Open Access Case Report

A Report of the Ruinous Effects of Pentazocine Abuse in a Female Adult with Sickle Cell Anaemia Seen in Uyo, Niger-Delta Region of Nigeria: An Urgent Call to Action

I. S. Akpan, E. H. Jumbo, E. E. Uboh

International Journal of TROPICAL DISEASE & Health, Page 1-9
DOI: 10.9734/IJTDH/2018/46603

Painful crisis is the commonest and most distressing clinical manifestation of sickle cell anaemia (SCA), thus prompt and adequate analgesia should be provided to ameliorate the suffering of the patient. Pentazocine is a potent opioid analgesic with mixed receptor activities commonly used in the management of pain in SCA patients. Its abuse among SCA patients has remained a daunting challenge in medical practice worldwide, especially in developing economies like ours. However, reports on opioid abuse or dependence among SCA patients in our environment are inexistent. This report sets out to highlight the addictive potential of pentazocine and the complications associated with its abuse in SCA patients. We report a case of a 40-year-old known SCA female with a five-year history of excessive use of parenteral pentazocine. She commenced self-injection of pentazocine following a previous admission in a private hospital on account of bone pain crisis. Other analgesics such as diclofenac, ibuprofen, piroxicam and tramadol were not efficacious in alleviating her excruciating pain but the administration of parenteral pentazocine provided her with quick and complete relief, hence the beginning of her dependency. She had a hankering desire to use the drug which she used on daily basis. Initially, she injected 30-60 mg (1 – 2 ampules) of pentazocine per day but in the last one month before presentation in our facility, she increased the dose of the drug to 270 mg (9 ampoules) daily. She developed multiple cutaneous and musculoskeletal complications. A diagnosis of pentazocine dependence in a sickle cell anaemia patient was made. She was admitted and jointly managed by the Haematology, Orthopaedic and Mental Health Teams. We hereby advocate effective sensitization of healthcare providers, SCA patients, their caregivers and the society at large about the risks and complications of pentazocine abuse. This is to espouse the fervid need to exercise caution with pentazocine prescription and use. As much as possible, oral formulations, when deemed necessary, should be recommended since most of the observed physical complications occurred apparently as a result of parenteral administration of the drug. Lastly, pentazocine should be categorized as a controlled drug with stringent measures in place to regulate its sales in our environment.

Open Access Case Study

A Fatal Trio: Concurrent Infection with Malaria Parasite, Dengue and Influenza A (H1N1) Virus Together

Arun Agarwal, Pooja Parab, Ankit Swami

International Journal of TROPICAL DISEASE & Health, Page 1-6
DOI: 10.9734/IJTDH/2018/46127

There have been many case reports in the literature of mixed infection with two or more pathogenic organism including Dengue virus, Malaria parasite, Hepatitis virus, Scrub typhus, and Influenza virus but so far there have been no case reports of Dengue virus, Malaria parasite and influenza A (H1N1) virus concurrent infection together. The vector for all these three infections are different-Female anopheles mosquito for malaria, Aedes aegypti mosquito for dengue and direct or indirect contact and inhalation of virus laden aerosols for influenza. This case is unique because here mode of transmission is different yet the patient presented at the same time with this triad of infections and diagnosed on clinical suspicion.

Open Access Original Research Article

Prevalence of Hypertension and Knowledge of Its Risk Behaviors among Residents of Rural and Urban Communities in Rivers State, Nigeria

I. N. Ojule

International Journal of TROPICAL DISEASE & Health, Page 1-10
DOI: 10.9734/IJTDH/2018/46320

Background: Hypertension is the most common cardiovascular disease among blacks anywhere and a major threat to health and wellbeing. Hypertension has been known to vary among countries and even sub-populations within a country. Geographical variations in behavioral risk factors for hypertension have also been noted. Despite the high prevalence of hypertension among residents of developing nations, the level of knowledge of its risk behaviors in most parts of these nations is low compared with that of the developed world

Objectives: This study aimed to compare the prevalence of hypertension and level of knowledge of its risk behaviors among residents of rural and urban communities in Rivers State, a crude oil bearing state in the South-South region of Nigeria.

Materials and Methods: A community-based cross-sectional study design was used to survey 400 residents age ranged 15-84 years, 200 each from rural Elele-Alimini and urban Rumuekini areas in Rivers State. The multistage sampling technique was used to recruit residents of the communities into the study. Data was collected using structured interviewer administered questionnaire, after which blood pressure was measured using the mercury sphygmomanometer. Respondents with blood pressure measurement of ≥140/≥90mmHg, or already on anti-hypertensive medication were classified as having hypertension.

Results: The mean age of respondents from rural and urban communities was 43.3±17.9 and 37.9±15.1 years respectively (p<0.001), and there were more of females than male from both sites (p=0.269). The prevalence of hypertension was 27.0% rural (n=44) and 29.0% (n=58) for urban respondents (p=0.656). Overall, knowledge of hypertension and its risk behaviors was 63.8% and 70.2% for the rural and urban respondents respectively (p=0.210). 

Conclusion: The prevalence of hypertension was high among residents of rural and urban communities in Rivers State. The level of knowledge of its risk behaviors was high. In this study knowledge of hypertension and its risk behaviors did not translate into good hypertension control. There is therefore need to mount comprehensive and robust hypertension preventive and control programme in both rural and urban communities in the state.

Open Access Original Research Article

Vitamin D Level in Association with Body Fat Distribution among Obese Populations in Egypt

Raouf M. Afifi, Mostafa M. Sadek, Ashraf E. Saad, Sameh S. Zaytoun

International Journal of TROPICAL DISEASE & Health, Page 1-14
DOI: 10.9734/IJTDH/2018/46267

Background: Both obesity and vitamin D inadequacy are closely related; yet the relationship between body fat (BF) distribution pattern and vitamin D concentration needs further scrutiny. Study Aim: Analyze the relationship between visceral fat area (VFA) and impaired vitamin D levels among Qena populations, Upper Egypt.

Methods: Adults aging 20 and above seeking care at the outpatient department (OPD) of Qena University Hospital (QUH) were examined, fatness indices including body mass index (BMI) and waist circumference (WC) were measured, and VFA was assayed using bioelectrical impedance analysis (BIA). Visceral fat obesity (VFO) was specifically measured in association with serum vitamin D3 [25(OH) D3)] level.

Results: The study comprised 420 subjects, 246 men, 174 women (125 pre-menopausal, 49 post-menopausal). VFO in the case group (46.2%) was higher than overall obesity (21.2%); men had higher VFO indices [median (IQR)] vs. women: BMI=28.8(13) vs. 25.4(4), WC=95.2(5) vs. 82.8(8), VFA=117.3(27) vs. 85.5(26), respectively. Men had a lower 25(OH) D3 [31.1(14.3)] level than women [36.2(19)]. The prevalence of vitamin D deficiency (VDD) accounted 35.5% in men and 23.7% in all women (p= 0.009). Subjects’ 25(OH) D3 levels [median (IQR)] and VFA quartiles (Qs) were inversely related both in men [38.8(18), 31.4(15), 28.8(16), 23.2(14), p= 0.005] and pre-menopausal women [42.7 (26), 41.2 (25), 36.8 (21), p=0.03]. Only men suffer increasing vitamin D insufficiency across VFA quartiles (Q1=10.1%, Q2=13.3, Q3=37.7, Q4=39.8, p= 0.002); while both men and pre-menopausal women sustain escalating VDD pattern under VFA quartiles (Q1 20.1%, Q2 39.6, Q3 45.2, Q4 55.3, p<0.0001), (Q1 18.7%, Q2 20.3, Q3 23.6, Q4 37.1, p =0.00032), respectively. Men and pre-menopausal groups with the highest VFA were prone to 25(OH) D3 insufficiency/deficiency, compared with the lowest VFA groups [OR men 5.7 (95% CI 3.1 – 9.2; p=0.02), OR women 95% CI 2.2 - 4.5, p= 0.009].

Conclusions: Higher VFA may be risk for vitamin D inadequacy in men and pre-menopausal women. That VFA assessment using BIA provides a sex-specific adiposity measurement in identifying vitamin D inadequacy; VFA can be used as a simple and cost-effective method in population-based screening to prevent VDD, especially among high risk groups.

Open Access Original Research Article

In vitro Antiparasitic Activity of Camel Milk against Blastocystis sp.

Rowaida A. Bakri, Raafat T. Mohamed, Osama A. Alharthi, Sulaiman M. Hushlul, Adel El-Shehry, Mohammed A. El-Bali

International Journal of TROPICAL DISEASE & Health, Page 1-9
DOI: 10.9734/IJTDH/2018/45844

Aim: The aim of the current study was to investigate in vitro anti-protozoal activity of camel, cow, and goat raw milks against Blastocystis sp. strains isolated from symptomatic patients.

Place and Duration of Study: The study was carried out in two major health care centres of Makkah city, Saudi Arabia between 01 January and 30 March 2017.

Methodology: Stool specimens collected from patients and healthy individuals, were examined by microscopy and in vitro cultured using Dulbecco's modified Eagle medium. Cultures were examined after 24, 48, and 72 hrs. Blastocystis sp. subtyping was performed on genomic DNA extracts of positive cultures by polymerase chain reaction using sequence-tagged-site primers. Blastocystis sp. parasites susceptibility assays were performed in 2 ml final volumes seeded with 2x105 parasites and incubated for 48 h at 37°C. Concentrations of 250 µl/ml, 125 µl/ml, 62.5 µl/ml, 31.2 µl/ml, and 15.6 µl/ml of bovine, goat and camel raw milk were tested for their anti-parasitic activity against two Blastocystis sp. isolates identified as ST1 and ST3 subtypes. Metronidazole at (0.1 mg/ml) was used as positive antiparasitic control in all assays.

Results: Out of seven positive cultures, two isolates were identified as ST1 subtype and five isolates as ST3 subtype. A significant in vitro killing effect was obtained with camel raw milk at minimal concentration of 31.2 µl/ml compared to cow raw milk (P<0.05) and goat raw milk (P<0.05), on both subtypes. Both, cow and goat raw milk did not show a noticeable in vitro killing effect at the highest dose of 250 µl/ml.

Conclusion: Raw camel milk revealed a substantial dose-dependent in vitro antiparasitic activity against Blastocystis sp. ST1 and ST3 subtypes, opening a promising perspective for its use in the control of this wide spread gastrointestinal parasite both in humans and livestock. In contrast, cow and goat raw milks did not show noticeable anti-Blastocystis sp. activity against both subtypes.