Profiles of Tuberculosis Patients: A Single-Center Experience in a Semi-Urban Tuberculosis Center in Southeast Nigeria.

BACKGROUND AND OBJECTIVES: Tuberculosis infection (TB) is a global healthcare problem. In Sub-Saharan African countries TB-HIV co-infection is an evil duo. This study sought to evaluate TB characterization and mortality rate in TB subjects in a semi-urban tuberculosis center in Southeast Nigeria. METHODOLOGY: This was a retrospective study of 241 TB patients between September 2014 and August 2017. Data on clinical profiles, demography, anthropometry, occupation, HIV status, treatment, treatment outcome, and loss to treatment were retrieved and compared within subgroups. RESULTS: The male subjects were 97(40.2%) and female 144(59.8%). TB rate was low at extremes of age. Traders (38.2%) and artisans (17.4%) have high TB rate, with male preponderance, p=0.039. TB cure rate was 11.2%, death rate 17.4%, treatment completion 29.5%, loss to follow-up12.5%. TB-HIV co-morbidity rate was 42.3% and was high among traders, artisans, dependents, drivers, as well as civil servants, p=0.039 and specifically higher in females, p = 0.039. Low TB cure rate (25.0%) and high TB mortality rate (66.7%) occurred with TB-HIV co-infection, p=0.003. CONCLUSION: TB infection declined at extremes of age, and was high among traders and artisans. TB-HIV co-infection rate was high overall, associated with low TB cure rate and high mortality rate in this study.

Performance of Multiple True or False Options with Negative Scoring Schemes Against Single Best of Five Answer Options in a Medical School.

BACKGROUND AND OBJECTIVES: The multiple true or false (MTF) options with different negative scoring schemes and the Single Best of Five Answer (SBOFA) option of multiple choice questions are used in assessing knowledge in medical schools in Nigeria. There are diverse reasons for specific institutions to use a given scheme. These include large candidates' population, time pressure on those conducting the examination and limited resources. This study was set out to compare the performance of two negative scoring schemes of the MTF pattern of objective questions with the SBOFA pattern as the standard objective questions pattern in a medical school Methodology: In this cross-sectional comparative study, selected response items were administered to medical students. A set comprised of SBOFA options (taken here as A-score) and the other two, MTF options with different negative marking schemes; negative marking (-1/2) as B-score, and negative marking (-1) as C-score. The mean scores were compared among the three schemes. Cutoff or pass mark was 50% across-board. Correlation statistics, Bland Altman plots and ROC analyses were used to compare the two negative scoring schemes of the MTF pattern with the SBOFA pattern as the standard objective questions pattern Results: The mean scores of the students for the schemes were A-score 42.9%, B-score 45.6% and C-score 35.0%. The correlation between A-score and B-score was significant (r=0.351, p=0.009). A-score also correlated significantly with C-score, (r=0.381, p=0.004). In B-score versus A-score the bias was -2.6 (47.4%), limits of agreement -29.4 - 24.1 (20.6% -74.1%). In C-score versus A-score the bias was 8.1 (58.1%) and limits of agreement -21.5 - 37.7 (28.5%-087.7%). For B-score and A-score area under receiver operator curve (AUROC) was 0.720 and for C-score and A-score 0.714. B-score at best cutoff mark 45.0% (sensitivity 93%), predicted A-score 50.0%. C-sore at best cutoff mark 33.0% (sensitivity 93%) predicted A-score 50%. CONCLUSION: The MTF objective questions with negative marking scheme of -1/2 as penalty and the SBOFA scheme were more closely related than the MTF with -1 as penalty and SBOFA option. The SBOFA option had better correlation with the MTF with -1 as penalty while the -1/2 penalty had a much higher pass rate.

Gastrointestinal Parasitic Infections and Immunological Status of HIV/AIDS Coinfected Individuals in Nigeria.

BACKGROUND: Parasitic infections of the gastrointestinal tract is one of the highest causes of morbidity and mortality among HIV infected individuals. This is due to the colonization of the intestinal tract by parasites influenced by induced enteropathy caused by HIV infection. CD+4 t-lymphocytes count is a marker of the immune status of HIV infected individuals. OBJECTIVE: This study investigated the prevalence of gastrointestinal parasitic infections among HIV coinfected individuals in relation to their immunological status. METHODS: CD+4 t-lymphocytes count was determined using fluorescence-activated cell sorting (FACS) count system. Parasitological examination of faecal samples was conducted using direct wet mount, modified Z-N and Giemsa stain techniques. All prepared slides were examined under x10 and x40 objectives. FINDINGS: Out of the 891 HIV seropositive participants on antiretroviral therapy that were studied, 641 (71.9%) had CD+4 counts equals to or greater than 500 cells/mm3. All other seropositive participants had CD+4 counts below 500 cells/mm3. Gastrointestinal parasitic infections were recorded in 187 (20.9%) seropositive participants, with females (n = 108, 12.1%) having more infections than males. Multiple gastrointestinal parasitic infections were recorded in 28 (3.1%) seropositive participants. Out of the 150 seronegative participants, 79 (52.7%) of them had at least one gastrointestinal parasitic infection. Female seronegative participants also accounted for higher infection rate (n = 42, 28.0%) than males (n = 37, 24.7%). Multiple infections were also recorded in 18 (12.0%) seronegative individuals. The overall prevalence rate of infection between both positive and negative individuals was 25.5%. There was statistical significant difference in the infections of Cryptosporidium parvum (p < 0.003), Cyclospora cayetanensis (p < 0.011) and Cystoisospora belli (p < 0.011) between HIV seropositive and HIV seronegative individuals. Also, there was statistical significant difference in the infections of hook worm (p < 0.002) and Trichuris trichiura (p < 0.020) between seronegative and seropositive individuals. Gastrointestinal parasitic infection rate was significantly higher among seropositive participants with CD+4 counts between 200 and 350 cells/mm3 (n = 109, 58.3%). CONCLUSION: The study shows that HIV infected individuals continue to experience gastrointestinal infections even with antiretroviral treatment, especially those with CD+4 counts below 350 cells/mm3. Health care providers should prioritise routine screening of HIV patients for gastrointestinal parasites and provide prompt treatment. Antiparasitic drugs should also be provided as prophylaxis.

Epidemiology of intestinal helminth parasites in stray dogs from markets in south-eastern Nigeria.

A survey of gastrointestinal helminth parasites of stray dogs (Canis familiaris) was conducted at Obollo-Afor and Ekwulobia markets, in Enugu and Anambra States, south-eastern Nigeria, respectively, to determine the patterns of infection among dogs in different parts of south-eastern Nigeria. Faecal samples collected, using long forceps, from every dog encountered in the markets between June 2007 and December 2008 were analysed by the Kato-Katz technique. Out of 413 dogs examined in both markets, 217 (52.6%) were infected with at least one of five parasites (Toxocara spp., Dipylidium caninum, Ancylostoma caninum, Taenia spp. and Trichuris vulpis). Overall faecal egg intensity of infection was 49.9 ± 58.7 eggs/g (epg). The prevalence of infection was comparable between the markets and between the male and female dogs, but varied significantly (P < 0.05) by age, decreasing from 78.9% in pups to 36.0% in adult dogs. The mean intensity pattern was similar to that of prevalence, decreasing from 86.7 ± 63.0 epg in pups to 22.1 ± 34.4 in adults. The most important individual parasite infection was Ancylostoma spp. (39.2%; 30.0 ± 41.2 epg) while T. vulpis was the least important (1.9%; 0.7 ± 5.4 epg). Generally, prevalence and intensity patterns of each parasite were also comparable between the markets and between sexes, but significantly (P < 0.05) age-dependent. The implications of these findings to public health in Nigeria and other endemic countries are discussed in relation to options for cost-effective control design and implementation.

Factors associated with urinary schistosomiasis in two peri-urban communities in south-western Nigeria.

In Nigeria, there is only very limited epidemiological information on which the control of human urinary schistosomiasis could be based. In a cross-sectional study, therefore, the prevalences and intensities of, and risk factors for, human infection with Schistosoma haematobium infection were explored in two endemic peri-urban villages in the south-western state of Osun. The villagers' knowledge about the infection and demographic, socio-economic and environmental variables were recorded using a structured questionnaire. Of the 1023 individuals who were investigated, 634 (62.0%) were found infected, with a mean (S.D.) overall intensity of 114.2 (327.7) eggs/10 ml urine. The subjects aged 10-14 years had both the highest prevalence (83.6%) and the highest mean (S.D.) intensity of infection [196.67 (411.7) eggs/10 ml urine]. Most (70.0%) of the subjects appeared to have no knowledge of the transmission of S. haematobium. The results of multivariate regression analysis indicated that infection and moderate-heavy infection (i.e. >50 eggs/10 ml urine) were both associated with: a low family income, of

The use of simple ketamine anaesthesia for day-case diagnostic laparoscopy.

General anaesthesia using ketamine has been shown to be safe. It is generally used in our private hospitals where there is lack of qualified personnel and sophisticated anaesthetic machines. A retrospective review of 295 cases of laparoscopy was performed over 28 months at the fertility Unit of Life Specialist Hospital Nnewi, Anambra State, Nigeria. Ketamine general anaesthesia was used for all the patients after premedication with 0.6 mg of atropine. Seventy-six and 102 patients who had additional premedication of 10 mg diazepam and 50 mg promethazine, respectively, were compared. The duration of this procedure ranged between 7 and 18 minutes, with a mean of 12 minutes. The dose of ketamine used was 100 mg mean (range 50-180 mg); 12.6% of the patients had some form of reaction. Diazepam reduced talkativeness during recovery but increased the recovery time significantly, from an average of 45 minutes to 3 hours. Promethazine significantly reduced vomiting and restlessness and did not significantly prolong the recovery time (from an average of 45 minutes to 70 minutes). Two patients who had only atropine as premedication had an idiosyncratic reaction of breathlessness and tonic-clonic-like movements. They responded to intravenous diazepam. Ketamine produces a safe, effective and simple general anaesthesia and is recommended for use in day-case laparoscopy, where standard anaesthetic machines and trained personnel are lacking. Use of promethazine premeditation is advocated for improved outcome.