Challenges of Case Management of COVID-19 in University of Uyo Teaching Hospital: A One-Year Experience

BACKGROUND AND OBJECTIVES: Coronavirus disease 2019 (COVID-19) is a global pandemic. Older people and those with poorly controlled co-morbidities have higher risk of mortality. This study was conducted to highlight the clinical features, challenges of management and outcome for the patients we have seen in our centre over the past one year. METHODS: This was a retrospective cross-sectional study involving all patients admitted in the COVID-19 Isolation unit of University of Uyo Teaching Hospital (UUTH) from June, 2020­May, 2021. Clinical and laboratory information were obtained from the patient case notes. Ethical clearance for the conduct of the study was obtained from the Ethics committee, UUTH, Uyo. Data was analysed with STATA version 13. RESULTS: Thirty-three (37.9%) patients were COVID-19 PCR positive. The mean ± SD age of COVID-19 PCR positive patients was 57.3 ± 13.4 years with majority (69.7%) being above 50 years. There was a male preponderance (75%). Eleven (34.4%) patients died while 21(65.6%) were discharged. The highest co-morbidity associated with COVID-19 mortality was diabetes mellitus (7 out of 11; 63.6%). There was a poor uptake of supportive investigations for the management of COVID-19 patients. A raised body temperature (P=0.0006), a low SPO2(0.00004), high respiratory rate (0.0009) on admission and shorter duration of admission (0.0002), were associated with mortality. CONCLUSION: The presence of co-morbidities, fever, low SPO2 and high respiratory rates on admission are associated with increased mortality from COVID-19 disease. A paucity of supportive investigations was a major challenge to COVID-19 management. We therefore recommend the strengthening of our laboratory capacity.

Outcome of Directly Observed Therapy Short Course (DOTS) Regimen in a Rural Communicty of the Nigerian Niger Delta

Background: The objective of this retrospective study was to evaluate the outcome of directly observed therapy short course (DOTS) application in a Nigerian rural community.Methods: A retrospective study of all the records of DOTS at the centre from January 2001 to December 2005 was compiled and features such as: age; gender; drugs used; and outcome of treatment (defaulted; cured; died; or developed multidrug resistant-TB) were considered. Also the different personnel and infrastructure at the centre for the programme were also assessed. Results were analysed using Epi Info 6 statistical software; and P values 0.05 were considered significant. Results: Two hundred and seventy four (274) cases of pulmonary TB were registered at the centre during the study period; consisting of 100(36.5) females and 174(63.5) males with a statistically significant gender difference (P0.001). The age range with the highest number of pulmonary tuberculosis cases was 31-40 years (24.8; n=68); and the age range with the lowest number was 71 years and above (1.1; n=3). Treatment outcome showed that 84.7(n=232) completed treatment with cure; 2.5(n=7) developed multidrug resistance at completion of treatment; 5.5(n=15) defaulted; 3.3(n=9) died in the course of treatment; and treatment in 11 people was still ongoing. Conclusion: The outcome of DOTS in the present study was impressive; and the programme should be extended to other rural communities; however; more efforts should be made towards the tracing of defaulters

Prevalence and Pattern of Abnormal Glucose Tolerance in Adult Nigerians with Primary Hypertension

Background: Hypertension and diabetes mellitus relate to one another aetiologically and prognostically. Studies show that hypertension occurs frequently in diabetics than non-diabetics. Data on the prevalence of abnormal glucose tolerance in hypertensive Nigerians are scanty. This study assesses the magnitude of this problem in adult Nigerians with primary hypertension. Method: Oral glucose tolerance test was performed on 124 adult Nigerians (64hypertensives; 60normotensives) to determine the prevalence of abnormal glucose tolerance. Body mass index and waist circumference were measured. Plasma glucose was analyzed by the glucose oxidase method. Results: The hypertensive(32 males;32females) and normotensive (30males; 30females) had mean ages of 47.6+/-10.1years and 44.2+/-7.6years.The mean body mass index and waist circumference of hypertensives and normotensives were 30.2+/-80kg/m;100.8+/-17.2cm and28.5kg/m;88.5+/-14.1cm. The mean plasma glucose in mmols/l; during oral glucose tolerance test of hypertensives and normotensives; at 0hr; 1hr and 2hrs were;4.79+/-0.99;6.94+/-1.5;5.96+/-1.82 and4.42+/-0.90;6.25+/-1.02;5.05++/-1.8 respectively. The response to glucose load was significantly higher in the hypertensives than normotensives particularly at 2hours p

Prevalence and Pattern of Abnormal Glucose Tolerance in Adult Nigerians with Primary Hypertension

Background: Hypertension and diabetes mellitus relate to one another aetiologically and prognostically. Studies show that hypertension occurs frequently in diabetics than non-diabetics. Data on the prevalence of abnormal glucose tolerance in hypertensive Nigerians are scanty. This study assesses the magnitude of this problem in adult Nigerians with primary hypertension. Method: Oral glucose tolerance test was performed on 124 adult Nigerians (64hypertensives; 60normotensives) to determine the prevalence of abnormal glucose tolerance. Body mass index and waist circumference were measured. Plasma glucose was analyzed by the glucose oxidase method. Results: The hypertensive(32 males;32females) and normotensive (30males; 30females) had mean ages of 47.6+/-10.1years and 44.2+/-7.6years.The mean body mass index and waist circumference of hypertensives and normotensives were 30.2+/-80kg/m;100.8+/-17.2cm and28.5kg/m;88.5+/-14.1cm. The mean plasma glucose in mmols/l; during oral glucose tolerance test of hypertensives and normotensives; at 0hr; 1hr and 2hrs were;4.79+/-0.99;6.94+/-1.5;5.96+/-1.82 and4.42+/-0.90;6.25+/-1.02;5.05++/-1.8 respectively. The response to glucose load was significantly higher in the hypertensives than normotensives particularly at 2hours p

Enhanced Dietary Awareness and Lifestyle Changes in First-Year Medical Students Following Exposure to Problem-Based Nutrition Education

Background: The ever-increasing prevalence of chronic lifestyle-associated diseases has resulted in greater awareness of the importance of preventative medicine and its incorporation as an integral component of modern undergraduate medical curricula. As excessive dietary intake and physical inactivity are widely acknowledged as leading risk factors for the onset of chronic lifestyle-associated diseases; the promotion of a healthy lifestyle is regarded as a priority for today's primary care physicians. For this reason; it was deemed appropriate by the designers of the problem-based learning (PBL) curriculum; which was introduced at the Nelson R. Mandela School of Medicine in 2001; to include a six-week Nutrition theme early in the medical students' five-year curriculum. This study set out to determine the impact of this theme; which included a specific focus on the importance of nutrition in avoiding lifestyle-associated disorders; on the dietary awareness and lifestyle of the 2004 intake of medical students.Methods: First-year medical students (n = 213) spent the first six weeks of their curriculum (following an orientation period) engaged in a problem-based learning Nutrition theme; which included active; personalised learning experiences such as analysing their own dietary intakes and recording their personal anthropometric measures. They were questioned two weeks after conclusion of the theme regarding (i) the impact of the theme on their dietary awareness and lifestyles; (ii) whether they had; since the start of the theme; shared their newly acquired insights with others; and (iii) the extent to which they recalled their personal measured anthropometric data and calculated kilojoule (kJ) intakes derived during the practical sessions.Results: Nearly 84 of the students responded to the anonymous survey (n = 178). A greater awareness of their personal dietary intake following the completion of the Nutrition theme was acknowledged by 88.2( n = 157); while 65.1 (n = 116) reported improvements to their general lifestyle. Eighty-five percent reported having counselled family members and friends about diet and lifestyle-related issues in the eight-week period since the start of the theme. While recall of body mass indices was higher (p 0.01) in females (85.8) than in males (61.5 ); recall of daily kJ intakes was independent of gender. Unsolicited mention by the students surveyed in this study of components of the South African Food-based Guidelines and recent alternative food pyramids suggests that these models were recognised as health priority areas by this student cohort.Conclusion: The introduction of a Nutrition theme at the start of the problem-based medical learning curriculum appeared to have impacted significantly on the dietary awareness and lifestyles of the students surveyed; with a tendency among students to share this awareness with others. From the open-ended responses of the students; the findings of this study appear to confirm that medical students appreciated learning about their own health factors; and that personalising the information made the learning experience more valuable to them. Attitudinal changes and apparent internalisation of the newly acquired nutritional awareness were reflected by the high percentage of students who acknowledged that they had advised others within the two-week period following the completion of the theme. This augurs well for the potential preventative counselling practices of these future medical graduates. It will; however; be of interest to survey this student cohort longitudinally to establish whether their changed perceptions have a longer term impact and result in attitudes and practices that support preventative health care

Augmentation of the acute phase response in vitamin C-supplemented ultramarathoners

Objective. To investigate the effects of vitamin C (VC) supplementation on the alterations in systemic markers of inflammation as a result of participation in a 90 km down run from Pietermaritzburg to Durban in 29 subjects who completed the 1999 Comrades Marathon. Interventions. Runners were divided into groups receiving 500 mg/day VC (VC500; N = 10); 1 500 mg/day VC (VC1500; N = 12) or placebo (P; N = 7) for 7 days before the race; on the day of the race; and for 2 days following completion. Main outcome measures. Each subject recorded dietary intake before; during and after the race and provided 35 ml blood samples 15 - 18 hours before the race; immediately post race; 24 hours post race and 48 hours post race. These were analysed for full blood count; vitamins A; C and E; glucose; C-reactive protein (CRP); amyloid A; interleukin-6 (IL-6) and interleukin-8 (IL-8) concentrations. All post race concentrations were adjusted for plasma volume changes. Results. Analyses of dietary intakes and blood glucose and anti-oxidant status on the day preceding the race and the day of the race excluded carbohydrate intake or plasma vitamins E and A as significant confounders in the study. Mean pre-race concentrations of serum vitamin C in VC500 and VC1500 groups (128 - 10.2 and 153 - 10.2 mol/l) were significantly higher (p 0.01) than in the P group (83 - 10.8 mol/l) and confirmed the additional dietary VC intake of both groups. Serum CRP concentrations were significantly higher (p 0.05) in the VC500 group than in the VC1500 and P groups. This finding was supported by similar trends in serum amyloid A; plasma IL-6 and IL-8. When the data from the two VC groups were pooled and the vitamin intake in the placebo (N 500 mg per day