Identification and Characterization of Microsporidia from Fecal Samples of HIV-Positive Patients from Lagos, Nigeria

BACKGROUND: Microsporidia are obligate intracellular parasites that infect a broad range of vertebrates and invertebrates. They have been increasingly recognized as human pathogens in AIDS patients, mainly associated with a life-threatening chronic diarrhea and systemic disease. However, to date the global epidemiology of human microsporidiosis is poorly understood, and recent data suggest that the incidence of these pathogens is much higher than previously reported and may represent a neglected etiological agent of more common diseases indeed in immunocompetent individuals. To contribute to the knowledge of microsporidia molecular epidemiology in HIV-positive patients in Nigeria, the authors tested stool samples proceeding from patients with and without diarrhea. METHODOLOGY/PRINCIPAL FINDINGS: Stool samples from 193 HIV-positive patients with and without diarrhea (67 and 126 respectively) from Lagos (Nigeria) were investigated for the presence of microsporidia and Cryptosporidium using Weber's Chromotrope-based stain, Kinyoun stain, IFAT and PCR. The Weber stain showed 45 fecal samples (23.3%) with characteristic microsporidia spores, and a significant association of microsporidia with diarrhea was observed (O.R. = 18.2; CI: 95%). A similar result was obtained using Kinyoun stain, showing 44 (31,8%) positive samples with structures morphologically compatible with Cryptosporidium sp, 14 (31.8%) of them with infection mixed with microsporidia. The characterization of microsporidia species by IFAT and PCR allowed identification of Enterocytozoon bieneusi, Encephalitozoon intestinalis and E. cuniculi in 5, 2 and 1 samples respectively. The partial sequencing of the ITS region of the rRNA genes showed that the three isolates of E.bieneusi studied are included in Group I, one of which bears the genotype B. CONCLUSIONS/SIGNIFICANCE: To our knowledge, this is the first report of microsporidia characterization in fecal samples from HIV-positive patients from Lagos, Nigeria. These results focus attention on the need to include microsporidial diagnosis in the management of HIV/AIDS infection in Nigeria, at the very least when other more common pathogens have not been detected

Malaria Treatment in Enugu Urban Nigeria: Physicians\' Compliance with the National Treatment Guidelines

Incorrect use of antimalarial drugs undermines therapeutic effectiveness and promotes emergence and spread of drug-resistant malaria. Strategies for improving compliance require accurate information about current practices. This is a survey of the attitude and practices in the treatment of malaria among doctors practicing in Enugu urban, Nigeria. Standard questionnaire technique was used among 300 doctors practicing in Enugu urban. Chloronquine and sulfadoxine – pyrimethamine were the commonest drugs used for treating uncomplicated malaria, while quinine was the commonest drug used for treating severe malaria. More than 60% of the doctors prescribe intramuscular chloroquine in the dosage of 5ml (~200mg) daily for 3 days for adults and 5mg/kg/daily for 3 days for children. Recommended dosage of quinine was used by 41.8% of the doctors in treating children, and 50% of doctors in treating in treating children, and 50% of doctors in treating adults. Only 40% of the doctors utilized the National guidelines for treatment of malaria. Comparison between duration of practice, or area of intramuscular chloroquine and intravenous quinines showed no significant difference with P values > 0.05. It was concluded that incorrect use of parental antimalarial drugs occurs at all levels and specialties of medical doctors practicing in Enugu. NQJHM Vol. 14 (3&4) 2004: pp. 227-23

In-vitro Assessment of Brands of Ampicillin Sold in Nigerian Markets

Objective: To determine the efficacy of ampicillin sold in Nigerian markets on bacterial pathogens and to ascertain their usefulness in the control of bacterial infections.Method: Five brands of ampicillin; Reichlin, Amcillin, Amikap, Neslin and Rajampi were tested for susceptibility using disc diffusion and broth dilution methods. Assay using Minimal Inhibitary Concentration (MIC) and Minimal bactericidal Concentration (MBC) were by two-fold dilution method.Concentrations 250μg/ml and 100 μg/ml served as stock.Results: Susceptibility were, Staphylococcus aureus (50%), Enterococcus faecalis(90%),E.coli (0%), Ps.aeruginosa (0%) and S.typhi (100%) . MIC (3-63)μg/ml and MBC (8-125)μg/ml were the range for all brands against S.aureus and E.faecalis, while Neslin and Rajampi were between (8-31)μg/ml for Salmonella typhi. The MIC critical values were (4-63) μg/ml at (30 to 40%) occurrence.Conclusion: This study has shown that ampicillin can be useful in the treatment of infections involving gram-positive organisms, in contrast to the illusion that it has no place in therapy, although S.aureusexpressed resistance to Neslin and Rajampi. Ps.aeruginosa and E.coli were 100% resistant therefore not useful for treatment of infections involving them. .The study provides the basis for continous monitoring of shelved antibiotics which may turn out to be useful, cost effective and indirectly conserve the tenacity of newer antibiotics

Prevalence Of Iron Deficiency In Children 6-24 Months In Lagos

Background: iron deficiency is the commonest cause of nutritional anaemia in children worldwide particularly in developing countries. Infants and toddlers are prone to developing iron deficiency anaemia (IDA). This study was carried out to determine the prevalence of IDA and some factors associated with it in this group of children. Study Design: In a study, haemoglobin concentration and mean corpuscular volume (MCV) estimations done in 282 apparently well children aged 6-24 months. Estimations of serum iron (SI), total iron binding capacity (TIBC), serum ferritin (SF) and transferrin saturation (TS) were also determined in children with anaemia (Hb concentratio

mHealth Interventions for Treatment Adherence and Outcomes of Care for Cardiometabolic Disease Among Adults Living With HIV: Systematic Review

BackgroundThe success of antiretroviral therapy has led to an increase in life expectancy and an associated rise in the risk of cardiometabolic diseases (CMDs) among people living with HIV. ObjectiveOur aim was to conduct a systematic review to synthesize the existing literature on the patterns of use and effects of mobile health (mHealth) interventions for improving treatment adherence and outcomes of care for CMD among people living with HIV. MethodsA systematic search of multiple databases, including PubMed-MEDLINE, Embase, CINAHL, Scopus, Web of Science, African Journals online, ClinicalTrials.gov, and the World Health Organization Global Index Medicus of peer-reviewed articles, was conducted with no date or language restrictions. Unpublished reports on mHealth interventions for treatment adherence and outcomes of care for CMD among adults living with HIV were also included in this review. Studies were included if they had at least 1 component that used an mHealth intervention to address treatment adherence or 1 or more of the stated outcomes of care for CMD among people living with HIV. ResultsOur search strategy yielded 1148 unique records. In total, 10 articles met the inclusion criteria and were included in this review. Of the 10 studies, only 4 had published results. The categories of mHealth interventions ranged from short messaging, telephone calls, and wearable devices to smartphone and desktop web-based mobile apps. Across the different categories of interventions, there were no clear patterns in terms of consistency in the use of a particular intervention, as most studies (9/10, 90%) assessed a combination of mHealth interventions. Short messaging and telephone calls were however the most common interventions. Half of the studies (5/10, 50%) reported on outcomes that were indirectly linked to CMD, and none of them provided reliable evidence for evaluating the effectiveness of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. ConclusionsDue to the limited number of studies and the heterogeneity of interventions and outcome measures in the studies, no definitive conclusions could be drawn on the patterns of use and effects of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. We therefore recommend that future trials should focus on standardized outcomes for CMD. We also suggest that future studies should consider having a longer follow-up period in order to determine the long-term effects of mHealth interventions on CMD outcomes for people living with HIV. Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42018086940; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD4201808694

Potential for false-positive HIV test results using rapid HIV testing algorithms

Background: In order to scale up access to HIV counselling and testing in Nigeria, an HIV diagnostic algorithm based on rapid testing was adopted. However, there was the need to further evaluate the testing strategy in order to better assess its performance, because of the potential for false positivity. Objectives: The objective of this study was to compare positive HIV test results obtained from the approved rapid testing algorithm with results from western blot tests performed on samples from the same patient. Methodology: A retrospective review was conducted of HIV screening and confirmatory results for patients seen between 2007 and 2008. Rapid test and western blot results were extracted and compared for concordance. Discordant results were further reviewed using a combination of HIV-1 RNA viral load and CD4+ cell count test results and clinical presentation from medical records. Results: Analysis of 2228 western blot results showed that 98.3% (n = 2191) were positive for HIV-1, 0.4% (n = 8) were positive for HIV-2 and 0.3% (n = 7) were dual infections (positive for both HIV-1 and HIV-2); 0.6% (n = 13) were indeterminate and 0.4% (n = 9) were negative. Further investigation of the 13 indeterminate results showed nine to be HIV-1 positive and four to be HIV-negative, for a total of 13 negative results. The positive predictive value of the HIV counselling and testing algorithm was 99.4%. Conclusion: Using the rapid testing algorithm alone, false positives were detected. Therefore, effective measures such as training and retraining of staff should be prioritised in order to minimise false-positive diagnoses and the associated potential for long-term psychological and financial impact on the patients

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society