Reported Case of Paracetamol and Non-Steroidal Anti- Inflammatory Drug (NSAID)-Induced Seizures in a Patient with HIV Infection

Commonly available analgesics, such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), are used widely with few or no adverse events by most individuals. However, some adverse events have been observed following the use of these drugs. This paper reports a case of paracetamol and NSAID-induced seizures in a patient with the human immunodeficiency virus infection/acquired immune deficiency syndrome (HIV/AIDS). These seizures occurred at different times, first with paracetamol and then diclofenac (a NSAID). She was concurrently on anti-retroviral drugs and antibiotics. We were unable to readily explain this unusual adverse event as most documented paracetamol-related adverse events are either immunoglobulin E (IgE)-mediated or due to directparacetamol-induced hepatic necrosis following an overdose. This case is a probable drug-drug interaction not supported by existing literature, and it is possible that the background HIV infection may have a role to play. Keywords: Paracetamol, Diclofenac, Adverse events, Seizures, HIV/AIDS

Human immunodeficiency virus infection presenting as a fatal case of Guillain-Barré syndrome on a background of diabetes mellitus

Background: Guillain-Barré syndrome (GBS), a post-infective acute polyneuropathy, which occurs rarely among Africans, has been associated with HIV infection and less commonly with diabetes mellitus. Aim: The article documents a case of GBS occurring on the setting of HIV infection on a background of diabetes mellitus. Findings: A 47 years old man presented with features of inability to walk, “pins and needles” sensation in the lower limbs, progressive lower limb weakness of 3 days duration and later on admission involving the upper limbs and, finally respiratory distress leading to his death on the 3rd day of hospital admission. He had an antecedent history of a diarrheal illness 3 weeks prior to his admission, and was treated at a private hospital without any complication. He was observed to have concomitant HIV infection and diabetes mellitus. He was not previously known to have any of these diseases and initially diagnosed as having acute diabetic neuropathy. Conclusion: GBS can occur in the setting of HIV infection on a background of DM and may be associated with a poor prognosis. There is a need to have a high index of suspicion in making a diagnosis of GBS in diabetic patients when it occurs concomitantly with HIV infection.Key words: HIV, Guillain-Barré Syndrome, diabetes mellitus, paralysis, presenting, progressive weaknes

Unilateral renal agenesis associated with ovarian cysts in a 19 year old woman in Orlu, South-East Nigeria

Background: Anomalies linked with unilateral renal agenesis are not completely known.Aim: We report here a rare occurrence of ovarian cysts associated with unilateral renal agenesis in Orlu, Nigeria.Methods: A 19 year-old woman was being evaluated for acute pyelonephritis.Findings: We noted that this patient had acute pyelonephritis on a background of right renal agenesis that was associated with bilateral ovarian cysts. Ovarian cyst in the index patient was an incidental finding whereas acute pyelonephritis, perhaps, was a complication of unilateral renal agenesis.Conclusion: This case report highlights the need for consideration of possibility of ovarian cysts during evaluation of unilateral renal agenesis as many abnormalities of the ovaries, uterus and vagina are associated with renal agenesis and may impact negatively on fertility.Keywords: Unilateral renal agenesis, ovarian cysts, pyelonephritis, urogenital abnormalities, Orlu, Nigeri

Sero-prevalence of hepatitis B virus and hepatitis C virus among HIV patients in a suburban University Teaching Hospital in South-East Nigeria

Introduction: Highly active antiretroviral therapy (HAART) has improved  survival of human immunodeficiency virus (HIV) patients. Concurrent morbidities from liver diseases among these patients have also been observed due to co-infection with hepatitis B and C viruses (HBV and HCV).HAART reduces liver-associated morbidities and mortalities in such  patients. Unfortunately free testing of HBV and HCV are not provided alongside free HIV testing and treatment in Nigeria. We assessed the seroprevalence of HBV and HCV among HIV patients presenting for  treatment in our center. Methods: This prospective study of adult patients with HIV/AIDS assessed the seroprevalence of HBV and HCV co-infection using a 19- item  questionnaire and collection of 2ml venous blood for hepatitis B surface antigens (HBsAg) and anti-HCV antibodies. All previously diagnosed HIV patients of the unit were excluded from the study. Results: Of the 404 patients, 69.2% were females while 30.8% were  males. Married participants were 59.6%, 25.3% were single and 15% were previously married. A large proportion (69%) of patients were farmers,  artisans and traders. Most had some formal education; secondary   (55.3%), primary 27.3%, tertiary 13.8%. HBsAg positive participants were 9 (2.2%) while 3 (0.7%) were positive for HCV. No participant had triple infection of HIV/HBV/HCV. Conclusion: Seroprevalence of HBV and HCV is low among HIV patients in Orlu. However there is a need for HBV and HCV testing of all HIV positive patients to reduce morbidities and mortalities from liver diseases

Knowledge, Attitude and Practice of Adverse Drug Reaction Reporting among Healthcare Workers in a Tertiary Centre in Northern Nigeria

Purpose: To determine the knowledge, attitude and practice of ADR monitoring and reporting among healthcare workers in a teaching hospital in Kano, Nigeria Methods: The study was cross-sectional and questionnaire-based involving mainly medical doctors, nurses and pharmacists working in different departments of the Aminu Kano Teaching Hospital hospital. A total of 110 questionnaires were distributed to the respondents (60 doctors, 40 nurses, 10 pharmacists). The completion of the questionnaire by respondents was taken as their consent toparticipate in the study. Results: Only 65 respondents filled and returned the questionnaire within the stipulated time frame giving a response rate of about 59.1 %. The standard yellow reporting form for adverse drug reactions was only known to 35.9 % of the participating health care workers. Only 42.7 % of the respondents had ever reported an adverse drug reaction and the report was verbal in over 75 % of cases. Ignorance of the rules and procedures of reporting, lack of knowledge of the forms for reporting and which ADRs to report were some of the factors responsible for non-reporting of adverse drug reactions among respondents in the study Conclusion: Adverse drug reaction reporting using the yellow card reporting scheme is low among health care workers (doctors, nurses and pharmacists) in Kano, Nigeria. There is a need for regular training and re-enforcement of guidelines for ADR reporting among health care personnel. The inclusion of nurses in pharmacovigilance will go a long way in improving reporting of ADRs.Keywords: Adverse drug reactions; Knowledge, attitude and practice; Health care workers; Yellow card reporting schem

Prevalence and awareness of hypertension and associated risk factors among bank workers in Owerri, Nigeria

Background: Hypertension is largely asymptomatic and common among adult Nigerians, and considered to be of public health importance. Banking work is associated with stress, a risk for hypertension.Aim: To evaluate the prevalence and awareness of hypertension and its associated risk factors among bankers in Owerri.Methods: This cross-sectional descriptive study was aimed at determining the knowledge, prevalence of hypertension and other risk factors for cardiovascular disease among bank workers in Owerri. We randomly selected banks by balloting in Owerri and assessed 194 bankers using a self-administered questionnaire on their knowledge and social habits. Their blood pressure (mmHg), weight (Kg) and heights (meter) were measured. Results are presented in proportions and odds ratio.Results: We studied 194 bankers; 100 males and 94 females. Most respondents (98%) had a good knowledge of hypertension but 80.4% (156) had poor knowledge of the risk factors of hypertension; 86.6% (118) and 59.3% (115) had poor knowledge of its treatment and complications respectively. The prevalence of hypertension was 12.4% with odds of a male being hypertensive 4.2 (95% CI 1.5 – 11.7), P-value= 0.006. Thirteen (68.4%) bankers with hypertension had good blood pressure control. Alcohol consumption in 12 (50%) and obesity in 9 (37.5%) bankers were the commonest cardiovascular risk factors.Conclusion: Bank workers in Owerri have a good knowledge of hypertension despite a low prevalence of hypertension. Additional educational effort aimed at addressing blood pressure control and life style modification is necessary among bankers.Keywords: Hypertension, prevalence, bankers, awareness, risk factors, cardiovascular diseas

Invasive bacterial co-infection in African children with Plasmodium falciparum malaria: a systematic review.

Background: Severe malaria remains a major cause of pediatric hospital admission across Africa. Invasive bacterial infection (IBI) is a recognized complication of Plasmodium falciparum malaria, resulting in a substantially worse outcome. Whether a biological relationship exists between malaria infection and IBI susceptibility remains unclear. We, therefore, examined the extent, nature and evidence of this association.Methods: We conducted a systematic search in August 2012 of three major scientific databases, PubMed, Embase and Africa Wide Information, for articles describing bacterial infection among children with P. falciparum malaria using the search string (malaria OR plasmodium) AND (bacteria OR bacterial OR bacteremia OR bacteraemia OR sepsis OR septicaemia OR septicemia). Eligiblity criteria also included studies of children hospitalized with malaria or outpatient attendances in sub-Saharan Africa.Results: A total of 25 studies across 11 African countries fulfilled our criteria. They comprised twenty cohort analyses, two randomized controlled trials and three prospective epidemiological studies. In the meta-analysis of 7,208 children with severe malaria the mean prevalence of IBI was 6.4% (95% confidence interval (CI) 5.81 to 6.98%). In a further meta-analysis of 20,889 children hospitalised with all-severity malaria and 27,641 children with non-malarial febrile illness the mean prevalence of IBI was 5.58 (95% CI 5.5 to 5.66%) in children with malaria and 7.77% (95% CI 7.72 to 7.83%) in non-malaria illness. Ten studies reported mortality stratified by IBI. Case fatality was higher at 81 of 336, 24.1% (95% CI 18.9 to 29.4) in children with malaria/IBI co-infection compared to 585 of 5,760, 10.2% (95% CI 9.3 to 10.98) with malaria alone. Enteric gram-negative organisms were over-represented in malaria cases, non-typhoidal Salmonellae being the most commonest isolate. There was weak evidence indicating IBI was more common in the severe anemia manifestation of severe malaria.Conclusions: The accumulated evidence suggests that children with recent or acute malaria are at risk of bacterial infection, which results in an increased risk of mortality. Characterising the exact nature of this association is challenging due to the paucity of appropriate severity-matched controls and the heterogeneous data. Further research to define those at greatest risk is necessary to target antimicrobial treatment. © 2014 Church and Maitland; licensee BioMed Central Ltd

Antimalarial drug dispensing in Ibadan, Nigeria: a cross-sectional survey of the knowledge and practice among drug dispensers

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Azithromycin-induced Hiccups

Background: Hiccups are not only known symptoms of some diseases but have been found to be induced by some drugs. In this report, we present a very rare case of azithromycin induced hiccups seen in a young male adult.Methods: The case records of a 34 year old male who was admitted and successfully managed for sepsis but placed on azithromycin as the only medication at the time of discharge was reviewed.Results: T he patient presented again at the hospital within twelve (12) hours of discharge with a history of severe hiccups which improved significantly with administered chlorpromazine.H e was sent home the following day while still on azithromycin.T he patient stopped all the medications at home after the second dose of azithromycin due to persistent drowsiness and decided to take the last dose of azithromycin two days later after realizing that the drowsiness was chlorpromazine induced.H e developed another severe episode of hiccups which was successively retreated with oral chlorpromazine.Conclusion: The patient developed hiccups within 12 hours while he was taking only azithromycin on two (2) different occasions. We then concluded that azithromycin was the probable cause of the hiccups.Keywords: hiccups, azithromycin, drug-induced,ad verse drug reactio