Peripheral Facial Paralysis as a Manifestation of HIV Infection

Three cases of infranuclear facial nerve palsy associated with infection by the human immunodeficiency virus type 1 are reported. All were previously asymptomatic and had no other symptom suggestive of HIV infection. Two patients had typical Bell's palsy while one had a facial diplegia. CD4 cell counts were above 100 cells/mm3 in all cases. A review of the literature confirmed that peripheral facial nerve palsy could occur at any stage of HIV infection and in various clinical contexts. It is suggested that adult patients presenting with peripheral facial paralysis should be counseled, and screened for HIV Infection

Nutrient Intakes and Nutritional Status of Mothers and their Under-Five Children in a Rural Community of Oyo State, Nigeria

Malnutrition in sub-Saharan Africa contributes to high rates of childhood morbidity and mortality which make it a public health concern in Africa. This study assessed the nutrient intakes and nutritional status of mothers and their under-five children in a rural community of Oyo State, Nigeria. A total of 500 households with a mother and child pair were sampled using a multi-stage sampling procedure. Information on household socio-economic status, hygiene practices, breastfeeding practices and clinical observation for signs of malnutrition were collected using pre-tested semi-structured questionnaires by trained interviewers. Weight for age (WAZ), weight for height (WHZ), and height for age (HAZ) for underweight, wasting and stunting, respectively were calculated and assessed by Epi Info software using the NCHS/WHO international reference values. BMI (weight/height2) of mothers were also constructed from the measurements of mothers’ weights and heights. The waist/hip ratio of mothers was also determined. An interactive 24 h recall repeated for three days was used to obtain data on food and nutrient intakes of the women. Information on foods consumed was converted into quantitative data of nutrients using Food Composition Table. The result showed a high proportion (81%) of mothers ate three times daily while 14% ate twice and 5% ate more than thrice daily. The mean daily intakes of calcium, vitamins A, B6, B12, niacin, and folate were found to be inadequate compared with the Recommended Intakes. The WHR of the mothers indicated that majority had low risk. Most of the mothers (69.2%) were normal, underweight 9.6%, overweight 15.8% and obese 5.4%. About 37% of the children were stunted, 18% were underweight and 14.3% were wasted. BMI correlated negatively with age (r = -0.41; p <0.05), and positively with education (r = 0.22; p<0.05) and income (r = 0.45; p <0.05). Clinical observation revealed PEM prevalence in 12% children while eyes pallor and palm pallor were present in 15% and 20% respectively. The nutritional status of mothers and their under-five children is poor with respect to the overall food consumption and micronutrient intake. Consequently, nutrition programmes in this area should include effective measures to promote nutritional status of mothers and children

Cost-effectiveness analysis of PCR for the rapid diagnosis of pulmonary tuberculosis

<p>Abstract</p> <p>Background</p> <p>Tuberculosis is one of the most prominent health problems in the world, causing 1.75 million deaths each year. Rapid clinical diagnosis is important in patients who have co-morbidities such as Human Immunodeficiency Virus (HIV) infection. Direct microscopy has low sensitivity and culture takes 3 to 6 weeks <abbrgrp><abbr bid="B1">1</abbr><abbr bid="B2">2</abbr><abbr bid="B3">3</abbr></abbrgrp>. Therefore, new tools for TB diagnosis are necessary, especially in health settings with a high prevalence of HIV/TB co-infection.</p> <p>Methods</p> <p>In a public reference TB/HIV hospital in Brazil, we compared the cost-effectiveness of diagnostic strategies for diagnosis of pulmonary TB: Acid fast bacilli smear microscopy by Ziehl-Neelsen staining (AFB smear) plus culture and AFB smear plus colorimetric test (PCR dot-blot).</p> <p>From May 2003 to May 2004, sputum was collected consecutively from PTB suspects attending the Parthenon Reference Hospital. Sputum samples were examined by AFB smear, culture, and PCR dot-blot. The gold standard was a positive culture combined with the definition of clinical PTB. Cost analysis included health services and patient costs.</p> <p>Results</p> <p>The AFB smear plus PCR dot-blot require the lowest laboratory investment for equipment (US$20,000). The total screening costs are 3.8 times for AFB smear plus culture versus for AFB smear plus PCR dot blot costs (US$ 5,635,760 versus US$1,498, 660). Costs per correctly diagnosed case were US$ 50,773 and US$13,749 for AFB smear plus culture and AFB smear plus PCR dot-blot, respectively. AFB smear plus PCR dot-blot was more cost-effective than AFB smear plus culture, when the cost of treating all correctly diagnosed cases was considered. The cost of returning patients, which are not treated due to a negative result, to the health service, was higher in AFB smear plus culture than for AFB smear plus PCR dot-blot, US$ 374,778,045 and US$ 110,849,055, respectively.</p> <p>Conclusion</p> <p>AFB smear associated with PCR dot-blot associated has the potential to be a cost-effective tool in the fight against PTB for patients attended in the TB/HIV reference hospital.</p

Safety and long-term immunogenicity of the two-dose heterologous Ad26.ZEBOV and MVA-BN-Filo Ebola vaccine regimen in adults in Sierra Leone: a combined open-label, non-randomised stage 1, and a randomised, double-blind, controlled stage 2 trial

Background The Ebola epidemics in west Africa and the Democratic Republic of the Congo highlight an urgent need for safe and effective vaccines to prevent Ebola virus disease. We aimed to assess the safety and long-term immunogenicity of a two-dose heterologous vaccine regimen, comprising the adenovirus type 26 vector-based vaccine encoding the Ebola virus glycoprotein (Ad26.ZEBOV) and the modified vaccinia Ankara vector-based vaccine, encoding glycoproteins from Ebola virus, Sudan virus, and Marburg virus, and the nucleoprotein from the Tai Forest virus (MVA-BN-Filo), in Sierra Leone, a country previously affected by Ebola. Methods The trial comprised two stages: an open-label, non-randomised stage 1, and a randomised, double-blind, controlled stage 2. The study was done at three clinics in Kambia district, Sierra Leone. In stage 1, healthy adults (aged ≥18 years) residing in or near Kambia district, received an intramuscular injection of Ad26.ZEBOV (5×1010 viral particles) on day 1 (first dose) followed by an intramuscular injection of MVA-BN-Filo (1×108 infectious units) on day 57 (second dose). An Ad26.ZEBOV booster vaccination was offered at 2 years after the first dose to stage 1 participants. The eligibility criteria for adult participants in stage 2 were consistent with stage 1 eligibility criteria. Stage 2 participants were randomly assigned (3:1), by computer-generated block randomisation (block size of eight) via an interactive web-response system, to receive either the Ebola vaccine regimen (Ad26.ZEBOV followed by MVA-BN-Filo) or an intramuscular injection of a single dose of meningococcal quadrivalent (serogroups A, C, W135, and Y) conjugate vaccine (MenACWY; first dose) followed by placebo on day 57 (second dose; control group). Study team personnel, except those with primary responsibility for study vaccine preparation, and participants were masked to study vaccine allocation. The primary outcome was the safety of the Ad26.ZEBOV and MVA-BN-Filo vaccine regimen, which was assessed in all participants who had received at least one dose of study vaccine. Safety was assessed as solicited local and systemic adverse events occurring in the first 7 days after each vaccination, unsolicited adverse events occurring in the first 28 days after each vaccination, and serious adverse events or immediate reportable events occurring up to each participant’s last study visit. Secondary outcomes were to assess Ebola virus glycoprotein-specific binding antibody responses at 21 days after the second vaccine in a per-protocol set of participants (ie, those who had received both vaccinations within the protocol-defined time window, had at least one evaluable post-vaccination sample, and had no major protocol deviations that could have influenced the immune response) and to assess the safety and tolerability of the Ad26.ZEBOV booster vaccination in stage 1 participants who had received the booster dose. This study is registered at ClinicalTrials.gov, NCT02509494. Findings Between Sept 30, 2015, and Oct 19, 2016, 443 participants (43 in stage 1 and 400 in stage 2) were enrolled; 341 participants assigned to receive the Ad26.ZEBOV and MVA-BN-Filo regimen and 102 participants assigned to receive the MenACWY and placebo regimen received at least one dose of study vaccine. Both regimens were well tolerated with no safety concerns. In stage 1, solicited local adverse events (mostly mild or moderate injection-site pain) were reported in 12 (28%) of 43 participants after Ad26.ZEBOV vaccination and in six (14%) participants after MVA-BN-Filo vaccination. In stage 2, solicited local adverse events were reported in 51 (17%) of 298 participants after Ad26.ZEBOV vaccination, in 58 (24%) of 246 after MVA-BN-Filo vaccination, in 17 (17%) of 102 after MenACWY vaccination, and in eight (9%) of 86 after placebo injection. In stage 1, solicited systemic adverse events were reported in 18 (42%) of 43 participants after Ad26.ZEBOV vaccination and in 17 (40%) after MVA-BN-Filo vaccination. In stage 2, solicited systemic adverse events were reported in 161 (54%) of 298 participants after Ad26.ZEBOV vaccination, in 107 (43%) of 246 after MVA-BN-Filo vaccination, in 51 (50%) of 102 after MenACWY vaccination, and in 39 (45%) of 86 after placebo injection. Solicited systemic adverse events in both stage 1 and 2 participants included mostly mild or moderate headache, myalgia, fatigue, and arthralgia. The most frequent unsolicited adverse event after the first dose was headache in stage 1 and malaria in stage 2. Malaria was the most frequent unsolicited adverse event after the second dose in both stage 1 and 2. No serious adverse event was considered related to the study vaccine, and no immediate reportable events were observed. In stage 1, the safety profile after the booster vaccination was not notably different to that observed after the first dose. Vaccine-induced humoral immune responses were observed in 41 (98%) of 42 stage 1 participants (geometric mean binding antibody concentration 4784 ELISA units [EU]/mL [95% CI 3736–6125]) and in 176 (98%) of 179 stage 2 participants (3810 EU/mL [3312–4383]) at 21 days after the second vaccination. Interpretation The Ad26.ZEBOV and MVA-BN-Filo vaccine regimen was well tolerated and immunogenic, with persistent humoral immune responses. These data support the use of this vaccine regimen for Ebola virus disease prophylaxis in adults

Safety and immunogenicity of the two-dose heterologous Ad26.ZEBOV and MVA-BN-Filo Ebola vaccine regimen in children in Sierra Leone: a randomised, double-blind, controlled trial

Background—Children account for a substantial proportion of cases and deaths from Ebola virus disease. We aimed to assess the safety and immunogenicity of a two-dose heterologous vaccine regimen, comprising the adenovirus type 26 vector-based vaccine encoding the Ebola virus glycoprotein (Ad26.ZEBOV) and the modified vaccinia Ankara vectorbased vaccine, encoding glycoproteins from the Ebola virus, Sudan virus, and Marburg virus, and the nucleoprotein from the Tai Forest virus (MVA-BN-Filo), in a paediatric population in Sierra Leone. Methods—This randomised, double-blind, controlled trial was done at three clinics in Kambia district, Sierra Leone. Healthy children and adolescents aged 1–17 years were enrolled in three age cohorts (12–17 years, 4–11 years, and 1–3 years) and randomly assigned (3:1), via computer-generated block randomisation (block size of eight), to receive an intramuscular injection of either Ad26.ZEBOV (5 × 1010 viral particles; first dose) followed by MVA-BN-Filo (1 × 108 infectious units; second dose) on day 57 (Ebola vaccine group), or a single dose of meningococcal quadrivalent (serogroups A, C, W135, and Y) conjugate vaccine (MenACWY; first dose) followed by placebo (second dose) on day 57 (control group). Study team personnel (except for those with primary responsibility for study vaccine preparation), participants, and their parents or guardians were masked to study vaccine allocation. The primary outcome was safety, measured as the occurrence of solicited local and systemic adverse symptoms during 7 days after each vaccination, unsolicited systemic adverse events during 28 days after each vaccination, abnormal laboratory results during the study period, and serious adverse events or immediate reportable events throughout the study period. The secondary outcome was immunogenicity (humoral immune response), measured as the concentration of Ebola virus glycoprotein-specific binding antibodies at 21 days after the second dose. The primary outcome was assessed in all participants who had received at least one dose of study vaccine and had available reactogenicity data, and immunogenicity was assessed in all participants who had received both vaccinations within the protocol-defined time window, had at least one evaluable post-vaccination sample, and had no major protocol deviations that could have influenced the immune response. This study is registered at ClinicalTrials.gov, NCT02509494. Findings—From April 4, 2017, to July 5, 2018, 576 eligible children or adolescents (192 in each of the three age cohorts) were enrolled and randomly assigned. The most common solicited local adverse event during the 7 days after the first and second dose was injection-site pain in all age groups, with frequencies ranging from 0% (none of 48) of children aged 1–3 years after placebo injection to 21% (30 of 144) of children aged 4–11 years after Ad26.ZEBOV vaccination. The most frequently observed solicited systemic adverse event during the 7 days was headache in the 12–17 years and 4–11 years age cohorts after the first and second dose, and pyrexia in the 1–3 years age cohort after the first and second dose. The most frequent unsolicited adverse event after the first and second dose vaccinations was malaria in all age cohorts, irrespective of the vaccine types. Following vaccination with MenACWY, severe thrombocytopaenia was observed in one participant aged 3 years. No other clinically significant laboratory abnormalities were observed in other study participants, and no serious adverse events related to the Ebola vaccine regimen were reported. There were no treatment-related deaths. Ebola virus glycoprotein-specific binding antibody responses at 21 days after the second dose of the Ebola virus vaccine regimen were observed in 131 (98%) of 134 children aged 12–17 years (9929 ELISA units [EU]/mL [95% CI 8172–12 064]), in 119 (99%) of 120 aged 4–11 years (10 212 EU/mL [8419–12 388]), and in 118 (98%) of 121 aged 1–3 years (22 568 EU/mL [18 426–27 642]). Interpretation—The Ad26.ZEBOV and MVA-BN-Filo Ebola vaccine regimen was well tolerated with no safety concerns in children aged 1–17 years, and induced robust humoral immune responses, suggesting suitability of this regimen for Ebola virus disease prophylaxis in children

Evaluation oe the safety and efficacy of Combivir (3TC 150MG/ZDV 300mg) tablets and Agenerase (Amprenavir) (APV 150mg)capsules in HIV positive patients with CD4 cell count of 100 - 300/mm3 in Zaria, Nigeria

The study was an open labeled non-comparative study to evaluate the safety and efficacy of CombivirTM (3TC 15Omg/ZDV 300mg) tablets and AgeneraseTM (Amprenavir) (APV 150mg) capsules in the treatment of HIV positive patients with CD4 cell counts of 100 - 300/mm3. Twenty-one patients aged 25 to 63 years who met the admission criteria were recruited into the study. There were ten males and eleven females. Informed consent was obtained from each patient. Baseline CD-4 Lymphocyte count, Full Blood Count and Complete Serum Biochemistry were done for each patient. Each patient received combivirTM 450mg b.d. and AgeneraseTM 1200mg b.d. dispensed 4-weekly over a twenty-four week period. 80.5% of the patients showed an immunological response to therapy with the mean CD4 cell count of the patients rising from 184 cells/mm3 at the beginning of the study to 545 cells/mm3 at the end (p=0.000). The patients also experienced weight gain and improvement in quality of life. Few side effects were reported and these were mainly gastrointestinal. One patient wfthdrew from the study on account of abdominal pain and failure to notice a clinical response after eight weeks of therapy. One patient who was a known diabetic had a worsening of his blood sugar control. This responded to Insulin therapy. No other significant laboratory abnormalities were noted. It was concluded that the combination of CombivirTM (3TC 15Omg/ZDV 300mg) tablets and AgeneraseTM (Amprenavir) (APV 150mg) capsules was safe and efficacious in the treatment of H1V positive patients with CD4 cell counts of 100 - 300/mm3

Evaluation Oe the Safety and Efficacy Of CombivirTM(3TC 150MG/ZDV 300MG) Tablets AND AgeneraseTM(Amprenavir) (APV 150MG) Capsules in H1V Positive Patients With CD4 Cell Count OF 100 - 300/MM3 in Zaria, Nigeria

The study was an open labeled non-comparative study to evaluate the safety and efficacy of CombivirTM (3TC 15Omg/ZDV 300mg) tablets and AgeneraseTM (Amprenavir) (APV 150mg) capsules in the treatment of HIV positive patients with CD4 cell counts of 100 - 300/mm3. Twenty-one patients aged 25 to 63 years who met the admission criteria were recruited into the study. There were ten males and eleven females. Informed consent was obtained from each patient. Baseline CD-4 Lymphocyte count, Full Blood Count and Complete Serum Biochemistry were done for each patient. Each patient received combivirTM 450mg b.d. and AgeneraseTM 1200mg b.d. dispensed 4-weekly over a twenty-four week period. 80.5% of the patients showed an immunological response to therapy with the mean CD4 cell count of the patients rising from 184 cells/mm3 at the beginning of the study to 545 cells/mm3 at the end (p=0.000). The patients also experienced weight gain and improvement in quality of life. Few side effects were reported and these were mainly gastrointestinal. One patient wfthdrew from the study on account of abdominal pain and failure to notice a clinical response after eight weeks of therapy. One patient who was a known diabetic had a worsening of his blood sugar control. This responded to Insulin therapy. No other significant laboratory abnormalities were noted. It was concluded that the combination of CombivirTM (3TC 15Omg/ZDV 300mg) tablets and AgeneraseTM (Amprenavir) (APV 150mg) capsules was safe and efficacious in the treatment of H1V positive patients with CD4 cell counts of 100 - 300/mm3