Problems associated with treatment compliance among type 2 diabetic patients at a tertiary health institution in Nigeria

This study analyses the problems associated with compliance to treatment among type 2 diabetic patients attending the out-patient clinic in Federal Medical Centre, Owerri, Imo State, Nigeria. It also determines the extent to which patients comply with medications and understand blood sugar control. Data were collected using pre-tested questionnaires from 30 randomly selected subjects. An analysis was done using Statistical Package for Social Sciences (SPSS). Results showed that 30% of the respondents were aged between 40 and 50 years, 63% were married, and 37% had secondary education. Those with a duration of diabetes of more than 5 years totalled 30%. 43% reported on understanding of good glycaemic control, while 33% defaulted in taking medications. Also, 37% agreed that medications should be stopped when they are feeling well, while 40% agreed that compliance was associated with fear of hypoglycaemia. It is important to explore the precursors to treatment adherence behaviour and to carry out interventions that can change negative attitudes toward treatment compliance and promote medical knowledge, which may help improve compliance in the treatment of type 2 diabetes

Possible biochemical markers of antiretroviral therapy (ART) failure in resource-constrained areas.

Possible biochemical parameters that can distinguish clinically-failing people living with HIV/AIDS (PLWHA) from clinically-stable PLWHA on antiretroviral therapy (ART) were investigated in a north central location of Nigeria. The major aim of the study was to determine possible diagnostic biochemical markers that can be helpful in resource- and manpower-poor environments. Eighty (80) consenting persons living with HIV/AIDS who were on combined ART while attending a tertiary hospital in the North Central part of Nigeria were recruited for the study. Fifty (50) persons had clinically failing (CF) conditions while 32 were clinically stable (CS). Of the 50 CF cases 32 persons switched drugs while 18 did not in the course of their ART. In all, serum total bilirubin, total protein, total cholesterol, albumin, alkaline phosphatase (ALP), glucose, creatinine, urea and CD4 cell count were assayed. The values of these parameters in the CF and CS persons were statistically compared. The same parameters in the CF cases that switched drugs and those that maintained their drugs were also statistically compared with the corresponding values for the same parameters in the clinically stable persons. Alkaline phosphatase activity and total cholesterol levels and CD4 count in the CF cases were significantly (pd"0.05) different from the values for the CS persons. Only creatinine levels in CF persons that switched drugs differed significantly (pd"0.05) from the corresponding values in CF, persons that did not switch drugs even when there was no difference in creatinine values between the latter and the CS persons. CD4 count and total cholesterol levels may serve as useful indicators of potential clinically-failing and/or clinically stable cases of PLWHA on antiretroviral therapy. Creatinine levels on the other hand, may be useful in distinguishing PLWHA that switched drugs and those that did not. These parameters may serve as reliable rapid assessment tools for HIV/AIDS research and diagnosis in resources-poor areas.

Malaria infection in HIV/AIDS patients and its correlation with packed cell volume (PCV).

BACKGROUND & OBJECTIVES: The study was designed: (i) to determine the prevalence of malaria parasites; (ii) to determine the relationship between parasitaemia and age/sex; (iii) to correlate the PCV levels with parasitaemia; and (iv) to determine the influence of protection against natural transmission on the prevalence of malaria. METHODS: Participants were recruited at the Plateau State Human Virology Research Laboratory (PLASVIREC), Robert Gallo House at the Plateau State Specialist Hospital, Jos and grouped into: (i) Malaria and HIV co-infection group (n = 64); and (ii) HIV infected group without concurrent malaria infection (n = 136). Standard laboratory procedures were used for the HIV and Plasmodium parasites screening, malaria parasite density, and packed cell volume. RESULTS: The results showed a significant difference (p >0.05) among the sexes and age groups. About 64 (32%) of the individuals had Plasmodium infection (30% Plasmodium falciparum, 0.5% P. malariae, and 1.5% mixed infections of P. falciparum and P. malariae). Malaria parasites were more common among the rural dwellers and in the age group of 21-30 yr. Regression analysis showed a negative association of malaria parasitaemia and PCV among the malaria-HIV positive and malaria-HIV negative (r2 = 0.529; p <0.001). INTERPRETATION & CONCLUSION: In the present study, PCV might be of useful indicator and if not monitored could lead to AIDS establishment especially where high malaria parasitaemia is noted. The findings further suggest that the defined stage of HIV infection in the study, malaria coinfection may moderate the impact of HIV infection on PCV.

The prevalence, intensity and clinical manifestations of Onchocerca volvulus infection in Toro local government area of Bauchi State, Nigeria.

Between January and October 1994, a study of the prevalence, intensity and clinical manifestations of onchocerciasis in nine communities of Toro local government area of Bauchi State, Nigeria was undertaken using the skin-snip method. Of the 1117 inhabitants examined, 188 (16.8%) were positive for microfilariae of Onchocerca volvulus. The prevalence of onchocerciasis was significantly higher (P < 0.05) among males than females, in subjects 21 years of age and above than in those in the first two decades of life, in nomads, farmers, hunters and fishermen than smiths and traders. Intensity of infection was light, not exceeding a geometric mean of 5.3 microfilaria per 2 mm skin bite. Preponderance of positive cases below 20 years presented no chronic signs. Conversely, persons above 20 years had higher microfilaria counts which coincides with the period when most clinical signs manifest. Microfilarial-rate and -density in relation to age were closely associated (r = 0.75, P < 0.001). The need for a sustained mass distribution of Mectizan in these communities is highlighted.

Glycogen, protein and lipid content of adult Fasciola gigantica (Trematoda).

The concentration of carbohydrates, proteins, and lipids in the whole worm, gut, and body musculature of Fasciola gigantica was investigated from worms collected from cattle slaughtered in the Jos abattoir. Protein accounted for the highest concentration of the constituents constituting 62.59 +/- 0.86% of the dry weight of the fluke. This was followed by lipid with 28.15 +/- 0.86% of the dry weight while carbohydrate (glycogen) was 6.29 +/- 0.11% of the dry weight. Thin-layer chromatography revealed the presence of six distinct bands of neutral lipids, namely: monoglycerides, 1,2-diglycerides, 1,3-diglycerides, free fatty acids, triglycerides and sterol esters from both whole worm homogenate and fractions of the gut and muscle tissues. In the case of phospholipids, lysophosphatidyl choline, sphingomyeline, phosphatidyl choline and phosphatidyl-ethanol amine were recovered. When the free fatty acids were subjected to further fractionation, palmitic, stearic, as well as oleic acids were recovered in appreciable quantities indicating that lipids are being catabolized in these trematodes.