High cadmium / zinc ratio in cigarette smokers: potential implications as a biomarker of risk of prostate cancer.

Tobacco smoke may be one of the most common sources of cadmium (Cd) in the general population, particularly in the rising population of smokers in developing countries. Although a relationship between bothcigarette smoking and environmental Cd contamination with prostate cancer exist, the mechanisms are unclear. Most prospective cohort studies found a positive association between current smoking and a fatal cancer of the prostate. We investigated the interaction between zinc and cadmium and the potential risk of prostate cancer insmokers. Serum cadmium level was significantly (

Biochemical changes associated with sickle cell anaemia

Some blood chemical parameters including some enzyme activities were determined in forty two sickle cell patients in Ekiti state, Nigeria. All the parameters of interest analyzed for were found present in all the samples. The mean values for uric acid (0.35±0.16 mol/l), creatinine (100.55±8.13 μmol/l), urea (10.50±6.28 mmol/l), Total bilirubin (14.42±2.03 μmol/l), conjugated bilirubin (10.53±2.67 μmol/l), alkaline phosphatase (82.67±10.87 μ/l) aspartate transaminase (SGOT)(20.68±9.85 μ/l) and alanine transaminase (SGPT)(28.68±9.85 μ/L) were significantly higher (P 0.05). The significant raised level of SGPT, SGOT, ALP, total bilirubin, conjugated bilirubin, and significant lower levels of total protein, albumin, calcium, inorganic phosphate indicates that there may be abnormal liver and renal function as well as muscular and bone dysfunction in these patients

From caution to urgency: the evolution of HIV testing and counselling in Africa.

OBJECTIVE: To describe recent changes in policy on provider-initiated testing and counselling (PITC) for human immunodeficiency virus (HIV) infection in African countries and to investigate patients' experiences of and views about PITC. METHODS: A review of the published literature and of national HIV testing policies, strategic frameworks, plans and other relevant documents was carried out. FINDINGS: Of the African countries reviewed, 42 (79.2%) had adopted a PITC policy. Of the 42, all recommended PITC for the prevention of mother-to-child HIV transmission, 66.7% recommended it for tuberculosis clinics and patients, and 45.2% for sexually transmitted infection clinics. Moreover, 43.6% adopted PITC in 2005 or 2006. The literature search identified 11 studies on patients' experiences of and views about PITC in clinical settings in Africa. The clear majority regarded PITC as acceptable. However, women in antenatal clinics were not always aware that they had the right to decline an HIV test. CONCLUSION: Policy and practice on HIV testing and counselling in Africa has shifted from a cautious approach that emphasizes confidentiality to greater acceptance of the routine offer of HIV testing. The introduction of PITC in clinical settings has contributed to increased HIV testing in several of these settings. Most patients regard PITC as acceptable. However, other approaches are needed to reach people who do not consult health-care services

Comparison of Bacterial Culture With Biofire® Filmarray® Multiplex PCR Screening of Archived Cerebrospinal Fluid Specimens From Children With Suspected Bacterial Meningitis in Nigeria

BACKGROUND: Diagnosis of bacterial meningitis remains a challenge in most developing countries due to low yield from bacterial culture, widespread use of non-prescription antibiotics, and weak microbiology laboratories. The objective of this study was to compare the yield from standard bacterial culture with the multiplex nested PCR platform, the BioFire® FilmArray® Meningitis/Encephalitis Panel (BioFire ME Panel), for cases with suspected acute bacterial meningitis. METHODS: Following Gram stain and bacterial culture on cerebrospinal fluid (CSF) collected from children aged less than 5 years with a clinical suspicion of acute bacterial meningitis (ABM) as defined by the WHO guidelines, residual CSF specimens were frozen and later tested by BioFire ME Panel. RESULTS: A total of 400 samples were analyzed. Thirty-two [32/400 (8%)] of the specimens were culture positive, consisting of; three Salmonella spp. (2 Typhi and 1 non-typhi), three alpha hemolytic Streptococcus, one Staphylococcus aureus, six Neisseria meningitidis, seven Hemophilus influenzae, 11 Streptococcus pneumoniae and 368 were culture negative. Of the 368 culture-negative specimens, the BioFire ME Panel detected at least one bacterial pathogen in 90 (24.5%) samples, consisting of S. pneumoniae, N. meningitidis and H. influenzae, predominantly. All culture positive specimens for H. influenzae, N. meningitidis and S. pneumoniae also tested positive with the BioFire ME Panel. In addition, 12 specimens had mixed bacterial pathogens identified. For the first time in this setting, we have data on the viral agents associated with meningitis. Single viral agents were detected in 11 (2.8%) samples while co-detections with bacterial agents or other viruses occurred in 23 (5.8%) of the samples. CONCLUSIONS: The BioFire® ME Panel was more sensitive and rapid than culture for detecting bacterial pathogens in CSF. The BioFire® ME Panel also provided for the first time, the diagnosis of viral etiologic agents that are associated with meningoencephalitis in this setting. Institution of PCR diagnostics is recommended as a routine test for suspected cases of ABM to enhance early diagnosis and optimal treatment

The prevalence of psychological co-morbidity in people with vitiligo: a systematic review and meta-analysis

Background: Vitiligo is a chronic disorder causing skin depigmentation with global prevalence varying from 0.2 to 1.8%. UK guidelines recommend assessment of psychological state during clinical evaluation of vitiligo. However, the prevalence of psychological co-morbidity in people with vitiligo has not been described. Objectives: We aimed to establish the prevalence of psychological symptoms or disorders in people with vitiligo and describe the outcome measures used. Methods: We performed a comprehensive search of MEDLINE, Embase, CINAHL and PsychInfo to identify observational studies assessing the prevalence of psychological symptoms or disorders (December 2016). DerSimonian and Lard random-effects models were utilized to estimate the overall pooled prevalence. Results: We identified 29 studies with 2530 people with vitiligo. Most studies included a measure of either depression (n=25) or anxiety (n=13).The commonest tools were the Hospital Anxiety and Depression Scale and the Centre for Epidemiology Studies Depression Scale. Ten studies provided information on thirteen other psychological outcomes. Pooled prevalence using depression-specific and anxiety-specific questionnaires was 0.29 (95%CI 0.21, 0.38) and 0.33 (95%CI 0.18, 0.49) respectively. Prevalence was lower for clinically diagnosed depression (0.21; 95%CI 0.15, 0.28) and anxiety (0.15; 95%CI 0.06, 0.24). When non-specific tools were used the prevalence remained similar for depression (0.27; 95%CI 0.08, 0.46) but increased for anxiety (0.46; 95% CI 0.39, 0.52). High heterogeneity was observed. Conclusions: A range of psychological outcomes are common in people with vitiligo. The prevalence of anxiety was influenced by type of screening tool, suggesting validation of psychological outcome screening tools in the field of dermatology

Sex in the shadow of HIV:A systematic review of prevalence, risk factors, and interventions to reduce sexual risk-taking among HIVpositive adolescents and youth in sub-Saharan Africa

Background Evidence on sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa is urgently needed. This systematic review synthesizes the extant research on prevalence, factors associated with, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa. Methods Studies were located through electronic databases, grey literature, reference harvesting, and contact with researchers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quantitative studies that reported on HIV-positive participants (10-24 year olds), included data on at least one of eight outcomes (early sexual debut, inconsistent condom use, older partner, transactional sex, multiple sexual partners, sex while intoxicated, sexually transmitted infections, and pregnancy), and were conducted in sub-Saharan Africa were included. Two authors piloted all processes, screened studies, extracted data independently, and resolved any discrepancies. Due to variance in reported rates and factors associated with sexual risk-taking, meta-analyses were not conducted. Results 610 potentially relevant titles/abstracts resulted in the full text review of 251 records. Forty-two records (n=35 studies) reported one or multiple sexual practices for 13,536 HIV-positive adolescents/youth from 13 sub-Saharan African countries. Seventeen cross-sectional studies reported on individual, relationship, family, structural, and HIV-related factors associated with sexual risk-taking. However, the majority of the findings were inconsistent across studies, and most studies scored Conclusions Sexual risk-taking among HIV-positive adolescents and youth is high, with inconclusive evidence on potential determinants. Few known studies test secondary HIV-prevention interventions for HIV-positive youth. Effective and feasible low-cost interventions to reduce risk are urgently needed for this group.</p

Malignant Hypertension with Multi-organ Failure in a young Nigerian

Malignant hypertension is a known complication of primary hypertension and its multiorgan involvement leads to increased morbidity and mortality. A fact that should prompt its early diagnosis and treatment. We present the case of a 36-year old man who had no prior history of hypertension but presented on account of a persistent headache, amaurosis fugax and blurring of vision which have failed to respond to several selfadministered medications. He was found to have a severe systemic hypertension on clinical evaluation and laboratory investigations confirmed the multi-organ involvement of malignant hypertension in hi

An exploratory qualitative study on perceptions about mosquito bed nets in the Niger Delta: what are the barriers to sustained use?

Kathleen T Galvin1, Nick Petford2, Frances Ajose3, Dai Davies41Bournemouth University, Talbot Campus, Fern Barrow, Poole, Dorset, UK; 2University of Northampton, Northampton, UK; 3Department of Medicine, Lagos State University and The Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; 4Niger Delta Development Initiative, Poole, Dorset, UKBackground: The effectiveness of malaria control programs is determined by an array of complex factors, including the acceptability and sustained use of preventative measures such as the bed net. A small-scale exploratory study was conducted in several locations in the Niger Delta region, Nigeria, to discover barriers against the use of bed nets, in the context of a current drive to scale up net use in Nigeria.Methods: A qualitative approach with a convenience sample was used. One to one interviews with mostly male adult volunteers were undertaken which explored typical living and sleeping arrangements, and perceptions about and barriers against the use of the mosquito prevention bed net.Results: Several key issues emerged from the qualitative data. Bed nets were not reported as widely used in this small sample. The reasons reported for lack of use included issues of convenience, especially net set up and dismantling; potential hazard and safety concerns; issues related to typical family composition and nature of accommodation; humid weather conditions; and perceptions of cost and effectiveness. Most barriers to net use concerned issues about everyday practical living and sleeping arrangements and perceptions about comfort. Interviewees identified were aware of malaria infection risks, but several also indicated certain beliefs that were barriers to net use.Conclusions: Successful control of malaria and scale up of insecticide-treated net coverage relies on community perceptions and practice. This small study has illuminated a number of important everyday life issues, which remain barriers to sustained net use, and has clarified further questions to be considered in net design and in future research studies. The study highlights the need for further research on the human concerns that contribute to sustained use of nets or, conversely, present significant barriers to their use.Keyword: malaria, Nigeria, children under 5, interviewee

Severe idiosyncratic drug reactions with epidermal necrolysis: A 5-year study

Introduction: Idiosyncratic drug reactions (IDRs) are unexpected responses to a drug. The spectrums of severe cutaneous reactions include Stevens-Johnson Syndrome (SJS), SJS/Lyell Syndrome and Toxic Epidermal Necrolysis (TEN). The conditions are associated with high mortality. This study was designed to determine the causal agents, patterns of presentations, review the management and make recommendations to reduce the incidence and mortality of this class of drug reactions. Materials and Methods: A retrospective study was made of patients seen with IDR in the Lagos State University Teaching Hospital, LASUTH, between January, 2004 and December, 2008. They were cases admitted with bullous skin eruptions with associated systemic symptoms. Results: Sixty-seven patients were seen, with 45 (67.2%) satisfying the inclusion criteria. Fifteen males and 30 females were involved, giving a male to female (M:F) ratio of 1:2. Their ages ranged from 7 to 79 years (mean, 40.02 ± 17.89 years). Peak incidences occurred among the 20-24 and 30-34 year age groups. The causal agents were antibiotics (48.89%), sulphonamides (24.44%), herbal preparations (17.78%) and artemisinin drugs (8.89%). Conclusions: The age groups with the peak incidence are the most likely to indulge more in drug abuse in environments with poor drug control. Diagnosis of SJS, SJS/TEN and TEN were missed in many patients at first contact due to the progressive nature of the conditions. Patients needed reviews at regular intervals when IDR was suspected. Health education to prevent drug abuse is important and herbal preparations should be scientifically studied to determine the efficacy and side-effects