Knowledge, Attitude and practices of HIV post exposure prophylaxis amongst health workers in Lagos University teaching hospital

Introduction: timely PEP after needle stick exposure to high risk body fluids can reduce the rate of occupational transmission significantly. Ignorance of this may increase the risk of seroconversion to HIV for healthcare workers. This study was conducted with the aim of demonstrating the current level of knowledge and practise of healthcare workers as regards PEP. Methods: this was a cross-sectional study, pretested questionnaire were self administered to 372 health workers from various clinical specialties. The responses were collated and analyzed; results were presented in frequency tables. Results: this study revealed a high level of awareness among the respondents as 83.3% were aware of PEP. Despite the high level of awareness, respondents still have an inadequate knowledge about PEP, only 32% of the respondents could name at least two of the recommended drugs for PEP, only 54.0% of respondents knew when to commence PEP following occupational exposure to HIV. There was a low level of practice of PEP among the respondents as only 6.3% of respondents had PEP despite occurrence of needle stick injury. Conclusion: this study revealed a general low level use of PEP despite the average knowledge of PEP and the favourable attitude towards HIV PEP amongst the respondents

A Rare Case of Nonsecretory Multiple Myeloma in Lagos, Nigeria: A Case Report and Literature Review

Multiple myeloma (MM) is a plasma cell disorder associated with clonal proliferation of plasma cells. Nonsecretory multiple myeloma (NSMM) is a rare variant of MM and accounts for approximately 1% to 5% of all cases. It is defined as symptomatic myeloma without detectable monoclonal immunoglobulin on serum or urine electrophoresis. This variant usually poses a diagnostic challenge to the clinician. We present a 60-year-old Nigerian man who was investigated extensively for bone pain, weight loss, and anaemia. He was eventually diagnosed as having nonsecretory multiple myeloma based on histology and immunohistochemistry results of bone marrow trephine biopsy. He is currently being managed with bortezomib, doxorubicin, and thalidomide, as well as zoledronic acid. He is also on anticoagulation. He continues to show remarkable clinical improvement. We describe this case report and literature review for better awareness amongst medical practitioners and pathologists

Prevalence of activated protein C resistance (Factor V Leiden) in Lagos, Nigeria

Objectives: Hereditary resistance to activated Protein C (Factor V Leiden) is the commonest genetic defect known to confer a predisposition to thrombosis. This study aims to determine the prevalence of activated protein C resistance (APCr) in Lagos, and to determine if any association exists between APCr and ABO, Rhesus blood types, and hemoglobin phenotypes.Materials and Methods: A functional APCr test was conducted on healthy adult volunteers to get a Factor-V-related activated protein C ratio (APC-V ratio). APCr due to Factor V mutation was indicated when the APC-V ratio is below a cut-off value that was determined by calibration. Subjects’ hemoglobin, red cell ABO, and Rhesus phenotypes were determined by standard methods.Results: Six (2%) of 297 participants with normal baseline coagulation screening tests had functional resistance to activated protein C (APC-V ratio < 2). None of the six subjects with APCr had history of venous thromboembolism. One of the six subjects was a female but the male sex did not demonstrate a risk of inheritance of APCr (P = 0.39). Four (67%) of the six subjects with APCr were non-O blood group. Whereas only two (0.9%) of 226 non-A subjects (blood groups 0 and B) had APCr, 4 (6%) of 71 subjects with A gene (blood groups A and AB) had APCr. The inheritance of A gene appears to constitute a risk to inheritance of APCr (P = 0.03). No association was demonstrable between APCr and hemoglobin phenotypes.Conclusion: Only 2% of the studied population had resistance to APC. The inheritance of blood group A may be a predisposition to APCr

Factors influencing CD4 cell count in HIV-positive pregnant women in a secondary health center in lagos, nigeria

Background: Immunity in pregnancy is physiologically compromised, and this may affect CD4 count levels. It is well-established that several factors affect CD4 count level in pregnancy. This study aimed to determine the mean and reference range of CD4 count in human immunodeficiency virus (HIV)-positive pregnant women in Lagos, Nigeria. Methods: A retrospective study was carried out at antenatal clinics of the Maternal and Child Center of a secondary health center in Lagos State, Nigeria. Records of HIV-positive pregnant women at various gestational ages, including CD4+ cell count at booking, packed cell volume (PCV) at booking and labor, gestational age at delivery, and infant weight and sex were retrieved. The descriptive data was given as mean ± standard deviation (SD). Pearson's chi-squared test and correlation were used for analytical assessment. Results: Data were retrieved for a total of 143 patients. The mean age was 31.15±3.78 years. The mean PCV was 31.01%±3.79% at booking and 30.49%±4.80% during labor. The mean CD4 count was 413.87±212.09 cells/µL, with a range of 40 to 1,252 cells/µL. The mean infant weight was 3.05±0.45 kg, with a range of 2 to 5 kg. Age of the mother, gestational age, and PCV at booking were not statistically significantly associated with CD4 count. Conclusion: Maternal age, gestational age, and PCV at booking had no significant effects on CD4+ cell count levels in pregnancy. The mean CD4+ cell count of HIV-positive pregnant women in Lagos is 413.87±212.09 cells/µL

Quality of sleep in an HIV population on antiretroviral therapy at an urban tertiary centre in Lagos, Nigeria

Aim. To determine the prevalence of sleep disturbance and its associated characteristics in HIV-positive outpatients on HAART using the PSQI. Methods. Using a cross-sectional design, 300 patients attending the outpatient HIV/AIDS clinic at the Lagos State University Teaching Hospital were recruited. Baseline data obtained included the participants’ demographic data, educational qualification, and marital status. Their treatment history, including duration since HIV diagnosis, the most recent CD4 cell count, and current antiretroviral therapies, was obtained from their case records. Each participant completed the PSQI questionnaire and those with scores ≥5 were diagnosed with poor sleep quality. Results. The participants were made up of 70.7% females and 29.3% males. Their ages ranged between 18 and 74 years with a mean of 38.9 ± 10.3 years. According to the PSQI, 59.3% reported poor sleep quality. The mean score of those with poor quality sleep (9.2 ± 3.3) was comparable to that of those with good quality sleep (1.26 ± 1.4). \u1d443 < 0.001. Significant differences were observed in all the individual components of the PSQI (\u1d443 < 0.001). On multivariate analyses, the independent associations with sleep quality were the duration since HIV diagnosis (\u1d443 = 0.29), efavirenz based regimen (\u1d443 < 0.001), and lower CD4 cell count (\u1d443 < 0.001). Conclusions. Sleep disturbances are quite common in the HIV population even in the era of HAART. Early recognition via routine assessment and effective treatments could prevent the resultant complications and improve quality of life

Hemoglobin and ferritin concentrations in subjects with metabolic syndrome

Background Metabolic syndrome (MetS), a clinical condition characterized by insulin resistance, glucose intolerance, dyslipidemia, hypertension, and obesity, has been linked with raised levels of serum ferritin (Sfr) concentrations. Objectives This study was carried out to compare hemoglobin (Hb) and Sfr concentrations in patients with MetS, regular donors and first-time donors. Materials and Methods A total of 102 subjects who were between 18 and 60 years were enrolled for the study. They were divided into three groups. The first group (n = 20) was made up of 5 males and 15 females, all who met the criteria that define MetS. The second group (n = 52; M = 34, F = 18) were regular donors, while the last group (n = 30; M = 16, F = 14) were first-time donors or those who had not donated before. Following an overnight fast, 20 mL of venous blood was drawn from each subject. About 5 mL of this was put into sodium ethylenediaminetetraacetate (EDTA) specimen bottles for the full blood count parameters with Sysmex KX-21N hematology analyzer (made in Japan). The remaining 15 mL had serum separated for Sfr assay using enzyme-linked immunosorbent assay (ELISA) with a commercial assay kit manufactured by Teco Diagnostics. Results Significant difference was found in the mean Sfr concentration of subjects with MetS (163 ± 136.92 ng/mL) and regular donors (41.46 ± 40.33 ng/mL), P = 0.001. The mean Sfr concentrations of subjects with MetS (163 ± 136.92 ng/mL) were also higher than that of first-time donors (102.46 ± 80.26 ng/mL), but it was not statistically significant, P = 0.053. The Hb concentrations of the three groups were not significantly different. Conclusion Sfr concentrations of regular donors were lower than that of subjects with MetS and first-time donors. The difference between regular donors and subjects with MetS was statistically significant. However, there is no significant difference in the Hb concentrations in the three groups. MetS is not associated with anemia or hyperferritinemia

Impact of HIV infection and zidovudine therapy on RBC parameters and urine methylmalonic acid levels

Background. Anaemia is a common complication of human immunodeficiency virus (HIV) infection. The aim of this study was to investigate the impact of HIV infection and zidovudine on red blood cells (RBC) parameters and urine methylmalonic acid (UMMA) levels in patients with HIV infection. Material and Methods. A cross-sectional study involving 114 subjects, 94 of which are HIV-infected nonanaemic and 20 HIV negative subjects (Cg) as control. Full blood count parameters and urine methylmalonic acid (UMMA) level of each subject were determined. Associations were determined by Chi-square test and logistic regression statistics where appropriate. Results. Subjects on zidovudine-based ART had mean MCV (93 fL) higher than that of control group (82.9 fL) and ART-naïve (85.9 fL) subjects and the highest mean RDW. Mean UMMA level, which reflects vitamin B12 level status, was high in all HIV-infected groups but was significantly higher in ART-naïve subjects than in ART-experienced subjects. Conclusion. Although non-zidovudine therapy may be associated with macrocytosis (MCV > 95 fL), zidovudine therapy and ART naivety may not. Suboptimal level of vitamin B12 as measured by high UMMA though highest in ART-naïve subjects was common in all HIV-infected subjects

Cord blood full blood count parameters in Lagos, Nigeria

Introduction: Full blood count (FBC), one of the most frequently requested for laboratory investigations, is a simple, fast and cheap test and is a reliable indicator of health. Due to its usefulness in the  assessment of health status of individuals, its parameters in cord blood, a major source of haemopoietic stem cell transplantation and an ideal source for laboratory investigations for newborns were determined to provide a useful guide to local neonatologists and stem cell transplant physicians. Methods: Three millilitres of umbilical cord blood was collected from 130 normal birth weight newborns (69 males and 61 females) whose cord were clamped immediately after delivery, at a teaching hospital in Lagos, Nigeria and full blood count parameters were determined using Sysmex autoanalyzer, model  KX-21N. Consented mothers of the newborns were selected based on, age between 18 and 45 years;  uneventful pregnancy and delivery and haemoglobin (Hb) concentration ≥ 10 g/dL. Results: There were no statistical gender differences in the mean values of Hb concentrations (M=13.27  ±1.60 g/dL; F=13.32±1.61g/dL; p=0.93), total white cell count (M=3.16±5.43 × 109/L; F=13.07±4.98  × 109/L; p= 0.92), platelet count (M= 223.64± 64.21 × 109/L; F=226.69±80.83 × 109/L; p=0.81) and other parameters. Conclusion: Mean values of full blood count parameters obtained in this study are  comparable to reports from other studies in developing countries and could be a useful guide for neonatologists and stem cell transplant physicians in our geographical location.Key words: Haemoglobin, cord blood, stem cell, umbilical cord, neonatologis

Chest X-ray findings in HIV- infected Highly Active Antiretroviral Treatment (HAART) - naïve patients

Introduction: Patients with human immunodeficiency virus (HIV) infection frequently present with a wide spectrum of pulmonary and cardiaccomplications from the virus, opportunistic infections and neoplasms that may be associated with a high mortality rate. Diseases of the respiratorytract account for about half of deaths from AIDS, while cardiac diseases account for more than a quarter of deaths from AIDS. This study aimed atdetermining the prevalence of pulmonary and cardiac diseases using a chest radiograph in HAART-naïve HIV-infected patients. Methods: Thisstudy was conducted at Lagos State University Teaching Hospital (LASUTH) HIV clinic between September 2010 and August 2011 amongst allregistered HAART-naïve HIV/AIDS patients. Patients had posterior-anterior chest radiographs done in full inspiration. Participants were asked andaided to fill the structured questionnaires to obtain demographic data. Results: Out of a total of one hundred and two recruited for the study, 54 (52.94%) had a normal chest radiograph, while 48 (47.06%) had abnormal chest radiograph .The abnormal findings included, 27.45% who hadbronchopneumonia, 6.86% cardiomegaly, 5.88% pulmonary tuberculosis, 5.88% radiological features of congestive cardiac failure, and 0.98%bronchitis. Conclusion: It appears that more than half of HAART–naïve HIV-infected patients have normal chest radiographs. Bronchopneumonia(27.5%) is the commonest pulmonary abnormality associated with HIV infection, while the prevalence of pulmonary tuberculosis is 5.88%.Key words: Chest X-ray, HIV-infected, HAART-naïve

Qualité de vie chez des enfants nigérians épileptiques

Contexte L’épilepsie est un trouble neurologique de l’enfant entrainant une charge lourde dans les pays en développement. La gestion de l’épilepsie comprend le contrôle optimal de la maladie, ainsi quel’amélioration de la qualité de vie (HRQOL) des enfants touchés.Objectifs Cette étude a été menée afin d’évaluer l’HRQOL des enfants nigérians atteints par l’épilepsie ainsi que l’impact psychosocial de la maladie sur les parents des enfants concernés. Méthodes Un questionnaire normalisé adapté de la PedsQL questionnaire a été appliqué pour évaluer les HRQOL chez 66 consécutifs enfants épileptiques, âgés de ≥ 5 années à l’University College Hospital, Ibadan au cours d’une période de 3 mois. Résultats Vingt enfants (30,3%) ont montré d’importantes déficiences dans le HRQOL avec un impact majeur dans les domaines de la santé en général, la vie familiale, scolaire et l’estime de soi. Il y avait une associationstatistiquement significative entre la gravité de saisie, l’autorité parentale, l’impact émotionnel, le niveau d’éducation maternelle.Conclusion Les atteintes de la qualité de vie (HRQOL) est un problème majeur au Nigeria chez les enfants épileptiques. Le soutien familial étendu ne semble pas avoir d’effet sur l’amélioration du stress vécu. Cette étude suggère la nécessité d’un soutien psychosocial chez les enfants traités par les antiépileptiques