Effects of Structured lifestyle Modification on Cardiovascular Risk Factors in Type-2 Diabetes Mellitus: A Randomized Controlled Trial

Several clinical trials have shown that lifestyle modifications lower blood pressure, affect weight as well as lipid profile and lower risk factors for cardiovascular diseases. The study assessed the effect of structured lifestyle modification on cardiovascular risk factors amongst type 2 diabetic patients that attend the General Outpatient Clinic (GOPC) of Jos University Teaching Hospital (JUTH). The study was a randomized controlled trial on 352 participants at the GOPC of JUTH, from October 2015 to February 2016. The intervention offered was counselling on structured lifestyle modification in diet and exercise for a period of 12 weeks. The primary outcome measures were changes in blood pressure, weight and lipid profile. The data were analyzed using Epi Info version 3.5.3. There were significant differences between groups in favor of the intervention group; mean systolic blood pressure of -65 mmHg (t = 5.344; p = 0.017) and mean weight of -1.78kg (t = 2.452; p = 0.015). Structured lifestyle modification caused significant improvement on modifiable cardiovascular risk factors in patients with type 2 diabetes mellitus attending the general outpatient clinic of the Jos University Teaching Hospital.

Substance Use and Mental Illness among Women Admitted in a Rehabilitation Center in Jos, Nigeria: A 5-Year Profile

Substance use disorder are among the most common public health problems caused by using legal and/or illegal substances. Therefore, this study is aimed at reviewing a five-year profile of women admitted at a rehabilitation center in Jos, Nigeria for substance use and mental illness. This is a retrospective cross-sectional study carried out on 183 females admitted between 2012 and 2017 at a rehabilitation center in Jos, Nigeria. Data collection was carried out from documents note of these female participants. Data were analyzed using SPSS version 22. The mean age of the participants was 38.515.3 years. Almost half of the participants were within the age bracket of 20 – 29 years and married (45.9%). Depressive disorder (36.1%) was the commonest mental disorder in the studied participants. Among those abusing substances, multiple substance use (12.6%) was the most prevalent with alcohol use disorder (9.3%) the main diagnosis among those with substance use disorder. According to the result almost half of the studied participants were young, married and educated females. Depression and multiple substance abuse with alcohol the main drug of abuse was a cause for concern in this population. This portrays significant health and economic consequences and the need for urgent action.

Cryptococcal Meningitis amomg HIV-Infected and HIV-Uninfected Patients in Jos, North Central Nigeria

Cryptococcal meningitis is a global opportunistic infection caused by several serovars of Cryptococcus neoformans and Cryptococcus gattii with significant morbidity and mortality, particularly in immunocompromised patients. Management principles involve early and specific diagnosis followed by appropriate antifungal therapy. The study was conducted among in-patients with clinical features of meningitis admitted into tertiary healthcare facilities in Jos, north-central Nigeria from November 2017 to December 2018. Cerebrospinal fluid and blood samples were collected from the patients for culture and sensitivity, serology and genomic studies. Univariate and bivariate analysis was carried out using STATA (version 14IC). The serologic prevalence of cryptococcal meningitis among patients with clinical features of meningitis was 16.8%. The prevalence among HIV-infected and HIV-uninfected patients were 13.4% and 18.8% respectively. The antifungal susceptibility of the Cryptococcus neoformans isolated from sample cultures at MIC90ug/ml to Amphotericin B, Fluconazole and Itraconazole were all within the reference range. Gene accession numbers of cryptococcal isolates deposited in the gene bank include MK886574.1, MK886568.1, MK886570.1, MK886563.1, MK886560.1, MK886573.1, MK886562.1, MK886558.1. Cryptococcus neoformans are a major cause of meningitis in both HIV-infected and HIV-uninfected patients. This study highlights the fact that routine surveillance should be put in place for culture, antifungal susceptibility tests and genomic studies to ascertain the antifungal susceptibility pattern and genotypes of cryptococcus in circulation.

Cryptosporidiosis among HIV/AIDS Patients with Diarrhoea and Associated Risk Factors in Jos, North-Central Nigeria

Cryptosporidiosis is an opportunistic, parasitic infection caused by Cryptosporidium parvum. It is transmitted via faecal-oral route and causes life-threatening, cholera-like diarrhoea in immunocompromised individuals such as HIV/AIDS patients. This study aimed to determine the prevalence of cryptosporidiosis and associated risk factors among HIV/AIDS patients with diarrhoea. This was a cross-sectional study of 100 HIV/AIDS patients with diarrhoea in a tertiary health institution in Jos, North-central Nigeria between April and November 2019. Fifteen millilitres (15ml) of stool samples were collected from each patient after signing a consent form and filling a well-structured questionnaire. The oocytes of Cryptosporidium parvum were identified in the stool samples using modified Ziehl-Neelsen stain and polymerase chain reaction (PCR). The results obtained were computed using SPSS version 21. The mean age (standard deviation) of the study participants was 37.0 (± SD9.6), with a minimum age of 20years and a maximum age of 63 years. The study comprises of 53(53.0%) males and 47(47.0%) females. Fifty-four (54) of the participants were on antiretroviral (ARV) drugs while 46 were ARV drug naïve. The prevalence of cryptosporidiosis among the study population was 13.0%. Cryptosporidiosis was found in 10(21.7%) of the 46 ARV drugs naïve participants and in 3(5.6%) of the 54 participants on antiretroviral therapy. This was statistically significant at p = 0.016. There was also a significant relationship (p = 0.012) between the prevalence of cryptosporidiosis and the level of CD4+ T-lymphocytes count of the study participants. The infection was more among participants with CD4+ T-lymphocytes count less than 200 cells/μl. This stress the need for good personal hygiene, sanitation and compliance to antiretroviral treatment among HIV/AIDS patients to reduce the risk of opportunistic infections such as cryptosporidiosis.

Hepatitis B Surface Antigen-Prevalence, Knowledge, Attitude and Vaccination Status among Healthcare Workers in a Tertiary Health Facility

Healthcare workers (HCWs) are at increased risk of acquiring hepatitis virus B infection through occupational exposure. Having adequate knowledge and proper attitudes toward hepatitis B virus infection are crucial for its prevention. This study assessed the knowledge, attitude, and hepatitis B virus vaccination status of health care workers. A descriptive cross-sectional study among 120 healthcare workers that attended the World Hepatitis B-Day Celebration in June 2018 was undertaken. Data were obtained with a self-administered questionnaire on socio-demographic characteristics, knowledge, attitude towards HBV infection, and practice of hepatitis B vaccination. Commercial enzyme-linked immunosorbent assay kits were used to determine the prevalence of hepatitis B surface antigen. Data were analyzed using computer software SPSS version 22. The prevalence of HBsAg among the subjects was 4.5%. Only 53(47.7%) of the respondents had good knowledge of hepatitis B virus infection. The majority of respondents 91(82.0%) demonstrated a positive attitude towards hepatitis B virus infection and vaccination. Over 30% of respondents were aware of their hepatitis B virus infection status, and 29(26.1%) of them had received the hepatitis B virus vaccine. The major reason for the poor uptake of hepatitis B virus vaccination was not knowing where to get the vaccine in 40(57.1%) of them. Good knowledge of HBV infection had a statistically significant association with the age of respondents and their years of experience (p<0.05). It is recommended that a healthcare worker should be provided with more education and information on hepatitis B virus infection and vaccination. Also, hepatitis B screening and vaccination should be made mandatory as part of the pre-employment exercise of all healthcare workers with follow up screening before any upgrade or promotional examination exercise.

Cervical Dumbbell Ganglioneuroma Causing Quadriplegia

Ganglioneuroma is a rare benign tumour that originates from the ganglion cells of the sympathetic nervous system. They are rare in cervical spine region and only 8 % of ganglioneuromas occur in the neck. The common sites of occurrence are in the posterior mediastinum, retroperitoneum and adrenal medulla, and as such, a cervical occurrence presenting with quadriplegia is a reportable event. We present a 26-year old young male with a two-year history of neck pain and progressive quadriplegia. He later became wheelchair-bound. Musculoskeletal examination revealed multiple generalized nodular skin swellings with café au lait macules. Magnetic resonance imaging showed a huge dumbbell tumour of the first two cervical vertebrae, to the right side of the spinal canal causing significant spinal cord compression. He had surgical intervention, aimed at complete tumour resection, postoperatively, power of the limbs improved to normal. Histological examination was consistent with ganglioneuroma. We present this report because the occurrence of ganglioneuroma is rare, secondly a cervical presentation is unusual and thirdly it presented as a rare cause of quadriplegia.

Galvanizing Communities towards Zero Malaria in Nigeria: An Account of 2019 World Malaria Day in Bayelsa State

Nigeria had a vision of zero death from malaria by 2020 and was making efforts to achieve the goal. Reducing malaria mortality or eliminating malaria requires community ownership and active participation. This paper describes activities carried out in Bayelsa State to commemorate the 2019 World Malaria Day – an important global event towards eliminating malaria. Several organizations in the state collaborated to organize the event and used various media to spread the key messages of the day. Inadequate resources however limited full commemoration. A better- funded event in the future has potential for a larger impact.

Histopathological Analysis of Gastric Cancers in University of Ilorin Teaching Hospital: A 20-Year Review

Gastric cancer is a relatively common malignancy in Nigeria. Gastric cancer varies from region, being 4th to 20th in proportion to other malignancies. The symptom and signs are often non-specific with the early stages of the disease. This may be responsible for late presentation and poor prognosis. This is a 20-year retrospective analysis of 107 histopathologically confirmed gastric cancers in the department of pathology. This study aimed to analyze the Histopathological patterns of all the gastric cancer cases diagnosed in U.I.T.H Ilorin, over a twenty-year period. Gastric cancers were classified according to WHO 2010 and Lauren classification of gastric cancers. A total of 107 cases of gastric cancers diagnosed, that met the inclusion criteria, were analyzed with male: female ratio of 1.3:1 out of which epithelial malignancy accounted for 93.5% with tubular adenocarcinoma representing the commonest epithelial subtype. Epithelial malignancy is the commonest histological type in this area. Therefore, it is recommended that patients above 40 years with dyspepsia and other alarm features should undergo routine endoscopic screening.

Fourth-Generation ELISA Screening of Blood Donors: A Reliable Alternative to Nucleic Acid Testing

The gold standard for HIV screening of blood donors is individual nucleic acid amplification testing (NAT). However, individual NAT testing is cost-prohibitive, especially in a resource-limited setting. The fourth-generation ELISA that detects both p24 antigen and antibody to HIV-1 and 2 has been recommended as the minimum test for HIV to enhance blood transfusion safety and can be an alternative to NAT testing in resource-limited settings. The aim was to assess the performance of a fourth-generation ELISA in use at a regional blood transfusion service using nucleic acid amplification testing on units of screened blood negative to HIV. The study was a cross-sectional study conducted at the National Blood Transfusion Service center and the Plateau State Virology Research Centre, both in Jos, Nigeria. Between August and October 2016, one thousand and eighteen voluntary blood donors were recruited consecutively and had their samples tested using fourth-generation ELISA. One thousand p24 antigen-negative samples were pooled for NAT in an aliquot of 50 samples. All the pools of fifty samples of 1,000 HIV p24 antigen-antibody negative donor blood screened by the fourth-generation ELISA tested negative for HIV RNA on nucleic acid amplification. The yield of pooled NAT for HIV after a fourth-generation ELISA screening of blood donors was found to be zero in this study, thus establishing the fourth-generation ELISA's reliability. Therefore, we recommend adopting the fourth-generation ELISA test as a minimum requirement for blood donor screening.

Cardiovascular Risk Factors in HIV-Infected Adults in North-Central Nigeria: Prevalence, Associated Factors and Assessment of Risk Using the Framingham Risk Score – Preliminary Results from a Survey

HIV/AIDS is an increasingly important cause of cardiovascular (CVD) morbidity world-wide. We sought to evaluate the prevalence of CVD risk factors in HIV positive (HIV+) adults and assessment of these risks using the Framingham risk score (FRS). A cross-sectional study of adult clients of the HIV clinic at Jos University Teaching Hospital. One hundred and fifty HIV+ selected randomly with 50 (age and sex matched) HIV negative (HIV-) participants were enrolled. Relevant history, physical examination and biochemical investigations and 12-lead electrocardiography were performed. Data was analyzed using Epi-info 7.2 statistical software and P value < 0.05 was considered significant. The prevalent major CVD risk factors were dyslipidaemia (30.0% versus 6.0%), hypertension (34.0% versus 10.0%) and diabetes mellitus (10.0% versus 2.0%) among the HIV+ and HIV- participants respectively. The FRS of the HIV+, 3 (IQR 3-28) were statistically significantly higher than that of the HIV- participants, 2 (IQR 1-13); P=0.001. Furthermore, 32% of the HIV+ had moderate-high FRS compared to 2% of HIV- participants. CD4 count ≤ 200 cells/ml, use of anti-retroviral (ART), ART use ≥ 2 years and use of protease inhibitors (PI) emerged as predictors of moderate-high FRS among the HIV+ participants. In conclusion, a high prevalence of CVD risk factors exists among HIV+ population in our local environment. These risk factors can be identified early by baseline/periodic cardiovascular work-up which should include use of CVD risk tools. Early diagnosis and treatment will significantly reduce morbidity and mortality in these patients.