Impact of Seasonal Changes on Asthma Control in North-Western Nigeria.

BACKGROUND: Asthma control is poor worldwide and is often affected by changes in environmental conditions. Effort to determine the cause of this heavy burden on patients and the healthcare system is crucial. AIM: To determine the role of seasonal changes on asthma control in Sokoto, North-Western Nigeria. METHODS: One hundred and one (101) patients with physician diagnosed asthma were consecutively recruited after obtaining informed consent. A structured researcher administered questionnaire was used as instrument of data collection and asthma control test questionnaire was also used to assess level of asthma control in each participant. Five items with a 4-week recall were assessed. Data for temperature, humidity, wind and rain was obtained from the Nigerian Meteorological Agency (NIMET), Sokoto. We computed frequency and level of asthma control with seasons of the year and weather variables. RESULTS: One hundred and one patients comprising 71 females and 30 males with a mean age of 32.14 ± 10.68 years participated in the study. Level of asthma control was found to be poor among the participants with 41(40.6%) having very poorly controlled asthma, 30(29.7%) with not well controlled and 30(24.8%) well controlled asthma respectively. Among patients with very poorly controlled asthma, 22(48.9%) occurred during harmattan season and 14(31.1%) during rainy season. Weather parameters such as humidity shows significant relationship with asthma control (B= -0.504, P= 0.031, 95% CI [-0.012, -0.0253]). CONCLUSION: The study shows that asthma control is poor among the participants and presentation with poor asthma control is more during harmattan season.

CONTEXTE: Le contrôle de l'asthme est médiocre dans le monde entier et est souvent affecté par les changements des conditions environnementales. L'effort pour déterminer la cause de ce lourd fardeau pour les patients et le système de santé est crucial. OBJECTIF: Déterminer le rôle des changements saisonniers sur le contrôle de l'asthme à Sokoto, dans le nord-ouest du Nigeria. MÉTHODES: Cent un (101) patients atteints d'asthme diagnostiqué par un médecin ont été recrutés de manière consécutive après avoir obtenu leur consentement éclairé. Un questionnaire structuré administré par le chercheur a été utilisé comme instrument de collecte de données et le questionnaire de test de contrôle de l'asthme a également été utilisé pour évaluer le niveau de contrôle de l'asthme chez chaque participant. Cinq éléments avec une période de rappel de 4 semaines ont été évalués. Les données sur la température, l'humidité, le vent et la pluie ont été obtenues auprès de l'Agence météorologique nigériane (NIMET) de Sokoto. Nous avons calculé la fréquence et le niveau de contrôle de l'asthme en fonction des saisons de l'année et des variables météorologiques. RÉSULTATS: Cent un patients, comprenant 71 femmes et 30 hommes, avec un âge moyen de 32,14 ± 10,68 ans, ont participé à l'étude. Le niveau de contrôle de l'asthme s'est avéré médiocre parmi les participants, avec 41 (40,6 %) ayant un asthme très mal contrôlé, 30 (29,7 %) un asthme non bien contrôlé et 30 (24,8 %) un asthme bien contrôlé, respectivement. Parmi les patients souffrant d'asthme très mal contrôlé, 22 (48,9 %) ont été signalés pendant la saison de l'harmattan et 14 (31,1 %) pendant la saison des pluies. Les paramètres météorologiques tels que l'humidité montrent une relation significative avec le contrôle de l'asthme (B= -0,504, P=0,031, IC à 95 % [-0,012, -0,0253]). CONCLUSION: L'étude montre que le contrôle de l'asthme est médiocre parmi les participants et que les cas d'asthme mal contrôlé sont plus fréquents pendant la saison de l'harmattan. MOTS-CLÉS: Asthme, Contrôle de l'asthme, Saison, Harmattan.

Immunophenotypic characterisation of peripheral T lymphocytes in pulmonary tuberculosis.

BACKGROUND: The cellular immune response plays an important role in determining the outcome of infection and disease in Mycobacterium tuberculosis. Many studies of these disease interactions yield contradictory results. AIM: This study aims at determining the changes that take place in the subpopulations of T lymphocytes in the blood of patients with pulmonary tuberculosis (TB). SETTINGS AND DESIGN: This cross-sectional study was done at King Khalid University Hospital, Riyadh, Saudi Arabia. MATERIALS AND METHODS: Flow cytometry was used to determine the absolute numbers and percentages of T CD3, T CD4, T CD8, T CD19 and natural killer (NK) T cells in 54 patients with active pulmonary TB before the commencement of treatment and in 25 healthy PPD negative volunteers. STATISTICAL ANALYSIS: Statistical Package for Social Sciences (version 11.5) was used for analysis. RESULTS: There were significant differences in the values of CD3, CD4 and NK T cells among the groups. The numbers of CD3 and CD4 cells were lower in subjects than in controls [1091.9 +/- 321.4 vs. 1364.6 +/- 251.2; P < 0.001 and 639.8 +/- 285 vs. 822 +/- 189.9; P < 0.004, respectively] while numbers of NK T cells were much higher in patients than in controls (410.7 +/- 286 vs. 182.3 +/- 140; P < 0.001). The numbers of CD8 cells were not significantly changed with disease (609 +/- 233.5 in subjects and 613.4 +/- 170.3 in controls P = 0.761). CONCLUSION: There are significant changes in the cellular immune response particularly affecting the CD3, CD4 and NK T cells with the development of pulmonary TB. Therefore, further studies of these changes may have important implications on the development of diagnostic tools, vaccines and treatment modalities.

Tuberculosis of the Breast: An Initial Presentation of the Metabolic Syndrome with Type 2 Diabetes Mellitus in a Young Nigerian Woman.

Breast tuberculosis is an uncommon presentation of extra pulmonary tuberculosis. A 40-year-old obese woman presented with a right breast abscess which had failed to heal after surgical drainage. There was no family history of breast disease. Biopsy and histology of the lesion showed chronic granulomatous inflammation with positive stains for acid fast bacilli compatible with tuberculosis. Further evaluation confirmed metabolic syndrome with type 2 diabetes mellitus. She was placed on antituberculosis chemotherapy and appropriate therapy for diabetes mellitus with complete resolution of the lesion. We report this case because of its rarity and to highlight the association between tuberculosis an infectious disease and overnutrition in diabetes mellitus, a noncommunicable disease.

Congenital hepatic fibrosis: A study of a Saudi family and review.

A Saudi family with three members afflicted with congenital hepatic fibrosis (CHF) is described. CHF was associated with cystic dilatation of the intrahepatic bile ducts and autosomal dominant polycystic kidney disease (ADPKD) in all of the three siblings. The proband's case report is presented and the detection of the other two children by family screening is described. This is the first report of CHF in a Saudi family. Review of the disease is outlined.

Should oxygen saturation be included in the vital signs sheet of all medical admissions?

Hypoxaemia is not uncommon in hospitalised patients and may be overlooked because cyanosis is a late sign. To estimate the incidence of undetected hypoxaemia we measured oxygen saturation (SpO2) by pulse oximetry randomly in medical patients who were not receiving supplemental oxygen in a teaching hospital and a community hospital. Of 580 patients studied, nine patients (1.55%) had SpO2 <92%. All nine patients had multiple morbidities, but all had cardiopulmonary disease in common. There was no significant difference between the teaching and the community hospitals. We conclude that undetected hypoxaemia is not common in patients on the medical wards, and that routine pulse oximetry is not necessary except for patients with known cardiopulmonary disease.

Pattern and antibiotic susceptibility of bacteria in pyogenic meningitis in a children's emergency room population in Maiduguri, Nigeria, 1988-1992.

From January 1988 to November 1992, 107 (3.5%) of 3074 postneonatal children admitted to the Children's Emergency Room, University of Maiduguri Teaching Hospital, Nigeria, had sporadic pyogenic meningitis; 66 (61.7%) were aged < or = 12 months. Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae together were responsible for 77.3% (58) of 75 culture-proven cases, 13.4% (10) had Enterobacteriaceae, 5.3% (4) had Staphylococcus aureus and 4% (3) untyped alpha-haemolytic streptococci. Fifty percent of 62 bacteria were resistant to ampicillin, 47.2% of 36 to penicillin and 10.7% of 56 to chloramphenicol; none of 21 bacteria was simultaneously resistant to all three antibiotics. Up until 1992, we have encountered treatment failure with a regimen containing chloramphenicol in only 2 of 53 patients; the 2 patients had coliform meningitis. Non-meningococcal bacteria are an important cause of sporadic pyogenic meningitis in sub-Saharan Nigeria and chloramphenicol is the most appropriate initial drug of choice at the present time for the management of sporadic meningitis.