Background: Cryptococcal meningitis (CM) is the most common severe life threatening fungal infection in AIDS patients. It is an important cause of morbidity and mortality. There is paucity of data on the prevalence of CM in Nigeria. We aimed to determine the frequency of CM, the clinical presentation and immunological profile. Methods: A cross sectional study was carried out at the Jos University Teaching Hospital (JUTH), A total of 100 HIV-1 infected patients suspected of having meningitis or meningoencephalitis were subjected to cerebrospinal fluid (CSF) analysis (including Indian ink preparation and fungal culture by conventional methods) and CD4 count was determined using flow cytometry (count bit Y-R 1004 Partec Muster Germany).Results: The freguency of CM was 36% in our cohort. The commonest clinical presentation included headache (100.0%), neck stiffness (77.8%), fever (72.0%), vomiting (55.6%), personality changes (55.6%), photophobia (27.8%) and convulsions (27.8%). The mean duration of symptoms was 24 ±22 days with a median of 17 days. The 3 mean CD4 count was 89±60 cells/mm with a median of 3 82 cells/mm . Conclusion:The high prevalence of CM and the associated severe immunosuppression underscores the importance of early diagnosis of HIV infection which may reduce the incidence of CM. There is the urgent need for access to Amphotericin B and fluconazole in resource constrained settings in addition to a wide access to HAART.
Self discharge (SD) of hospitalized patients is an adverse clinical event often resulting from a fundamental disagreement between the patient or an interested third party and the attending physician and / or the hospital environment. This culminates in the patient’s withdrawal of their initial voluntary consent for hospitalisation and abrupt termination of in - patient medical care. Patients who left hospital admission against the advice of their doctors are both a concern and a challenge for individuals in the health industry. It negatively impacts treatment outcomes and exposes the clinician and health care administrators to the hazards of litigations. The study was aimed at determining the incidence of SD and associated factors in medical admissions. It was a retrospective descriptive hospital based study of patients who self discharged from medical wards of Federal Medical Center, Makurdi from June 2012 – May 2017. Approval was obtained from the institution’s research ethics board. Thirty one individuals (0.62% of total admission) self discharged within the study period. Financial constraints was responsible for 32.2% (10) of SD followed by proximity to social support 19.4% (6). Five patients (16.1%) elected not to disclose any reasons. The incidence reduced from 0.21% to 0.02% at the start and end of study period respectively. Though SD was relatively low in this study, the incidence could be reduced further by expanding the scope of health insurance scheme, skilful communication and negotiating patient management using patient – centred methods.
Background: Coronavirus Disease 2019 mortality figures in Africa are comparatively lower than the figures in Europe, Asia and the Americas. Many reasons have been adduced for the differences which include the younger population in Africa. We therefore out set to describe the epidemiology and clinical features among in-hospital mortalities in our setting. Methods: This was a retrospective study of all mortalities due to confirmed COVID-19 at the Jos University Teaching Hospital from April 2020 to April 2021. Descriptive statistics were used to present results and Chi Square analysis used to determine the association between morbidities, sex and ventilator use. A p-value of <0.05 was considered statistically significant. Results: A total of 80 mortalities were recorded over the 12 month period. Sixty one (76.0%) were males. The mean age of the study population was 61 ± 15 years and twenty nine (36.3%) were aged ≤59 years. The median duration of hospitalization for in-hospital mortality was 4days (IQR 1-35). Fever; 61(76.3%), cough; 59(73.8 %) and dyspnea; 56 (70.0%) were the commonest presenting symptoms and 35(43.8%) had the three symptoms. Hypertension; 48(60.0%) and type 2 diabetes mellitus; 36(45.0%) were the commonest co-morbidities in the patients, and 31(38.8%) had at least two co-morbidities. Eighteen (22.5%) had both hypertension and diabetes mellitus. Hypertension and having two or more co-morbidities where associated with requirement for ventilator support (P <0.013 and P<0.001 respectively). Conclusion: Fever, cough, dyspnea and two or more co-morbidities are common among COVID-19 mortalities in Jos. Efforts to quickly identify such patients and manage comorbidities are needed to reduce mortality.
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