An open comparative study of dispersible piroxicam versus soluble acetylsalicylic acid for the treatment of osteoarticular painful attack during sickle cell crisis.

We compared the efficacy and tolerability of oral piroxicam 1 mg/kg/day with soluble aspirin given at 100 mg/kg/day taken four-hourly in 58 patients with sickle cell anaemia and severe ostcoarticular painful attacks requiring hospitalization in a randomized, paralleled study. Main investigational criteria were pain relief, limitation of movement, fever, and insomnia or agitation. Both groups were well-matched at the commencement of therapy but most patients on piroxicam showed remarkable and significant pain relief and improvement in other parameters within 24 h. Unwanted effects were absent in the piroxicam-treated group whereas those treated with aspirin experienced nausea and vomiting. There were no significant changes in liver function tests with both forms of treatment. Oral piroxicam is an effective and safe treatment in the management of the osteoarticular painful crisis in sickle cell anaemia. It might prevent the use of parenteral analgesics and hospitalization and reduce the loss of school hours in patients who are being treated for bone pain crises that characterize sickle cell anaemia.

Fluconazole in the therapy of tropical deep mycoses.

A clinical study was conducted to test the efficacy of fluconazole in the treatment of tropical deep mycoses. Two out of four patients with zygomycosis due to Conidiobolus coronatus who were treated with the drug were completely cured; the other two patients exhibited considerable improvement but could not be followed up. Two patients with eumycetoma, one due to an Acremonium sp. and one due to Pseudallescheria boydii, were treated successfully, whereas another patient with a eumycetoma caused by an unidentified fungus could not be followed up. A complete cure was achieved with one patient with African histoplasmosis and one with candiduria. A case of cerebral phaeohyphomycosis due to Cladosporium sp. showed some improvement but the patient later developed meningitis and died.

The menace of beta-lactamase production on antibiotic prescription in community acquired-infections in Nigeria.

Antibiotic resistance is a major clinical problem in the management of infectious diseases. The production of beta-lactamases by pathogens of all grades which has spread extensively during the last decade has further narrowed down the choice of antibiotics. Those antibiotics that are efficacious are costly and not readily available. The purposes of this study therefore were: To evaluate the incidence of beta-lactamase producing organisms responsible for common community-acquired infections. To evaluate the incidence of bacterial resistance to commonly prescribed antibiotics in the general practice. Nitrocefin strip was used to test each isolate for beta-lactamase production. All isolates were tested against five commonly prescribed antibiotics and a new oral cephalosporin. A nationwide survey revealed that 78% of community-acquired pathogens produced beta-lactamases while more than 50% of most community isolated showed in-vitro resistance to most commonly prescribed antibiotics. We conclude that treatment of bacterial infections are becoming more difficult and more costly. There is need therefore to continually review the susceptibility profiles of community-acquired pathogens.

Parental piroxicam arthralgia and musculoskeletal conditions of acute malarial [sic] : an open randomised comparison with oral acetylsalicylic acid and paracetamol

An open comparative trial of the toleration and safety of piroxicam; paracetamol and acetylsalicylic acid was conducted in 115 out patients with acute plasmodium falciparum malaria. Patients of both sexes received a single dose of sulfadoxine or pyrimethamine as anti-malarial therapy. Study participants were subsquently randomized to receive standard oral doses of paracetamol; acetylsalicylic; or injectable piroxicam; followed by oral doses of piroxicam; for management of fever; arthralgia and headache associated with acute malaria

An open non-comparative pilot study of the safety and efficacy of oral fluconazole in the treatment of dermatophyte infections in Nigeria

In an non-comparative study to assess the efficacy and safety of oral fluconazole in superficial fungal diseases of the skin; 82 adult Nigerian patients (58 males and 24 females) with clinical and mycological diagnosis of dermatomycoses were enrolled for the trial. Sixty-five patients completed the trial and each of them received a daily dose of 50mg fluconazole for a period of 4 weeks. An overall 90 per cent cure rate was observed in patients with other forms of dermatomycoses and 80 per cent for patients with pityriasis versicolor. The drug was well tolerated by all the patients and very few side effects were noticed

A therapeutic audit in the management of hypertension in Nigerians.

The prevalence of hypertension in adult Nigerians is about 20% and hypertension remains a significant risk factor in cardiovascular morbidity and mortality. In Africans, hypertension carries a dismal prognosis, has a late clinical presentation and certain antihypertensives may be less effective. We therefore conducted a therapeutic audit in order to assess the initial cardiovascular risk profile of Nigerian patients as well as the safety and efficacy of different antihypertensive agents. A cross-sectional survey of 367 patients (M:F:2:1) modal age 25-44 years, mostly WHO II, enrolled in our clinic was undertaken. 56% had been on treatment for up to one year and 2% for longer than ten years. 12.5% had concomitant diabetes mellitus. Statistical analyses of drug efficacy were done by Spearman correlation and Analysis of Variance (ANOVA). The rank order of hypertensive efficacy was as follows: Thiazides (T) (r = 0.57, P less than 0.05), T + Methyldopa (M) (r = 0.91, P less than 0.001) T + M + Hydralazine (r = 0.92, P less than 0.001). Neither propranolol, nor frusemide showed significant overall efficacy. However, propranolol appeared efficacious in hypertensives with renal impairment. Postural dizziness was occasionally reported. Total mortality was 6% occurring mostly in the modal age group. Diabetic hypertensives had a 5 fold enhanced risk of a fatal outcome (X2 P less than 0.001). Our findings support a rational stepped care approach to pharmacotherapy of hypertension in black Africans, a cost-effectiveness analysis of common antihypertensives; it elucidates the associated adverse effects to patients, and draws attention to the lethality of concomitant hypertension and diabetes. Prospective large scale studies of the treatment of hypertension in Africans are required.

Enalapril in African patients with congestive cardiac failure.

In a preliminary double-blind study in African patients with heart failure, enalapril tended to increase treadmill exercise duration relative to placebo (95% confidence interval--11.5 to 144.3 s). This was associated with a significant improvement in NYHA functional class and subjective well being (P less than 0.05 ANOVA) with a concomitant reduction in body weight (P less than 0.05 ANOVA). It significantly increased pulse pressure during forearm isometric exercise (P less than 0.05 ANOVA), but the Valsalva's manoeuvre and the orthostatic response were unchanged.

Enalapril and hydrochlorothiazide in hypertensive Africans.

The antihypertensive efficacy both of angiotensin converting enzyme (ACE) inhibitors and thiazide diuretics has been claimed to be influenced by plasma renin activity, which declines with age and is low in blacks. In a double-blind, placebo-controlled, double-dummy, randomized, parallel-group preliminary study, the antihypertensive efficacy and tolerability of the ACE inhibitor enalapril (20 mg day-1) and hydrochlorothiazide (50 mg day-1) were evaluated and compared for 4 weeks in 20 African patients with essential hypertension. The two groups had similar baseline clinical features and serum Na+ and K+ levels. Hydrochlorothiazide caused a significant and sustained fall in erect blood pressure with a reflex tachycardia. Enalapril exerted only a modest antihypertensive action, but significantly reduced erect heart rate. Direct comparison of hydrochlorothiazide- and enalapril-induced hypotension suggested a greater fall in subjects on the thiazide. The 95% confidence limits for the thiazide-enalapril difference in antihypertensive action at the end of the study was 39.5 to -7.5 mm Hg systolic and 22.0 to -6.6 mm Hg diastolic. The maximal blood pressure fall after hydrochlorothiazide was positively correlated with age (r = 0.50; p less than 0.05), whilst that of enalapril was inversely related age to (r = -0.57, p less than 0.05). The results are compatible with the notion that ACE inhibitor monotherapy may be less effective than thiazide diuretic treatment in African and black patients with essential hypertension. The findings also support the concept that age and racial factors may influence the response to antihypertensive treatment.

Hyperbilirubinaemia in neonatal rats after oxytocin or prostaglandin F2 alpha treatment of pregnant rats.

Serum bilirubin concentrations were investigated in neonatal rats. High concentrations were found on day 1 falling to adult values by day 4. Oxytocin (500 IU/kg) given subcutaneously to the dams on day 22 of pregnancy increased bilirubin concentrations in neonatal rats. This dose of oxytocin shortened gestational length but increased the neonatal death rate. Oxytocin (500 IU/kg) also increased uterine contractions on day 22 of pregnancy, measured using intrauterine balloons inserted on day 19 of pregnancy. Rats delivered by Caesarian section at the same gestational age as the oxytocin-treated group did not exhibit hyperbilirubinaemia. Prostaglandin F2 alpha (300 micrograms/kg) administered intramuscularly on day 20 of pregnancy was found to advance parturition and produced a small rise in serum bilirubin concentrations in neonatal rats. The rat could serve as a model for investigating the mechanisms of neonatal hyperbilirubinaemia which has been suggested to occur after the use of oxytocin or prostaglandins in the human.