Bukar Bakki

Hepatic transaminase and alkaline phosphatase enzyme levels in HIV/HBV co‑infected and HIV mono‑infected patients in Maiduguri, Nigeria

BACKGROUND Studies have shown that HIV-HBV co-infected patients have an increased risk of liver-related morbidity and mortality compared to their HIV-mono-infected counterparts. Furthermore, it has been reported that HIV-HBV co-infected patients have a significantly high incidence of drug-induced hepatotoxicity following commencement of HAART than HIV-mono-infected patients. OBJECTIVES To compare the levels of aspartate amino transferase (AST), alanine amino transferase (ALT) and alkaline phosphatase (ALKPO 4 ) enzyme levels between HAART naïve HIV-HBV co-infected patients and their HIV-mono-infected counterparts. MATERIALS AND METHODS A cross-sectional descriptive study in which 142 newly diagnosed HIV/HBV co-infected and HIV mono-infected adults were investigated for alkaline aminotransferase, aspartate aminotransferase and alkaline phosphatase enzyme levels. RESULTS The study subjects comprised of 80 (56.3%) females and 62 (46.7%) males. The age range of the study population was 15-65 years. The mean ages of male and female subjects were 45.5 ± 10.5 years and 39.1 ± 7.5 years respectively ( P < 0.05). Sixty-three (44.4%) study subjects were HIV/HBV co-infected while 79 (55.6%) were HIV mono-infected. The mean ALT enzyme level of HIV/HBV co-infected subjects was significantly higher than that of HIV mono-infected ones i.e., 42.12 IU/l vs. 27.86 IU/l, ( P = 0.038). However, there was no statistically significant difference in the mean AST (30.14 IU/l vs. 29.09 IU/l, P = 0.893) and ALKPO 4 (55.86 IU/l vs. 60.97 IU/l, P = 0.205) enzyme levels between HIV-HBV co-infected and HIV mono-infected subjects albeit the two enzymes were moderately elevated in both categories of subjects. CONCLUSION The significantly elevated ALT enzyme levels amongst HIV-HBV co-infected subjects suggest that HIV-HBV co-infected patients may have an increased risk of liver-related morbidity and mortality than their HIV mono-infected counterparts. Screening for serological markers of chronic HBV infection, as well as hepatic transaminase enzyme levels in all newly diagnosed HIV-positive patients is therefore recommended before commencement of HAART.

Spectrum of cardiovascular diseases diagnosed using transthoracic echocardiography: Perspectives from a tertiary hospital in North-Eastern Nigeria

Background: The advent of echocardiography has tremendously improved the diagnosis of cardiovascular diseases. We present a review of cardiovascular disorders diagnosed using transthoracic echocardiography over 3 years. Materials and Methods: Echocardiographic data of patients from January 2011 to December 2013 were retrieved. All subjects had standard transthoracic echocardiography including Doppler modalities where appropriate. Descriptive statistics was used in assessing the occurrence of the different cardiac disorders. Results: One thousand three hundred and two echocardiograms were considered, out of which 1224 (94%) comprising 591 (48.3%) males and 633 (51.7%) females were analyzed. Ages ranged from 4 days to 105 years with a mode of 60 years and a mean of 39.62 ± 20.58 years. The most common indications were hypertensive heart disease (HHD) (28.2%) and congestive cardiac failure (23.4%). HHD was the most common diagnosis (25.1%) followed by cardiomyopathies (23.9%). Idiopathic dilated (29.3%) and peripartum cardiomyopathy (23.1%) were the most common cardiomyopathies. Valvular heart diseases (VHD) were diagnosed in 14.9%, with rheumatic (60.4%), and degenerative (36.4%) being dominant. Congenital heart disease was diagnosed in 7.2%, with 70.5% of the cases in those ≤14 years. Ischemic heart disease was diagnosed in 6.6%. Pericardial diseases were found in 3.2%, while cor pulmonale was documented in 0.8%. Atrial myxoma dissection of the ascending aorta, athletes heart, and amniotic fluid embolism were each observed in <1%. A normal echocardiogram was reported in 13.3%. Conclusion: The most common echocardiographic diagnoses in our center are HHD, cardiomyopathies, and VHD. Congenital and ischemic heart diseases are also prevalent.

Cryptococcal neorformans Antigenemiaamong HIV-Infected Patients in NorthEastern Nigeria

Background: Cryptococcus neoformans infection is a common fungal infection that is cosmopolitan in distribution and causes a life-threatening disease among HIV-infected patients especially in advanced disease. Screening for cryptococcal antigen (CrAg) in patients enrolling in ART programs may identify those at risk of cryptococcal meningitis and permit targeted use of pre-emptive therapy. Methods: This was a cross survey study of 215 consecutive HIV-infected patients at an ART treatment centre were screened for cryptococcal antigenaemia using the cryptococcalantigen lateral flow assay (CrAg LFA). Study subjects were assessed for clinical features of Cryptococcus neoformans infection. CD4+ cell count, haemoglobin concentration as well as HIV-1 RNA viral load was also compared between cryptococcalantigen positive and negatives. Results: 37 (16.7%) patients were positive for cryptococcal antigenaemia. Cryptococcal antigen positive subjects had a lower median CD4+ cell count (58 cells/uL vs. 273 cells/uL, p<0.001) and higher median viral load (log 3.6 copies/mL vs. log2.3 copies/mL, p=0.05) compared to cryptococcal antigen negative subjects. The commonest predictors of positive CrAg status in the study were; low BMI, low Hb, fever and cough. Conclusion: The study has shown the prevalence of cryptococcal antigenaemia to be high among the study subjects attending this service. Therefore, screening of patients receiving care at this centre may help in identifying individuals who are at risk of cryptococcalmeningitis for prophylactic treatment.

Cardiac masses diagnosed on transthoracic echocardiography at Nigerian Tertiary Hospital: A 3-year review

Background: Echocardiography has since its inception, assumed a significant role in evaluation of cardiac masses, supplanting other diagnostic modalities for this purpose. We reviewed the various kinds of cardiac masses detected using transthoracic echocardiography in our center over a period of 3-year. Materials and Methods: Echocardiographic data of patients that underwent transthoracic echocardiography from January 2011 to December 2013 were retrieved. All subjects had standard transthoracic echocardiography including all forms of Doppler modalities where appropriate. Descriptive statistics was used in assessing the proportion of the different cardiac masses observed. Results: One thousand three hundred and two transthoracic echocardiograms were performed over the 3-year period, out of which 1224 comprising 591 (48.3%) males and 633 (51.7%) females were retrieved and reviewed. Their mean age was 39.62 (20.6) years. Cardiac masses were documented in 106 (8.7%) of the subjects. The most common cardiac mass was intracardiac thrombus, observed in 89 (84.0%) followed by vegetation in 10 (9.4%). A presumptive diagnosis of right atrial myxoma was made in 4 (3.8%), whereas 1 (0.9%) had a right atrial mass of uncertain cause. Inferior vena cava mass and metastatic lesion to pericardium were each diagnosed in 1 (0.9%) patient. Most of the cardiac thrombi involved the left ventricle (94.4%), whereas vegetations were mainly on the mitral valve (80%). Conclusion: The dominant causes of cardiac mass observed are cardiac thrombus, commonly involving the left ventricle, and vegetations on mitral valve.

Extrapulmonary TB in North Eastern Nigeria: A 10-Year Retrospective Review

Background: Information on extrapulmonary TB is scarce in Nigeria despite being one of the 22 countries with highest burden of tuberculosis in the world and the most populous country in sub-Saharan Africa where the dual epidemics of TB and HIV/AIDS mutually co-exist. Objective: The purpose of this study was to document the burden of extrapulmonary TB in North-eastern Nigeria. Methodology: A retrospective cross-sectional study was conducted at a DOTS treatment centre in a tertiary hospital in North-eastern Nigeria. TB treatment registers and case records of 1240 patients were reviewed over a 10-year period. Results: Out of the 1240 TB cases who received treatment at the facility; 179 (14.4%) had extra-pulmonary TB. Skeletal TB and TB lymphadenitis were the predominant forms of extra-pulmonary TB in the study i.e. 51 (28.5%) and 50 (28.0%), respectively. This was closely followed by abdominal TB (38 (21.2%), tuberculous pleural effusion (23 (12.8%), miliary TB (9 (5.0%), TB meningitis (3 (1.7%) and others (5 (2.8%): viz; 1 (0.6%) each of- TB of the breast, TB of the skin, adrenal TB, genitourinary TB and TB pericarditis respectively. Only 101 (56.4%) of the study subjects had information on their HIV status; of whom 52 (51.5%) were HIV positive and 49 (48.5%) HIV negative. Conclusion: The study has shown that extrapulmonary TB was relatively common among TB patients receiving care at the facility despite its diagnostic challenges particularly in a resource poor setting like ours.

0491: Sudden cardiac death: clinical perspectives from the University of Maiduguri Teaching Hospital, Nigeria

Background Despite tremendous advances in the management of cardiovascular diseases and cardiac arrest, there is paucity of information regarding sudden cardiac death in sub-Saharan Africa. We present a two-year review of sudden cardiac death cases among patients managed at a Nigerian tertiary hospital. Material and Methods Patients admitted from January 2012 to December 2013 were prospectively followed-up and cases of sudden cardiac death identified. Diagnosis was based on records of events preceding death, direct interview of attending physician/nurses, and family members/eye witnesses for out-of-hospital sudden cardiac death. Causes of death were obtained from the death certificates for cases of in-hospital events. Results Three hundred and eighty eight (M:F=1:1.3) patients with a mean age of 42.22±19.30 years were admitted into the cardiac unit during the period, out of whom 56 (14.4%) died. Twenty three (41.1%) were classified as sudden cardiac death. The predominant etiology was ischemic cardiomyopathy (39.1%), followed by peripartum cardiomyopathy (21.7%) and dilated cardiomyopathy (17.4%). Rheumatic heart disease was diagnosed in 17.4%, while 4.3% had pulmonary hypertension. Nineteen (82.6%) of the subjects had congestive cardiac failure. Hypokalemia and hypocalcaemia were recorded in 2 (8.7%) patients who developed prolongation of the QT interval following commencement of diuretics. Chest-compression- only cardiopulmonary resuscitation was attempted in 12 (52.1%) with a success rate of 8.3%. Conclusion Sudden cardiac death is common among our patients admitted with cardiovascular diseases. The most common etiology is ischemic cardiomyopathy, followed by peripartum cardiomyopathy. Most of the victims were young, and there were no optimum resuscitative measures.

Aspiration pneumonia in patients with stroke in Northeast Nigeria

Dear Editor A prospective study by Hilker et al. (1) reported that stroke-associated pneumonia occurred in 21·4% of patients and identified mechanical ventilation, multiple strokes, vertebrobasilar stroke, and dysphagia as risk factors. These patients had higher mortality rates and poorer clinical outcome. We conducted a prospective study at the University of Maiduguri Teaching Hospital titled ‘Aspiration Pneumonia in patients with stroke in Northeast Nigeria’, between January 2005 and May 2011. We identified the frequency and factors predicting the development of aspiration pneumonia. Aspiration pneumonia occurred in 12·4% of stroke patients. Factors associated with the development of aspiration pneumonia suggested by regression analysis (Table 1) are: age >60 years; Glasgow coma score 12; dysphagia; dysphasia; modified Rankin disability score 4; National Institutes of Health Stroke Score 11; Barthel Activity of Daily Living (ADL) index <30. These patients had a higher 60-day fatality (75·4% versus 9·4%; P 0·001, c test) and lower duration of stay (25·3 17·5 versus 34·6 28·3; P = 0·01). In contrast to the studies by Hilker et al. (1) and Langmore et al. (2), the lower rate of pneumonia in our patients may be due to differences in definition, identification, and diagnosis of patients. We did not include other causes of pneumonia not attributed to aspiration; this may have also affected the rate. Most of our patient had no neuroimaging, and so we could not assess the effect of stroke sub-type, area, and size of lesion with these predictors as it influences the development of aspiration pneumonia. We also did not study the influence of nasogastric tube insertion as in the study by Nakajoh et al. (3). Finally, our study agrees with the other authors (1,2,4) that aspiration pneumonia is associated with severe stroke and higher mortality rate, and prevention of pneumonias in stroke patient should be a treatment priority.