Multiple myeloma in Nigeria: a multi-centre epidemiological and biomedical study

Introduction: Myelomatosis is a malignant proliferation of plasma cells in the bone marrow, with  relatively high prevalence in African populations. Variation in genetic mutations has been observed in individual patients and may be responsible for differences in disease pattern and treatment outcomes. This study described the presentations and treatment outcomes of multiple myeloma in nigerian. Methods: The data was obtained retrospectively from the case notes of 135 patients diagnosed with multiple myeloma from eight tertiary health institutions across the six geopolitical zones of Nigeria from 2005 to 2014. Data analysis was carried out using SPSS 17.0.Results: The predominant presentations were bone pain in 97 (74%), nephropathy in 47 (35.9%) and pathological fractures in 58 (44.3%). Sixty-seven percent (67%) of the patients were less than 60 years, and 35% had Bence Jones proteinuria. The overall survival beyond 6 months was 91.3%, mean duration of survival rate was 7.4 months. Majority (66.2%) were on Melphalan alone or on melphalan-containing combinations. A higher packed cell volume (PCV) and total serum protein levels at presentation were associated with increased survival, p=0.033 and 0.036, respectively.Conclusion: This study portrayed the importance of detail investigation on the causes of bone pain and anaemia in person's aged 40 years and above. There is a high prevalence of nephropathy in this cohort of patients which needs to be further investigated. Majority of the patients, though < 65 years of age were placed on melphalan-containing combinations, which foreclosed chances of future autologous bone marrow transplantation.Key words: Multiple myeloma, Nigeria, presentation, treatment modalitie

Sero-prevalence and factors associated with Hepatitis B and C co-infection in pregnant Nigerian women living with HIV Infection

Introduction: Perinatal and horizontal transmission of Hepatitis B occur in areas of high endemicity as most infections are acquired in the first 5 years of life. Unless Hepatitis B and C infected pregnant women identified, and appropriate treatment provided, children born to these women are at high risk of chronic Hepatitis B (and C) virus infection. The objecive of this study was to determined the prevalence and the factors associated with Hepatitis B and C Virus infection in pregnant HIV positive Nigerians. Methods: A cross sectional study among HIV Positive pregnant women seen at a large PMTCT clinic in  Lagos Nigeria. The women were screened for Hepatitis B and C Virus infection at enrollment. HIV viral  load, CD4 count, liver transaminases and hemoglobin levels were also determined. Data were managed  with SPSS for windows version. Ethical approval was obtained from the Institution?s Ethical Review  Board. Results: Of the 2391 studied subjects, 101(4.2%) and 37(1.5%) respectively were seropositive for  Hepatitis B and C Virus infection. Twowomen (0. 08%) had triple infections. blood transfusion, (cOR: 2.3; 95% CI:1.1 - 4.6), history of induced abortion (cOR:2. 2;95% CI:1.3 - 3.6), and elevated baseline ALT (cOR:2. 2; 95%CI:2. 2;4.2) were significantly associated with HBV. History of induced abortion was the only factor found to be associated with HIV/ HCV (cOR: 1.9;95%CI:1. 3-3.9). Conclusion: Hepatitis B Virus infection (4.2%) is relatively common in our environment and associated  with induced abortion, blood transfusion and elevated baseline transaminase. Hepatitis C Virus infection (1.5%) is less common and associated with only history of induced abortion. Key words: Hepatitis B virus, Hepatitis C virus, HIV, pregnanc

Fetal‐haemoglobin enhancing genotype at BCL11A reduces HbA2 levels in patients with sickle cell anaemia

Abstract Understanding the interplay of genetic factors with haemoglobin expression and pathological processes in sickle cell disease is important for pharmacological and gene‐therapeutic interventions. In our nascent study cohort of Nigerian patients, we found that three major disease‐modifying factors, HbF levels, α‐thalassaemia deletion and BCL11A genotype, had expected beneficial haematological effects. A key BCL11A variant, while improving HbF levels (5.7%–9.0%), also led to a small, but significant decrease in HbA2. We conclude that in general, interventions boosting HbF are likely to reduce HbA2 in patients’ erythroid cells and that such therapeutic strategies might benefit from a parallel stimulation of HbA2 through independent mechanisms

Prevalence of vitamin B deficiency among metformin-treated type 2 diabetic patients in a tertiary institution, South-South Nigeria

Background: The risk of chronic metformin pharmacotherapy to cause vitamin B 12 deficiency and its associated medical complications has been of immense concern among diabetic patients. Some studies have postulated that vitamin B 12 deficiency is highly prevalent among chronic metformin-treated adult diabetic patients. Aim: This study aimed to determine the prevalence of vitamin B 12 deficiency among metformin-treated and metformin-naïve type 2 diabetes mellitus patients. Materials and methods: This was a case-control, prospective, analytical, observational study of 200 adult participants (100 per group) attending the Endocrinology, Medical Out-patients Clinic of Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria. The participants’ serum vitamin B 12 levels were determined using an immunoassay technique. Data were presented using tables and charts. Chi-square test was used to compare non-continuous proportional variables. Results: The prevalence of vitamin B 12 deficiency was 41% and 20% among metformin-treated and metformin-naïve type 2 diabetes mellitus groups, respectively (p = 0.001). Borderline vitamin B 12 status was present among 59% of metformin-treated group and 80% of metformin-naïve group (p = 0.001). Neither metformin-treated nor metformin-naïve groups had normal serum vitamin B 12 levels. Conclusion: The prevalence of vitamin B 12 deficiency was significantly high in diabetics, especially the metformin-treated patients. We advocate for vitamin B 12 supplementation among this group of patients in order to prevent the occurrence of vitamin B 12 deficiency complications such as macro-ovalocytic anemia, impaired immunity with hypersegmented neutrophils, peripheral neuropathy and subacute degeneration of the spinal cord

Ovarian reserve in nigerian women with sickle cell anaemia: a cross- sectional study

Abstract Introduction Sickle cell disease is the most common monogenetic disorder worldwide. There have been reports of endocrine dysfunction and gonadal failure among affected individuals, especially in males. The findings on ovarian reserve and failure in women with sickle anaemia have been inconsistent. Aim and objective The aim of this study was to determine and compare the ovarian reserve of Nigerian women with and without sickle cell anaemia attending a University Teaching Hospital. Study Design This cross-sectional study was carried out at the Adult Sickle Cell Clinic and the Community Health Clinic of the Lagos University Teaching Hospital. Methodology A total of 166 participants who met the selection criteria, were recruited for the study. The study population consisted of two groups of women matched for age: 83 women with HbSS and 83 women with HbAA. The haemoglobin phenotype of each participant was determined on alkaline electrophoresis (pH 8.4) before analysis. Serum Anti-Mullerian Hormone (AMH) was determined using Enzyme-linked immunosorbent assay (ELISA) method (Calbiotech Inc. USA, Catalog no AM448T). Results The mean ± SD of serum AMH level in women with HbSS was 3.64 ± 0.65 ng/mL and was lower than that of women with HbAA 7.35 ±1.19 ng/mL (p < 0.001). Serum AMH negatively correlated with age in both study groups (HbAA and HbSS). Also, a significant negative correlation was found between serum AMH and BMI in women with HbAA. Conclusion The study showed diminished ovarian reserve in women with HbSS when compared to age-matched women with HbAA

Pattern, challenges and correlates of condom use among Nigerians living with HIV infection.

Objective: To determine the pattern, challenges and correlates of condom use among Nigerians living with HIV Infection. Methods: A cross sectional questionnaire study among HIV positive adults attending an HIV treatment centre in Lagos, Nigeria. Data entry and analysis were done with Epi-info version 3.5.1. Results: The mean age of respondents was 35 (SD=7.7; range: 17–58 years) and mean age at sexual debut was 20 years old (range: 7–37 years). Majority were women (66.6%), had at least secondary school education(91.1%), married (68.2%)), on ART (50.7%) and knew their partners HIV status(60.9%). The rate of condom use at last sex act was 65.9%, but only 48.8% used condom consistently. Factors associated with condom use were male gender (OR=2.43, CI=1.35–4.33, P=0.002), less than secondary school education (OR=3.12, CI=1.04–9.28, P=0.05) and Not knowing partner's HIV status (OR=1.90, CI=1.04–3.80, P=0.04). Refusal to use condom (28.4%) were as a result of pregnancy intention, undesirability of condom in marriage and decreased sexual pleasure. Conclusion: There is low consistent condom use rate of 48.8% among this cohort despite their exposure to behavioural change messages. A review of the present counselling strategy and combination prevention is therefore advocated