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

Chronic Kidney Disease Screening and Renoprotection in Type 2 Diabetes

Background: Type 2 diabetes (T2D) is a major cause of chronic kidney disease. Control of hypertension and the use of angiotensin converting enzyme inhibitors (ACEI) and/or angiotensin II receptor blockers especially in those with proteinuria have been shown to protect against chronic kidney disease and delay its progression to kidney failure. Methods: We reviewed the medical records of 169 patients at 12 months with a view of auditing the screening for chronic kidney disease and the use of renoprotective measures. Results: Urinalysis was done in 49.1% and serum creatinine in 50.3%. No patient had glomerular filtration rate estimated. Seventy nine (67.6%) of the hypertensive patients were on anti-hypertensives. ACEI was used in 49 (45.8%) of these patients BP control was optimal in 29.1%. Conclusion: There is poor adherence to guidelines on chronic kidney disease screening and renoprotection in T2D.Fond: Le type 2 le diab\ue8te (T2D) est une cause importante de la maladie chronique de rein. La commande de l'hypertension et l'utilisation des inhibiteurs d'enzyme convertissants d'angiotensine (ACEI) et/ou des dresseurs de r\ue9cepteur de l'angiotensine II particuli\ue8rement dans ceux avec le proteinuria ont \ue9t\ue9 montr\ue9es pour se prot\ue9ger contre la maladie chronique de rein et pour retarder sa progression \ue0 l'\ue9chec de rein. M\ue9thodes: Nous avons pass\ue9 en revue les disques m\ue9dicaux de 169 patients \ue0 12 mois avec une vue d'auditer le criblage pour la maladie chronique de rein et l'utilisation des mesures renoprotective. R\ue9sultats: L'analyse d'urine a \ue9t\ue9 faite en 49.1% et cr\ue9atinine de s\ue9rum dans 50.3%. Aucun patient n'a fait estimer le taux de filtrage glom\ue9rulaire. Soixante-dix-neuf (67.6%) des patients hypertendus \ue9taient sur des antihypertensifs. ACEI a \ue9t\ue9 employ\ue9 dans 49 (45.8%) de ces patients que la commande de BP \ue9tait optimale dans 29.1%. Conclusion: Il y a d'adh\ue9rence pauvre aux directives sur le criblage et le renoprotection chroniques de la maladie de rein dans T2D