Hepatic transaminase and alkaline phosphatase enzyme levels in HIV/HBV co‑infected and HIV mono‑infected patients in Maiduguri, Nigeria

Background: Studies have shown that HIV‑HBV co‑infected patients have an increased risk of liver‑related morbidity and mortality compared to their HIV‑mono‑infected counterparts. Furthermore, it has been reported that HIV‑HBV co‑infected patients have a significantly high incidence of drug‑induced hepatotoxicity following commencement of HAART than HIV‑mono‑infected patients.Objectives: To compare the levels of aspartate amino transferase (AST), alanine amino transferase (ALT) and alkaline phosphatase (ALKPO4) enzyme levels between HAART naïve HIV‑HBV co‑infected patients and their HIV‑mono‑infected counterparts.Materials and Methods: A cross‑sectional descriptive study in which 142 newly diagnosed HIV/HBV co‑infected and HIV mono‑infected adults were investigated for alkaline aminotransferase, aspartate aminotransferase and alkaline phosphatase enzyme levels.Results: The study subjects comprised of 80 (56.3%) females and 62 (46.7%) males. The age range of the study population was 15‑65 years. The mean ages of male and female subjects were 45.5 ± 10.5 years and 39.1 ± 7.5 years respectively (P < 0.05). Sixty‑three (44.4%) study subjects were HIV/HBV co‑infected while 79 (55.6%) were HIV mono‑infected. The mean ALT enzyme level of HIV/HBV co‑infected subjects was significantly higher than that of HIV mono‑infected ones i.e., 42.12 IU/l vs. 27.86 IU/l, (P = 0.038). However, there was no statistically significant difference in the mean AST (30.14 IU/l vs. 29.09 IU/l, P = 0.893) and ALKPO4 (55.86 IU/l vs. 60.97 IU/l, P = 0.205) enzyme levels between HIV‑HBV co‑infected and HIV mono‑infected subjects albeit the two enzymes were moderately elevated in both categories of subjects.Conclusion: The significantly elevated ALT enzyme levels amongst HIV‑HBV co‑infected subjects suggest that HIV‑HBV co‑infected patients may have an increased risk of liver‑related morbidity and mortality than their HIV mono‑infected counterparts. Screening for serological markers of chronic HBV infection, as well as hepatic transaminase enzyme levels in all newly diagnosed HIV‑positive patients is therefore recommended before commencement of HAART.Keywords: Alkaline phosphatase enzyme, hepatitis B virus surface antigen, hepatic transaminase enzymes, human immunodeficiency virusNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Frontonasal dysplasia Sequence : A case report

Frontonasal dysplasia (FND) is a very rare congenital abnormality in which the mid face does not develop normally. It affects mainly the head and face. Cause is unknown but may be sporadic or familial. We report a rare case of a full term baby who presented with classical features of FND in Maiduguri, Nigeria. Management difficulty in resource limited setting is highlighted.Key words: Dysmorphism, Frontonasaldysplasia, Neonate

Seroprevalence of IgG anti- T. Gondii antibody among HIV-infected patients in Maiduguri, north eastern Nigeria.

Background: Toxoplasma gondii infection is one of the commonest opportunistic infections in HIV-infected patients, with the fatal consequences of toxoplasmic encephalitis particularly in advanced disease. However, data regarding T.gondii infection in the setting of HIV/AIDS are scant in Nigeria. Objective: To determine the seroprevalence of T.gondii amongst HIV-infected patients as well as to determine the correlation between anti-T.gondii IgG titre and the CD4+ cell count/HIV-1 RNA viral load. Method: A cross sectional study in which a total of 190 subjects were involved i.e. 110 newly diagnosed HAART naïve HIV-positive patients and 80 apparently healthy HIV-negative age- and-sex matched controls that were selected by simple random sampling method. Results: The age range of the study population was 20-64 years. The mean ages of male subjects for both HIV-positives and controls were 37.52 ±8.20 years and 35.79 ±12.31years, respectively, (p= 0.462). On the other hand, the mean ages of female subjects for both HIV-positives and controls were 29.90 ±6.98 years and 32.30 ±10.29 years, respectively, (p=0.149). Twenty one subjects (19.1%) among HIV-positives and 1 (1.25%) HIV-negative tested positive for anti-T.gondii IgG, respectively, (p= 0.000). The prevalence rate ration of anti-T. gondii IgG of HIV positives compared to HIVnegatives was 15.28. Significant proportion of anti-T.gondii positive subjects presented with AIDS defining illnesses compared with their anti-T.gondii negative counterparts. Conclusion:The study has shown that anti-T.gondii IgG is about 15 times more prevalent among HIV positive patients compared to controls. Routine screening for T.gondii IgG anti-body is therefore recommended for all HIV-infected subjects at the facility as well as commencement of chemoprophylaxis against Toxoplasmic encephalitis in HIV-infected patients with CD4+ cell count of <100 cells/ml

Cardiovascular disease and the role of oral bacteria

In terms of the pathogenesis of cardiovascular disease (CVD) the focus has traditionally been on dyslipidemia. Over the decades our understanding of the pathogenesis of CVD has increased, and infections, including those caused by oral bacteria, are more likely involved in CVD progression than previously thought. While many studies have now shown an association between periodontal disease and CVD, the mechanisms underpinning this relationship remain unclear. This review gives a brief overview of the host-bacterial interactions in periodontal disease and virulence factors of oral bacteria before discussing the proposed mechanisms by which oral bacterial may facilitate the progression of CVD

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Snake bite in Gombe

Aims: Snake bite is an important cause of morbidity and mortality in Nigeria as in many parts of the tropics. This study was undertaken to determine the prevalence and the clinical pattern of snake bite in Gombe. Methods: Two hundred and seven (207) cases of snakebite admitted at the State Specialist Hospital Gombe over a 4-year period were retrospectively studied. Results: The highest proportion was in the 21-30 years age group accounting for 36.9% of the total. There is a male preponderance with a male to female ratio of 6: 1. Most of the victims were bitten outdoors (75%). The lower limb was the most frequently bitten site (68.1%). The highest number of bites (77.3%) occurred during the rainy season, with farmers accounting for 64.2% of cases. 92% of the bites occurred during the day. Systemic envenomation was noted in 46.4% of the victims. 96.6 % of them received polyvalent antivenom, while 89.5% and 78.4% received antibiotics and antitetanus prophylaxis respectively. The mortality rate was 10.6%. Conclusion: The prevalence of snake bite in Gombe is high. The morbidity and mortality can be reduced through health education to avoid harmful traditional practices, prompt conveyance of victims to hospital and early administration of adequate doses of antivenom. KEY WORDS: Snakebite, prevalence, clinical presentation, treatment, Gombe Highland Medical Research Journal Vol.1(4) 2003: 22-2

The prevalence of Hepatitis B surface antigenaemia in patients with human immunodeficiency virus (HIV) infection in Gombe, Nigeria

Background: Both Hepatitis Virus B (HBV) and HIV infection are highly endemic in Nigeria and are important causes of morbidity and mortality. Co-infection is known to occur since the two viruses share common modes of transmission. HBV is known to produce a protein X that can stimulate the replication of HIV in vitro, and it has been observed that HIV positive men with HBV infection are at increased risk of liver related mortality. Methods: Two hundred consecutively recruited HIV-infected individuals comprising 97 males and 103 females were screened for HBsAg using ELISA. HIV-negative blood donors in the same area were used as controls. Results: Fifty-three of the patients tested positive for HBsAg giving an overall prevalence rate of 26.5% which was significantly higher (p < 0.001) than the 10.4% recorded among non-HIV-infected individuals. Co-infection rate in males (24.7%) did not differ significantly from that of females (28.2%). Co-infection was highest in the 40-49 years age group (41.6%), while no case of co-infection was recorded in the &#8804; 19 years. Among the different occupational groups businessmen had the highest co-infection rate (44%) followed by long distance drivers (39.5%). In relation to marital status, divorcees/widows had the highest proportion of those with co-infection (53%) followed by those who were unmarried (32.5%) and those married (21.6%). Conclusion: This study confirms the high prevalence rate of HBV co-infection in HIV-infected patients compared to the non-HIV- infected population. Therefore, there is a need to screen all HIV-infected patients for HBV infection. Key Words: Hepatitis B surface antigen, HIV infection Annals of African Medicine Vol.3(1 ) 2004: 10-1