serum levels of IgE, and 25 (OH) vitamin D3 were determined by sandwich enzyme-linked immunosorbent assay (ELISA); and compared between groups using the Student's t-tests. Association between IgE, 25 (OH) vitamin D3 levels, and asthma control were determined using the Chi-square. RESULTS: Sixty-five (65) asthma patients and thirty-three (36) non-asthma controls were studied. Mean serum level of IgE (411.32± 220.18 IU/ml) was significantly raised in asthma patients compared to controls (163.51 ± 186.36 lU/ml); p=0.001. There was no significant difference in mean 25 (OH) vitamin D3 levels in asthma (68.55 ± 25.91 ng/ml) compared to controls (77.25 ± 34.01 ng/ml); p=0.153. No significant association was found between patient's asthma control status, and serum IgE and 25 (OH) vitamin D3 levels. CONCLUSION: Asthma control status was not associated with Immunoglobulin E and 25 (OH) vitamin D3 levels in those studied. More robust study is required to evaluate the relationship between asthma control, IgE and vitamin D levels.

BACKGROUND: Les symptômes de l'asthme sont souvent médiés par des changements des réponses immunitaires aux allergènes, mesurées par les taux d'immunoglobuline E (IgE) et de régulateurs non protéiques tels que le 25- hydroxycholécalciférol (25 (OH) vitamine D3). La relation entre les niveaux sériques d'IgE, de 25 (OH) vitamine D3 et le contrôle de l'asthme chez les patients asthmatiques n'est pas claire. OBJECTIF: Mesurer les taux sériques d'IgE et de 25 (OH) vitamine D3 chez les patients asthmatiques et déterminer leur relation avec le contrôle de l'asthme chez les patients. MÉTHODES: Il s'agit d'une étude transversale d'enfants et d'adultes asthmatiques âgés de 5 à 60 ans; ainsi que de leurs témoins vus dans un hôpital tertiaire d'Enugu, dans le sud-est du Nigeria, d'octobre 2018 à janvier 2019. Les taux sériques d'IgE et de 25 (OH) vitamine D3 ont été déterminés par dosage immuno-enzymatique en sandwich (ELISA); et comparés entre les groupes à l'aide des tests t de Student. L'association entre les niveaux d'IgE, de 25 (OH) vitamine D3 et le contrôle de l'asthme a été déterminée à l'aide du chi carré. RÉSULTATS: Soixante-cinq (65) patients asthmatiques et trentetrois (36) témoins non asthmatiques ont été étudiés. Le taux sérique moyen d'IgE (411,32 ± 220,18 UI/ml) était significativement plus élevé chez les patients asthmatiques que chez les témoins (163,51 ± 186,5 UI/ml); p=0,001. Il n'y avait pas de différence significative dans les taux moyens de 25 (OH) vitamine D3 chez les asthmatiques (68,55 ± 25,91 ng/ml) par rapport aux témoins (77,25 ± 34,01 ng/ml); p=0.153. Aucune association significative n'a été trouvée entre le statut de contrôle de l'asthme du patient et les taux sériques d'IgE et de 25 (OH) vitamine D3. CONCLUSION: Le contrôle de l'asthme n'était pas associé aux taux d'immunoglobulines E et de 25 (OH) vitamine D3 chez les personnes étudiées. Une étude plus solide est nécessaire pour évaluer la relation entre le contrôle de l'asthme, les taux d'IgE et de vitamine D. Mots clés: 25 hydroxyl vitamine D3, Immunoglobuline E, Contrôle de l'asthme, Enfants, contrôle, Enfants.

Physical and socioeconomic impact of asthma in Nigeria: Experience of patients attending three tertiary hospitals.

BACKGROUND: Understanding the impact of asthma is the key to optimal care. OBJECTIVE: To determine the physical, economic, and social impact of asthma from the perspectives of individual patients in Nigeria. METHODS: This was a multicenter study of 172 adult asthma patients attending tertiary hospitals. We assessed the different impact of asthma in the preceding 12 months using a questionnaire. Physical impact (such as daily activity/chores, sport/exercise, and sleep quality), social impact (such as job loss, mental anguish, employer, and peers discrimination) and economic impact (like savings, indebtedness, mortgage/asset, and school or work absence). RESULTS: The physical, social and economic impacts were perceived by 59.3%, 47.7%, and 51.2% of patients, respectively. The physical impacts were poor sleep (44.2%), limitation of daily activity/chores (38.4%), and sporting/exercise (39.5%). The economic impacts were reduced savings (38.4%) and indebtedness (17.4%). Absence from school and work were respectively reported by 75% of students and 38.3% of workers. Socially, 34.9% reported mental torture, 10.5% changed job, 4.7% experienced discrimination and 3.5% lost their jobs due to asthma. Asthma-related emergency department visit was 42% and hospitalization was 32.6%. The physical impact was associated with non-adherence to ICS and persistent asthma symptoms. Economic impact was associated with asthma hospitalization, work absenteeism, comorbidity, and National Health Insurance (NHIS) coverage. Male sex and lack of post-secondary education were associated with social impact. CONCLUSION: Asthma causes broad and substantial physical and socioeconomic impacts in our sample of patients. Exploring these impacts and engaging the patient is imperative for holistic management and good health outcomes.

Peak expiratory flow as a surrogate for health related quality of life in chronic obstructive pulmonary disease: a preliminary cross sectional study.

BACKGROUND: Health Related Quality of Life (HRQL) measures can capture the non-respiratory effects of Chronic Obstructive Pulmonary Disease (COPD). However the relationship with Peak Expiratory Flow (PEF) is not well understood. AIM: To determine the relationship of PEF and quality of life measurements in patients with COPD. SETTINGS AND DESIGN: A cross section of consecutive patients in a university clinic. METHODS: Stable patients with COPD defined by the Global Initiative on chronic Obstructive Lung Disease (GOLD) criteria, were recruited into the study. Spirometry was done using American Thoracic Society's standards and reference equations from African American norms of the US population. Quality of life was measured with the St George's Respiratory Questionnaire (SGRQ). RESULTS: Out of 50 patients recruited for the study, 48 provided complete data with acceptable spirometry and PEF data. The mean (SD) age and body mass index was 68.4 (8.9) years and 21.4 (4.6) kg/m(2) respectively and 96% of the patients were in moderate-severe stages of COPD using the GOLD criteria. Percent predicted PEF correlated with percent predicted FEV1; r= 0.559 p<0.001 and also showed a significant, though moderate correlation between PEF readings and SGRQ scores especially in the activity (r= -0.455 p< 0.01) and total scores (r=-0.415 p<0.01) for pre bronchodilator (BD) percent predicted PEF. In regression analysis, PEF was associated with SGRQ (-0.11 95% CI -0.19, -0.03) after adjusting for age, sex, height, smoking and disease severity. CONCLUSIONS: PEF correlates with SGRQ scores and may be a useful surrogate for HRQL in patients with COPD.

Evaluation of Inhaler Techniques among Asthma Patients Seen in Nigeria: An Observational Cross Sectional Study

Background: An Adequate and an effective dose of inhalation drugs can be administered only if the correct inhaler-specific technique is followed by asthma patients. There is paucity of data on this subject among Nigerians and Africans. Aims: This observational study was to assess the inhaler techniques among asthma patients in Nigeria and also to identify the factors related to an inaccurate or poor inhaler use. Subjects and Methods: Consenting asthma patients on inhalers; who attended medical out-patients clinic; of two university hospitals in Nigeria were asked to use their inhalers while an inhaler-administration checklist was used to assess each patients inhaler technique. Information on demographics; asthma symptoms history and history of technique education were obtained. Data was analyzed using standard statistical methods. Results: A total of 140 asthma patients participated out of which 75 were females. All the patients used pressurized metered dose inhalers (pMDI) type; 51 of them used dry powder inhalers (DPI) in addition. For pMDI; 22.1 (31/140) completed all required steps while 37.3 (19/51) did so for DPI (P = 0.04). Patients with higher educational qualification (P 0.01) and those with less frequent asthma symptoms (P 0.01) are more likely to use the pMDI inhalers more accurately while patients who have been taught previously by a Doctor were more likely to use the DPI better. Conclusion: Majority of asthma patients use their inhalers inaccurately. Patient-dependent factors were identified as the cause of incorrect technique of inhaler use. Asthma patients on inhalation medications should have routine assessment of their inhaler technique at every visit and corrected if found to be poor

Factors affecting interest in respiratory medicine as a subspecialty of choice: survey of internal medicine residents in Nigeria.

AIMS AND OBJECTIVES: The objective of this study was to determine the factors that affect the interest in respiratory medicine (RM) as a subspecialty of choice among internal medicine residents in Nigeria. SUBJECTS, MATERIALS AND METHODS: This was a cross-sectional study of 136 internal medicine residents recruited from seven teaching hospitals from January 2011 to June 2011. A semi-structured questionnaire that was self administered by residents was used to obtain socio-demographic information and factors affecting residents' interest in respiratory medicine. RESULTS: Out of 136 residents that completed the study, 78 (57.4 %) were junior residents (PG year 1-3) and 58(42.6%) were senior residents (PG year >3). Thirty four (43.6%) junior residents and 21(36.2%) senior residents considered respiratory medicine as a sub-specialty of choice. Only 2(3.5%) of the senior residents were presently committed to RM. In the junior residents, interest in respiratory medicine was correlated with personal intelligence and ability (RR=2.58, ;95% confidence interval(CI): 1.16-7.07, p-0.01) , availability of respiratory physician (RR=2.42; 95% CI 1.07-7.63 ,p-0.02) and postgraduate examiners in RM in training institutions RR= (2.20; 95% CI 1.06-5.45,p-0.03), experience during rotation in medical school and residency (RR=2.11 ; 95% CI 1.11-4.21,p-0.03) and future annual income (RR=2.04;C:I1.03-4.68,p-0.04). In the senior residents, interest in RM was correlated with the availability of postgraduate examiners in RM in training institutions (RR- 6.36; 95% CI 1.16-66.80, P-<0.01), future opportunity for scholarships and travel grants (RR- 4.23; 95% CI 1.19-25.92,p-< 0.01), personal intelligence and ability (RR= 3.41; 95% CI.16-13.87,p-0.01) and prospect for rapid elevation in career (RR=2.92; 95% CI 1.03-11.91,p -0.04). Provisions of modern facilities in training institutions, mentoring by senior colleagues and promotion of subspecialty by respiratory physicians were rated by the senior residents as the most important ways of increasing interest in respiratory medicine and making it a specialty of choice. CONCLUSION: The interest in respiratory medicine among internal medicine residents is low and decline as their level of training advances. The factors affecting the interest in respiratory medicine have been highlighted and the policy makers need to understand, and if possible modify these factors by formulating appropriate changes to our training programs so as to increase future numbers of respiratory physician.

Prevalence of cervical squamous intraepithelial lesions among HIV-positive women in Enugu, South-eastern Nigeria.

HIV infection is a risk factor for cervical cancer and both diseases are prevalent in Nigeria. The study determined the prevalence of cervical squamous intraepithelial lesion (SIL) among HIV-positive women in Enugu state, which has the highest HIV burden in South-eastern Nigeria. Pap smear was carried out on 150 HIV-positive (HIV+ve) women and 150 HIV-negative (HIV?ve) controls at the University of Nigeria Teaching Hospital, Enugu, Nigeria from December 2007 to March 2008. The prevalence of SIL for the HIV+ve group and the control group were 12.6% and 4.6%, respectively (p = 0.014). Also, the prevalence of each category of SIL identified in the study, was higher among the HIV+ve group. There is an association between HIV infection and SIL in Enugu, South-eastern Nigeria. Cervical cancer screening should be incorporated into the antiretroviral (ARV) clinics, so as to prevent the impending surge in the burden of cervical cancer in Nigeria.

Secondhand Smoke Exposure among Nonsmoking Adults in two Nigerian Cities

Background: Tobacco control policy can only succeed if the burdens of smoking are known. The objective of this study was to determine the prevalence and correlates of secondhand smoke (SHS) exposure among nonsmoking adults in two Nigerian cities. Materials and Methods: We carried out a cross-sectional study from October 2009 to April 2010 among adult population of two Nigerian cities: Enugu and Ilorin. A semi-structured questionnaire was administered by interviewers to obtain socio-demographic information; and information regarding pattern of SHS exposure; wareness of tobacco control policy and the harmful effects of SHS. SHS exposure was defined as regular exposure to tobacco smoke in the previous 30 days in a nonsmoking adult. Results: Of the 585 nonsmoking adults that completed the study; 38.8had regular exposure to SHS; mostly; in public places (24.4). More men were exposed at public places when compared with women (27.0vs. 19.5). The strongest factor associated with exposure to SHS in women was having a smoking spouse [prevalence rate (PR) ratio-7.76; 95confidence interval (CI); 3.08-9.42]; and in men; it was lack of home smoking restriction (PR ratio-6.35; 95CI; 4.51-8.93). Among men; SHS exposure at any location was associated with lack of secondary school education; residing in slum apartment (house with many households); living with a smoking family member (non-spouse); lack of home smoking restriction; and alcohol intake. Among women; SHS exposure at any location was associated with having a smoking spouse; residing in slum apartment and lack of home smoking restriction. Seventy-two percent of respondents were aware of the harmful effects of SHS on their health. Lack of awareness of the harmful effects was significantly associated with increasing age (r= +0.45; P = 0.01); lack of secondary school education (rof the employees reported availability of outdoor smoking area at their workplaces. Conclusion: Our results show that prevalence of SHS exposure was the highest in public places. These findings underscore the need for enactment of comprehensive smoke-free legislation and implementation of educational strategies to reduce SHS exposure in homes

Respiratory symptoms and ventilatory function tests in Nigerians with HIV infection.

BACKGROUND: The impact of the human immunodeficiency virus (HIV) infection on the respiratory system of Africans has been little studied. This study aimed to determine the pattern of respiratory symptoms and ventilatory functions in HIV infected Nigerians. METHODS: In this cross sectional study, Respiratory symptoms frequency, Forced vital capacity (FVC), Forced expiratory volume in one second (FEV(1)), FEV(1)/FVC ratio, Forced expiratory flow between 25% and 75% of FVC, were determined in 100 HIV positive subjects and compared with values in 100 HIV negative controls. RESULTS: HIV positive patients had significantly more respiratory symptoms and lower ventilatory function tests values compared to the matched controls (p<0.05). HIV patients with at least one respiratory symptom and those with CD4 count less than 200 cells/µl had lower ventilatory function values than their counterparts. 32% of the HIV patients had restrictive ventilatory functional impairment. (p<0.05). Using regression analysis, factors like HIV status, CD4 count and presence of respiratory symptoms were found to be associated with impairment in ventilatory functions. CONCLUSIONS: HIV infected patients had more frequent respiratory symptoms and lower ventilatory function values. Further lung function studies and CT scanning in HIV positive patients especially in those with respiratory symptoms are indicated.

Gender perspectives of sexual and reproductive practices of people living with HIV/AIDS in Enugu, South East Nigeria.

BACKGROUND: a major focus of attention in the efforts at controlling the spread of HIV infection has become the role of gender inequality. The objective of the study was to compare the sexual practices of HIV-positive male and female patients who received counselling and treatment at an Anti-retroviral Clinic in Enugu, South-East Nigeria. METHOD: A comparative cross-sectional descriptive study of patients attending the free anti-retroviral clinic at the University of Nigeria Teaching Hospital Enugu was done. RESULTS: A total of 146 males (30.8%) and 328 females (61.9%) were studied. Although there was no significant difference in the prevalence of sexual activity between the sexes, the reasons for sexual practices differed. Females indulged in risky sexual activity principally in obedience to the demands of their male partners and were more likely to have sexual partners who were unaware of their seropositivity than males. CONCLUSION: Risky sexual behaviour among women living with HIV/AIDS in Enugu despite exposure to intensive counselling was still mainly driven by the subordinate traditional gender roles of women in this culture.

Gender Perspectives of Sexual and Reproductive Practices of People Living With HIV/AIDS in Enugu; South East Nigeria

Nigerian major focus of attention in the efforts at controlling the spread of HIV infection has become the role of gender inequality.1; 2 The objective of the study was to compare the sexual practices of HIV-positive male and female patients who received counselling and treatment at an Anti-retroviral Clinic in Enugu; South-East Nigeria. Method: A comparative cross-sectional descriptive study of patients attending the free anti-retroviral clinic at the University of Nigeria Teaching Hospital Enugu was done. Results: A total of 146 males (30.8) and 328 females (61.9) were studied. Although there was no significant difference in the prevalence of sexual activity between the sexes; the reasons for sexual practices differed. Females indulged in risky sexual activity principally in obedience to the demands of their male partners and were more likely to have sexual partners who were unaware of their seropositivity than males. Conclusion: Risky sexual behaviour among women living with HIV/AIDS in Enugu despite exposure to intensive counselling was still mainly driven by the subordinate traditional gender roles of women in this culture.:

Indications for spirometry at a tertiary hospital in south east, Nigeria.

BACKGROUND: Spirometry evaluation of ventilatory functions plays a critical role in the diagnosis, differentiation and management of respiratory illness such as asthma, chronic obstructive pulmonary disease and restrictive lung disorders. It appears to be underutilized especially by most primary care physicians. AIM: This study was aimed at determining the indications for spirometry at a tertiary health institution in Nigeria and to determine the source of referral of the patients. METHODS: Clinical and anthropometric data of all subjects who underwent spirometry at the University of Nigeria Teaching Hospital, Enugu, Nigeria over a three year period were retrieved from the records book and analyzed to determine the sex distribution, age distribution, indication for the procedure, and source of referral. RESULTS: A total of fifty two patients had the procedure over a three year period (Jan 2004-Dec 2006). The male to female ratio was 1: 1.08. Their ages ranged from 5 to 85 years of age with a mean age of 42.3 +/- 20.50 years. The commonest indication for spirometry during the study period was Bronchial asthma followed by Chronic Obstructive Pulmonary disease (COPD). Most of the patients were referred by the respiratory unit performing the procedure followed by the surgical units and no referral came from the neighbouring peripheral hospitals. CONCLUSION: Bronchial Asthma is the commonest indication for the use of spirometry. There is poor referral from the peripheral primary care centers. Primary care general physicians and surgeons should be encouraged to use of spirometry.

Experience with tetanus in a tertiary hospital in south east Nigeria.

BACKGROUND: Tetanus has for long been an avoidable source of morbidity and mortality particularly in developing countries. The aim of this study was to review the experience with managing tetanus in a regional tertiary hospital in Nigeria. METHODS: A retrospective study of patients who were admitted with a clinical diagnosis of tetanus between January 1999 and December 2003 was done. Relevant data were extracted from the patients'case records. RESULTS: A total of 12 patients were identified within the time frame with a diagnosis of tetanus. There were more male than female patients (ratio 1.4:1) with city dwellers constituting a small majority. The mean age of the patients was 29.8 years. Lower limb injuries accounted for the portal of entry in 75% of cases while one case followed a practice of oral sex. All patients were managed in the general ward and no mortality was recorded despite the presence of dysautonomia in some patients. CONCLUSION: Despite the high rate of morbidity and mortality associated with tetanus in developing countries and despite some regional differences in presentation, careful clinical management even in resource poor countries can result in very good outcomes.