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Müller A, Wouters EF, Koul P, Welte T, Harrabi I, Rashid A, Loh LC, Al Ghobain M, Elsony A, Ahmed R, Potts J, Mortimer K, Rodrigues F, Paraguas SN, Juvekar S, Agarwal D, Obaseki D, Gislason T, Seemungal T, Nafees AA, Jenkins C, Dias HB, Franssen FME, Studnicka M, Janson C, Cherkaski HH, El Biaze M, Mahesh PA, Cardoso J, Burney P, Hartl S, Janssen DJA, Amaral AFS. Association between lung function and dyspnoea and its variation in the multinational Burden of Obstructive Lung Disease (BOLD) study. Pulmonology 2024:S2531-0437(24)00044-8. [PMID: 38614859 DOI: 10.1016/j.pulmoe.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/17/2024] [Revised: 03/14/2024] [Accepted: 03/31/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Dyspnoea is a common symptom of respiratory disease. However, data on its prevalence in general populations and its association with lung function are limited and are mainly from high-income countries. The aims of this study were to estimate the prevalence of dyspnoea across several world regions, and to investigate the association of dyspnoea with lung function. METHODS Dyspnoea was assessed, and lung function measured in 25,806 adult participants of the multinational Burden of Obstructive Lung Disease study. Dyspnoea was defined as ≥2 on the modified Medical Research Council (mMRC) dyspnoea scale. The prevalence of dyspnoea was estimated for each of the study sites and compared across countries and world regions. Multivariable logistic regression was used to assess the association of dyspnoea with lung function in each site. Results were then pooled using random-effects meta-analysis. RESULTS The prevalence of dyspnoea varied widely across sites without a clear geographical pattern. The mean prevalence of dyspnoea was 13.7 % (SD=8.2 %), ranging from 0 % in Mysore (India) to 28.8 % in Nampicuan-Talugtug (Philippines). Dyspnoea was strongly associated with both spirometry restriction (FVC CONCLUSION The prevalence of dyspnoea varies substantially across the world and is strongly associated with lung function impairment. Using the mMRC scale in epidemiological research should be discussed.
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Affiliation(s)
- A Müller
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
| | - E F Wouters
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Sigmund Freud University, Faculty of Medicine, Vienna, Austria; Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - P Koul
- Department of Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | - T Welte
- Department of Respiratory Medicine/Infectious Disease, Member of the German Centre for Lung Research, Hannover School of Medicine, Hannover, Germany
| | - I Harrabi
- Faculté de Médecine, Sousse, Tunisia
| | - A Rashid
- RCSI and UCD Malaysia Campus, Penang, Malaysia
| | | | - M Al Ghobain
- King Abdullah International Medical Research Center, King Saud ben Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - A Elsony
- The Epidemiological Laboratory, Khartoum, Sudan
| | - R Ahmed
- The Epidemiological Laboratory, Khartoum, Sudan
| | - J Potts
- National Heart and Lung Institute, Imperial College London, London, UK
| | - K Mortimer
- University of Cambridge, Cambridge, UK; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - F Rodrigues
- Pulmonology Department, Lisbon North Hospital Centre, Lisbon, Portugal; Institute of Environmental Health, Associate Laboratory TERRA, Lisbon Medical School, Lisbon University, Lisbon, Portugal
| | - S N Paraguas
- Philippine College of Chest Physicians, Manila, Philippines
| | - S Juvekar
- KEM Hospital Research Centre, Pune, India
| | - D Agarwal
- KEM Hospital Research Centre, Pune, India
| | - D Obaseki
- Department of Medicine, Obafemi Awolowo University, Nigeria; Faculty of Medicine, University of British Columbia, Canada
| | - T Gislason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - T Seemungal
- Faculty of Medical Sciences, University of West Indies, St Augustine, Trinidad and Tobago
| | | | - C Jenkins
- Woolcock Institute of Medical Research, Sydney, Australia
| | - H B Dias
- Escola Superior de Tecnologia da Saúde de Lisboa, Politecnico de Lisboa, Lisbon, Portugal
| | - F M E Franssen
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Research and Development, Ciro, Horn, the Netherlands
| | - M Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - C Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - H H Cherkaski
- Faculty of Medicine, University Badji Mokhtar, Annaba, Algeria
| | - M El Biaze
- Department of Respiratory Medicine, Faculty of Medicine, Mohammed Ben Abdellah University, Fes, Morocco
| | - P A Mahesh
- Department of Respiratory Medicine, JSS Medical College and Hospital, Mysore, Karnataka, India
| | - J Cardoso
- Pulmonology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; NOVA Medical School, Nova University Lisbon, Lisboa, Portugal
| | - P Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - S Hartl
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Sigmund Freud University, Faculty of Medicine, Vienna, Austria
| | - D J A Janssen
- Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Research and Development, Ciro, Horn, the Netherlands
| | - A F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK; NIHR Imperial Biomedical Research Centre, London, UK
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Adewole OO, Omotoso BA, Ogunsina M, Aminu A, Odeyemi AO, Awopeju OF, Ayoola O, Adedeji T, Sogaolu OM, Adewole TO, Jiya E, Andero V, Obaseki D, Akintomide AO, Erhabor GE. Atorvastatin accelerates Mycobacterium tuberculosis clearance in pulmonary TB: a randomised phase IIA trial. Int J Tuberc Lung Dis 2023; 27:226-228. [PMID: 36855033 DOI: 10.5588/ijtld.22.0548] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Affiliation(s)
- O O Adewole
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria, Department of Medicine Obafemi Awolowo University Teaching Hospitals, Ile Ife, Nigeria
| | - B A Omotoso
- Department of Medicine Obafemi Awolowo University Teaching Hospitals, Ile Ife, Nigeria, Clinical Pharmacology & Therapeutic Department, Obafemi Awolowo University, Ile Ife, Nigeria
| | - M Ogunsina
- Department of Medicine, Kaduna State University, Kaduna, Nigeria
| | - A Aminu
- Department of Medicine, Usman Fodiyo University, Sokoto, Nigeria
| | - A O Odeyemi
- Department of Medicine, Bowen University, Iwo, Nigeria
| | - O F Awopeju
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria, Department of Medicine Obafemi Awolowo University Teaching Hospitals, Ile Ife, Nigeria
| | - O Ayoola
- Department of Radiology, Obafemi Awolowo University/Teaching Hospitals, Ile Ife, Nigeria
| | - T Adedeji
- Department of Chemical Pathology, Obafemi Awolowo University/Teaching Hospitals, Ile Ife, Nigeria
| | - O M Sogaolu
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | - T O Adewole
- Department of Family Medicine, Obafemi Awolowo University Teaching Hospitals, Ile Ife, Nigeria
| | - E Jiya
- National Tuberculosis Reference Laboratory, Zare, Kaduna, Nigeria
| | - V Andero
- Department of Medicine Obafemi Awolowo University Teaching Hospitals, Ile Ife, Nigeria
| | - D Obaseki
- Department of Medicine Obafemi Awolowo University Teaching Hospitals, Ile Ife, Nigeria
| | - A O Akintomide
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria, Department of Medicine Obafemi Awolowo University Teaching Hospitals, Ile Ife, Nigeria
| | - G E Erhabor
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria, Department of Medicine Obafemi Awolowo University Teaching Hospitals, Ile Ife, Nigeria
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Halpin DMG, Celli BR, Criner GJ, Frith P, López Varela MV, Salvi S, Vogelmeier CF, Chen R, Mortimer K, Montes de Oca M, Aisanov Z, Obaseki D, Decker R, Agusti A. The GOLD Summit on chronic obstructive pulmonary disease in low- and middle-income countries. Int J Tuberc Lung Dis 2019; 23:1131-1141. [PMID: 31718748 DOI: 10.5588/ijtld.19.0397] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the top three causes of death worldwide, but governments and non-governmental organisations have not given its prevention and treatment the priority it requires. This is particularly true in low- and middle-income countries, where most of the people suffering from this disease live. The United Nations (UN) has targeted a reduction of premature deaths from non-communicable diseases (NCDs) by a third by 2030; however, a coordinated UN/World Health Organization (WHO) strategy to address the burden of COPD (one of the most important NCDs) is still lacking. To explore the extent of the problem and inform the development of policies to improve the situation, the Board of Directors of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) held a 1-day Summit. The key themes that emerged were the need to ensure accurate data on prevalence, raise awareness of the disease among the public, healthcare professionals and governments, including the fact that COPD aetiology goes beyond smoking (and other inhaled pollutants) and includes poor lung development in early life, and ensure that spirometry and both pharmacological and non-pharmacological therapies are available and affordable. Here, we present the actions that must be taken to address the impact of COPD. We believe that the WHO is particularly well-positioned to co-ordinate an attack on COPD, and GOLD will do all it can to help and rally support.
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Affiliation(s)
- D M G Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - B R Celli
- Pulmonary Division, Brigham and Women's Hospital, Boston, MA
| | - G J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - P Frith
- Flinders University College of Medicine and Public Health, Adelaide, SA, Australia
| | - M V López Varela
- Cátedra de Neumología, Facultad de Medicina, Universidad de la República Hospital Maciel, Montevideo, Uruguay
| | - S Salvi
- Chest Research Foundation, Pune, India
| | - C F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg (Member of the German Center for Lung Research, DZL), Philipps-Universität Marburg, Germany
| | - R Chen
- Guangzhou Institute of Respiratory Disease, State Key Lab of Respiratory Disease & National Clinical Research Center for Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - K Mortimer
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - M Montes de Oca
- Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
| | - Z Aisanov
- Department of Pulmonology, N I Pirogov Russian State National Research Medical University, Healthcare Ministry of Russia, Moscow, Russia
| | - D Obaseki
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - R Decker
- Global Initiative for Chronic Obstructive Lung Disease, Fontana, WI, USA
| | - A Agusti
- Institut Respiratori, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Centro de Investigación Biomédica en Red Enfermedades Respiratorias Spain, Barcelona, Spain
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Adeniyi B, Ilesanmi O, Obaseki D, Desalu O, Betiku B, Erhabor G. Relationship between knowledge and quality of asthma care among physicians in South-West Nigeria. Niger J Clin Pract 2019; 20:566-572. [PMID: 28513515 DOI: 10.4103/1119-3077.206363] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Adequate knowledge of asthma management and adherence to international guidelines are known to increase the quality of care offered by Physicians. We conducted this study to assess the level of asthma knowledge and quality of care among physicians practicing in Ondo State. METHODS We conducted a cross sectional survey of 96 physicians from various specialties participating in a continuous professional development (CPD) lecture using adapted questionnaires. RESULT Respondents ranged in age from 23-62years (42.5±19.4). There were more male (70%). The minority (17%) had additional postgraduate medical qualifications. There was a high distribution of correct answers for individual knowledge questions. The greatest areas of knowledge gaps appeared in diagnostic instruments, asthma severity and drugs. We observed gaps regarding the use of GINA guidelines (6%) and prescribing combined inhaled steroid and long acting bronchodilator for patients who are not controlled on inhaled steroid alone (29%). A large number of the respondents do not confirm the diagnosis of asthma by spirometry (32%). Only 8% of the respondents with high knowledge reported a corresponding high quality of Asthma care. CONCLUSION We concluded that although physicians in South-West Nigeria appear to have good knowledge, there are areas of gap in the quality of asthma care with regards to standard guideline. There is need for constant training and re-training of physicians in order to keep them up to date with international guidelines. In addition, increase access to diagnostic facilities and adapting international guideline to local realities will help improve standard of Asthma care.
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Affiliation(s)
- B Adeniyi
- Department of Internal Medicine, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - O Ilesanmi
- Department of Community Medicine, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - D Obaseki
- Department of Internal Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - O Desalu
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria
| | - B Betiku
- Department of Family Medicine, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - G Erhabor
- Department of Internal Medicine, Federal Medical Centre, Owo, Ondo State, Nigeria
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Gnatiuc L, Buist AS, Kato B, Janson C, Aït-Khaled N, Nielsen R, Koul PA, Nizankowska-Mogilnicka E, Obaseki D, Idolor LF, Harrabi I, Burney PGJ. Gaps in using bronchodilators, inhaled corticosteroids and influenza vaccine among 23 high- and low-income sites. Int J Tuberc Lung Dis 2015; 19:21-30. [PMID: 25519786 PMCID: PMC4531306 DOI: 10.5588/ijtld.14.0263] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing access to essential respiratory medicines and influenza vaccination has been a priority for over three decades. Their use remains low in low- and middle-income countries (LMICs), where little is known about factors influencing use, or about the use of influenza vaccination for preventing respiratory exacerbations. METHODS We estimated rates of regular use of bronchodilators, inhaled corticosteroids and influenza vaccine, and predictors for use among 19 000 adults in 23 high-income countries (HICs) and LMIC sites. RESULTS Bronchodilators, inhaled corticosteroids and influenza vaccine were used significantly more in HICs than in LMICs, after adjusting for similar clinical needs. Although they are used more commonly by people with symptomatic or severe respiratory disease, the gap between HICs and LMICs is not explained by the prevalence of chronic obstructive pulmonary disease or doctor-diagnosed asthma. Site-specific factors are likely to influence use differently. The gross national income per capita for the country is a strong predictor for use of these treatments, suggesting that economics influence under-treatment. CONCLUSION We still need a better understanding of determinants for the low use of essential respiratory medicines and influenza vaccine in low-income settings. Identifying and addressing these more systematically could improve the access and use of effective treatments.
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Affiliation(s)
- L Gnatiuc
- National Heart and Lung Institute, Imperial College, London, UK
| | - A S Buist
- Oregon Health & Science University, Portland, Oregon, USA
| | - B Kato
- National Heart and Lung Institute, Imperial College, London, UK
| | - C Janson
- Respiratory Medicine & Allergology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - N Aït-Khaled
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - R Nielsen
- Institute of Medicine, University of Bergen, Bergen, Norway; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - P A Koul
- Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | | | - D Obaseki
- Obafemi Awolowo University, Ile-Ife, Nigeria
| | - L F Idolor
- Department of Pulmonary Medicine, Lung Centre of the Philippines, Quezon City, The Philippines
| | - I Harrabi
- Faculty of Medicine, Sousse, Tunisia
| | - P G J Burney
- National Heart and Lung Institute, Imperial College, London, UK
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Nwashilli NJ, Obaseki D, Momoh MI. Malignant Breast Tumour in a 13-Year Old Girl. West Afr J Med 2014; 33:285-287. [PMID: 26445074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report a case of primary malignant fibrous histiocytoma of the breast in a 13-year old girl. She has had wide local excision of the tumour and six cycles of adjuvant cytotoxic chemotherapy. Four years after treatment, she was free from local recurrence; however, the presence of distant metastasis could not be assessed because of inadequate imaging investigations.
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Affiliation(s)
- N J Nwashilli
- Department of Surgery,University of Benin Teaching Hospital, Benin City, Edo State,Nigeria
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Obaseki D, Potts J, Joos G, Baelum J, Haahtela T, Ahlström M, Matricardi P, Kramer U, Gjomarkaj M, Fokkens W, Makowska J, Todo‐Bom A, Toren K, Janson C, Dahlen S, Forsberg B, Jarvis D, Howarth P, Brozek G, Minov J, Bachert C, Burney P. The relation of airway obstruction to asthma, chronic rhinosinusitis and age: results from a population survey of adults. Allergy 2014; 69:1205-14. [PMID: 24841074 PMCID: PMC4233404 DOI: 10.1111/all.12447] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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] [Accepted: 05/14/2014] [Indexed: 11/27/2022]
Abstract
RATIONALE There is conflicting evidence on whether patients with asthma experience an accelerated decline in lung function with age. We examined the association between postbronchodilator lung function, asthma, chronic rhinosinusitis (CRS), and atopy with age using a large European sample. METHODS In 17 centers in 11 European countries, case-control studies were nested within representative cross-sectional surveys of adults aged less than 75 years. Representative samples of participants with asthma, CRS or both and controls were assessed for postbronchodilator ventilatory function, smoking history, atopy, and treatment. Multiple regression was used to assess the interactive effects of age and diagnostic group on decline in postbronchodilator ventilatory function. RESULTS A total of 3337 participants provided adequate data (778 with asthma, 399 with CRS, 244 with both asthma and CRS and 1916 controls who had neither asthma nor CRS). Participants with asthma had lower FEV1 /FVC (-4.09% (95% CI: -5.02, -3.15, P < 0.001) and a steeper slope of FEV1 /FVC against age (-0.14%/annum [95%CI: -0.19, -0.08]) equivalent to smoking 1-2 packs of cigarettes per day. Those with atopy had a slope equivalent to controls. CONCLUSIONS People with asthma have a steeper decline in postbronchodilator lung function with age, but neither CRS nor atopy alone were associated with such decline.
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Affiliation(s)
- D. Obaseki
- Department of Medicine Obafemi Awolowo University Ile‐Ife Nigeria
- Respiratory Epidemiology and Public Health Group National Heart and Lung Institute Imperial College London London UK
| | - J. Potts
- Respiratory Epidemiology and Public Health Group National Heart and Lung Institute Imperial College London London UK
| | - G. Joos
- Department of Respiratory Medicine Ghent University Hospital Ghent Belgium
| | - J. Baelum
- Odense University Hospital Odense University Odense Denmark
| | - T. Haahtela
- Skin and Allergy Hospital Helsinki University Helsinki Finland
| | - M. Ahlström
- Skin and Allergy Hospital Helsinki University Helsinki Finland
| | - P. Matricardi
- Department of Pediatric Pneumonology and Immunology Charité‐Universitätsmedizin Berlin Berlin Germany
| | - U. Kramer
- IUF – Leibniz Research Institute for Environmental Medicine Düsseldorf Germany
- Department of Dermatology and Allergy am Biederstein Technical University Munich Munich Germany
| | - M. Gjomarkaj
- Institute of Biomedicine and Molecular Immunology National Research Council Palermo Italy
| | - W. Fokkens
- Department of Otorhinolaryngology Academic Medical Center Amsterdam the Netherlands
| | - J. Makowska
- Department of Immunology Rheumatology and Allergy Medical University of Lodz Lodz Poland
| | - A. Todo‐Bom
- Faculty of Medicine University of Coimbra Coimbra Portugal
| | - K. Toren
- Section of Occupational and Environmental Medicine University of Gothenburg Gothenburg Sweden
| | - C. Janson
- Department of Medical Sciences: Respiratory Medicine and Allergology University of Uppsala Uppsala Sweden
| | - S.‐E. Dahlen
- CfA ‐ The Centre for Allergy Research Karolinska Institute Stockholm Sweden
| | - B. Forsberg
- Occupational and Environmental Medicine Umeå University Umeå Sweden
| | - D. Jarvis
- Respiratory Epidemiology and Public Health Group National Heart and Lung Institute Imperial College London London UK
| | - P. Howarth
- Clinical and Experimental Sciences Faculty of Medicine Southampton General Hospital Southampton UK
| | - G. Brozek
- Department of Epidemiology Medical University of Silesia in Katowice Katowice Poland
| | - J. Minov
- Institute for Occupational Health of Republic of Macedonia Skopje Republic of Macedonia
| | - C. Bachert
- Upper Airway Research Laboratory University of Ghent Ghent Belgium
- Division of Ear, Nose, and Throat Diseases Clintec Karolinska Institute Stockholm Sweden
| | - P. Burney
- Respiratory Epidemiology and Public Health Group National Heart and Lung Institute Imperial College London London UK
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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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Abstract
BACKGROUND Churg Strauss syndrome is a medical condition of unknown aetiology characterized by asthma, eosinophilia and finally vasculitis involving small vessels in the limbs and nasal sinuses and the lungs. The purpose of this review is to highlight the natural history of this condition, the pathogenesis, clinical features and treatment modalities available and the prognosis. METHODS Literature on the subject was reviewed using manual library search, articles in journals, internet search and conference abstracts. RESULT Churg Strauss syndrome has been reported to be predominantly common in middle aged individuals in their middle age of life with a history of new onset or worsened asthma. The condition has a male predisposition. Prior to the advent of steroid therapy this condition invariably leads to death, but since the introduction of prednisolone therapy and other immunosuppressive therapy the outlook has improved for sufferers and long-term survival has been seen. CONCLUSION Suspicion of this condition should be based on a good history, physical examination and laboratory investigations and diagnosis based on the criteria that has been drawn by the American College of Rheumatology.
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Affiliation(s)
- M E Borke
- Department Haematology and Blood Transfusion, Faculty of Clinical Medicine, Delta State University, Abraka, Delta State, Nigeria
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Osime OC, Osime U, Njoku T, Adeyekun AA, Obonna G, Okoro E, Obaseki D, Igbe A. Urethral fibrosis with pyonephrosis in a patient with situs inversus totalis: a case report. West Afr J Med 2007; 26:246-249. [PMID: 18399345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Cases of a case of situs inversus totalis are very rare and therefore when encountered, they are likely to be missed or poorly managed. OBJECTIVE To present a case of situs inversus totalis with a view to creating more awareness about this rare clinical entity. PATIENT AND METHOD The patient, a 22 year old boy was referred from a private clinic after a failed and complicated attempted appendicectomy carried out by a general medical practitioner. The patient was admitted, resuscitated and had investigations done. Some of the investigations done were abdominal ultrasound scan, computerized axial tomography scan, a chest x ray, complete blood count, urinalysis and electrolyte and urea. RESULTS Investigations showed features of situs inversus totalis. There was also bilateral hydronephrosis, worse on the right side. The patient also had features of renal failure. He died after three days on admission. Autopsy finding confirmed bilateral pyonephrosis which was worse on the right side. There was associated urethral fibrosis. Cause of death was urethral fibrosis resulting in obstructive uropathy, pyonephrosis and renal failure. CONCLUSION Situs inverses totalis is rare but can psented in diverse ways and thus the diagnosis may be missed and the patient wrongly managed. A high index of clinical suspicion is required if we the diagnosis is to be made early and wrong treatments avoided.
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Affiliation(s)
- O C Osime
- Department of Surgery, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
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