Sputum smear positivity among patients presenting to the dots clinic with chronic cough

Cough is one of the cardinal features of Pulmonary Tuberculosis (PTB). However, even in communities with high prevalence of TB, lung diseases other than TB appear to account for this symptom. Objective: To estimate the prevalence of sputum smear positivity among patients with TB who presented with complaints of chronic cough to the Directly Observed Therapy Short Course (DOTS) clinic at the University of Maiduguri Teaching Hospital, North Eastern Nigeria. Methodology: A cross sectional study was conducted at the University of Maiduguri Teaching Hospital (UMTH) Borno state, Northeastern Nigeria between September 2014 and January 2017. All patients (new or previously treated) who presented to the DOTS clinic of the UMTH with complaints of chronic cough and had screening for pulmonary TB using sputum smear microscopy were reviewed. The minimum and the maximum ages were 1 year and 85 years, respectively, and the mean age was 36.0 (SD=14.0) years. The mean age did not differ among the male and female patients (i.e.37.3 ± 14.4 vs 34.1 ± 13.2, p=0.78). The overall prevalence of sputum smear positivity for TB was 26.5%. Although majority of patients who were sputum smear positive for TB fell within the age groups 30-39 and 20-29 thus accounting for 42.6% and 28.7% respectively, however, there was no significant association between age of those with chronic cough and sputum smear positivity TB (p=0.80). Among those who were sputum smear positive, 24.3% were new cases and 2.2% were previously treated. Conclusions: Data were entered into a computer database and analyzed with SPSS version 20.0 statistical software. Results: This study showed a high prevalence of sputum smear positivity among suspected TB patients with complaints of chronic cough This could be explained by the fact that the DOTS strategy has improved the case detection of PTB in this community. All patients with chronic cough should be evaluated for PTB

Hepatic transaminase and alkaline phosphatase enzyme levels in HIV/HBV co‑infected and HIV mono‑infected patients in Maiduguri, Nigeria

Background: Studies have shown that HIV‑HBV co‑infected patients have an increased risk of liver‑related morbidity and mortality compared to their HIV‑mono‑infected counterparts. Furthermore, it has been reported that HIV‑HBV co‑infected patients have a significantly high incidence of drug‑induced hepatotoxicity following commencement of HAART than HIV‑mono‑infected patients.Objectives: To compare the levels of aspartate amino transferase (AST), alanine amino transferase (ALT) and alkaline phosphatase (ALKPO4) enzyme levels between HAART naïve HIV‑HBV co‑infected patients and their HIV‑mono‑infected counterparts.Materials and Methods: A cross‑sectional descriptive study in which 142 newly diagnosed HIV/HBV co‑infected and HIV mono‑infected adults were investigated for alkaline aminotransferase, aspartate aminotransferase and alkaline phosphatase enzyme levels.Results: The study subjects comprised of 80 (56.3%) females and 62 (46.7%) males. The age range of the study population was 15‑65 years. The mean ages of male and female subjects were 45.5 ± 10.5 years and 39.1 ± 7.5 years respectively (P < 0.05). Sixty‑three (44.4%) study subjects were HIV/HBV co‑infected while 79 (55.6%) were HIV mono‑infected. The mean ALT enzyme level of HIV/HBV co‑infected subjects was significantly higher than that of HIV mono‑infected ones i.e., 42.12 IU/l vs. 27.86 IU/l, (P = 0.038). However, there was no statistically significant difference in the mean AST (30.14 IU/l vs. 29.09 IU/l, P = 0.893) and ALKPO4 (55.86 IU/l vs. 60.97 IU/l, P = 0.205) enzyme levels between HIV‑HBV co‑infected and HIV mono‑infected subjects albeit the two enzymes were moderately elevated in both categories of subjects.Conclusion: The significantly elevated ALT enzyme levels amongst HIV‑HBV co‑infected subjects suggest that HIV‑HBV co‑infected patients may have an increased risk of liver‑related morbidity and mortality than their HIV mono‑infected counterparts. Screening for serological markers of chronic HBV infection, as well as hepatic transaminase enzyme levels in all newly diagnosed HIV‑positive patients is therefore recommended before commencement of HAART.Keywords: Alkaline phosphatase enzyme, hepatitis B virus surface antigen, hepatic transaminase enzymes, human immunodeficiency virusNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

HIV sero-positive status among clients aged ≥ 50 years that presented for care in a tertiary health facility in northeastern Nigeria.

The introduction of highly active antiretroviral therapy (HAART) has transformed HIV infection from hopeless to manageable health condition comparable to non-infectious diseases such as asthma and diabetes mellitus. This modest achievement has reduced morbidity and mortality and increased longevity and quality of life among HIV infected persons. Although reports from developing countries such as Nigeria, shows that youth within the reproductive are most affected by the scourge of HIV/AIDS. Older patients with features that may be indicative of HIV infection are often overlooked in favour of other differential diagnosis. Objective: To document HIV positive sero-status among client aged 50 years and above that necessitated HIV test as part of their clinical evaluation after voluntary counseling and testing at a tertiary health facility. Method: Record of 1674 adults participants that presented for care between January 2009- December 2013, were retrieved for this study. Results: The HIV-seropositive status among the participants was 370 (22.1%). It showed a female preponderance of 136 (26.0%) than 234 (20.0%) in males. The peak annual prevalence was observed in the year 2010, steady decline was observed thereafter. Overall, older participants between 60-70 years had higher HIV-seropositivity status. This study shows one out four males and five females with index of suspicion either based on clinical presentation or risky sexual behavior are positive for HIV infection. Conclusion: This report underscores the need to explore other risk factors that may be peculiar to older segment of the society and introduce HIV intervention strategies for the older populations. Delivery of HIV intervention measures and services to this segment of the population is expedient. Measures and interventions should take into consideration the peculiarities, specific vulnerabilities and HIV-related challenges faced by this group of clients

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 <100 cells/ml

A transition from unimodal to multimodal activations in four sensory modalities in humans: an electrophysiological study

<p>Abstract</p> <p>Background</p> <p>To investigate the long-latency activities common to all sensory modalities, electroencephalographic responses to auditory (1000 Hz pure tone), tactile (electrical stimulation to the index finger), visual (simple figure of a star), and noxious (intra-epidermal electrical stimulation to the dorsum of the hand) stimuli were recorded from 27 scalp electrodes in 14 healthy volunteers.</p> <p>Results</p> <p>Results of source modeling showed multimodal activations in the anterior part of the cingulate cortex (ACC) and hippocampal region (Hip). The activity in the ACC was biphasic. In all sensory modalities, the first component of ACC activity peaked 30–56 ms later than the peak of the major modality-specific activity, the second component of ACC activity peaked 117–145 ms later than the peak of the first component, and the activity in Hip peaked 43–77 ms later than the second component of ACC activity.</p> <p>Conclusion</p> <p>The temporal sequence of activations through modality-specific and multimodal pathways was similar among all sensory modalities.</p

The effect of water immersion on short-latency somatosensory evoked potentials in human

<p>Abstract</p> <p>Background</p> <p>Water immersion therapy is used to treat a variety of cardiovascular, respiratory, and orthopedic conditions. It can also benefit some neurological patients, although little is known about the effects of water immersion on neural activity, including somatosensory processing. To this end, we examined the effect of water immersion on short-latency somatosensory evoked potentials (SEPs) elicited by median nerve stimuli. Short-latency SEP recordings were obtained for ten healthy male volunteers at rest in or out of water at 30°C. Recordings were obtained from nine scalp electrodes according to the 10-20 system. The right median nerve at the wrist was electrically stimulated with the stimulus duration of 0.2 ms at 3 Hz. The intensity of the stimulus was fixed at approximately three times the sensory threshold.</p> <p>Results</p> <p>Water immersion significantly reduced the amplitudes of the short-latency SEP components P25 and P45 measured from electrodes over the parietal region and the P45 measured by central region.</p> <p>Conclusions</p> <p>Water immersion reduced short-latency SEP components known to originate in several cortical areas. Attenuation of short-latency SEPs suggests that water immersion influences the cortical processing of somatosensory inputs. Modulation of cortical processing may contribute to the beneficial effects of aquatic therapy.</p> <p>Trial Registration</p> <p>UMIN-CTR (UMIN000006492)</p

Limited emergence of resistance to integrase strand transfer inhibitors (INSTIs) in ART-experienced participants failing dolutegravir-based antiretroviral therapy: a cross-sectional analysis of a Northeast Nigerian cohort

Background Due to the high prevalence of resistance to NNRTI-based ART since 2018, consolidated recommendations from the WHO have indicated dolutegravir as the preferred drug of choice for HIV treatment globally. There is a paucity of resistance outcome data from HIV-1 non-B subtypes circulating across West Africa. Aims We characterized the mutational profiles of persons living with HIV from a cross-sectional cohort in North-East Nigeria failing a dolutegravir-based ART regimen. Methods WGS of plasma samples collected from 61 HIV-1-infected participants following virological failure of dolutegravir-based ART were sequenced using the Illumina platform. Sequencing was successfully completed for samples from 55 participants. Following quality control, 33 full genomes were analysed from participants with a median age of 40 years and median time on ART of 9 years. HIV-1 subtyping was performed using SNAPPy. Results Most participants had mutational profiles reflective of exposure to previous first- and second-line ART regimens comprised NRTIs and NNRTIs. More than half of participants had one or more drug resistance-associated mutations (DRMs) affecting susceptibility to NRTIs (17/33; 52%) and NNRTIs (24/33; 73%). Almost a quarter of participants (8/33; 24.4%) had one or more DRMs affecting tenofovir susceptibility. Only one participant, infected with HIV-1 subtype G, had evidence of DRMs affecting dolutegravir susceptibility—this was characterized by the T66A, G118R, E138K and R263K mutations. Conclusions This study found a low prevalence of resistance to dolutegravir; the data are therefore supportive of the continual rollout of dolutegravir as the primary first-line regimen for ART-naive participants and the preferred switch to second-line ART across the region. However, population-level, longer-term data collection on dolutegravir outcomes are required to further guide implementation and policy action across the region

Polymorphism of SERPINE2 gene is associated with pulmonary emphysema in consecutive autopsy cases

<p>Abstract</p> <p>Background</p> <p>The <it>SERPINA1</it>, <it>SERPINA3</it>, and <it>SERPINE2 </it>genes, which encode antiproteases, have been proposed to be susceptible genes for of chronic obstructive pulmonary disease (COPD) and related phenotypes. Whether they are associated with emphysema is not known.</p> <p>Methods</p> <p>Twelve previously reported single nucleotide polymorphisms (SNPs) in <it>SERPINA1 </it>(rs8004738, rs17751769, rs709932, rs11832, rs1303, rs28929474, and rs17580), <it>SERPINA3 </it>(rs4934, rs17473, and rs1800463), and <it>SERPINE2 </it>(rs840088 and rs975278) were genotyped in samples obtained from 1,335 consecutive autopsies of elderly Japanese people. The association between these SNPs and the severity of emphysema, as assessed using macroscopic scores, was determined.</p> <p>Results</p> <p>Emphysema of more than moderate degree was detected in 189 subjects (14.1%) and showed a significant gender difference (males, 20.5% and females, 7.0%; p < 0.0001). Among the 12 examined SNPs, only rs975278 in the <it>SERPINE2 </it>gene was positively associated with emphysema. Unlike the major alleles, homozygous minor alleles of rs975278 were associated with emphysema (odds ratio (OR) = 1.54; 95% confidence interval (CI) = 1.02-2.30; p = 0.037) and the association was very prominent in smokers (OR = 2.02; 95% CI = 1.29-3.15; p = 0.002).</p> <p>Conclusions</p> <p><it>SERPINE2 </it>may be a risk factor for the development of emphysema and its association with emphysema may be stronger in smokers.</p

A systematic review of physiological methods in rodent pharmacological MRI studies

Rationale: Pharmacological magnetic resonance imaging (phMRI) provides an approach to study effects of drug challenges on brain processes. Elucidating mechanisms of drug action helps us to better understand the workings of neurotransmitter systems, map brain function or facilitate drug development. phMRI is increasingly used in preclinical research employing rodent models; however, data interpretation and integration are complicated by the use of different experimental approaches between laboratories. In particular, the effects of different anaesthetic regimes upon neuronal and haemodynamic processes and baseline physiology could be problematic. Objectives: This paper investigates how differences in phMRI research methodologies are manifested and considers associated implications, placing particular emphasis on choice of anaesthetic regimes. Methods: A systematic review of rodent phMRI studies was conducted. Factors such as those describing anaesthetic regimes (e.g. agent, dosage) and parameters relating to physiological maintenance (e.g. ventilatory gases) and MRI method were recorded. Results: We identified 126 eligible studies and found that the volatile agents isoflurane (43.7 %) and halothane (33.3 %) were most commonly used for anaesthesia, but dosage and mixture of ventilatory gases varied substantially between laboratories. Relevant physiological parameters were usually recorded, although 32 % of studies did not provide cardiovascular measures. Conclusions: Anaesthesia and animal preparation can influence phMRI data profoundly. The variation of anaesthetic type, dosage regime and ventilatory gases makes consolidation of research findings (e.g. within a specific neurotransmitter system) difficult. Standardisation of a small(er) number of preclinical phMRI research methodologies and/or increased consideration of approaches that do not require anaesthesia is necessary to address these challenges

Factors influencing overall survival rates for patients with pineocytoma

Given its rarity, appropriate treatment for pineocytoma remains variable. As the literature primarily contains case reports or studies involving a small series of patients, prognostic factors following treatment of pineocytoma remain unclear. We therefore compiled a systematic review of the literature concerning post-treatment outcomes for pineocytoma to better determine factors associated with overall survival among patients with pineocytoma. We performed a comprehensive search of the published English language literature to identify studies containing outcome data for patients undergoing treatment for pineocytoma. Kaplan–Meier analysis was utilized to determine overall survival rates. Our systematic review identified 168 total patients reported in 64 articles. Among these patients, 21% underwent biopsy, 38% underwent subtotal resection, 42% underwent gross total resection, and 29% underwent radiation therapy, either as mono- or adjuvant therapy. The 1 and 5 year overall survival rates for patients receiving gross total resection versus subtotal resection plus radiotherapy were 91 versus 88%, and 84 versus 17%, respectively. When compared to subtotal resection alone, subtotal resection plus radiation therapy did not offer a significant improvement in overall survival. Gross total resection is the most appropriate treatment for pineocytoma. The potential benefit of conventional radiotherapy for the treatment of these lesions is unproven, and little evidence supports its use at present