An Outbreak of Arboviral Infection in a Region with Background Malaria Endemicity from Northwestern Nigeria: An Investigation Report.

INTRODUCTION: Arboviruses are a group of infectious agents transmitted by blood-sucking arthropods from one vertebrate host to another. The agents include Dengue fever and West Nile Virus, amongst others. However, Dengue fever is now the world's fastest-spreading tropical disease, with the annual number of cases increasing 30-fold in the last 50 years. Cases of an unknown febrile illness were reported in Sokoto, northwestern Nigeria, in the last quarter of 2016. We investigated to verify the existence of the outbreak and described the socio-demographic characteristics and management outcome of the cases seen. METHODS: We conducted a descriptive, cross-sectional study and an analytical case control study. For the descriptive study, we defined suspected and confirmed cases of outbreak using established protocol. Cases were identified using stimulated passive and active surveillance. For each suspected case, we collected information on age, sex, residence and time of onset. We described the outbreak by time, place and person. Blood specimens were collected and submitted to the reference laboratory for detection of viral agents. We conducted a case-control study with 185 cases and 370 controls. Information on the socio-demographics and risk factors for arboviral infection and malaria among the cases and controls was collected. RESULTS: The outbreak of febrile illness in Sokoto started on the 3rd of October, 2016. A total 1477 cases were line listed (3rd Oct-11th November 2016) and 16 deaths (case fatality rate: 1.1% reported). The most affected areas were urban slums in two urban Local Government Areas (LGA) - Sokoto North and Sokoto South. Laboratory analysis revealed Dengue, West Nile and Malaria in increasing order from the representative samples. There were 57 (43.2%) respondents in the age-group 21-30 among the cases, while 99 (53.5%) of them were males. Cases living in a bushy neighborhood (OR=1.6, 95% CI=1.1-2.4), keeping waste bins in their houses (OR=1.5, 95% CI=1.0-2.1), having uncovered well or uncovered water containers (OR=3.6, 95% CI=2.1- 6.0) were more likely to develop arboviral infection or malaria compared to controls. Having window nets (OR=0.3, 95% CI=0.2-0.5) was found to be a protective factor against arboviral infection or malaria among the cases. CONCLUSIONS: The outbreak of febrile illness in Sokoto was linked to arboviral agents (Dengue virus and West Nile virus) in a malaria-endemic zone. We draw attention to the fact that arboviral infections can coexist with malaria in our region especially in an outbreak setting.

INTRODUCTION: Les arbovirus sont un groupe d'agents infectieux transmis par des arthropodes hématophages d'un hôte vertébré à un autre. Ces agents comprennent, entre autres, la fièvre de la Dengue et le virus du Nil occidental. Cependant, la dengue est aujourd'hui la maladie tropicale qui se propage le plus rapidement dans le monde, le nombre annuel de cas ayant été multiplié par 30 au cours des 50 dernières années. Des cas d'une maladie fébrile inconnue ont été signalés à Sokoto, dans le nord-ouest du Nigeria, au cours du dernier trimestre 2016. Nous avons enquêté pour vérifier l'existence de cette épidémie et décrit les caractéristiques sociodémographiques et le résultat de la prise en charge des cas vus. MÉTHODES: Nous avons mené une étude descriptive, transversale et une étude analytique cas-témoins. Pour l'étude descriptive, nous avons défini les cas suspects et confirmés d'épidémie en utilisant le protocole établi. Les cas ont été identifiés en utilisant une surveillance passive et active stimulée. Pour chaque cas suspect, nous avons recueilli des informations sur l'âge, le sexe, le lieu de résidence et le moment de l'apparition des symptômes. Nous avons décrit l'épidémie par temps, lieu et personne. Des échantillons de sang ont été prélevés et soumis au laboratoire de référence pour la détection des agents viraux. Nous avons mené une étude cas-témoins avec 185 cas et 370 témoins. Des informations sur les données sociodémographiques et les facteurs de risque d'infection par les arbovirus et le paludisme ont été recueillies parmi les cas et les témoins. RÉSULTATS: L'épidémie de maladie fébrile à Sokoto a commencé le 3 octobre 2016. Au total, 1477 cas ont été répertoriés (du 3 octobre au 11 novembre 2016) et 16 décès (taux de létalité : 1,1% rapporté). Les zones les plus touchées étaient les bidonvilles urbains dans deux zones urbaines de gouvernement local (LGA) - Sokoto Nord et Sokoto Sud. Les analyses de laboratoire ont révélé la présence de la dengue, du virus du Nil occidental et du paludisme par ordre croissant dans les échantillons représentatifs. Parmi les cas, 57 (43,2 %) étaient âgés de 21 à 30 ans, tandis que 99 (53,5 %) d'entre eux étaient des hommes. Les cas vivant dans un quartier broussailleux (OR=1,6, IC 95%=1,1-2,4), gardant des poubelles dans leurs maisons (OR=1,5, IC 95%=1,0-2,1), ayant un puits non couvert ou des récipients d'eau non couverts (OR=3,6, IC 95%=2,1- 6,0) étaient plus susceptibles de développer une infection arbovirale ou le paludisme par rapport aux témoins. Le fait de posséder des moustiquaires de fenêtre (OR=0,3, IC 95 %=0,2-0,5) s'est avéré être un facteur de protection contre l'infection à arbovirus ou le paludisme chez les cas. CONCLUSIONS: L'épidémie de maladie fébrile à Sokoto a été liée à des agents arboviraux (virus de la dengue et virus du Nil occidental) dans une zone où le paludisme est endémique. Nous attirons l'attention sur le fait que les infections arbovirales peuvent coexister avec le paludisme dans notre région, en particulier dans le cadre d'une épidémie. MOTS-CLÉS: Fièvre, Paludisme, Arbovirus, Epidémie.

Prevalence and Correlates of Peripheral Arterial Disease in Nigerians with Type 2 Diabetes.

Background. Peripheral arterial disease (PAD) is a major risk factor for nonhealing foot ulcers in people with diabetes. A number of traditional risk factors have been reported to be associated with PAD; however, there may be a need to consider nontraditional risk factors especially in some vulnerable populations. This study determined the prevalence and risk factors associated with PAD in diabetics. Methods. One hundred and fifty type 2 diabetics and an equal number of age- and sex-matched apparently healthy controls were studied. Assessment of PAD was made using history, palpation of lower limb vessels, and measurement of ankle-brachial index (ABI). Statistically significant differences between categorical and continuous variables were determined using Chi square (χ2) and Student t-tests, respectively. Regression analysis was done to determine the associated risk factors for PAD. Results. Prevalence of PAD using ABI was 22.0% and 8.0% among diabetic and nondiabetic populations, respectively. Peripheral arterial disease was associated with age, male gender, waist circumference, and high-sensitivity C-reactive protein. Conclusion. This study highlights the high prevalence of PAD in people with type 2 diabetes mellitus and in apparently healthy controls; age, male gender, abdominal obesity, and high hs-CRP values were the associated risk factors.

Comparison of lispro insulin and regular insulin in the management of hyperglycaemic emergencies.

This study compared the efficacy and safety of Lispro insulin and regular insulin in the management of hyperglycemic emergencies (HE). Fifty patients who presented in HE to the Emergency unit of Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife participated in the study. Hyperglycaemic emergency was diagnosed when plasma glucose level was >17 mmol/L (300 mg/dl) in the presence of polyuria and polydipsia that warrants emergency hospital admission. Subjects in the Lispro insulin group had a statum dose of 0.3 IU/kg, while those in the regular insulin group had a statum dose of 20 IU equally split between the intravenous and intramuscular routes. Further insulin therapy was by the intramuscular route. Data was analysed using the Statistical package for social sciences (SPSS) version 11. Hyperglycaemia resolved within the first 8 hours in 60 and 40% percent of subjects in the lispro and regular insulin treated groups respectively. The time taken for resolution of hyperglycaemia was similar in both treatment groups, 6.6 +/- 0.8 hours for the lispro insulin group and 7.4 +/- 0.8 hours for the regular insulin group p = 0.51. The number of episodes of hypoglycaemia and hypokalemia in the two treatment groups did not differ statistically (p = 1.0 and 0.38 respectively). Eight (16%) subjects died. Lispro insulin is a safe and efficacious alternative to regular insulin in the treatment of HE.

Comparison of lispro insulin and regular insulin in the management of hyperglycaemic emergencies

This study compared the efficacy and safety of Lispro insulin and regular insulin in the management of hyperglycemic emergencies (HE). Fifty patients who presented in HE to the Emergency unit of Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife participated in the study. Hyperglycaemic emergency was diagnosed when plasma glucose level was >17 mmol/L (300 mg/dl) in the presence of polyuria and polydipsia that warrants emergency hospital admission. Subjects in the Lispro insulin group had a statum dose of 0.3 IU/kg, while those in the regular insulin group had a statum dose of 20 IU equally split between the intravenous and intramuscular routes. Further insulin therapy was by the intramuscular route. Data was analysed using the Statistical package for social sciences (SPSS) version 11. Hyperglycaemia resolved within the first 8 hours in 60 and 40% percent of subjects in the lispro and regular insulin treated groups respectively. The time taken for resolution of hyperglycaemia was similar in both treatment groups, 6.6 +/- 0.8 hours for the lispro insulin group and 7.4 +/- 0.8 hours for the regular insulin group p = 0.51. The number of episodes of hypoglycaemia and hypokalemia in the two treatment groups did not differ statistically (p = 1.0 and 0.38 respectively). Eight (16%) subjects died. Lispro insulin is a safe and efficacious alternative to regular insulin in the treatment of HE