Editorial

Objective We determined the prevalence of rifampicin resistance in pulmonary tuberculosis patients in Enugu Nigeria. Methods A prospective hospital-based study involving 1300 presumptive multidrug-resistant tuberculosis patients was conducted in Enugu between April 2017 and 31st March, 2019. Participants age ranged from 15 years and older and each submitted one sputum specimens Sputum specimens were analyzed using the Gene Xpert MTB/RIF assay to detect resistance to rifampicin according to manufacturer's protocol. Results The prevalence of rifampicin resistant tuberculosis was 6.8% (95% CI: 5.5- 8.3). Rifampicin resistance was significantly higher in males (9.0%) than females (4.2%) (P = 0.036< 0.05). Most of the cases were seen in the age group 35–44 years (28.4%). Prevalence of rifampicin resistant tuberculosis was 2.7% in treatment naive (new) patients and 4.1% in patients on anti-tuberculosis therapy (previously treated). Conclusion The prevalence of rifampicin resistant tuberculosis in Enugu was high. Rifampicin resistance in treatment naive (new) patients was also high. This study therefore highlights that active transmission of Multidrug-resistant tuberculosis among young males could be on-going.

Background Patients who are lost to follow-up while on treatment compromise their own health and the long-term success of antiretroviral therapy (ART) programs. Besides, loss to follow-up (LTFU) increases HIV-related morbidity and mortality. Therefore, this study aimed to determine the incidence of LTFU and its predictors among adult HIV positive patients on anti-retroviral therapy at North Shoa zone public hospitals, Northeast Ethiopia. Methods A retrospective follow up study of 517 people living with HIV/AIDS and attending an ART clinic between 2015 and 2020 was conducted at North Shewa zone, public hospitals. Kaplan-Meier failure function together with log rank test was used to compare failure function. Multivariable Cox proportion hazards regression model was used to determine predictors of LTFU. Result The incidence density rate of lost to follow up among HIV positive adult on ART was found to be 8.9 per 100 adult years observation (95%CI; 7.45, 10.68). In multivariable cox proportional regression analysis, WHO clinical stage-IV (AHR = 1.50; 95% CI: 1.08, 3.75), comorbidity disease (AHR = 0.54; 95% CI; 0.30, 0.97), body mass index less than 18kg/m2 (AHR = 1.60; 95% CI; 1.02, 2.51), cotrimoxazole preventive therapy (AHR = 1.57; 95% CI;1.09, 2.53), and a low CD4 count (AHR = 1.66; 95% CI; 1.29, 3.49) were found to be a significant predictors of lost to follow up. Conclusion The current study showed that the incidence rate of loss to ART follow-up was high. Body mass index score less than 18kg/m2, advanced WHO clinical stage, CD4<200cell/mm 3 , had comorbidity disease, and cotrimoxazole therapy were a significant predictors of lost to ART follow up. Therefore, appropriate mitigation measures in the at-risk group need to be instigated to advance retention rate.

Introduction Remimazolam and midazolam are used for the sedation of gastrointestinal endoscopy, but their efficacy remains controversial. We conduct a systematic review and meta-analysis to compare the sedation of remimazolam with midazolam for gastrointestinal endoscopy. Methods PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched. Randomized controlled trials (RCTs) assessing the influence of remimazolam versus midazolam on gastrointestinal endoscopy were included. Two investigators independently have searched articles, extracted data, and assessed the quality of included studies. This meta-analysis was performed using the random-effect model. Results Three RCTs involving 528 patients were included in the meta-analysis. Compared with midazolam for gastrointestinal endoscopy, remimazolam was associated with higher procedure success (OR=9.78; 95% CI=1.48 to 64.71; P=0.02), lower need for rescue medication (OR=0.09; 95% CI=0.01 to 0.80; P=0.03), shorter total recall (Std. MD=0.93; 95% CI=0.15 to 1.72; P=0.02) and delayed recall (Std. MD=0.44; 95% CI=0.05 to 0.83; P=0.03), reduced incidence of hypotenson (OR=0.39; 95% CI=0.25 to 0.62; P<0.0001) and adverse events (OR=0.36; 95% CI=0.17 to 0.79; P=0.01), but had no obvious influence on fully alert (Std. MD=-0.75; 95% CI=-1.58 to 0.08; P=0.08). Conclusions Remimazolam demonstrated better efficacy and safety for the sedation of gastrointestinal endoscopy compared to midazolam.