Prevalence of rifampicin resistant tuberculosis among pulmonary tuberculosis patients In Enugu,Nigeria

ObjectiveWe determined the prevalence of rifampicin resistance in pulmonary tuberculosis patients in Enugu Nigeria.MethodsA prospective hospital-based study involving 1300 presumptive multidrug-resistant tuberculosis patients was conducted in Enugu between April 2017 and 31st March, 2019.Participants age ranged from 15 years and older and each submitted one sputum specimens Sputum specimens were analyzed using the Gene Xpert MTB/RIF assay to detect resistance to rifampicin according to manufacturer''s protocol.ResultsThe prevalence of rifampicin resistant tuberculosis was 6.8% (95% CI: 5.5- 8.3). Rifampicin resistance was significantly higher in males (9.0%) than females (4.2%) (P = 0.036< 0.05). Most of the cases were seen in the age group 35–44 years (28.4%). Prevalence of rifampicin resistant tuberculosis was 2.7% in treatment naive (new) patients and 4.1% in patients on anti-tuberculosis therapy (previously treated).ConclusionThe prevalence of rifampicin resistant tuberculosis in Enugu was high. Rifampicin resistance in treatment naive (new) patients was also high. This study therefore highlights that active transmission of Multidrug-resistant tuberculosis among young males could be on-going.     

Angiotensin converting enzyme inhibitors and magnesium conservation in patients with congestive cardiac failure.

OBJECTIVE--To investigate whether angiotensin converting enzyme inhibitors reduce diuretic induced magnesium excretion in patients in congestive cardiac failure. DESIGN--Cohort analytic study. SETTING--A London district general hospital. SUBJECTS--Thirty four patients with chronic congestive cardiac failure caused by ischaemic heart disease or cardiomyopathy selected consecutively from inpatients under the care of two consultant cardiologists. Nineteen patients (group 1) on diuretics alone were compared with 15 patients (group 2) taking diuretics plus either enalapril or captopril. All drug regimens were stable for at least three months before the study. Patients with impaired renal function (plasma creatinine greater than 120 mumol/l) were excluded. INTERVENTIONS--An intravenous loading dose of magnesium sulphate was given to minimise the variability in baseline magnesium state. MAIN OUTCOME MEASURE--Total urine magnesium excretion and creatinine clearance in 24 hour urine collections. RESULTS--Plasma magnesium was similar in the two groups. However, 24 hour urine magnesium excretion was significantly lower in group 2 than in group 1. Furthermore, creatinine clearance was also significantly lower in group 2 and correlated strongly with magnesium excretion. There was no such relation in group 1. There was no difference in fractional clearance of magnesium between groups. CONCLUSION--Angiotensin converting enzyme inhibitors have an important magnesium conserving action, possibly via their effect on glomerular filtration rate.     

Angiotensin converting enzyme inhibitors and magnesium conservation in patients with congestive cardiac failure.

OBJECTIVE--To investigate whether angiotensin converting enzyme inhibitors reduce diuretic induced magnesium excretion in patients in congestive cardiac failure. DESIGN--Cohort analytic study. SETTING--A London district general hospital. SUBJECTS--Thirty four patients with chronic congestive cardiac failure caused by ischaemic heart disease or cardiomyopathy selected consecutively from inpatients under the care of two consultant cardiologists. Nineteen patients (group 1) on diuretics alone were compared with 15 patients (group 2) taking diuretics plus either enalapril or captopril. All drug regimens were stable for at least three months before the study. Patients with impaired renal function (plasma creatinine greater than 120 mumol/l) were excluded. INTERVENTIONS--An intravenous loading dose of magnesium sulphate was given to minimise the variability in baseline magnesium state. MAIN OUTCOME MEASURE--Total urine magnesium excretion and creatinine clearance in 24 hour urine collections. RESULTS--Plasma magnesium was similar in the two groups. However, 24 hour urine magnesium excretion was significantly lower in group 2 than in group 1. Furthermore, creatinine clearance was also significantly lower in group 2 and correlated strongly with magnesium excretion. There was no such relation in group 1. There was no difference in fractional clearance of magnesium between groups. CONCLUSION--Angiotensin converting enzyme inhibitors have an important magnesium conserving action, possibly via their effect on glomerular filtration rate.     

Seasonal ataxia: A case report of a disappearing disease

Introduction

Seasonal ataxia is a clinical syndrome of acute cerebellar ataxia which follows ingestion of roasted larvae of Anaphe venata Butler, an alternative protein source consumed in western Nigeria. It was first reported in the 1950s in western Nigeria when it caused a wave of epidemics. This is the first case report of this condition in the literature since 1993.

Case report

We present the case of a 35 year old woman from western Nigeria who was admitted in October 2012 with acute onset of gait instability and bilateral hand tremors, preceded by several episodes of vomiting. She had ingested a meal containing roasted larvae of the African silkworm, 2 hours before the onset of vomiting.

Conclusion

Seasonal ataxia is an important differential diagnosis of acute cerebellar ataxia among the indigenous ethnic population of western Nigeria.It is non-fatal and treatable, with complete resolution of symptoms usually following thiamine therapy.     

Evidence that progesterone receptor antagonists may help in the treatment of a variety of cancers by locally suppressing natural killer cell activity

PURPOSE: To propose a novel concept that progesterone receptor antagonists, e.g., mifepristone, may prove effective in treating a variety of cancers--even those not shown to be hormonally dependent or possessing progesterone receptors. METHODS: Multiple human leukemia cell lines were evaluated for mRNA expression of an immunomodulatory protein called the progesterone-induced blocking factor (PIBF) that suppresses natural killer (NK) cell activity during normal pregnancy. Furthermore, we evaluated the effects of progesterone (P) and mifepristone in PIBF protein expression. Finally, the effect of mifepristone treatment of mice with advanced leukemia was evaluated. RESULTS: All tumor cell lines evaluated were found to express mRNA for PIBF and some were found to even express the PIBF protein. The addition of P to the media increased the expression of PIBF and mifepristone downregulated its expression. Treatment of mice with spontaneous leukemia when they already had extensive disease seemed to increase the length and quality of their life. CONCLUSIONS: These data and other experience with mice with lung cancer and some anecdotal human cancer experience suggest that various cancers may utilize similar mechanisms used by the fetus to escape NK cell surveillance. Mifepristone and other progesterone receptor antagonists may deserve a clinical trial in human cancer even where there is no knowledge of the presence of progesterone receptors.     

Case series of volar juvenile xanthogranuloma: Clinical observation of a peripheral rim of hyperkeratosis

Juvenile xanthogranuloma is a benign histiocytic tumor predominantly occurring in children as yellowish papules on the head and trunk. Presentations on the volar surfaces are rare and may cause diagnostic confusion with pyogenic granuloma, eccrine poroma and digital fibrokeratoma. We report two patients with unusual presentations of solitary juvenile xanthogranuloma on the palm or sole. Both had lesions lacking the classic yellowish color and demonstrating a well‐defined, peripheral hyperkeratotic rim. Histopathological evaluation revealed prominent orthokeratosis corresponding to the rim. Additional histological features, including dermal histiocytes and Touton giant cells, were consistent with the diagnosis of juvenile xanthogranuloma. Given the unusual locations and colors of the lesions, we conclude that histopathological evaluation is central to diagnosing volar juvenile xanthogranuloma. We additionally suggest that juvenile xanthogranuloma should be included in the differential diagnoses of volar lesions displaying a peripheral hyperkeratotic rim.     

The costs of childhood epilepsy in Italy: comparative findings from three health care settings

PURPOSE: To determine the direct costs of epilepsy in a child neurology referral population, stratified by disease, duration, and severity, comparing three different health care settings [i.e., teaching or clinical research (CR) hospitals, general hospitals, and outpatient services]. METHODS: Patients were accepted if they had confirmed epilepsy and were resident in the center catchment area. Eligible subjects were grouped in the following categories: (a) newly diagnosed patients; (b) patients with epilepsy in remission; (c) patients with active non-drug-resistant epilepsy; and (d) those with drug-resistant epilepsy. Over a 12-month period, data regarding the consuming of all resources (i.e., consultations, tests, hospital admissions, drugs), were collected for each patient. Using the Italian National Health Service tariffs, the unit cost of each resource was calculated and indicated in Euros, the European currency. RESULTS: A total of 189 patients was enrolled by two teaching-CR hospitals, two general hospitals, and two outpatient services. The patients were evenly distributed across the four categories of epilepsy. The mean annual cost per person with epilepsy was 1,767 Euros. Drug-resistant epilepsy was the most expensive category (3,268 Euros) followed by newly diagnosed epilepsy (1,907 Euros), active non-drug-resistant epilepsy (1,112 Euros), and epilepsy in remission (844 Euros). Costs were generally highest in teaching-CR hospitals and lowest in outpatient services. Hospital services were the major cost in all epilepsy groups, followed by drugs. CONCLUSIONS: The cost of epilepsy in children and adolescents in Italy tends to vary significantly depending on the severity and duration of the disease Hospitals services and drugs are the major sources of costs. The setting of health care plays a significant role in the variation of the costs, even for patients in the same category of epilepsy.     

Epidemiology, therapeutic agents and cost of management of paediatric malaria in a Nigerian tertiary hospital

BACKGROUND AND OBJECTIVES: Malaria is the most widespread parasitic disease in sub-Saharan Africa with associated high morbidity and mortality especially among the highly predisposed population of pregnant women and children of age five years and below. Living in malaria endemic regions of the world has become associated with health and economic hazards placing financial and productive burden on affected households. METHODS: A prospective study of children treated for malaria and other associated illnesses at a Nigeria tertiary health institution between May and October 2003 was undertaken. The various malaria-associated diseases treated were determined from their provisional diagnosis, hospital records and causative agents confirmed from their diagnostic laboratory results. Cost of treatment was determined from the patients' guardian and confirmed from relevant hospital departments. Common drugs for malaria treatment, their costs, relative effectiveness and frequency of use were determined through a completed questionnaire by health officers and patients' guidance. RESULTS: Of 5356 paediatric patients suspected of having malaria, 5100 (95.2%) were confirmed positive for malaria parasites microscopically. Of these, 4119 (80.8%) were aged 0 - 6 years, with children aged 1 to 3 years being mostly affected. Eight hundred and twenty (16.1%) of them were in-patients spending an average of six days on hospital bed. Over 22 million naira (dollar 0.22 m) was spent on the treatment of malaria with drugs accounting for the major cost (66.81%). About 33.7% of the patients had malaria complicated with other diseases. INTERPRETATION AND CONCLUSION: The effectiveness of common therapeutic agents used for malaria treatment, their costs and associated side effects is discussed. Recommendations are made for appropriate care and government subsidy for paediatric malaria management in sub-Saharan Africa.     

Carotid body tumors. Observation of an unusual case associated with thyroid disease]

A case of tumour of the carotid glomus associated with diffuse cystic colloid struma of the thyroid is examined. Classification, symptomatological, diagnostic and therapeutic problems are reassessed on the basis of the case in question and the literature. Stress is laid on the importance of carotidography as a decisive examination for preoperative diagnosis of the nature of the case. Some basic problems of surgical treatment are examined and the operating techniques that have proved most valid are proposed.