Atorvastatin improves sputum conversion and chest X-ray severity score.

BACKGROUND: We report the results of a phase IIB study investigating the safety and effectiveness of atorvastatin use with standard anti-TB drugs.METHODS: In this multicentre, open-labelled study, we recruited treatment-naÏve patients with uncomplicated pulmonary TB aged at least 18 years. Participants were randomly assigned to standard-of-care or standard-of-care plus oral dose of atorvastatin (40 mg) daily for 2 months. Primary end points were safety measured by the number of participants with severe adverse events and effectiveness measured by the number of participants with negative sputum culture. Secondary endpoint was chest X-ray (CXR) severity score.RESULTS: Of the 185 participants screened, 150 were enrolled and equally assigned to the standard-of-care and atorvastatin groups. Adverse event severity was similar in the two groups. There was increased frequency of muscle pain in the trial group (12/75, 16% vs. 4/75, 5%). For efficacy analysis, respectively 64 (97%) and 57 (85.1%) patients in the trial and control groups had culture-negative results (P = 0.02) and experienced a reduction in CXR severity score of respectively 37% and 22%, with a mean difference of 1.4-4.9%.CONCLUSION: Atorvastatin is safe and associated with improved microbiological and radiological outcomes in TB.

Non-Mycobacteria Tuberculosis in Africa: A Literature Review.

Background: Non-tuberculous mycobacteria (NTM) have been reported to cause pulmonary and extrapulmonary infections. These NTMs are often misdiagnosed as MTB due to their similar clinical presentations to tuberculosis, leading to inappropriate treatment and increased morbidity and mortality rates. This literature review aims to provide an overview of the prevalence, clinical manifestations, diagnosis, and management of NTM infections in Africa. Methods: A systematic search was performed using various electronic databases including PubMed, Scopus, and Web of Science. The search was limited to studies published in the English language from 2000 to 2021. The following keywords were used: "non-tuberculous mycobacteria", "NTM", "Africa", and "prevalence". Studies that focused solely on the Mycobacterium tuberculosis complex or those that did not report prevalence rates were excluded. Data extraction was performed on eligible studies. Overall, a total of 32 studies met the inclusion criteria and were included in this review. Results: In our literature review, we identified a total of 32 studies that reported non-tuberculosis mycobacteria (NTM) in Africa. The majority of these studies were conducted in South Africa, followed by Ethiopia and Nigeria. The most commonly isolated NTM species were Mycobacterium avium complex (MAC), Mycobacterium fortuitum, and Mycobacterium abscessus. Many of the studies reported a high prevalence of NTM infections among HIV-positive individuals. Other risk factors for NTM infection included advanced age, chronic lung disease, and previous tuberculosis infection. Conclusion: In conclusion, this literature review highlights the significant burden of non-tuberculosis mycobacteria infections in Africa. The prevalence of these infections is high, and they are often misdiagnosed due to their similarity to tuberculosis. The lack of awareness and diagnostic tools for non-tuberculosis mycobacteria infections in Africa is a major concern that needs to be addressed urgently. It is crucial to improve laboratory capacity and develop appropriate diagnostic algorithms for these infections.

Influence of social disadvantage among children admitted to the pediatric emergency unit of a tertiary Hospital in Nigeria.

Background: Social disadvantage has an influence on the health of individuals. In developed countries, the prevalence, pattern of social disadvantage, and the outcome of admissions in socially disadvantaged children are under-studied. Aim: To determine the prevalence of social disadvantage, pattern of diseases, and illness outcomes among socially disadvantaged children. Patients and Methods: This was a prospective hospital-based study involving 400 patients who presented at the pediatric emergency unit (PEU) of a tertiary hospital in Southwest Nigeria. Information on socio-demography and history of illness was obtained from consecutive children using a proforma. The data was analyzed using SPSS version 20. Results: The 400 participants comprised 276 male and 124 female giving a ratio of 2.2:1. Their age range was 1-14 years; the mean ± SD age was 4.6 ± 2.3. Three hundred (75%) of the children were socially disadvantaged. The social factors associated with social disadvantage were low income, unemployment of mothers, polygamous setting, single parenting, rural residence, and low registration for health insurance. There was a significant association between social disadvantage and the development of malaria (P = 0.03), pneumonia (P = 0.01), septicemia (P = 0.03), diarrhea diseases (P = 0.04), neonatal jaundice (P = 0.04), meningitis (P = 0.04), and protein-energy malnutrition (P = 0.003). Death was significantly worse among the children who are socially disadvantaged (P = 0.0001). Conclusion: Many children admitted to the PEU in Osogbo are socially disadvantaged. Children of low-income parents, unemployed mother, single parent, residents of rural places, and those without health insurance are more vulnerable to developing infectious disease as well as neonatal jaundice and protein-energy malnutrition. Socially disadvantage increases the risk of poor illness outcome (death).

Primary Hypertension with Target Organ Damage among Apparently Healthy Secondary School Students in Osogbo, South-Western Nigeria.

INTRODUCTION: In recent times, there has been an increase in the frequency of hypertension among young people which is contributing globally to the increase in cardiovascular morbidity and mortality in adults. OBJECTIVE: The aim of this study was therefore to determine the prevalence of primary hypertension and its risk factors among apparently healthy secondary school students in Osogbo, southwestern Nigeria. METHODS: A school-based cross-sectional study of a total of 404 secondary school students in Osogbo city. Following informed parental consents of all the students involved in the study, blood pressure (BP) measurements were taken at 2 different visits by auscultation after a negative urine dip stick test result (thus excluding haematuria or proteinuria) in every subject before each BP was measured. RESULTS: The overall prevalence of hypertension and prehypertension in this study was 3.5% (n = 14) and 6.2% (n = 25), respectively. Obesity, consumption of extra - uncooked salt, high parental education and attendance of privately-owned secondary schools were identified risk factors associated with elevated BP. Seven (29%) of 24 subjects with hypertension had features of left ventricular hypertrophy (an evidence of target organ damage) on echocardiography and electrocardiography. All subjects with elevated BP had normal renal scan. CONCLUSION: Hypertension with features of target organ damage exists among adolescents. No known primary aetiologies were found among the hypertensive adolescents in the study and thus they were all deemed to have essential hypertension.

INTRODUCTION: Ces derniers temps, on a constaté une augmentation de la fréquence de l'hypertension chez les jeunes, ce qui contribue globalement à l'augmentation de la morbidité et de la mortalité cardiovasculaires chez les adultes. OBJECTIF: Le but de cette étude était donc de déterminer la prévalence de l'hypertension primaire et de ses facteurs de risque parmi des élèves du secondaire apparemment en bonne santé à Osogbo, sud-ouest du Nigeria. MÉTHODES: Étude transversale en milieu scolaire portant sur un total de 404 élèves du secondaire dans la ville d'Osogbo. Après avoir obtenu le parents informés de tous les élèves participant à l'étude, des mesures de l'étude, la pression artérielle a été mesurée par auscultation lors de 2 visites après un résultat négatif à la bandelette urinaire (excluant ainsi l'hématurie ou la protéinurie) chez chaque sujet avant que la TA ne soit mesurée. RÉSULTATS: La prévalence globale de l'hypertension et de la préhypertension dans cette étude était de 3,5% (n = 14) et de 6,2% (n = 25), respectivement. L'obésité, la consommation de sel extra-cuit, le haut niveau d'éducation des parents et la fréquentation d'écoles secondaires privées ont été identifiés comme des facteurs de risque associés à une tension artérielle élevée. Sept (29%) des 24 sujets hypertendus présentaient des caractéristiques d'hypertrophie du ventriculaire gauche (preuve d'une atteinte des organes cibles) à l'échocardiographie et à l'électrocardiographie. Tous les sujets présentant une PA élevée avaient une scintigraphie rénale normale. CONCLUSION: L'hypertension avec des caractéristiques d'atteinte des organes cibles existe chez les adolescents. Aucune étiologie primaire connue n'a été trouvée chez les adolescents hypertendus de l'étude et donc tous considérés comme souffrant d'hypertension essentielle. Mots clés: Hypertension primaire, dommages aux organes cibles, adolescents sains.

Malaria Parasitaemia and its Associated Factors among Febrile Children in a Tertiary Hospital in Southwest Nigeria.

BACKGROUND: Malaria is a parasitic disease of public health concern especially among children because of their vulnerability. Objective: The study sought to evaluate the prevalence and severity of malaria and to assess the factors associated with malaria parasitaemia among children. METHODS: This was a hospital-based cross-sectional observation study. We enrolled 303 children aged 6 to 59 months who presented with fever. A structured questionnaire was used to obtain the demographic characteristics, determinant factors and the use of malaria preventive measures. Microscopic examination of blood film for malaria parasite was done. Data were analysed using SPSS version 23.0. The Pearson's Chi-square was used to determine the association between selected socio-demographic variables, clinical characteristics of participants and presence of malaria parasitaemia. A p-value less than 0.05 was considered significant. RESULTS: The mean ± SD age was 24.36 ± 16.63 months, 183 (60.4%) were male. Two hundred and thirteen (70.3%) participants tested positive for Plasmodium falciparum. Severe malaria accounted for 21.1% of all malaria cases. Severe anaemia (37.8%) and cerebral malaria (24.4%) were the common complications observed. Malaria was significantly associated with increasing age (p = 0.007). Children who slept regularly under LLIN and those using insecticidal spray were more likely to be protected from developing malaria (p = 0.002, p = 0.001, respectively). The socioeconomic status, maternal education, family size and knowledge of LLIN were not associated with the development of malaria (p= 0.901, 0.136, 0.413, 0.166, respectively). CONCLUSION: The prevalence of malaria is high; there is a need to increase the coverage of IRS, together with LLINs to reduce the transmission and burden of malaria, particularly among the susceptible population.

CONTEXTE: Le paludisme est une maladie parasitaire de la santé publique inquiètent particulièrement les enfants en raison de leur vulnérabilité. OBJECTIF: L'étude visait à évaluer la prévalence et la gravité du paludisme et d'évaluer les facteurs associés à la parasitémie palustre chez les enfants. MÉTHODES: Il s'agissait d'une observation transversale en milieu hospitalier. Nous avons inscrit 303 enfants âgés de 6 à 59 mois qui ont présenté avec de la fièvre. Un questionnaire structuré a été utilisé pour obtenir les caractéristiques démographiques, les facteurs déterminants et l'utilisation du mesures préventives contre le paludisme. Un examen microscopique du film sanguin pour le parasite du paludisme a été fait. Les données ont été analysées à l'aide de la version 23.0 du SPSS. Le Chi-carré de Pearson a été utilisé pour déterminer l'association entre certaines variables sociodémographiques, caractéristiques cliniques des participants et présence de parasitémie palustre. Une valeur de p en moins que 0,05 a été jugé significatif. RÉSULTATS: La moyenne ±'âge du DT était de 24,36 ± 16,63 mois, 183(60,4 %) étaient des hommes. Deux cent treize (70,3 %) participants testé positif pour Plasmodium falciparum. Paludisme sévère comptabilisé pour 21,1 % de tous les cas de paludisme. Anémie sévère (37,8 %) et le paludisme cérébrale, (24,4 %) étaient les complications courantes observées. Paludisme était significativement associé à l'augmentation de l'âge (p = 0,007). Enfants qui dormaient régulièrement sous LLIN et ceux qui utilisaient un spray insecticide étaient plus susceptibles d'être protégés contre le développement du paludisme (p = 0,002,p = 0,001, respectivement). Le statut socio économique, l'éducation maternelle, la taille de la famille et la connaissance de LLIN n'étaient pas associées avec le développement du paludisme (p= 0,901, 0,136, 0,413, 0,166,respectivement). CONCLUSION: La prévalence du paludisme est élevée; il y a un besoin pour augmenter la couverture de l'IRS, ainsi que les LLIAN pour réduire le transmission et charge du paludisme, en particulier parmi les personnes population sensibles. Mots-clés: Paludisme, Plasmodium falciparum, enfants de moins de cinq ans.

Hypertension and its Clinical Correlates in a Rural Community in South Western Nigeria.

BACKGROUND: Hypertension is the commonest cardiovascular risk factor globally and is a cause of untold morbidity and mortality. However, its clinical correlates at the community level have not been well elucidated. METHODS: History taking, anthropometric measurements, electrocardiograms and laboratory investigations were done for all the study subjects. Ethical approval was obtained from the institution's ethical body. Analysis was done using SPSS version 20. Two hundred people were recruited for the study. The prevalence of hypertension in the community was 58.5% with 31(15.5%) being newly diagnosed. The Body Mass Index [BMI] (28.2±6vs 25.6±5.3; P=0.003),Waist-Hip ratio (0.9±0.08 vs 0.86±0.06; p= 0.001), total cholesterol (5.675±1.8 vs 4.6±1.7, P=0.000), triglycerides (1.19±0.85 vs 0.91±0.59; p=0.019), LDL cholesterol (3.38±1.6 vs 2.66±1.5; p=0.002), heart rate (82.4±15.8 vs 76.8±11.2; p=0.018) QRS duration (84.8±13.4 vs 80.5±11.2; p=0.040), and QTc (0.423±0.041 vs 0.402±0.035; p=0.001) were higher in those with hypertension. NYHA functional class was worse in hypertensives (p=0.041). Prevalence of left ventricular hypertrophy (LVH) in hypertensives ranged from 2.6 to 48.2%, depending on the criteria used. Systolic blood pressure, pulse pressures, HDL levels and hip circumferences were higher in those with electrocardiographic LVH. Systolic blood pressure (OR:1.045, P=0.006; CI: 1.013-1.079) and a normal BMI (OR: 0.159, p= 0.004; CI: 0.045-0.559) were the independent predictors of LVH in this study. CONCLUSION: The prevalence of hypertension is rising, even in rural populations, with accompanying LVH, higher QTc and florid cardiovascular risk factors. It is therefore imperative to tighten the reins of control of blood pressure and other cardiovascular risk factors before the cardiovascular morbidity and mortality explode in the rural communities.

CONTEXTE: L'hypertension est le facteur de risque cardiovasculaire le plus courant dans le monde et est une cause de morbidité et de mortalité indicibles. Cependant, ses corrélats cliniques au niveau communautaire n'ont pas été bien élucidés. MÉTHODES: Des antécédents, des mesures anthropométriques, des électrocardiogrammes et des examens de laboratoire ont été effectués pour tous les sujets de l'étude. L'approbation éthique a été obtenue de l'organe déontologique de l'institution. L'analyse a été effectuée à l'aide de la version 20 de SPSS. Deux cents personnes ont été recrutées pour l'étude. La prévalence de l'hypertension dans la communauté était de 58,5%, 31 (15,5%) nouvellement diagnostiqués. L'indice de masse corporelle [IMC] (28,2 ± 6 vs 25,6 ± 5,3; P = 0,003), le rapport taille-hanches (0,9 ± 0,08 vs 0,86 ± 0,06; p = 0,001), le cholestérol total (5,675 ± 1,8 vs 4,6 ± 1,7, P = 0,000), triglycérides (1,19 ± 0,85 vs 0,91 ± 0,59; p = 0,019), cholestérol LDL (3,38 ± 1,6 vs 2,66 ± 1,5; p = 0,002), fréquence cardiaque (82,4 ± 15,8 vs 76,8 ± 11,2; p = 0,018) Durée du QRS (84,8 ± 13,4 vs 80,5 ± 11,2; p = 0,040) et l'intervalle QTc (0,423 ± 0,041 vs 0,402 ± 0,035; p = 0,001) étaient plus élevés chez les personnes souffrant d'hypertension. La classe fonctionnelle NYHA était pire chez les hypertendus (p = 0,041). La prévalence de l'hypertrophie ventriculaire gauche (LVH) chez les hypertendus variait de 2,6 à 48,2%, selon la critères utilisés. La pression artérielle systolique, les pressions de pouls, les taux de HDL et la circonférence de la hanche étaient plus élevés chez les personnes atteintes de LVH électrocardiographique. La pression artérielle systolique (OR: 1,045, P = 0,006; IC: 1,013­1,079) et un IMC normal (OR: 0,159, p = 0,004; IC: 0,045­0,559) étaient les prédicteurs indépendants de l'HGV dans cette étude. CONCLUSION: La prévalence de l'hypertension est en hausse, même dans les populations rurales, accompagnée de LVH, d'un QTc plus élevé et de facteurs de risque cardiovasculaires florissants. Il est donc impératif de resserrer les rênes du contrôle de la pression artérielle et des autres facteurs de risque cardiovasculaire avant que la morbidité et la mortalité cardiovasculaires n'explosent dans les communautés rurales. Mots clés: Hypertension, hypertrophie ventriculaire gauche, indice de masse corporelle, HDL.

Determinants of Outcome among Under-Five Children Hospitalized with Pneumonia at a Tertiary Health Facility in South-West Nigeria.

BACKGROUND: Pneumonia contributes largely to mortality among children particularly in developing countries. In 2018, about 15% of all deaths in children aged less than 5 years were attributed to pneumonia globally. This study aimed to identify factors at presentation that determine mortality among children less than 5 years of age hospitalized with pneumonia. METHODS: This was a prospective observational study conducted at the Children emergency unit of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria. Subjects were consecutive children aged between 1-60 months with clinical and radiological pneumonia. Treatment outcome and determinants of mortality were studied. RESULTS: A total of 129 subjects were studied with a male to female ratio of 1.5: 1. Thirteen subjects died, giving a case fatality rate of 10.1%. Mortality was associated with age <24 months (p= 0.001), severe wasting (p< 0.001), temperature >38.30C (p= 0.001), grunting (p< 0.001), central cyanosis (p < 0.001), hypoxaemia (p < 0.001), loss of consciousness (p = 0.007), severe anaemia (p < 0.001), and leucopaenia (p = 0.001). Among the significant variables, temperature >38.30C [adjusted odds ratio (OR) 34.241, 95% confidence interval (CI) 2.496 - 469.815], grunting (OR 19.444, 95% CI 1.744 - 216.725), central cyanosis (OR 43.984, 95% CI 2.001- 966.729), hypoxaemia (OR 41.883, 95% CI 1.918 - 914.495) and severe anaemia (OR 48.201, 95% CI 3.351 - 693.432) were the independent determinants of mortality. CONCLUSION: Children hospitalized for pneumonia with temperature >38.30C, grunting, cyanosis, hypoxaemia, and severe anaemia are more likely to die. Hence, they must be treated intensively.

Risk of Obstructive Sleep Apnoea among Adults in a Rural Community in Southwest Nigeria.

BACKGROUND: Obstructive sleep apnoea (OSA) is a common medical condition which has long been recognized as a major contributor to morbidity and mortality in developed countries but that remains underdiagnosed, particularly in rural communities. This study aimed to assess the prevalence of adults who have a high risk of obstructive sleep apnoea in a sample of adults living in Ejigbo, a rural community in south western Nigeria. METHODS: This was a community-based cross-sectional descriptive study done to assess the prevalence of high risk of obstructive sleep apnoea in adult residents of the community using the STOP-BANG questionnaire. Data collected include socio-demographic characteristics, anthropometric measurements and blood pressure. A blood sample was also taken for lipid profile. Factors associated with a high risk of obstructive sleep apnoea were identified. RESULTS: The study involved 257 participants out of which 88 (34.2%) had a high risk of OSA. Risk of obstructive sleep apnoea was significantly associated with male sex (p<0.001), age (p<0.001), body mass index (BMI) (p=0.001), neck circumference (p<0.001), cigarette smoking (p=0.039) and low density lipoprotein (p=0.043). CONCLUSION: Obstructive sleep apnoea is relatively common in the study area. This calls for urgent preventive measures to stem the tide and mitigate the associated morbidity and mortality.

Atopy in HIV-infected children attending the pediatric antiretroviral clinic of LAUTECH Teaching Hospital, Osogbo.

BACKGROUND: Atopy is poorly researched in HIV children living in the developing countries. There is no previous report on this subject in Nigeria and this pioneering study is undertaken to create an awareness of the burden of this disease among health practitioners. AIMS: The aim of this study was to document the atopic diseases present among HIV-infected children attending the antiretroviral (ARV) clinic of a Nigerian tertiary hospital. METHODS: Information was obtained from consecutive consenting caregiver/HIV-infected child attending the pediatric ARV clinic, by the use of a proforma specifically designed for the study. The data obtained were analyzed using Statistical Package for the Social Sciences (SPSS) software program, version 16.0. RESULTS: Seventy patients were studied and their ages ranged between 2 and 17 years. These 70 were constituted by 34 (48.6%) boys and 36 (51.4%) girls. Ten (14.3%) of the 70 studied, had atopic diseases. Nine (12.9%) patients had allergic conjunctivitis and 1 (1.4%) had allergic rhinitis. The single patient with allergic rhinitis also had bronchial asthma. No case of atopic eczema, or food allergy was recorded. Atopic disease conditions were more commonly recorded among the male sex and those whose parents have atopic diseases (P < 0.05). Atopic diseases were also more common among children without advanced HIV diseases and those with eosinophilia. Cosmetic and psychological embarrassment from eye discoloration and itching were the negative impacts on the quality of living. CONCLUSION: Allergic conjunctivitis is common in HIV-infected Nigerian children. Atopies are more common in boys and children with parental atopies.

Complications of pneumonia and its associated factors in a pediatric population in Osogbo, Nigeria

Introduction: Pneumonia is one of the leading causes of morbidity and mortality in underfive children. Nigeria still has a high burden of child death due to pneumonia. Many of these deaths result from the development of complications. This study was done to determine the pattern of pneumonia complications and its associated factors amongst underfive children with pneumonia.Methods: It was a hospital-based cross-sectional observational study involving 129 children aged 1 - 60 months with a diagnosis of pneumonia. The participants were recruited over a nine-month period. Clinical signs were recorded, and a confirmatory chest radiograph was obtained within 24 hours of admission.Result: Of the129 subjects studied, 70 (54.3%) had complications. Children less than 24 months had a higher frequency of complications at presentation. Heart failure and anemia occurred more commonly. Other complications were pleural effusion, empyema, pneumatocele and pneumothorax. More than half (57.1%) of those with complication were hypoxaemic at presentation. Complicated pneumonia was significantly associated with prolonged hospital stay and risk of mortality.Conclusion: Complication is common among children hospitalized for pneumonia in Osogbo. Heart failure was the most common complication. Presence of pneumonia complications and hypoxaemia are important contributors to mortality in this environment

Indirect treatment comparison of belatacept versus tacrolimus from a systematic review of immunosuppressive therapies for kidney transplant patients.

OBJECTIVE: End-stage renal disease is the final and irreversible stage in chronic kidney disease, leading to patient mortality, unless managed by dialysis or transplantation (the treatment of choice). This study aimed to compare a currently recommended immunosuppressive treatment, tacrolimus, against a newer treatment, belatacept, using indirect treatment comparison (ITC) techniques since no head-to-head randomized controlled trials (RCTs) comparing tacrolimus against belatacept currently exist. METHODS: ITC was employed to calculate estimates for the relative risks and mean difference of tacrolimus against belatacept. The choice of the Bucher ITC model was driven by the available data and the simple indirect treatment comparison involving three treatments was considered appropriate. RESULTS: The results of the indirect analysis showed no significant differences between belatacept and tacrolimus treatments for mortality and graft loss. The acute rejection rate was significantly lower with tacrolimus (Prograf* and Advagraf (*) ) compared with belatacept (0.22 [0.13, 0.39] to 0.44 [0.20, 0.99]). CONCLUSIONS: The results of this systematic review and meta-analysis suggests that tacrolimus is significantly superior to belatacept in terms of acute rejection outcomes but comparable for graft and patient survival. Further research should include a properly designed clinical trial comparing tacrolimus against belatacept directly. LIMITATIONS: These include variations in terms of clinical and design differences among the trials, weaknesses in the Bucher method and the lack of long-term clinical trial data with tacrolimus to compare with the recent long-term (7 years) belatacept trial data.