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Agbaji OO, Abah IO, Ebonyi AO, Gimba ZM, Abene EE, Gomerep SS, Falang KD, Anejo-Okopi J, Agaba PA, Ugoagwu PO, Agaba EI, Imade GE, Sagay AS, Okonkwo P, Idoko JA, Kanki PJ. Long Term Exposure to Tenofovir Disoproxil Fumarate-Containing Antiretroviral Therapy Is Associated with Renal Impairment in an African Cohort of HIV-Infected Adults. J Int Assoc Provid AIDS Care 2020; 18:2325958218821963. [PMID: 30672363 PMCID: PMC6546287 DOI: 10.1177/2325958218821963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES AND METHOD There are growing concerns of tenofovir disoproxil fumarate (TDF)-associated renal toxicity. We evaluated the effect of long-term TDF exposure on renal function in a cohort of HIV-1-infected Nigerians between 2006 and 2015. Multivariate logistic regression was used to identify predictors of renal impairment at different time over 144 weeks of antiretroviral therapy (ART). RESULTS Data of 4897 patients, median age 42 years (interquartile range: 36-49), and 61% females were analyzed. The prevalence of renal impairment increased from 10% at week 24 to 45% at 144 weeks in TDF-exposed participants compared to an increase from 8% at 24 weeks to 14% at 144 weeks in TDF-unexposed participants. Tenofovir disoproxil fumarate exposure predicted the risk of renal impairment at 144 weeks of ART (odds ratio: 2.36; 95% confidence interval: 1.28-4.34). CONCLUSION Long-term exposure to TDF-based ART significantly increases the likelihood of renal impairment. The continued use of TDF-based regimen in our setting should be reviewed. We recommend the urgent introduction of tenofovir alafenamide-based regimen in the HIV treatment guidelines of Nigeria and other resource-limited countries.
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Affiliation(s)
- Oche O Agbaji
- 1 Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria.,2 APIN-supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria
| | - Isaac O Abah
- 2 APIN-supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria.,3 Pharmacy Department, Jos University Teaching Hospital, Jos, Nigeria
| | - Augustine O Ebonyi
- 2 APIN-supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria.,4 Department of Paediatrics, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Zumnan M Gimba
- 1 Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Esla E Abene
- 1 Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Simji S Gomerep
- 1 Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria.,2 APIN-supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria
| | - Kakjing D Falang
- 2 APIN-supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria.,5 Department of Pharmacology, University of Jos, Jos, Nigeria
| | - Joseph Anejo-Okopi
- 2 APIN-supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria.,6 Department of Microbiology, University of Jos, Jos, Nigeria
| | - Patricia A Agaba
- 2 APIN-supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria.,7 Department of Family Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Placid O Ugoagwu
- 2 APIN-supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria
| | - Emmanuel I Agaba
- 1 Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Godwin E Imade
- 2 APIN-supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria.,8 Department of Obstetrics and Gynaecology, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Atiene S Sagay
- 2 APIN-supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria.,8 Department of Obstetrics and Gynaecology, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | | | - John A Idoko
- 1 Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Phyllis J Kanki
- 10 Department of Immunology & Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Onyedibe KI, Shehu NY, Pires D, Isa SE, Okolo MO, Gomerep SS, Ibrahim C, Igbanugo SJ, Odesanya RU, Olayinka A, Egah DZ, Pittet D. Assessment of hand hygiene facilities and staff compliance in a large tertiary health care facility in northern Nigeria: a cross sectional study. Antimicrob Resist Infect Control 2020; 9:30. [PMID: 32046790 PMCID: PMC7014740 DOI: 10.1186/s13756-020-0693-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background The burden of healthcare-associated infection (HAI) is 2 to 18 times higher in developing countries. However, few data are available regarding infection prevention and control (IPC) process indicators in these countries. We evaluated hand hygiene (HH) facilities and compliance amongst healthcare workers (HCW) in a 600-bed healthcare facility in Northcentral Nigeria providing tertiary care service for a catchment population of about 20 million. Methods An in-house facility assessment tool and the World Health Organization (WHO) direct observation method were used to assess the HH facilities and compliance, respectively. Factors associated with good compliance were determined by multivariate analysis. Results The facility survey was carried out in all 46 clinical units of the hospital. 72% of the units had no poster or written policy on HH; 87% did not have alcohol-based hand rubs; 98% had at least one handwash sink; 28% had flowing tap water all day while 72% utilized cup and bucket; and 58% had no hand drying facilities. A total of 406 HH opportunities were observed among 175 HCWs. The overall compliance was 31%, ranging from 18% among ward attendants to 82% among medical students. Based on WHO “5 moments” for HH, average compliance was 21% before patient contact, 23% before aseptic procedure, 63% after body fluid exposure risk, 41% after patient contact and 40% after contact with patients’ surrounding. Being a medical student was independently associated with high HH compliance, adjusted odds ratio: 13.87 (1.70–112.88). Conclusions Availability of HH facilities and HCW compliance in a large tertiary hospital in Nigeria is poor. Our findings confirm that HCWs seem more sensitized to their risk of exposure to potential pathogens than to the prevention of HAI cross-transmission. Inadequate HH facilities probably contributed to the poor compliance. Specific measures such as improved facilities, training and monitoring are needed to improve HH compliance.
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Affiliation(s)
| | - Nathan Y Shehu
- Infectious Diseases Unit, Department of Medicine, University of Jos, Jos, Nigeria
| | - Daniela Pires
- Infection Control Programme and WHO Collaborating Centre on Patient Safety - Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.,Department of Infectious Diseases, Centro Hospitalar Lisboa Norte and Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Samson E Isa
- Infectious Diseases Unit, Department of Medicine, University of Jos, Jos, Nigeria
| | - Mark O Okolo
- Department of Medical Microbiology, University of Jos, Jos, Nigeria
| | - Simji S Gomerep
- Infectious Diseases Unit, Department of Medicine, University of Jos, Jos, Nigeria
| | - Comfort Ibrahim
- Department of Nursing Services, Jos University Teaching Hospital, Jos, Nigeria
| | - Sunday J Igbanugo
- Department of Pharmacy, Jos University Teaching Hospital, Jos, Nigeria
| | - Rachel U Odesanya
- Department of Pharmacy, Jos University Teaching Hospital, Jos, Nigeria
| | - Adebola Olayinka
- Department of Medical Microbiology, Ahmadu Bello University, Zaria, Nigeria
| | - Daniel Z Egah
- Department of Medical Microbiology, University of Jos, Jos, Nigeria
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Centre on Patient Safety - Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
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3
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Shehu NY, Onyedibe KI, Igbanugo JS, Okolo MO, Gomerep SS, Isa SE, Egah DZ. Hand hygiene knowledge, training and practice: A cross-sectional study in a tertiary health institution, North-central Nigeria. Niger J Clin Pract 2019; 22:1008-1013. [PMID: 31293269 DOI: 10.4103/njcp.njcp_204_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Hand hygiene (HH) is the single most important means of preventing hospital-acquired infections. We set out to determine the knowledge, training gaps, and practice of HH in a tertiary health institution in a resource constrained setting. Methods This cross-sectional study was conducted among health care workers in a 600-bed capacity tertiary health centre. The study was conducted between April and November 2013. A multi-stage randomized sampling method was used to self-administer 322 WHO HH knowledge questionnaires. Information on HH training in the past 3 years, knowledge and practice of HH were obtained, and data were analysed using Epi-Info version 3.5.1. Results A response rate of 98.5% was obtained for the HH knowledge assessment. Mean age of the study population was 39 ± 9.8. About 64% were females. Of all the respondents, only 16% had good knowledge of HH, 52% had moderate knowledge while 32% had poor knowledge. About 24% had formal training on HH. In terms of practice, only about 22% of the respondents self-reported routine practice of HH. Conclusions The findings in this study suggest that there is sub-optimal HH knowledge, practice and training. It is imperative to improve the HH training and retraining of health care workers with a focus on attendants. Administrative controls and bold signage in healthcare institutions are also recommended.
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Affiliation(s)
- N Y Shehu
- Department of Medicine, Infectious Diseases Unit, Jos University Teaching Hospital, Plateau State, Nigeria
| | - K I Onyedibe
- Department of Medical Microbiology, Jos University Teaching Hospital, Plateau State, Nigeria
| | - J S Igbanugo
- Department of Pharmacy, Jos University Teaching Hospital, Plateau State, Nigeria
| | - M O Okolo
- Department of Medical Microbiology, Jos University Teaching Hospital, Plateau State, Nigeria
| | - S S Gomerep
- Department of Medicine, Infectious Diseases Unit, Jos University Teaching Hospital, Plateau State, Nigeria
| | - S E Isa
- Department of Medicine, Infectious Diseases Unit, Jos University Teaching Hospital, Plateau State, Nigeria
| | - D Z Egah
- Department of Medical Microbiology, Jos University Teaching Hospital, Plateau State, Nigeria
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Shehu NY, Gomerep SS, Isa SE, Iraoyah KO, Mafuka J, Bitrus N, Dachom MC, Ogwuche JE, Onukak AE, Onyedibe KI, Ogbaini-Emovon E, Egah DZ, Mateer EJ, Paessler S. Lassa Fever 2016 Outbreak in Plateau State, Nigeria-The Changing Epidemiology and Clinical Presentation. Front Public Health 2018; 6:232. [PMID: 30211144 PMCID: PMC6123362 DOI: 10.3389/fpubh.2018.00232] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/30/2018] [Indexed: 12/20/2022] Open
Abstract
Lassa fever (LF) outbreaks in Nigeria mostly occur in rural areas and during the dry season, peaking between December through February. Fever is a cardinal presenting feature among the myriad manifestations of LF. Thirty four patients with clinical diagnosis of LF were analyzed. However, only 11 (32%) LASV infections were confirmed by RT-PCR. The 2016 LF outbreak showed a preferential urban occurrence and a high case fatality. Fever (≥38°C) was not detected in over a fourth of the patients at the time of examination. Bleeding diathesis was the most common presentation while abdominal pain and headache were present in more than half of the confirmed cases. Changes in the geographical distribution and clinical presentation may have implications for disease control efforts and the risk of transmission, both locally and internationally. In order to guide interventions, public health authorities should be aware that the epidemic patterns may be changing.
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Affiliation(s)
- Nathan Y Shehu
- Infectious Disease Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Simji S Gomerep
- Infectious Disease Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Samson E Isa
- Infectious Disease Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | | | - Johnson Mafuka
- Infectious Disease Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Nandom Bitrus
- Infectious Disease Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Matthias C Dachom
- Infectious Disease Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - John E Ogwuche
- Infectious Disease Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Asukwo E Onukak
- Infectious Disease Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Kenneth I Onyedibe
- Infectious Disease Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | | | - Daniel Z Egah
- Infectious Disease Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Elizabeth J Mateer
- Department of Pathology and Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, United States
| | - Slobodan Paessler
- Department of Pathology and Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, United States
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Mathé P, Egah DZ, Müller JA, Shehu NY, Obishakin ET, Shwe DD, Pam VC, Okolo MO, Yilgwan C, Gomerep SS, Fuchs J, Abok I, Onyedibe KI, Olugbo EJ, Isa SE, Machunga-Mambula SS, Attah CJ, Münch J, Oguche S, Panning M. Low Zika virus seroprevalence among pregnant women in North Central Nigeria, 2016. J Clin Virol 2018; 105:35-40. [PMID: 29885620 DOI: 10.1016/j.jcv.2018.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/15/2018] [Accepted: 05/25/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Zika virus (ZIKV) has been known for decades in Africa but contemporary data is lacking at large. OBJECTIVES To describe the seroepidemiology of ZIKV in North Central Nigeria. STUDY DESIGN We performed a cross-sectional study at six health care facilities in North Central Nigeria from January to December 2016. Detection of ZIKV antibodies was done using an anti-ZIKV recombinant non-structural protein 1 (NS1)-based ELISA. A colorimetric assay to detect ZIKV neutralizing antibodies was used on ELISA reactive and randomly selected ELISA non-reactive samples. ZIKV real-time RT-PCR was done on a subset of samples. RESULTS A total of 468 individual samples were included with almost 60% from pregnant women. Using NS1-based ELISA, an anti-ZIKV positive rate of 6% for IgM and 4% for IgG was found. Pregnant women showed anti-ZIKV positive rates of 4% for IgM and 3% for IgG. None of the ZIKV antibody positive samples tested ZIKV RT-PCR positive. An association with male sex was found for anti-ZIKV IgG ELISA positivity (prevalence ratio 3.49; 95% confidence interval: 1.48-8.25; p = .004). No association with pregnancy, yellow fever vaccination or malaria was found for anti-ZIKV IgM or IgG positivity. ZIKV neutralizing antibodies were detected in 17/18 (94%) anti-ZIKV NS1 positive/borderline samples and in one sample without detectable ZIKV NS1 antibodies. Partial ZIKV E gene sequence was retrieved in one sample without ZIKV antibodies, which clustered within the West African ZIKV lineage. CONCLUSIONS Our results show a largely ZIKV immunologically naïve population and reinforce the importance of ZIKV surveillance in Africa.
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Affiliation(s)
- Philipp Mathé
- Institute of Virology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Z Egah
- Department of Medical Microbiology, Jos University Teaching Hospital, Jos, Nigeria
| | - Janis A Müller
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | - Nathan Y Shehu
- Department of Medical Microbiology, Jos University Teaching Hospital, Jos, Nigeria
| | - Emmanuel T Obishakin
- Biotechnology Department, National Veterinary Research Institute, Vom-Jos, Nigeria
| | - David D Shwe
- Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Victor C Pam
- Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Jos, Nigeria
| | - Mark O Okolo
- Department of Medical Microbiology, Jos University Teaching Hospital, Jos, Nigeria
| | | | - Simji S Gomerep
- Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Jos, Nigeria
| | - Jonas Fuchs
- Institute of Virology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ibrahim Abok
- Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Jos, Nigeria
| | - Kenneth I Onyedibe
- Department of Medical Microbiology, Jos University Teaching Hospital, Jos, Nigeria
| | | | - Samson E Isa
- Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Jos, Nigeria
| | | | - Caleb J Attah
- Department of Paediatrics, Federal Medical Center, Keffi, Nigeria
| | - Jan Münch
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | - Stephen Oguche
- Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Jos, Nigeria
| | - Marcus Panning
- Institute of Virology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Gomerep SS, Eze UA, Chiegboka LO, Olanipekun TO, Ezeudu CC, Shityo T, Isa SE. SPUTUM SMEAR PATTERN AMONG PATIENTS DIAGNOSED WITH PULMONARY TUBERCULOSIS IN MAKURDI, NORTH CENTRAL NIGERIA. Niger J Med 2015; 24:201-206. [PMID: 27487590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) is endemic in Nigeria due mainly to the high burden of HIV/AIDS and especially in Benue state which has the highest prevalence of HIV in Nigeria. Sputum smear examination is of importance in the diagnosis of pulmonary TB and can be smear-positive or negative. In this study, we analyzed the sputum smear results of all patients diagnosed to have PTB during the time under review. METHODS The study was a retrospective study done with records of patients diagnosed with PTB between July 2009 and July 2011. The sample size was 305. AIM To determine the smear patterns in pulmonary tuberculosis and its relationship with HIV status. RESULTS There was slight male preponderance among the study group. 37% were found to be smear positive, out of which 63.7% and 36.3% were males and females respectively. The highest frequency was between 21-40 years and in this age group there were more males than females.72.1% wereTB/HIV co-infected and 29.1% of the TB/HIV co-infected patients had smear-positiveTuberculosis. CONCLUSION There is a high burden of TB/HIV co-infection affecting predominantly the youths. Sputum smear results in TB/HIV co-infection are largely negative. There is the need for provision of other diagnostic tests to improve the diagnosis of TB in our environment and targeted intervention among the youth to reduce the burden of TB/HIV.
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Eze UA, Gomerep SS, Chiegboka LO, Olanipekun TO, Ezeudu CC, Shityo T, Isa SE. Sputum smear pattern among patients diagnosed with pulmonary tuberculosis in Makurdi, North Central Nigeria. Niger J Med 2015. [DOI: 10.4103/1115-2613.278928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
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Obaseki DO, Kolawole BA, Gomerep SS, Obaseki JE, Abidoye IA, Ikem RT, Erhabor GE. Prevalence and predictors of obstructive sleep apnea syndrome in a sample of patients with type 2 Diabetes Mellitus in Nigeria. Niger Med J 2014; 55:24-8. [PMID: 24970965 PMCID: PMC4071658 DOI: 10.4103/0300-1652.128154] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction: Obstructive sleep apnea (OSA) and Diabetes Mellitus (DM) are growing health challenges worldwide. However, the relation of OSA with type 2 diabetes is not well understood in developing countries. This study described the prevalence and predictors of OSA in type 2 DM patients using a screening questionnaire. Materials and Methods: Patients aged 40years and above with type 2 diabetes mellitus were recruited into the study consecutively from the outpatient clinics of a university hospital. They were all administered the Berlin questionnaire and the Epworth sleepiness scale (ESS) to assess the risk of OSA and the tendency to doze off, respectively. Anthropometric details like height, weight and body mass index (BMI) were measured and short-term glycaemic control was determined using fasting blood glucose. Results: A total of 117 patients with type 2 diabetes mellitus were recruited into the study. The mean (SD) age, height and BMI was 63 years (11), 160 cm (9) and 27.5 kg/ m2 (5.7), respectively. Twenty-seven percent of the respondents had a high risk for OSA and 22% had excessive daytime sleepiness denoted by ESS score above 10. In addition, the regression model showed that for every 1 cm increase in neck circumference, there is a 56% independent increase in the likelihood of high risk of OSA after adjusting for age, sex, BMI, waist, hip circumferences and blood glucose. Conclusion: Our study shows a substantial proportion of patients with type 2 diabetes may have OSA, the key predictor being neck circumference after controlling for obesity.
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Affiliation(s)
- Daniel O Obaseki
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Simji S Gomerep
- Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Josephine E Obaseki
- Department of Preventive Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Ibukun A Abidoye
- Department of Radiology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Rosemary T Ikem
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Gregory E Erhabor
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
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Gomerep SS, Idoko JA, Ladep NG, Ugoya SO, Obaseki D, Agbaji OA, Agaba P, Akanbi MO, Badung BP, Otitoloju O. Frequency of cryptococcal meningitis in HIV-1 infected patients in north central Nigeria. Niger J Med 2011; 19:395-9. [PMID: 21526627 DOI: 10.4314/njm.v19i4.61963] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- S S Gomerep
- APIN-PLUS/PEPFAR HARVARD, Jos University teaching Hospital, Jos, Nigeria.
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