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   2014| January-March  | Volume 1 | Issue 1  
    Online since March 24, 2014

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HIV-Associated tuberculosis: A sub-saharan african perspective
Mukhtar A Adeiza, Abdullah A Abba, Juliana U Okpapi
January-March 2014, 1(1):1-14
The sub-Saharan Africa bears the brunt of being the region with the highest burden of both Human Immunodefiency Virus (HIV) infection and of tuberculosis (TB). While only 10% of immunocompetent individuals infected with M.tuberculosis go on to develop active disease in their lifetime, 50% of those co-infected with HIV develop active TB. Qualitative and quantitative defects of CD4+ T-lymphocytes explain the inability of HIV-infected individuals to contain mycobacterial proliferation. Similarly, TB also accelerates the progression of HIV infection. The clinical and radiological presentation of TB in patients infected with the HIV virus may be different and atypical posing significant diagnostic challenges. This is compounded by the dearth of diagnostic facilities in sub-Saharan Africa. The initiation of antiretroviral therapy (ART) during anti-TB therapy (ATT) significantly improves survival of TB/HIV co-infected persons. There are challenges in treatment of HIV associated TB because of overlapping drug toxicities, pill burden and suboptimal adherence, drug-drug interactions between ART and ATT as well as timing of ART. Of particular importance are the immune reconstitution inflammatory syndrome (IRIS) and the emergence of multi-drug resistant (MD-R) and extensively drug resistant (X-DR) TB. Centre's for tuberculosis diagnosis and treatment and for HIV care and treatment need to be integrated. This has not been so successful in sub-Saharan Africa. In spite of sustained support by donor organizations, a substantial number of HIV-TB co-infected individuals remain undiagnosed and are poorly managed. This review focuses on the epidemiology and pathogenesis of HIV-TB co-infection and the special areas of difficulty in the diagnosis and treatment of the dual infection. Emphasis is placed on the peculiarities of management in sub-Saharan Africa, the region with the highest burden of both infections.
  18,318 944 -
Anemia and iron deficiency in pregnant women in Zaria, Nigeria
Abdul-Aziz Hassan, Aisha Indo Mamman, Sunday Adaji, Bolanle Musa, Simon Kene
January-March 2014, 1(1):36-39
Introduction: Anemia is common in pregnancy and iron deficiency is a major cause of anemia in pregnant women in Africa. This is due to increased demands of the fetus, growing uterus, placenta, and poor nutritional habits. Objectives: To determine the prevalence of anemia and the role of iron deficiency in causation of anemia in pregnant women attending the antenatal clinic of the Ahmadu Bello University teaching hospital (ABUTH) in Zaria, Nigeria. Materials and Methods: Ninety (90) consenting pregnant women were entered for this study with an equal number of controls. A structured questionnaire was administered to participants. Full blood count, serum ferritin, urine and stool microscopy for parasites were carried out. Results: The mean hematocrit in the pregnant and non-pregnant subjects was 35% (SD ± 3.8; 95 CI = 34.2-35.8) and 39% L/L (SD ± 3.2; 95% CI = 37.3-38.7) with P < 0.001. In the pregnant subjects 11(12.2%) had anemia while none of the controls was anemic. Mean serum ferritin among the pregnant and non-pregnant subjects was 26.0 μg/L (SD ± 35.2; 95% CI = 18.6-33.4) and 70.3 μg/L (SD ± 106.1; 95% CI 48.1-92.5), respectively, with P-value of <0.001. Even though iron deficiency was observed in 68/90 (75.6%) of pregnant women, it was latent in 61/68(89.7%) of the women while it was frank in 7/68 (10.3%). In the non-pregnant subjects, 23/90 (25.6%) had iron deficiency despite a normal hematocrit. Of the 11/90 (12.2%) of pregnant subjects that had anemia 7/11(63.6%) had frank iron deficiency anemia while 4/11 (36.4) had anemia due to other causes. 2/90 (2.2%) of the pregnant subjects had ova of hookworm in their stool samples and both had iron deficiency anemia. Conclusion: Iron deficiency underlies many cases of anemia in pregnancy, thus justifying the use of iron supplementation in pregnancy as is currently practiced. Latent iron deficiency among non-pregnant controls suggests that iron supplementation may benefit non-pregnant women within the reproductive age group could help to improve their iron stores before the contemplation of pregnancy, thereby, reducing the prevalence of pregnancy related anemia in this environment.
  11,475 842 -
Determinants and outcome of teenage pregnancy in a rural community in Jos, Plateau State, Nigeria
Esther A Envuladu, Hadiza A Agbo, Victor A Ohize, Ayuba I Zoakah
January-March 2014, 1(1):48-52
Background: In Nigeria, the rate of teenage mothers was reported in 2008 to be 22.9% and the poor socio-demographic status of the pregnant teens play a major role in the poor maternal and child health indices and contribute to the slow pace of attainment of the related Millennium Development Goals (MDGs). This study was designed to determine the proportion of teenagers who have been pregnant, the outcome of the pregnancy and the socio-demographic determinants of the affected teens in the community. Materials and Methods: It was a community-based cross-sectional study in which an interviewer administered questionnaires was administered to 192 respondents aged 13-19 years. Results: the proportion of those who have ever been married was 25.5%, with significant association found between the age of the teenagers and being pregnant (P < 0.001). Most of the teenagers were single (75.6%) and a significant association was found between TP and teenage marriage (P < 0.001). Although 72.9% were still in school, TP was significantly associated with teenagers that were out of school (P = 0.001). TP was observed to be higher among teens with lower level of parental education though not statistically significant. (Father- none-33% and primary-36.4%; Mother: Primary-30.4%). TP was also found to be higher among teens of unskilled parent (30.4%), from polygamous family setting (42.3%) and teens in tertiary level of education (40.7%), though no statistical significant association was observed. Conclusion: Teenage pregnancy still remains a major issue in our environment and the socio-demographic characteristics of both the parents and the teenagers were found to be determinants of teenage pregnancy.
  9,408 810 -
Pneumococcal Infection in Nigeria: Preparing for the vaccine
Garba Iliyasu, Abdulrazaq G Habib, Musa Mohammad Borodo, Musa Babashani, Mohammad Ahmed
January-March 2014, 1(1):15-19
Background: The Pneumococcus is the most common cause of community-acquired pneumonia (CAP), sporadic bacterial meningitis, and bacteremia worldwide. It is an important public health concern throughout the world with global burden in causing disease and deaths comparable to that of human immunodeficiency virus (HIV), malaria, and tuberculosis. Nigeria accounts for 5% of the total global burden. Many of these morbidity and mortality could be averted with the use of pneumococcal vaccine, which is shown to be highly effective. This review is set out to highlight the burden of pneumococcal infection (PI) in Nigeria, its attendant mortality, antibiotic resistance, and the rational for the need to introduce routine pneumococcal vaccination. Materials and Methods: Relevant literatures were reviewed from medical journals, library search, and internet source. Other relevant websites like Global Alliance for Vaccines and Immunisation (GAVI), WHO were also visited as source for information. The key words employed were: pneumococcal infection, Nigeria, and vaccine. Results: Several studies have shown high burden of PI and high prevalence of antibiotic resistant Pneumococcus in Nigeria. Mortality rate has also been shown to be high and the need for effective implementation of pneumococcal vaccine into routine childhood vaccination program has been underscored. Conclusion: Prevention of pneumococcal disease and death is achievable only if efforts to deliver and implement prevention in regions with the greatest burden of disease are successful. National Primary Healthcare Development Agency (NPHCDA) should introduce either pneumococcal conjugate vaccine (PCV)-13 or PCV-10 through GAVI support to eligible children and at risk adult all over the country. As these new vaccines are introduced, it is imperative that we conduct surveillance to document changes, positive or negative, which occur in disease epidemiology. This entails continuing surveillance pre- and post-vaccine introduction, assessing resistance, changes in invasive PI (IPI), serotypes, and any replacement.
  7,652 557 -
Lipid profile of HIV/AIDS patients attending antiretroviral clinic in Zaria, North-Western Nigeria
Rasheed Yusuf, Aliyu Ibrahim Sambo, Muktar Haruna Mohammed, Hassan Abdulaziz
January-March 2014, 1(1):31-35
Introduction: Nigeria, the tenth most populous country in the world and the most populous country in sub-Saharan Africa, has the second highest population of people living with HIV, after South Africa. A variety of endocrinologic, metabolic and nutritional disturbances are common during the course of HIV infection. Most HIV/AIDS patients develop multiple metabolic abnormalities including insulin resistance, lipodystrophy and dyslipidemia leading to increased risk of cardiovascular disease (CVD). Objective: To assess the lipid profile of HIV/AIDS patients attending antiretroviral (ARV) clinic in Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria. Materials and Methods: Fifty HIV-seropositive patients on ARV therapy, 50 ARV-naοve HIV patients and also 50 HIV-negative controls were assessed for lipid profile status and CD4 count. BMI of all participants was calculated. Data obtained were analysed using SPSS 15.0. A P- value ≤ 0.05 was considered as statistically significant. Results: The mean values of lipid profile showed a significantly higher total cholesterol (P < 0.01) and HDL-cholesterol (P < 0.001) in HIV-positive patients on ARV therapy compared with ARV-naïve patients and controls. There was a positive significant correlation between CD4 count and total cholesterol as well as between CD4 count and LDL-cholesterol in patients on ARV therapy. A negative significant correlation was found between CD4 count and triglyceride in ARV-naïve patients. Atherogenic index was significantly lower (P < 0.01) in HIV-positive patients on ARV therapy. Conclusion: HIV infection leads to dyslipidemia which is probably worsened by ARV therapy; however, these dyslipidemia did not constitute CVD risk.
  6,175 568 -
Seroprevalence of hepatitis C virus antibody and its associated risk factors in children with sickle cell anaemia
Baba Jibrin, Nma M Jiya, Hamidu Ahmed
January-March 2014, 1(1):20-25
Background: Hepatitis C virus (HCV) is an important hepatotrophic virus known to be transmitted percutaneouly through contaminated sharp objects, blood and blood products. Blood transfusion is a major risk factor for the acquisition of HCV in sub-Saharan Africa and it is attributable to the absence of consistent screening of blood donors. Children and adults are all at risk of being infected especially those with sickle cell disease. Objective: To determine the seroprevalence of hepatitis C viral antibodies among transfused sickle cell anemia (SCA) children. Materials and Methods: Three hundred (300) SCA children aged 6 months-15 years attending the SCA clinic and on admission in emergency pediatric unit (EPU) and pediatric medical ward (PMW), (both in steady state and in crises) of Usmanu Danfodiyo University Teaching Hospital, Sokoto, were screened for hepatitis C infection using anti-HCV as marker of infection and the sensitive enzyme-linked immunosorbent assay method was used for detection of the marker. Three hundred (300) children with minor illness attending pediatric outpatient department and on admission in for various treatment of the same hospital served as gender- and age-marched controls. Results: The result showed that the prevalence of anti-HCV seropositivity for HCV infection among SCA children was 12.7% (38/300) compared with 10.3% (31/300) of the control (P = 0.958). The prevalence of HCV infection increases significantly with increase in frequencies of blood transfusions both in SCA children (P = 0.0001) and the controls (P = 0.0001). Other risk factors for HCV infection such as traditional scarification (SCA 4 out 12, controls 4 out 16) and injections (SCA 38 out of 168, controls 27 out 172) significantly affect the prevalence of HCV infection in both SCA children and controls, (P = 0.0001). Conclusion: The prevalence of HCV infection in both SCA children and controls is high and the higher the frequency of blood transfusions the greater the rate of HCV infections.
  5,219 348 -
Validity of new flow cytometric protocol in diagnosis of low-grade myelodysplastic syndromes
B Jamoh Yusuf, P Goggolidou, T Milne, AA Abba, AG Bakari, A Sa'idu, AI Dutse, BA Gwaram, K Ashfaq, SA Abubakar
January-March 2014, 1(1):40-47
Background: Myelodysplastic syndromes (MDS) are the most common of myeloid malignancies, yet the morphological diagnosis is usually not straightforward especially in the low-grade forms. Immunophenotyping by Flow cytometry (FCM) is considered essential in the WHO's co-criteria for diagnosis of MDS. The Existing FCM Protocol utilizes a two-tube, two-colour approach to identify lineage specific cluster of differentiation (CD) markers, which is labour-intensive and time-consuming. A new FCM was recently developed and validated among Japanese cohorts. It utilizes a three-tube, five-colour approach and generates more information in the form of 'cardinal parameters'. The aim of this study is to determine the diagnostic utility of the new protocol by comparing it with the existing protocol, in the diagnosis of low-grade MDS in our study population. Materials and Methods: We analyzed bone marrow samples of 30 subjects at King's, London. They comprised of 27 patients who had a tentative diagnosis of MDS and three healthy bone marrow donors as controls. Immunophenotyping by FCM was performed using the Existing and New Protocols and the data obtained by the two different methods were compared. 'Cardinal parameters' were generated in the new protocol, which are not applicable to the existing protocol. Results: There was no statistical difference between the data generated by the two protocols in the diagnosis of MDS. The sensitivity and specificity of the 'cardinal parameters' of the new protocol appeared to be outstanding. Conclusion: It has been shown that the new multiplex FCM protocol for the diagnosis of MDS is relatively easy, cost effective and not inferior, compared to the Existing Protocol. However, small sample size has been identified as a limitation to the study and therefore a larger, multicenter study is recommended to assess this validation exercise.
  4,751 292 -
Mycobacterium riyadhense lung infection in a patient with HIV/AIDS
Musa Abubakar Garbati, Ahmed Musa Hakawi
January-March 2014, 1(1):56-58
Mycobacterium riyadhense was first isolated in 2009. Five additional cases were reported since then. This is, however, the first case of M. riyadhense with human immunodeficiency virus coinfection in the literature. A 54-year-old male diabetic presented with 4 months history of diarrhea, productive cough, odynophagia, and dysphagia with progressive weight loss. He looked cachectic with oropharyngeal thrush, bilateral axillary lymph node enlargement and herpes zoster involving the first two thoracic dermatomes. He had right-sided consolidation on chest examination. He was anemic with a normal platelet count. Sputum examination was positive for acid-fast bacilli (AFB); however, deoxyribonucleic acid probe-detection assay for MTB (complex) was negative. The isolate was confirmed as M. riyadhense at the Bioscientia laboratories (Ingelheim, Germany). Stool was positive for Clostridium difficile toxins by polymerase chain reaction (PCR). Human immunodeficiency virus (HIV) test was also positive. The patient showed improvement in clinical, bacteriologic, and immunologic parameters with antituberculous and antiretroviral medications. The lesson from this case is for clinicians to suspect infection with atypical mycobacteria once mycobacterium tuberculosis (MTB) PCR is negative in a patient with a positive smear for AFB so that appropriate therapy for nontuberculous mycobacterial disease can be initiated early.
  4,604 309 -
Distribution of plasma C-reactive protein measured by high-sensitivity assay in healthy Nigerian adults
Isah Adagiri Yahaya
January-March 2014, 1(1):26-30
Background: The plasma levels of C-reactive protein (CRP) within the reference interval have been shown to be a strong predictor of coronary heart disease (CHD) and are being considered in cardiovascular disease risk assessment. And for effective utilization of CRP in this regard, its distribution among healthy individuals in the general population should be established, using the high-sensitivity CRP (hsCRP). Aim: The aim of this study was to describe the plasma distribution of hsCRP concentration in healthy adult Nigerians and to estimate the proportions of those at high risk for cardiovascular disease. Materials and Methods: hsCRP glucose, total cholesterol, high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C) and triglycerides were measured in 120 adult Nigerians free of clinical and biochemical features, suggestive of cardiovascular disease and not on any form of hormonal therapy. The blood pressure, height and weight of the participants were also measured. hsCRP was measured by synthron CRP ultrasensitive enzyme-linked immunosorbent assay method, glucose was measured by the glucose oxidase method, while the lipid profile parameters were measured by enzymatic colorimetric methods. Results: hsCRP concentration ranged from 0.62 to 11.64 mg/L (median: 1.3 mg/L, mean: 2.3 mg/L, 95% confidence interval, 0.75-11.0 mg/L). About 81.7%, 15.0%, and 3.3% of the participants had hsCRP concentrations of less than 3 mg/L, 3-10 mg/L, and higher than 10 mg/ L, respectively. The plasma levels of glucose and lipid profile parameters were within the reference limits established at the Chemical Pathology Laboratory of Aminu Kano Teaching Hospital (AKTH). None of the participants was obese (mean body mass index was 18.6 kg/m 2 ). Conclusion: This study describes the plasma distribution of hsCRP in healthy Nigerian adults. The results obtained would be of further help in the risk-assessment of individuals for future cardiovascular disease.
  4,605 294 -
Disseminated norcardial infection in a patient with myasthenia gravis on prolonged steroid therapy: A case report
Farouq M Dayyab, Tiamiyu B Abdulwasi'u, Edwin P Chinagozi, Garba Iliyasu, Habib G Abdulrazaq, Ibrahim Nashabaru, Muhammad Hamza, Mahmoud Dalhat, Sirajo Halliru, Habib G Zaiyad
January-March 2014, 1(1):53-55
This article presents the clinical manifestation of Norcardial infection in the setting of iatrogenic immunosuppression. The patient suffered from myasthenia gravis for which he received a prolonged course of high dose steroid. At the time of presentation he had lesions in the brain, lungs, and soft tissue consistent with Norcardial infection. He developed disseminated intravascular coagulopathy (DIC) and acute kidney injury (AKI) and died on the 12 th day in intensive care unit (ICU).
  4,364 235 -