Brain computed tomography of patients with HIV/AIDS before the advent of subsidized treatment program in Nigeria

Background: The objective is to study intracranial complications of HIV/AIDS using brain‑computed tomography in patients who presented with neurological features before the advent of subsidized HIV/AIDS treatment program with highly active antiretroviral therapy (HAART) in Nigeria. Materials and Methods: Retrospective study of patients’ records retrieved from radiology and medical records departments of the hospital. The studied patients had HIV/AIDS and presented with neurological features and underwent CT scan. Results: A total of 36 patients who tested positive for HIV and who presented with neurological features suspected to be complications of AIDS were examined with CT scan. They consisted of 24 male and 12 females. The male to female ratio was 2:1. The age of the patients ranged from 27 to 45 years. Seventeen patients (47.2%) were aged 30–34 years. Twenty‑four patients (60%) were single while 12 (40%) were married. Twenty‑seven patients (75%) were infected with HIV 1 and 2, five patients (13.9%) were infected only with HIV‑1 while four were infected with only HIV‑2. Presenting neurological complaints include left hemiplegia 13 (36.1%), right hemiplegia 6 (16.7%), coma 7 (19.4%), memory loss/dementia complex 5 (13.9%), convulsion with coma 2 (5.6%), left hemi‑pariesis with memory loss 2 (5.6%), and staggering gait 1 (2.8%). The findings in CT scan include infarcts‑like lesions 14 (38.9%), multiple ring‑enhancing lesions 7 (19.4%), cerebral atrophy 5 (13.9%), multiple nodular lesions 4 (11.1%), acute intracerebral hemorrhage 3 (8.3%), cerebral hemiatrophy 2 (5.6%), and solitary ring‑enhancing lesions 1 (2.8%). Eight patients with single or multiple ring enhancing lesions were treated with empirical treatment for toxoplasmosis but only three (37.5%) made full recovery. Conclusion: Brain CT scan showed extensive structural damages in patients with HIV/AIDS who were not treated with HAART. Out‑of‑pocket payment for investigations and treatment and absence of HAART could be partly responsible for high rate of advanced disease.Keywords: Brain‑computed tomography, HIV/AIDS, neurological features, Nigeria, povertyNigerian Medical Journal | Vol. 53 | Issue 4 | October-December | 201

Effect of anemia on hepatotoxicity of HAART in HIV patients in Benin city

Background: Hepatotoxicity is a relevant adverse effect of highly active antiretroviral Treatment owing to its frequency, and it can cause interruption of therapy, hepatitis, and death. There is dearth of information on hepatotoxicity arising from highly active antiretroviral therapy (HAART) in anemic patients. Anemia is the most common symptom in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome. We studied the effect of anemia on hepatotoxicity in HIV patients who were about to start HAART, attending clinic, or in the medical wards. Materials and Methods: This was a prospective study in which patients were recruited consecutively and followed up for 24 weeks. Results: In all, 84 patients were recruited and 42 were enrolled as controls. The mean ages of the cases and controls were 35.2΁9.9 and 35.5΁9.0 years, respectively. The age range of the cases was 18-68 years with a median age of 31.5 years, whereas the mean age of the controls was 20-57 years with a median age of 33.5 years. There was no difference (t=0.197, df=124, and P=0.844). There were 61 females (72.6%) and 23 males (27.4%) in the cases, whereas in the controls, there were 34 females (81.0%) and 8 males (19.0%). Among the cases, 30 (35.7%) were anemic, while 54 (64.3%) were not anemic. Six (20%) of the anemic patients had hepatotoxicity, and 9 (16.7%) of the patients with normal packed cell volume had hepatotoxicity. Among the controls, all 42 (100%) patients had normal packed cell volume. Four (9.5%) of the patients had hepatotoxicity. There was no association between hepatotoxicity and anemia (χ2 =3.243, df=2, P=0.198). Conclusion: Anemia did not affect hepatotoxicity of HAART in this study

Usefulness of the HIV Dementia Scale in Nigerian patients with HIV/AIDS

Objective: Information on the cognitive complications of HIV/AIDS from sub-Saharan Africa, where statistics on HIV is alarming, is sparse because of lack of validated cognitive tools. This study assessed the usefulness and predictive validity of the HIV Dementia Scale (HDS) as a screening tool among HIV-positive Nigerian Africans. Design: HIV-positive patients were randomly selected over a period of two months. Setting: The HIV/AIDS outpatient clinic of the University teaching hospital, Benin City, Nigeria. Subjects: Asymptomatic and symptomatic HIV-positive patients were compared with age, sex and level of education-matched controls. Outcome measures: Cognitive performances on the modified HIV Dementia scale. Results: The performances of 160 HIV-positive (comprising 80 asymptomatic and 80 symptomatic) subjects were compared with 80 age, sex and level of education-matched HIV-negative subjects on the HDS. The mean HDS scores (maximum =12) were 10.78±1.18 (comparison subjects), 8.85±1.38 (asymptomatic) and 5.2±1.13 (symptomatic);

Health implications of stream water contamination by industrial effluents in the Onitsha urban area of Southeastern Nigeria

Nigeria has abundant surface and ground water resources many of which are polluted and can be detrimental to human health when consumed. This study investigated the effects of effluents discharged by industries into streams on the health of people who depend on stream water for domestic purposes in the Onitsha urban area of eastern Nigeria. Water samples collected from eleven discharge locations underwent physico-chemical and microbiological analyses. Data on the effects of industrial effluents on health were obtained from records in the public hospitals located in Onitsha as well as through questionnaire surveys and field observations. The results of the analyses revealed that the effluents grossly degrade surface water bodies; several parameters (temperature, iron, dissolved oxygen, turbidity, biological oxygen demand, chemical oxygen demand, lead, magnesium, total heterotrophic counts, total coliform group, pH) had values which were higher than the WHO (2011) safety limits for drinking water. The contamination of investigated streams by effluents had negative impact on the health of stream users. The discussion included health effects of polluted water and the prevalence of water borne or related diseases in the area. Implications of these findings were also discussed. Management measures capable of minimizing contamination of surface water in the study area were suggested

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways