Chronic pulmonary aspergillosis as a cause of smear-negative TB and/or TB treatment failure in Nigerians

OBJECTIVE

To evaluate chronic pulmonary aspergillosis (CPA) as an alternative diagnosis of smear-negative tuberculosis (TB) and treatment failure in TB patients in Nigeria.

METHODS

We conducted a cross-sectional multicentre survey in human immunodeficiency virus (HIV) positive and negative adult patients at the end of their TB treatment in clinics in Lagos and Ilorin states. All were assessed using clinical examination, chest X-ray (CXR) and aspergillus immunoglobulin G (IgG) serology, and some for sputum fungal culture. CPA was defined as a positive Aspergillus fumigatus IgG titre with compatible CXR or a positive sputum culture of Aspergillus with a visible fungal ball on CXR with symptoms of underlying lung disease.

RESULTS

Of 208 patients recruited between June 2014 and May 2015, 153 (73.6%) were HIV-positive. The mean age was 39.8 years, 124 (59.6%) were female and 39 (18.8%) were unable to work. The median CD4 count was 169.5 cells/ml (range 4-593) in HIV-infected patients with positive Aspergillus IgG. Overall, 109 (52.4%) had documented TB, 140 (67.3%) had a productive cough and 50 had haemoptysis. CPA prevalence was 8.7%; 10 (6.5%) had HIV infection and 8 (14.5%) were HIV-negative (Fisher's exact P = 0.092).

CONCLUSION

CPA is a neglected disease in Nigeria, and most cases match the World Health Organization diagnostic criteria for smear-negative TB.

The agreement of point-of-care and standard laboratory electrolyte and glucose analysis in critically ill patients in a sub-Saharan tertiary teaching hospital

BACKGROUND

The critically ill patient undergoes rapid changes in the internal milieu requiring quick intervention. Point of care testing has been shown to be valuable in the early diagnosis and management of such patients.

OBJECTIVE

This study determined the agreement between I-STAT Abbot point of care testing with standard laboratory testing in the analysis of electrolytes and glucose concentrations in critically ill patients.

METHODS

The study was performed in a Sub-Saharan Tertiary Teaching Hospital in critically ill patients. Electrolyte and glucose analysis were measured with I-STAT Abbot Analyzer unit with parallel blood specimens (n = 30) tested in the laboratory on an ion-selective electrode, SFRI analyzer ISE 6000.

RESULTS

There was no significant difference in mean sodium, potassium, chloride and glucose between I-STAT POCT and standard laboratory measurements. The agreement between POCT and laboratory glucose was good p(c) = 0.967, mean difference of 0.79 and 95% limit of agreement from -3.83 to +5.107 mmol/L, p = 0.733. Bicarbonate was moderate (p) = 0.637, mean difference of 1.95 and 95% limit of agreement from -4.294 to +0.394 mmol/L, p = 0.101. There was moderate agreement for sodium (p(c)) = 0.32, mean difference of 5.8 and 95% limit of agreement from -0.378 to +11.98 mmol/L, p = 0.064. Agreement for potassium was moderate (p(c)) = 0.439, mean difference of 0.15 and limit of agreement from -0.401 to +0.701 mmol/L, p = 0.588. There was, however, a significant difference in mean chloride, and BUN values; chloride (p(c)) = 0.0796, mean difference of 13.8 and 95% limit of agreement from -7.55 to + 20.015 mmol/L. Blood urea nitrogen (p(c)) = 0.064, mean difference of 18.55 and 95% limit of agreement from -30.126 to +6.974 mmol/L.

CONCLUSION

The mean sodium, potassium, glucose and bicarbonate were comparable with moderate to good agreement between I-STAT POCT and ISE 6000 Analyzer. Though, the mean BUN and chloride levels between the analytical methods differ significantly.

The accuracy of ultrasonography in the diagnosis of breast pathology in symptomatic women

BACKGROUND

Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23% of total cancer cases and 14% of cancer deaths worldwide. The developing countries are catching up with this trend. Breast ultrasound when properly performed and interpreted, is an indispensable tool in breast imaging. The early diagnosis and treatment of breast masses reduces the morbidity and mortality associated with delayed diagnosis of breast carcinoma. The use of breast ultrasound is gaining ground in recent time, this is due to current advances in ultrasound technology which permit greater spatial and contrast resolution and shortened scan time.

OBJECTIVE

To determine the sensitivity, specificity and positive predictive value of ultrasound in the detection of palpable breast masses and to correlate the findings of ultrasound with the findings of fine needle aspiration cytology, or histopathology.

METHODS

Breast ultrasound scanning was done in 100 patients with signs and symptoms of breast lesion referred from the Surgical out Patient Clinic to the Radiodiagnosis Department of Lagos University Teaching Hospital (LUTH). Histology reports were collected from either the case note or Morbid Anatomy department to correlate the findings with ultrasound diagnosis.

RESULTS

The mean age was 41.7 +/- 11.34 (18-59) years. Symptoms of breast lesion were highest in the age group 41-50 years 38 (38%), and least in 18-20 years 4 (4%). When the use of ultrasonography was compared with the histopathology report in the diagnosis of breast lesion in the studied population, the sensitivity was 100%, specificity (96.6%), accuracy (97%), posting predictive value (PPV) 81.3%, and negative predictive value (NPV) 100%. The accuracy, specificity and PPV however decreased with increasing age.

CONCLUSION

Ultrasonography of the breast is useful in the diagnosis of breast lesions, because of the high sensitivity, specificity and diagnostic value it exhibited with histopathologic findings.

Occupational stress among radiographers in Lagos, Nigeria

BACKGROUND

Occupational stress induced injuries occur in various professions that require repetitive motion or physical exertion, such as Radiography. The injuries may involve body parts such as the neck, the upper back, mid back, low back (waist), knee, elbow, wrist and hand and eyes.

OBJECTIVE

To assess work related injuries medical radiographers are prone to, during practice of the profession in relation to their working conditions.

METHODS

This study was conducted among registered practicing radiographers in Lagos State, South-West, Nigeria. Lagos is one of Nigeria's most populated states and economic nerve centre of Nigeria. Due to its population, there are many hospitals with radiodiagnostic facilities and radiodiagnostic centres which are either government or privately owned. Eighty registered radiographers in 21 hospitals and diagnostic centres participated in the study. They include three federal government owned institutions, three State government owned institutions and fifteen privately owned diagnostic centres. The respondents' status were made up of 38 males and 42 females where 37 of them were between 20-30 years, 11 were between 41-50 years and those above 51 years were 12.

RESULTS

The results revealed that a majority (91.2%) of respondents stand during the course of their work. Waist, neck, heel, wrist and shoulder pains were common among the respondents. Some respondents frequently manifest frustration (78.7 %), insomnia (52.5 %), difficulty in concentration (56.2%), poor appetite (50.0%), irritation (67.5 %) and tension (63.8%) while lesser percentages experience such.

CONCLUSION

This study showed that occupational stress sites susceptible to work induced stress injury. Musculoskeletal strain was the most common type. Waist/ low back, plantar/heel and wrist pains were also common among radiographers in Lagos, Nigeria.

X-ray pelvimetry and labour outcome in term pregnancy in a rural Nigerian population

BACKGROUND

X-ray pelvimetry is a radiological investigation that involves the measurement of different anthropometric dimensions of the pelvis. The pelvic inlet and outlet play important role in labour outcome. The query as to whether x-ray pelvimetry has a useful predictive value regarding labour outcome prompted this study.

OBJECTIVES

To determine whether the use of X-ray pelvimetry is still relevant in term pregnancy, and its reliability in predicting labour outcome.

METHOD

This was a retrospective study of pregnant patients who had X-ray pelvimetry at term and successfully delivered at a rural community based mission maternity hospital between 2005-2008. Each x- ray pelvimetry report was matched with the mode of delivery of the patient. 150 patients who were found suitable had data such as age, mode of delivery, etc, extracted.

RESULTS

In a review of 150 X -ray pelvimetry films, 119 (79.33%) were categorised as adequate pelvis, 10(6.67%) borderline pelvis and 21 (14%) inadequate pelvis respectively based on the conclusions of the radiologist. Out of the 21 patients with inadequate pelvis, 14 (67%) had normal delivery and 7 (33%) had caesarean section. For the 10 patients with borderline pelvis, 7 (67%) had normal delivery and 3 (33%) had caesarean section.

CONCLUSION

This study has demonstrated that X-ray pelvimetry may not be accurate but has fair predictive value on mode of delivery in term pregnancy.

The relationship between microalbuminuria, cardiovascular risk factors and disease management in type 2 diabetes

BACKGROUND

In patients with type 2 diabetes, microalbuminuria is an early clinical sign suggestive of vascular damage to the glomerulus. Microalbuminuria has also been currently reported as an important risk factor for cardiovascular disease and becomes relevant in the management of type 2 diabetes.

OBJECTIVES

This study is to determine the prevalence of microalbuminuria, identify the risk factors associated with microalbuminuria in type 2 diabetes, and to asses the achievement of treatment goals for cardiovascular risk reduction in type 2 diabetics.

SUBJECTS AND METHODS

Seventy- two subjects with microalbuminuria were recruited from three hundred consecutively screened type 2 diabetics attending the Diabetic Clinic at the Lagos University Teaching Hospital. Clinical data were obtained by interviewing the participants. Anthropometric measurements were made and blood specimens were collected for analysis.

RESULTS

The prevalence of microalbuminuria was twenty-four percent (24%) in type 2 diabetes. Multiple logistic regression identified duration of diabetes (odds ratio 1.3 (95% CI; 0.03-1.58), hypertension(odds ratio 5.2 (95% Cl; 1.24-18.62), Body mass index (BMI) (odds ratio 1.27 (95% CI; 1.0-1.6), waist/hip ratio (WHR) (odds ratio 1.9 (95% Cl; 1.3-3.5), andHbA,c (odds ratio 6.6 (95% Cl; 1.02-27) as independent risk factors associated with microalbuminuria in type 2 diabetics. Optimum blood pressure, glycemic and weight control were achieved in eighty five percent (85%), fifty eight percent (58%) and nineteen percent (19%) of the type 2 diabetes respectively.

CONCLUSION

This study showed that microalbuminuria is common among patients with type 2 diabetes. It also showed improvement in glycemic control and modifiable cardiovascular risk factor control when compared with previous studies.