Addiction or pseudoaddiction in sickle cell disease patients: Time to decide - a case series

Objective: The objective of this report is to highlight the background factors associated with opioid abuse among Sickle Cell Disease (SCD) patients.Patients: Eleven patients aged 13-53 years (mean, 26.1yrs) which included six female and five male were seen in the last six year at a tertiary health facility. The modes of abuse ranged from obtaining analgesic prescription from multiple sources, injecting analgesics and sharing analgesics between patients in the hospital.Results: Five female had either avascular necrosis of the femoral head or pathological fracture secondary to chronic osteomyelitis, so were classified as pseudoaddiction while five male and one female without any identifiable  cause of chronic pain were adjudged to be addicted to opioids. The role of a dysfunctional family background in the response of SCD patients to pain treatment and substance abuse is highlighted.Conclusion: These cases reveal drug abuse as an emerging or understudied problem among SCD patients and its association with chronic pain in some patients. It is therefore necessary for pain physicians and SCD experts to address the use of opioid in chronic sickle cell pain and provide alternatives and a suitable guideline for their use.Keywords: Opioid, chronic pain, sickle cell pain, psychosocial issues, substance abus

Pattern of Family Support among HIV Patients in a Tertiary Health Center in Southwest Nigeria

Background: The impact of the HIV/AIDS pandemic on the social and economic development of Nigeria has been substantial. Adequate family support remains a critical factor for the achievement of optimal HIVcare. This study investigated the level and pattern of family support received by people living with HIV/AIDS (PLWHA).Method: A descriptive, cross-sectional study was carried out among PLWHAs receiving care within the family practice at the Federal Medical Centre, Ido-Ekiti, Nigeria. Respondents were selected using systematic random sampling technique. A structured, interviewer-administered questionnaire was used to collect data from the respondents. Data was analysed using SPSS version 16.0.Result: A total of one hundred (100) PLWHA were interviewed. Their mean age was 43.0 (SD12.0) years. Sixty-one per cent (61.0%) were females. A greater proportion of the subjects (81%) were married. Monogamous family structure was observed in 72% of all the subjects. Family support was strong amongst 85% and a significant positive association was found between family support and age (p=0.008), family structure (p=0.003) and marital status (p=0.000).Conclusion: Most PLWHA studied had strong family support. Middle age and being married in a monogamous family setup were significant factors for this support. Family involvement and support during initiation and continuation of their antiretroviral therapy is recommended.Keywords: Family Support; ART; HIV/AIDS; PLWHAs; Nigeri

The World Health Organization ACTION-I (Antenatal CorTicosteroids for Improving Outcomes in preterm Newborns) Trial: a multi-country, multi-centre, two-arm, parallel, double-blind, placebo-controlled, individually randomized trial of antenatal corticosteroids for women at risk of imminent birth in the early preterm period in hospitals in low-resource countries

BACKGROUND: Antenatal corticosteroids (ACS) have long been regarded as a cornerstone intervention in mitigating the adverse effects of a preterm birth. However, the safety and efficacy of ACS in hospitals in low-resource countries has not been established in an efficacy trial despite their widespread use. Findings of a large cluster-randomized trial in six low- and middle-income countries showed that efforts to scale up ACS use in low-resource settings can lead to harm. There is equipoise regarding the benefits and harms of ACS use in hospitals in low-resource countries. This randomized controlled trial aims to determine whether ACS are safe and efficacious when given to women at risk of imminent birth in the early preterm period, in hospitals in low-resource countries. METHODS/DESIGN: The trial design is a parallel, two-arm, double-blind, individually randomized, placebo-controlled trial of ACS (dexamethasone) for women at risk of imminent preterm birth. The trial will recruit 6018 women in participating hospitals across five low-resource countries (Bangladesh, India, Kenya, Nigeria and Pakistan). The primary objectives are to compare the efficacy of dexamethasone with placebo on survival of the baby and maternal infectious morbidity. The primary outcomes are: 1) neonatal death (to 28 completed days of life); 2) any baby death (any stillbirth postrandomization or neonatal death); and 3) a composite outcome to assess possible maternal bacterial infections. The trial will recruit eligible, consenting pregnant women from 26 weeks 0 days to 33 weeks 6 days gestation with confirmed live fetuses, in whom birth is planned or expected within 48 h. The intervention comprises a regimen of intramuscular dexamethasone sodium phosphate. The comparison is an identical placebo regimen (normal saline). A total of 6018 women will be recruited to detect a reduction of 15% or more in neonatal deaths in a two-sided 5% significance test with 90% power (including 10% loss to follow-up). DISCUSSION: Findings of this trial will guide clinicians, programme managers and policymakers on the safety and efficacy of ACS in hospitals in low-resource countries. The trial findings will inform updating of the World Health Organization's global recommendations on ACS use. TRIAL REGISTRATION: ACTRN12617000476336 . Registered on 31 March 2017