The HIV prevalence rate has continued to rise steadily from less than 0. Although the knowledge about HIV and its mode of transmission is widespread, it is however disheartening to note that this did not result into appreciable attitudinal change and behavior modification among Nigerians. HIV-infected patients in Nigeria are also co-infected with other viral and bacterial infections, the commonly reported ones being co infections with hepatitis B and C. Although treatment of infected patients has increased recently, more effort is needed, especially in the area of patients monitoring, to maximize the benefits of ART in Nigeria.
Finally, Nigeria has made appreciable efforts in vaccine development and candidate HIV DNA vaccines have been developed utilizing the sequences from predominant subtypes, and these candidates have been shown to be immunogenic in animal models. The discovery of what is now known as the human immunodeficiency virus HIV , the causative agent for the dreaded acquired immunodeficiency syndrome AIDS , dates back to June 5 th , , when the Center for Disease Control, CDC, reported five cases of Pneumocystis carinii pneumonia in active homosexual males, from three different hospitals in Los Angeles, California.
In , Luc Montagnier and his group at the Pasteur institute, in France, isolated the virus, and in the following year, Dr Robert Gallo, of the United States, published some works affirming also that the acquired immunodeficiency syndrome was caused by the HIV virus . Ever since then, the virus and its infection have been reported from all parts of the globe, reaching an epidemic level in a few years, in several countries, especially in sub-Saharan Africa.
Because of the widespread patronage of this group of people, cases of HIV infection were occasionally reported from various parts of the country , and have been growing steadily. Nigeria is the tenth largest country in the world, and the most populous country in Africa. Ever since it was reported, the infection rate has continued to rise steadily from less than 0.
The AIDS epidemic in Nigeria is generalized, with infection primarily occurring through heterosexual transmission . Some parts of the country are worse affected than others, but no State or community is free from its scourge. It affects people from all ways of life, both the young and the old, though the prevalence rate may differ. It is the leading course of morbidity and mortality in sub-Saharan Africa.
Data from several parts of Nigeria point to an increasing sexual activity among single adolescents of both sexes, with progressive decrease in the age of sexual initiation, and poor contraceptive use . The disease is known to affect all age groups, but generally speaking, youths between the ages of 20 and 29 are more affected.
Many studies have been published on various aspects of the HIV epidemic in Nigeria by individuals, government agencies, health institutions and researchers in and out of the country. Over of these articles pulled from various local and international journals as cited on www. The important findings are presented in this review. Prevalence of HIV in Nigeria. Several HIV seroprevalence sentinel surveys involving pregnant women attending antenatal clinics have been repeatedly conducted in Nigeria since by the Federal Ministry of Health in collaboration with some international donor agencies on a two year interval since till date .
Most, and recently all the States of the federations were covered, including the Federal Capital Territory. Other studies from several centers across the nation has also been reported, using pregnant women, emergency department patients, intending couples, patients attending special treatment clinics and others. The adult HIV prevalence has increased from 1. A breakdown of the prevalence per State and zone is shown in Figure 2 and Table 1. It should be noted that AIDS case reporting has been characterized by under-reporting, delayed reporting and under recognition.
Despite this trend, the number of reported cases has been increasing, especially since This can be attributed to unrestrained and increasing sexual activities which are often unprotected; lack of positive behavioral changes, despite increase knowledge about the disease; stigmatization, which drives the disease underground; transfusion of unscreened blood in some localities; inadequate measures to prevent mother to child transmission and others.
According to the national survey, HIV prevalence rate among female sex workers in Nigeria has remained high, and is on the increase from This group constitutes an important reservoir of HIV infection for transmission to the general population, through their sexual network. Among emergency department patients in Lagos, they reported a prevalence rate of 5. Also, Sagay et al. Among some people regarded as high risk groups, high prevalence rates were encountered in different parts of the country. Kehinde et al. In Port Harcourt, a study among intending couples reported a rate of Kaposi's sarcoma and herpes zoster are commonly associated with HIV infection.
However, only a rate of 4. An overwhelming ten out of 11 children aged from four weeks to 11 months with acquired rectal fistulae were found to be HIV-positive in Jos. All their mothers were HIV-positive . In Ile Ife, Adejuyigbe et al. Knowledge, Attitude and Practice. Knowledge has been identified as a powerful tool for positive change in all aspects of human endeavor.
In the 80's and early 90's, the people's knowledge about HIV was indeed low, and filled with several misconceptions, especially among those with no formal education. This trend has however been reversed in this new millennium, with a high percentage of the population having good and accurate knowledge of all the aspect of the epidemic .
It is however disheartening to note that this high level of knowledge about the disease did not result into appreciable attitudinal change and behavior modification among Nigerians [20, 22]. Anochei and Ikpeme, in Port Harcourt , showed that among final year primary school students, A study conducted by Lipase et al. They also found that those having tertiary education were three times more likely to accept VCT than those with a low level of education.
Twenty-nine percent of the students assessed were sexually active, but only Sunmola , in the same institution, found out that students believe that condom hinders their sexual satisfaction, causes health problems for them, and reduces their sexual interest; and therefore were not willing to use it. A similar study among undergraduates in Enugu reported that all the participants had a high knowledge about the infection. There was however a significant tendency towards a more consistent use of condom .
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Out of these, Eleven point nine percent of the students disapproved the use of contraceptives by singles . Complaints like partner and personal dislike, as well as reduction in sexual pleasure, were reasons for non-condom use . This pattern of high sexual exposure among the youths is also seen among our secondary school students. Owolabi et al. The median age of sexual exposure was 12 years years. In fact, it was showed by another group that about Oshi et al. This situation can be seen in several communities in Nigeria.
Therefore, sex education should be introduced into secondary schools curriculum in order to curb this ugly trend among this population. They discovered that more Gwari and Hausa respondents did not use any form of protection during their first sexual experience, compared to Yoruba and Igbo respondents . This may be related to the cultural values of the various ethnic groups.
Means of preventing pregnancies or STD were rarely employed. Among commercial bus drivers, it was found by Ekenem et al.
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Condom ever use was About The situation among naval staff is also disturbing. Eighty-eight point one percent of them, a rather high figure, had a life time multiple sexual partners, ranging from , with mean of 5. Thirty-two percent of the officers have had sex with female sex workers, A number of married men engage in extramarital affairs, and also patronizes sex workers. Eleven percent of 1, men interviewed across Nigeria had extramarital affairs, this being affected by religion, wealth, and age of sexual debut .
The mode of spread of the human immunodeficiency virus has been clearly documented. Other means of transmission include transfusion of infected blood and blood products, homosexual relationship among men, sharing of needles and sharp piercing instruments with infected persons, and also from an infected mother to her child . As seen from the foregoing, there is an increasing high rate of sexual practice in the country, ranging from students in the secondary schools to the tertiary institutions, youths in the garage and motor parks, the drivers, uniformed men, and even among married men.
This has led to a high number of people with multiple sexual partners and to an increase in the number of visits to sex workers. Vertical transmission of the virus can occur from an infected mother to her child via placenta in utero, during labour and delivery, and also through the breast milk.
With the high prevalence rate of HIV in Nigeria, it was projected using the Estimation and Projection Package EPP , in , that the total number of people living with the virus at the end of that year would be between 3. In the low prevalence scenario, this is expected to rise to 3. There would be a cumulative death of 3. Interventions for the prevention of mother to child transmission include VCT, use of antiretroviral drugs ARV , and modification of obstetric practices with infant feeding options .
Iliyasu et al. Of the positive patients seen, the male to female was 2. Thirty-eight point five percent had secondary education, Fifty percent of them were Hausas. Sixty-seven percent of them reported occasional use of condom, while 8. Rufus, in , identified blood transfusion and mother to child transmission as the major modes of transmission of HIV among paediatric patients .
Among induced abortion seekers in Benin City, Teenage pregnancy was identified as a major risk factor for HIV acquisition, as one out of three teenage mothers were positive years , against none in mothers above 39 years . HIV transmission via transfusion of an infected blood is also a major factor in Nigeria. Dorosinmi et al. Twenty-nine point nine percent and Blood donation is usually done for various reasons, ranging from antenatal registration benefit HIV prevalence of Co-infection was established in Out of clients in another study, Syphilis was the most prevalent STI here If intervention measures in the form of peer education, training of STI treatment providers, health clubs in schools and public lectures are provided in communities, positive change in attitude can be seen with early treatment among Nigerian youths .
Occupational risk is also a means whereby HIV can be acquired among health workers. Obi et al. Of the surgeons interviewed, Ninety-two percent of them support preoperative screening of patients. Seventy-nine point five percent believed that infected patients should not be discriminated, regarding the management of provided protective measures .
In Calabar, however, it was shown that among three tertiary institutions, material and equipments needed for protective and hygienic practices were inadequate. Opportunistic Infections. The world, for instance, has witnessed the resurgence of tuberculosis TB. It was reported that TB-related deaths occurred in more than in any other year before then in history, almost 3 million, compared to 2. In the next 50 years, as many as million people may develop TB if current rate continues, especially, multidrug-resistant TB . Okeke et al. This abnormality was higher in patients with lower CD4 count.
Similarly, Mohammed et al. Type 1 is the commonest type worldwide, accounting for the majority of HIV infections, while type 2 is restricted majorly to West Africa, accounting for a small percentage of infections. HIV-1 strains from around the world can be placed into two major genotypic subgroups: the M main and O outlier group.
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Within the M group, there are discrete genotypic clusters genotypes or clades , being given a letter designation to them; subtypes from A to I were identified. Partial sequencing of four HIV-1 isolates demonstrated the presence of subtype G viruses in Nigeria . A full genome sequence of HIV-1 IbNg was later shown to cluster with subtype A, but with unique genetic features . The presence of subtypes G and IbNg were further documented in Nigeria . Montavon C et al. The presence of HIV-2 in Nigeria has been confirmed serologically . Eighteen HIV-2 isolates were recently characterized genetically; 16 were subtype A and associated with heterotypic infections and two were subtype B and were associated with monotypic infections .
Sometimes, HIV does not exist alone, and cases of co-infection with other viruses have been encountered. It was also higher in commercial sex workers Agwale et al. Forbi et al. HIV alone was present in Good education and counseling would cause appreciable number of people to consent to screening. Seventy-eight percent of women who were counseled during pregnancy accepted to be tested . Some people however are afraid of testing for several reasons. Good counseling before testing would greatly reduce this trend, apart from psychologically preparing the patient.
Other tests like CD4 count and viral load are also conducted to monitor patients, especially those on treatment. Njoku et al. These parameters need to receive adequate attention for possible correction in this group of patients. Nigeria has adopted the use of lamivudine, nevirapine and stavudine as first line drugs, and they have been showed to be very effective. Their activities however have been limited to a few centers, especially in the urban areas, with only a small percentage of those infected having access to these drugs.
The use of these drugs in 50 patients followed up for the period of 12 months showed viral decrease by 1. Idoko et al. This combination was adjudged to be effective and relatively safe in treating patients with HIV . More studies are needed in this area to give us the most effective and safest combinations to use in Nigeria, especially in this era of newer ARVs.
There is however the increasing need for adequate monitoring of these patients using viral load and drug resistance tests, which currently have been lacking in the current treatment programmes in the country. This will go a long way in improving the effectiveness of the current programme. The duration of the operation in our study is Conclusion: Lauromacrogol colonoscopic sclerotherapy therapy is an efficient, cost-effective and simple outpatient treatment for bleeding internal hemorrhoids with minimal complications.
Hemorrhoids are the most prevalent anorectal disorder among adults, and it has been stated that up to half of people may experience problems with hemorrhoids at some point in their lives [1,2]. Symptomatic internal hemorrhoids lead to nearly 3. Bleeding is the common and severe internal hemorrhoid complain and represent the second most-common colorectal cause of severe hematochezia, however, these patients should undergo colonoscopy or screening flexible sigmoidoscopy to exclude other causes of colorectal bleeding .
There are different non-operative and surgical therapeutic approaches to internal hemorrhoids bleeding. However, all method for treatment of hemorrhoid has advantages, disadvantages, limitations and complications . Sclerotherapy is one of the nonsurgical treatments, which involves the injection of one of a number of sclerosants into the submucosal space of the hemorrhoid to be treated or into the apex of the hemorrhoid itself .
Sclerotherapy has the advantage of being an easy, fast, and inexpensive outpatient procedure. However, serious complications have been reported after sclerotherapy, including severe rectal pain, hematoma, and perirectal abscesses, as well as sepsis . Rubber band ligation RBL is probably well-accepted and highly efficacious nonsurgical therapy for hemorrhoidal disease. Chen et al. It has similar clinical effects to sodium morrhuate; while it has fewer side effects. The soft tissue reaction that follows causes thrombosis of the involved vessels, sclerosis of the connective tissue, and a refixation of the prolapsing mucosa to the underlying rectal muscular tissue.
Inspired by the success of endoscopic sclerotherapy for the treatment of bleeding gastric varices, we investigated a new minimally invasive method for the treatment of bleeding internal hemorrhoids. Between August and February , this study enrolled consecutive outpatients with 2- or 3-degree internal hemorrhoids bleeding. Colonoscopy was performed to exclude other sources of bleeding. Patients were excluded from these studies, who were with a history of surgical intervention in the anus and rectum for colorectal tumor, anal fissure, anal fistula, hypertrophied anal papillae, blood coagulation disorder, immunodeficiency, pregnant woman, fourth-degree hemorrhoids and other complicated hemorrhoids.
The clinical features and personal information were recorded, including bleeding, prolapse, anal pain, abnormal defecation, age, sex, occupation and address.
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All treatments were accomplished in the Endoscopy Department of our outpatient clinic. Ltd, 97 medicine authorized No. H each patient, according to the size of internal hemorrhoidal bundle. Approximately 1—2 mL of Lauromacrogol was injected into the vessels of the hemorrhoids. Lauromacrogol was injected in the internal hemorrhoidal bundle around the dentate line in angle on the rectal mucosa to assume the sclerosant into the involved vessels with an appropriate depth—not to blanch the mucosa, and not deep enough to injure the underlying muscle.
We compressed the injection position seconds using the front of colonoscopy to achieve hemostasis. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb of its first issue, it contained 5 articles only, and now in its recent volume published in April , it contained 67 manuscripts.
This e-journal is fulfilling the commitments and objectives sincerely, as stated by Editor-in-chief in his preface to first edition i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help.
JCDR provides authors help in this regards. Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn. In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time.
Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them. It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb This had been made possible due to the efforts and the hard work put in it.
The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR. Rajendra Kumar Ghritlaharey, M. Shankar P. Hemant Jain, Editor, in March , which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we I and my colleagues have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1.
The reasons could be many, including lack of optimal secretarial and other support.
Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process.
Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in , before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did! Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue.
Recently, due to the increased volume of the submissions, the review process has become slower and it?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. I especially like the new and colorful page format of the journal.
Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors. Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened.