Immunovirological treatment outcomes after 2 years of antiretroviral therapy in children living with the human immune deficiency virus in Lagos Nigeria

Background/objective: The World Health Organization (WHO) recommends routine assessment of antiretroviral treatment outcomes to detect  treatment failure early and prevent the development of drug resistance. The aim of this study was to describe treatment outcomes of antiretroviral therapy (ART) over 2 years in children living with the human immune deficiency virus enrolled in the paediatric HIV clinic at the Lagos UniversityTeaching Hospital (LUTH).Materials and methods: This was a retrospective study of antiretroviral treatment outcomes in 278 children receiving antiretroviral therapy at the paediatric HIV clinic of LUTH. Demographic, clinical and laboratory data were retrospectively collected from clinical records of pediatric patientswho received antiretroviral therapy for 2 years ( from November 2015 to December 2017) . Virological failure was defined as viral load > 400  copies/ml and immunological failure was defined as a CD4 count <100 cells/mm3 or CD4 % <15% after receiving antiretroviral agents for 12 months. Data was analysed using graph pad prism version 5.0.Results: After 12 months on antiretroviral therapy (ART), 101 (36%) had virological failure while 14 (5%) and 36 (13%) failed immunologically [CD4 count <100 cells/mn3 and CD4 <15% respectively]. Virological blips were observed at 24 months in 6.1% of patients while immunovirological discordance occurred in 30% of patients (poor virological clearance despite good immunological recovery) . High baseline viral load (>5000  copies/ml), poor adherence (<95%) and low baseline CD4 counts (101-249 cells/mn3) were significantly associated with virological failure, while low baseline CD4 counts (<350 cells/mn3) and poor adherence (<95%) were significantly associated with immunologic failure.Conclusion: The treatment outcomes observed in this study are similar to those reported in earlier studies. At 1 and 2 years of antiretroviral therapy , there was immune restoration however 101 (36%) and 87 (31%) respectively had virological failure despite good adherence to therapy and good Immunological restoration. This calls for early initiation and switch to second and third line drugs . Key words: Human immunodeficiency virus (HIV), zidovudine, lamivudine, nevirapine, virological blips, immunovirological discordance , children, Nigeria

Effects of electromagnetic radiations on the male reproductive system

Electromagnetic radiation (EMR) emitting from the natural environment, as well as from the use of industrial and everyday appliances, constantly influences the body of the animal. It is expected that the interactions between electromagnetic radiation and the living organism would depend on the amount and parameters of the transmitted energy and type of tissue exposed. Electromagnetic waves exert an influence on the male reproductive system causing spermatozoa to have decreased motility, morphometric abnormalities, increased peroxidation due to oxidative stress, histological aberrations in the testes and in some cases atrophy of the testicular tissue. This review presents from literature some of effects of electromagnetic radiations on the male reproductive system.Keywords: Electromagnetic Radiations, Male Reproductive System, Animals, Human

Optimal timing of post-operative haematocrit check in obstetric and gynaecological surgeries

Background: Haemorrhage is a feared albeit common complication of surgery in Obstetrics and Gynaecology. Measurement of haematocrit post operatively is believed to be part of good medical practice since it gives an inkling to intraoperative and immediate post-operative blood loss and the need for blood transfusion. The objective of the study is to determine if there was any difference between haematocrit values gotten on day 1 and 2 and also to determine the optimal time for the post-operative haematocrit check.Methods: One thousand patients who had surgery in the department of Obstetrics and Gynaecology of LAUTECH Teaching Hospital (LTH) and Bowen University Teaching Hospital (BUTH), Ogbomoso were recruited. Capillary blood samples were obtained at 24hours and 48 hours post operatively. The haematocrit was determined using a 24 place micro haematocrit centrifuge and the values checked using a haematocrit reader. Frequency tables and charts were made and results were tested for significance with level of significance (x) set at 0.05.Results: The mean age of the patients was 32.88±9.45, with a modal age group of 21-30years. The commonest obstetric surgery done was caesarean section (60.6%) while the commonest gynaecological surgery was myomectomy (13.8%). There is a significant difference between the haematocrit values gotten on day one and two (p= 0.000). There was significant difference between the haematocrit values on both days and the unit the patient was managed; the type of surgery done and the age group of the patient.Conclusion: The haematocrit on postoperative day 2 is more representative of the blood loss.Keywords: postoperative, haematocrit, obstetrics, gynaecolog

Outcome of Infertility Consultations in a tropical tertiary health institution in Nigeria

Aim: To examine the outcome of gynaecological consultations for infertility in a tropical Teaching Health facility.Material & Methods: This is a cross-sectional study of infertility cases seen at the Bowen University Teaching Hospital, Ogbomoso over a year (16 October, 2010 to 15 October, 2011). The patients were followed up for twelve months thereafter. Data collection was done using a designed profoma. All patients coming for gynaecological consultations because of infertility within the study period were included in the study after giving their informed consents. Patient information recorded in the profoma included age, parity, educational status, occupation, duration of infertility, investigations, modality of treatment and treatment outcome. Outcome was measured by the number of live births amongst treated patients.Results: A total of 195 patients presented for gynaecological consultations during the one year period; infertility was one of the commonest reasons for gynaecological consultation, accounting for 38.5% (75) of the cases. Tubal factor, 25(33.5%) was the commonest etiological cause. The treatment modality involved myomectomy (20, 26.6%), ovulation induction (20, 26.6%), laparoscopic adhesiolysis (8, 10.7%) and tubal surgery (5, 6.7%). Treatment of infertility resulted in 10 (13.3%) live births, with ovulation induction giving the highest percentage of live births (5, 50%).Conclusion: The outcome of treatment of infertility is poor. Therefore, establishing a standard assisted reproductive technology (ART) unit will be of immense value in improving the outcome.Keywords: Infertility, consultation, outcom

Food and feeding habits of Hepsetus odoe and Polypterus senegalus in Eleyele Lake, Southwestern Nigeria

A study was carried out on the food and feeding habits of Hepsetus odoe and Polypterus senegalus in Eleyele Lake to determine their feeding activities and food resources. The stomach fullness varied with size and sex. Males had lower feeding activities in H. odoe and P. senegalus. Generally the percentage of specimens with empty stomachs decreased with length in both species. The food richness of H. odoe was 5 and fish was the most important food item (52.40%) in the stomach. Insects (64.3%) were more important to the smaller size group. The food richness of P. senegalus was 9 and the diet in Eleyele Lake was dominated by insects (71.65%). Relative Importance of fish components increased with length group in P. senegalus. P. senegalus and H. odoe are both carnivorous in Eleyele Lake. The higher feeding intensity of P. senegalus was due to the availability of prey as reflected in the food richness.Keywords: diet, food richness, intersexual variation, feeding intensity, Hepsetus odoe, Polypterus senegalu

Low Birthweight and its Predictors in Primary Health Care Facilities in Osogbo, Osun State

Low birth weight is one of the major causes of perinatal mortality and ultimately underfive mortality. To achieve Millennium Development Goal of reducing this mortality, effort must be geared towards reducing perinatal mortality by identifying risk factors to low birth weight and provision of cost effective neonatal services. The objective of this study is to identify the risk factors to low birth weight at primary care level with a view to ensuring prompt referral to higher level of health care. Records of four Primary Health Care facilities were looked into. The prevalence of low birth weight was 6.8%. This was higher among the female babies, teenagemothers, preterm deliveries, nulliparous women, breech deliveries and late booking. Adjusting for other risk factors, preterm delivery and nulliparity remain significant predictive factors. Conclusion: Among the pregnant women presenting to primary health care facilities, the high risk groups for low birth weight are those presenting with preterm labour and nulliparous women. These categories of pregnant women should be referred to facilities providing secondary health care.Key Words: Low Birth weight, Primary Health Care, Risk factors

Impacts of agriculture and forestry in the control of climate change: The role of extension services

Climate change is recognized as an important issue at the center of world discussion. The importance of agriculture and forestry in the control or mitigation of climate is an important issue that has gained a lot of attention recently. Climate smart agricultural and forestry practices a situation where practices that will promote mitigation and reduce emission towards a better food security and environmental friendly weather are considered in this review paper. Also the role played by extension workers was also discussed. Climate smart agricultural and forestry practices such as planting of drought resistant crops, changes in cropping pattern, irrigation efficiency improvement, afforestation and agro-forestry were elucidated. It was concluded that an extensive extension service that will adequately educate and reach out to stakeholders at all levels will improve capacity to control the impact of climate change

Effects of caesarean section on the perinatal outcome in Singleton Breech deliveries in Ibadan

Objective: The aim of the study was to ascertain whether or not abdominal delivery is associated with less perinatal mortality and morbidity than vaginal delivery in singleton fetuses with breech presentation. Materials and Method: Data from patients with singleton breech fetuses in a teaching hospital in the south-western part of Nigeria over the ten year period between 1st January, 1990 and 31st December 1999 were analysed. Perinatal mortality and morbidity data in those having vaginal deliveries were compared with those having caesarean section. Results: Seven hundred and forty nine singleton breech fetuses were delivered in the study period, giving an incidence of 5.7%. There was no significant difference in the mean age of the two groups. Caesarean section was associated with lower perinatal mortality in nullipara, patient who did not register for antenatal care, and in preterm and term deliveries. Fetuses with birth weights greater than 3.5kg at birth had lower perinatal mortality rates when delivered abdominally. No measurable difference in the frequency of asphyxia was detected between the two modes of delivery. Conclusion: Caesarean section is associated with lower perinatal mortality in the study population. Formulation and strict adherence to delivery protocol concerning breech presentation is advised. [Nig J Clinical Practice Vol.5(1) 2002: 41-44

Choice of Anaesthesia for Caesarean Section Among Female Health Workers

Current trend in anaesthesia for obstetric patient is toward regional anaesthesia with less general anaesthesia, and the Royal College of Anaesthetists has proposed that 85% of emergency Caesarean section should be carried out under regional anaesthesia. It had been documented that general anaesthesia was found to be associated with 12.5% maternal mortality, while regional anaesthesia is associated with a reduction in maternal and fetal mortality and morbidity. The aim of this survey therefore is to assess the knowledge and attitude of female health workers to the use of spinal anaesthesia for Caesarean delivery. Two hundred and fifty respondents were obtained, and most of them 170 (68.0%) would prefer spinal anaesthesia for Caesarean section. It was found that spinal anaesthesia was chosen by those with higher educational status, who also were the people in the higher medical cadre. Previous experience of anaesthesia significantly affects the choice of anaesthetic technique for Caesarean section (df = 2, p= 0.019, X2= 7.939). Pre-operative counselling should aim to dispel patients' misconceptions, fears and anxieties about anaesthesia generally.Key words:Spinal anaesthesia, Choice, Caesarean section

The relationship between zidovudine, lamivudine and nevirapine plasma drug levels and antiretroviral treatment outcomes in Nigeria children living with HIV

Plasma concentrations of antiretrovirals are significant and important determinants of treatment failure and toxicity. The relationship between antiretroviral pharmacokinetic exposures and immunovirological outcomes has not been extensively studied in our setting. The aim of this study was to investigate the relationship between antiretroviral plasma concentrations and virological and immunological treatment outcomes in children living with human immunodeficiency virus (HIV) A retrospective collection of demographic, clinical , laboratory data and a prospective determination of plasma drug concentrations in 120 children aged 2-14 years after two years of receiving fixed dose zidovudine, lamivudine and nevirapine tablets using a simple, rapid, sensitive and validated method of high performance liquid chromatography with UV detection for simultaneous quantification of zidovudine, lamivudine and nevirapine in human plasma. All analyses were performed using graph pad prism version 5.0. A perfect agreement (p<.001) was found between nevirapine drug levels and prescriptionrefill visit adherence records (Kappa 0.093). Plasma zidovudine, lamivudine and nevirapine concentrations were not statistically associated with virological success (Viral load <400copies/μl ) and immunological success (CD4 cells >100 cells/mm3). At 2 years zidovudine, lamivudine and nevirapine therapeutic levels, zidovudine supra therapeutic levels ,and nevirapine subtherapeutic levels were respectively significantly associated with immunologic success (CD4%>15 %). Low nevirapine levels can be used to identify those that require adherence counseling. Despite good virological and immunological outcomes, plasma concentrations of zidovudine, lamivudine and nevirapine were not significantly associated with virological and immunological outcomes (Absolute CD4 counts) but was significantly associated with immunological outcomes (CD4%). Plasma drug levels may be good surrogates of adherence but not of treatment outcomes. Monitoring CD4% remains important to optimize paediatric HIV treatment.Keywords: Antiretroviral treatment, children, therapeutic drug monitoring, treatment outcomes, immune-virological outcomes, plasma concentrations, zidovudine, lamivudine and nevirapin