Time to sputum culture conversion and treatment outcome among the first cohort of multidrug resistant tuberculosis patients in a high burden country

BACKGROUND

Sputum conversion considered the most important interim indicator of the efficacy of anti-tuberculosis treatment was assessed at varying time points among the first cohort of multidrug resistant tuberculosis (MDR-TB) patients in a National TB Control Programme.

METHODS

A retrospective study was conducted for the period between 2010 and 2013, at the premiere MDR-TB treatment center in Nigeria. Genexpert, culture and drug susceptibility tests were carried out. Total duration of treatment was 20 months.

RESULTS

A total of 115 patients were studied consisting of 76 (66.1%) males and 39 (33.9%) females with ages ranging between 15 and 65 years. Median time to sputum conversion was 2.06 months (95% confident interval [CI] = 1.82, 2.30). At the end of the first month, 43 (37.4%) patients sputum converted, increasing to 104 (90.4%) at the end of three months. There was no significant interaction with Human Immunodeficiency Virus (HIV) status. Overall treatment success was 69.4%. The default rate was 8.7% (10/115) and 25 (21.7%) deaths were recorded.

CONCLUSION

The treatment success rate in the study was high with most of cases with or without HIV infection, achieving sputum culture conversion within 2 months of commencing treatment. Expansion of MDR-TB treatment services is necessary to reduce the death rate.

ASSESSMENT OF SOCIOECONOMIC STATUS AND CONTROL OF ASTHMA IN ADULTS

BACKGROUND

Asthma is a chronic disease which places considerable economic, social and public health burdens on the society. Education, occupation and income are the most widely used indicators of socioeconomic status (SES). Studies have shown increased asthma hospital admissions for those who are materially deprived and increased asthma severity in low social class groups. The aim of this study is to determine the impact of socioeconomic status on control of asthma in adults.

METHOD

The study was a cross-sectional analytical one, conducted over a year at the Medical Outpatient Clinic of the University College Hospital Ibadan. The study population was composed of 355 randomly selected adults aged between 18years and 55years with an established diagnosis of asthma already on treatment.

RESULTS

Respondents with monthly income of 40000 and above had a higher proportion with good asthma control (74.1%) compared to those that earned 10000 to 39999 (69.0%) and less than 10000 (47.8%). This was statistically significant. Respondents in occupational class I/II had a slightly higher proportion with good asthma control (70.9%) compared to those in occupation class III/IV (70.1%) and occupation class V/VI (50.6%). This was statistically significant at p = 0.003.

CONCLUSION

Respondents in the higher occupational class had better asthma control than respondents in the lower occupational class. Respondents who were earning 40000 and above as monthly income had better control of asthma than other respondents. After adjusting for other variables, the predictor of good asthma control was monthly income of the respondents.

Atopy is a risk factor for adult asthma in urban community of Southwestern Nigeria

RATIONALE

Factors affecting asthma course are not clearly elucidated in urban communities in developing countries. Furthermore, the interaction between factors such as atopy, environmental exposure, urbanization, and helminthic infections in modulating asthma have not been well investigated.

OBJECTIVES

To determine factors, which affect asthma in adults being evaluated at urban tertiary health center of Southwestern part of Nigeria.

MATERIALS AND METHODS

A random sample of 24 (12 males, 12 females) consecutive asthmatics seen in the Outpatient Pulmonary Clinic of University College Hospital of Ibadan and 27 (13 males, 14 females) age and gender-matched controls underwent evaluation, which included blood tests for eosinophils, serum IgE, allergy skin tests to eight common environmental allergens, and spirometry. The modified version of the questionnaire of the International study of Asthma and Allergies in Children (ISAAC) Phase III used by the same study group of researchers in Nigeria was used to assess the asthma symptoms. Wilcoxon sign-rank tests were used to compare eosinophil counts, percentage eosinophils, and allergic skin test between the two groups, while paired t test was used to compare spirometry variables.

RESULTS

Asthmatics had significantly more positive skin reaction to house dust mite and mould than controls (P<0.05). Total serum IgE was also significantly higher in asthmatics than in controls (mean 210 vs 60 IU/mL; P=0.003). However, no significant differences were observed in total eosinophil counts. No significant difference in the degree of intestinal helminthes infection in the two groups, which means stool parasitism was similar. FEV(1) % was significantly lower in asthmatics (P=0.02) but FEV(1) was similar between the two groups (P=0.02).

CONCLUSION

The elevated levels of IgE and positive skin reactions to some of the common environmental allergens suggests an important role of atopy in the expression of asthma in this developing country's urban setting. Intestinal parasites were seen in both, control and asthma subjects, but appear not to play any role in the course of asthma, so also is the blood group, genotype and G6PD status.

Atopy is associated with asthma in adults living in rural and urban southwestern Nigeria

RATIONALE

Factors affecting the course of asthma are not clearly understood in rural and urban communities within low-resource countries. Furthermore, the interactions between atopy, environmental exposure, and helminthic infections in modulating asthma have not been well investigated.

OBJECTIVES

To conduct a feasibility study to examine the relationship between atopy and asthma in adults at two rural Health Centers and urban university college hospital in southwestern Nigeria.

METHODS

A convenient sample of 55 consecutive patients with stable physician-diagnosed asthma and 55 age-matched nonasthmatic controls seen at the outpatient clinics in two rural Health Centers and an urban university hospital were enrolled. All subjects underwent blood test, allergy skin test, and stool examination for ova and parasites. Wilcoxon sign-rank tests were used to compare serum eosinophilia and allergy skin test between the two groups.

RESULTS

Asthmatics in both urban and rural settings had significantly more positive skin reactions to house dust mite, cockroach, mold, and mouse epithelium than nonasthmatic controls (p < .05). Mean total serum IgE was also significantly higher in asthmatics than in nonasthmatic controls (360 vs. 90 IU/L, p <.001). Stool parasitemia was infrequent in both groups and not statistically significant.

CONCLUSION

Atopy is associated with adult asthma in southwest Nigeria. Larger studies to confirm the nature of this association and to examine the role of helminthic infection and other environmental factors on the expression of asthma are needed.

Pulmonary tuberculosis among health care workers at two designated DOTS Centers in urban city of Ibadan, Nigeria

BACKGROUND & OBJECTIVES

Tuberculosis (TB) infection control interventions are not routinely implemented in many Sub-Saharan African countries including Nigeria. This study was carried out to ascertain the magnitude of occupationally-acquired pulmonary TB (PTB) among health care workers (HCWs) at two designated DOTS centers in Ibadan, Nigeria.

METHODS

One year descriptive study (January-December 2008) was carried out at the University College Hospital and Jericho Chest Hospital, both located in Ibadan, Nigeria. A pre-tested questionnaire was used to obtain socio-demographic data and other relevant information from the subjects. Three sputum samples were collected from each subject. This was processed using Zeihl-Neelsen (Z-N) stains. One of the sputum was cultured on modified Ogawa egg medium incubated at 37 ° C for six weeks. Mycobacterium tuberculosis was confirmed by repeat Z-N staining and biochemical tests.

RESULTS

A total of 271 subjects, 117 (43.2%) males and 154 (56.8%) females were studied. Nine (3.3%) had their sputum positive for acid fast bacilli (AFB) while six (2.2%) were positive for culture. The culture contamination rate was 1.8 per cent. Significantly, all the six culture positive samples were from males while none was obtained from their female counterparts. About half of the AFB positive samples were from subjects who have spent five years in their working units. Eight AFB positive cases were from 21-50 yr age group while students accounted for seven AFB positive cases.

INTERPRETATION & CONCLUSIONS

The study shows that occupationally-acquired PTB is real in Ibadan. Further studies are needed to ascertain and address the magnitude of the problem.

Five year review of treatment outcome of directly observed therapy (DOT) for re-treatment pulmonary tuberculosis patients in UCH, Ibadan, Nigeria

Tuberculosis (TB) is a major health problem in Nigeria. The country is currently fourth among the 22 high-burden countries (HBCs) of the world, with an incident of all new cases of 311/100,000 population per year out of which 137/100,000 population are smear positive and prevalence of 616/100,000 population. To highlight the burden of re-treatment smear positive pulmonary TB with and without HIV infection and determine how directly observed therapy (DOT) using the retreatment regimen has affected the treatment outcome in the management of these patients. A five-year retrospective study from April 2003 to March 2008 to evaluate the treatment outcome data of re-treatment pulmonary TB who were also screened and confirmed for HIV at the outpatient clinic of the University College Hospital Ibadan, Nigeria. The effect of HIV status and treatment outcome was assessed so also the prevalence of HIV among recurrent FPTB patients. The total number of cases assessed was 127. Majority of the patients were between the ages of 20 to 49 (73.2%). Forty-two of the PTB patients were HIV positive (33.1%). The treatment outcome was as follows: Cured 81 (63.8); Treatment completed 13(10.2%); Died 22 (17.3%); Defaulted four (3.1%) and transferred out seven (5.5%) More patients were cured and had treatment completion among the HIV negative patients compared with HIV positive patients (p < 0.0001) The mortality was higher in those with HIV positive than negative patients (p < 0.0001). Re-treatment pulmonary TB is frequent at this referral centre. A contribution to re-treatment prevention entails more rigorous management of new TB cases, particularly at lower levels of care. This effort will reduce the emergence of multi-drug resistant (MDR-TB) tuberculosis.

Outpatient pulmonary rehabilitation in severe chronic obstructive pulmonary disease

OBJECTIVES

An outpatient programme for rehabilitation of patients with severe ventilatory impairment due to chronic obstructive pulmonary disease (COPD) was conducted. Its main purpose was to assess the feasibility of the programme for COPD patients.

METHODS

Initial assessment included a shuttle walking test, administration of the chronic respiratory disease questionnaire (CRDQ), assessment of the hospital anxiety and depression scale (HAD) and sickness impact profile (SIP). The patients were entered into a 6-week outpatient programme between January 2007 to July 2007 during which they attended twice weekly for a 2 1/2 hour session. Assessment was repeated on completion of the study at three months and later at six months.

RESULTS

The study included 44 (28 males) patients with COPD with a mean age 66 years. All patients had severe ventilatory impairment as defined by a forced expiratory volume in one second (FEV1) of less than 40% of predicted. The shuttle walking distance improved significantly and was maintained at the improved level for six months. The improvement in all four dimensions of the CRDQ was statistically significant (p < 0.05) and reached clinical significance for fatigue and for mastery. On entry, a notable level of depression was found in 32% of patients, and anxiety in 40 percent. There was a significant reduction in both of these that was maintained at six months (p < 0.05). There was no improvement in the SIP at three months, but significant improvement was found at six months (p < 0.05).

CONCLUSIONS

This study shows that a successful outpatient programme can be conducted in patients with severe ventilatory impairment, and that benefits in physical ability and in health-related quality of life (HRQOL) can be achieved. The improvements were maintained at six months.

Effectiveness and safety of adjustable maintenance dosing with budesonide/formoterol turbuhaler compared with traditional fixed doses in bronchial asthma: a multi-centre Nigerian study

The modern treatment guideline of bronchial asthma recognize that combination of long acting beta2-agonists and inhaled glucocorticoids, enables better control of inflammation and symptoms of asthma than inhaled glucocorticoids only. These guidelines recommended that patients are educated to adjust their medication to their asthma severity using physician-guided self-management plans. However, many patients take a fixed dose of their controller medication and adjust their reliever medication to asthma symptoms Therefore, combination of formoterol and budesonide can be delivered at different dosing level without the need to change inhalers. This study examined whether asthma control improved if patients adjusted the maintenance doses(AMD) ofbudesonide/formoterol (Symbicort, 80/ 4.5 microg and 160/4.5 microg) according to asthma severity compared with traditional fixed dosing (FD) regimens. This was a prospective open randomized trial carried out in five teaching hospitals across Nigeria between 15th July 2002 and 15th July 2003. Patients with bronchial asthma who met the enrollment criteria were randomized to receive either adjustable dosing or fixed dosing for a period of twelve weeks. The results obtained at the start and the end of the study showed that budesonide/formoterol combination effectively achieved and maintained control of asthma. The adjustable dosing achieves more effective control compared to fixed dosing in terms of the number of patients that are redistributed to less severe forms of persistent asthma. The percentage of patients with intermittent asthma increased from 9.3% at randomization to 55.6% at the end of therapy with more patients at the AMD arm of treatment. Also for mild persistent asthma there was an increase from 20.4% to 24.1%. This showed that at the end of treatment, majority (79.7%) of the patients had intermittent and mild persistent asthma. The frequency of use of budesonide/formoterol in the two arms of treatment showed that patients in the adjustable groups used less number of inhalations of budesonide/formoterol for treatment on average of 2.5 inhalations per day compared to those on fixed dosing who used 4 inhalations per day (p = 0.0001). The number of times patients stayed awake because of asthma was noticed to be more reduced at the adjustable arm of treatment but this was of no statistical significance. It is therefore concluded, that budesonide/formoterol combination in a single inhaler is a simple, well tolerated, convenient treatment which provides effective control of bronchial asthma using a practical self-management plan consistent with current guidelines.

Risk factors for pulmonary tuberculosis among health-care workers in Ibadan, Nigeria

Data on TB infection control programs is limited in many of the TB high burden countries. We carried out a one-year cross sectional epidemiological study (January-December, 2008) to determine the prevalence of occupationally-acquired pulmonary tuberculosis (PTB) among Health- Care Workers (HCWs) in Ibadan, Nigeria. This information is important for planning preventive strategies. All consenting HCWs at two TB centres in Ibadan--the University College Hospital (UCH) and Jericho Chest Hospital were enrolled into the study. A well structured questionnaire was used to obtain information on socio-demographic characteristics of the subjects including their medical and social data. Three sputum samples collected from each subject were processed for acid-fast bacilli (AFB) and culture on selective medium. Isolates were confirmed as M. tuberculosis by standard biochemical tests. Of the 271 subjects recruited, nine (3.3%) had their sputum positive for AFB while six (2.2%) were positive for culture. Subjects aged 20 years and above, female gender and unskilled professionals had higher risk for occupationally-acquired PTB than those who were 20 years and below, male gender and skilled professionals (Odd Ratio OR = 1.9, 95% Confidence Interval, 95% CI = 0.23-16.3, Fisher's exact P = 0.37; OR = 1.1, 95% CI = 0.28-4.0, p = 0.01; OR = 1.05, 95% CI = 1.02-1.08, p = 3.43) respectively. Multivariate logistic regression analysis showed that subjects who received BCG vaccination were less likely to have occupationally-acquired PTB than those without vaccination (OR = 0.86, 95% CI = 0.20-3.6, p = 0.83 for microscopy; OR = 0.76, 95% CI = 0.13- 0.44, p = 0.76 for culture). Even though the risk for occupationally-acquired PTB was lower in subjects who had not spent up to two years in their units, the association was not statistically significant (OR = 0.84, 95% CI = 0.20-3.5, p = 0.82 for microscopy and OR = 1.21, 95% CI = 0.22-0.65, p = 0.82 for culture). There is a need to develop and implement affordable and cost-effective TB infection control strategies in Nigeria in order to reduce the burden of occupationally-acquired PTB in the country.

Trends in bacterial pathogens of lower respiratory tract infections

OBJECTIVES

This study was conducted to determine the bacterial aetiology of lower respiratory tract infections in this environment as well as update the clinicians in the various antimicrobial alternatives available in the treatment.

METHODS

Between September 2002 and February 2005, 157 bacterial pathogens from 556 patients with lower respiratory tract infections were isolated from sputum specimens, and subjected to susceptibility testing, using standard bacteriologic techniques.

RESULTS

Out of the 556 cases, only 150 (27%) had an established bacterial aetiology. One pathogen was demonstrated in 143 (95.3%) patients and seven (4.7%) had mixed infections. The most prevalent single pathogen was Klebsiella pneumoniae (38%) while the most prevalent bacterial combination was Klebsiella and Pseudomonas species (2%). Isolates of Klebsiella pneumoniae were susceptible to ciprofloxacin, gentamicin and ceftriaxone.

CONCLUSIONS

Bacteriological diagnosis and antibiotic resistance surveillance are indispensable in the effective management of lower respiratory tract infections.

Pulmonary tuberculosis in Ibadan: a ten-year review of laboratory reports (1996-2005)

Tuberculosis (TB) control programme is a balance between accurate diagnosis of the disease and effective treatment of cases to eliminate the disease in the community. We carried out a retrospective review of the specimens processed in the TB laboratory of the Department of Medical Microbiology, University College Hospital, Ibadan between 1996 and 2005. Majority of the specimens processed were sputum (75.2%) while cerebrospinal fluid and aspirates from other sources accounted for 4.3% and 20.5% respectively. Of the sputum processed, 2,738 (62.4%) were from male patients while 1,650(37.6%) were from female patients giving a male to female ratio of 1.66:1.00. Only 380 (9.5%) were reported smear positive while 477 (10.9%) were positive for culture. Three hundred and four (6.9%) were smear negative but culture positive while 207 (4.7%) were smear positive but negative for culture. Those sputum that were missed by smear microscopy (6.9%) were only confirmed by culture after six to eight weeks incubation. This culture method is only available in few reference centers in Nigeria. Thus, undiagnosed cases resulting from inadequate diagnostic facilities contribute an impediment to TB control efforts in the community. Hence there is an urgent need to have more accurate, affordable tools that would be available for use at the all levels of health care to achieve total eradication of TB in the community.

Pattern of presentation of tuberculosis and the hospital prevalence of tuberculosis and HIVco-infection in University College Hospital, Ibadan: a review of five years (1998 - 2002)

A 5-year review (1998-2002) was done at the pulmonary unit of the University College Hospital (UCH), Ibadan, Nigeria to determine the pattern of presentation of tuberculosis (TB) and the prevalence of TB and human Immunodefiency virus (HIV) co-infection. A total of one thousand patients were managed for TB but 777 confirmed as having TB had their case files analysed. There were 418 males and 359 females giving a male to female ratio of 1.16:1.00. Pulmonary tuberculosis (PTB) accounted for 78.6% of the patients seen over the period, followed by tuberculosis meningitis 7.8% then TB spine 6.8% and that of the lymph node 4.1%. The other types of TB (Abdomen, pericardial and miliary) accounted for less than 3%. The highest number of cases of tuberculosis (27.8%) was in the 20-29 age group for both male and female followed by those less than 40 years (26.0%). Less than 20% (18.3%) were 40 years old and above. The number of TB cases decreased sharply from a total of 188 in the year 2000 to 89 in 2002. The decrease in number was most likely due to the fact that directly observed therapy short course (DOTS) are now available at other centres within the city and its environs. Only 180 out of the 640 cases of TB were confirmed as HIV positive giving a seroprevalence rate of 28.12%. The annual distribution of TB/HIV co-infection showed a rising trend from 26 cases in 1998 to 42 cases in 2002.

Computed tomographic evaluation of TB spine in Ibadan

BACKGROUND

Tuberculosis still remains a major problem in the developing countries. The involvement of the spine is also of increasing importance, because of the resurgence of TB in association with AIDS. This paper is designed to evaluate the applicability of CT in the diagnosis and definition of tuberculosis of the spine in Ibadan.

METHOD

A restrospective study of the Computed Tomographic examination of 22 cases of spinal tuberculosis (Pott's disease) over a four-year period at the Radiology Department of the University College Hospital, Ibadan.

RESULTS

There was a male prevalence in the study. The mean age of respondents was 41.2 years. Neurological symptoms and back pain were the most common presentations. The thoracic spine was mostly involved while the cervical spine was least involved. Most lesions 77.3 % were demonstrated in two contiguous vertebral bodies. The vertebral bodies were destroyed in all the patients while the posterior elements were involved in 59%. The other CT findings were paravertebral soft tissue shadow in 40.9%, narrowed irregular disc spaces in 27.3% and fusion of vertebral bodies in 13.6%. The frequent bony destruction was osteolytic in nature, and was present in 64% of patients.

CONCLUSION

CT is an adequate modality for thorough imaging and diagnosis of Pott's disease especially in patients with non specific or ambiguous presentations. It offers a unique opportunity of demonstrating clearly the various component of the spine, it also defines the pattern and extent of the destructive process.

Evaluation of modified short course chemotherapy in active pulmonary tuberculosis patients with human immunodeficiency virus infection in University College Hospital, Ibadan, Nigeria--a preliminary report

Over the period, 1st October 1999 to 30th April 2002 a clinical trial of the modified short-course chemotherapy (SCC) in newly diagnosed cases of pulmonary tuberculosis with human immunodeficiency virus (HIV) infection in Ibadan, Nigeria was carried out. The modified SCC used was adopted by World Health Organisation (WHO)/International Union against Tuberculosis and Lung Diseases (IUALTD) for developing countries and also by the Nigerian National Tuberculosis and Leprosy Control Programmed (NTLCP). The regimen used consisted of ethambutol (E), isoniazid (H), rifampicin (R) and pyrazinamide (Z) in the intensive phase of 2 months. The continuation phase was 6 months of ethambutol (E) and isoniazid(H), i.e. 2EHRZ/6EH. Sputum conversion was 90% at the second month of treatment and there was no bacteriological relapse after 18 months of follow-up. Side effects were few and consisted mainly of acne vulgaris in 20 (22.5%) of 89 patients during the continuation phase. It is concluded that this modified 8-month chemotherapy regimen adopted by NTLCP is efficacious in treatment of smear positive pulmonary tuberculosis (PTB) patients with background HIV infection.

A single blinded randomised trial to compare the efficacy and safety of once daily budesonide (400microg) administered by turbuhaler with beclomethasone dipropionate (400microg) given twice daily through a metered-dose inhaler in patients with mild to moderate asthma

The study compared clinical efficacy and safety of beclomethasone dipropionate (BDP) given at a dose of 400microg in the mornings and evenings and delivered via pressurised metered dose inhaler (pMDI) with budesonide given via a dry-powder, inspiratory flow driven device at a daily dose of 400microg in the evening. The study was conducted as a week screening. 8-week open comparative clinical trial. At the commencement of the therapy, the baseline characteristics of the patients randomised into the two drug groups were comparable. Efficacy was assessed by changes in symptoms, number of times beta2-agonist was used and results of pulmonary function tests (PEF and FEV1) while safety was assessed by adverse event experiences. At the end of the study, 24 patients (12 in each group) were evaluated. Both drugs were effective in reducing asthma symptoms and frequency of beta2-agonist usage, as well as improving the lung function tests (FEV1 and PEF). However, budesonide given via Turbuhaler provided better effects in all parameters. The drugs were well tolerated and no adverse event was noticed in any of the patients. We therefore concluded that budesonide Turbuhaler administered once daily at a dose of 400microg is more efficacious than beclomethasone 400microg twice daily administered via pressurized metered dose inhaler.

Prevalence of active pulmonary tuberculosis in human immunodeficiency virus seropositive adult patients in University College Hospital, Ibadan, Nigeria

Infection with Human Immunodeficiency Virus (HIV) has reached a pandemic proportion. There is a resurgence of tuberculosis (TB) Worldwide, this return of an old enemy has been attributed to a number of factors among which HIV infection has emerged as the strongest known risk factor determining the outcome of infection with Mycobaterium tuberculosis (M. tuberculosis). Pulmonary tuberculosis (PTB) accounts for more than 80% of TB cases and is the main problem on account of its frequency and infectivity. There have been studies determining prevalence of HIV in TB cases but that of prevalence of PTB in HIV infected patients have been limited. This study was undertaken to establish the prevalence of active PTB in HIV seropositive adult patients in University College Hospital (UCH), Ibadan. Fifty-eight confirmed HIV-seropositive adults patients were studied. All subjects were interviewed and examined. Subjects with positive respiratory symptoms and signs had their sputum examined and cultured for M. tuberculosis and had chest radiograph done. In this study, the prevalence of active PTB in HIV-seropositive subjects was 32.8% The TB prevalence shows a bimodal distribution at the extremes of age, while the age group 30-39 years had the lowest prevalence of 23.3%.

Respiratory symptoms and ventilatory function of the bakery workers in Ibadan, Nigeria

A total of five hundred Bakery workers were studied to assess occupational induced lung impairment as a result of exposure to grain and flour dust. Occupational related symptoms were recorded using structured questionnaire. Age and sex matched controls consisting of 500 University College Hospital (UCH) Ibadan workers and students were used. They were apparently healthy and work and live at places free of fumes and smoke. Peak expiratory flow rate (PEFR) was measured in all subjects. However, full spirometry work up was done on 100 bakery workers and 100 control subjects that had been selected using simple random sampling technique. The most frequent pulmonary symptoms among the bakery workers were sneezing and running nose (53.30%) and periodic breathlessness/chest tightness (23.16%) while the symptom of cough/phlegm present in (21.53%) of the subjects. The mean PEFR of the bakery workers (463.20 + 51.39 L/ min) was significantly lower (P < 0.0001) than that of the control subjects (538.0 + 47.23 L/min). Similarly, the mean values of FEV1, FVC and FEV1% were also significantly lower than the control subjects. The findings indicate that respiratory symptoms are common during the working hours among the bakery workers and 23.16% of the subjects studied suffered some degree of airway obstruction.

The clinical efficacy of fluticasone propionate (Fluvent) compared with beclomethasone dipropionates (Becotide) in patients with mild to moderate brochial asthma at the University College Hospital, Ibadan, Nigeria

This open, randomized trial was conducted at the Medical Out patient Department of University College Hospital, Nigeria to compare the clinical efficacy of Beclomethasome dipropionate (Becotide) with Fluticasone propionate (Fluvent) in patients with mild to moderate bronchial asthma. The study was performed as a week screening, 8-weeks open comparative clinical trial involving Fluticasone propionate (Fluvent) at a daily dose of 22 microg and Beclomethasone Dipropionate (Becotide) at a dose of 400 microg daily delivered through pressurized metered-dose inhaler (pMDI). The main objective of this study is to assess the efficacy of Fluvent in patients with mild to moderate asthma compared to Becotide. At the second visit (end of 1 week), 10 patients were given either Becotide of Fluvent but all were maintained on as needed beta2agonist (Salbutamol inhaler) therapy throughout the study. Efficacy was assessed by changes in symptoms, number of times beta2-agonist was used and results of pulmonary function tests (PEFR and FEV1) while safety was assessed by adverse event experiences. The baseline characteristics of the patients randomized into the two drug groups were comparable and of no statistical significance. The changes in the pulmonary function tests as well as the reduction in the asthma symptoms suggest a statistically significant improvement in the asthma status of the patients. However, these changes were more rapid among the patients using Fluvent. Also, there was higher percentage decline in the episodes of asthma symptoms either in the morning, day or night in the Fluvent group than Becotide group. The drugs were well tolerated and no adverse event was noticed on any of the patients. We therefore concluded that Fluvent would be more efficacious than Becotide in the treatment of Asthma.

Pattern of active pulmonary tuberculosis in human immunodeficiency virus seropositive adult patients in University College Hospital, Ibadan, Nigeria

Fifty-eight confirmed HIV-seropositive adult patients were studied. All subjects were interviewed and examined. Subjects with positive respiratory symptoms and signs had their sputum examined and cultured for Mycobacterium tuberculosis (M. tuberculosis). Their chest radiograph, full blood count (FBC) and erythrocyte sedimentation rate (ESR) were also estimated. Subjects with Pulmonary tuberculosis were treated using directly observed therapy short course (DOTS) regimen. Sixty-three percent of subjects were positive for Mycobacterium tuberculosis on direct smear and/or culture. Sputum acid fast bacilli (AFB) positive subjects who completed the intensive phase of antituberculous drugs were sputum converted at 2 months. The chest x-ray finding at diagnosis showed 2 subjects (11%) with normal chest x-ray; localised lesion in 7 (37%) subjects; diffuse lesion in 7 (37%); pulmonary cavities in 3 (16%); miliary pattern in 2 (11%); pleural effusion in 2 (11%); hilar adenopathy in 2 (11%). Repeat chest-x-ray at 3 months showed complete clearance of pulmonary infiltrates in 29% whilst 71% had appreciable improvement in radiologic features. The study showed that although chest x-ray may be "normal" in sputum AFB positive HIV infected individuals, radiologic picture tends to be more diffuse and extensive. This study was therefore undertaken to determine the pattern of PTB in HIV seropositive adult patients in U.C.H., Ibadan.

An open study to evaluate the safety and efficacy of zafirlukast ("Accolate") in patients with mild to moderate asthma in Ibadan, Nigeria

An open study to evaluate the safety and efficacy of Zafirlukast (oral leukotriene-receptor antagonist) in patients with mild to moderate asthma was conducted at the out-patient department of the University College Hospital (UCH), Ibadan. A total of 30 patients aged 16-70 years were screened into the trial but 20 patients that fulfilled the inclusion and exclusion criteria were enrolled in a 7-week open study to receive 20mg b.i.d. of "Accolate". Efficacy of treatment was assessed by changes in symptoms, beta-agonist use and pulmonary function tests (PEFR and FEV1). Safety was assessed by adverse experiences, laboratory test results, results of physical examination and chest-x-ray (when necessary). Zafirlukast (Accolate) significantly decreased daytime asthma symptoms scores (28.8%), night-time awakenings (80.76%), morning with asthma (36.4%) and beta-agonist use (31.3%) and significantly increased the mean PEFR values (11.3%); FEV, (17.4%) at end point from their baseline values. Changes in symptoms, beta-agonist use, and pulmonary function occurred within the first week of zafirlukast treatment and continued throughout the trial. Zafirlukast was well tolerated. Headache was reported in two patients. No significant changes were observed in laboratory test results, findings on physical examination. I concluded that zafirlukast produces early and sustained effects in the treatment of mild-to-moderate asthma.

Respiratory symptoms and ventilatory function of the sawmillers in Ibadan, Nigeria

A total of five hundred sawmillers in Ibadan were studied to assess occupation-induced lung impairment as a result of exposure to saw dust. Occupation-related symptoms were recorded using structured questionnaire. Age and sex matched controls consisting of 500 University College Hospital (UCH) Ibadan workers or students were used. They were apparently healthy and work and live at places free of fumes and smoke. Peak expiratory flow rate (PEFR) was measured in all subjects. However, full spirometry work-up was done on 120 sawmillers and 120 control subjects that had been selected using simple random sampling technique. The most frequent pulmonary symptoms among the sawmill workers were running nose and sneezing (57.40%) and productive cough (34.30%), while the symptoms of dyspnoea and wheezing were each present in (4.10%) of the subjects. The mean PEFR of the sawmillers (463.8 +/- 63.4 L/min) was significantly lower (P < 0.0001) than that of the control subjects (537.7 +/- 71.5 L/min). Similarly, the mean values of FEV1, FVC and FEV1% (FEV1%) were also significantly lower in the FVC sawmillers than the control subjects. The findings indicate that respiratory symptoms are common during the working hours among the sawmillers and 4.1% of the subjects studied suffered some degree of airway obstruction.

Modified short-course chemotherapy of pulmonary tuberculosis in Ibadan, Nigeria--a preliminary report

Over a 3 year period 3rd of April 1995 and 6th of April 1998 a controlled clinical trial of the modified short-course chemotherapy (SSC) in newly diagnosed cases of pulmonary tuberculosis in Nigeria was carried out. Between The SCC used was the one adopted from World Health Organisation/International Union Against Tuberculosis and Lung Diseases for developing countries by the Nigerian National Tuberculosis and Leprosy Control Programme (NTLCP). The regimen used consisted of streptomycin (S), isoniazid (H), Rifampicin (R) and pyrazinamide (Z) in the initial or intensive phase of 2 months. Ethambutol (E) was sometimes substituted for streptomycin. The continuation phase was 6 months of thiacetazone, (T) and isoniazid (H), i.e., 2SHRZ/6TH or 2EHRZ/6TH. Sputum conversion was 90% at the second month of treatment and there was no bacteriological relapse after 18 months of follow-up. Side effects were few and consisted mainly of acne vulgaris which occurred in twenty (20.6%) of 97 patients during the continuation phase. It is concluded that the 8-month chemotherapy regimen adopted by NTLCP is efficacious in treatment of smearpositive pulmonary tuberculosis (PTB).