Molecular diagnosis of MDR-TB using GenoType MTBDRplus 96 assay in Ibadan, Nigeria

Summary: Multidrug resistant Mycobacterium tuberculosis (MDR-TB) is of great public health importance worldwide. This three month laboratory- based study (1st September-30th November, 2011) was carried out at the TB laboratories of the University College Hospital, Ibadan, Nigeria to determine the magnitude of MDR-TB using molecular based GenoType MTBDRplus 96 assay. Two sputum samples were collected from each subject. These were processed using Ziehl -Neelsen (ZN) reagents. The sputa were cultured on Loewenstein-Jensen egg –based medium and incubated at 370C for eight weeks. Mycobacterium tuberculosis complex (MTBC) was confirmed by colonial morphology and repeat ZN staining. All the Acid-fast bacill (AFB) positive smears and culture positive isolates were tested for genetic identification and drug susceptibility testing (DST) using PCR- based GenoType MTBDRplus 96 assay (HAINs Lifesciences, GmbH, Nehren, Germany) according to manufacturers’ instructions. Of the 68 samples processed, 11 (16.2%) were AFB positive while six (8.8%) were positive for culture. Eleven (64.7%) out of the 17 samples tested for genetic identification were MTBC while six were Non Tuberculosis  Mycobacteria (NTM). All NTM were from AFB positive sputum while none was from culture positive isolates. Of the six culture isolates tested for DST, three (33.3%) were susceptible to isoniazid and rifampicin; one (16.7%) showed mono-resistance to isoniazid while two (30.0%) were resistant to the two drugs. This study shows that MDR-TB is present in Ibadan. There is a need to make DST diagnostic facilities more available and accessible in Nigeria.Keywords: Molecular diagnosis, MDR-TB, GenoType MTBDRplus 96assay, Ibadan, Nigeri

Health Literacy Amongst Tuberculosis Patient in a General Hospital in North Central Nigeria

Background: Healthy literacy has been shown to improve health care access and adherence to Tuberculosis (TB) treatment. Still it remains largely unstudied in many high risks, underserved and low literacy African populations. This study aims to bridge the existing knowledge gap by assessing health literacy among patients with TB in a rural town in Northern Nigeria.Methodology: A cross sectional study was conducted among patients who attended the TB clinic of a secondary health care facility in Babura, Jigawa State, Nigeria between Oct 2008 and March 2009. All patients who visited the TB clinic during this period were interviewed.Result: Many (71.6%) reported having been educated about TB by a health worker, mostly on predisposing factors 43.2%, general facts (31.1%) and disease process (21.6%) but less on patient's role in disease management (1.4%). Functional health literacy was high; mean score was 7.9±0.3 out of 10. Knowledge about the disease process, diagnostic requirements and treatment regimen were the highest. However 97.3% felt drugs were no longer necessary once symptoms abated. Patient involvement in treatment decisions was also suboptimal as only 52.7% reported making a joint decision about drug “pick up” options with their physicians.Conclusion: Very high functional literacy score seemed to have been achieved among these rural low literacy TB patients even without a structured health literacy program. However patient participation in treatment seems to be underemphasized and was thus suboptimal. An important gap in patient education regarding continued TB treatment was identified and should be targeted for intervention.Keywords: Health Literacy, Tuberculosis, General Hospital, Nigeri

Genome-wide association study of prevalent and persistent cervical high-risk human papillomavirus (HPV) infection

Background: Genetic factors may influence the susceptibility to high-risk (hr) human papillomavirus (HPV) infection and persistence. We conducted the first genome-wide association study (GWAS) to identify variants associated with cervical hrHPV infection and persistence. Methods: Participants were 517 Nigerian women evaluated at baseline and 6 months follow-up visits for HPV. HPV was characterized using SPF10/LiPA25. hrHPV infection was positive if at least one carcinogenic HPV genotype was detected in a sample provided at the baseline visit and persistent if at least one carcinogenic HPV genotype was detected in each of the samples provided at the baseline and follow-up visits. Genotyping was done using the Illumina Multi-Ethnic Genotyping Array (MEGA) and imputation was done using the African Genome Resources Haplotype Reference Panel. Association analysis was done for hrHPV infection (125 cases/392 controls) and for persistent hrHPV infection (51 cases/355 controls) under additive genetic models adjusted for age, HIV status and the first principal component (PC) of the genotypes. Results: The mean (±SD) age of the study participants was 38 (±8) years, 48% were HIV negative, 24% were hrHPV positive and 10% had persistent hrHPV infections. No single variant reached genome-wide significance (p < 5 X 10− 8). The top three variants associated with hrHPV infections were intronic variants clustered in KLF12 (all OR: 7.06, p = 1.43 × 10− 6). The top variants associated with cervical hrHPV persistence were in DAP (OR: 6.86, p = 7.15 × 10− 8), NR5A2 (OR: 3.65, p = 2.03 × 10− 7) and MIR365–2 (OR: 7.71, p = 2.63 × 10− 7) gene regions. Conclusions: This exploratory GWAS yielded suggestive candidate risk loci for cervical hrHPV infection and persistence. The identified loci have biological annotation and functional data supporting their role in hrHPV infection and persistence. Given our limited sample size, larger discovery and replication studies are warranted to further characterize the reported associations

Baricitinib in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial and updated meta-analysis

Background: We aimed to evaluate the use of baricitinib, a Janus kinase (JAK) 1–2 inhibitor, for the treatment of patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple possible treatments in patients hospitalised with COVID-19 in the UK. Eligible and consenting patients were randomly allocated (1:1) to either usual standard of care alone (usual care group) or usual care plus baricitinib 4 mg once daily by mouth for 10 days or until discharge if sooner (baricitinib group). The primary outcome was 28-day mortality assessed in the intention-to-treat population. A meta-analysis was done, which included the results from the RECOVERY trial and all previous randomised controlled trials of baricitinib or other JAK inhibitor in patients hospitalised with COVID-19. The RECOVERY trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936) and is ongoing. Findings: Between Feb 2 and Dec 29, 2021, from 10 852 enrolled, 8156 patients were randomly allocated to receive usual care plus baricitinib versus usual care alone. At randomisation, 95% of patients were receiving corticosteroids and 23% were receiving tocilizumab (with planned use within the next 24 h recorded for a further 9%). Overall, 514 (12%) of 4148 patients allocated to baricitinib versus 546 (14%) of 4008 patients allocated to usual care died within 28 days (age-adjusted rate ratio 0·87; 95% CI 0·77–0·99; p=0·028). This 13% proportional reduction in mortality was somewhat smaller than that seen in a meta-analysis of eight previous trials of a JAK inhibitor (involving 3732 patients and 425 deaths), in which allocation to a JAK inhibitor was associated with a 43% proportional reduction in mortality (rate ratio 0·57; 95% CI 0·45–0·72). Including the results from RECOVERY in an updated meta-analysis of all nine completed trials (involving 11 888 randomly assigned patients and 1485 deaths) allocation to baricitinib or another JAK inhibitor was associated with a 20% proportional reduction in mortality (rate ratio 0·80; 95% CI 0·72–0·89; p<0·0001). In RECOVERY, there was no significant excess in death or infection due to non-COVID-19 causes and no significant excess of thrombosis, or other safety outcomes. Interpretation: In patients hospitalised with COVID-19, baricitinib significantly reduced the risk of death but the size of benefit was somewhat smaller than that suggested by previous trials. The total randomised evidence to date suggests that JAK inhibitors (chiefly baricitinib) reduce mortality in patients hospitalised for COVID-19 by about one-fifth. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Higher dose corticosteroids in patients admitted to hospital with COVID-19 who are hypoxic but not requiring ventilatory support (RECOVERY): a randomised, controlled, open-label, platform trial

BACKGROUND: Low-dose corticosteroids have been shown to reduce mortality for patients with COVID-19 requiring oxygen or ventilatory support (non-invasive mechanical ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation). We evaluated the use of a higher dose of corticosteroids in this patient group. METHODS: This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing multiple possible treatments in patients hospitalised for COVID-19. Eligible and consenting adult patients with clinical evidence of hypoxia (ie, receiving oxygen or with oxygen saturation <92% on room air) were randomly allocated (1:1) to either usual care with higher dose corticosteroids (dexamethasone 20 mg once daily for 5 days followed by 10 mg dexamethasone once daily for 5 days or until discharge if sooner) or usual standard of care alone (which included dexamethasone 6 mg once daily for 10 days or until discharge if sooner). The primary outcome was 28-day mortality among all randomised participants. On May 11, 2022, the independent data monitoring committee recommended stopping recruitment of patients receiving no oxygen or simple oxygen only due to safety concerns. We report the results for these participants only. Recruitment of patients receiving ventilatory support is ongoing. The RECOVERY trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). FINDINGS: Between May 25, 2021, and May 13, 2022, 1272 patients with COVID-19 and hypoxia receiving no oxygen (eight [1%]) or simple oxygen only (1264 [99%]) were randomly allocated to receive usual care plus higher dose corticosteroids (659 patients) versus usual care alone (613 patients, of whom 87% received low-dose corticosteroids during the follow-up period). Of those randomly assigned, 745 (59%) were in Asia, 512 (40%) in the UK, and 15 (1%) in Africa. 248 (19%) had diabetes and 769 (60%) were male. Overall, 123 (19%) of 659 patients allocated to higher dose corticosteroids versus 75 (12%) of 613 patients allocated to usual care died within 28 days (rate ratio 1·59 [95% CI 1·20–2·10]; p=0·0012). There was also an excess of pneumonia reported to be due to non-COVID infection (64 cases [10%] vs 37 cases [6%]; absolute difference 3·7% [95% CI 0·7–6·6]) and an increase in hyperglycaemia requiring increased insulin dose (142 [22%] vs 87 [14%]; absolute difference 7·4% [95% CI 3·2–11·5]). INTERPRETATION: In patients hospitalised for COVID-19 with clinical hypoxia who required either no oxygen or simple oxygen only, higher dose corticosteroids significantly increased the risk of death compared with usual care, which included low-dose corticosteroids. The RECOVERY trial continues to assess the effects of higher dose corticosteroids in patients hospitalised with COVID-19 who require non-invasive ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation. FUNDING: UK Research and Innovation (Medical Research Council), National Institute of Health and Care Research, and Wellcome Trust

Casirivimab and imdevimab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: Casirivimab and imdevimab are non-competing monoclonal antibodies that bind to two different sites on the receptor binding domain of the SARS-CoV-2 spike glycoprotein, blocking viral entry into host cells. We aimed to evaluate the efficacy and safety of casirivimab and imdevimab administered in combination in patients admitted to hospital with COVID-19. Methods: RECOVERY is a randomised, controlled, open-label platform trial comparing several possible treatments with usual care in patients admitted to hospital with COVID-19. 127 UK hospitals took part in the evaluation of casirivimab and imdevimab. Eligible participants were any patients aged at least 12 years admitted to hospital with clinically suspected or laboratory-confirmed SARS-CoV-2 infection. Participants were randomly assigned (1:1) to either usual standard of care alone or usual care plus casirivimab 4 g and imdevimab 4 g administered together in a single intravenous infusion. Investigators and data assessors were masked to analyses of the outcome data during the trial. The primary outcome was 28-day all-cause mortality assessed by intention to treat, first only in patients without detectable antibodies to SARS-CoV-2 infection at randomisation (ie, those who were seronegative) and then in the overall population. Safety was assessed in all participants who received casirivimab and imdevimab. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between Sept 18, 2020, and May 22, 2021, 9785 patients enrolled in RECOVERY were eligible for casirivimab and imdevimab, of which 4839 were randomly assigned to casirivimab and imdevimab plus usual care and 4946 to usual care alone. 3153 (32%) of 9785 patients were seronegative, 5272 (54%) were seropositive, and 1360 (14%) had unknown baseline antibody status. 812 (8%) patients were known to have received at least one dose of a SARS-CoV-2 vaccine. In the primary efficacy population of seronegative patients, 396 (24%) of 1633 patients allocated to casirivimab and imdevimab versus 452 (30%) of 1520 patients allocated to usual care died within 28 days (rate ratio [RR] 0·79, 95% CI 0·69–0·91; p=0·0009). In an analysis of all randomly assigned patients (regardless of baseline antibody status), 943 (19%) of 4839 patients allocated to casirivimab and imdevimab versus 1029 (21%) of 4946 patients allocated to usual care died within 28 days (RR 0·94, 95% CI 0·86–1·02; p=0·14). The proportional effect of casirivimab and imdevimab on mortality differed significantly between seropositive and seronegative patients (p value for heterogeneity=0·002). There were no deaths attributed to the treatment, or meaningful between-group differences in the pre-specified safety outcomes of cause-specific mortality, cardiac arrhythmia, thrombosis, or major bleeding events. Serious adverse reactions reported in seven (<1%) participants were believed by the local investigator to be related to treatment with casirivimab and imdevimab. Interpretation: In patients admitted to hospital with COVID-19, the monoclonal antibody combination of casirivimab and imdevimab reduced 28-day mortality in patients who were seronegative (and therefore had not mounted their own humoral immune response) at baseline but not in those who were seropositive at baseline. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

BACKGROUND: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. METHODS: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). FINDINGS: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). INTERPRETATION: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids

Evaluating subscribers preference for service attributes of mobile telecommunication in Nigeria using analytic hierarchy process (AHP)

&lt;p&gt;Policy and strategies in the growing Nigerian telecommunications industry can only have significant impact if they are substantially driven by research on what subscribers prefer and why they prefer it? Thus, there is a need for an operations research model (AHP) to evaluate customer preferences for their mobile telecommunications attributes in order to direct policy and strategies toward what is important to subscribers. This paper built a hierarchical model for choice&lt;strong&gt;/&lt;/strong&gt;determinant of subscriber’s preferences for mobile telecommunications attributes in Nigeria using seven main attributes as the criteria for evaluation.  The four main players in the Global System for Mobile communication (GSM) market (MTN, Airtel, Glo and Etisalat) are the alternatives. An AHP based questionnaire was administered among students of tertiary institutions in Lagos. Out of the four hundred questionnaires distributed, three hundred and eighty six were completed, returned and found suitable for the analysis. The data was analysed, considering the set of evaluation criteria (service attributes), and a set of alternative (network providers) scenarios from which the best decision was to be made. We generated a weight for each evaluation criterion and scenario according to the information provided by the decision makers (stakeholders). AHP was used to combine the objective and scenario evaluations to determine the ranking for scenarios. The results revealed that an average student preferred network providers with low rates (affordable), followed by quality of connections and a reliable data plan for internet service. A priority was done for the criteria to direct strategic decisions in the telecommunication industry towards meeting subscriber’s needs.  Coverage was not given significant priority as the respondents assumed that all providers have similar coverage. The results of this study will help improve the quality of decision making by stakeholders.&lt;/p&gt;</jats:p

Predicting customer churn and retention rates in Nigeria’s mobile telecommunication industry using Markov chain modelling

Abstract The telecommunication industry is one of the service industries that is most affected by the problem of subscribers’ churn. Although several techniques have been used to predict customer churn in developed countries, many of those studies used secondary data which are not readily available in Nigeria for researchers. This study investigates how Markov chains help in modelling and predicting the customer churn and retention rate in the Nigerian mobile telecommunication industry. The data generated through the survey were input in the Windows-based Quantitative System for Business (WinQSB) for analysis. The results reveal that in the study area MTN has the highest retention rate (86.11%), followed by GLO (70.51%), Airtel (67%), and Etisalat (67.5%). This result has implications for telecom firms’ strategies for competitive advantage in particular and survival in general.</jats:p

Prevalence of Vulvovaginal Candidiasis Among Women with Diabetes mellitus in Ibadan, Oyo State, Nigeria

Background: Diabetes mellitus predisposes to both bacterial and fungal infections, includingCandida species. Hitherto, Candida albicans has been identified as the most common opportunistic pathogen amongpatients with diabetes mellitus. More recently, Non-Candida albicans Candida (NCAC) species are increasingly recognized as the cause of candida infections. Objective: To determine the prevalence of vulvovaginal candidiasis (VVC) as well as the species of Candida frequently identified among women with diabetes mellitus in Ibadan, Nigeria. Methods: A cross-sectional study of 213 women diagnosed with diabetes mellitus was carried out in 2010. Direct microscopy and fungal cultures of high vaginal swabs were done using Sabouraud--Dextrose Agar and ChromAgar. Results: The prevalence of VVC among 213 women with diabetic mellitus was 18.8% (40/213). The predominant Candida species isolated were Candida glabrata (30.0%), C. albicans and C. tropicalis (17.5%) each and C. Gulliermondii (15.0%). Diabetic women had higher rates of moderate and heavy growth of Candida density. Twenty-nine (72.5%) patients with candidiasis were symptomatic and the most common symptom was vulval/vaginal itching 48.3% (14/29). Conclusion: This study put the prevalence rate of VVC among women with diabetes mellitus in Ibadan at 18.8%. The most common Candida species isolated was C.glabrata and majority of the patients were symptomatic