Ocular manifestations in HIV-AIDS patients in a Nigerian community

Background: The aim of this study was to determine the ocular manifestations of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) among the study population.Method: A cross-sectional descriptive study was conducted among HIV-AIDS patients at the Federal Medical Centre, Owo, Nigeria. Ethics clearance was obtained from the ethics review committee of the hospital. Informed consent was obtained from all the respondents. This study was conducted over a period of nine months, from October 2010-June 2011, at the medical outpatient centre and the eye clinic of the hospital. The obtained information included the socio-demographics of the respondents, World Health Organization clinical stage of AIDS, CD4 count, duration of HIV-positive status, history of ocular problems and the treatment sought.Results: A total of 112 consenting respondents participated in this study. Not many respondents (36, 32.1%) were aware of eye complications that relate to HIV-AIDS. Most informed respondents had been enlightened by health workers (20, 55.6%). Few respondents (16, 14.3%) had HIV-AIDS ocular manifestations. Squamous cell carcinoma was the most common ocular manifestation.Conclusion: Efforts should be made to promote the ocular health of HIV-AIDS patients to prevent blinding ocular manifestation.S Afr Fam Pract 2012;54(5):455-45

Pattern and perception of wellbeing, quality of work life and quality of care of health professionals in Southwest Nigeria

Background: Personal wellbeing (PW) including quality of life and work life is a very complex concept that influences health professionals’ commitment and productivity. Improving PW may result in positive outcomes and good quality of care. Therefore, this study aimed to assess the pattern and perception of wellbeing, quality of work life (QoWL) and quality of care (QoC) of health professionals (HPs) in southwest Nigeria. Methods: The study was a convergent parallel mixed method design comprising a cross-sectional survey (1580 conveniently selected participants) and a focus group interview (40 purposively selected participants). Participants’ PW, quality of life (QoL), QoWL, and QoC were assessed using the PW Index Scale, 5-item World Health Organization Well-Being Index, QoWL questionnaire, and Clinician QoC scale, respectively. The pattern of wellbeing, QoWL and quality of care of HPs were evaluated using t-test and ANOVA tests. Binary regression analysis was used to assess factors that could classify participants as having good or poor wellbeing, QoWL, and quality of care of HPs. The qualitative findings were thematically analyzed following two independent transcriptions. An inductive approach to naming themes was used. Codes were assigned to the data and common codes were grouped into categories, leading to themes and subthemes. Results: Of 1600 administered questionnaires, 1580 were returned, giving a 98.75% response rate. Only 45.3%, 43.9%, 39.8% and 38.4% of HP reported good PW, QoL, QoC and QoWL, respectively; while 54.7%, 56.1%, 60.2% and 61.6% were poor. There were significant gender differences in PW and QoC in favor of females. With an increase in age and years of practice, there was a significant increase in PW, QoWL and QoC. As the work volume increased, there was significant decrease in QoWL. Participants with master's or Ph.D. degrees reported improved QoWL while those with diploma reported better QoC. PWI and QoC were significantly different along the type of appointment, with those who held part-time appointments having the least values. The regression models showed that participant’s characteristics such as age, gender, designation, and work volume significantly classified health professionals who had good or poor QoC, QoWL, PW and QoL. The focus group interview revealed four themes and 16 sub-themes. The four themes were the definitions of QoC, QoWL, and PW, and dimensions of QoC. Conclusion: More than half of health professionals reported poor quality of work life, quality of life and personal wellbeing which were influenced by personal and work-related factors. All these may have influenced the poor quality of care reported, despite the finding of a good knowledge of what quality of care entails

Tuberculosis Treatment Outcomes and Interruption among Patients Assessing Dots Regimen in a Tertiary Hospital in Semi-Urban Area of South-Western Nigeria

BackgroundTuberculosis remains one of the most infectious diseases worldwide especially with the HIV pandemic. It is a cause of high morbidity andmortality in developing countries including Nigeria. Reasons contributing to high morbidity and mortality include high defaulting rate and treatment interruption. Several studies had evaluated the treatment outcome of tuberculosis but there is paucity of published literature on the outcome of treatment interruption especially in this environment. This study thus assessed the outcome of treatments and interruption among patients assessing DOTS regimen in a tertiary hospital located in a semi urban area in south-western Nigeria.MethodologyThe study was a review of TB register of the federal medical centre,Owo from its inception in 2008 to 2011. All the patients that have completed at least one course of chemotherapy (defined as 8 months of  anti-tuberculosis treatment- 2months intensive phase and 6 months continuation phase) were included. Treatment outcome and interruption were defined in accordance with World Health Organisation (WHO) recommendations. Data were analysed with SPSS version 17.ResultsA total of 400 patients were included. The mean age of patients was 36.8 ± 16.8 years and 56.3% were male. Majority, (79.7%) were adults aged 19-64 years, 12.5% were in the paediatric age group and 7.8% were  elderly. Less than half, 45.3% had TB/HIV co-infection. Regarding treatment outcome of tuberculosis, 75.5% were cured, 14.8% died, 4%  relapsed and 3% defaulted. A little above one-fifth, 21 (5.3%) hadtreatment interruption among whom 9 (42.9%) were successfully traced and completed treatment. Significantly, higher proportion of those that had treatment interruption died, 54.1% compared with their counterpart, 14.9%, (p<0.001) and had relapse. (14.3% versus 3.4%, p = 0.01).ConclusionA high rate of tracking failure among patients with treatment interruption was found in the study. In addition, mortality and morbidity were higher among patients with treatment interruption. A more concerted effort is needed in tracking / tracing patients with treatment interruption in order to reduce morbidity and mortality among TB patients assessing treatment

Neuroprotective effect of olanzapine and fluoxetine in rotenone-induced Parkinson's disease in mice: role of antioxidant systems

Background: Depression may antedate motor manifestations of Parkinson's disease (PD) and is usually of moderate or mild intensity. Moreover, depression is of major impact on the quality of life in PD patients according to a recent survey. Conversely, drug-induced psychosis is one of the major therapeutic challenges in Parkinson's disease and may occur in up to 6% in otherwise uncomplicated de novo patients when first receiving dopaminergic therapy.Objective: This study sought to investigate the protective effect of olanzapine and fluoxetine when used alone or in combination against rotenone-induced Parkinsonism in mice.Methods: Olanzapine (1, 5, 10 mg/kg), fluoxetine (5, 10, 20 mg/kg) or sub-effective doses of olanzapine (1 mg/kg) or fluoxetine (5 mg/kg, respectively) were given to mice orally for 30 days. PD-like behaviour was induced with rotenone (2 mg/kg, i.p., in sunflower oil for 28 days from day 3). The effects on motor coordination were assessed using open field test (OFT), bar test and rotarod test while memory function was investigated using the elevated plus maze test (EPM). On day 28, animals were sacrificed for biochemical estimation of oxidative and nitrosative stress parameters in the brains.Results: Acute treatment with olanzapine (1, 5, 10 mg/kg) did not affect blood glucose level. However, coadministration of sub-effective doses of olanzapine (1 mg/kg) and fluoxetine (5 mg/kg) showed significant (P<0.01) increase in the level of blood glucose. Subchronic treatment of mice with olanzapine (1, 5 mg/kg) or fluoxetine (10, 20 mg/kg) significantly attenuated rotenoneinduced catalepsy in mice similar to the effect of trihexyphenidyl (reference drug) between days 8 and 16. However, by day 24 of treatment, olanzapine (5, 10 mg/kg) showed a dose-dependent increase in rotenone-induced catalepsy but not fluoxetine or olanzapine-fluoxetine combination. In addition, rotenone induced significant (p<0.01) motor deficit which was reversed by olanzapine (1 mg/kg) but not 5 and 10 mg/kg treatment in OFT. Moreover, fluoxetine treatment enhanced ambulatory activity of the animals. However, pretreatment of mice with olanzapine (1, 5, 10 mg/kg) and fluoxetine (5, 10, 20 mg/kg) failed to prevent rotenone-induced memory deficit on days 9 and 10. In contrast, rotenone increased (P<0.001) brain malondialdehyde and nitrite generation with concomitant decrease in the level of reduced glutathione, catalase and superoxide dismutase. Conversely, olanzapine (1, 5 mg/kg) or fluoxetine (10, 20 mg/kg) treatment significantly attenuated the effect of rotenone.Conclusion: These findings suggest that olanzapine and fluoxetine (alone or in combination) could protect against rotenone-induced motor deficit through enhancement of  brain antioxidant systems. Thus suggesting that olanzapine and fluoxetine could be used as adjuvants in the treatment of PD.Keywords: Rotenone; elevated plus maze; bar test; glutathione; malondialdehyd

The impact of decision – delivery interval on maternal and fetal outcome: a three- year experience in a tertiary hospital.

Background: Human resources development has been identified as a very important tool in improving maternal and child health. An enhanced human resource capability helps in the reduction of the decision delivery interval (DDI), which has been identified as a key factor in improving the feto-maternal outcome in emergency caesarean delivery (ECD) for fetal and maternal reason.Aim: This study aims to find out the feasibility of 30-minute decision-delivery interval (DDI) and the average decision-delivery interval in our setting, the effect of delayed decision-delivery interval on maternal and fetal outcome; to identity the prevailing factors and to proffer solutions.Materials and Methods: This was a retrospective study carried out over a 3-year period between 1st January 2011 and 31st December 2013. The case notes of 577 patients who had emergency caesarean delivery during this period were reviewed and information relating to socio-demographic characteristics, indications for the caesarean delivery, decision-delivery interval, reasons for delay and feto-maternal outcome were obtained. All cases of preterm deliveries, intra-uterine fetal demise and multiple pregnancies were excluded.Results: The prevalence of caesarean delivery during this period of study was 36.4% with 83.3% done as emergency. Seventy One percent of the parturients were multiparous women who were mostly unbooked (54.8%). The indication for surgery was fetal distress in majority of cases (40.4%). None of the parturient was delivered within 30 minutes of decision and the mean DDI was 120.35±40.26 minutes overall but lower for cases of fetal distress (96.38±34.72 minutes, P<0.001). The major reasons for delay in delivery were laboratory challenges and financial constraint (63.6% and 53.4% respectively). There was a statistically significant reduced mean time interval for instituting general anaesthesia compared with spinal anaesthesia. Severe fetal morbidity and mortality occurred with increase in DDI but was not shown to be statistically significant. Perinatal mortality rate among study group was 7.3%. Maternal mortality and near misses increased with increase in DDI and was shown to be significant (P=0.014). The maternal mortality rate from this study was 2.6%.Conclusion: The decision-delivery interval of 30- minutes is difficult to achieve in low resource settings; even in the face of emergency, due to prevailing factors which include poor human capital development, poor standard of living, bad attitude of health workers and infrastructural challenges

Lassa fever clinical course and setting a standard of care for future randomized trials: A protocol for a cohort study of Lassa-infected patients in Nigeria (LASCOPE)

Background: Lassa Fever (LF), is a severe viral disease prevalent in Western Africa. It is classified as a priority disease by the World Health Organization (WHO). Ribavirin is the recommended therapy despite weak evidence of its efficacy. Promising therapeutic agents are becoming available for evaluation in human. Before launching therapeutic trials, we need data on the evolution of the disease under the best possible conditions of care. Methods: We have initiated a prospective study in Nigeria to better understand the clinical course and prognostic factors of LF while implementing high quality standardized care. Inclusion criteria are: suspected or confirmed LF and informed consent. Participants are followed 60 days from admission and receive free of charge standardized supportive care and biological monitoring, as well as intravenous ribavirin for those with confirmed LF. Data are collected using standardized case report forms (CRF). Primary and secondary outcomes are fatality and severe morbidity, with special focus on acute kidney dysfunction and pregnancy complications. Factors associated with outcomes will be investigated. Results: The cohort is planned for 3 years. Inclusions started in April 2018 at the Federal Medical Center Owo in Ondo State. A second site will open in Nigeria in 2020 and discussions are underway to open a site in Benin. 150 to 200 new participants are expected per year. Conclusions: This cohort will: provide evidence to standardize LF case management; provide key inputs to design future clinical trials of novel therapeutics; and establish clinical research teams capable of conducting such trials in LF-endemic areas