Lipid abnormalities among type 2 diabetes mellitus patients: our experience in Ilorin, Nigeria.
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Biomedical subjects
Publications and source records attributed to A K Salami.
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A 75-year-old woman presented at the eye clinic of the University of llorin Teaching Hospital with swelling of the left eyelids and protrusion of the left eyeball. The swelling was painless. Physical examination revealed no systemic abnormality. An incisional biopsy of the lid swelling revealed tuberculous orbital involvement. She responded well to anti-tuberculosis therapy, with regression of the lid swelling and proptosis. The importance of including intraorbital tuberculosis as a differential of orbital swelling in the environment is emphasised.
OBJECTIVE: This study evaluates the management outcome of patients with pulmonary tuberculosis (PTB) over a nine year period. Essentially the cure rate, rate of default and fatality rate were all estimated. Factors predisposing to poor drug compliance were also reviewed. METHODS: This was conducted by analysing the medical records of all newly diagnosed cases of PTB. Patients' demographic data, their social and past medical histories were obtained from their records. The extents of the lung lesions were determined from their chest X-rays. Criteria were set to define those that were (a) cured, (b) defaulted (c) transferred (d) had treatment failure and (e) died. The chi-square test of significance was used to estimate the difference between those that were cured and those that defaulted therapy. Multiple regression models were used to determine the level of interplay among the various factors contributing to patients' poor therapy compliance; the best of these was recorded. RESULTS: Out of the 1,741 cases of PTB treated over the studied period, 43.7% were cured, 0.3% had treatment failure, 44.2% defaulted therapy, 0.2% were transferred to other treatment centers while a fatality rate of 11.6% was recorded. Male gender, old age (> or =) 65 years), unmarried status, and previous default from therapy were found associated with poor therapy compliance. Others were unemployment, cigarette smoking and the use of alcohol. CONCLUSION: The cure rate of PTB in this study was very low, while the rate of default from therapy was quite high. These are in contrast to WHO target for TB control. To improve on these, directly observed therapy short course (DOTS) strategy for treating TB has to be adopted and implemented at all our treatment points for PTB. There should be emphasis on the Primary health Care (PHC) centers, because majority of PTB patients are grass root people and PHC set-ups are closer to them.
Since the advent of HIV/AIDS, many opportunistic organisms have proved to be potential pathogens in infected patients. We present a case report of opportunistic filamentous fungal meningitis caused by Scopulariopsis species in a 38 year old Nigerian male.
OBJECTIVE: To determine the incidence, microbiological pattern and prognostic factor of bacterial pneumonia in AIDS patients. STUDY DESIGN: Prospective study of AIDS patients from July 2001 to Dec 2002. METHODOLOGY: Adults AIDS patients on HAART drugs that develop acute fever, cough with bronchial breathing or lung crepitations had diagnostic evaluation that included chest x-ray, paired sputum microscopy, culture and sensitivity, paired blood culture and haematological profiles including CD4' cell count. RESULTS: Twenty-one patients (22.6%), 9 males and 12 females developed community acquired pneumonia during this 16-month period. Pneumonia was confirmed in 9 patients (42.9%), presumed in 4 (19%) and probable in 8 (38%). Streptococcus pneumoniae accounted for 22% of the cases when immunity was less impaired. Staplhylococcus aureus accounted for another 22 % while Klebsiella pneumoniae, Pseudomonas aeraginosa and Escherichial coli were isolated in 11% each when immunity was severely compromised. Fifteen patients (71.4%) were successfully treated with routine antibiotics. Six cases (28.6%) died. All had anaemia, leucopoenia and low CD4 cell count. Four (66.7%) of this had positive bacterial culture with bacteremia in three of them. CONCLUSION: Bacterial pneumonia in HIV-infected patients has similar presentation to that in the general population, Staphylococcus aureus and gram-negative bacilli especially Klebsiella pneumoniae were seen in a good proportion of the cases. Outcome of treatment was poor in the presence of positive bacterial culture, anemia, leucopoenia and very low CD4+ lymphocytes.
BACKGROUND: Opportunistic diseases (ODs) of varying types and severities have been reported amongst HIV infected patients around the world, this made us to define the incidence, spectrum and effects of ODs on HIV infected Nigerians' CD4+cells count and survival rate. DESIGN: Retrospective analyses of HIV register from February 2002 to July 2004. RESULTS: ODs developed in 201 (68.6%) patients, 107 (53.2%) were AIDS-defining viz; TB, HIV-encephalopathy, scopulariopsis meningitis, cutaneous kaposis sarcoma and pulmonary candidiasis. Mean CD4+ count was lower with ODs compared to the controls, 138/ul vs 211/ul, p < -0.0006. It was low with non-AIDS-defining infection, 221.6/ul, lower with non-infectious AIDS-defining diseases, 192.4/ul and lowest with AIDS-defining infections, 117.7/ul. Mortality rate was 29.4%; 51 infectious and 8 non-infectious ODs against 19 (18.4%) from the controls. Risk of death was four folds higher with ODs over the controls, 59 vs 19, OR=3.98, 95%CI= 2.20- 7.27, X=24.2, p-<0.0001. This risk was also higher with infectious AIDS-defining illnesses compared to non-infectious ones, 48 vs 8, RR=4.83, 95 %CI=2.80- 8.34, X= 51.7, p-<0.0001. Death from TB was over 2(1/2) times higher than deaths from other AIDS-defining diseases, 45 vs 14, RR=2.7,95%CI=2.01-3.73,x=37.3, p-<0.0001. Average survival was shorter with ODs; 12.3weeks compared to controls, 37.8weeks, p-< -0.039. Mean survival was longest with EPTB, 29.8weeks and shortest with fungal meningitis, 1.9weeks. CONCLUSION: incidence of ODs was high, 68.6%; it was associated with lower CD4+ count and shorter patient's survival especially when it was infectious and AIDS defining.
This is a hospital based retrospective study that determines the prevalence of pulmonary tuberculosis (PTB) and seroprevalence of Human Immunodeficiency Virus (HIV) infection amongst PTB cases. The study was over a nine year period. The annual distribution of all PTB and PTB/HIV co-infected cases were estimated, so was the annual distribution of all medical cases seen over the same period. A total of 104,240 medical cases were seen, out of which 9697 were confirmed PTB. This gives a prevalence rate of 9.2%. Their sex ratio was M:F 1.3:1 and about 81.6% of them were between 15-54 years of age. Only 189 out of 1496 cases of PTB screened for HIV antibody were seropositive giving a seroprevalence rate of 12.6%. The annual distribution of PTB/HIV co-infection showed a rising trend from only one case in 1991 to 20 cases in 1999. Majority of those who were seropositive were traders, housewives and drivers.