An Eight-Year Review of Morbidity and Mortality among Adult Patients with Tetanus at a Tertiary Hospital in Zaria, Northern Nigeria.

Background: Tetanus infection is a major cause of morbidity and mortality in many developing countries. The infection results from contamination of wound by Clostridium tetani in unimmunized individuals. The morbidity is mainly due to sustained skeletal muscle spasms from unopposed action of tetanospamin on excitatory neurons in the central nervous system. The clinical presentation and outcome depend on both patient and disease factors. Health education and immunization would contribute to prevention and eradication of the infection. This review studied morbidity and mortality patterns among adults treated for tetanus at a tertiary hospital in Zaria from January 2006 to December 2013. Materials and Methods: Medical records of adults admitted with the diagnosis of tetanus were retrieved and reviewed. Information on socio-demography, clinical presentation, complications, co morbidities and outcomes were obtained and analysed using the Statistical Package for Social Sciences version 17.0. Results: Forty-seven patients were admitted during the period, with an average of 6 patients per year. Male (70.2%): female (29.8%) ratio was 2.4: 1. Their ages ranged from 15 years to 65 years, the age group 20-39 years constituting 76.6% of the population. 51.2% were students. The lower limbs were portal of entry in 70.6% of cases, and 52.9% of the wounds were dirty. 82.4% of the patients were unimmunized and overall mortality was 40.4%. Predictors of mortality were short incubation period, short onset time, severe muscle spasms, non-immunization and presence of complications. Conclusion: Tetanus remains a major preventable disease among unimmunized and low income people. Therefore, immunization of people at risk would prevent tetanus infection and its associated complications.

Spinal Neurobrucellosis is an Unusual Cause of Nontraumatic Paraplegia in Zaria, Northern Nigeria: A report of 3 Cases and Review of Current Literature.

Introduction: Brucellosis is a zoonotic febrile infection common among farmers or herdsmen who come into contact with animals or animal products. Neurological complications are uncommon, but when they occur can be confused with other neurological diseases, particularly those due to tuberculosis (TB). Aim: This report is intended to remind health workers and people living in Brucella endemic communities that spinal neurobrucellosis can mimic Potts’ disease as the cause of nontraumatic paraparesis or paraplegia. Study Design: longitudinal case series. Methodology: We report the cases of three patients who presented with paraplegia following months of constitutional symptoms of fever, headache, malaise and weight loss. All were exposed to cows, goats and sheep. One patient had received antituberculous therapy for 18 months with minimal recovery. Serology and neuroimaging were used to confirm the diagnosis. Results: All patients recovered within 6 to 12 weeks of rifampicin, doxycycline, trimethoprim-sulfamethoxazole or streptomycin, but with residual paraparesis. Conclusion: spinal neurobrucellosis can be confused with Pott’s disease (TB of the spine) with consequent poor treatment outcome.

Antiretroviral Drug Resistance- Implications for HIV/AIDS Reduction in Sub-Saharan Africa

Background:The introduction of the highly active antiretroviral therapy in the mid-1990s has significantly reduced morbidities and prolonged the lifespan of people living with HIV. However; the emergence of resistance to the antiretroviral drugs is becoming a major cause of treatment failure. While the problem of drug resistance is being tackled in developed countries; not much seem to be done in this regard in developing countries of Africa; Asia and Latin America. This review looked at the regional distribution of HIV groups and subtypes and how this has affected the pattern of antiretroviral resistance. Methods: The review was sourced from papers presented at international conferences on HIV/AIDS and rational drug use; relevant journals and Medline search using the keywords- Antiretroviral drugs; drug resistance; HIV subtypes and resistance testing. Results: The types; groups; subtypes; sub-subtypes and recombinant forms of HIV-1 have been identified according to their geographical distributions. The evolution of HIV viral mutations; process (es) involved in development of primary and secondary antiretroviral drug resistance; including the role of HIV genetic polymorphisms; and transmitted resistance have been discussed. Conclusion: The pitfalls in the current resistance testing based on HIV-1 subtype B have been highlighted. The design of resistance testing algorithm based on HIV-1 subtype non-B has been suggested for the developing world

Prognosis of Non Traumatic Coma: The Role of some Socio-Economic Factors on its Outcome in Ibadan; Nigeria

Background : Coma occurring in the course of an illness; irrespective of cause; traditionally implies a poor prognosis and many factors may determine its outcome. These factors must be identified and possibly stratified in their order of importance. This research seeks to identify these factors and how they influenced the outcome of non-traumatic coma in our environment. Methods : Two hundred consecutive patients; aged 18-79 years who met the inclusion criteria; the Glasgow coma scale (GCS) score of 8; history and physical findings suggestive of medical illness; no head trauma or sedation; were recruited into the study from August 2004 to March 2005 at the University College Hospital (UCH); Ibadan; after obtaining institutional ethical clearance and consent from patients' guardians. Detailed history of illness including the bio-data and time to present to the hospital and treatments given were noted. Thereafter; the clinical course of the patients was monitored daily for a maximum of 28 days during which the support of the family and/ or the hospital social welfare was evaluated. Results : During the 8-month period of the study; 76(152) of the patients died while 24(48) survived. The following factors were associated with high mortality rate: inability to confirm diagnosis (100); poor family support (97.1); delay in making a diagnosis within 24 h (85.4); poor family understanding of disease (84.1); need for intensive care admission and management (83.3); poor hospital social welfare support (82.4); presentation to UCH after 6 h of coma (76.7); and referral from private health facilities (75.7). Others include substance abuse (100) and seropositivity to HIV (96) and hepatitis B surface antigen (92) antibodies; among others. Conclusion : This study has demonstrated that socio-economic factors such as gender; occupation; risky lifestyle behaviors; late presentation or referral to hospital; late diagnosis and treatment; and poor family support contributed to poor outcome of nontraumatic coma. It is hoped that improvement; modification; or correction of these factors may improve coma outcome