Opportunistic fungal infections in persons living with advanced HIV disease in Lagos,Nigeria; a 12-year retrospective study

IntroductionNigeria has a large estimated burden of AIDS-related mycoses. We aimed to determine the proportion of patients with AIDS-related opportunistic fungal infections (OFIs) at an urban antiretroviral treatment (ART) centre in Nigeria.MethodsA retrospective analysis of a cohort of ART-naïve, HIV-infected patients, assessed for ART eligibility and ARTexperience at the PEPFAR outpatient clinic at Lagos University Teaching Hospital over a 12-year period (April 2004-February 2016) was conducted.ResultsDuring this period, 7,034 patients visited the clinic: 4,797 (68.2%) were female; 6161 patients had a recorded baseline CD4 count, and the median CD4 count was 184 cells/µl (IQR, 84–328). A baseline HIV-1 viral load (VL) was recorded for 5,908 patients; the median VL was 51,194 RNA copies/ml (IQR, 2,316–283,508) and 6,179/7046(88%) had initiated ART. Some 2,456 (34.9%) had a documented opportunistic infections, of whom 1,306 (18.6%) had an opportunistic fungal infection. The total number of OFI episodes was 1,632: oral candidiasis (n=1,473, 90.3%), oesophageal candidiasis (n=118; 8%), superficial mycoses (n=23; 1.6%), Pneumocystis pneumonia (PJP) (n=13; 0.8%), and cryptococcal meningitis(CM) (n=5; 0.4%). 113 (1.6%) were known to have died in the cohort.ConclusionApproximately 1 in 5 HIV-infected patients in this retrospective cohort, most of whom had initiated ART, were clinically diagnosed with an OFI. Improved access to simple accurate diagnostic tests for CM and PJP should be prioritised for this setting.     

Susceptibility profile of Enterococcus faecalis isolated at the Lagos University Teaching Hospital,Nigeria

Enterococcus faecalis is the most common of the Enterococcus genus causing infection, particularly urinary tract infections, worldwide. It is also a common cause of nosocomial infections and resistance to various antibiotics is on the increase worldwide. Thirty-five strains of E. Faecalis isolated from various clinical specimens (blood, wound swabs endocervical swabs but mostly urine) were screened for high-level aminoglycoside resistance. Their susceptibility nine antibiotics (ampicillin, gentamicin, streptomycin, vancomycin, tetracycline cotrimoxazole and chloramphenicol, ciprofloxacin and erthromycin) was also determined. All isolates were susceptible to Ampicillin and Vancomycin with MIC90 of 4microg/ml but resistant to Nalidixic acid with an MIC90>256microg/ml. Four (11%) of the isolates showed high-level resistance to Gentamicin while 11(32%) exhibited high-level resistance streptomycin after 24 hours incubation. It will appear that Ampicillin in combination with gentamicin but not streptomycin, can still be used empirically for the treatment of Enterococcal infections.     

Perception and Practice of Emergency Contraception among Female Undergraduates of the University of Ibadan, Nigeria

Objective To assess perception and level of proper utilization of emergency contraception （EC） among female undergraduates. Methods Cross-sectional questionnaire study was performed on 383 female undergraduates in Nigeria in June 2006. Data analysis was with Z-square test and logistic regressions （P 〈O. 05）. Results One hundred and five （48.2%） had been sexually exposed. Only 32 （30.5%） used regular contraception. Seventy-three （24.3%）female undergraduates were aware of EC. Only 29 （7.6%） had used EC before. Most would not use emergency contraceptive drugs in future due to lack of awareness （64.8%）, and fear for future fertility and of drugs being injurious to health. Use of EC was associated with awareness of correct interval for use （OR=9.1; 95%CI： 2.1-39.9）. Conclusion There is poor knowledge about EC and poor use, while significant need remains. Most knowledge was acquired from peers and inaccurate. Peer educators are important and professionals＇ knowledge needs improvement.     

Television, walking, and diet: associations with postpartum weight retention

BACKGROUND: For many women, pregnancy begets long-term weight gain. Modifiable behaviors that contribute to postpartum weight retention have not been well studied. METHODS: Prospective cohort study of 902 women enrolled in Project Viva, examining associations of postpartum television viewing, walking, and trans fat intake with weight retention equal to or greater than 5 kg at 12 months postpartum. Data were collected in 1999-2003 and analyzed in 2005-2006. RESULTS: At 6 months postpartum, women reported a mean (SD) of 1.7 (1.3) hours of television viewing, 0.7 (0.7) hours of walking, and 1.1% (0.5) of energy intake from trans fat per day. At 1 year, participants retained a mean of 0.6 kg (range: -17.3 to 25.5), and 12% retained at least 5 kg. In multivariate logistic regression models, adjusting for maternal sociodemographics, parity, prepregnancy body mass index, gestational weight gain, breastfeeding, and smoking, the odds ratio of retaining at least 5 kg was 1.24 (95% confidence interval [CI]: 1.06-1.46) per daily hour of television viewing, 0.66 (95% CI: 0.46-0.94) per daily hour of walking, and 1.33 (95% CI: 1.09-1.62) per 0.5% increment in daily energy intake from trans fat. Women who watched less than 2 hours of television, walked at least 30 minutes, and consumed trans fat below the median had an odds ratio of 0.23 (95% CI: 0.08-0.66) of retaining at least 5 kg. CONCLUSIONS: Postpartum television viewing, walking, and trans fat intake were associated with weight retention. Interventions to modify these behaviors may help reduce excess postpartum weight gain and prevent obesity among women.     

HIV/aids related home based care practices among primary health care workers in Ogun state, Nigeria

ABSTRACT: BACKGROUND: HIV/AIDS is fast becoming a chronic disease with the advent of antiretroviral drugs, therefore making home based care key in the management of chronically ill HIV/AIDS patient. The objective of this study was to determine the perception and practice of health care workers on HIV/AIDS related home based care in the health facilities in Ogun state, Nigeria. METHODS: This study is an analytical cross-sectional study. A multistage cluster sampling technique was used to obtain a representative sample of the primary health care workers in Ogun state. An interviewer administered structured questionnaire was administered by trained health workers to elicit the required information. Result A total of 350 health care workers were interviewed, 70% of the respondents could adequately describe the components of home based care. Only 38.7% were aware of the National guideline on home based care practices and 17.1% believe that home based care will not significantly improve the prognosis of PLWAs. Few 19.1% had ever been trained or ever involved 16.6% in home based care practices. Only 20 [5.7%] are involved on a weekly basis, 16 [4.6%] monthly and 22 [6.3%] quarterly. Reasons given for non implementation of home based care are inadequate number of healthcare workers 45%, lack of political will 24.4%, lack of implementation by facility managers 14% and inadequate funds 16.6%. Factors that were significantly associated with the practice of home based care were perception of its relevance in improving prognosis [OR = 54.21, C.I = 23.22-129.52] and presence of a support group in the facility [OR = 4.80, C.I = 2.40-9.57]. There was however no statistically significant relationship between adequate knowledge of home based care [OR = 0.78, C.I = 0.39-1.54] and previous training on home based care (OR = 1.43, C.I = 0.66- 3.06]. CONCLUSION: The practice of home based care for HIV/AIDS among the study population is low and it is greatly influenced by perception of its effectiveness and relevance. The study recommends that the health care workers should be adequately educated on the importance of home based care in the management of chronic illnesses in order to enhance its practice.     

Carbamylation of N-Terminal Proline

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