Social Networks as Predictors of Colorectal Cancer Screening in African Americans

Background: Early detection can reduce colorectal cancer (CRC) mortality by 15%–33%, and screening is widely recommended for average-risk adults beginning at age 50 years. Colorectal cancer mortality rates are higher in African Americans than in whites, while screening rates are somewhat lower. Individual social networks can reduce emotional and/or logistical barriers to healthpromoting but distasteful procedures such as CRC screening. The aim of this study was to examine social network interactions, and their impact on CRC screening among African Americans. We hypothesized a positive association between social network index (SNI) scores and CRC screening. Methods: In a community intervention trial with four arms, we previously demonstrated the efficacy of a small group educational intervention to promote CRC screening among African Americans. This intervention outperformed a one-on-one educational intervention, a reduced out-of-pocket expense intervention, and a control condition. In the present analysis, we compared the SNI scores for participants in the small group intervention cohort with a comparison group comprised of the other three cohorts. Social networks were assessed using the Social Network Index developed by Cohen. Results: Small group participants had a significantly higher network diversity score (Mean difference 0.71; 95% CI, 0.12-1.31; p=0.0017) than the comparison group. In the second component of the SNI score - -the number of people talked to over a two week period -- the small group intervention cohort also scored significantly higher than the comparison group. (Mean difference, 9.29; 95% CI, 3.963-14.6266; p=0.0004). Conclusions: The findings suggest that social interaction and support was at least partially responsible for the relatively high post-intervention screening rate in the small group intervention participants. Education in small groups could foster strong social networks. Strong and positive network diversity and a large number of people in social networks may enhance CRC screening rates among African Americans

Effectiveness and tolerability of Perindopril plus Amlodipine single pill combination in Nigeria: The 13 City Hypertension Study

Background: There is no large-scale study that has shown the efficacy of single pill combination (SPC) antihypertensive medications in black African population. We therefore evaluated the blood pressure (BP) lowering efficacy and the tolerability of Perindopril plus Amlodipine SPC in black African patients. Methods: It was a multi-centre, prospective, observational programme among hypertensive patients using different doses of Perindopril and Amlodipine. Primary endpoint was assessed as the change in mean sitting systolic and diastolic BPs from baseline to 3 months. Results: 937 patients (55.7% female) were analysed, and the mean age was 56.4 ± 12.7 years. Systolic and diastolic BPs were significantly reduced by 17.3/ 9.4mmHg, 21.1/10.8mmHg mmHg and 24.6/12.7mmHg at 4, 8 and 12 weeks respectively compared to baseline value (p<0.0001). Dry cough was seen in 0.64% and angioedema 0.1% of the patients. Conclusions: Perindopril plus Amlodipine SPC provided clinically meaningful BP reductions and is well tolerated in a black African population. SAHeart 2022;19:6-1

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p < 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Drug Resistance among Pulmonary Tuberculosis Patients in Calabar, Nigeria

Background. This study aimed to determine the pattern of drug susceptibility to first-line drugs among pulmonary TB patients in two hospitals in Calabar, Nigeria. Methods. This was a descriptive cross-sectional study carried out between February 2011 and April 2012. Sputum samples from consecutive TB patients in Calabar were subjected to culture on Lowenstein-Jensen (LJ) slopes followed by drug susceptibility testing (DST). The DST was performed on LJ medium by the proportion method. Results. Forty-two of the 100 Mycobacterium tuberculosis strains were found to be resistant to at least one drug. Resistance to only one drug (monoresistance) was found in 17 patients. No strains with monoresistance to rifampicin were found. Resistance to two drugs was found in 22 patients, while one patient was resistant to both three and four drugs. MDR TB was seen in 4% (4/100). The independent variables of HIV serology and sex were not significantly associated with resistance (P>0.05). Conclusion. There was a high prevalence of anti-TB drug resistance in Calabar

PATTERN OF BLOOD PRESSURE IN URBAN NIGERIAN ADOLESCENTS-EXPERIENCE FROM SOUTH-EASTERN NIGERIA

The pattern of blood pressure in a cross-section of urban apparently healthy Nigerian adolescents aged 13 to 18 years as well as the prevalence of elevated blood pressure (hypertension) in the group is presented. Four hundred and forty three (443) students attending two secondary schools in the city of Calabar formed subjects for the study. They had their blood pressures measured, Heights, weights were also measured using standard methods and Body Mass index (B.M.I) calculated. Both systolic and diastolic blood pressures were found to rise with age with females having higher values. There were positive correlations of blood pressure with anthropometric parameters (weight, height and B.M.I) in most age groups. Some of the correlations were statistically significant illustrating the relationship between blood pressure and body mass. As regards elevated blood pressure (Hypertension), the prevalence was 1.6% for adolescents 13 to 15 years, while 3.6% was found for those 16 to 18 years. Though the prevalence was higher in males, the difference was not statistically significant (P>0.05). Hypertension is thus a significant health problem in urban Nigerian adolescents. The need for early detection and treatment cannot be over-emphasized as it has been long recognized that what constitutes hypertension in adults may have its onset in childhood and adolescence. A group reference level of blood pressure that should define hypertension in adolescents is thus desirable. Routine or periodic blood pressure screening within the school system is also recommended. Larger studies on adolescent blood pressure are suggested to facilitate the establishment of a group reference level which will serve as a guide as to what should constitute hypertension in Nigerian adolescents. KeyWords: Blood Pressure, adolescents, Nigeria. (Global J Med Sci: 2002 1(1): 1-6

PANCREATIC PSEUDOCYST - A DIAGNOSTIC DILEMMA IN THE TROPICS - A CASE REPORT

Pancreatic pseudocyst is a local but serious complication of acute pancreatitis. The diagnosis is difficult in the tropics where a number of diseases exist which may mimic this condition and diagnostic facilities are few and often inaccessible. A case seen in the medical department of the University of Calabar Teaching Hospital, Calabar Nigeria illustrating this diagnostic difficulty is presented. Key Words: Pancreatic pseudocyst, tropics. (Global J Med Sci: 2002 1(1): 65-67

Prevalence and pattern of cognitive impairment among Nigerians with heart failure

Introduction Cognitive impairment following heart failure is a major determinant of clinical outcomes and the patient’s ability to adhere to the treatment regimen. It significantly affects their quality of life. Among patients with heart failure, rates of anxiety and depression are reported to be between 13– 39% and have further negative impacts on their cognitive function

Coronary Artery Disease and the Profile of Cardiovascular Risk Factors in South South Nigeria: A Clinical and Autopsy Study

Introduction. Death from coronary artery disease (CAD) has been until recently considered rare in Nigeria. We present a report of a study of CAD with its predisposing cardiovascular (CVD) risk factors in South South Nigeria. Methods. We examined the autopsy reports of 747 coroner cases and 41 consecutive clinically diagnosed cases of ischemic heart disease seen in South South Nigeria. Results. CAD was diagnosed in 13 (1.6%) of 747 autopsies. They were predominantly males, urban residents, and of high social class with combination of CVD risk factors of hypertension, alcohol use, diabetes mellitus, cigarette smoking, poor physical activities, and obesity. The mean serum cholesterol of the clinical subjects was 4.7±1.57 mmol/L and 5.07±1.94 mmol/L for angina and myocardial infarction, respectively, which was higher than the mean total cholesterol for locality of 3.1 mmol/L. Conclusion. CAD and its risk factors are contributing to mortality and morbidity in South South Nigeria. These risk factors include hypertension, alcohol use, diabetes mellitus, cigarette smoking, poor physical activity, and obesity. Nigerians in this locality with CAD have raised serum lipids