Baseline PI susceptibility by HIV-1 Gag-protease phenotyping and subsequent virological suppression with PI-based second-line ART in Nigeria

Objectives: Previous work showed that gag-protease-derived phenotypic susceptibility to PIs differed between HIV-1 subtype CRF02_AG/subtype G-infected patients who went on to successfully suppress viral replication versus those who experienced virological failure of lopinavir/ritonavir monotherapy as first-line treatment in a clinical trial. We analysed the relationship between PI susceptibility and outcome of second-line ART in Nigeria, where subtypes CRF02_AG/G dominate the epidemic. Methods: Individuals who experienced second-line failure with ritonavir-boosted PI-based ART were matched (by subtype, sex, age, viral load, duration of treatment and baseline CD4 count) to those who achieved virological response (‘successes’). Successes were defined by viral load <400 copies of HIV-1 RNA/mL by week 48. Full-length Gag-protease was amplified from patient samples for in vitro phenotypic susceptibility testing, with PI susceptibility expressed as IC50 fold change (FC) relative to a subtype B reference strain. Results: The median (IQR) lopinavir IC50 FC was 4.04 (2.49–7.89) for virological failures and 4.13 (3.14–8.17) for virological successes (P = 0.94). One patient had an FC >10 for lopinavir at baseline and experienced subsequent virological failure with ritonavir-boosted lopinavir as the PI. There was no statistically significant difference in single-round replication efficiency between the two groups (P = 0.93). There was a moderate correlation between single-round replication efficiency and FC for lopinavir (correlation coefficient 0.32). Conclusions: We found no impact of baseline HIV-1 Gag-protease-derived phenotypic susceptibility on outcomes of PI-based second-line ART in Nigeria

Deep sequencing of HIV-1 reveals extensive subtype variation and drug resistance after failure of first-line antiretroviral regimens in Nigeria

BACKGROUND: Deep sequencing could improve understanding of HIV treatment failure and viral population dynamics. However, this tool is often inaccessible in low- and middle-income countries. OBJECTIVES: To determine the genetic patterns of resistance emerging in West African HIV-1 subtypes during first-line virological failure, and the implications for future antiretroviral options. PATIENTS AND METHODS: Participants were selected from a Nigerian cohort of people living with HIV who had failed first-line ART and subsequently switched to second-line therapy. Whole HIV-1 genome sequences were generated from first-line virological failure samples with Illumina MiSeq. Mutations detected at ≥2% frequency were analysed and compared by subtype. RESULTS: HIV-1 sequences were obtained from 101 participants (65% female, median age 30 years, median 32.9 months of nevirapine- or efavirenz-based ART). Thymidine analogue mutations (TAMs) were detected in 61%, other core NRTI mutations in 92% and NNRTI mutations in 99%. Minority variants (<20% frequency) comprised 18% of all mutations. K65R was more prevalent in CRF02_AG than G subtypes (33% versus 7%; P = 0.002), and ≥3 TAMs were more common in G than CRF02_AG (52% versus 24%; P = 0.004). Subtype G viruses also contained more RT cleavage site mutations. Cross-resistance to at least one of the newer NNRTIs, doravirine, etravirine or rilpivirine, was predicted in 81% of participants. CONCLUSIONS: Extensive drug resistance had accumulated in people with West African HIV-1 subtypes, prior to second-line ART. Deep sequencing significantly increased the detection of resistance-associated mutations. Caution should be used if considering newer-generation NNRTI agents in this setting

Review of prostate cancer research in Nigeria

Prostate cancer (CaP) disparities in the black man calls for concerted research efforts. This review explores the trend and focus of CaP research activities in Nigeria, one of the ancestral nations for black men. It seeks to locate the place of the Nigerian research environment in the global progress on CaP disparities. Literature was reviewed mainly through a Pubmed search with the terms “prostate cancer”and “Nigeria”, as well as from internet and hard copies of journal pages

Urinary Retention Caused by Foreign Body

A 54-year-old man was referred from a private hospital with recurrent episodes of urinary tract infection and urinary retention, 18 months following transvesical prostatectomy for benign prostatic hyperplasia. A retained gauze embedding a stone was removed from the bladder neck at exploration. Adherence to sound surgical principle will avoid the hazards of retained gauze and other instruments. (Nig J Surg Res 2001; 3: 90 – 92) KEY WORDS: Retained Gauze, Preventio

Ring Entrapment of the Finger in a Psychiatric Patient

Ring entrapment of the finger is an uncommon occurrence in our environment and is usually amenable to conservative treatment by removal of the entrapped ring. Gangrene of the affected digit is rare. This is a report of a 57-year-old schizophrenic who developed ulceration, severe oedema and gangrene of the right middle finger following entrapment by a ring like motor spare part. Disarticulation at the metacarpophalangeal joint was necessary. The gangrene was possibly due to a combination of severe oedema, infection or a Raynaud's like phenomenon. (Nig J Surg Res 2001;3:37-40) KEY WORDS: Ring, finger entrapment, gangrene, psychiatric illnes

The management of upper urinary tract obstruction in resource-poort settings

Objective: The management of upper urinary tract obstruction in the absence of modern facilities presents a major challenge to Urologic practice in developing countries. The aim of this study was to describe the etiology, presentation and treatment of upper urinary tract obstruction at the Jos University Teaching Hospital, Nigeria. Patients and Methods: This is a prospective analysis of 37 consecutive patients (18 males, 19 females) with a mean age of 35.5 years (range 3-55) who were managed for upper urinary tract obstruction at our department between January 2001 and December 2005. Two of them presented with a second pathology, so that we treated 39 pathologies in total. Flank pain was the most common clinical feature, being present in 35 patients (94.6%). Other clinical features were gross hematuria in 12 (32.4%), an enlarged kidney in 5 (13.5%), renal impairment in 4 (10.8%) and hypertension in 3 (8.1%) patients. Diagnostic work-up consisted of plain radiography, abdominal ultrasound scan, intravenous urography and retrograde pyelography. Renal pelvic stones were the leading cause of obstruction (13 patients; 35.1%), while congenital pelvi-ureteric junction (PUJ) obstruction was found in 7 (18.9%) and ureteric stricture and vesical schistosomiasis in 4 (10.8%) and 3 (8.1%) patients, respectively. Two patients had bilateral obstruction from two different causes. Results: Twenty-nine open surgical procedures were carried out. They consisted of pyelolithotomy (n=12), pyeloplasty (n=6), ureteroureterostomy (n=4), ureteroneocystostomy (n=3), nephrectomy (n=2) and ureterolithotomy (n=2). Eight patients were treated non-surgically. Two patients are awaiting definitive surgical treatment. A total of 4 (13.8%) complications following 29 operative procedures was encountered: two cases of migration of double-J ureteric stents and one case each of prolonged urine leakage and wound infection. Conclusion: Upper urinary tract obstruction is not uncommon in our environment. In the absence of modern facilities, open surgery remains our main option of treatment; and it is relatively safe. Objectif: La prise en charge de l'obstruction du haut appareil urinaire en l'absence des équipements modernes présente un défi important de la pratique urologique dans les pays en voie de développement. Le but de cette étude était de décrire l'étiologie, la présentation clinique et le traitement de l'obstruction du haut appareil urinaire à l'hôpital universitaire de Jos, Nigéria. Patients et méthodes: C'est une analyse prospective de 37 patients consécutifs (18 mâles, 19 femelles) présentant un âge moyen de 35.5 ans (3-55 ans) qui ont été contrôlés pour obstruction du haut appareil urinaire à notre service entre janvier 2001 et décembre 2005. Deux ont présenté une deuxième obstruction après qu'ils aient été traités pour la première, de sorte qu'en fait nous avons traité 39 cas. La douleur du flanc était la présentation clinique la plus commune, étant présente chez 35 patients (94.6%). Les autres manifestations cliniques étaient : hematurie chez 12 (32.4%), un gros rein chez 5 (13.5%), insuffisance rénale chez 4 (10.8%) et hypertension chez 3 (8.1%) patients. La démarche diagnostique est faite de ASP, échographie abdominale, urographie intraveineuse et pyélographie rétrograde. Les lithiases urétérales pelviennes étaient la principale cause de l'obstruction (13 patients ; 35.1%), alors que l'obstruction congénitale de la jonction pyélo-urétérale (PUJ) était diagnostiquée chez 7 (18.9%) et le rétrécissement urétéral et schistosomiase vésicale chez 4 (10.8%) et 3 (8.1%) patients, respectivement. Deux patients ont eu une obstruction bilatérale de deux causes différentes. Résultats: 29 cures chirurgicales à ciel ouvert ont été réalisées : pyélolithotomie (n=12), pyéloplastie (n=6), urétérourétérostomie (n=4), urétéronéocystostomie (n=3), néphrectomie (n=2) et urétérolithotomie (n=2). Huit patients ont été traités d'une façon non chirurgicale. Deux patients attendent le traitement chirurgical définitif. Un total de 4 (13.8%) complications sur 29 cures effectives ont été notées : deux cas de migration de sondes urétérales en double-J, un cas de fuite prolongée d'urine et un cas d'infection. Conclusion: L'obstruction du haut appareil urinaire n'est pas rare dans notre environnement. En l'absence des équipements modernes, la chirurgie ouverte demeure notre option principale de traitement; et c'est relativement sûr. African Journal of Urology Vol. 13 (1) 2007: pp. 30-3

Antimicrobial Susceptibility Profiles of Uropathogenic Bacterial Isolates from Community- and Hospital-Acquired Urinary Tract Infections in Yobe State, Nigeria.

The study was designed to find out the prevalence of urinary tract infection (UTI) in Yobe State with particular emphasis on community-acquired (CA) and hospital acquired (HA) UTIs and antibiotic susceptibility patterns of causative bacterial strains. A retrospective study of 1,577 urine samples processed at the Federal Medical Centre (FMC) Nguru from June 2001 to June 2005 was undertaken. The urines were collected from in-patients and out-patients services and processed under standard laboratory procedures, while antibiotic susceptibility test was carried out using Kirby-Bauer method. Results were analysed using SPSS 11.0 statistical software while p values < 0.05 were considered significant. The overall prevalence of UTI was 17.3%; with males and females accounting for 6.0% and 11.3% episodes respectively. The rate of UTI decreased proportionately with the increasing age of the patients; these age-specific variations were found to be statistically significant (p < 0.05). The rate of UTI among in-patients (6.8%) was also found to be significantly higher than that of out-patients (10.5%) (p < 0.05). The commonest organism encountered in the study was Escherichia coli (CA-19.9%; HA-11.5%) followed by Klebsiella spp. (CA-12.8%; HA-8.9%). Other organisms were Staphylococcus aureus (CA-10.1%; HA-5.8%); Salmonella spp. (CA-2.4%; HA-0.0%); Coagulase negative Staphylococcus (CNS) (CA-4.7%; HA-2.7%); Pseudomonas aeruginosa (CA-1.7%; HA-3.7%), Streptococcus faecalis (CA-1.4%; HA-5.7%); Proteus mirabilis (CA-1.7%; HA-3.0%), Candida albicans (CA-2.0%; HA-1.7%); and Neisseria gonorrhoeae (CA-2.4%; HA-0.0%). Most isolates were resistant to Penicillins, Tetracycline, Cotrimoxazole, Nalidixic acid and Erythromycin, while Augmentin, Ofloxacin, Ceftazidime and Ceftriaxone recorded high levels of activity against majority of the isolates. Augmentin, Ofloxacin, Ceftazidime and Ceftriaxone should be considered along with other clinical factors in the choice of first-line drugs for the treatment of UTI where susceptibility test is unavailable. Keywords: Urinary tract infection, community-acquired, hospital-acquired Journal of Medical Laboratory Sciences Vol. 14 (2) 2005: pp. 54-6

CASE REPORT - Spontaneous scrotal faecal fistula in a neonate: report of a case

A 21 day old boy with spontaneous scrotal faecal fistula following a neglected strangulated right inguinal hernia is reported. He had necrotizing fasciitis of the right scrotum with sparing of the testis. He successfully had debridement, herniotomy and bowel resection with end-to-end anastomosis. This is a rare occurrence in infants and seems to result from late presentation. Health education coupled with early referral and prompt repair of inguinal hernia in neonates and infants would reduce this complication