Prognosis and outcome of acute stroke in the University College Hospital Ibadan, Nigeria

Background: Many factors influence the outcome of acute stroke, the third leading cause of morbidity and mortality globally.Objective: To identify the determinants of outcome of acute stroke.Materials and Methods: A prospectively study of 66 adult patients who presented to the medical emergency unit of University College Hospital (U.C.H), Ibadan, in coma from acute stroke, from August 2004 to March 2005, was undertaken after obtaining ethical clearance and written consent of the patients’ relations.Result: Acute stroke constituted 33% of medical coma, 3.2% of hospital emergencies, 1.0% of total hospital admissions, and 7.3% of medical deaths during the study period. The stroke subtypes were intracerebral hemorrhage (78.8%) and large cerebral infarction (21.2%) with respective case fatalities of 69.7% and 13.6% at 4 weeks. Males constituted 75.8% of the patient population with sex-specific mortality of 68.2%. The highest age specific mortality of 65.2% was in the 40-59 years group. The common risk factors were systemic hypertension, obesity, alcohol/substance abuse, and diabetes mellitus. Co-morbidities included aspiration pneumonia, recurrent seizures, hyperglycemia, and sepsis.Conclusion: Age above 39 years, male gender, systemic hypertension, early onset of coma after stroke, and presence of co-morbidities were associated with poor stroke outcome

Treatment Outcomes in Patients Receiving Combination Antiretroviral Therapy in Central Hospital, Benin City, Nigeria

Purpose: This study investigated mortality rate, early CD4 responses, pattern of ARVs substitutions and medication adherence of HIV-infected patients on first-line triple combination antiretroviral therapy (ART) in Central Hospital, Benin City, Nigeria. Methods: A retrospective assessment of 196 HIV-infected patients on first-line combination ART regimens was performed following 18 months of therapy. Medication adherence assessment of a 69- patient follow-up target group was based on a study-specific questionnaire. Paired sample t-test and simple linear correlation were used to test the association of the CD4-cell counts at different time intervals. Kaplan-Meier model was used to assess survival functions while log-rank test was applied to assess statistical difference at 95 % confidence interval (CI). Mean age of participants was 33.6 years (95 % CI, 32.1 - 35.2; 67.9 % were females. Results: At ART initiation, 27.0 % were at WHO clinical stage II, 47.0 % at stage III. Mortality rate (N = 196) was 20.3 deaths per 100 patient-months; 31.6 % occurred in < 30 days while 52.6 % occurred post-120 days of treatment. The mean CD4-cell count (cells/mm3) at ART initiation was 179.2 which increased to 328.5 at 3 months, 325.6 at 6 months, 357.4 at 12 months, and 366.7 at 18 months, (p < 0.01). Patients started on stavudine-based or efavirenz-based regimens were considerably more likely to have that drug substituted, compared to patients started on zidovudine-based or nevirapine-based regimens. The level of adherence reported after 18 months on ART was 73.8 %. Conclusion: In this setting, patients receiving ART showed significant improvements in CD4-cell status but adherence level was relatively poor. Patients were more stable on zidovudine-based or nevirapinebased regimens than on stavudine-based or efavirenz-based regimens. Early mortality rate was high, indicating a need for early interventions.Keywords: Antiretroviral therapy; HIV/AIDS; Mortality; Therapy outcomes, Nigeri

Photosynthetic acclimation to temperature of four Eucalyptus species and Sequoia sempervirens

The 3-PG physiological/mensurational hybrid model is a useful forest management tool capable of producing accurate growth results across a number of parameterised species. The temperature data used in the model are the average maximum and minimum values for photosynthesis above the compensation point (Landsberg and Sands 2011). There is a minimum temperature below which positive net CO₂ exchange will not occur, a maximum temperature above which it will not occur and an optimum temperature at which it is maximised. These parameters are used in the 3-PG physiological model of forest production. However, a species’ photosynthetic response to short-term variation may differ from one season to another as species acclimate to temperatures over periods of a few weeks. In this study, acclimation responses of four species of eucalypt and Sequoia sempervirens to long-term temperatures were studied over a wide range of short-term temperature changes in order to identify the minimum, optimum and maximum temperatures of CO₂ assimilation for physiological/mensurational hybrid modelling, and also to identify the sites for which the species would be best suited. In order to achieve the aims of this study, a growth chamber experiment was established. Seedlings of four eucalypt species and Sequoia sempervirens were grown at base-line day/night temperatures of 30/16, 22/12 and 10/5ºC in controlled environment chambers for three months and leaf gas exchange measurements were made of the species at seven short-term temperature levels (5, 10, 15, 20, 25, 30 and 35ºC). The optimum and the maximum temperatures for net photosynthesis increased with an increase in base-line temperature for all species. The highest optimum temperature and net photosynthetic rates recorded were in plants grown at 30/16ºC and the lowest were in those grown at 10/5ºC. The maximum rate of net CO₂ assimilation increased with the temperature at which plants were grown partly because of acclimation in key photosynthetic processes in the Calvin cycle. Responses of maximal carboxylation rate (Vcmax) and also the maximal light-driven electron flux (Jmax) to short-term temperature change varied with base-line temperature for all species studied. Net photosynthesis and photosynthetic parameters measured did not vary significantly with effects of nitrogen, phosphorus and their interaction (p = 0.1468). The ratio of Jmax to Vcmax decreased with increasing leaf temperatures for all species (p < 0.001). These results indicate that the species studied will adapt to long-run changes in temperature, and the parameters obtained from these studies can be used for models that simulate the physiology and growth of the species.

Public health in community pharmacy: a systematic review of pharmacist and consumer views

BACKGROUND The increasing involvement of pharmacists in public health will require changes in the behaviour of both pharmacists and the general public. A great deal of research has shown that attitudes and beliefs are important determinants of behaviour. This review aims to examine the beliefs and attitudes of pharmacists and consumers towards pharmaceutical public health in order to inform how best to support and improve this service. METHODS Five electronic databases were searched for articles published in English between 2001 and 2010. Titles and abstracts were screened by one researcher according to the inclusion criteria. Papers were included if they assessed pharmacy staff or consumer attitudes towards pharmaceutical public health. Full papers identified for inclusion were assessed by a second researcher and data were extracted by one researcher. RESULTS From the 5628 papers identified, 63 studies in 67 papers were included. Pharmacy staff: Most pharmacists viewed public health services as important and part of their role but secondary to medicine related roles. Pharmacists' confidence in providing public health services was on the whole average to low. Time was consistently identified as a barrier to providing public health services. Lack of an adequate counselling space, lack of demand and expectation of a negative reaction from customers were also reported by some pharmacists as barriers. A need for further training was identified in relation to a number of public health services. Consumers: Most pharmacy users had never been offered public health services by their pharmacist and did not expect to be offered. Consumers viewed pharmacists as appropriate providers of public health advice but had mixed views on the pharmacists' ability to do this. Satisfaction was found to be high in those that had experienced pharmaceutical public health. CONCLUSIONS There has been little change in customer and pharmacist attitudes since reviews conducted nearly 10 years previously. In order to improve the public health services provided in community pharmacy, training must aim to increase pharmacists' confidence in providing these services. Confident, well trained pharmacists should be able to offer public health service more proactively which is likely to have a positive impact on customer attitudes and health

Adverse drug reactions to antiretroviral therapy: Results from spontaneous reporting system in Nigeria

Aim: This study evaluated the suspected adverse drug reactions (ADR) reported from a spontaneous reporting program in Human Immunodeficiency Virus (HIV) positive patients receiving antiretroviral therapy (ART) in Nigeria Materials and Methods: This descriptive study analyzed individual case safety reports (ICSRs) in HIV-positive patients receiving ART between January 2011 and December 2011 in 38 secondary hospitals. All ICSRs during this period were included. Chi-square was used to test the association between variables at 95% confidence interval. Results: From 1237 ICSRs collated, only 1119 (90.5%) were valid for analysis. Mean age of patients was 35.3 (95%CI, 35.1-35.5) years; and 67.1% were females. A total of 1679 ADR cases were reported, a mean (± Standard Deviation, SD) of 1.5 (± 0.8) ADR cases per patient. Of reported ADRs, 63.2%, 8.2% and 19.3% occurred in patients on Zidovudine-based, Stavudine-based and Tenofovir-based regimens, respectively. The commonest ADRs included (12.0%) peripheral neuropathy, (11.4%) skin rash, (10.1%) pruritus and (6.5%) dizziness. ADR occurrence was associated with ART regimens, concomitant medicines and age (P < 0.05) unlike gender. Anaemia was associated with Zidovudine (AZT)/ Lamivudine (3TC) /Nevirapine (NEV) regimen [Odds ratio, OR = 6.4 (3.0-13.8); P < 0.0001], and peripheral neuropathy with Stavudine (d4T)/3TC/NEV regimen [OR = 8.7 (5.8-30.0), P < 0.0001] and Tenofovir (TDF)/Emtricitabine (FTC)/Efavirenz (EFV) regimen [OR = 2.1 (1.0-4.1), P = 0.0446]. Skin rash and peripheral neuropathy were associated with patients aged < 15years [OR = 3.0 (1.3-6.6), P = 0.0056] and 45-59years [OR = 1.9 (1.3-2.7), P = 0.0006] respectively. Palpitation and polyuria were associated with Salbutamol [OR = 55.7 (4.9-349.6), P = 0.0000] and Nonsteroidal anti-inflammatory drugs (NSAIDS) [OR = 50.2 (0.9-562.1), P = 0.0040] respectively. Conclusion: ADRs were less likely to occur in patients on stavudine-based and tenofovir-based regimens compared to zidovudine-based regimens. Peripheral neuropathy was also found to be associated with tenofovir-based regimen. This may require further studies and evaluation