Background: Chloroquine (CQ) has been in use in Africa for a long time. Because of misuse, this drug has now lost its efficacy due to the emergence of resistance strains in most parts of Africa. Recently, it was shown that after chloroquine has been withdrawn from the market, chloroquine-sensitive Plasmodium falciparum re-emerged and chloroquine could again be used successfully as an antimalarial. Surveillance of parasite populations is, therefore, important to decide whether chloroquine could be re-introduced.

IntroductionPregnancy is associated with major haemodynamic and cardiac changes, which can mimic or precipitate cardiac diseases. There is a paucity of this kind of data among pregnant Nigerian women. This study was aimed at describing the cardiovascular and electrocardiographic changes found among healthy pregnant Nigerian women.MethodsThis was an age-matched control study of 69 consecutive normal pregnant and 70 healthy non-pregnant controls. The study protocol included history, physical examination and 12-lead electrocardiography.ResultsDiastolic blood pressure < 60 mmHg was significantly commoner among pregnant subjects than controls (64.7 vs 24.3%, respectively, p < 0.005). Mean heart rate was higher among pregnant women (88.34 ± 11.46 bpm) than the controls (75.16 ± 12.22 bpm, p = 0.020). Pregnant subjects also had a higher proportion of left ventricular hypertrophy (LVH) (10.2 vs 0%, p < 0.05) than non-pregnant controls. Abnormal cardiac findings included a loud second heart sound (P2), missed beats and systolic murmurs (41.2% in pregnant subjects vs 12.9% in non-pregnant controls, p < 0.05). Negroid-pattern ST-segment elevation was commoner among controls (24.3%) than pregnant subjects (2.9%, p < 0.005). Arrhythmias were rare among the study participants.ConclusionSignificant findings on examination were low diastolic blood pressure and a systolic ejection murmur. However, ECG changes showed a normal frontal-plane QRS axis, normal PR interval, significantly rare normal Negroidpattern ST elevation, significant LVH based on Araoye RI > 12 mm and a rarity of all forms of arrhythmias. These data may help resolve some cardiac diagnostic difficulties during pregnancy.

Chloroquine (CQ) resistance in

Background: The aim of this prospective study was to determine the prevalence of HCV antibodies among pregnant women and their corresponding offspring in a tertiary medical centre in Southwestern Nigeria. Method: Anti-HCV antibodies (anti-HCV antibodies) were analyzed in blood samples from mothers and cord samples from their corresponding offspring using the Enzyme Linked Immunosorbent Assay (ELISA) method. The results obtained from the study were expressed in simple percentages. Results: Out of the 272 consenting pregnant women screened for anti-HCV antibodies, 25 (9.2%) of them were positive. As none of the pregnant women had multiple births, screening the 272 cord sera from their offspring for the same antibodies revealed that 3 (1.10%) of them were also positive. Thus, the prevalence of anti-HCV antibodies in the pregnant women and their offspring were 9.2% and 1.1% respectively. Conclusion: If vertical transmission of HCV were to be based on the acquisition of anti-HCV antibodies alone, the prevalence of vertical transmission from HCV infected mothers to offspring in the study was 12.0%. Further studies on vertical transmission are suggested to include analysis for HCV-RNA quantification in pregnant mothers and their offspring as well as a long-term follow-up of neonates seropositive for HCV markers. Such studies are necessary to justify any recommendations to be made for the purpose of reducing HCV infection through vertical transmission.

Background:Tramadol is licensed primarily as an analgesic, but has additional properties, one of which is the ability to increase gastric pH. However, it has not been established if this action is dose related, hence we set out to provide further evidence about this action of tramadol.Patients and Methods:Fifty-five female adult patients presenting for gynecological surgery were randomized into three groups. After induction, 2.5 ml of gastric juice was aspirated to determine baseline pH, after which groups 1, 2, and 3 received 50 mg, 75 mg, and 100 mg of IV tramadol, respectively. Gastric pH was subsequently assessed every 30 min for as long as the surgery lasted.Results:There was no significant difference in the pH of the three groups before anesthesia (3.88 ± 0.75, 3.54 ± 0.73, and 3.75 ± 0.70; P = 0.393). Similarly, no significant statistical difference was observed in the pH of the three tramadol groups during the subsequent three readings (pH1: 4.21 ± 0.93, 4.27 ± 0.95, 4.07 ± 0.82; pH2: 4.75 ± 1.00, 4.68 ± 0.94, 4.59 ± 0.78; pH3: 5.33 ± 0.86, 5.13 ± 0.95, 4.97 ± 0.78; P = 0.793, 0.876, and 0.490). There were statistically significant increases in the pH of each group when the baseline pH was compared with the subsequent three readings, with P values of 0.002, 0.0001, 0.001 in the 50 mg group, 0.0001, 0.0001, 0.0001 in the 75 mg group, and 0.008, 0.0001, 0.001 in the 100 mg group.Conclusion:Our result further confirms that tramadol elevates gastric pH. However, the degree of elevation was not found to be dose dependent.

To assess the affordability of antiretroviral drugs (ARVs) and accessibility to treatment for opportunistic infections (OIs) among HIV-1 seropositive persons, we used semi-structured interviewer-administered questionnaires to interview 154 individuals seeking ARV treatment at the Daughter of Charity German Leprosy and Tuberculosis Centre in South-West Nigeria. The respondents' mean age was 37 years (range 13-65 years) and their average monthly income was NGN9 603 (approx. US$73). One hundred and eleven respondents (72.1%) had sought care elsewhere before seeking ARV therapy: 67 (60.4%) from private hospitals, 26 (23.4%) from public hospitals, 17 (15.3%) from traditional healing homes, and one from an NGO; the remaining 43 (27.9%) had not sought medical care before ARV therapy. Thirty-nine respondents (25.3%) had symptomatic AIDS with evidence of opportunistic infections (OIs), and 115 (74.7%) were HIV-1 seropositive only. One hundred and twenty-six (81.8%) believed that ARV treatment would prolong their lives, of which 27 anticipated a cure for AIDS; eight (11.7%) had no knowledge of the benefits of ARV therapy, six (3.9%) had strong fears of stigmatisation and discrimination as a consequence of ARV therapy, and four (2.6%) did not express any opinion. Sixty-three respondents (40.9%) perceived the cost of ARVs as expensive and unaffordable, 58 (37.7%) wanted free drugs, 20 (12.9%) wanted to pay a maximum of NGN2 000 (US$15) for monthly supplies (while the actual cost was NGN13 000 or US$98), and 13 (8.5%) did not comment. There was a strong association between literacy level and knowledge of ARV therapy. The more educated tended to have higher incomes and their perception of ARV therapy was laudable despite having sought other treatment elsewhere, while the less educated tended to earn less and perceived ARV therapy as unaffordable, and therefore had not bothered to seek previous treatment. We urge that ARVs be made more affordable to enhance their accessibility and treatment compliance, especially among lower-income patients.

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