ABSTRACT
BACKGROUND: Human immunodeficiency virus (HIV) and tuberculosis (TB) are the leading causes of death from infectious disease worldwide. The World Health Organization estimates that the prevalence of HIV among children with TB in moderate to high prevalence countries ranges between 10% and 60%. This study aimed to determine the access to HIV services of HIV-TB co-infected children. METHODS: A retrospective review of data of children diagnosed with TB in Lagos State, Nigeria from 1 January 2012 to 31 December 2013. RESULTS: A total of 1199 children aged between 0 and 14 years were diagnosed with TB. Of 1095 (91.3%) who underwent testing for HIV, 320 (29.2%) were HIV seropositive. The male-to-female ratio of HIV-TB positive outcomes was 1:0.9. Of the 320 HIV-TB co-infected children, 57 (17.8%) were aged <1 year, 86 (26.9%) 1-4 years and 186 (58.1%) 5-14 years; 186/320 (58.1%) began cotrimoxazole preventive therapy (CPT), and 151 (47.2%) were put on antiretroviral treatment (ART). ART uptake was not significantly higher in facilities where HIV-TB services were co-located (P > 0.05). CONCLUSION: The uptake of CPT and ART was low. There is a need to intensify efforts to improve access to HIV services in Lagos State, Nigeria.
Contexte : Le virus de l'immunodéficience humaine (VIH) et la tuberculose (TB) sont les causes majeures de décès dû à une maladie infectieuse dans le monde. L'Organisation Mondiale de la Santé estime que la prévalence du VIH parmi les enfants atteints de TB dans des pays à prévalence modérée à élevée va de 10% à 60%. Cette étude a eu pour but de déterminer l'accès aux services VIH pour les enfants coinfectés par TB-VIH.Méthodes : Une revue rétrospective des données d'enfants ayant eu un diagnostic de TB dans l'état de Lagos au Nigeria entre le 1e janvier 2012 et le 31 décembre 2013.Résultats : Un total de 1199 enfants âgés de 0 à 14 ans ont eu un diagnostic de TB. Parmi eux, 1095 (91,3%) ont eu un test VIH, dont 320 (29,2%) ont été positifs. Le ratio garçon/fille de coinfection TB-VIH a été de 1:0,9. Sur les 320 enfants coinfectés TB-VIH, 57 (17,8%), 86 (26,9%) et 186 (58,1%) respectivement avaient <1 an, 14 ans et 514 ans. Sur les 320 enfants coinfectés TB-VIH, 186 (58,1%) ont débuté le cotrimoxazole (CPT) tandis que 151 (47,2%) étaient sous traitement antirétroviral (ART). La mise sous ART n'a pas été significativement plus élevée dans les structures où les services TB-VIH se trouvaient au même endroit (P > 0,05).Conclusion : La mise sous CPT et ART a été faible. Il est nécessaire d'intensifier les efforts d'amélioration de l'accès aux services VIH à Lagos, Nigeria.
Marco de referencia: La infección por el virus de la inmunodeficiencia humana (VIH) y la tuberculosis (TB) son las principales causas de muerte por enfermedad infecciosa en todo el mundo. La Organización Mundial de la Salud considera que la prevalencia de infección por el VIH en los niños con TB de los países con prevalencia moderada o alta oscila entre 10% y 60%. El presente estudio tuvo por objeto determinar el acceso de los niños coinfectados por el VIH y la TB a los servicios relacionados con el VIH.Método: Se llevó a cabo un examen retrospectivo de los datos sobre los niños con diagnóstico de TB en el estado de Lagos en Nigeria del 1° de enero del 2012 al 31 de diciembre del 2013.Resultados: Se estableció el diagnóstico de TB en 1199 niños de 0 a 14 años de edad, de los cuales 1095 contaban con una prueba diagnóstica del VIH (91,3%) y 320 habían obtenido un resultado positivo (29,2%). La proporción entre el sexo masculino y femenino fue 1:0,9 en los niños coinfectados. De los 320 casos de coinfección, 57 eran menores de un año de edad (17,8%), 86 tenían entre 1 y 4 años (26,9%) y 186 entre 5 y 14 años de edad (58,1%). De los 320 niños coinfectados, se inició tratamiento preventivo con cotrimoxazol (CPT) en 186 (58,1%) y 15 niños comenzaron el tratamiento antirretrovírico (ART) (47,2%). La aceptación del ART no fue significativamente más alta en los establecimientos donde los servicios contra la TB y el VIH compartían la ubicación (P > 0,05).Conclusión: La aceptación del CPT y el ART fue baja. Es preciso intensificar las iniciativas tendentes a mejorar el acceso a los servicios relacionados con el VIH de Lagos, en Nigeria.
ABSTRACT
SETTING: Private and public tuberculosis (TB) treatment centres in Lagos State, Nigeria. OBJECTIVE: To assess the contribution of private health care providers to TB and TB-HIV (human immunodeficiency virus) case finding in Lagos State. DESIGN: A retrospective review of programme data submitted to the Lagos State TB and Leprosy Control Programme in 2011 by public, private for-profit (PFP) and private not-for-profit (PNFP) health care providers. RESULTS: A total of 8425 TB cases were notified by 31 private (11 PFP and 20 PNFP) and 99 public health facilities in Lagos State. Overall, the private facilities were responsible for 10.3% (866/8425) of the total TB cases notified. The proportion of TB patients tested for HIV was respectively 86.2%, 53.1% and 96.5% among public, PFP and PNFP facilities. Overall, 22.4% of the TB patients were HIV-positive. The HIV positivity rate among public, PFP and PNFP facilities was respectively 23.8%, 7.8% and 9.9%. Uptake of cotrimoxazole preventive therapy was respectively 69.6%, 25% and 38.2% among public, PFP and PNFP facilities, while that of antiretroviral therapy was respectively 23.8%, 8.3% and 9.1% in public, PFP and PNFP facilities. CONCLUSION: There is a need to scale up collaboration with the private sector, and particularly PNFP health providers.
Subject(s)
Anti-HIV Agents/therapeutic use , Antitubercular Agents/therapeutic use , Coinfection , HIV Infections/drug therapy , Private Sector , Public Health , Public-Private Sector Partnerships , Tuberculosis/drug therapy , Cooperative Behavior , Delivery of Health Care, Integrated , Directly Observed Therapy , Disease Notification , HIV Infections/diagnosis , HIV Infections/epidemiology , Hospitals, Proprietary , Hospitals, Voluntary , Humans , Interinstitutional Relations , Nigeria/epidemiology , Practice Patterns, Physicians' , Retrospective Studies , Treatment Outcome , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Tuberculosis/diagnosis , Tuberculosis/epidemiology , Urban Health ServicesABSTRACT
Nine cases of solitary caecal diverticulitis treated in Kuwait are presented and the literature is reviewed. The preoperative diagnosis was acute appendicitis in all cases, but diverticulitis was detected during surgical exploration and histologically confirmed. The surgical management in seven cases was simple excision of the diverticulum with closure of resultant defect or invagination of the mucosal bulge with suture of the colonic wall. Right hemicolectomy was performed in two cases because of gangrenous patches in the caecal wall and suspicion of carcinoma. Recognition of solitary caecal diverticulitis requires considerable experience, especially in order to avoid more radical procedures such as right hemicolectomy. Solitary caecal diverticulum does not seem to occur in the indigenous people of Kuwait. All nine patients were of other nationalities, including five from countries of the Far East.
Subject(s)
Cecal Diseases/epidemiology , Diverticulitis/epidemiology , Adult , Cecal Diseases/diagnosis , Cecal Diseases/surgery , Diagnosis, Differential , Diverticulitis/diagnosis , Diverticulitis/surgery , Female , Humans , Intestinal Mucosa/pathology , Kuwait/epidemiology , Male , Middle AgedABSTRACT
The effect of acetic or propionic acid rumen fermentation patterns on whole-body protein turnover, tissue protein synthetic rates and body composition was investigated in growing lambs. Protein turnover was assessed using a continuous intravenous infusion of [2,3-3H]tyrosine and tissue protein fractional synthetic rates (FSR) from the specific activities of plasma free, intracellular free and tissue bound tyrosine. Only the FSR of muscle tissue approached significance. The high FSR in the propionic group was attributed to the high plasma insulin concentration. Values for whole-body protein synthesis, corrected for tyrosine oxidation, were similar to those obtained by summating protein synthesis in individual tissues, confirming that tyrosine oxidation should be measured accurately if reliable whole-body protein synthesis values are required. Tyrosine oxidation and flux were high in the acetic acid group, suggesting that amino acids are used for gluconeogenesis. The high protein turnover rate probably ensures an adequate supply of gluconeogenic amino acids and that the penalty of mobilizing body proteins for gluconeogenic amino acids is minimal. In the propionic acid group, high plasma glucose and insulin concentrations were associated with a low protein turnover rate, high ratio of deposited: synthesized protein and a high body fat content. It is concluded that changing the proportion of ruminal volatile fatty acids influences protein turnover, protein synthesis and the efficiency of protein retention. Such factors probably contribute, indirectly, to the observed differences in body composition.
