Contemporary Anti-Retroviral Drugs (ARVDs) Disrupt Follicular Development in Female Wistar Rats.

Introduction: There are genuine concerns that long-term use of anti-retroviral drugs may be associated with reproductive complications in females. This study aimed to ascertain the effect of highly active anti-retroviral drugs on the ovarian reserve and reproductive potential of female Wistar rats and by extension to HIV-positive human females. Methods: A total of 25 female Wistar rats, weighing between 140g and 162g, were randomly allotted into non-intervention and intervention groups, receiving the anti-retroviral drugs, Efavirenz (EFV), Tenofovir Disoproxil Fumarate (TDF), Lamivudine (3TC), and a fixed-dose combination (FDC). The dosage was administered orally at 8 am daily for 4 weeks. Serum concentrations of anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), luteinising hormone (LH), and estradiol were measured using standard biochemical techniques (ELISA). Follicular counts were made on fixed ovarian tissue from the sacrificed rats. Results: The mean AMH level for the control group and the EFV, TDF, 3TC, and FDC groups were 11.20, 6.75, 7.30, 8.27, and 6.60 pmol/L, respectively. The EFV and FDC groups had the lowest AMH, compared to the other groups, but there was no statistically significant difference in AMH across the groups. The mean count of antral follicles was significantly lower in the group that received EFV when compared to the other groups. The corpus luteal count was significantly higher in the control group than in the intervention groups. Conclusion: The study demonstrated a disruption in the reproductive hormones of female Wistar rats receiving anti-retroviral regimens containing EFV. Clinical studies are required to determine if these changes are seen in women receiving EFV-based treatment, as this may compromise reproductive function and predispose them to early menopause.

A survey of chloroquine use for prevention and treatment of COVID-19 in Nigeria.

Background: Rampant chloroquine/hydroxychloroquine poisoning in Nigerian hospitals following suggestions of its possible efficacy in the treatment and prevention of the newly emerged COVID-19 disease informed this survey. Objectives: The aim of this study was to assess the knowledge, attitude and perception of the Nigerian populace on the use of chloroquine in the COVID-19 pandemic. Methods: This cross-sectional study was done by administering an electronic questionnaire created using Google Docs, through social media cascade methods including the WhatsApp application software to capture data on chloroquine use between April 20 and June 20, 2020. Results: Six hundred and twenty-eight people responded to the questionnaire (response rate 99.2%, mean age 41.05 ± 12.3) from the six geopolitical zones in Nigeria with 556 (88.5%) having tertiary level education. Only 21 (3.3%) of the respondents took chloroquine for treatment or prevention. Respondents from the North-west geopolitical zones used chloroquine 5.8 (95% CI: 1.55, 21.52, p=0.02) more times than other zones while the age group 20-29 were 8.8 times more likely to use chloroquine than any other age group (95% CI: 3.53, 21.70, p = 0.00). Female respondents were 2.3 times more likely to use chloroquine than the males (OR 2.26 95% CI: 0.90-5.68; p=0.08) and those in the income bracket of N75,000-99,000, 2.5 times more than other income groups. Conclusion: Young adults, North-western geopolitical zone, and female gender should be target groups for education on rational chloroquine use. The danger of chloroquine overdose should be communicated to the general population in Nigeria.

Self-reported use of and access to personal protective equipment among healthcare workers during the COVID-19 outbreak in Nigeria.

The SARS-CoV-2 virus is highly infectious resulting in increased infection and death among the front-line Healthcare Workers (HCW) because of limited access to personal protective equipment (PPE). This study assesses the availability and self-reported use of PPE amongst HCW during the COVID-19 pandemic in Nigeria. A mixed-method study was conducted through a cross-sectional survey and in-depth interviews amongst HCW. Quantitative data analysis was done using SPSS version 26 and thematic analysis was done for the in-depth interview. A total of 258 HCW completed the survey while 15 HCW took part in the in-depth interview. The mean age was 40 (±8.6) years, 67.4% were female and 83.3% were married. 49% were Doctors, 21.1% were Nurses, 28.7% were other allied HCW and 62.2% had at least 10 years of practice experience. Only 22.1% of HCWs had regular access to PPE and only 20.6% had access to N-95 facemask compare to other PPEs. Male HCWs and those working at secondary or tertiary facilities had access to N-95 facemask (p-value 0.025 and 0.010 respectively). The facilitator of PPE use is leadership quality of hospital head and donation of PPE to the facilities while the barriers to PPE use include a limited supply of PPE, as well as facility's infrastructural and operational challenges. The study reported limited access to essential PPE with varying perspectives on its use. Therefore, access, knowledge, and appropriate use of PPE need urgent attention with improved implementation of infection control policy at the facility level.

Implementation of a modified drive-through sampling strategy for SARS-CoV-2-the Nigerian experience.

INTRODUCTION: effective and safe means of sample collection is a crucial component of testing for Covid-19. Uptake of testing is key to containing and controlling the spread of the virus. Scientists have been working on various strategies that will increase the uptake of testing for COVID-19. One such method involves the use of the drive-through sampling strategy. METHODS: data was collected by both qualitative and quantitative methods. An eligibility form was filled online. While in-depth interviews were conducted for the qualitative aspect of the study. RESULTS: 2,600 visits were recorded at the website, 2300 (88.46%) participants successfully registered for the test. 57.4% were found eligible of which 78.0% presented for the test. This Consisted of 78.0% drive-through and 22.0% walk-in. The average time for transiting through the drive-through site was 19.2 ± 4.6minutes while that of the walk-in was 28 ± 9.2min. This difference was statistically significant (p<0.001). In the qualitative component, respondents opined that maximum safety measures were deployed to protect both participants and health workers. Most said that the turnaround time for the sampling process was short. CONCLUSION: the sampling strategy although largely successful, is largely dependent on Internet penetrability, thus this sampling modality will be best utilized as an adjunct to established models of sample collection.

Diuretic drugs benefit patients with hypertension more with night-time dosing.

OBJECTIVES: Night-time chronotherapy in antihypertensive drugs has been shown to produce better blood pressure control and protect from cardiovascular morbidity and mortality. To date, this has been proven for several drug classes excluding thiazides diuretics. Given the peculiar response of blood pressure to thiazides in black people we sought to determine whether night-time chronotherapy with thiazides produces better control as already shown with other drug classes. METHODS: A subanalysis of a larger chronotherapy study with antihypertensive drugs in Nigerian Africans was done. The subpopulation of those whose disease was controlled after 12 weeks of diuretic monotherapy was analysed. Those who received drugs in the morning and at night were compared along control lines and some cardiac indices. RESULTS: Both groups were similar on all scores at baseline. After 12 weeks of monotherapy patients who received drugs at night had significantly lower systolic and diastolic blood pressure though control was achieved with both morning and night-time dosing. Also the left ventricular posterior and septal walls regressed better as well as left ventricular mass in the night-time group. CONCLUSION: Though equally effective in reducing blood pressure and cardiac indices related to hypertension, patients taking their drugs at night recorded better values. This makes diuretics equally amenable to night-time chronotherapy as other drug classes. This effect should be explored to reduce the morbidity and mortality consequences of hypertension.

Chronotherapy in Nigerian hypertensives.

OBJECTIVES: Hypertension continues to cause significant morbidity and mortality worldwide, and the situation is worse in Blacks. Treatment has proved to be beneficial, but control has remained abysmal. Night-time chronotherapy is producing better control and outcome, but has only largely been tried in the West. This work attempts to see what benefits would emerge with night-time chronotherapy as compared with the current recommended morning intake of antihypertensives in an entirely African cohort. METHODS: Ambulant grade 1 and 2 hypertensives attending our outpatient service were randomized after a washout period into morning or night-time ingestion groups. Drugs were tailored towards each patient's cardiovascular disease profile and reviewed to ensure control. They were comprehensively evaluated on enrolment and 12 weeks later. RESULTS: Both groups were similar on all scores at baseline. After 12 weeks of treatment, the mean changes in diastolic blood pressure (DBP), mean arterial pressure (MAP), left ventricular posterior diameter (LVPWD) and left ventricular mass (LVM) were greater, to a statistically significant extent in the night-time group. The difference in the systolic blood pressure (SBP) and interventricular septum diameter (IVSD) tended to be greater in the same group but did not differ between the groups to a statistically significant extent. CONCLUSION: Chronotherapeutic studies in the West recorded greater success with night-time ingestion which produced better control and a day-long profile. Generalization to other races was cautioned against until such observations could be replicated. We have shown that patients using their once-daily antihypertensives at night after 12 weeks recorded better reductions in SBP, DBP, MAP, LVPWD, IVSD and LVM. Since blood pressure problems run a worse course in Blacks, we recommend encouragement of night-time intake in those preferring it and suggest that in those requiring two or more drugs one should be taken at night.