Impact of Seasonal Changes on Asthma Control in North-Western Nigeria.

BACKGROUND: Asthma control is poor worldwide and is often affected by changes in environmental conditions. Effort to determine the cause of this heavy burden on patients and the healthcare system is crucial. AIM: To determine the role of seasonal changes on asthma control in Sokoto, North-Western Nigeria. METHODS: One hundred and one (101) patients with physician diagnosed asthma were consecutively recruited after obtaining informed consent. A structured researcher administered questionnaire was used as instrument of data collection and asthma control test questionnaire was also used to assess level of asthma control in each participant. Five items with a 4-week recall were assessed. Data for temperature, humidity, wind and rain was obtained from the Nigerian Meteorological Agency (NIMET), Sokoto. We computed frequency and level of asthma control with seasons of the year and weather variables. RESULTS: One hundred and one patients comprising 71 females and 30 males with a mean age of 32.14 ± 10.68 years participated in the study. Level of asthma control was found to be poor among the participants with 41(40.6%) having very poorly controlled asthma, 30(29.7%) with not well controlled and 30(24.8%) well controlled asthma respectively. Among patients with very poorly controlled asthma, 22(48.9%) occurred during harmattan season and 14(31.1%) during rainy season. Weather parameters such as humidity shows significant relationship with asthma control (B= -0.504, P= 0.031, 95% CI [-0.012, -0.0253]). CONCLUSION: The study shows that asthma control is poor among the participants and presentation with poor asthma control is more during harmattan season.

CONTEXTE: Le contrôle de l'asthme est médiocre dans le monde entier et est souvent affecté par les changements des conditions environnementales. L'effort pour déterminer la cause de ce lourd fardeau pour les patients et le système de santé est crucial. OBJECTIF: Déterminer le rôle des changements saisonniers sur le contrôle de l'asthme à Sokoto, dans le nord-ouest du Nigeria. MÉTHODES: Cent un (101) patients atteints d'asthme diagnostiqué par un médecin ont été recrutés de manière consécutive après avoir obtenu leur consentement éclairé. Un questionnaire structuré administré par le chercheur a été utilisé comme instrument de collecte de données et le questionnaire de test de contrôle de l'asthme a également été utilisé pour évaluer le niveau de contrôle de l'asthme chez chaque participant. Cinq éléments avec une période de rappel de 4 semaines ont été évalués. Les données sur la température, l'humidité, le vent et la pluie ont été obtenues auprès de l'Agence météorologique nigériane (NIMET) de Sokoto. Nous avons calculé la fréquence et le niveau de contrôle de l'asthme en fonction des saisons de l'année et des variables météorologiques. RÉSULTATS: Cent un patients, comprenant 71 femmes et 30 hommes, avec un âge moyen de 32,14 ± 10,68 ans, ont participé à l'étude. Le niveau de contrôle de l'asthme s'est avéré médiocre parmi les participants, avec 41 (40,6 %) ayant un asthme très mal contrôlé, 30 (29,7 %) un asthme non bien contrôlé et 30 (24,8 %) un asthme bien contrôlé, respectivement. Parmi les patients souffrant d'asthme très mal contrôlé, 22 (48,9 %) ont été signalés pendant la saison de l'harmattan et 14 (31,1 %) pendant la saison des pluies. Les paramètres météorologiques tels que l'humidité montrent une relation significative avec le contrôle de l'asthme (B= -0,504, P=0,031, IC à 95 % [-0,012, -0,0253]). CONCLUSION: L'étude montre que le contrôle de l'asthme est médiocre parmi les participants et que les cas d'asthme mal contrôlé sont plus fréquents pendant la saison de l'harmattan. MOTS-CLÉS: Asthme, Contrôle de l'asthme, Saison, Harmattan.

Assessment of respiratory symptoms and lung function among textile workers at Kano Textile Mills, Kano, Nigeria.

BACKGROUND: The number of textile industries in Nigeria with large work force is on the rise. There is thus the need to assess medical challenges of its workers, one of which is respiratory ailments. Although much has been written about the subject globally, only few studies have been done in Nigeria. This study aims to address this gap. OBJECTIVE: A cross-sectional study was undertaken to determine the prevalence of respiratory symptoms and pulmonary functions among Textile Workers in Kano, Nigeria. MATERIALS AND METHODS: A cross sectional study was done, Two hundred male workers exposed to raw cotton dust and its end products in a Textile Company and 200 unexposed workers with similar age- and gender-matched were investigated. Their forced vital capacity (FVC), forced expiratory volume in one second (FEV11), and peak expiratory flow rate (PEFR) were determined with a flow-sensing spirometer and Wright's peak flow meter. RESULTS: Exposed workers generally complained of cough, phlegm production, rhinitis, wheezing, chest pain, and breathlessness. Unexposed worker has a significant lower frequency (P < 0.001) of symptoms as well as higher (P < 0.001) forced vital capacity (FVC), forced expiratory volume in one second (FEV11), and peak expiratory flow rate (PEFR) than exposed workers. The reduction in ventilatory function of exposed from predicted values for Nigerian men was significantly higher (P < 0.001) than unexposed workers. The smokers among the exposed and unexposed workers had significantly lower lung function values than nonsmokers. CONCLUSION: Respiratory symptoms were more prevalent among workers in most dusty sections of the factory. Use of protective mask should be enforced. Workers in the spinning and weaving sections of the company compared with workers in other sections had the lowest lung function indices.

Effectiveness and safety of adjustable maintenance dosing with budesonide/formoterol turbuhaler compared with traditional fixed doses in bronchial asthma: a multi-centre Nigerian study.

The modern treatment guideline of bronchial asthma recognize that combination of long acting beta2-agonists and inhaled glucocorticoids, enables better control of inflammation and symptoms of asthma than inhaled glucocorticoids only. These guidelines recommended that patients are educated to adjust their medication to their asthma severity using physician-guided self-management plans. However, many patients take a fixed dose of their controller medication and adjust their reliever medication to asthma symptoms Therefore, combination of formoterol and budesonide can be delivered at different dosing level without the need to change inhalers. This study examined whether asthma control improved if patients adjusted the maintenance doses(AMD) ofbudesonide/formoterol (Symbicort, 80/ 4.5 microg and 160/4.5 microg) according to asthma severity compared with traditional fixed dosing (FD) regimens. This was a prospective open randomized trial carried out in five teaching hospitals across Nigeria between 15th July 2002 and 15th July 2003. Patients with bronchial asthma who met the enrollment criteria were randomized to receive either adjustable dosing or fixed dosing for a period of twelve weeks. The results obtained at the start and the end of the study showed that budesonide/formoterol combination effectively achieved and maintained control of asthma. The adjustable dosing achieves more effective control compared to fixed dosing in terms of the number of patients that are redistributed to less severe forms of persistent asthma. The percentage of patients with intermittent asthma increased from 9.3% at randomization to 55.6% at the end of therapy with more patients at the AMD arm of treatment. Also for mild persistent asthma there was an increase from 20.4% to 24.1%. This showed that at the end of treatment, majority (79.7%) of the patients had intermittent and mild persistent asthma. The frequency of use of budesonide/formoterol in the two arms of treatment showed that patients in the adjustable groups used less number of inhalations of budesonide/formoterol for treatment on average of 2.5 inhalations per day compared to those on fixed dosing who used 4 inhalations per day (p = 0.0001). The number of times patients stayed awake because of asthma was noticed to be more reduced at the adjustable arm of treatment but this was of no statistical significance. It is therefore concluded, that budesonide/formoterol combination in a single inhaler is a simple, well tolerated, convenient treatment which provides effective control of bronchial asthma using a practical self-management plan consistent with current guidelines.

Abdominal tuberculosis in surgical practice in northern Nigeria.

BACKGROUND: Abdominal tuberculosis is a common complication of pulmonary tuberculosis. With the rising incidence of HIV, tuberculosis has become a major public health problem particularly in developing countries. METHODS: This is a retrospective study involving patients whose surgical specimens were processed at the central histopathology laboratory of the Ahmadu Bello University Teaching Hospital (ABUTH) Zaria--Nigeria, between January 1975 to December 2006. RESULTS: There were 68 males and 49 females, aged 12-70 years (mean 28.6 yrs 11 yrs). While paroxysmal dry cough was present in about 20 patients, abdominal pain and distension were very common. Concomitant pulmonary tuberculosis was confirmed in 15 patients (14%). The findings at Surgery in 66 patients are presented in fig. 2. Multiple deposits on the peritoneum and omentum were the commonest findings (48.7% and 26.2%) respectively CONCLUSION: Abdominal tuberculosis is not uncommon and there is need to establish an early less invasive diagnostic protocol.

Abdominal Tuberculosis in Surgical Practice in Northern Nigeria

Background: Abdominal tuberculosis is a common complication of pulmonary tuberculosis. With the rising incidence of HIV; tuberculosis has become a major public health problem particularly in developing countries. Methods: This is a retrospective study involving patients whose surgical specimens were processed at the central histopathology laboratory of the Ahmadu Bello University Teaching Hospital (ABUTH) Zaria - Nigeria; between January1975 to December 2006. Results: There were 68 males and 49 females; aged 12-70 years (mean 28.6yrs 11yrs). While paroxysmal dry cough was present in about 20 patients; abdominal pain and distension were very common. Concomitant pulmonary tuberculosis was confirmed in 15 patients (14). The findings at Surgery in 66 patients are presented in fig.2. Multiple deposits on the peritoneum and momentum were the commonest findings (48.7and 26.2) respectively. Conclusion: Abdominal tuberculosis is not uncommon and there is need to establish an early less invasive diagnostic protocol

Comparison of the efficacy and safety of budesonide turbuhaler administered once daily with twice the dose of beclomethasone dipropionate using pressurised metered dose inhaler in patients with mild to moderate asthma.

BACKGROUND: Current treatment guidelines have clearly defined the central place and benefits of inhaled glucocorticoids in the management of bronchial asthma. However, compliance with therapy is often poor due to complexity of treatment regimens. Therefore, a single once daily regimen with a simple device, the turbuhaler might be expected to result in improved compliance and better efficiency. STUDY DESIGN: This was a prospective open randomized trial with parallel groups conducted in five tertiary medical institutions. Asthmatic patients who met the enrolment criteria were randomized to receive either budesonide 400 microg daily or beclomethasone dipropionate 400 microg twice daily for eight weeks. RESULT: At the end of the study, both drugs were found to be effective in reducing the symptoms of asthma, reduction of beta2 agonist usage and improvement in lung function tests. However Budesonide Turbuhaler provided better effects in all parameters (p < 0.05). Both drugs were well tolerated. CONCLUSION: It is therefore concluded that Budesonide Turbuhaler administered once daily at a dose of 400 microg is more efficacious than Beclomethasone dipropionate 400 microg twice daily administered via pressurized metered dose inhaler.

Cardiovascular involvement in HIV/AIDS: report of 3 cases.

Three cases of dilated cardiomyopathy in patients with IIIV/AIDS are being reported. The three patients are of young age group and they presented with cardiac symptoms for the first time. They were all heterosexuals and not known was as intravenous drug abuser. There was no history of rheumatic fever or hypertension or diabetes mellitus and ischaemic heart disease. Examination confirmed cardiac failure and investigations including chest x-ray, echocardiograph and electrocardiograph confirmed dilated heart. All the patients tested positive to HIV-1 antibodies. They were managed with the usual anticardiac failure regimen. Two of the patients died on admission, one developed multi organ failure and the other had tonic-clonic seizure. In other parts of Africa reports have also emerged describing the cardiovascular involvement in HIV/AIDS.

Efficacy and safety of Zafirlukast ('Accolate') in the management of patients with mild-to-moderate asthma.

The efficacy and safety of the oral leukotriene receptor antagonist Zafirlukast ('Accolate') was assessed as maintenance therapy for black (Nigerian) patients with mild to moderate asthma. A total of eighty-one patients aged 16-70 years were screened and sixty patients were enrolled in a 7-week multicenter open study to receive 20 mg of 'Accolate' twice daily. Those enrolled had FEV1 > or = 60%, reversibility > or = 15% and cumulative daytime asthma symptoms score > or = 10 over seven consecutive days before visit 2 to be considered eligible to receive trial therapy, and the patients were maintained on as required beta 2-agonist therapy. Efficacy was assessed by changes in symptoms, number of times beta 2-agonist was used and results of pulmonary function tests. Safety was assessed by adverse event experiences, results of laboratory tests and physical examination. At the endpoint, patients reported a statistically significant increase in lung function and a significant reduction in episodes of asthma symptoms either in the morning, day or night. The mean beta 2-agonist use was also statistically reduced over the weeks as treatment progressed while the cumulative daytime total asthma score showed a sharp decline following drug use. Change in symptoms, beta 2-agonist use and pulmonary function occurred within one week of Zafirlukast treatment and continued throughout the trial. Zafirlukast was well tolerated. Headaches and pneumonia were the only side effects in three patients and these were not considered to be related to trial therapy. No clinically significant changes were observed in laboratory test results, or on physical examination. We conclude that Zafirlukast ('Accolate') 20 mg b.d. is an effective and well tolerated medication for maintenance therapy in black (Nigerian) patients with mild-to-moderate asthma.

Ventricular tachycardia in a patient with lymphocytic (non Hodgkin's) lymphoma.

A 19 year old student was admitted with generalised lymphadenopathy, paraplegia, double incontinence and weight loss in our hospital (Abuth Zaria). A histological diagnosis of lymphocytic (non-Hodgkin's) lymphoma was made on lymph node biopsy. Before treatment could be started the patient developed increasing difficulty in breathing. He was transferred to our ICU where he was noted to have developed no sustained VT. Subsequent repeated episodes did not respond to resuscitative measures (i.v. lignocaine 100 mg for five minutes, oxygen and assisted respiration). The patient died.

Felty's syndrome in a Nigerian.

The first case of Felty's syndrome to be reported in a Nigerian, a fifty five-year-old woman who developed splenomegaly and leukopenia during the course of strongly seropositive rheumatoid arthritis of ten years duration is presented. her arthritis had lasted for about ten years, but she did not have the severe deforming disease known to be associated with Felty's syndrome. Radiologically there were no erosions and subcutaneous nodules were absent. She had a positive granulocyte specific anti-nuclear factor, cryoglobulins containing IgA and IgM and her polymorph-nuclear granulocytes showed evidence of impaired killing of staphylococci.

Alpha-1-antitrypsin, immunoglobulins and radiological type in Nigerians with pulmonary tuberculosis.

Tuberculin skin test tended to be more intensely reactive in the caseonodular and other groups than the military group. Serum IgA, IgG and IgM and alpha-I-antitrypsin levels were higher in Northern Nigerians with pulmonary tuberculosis than in controls. IgA and IgG levels were higher in miliary tuberculosis than caseonodular and cavitating tuberculosis. The cavitatory lesions in tuberculosis may not result from autodigestion by inflammatory proteases since alpha-I-antitrypsin-the major inhibitor of proteases was not deficient in cavitatory tuberculosis. While an unqualified immunological spectrum of tuberculous disease in our patients has not clearly been demonstrated due to limited facilities, our results show a tendency to this spectrum.