Pc Inyang-Etoh

Efficacy of a combination of praziquantel and artesunate in the treatment of urinary schistosomiasis in Nigeria

The combined effects of praziquantel and artesunate in the treatment of urinary schistosomiasis were assessed among 312 randomly selected schoolchildren aged 4-20 years in Adim community, Nigeria. In the preliminary screening, infection was confirmed in 327 (38.5%) of the 850 subjects screened. Infected subjects who reported for treatment were then divided into six treatment groups of 52 subjects each; 44 subjects in each group completed their treatment regimens and submitted their urine for post-treatment assessment. Praziquantel and artesunate were administered orally at 40 mg/kg and 4 mg/kg body weight, respectively. Adverse effects due to drug reactions were assessed 72 h after medication and all perceived episodes of illness were treated. Morbidity indicators were assessed 56 days after the final dose of the drug regimens. All treatment regimens were well tolerated. The cure rates were 72.7% in the praziquantel plus placebo-treated group and 70.5% in the artesunate plus placebo group, while the artesunate plus praziquantel group had the highest cure rate (88.6%). Haematuria and proteinuria were extensively reduced after treatment with the three drug regimens. This study confirmed that the treatment of urinary schistosomiasis with the combination of praziquantel and artesunate is safe and more effective than treatment with either drug alone.

Efficacy of artesunate in the treatment of urinary schistosomiasis, in an endemic community in Nigeria

Abstract The efficacy and tolerability of oral artesunate for the treatment of urinary schistosomiasis was assessed among schoolchildren aged 5–18 years in Adim community, Nigeria. Overall, 500 children, randomly selected from those attending the Presbyterian primary school, were each invited to provide two consecutive urine samples. Using standard parasitological procedures, Schistosoma haematobium ova were found in the samples from 145 (29.0%) of the subjects. Most (87) of the infected subjects were then treated orally with artesunate, using two doses, each of 6 mg/kg, given 2 weeks apart. When the treated children were re-examined 4 weeks after the second dose of artesunate, 61 (70.1%) appeared egg-negative and were therefore considered cured. Post-treatment, the geometric mean egg count (GMEC) for the treated subjects who were not cured was significantly lower than the pre-treatment GMEC for all the treated subjects, with log10[(eggs/10 ml urine) + 1] values of 0.9 v. 1.75 (t = 4.45; P < 0.05). The cure rate for the subjects aged ≥ 10 years was slightly higher than that among the younger subjects. It was lowest for the heavier subjects (70% for those weighing 41–50 kg) and highest (79%) for the subjects who weighed 31–40 kg. The artesunate was well tolerated. This observation of a therapeutic effect of artesunate against S. haematobium in Nigeria confirms recent observations from Senegal. In the Adim community at least, it would be more cost-effective to treat urinary schistosomiasis with artesunate than with praziquantel. The wide-spread use of artesunate against schistosomiasis has to be considered carefully, however, if it is not to compromise the efficacy of the drug as an antimalarial, by increasing the risk of resistance developing in local Plasmodium.

The role of prophylactic antimalarial in the reduction of placental parasitemia among pregnant women in Calabar, Nigeria

Introduction: Intermittent preventive treatment of malaria with sulfadoxine-pyrimethamine is a recommendation of the World Health Organization as part of the malaria control strategy in pregnancy in areas with malaria burden. Aim: This study set out to appraise the effectiveness of this regimen in the prevention of placental parasitemia among parturients in Calabar, Nigeria. Materials and Methods: Pretested, precoded questionnaires were administered to eligible women at the antenatal clinic and later updated at the labor ward. Intermittent preventive treatment was administered under direct observation at the clinic, while packed cell volume, placental parasitemia, and other laboratory tests were measured at the labor ward. Results: The gross presence of placental malaria in the intermittent preventive treatment (IPT)-treated and the control groups was 10.6% and 11.3% respectively (P=0.76). Anemia occurred in 3.1% of the IPT-treated group compared to 11.7% among the control group (P=0.000). Only 7.9% of the IPT-treated women had moderate to severe placental parsitemia whereas as many as 53.2% of women in the control group had moderate to severe parasitemia (P=0.000). Conclusion: Intermittent preventive treatment of malaria with sulfadoxine-pyrimethamine was associated with significant reduction in the degree of placental parasitemia among women in the IPT-treated group, although it did not completely eradicate placental malaria in the treatment group.

Nuclear Matrix Protein 22 and Cytological Findings in Urine of Residents of Urogenital Schistosomiasis in an Endemic Community

Objective: Urogenital schistosomiasis has continued to cause severe morbidity among residents of Adim community. The aim of the study was to screen both adults and children residents of this community for urine tumour markers and to stain cytologically for epithelial changes which indicate the risk of them being predispose to bladder cancer. Methods: Terminal urine samples were collected by simple random sampling method from 350 subjects (300 children and 50 adults) in Adim Community for microscopy using standard parasitological methods, urinalysis, ELISA-based Nuclear Matrix Protein 22 (NMP22), and Papanicolaou- and Alcian blue-stained cytological analysis. Results: S. haematobium infection was observed in 18 (5.1%), proteinuria 21 (6.0%) and hematuria 30 (8.6%). Age group 25-31 years had the highest level of NMP22 values (1692.3 ± 46.4) among the adults and children. The difference was statistically significant (P=0.001). In general male subjects had higher NMP22 values (1214.6+ 487.1) than females (1198.9+ 472.9) (P=0.389). The cytological findings showed abnormal epithelial cells in Papanicolaou stain 2 (0.57%) and hyaluronic acid 1 (0.29%). Cytological findings with Papanicolaou stain revealed metaplasia 1 (0.3%), mild dysplasia 1 (0.3%), inflammation 6 (1.7%), and hyaluronic acid positive cells 1 (0.29%). Conclusion: The study showed S. haematobium prevalence of 5.1% but NMP 22 values were not positive for bladder cancer. The cytological findings revealed metaplasia, mild dysplasia and hyaluronic acid positive epithelial changes which are indicators for bladder cancer. J Microbiol Infect Dis 2018; 8(3):89-96

Efficacy of Histochemical Staining Techniques in the Detection of Plasmodium falciparum Histidine-Rich Proteins in Blood of Children with Malaria

Objective: Falciparum malaria predominates in sub-Saharan Africa and children below five years are the most vulnerable. Giemsa-stained microscopy is the gold standard in malaria diagnosis. Diagnosis with rapid diagnostic test (RDT) kit is also common and over 80% of available malaria RDT kits is Plasmodium falciparum histidine-rich protein 2-based (Pfhrp2). However, these histidine-rich protein 2-based kits have been observed to give false positive and negative results due to persistent antigenemia and low parasitaemia respectively. Thus, the methods of Pauly, Perls, and Means & Feeney were adopted to explore the advantage of using microscopy for specific detection of these histidine-rich proteins and their usefulness in detecting low parasitemia in children. Methods: Children aged 0-5 years (n=200) visiting three hospitals and private laboratories in Calabar were recruited. Whole blood samples were tested with CareStart Malaria HRP2-based kit, and blood films were made and stained with Giemsa, Pauly, Perls and Means & Feeney for microscopy. Results: The sensitivity and specificity were Giemsa (56.4%, 79.8%), Means & Feeney (52.5%, 77.8%), Perls (47.5%, 85.9), Pauly (45.5%, 86.9%), and RDT (23.8%, 96%). Pauly method had the highest area under the curve of 0.830 while RDT method had the lowest of 0.661. Among the positive cases low parasitemia detected by the histochemical methods was Perls 36 (75%), Pauly 32 (69.6%), and Means & Feeney 34 (64.2%), and for Giemsa method 40 (70.2%). Conclusion: Pauly method was the most accurate. All three methods were sensitive in detecting low parasitemia. These diagnostic methods are useful in malaria diagnosis in this endemic population. J Microbiol Infect Dis 2018; 8(2):55-60

Occurrence of Asymptomatic Bacteriuria amongst Inmates of Federal Neuropsychiatric Hospital Calabar, Nigeria

Aims: To determine the occurrence and prevalence of asymptomatic bacteriuria, influence of gender and duration of illness on the prevalence of this infection among inmates of Federal Neuropsychiatric Hospital, Calabar. Study Design: This was a cross sectional study. Ethical approval was obtained, consent forms were signed by the patients, questionnaires were also administer followed by collection and processing of clean catch mid-stream urine specimens. Place and Duration of Study: The study was carried out at Federal Neuropsychiatric Hospital Calabar, Nigeria between August, 2010 and September, 2011. Sample: Urine samples from two hundred (200) inmates and one hundred (100) apparently healthy staff of the same hospital (control subjects). Original Research Article Inyang-Etoh et al.; JAMPS, 11(4): 1-6, 2016; Article no.JAMPS.30491 2 Methodology: Urine samples were collected in sterile universal bottles and analyzed using standard laboratory diagnostic techniques and cultured using Lee and Williams technique. The modified Kirby-Bauer sensitivity testing technique was used for antimicrobial testing of the isolates. Results: Significant bacteriuria was established in 60(30%) of the inmates while only 8(8%) of the control subjects had bacteriuria. The difference in infection between the inmates and the control subjects was statistically significant (P = 0.001). Females 40(40%) were more infected than male subjects 20 (20%) but this was not statistically significant (P = 0.052). Inmates with 16-20 weeks of duration of mental disease had the highest level of infection 4(40%) while inmates with 1-5 weeks of duration of mental disease had the lowest level of infection 12(28%) and this was statistically significant (P = 0.001). The most common urinary pathogens isolated amongst both the test and control subjects were Escherichia coli (34) followed by Proteus spp (14) while Staphylococcus saprophyticus was the least isolated organism. Conclusion: This work has shown that asymptomatic bacteriuria is common among inmates of Federal Neuropsychiatric hospital, Calabar and the need to put in place strategies to control this infection among this category of patients in the study area.

Cytological findings in urine of adult residents of urinary schistosomiasis endemic community in Cross River State, Nigeria.

Aims: To investigate urinary cytological abnormalities among adult residents of a urinary schistosomiasis endemic community. Study Design: Ethical approval, consent from the village Head/villagers, parasitological survey and cytological analysis of urine. Place and Duration of Study: Adim Community in Cross River State, Nigeria between May and November 2014 Methodology: Urine samples from 160 sex matched adults aged 18–85 years were examined using standard parasitological techniques for the presence of ova of Schistosoma haematobium. The urine smears were stained with Papanicolaou and Alcian Blue (PH 2.5) staining techniques and examined for cytological abnormalities and the presence of Hyaluronic acid respectively. Results: 18 (11.3%) subjects were infected. Subjects in the age groups >35 – 45 years had the Original Research Article Inyang-Etoh et al.; BJMMR, 8(11): 948-955, 2015; Article no.BJMMR.2015.525 949 highest prevalence rate 9(20.5%) while those in the age group >75 – 85 years had the lowest prevalence rate 0(0%) and the difference was statistically significant (P = 0.359). The infection rate was higher among females 11(12.5%) than the males 7(9.7%) but the difference was not statistically significant (P = 0.580). Males had a higher mean egg count (18±25.7 egg/10 ml of urine) than the females (17±15.5 egg/10 ml of urine). Subjects in the age group >35–45 years had the highest level of abnormal epithelial cells 1(11.1%). Males had a higher prevalence of abnormal cells 3(42.9%) than the females 1(9.1%). There was a positive correlation between the occurrence of infection and abnormal epithelial cells (r = 0.5). 3(1.9%) of the subjects were positive for hyaluronic acid. Male subjects had a higher level of epithelial cells positive for hyaluronic acid 2(2.8%) than the female subjects 1(1.14%) but this was not statistically significant (p<0.05). Conclusion: This study has reconfirmed the endemicity of urinary schistosomiasis and has also revealed the presence of abnormal epithelial cells as an indicator for bladder cancer in the urine of residents in Adim community.

Occurrence of hepatitis 'B' and 'C' amongst patients on antiretroviral drug therapy (ART) in a treatment centre in Calabar, Nigeria

The occurrence of hepatitis ‘B’ and ‘C’ virus amongst patients on antiretroviral drug therapy (ART) was studied. Two hundred (200) human immunodeficiency virus (HIV) positive subjects on ART and 100 apparently healthy HIV negative subjects (control) were recruited for the study. The subjects aged 1 to 75 years were screened for hepatitis B and C viral antibodies using hepatitis B and C test strips manufactured by ACON Laboratories. Questionnaire were also administered. CD4 counts of the subjects were determined using CyFlow Counter manufactured by GEM Laboratories, Germany. Fourteen (7%) of the subjects were positive for hepatitis B virus (HBV) infection, 6 (3%) for hepatitis C virus (HCV) and 2 (1%) for mixed infections. In the control group, a prevalence of 6 (6%) was recorded for HBV, 4 (4%) for HCV and none for mixed infections. Among the test group, subjects in age group 51 to 60 years had the highest prevalence rate for HBV (25%), 31 to 40 years for both HCV (7.3%) and mixed infection (3.6%). There was no statistically significant difference in infection according to age P=0.475. Males had a higher prevalence rate (9.1%) than the females (5.4%) for HBV, but there was no statistically significant difference in HBV infections according to gender P=0.404. In HCV infection, males had a higher prevalence rate (5.7%) than females (0.9%), but there was no statistically significant difference in HCV infection according to gender P=0.089.xa0 Subjects with CD4 counts in the range of 1401 to 1600 had the highest infection rate (50%) for HBV and 201 to 400 for HCV (7.7%) and mixed infection (5.1%). This work has shown that HBV and HCV are common among patients on ART and the need for routine screening of this category of patients in order to aid in the effective management of co-infections. n n Key words: Hepatitis B, Hepatitis C, antiretroviral therapy, HIV, Calabar.