Effect of Hepatitis-B Virus Co-Infection on CD4 Cell Count and Liver Function of HIV Infected Patients

Background: Human immunodeficiency virus (HIV) and Hepatitis B virus (HBV) share similar routes of transmission, making it possible for an individual to have a co-infection. HBV infection is well known to be a major cause of chronic liver diseases worldwide. The aim of this study was to determine the prevalence of HBV infection among HIV infected HAART naïve patients and investigate the effect of co-infection on CD4 count and liver function.Study design: This was a hospital based descriptive cross sectional study of one hundred consecutive therapy- naive HIV-infected individuals. The CD4 count, Hepatitis B surface antigen, Serum albumin, total Protein, and liver  enzymes were determined using standard techniques.Results: The prevalence of HIV and HBV co-infection was 37%. The mean serum ALT and ALP were significantly higher in the co- infected patients (P-values <0.05). The mean CD4 count of the mono infected patients was significantly higher (p-value of 0.014). The mean serum ALT, AST and ALP of mono and coinfected patients with CD4 count<200/μl were significantly higher than those with count ≥ 200 cells/μl. (pvalue of <0.01). The mean ALT and  AST of the co - infected patients and all patients with CD4 count <200 cells/μl were higher than the normal reference range.Conclusion: Approximately one third of HIV positive patients had hepatitis B virus co-infection. Coinfection and CD4 count <200 cells/μl are likely to result in abnormal ALT and AST. We recommend those co-infected patients and those with CD4 count <200 cells/μl should be given non-hepatotoxic antiretroviral drug.Keywords: HIV, Hepatitis B, CD4 count, liver function, co-infectio

Safety in the workplace: The burden and pattern of markers of Hepatitis B virus infection in routine blood samples in haematology laboratory at Irrua, Edo, Nigeria

Hepatitis B virus [HBV] infection is a worldwide problem resulting in many deaths yearly from cirrhosis and liver cancer. Regrettably also, healthcare workers get exposed to blood-borne pathogens, including hepatitis B virus at work. HBV infection in immuno-competent hosts results in acute fulminant illness which may be fatal, partially resolved to become chronic, or completely resolved. HBV immunization in the country cover neonates and health workers leaving many people uncovered. Lack of monitoring and confirmation of successful HBV immunization in heath workers reduces coverage in this group leaving many susceptible to HBV infection at work. We aimed to determine the magnitude of this risk for occupational exposure to HBV infection. We therefore analyzed sixty nine routine blood samples coming to our Haematology laboratory at Irrua, Edo, Nigeria, using the five parameter hepatitis B virus kit manufactured by Micropoint Diagnostics USA. Results showed that HBsAg, Ant-HBs, HBeAg, Anti-HBe and Anti-HBc were reactive in 11.6%, 23%, 1.4%, 7% and 7% of our study samples indicating that the burden of HBV infectivity is high. We recommend active monitoring and routine confirmation of successful HBV immunization in health workers with expansion of the program to cover more of our population.Keywords: Chronic HBV Infection, Occupational exposure, Immunization, Management of Chronic HBV infectio

Quality of care: Ensuring patient safety in blood transfusion in Irrua, Edo State Nigeria

Blood transfusion can be very beneficial and life saving to patients; though it carries with it the risk of Transfusion Transmissible Infections [TTIs] likes the Human Immuno deficiency Virus [HIV], Hepatitis B Virus [HBV], Hepatitis C Virus [HCV] and Syphilis. Unfortunately, many hospitals in Nigeria are unable to undertake adequate donor-blood screening for TTIs using the ELISA Technique, owing to lack of facilities, manpower and/or funding. As our center partners with the National Blood Transfusion Service [NBTS] for screening with ELISA, we set out to determine the prevalence of the TTIs among blood donors in order to underscore the desirability of optimal screening of blood and partnering with the NBTS to improve blood safety. Donor blood units were sent to the NBTS for rescreening with ELISA technique, after we had screened for the TTIs using rapid kits. We then reviewed the results of 613 donors over two years to determine the prevalence of TTIs among donors. Overall results showed that 86 (13.6%) was reactive for one or two of the TTIs: HIV 23(3.6%); HBV 41 (6.5%); HCV 17 (2.7%) and Syphilis 5(0.8%). Our findings suggest that screening donor blood with rapid kits only is froth with dangers to the patient; hence hospitals lacking the capacity to screen with ELISA should partner with the NBTS.Keywords: Blood Safety, ELISA Screening, Rapid Kit Screening, TTIs, NBT

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.

BACKGROUND: Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. FINDINGS: Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95% uncertainty interval 2·9-3·0) for men and 3·5 years (3·4-3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78-0·92) and 1·2 years (1·1-1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. INTERPRETATION: Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum. FUNDING: Bill & Melinda Gates Foundation

On the existence and uniqueness result for a two-step reactive-diffusive equation with variable pre-exponential factor

We examine the existence and uniqueness result of the steady-state solutions for the exothermic chemical reactions taking the diffusion of the reactants in a slab into account and assuming Arrhenius dependence with variable pre-exponential factor. We establish the criteria\'s and conditions for existence and uniqueness of solution for the newly formulated problem. It is shown that if &#915>o, 0&#8804x1&#88041, 0&#8804x2&#8804b and -c&#8804x3&#8804C where b, c and C positive constants are then the newly formulated model will have only one solution. We further discovered that there are certain values for n, m, r and &#946 that the problem can accommodate for solution to be stable. Similarly, Frank-Kamenetskii parameters &#9481, &#9482 must not exceed some values for the solution to exist and at the same time stable. Finally, the Frank-Kamenetskii parameter must not exceed the critical value for the solution to have physical implication or application and r must not be large for convergence of the solution (i.e r < 1). Journal of the Nigerian Association of Mathematical Physics Vol. 10 2006: pp. 403-40

Efficacy of the African Breadfruit DM (Treculia africana) in the Nutritional Rehabilitation of Children with Protein-energy Malnutrition

One hundred and fifty children with mild to moderate malnutrition (Group A) aged six to 66 months were recruited from four semi-urban/rural communities within Ikenne Local Government Area of Ogun State. They were offered supplementary feeds of African breadfruit (Treculia africana) porridge for a period of 12 weeks. Their anthropometric response to the feeds was compared with that of controls who were not offered the feeds and consisting of (a) 106 well-nourished children of the same ages recruited from within the same communities (Group B), and (b) 53 other children (Group C) of similar ages with similar grades of malnutrition. Observed prevalence of malnutrition in the study population ranged between 51.5 per cent and 64 per cent. No case of kwashiorkor was observed. During the study period, the mean weight gain of children in Group A was at 2.78kg 1.16, significantly greater than corresponding figures of 0.l8kg 1.26 and 0.25kg 0.91 in Groups B and C, respectively (p = 0.0000). However, the nutritional supplementation did not significantly affect the heights (p = 1.000). An improvement in the mid-upper arm circumference (MUAC) was observed in children in group A who gained a mean of 1.10cm during the study; this gain was 16 times and twice the mean gains by Groups B and C, respectively. The breadfruit porridge was found to be acceptable to 96.7 per cent of group A children, and no adverse reactions were reported or observed. African breadfruit is thus suggested as a good, locally available and acceptable food of high nutritive value in the nutritional rehabilitation of children with mild to moderate protein-energy malnutrition. Nigerian Journal of Paediatrics 2001; 28:128. pp. 128-13

Postpartum Sexual Abstinence and Breastfeeding Pattern in Sagamu, Nigeria

This was a prospective study involving 371 mothers. The mean age of the mothers was 27.5 (.3.6) years with a mean years at school (Educational years) of 11.3 (2.9) years. All the mothers had previously breastfed at one of their infants for at least 6 months, while the mothers also breastfed their last child for an average (mean) of 10.3 (4.0) months. The overall mean of previous live births was 1.9 (0.8). In the first month postpartum, 84.6% of the mothers abstained from sexual intercourse, but by the 4th-5th month the proportion had dropped to 18.1%, with just 2.1% of the study population abstaining from sexual intercourse at 11-15 months post-partum. Forty seven (13.5%), 30 (8.6% ) and 3 (0.9 % ) mothers in social classes 2,3 and 1 respectively have resumed sexual intercourse at 4-5 months, while only 12(3.4%) and 4(1.1%) in social classes 2 and 3 respectively continued with sexual intercourse at 11-15 months. More mothers resumed sexual intercourse from 1 to 15 months post-partum when they breast fed for 6-10 minutes and 11-15 minutes than those who breast fed for 1-5 minutes, 16-20 minutes and 21-25 minutes. Also more mothers within the 25-29 years age group resumed sexual intercourse from the first month to the fifteenth month post-partum than mothers in the other age groupsKeywords: Postpartum, Sexual, Abstinence, Breastfeeding, Sexually Transmitted InfectionsAfrican Journal of Reproductive Health Vol. 12 (1) 2008: pp. 96-10

The impact of acne and facial post-inflammatory hyperpigmentation on quality of life and self-esteem of newly admitted Nigerian undergraduates

Adeolu Oladayo Akinboro,1 Ogochukwu Ifeanyi Ezejiofor,2 Fatai Olatunde Olanrewaju,3 Mufutau Muphy Oripelaye,3 Olatunde Peter Olabode,4 Olugbenga Edward Ayodele,4 Emmanuel Olaniyi Onayemi3 1Dermatology Unit, Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso and LAUTECH Teaching Hospital, Ogbomoso, Nigeria; 2Dermatology Unit, Department of Medicine, Nnamdi Azikiwe University, Nnewi, Nigeria; 3Department of Dermatology and Venereology, Obafemi Awolowo University and OAUTHC, Ile-Ife, Nigeria; 4Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso and LAUTECH Teaching Hospital, Ogbomoso, Nigeria Background: Acne and facial post-inflammatory hyperpigmentation are relatively common clinical conditions among adolescents and young adults, and inflict psychosocial injuries on sufferers.Objective: To document the psychosocial and self-esteem implications of acne and facial hyperpigmentation on newly admitted undergraduates.Materials and methods: A cross-sectional survey was conducted among 200 undergraduates. Demographics and clinical characteristics were obtained and acne was graded using the US Food and Drug Administration 5-category global system of acne classification. Participants completed the Cardiff Acne Disability Index (CADI) and the Rosenberg self-esteem scale (RSES), and data were analyzed using SPSS 20.Results: Mean age of acne onset was 16.24 &plusmn; 3.32 years. There were 168 (84.0%) cases categorized as almost clear, 24 (12.0%) as mild acne, 4 (2.0%) as moderate acne and 4 (2.0%) as severe acne. Acne with facial hyperpigmentation, compared to acne without hyperpigmentation, was associated with significant level of anxiety in 30 participants (26.5% vs 10.3%, p=0.004) and emotional distress in 40 (35.4% vs 10.3%, p&lt;0.001). Acne severity correlated with total CADI score but not with total RSES score. Quality of life (QoL) was significantly reduced among acne patients with facial hyperpigmentation (1.77&plusmn;1.62, vs 1.07&plusmn;1.02, p&lt;0.001) compared to those without hyperpigmentation. Acne and facial hyperpigmentation was associated with social life interference, avoidance of public facilities, poor body image and self-esteem and perception of worse disease. There was no association between gender and QoL but acne was related to a reduction of self-worth. Low self-esteem was present in 1.5%, and severe acne was associated with an occasional feeling of uselessness in the male gender. Conclusion: Acne with facial hyperpigmentation induces poorer QoL and self-esteem is impaired only in severe acne. Beyond the medical treatment of acne, dermatologists should routinely assess the QoL and give attention to treatment of facial post-inflammatory hyperpigmentation among people of color. Keywords: acne, quality of life, self-esteem, facial hyperpigmentation, undergraduate