Biomarkers and histopathologic changes in rats with monocrotaline-induced pulmonary hypertension following administration of antiretroviral medications.

Masters Degree. University of KwaZulu-Natal, Durban.Pulmonary hypertension (PH) is a progressive life-threatening vasculopathy characterized by dysregulated pulmonary vascular remodelling that results in an increased pulmonary vascular resistance, right ventricular hypertrophy, right heart failure and untimely death. Human Immunodeficiency Virus (HIV) is a recognized cause of PH with a relatively stable prevalence of HIV associated PH of 0.5% in most developed countries. One of the animal models of PH is comprises a once off monocrotaline (MCT) in rats, which leads to PH that mimics typical PH presentation observed in humans. Early administration of antiretroviral medication has been shown to prevent the development of PH in human subjects, however, in advanced cases no significant improvement was reported. The impact of antiretroviral medications is controversial; however, nucleoside reverse transcriptase inhibitors (NRTI) and protease inhibitors (PI) have been shown to improve outcome in PH animal models. A potential connection between combination antiretroviral and PH in human subjects has been established which was contrary the protective effects of solely administer NRTI. The study was conducted to test the hypothesis that antiretroviral medications could ameliorate MCT induced PH in rat models and identify potential biomarker for PH. An approval was given by the Animal Research Ethics Committee of the institution (AREC/066/018M) of University of KwaZulu-Natal, Durban, South Africa, to conduct the study. Forty adult male Sprague-Dawley rats (body weight: 200-250 g) were randomly divided into five groups (n=8 per group). The treatment groups received a single intraperitoneal injection of MCT (60 mg kg-1) while the control group received an equivalent volume of intraperitoneal saline injection. Zidovudine (100 mg kg-1), ritonavir (30 mg kg-1), or combination of both drugs (zidovudine 100 mg kg-1 and ritonavir 30 mg kg-1) were administrated daily for the study period of 28 days to the rats in three of the four groups with MCT for 28 days respectively. On the twenty-eighth day of the study, rats were sacrificed, and the harvested lungs and hearts organ were analyzed. Gene expression was conducted using RT-PCR for the antioxidant’s enzymes, ASK-1 and a laboratory assay for lipid peroxidation was performed. A significantly higher mRNA gene expression of catalase, superoxide dismutase, and glutathione peroxidase in the heart tissue of the antiretroviral treated rats was observed and compared to the untreated groups. There was an increase in malondialdehyde (MDA) in the heart tissues of untreated rats (37.01±1.16 nmol/g, p<0.0001) compared to the control group (3.46±0.97 nmol/g) with an associated reduction in MDA by the antiretrovirals. Furthermore, an increase in the total antioxidant capacity (TAC) in AZT (0.85±0.02 nmol/g, p<0.0001), RTV (0.63±0.03 nmol/g, p<0.0001) and combination of AZT/RTV (0.77±0.06 nmol/g, p<0.0001) compared to untreated (0.28±0.025) rats. Furthermore, lower relative mRNA gene expression of ASK-1 was observed in the heart of the treated rats with zidovudine (2.67 ± 0.09, p < 0.0001), ritonavir (2.57 ±0.11, p < 0.0001) and a combination of both (2.75 ± 0.06, p < 0.0001) when compared to rats in the untreated group. An overexpressed mRNA gene of ASK-1 in the untreated rats (12.0 ± 0.90, p < 0.0001) when compared to the control. This study shows evidence that zidovudine and ritonavir ameliorate MCT-induced PH in rats by suppressing oxidative stress. Also, ASK-1 is a potential biomarker for anti-apoptotic characteristics of PH. Our findings indicate the antioxidative role of antiretroviral medications in PH and the role of biomarkers in PH

Sexuality in Nigerian older adults

Introduction: Oftentimes the older adults are assumed to be asexual as few studies explore into the sexuality of this age group worldwide and even in Nigeria. It is an important aspect of quality of life which is often neglected by people in this age group, attending physicians and the society as a whole. The study was aimed at determining the perception of older adults about sexuality, identify the factors that could militate against sexuality and fill any void in information in this regard. Methods: Descriptive study conducted in one hundred older adults. A semistructured questionnaire was administered to consenting participants between 1st of September 2013 and 31st of March 2014. Results: Mean age of respondents was 66.42± 5.77 years. Seventy-eight percent of the male respondents considered engaging in sexual activity as safe compared to 45.8% of the female respondents. More of the women (33.3%) regarded sexuality in the older adults as a taboo when compared to the men (5.4%). However, the men were more favourably disposed to discussing sexual problems than the women with their spouses (42% vs 20%) and Physicians (23.2% vs 0.0%). Major factors responsible for sexual inactivity were participants' medical ailments (65%), partners' failing health (15%) as well as anxiety about sexual performance (25%) in the men and dyspareunia (25%) in women. Conclusion: There is an urgent need to correct the misconception about sexuality in this age group especially among the women and for the physicians to explore the sexual history of every patient.Pan African Medical Journal 2015; 2

Oxidative stress and gene expression of antioxidants enzymes in monocrotaline-induced pulmonary hypertension following the administration of antiretroviral medications in rats

Objectives: Pulmonary hypertension (PH) is a severe life-threatening pulmonary vasculopathy. This study investigated the effects of zidovudine (AZT) and/or ritonavir (RTV) in the oxidative process of monocrotaline (MCT)-induced PH in rats. Materials and Methods: Forty male Sprague-Dawley rats weighing between 200 and 250 g were randomized into five different groups (n = 8 per group). A single dose intraperitoneal injection of MCT (60 mg/kg) was administered to all the rats in four of the groups. Daily oral administration of the antiretroviral (ARV) medications – (1) AZT-only (100 mg/kg); (2) RTV only (30 mg/kg); (3) AZT+ RTV (100+30 mg/kg); and (4) the untreated group had equivalent volume of saline for 28 days, respectively, while the (5) control group had neither MCT nor ARV. Gene expression using RT-PCR for the antioxidants and laboratory assay for lipid peroxidation was analyzed. Results: A significantly higher mRNA gene expression of catalase, superoxide dismutase and glutathione peroxidase in the treated rats was observed compared to the untreated. There was an increase in malondialdehyde (MDA) in the heart tissues of untreated rats (37.01 ± 1.16 nmol/g, P &lt; 0.0001) compared to the control group (3.46 ± 0.97 nmol/g) with an associated reduction in MDA by the ARVs. Furthermore, an increase in the total antioxidant capacity in AZT (0.85 ± 0.02 nmol/g, P &lt; 0.0001), RTV (0.63 ± 0.03 nmol/g, P &lt; 0.0001), and combination of AZT/RTV (0.77 ± 0.06 nmol/g, P &lt; 0.0001) compared to untreated (0.28 ± 0.03) rats. Conclusion: AZT and RTV ameliorate PH in experimental rats. This study demonstrated that MCT-induced PH generates ROS in rats and the protective role of ARV drugs in the treatment of PH

Bronchoscopy in Nigerian Clinical Practice: A Survey of Medical Doctors’ Perception, Use and Associated Challenges

BACKGROUND: Bronchoscopy is a vital diagnostic and therapeutic procedure in pulmonological practice. The aim of this study was to determine the perception, use and challenges encountered by Nigerian medical doctors involved in this procedure.MATERIALS AND METHODS: A cross-sectional study was conducted among 250 medical doctors recruited from three major tertiary institutions in Nigeria between September 2013 and June 2014. A semi-structured questionnaire was self-administered to adult physicians, paediatricians, and surgeons as well as their trainees to obtain their perception, use and associated challenges in the use of bronchoscopy in clinical practice.RESULTS: The majority (91.6%) of the respondents perceived bronchoscopy as a beneficial procedure to respiratory medicine. However, 59.2% of them were not aware of the low mortality rate associated with this procedure. The commonest indications for bronchoscopic use were foreign body aspiration (88.8%) and management of lung tumors (75.6%). Only 21 (8.4%) of the respondents had received formal training in bronchoscopy. Very few procedures (1-5 cases per month) were performed. The respondents identified the lack of formal training in the art of bronchoscopy as the foremost challenge facing its practice in Nigeria. In addition, availability of bronchoscopes, level of awareness, knowledge of the procedure among medical doctors and the cost of the procedure were the challenges faced by the medical doctors.CONCLUSION: There is an urgent need to equip training centers with modern bronchoscopic facilities. In addition,well-structured bronchoscopic training programme is imperative to enhance the trainees’ proficiency for the furtherance of bronchoscopic practice.KEYWORDS: Bronchoscopy, Nigeria, Respiratory medicine, Interventional pulmonology, Trainin

KNOWLEDGE, ATTITUDE AND RISK PERCEPTION OF COVID-19 AMONG NIGERIANS

Background: COVID-19 emerged as a novel disease with global health importance. Personal and collective behaviours have been modified to prevent the spread of this pandemic. Objectives: To assess the knowledge, attitude and risk perception of Nigerians towards COVID-19. Method: A cross-sectional survey was conducted between the 30th of April and 17th of May 2020 with a national representative across Nigerians using a combination of online and interviewer administered questionnaire. Results: A total of 1,135 respondents participated in the study with a slight male preponderance (M: F=1.5:1). The mean age of the participants was 42±12.2 years with the majority (77%) between the ages of 26 and 55 years. The majority were aware of the pandemic, mostly through mass and social media. Most of the respondents demonstrated good knowledge of COVID-19 but the unaware minority (0.6%) were likewise uneducated. Educational status had no significant association with attitude towards hand washing and wearing of facemask (p&gt;0.05). Risk perception was however low to moderate despite their concerns on COVID-19 and lack of trust in the governments’ response to the disease. Conclusion: The risk perception of COVID is not encouraging, hence more advocacy and public orientation must be done to curb further spread of COVD-19 in our setting

Impact of pre-exposure and post-exposure prophylaxes prevention programme on HIV burden and services in a low-resource setting: a simulation modelling approach

Introduction:&nbsp;sub-Saharan African countries contribute substantially to the global HIV disease burden. Despite this burden, and the promises that prevention could deliver, the implementation and uptake of HIV prevention programmes are still low. The study used the decision support system model to explore the potential impacts of prevention implementation on HIV burden (incidence) and service delivery. Methods:&nbsp;an operational research technique known as discrete event simulation model was used to capture an individual patient´s pathways through the HIV care process from diagnosis to treatment and monitoring. The regular monitoring, over a 5-year period, including all the activities and resources utilized at each stage of the pathway were analysed, and the impact of increasing prevention measures for an HIV treatment service in a treatment centre in Nigeria was tested using the simulation model. Results:&nbsp;forty-three patients currently access the Pre-Exposure Prophylaxis (PrEP) and Post Exposure Prophylaxis (PEP) annually, with a 20% and 80% split in the number of patients offered PrEP and PEP, respectively. Scenarios-based on increasing the number of people offered PrEP and PEP from 43 to 250 with a 50/50 split were tested. The outputs revealed improved preventive care by averting new HIV cases, reduction in service demand and utilization, but an increase in the required human resource as well as financial burden. In the next 5 years, the cumulative averted HIV cases are expected to increase from 2 and 5 people (baseline) to 24 and 20 people for PrEP and PEP, respectively. The potentially averted 2 cases per infected persons based on the basic reproductive number of HIV. Conclusion:&nbsp;the effective implementation of PrEP/PEP programme offers an additional safety measure to prevent HIV transmission in at-risk individuals and possibility of ending HIV epidemic

Evaluating the factor structure, reliability and validity of the Copenhagen Burnout Inventory-Student Survey (CBI-SS) among faculty of arts students of Ekiti State University, Ado-Ekiti, Nigeria

Abstract The Copenhagen burnout inventory-student survey (CBI-SS) has shown promising psychometric properties in diverse student populations. This study aims to investigate the psychometric properties of the Nigerian version of the CBI-SS. This was a cross-sectional study of 635 students from Ekiti State University, Ado-Ekiti, Nigeria. Confirmatory factor analysis (CFA) was utilized to assess the CBI-SS validity. The reliability score of the CBI-SS was 0.957, ranging from 0.862 to 0.914 for the subscales. Correlation coefficients among the four CBI-SS factors ranged from 0.507 to 0.713. The CFA indicated an adequate goodness-of-fit for the four-factor model of the CBI-SS with the sample data. However, Item 10 was removed due to unacceptably low Average Variance Extracted score. The four factors demonstrated a negative correlation with both General Academic Self-Efficacy Scale and Cumulative Grade Point Average. Furthermore, both self-reported burnout and perceived course stress showed associations with the CBI-SS, where lower levels of burnout corresponded with lower median scores on the CBI-SS scales. This study underscores the significance of the CBI-SS in evaluating student burnout within our student population. The findings indicate that the CBI-SS is a highly reliable and valid instrument for assessing student burnout, suggesting its potential for effective utilization in the Nigerian academic context