Health careworkers and risk of hospital-related tuberculosis

To determine the incidence and risk of hospital-related TB amongst the health care workers and trainee students of this institution.Retrospective study. Chart review of PTB and EPTB diagnosed byAAFB in sputum, suggestive chest X-ray features of TBand aspiration cytology or tissue histology. Thirty-two (1.5%) of the 2,173 total staff strength developed occupation-related TB in a 15 year period, 15 (47.0%) of which presented as HIV/TB co-infection. Junior HCWs were mostly affected and the male:female ratiowas about 1:2. PTB occurred in 25 staffs (78.1%), EPTB occurred in 5 (15.6%) and 2 (6.3%) had disseminated TB. HCWs directly caring for patients; 24 (75.0%) were mostly affected. They were HCWs from nursing, 15 (47.0%) and clinical services, 9 (28.0%). Duration of employment of the affected HCWs varied from half a year to 11.5 years and the rate of diagnosis of cases varied from nil to 3 per year. Identified risks for acquiring and developing active TB in the hospitalwere; HIVinfection 47.%, diabetesmellitus 9.4%, “alcoholic” liver cirrhosis; 6.3%and chronic obstructive pulmonary disease 3.1%. Incidence of hospital-related TB is low amongst the staffs of UITH; however, all the HCWs of the hospital were at risk of exposure. Staffs at the clinical sections had the highest frequency of developing occupation-relatedTB, and HIV infectionwas the commonest risk factor. . Keywords:Hospital-related TB; Health care workers and Risk factors Nigerian Journal of Clinical Practice Vol. 11 (1) 2008: pp.32-3

HIV-associated neurosyphilis: Report of a fatal case due to fear of work-place stigma

Syphilis and HIV infection are two STI diseases that have bidirectional influence on the clinical course of each other. There is a high risk of neurological extension if syphilis is not diagnosed early or if the patient has a co-infection with HIV. Both diseases have stigma associated with them and could affect the compliance to treatment, as was the case with this young employee of the medical department of a Nigerian tertiary hospital. He was diagnosed with HIV/ neurosyphilis co-infection and responded to penicillin therapy, but the fear of stigma at his workplace has made him to abandon hospital treatment for unorthodox therapy, which unfortunately cost him his life.Syphilis et infection par le VIH sont deux maladies qui ont des STI bidirectionnel infl uence sur l\u2019\ue9volution clinique de l\u2019autre. Il ya un risque \ue9lev\ue9 de troubles neurologiques extension si la syphilis n\u2019est pas diagnostiqu\ue9 \ue0 un stade pr\ue9coce ou si le patient a une co-infection avec le VIH. Les deux maladies sont les stigmatiser et pourrait infl uer sur la conformit\ue9 du traitement, comme ce fut le cas avec ce jeune personnel m\ue9dical d\u2019un h\uf4pital tertiaire nig\ue9riane. Il a re\ue7u un diagnostic de neurosyphilis et a r\ue9pondu \ue0 la th\ue9rapie de p\ue9nicilline, mais la peur de la stigmatisation \ue0 son lieu de travail a fait de lui \ue0 renoncer \ue0 l\u2019h\uf4pital pour un traitement de th\ue9rapie peu orthodoxe qui, malheureusement, lui a co\ufbt\ue9 la vie

General practitioner reported follow–up visits among asthma patients in North Central Nigeria

Background: Despite the benefits of regular follow–up in the long–term care of asthma, no previous study has reported on it among asthma patients in Nigeria. Objective: This survey was designed to evaluate GP–reported follow–up visits among asthma patients in North Central Nigeria. Methods: It was a cross–sectional survey conducted among GPs in three North Central states of Nigeria. Results: Overall, 48.3% of the GPs reported that their patients usually come for follow-up visits. About 63.6%, 40.0%, and 55.3% of the GPs in Kwara, Kogi, and Niger states, respectively, reported that their patients came for follow–up visits in the month prior to this study. Less than two–third of GPs in both private (55.1%) and public (56.8%) hospitals reportedly attended to patients on follow–up visits. About 46.5%, 37.5%, and 52.0% of the GPs who attended to patients 2 weeks prior to the study reported that their patients came for follow–up visits. There was signifi cant difference (P = 0.04) in the reported follow–up visits by GPs who attended to ≥ 10 asthma patients compared to others. None of the nine GPs who reportedly treated ≥ 10 patients in the preceding month of the study attended to any patient on follow–up visits. Conclusion: The GP–reported rates of follow–up visits in patients that are accessing asthma care from GPs practicing in the North Central part of Nigeria are low. Further studies to identify barriers to follow–up visits and how to correct them are therefore recommended.Keywords: Asthma care, follow—up visits general practitioners, NigeriaArrière-plan: Malgré les avantages de suivi régulier–jusqu’à long - term care de l’asthme, aucune étude antérieure n’a signalé sur elle chez les patients asthmatiques au Nigeria. Objectif: Ce sondage a été conçu pour évaluer les GP–signalés suivi–visites chez les patients asthmatiques au Centre Nord du Nigéria. Méthodes: C’est une croix–sectionnelle enquête menée parmi les GPs dans trois États centrale du Nord du Nigéria. Résultats: Dans l’ensemble, 48,3% des GPs a signalé que les patients sont en général pour des visites de suivi. 63,6% Environ, 40,0% 55,3% des GPs dans les États Kwara, Kogi et au Niger, respectivement, rapporte et que leurs patients sont venus pour suivi–visites dans le mois précédant cette étude. Moins de deux - tiers des GPs dans les hôpitaux publics (56,8%) et le privé (55,1%) auraient été assisté aux patients sur suivi–visites. Environ 46,5%, 37,5% et 52,0% le GPS qui ont participé aux patients 2 semaines avant l’étude rapporte que leurs patients sont venus pour suivi–visites. Il y avait une différence signifi cative (P = 0,04) dans le suivi déclaré–up visites par GPs qui ont participé à ≥ 10 patients asthmatiques par rapport aux autres. Aucun des neuf GPs qui auraient été traités ≥ 10 patients dans le mois précédent de l’étude ont assisté à tout patient sur suivi–visites. Conclusion: Le GP–taux signalés de suivi–visites chez les patients qui sont à accéder aux soins de l’asthme de GPs pratiquant dans la partie centrale du Nord du Nigéria sont faibles. D’autres études pour identifi er les obstacles à suivre–visites et comment à correct eux sont donc recommandés.Mots clés: L’asthme care, suivre — up généralistes, des visites, Nigeri

Stability and Release Kinetics of an Advanced Gliclazide-Cholic Acid Formulation: The Use of Artificial-Cell Microencapsulation in Slow Release Targeted Oral Delivery of Antidiabetics

Introduction: In previous studies carried out in our laboratory, a bile acid (BA) formulation exerted a hypoglycaemic effect in a rat model of type-1 diabetes (T1D). When the antidiabetic drug gliclazide (G) was added to the bile acid, it augmented the hypoglycaemic effect. In a recent study, we designed a new formulation of gliclazide-cholic acid (G-CA), with good structural properties, excipient compatibility and exhibits pseudoplastic-thixotropic characteristics. The aim of this study is to test the slow release and pH-controlled properties of this new formulation. The aim is also to examine the effect of CA on G release kinetics at various pH values and different temperatures. Method: Microencapsulation was carried out using our Buchi-based microencapsulating system developed in our laboratory. Using sodium alginate (SA) polymer, both formulations were prepared: G-SA (control) and G-CA-SA (test) at a constant ratio (1:3:30), respectively. Microcapsules were examined for efficiency, size, release kinetics, stability and swelling studies at pH 1.5, pH 3, pH 7.4 and pH 7.8 and temperatures of 20 and 30 °C. Results: The new formulation is further optimised by the addition of CA. CA reduced microcapsule swelling of the microcapsules at pH 7.8 and pH 3 at 30 °C and pH 3 at 20 °C, and, even though microcapsule size remains similar after CA addition, percent G release was enhanced at high pH values (pH 7.4 and pH 7.8, p < 0.01). Conclusion: The new formulation exhibits colon-targeted delivery and the addition of CA prolonged G release suggesting its suitability for the sustained and targeted delivery of G and CA to the lower intestine

A 37-year-old woman presenting with impaired visual function during antituberculosis drug therapy: a case report

Abstract Introduction Combination antituberculosis drug therapy remains the mainstay of treating tuberculosis. Unfortunately, antituberculosis drugs produce side effects including (toxic) impaired visual function, which may be irreversible. We report a case of antituberculosis-drug-induced impaired visual function that was reversed following early detection and attention. Case presentation A 37-year-old Yoruba woman, weighing 48 kg, presented to our facility with impaired visual functions and mild sensory polyneuropathy in about the fourth month of antituberculosis treatment. Her therapy comprised ethambutol 825 mg, isoniazid 225 mg, rifampicin 450 mg, and pyrazinamide 1200 mg. Her visual acuity was 6/60 in her right eye and 1/60 in her left eye. She had sluggish pupils, red-green dyschromatopsia, hyperemic optic discs and central visual field defects. Her intraocular pressure was 14 mmHg. Her liver and kidney functions were essentially normal. Screening for human immunodeficiency virus was not reactive. Her impaired visual function improved following prompt diagnosis and attention, including the discontinuation of medication. Conclusions The ethambutol and isoniazid in antituberculosis medication are notorious for causing impaired visual function. The diagnosis of ocular toxicity from antituberculosis drugs should never be delayed, and should be possible with the patient's history and simple but basic eye examinations and tests. Tight weight-based antituberculosis therapy, routine peri-therapy visual function monitoring towards early detection of impaired function, and prompt attention will reduce avoidable ocular morbidity.</p

Reference values of haematological parameters of healthy adults in the north central zone of Nigeria

Background: Haematological parameters differ from one population to another due to several factors. To determine the clinical implication of the blood parameters of an individual in the state of health or disease, we need to have the knowledge of the normal reference range for that locality.Objectives: To determine the reference values of haematological parameters of apparently healthy adults in Ilorin.Design: A descriptive cross sectional study.Setting: Ilorin, North Central zone of NigeriaSubjects: Nine hundred and ten (443 males and 467 females) randomly selected normal, HIV negative individuals aged 18-65 yearsResults: The red blood cell count, Haemoglobin concentration, PCV and MCHC were significantly higher among males than females while the platelet count, total WBC count and absolute neutrophil count were significantly higher in females than in males. There was however no significant gender difference in the values of MCV, MCH and absolute lymphocyte count. The normal reference values obtained in this study were notably different from those that are used currently in the hospital.Conclusion: The normal reference value obtained in this study was notable different from those that are currently used in the hospital. These findings will have clinical implications regarding the adjustment of our current reference values and definitely add value to the management of patients in this part of the country

Diabetes and hypertension increase the placental and transcellular permeation of the lipophilic drug diazepam in pregnant women

Background: Previous studies carried out in our laboratories have demonstrated impaired drug permeation in diabetic animals. In this study the permeation of diazepam (after a single dose of 5 mg/day, administered intramuscularly) will be investigated in diabetic and hypertensive pregnant women.Methods: A total 75 pregnant women were divided into three groups: group 1 (healthy control, n = 31), group 2 (diabetic, n = 14) and group 3 (hypertensive, n = 30). Two sets of diazepam plasma concentrations were collected and measured (after the administration of the same dose of diazepam), before, during and after delivery. The first set of blood samples was taken from the mother (maternal venous plasma). The second set of samples was taken from the fetus (fetal umbilical venous and arterial plasma). In order to assess the effect of diabetes and hypertension on diazepam placental-permeation, the ratios of fetal to maternal blood concentrations were determined. Differences were considered statistically significant if p=0.05.Results: The diabetes and hypertension groups have 2-fold increase in the fetal umbilical-venous concentrations, compared to the maternal venous concentrations. Feto: maternal plasma-concentrations ratios were higher in diabetes (2.01 ± 1.10) and hypertension (2.26 ± 1.23) groups compared with control (1.30 ± 0.48) while, there was no difference in ratios between the diabetes and hypertension groups. Umbilical-cord arterial: venous ratios (within each group) were similar among all groups (control: 0.97 ± 0.32; hypertension: 1.08 ± 0.60 and diabetes: 1.02 ± 0.77).Conclusions: On line with our previous findings which demonstrate disturbed transcellular trafficking of lipophilic drugs in diabetes, this study shows significant increase in diazepam placental-permeation in diabetic and hypertensive pregnant women suggesting poor transcellular control of drug permeation and flux, and bigger exposure of the fetus to drug-placental transport

Short Conduction Delays Cause Inhibition Rather than Excitation to Favor Synchrony in Hybrid Neuronal Networks of the Entorhinal Cortex

How stable synchrony in neuronal networks is sustained in the presence of conduction delays is an open question. The Dynamic Clamp was used to measure phase resetting curves (PRCs) for entorhinal cortical cells, and then to construct networks of two such neurons. PRCs were in general Type I (all advances or all delays) or weakly type II with a small region at early phases with the opposite type of resetting. We used previously developed theoretical methods based on PRCs under the assumption of pulsatile coupling to predict the delays that synchronize these hybrid circuits. For excitatory coupling, synchrony was predicted and observed only with no delay and for delays greater than half a network period that cause each neuron to receive an input late in its firing cycle and almost immediately fire an action potential. Synchronization for these long delays was surprisingly tight and robust to the noise and heterogeneity inherent in a biological system. In contrast to excitatory coupling, inhibitory coupling led to antiphase for no delay, very short delays and delays close to a network period, but to near-synchrony for a wide range of relatively short delays. PRC-based methods show that conduction delays can stabilize synchrony in several ways, including neutralizing a discontinuity introduced by strong inhibition, favoring synchrony in the case of noisy bistability, and avoiding an initial destabilizing region of a weakly type II PRC. PRCs can identify optimal conduction delays favoring synchronization at a given frequency, and also predict robustness to noise and heterogeneity

Pseudomonas aeruginosa Pili and Flagella Mediate Distinct Binding and Signaling Events at the Apical and Basolateral Surface of Airway Epithelium

Pseudomonas aeruginosa, an important opportunistic pathogen of man, exploits numerous factors for initial attachment to the host, an event required to establish bacterial infection. In this paper, we rigorously explore the role of two major bacterial adhesins, type IV pili (Tfp) and flagella, in bacterial adherence to distinct host receptors at the apical (AP) and basolateral (BL) surfaces of polarized lung epithelial cells and induction of subsequent host signaling and pathogenic events. Using an isogenic mutant of P. aeruginosa that lacks flagella or utilizing beads coated with purified Tfp, we establish that Tfp are necessary and sufficient for maximal binding to host N-glycans at the AP surface of polarized epithelium. In contrast, experiments utilizing a P. aeruginosa isogenic mutant that lacks Tfp or using beads coated with purified flagella demonstrate that flagella are necessary and sufficient for maximal binding to heparan sulfate (HS) chains of heparan sulfate proteoglycans (HSPGs) at the BL surface of polarized epithelium. Using two different cell-free systems, we demonstrate that Tfp-coated beads show highest binding affinity to complex N-glycan chains coated onto plastic plates and preferentially aggregate with beads coated with N-glycans, but not with single sugars or HS. In contrast, flagella-coated beads bind to or aggregate preferentially with HS or HSPGs, but demonstrate little binding to N-glycans. We further show that Tfp-mediated binding to host N-glycans results in activation of phosphatidylinositol 3-kinase (PI3K)/Akt pathway and bacterial entry at the AP surface. At the BL surface, flagella-mediated binding to HS activates the epidermal growth factor receptor (EGFR), adaptor protein Shc, and PI3K/Akt, and induces bacterial entry. Remarkably, flagella-coated beads alone can activate EGFR and Shc. Together, this work provides new insights into the intricate interactions between P. aeruginosa and lung epithelium that may be potentially useful in the development of novel treatments for P. aeruginosa infections

Risk factors for default from tuberculosis treatment in HIV-infected individuals in the state of Pernambuco, Brazil: a prospective cohort study

BACKGROUND: Concomitant treatment of Human Immunodeficiency Virus (HIV) infection and tuberculosis (TB) presents a series of challenges for treatment compliance for both providers and patients. We carried out this study to identify risk factors for default from TB treatment in people living with HIV. METHODS: We conducted a cohort study to monitor HIV/TB co-infected subjects in Pernambuco, Brazil, on a monthly basis, until completion or default of treatment for TB. Logistic regression was used to calculate crude and adjusted odds ratios, 95% confidence intervals and P-values. RESULTS: From a cohort of 2310 HIV subjects, 390 individuals (16.9%) who had started treatment after a diagnosis of TB were selected, and data on 273 individuals who completed or defaulted on treatment for TB were analyzed. The default rate was 21.7% and the following risk factors were identified: male gender, smoking and CD4 T-cell count less than 200 cells/mm3. Age over 29 years, complete or incomplete secondary or university education and the use of highly active antiretroviral therapy (HAART) were identified as protective factors for the outcome. CONCLUSION: The results point to the need for more specific actions, aiming to reduce the default from TB treatment in males, younger adults with low education, smokers and people with CD4 T-cell counts < 200 cells/mm3. Default was less likely to occur in patients under HAART, reinforcing the strategy of early initiation of HAART in individuals with TB