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

Effect of tranexamic acid on coagulation and fibrinolysis in women with postpartum haemorrhage (WOMAN-ETAC): a single-centre, randomised, double-blind, placebo-controlled trial

Background: Postpartum haemorrhage (PPH) is a leading cause of maternal death. The WOMAN trial showed that tranexamic acid (TXA) reduces death due to bleeding in women with PPH. We evaluated the effect of TXA on fibrinolysis and coagulation in a sample of WOMAN trial participants. Methods: : Adult women with a clinical diagnosis of PPH were randomised to receive 1 g TXA or matching placebo in the WOMAN trial. Participants in the WOMAN trial at University College Hospital (Ibadan, Nigeria) also had venous blood taken just before administration of the first dose of trial treatment and again 30 (±15) min after the first dose (the ETAC study).  We aimed to determine the effects of TXA on fibrinolysis (D-dimer and rotational thromboelastometry maximum clot lysis (ML)) and coagulation (international normalized ratio and clot amplitude at 5 min). We compared outcomes in women receiving TXA and placebo using linear regression, adjusting for baseline measurements. Results: : Women (n=167) were randomised to receive TXA (n=83) or matching placebo (n=84). Due to missing data, seven women were excluded from analysis. The mean (SD) D-dimer concentration was 7.1 (7.0) mg/l in TXA-treated women and 9.6 (8.6) mg/l in placebo-treated women (p=0.09). After adjusting for baseline, the D-dimer concentration was 2.16 mg/l lower in TXA-treated women (-2.16, 95% CI -4.31 to 0.00, p=0.05). There was no significant difference in ML between TXA- and placebo-treated women (12.3% (18.4) and 10.7% (12.6), respectively; p=0.52) and no significant difference after adjusting for baseline ML (1.02, 95% CI -3.72 to 5.77, p=0.67).  There were no significant effects of TXA on any other parameters. Conclusion: TXA treatment was associated with reduced D-dimer levels but had no apparent effects on thromboelastometry parameters or coagulation tests. Registration: ISRCTN76912190 (initially registered 10/12/2008, WOMAN-ETAC included on 22/03/2012) and NCT00872469 (initially registered 31/03/2009, WOMAN-ETAC included on 22/03/2012)

A population-based estimation of maternal mortality in Lagos State, Nigeria using the indirect sisterhood method.

BACKGROUND: Pregnancy and delivery deaths represent a risk to women, particularly those living in low- and middle-income countries (LMICs). This population-based survey was conducted to provide estimates of the maternal mortality ratio (MMR) in Lagos Nigeria. METHODS: A community-based, cross-sectional study was conducted in mapped Wards and Enumeration Areas (EA) of all Local Government Areas (LGAs) in Lagos, among 9,986 women of reproductive age (15-49 years) from April to August 2022 using a 2-stage cluster sampling technique. A semi-structured, pre-tested questionnaire adapted from nationally representative surveys was administered using REDCap by trained field assistants for data collection on socio-demographics, reproductive health, fertility, and maternal mortality. Data were analysed using SPSS and MMR was estimated using the indirect sisterhood method. Ethical approval was obtained from the Lagos State University Teaching Hospital Health Research and Ethics Committee. RESULTS: Most of the respondents (28.7%) were aged 25-29 years. Out of 546 deceased sisters reported, 120 (22%) died from maternal causes. Sisters of the deceased aged 20-24 reported almost half of the deaths (46.7%) as due to maternal causes, while those aged 45-49 reported the highest number of deceased sisters who died from other causes (90.2%). The total fertility rate (TFR) was calculated as 3.807, the Lifetime Risk (LTR) of maternal death was 0.0196 or 1-in-51, and the MMR was 430 per 100,000 [95% CI: 360-510]. CONCLUSION: Our findings show that the maternal mortality rate for Lagos remains unacceptable and has not changed significantly over time in actual terms. There is need to develop and intensify community-based intervention strategies, programs for private hospitals, monitor MMR trends, identify and contextually address barriers at all levels of maternal care

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Apert Syndrome in Lagos – a Case Report and Literature Review

Apert Syndrome is a rare autosomal dominant disorder characterized by premature fusion of sutures of bones of the skull (Craniosynostosis), fingers and toes (Syndactyly) to different degree. Though it is rare, it is pertinent for clinicians to know about this condition so as to improve their ability to manage it and to note that management is multidisciplinary. We present a case of Apert Syndrome in a one month old Nigerian female, and one of a set of twins that presented with proptosis, hypertelorism, high arched palate and fusion of bones of fingers and toes.Keyword: Apert syndrome, craniosynostosis, proptosis, hypertelorismNigerian Medical Practitioner Vol. 63 No 1-2, 201

Amblyopia in rural Nigerian school children

Purpose: Globally, amblyopia remains a common cause of visual impairment in children. Early screening and treatment is necessary to prevent permanent visual loss. This study aimed to evaluate the prevalence, etiologic factors, and characteristics of amblyopia among rural, public primary school children in Ijebu East Local Government Area (IELGA) of Ogun state, southwest Nigeria.Materials and Methods: The study was a cross-sectional descriptive study conducted among pupils of randomly selected public primary schools in IELGA from 27th October to 7th November 2014. Data on sociodemographics, ocular history, and ocular examination were collected. Descriptive and comparative analyses were performed. Values of P 0.05 were considered statistically significant.Results: There were 1180 public primary school pupils enrolled for the study. The data of 1153 pupils were analyzed giving a 97.7% response rate. The mean age was 9.2 ± 2.8 years with age range from 4 years to 16 years. There were more female students (586; 50.8%) with a male-to-female ratio of 1:1.03. Majority of the pupils were from the Yoruba ethnic group (819; 71.0%) and from basic one academic class (236; 20.5%). Six of the examined pupils were found to have amblyopia, giving a prevalence of 0.5%. The following three types of amblyopia were seen in this study: anisometric amblyopia (2; 0.17%), ametropic amblyopia (2; 0.17%), and strabismic amblyopia (2; 0.17%). Three pupils had unilateral amblyopia while three had bilateral amblyopia. All amblyopias were classified as mild-to-moderate amblyopia.Conclusion: The prevalence of amblyopia among these rural school children was low. However, because children with amblyopia could have a lifetime of blindness ahead of them, the number of “blind person years” in those whose blindness started in childhood is enormous. Early screening is required to prevent the attendant consequences of socioeconomic burden following visual impairment in this vulnerable subsection of the Nigerian rural populace.Keywords: Amblyopia, children, nigeria, rural, visual impairmen

Occupational exposure, attitude to HIV-positive patients and uptake of HIV counselling and testing among health care workers in a tertiary hospital in Nigeria

Health care workers (HCWs) are at risk of occupational exposure to HIV. Their attitude to HIV-positive patients influences patients’ willingness and ability to access quality care. HIV counselling and testing (HCT) services are available to inform HCWs and patients about their status. There is little information about HCT uptake and attitude to HIV-positive patients among HCWs in tertiary health facilities in Nigeria. The aim of this study was to determine occupational exposure and attitude to HIV-positive patients and level of uptake of HCT services among HCWs in a tertiary hospital in Nigeria. A cross-sectional design was utilized. A total of 977 HCWs were surveyed using semi-structured, self-administered questionnaires. Nurses and doctors comprised 78.2% of the respondents. Their mean age was 35 ± 8.4 years. Almost half, 47.0%, reported accidental exposure to blood and body fluids (BBFs) in the preceding year. The main predictor of accidental exposure to BBFs in the last year was working in a surgical department, OR = 1.7, 95% CI (1.1–2.6). HCWs aged 5 years, OR = 3.6, 95% CI (1.4–9.3) and who work in nursing department, OR = 6.8, 95% CI (1.7–27.1) were more likely to be exposed to BBFs. Almost half, 52.9%, had accessed HCT services. Predictors for HCT uptake were age 5 years OR = 1.5, 95% CI (1.03–2.2) and working in medical department OR = 1.7, 95% CI (1.1–2.8). Respondents in nursing departments were more likely to require routine HIV test for all patients, OR = 3.9, 95% CI (2.4–6.2). HCWs in the laboratory departments were more likely to believe that HIV patients should be on separate wards, OR = 3.6, 95% CI (1.9–7.0). HCWs should be protected and encouraged to access HCT services in order to be effective role models in the prevention of HIV/AIDS

Undergraduates’ Readiness for Utilizing Cloud Computing for Learning in Nigerian Universities

Cloud computing is one of the newer technological tools users to have access to storage, space, processing and networking resources. However, studies revealed that learners enjoyed numerous benefits of cloud computing for fun; but not on the domain for learning. This study investigated undergraduates’ readiness to utilize cloud computing resources for learning in Nigerian Universities. The study adopted descriptive research design, using quantitative survey method. Two research questions and one hypothesis were answered and tested respectively. The instrument employed was a researcher-designed questionnaire which contained two sections to ascertain Nigerian undergraduates’ readiness for utilizing cloud computing for learning. A total of three hundred and ninety-eight (398) copies of questionnaires were retrieved out of 450 copies that were administered representing 88.44% responses were randomly sampled. Frequency counts, percentages and mean were employed to answer the study’s research questions while the hypothesis was tested using t-test. The findings of the study revealed that majority of undergraduates are ready to utilize cloud computing for learning. However, there was no significant difference between male and female undergraduates’ readiness to utilize cloud computing for learning. The study therefore concluded that undergraduates are ready to utilize cloud computing resources for pedagogical experiences despite perennial challenges encountered on their usage. The study recommended that Nigerian universities should encourage undergraduates to explore inherent benefits of cloud computing in other to improve their learning; irrespective of students’ gender

Post Donation Prevalence of Major Transfusion- Transmissible Infectious Agents among Blood Donors: A Six Year Experience, 2007 - 2012

This study was designed to evaluate the post donation prevalence of Human immunodeficiency virus (HIV), Hepatitis C virus (HCV), Hepatitis B virus (HBV) and syphilis infections, and co-infections among blood donors from 2007 to 2012 in a Lagos tertiary hospital. A retrospective analysis of consecutive blood donors' records was carried out. Records of post donation screening results for transfusion transmissible infectious agents were reviewed. Information about seropositivity for HIV antibodies, Hepatitis B surface antigen (HBsAg), Hepatitis C virus antibodies (anti-HCV) and Treponema Pallidum antibodies were extracted from the blood donor registers at the centre. A total of 24,303 consecutive blood donors' records were reviewed. The donors comprised 23,031 (94.76%) males and 1,272 (5.23%) females. The age of the blood donors ranged from 18 to 61 years with a mean of32 ± 7.85. The prevalence of markers of infection for HIV, HBV, HCV and syphilis fluctuated through the study period. The overall prevalence of serological evidence of infection with at least one pathogen was 917 (3.77%) while for multiple pathogens was 18 (0.07%). The prevalence of markers of infection for HIV,HBV, HCV, syphilis were 1.06%, 1.45%, 0.83% and 0.49% respectively. The co- infection rates among donors were; HBV/HCV and HIV/HCV 5 (0.02%) each, syphilis/HBV 0.016%, while syphilis/HCV and syphilis/HIV were 0.004% each. The overall post donation prevalence of transfusion- transmissible infectious agents was 3. 77% while for co- infections was 0.07% among blood donors. The prevalence of markers of infection for these infectious agents also fluctuated through 2007 to 2012.Keywords: blood donors, transfusion- transmissible infections, Nigeri