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Confusion and delirium in acute falciparum malaria infection
(1996) Salako, B.L.; Ajayi, S.O.
Blood pressure changes in haemodialysis: the nigerian experience
(1998) Salako, B.L.; Ajayi, S.O.; Kadiri, S.; Arije, A.; Osoba, O.A.
The blood pressure changes in haemodialysis were assessed during 59 sessions in 21 patients. Blood pressure was measured with I he corresponding pulse before and subsequently hourly during dialysis, and the patients weights were measured before and after dialysis. The mean systolic blood pressure before dialysis was 170,22 + 29.64mmHg. This showed a statistically sig nificant decrease at l hour. being 167^31.79mmHg (P < 0.002 at 2 hours, being 164.83 + 40.26mmHgwith (P < 0.001). at 3 hours, being 166.84+ 36.94mm Hg (P< 0.001) intradialysis, and immediately after 4 hours of dialysis 166.28 ±35.70mmHg t P < 001). The mean diastolic blood pressure before dialysis of 109.90 + 20.SOmmHg also showed a significant decrease at 1 hour 106.07 + 22.84mmHg (P< 001) 2 hours 105.98+ 22.10mmHg (P < 0.001) and 3 hours intradialysis 107.81 + 25.39mmHg (P< 0.001). These findings suggest that blood pressure changes in haemodialysis are affected by drop in weight that invariably occurs in haemodialysis due to the accompanying process of ultrafiltration
Quinolones for short-term treatment of uncomplicated urinary tract infection.
(1999) Kadiri, S.; Ajayi, S.O.; Toki, R.A.
Objectives: To investigate whether quinolones produce in vivo responses comparable to reported in vitro activity against the spectrum of organisms in uncomplicated urinary tract infection (UTI) in Nigeria, Design: Equal numbers of patients with urine culture positive UTI were randomised to oral quinolone, pefloxacin 400 mg Bd and ofloxacin 200 mg Bd for 5 days. Setting: Out-patient clinics and wards at the University College Hospital. Ibadan. Subjects: Sixty patients aged sixteen years and above with uncomplicated UTI. Main outcome measures: Number of isolates, number of patients with clinical and bacteriological cure one week after commencing therapy. Relative effectiveness and side effects of the drugs. Results: Sixty four bacterial isolates were obtained with the enterobacteriaccae comprising 86%. 62 (97%) were sensitive to both drugs in vitro. Clinical cure occurred in 57 patients (95%), being 28 (93%) in those taking perfloxacin and 29 (97%) in those taking ofloxacin. Bacteriological cure occurred in 55 patients (92%), being 27 (90%) in those taking perfloxacin and 28 (93%) in those taking ofloxacin. 59 of the 64 isolates (92%) were eliminated week, 30 of 33 (91 %) in those taking pefloxacin, and 29 of 31 (94%) in those taking ofloxacin; the difference was insignificant (p=1.16). The enterobacteriaceae were generally susceptible to both drugs. Side effects were minor and infrequent. Conclusion: Quinolones were highly active against the common urinary pathogens in these Nigerian patients and can be reliably employed in treatment when culture results are unavailable.
Bronchial asthma: a risk factor for hypertension?
(2000) Salako, B.L.; Ajayi, S.O.
Several attempts have been made to improve primary prevention of essential hypertension and many of these have been directed at avoiding the well known risk factors. Both asthma and hypertension are spastic disorders of smooth muscle, also asthmatics and hypertensives have been found to be salt sensitive. There is a suspicion that the similarities between these two diseases may predispose the individuals with one disease to the other, as pulmonary hypertension has been described during exercise- induced bronchoconstriction. We therefore, studied the blood pressure pattern during and after acute severe asthma (ASA) along with the frequency of hypertension in stable asthmatic patients. Two groups of patients were studied. Group 1 consisted of 12 patients with ASA (2 males, 10 females) with a mean age of 30 ± 9,9.years. The mean blood pressure during attack of ASA (147±16.9/ 100±8.2 mmHg) was higher than the mean BP (132±8.3/82±7 mmHg) 2 weeks after discharge from hospital without treatment in all patients (P < 0.05). Group 2 included 134 asthmatic subjects in stable state (54 males, 80 females) with a mean age of 45 ± 15 years and a range of 15-90 years. The overall frequency of hypertension was 37% with a proportion of 39% in males and 35% in females. Hypertension was defined as systolic blood pressure of £ 140mmHg and or diastolic blood pressure of £ 90mmHg. There was no difference between the frequency of attack of ASA in hypertensives (5.7 ±5.6 per year) and nonhypertensives (5.5 ± 3.8 per year), P < 0.05. We concluded that transient elevation of blood pressure may occur during ASA. The frequency of hypertension among asthmatics is quite high and concurrent family history of hypertension and frequency of attack of ASA did not seem to determine the status of blood pressure. Patients with asthma should have regular blood pressure check during follow-up visits.
Variability in the relationship between serum creatinine and creatinine clearance in hypertensives and normotensives with normal renal function
(2000) Kadiri, S.; Ajayi, S.O.
Variabilities exist in the relationship between serum creatinine (Se-C) and creatinine clearance (CCr) due to the influences of age, muscle mass and gender on creatinine production. We studied this variability in a group of hypertensives (n = 62, 30 male, age 44 ± 7 years) and normotensives (n = 90, 47 male, age 42 ± 1 0 years) with normal renal function (Se-C< 0.01) and females (84 ± 19mL/min Vs 96 ± 19mL/min, P < 0.01). Crude CCr was significantly higher in men than women (.P < 0.05) in the whole group but not significantly in the normotensive or hypertensive subgroups. After adjustment, the differences diminished and became insignificant in the whole group. Some subgroups had identical mean Se-C values but different adjusted CCr. A particular Se-C value did not always indicate a particular CCr. Adjustment of CCr to 1.73 m2 BSA reduced the variability between Se-C and CCr and the difference between the genders. CCr showed significant difference in renal function between subgroups where Se-C did not.
Decreased dose requirement of antihypertensive agents with age.
(2001) SalakoB.L.; Ajayi, S.O.; Kadiri, S.; Arije, A.
Hypertension is very prevalent in the elderly and treatment has been shown to be beneficial. However, inappropriate doses of drugs may impair the quality of life in this group of patients. In an attempt to assess the role of advancing age on therapy and doses of antihypertensives, the authors studied the antihypertensive dose/response pattern as hypertensive subjects on regular treatment move from the young to the elderly age group. Forty-nine hypertensives who were still being followed up at the medical outpatient clinic. University College Hospital, Ibadan were recruited into the study. The patients were extensively inter viewed and information relating to age, sex, year, age of diagnosis, as well as blood pressure at diagnosis, 6 months and 5 years of therapy were noted. There were HI males and 39 females with mean ages of 66.5 ± 6.6 and 64.5 ± 4.5 years respectively. The mean ages at diagnosis for both male and female groups were 52 ± 9.3 and 50 ± 7.5 years respectively. At diagnosis, 22 (44.8%) patients were started on single (antihypertensive) drug therapy, 23 (46.9%) on two drags while 4 (8.3%) were on 3 drugs. By 5 years of fairly consistent therapy, there were 33 (67.3%) patients on single drug and 16 (32.7%) patients on 2 drugs. No patient was on 3 drugs regimen. The mean blood pressure at diagnosis of 174 ± 24/105 ± 9 mmHg dropped significantly and was maintained at 6 months of therapy at (139 ± 20 / 87 ± 13 mmHg) p < 0.001. After 5 years of therapy the mean was (139 ±24/81 ±8 mmHg) inspite of dose reduction in these patients (p < 0.001). The authors concluded that, in a hypertensive patient who is un regular treatment, consistent and gradual reduction of antihypertensive doses may be carried out with blood pressure remaining within acceptable limits as the patient grows old.
Cardiac baroreceptor sensitivity: a prognostic marker in predialysis chronic kidney disease patients?
(2005) Bavanandan S.; Ajayi, S.O.; Fentum B.; Paul S.K.; Carr S. J.; Robinson T.G.
Background. Small, uncontrolled studies of dialysis dependent chronic kidney disease (CKD) patients have demonstrated abnormalities of cardiovascular autonomic control and vascular compliance, which may contribute to adverse cardiovascular morbidity in this population. However, there is little information utilizing newer, noninvasive techniques in predialysis patients with increasing degrees of uremia. Methods. One hundred and five nondialysis CKD patients with a median GFR of 23 mL/min/1.73m2 (range: 6 to 102) at baseline were studied. Cardiac baroreceptor sensitivity (BRS) was recorded by time- and frequency-domain techniques, and its relationship with increasing degrees of uremia studied. During a mean follow-up period of 42 months (range: 3 to 70), primary (death, dialysis, transplantation) and secondary (fatal and nonfatal cardiovascular events) outcome measures were recorded. The importance of cardiac BRS in comparison to other important renal and cardiovascular prognostic variables in predicting outcome was assessed. Results. Median cardiac BRS by time domain analysis at baseline was 8.85 msec/mm Hg (interquartile range: 6.85), and impaired cardiac BRS was related to reduced GFR, increasing age, and hypertension on quantile regression analysis. ‘Impaired’ cardiac BRS was associated with a trend toward increased likelihood of both primary and secondary outcomes, and may act as a surrogate measure of other cardiovascular risk factors, including age, hyperlipidemia, hypertension, previous cardiovascular disease, and doubling of creatinine. Conclusion. Nondialysis-dependent CKD patients have impaired cardiac BRS, and this was related to decreasing GFR. There was a trend toward poorer prognosis in patients with impaired cardiac BRS that requires further study. Cardiac BRS may provide a simple, bedside, noninvasive assessment of overall cardiovascular risk in this population.
Assessment of risk factors for kidney disease in an unselected population of nigerians: a report of the routine screening conducted during the national kidney disease awareness and sensitizing programme.
(2006) Ulasi I.; Arogundade, F.A.; Aderibigbe, A.; Oviasu, E.; Akinsola, A.; Arije, A.; Ijoma, C.K.; Anteyi, E.A.; Ajayi, S.O.; Mamven, M.; Adeniyi A.B.; Mbah I.; Salako B.L.; Sanusi A.A.; Angbarzo I.; Kwaifa A.
To be able to define some risk factors for renal disease in an unselected population of Nigerians the Nigerian Association of Nephrology conducted a screening exercise during the National Kidney Disease Awareness and Sensitization Programme whose theme was “Renal Disease in Nigeria: Taming the Lion” which was held at the capital city of Abuja on the 9th of February 2006. A total of unselected 129 respondents who consented were screened. One hundred and nine (56 male and 72 female respondents) were analyzed and the others [2] could not be analyzed because of incomplete data. The mean age of respondents was 27.03 (±10.75) years and majority (89.1 %), were in age group 15 to 44 years with no sex preference. Most of the respondents had normal BMI, the mean being 23.32 (±4.52)mg/m2. More females than males were found to be obese (16% versus 4%), the difference was not statistically significant (p=0.76). A relatively high percentage of respondents gave positive family history of hypertension (40%) as against 25% for diabetes mellitus. Only 5% of respondents gave positive history of renal disease. Use of nephrotoxic agents - medicated soap, native medication and herbal supplements/tea was found in 40%, 30% and 19% respectively. More than half of the studied population did not have routine medical check and about a third engaged in self medication. The prevalence of hypertension and proteinuria were 13.6% and 19% respectively. It is concluded from this study that the risk factors for development of chronic kidney disease (CKD) is high in the studied population and the level of awareness regarding need for routine medical check and appropriate attitude to health low. There is crying need for more intensive, aggressive and comprehensive education aimed at increasing the health seeking attitude of our population as well as establishment of preventive programmes against CKD in the country.
Hypertension and chronic kidney disease
(2007) Ajayi, S.O.; Harris, K.P.G.
Prevalence of dyslipidemia in normoglycemic subjects with newly diagnosed high blood pressure in Abuja, Nigeria.
(2009) Ojji, D.B.; Ajayi, S.O.; Manmak, H. M.; Atherthon J.
The H3Africa Consortium (2014). Enabling the Genomic Revolution In Africa. American Association for the Advancement of Science: . 1346-1348pp. ISBN: 1612309842 (United States of America ) (Contribution : 20%) h. Background: High blood pressure and dyslipidemia additively increases the risk of cardiovascular disease. There is a high prevalence of high blood pressure in Nigeria, but there are little data regarding the prevalence of dyslipidemia in subjects with high blood pressure. OBJECTIVE: In this observational prospective study, we examined the prevalence of dyslipidemia in newly diagnosed normoglycemic subjects with high blood pressure. Methods: A total of 171 subjects presenting with high blood pressure for the first time in the cardiology and nephrology clinics at the University of Abuja Teaching Hospital were studied. Height, weight, and blood pressure were measured. Total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were determined in fasting plasma. The total cholesterol/HDL-C and non–HDL-C values were calculated. These measures were then classified according to the 2001 report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. RESULTS: Of the 171 subjects studied, 84 (49%) were male and 87 (51%) were female. Low HDL-C was present in 71 (45.8%), elevated LDL-C in 29 (17%), elevated total cholesterol in 19 (11.1%), and elevated triglyceride in 13 (7.6%), whereas eight (4.7%) of the study population had combined elevated total cholesterol and triglyceride. Female subjects had higher total cholesterol and lower HDL-C than male subjects, but these differences were not statistically significant. Obese subjects, compared to the nonobese, had significantly higher LDL-C and total cholesterol/HDL-C ratios in males and significantly higher triglyceride levels in females. Conclusions: Given the prevalence of dyslipidemia seen in this study, we suggest that fasting lipid measurements should be performed in all Nigerians with high blood pressure. These data suggest the need for health education and lifestyle modifications in hypertensive Nigerians to reduce both types of risk factors.
Glomerular disease in the tropics. NewYork
(Oxford University Press, 2009) Ajayi, S.O.
Pattern of heart failure in Abuja, Nigeria: an echocardiographic
(2009) Ojji, D.B.; Alfa, J.; Ajayi, S.O.; Mamven, M.H.; Falase A.O.
Aim: Despite heart failure having been identified in subjects in sub-Saharan Africa over the last 60 years, there is still a dearth of data, especially echocardiographic data on heart failure. We therefore set out to analyse the clinical and echocardiographic features of all consecutive subjects presenting with heart failure in a tertiary institution in Nigeria. Methods: Three hundred and forty subjects with heart failure, according to the guidelines of the European Society of Cardiology, were studied. Each patient had two-dimensional guided transthoracic echocardiography. Results: The mean age of the patients was 50.60 ± 15.29 years, and 50.9% of the study population were males while 49.1% were females. The commonest cause of heart failure identified was hypertension in 61.5% of the patients; 75.5% had systolic heart failure, whereas 23.5% had heart failure with preserved ejection fraction. Conclusions: Untreated hypertension has been identified as the leading cause of heart failure in Abuja, Nigeria, which is similar to that in many other parts of sub-Saharan Africa. Coronary artery disease is a rare cause of heart failure in this population group.
Patient retention and adherence to antiretrovirals in a large antiretroviral therapy program in Nigeria: a longitudinal analysis for risk factors.
(2010) Charurat M.; Oyegunle M.; Benjamin R.; Habib A.; Eze E.; Ele P.; Ibanga I.; Ajayi, S.; Eng M.; Monda P.; Dakum P.; Farley P.; Blattner W.
Background: Substantial resources and patient commitment are required to successfully scale-up antiretroviral therapy (ART) and provide appropriate HIV management in resource-limited settings. We used pharmacy refill records to evaluate risk factors for loss to follow-up (LTFU) and non-adherence to ART in a large treatment cohort in Nigeria. Methods and Findings: We reviewed clinic records of adult patients initiating ART between March 2005 and July 2006 at five health facilities. Patients were classified as LTFU if they did not return .60 days from their expected visit. Pharmacy refill rates were calculated and used to assess non-adherence. We identified risk factors associated with LTFU and non-adherence using Cox and Generalized Estimating Equation (GEE) regressions, respectively. Of 5,760 patients initiating ART, 26% were LTFU. Female gender (p,0.001), post-secondary education (p = 0.03), and initiating treatment with zidovudine-containing (p = 0.004) or tenofovir-containing (p = 0.05) regimens were associated with decreased risk of LTFU, while patients with only primary education (p = 0.02) and those with baseline CD4 counts (cell/ml3 ) .350 and ,100 were at a higher risk of LTFU compared to patients with baseline CD4 counts of 100–200. The adjusted GEE analysis showed that patients aged ,35 years (p = 0.005), who traveled for .2 hours to the clinic (p = 0.03), had total ART duration of .6 months (p,0.001), and CD4 counts .200 at ART initiation were at a higher risk of non-adherence. Patients who disclosed their HIV status to spouse/ family (p = 0.01) and were treated with tenofovir-containing regimens (p#0.001) were more likely to be adherent Conclusions: These findings formed the basis for implementing multiple pre-treatment visit preparation that promote disclosure and active community outreaching to support retention and adherence. Expansion of treatment access points of care to communities to diminish travel time may have a positive impact on adherence.
PSYCHOSOCIAL HAZARDS AND HEALTH STATUS OF POLICE OFFICERS IN IBADAN
(2010-12) OLUFEMI, JOLAOLUWA OLUWATOSIN
Police officers while maintaining law and order may experience psychosocial hazards which adversely affect their health. Work conditions can influence psychosocial well being, which in turn could influence their work performance, therefore affecting their attitude to the public. As there is little information on this subject, this study was conducted to determine the psychosocial hazards and health status of police officers in Ibadan, Nigeria. A cross-sectional study was conducted, which utilized cluster sampling technique to select 435 police officers in the two area commands in Ibadan. A total of 37 divisions in both area commands were grouped into large and small, based on a calculated average population of 100 police officers per division. Three divisions each (one large and two small) were selected by balloting from the two area commands. All police officers in the selected divisions were requested to participate in the study. A structured self administered questionnaire was used to collect data on socio-demographic characteristics, operational and organizational stressors, psychosocial hazards and general health status. The General Health Questionnaire 12 was used to assess psychological distress with a maximum obtainable score of 12 and scores of ≥3 were indicative of psychological distress. Descriptive statistic, chi-square test and logistic regression were used for data analysis. Results were deemed significant at p<0.05. Among the respondents 72.4% were males. Mean age was 31.8 ± 8.3 years and 87.6% were junior officers. Organizational stressors experienced included multiple tasks, working overtime and poor support from superiors. The most important operational stressor among junior and senior officers was witnessing the death of a colleague 45.7% and 61.1% respectively (p<0.05). Psychosocial problems consisted of low public regard for their work (32.6%) and dissatisfaction with their living environment (46.2%). The use of sedatives (3.0%) and alcohol abuse (4.8%) were reported. Only 58.4% had a medical checkup in the preceding one month. General health symptoms at the time of interview included cough (21.1%), catarrh (30.6%), urethral and vaginal discharge (1.4%) and (3.9%), headaches (36.3%) and low back pain (27.8%). Psychological distress was observed in 34.3% of police officers: 34.9% junior officers and 29.6% senior officers. Significant predictors of UNIVERSITY OF IBADAN LIBRARY iv psychological distress were female sex (O.R:1.91, 95% CI 1.16-3.15), multiple tasks (O.R:2.74, 95% CI 1.53-4.89), special duty (O.R:2.36, 95% CI 1.28- 4.37), confused feedback (O.R:3.05, 95% CI 1.44- 6.42), bureaucratic hassles (O.R:2.71, 95%CI 1.33-5.51), constant use of sedatives (O.R:2.15, 95% CI 1.22-3.79), and frequent alcohol consumption (O.R:5.15, 95% CI 1.58- 16.75). Psychosocial hazards and psychological distress were common among police officers. Improved work conditions and early interventions to prevent psychological ill health should be instituted in the Nigeria Police Force. There is need for provision of adequate health services for psychological screening, and treatment of the common ailments which were prevalent in this study. Key words: Police officers, Psychosocial hazards, Organizational stressors, Operational stressors, Psychological distress. Word Count: 450
A predominance of hypertensive heart failure in the Abuja heart study cohort of urban Nigerians: a prospective clinical registry of 1515 de novo cases.
(2012) Ojji D.; Stewart, S.; Ajayi, S.; Manmak, M.; Sliwa K.
Aims: Even though cardiovascular disease is gradually becoming the major cause of morbidity and mortality in sub-Saharan Africa, there are very few data on the pattern of heart disease in this part of the world. We therefore decided to determine the pattern of heart disease in Abuja, which is one of the fastest growing and most westernized cities in Nigeria, and compare our findings with those of the Heart of Soweto Study in South Africa. Methods and results: Detailed clinical data were consecutively captured from 1515 subjects of African descent, residing in Abuja, and equivalent Soweto data from 4626 subjects were available for comparison. In Abuja, male subjects were on average, 2 years older than female subjects. Hypertension was the primary diagnosis in 45.8% of the cohort, comprising more women than men [odds ratio (OR) 1.96, 95% confidence interval (CI) 1.26– 2.65], and hypertensive heart failure (HF) was the most common form of HF in 61% of cases. On an age- and sex-adjusted basis, compared with the Soweto cohort, the Abuja cohort were more likely to present with a primary diagnosis of hypertension (adjusted OR 2.10, 95% CI 1.85– 2.42) or hypertensive heart disease/failure (OR 2.48, 95% CI 2.18–2.83); P , 0.001 for both. They were, however, far less likely to present with CAD (OR 0.04, 95% CI 0.02 –0.11) and right heart failure (2.5% vs. 27%). Conclusion: As in Soweto, but more so, hypertension is the most common cause of de novo HF presentations in Abuja, Nigeria.
Prevalence of metabolic syndrome among hypertensive subjects in abuja, Nigeria
(2012) Ojji D.B.; Ajayi, S.O.; Mamven, M.H.; Alabi P.
Background: It is well known that factors like high blood pressure, hyperglycemia, dyslipidemia, obesity and hyperuricemia tend to cluster together giving rise to what is called metabolic syndrome. In spite of the high prevalence of hypertension in Nigeria, there is a dearth of data describing the prevalence of metabolic syndrome in Nigerian hypertensive patients. We therefore set out to look at the prevalence of metabolic syndrome in hypertensive patients presenting to the cardiology clinic of a tertiary institution in Abuja, Nigeria. Methods: Metabolic syndrome was defined in patients according to the World Health Organisation’s definition. Results: Of the 362 patients studied, 56.9% were male and 43.1% were female. The mean age was 51.80 6 11.63 years, mean duration of hypertension was 8.90 6 3.95 years, mean body mass index was 29.36 6 6.12 kg/m2 and mean arterial blood pressure was 110.28 6 18.17 mm Hg. Overall, 13.0% of the study population had metabolic syndrome; 16.7% of females and 10.2% of males. Conclusion: The prevalence of metabolic syndrome among hypertensive patients in Abuja, Nigeria is comparable to rates observed in some general populations in Europe. This might imply the epidemiological transition in disease pattern already being experienced in many parts of sub-Saharan Africa.
Tuberous sclerosis complex and acute kidney injury in an adult female nigerian: a rare presentation and review of the literature.
(2012) Raji Y.R.; Ajayi S.O.; Jinadu Y.O.; Enigbokan O.; Salako B.L.
Tuberous sclerosis complex (TSC) is a rare condition classically characterized by mental retardation, facial angiofibroma (adenoma sebaceum) and epilepsy. It is an autosomal dominant disorder with formation of harmatomas involving multiple organs such as the skin, central nervous system, kidneys, lungs, and heart. The renal manifestations of TSC include formation of angiolipoma, cyst formation and renal malignancies. The occurrence of renal failure is very rare in patients with tuberous sclerosis, though it is projected that more cases with renal impairment will be seen as a result of improved life expectancy arising from improving standard of neurology care services received by these patients. We report a case of 25year old female Nigerian with tuberous sclerosis complex and acute kidney injury precipitated by sepsis.
Pattern of prescription of anti-hypertensive medications in a tertiary health care facility in Abuja, Nigeria.
(2013) Ojji D.B.; Ajayi S.O.; Mamven M.H.; Alfa J.; Albertino D.
Introduction: Marked changes have been made in the pharmacotherapy of hypertension over the years. In sub-Saharan Africa, hypertension pharmacotherapy is often thought to include only thiazide diuretics, beta blockers and centrally acting medications and, it is unclear if and how often calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers are used. Objective: To examine the anti-hypertensive prescription pattern in a tertiary health centre in Nigeria to determine how it conforms to current guidelines. Method: 590 newly diagnosed hypertensive patients presenting at the Cardiology Unit of University of Abuja Teaching Hospital over a three-year period were studied. Result: Calcium channel blockers were the most frequently prescribed anti-hypertensive medications (66.9% of all cases) and centrally acting medications were prescribed in only 5.01% of cases. Single-pill combination either alone or in combination with other antihypertensive medications were prescribed in 17.3% cases. Of these, calcium channel blocker-based combinations constituted the most frequently used multiple drug combinations. 94.6% of the patients required more than one medication for blood pressure control. Conclusion: Anti-hypertensive pharmacotherapy in Abuja, Nigeria, compares favorably with the current recommendations in the prescription pattern of anti-hypertensive medications. (Ethn Dis. 2013;23[4]:480–483)
Tuberculosis in antiretroviral treatment programs in lower income countries: availability and use of diagnostics and screening
(2013) Fenner L.; Ballif M.; Graber C.; Nhandu V.; Dusingize J.C.; Cortes C.P.; Carriquiry G.; Anastos K.; Garone D.; Jong, E.; Gnokoro J.C.; Sued O. Ajayi S.; Diero L.; Wools-Kaloustian K.; Kiertiburanakul S.; Castelnuovo B.; Lewden C.; Durier, N.; Sterling T.R.; Egger M.
Objectives: In resource-constrained settings, tuberculosis (TB) is a common opportunistic infection and cause of death in HIV-infected persons. TB may be present at the start of antiretroviral therapy (ART), but it is often under-diagnosed. We describe approaches to TB diagnosis and screening of TB in ART programs in low- and middle-income countries. Methods and findings: We surveyed ART programs treating HIV-infected adults in sub-Saharan Africa, Asia and Latin America in 2012 using online questionnaires to collect program-level and patient-level data. Forty-seven sites from 26 countries participated. Patient-level data were collected on 987 adult TB patients from 40 sites (median age 34.7 years; 54% female). Sputum smear microscopy and chest radiograph were available in 47 (100%) sites, TB culture in 44 (94%), and Xpert MTB/RIF in 23 (49%). Xpert MTB/RIF was rarely available in Central Africa and South America. In sites with access to these diagnostics, microscopy was used in 745 (76%) patients diagnosed with TB, culture in 220 (24%), and chest X-ray in 688 (70%) patients. When free of charge culture was done in 27% of patients, compared to 21% when there was a fee (p = 0.033). Corresponding percentages for Xpert MTB/RIF were 26% and 15% of patients (p = 0.001). Screening practices for active disease before starting ART included symptom screening (46 sites, 98%), chest X-ray (38, 81%), sputum microscopy (37, 79%), culture (16, 34%), and Xpert MTB/RIF (5, 11%). Conclusions: Mycobacterial culture was infrequently used despite its availability at most site.
Tenofovir based regimens associated with less drug resistance in hiv-1 infected nigerians failing first-line antiretroviral therapy.
(2013) Etiebet M.A.; Shepherd J.; Rebecca G.N.; Charurat M.; Chang, H.; Ajayi S.; Elegba, O.; Ndembib N.; Abimiku A.; Carra J.K.; Eyzaguirre L.M.; Blattner W.A.
Background: In resource-limited settings, HIV-1 drug resistance testing to guide antiretroviral therapy (ART) selection is unavailable. We retrospectively conducted genotypic analysis on archived samples from Nigerian patients who received targeted viral load testing to confirm treatment failure and report their drug resistance mutation patterns. Methods: Stored plasma from 349 adult patients on non-nucleoside reverse transcriptase inhibitor (NNRTI) regimens was assayed for HIV-1 RNA viral load, and samples with more than 1000 copies/ml were sequenced in the pol gene. Analysis for resistance mutations utilized the IAS-US 2011 Drug Resistance Mutation list. Results: One hundred and seventy-five samples were genotyped; the majority of the subtypes were G (42.9%) and CRF02_AG (33.7%). Patients were on ART for a median of 27 months. 90% had the M184V/I mutation, 62% had at least one thymidine analog mutation, and 14% had the K65R mutation. 97% had an NNRTI resistance mutation and 47% had at least two etravirine-associated mutations. In multivariate analysis tenofovir-based regimens were less likely to have at least three nucleoside reverse transcriptase inhibitor (NRTI) mutations after adjusting for subtype, previous ART, CD4, and HIV viral load [P < 0.001, odds ratio (OR) 0.04]. 70% of patients on tenofovir-based regimens had at least two susceptible NRTIs to include in a second-line regimen compared with 40% on zidovudine-based regimens (P ¼ 0.04, OR ¼ 3.4). Conclusions: At recognition of treatment failure, patients on tenofovir-based first-line regimens had fewer NRTI drug-resistant mutations and more active NRTI drugs available for second-line regimens. These findings can inform strategies for ART regimen sequencing to optimize long-term HIV treatment outcomes in low-resource settings.