Prevalence of Asymptomatic Bacteriuria in HIV Infected Patients in a Tertiary Hospital in Lagos, Nigeria

Background: People living with Human Immunodeficiency Virus (HIV) are more predisposed to urinary tract infections due to suppression of their immunity by the virus. Asymptomatic bacteriuria is associated with an increased risk of symptomatic urinary tract infection and the latter being an important contributor to development of chronic renal failure, hypertension and toxaemia of pregnancy. The aim of this study was to determine the prevalence of asymptomatic bacteriuria in HIV-infected patients and proffer a recommendation on the need or otherwise to screen. Methods: This was a cross sectional study of treatment-naive HIV-infected patients attending the HIV clinics of Lagos State University Teaching Hospital (LASUTH), Ikeja. A single voided aseptically collected mid-stream urine (MSU) was obtained from each patient and all samples processed immediately, were sent for urinalysis and culture. Isolates were considered significant if there were ≥105 colony forming unit/mL (CFU/mL) with 2 or less isolates, doubtful significance if <105 CFU/mL. Significant isolates were selected for identification. Data were analyzed using SPSS version 16.0 (Statistical Package for Social Sciences, Inc., Chicago, Ill). Results: A total of 156 consenting participants were recruited into the study. The mean age was 36.45 ± 8.65 years. There were 60 of 156 (38.4%) males and 96 of 156 (61.56%) females. Only 33 of 156 (21.2%) had significant bacteriuria, out of the 33 participants, 19 (57.8%) were asymptomatic, while 14 of 33 (42.4%) had significant growth but were symptomatic or on antibiotics. E. coli was isolated in 9 of 19 (47.3%), followed by Staph aureus 4 of 19 (21.05%). Conclusion: More than half of participants who had significant growth had asymptomatic bacteriuria, while one-fifth of all patients had significant growth. Considering this statistics, screening for or treatment of asymptomatic bacteriuria may be recommended in all HIV-infected patients

New-Onset Seizures in HIV Patients on Antiretroviral Therapy at a Tertiary Centre in South-West, Nigeria

Background: Seizures are associated with neurological manifestations of HIV. They may be the presenting symptom and can occur at any disease stage. Aim: To determine the frequency and clinical aspects of new-onset seizures in patients with human immunodeficiency virus (HIV) infection. Methods: A study of an HIV-infected patient cohort on highly active anti-retroviral therapy (HAART) in the out-patients clinic of the Lagos state university teaching hospital, Nigeria. In a cross-sectional design, 308 HIV infected patients were recruited over a period of 1 year. Cases with a first seizure during this period were further examined. Details of demographic data, the first seizure date, seizure characteristics, neurologic complications and CD4 count at the time of the seizure were documented. Results: A total of 20 (6.5%) had new-onset seizures during the study period. 6/20 (30%) were males and 14/20 (70%), females. Their ages ranged between 22 - 51 years with a mean of 34.2 ± 8.7 years. The seizure was focal in 2/20 (10%) of cases and generalised in 90% (18/20) of cases. A total of 13/20 (65%) had recurrence of their seizures. None of the cases had focal neurological deficit at the time of the first seizure. The mean CD4 count was 165.3 ± 145.7. The mean duration on HAART was 19.5 ± 12.7 months. Cases with CD4 counts ≤200 cells/mm3 constituted 70% (14/20) whilst those with CD4 counts >200 made up 30% (6/20) [p = 0.666]. Conclusions: Seizures remain a significant neurological manifestation of HIV infection and has a high recurrence rate. It occurs more commonly in the advanced stage with severe immune suppression and may be attributable to HIV encephalopathy. Early treatment would reduce the burden and improve patient’s quality of life

Prevalence of Priapism and Its Awareness amongst Male Homozygous Sickle Cell Patients in Lagos, Nigeria

Background. Priapism is a pathological condition of penile erection that persists beyond, or is unrelated to, sexual stimulation. Impotence and infertility are major problems in male sickle cell disease patients, and priapism has been implicated as a cause of impotence and infertility. The aim of this study is to determine priapism prevalence and assess the knowledge of male homozygous male patients about it in Lagos, Nigeria. Methods. A cross-sectional study was conducted amongst male homozygous sickle cell disease patients of Lagos State University Teaching Hospital. Pretested questionnaires were distributed to determine the prevalence and assess their knowledge on priapism. Data were analyzed using SPSS version 16.0. Results. A total of 114 consenting subjects filled the questionnaires, 85 of 114 (74.6%) had not heard about priapism before this study. A total of 77 of 114 (67.5%) did not know that they are at risk of priapism. Whilst 84 of 114 (73.7%) were not aware that priapism is a complication of SCD. The majority, 94 of 114 (82.5%), were not aware that priapism could cause impotence. Conclusion. There is a need to create more awareness about this complication amongst sickle cell disease patients in order to stem the incidence of impotence and infertility amongst them

Effect of sub-clinical hypothyroidism on clinical severity in first-ever acute ischemic stroke.

Background: Subclinical hypothyroidism has been documented to have a positive effect on the clinical presentation and outcome in acute ischemic stroke.Objective: To determine the prevalence of subclinical hypothyroidism in first ever ischemic strokes and to evaluate its effect on the clinical presentation.Methods: Using a cross-sectional study design, 138 patients diagnosed with first ever ischemic stroke within 7 days of onset were included in the study. Each participant had documentation of demographic data, followed by a detailed neurological examination. Stroke severity on admission was recorded using the National Institute of Health Stroke Scale (NIHSS) and blood samples for free thyroxine (T4) and thyroid stimulating hormone (TSH) were taken within 24h of onset of symptoms. For analysis, the patients were divided into two groups: those who had elevated TSH level (&gt; 2.5mIU/L) with normal FT4 level were assigned to the sub-clinical hypothyroidism group whilst those with normal thyroid function were assigned to the control group. All values were compared between the two groups.Results: The study population comprised of a total number of 138 participants with mean age of 63.4 ± 12.9 years. The females were 56 (40.6%) and the males were 82 (59.4%). A total number of 11(7.9%) had subclinical hypothyroidism whilst 127 participants (92%) had normal thyroid functions. The mean NIHSS score of cases with SCH on admission was significantly lower than that of those with normal thyroid functions (6.73± 3.6 vs 11.1 ± 6.3, p=0.025). A significantly higher proportion of patients in the SCH group had mild neurologic deficits on admission compared with the group with normal thyroid functions (81.8% vs 24.4%, p &lt; 0.001).Conclusion: Our study has suggested that subclinical hypothyroidism appears to confer a neuroprotective effect in acute ischemic stroke.Key words: Subclinical hypothyroidism, acute ischemic stroke, NIHSS, clinical severity

Quality of Sleep in an HIV Population on Antiretroviral Therapy at an Urban Tertiary Centre in Lagos, Nigeria

Aim. To determine the prevalence of sleep disturbance and its associated characteristics in HIV-positive outpatients on HAART using the PSQI. Methods. Using a cross-sectional design, 300 patients attending the outpatient HIV/AIDS clinic at the Lagos State University Teaching Hospital were recruited. Baseline data obtained included the participants’ demographic data, educational qualification, and marital status. Their treatment history, including duration since HIV diagnosis, the most recent CD4 cell count, and current antiretroviral therapies, was obtained from their case records. Each participant completed the PSQI questionnaire and those with scores ≥5 were diagnosed with poor sleep quality. Results. The participants were made up of 70.7% females and 29.3% males. Their ages ranged between 18 and 74 years with a mean of 38.9±10.3 years. According to the PSQI, 59.3% reported poor sleep quality. The mean score of those with poor quality sleep (9.2±3.3) was comparable to that of those with good quality sleep (1.26±1.4). P<0.001. Significant differences were observed in all the individual components of the PSQI (P<0.001). On multivariate analyses, the independent associations with sleep quality were the duration since HIV diagnosis (P=0.29), efavirenz based regimen (P<0.001), and lower CD4 cell count (P<0.001). Conclusions. Sleep disturbances are quite common in the HIV population even in the era of HAART. Early recognition via routine assessment and effective treatments could prevent the resultant complications and improve quality of life

Prevalence of Priapism and Its Awareness amongst Male Homozygous Sickle Cell Patients in Lagos, Nigeria

Background. Priapism is a pathological condition of penile erection that persists beyond, or is unrelated to, sexual stimulation. Impotence and infertility are major problems in male sickle cell disease patients, and priapism has been implicated as a cause of impotence and infertility. The aim of this study is to determine priapism prevalence and assess the knowledge of male homozygous male patients about it in Lagos, Nigeria. Methods. A cross-sectional study was conducted amongst male homozygous sickle cell disease patients of Lagos State University Teaching Hospital. Pretested questionnaires were distributed to determine the prevalence and assess their knowledge on priapism. Data were analyzed using SPSS version 16.0. Results. A total of 114 consenting subjects filled the questionnaires, 85 of 114 (74.6%) had not heard about priapism before this study. A total of 77 of 114 (67.5%) did not know that they are at risk of priapism. Whilst 84 of 114 (73.7%) were not aware that priapism is a complication of SCD. The majority, 94 of 114 (82.5%), were not aware that priapism could cause impotence. Conclusion. There is a need to create more awareness about this complication amongst sickle cell disease patients in order to stem the incidence of impotence and infertility amongst them. Background Sickle Cell Disease. Sickle cell disorder is a genetic abnormality involving haemoglobin and red cells. The glutamine on the 6th position of the chain is replaced with valine consequent on a single point mutation in which thymine replaces adenine on the deoxyribonucleic acid structure. Haemoglobin S resulting from the substitution causes polymerization of haemoglobin and red cell sickling on exposure to low-oxygen tension and unsickle on oxygenation. The sickled red cells obstruct blood vessels and impede free flow of blood of the affected vessel causing vascular congestion, oxygen deprivation, anaerobic glycolysis, lactic acidosis, and pain. This may be responsible for priapism, an acute complication of sickle cell disease. Priapism in Sickle Cell Disease. Priapism is a pathological condition of penile erection that persists beyond, or is unrelated to, sexual stimulation Priapism is due to occlusion of the outflow vessels from the corpora cavernosa by sickled cells, consistent with significantly lower HbF levels in affected cases Priapism may be self limited, and of short duration usually lasting less than 3 hours. It may also be chronic and recurrent lasting more than 24 hours. Increased rate of impotence has been reported in sickle cell patients whose attacks lasted more than 24 hours Sexual intercourse has been implicated to precipitate attack amongst Jamaican. Others reported spontaneous attacks that wake the patient from sleep Many treatment modalities are available for priapism, these include the use of drugs, exchange blood transfusion and surgical intervention. Drugs like -adrenergic agonist which increase the contractile state of the trabecular/arterial meshwork and facilitate venous outflow from the corpora Adequate hydration and analgesia may dislodge the trapped sickled red cells, partial exchange blood transfusion to lower the HbS level to less than 30% has been tried Surgical interventions which is usually the last procedure for unresolved priapism involves aspiration and irrigation of the corpora cavernosa with saline Infertility is a major problem in male sickle cell disease patients reported by Abudu et al. in which they noted a lower testosterone levels in males compared with age-matched controls Methods This cross-sectional study to determine the prevalence and assess the knowledge of male sickle cell disease patients on Consenting participants were recruited consecutively into the study after obtaining the institution&apos;s ethics and research committee approval. Pretested questionnaires were distributed to them to determine the prevalence and assess their knowledge on priapism. The questionnaire was designed by the authors, adapted from previous related studies Statistical Assessment Data were analyzed using SPSS version 16.0 (Statistical Package for Social Sciences, Inc., Chicago, IL, USA). The descriptive data was given as mean ± standard deviation (SD). The Pearson chi-squared test was used to test for association between discrete variables. A value was considered to be statistically significant when &lt;0.05. Result A total of 114 consenting subjects filled the questionnaires; the mean age was 21.97 ± 7.51, with a minimum of 14 years and maximum of 53 years. A total of 105 of 114 (92.1%) were single, while 9 of 114 (7.9%) were married. The majority, 65 of 114 (57%), had secondary education, 36 of 114 (31.6%) had tertiary education, 10 of 114 (8.8%) had primary education, while 3 of 114 (2.7%) had no education The A total of 23 of 45 (51.11%) did not get any treatment, 6 of 45 (13.33%) were admitted, and 8 of 45 (17.77%) were treated but not admitted. When asked about how many times they had episode of priapism, the majority, 11 of 45 (24.44%), had it twice followed by 9 of 45 (20%) once, 4 of 45 (8.8%) thrice, and 3 of 45 (6.66%) 5 times. When asked about precipitating factors, 17 of 45 (37.77%) had it after waking up from sleep followed by no known factors in 10 of 45 (22.22%), followed by 5 of 45 (11.11%) following bone pain crises, and 4 of 45 (8.88%) after sexual intercourse