Assessment of probability of pulmonary arterial hypertension among HIV-1 infected patients on haart and its relationship with Cd4 cells Count and viral load

HIV patients are more likely to develop cardiovascular disease than the general population and have a 2500-fold increased risk of developing pulmonary artery hypertension (PAH). HIV associated pulmonary hypertension was said to be more severe and is associated with higher mortality. Methodology: Across-sectional conducted among consecutive HIV patients age greater than 18 years receiving treatment at the antiretroviral therapy (ART) clinic of the Federal Medical Centre Nguru Yobe State Northeastern Nigeria. Results: One hundred and twenty (120) subjects were recruited into the study, thirteen had incomplete data and were excluded from the analysis. There was a significant negative correlation between CD4 cells count with tricuspid regurgitant flow velocity (TRv), pulmonary regurgitant flow velocity (PRv), pulmonary artery trunk diameter (PATd), right ventricular to left ventricular internal diameter (RV/LV) ratio, left ventricular eccentricity index (LVEI), and right atrial area (RAA), while the correlation between CD4 cells count and right ventricular acceleration time (RVAT) was positive and significant. On the other hand, the correlations between viral load and TRv, PRv, PATd, RV/LV ratio, and RAA were positive and significant while that between viral load and RVAT was negative and significant. Conclusions: This study revealed that HIV patients with low CD4 cell count and high viral load had a high probability of developing PAH (significant negative relationship between variables associated with the probability of PAH with CD4 cell count and significant positive relationship with viral load), In HIV patients the probability of developing PAH decreases with adequate treatment (that suppress viral replication and increases CD4 count). We, therefore, recommend routine assessment of the probability of PAH in patients with HIV infection particularly those with low CD4 cell count and high viral load and encourage early commencement of HAART to prevent the development of pulmonary arterial hypertension

Multiple Sexual Partners and Condom use among 10 - 19 Year-olds in four Districts in Tanzania: What do we Learn?

Although some studies in Tanzania have addressed the question of sexuality and STIs among adolescents, mostly those aged 15 - 19 years, evidence on how multiple sexual partners influence condom use among 10 - 19 year-olds is limited. This study attempts to bridge this gap by testing a hypothesis that sexual relationships with multiple partners in the age group 10 - 19 years spurs condom use during sex in four districts in Tanzania. Secondary analysis was performed using data from the Adolescents Module of the cross-sectional household survey on Maternal, Newborn and Child Health (MNCH) that was done in Kigoma, Kilombero, Rufiji and Ulanga districts, Tanzania in 2008. A total of 612 adolescents resulting from a random sample of 1200 households participated in this study. Pearson Chi-Square was used as a test of association between multiple sexual partners and condom use. Multivariate logistic regression model was fitted to the data to assess the effect of multiple sexual partners on condom use, having adjusted for potential confounding variables. STATA (10) statistical software was used to carry out this process at 5% two-sided significance level. Of the 612 adolescents interviewed, 23.4% reported being sexually active and 42.0% of these reported having had multiple (> 1) sexual partners in the last 12 months. The overall prevalence of condom use among them was 39.2%. The proportion using a condom at the last sexual intercourse was higher among those who knew that they can get a condom if they want than those who did not. No evidence of association was found between multiple sexual partners and condom use (OR = 0.77, 95% CI = 0.35 - 1.67, P = 0.504). With younger adolescents (10 - 14 years) being a reference, condom use was associated with age group (15 - 19: OR = 3.69, 95% CI = 1.21 - 11.25, P = 0.022) and district of residence (Kigoma: OR = 7.45, 95% CI = 1.79 - 31.06, P = 0.006; Kilombero: OR = 8.89, 95% CI = 2.91 - 27.21, P < 0.001; Ulanga: OR = 5.88, 95% CI = 2.00 - 17.31, P = 0.001), Rufiji being a reference category. No evidence of association was found between multiple sexual partners and condom use among adolescents in the study area. The large proportion of adolescents who engage in sexual activity without using condoms, even those with multiple partners, perpetuates the risk of transmission of HIV infections in the community. Strategies such as sex education and easing access to and making a friendly environment for condom availability are important to address the risky sexual behaviour among adolescents

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 &lt;100 cells/ml

Defining myocardial tissue abnormalities in end-stage renal failure with cardiac magnetic resonance imaging using native T1 mapping

Noninvasive quantification of myocardial fibrosis in end-stage renal disease is challenging. Gadolinium contrast agents previously used for cardiac magnetic resonance imaging (MRI) are contraindicated because of an association with nephrogenic systemic fibrosis. In other populations, increased myocardial native T1 times on cardiac MRI have been shown to be a surrogate marker of myocardial fibrosis. We applied this method to 33 incident hemodialysis patients and 28 age- and sex-matched healthy volunteers who underwent MRI at 3.0T. Native T1 relaxation times and feature tracking–derived global longitudinal strain as potential markers of fibrosis were compared and associated with cardiac biomarkers. Left ventricular mass indices were higher in the hemodialysis than the control group. Global, Septal and midseptal T1 times were all significantly higher in the hemodialysis group (global T1 hemodialysis 1171 ± 27 ms vs. 1154 ± 32 ms; septal T1 hemodialysis 1184 ± 29 ms vs. 1163 ± 30 ms; and midseptal T1 hemodialysis 1184 ± 34 ms vs. 1161 ± 29 ms). In the hemodialysis group, T1 times correlated with left ventricular mass indices. Septal T1 times correlated with troponin and electrocardiogram-corrected QT interval. The peak global longitudinal strain was significantly reduced in the hemodialysis group (hemodialysis -17.7±5.3% vs. -21.8±6.2%). For hemodialysis patients, the peak global longitudinal strain significantly correlated with left ventricular mass indices (R = 0.426), and a trend was seen for correlation with galectin-3, a biomarker of cardiac fibrosis. Thus, cardiac tissue properties of hemodialysis patients consistent with myocardial fibrosis can be determined noninvasively and associated with multiple structural and functional abnormalities

Application Of Wsola Gwsola Algorithms For Packet Loss Concealment

This papergives an overlook of time scale algorithms used for packet loss concealment.The time scale modification (TSM) approach can be used to overcome the quality degradation at the packet loss regions.The Overlap and add (OLA) algorithm does not consider what are the content of the input signal rather it just overlap and add the signal.To avoid time discontinuitiessynchronous overlap and add (SOLA) algorithm is introduced.The disadvantage of SOLA is that it does not maintain maximum local similarity. To overcome this problem WSOLA technique is used. This technique good quality output sound than other time scale modification algorithms.Gain control into the standard WSOLA technique which could adjust the level of the audio segments for overlap and add in order to maintain the audio signal level consistent. GWSOLA algorithm can be applied in the packet loss concealment of real time voice communication

Simultaneous curvature correction at the time of the penile fracture repair: Surgical and functional outcomes

Purpose: After a penile fracture (PF), an early surgical exploration and defect closure of the lesions are recommended to prevent long-term complications. However, postoperative unsatisfactory penile curvatures are frequent in the literature. In this study, we wished to present surgical outcomes of PF after surgical repair approach with an early intraoperative curvature correction and update our series with postoperative follow-up. Patients and methods: An institutional retrospective review study of 36 patients undergoing surgical treatment for PF was performed. Mean age of patients was 53.2 years. All surgical explorations were performed within 12 hours after the traumatic event. The surgical repair with a contemporary penile plication was then made to straighten the tunica angulations in patients with curvature greater than 30 degrees, using 2- 3 pairs of 2-0 absorbable suture of polydioxanone. Results: The length of the tear ranged from 8 to 20 mm. 77.7% of the patients required a correction of the cavernous body deviation. No early complications occurred in any case. The median patient stays in the hospital was 3.4 days. At a mean follow-up of 20.6 months, all patients were able to insert the penis in the partner's vagina, and were satisfied overall with sexual intercourse; three patients (10.7%) reported residual pain and discomfort for the knots of the sutures. Conclusions: An early intraoperative curvature correction may be used for a variety of angulation deformities and severe degrees of deviations secondary to a repair after penile trauma, and may be helpful in preventing postoperative morbidity

Spatum smear positive tuberculosis among tuberculosis patients in a sub-urban hospital in Northeastern Nigeria

Background: The global tuberculosis control strategy recommended by the World Health Organization. (WHO) directly observed therapy short Course (DOTS), is based on identification of sputum smear-positive pulmonary tuberculosis cases. The rate of sputum smear- positive tuberculosis has never been reported from this part of the country. Aim: To determine the prevalence of sputum smear positive tuberculosis. Materials and Methods: The study group comprised patients aged 14 years and above admitted either into the Infectious diseases or medical wards of the Federal Medical Centre, Nguru northeastern Nigeria from 1st January 2002 to 31st December 2002. Diagnosis of TB was based either on the detection of acid- and alcohol-fast bacilli on the sputum of suspected cases or the non-resolution of radiographic features following a course of broad spectrum antibiotic. All cases had sputum smear examination of three early morning specimens (5-10 ml each) by the Ziehl-Neelsen technique for the detection of tubercle bacilli. Results: Fifty five patients with TB comprising 37 (67.3%) males and 18 (32.7%) females qualified for the study out of which one (1.8%) had extra pulmonary TB. Their ages ranged between 14 and 75 years with a mean of 35.6 ± 12.4 years. Thirty five patients (63.6%) had positive sputum smears for Mycobacterium tuberculosis, out of which 26(74.3%) were males. Twenty (36.4%) had negative smears. Conclusion: There is a high rate of sputum smear positive tuberculosis among patients seen in this hospital and this may pose some risk to close contacts and care givers. Nigerian Journal of Health and Biomedical Sciences Vol. 7 (1) 2008 pp. 72-