Hepatitis B Vaccination Status and Needle stick Injuries among Medical Students in a Nigerian University

Background: Hepatits B virus (HBV) is the most common blood borne pathogen that poses an occupational risk to Health-care workers. The incidence of infection following needle stick injury has been reported to be high among medical students. Effective vaccines against HBV are available. The aim of this study was to determine the vaccination status and prevalence of needlestick injury among medical students in a tertiary institution in a developing country (Nigeria). Method: Information regarding hepatitis B status, history of needlestick injury and awareness of risk factors for HBV were obtained from clinical medical students using a self administered questionnaire. Three hundred and forty six students responded. Results: Three hundred and five (88.7%) agreed that medical education exposes one to HBV infection and 315 (91.6%) were aware of the availability of vaccine against HBV. Only 42 (47.7%) were vaccinated against HBV. Majority (57.4%) gave lack of opportunity as reason for non immunization while 34.7% had never given it a thought. One hundred and sixty-six (48%) of the respondents admitted to a previous needlestick injury and only 17 (10.2%) of those who reported history of needlestick injury had post-exposure prophylaxis against HBV infection. Conclusion: HBV vaccination status is very low among medical students in Nigeria and the prevalence of needle stick injuries is high. Universities must not only provide HBV vaccination free of charge but also enforce its use by these students. Nigerian Journal of Medicine Vol. 17 (3) 2008: pp. 330-33

Chronic kidney disease screening and renoprotection in type 2 diabetes

Background: Type 2 diabetes (T2D) is a major cause of chronic kidney disease. Control of hypertension and the use of angiotensin converting enzyme inhibitors (ACEI) and/or angiotensin II receptor blockers especially in those with proteinuria have been shown to protect against chronic kidney disease and delay its progression to kidney failure. Methods: We reviewed the medical records of 169 patients at 12 months with a view of auditing the screening for chronic kidney disease and the use of renoprotective measures. Results: Urinalysis was done in 49.1% and serum creatinine in 50.3%. No patient had glomerular filtration rate estimated. Seventy nine (67.6%) of the hypertensive patients were on anti-hypertensives. ACEI was used in 49 (45.8%) of these patients BP control was optimal in 29.1%. Conclusion: There is poor adherence to guidelines on chronic kidney disease screening and renoprotection in T2D

Association of HIV-Induced Immunosuppression and Clinical Malaria in Nigerian Adults

Despite the growing body of evidence on the interaction between HIV and malaria in sub-Saharan Africa, there is a dearth of data on clinical malaria in HIV-infected patients in Nigeria. We determined the burden of clinical malaria in HIVinfected adult Nigerians and further investigated the association between their immunological status and the rates of clinical malaria. Ninety seven antiretroviral treatment-naïve HIV-infected adults were enrolled in a cross-sectional study from August to December, 2009. The participants had a complete clinical evaluation, thick and thin blood films for malaria parasites and CD4 cell count quantification. Clinical malaria was defined as having fever (temperature ≥ 37.5oC or history of fever within 48 hours) and a malaria parasite density above the median value obtained for subjects with co-existing fever and parasitaemia. Clinical malaria was diagnosed in 10 out of 97 patients (10.3%). Lower CD4 cell counts were associated with increasing rates of clinical malaria which was 0% at CD4 cell count of ≥ 500, 2.6% at 200-499 and 30% at <200 cells/μL (χ2 = 18.3, p = 0.0001). This association remained significant after controlling for other factors in a multivariate analysis (AOR=22.98, 95% C.I: 2.62-20.14, p = 0.005). An inverse relationship between CD4 cell count and parasite density was demonstrated (regression co-efficient = -0.001, p = 0.0002). More aggressive malaria control measures are highly needed in severely immunosuppressed HIV-infected patients.Keywords: HIV, Immunosuppression, Clinical malaria, Adult

Relation Between Helicobacter Pylori, Inflammatory (neutrophil) Activity, Chronic Gastritis, Gastric Atrophy And Intestinal Metaplasia

Background: To determine the relation of Helicobacter pylori infection with chronic inflammation, atrophy, activity level and intestinal metaplasia. Patients and Methods: A cross-sectional study of 100 consecutive patients with dyspepsia. These patients were fasted for 12 hours and gastroscopic biopsy specimens were obtained from their gastric mucosae. The specimens were histologically evaluated for H. pylori, inflammatory activity, chronic inflammation, gastric atrophy and intestinal metaplasia. Results: There were 50(50%) females and 50(50%) males. The average ages of women and men were 36.3±11.5 and 42.9±12.8 respectively. Helicobacter pylori was found in 79%. Neutrophil activity was observed in 83%. Inflammation was found in 95%, glandular atrophy in 38%, intestinal metaplasia in 28% of the cases. Incidental (early gastric) cancer was found in 3%, dysplasia in 2% and reactive gastropathy in 7% of the cases. A statistically significant relationship was found between Helicobacter pylori colonization intensity and the degrees of neutrophil activity, chronic inflammation and intestinal metaplasia. Conclusion: We concluded that Helicobacter pylori infection results in neutrophil activation and chronic gastritis, and that it has a role in the development of intestinal metaplasia. The greater the intensity of Helicobacter pylori infection, the greater the degrees of neutrophil activation, chronic gastritis and intestinal metaplasia. Keywords: Helicobacter pylori, Gastritis, atrophy, Intestinal metaplasia, Gastric cancer, Jos Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 270-27

Association between erythrocyte Na+K+-ATPase activity and some blood lipids in type 1 diabetic patients from Lagos, Nigeria

<p>Abstract</p> <p>Background</p> <p>Altered levels of erythrocyte Na⁺K⁺-ATPase, atherogenic and anti-atherogenic lipid metabolites have been implicated in diabetic complications but their pattern of interactions remains poorly understood.</p> <p>This study evaluated this relationship in Nigerian patients with Type 1 diabetes mellitus.</p> <p>Methods</p> <p>A total of 34 consented Type 1 diabetic patients and age -matched 27 non-diabetic controls were enrolled. Fasting plasma levels of total cholesterol, triglycerides and HDL-cholesterol were determined spectrophotometrically and LDL-cholesterol estimated using Friedewald formula. Total protein content and Na+K+-ATPase activity were also determined spectrophotometrically from ghost erythrocyte membrane prepared by osmotic lysis.</p> <p>Results</p> <p>Results indicate significant (P < 0.05) reduction in Na⁺K⁺-ATPase activity in the Type 1 diabetic patients (0.38 ± 0.08 vs. 0.59 ± 0.07 uM Pi/mgprotein/h) compared to the control but with greater reduction in the diabetic subgroup with poor glycemic control (n = 20) and in whom cases of hypercholesterolemia (8.8%), hypertriglyceridemia (2.9%) and elevated LDL-cholesterol (5.9% each) were found. Correlation analyses further revealed significant (P < 0.05) inverse correlations [r = -(0.708-0.797] between all the atherogenic lipid metabolites measured and Na⁺K⁺-ATPase in this subgroup contrary to group with good glycemic control or non-diabetic subjects in which significant (P < 0.05) Na⁺K⁺-ATPase and HDL-C association were found (r = 0.427 - 0.489). The Na⁺K⁺-ATPase from the diabetic patients also exhibited increased sensitivity to digoxin and alterations in kinetic constants Vmax and Km determined by glycemic status of the patients.</p> <p>Conclusion</p> <p>It can be concluded that poor glycemic control evokes greater reduction in erythrocyte Na⁺K⁺-ATPase activity and promote enzyme-blood atherogenic lipid relationships in Type 1 diabetic Nigerian patients.</p

Editorial

Non-communicable diseases: Act or pay heavil

Sexual behavior of medical students: A single institutional survey

Objective: We investigated the sexual practices of medical students as they are positioned to serve as peer educators in the fight against HIV/AIDS. Methods: This was a cross sectional study, where self- administered questionnaires were distributed to consenting 4th to 6th year medical students in Jos, Nigeria with a view of elucidating information regarding sexual practices and condom utilization. Safe sex practice was defined as the use of condoms and being in a monogamous relationship. Results: Of a total of 400 questionnaires distributed, 365 respondents (249 males and 116 females) had adequate data for analysis. A large proportion (62%) of our students have never had sex before and less than 30% of them are sexually active. Only 6.1% had multiple sexual partners and homosexuality was uncommon (1.9%). Condom utilization amongst the sexually active was high (65%) and similar among male and female students (71.3% vs. 51.9% respectively, p = 0.08). Conclusion: There exists safe sexual practice among medical students in our setting. This group could be recruited as peer educators in the war against HIV/AIDS.Key Words: HIV/AIDS, Students, Sexual behaviour, Condom us

Audit of anti-hypertensive medication prescription in Nigeria: a comparison of two tertiary hospitals

Background: Guidelines exist streamlining the drug management of hypertension. We compared conformity of anti-hypertensive medication prescriptions to internationally acceptable guidelines at two tertiary hospitals in Nigeria.Methods: Antiypertensive prescriptions in consecutive patients with hypertension attending medical outpatient clinics at the Jos University Teaching Hospital (JUTH), Jos and the Federal Medical Centre (FMC), Makurdi were audited. Also evaluated among these patients were medication adherence and blood pressure control.Results: Appropriate prescriptions were present in 80.6% of the patients [89 (90.8%) JUTH patients and 86 (72.3%) FMC patients respectively; p = 0.0005]. The median number of drugs was two. Diuretics were the commonest drugs used (82.4% JUTH patients and 74.8% FMC patients; p = 0.18). Angiotensin converting enzyme inhibitors (ACEIs) were the second most commonly used medication (60.2% of JUTH and 52.9% of FMC patients respectively p = 0.28). The calcium channel blockers were used by 55.1% of JUTH 45.4% of FMC patients respectively (p = 0.15). Good medication adherence was present in 83  (84.7%) of JUTH and 78 (65.5%) of FMC patients; p = 0.001. BP control in the JUTH and FMC cohorts was 42.9% and 32.8% respectively; p = 0.12. On the whole, BP control was better among patients with good adherence compared to those without (41.6% vs. 25% respectively; p = 0.02).Conclusion: Anti-hypertensive prescriptions in this study conform to internationally acceptable guidelines. Diuretics and ACEIs are the most commonly used drugs. Renoprotection is however suboptimal in patients with DM. Keywords: Audit; Antihypertensive; Compelling Indications; Medication