Incidence of Adverse Drug Reactions in Patients on Antiretroviral Therapy: A study of Pharmaceutical Care in HIV Interventions in Nigeria

Background: Over 415;000 HIV-infected patients are receiving antiretroviral therapy (ART) in Nigeria but studies documenting their adverse reactions are limited. Objectives: This study determined the incidence and type of ADRs of severity grades II to IV in ART patients following pharmaceutical care directed active ADR surveillance program in Nigeria. Methods: This was a longitudinal study. A study-specific pharmaceutical care daily work sheet and national ADR reporting form were used for ADR screening and reporting respectively. Study population included 73;589 ART patients who were screened for ADR from April 2009 to December 2010 in 69 HIV treatment centres. All individual case safety reports (ICSRs) of severity grades II to IV in these patients were collated and analyzed. Chi-square was used to test the association between groups of variables at 95 Confidence Interval. Results: A total of 4600 ICSRs of severity grades II to IV reported were analyzed. Mean age of patients was 35.5(95CI; 35.2-35.9) years; 68.1 were females; and 7002 ADRs were reported; an average of 1.5 ADR perpatient. ADR incidences were 18.2 for d4T/3TC/EFV; 13.9 for d4T/3TC/NVP; and 4.4 for AZT/3TC/NV Pregimens; however overall incidence was 6.3. Major reported ADRs included skin rash (16.5); peripheral neuropathy (12.7); and headache (9.4). ADR occurrence was associated with specific ART regimens; concomitant medicines and age groups (p0.05); unlike gender. Lipodystrophy was associated withd4T/3TC/NVP [OR

Renal Cancer in Maiduguri: an 8-Year Review of Clinico-Pathological Pattern

Background: Primary renal cancer accounts for 10 - 20of all genito-urinary tract malignancies. The present study determined its clinico-pathological pattern and outcome of management. Methods: All patients with malignancies of the kidney seen between January 1999 and December 2007 were included in the study. These patients had surgery alone or in combination with preoperative/postoperative chemotherapy or radiotherapy and all specimens were confirmed malignant on histopathological examination. Results: Forty-nine patients with renal malignancies were seen of which 26(55.1) were males and 23(44.9) were females. The adults comprised 30(61.2) and children 19(38.8). The mean age was 27.60 +/- 22.12 years (range 7months-70 years). The male: female ratio was 1.1:1 and the mean duration of symptoms was 12.56 months (range 1-48 months). The most frequent clinical features were loin pain; 17 (44.7); and flank mass; 32(84.2). Others included haematuria; 13(34.2); fever; 19(50.0) and anaemia; 15(39.5). The main diagnostic investigations were ultrasonography and intravenous urography. Forty-seven (95.9) patients underwent radical unilateral nephrectomy and 2(4.1) had debulking or lymph node biopsies because of non-resectable tumours. These two had chemotherapy and subsequent nephrectomy. The most frequent renal malignancy was renal cell carcinoma (44.9) followed by nephroblastoma (38.8) which accounted for all the childhood renal tumours. All the children with nephroblastoma had postoperative 17(89.5) or preoperative 2(10.5) combination chemotherapy. Common postoperative complications included anaemia; fever; and chest and wound infections. There were 3 known deaths (mortality rate of 6.1). The main cause of death was advanced malignancy. Conclusions: Renal cell carcinoma is the most frequent malignant tumour of the kidney in the study population. Late presentation resulted in in-operable tumours with poor survival despite neo-adjuvant chemotherapy