Prevalence and Aetiology of Visual Impairment and Blindness in Persons with HIV/AIDS on Highly Active Anti-Retroviral Therapy in Benin City, Nigeria.

BACKGROUND: The use of Highly Active Anti-Retroviral Therapy (HAART) has revolutionized the course and pattern of eye diseases in persons with HIV/AIDS which ultimately affects the visual status. OBJECTIVE: To determine the prevalence and etiology of visual impairment and blindness in people with HIV/AIDS on HAART in Benin City, Nigeria. METHODOLOGY: This was a descriptive hospital-based study on all HIV/AIDS patients on HAART in the United States President's Emergency Plan for AIDS Relief (PEPFAR) clinics of University of Benin Teaching Hospital seen from July to August 2018 and Central Hospital, Benin City in October 2019. Demographic data and other relevant questions related to the disease were obtained from participants and recorded in an interviewer administered questionnaire. Participants were examined and ocular findings recorded. The IBM SPSS software version 21 was used for data analysis and level of significance set at p<0.05. RESULTS: There were 451 persons comprising 104 (23.1%) males and 347 (76.9%) females. More participants, 176(39%) were within the age group 41-50 years, with a mean age of 46.6± 10.78 years, and age range of 14-75 years. Visual impairment was present in 105 (23.3%), blindness in 10 (2.2%) and 336(74.5%) had normal visual acuity. Refractive error was the most common cause of mild 34 (29.6%) and moderate 23(20%) visual impairment. Cataract 4(3.5%) was the predominant cause of blindness. There was no case of severe visual impairment recorded. CONCLUSION: The major causes of visual impairment and blindness in persons with HIV are not HIV-related diseases which may be an indication of improved management protocols.

CONTEXTE: L'utilisation de la thérapie antirétrovirale hautement active (HAART) a révolutionné le cours et le modèle des maladies oculaires chez les personnes atteintes du VIH/SIDA, ce qui affecte finalement l'état visuel. OBJECTIF: Déterminer la prévalence et l'étiologie de la déficience visuelle et de la cécité chez les personnes atteintes du VIH/SIDA sous HAART à Benin City, au Nigeria. MÉTHODOLOGIE: Il s'agissait d'une étude descriptive en milieu hospitalier sur tous les patients atteints du VIH/sida sous HAART dans les cliniques du Plan d'urgence du président des États-Unis pour la lutte contre le sida (PEPFAR) de l'hôpital universitaire de Benin vu de juillet à août 2018 et de l'hôpital central de Benin City en octobre 2019. Les données démographiques et d'autres questions pertinentes liées à la maladie ont été obtenues des participants et enregistrées dans un questionnaire administré par un enquêteur. Les participants ont été examinés et les résultats oculaires enregistrés. Le logiciel IBM SPSS version 21 a été utilisé pour l'analyse des données et le niveau de signification fixé à p<0,05. RÉSULTATS: 451 personnes ont été recensées, dont 104 (23,1%) hommes et 347 (76,9%) femmes. La plupart des participants, 176 (39%) étaient dans la tranche d'âge 41-50 ans, avec un âge moyen de 46,6± 10,78 ans, et une fourchette d'âge de 14-75 ans. La déficience visuelle était présente chez 105 (23,3%), la cécité chez 10 (2,2%) et 336 (74,5%) avaient une acuité visuelle normale. L'erreur de réfraction était la cause la plus fréquente de déficience visuelle légère (34, 29,6%) et modérée (23, 20 %). La cataracte, 4 (3,5 %), était la cause prédominante de cécité. Aucun cas de déficience visuelle grave n'a été enregistré. CONCLUSION: Les principales causes de déficience visuelle et de cécité chez les personnes séropositives ne sont pas des maladies liées au VIH, ce qui peut indiquer une amélioration des protocoles de prise en charge. Mots clés: Déficience Visuelle, Cécité, VIH/SIDA, HAART.

First Cases of Sars-cov-2 Reinfection Coinciding with the Covid-19 Second Wave, Benin City, Nigeria.

BACKGROUND: Reinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has important public health implications pertaining to herd immunity and durability of protection from vaccines. A small but growing number of cases have been reported globally but none from Africa. This is due, in part, to adherence to definitions based on genetic sequencing, the capabilities of which are in short supply on the continent. METHODS: Based on epidemiological and clinical parameters, we report the first two cases of SARS-CoV-2 reinfection from a Nigerian tertiary hospital managing coronavirus disease 2019 (COVID-19) patients. RESULT: Two cases of SARS-CoV-2 reinfection were seen in December, 2020 and January, 2021. Both were males associated with a healthcare setting and aged 37 and 38 years respectively. The number of days between the first infection and the second ranged from 160-196 days. Symptoms ranged from mild to moderate and they recovered without sequelae. CONCLUSION: Public health action, including risk communication and reinfection surveillance backed by genomic sequencing, is advocated.

CONTEXTE: La réinfection par le coronavirus 2 du syndrome respiratoire aigu sévère (SRAS-CoV-2) a des implications importantes pour la santé publique en ce qui concerne l'immunité du troupeau et la durabilité de la protection contre les vaccins. Un nombre petit mais croissant de cas a été signalé dans le monde, mais aucun en Afrique. Cela est dû, en partie, au respect des définitions basées sur le séquençage génétique, dont les capacités sont rares sur le continent. MÉTHODES: Sur la base de paramètres épidémiologiques et cliniques, nous rapportons les deux premiers cas de réinfection par le SRAS-CoV-2 d'un hôpital tertiaire nigérian prenant en charge des patients atteints de la maladie à coronavirus 2019 (COVID-19). RÉSULTAT: Deux cas de réinfection par le SRAS-CoV-2 ont été observés en décembre 2020 et janvier 2021. Tous deux étaient des hommes associés à un établissement de soins de santé et âgés respectivement de 37 et 38 ans. Le nombre de jours entre la première infection et la seconde variait de 160 à 196 jours. Les symptômes variaient de légers à modérés et ils se sont rétablis sans séquelles. CONCLUSION: Une action de santé publique, y compris la communication des risques et la surveillance des réinfections appuyées par le séquençage génomique, est préconisée. MOTS CLÉS: COVID-19; SRAS-CoV-2; Réinfection; Nigeria; Pandémie.

Latent Tuberculosis among Human Immunodeficiency Virus (HIV) Positive Patients: Prevalence and Correlates.

BACKGROUND: Tuberculosis is the most common opportunistic infection affecting HIV-infected individuals and it remains the most common cause of death in patients with AIDS. Detection of latent tuberculosis and treatment largely prevents the development of active disease. OBJECTIVE: This study was to determine the prevalence and factors associated with latent TB in HIV-positive patients. METHODOLOGY: This is an analytical cross-sectional study which involved 160 consented patients. Active tuberculosis was excluded using signs, symptoms and laboratory tests. All participants were tested using Quantiferon TB Gold Plus test kits. Data analysed with SPSS version 25.0 included patient's demographics, clinical and laboratory features. P< 0.05 was considered significant. RESULTS: The mean age of HIV-infected patients was 42.69 ± 9.91 years and the mean age of the control was 41.29 ± 9.20 years with no significant statistical difference. The prevalence of latent tuberculosis among HIV-infected patients was found to be 22.50% while among controls was 10.0% which was statistically significant (p-0.001). CD4 cells count was observed to inversely predict latent tuberculosis (OR = 1.41; CI = 1.01-3.73) while viral load was found to directly predict latent tuberculosis (OR = 1.63; CI=1.04-4.25). CONCLUSION: The prevalence of latent tuberculosis infection is significantly higher among HIV-positive patients when compared with HIV-negative patients. Also, the prevalence of HIV infection was higher amongst the female and less educated population.

CONTEXTE: La tuberculose est l'infection opportuniste la plus courante chez les personnes infectées par le VIHet reste la cause la plus fréquente de décès chez les patients atteints du SIDA. La détection de la tuberculose latente et le traitement empêchent largement le développement de la maladie active. OBJECTIF: Cette étude visait à déterminer la prévalence et les facteurs associés à la tuberculose latente chez les personnes séropositives. MÉTHODOLOGIE: Il s'agit d'une étude transversale analytique qui a porté sur 160 patients consentants. La tuberculose active a été exclue à l'aide de signes, de symptômes et de tests de laboratoire. Tous les participants participants ont été testés à l'aide de kits de test Quantiferon TB Gold Plus. de Quantiferon TB Gold Plus. Les données analysées avec SPSS version 25.0 comprenaient les caractéristiques démographiques, cliniques et de laboratoire des patients. P< 0,05 a été a été considéré comme significatif. RÉSULTATS: L'âge moyen des patients infectés par le VIH était de 42,69 ± 9,91 ans et l'âge moyen du groupe témoin était de 41,29 ± 9,20 ans., sans différence statistic significative. La prevalence de tuberculose latente chez les patients infectés par le VIH était de 22,50 % alors qu'elle était de 10,0 % chez les témoins, ce qui était statistiquement significative (p-0,001). On a observé que le nombre de cellules CD4 de prédire de façon inverse la tuberculose latente (OR = 1,41; IC = 1,01- 3,73), tandis que la charge virale prédit directement la tuberculose latente (OR = 1,63 ; IC = 1,04-4,25). CONCLUSION: la prévalence de l'infection tuberculeuse latente est significativement plus élevée chez les patients séropositifs par rapport aux patients séronégatifs. De même, la prévalence de l'infection par le VIH était plus élevée chez les femmes et les personnes peu moins éduquée. Mots clés: Bacilles acido-alcoolo-résistants, indice de masse corporelle, extrapulmonaire, virus de l'immunodéficience humaine, interféron gamma, immunodéficience, tuberculose latente, ZiehlNeelsen.

Clinical Patterns of Vitiligo amongst Patients in Benin City, Nigeria.

BACKGROUND: Vitiligo is a pigmentary disorder of the skin with varied presentation across different populations. It may be associated with autoimmune conditions like type I diabetes mellitus, thyroiditis etc. This study sought to describe the clinical patterns of vitiligo amongst patients in Benin City, Nigeria. MATERIALS AND METHODS: This was a cross sectional study among adults with vitiligo consecutively recruited from the dermatology clinic at University of Benin Teaching Hospital, Benin City. Diagnosis of vitiligo was largely clinical. Data was obtained using a questionnaire and analyzed using SSPS version 21.0. Categorical and discrete variables were analyzed using Chi square, Fisher's Exact, T-Test and ANOVA. p-value of <0.05 was considered significant. RESULTS: A total of 40 patients were recruited for this study with males accounting for 24 (60%) of the study population. The mean age for the study group was 38.43  12.94. Non Segmental Vitiligo was more prevalent 27(67.5%) while vitiligo vulgaris was the most common clinical variant in this study 19(47.5%).Lesions occurred mostly on the exposed parts of the body (87.5%) but the mean VASI score was 4.81. Diabetes mellitus and alopecia areata were observed in 25% of vitiligo patients. Kobnerization was more on the extremities (p 0.034) while leukotrichia was more on the face and the trunk (p 0.046 and 0.005 respectively). CONCLUSION: The pattern of vitiligo differ across diverse populations. The clinical presentation of vitiligo in this study showed some differences from similar studies and therefore suggests for more studies in order to have a consensus on presentation of this disorder.

CONTEXTE: Le vitiligo est un trouble pigmentaire de la peau dont la présentation varie selon les populations. Il peut être associé à des maladies auto-immunes telles que le diabète sucré de type I, la thyroïdite, etc. Cette étude visait à décrire les schémas cliniques du vitiligo chez les patients de Benin City, au Nigeria. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude transversale chez des adultes atteints de vitiligo recrutés consécutivement à la clinique de dermatologie de l'hôpital universitaire de l'Université du Bénin, à Benin City. Le diagnostic de vitiligo était en grande partie clinique. Les données ont été obtenues à l'aide d'un questionnaire et analysées à l'aide de SSPS version 21.0. Les variables catégorielles et discrètes ont été analysées en utilisant le Chi carré, Fisher's Exact, T-Test et ANOVA. Une valeur p de < 0,05 a été considérée comme significative. RÉSULTATS: Au total, 40 patients ont été recrutés pour cette étude, les hommes représentant 24 (60 %) de la population étudiée. L'âge moyen du groupe d'étude était de 38,43 à 12,94 ans. Le vitiligo non segmentaire était plus répandu 27 (67,5 %) tandis que le vitiligo vulgaire était la variante clinique la plus courante dans cette étude 19 (47,5 %). Les lésions se produisaient principalement sur les parties exposées du corps (87,5 %) mais le score VASI moyen était de 4,81 . Un diabète sucré et une alopécie areata ont été observés chez 25% des patients atteints de vitiligo. La kobnérisation était plus sur les extrémités (p 0,034) tandis que la leucotrichie était plus sur le visage et le tronc (p 0,046 et 0,005 respectivement). CONCLUSION: Le schéma du vitiligo diffère selon les diverses populations. La présentation clinique du vitiligo dans cette étude a montré quelques différences par rapport à des études similaires et suggère donc d'autres études afin d'avoir un consensus sur la présentation de ce trouble. MOTS-CLÉS: Vitiligo, Patterns, Variantes, Kobnérisation.

Pattern of Presentation of Patients with Vitiligo in a Tertiary Hospital in Southern Nigeria: A Five Year Retrospective Study.

BACKGROUND: Vitiligo is an acquired progressive melanocytopenia of unknown cause. It manifests clinically as well circumscribed depigmented macules and patches often associated with poliosis. AIM: To determine the pattern of presentation of patients with vitiligo in the University of Benin Teaching Hospital, Benin City, Nigeria. MATERIALS AND METHODS: Records of patients managed for vitiligo over a 5-year period between December 2014- December 2019 were retrieved and the following information extracted: socio-demographic data of patients, duration of symptom, pattern of vitiligo, distribution, and percentage body surface area of affectation. SPSS version 21 was used to tabulate and analyze the data. The continuous data were presented as means and categorical variables were presented as frequencies and percentages. RESULTS: There were 52 patients with vitiligo amongst 1600 new cases seen over the 5year period constituting a prevalence of 3.3%. The male to female ratio was 1:1.1. The Median (IQR) of the age at presentation was 29.5 (14.75-49.50). The mean (SD) duration of symptom at presentation was 18.3±21.5 months. Children constituted 10 (19.2%), adolescents 8(15.4%), adults 31(59.6%) and elderly 3(5.8%). Family history of vitiligo was absent in all patients. The percentage body surface area (BSA) affected was 30% in 19(36.5%) of participants. The most common clinical type of vitiligo in this study was the generalized pattern accounting for 27(51.9%) of cases. Segmental pattern and focal pattern accounted for 13(25.0%) and 12(23.1%) respectively. The face, upper limbs and lower limbs were the most commonly affected anatomical sites found in the study accounting for 19(36.5%), 18(34.6%) and 17 (32.7%) respectively. CONCLUSIONS: Vitiligo is an uncommon skin disease that affects both genders almost equally. Generalized vitiligo remains the commonest form of vitiligo and the face and extremities are the most commonly affected sites. Furthermore, the prevalence of vitiligo has not changed in the last 20 years.

RÉSUMÉ: Le vitiligo est une mélanocytopénie progressive acquise de cause inconnue. Elle se manifeste cliniquement aussi bien par des macules dépigmentées circonscrites que par des plaques souvent associées à la poliose. OBJECTIF : Déterminer le modèle de présentation des patients atteints de vitiligo à l'hôpital universitaire de l'Université du Bénin, à Benin City, au Nigéria. MATÉRIELS ET MÉTHODES: Les dossiers des patients pris en charge pour le vitiligo sur une période de 5 ans entre décembre 2014 et décembre 2019 ont été récupérés et les informations suivantes extraites : données sociodémographiques des patients, durée des symptômes, schéma du vitiligo, distribution et pourcentage corporel surface d'affectation. La version 21 de SPSS a été utilisée pour tabuler et analyser les données. Les données continues ont été présentées sous forme de moyennes et les variables catégorielles ont été présentées sous forme de fréquences et de pourcentages. RÉSULTATS: Il y avait 52 patients atteints de vitiligo parmi 1600 nouveaux cas vus au cours de la période de 5 ans constituant une prévalence de 3,3%. Le ratio hommes/femmes était de 1:1,1. La médiane (IQR) de l'âge à la présentation était de 29,5 (14,75­49,50). La durée moyenne (SD) des symptômes à la présentation était de 18,3 ± 21,5 mois. Les enfants constituaient 10 (19,2 %), les adolescents 8 (15,4 %), les adultes 31 (59,6 %) et les personnes âgées 3 (5,8 %). Les antécédents familiaux de vitiligo étaient absents chez tous les patients. Le pourcentage de surface corporelle (BSA) affectée était de 30 % chez 19 (36,5 %) des participants. Le type clinique de vitiligo le plus courant dans cette étude était le type généralisé représentant 27 (51,9 %) des cas. Le motif segmentaire et le motif focal représentaient respectivement 13 (25,0%) et 12 (23,1%). Le visage, les membres supérieurs et les membres inférieurs étaient les sites anatomiques les plus fréquemment touchés trouvés dans l'étude représentant respectivement 19 (36,5 %), 18 (34,6 %) et 17 (32,7 %). CONCLUSIONS: Le vitiligo est une maladie de peau rare qui affecte presque également les deux sexes. Le vitiligo généralisé reste la forme la plus courante de vitiligo et le visage et les extrémités sont les sites les plus fréquemment touchés. De plus, la prévalence du vitiligo n'a pas changé au cours des 20 dernières années. MOTS-CLÉS: Vitiligo, Motif, Présentation, Nigéria.

Arterial Oxygen Saturation and other Clinical Predictors of Survival in Patients with Covid-19: A Review of Cases in a Tertiary Care Hospital in Nigeria.

BACKGROUND: We assessed clinical parameters in patients confirmed to have COVID-19 in relation to arterial hypoxaemia and survival. METHODOLOGY: This was a retrospective chart review of patients who were confirmed positive for SARS-CoV-2 virus by Real Time-Polymerase Chain Reaction (RT-PCR) testing. Data extracted from patients' case files included patient demographics, presenting symptoms, provisional diagnoses, and outcomes of hospitalisation. Descriptive variables were summarized; proportions were compared using Chi-square tests, and independent predictors of mortality were assessed using multivariate regression analysis. A p-value of < 0.05 was considered as statistically significant. RESULTS: There were a total of 61 patients with positive RT-PCR testing: mean age ± SD (minimum - maximum) was 53.0 ± 18.5 (5 months - 90) years. Persons aged 60 years and above were the largest group (n=24, 39.3%). More than half were male (n=35, 57.4%); about 43% had one morbidity; 41.0% had at least two co-morbidities. The mean (SD) arterial oxygen saturation (SpO2) was 86.9% ± 16.7. Patients who were clinically dyspnoeic at presentation, and who had co-morbidities were significantly more hypoxaemic (p = 0.026 and 0.04, respectively). Significantly more patients who had normal oxygen saturation at presentation survived (p = 0.006). None of these variables was an independent predictor of mortality, however. CONCLUSION: Arterial hypoxaemia was significantly associated with dyspnoea and underlying disease, and normal oxygen saturation at presentation was significantly associated with survival. Hospital managers and clinicians may thus prioritize routine pulse oximetry, supplemental oxygen therapy and management of co-morbidities in the COVID-19 fight.

An Analysis of COVID-19 Patients Receiving Care in a Tertiary Facility in Southern Nigeria.

BACKGROUND: Information pertaining to the clinical characteristics of COVID-19 in sub-Saharan Africa remains sparse. In Nigeria, it is limited to few isolated reports and case series confined to the early phase of the outbreak. The objective of this study is to describe the presenting characteristics, co-morbidities and outcomes of Nigerian patients managed over a 3-month period in a tertiary hospital. METHODS: This was a descriptive cross-sectional study involving the total population of patients with laboratory confirmed diagnosis of COVID-19 in the University of Benin Teaching Hospital, Edo State, Nigeria from March 31 to June 30, 2020. Data was collected using a review of patients' records. Analysis was by IBM SPSS version 25.0. The level of significance was set at p < 0.05. RESULTS: A total of 173 patients with mean age (SD) 50.7± 20.1 years were managed. One hundred and five (60.7%) were males and the commonest age group was 20-39 years (34.7%). The commonest presenting symptoms were fever, cough and malaise found in 103 (71.5%), 101 (70.1%) and 63 (43.8%) patients respectively. Twenty-five (14.5%) patients had severe disease; 60 (34.7%) had underlying medical conditions mostly hypertension and diabetes mellitus. Outcome analyses showed 117 (67.6%) discharges, 45 (26.0%) deaths, 10 (5.8%) discharges against medical advice, and 1 (0.6%) transfer to another facility. Male sex (p=0.044), increasing age (p<0.001), presence of symptoms (p=0.010), presence of co-morbidities (p=0.010) and non-healthcare worker status (p< 0.001) were significantly associated with mortality. CONCLUSION: The first epidemiological and clinical summary of COVID-19 cases in Edo state, Nigeria over a three-month period is presented showing globally recognized patterns of male predilection and higher mortality with increasing age and co-morbidity.

Clinicopathological Features of Pruritic Papular Eruption of HIV Patients seen in Benin-City, Nigeria.

BACKGROUND: Pruritic papular eruption (PPE) is a frequent cause of substantial morbidity in Human Immunodeficiency Virus (HIV) patients in Nigeria. This skin condition remains the most common cutaneous manifestation in HIV-infected patients and it is more prevalent in developing countries. AIMS: To describe the clinical and pathologic features of PPE in our patients, and compare with those seen in other parts of the world. MATERIALS AND METHODS: Specimen collection, analysis and write-up of the study lasted 18 months (January 2015 to June 2016) after ethical approval of the proposal. The study design was a cross-sectional descriptive study of confirmed HIV-infected patients with clinically active PPE lesions presenting at the Dermatology outpatient clinic, the HIV/ART clinic, and those admitted as in-patients in the medical wards of the University of Benin Teaching Hospital, Benin. Data generated from the study were entered into and analyzed using the Statistical Package for the Social Sciences (SPSS) version 21. RESULTS: Only 106 patients were histologically confirmed to be PPE and subsequently recruited for the study. The pattern of distribution of PPE-HIV suggested that the rash has a predilection for exposed parts of the body. The body regions most significantly affected were lateral surface of lower limb, upper limb extensor surface, dorsal surface of foot and dorsal surface of hand. The most common secondary changes observed among the patients were excoriated papules, post-inflammatory hyper- and hypopigmentation, scarring, lichenification. CONCLUSION: Lesions of pruritic papular eruptions (PPE) of HIV in this study were distributed predominantly on the exposed parts of the body especially the upper and lower limbs.

Specialty choices: Patterns and determinants among medical undergraduates in Enugu Southeast Nigeria.

BACKGROUND: Specialty choices of medical undergraduates are important in planning educational programs and human resources for health-care delivery. The aim of this study was to investigate the specialty preferences of medical undergraduates and determine the factors that influenced their specialty choices. METHODS: This was a cross-sectional questionnaire-based survey carried out among final year medical undergraduates of University of Nigeria Enugu Campus, Enugu Nigeria. A self-administered questionnaire was used for data collection from the participants. Sociodemographic characteristics, decision to specialize, the timing of the decision, specialty choices and factors influencing these choices were evaluated. Chi-squared test and unpaired t-test were used to analyze the observations. RESULTS: Surgery and surgical specialties 79 (52%) were the most preferred specialties among the students. This was followed by obstetrics and gynecology 22 (14.5%) and public health 16 (10.5%). Personal interest in a specialty, personal abilities/competence, and career prospects were the most influential determinants of specialty choices. The career choices of male students were preferentially influenced by family/societal expectations (P = 0.03) and diversity of patients (P = 0.01). Low work hours significantly (P = 0.04) influenced the career choices of female students. CONCLUSION: Surgical specialties, obstetrics and gynecology, and public health were the most preferred specialties among our participants. The most important determinants of specialty choices were personal interest, personal abilities, and career prospects.