Browsing by Author "Fowotade, A."

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A 4-Year cross-sectional study of Hepatitis B virus infection among pregnant women: need for policy decision
(Ecronicon, 2022-03) Fowotade, A.; Omoruyi, E. C.; Adesina, O.; Adekanmbi, O.; Adetunji, S.; Akande, K. O.; Adepoju, A.
Background: The elimination of hepatitis B virus (HBV) in Nigeria, especially among pregnant women requires commitment from the government and health policy makers. This is predicated on comprehensive surveillance and epidemiological data. The objective of the current study is to provide the epidemiological data and unique perspectives that will inform accurate advocacy and influence policy decisions. Materials and Methods: A 4-year cross-sectional study was conducted among 2,428 consecutively recruited consenting pregnant women attending antenatal care at the University College Hospital, Ibadan, Oyo State, Nigeria. Venous blood was screened for HBsAg using Enzyme Linked Immunosorbent Assay (ELISA). HBsAg sero-negative samples were further tested for other HBV serological markers (anti-HBc, HBeAg and anti-HBe by ELISA. Socio-demographic and clinical details were obtained using a semi-structured questionnaire. Results: Overall HBsAg prevalence was 5.1% (2,305/2,482). Twenty three (1%) of the HBsAg sero-negative women tested positive to both anti-HBc and anti-HBe while 5.3% and 0.8% tested positive to only anti-HBc and anti-HBe, respectively. Additionally, 6.4% (38/594) of the HBV fully vaccinated pregnant women tested positive to HBsAg. Conclusion: Hepatitis B is endemic among Nigerian pregnant women. Serological patterns indicated possible occult hepatitis B infection. More political commitment from government and policy makers is urgently required.
A multi-country phase 2 study to evaluate the suitcase lab for rapid detection of SARS CoV-2 in seven Sub-Saharan African countries: Lessons from the field
(Elsevier B.V., 2023) Ceruti, A.; Dia, N.; Bakarey, A. S.; Ssekitoleko, J.; Andriamandimby, S. F.; Malwengo-Kasongo, P.; Ahmed, R. H. A.; Kobialka, R. M.; Heraud, J. M.; Diagne, M. M.; Fowotade, A.
Background: The COVID-19 pandemic led to severe health systems collapse, as well as logistics and supply delivery shortages across sectors. Delivery of PCR related healthcare supplies continue to be hindered. There is the need for a rapid and accessible SARS-CoV-2 molecular detection method in low resource settings. Objectives: To validate a novel isothermal amplification method for rapid detection of SARS-CoV-2 across seven sub-Sharan African countries. Study design: In this multi-country phase 2 diagnostic study, 3,231 clinical samples in seven African sites were tested with two reverse transcription Recombinase-Aided Amplification (RT-RAA) assays (based on SARS-CoV-2 Nucleocapsid (N) gene and RNA-dependent RNA polymerase (RdRP) gene). The test was performed in a mobile suitcase laboratory within 15 min. All results were compared to a real-time RT-PCR assay. Extraction kits based on silica gel or magnetic beads were applied. Results: Four sites demonstrated good to excellent agreement, while three sites showed fair to moderate results. The RdRP gene assay exhibited an overall PPV of 0.92 and a NPV of 0.88. The N gene assay exhibited an overall PPV of 0.93 and a NPV 0.88. The sensitivity of both RT-RAA assays varied depending on the sample Ct values. When comparing sensitivity between sites, values differed considerably. For high viral load samples, the RT-RAA assay sensitivity ranges were between 60.5 and 100% (RdRP assay) and 25 and 98.6 (N assay). Conclusion: Overall, the RdRP based RT-RAA test showed the best assay accuracy. This study highlights the challenges of implementing rapid molecular assays in field conditions. Factors that are important for successful deployment across countries include the implementation of standardized operation procedures, in-person continuous training for staff, and enhanced quality control measures.
A randomized, open-label trial of combined nitazoxanide and atazanavir/ritonavir for mild to moderate COVID-19
(Frontiers Media, 2022-09) Fowotade, A.; Bamidele, F.; Egbetola, B.; Fagbamigbe, A. F.; Adeagbo, B. A.; Adefuye, B. O.; Olagunoye, A.; Ojo, T. O.; Adebiyi, A. O.; Olagunju, O. I.; Ladipo, O. T.; Akinloye, A.; Onayade, A.; Bolaji, O. O.; Rannard, S.; Happi, C.; Owen, A.; Olagunju, A.
Background: The nitazoxanide plus atazanavir/ritonavir for COVID-19 (NACOVID) trial investigated the efficacy and safety of repurposed nitazoxanide combined with atazanavir/ritonavir for COVID-19. Methods: This is a pilot, randomized, open-label multicenter trial conducted in Nigeria. Mild to moderate COVID-19 patients were randomly assigned to receive standard of care (SoC) or SoC plus a 14-day course of nitazoxanide (1,000 mg b.i.d.) and atazanavir/ritonavir (300/100 mg od) and followed through day 28. Study endpoints included time to clinical improvement, SARS-CoV-2 viral load change, and time to complete symptom resolution. Safety and pharmacokinetics were also evaluated (ClinicalTrials.gov ID: NCT04459286). Results: There was no difference in time to clinical improvement between the SoC (n = 26) and SoC plus intervention arms (n = 31; Cox proportional hazards regression analysis adjusted hazard ratio, aHR = 0.898, 95% CI: 0.492–1.638, p = 0.725). No difference was observed in the pattern of saliva SARS-CoV- 2 viral load changes from days 2–28 in the 35% of patients with detectable virus at baseline (20/57) (aHR = 0.948, 95% CI: 0.341–2.636, p = 0.919). There was no significant difference in time to complete symptom resolution (aHR = 0.535, 95% CI: 0.251–1.140, p = 0.105). Atazanavir/ritonavir increased tizoxanide plasma exposure by 68% and median trough plasma concentration was 1,546 ng/ml (95% CI: 797–2,557), above its putative EC90 in 54% of patients. Tizoxanide was undetectable in saliva. Conclusion: Nitazoxanide co-administered with atazanavir/ritonavir was safe but not better than standard of care in treating COVID-19. These findings should be interpreted in the context of incomplete enrollment (64%) and the limited number of patients with detectable SARS-CoV-2 in saliva at baseline in this trial.
A randomized, open-label trial of combined nitazoxanide and atazanavir/ritonavir for mild to moderate COVID-19
(Frontiers Media SA, 2022) Fowotade, A.; Bamidele, F.; Egbetola, B.; Fagbamigbe, A. F.; Adeagbo, B. A.; Adefuye, B. O.; Olagunoye, A.; Ojo, T. O.; Adebiyi, A. O.; Olagunju, O. I.; Ladipo, O. T.; Akinloye, A.; Onayade, A.; Bolaji, O. O.; Rannard, S.; Happi, C.; Owen, A.; Olagunju, A.
Background: The nitazoxanide plus atazanavir/ritonavir for COVID-19 (NACOVID) trial investigated the efficacy and safety of repurposed nitazoxanide combined with atazanavir/ritonavir for COVID-19. Methods: This is a pilot, randomized, open-label multicenter trial conducted in Nigeria. Mild to moderate COVID-19 patients were randomly assigned to receive standard of care (SoC) or SoC plus a 14-day course of nitazoxanide (1,000 mg b.i.d.) and atazanavir/ritonavir (300/100 mg od) and followed through day 28. Study endpoints included time to clinical improvement, SARS-CoV-2 viral load change, and time to complete symptom resolution. Safety and pharmacokinetics were also evaluated (ClinicalTrials.gov ID: NCT04459286). Results: There was no difference in time to clinical improvement between the SoC (n = 26) and SoC plus intervention arms (n = 31; Cox proportional hazards regression analysis adjusted hazard ratio, aHR = 0.898, 95% CI: 0.492–1.638, p = 0.725). No difference was observed in the pattern of saliva SARS-CoV2 viral load changes from days 2–28 in the 35% of patients with detectable virus at baseline (20/57) (aHR = 0.948, 95% CI: 0.341–2.636, p = 0.919). There was no significant difference in time to complete symptom resolution (aHR = 0.535, 95% CI: 0.251–1.140, p = 0.105). Atazanavir/ritonavir increased tizoxanide plasma exposure by 68% and median trough plasma concentration was 1,546 ng/ml (95% CI: 797–2,557), above its putative EC90 in 54% of patients. Tizoxanide was undetectable in saliva. Conclusion: Nitazoxanide co-administered with atazanavir/ritonavir was safe but not better than standard of care in treating COVID-19. These findings should be interpreted in the context of incomplete enrollment (64%) and the limited number of patients with detectable SARS-CoV-2 in saliva at baseline in this trial.
A rare case of Salmonella Typhi Meningitis in an eleven month old infant: a case report
(Association of Resident Doctors, University College Hospital, Ibadan, 2012) Nwadike, V. U.; Fowotade, A.; Tuta, K. E.; Olusanya, O. O.
Non-typhoidal Salmonella are infrequent causes of childhood meningitis. Most reports of Salmonella typhi meningeal infections are confined to neonates. A rare instance of S. typhi in an otherwise healthy eleven month old infant is being reported.
A review of swine Influenza: an emerging pandemic
(African Journals Online, 2009) Fowotade, A.; Agbede, O.; Nwabuisi, C.; Fadeyi, A.
An unprecedented epizootic swine Influenza A (HINT) virus that is highly pathogenic has crossed the species barrier in Mexico to cause many human fatalities and poses an increasing pandemic threat. This summary describes the aetiopathogenesis of human infection with Influenza A (HINI) and reviews recommendations for prevention and clinical management.
A year of genomic surveillance reveals how the SARS-CoV-2 pandemic unfolded in Africa
(American Association for the Advancement of Science, 2021) Wilkinson, E.; Giovanetti, M.; Tegally, H.; San, J. E.; Lessells, R.; Cuadros, D.; Martin, D. P.; Rasmussen, D. A.; Zekri, A. N.; Fowotade, A.
The progression of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in Africa has so far been heterogeneous, and the full impact is not yet well understood. In this study, we describe the genomic epidemiology using a dataset of 8746 genomes from 33 African countries and two overseas territories. We show that the epidemics in most countries were initiated by importations predominantly from Europe, which diminished after the early introduction of international travel restrictions. As the pandemic progressed, ongoing transmission in many countries and increasing mobility led to the emergence and spread within the continent of many variants of concern and interest, such as B.1.351, B.1.525, A.23.1, and C.1.1. Although distorted by low sampling numbers and blind spots, the findings highlight that Africa must not be left behind in the global pandemic response, otherwise it could become a source for new variants.
Antimalarial use and the associated factors in rural Nigeria following implementation of Affordable Medicines Facility-Malaria (AMFM) price subsidy
(Science Publications, 2013) Efunshile, A. M.; Fowotade, A.; Makanjuola, O. B.; Oyediran, E. I.; Olusanya, O. O.; Koenig, B.
Purpose This study was set out to find out the pattern of antimalarial drug use in a Nigerian rural community following the aggressive price subsidy of Artemisinin Combination Therapy(ACT) recently embarked upon by Roll Back Malaria partners through Affordable Medicines Facility-malaria (AMFm). Methods Questioners were administered to 310 adult members of the community with the most recent malaria episodes so as to find out about the drugs used and some of the factors associated with the choice of the drug. Result Although the overall use of ACT (13.55%) in this community was about 4 times higher than what it used to be, Chloroquine 123(39.62%) and sulphadozine/pyrimathamine 120(38.71%) were the mostly used antimalarial agents. Choice of drug used was significantly associated with perception of efficacy and price among other factors. Respondents liked the price of ACT (33.3%) most, CQ was the drug most liked in terms of efficacy (44.2%) while SP was the drug most liked in terms of lack of side effect (38.9%), taste (61.6%) and convenience (35.7%).( P= 0.001) Conclusion In addition to sustaining the current price control, there is a need to continuously monitor and effectively regulate the quality of the ACTs in circulation so as to gain the confidence of both the prescribers and the end users regarding efficacy and adherence to ACTs. This will help to safeguard the huge investment in ACT subsidy by the Roll Back Malaria partners.
Apparent rarity of asymptomatic herpes cervicitis in a woman with intra-uterine contraceptive device
(PAGEPress, 2013) Fowotade, A.; Okolo, A. C.; Manga, M. M.; Anaedobe, C. G.; Salami, A. A.; Akang, E. E. U.
Infection with genital herpes simplex virus (HSV) remains a common viral sexually transmitted disease, often subclinical and a major worldwide problem of women of reproductive age group. Herpes cervicitis is an unusual presentation of Herpes simplex virus infection in females. The finding of herpes cervicitis on routine pap smear of an asymptomatic woman on Intrauterine contraceptive device still further supports the need for increased awareness on the possibility of Herpes simplex virus infection among women, particularly those on Intrauterine contraceptive device. The index case is a 28 years old Nigerian female who was referred to our Special Treatment Clinic on account of an abnormal pap smear cytology which was in keeping with Herpes cervicitis. There was no history of genital ulcer in this patient; however ELISA for HSV 2 IgM was positive in her. We therefore describe a case of herpes cervicitis in an asymptomatic woman on intrauterine contraceptive device. This case highlights to clinicians the need to be aware of the possibility of this association and to carry out relevant investigations so as to identify and treat these patients appropriately. Therefore, there is a need to put in place adequate public health intervention strategy to prevent genital herpes in women of reproductive age group with a view to preventing the possibility of congenital herpes in subsequent pregnancy.
Association of the ABO blood group with SARS-CoV-2 infection in a community with low infection rate
(International Society of Blood Transfusion, 2021) Kotila, T. R.; Alonge, T. O.; Fowotade, A.; Famuyiwa, O. I.; Akinbile, A. S.
Background and objectives Reports on the association of the ABO phenotypes with infection by the SARS-CoV-2 virus have mostly come from countries with high infection rates. This study examined the possible association between SARS-CoV-2 infection and the ABO phenotype in Black Africa. Materials and methods This report is from a single centre where both asymptomatic and symptomatic patients were quarantined. At the time of this report, Oyo State, Nigeria had carried out 15 733 tests of which 3119 were positive for the virus with 1952 recoveries and 37 deaths. The ABO distribution of patients was compared with that of a blood donor population. Results Of the 302 participants, 297 (98%) had their blood group determined, asymptomatic and symptomatic individuals were 123 (40_7%) and 179 (59_3%) respectively. Blood group O was significantly less represented among the patients (P < 0_01) while blood groups B and AB were significantly more represented (P < 0_01, P = 0_03 respectively). Patients with anti-B (groups A and O) were significantly less represented than those without anti-B (B and/or AB): B and AB (P < 0_001), B (P = 0_002), AB (P = 0_01). There was no difference in the blood group distribution of symptomatic and asymptomatic patients (v2 (3, N = 302) = 2_29; P = 0_51), but symptomatic patients with anti-A (groups B and O) were more represented than asymptomatic patients with anti-A (v2 4_89; P = 0_03). Conclusion The higher prevalence of blood group O and more potent beta haemolysins (anti-B antibodies) are likely reasons for the lower infectivity by the SARS-CoV-2 virus and severity of COVID-19 disease in the community.
Asymtomatic bacteriuria in antenatal patients in Ilorin, NIgeria
(Oman Medical Specialty Board, 2012) Ajayi, A. B.; Nwabuisi, C,; Aboyeji, A. P.; Ajayi, N. S.; Fowotade, A.; Fakeye, O. O.
Objective: To determine the prevalence of asymptomatic bacteriuria, bacteriology and sensitivity pattern in Ilorin using the gold standard of urine culture. Methods: A prospective study was carried out from 1st July to 31st October 2007, at the University of Ilorin Teaching Hospital (UITH) on 125 consenting asymptomatic pregnant women. A structured proforma was used to collect information from the women and a midstream urine specimen collected for bacteriological culture. Results: Of the 125 pregnant women, 50 had bacteriuria on urine culture giving a prevalence of 40%. The mean age of the women was 28.5 years with a standard deviation of 4.95. The age ranged between 14 and 40 years. Staphylococcus aureus was the commonest pathogen isolated (72%), followed by Proteus spp (14%). Most of the organisms showed good sensitivity to Nitrofurantoin and gentamicin. Conclusion: The prevalence of asymptomatic bacteriuria in Ilorin is high and routine urine culture is advocated for all pregnant women at booking.
Awareness and practice of safety precautions among healthcare workers in the laboratories of two public health facilities in Nigeria
(Wolters Kluwer Medknow Publications, 2011) Fadeyi, A.; Fowotade, A.; Abiodun, M. O.; Jimoh, A. K.; Nwabuisi, C.; Desalu, O. O.
Aims and objectives: To determine the level of awareness and practice of SP among laboratory workers at two tertiary public health facilities in Nigeria. Methods: A semi-structured, self-administered questionnaire was used to assess the awareness, attitude and adherence to SP among laboratory workers. Information on the availability of safety equipment was also sought. The laboratory safety practice of respondents was assessed based on self-reported observance of basic principles of universal precautions in clinical settings. Results: Study participants were 130, mean age: 28.2 years (SD±6.6), number of years in hospital employment: 3.7 years (SD±2.4) and the male to female ratio was 1.8:1. Many (41.5%) were unaware and 25.4% do not observe SP. Participants attest to availability of various safety devices and equipment including hand gloves (86.2%), disinfectants (84.6%), HBV immunization (46.2%) and post exposure prophylaxis (PEP) for HIV and HBV (79.6%).Attitude to safety is unsatisfactory as 60.0% eat and drink in the laboratory, 50.8% recap needles and 56.9% use sharps box. Even though 83.1% are willing to take PEP, only 1.5% will present self following laboratory injury. Conclusion: This study shows the deficit in the awareness of SP among laboratory personnel and demonstrates that attitude and practice of safety rules are unsatisfactory. Training and re-training on SP is therefore desired. Counselling to induce a positive attitudinal change on HBV immunisation and PEP is similarly necessary.
Blueprint for health security in Nigeria by 2050: infectious diseases perspective
(University College Hospital, University of Ibadan, 2019) Adekanmbi, O.; Fowotade, A.; Ogunbosi, B.; Oladokun, R.
Background: Infectious Diseases remain a leading cause of morbidity and mortality in Nigeria. Notably, natural and socio-cultural differences across Nigeria account for significant differences in types of infectious diseases that occur in different parts of the country. The communicable nature of infectious diseases either from person to person or via vectors has made it difficult to eradicate or even stem the tide of these diseases. HIV/AIDS, tuberculosis and malaria in particular are well established and enduring contributors to the infectious disease burden in Nigeria and this is very likely to continue to be the case in the foreseeable future. Method: Literature from PubMed and Google was extracted using the keywords; Health Security, Year 2050 and Infectious Diseases Results: In more recent times in Nigeria, the problem of emerging and re-emerging infections, often of epidemic importance as well as antimicrobial resistance also add to the infectious disease burden and compete for the already inadequate resources available to battle infectious disease. Many infectious diseases can be prevented by simple, effective and relatively low-cost interventions. Such interventions need to be emphasized to maximize cost-effectiveness of any resources expended. Nigeria’s young, trainable, potential healthcare workforce and existing infrastructure such as the primary healthcare system, disease surveillance systems and widespread mobile phone use need to be strengthened arid leveraged for a good approach to infectious disease control. Conclusion: As Nigeria’s population is set to double by 2050, health security from an infectious disease standpoint will require policy change to support continuous training and re-training all cadres of healthcare workers to respond specifically to the problems that are fed back from the population while being fully aware of predictable (corruption, inadequate financing) and unpredictable (disease outbreaks, climate change, microbial mutation) factors that can serve as a hindrance.
Comparative analysis of Cervical Human Papillomavirus DNA testing and cytological findings among women presenting for “Pap” smear in a Tertiary Health Centre in Northern Nigeria
(SCIENCE DOMAIN International, 2016) Manga, M. M.; Fowotade, A.; Abdullahi, Y. M.; El-Nafaty, A. U.; Adamu, S.; Bojude, A. D.; Pindiga, H. U.; Bakare, R. A.; Osoba, A. O.
Aim: This study was conducted to compare different cytological findings with cervical HPV infection among women presenting for cervical cancer screening in Gombe north-eastern Nigeria. Study Design: It is a hospital based cross-sectional study. Place and Duration of Study: Departments of Obstetrics/Gynaecology and Histopathology Federal Teaching Hospital Gombe (FTHG) Nigeria, between August 2013 and May 2014. Methodology: Two hundred and nine (209) women were subjected to liquid-based cervical cytology and HPV DNA testing. Results: Of the 209 participants, cytological findings were normal in 126 (61.6%) women while 80 (39.0%) had abnormal features. Three (1.4%) respondents had unsatisfactory smears. The observed abnormal cytological features include HPV changes 30 (14.4%), HPV changes with inflammation 2 (1.0%), inflammatory changes alone 36 (17.3%), Low Squamous Intraepithelial Lesion; LSIL 3 (1.4%), High Squamous Intraepithelial Lesion; HSIL 5 (2.4%) and malignant changes 3 (1.4%). Positive HPV DNA testing was detected among 100 (48.1%) of the participants. Almost half 60 (47.6%) of the women with normal cytology were positive for HPV. Among women with cytologically detected HPV changes, only 16 (50%) were also HPV DNA positive. The sensitivity and specificity of cervical cytology in detecting HPV infection was 16.2% and 85.0% respectively. Conclusion: This study reports a very low sensitivity but relatively high specificity of cytology in detecting cervical HPV infection. It further justifies the need for introduction of HPV DNA testing to improve efficiency and maximise the sensitivity of cytology based cervical cancer screening for women above 30 years.
Comparative analysis of rapid test and Enzyme linked Immunosorbent assay for screening of blood donors for Hepatitis B surface Antigen seropositivity
(West African College of Physicians and West African College of Surgeons, 2021) Adeleke, A. S.; Fasola, F. A.; Fowotade, A.
BACKGROUND: The Hepatitis B surface Antigen (HBsAg) is the most utilized indicator marker of hepatitis B infection. This study assesses the accuracy of the two most common screening assays used to detect HBsAg among blood donors. MATERIALS AND METHODS: A total of 350 eligible blood donors were screened for HBsAg using both Bio-Check HBsAg Rapid screening kit (BioCheck Inc, South San Francisco, USA) and a fourth-generation Enzyme-Linked Immunoassays (ELISA) kit, MonolisaTM HBs Ag Ultra (Bio-Rad Laboratories, Marnes-la-Coquette-France). Questionnaires were used to inquire about risk factors for HBV infection among blood donors. The calculation of sensitivity, specificity, negative predictive and positive predictive values were carried out by comparing the performance of the rapid kit with ELISA test as the reference standard. RESULTS: The prevalence of HBV infection using Rapid Diagnostic Test (RDT) was 5.7% but was 14.6% by ELISA. Using ELISA as a reference, the sensitivity and specificity of RDT were 31.4% and 98.7% respectively. The positive predictive value and negative predictive value for RDT were 80.0% and 89.4% respectively. Overall non-compliance with transfusion-transmitted infection (TIT) risk-related deferral criteria was 38%. CONCLUSION: The low sensitivity of RDT kits precludes its continuous use in high HBV endemic regions where many donors fail to disclose full and truthful information about their risk for TTI. It is suggested that blood banks should complement the use of RDT with a more sensitive assay such as ELISA.
Cryptococcal Meningitis in a newly diagnosed AIDS patient: a case report
(West African College of Physicians and West African College of Surgeons, 2009) Salami, A. K.; Ogunmodede, J. A.; Fowotade, A.; Nwabuisi, C.; Wahab, K. W.; Desalu, O. O.; Fadeyi, A.
"BACKGROUND: Cryptococcus neoformans is a very important cause of fungal meningitis in immunosuppressed patients OBJECTIVE: To describe a case of cryptococcal meningoencephalitis in an HIV/AIDS patient from the University of Ilorin Teaching Hospital. METHODS: An 18 -year -old male student presented with cough, weight loss, and fever. He was clinically assessed and had full laboratory investigations including cerebrospinal fluid CSF and then started on chemotherapy. Both the clinical and neurological evaluation of the patient was described along with the laboratory analyses of his CSF. Outcome of how he was managed was also reported. RESULTS: Cryptococcus neoformans presented as an AIDS defining fungal infection for the first time in this 18 year old undergraduate who was infected probably from transfusion of unscreened blood He had advanced HIV infection (CD4+ count of 29cells/ul) and severe cryptococcal meningoencephalitis. He was unsuccessfully managed with fluconazole, a second choice drug for this condition, amphotericin B being not available. CONCLUSION: Nigerians should have access to effective blood transfusion services at all public and private hospitals across the country. The National Essential Drug list should be expanded to include drugs such as amphotericin B which hitherto were considered exotic.
Cytomegalovirus in immunosuppressed patients: a silent and potential killer.
(African Journals Online, 2012) Fowotade, A.; Nwadike, V. U.
Cytomegalovirus (CMV) is a recognized cause of morbidity and mortality among immunocompromised individuals. This review will concentrate on understanding the pathogenesis, clinical manifestations and laboratory diagnostic options for CMV infection.
Efficacy and safety of nitazoxanide plus atazanavir/ritonavir for the treatment of moderate to severe COVID-19 (NACOVID): A structured summary of a study protocol for a randomised controlled trial
(BioMed Central Ltd, 2021) Olagunju, A.; Fowotade, A.; Olagunoye, A.; Ojo, T. O.; Adefuye, B. O.; Fagbamigbe, A. F.; Adebiyi, A. O.; Olagunju, O. I.; Ladipo, O. T.; Akinloye, A.; Adeagbo, B. A.; Onayade, A.; Bolaji, O. O.; Happi, C.; Rannard, S.; Owen, A.
Objectives: To investigate the efficacy and safety of repurposed antiprotozoal and antiretroviral drugs, nitazoxanideand atazanavir/ritonavir, in shortening the time to clinical improvement and achievement of SARS-CoV-2 polymerase chain reaction (PCR) negativity in patients diagnosed with moderate to severe COVID-19. Trial design: This is a pilot phase 2, multicentre 2-arm (1:1 ratio) open-label randomised controlled trial. Participants: Patients with confirmed COVID-19 diagnosis (defined as SARS-CoV-2 PCR positive nasopharyngeal swab) will be recruited from four participating isolation and treatment centres in Nigeria: two secondary care facilities (Infectious Diseases Hospital, Olodo, Ibadan, Oyo State and Specialist State Hospital, Asubiaro, Osogbo, Osun State) and two tertiary care facilities (Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State and Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State). These facilities have a combined capacity of 146-bed COVID-19 isolation and treatment ward. Inclusion criteria: Confirmation of SARS-CoV-2 infection by PCR test within two days before randomisation and initiation of treatment, age bracket of 18 and 75 years, symptomatic, able to understand study information and willingness to participate. Exclusion criteria include the inability to take orally administered medication or food, known hypersensitivity to any of the study drugs, pregnant or lactating, current or recent (within 24 hours of enrolment) treatment with agents with actual or likely antiviral activity against SARS-CoV-2, concurrent use of agents with known or suspected interaction with study drugs, and requiring mechanical ventilation at screening. Intervention and comparator: Participants in the intervention group will receive 1000 mg of nitazoxanide twice daily orally and 300/100 mg of atazanvir/ritonavir once daily orally in addition to standard of care while participants in the control group will receive only standard of care. Standard of care will be determined by the physician at the treatment centre in line with the current guidelines for clinical management of COVID-19 in Nigeria. Main outcome measures: Main outcome measures are: (1) Time to clinical improvement (defined as time from randomisation to either an improvement of two points on a 10-category ordinal scale (developed by the WHO Working Group on the Clinical Characterisation and Management of COVID-19 infection) or discharge from the hospital, whichever came first); (2) Proportion of participants with SARS-CoV-2 polymerase chain reaction (PCR) negative result at days 2, 4, 6, 7, 14 and 28; (3) Temporal patterns of SARS-CoV-2 viral load on days 2, 4, 6, 7, 14 and 28 quantified by RT-PCR from saliva of patients receiving standard of care alone versus standard of care plus study drugs. Randomisation: Allocation of participants to study arm is randomised within each site with a ratio 1:1 based on randomisation sequences generated centrally at Obafemi Awolowo University. The model was implemented in REDCap and includes stratification by age, gender, viral load at diagnosis and presence of relevant comorbidities. Blinding: None, this is an open-label trial. Number to be randomised (sample size): 98 patients (49 per arm). Trial status: Regulatory approval was issued by the National Agency for Food and Drug Administration and Control on 06 October 2020 (protocol version number is 2.1 dated 06 August 2020). Recruitment started on 9 October 2020 and is anticipated to end before April 2021. Trial registration: The trial has been registered on ClinicalTrials.gov (July 7, 2020), with identifier number NCT0445 9286 and on Pan African Clinical Trials Registry (August 13, 2020), with identifier number PACTR202008855701534. Full protocol: The full protocol is attached as an additional file which will be made available on the trial website. In the interest of expediting dissemination of this material, the traditional formatting has been eliminated, and this letter serves as a summary of the key elements in the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).
Emergence and spread of two SARS-CoV-2 variants of interest in Nigeria
(Nature Portfolio, 2023-02) Olawoye, I. B.; Oluniyi, P. E.; Oguzie, J. U.; Uwanibe, J. N.; Kayode, T. A.; Olumade, T. J.; Ajogbasile, F. V.; Parker, E.; Eromon, P. E.; Abechi, P.; Fowotade, A.
Identifying the dissemination patterns and impacts of a virus of economic or health importance during a pandemic is crucial, as it informs the public on policies for containment in order to reduce the spread of the virus. In this study,we integrated genomic and travel data to investigate the emergence and spread of the SARS-CoV-2 B.1.1.318 and B.1.525 (Eta) variants of interest in Nigeria and the wider Africa region. By integrating travel data and phylogeographic reconstructions, we find that these two variants that arose during the second wave in Nigeria emerged from within Africa, with the B.1.525 from Nigeria, and then spread to other parts of the world. Data from this study show how regional connectivity of Nigeria drove the spread of these variants of interest to surrounding countries and those connected by air-traffic. Our findings demonstrate the power of genomic analysis when combined with mobility and epidemiological data to identify the drivers of transmission, as bidirectional transmission within and between African nations are grossly underestimated as seen in our import risk index estimates.
Epidemiological patterns of cervical human papillomavirus infection among women presenting for cervical cancer screening in North-Eastern Nigeria
(BioMed Central Ltd, 2015) Manga, M. M.; Fowotade, A.; Abdullahi, Y. M.; El-nafaty, A. U.; Adamu, D. B.; Pindiga, H. U.; Bakare, R. A.; Osoba, A. O.
Background: Sub-Saharan countries including Nigeria have the highest burden of Human Papillomavirus (HPV) infection in the world. Most studies on HPV surveillance in Nigeria were done in the southern part of the country. Geographical and socio-cultural diversity of Nigeria makes these data unlikely to be universally representative for the entire country. Northern Nigeria especially the North-East carries a higher prevalence of cervical cancer and many of its risk factors. The region may be harbouring a higher prevalence of HPV infection with a possibility of different genotypic distribution. This study was carried out to determine the burden and confirm the predominant HPV genotypes among women presenting for cervical cancer screening at the Federal Teaching Hospital Gombe (FTHG), North-eastern, Nigeria. Methods: The study was an observational hospital based cross sectional study among women who presented for cervical cancer screening in FTHG. A total of 209 consenting women were tested for cervical HPV infection using PCR. DNA sequencing was carried out on positive samples to determine the prevalent HPV genotypes. Results: The prevalence of cervical HPV infection among the participants with mean age of 39.6 ± 10.4 years was 48.1 %. The five most predominant genotypes were 18, 16, 33, 31 and 35, with prevalence of 44.7 %, 13.2 %, 7.9 %, 5.3 % and 5.3 % respectively. Other genotypes observed were 38, 45, 56, 58, 82 and KC5. Multiple HPV infections were detected among 7.9 % of participants. Risk factors such as level of education (X2 = 15.897; p = 0.007), age at sexual debut (X2 = 6.916; p = 0.009), parity (X2 = 23.767; p = 0.000), number of life time sexual partners (X2 = 7.805; p = 0.005), age at first pregnancy (X2 = 10.554; p = 0.005) and history of other malignancies (X2 = 7.325; p = 0.007) were found to have a statistically significant association with HPV infection. Conclusion: This study identified a high burden of HPV infection in Northern Nigeria while also confirming HPV 18 and 16 as the most predominant genotypes. It further justifies the potential benefit of the currently available HPV vaccines in the area. A larger and community based study is however recommended for better representation of the area.