An Evaluation of Renal Care received by Human Immunodeficiency Virus(HIV) Patients admitted in a Tertiary Hospital in Sierra Leone

INTRODUCTION: The burden of HIV is on the rise and patientswith HIV are also vulnerable to renal impairment from bothacute and chronic causes. This study sets out to evaluate renalcare received by such patients.METHODS: The study was conducted at Connaught Hospital,the main tertiary hospital (for medical and surgical cases) in thecountry. A retrospective review of all admitted patients withHIV between January and December 2019. Data was collectedusing a well- structured study proforma. RESULTS: A total of 230 patients were admitted with HIV duringthe study period. The mean age of patients was 36.9 ± (11.5) years with a female preponderance of 61.3%. A vast majority ofthe patients (54.8%) could afford to do some renal investigationsand only 13.9% were seen by renal physicians; 69.1% of patientswith azotaemia died while on admission.CONCLUSION: The extent of renal care observed from thestudy was poor because the majority of the patients were notseen b y r e na l physic ia ns a nd co uld no t affor d r e na linvestigations. Also, the occurrence of renal impairment inpatients with HIV suggests a poor prognosis. WAJM 2022;39(11): 1193­1197.

The future of precision medicine in opioid use disorder: inclusion of patient-important outcomes in clinical trials

Opioid use has reached an epidemic proportion in Canada and the United States that is mostly attributed to excess availability of prescribed opioids for pain. This excess in opioid use led to an increase in the prevalence of opioid use disorder (OUD) requiring treatment. The most common treatment recommendations include medication-assisted treatment (MAT) combined with psychosocial interventions. Clinical trials investigating the effectiveness of MAT, however, have a limited focus on effectiveness measures that overlook patient-important outcomes. Despite MAT, patients with OUD continue to suffer negative consequences of opioid use. Patient goals and personalized medicine are overlooked in clinical trials and guidelines, thus missing an opportunity to improve prognosis of OUD by considering precision medicine in addiction trials. In this mixed-methods study, patients with OUD receiving MAT (n=2,031, mean age 39.1 years [SD 10.7], 44% female) were interviewed to identify patient goals for MAT. The most frequently reported patient-important outcomes were to stop treatment (39%) and to avoid all drugs (25%). These results are inconsistent with treatment recommendations and trial outcome measures. We discuss theses inconsistencies and make recommendations to incorporate these outcomes to achieve patient-centered and personalized treatment strategies.

Reliability and Validity of the Child and Adolescent Functioning Impairment Scale in Children with Attention-Deficit/Hyperactivity Disorder

OBJECTIVE: The purpose of the present study was to develop reliable and valid parent and teacher scales for measurement of functional impairment in children and adolescents in order to assist the diagnosis of attention-deficit/hyperactivity disorder (ADHD). METHODS: Seventy-two children with ADHD fulfilling the Diagnostic and Statistical Manual of Mental Disorder, 4th Edition criteria and forty-two normal controls were enrolled in this study. Parents and teachers of the subjects completed the parent and teacher form of the preliminary items of Child and Adolescent Functioning Impairment Scale (CAFIS) made up by the authors. Based on the reliability and factor analysis, the final parent (CAFIS-parent form) and teacher version (CAFIS-teacher form) were constructed. Scales were analyzed for reliability and validity. Relative operating characteristics curve was drawn to calculate the cutoff scores of these scales for children with ADHD. RESULTS: The CAFIS-parent and CAFIS-teacher forms consist of four and three factors, respectively. Internal consistency and test-retest correlation of the scales were satisfactory. The CAFIS and Children's Global Assessment Scale were significantly correlated. All scores of subscales of CAFIS in ADHD group were significantly higher than those of control group. The sensitivity and specificity of the subscales were mostly at an appropriate level. CONCLUSION: The CAFIS is a brief layperson-administered scale to assess functional impairment of children and adolescents. It can be a useful tool for parents and teachers to objectively measure the functions of children at home and in school. This scale was found to be reliable and valid, and it appears to be a valuable instrument in Korean language.

Experimental swainsonine poisoning in goats ingesting Ipomoea sericophylla and Ipomoea riedelii (Convolvulaceae)

Ipomoea sericophylla and Ipomoea riedelii cause a glycoprotein storage disease in goats. This paper reports the experimental poisoning in goats by dried I. sericophylla and I. riedelii containing 0.05 percent and 0.01 percent swainsonine, respectively. Three groups with four animals each were used. Group 1 received daily doses of 2g/kg body weight (bw) of dried I. sericophylla (150mg of swainsonine/kg). Goats from this group had clinical signs 36-38 days after the start of ingestion. Group 2 received dried I. riedelii daily doses of 2g/kg of I. riedelii (30mg of swainsonine/kg) for 70 days. No clinical signs were observed, therefore the swainsonine dose was increased to 60mg/kg for another 70 days. Goats from Group 2 had clinical signs 26-65 days after increase in swainsonine dose to 60mg/kg. Group 3 was used as control. In these experiments the minimum toxic dose was 60mg/kg which represents 0.0004 percent of the dry matter in goats ingesting 1.5 percent bw of the dry matter. For goats ingesting 2 percent-2.5 percent bw of dry matter this dose would be 0.00024 percent-0.0003 percent of the dry matter. After the end of the experiment two goats were euthanized and another six were observed for recovery of clinical signs. Four goats that continued to consume swainsonine containing plant for 39-89 days after the first clinical signs had non reversible signs, while two goats that ingested the plant for only 15 and 20 days after the first clinical signs recovered completely. These and previous results indicate that irreversible lesions due to neuronal loss occur in goats that continue to ingest the plants for about 30 days after the first clinical signs. Clinical signs and histological lesions were similar to those reported previously for goats poisoned by swainsonine containing plants. No significant alterations were found in packed cell volume, red and white blood cell counts, hemoglobin and mean corpuscular hemoglobin concentrations, mean...

Ipomoea sericophylla e Ipomoea riedelii causam uma doença de armazenamento de glicoproteínas em caprinos. Este trabalho relata a intoxicação experimental em caprinos por I. sericophylla e I. riedelii contendo 0,05 por cento e 0,01 por cento de swainsonina, respectivamente. Foram utilizados três grupos de quatro animais. O Grupo 1 recebeu doses diárias de 2g/kg peso vivo (pv) de I. sericophylla dessecada (150mg de swainsonina/kg). Os caprinos deste grupo apresentaram sinais clínicos 36-38 dias após o início da ingestão. O Grupo 2 ingeriu diariamente 2g/kg de I. riedelii dessecada (30mg de swainsonina/kg) por 70 dias. Como não foram observados sinais clínicos a dose de suainsonina foi aumentada para 60mg/kg por outros 70 dias. Os caprinos do Grupo 2 apresentaram sinais clínicos 26-65 dias após o aumento da dose de swainsonina para 60mg/kg. O Grupo 3 foi utilizado como controle. Neste experimento, a menor dose tóxica de swainsonina foi de 60mg/kg, que representa 0,0004 por cento da matéria seca, em caprinos ingerindo 1,5 por cento pv de matéria seca. Para caprinos ingerindo 2 por cento-2,5 por cento pv de matéria seca essa dose corresponderia a 0,00024 por cento-0,0003 por cento da matéria seca. Após o final do experimento dois caprinos foram eutanasiados e outros seis foram observados para conferir a recuperação dos sinais clínicos. Quatro caprinos que continuaram ingerindo as plantas contendo suainsonina por 39-89 dias após os primeiros sinais clínicos permaneceram com sinais clínicos irreversíveis, enquanto que dois caprinos que ingeriram as plantas por 15 e 20 dias após os primeiros sinais clínicos se recuperaram totalmente. Estes resultados e os de trabalhos anteriores sugerem que as lesões irreversíveis, devidas à perda neuronal, ocorrem quando os caprinos continuam ingerindo a planta por aproximadamente 30 dias após o início dos sinais clínicos. Os sinais clínicos e as lesões histológicas foram similares às descritas anteriormente...

Plasmodium coatneyi-infected rhesus monkeys: a primate modelfor human cerebral malaria

Although several animal models for human cerebral malaria have been proposed in the past, name have shown pathological findings that are similar to those seen in humans. In order to develop an animal model for human cerebral malaria, we studied the pathology of brains of Plasmodium coatneyi (primate malaria parasite)-infected rhesus monkeys. Our study demonstrated parazitized erythrocyte (PRBC) sequestration and cytoadherence of knobs on PRBC to endothelial cells in cerebral microvessels of these monkeys. This similar to the findings een in human cerebral malaria. Crebral microvessels with sequestred PRBC were shown by immunohistochemistry to possess CD36, TSP and ICAM-1. These proteins were not evident in cerebral microvessels of uninfected control monkeys. Our study indicates, for the first time, that rhesus monkeys infected with P. coatneyi can be used as a primate model to study human cerebral malaria

Disabilities in leprosy patients ascertained in a total population survey in Karonga District; northern Malawi

This paper describes the pattern of disability among 1654 leprosy patients ascertained between 1973 and 1987 in Karonga District; Northern Malawi. Approximately 20 percent of patients identified prior to 1980 had some disability at registration; but this percentage fell to approximately 10 percent with the introduction of total population surveys in the Lepra Evaluation Project. The proportion of patients with disabilities at registration increased with age; was higher among males than females; was higher among borderline and lepromatous than tuberculoid patients; and was higher for passively than for actively detected patients. The risk of developing disabilities among patients without any disabilities at registration was approximately 5 per 1000 person years; and appeared to be slightly higher after the completion of treatment than during treatment