Churg Strauss Syndrome: a Review

Churg Strauss syndrome is a medical condition of unknown aetiology characterized by asthma, eosinophilia and finally vasculitis involving small vessels in the limbs and nasal sinuses and the lungs. The purpose of this review is to highlight the natural history of this condition, the pathogenesis, clinical features and treatment modalities available and the prognosis. Literature on the subject was reviewed using manual library search, articles in journals, internet search and conference abstracts.Churg Strauss syndrome has been reported to be predominantly common in middle aged individuals in their middle age of life with a history of new onset or worsened asthma. The condition has a male predisposition. Prior to the advent of steroid therapy this condition invariably leads to death, but since the introduction of prednisolone therapy and other immunosuppressive therapy, the outlook has improved for sufferers and long term survival has been seen. Suspicion of this condition should be based on a good history, physical examination and laboratory investigations and diagnosis based on the criteria that has been drawn by the American College of Rheumatology.Keywords:Asthma, Churg Strauss syndrome, Eosinophilia, Vasculitis

Frequency of Cryptococcal Meningitis in HIV-1 Infected Patients in North Central Nigeria

Background: Cryptococcal meningitis (CM) is the most common severe life threatening fungal infection in AIDS patients. It is an important cause of morbidity and mortality. There is paucity of data on the prevalence of CM in Nigeria. We aimed to determine the frequency of CM, the clinical presentation and immunological profile.Methods: A cross sectional study was carried out at the Jos University Teaching Hospital (JUTH), A total of 100 HIV-1 infected patients suspected of having meningitis or meningoencephalitis were subjected to cerebrospinal fluid (CSF) analysis (including Indian ink preparation and fungal culture by conventional methods) and CD4 count was determined using flow cytometry (count bit Y-R 1004 Partec Muster Germany).Results: The freguency of CM was 36% in our cohort. The commonest clinical presentation included headache (100.0%), neck stiffness (77.8%), fever (72.0%), vomiting (55.6%), personality changes (55.6%), photophobia (27.8%) and convulsions (27.8%). The mean duration of symptoms was 24 ±22 days with a median of 17 days. The mean CD4 count was 89±60 cells/mm3 with a median of 82 cells/mm3.Conclusion: The high prevalence of CM and the associated severe immunosuppression underscores the importance of early diagnosis of HIV infection which may reduce the incidence of CM. There is the urgent need for access to Amphotericin B and fluconazole in resource constrained settings in addition to a wide access to HAART.Key words: Cryptococcal meningitis, HIV, North central Nigeri

The association of spirometric small airways obstruction with respiratory symptoms, cardiometabolic diseases, and quality of life: Results from the Burden of Obstructive Lung Disease (BOLD) study

Background: Spirometric small airways obstruction (SAO) is common in the general population. Whether spirometric SAO is associated with respiratory symptoms, cardiometabolic diseases, and quality of life (QoL) is unknown. Methods: Using data from the Burden of Obstructive Lung Disease study (N = 21,594), we defined spirometric SAO as the mean forced expiratory flow rate between 25 and 75% of the FVC (FEF25-75) less than the lower limit of normal (LLN) or the forced expiratory volume in 3 s to FVC ratio (FEV3/FVC) less than the LLN. We analysed data on respiratory symptoms, cardiometabolic diseases, and QoL collected using standardised questionnaires. We assessed the associations with spirometric SAO using multivariable regression models, and pooled site estimates using random effects meta-analysis. We conducted identical analyses for isolated spirometric SAO (i.e. with FEV1/FVC ≥ LLN). Results: Almost a fifth of the participants had spirometric SAO (19% for FEF25-75; 17% for FEV3/FVC). Using FEF25-75, spirometric SAO was associated with dyspnoea (OR = 2.16, 95% CI 1.77–2.70), chronic cough (OR = 2.56, 95% CI 2.08–3.15), chronic phlegm (OR = 2.29, 95% CI 1.77–4.05), wheeze (OR = 2.87, 95% CI 2.50–3.40) and cardiovascular disease (OR = 1.30, 95% CI 1.11–1.52), but not hypertension or diabetes. Spirometric SAO was associated with worse physical and mental QoL. These associations were similar for FEV3/FVC. Isolated spirometric SAO (10% for FEF25-75; 6% for FEV3/FVC), was also associated with respiratory symptoms and cardiovascular disease. Conclusion: Spirometric SAO is associated with respiratory symptoms, cardiovascular disease, and QoL. Consideration should be given to the measurement of FEF25-75 and FEV3/FVC, in addition to traditional spirometry parameters

A Manifesto Concerning the Legal Protection of Computer Programs

Rationale: There is conflicting evidence on whether patients with asthma experience an accelerated decline in lung function with age. We examined the association between postbronchodilator lung function, asthma, chronic rhinosinusitis (CRS), and atopy with age using a large European sample. Methods: In 17 centers in 11 European countries, case control studies were nested within representative cross-sectional surveys of adults aged less than 75 years. Representative samples of participants with asthma, CRS or both and controls were assessed for postbronchodilator ventilatory function, smoking history, atopy, and treatment. Multiple regression was used to assess the interactive effects of age and diagnostic group on decline in postbronchodilator ventilatory function. Results: A total of 3337 participants provided adequate data (778 with asthma, 399 with CRS, 244 with both asthma and CRS and 1916 controls who had neither asthma nor CRS). Participants with asthma had lower FEV1/FVC (-4.09% (95% CI: -5.02, -3.15, P < 0.001) and a steeper slope of FEV1/FVC against age (-0.14%/annum [95%CI: -0.19, -0.08]) equivalent to smoking 1-2 packs of cigarettes per day. Those with atopy had a slope equivalent to controls. Conclusions: People with asthma have a steeper decline in postbronchodilator lung function with age, but neither CRS nor atopy alone were associated with such decline

Chronic airflow obstruction and ambient particulate air pollution

Smoking is the most well-established cause of chronic airflow obstruction (CAO) but particulate air pollution and poverty have also been implicated. We regressed sex-specific prevalence of CAO from 41 Burden of Obstructive Lung Disease study sites against smoking prevalence from the same study, the gross national income per capita and the local annual mean level of ambient particulate matter (PM2.5) using negative binomial regression. The prevalence of CAO was not independently associated with PM2.5 but was strongly associated with smoking and was also associated with poverty. Strengthening tobacco control and improved understanding of the link between CAO and poverty should be prioritised

Knowledge of Nigerian Policemen about Modern Forensics

The Nigeria Police force has been maligned in recent times for their inability to solve some sensational crimes in the country. Although the problems of the Nigeria Police force have been attributed to its origins as a coercive force and the many years of Military rule in Nigeria, the knowledge and use of forensic techniques by the Nigeria Police was investigated in this study, the population was drawn from participants of a course in the Police Staff College, Jos and almost all were graduates. Social science and Art graduates made up 85.9% of respondents. Science graduates made up only 10.8% of respondents. 81.6% of respondents did not know what next to do if they could not extract a confessional statement from their suspects. The science graduates had a much better understanding of forensics than the other respondents. We conclude by advising the recruitment of more science graduates into the Nigeria Police force and introduction of elaborate forensic science and medicine lectures into the curricular in the Police training Schools.Keywords: Forensic, DNA, Police, Forensic Odontology

Conventional Pap Technique (CPT) in Comparison to the Modified Emergency Method (Mem) in Cytodiagnosis of Pap Smear and Fine Needle Aspiration Cytology Specimens.

The generally acceptable staining technique for cytology is the Papanicolaou staining procedure; which has undergone different modifications over time. In this study, the modified technique is referred to as Modified emergency method (MEM). The study is designed to establish a superior and more improved qualitative staining technique that is simple and a cheap and rapid alternative for diagnosis of cytology specimens. 40 Pap smears from 20 patients (2 per subject) as well as 20 FNAC from 10 patients were collected in the months of March and April, 2013. One set of smears was stained by the conventional pap technique (CPT) while the other set by MEM. The results showed that cytoplasmic and nuclear staining were optimal in 99% of smears stained by MEM, while 95% of smears were optimal by CPT. The cost of production was reduced by 45% while the staining duration in MEM was 7 ± 0.5 as against 26 ± 0.5 minutes in CPT. Therefore, this study showed that MEM is relatively simple, cheaper and a more suitable rapid alternative for routine use with minimum cost.Keywords: Polychromatic, Monochromatic, Optimal, Sub-optimal and Cytodiagnosis