Knowledge, Attitude and Practice of Blood Conservation Strategies amongst Physicians’ in Tertiary Hospitals

Aim: To assess the extent of available knowledge, as well as the attitudes and the utilization of blood conservation strategies amongst medical doctors, who are the implementers of blood transfusion and conservation in clinical practice. Study Design: A cross-sectional study. Place and Duration of Study: Clinical Departments in both Lagos State University Teaching Hospital, Lagos State and Babcock University Teaching Hospital, Ogun State between August 2013 and November 2013. Methodology: We included clinicians from various medical specialties in the study (78 from public hospital and 26 from private hospital). A pre-tested, self-administered questionnaire was devised to collect data. Data was entered and analyzed descriptively and qualitatively. Result: A total of 104 doctors participated in the study consisting of 57 males (54.80%) and 47 females (45.29%). Almost all participants had transfused blood in their practice and all participants were aware that blood transfusions have complications. Majority 80 (76.9%) had heard about blood conservation techniques, about 51 (49%) had used any of the strategies. If available, 93 (89.4%) would use any of the strategies, only 1 (1%) would not. Conclusion: There is a need for hospital transfusion committees to educate and increase the drive for utilization of blood conservation methods amongst doctors, so as to increase its practice

Prevalence of Rhesus C and D Alloantibodies among Rhesus-Negative Women of Child Bearing Age at a Tertiary Hospital in South-West Nigeria

Background: A major cause of hemolytic disease of the fetus and newborn (HDFN) is an incompatibility of the Rhesus (Rh) blood group between the mother and fetus. Aim: To determine the prevalence of Rh c and D alloantibodies among Rh-negative women of childbearing age (18–49 years). We conducted a cross-sectional study among women who attended the antenatal, gynecology and blood donor clinics at a Tertiary Hospital in South-West Nigeria from January to August 2019. Serological typing of Rh c and D was done manually with the tube test using anti-c and anti-D antisera, while indirect antiglobulin test was then performed to screen for Rh antibodies. Subjects and Methods: Data was analyzed using Stata 16.1 software; Categorical data was summarized using frequency and percentages while continuous variables were described using the mean and standard deviation or median and interquartile range. Pearson's Chi-square (or Fisher's exact) test was used to test for association between categorical variables and Rh status. P values of ≤0.05 were assumed to be statistically significant. Results: A total of 700 consenting women, comprising 505 pregnant (72.1%) and 195 non-pregnant (27.9%) women were recruited into this study. The mean age was 30.7 ± 4.9 years. All (100%) participants were Rhc positive while 641 (91.6%) were RhD positive and 59 (8.4%) were RhD negative. All 59 RhD negative subjects tested negative for anti-D. There was no statistically significant difference between proportion of RhD-negative women who had a jaundiced baby and the proportion of RhD-positive women who had a jaundiced baby (15.6% vs. 18.6%, P = 0.540). Conclusions: This study did not identify any Rhc and D alloantibodies in the study population suggesting there is a low risk of alloimmunization and HDFN due to anti-Rhc and D in this population

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

Effects of selenium supplementation on pregnancy outcome and disease progression in HIV-infected pregnant women in Lagos, Nigeria: Study protocol for a randomised, double-blind, placebo-controlled trial

Background: Micronutrient deficiencies are common during pregnancy, especially in pregnant women from economically disadvantaged settings where diets with low content of minerals and vitamins are consumed. Selenium is a non-metallic chemical element of great importance to human health. This study will assess the effect of selenium supplementation on major pregnancy outcomes and disease progression among HIV-infected pregnant women in Lagos, Nigeria. Methods: A randomized, double-blind, placebo-controlled trial involving confirmed HIV-positive pregnant women at the Lagos University Teaching Hospital (LUTH) between September 2018 and February 2019. Eligible participants are HIV-infected pregnant women aged 15 to 49 years and have a singleton gestation at 14 to 27 weeks’ gestation. At enrolment, 90 women will be randomly assigned into each intervention arm to receive either a daily tablet of 200 μg elemental selenium or placebo. Relevant participants’ data will be collected at enrolment and at delivery. Statistical analyses will be carried out using SPSS version 23.0 for Windows. The associations between any 2 groups of continuous variables will be tested using the t test or the Mann-Whitney U test and that of 2 groups of categorical variables with chi-square or Fishers exact test where appropriate. A series of multivariable analyses will also be carried out to identify and control for several possible confounders of the major pregnancy outcomes and HIV disease progression. Statistical significance will be defined as P < .05. Ethical approval for the study was obtained from the LUTH's Health Research and Ethics Committee (Approval number: ADM/DCST/HREC/APP/2438; 30th August 2018). Discussion: This trial will assess the effect of selenium supplementation on pregnancy outcome and HIV disease progression among HIV-infected pregnant women in Lagos. This will help to determine if routine selenium supplementation in HIV-infected pregnant women will contribute to the improvement in the major adverse pregnancy outcomes such as preterm birth and low birth weight and the HIV disease surrogate markers such as CD4+ cells count and viral load. Trial registration: PACTR, PACTR201809756724274. Registered on 3rd September 2018, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3571

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

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

Prevalence and type of monoclonal gammopathy of undetermined significance in an apparently healthy Nigerian population: a cross sectional study

Background The prevalence of monoclonal gammopathy of undetermined significance (MGUS), a premalignant plasma-cell disorder has not been determined in our geographic area Nigeria. Methods A cross sectional survey was carried on apparently healthy Nigerians selected by multistage sampling technique from the cosmopolitan city of Lagos, Nigeria. Subjects enrolled into the study had 2-step screening for the presence, type and concentration of monoclonal band. Agarose-gel electrophoresis was performed on all serum samples, and any serum sample with a discrete band of monoclonal protein or thought to have a localized band was subjected to Immunofixation. Subjects were also evaluated for Bence jones proteinuria, haematological and biochemical parameters. Results Four hundred and ten subjects with a mean age of 45.68 ± 10.3 years, a median of 45.00 years and a range of 20 to 80 years were enrolled into the study. MGUS was identified in only one (0.24 percent) of the 410 study subject. This subject was demonstrated to have a double monoclonal gammopathy; IgGλ at 16.9 g/L and IgAκ at 8.5 g/L. None of them including the sole subject with MGUS had a monoclonal urinary light chain. Conclusion Among residents of Lagos, Nigeria, MGUS was found in only 0.24% percent of apparently normal persons with a median age of 45 years. This suggests that MGUS which represents the earliest stage of monoclonal plasma/lymphoid cell proliferation is not a common finding in the relatively young population of Nigeria. Future epidemiologic studies dealing with plasma cell disorders in older people are required to carefully examine the relationship between environmental factors and prevalence of MGUS and its ultimate progression to MM

The Kikuchi-Fujimoto Disease in Nigeria: A Case Report and Literature Review

The Kikuchi-Fujimoto is a rare, self-limiting disease, which is characterized by regional lymphadenopathy. It occurs worldwide with a higher prevalence among Asians and women below the age of forty years. We present 41-year-old Nigerian woman who was investigated extensively for unilateral left cervical lymphadenopathy. She was eventually diagnosed as having the Kikuchi-Fujimoto disease and was managed conservatively thereafter. We describe a case report and review of literature for better awareness of the disease amongst medical practitioners and pathologists in Africa

Prevalence and Factors Associated with Parvovirus B19 Infection among Blood Donors: A Hospital‑Based Study in South‑West, Nigeria

Background: Parvovirus B19 (B19V) is a transfusion transmissible infection that can result in severe consequences in vulnerable population that includes pregnant women, immunocompromised and chronic hemolytic anemia patients. The aim of this study was to determine the prevalence and factors associated with B19V infection amongst blood donors in South–West Nigeria. Materials and Methods: We conducted a comparative cross‑sectional study to determine the seroprevalence of B19V immunoglobulin M (IgM) antibody among 183 blood donors at the blood bank of a tertiary hospital. The results were analyzed with SPSS 23 software, prevalence and associated factors were determined using frequencies and logistic regression, respectively. Results: The prevalence of B19V IgM was 7.1% (95% confidence interval: 4–11) with a higher prevalence among male donors compared to females (84.6% vs. 15.4%, P = 0.54). There was a statistically significant difference in the seropositivity of B19V IgM amongst the ethnic groups with the Yoruba ethnic group having a higher proportion of B19V IgM‑positive participants P = 0.04. Ethnicity, gender, and steady employment were also associated with increased odds of infection, while increasing age appeared to be protective; though none of these factors were statistically significant. Conclusion: This study has shown that there is still high exposure to transfusion transmissible B19V infection. Keywords: Blood donor, parvovirus immunoglobulin M antibody, sickle cell anaemi

Prognostic performance of pretreatment systemic immune-inflammation index in women with epithelial ovarian cancer

Purpose: This study investigated the prognostic performance of the systemic immune-inflammation index (SII) in patients with epithelial ovarian cancer (EOC) in Lagos, Nigeria. Methods: We performed a secondary analysis of the data of 91 women who had treatment for EOC between 2009 and 2018. The associations between pretreatment SII and survivals were tested. Results: Pretreatment SII more than 610.2 was a significant independent predictor of reduced progression-free survival (HR = 2.68; 95% CI, 1.17 to 6.09) while SII greater than 649.0 was a significant independent predictor of reduced 3-year overall survival (HR = 2.01; 95% CI, 1.01 to 3.99). Conclusion: These findings suggest that high SII may be a potential prognostic indicator and useful marker for more intensive surveillance and design of personalized treatment in patients with EOC