Treatment of Histoplasmosis

Histoplasmosis, caused by the thermally dimorphic fungus Histoplasma capsulatum, is an uncommon multisystem disease with a global distribution. The spectrum of clinical manifestations ranges from an asymptomatic or minimally symptomatic acute pulmonary disease following inhalation of a large inoculum of Histoplasma microconidia to chronic pulmonary disease in patients with underlying structural lung disease. It also extends to acute progressive disseminated disease in patients with severe immunodeficiency. Generally, antifungal therapy is indicated for patients with progressive acute pulmonary histoplasmosis, chronic pulmonary histoplasmosis and acute progressive disseminated histoplasmosis. In immunocompetent patients, acute pulmonary histoplasmosis may be a self-limiting disease without the need for systemic antifungal therapy. Oral triazole antifungal drugs alone are recommended for less severe disease. However, moderate-to-severe acute pulmonary histoplasmosis requires intravenous amphotericin B therapy for at least 1–2 weeks followed by oral itraconazole for at least 12 weeks. For acute progressive disseminated histoplasmosis, intravenous amphotericin B therapy is given for at least 2 weeks (4–6 weeks if meningeal involvement) or until a patient can tolerate oral therapy, followed by oral itraconazole (or an alternative triazole) for at least 12 months. Chronic cavitary pulmonary histoplasmosis is treated with oral itraconazole for 1–2 years. There is insufficient evidence to support the use of isavuconazole or the echinocandins for the treatment of histoplasmosis

Using a mHealth tutorial application to change knowledge and attitude of frontline health workers to Ebola virus disease in Nigeria: a before-and-after study

Background: The Ebola epidemic exposed the weak state of health systems in West Africa and their devastating effect on frontline health workers and the health of populations. Fortunately, recent reviews of mobile technology demonstrate that mHealth innovations can help alleviate some health system constraints such as balancing multiple priorities, lack of appropriate tools to provide services and collect data, and limited access to training in health fields such as mother and child health, HIV/AIDS and sexual and reproductive health. However, there is little empirical evidence of mHealth improving health system functions during the Ebola epidemic in West Africa. Methods: We conducted quantitative cross-sectional surveys in 14 health facilities in Ondo State, Nigeria, to assess the effect of using a tablet computer tutorial application for changing the knowledge and attitude of health workers regarding Ebola virus disease. Results: Of 203 participants who completed pre- and post-intervention surveys, 185 people (or 91%) were female, 94 participants (or 46.3%) were community health officers, 26 people (13 %) were nurses/midwives, 8 people (or 4%) were laboratory scientists and 75 people (37%) belonged to a group called others. Regarding knowledge of Ebola: 178 participants (or 87.7%) had foreknowledge of Ebola before the study. Further analysis showed an 11% improvement in average knowledge levels between pre- and post-intervention scores with statistically significant differences (P < 0.05) recorded for questions concerning the transmission of the Ebola virus among humans, common symptoms of Ebola fever and whether Ebola fever was preventable. Additionally, there was reinforcement of positive attitudes of avoiding the following: contact with Ebola patients, eating bush meat and risky burial practices as indicated by increases between pre- and post-intervention scores from 83 to 92%, 57 to 64% and 67 to 79%, respectively. Moreover, more participants (from 95 to 97%) reported a willingness to practice frequent hand washing and disinfecting surfaces and equipment following the intervention, and more health workers were willing (from 94 to 97%) to use personal protective equipment to prevent the transmission of Ebola. Conclusions: The modest improvements in knowledge and reported attitudinal change toward Ebola virus disease suggests mHealth tutorial applications could hold promise for training health workers and building resilient health systems to respond to epidemics in West Africa

Global variations in diabetes mellitus based on fasting glucose and haemogloblin A1c

Fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) are both used to diagnose diabetes, but may identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening had elevated FPG, HbA1c, or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardised proportion of diabetes that was previously undiagnosed, and detected in survey screening, ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the agestandardised proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global gap in diabetes diagnosis and surveillance.peer-reviewe

Statin-use and perceptions of high cholesterol as predictors of healthy lifestyle behaviours in Nigerians.

It is unclear how statin-use influences the adoption of healthy lifestyle choices. It is important to understand the nature of this relationship as this could facilitate targeted public health interventions which could help promote a healthy lifestyle, curb the rise of non-communicable diseases, and facilitate overall health. This study aimed to explore whether statin-use influenced the adoption of healthy lifestyle choices by changing the way urban and semi-urban Nigerians thought about their high cholesterol and their future risk of cardiovascular disease. Structured questionnaires were used to compare the lifestyle behaviours, perceptions of high cholesterol and future risk of cardiovascular disease of statin users and non-statin users recruited in urban and a semi-urban Nigeria. In-depth, face-to-face interviews were used to further explore the relationship between statin-use and the adoption of healthy lifestyle choices, and explore the influence of personal and social factors on this relationship. The odds of adopting a low-fat diet increased as perceived statin-effectiveness increased (OR = 2.33, p<0.05), demonstrating a synergistic relationship between statin-use and the adoption of healthy of lifestyle choices. In addition to this synergistic association, at interview, two other relationships were found between statin use and the adoption of healthy lifestyle choices: an antagonistic relationship fuelled by a strong perception of statin effectiveness and a perceived inability to make healthy lifestyle changes, which favoured statin-use, and an antagonistic relationship fuelled by congruous cause-control beliefs and concerns about medication-use which favoured the adoption of healthy lifestyle choices. The odds of adopting a low-fat diet was 5 times greater in urban dwellers than in semi-urban dwellers (p<0.01). Statin-use influenced the adoption of healthy lifestyle choices in three different ways, which require exploration at clinical consultation. Gender, social obligations, and physical environment also influenced statin-use and the adoption of healthy lifestyle choices

Statin-use and perceptions of high cholesterol as predictors of healthy lifestyle behaviours in Nigerians.

It is unclear how statin-use influences the adoption of healthy lifestyle choices. It is important to understand the nature of this relationship as this could facilitate targeted public health interventions which could help promote a healthy lifestyle, curb the rise of non-communicable diseases, and facilitate overall health. This study aimed to explore whether statin-use influenced the adoption of healthy lifestyle choices by changing the way urban and semi-urban Nigerians thought about their high cholesterol and their future risk of cardiovascular disease. Structured questionnaires were used to compare the lifestyle behaviours, perceptions of high cholesterol and future risk of cardiovascular disease of statin users and non-statin users recruited in urban and a semi-urban Nigeria. In-depth, face-to-face interviews were used to further explore the relationship between statin-use and the adoption of healthy lifestyle choices, and explore the influence of personal and social factors on this relationship. The odds of adopting a low-fat diet increased as perceived statin-effectiveness increased (OR = 2.33, p<0.05), demonstrating a synergistic relationship between statin-use and the adoption of healthy of lifestyle choices. In addition to this synergistic association, at interview, two other relationships were found between statin use and the adoption of healthy lifestyle choices: an antagonistic relationship fuelled by a strong perception of statin effectiveness and a perceived inability to make healthy lifestyle changes, which favoured statin-use, and an antagonistic relationship fuelled by congruous cause-control beliefs and concerns about medication-use which favoured the adoption of healthy lifestyle choices. The odds of adopting a low-fat diet was 5 times greater in urban dwellers than in semi-urban dwellers (p<0.01). Statin-use influenced the adoption of healthy lifestyle choices in three different ways, which require exploration at clinical consultation. Gender, social obligations, and physical environment also influenced statin-use and the adoption of healthy lifestyle choices

Assessment of anthropometric indices among residents of Calabar, South-East Nigeria

Background: Obesity is a risk factor for type 2 diabetes mellitus which may be addressed by application of intensive lifestyle interventions. Thus, establishing normative values of anthropometric indices in our environment is crucial. This study aimed to determine normative values of anthropometric indices of nutrition among residents of Calabar. Materials and Methods: This cross sectional observational study recruited residents of Calabar aged between 15-79 years using a multistage sampling method. Trained research assistants collected socio-demographic data and did anthropometric measurements. Results: There were 645 (56.5%) males and 489 (43.1%) females. Males had significantly lower general adiposity and hip circumference (HC) than females while females had significantly lower waist circumference (WC) and waist hip ratio (WHR) than males. The WHR increased with age particularly among males. Body mass index (BMI) also increased with age in both males and females with a peak in the middle age bracket, followed by a decline among the elderly. The mean (SD) BMI was 27.7 (5.0) kg/m 2 . Males had a mean (SD) BMI of 27.0 (4.4) kg/m 2 , while females had a mean (SD) BMI of 28.5 (5.5) kg/m 2 respectively. WC correlated positively and significantly with BMI and WHR in males and females. WHR correlated positively and significantly with BMI in males and females. Conclusion: There are positive linear inter relationships between the indices of nutrition which is strongest between WC and BMI. In view of the strong independent association of DM with indices of nutrition, it is appropriate to derive normal cut-off values for WC, WHR and BMI nationally