Pre-deposit autologous blood donation as a tool for reducing risks associated with allogeneic blood transfusion in Nigeria: is it worth nurturing?

Background: Pre-deposit autologous blood donation (PAD) wherein patient's own blood is collected over a period of time in the lead up to a planned transfusion to the same patient may be a viable alternative to reducing the known and unknown risks often associated with allogeneic blood.Objectives: To assess the practice of pre-deposit autologous blood donation at a hospital-based blood bank unit in north central Nigeria over a four year period.Materials and method: This cross sectional study retrospectively assessed blood transfusion documents and records at the blood bank unit of Federal Medical Centre, Makurdi from 2009 to 2012. Information on predeposit autologous and allogeneic blood donations, types of blood donors and components or products utilized from the records and documents were analysed for proportions using Microsoft Excel and manual methods.Results: Pre-deposit autologous blood donation was generally low ( average 0.40%) and showed a gradual decline over the years; 0.79, 0.31, 0.27 and 0.21 percent in comparison with allogeneic blood donation (76.71, 78.21, 84.76 and 80.36%) average 80.02% and 22.50, 21.49, 14.95 and 19.44 average 19.60% for family replacement and VNRBDs respectively in the years 2009, 2010, 2011 and 2012 respectively. Whole blood and packed red cells transfusions were the predominant blood products utilized over the years with 96.64, 99.04, 97.83 and 98.18% (average 98.32) transfusedas whole blood while 2.57, 0.65, 1.90 and 1.61% (average 1.68%) was transfused as packed cells respectively. All the pre-deposit autologous donations and over 95% of all allogeneic blood donations were transfused as whole blood over the study period.Conclusion: Pre-deposit autologous blood donation is hardly practiced in a setting of high risk and unsafe allogeneic blood due to inadequate implementation of practice guidelines by practitioners.Recommendation: Further researches are needed to improve the overall safety of pre-deposit autologous blood donation especially in a weakened centrally controlled blood system existent in Nigeria. It may be pertinent to provide adequate knowledge, reassess and develop existing guidelines for the practice of PAD in Nigeria.Keywords: Pre-deposit autologous donation; allogeneic blood donation; hospital blood bank; northcentral Nigeri

Technology – Enhanced Pathology Education: Nigerian Medical Students Perspectives

Background: The delivery of pathology education traditionally through instructor centred didactic lectures, small group tutorials, and practical demonstrations using microscope glass slides, gross pot specimens and autopsy sessions, is paving way for electronic learner-centred methods. Successful adoption and implementation of rapidly advancing educational technologies in the resource-constrained environment obtainable in most of sub-Sahara Africa requires a comprehensive analysis of the learners’ reflections on their use and effectiveness.Aims: This study aimed to evaluate the perspectives of medical students towards the ever-advancing ways of teaching and learning pathology in Nigeria.Materials and methods: Fifty-five fourth year medical students randomly selected from two universities were given survey questionnaire. The questionnaires enquired into opinions of the students on the various aspects of the use of ICT in pathology education.Results: Studying with microscope mounted glass slides was considered by the majority (33, 60%) of the 55 respondents to be the most effective method of learning pathology and 24 (43.6%) favoured the projection of the glass slide on a large screen using a camera-mounted microscope. Twenty-seven (49.1%) preferred projected computer based digital microscope images. Twenty students (36.4%) disagreed with the use of internet-based images during practical classes. Prior distribution of digital images to students’ hand – held devices days before classes was agreed to by 19 (34.5%) and strongly agreed to by 15 (27.3%) students. Annotated digital images, instead of glass slides, were favoured by 50, (91%) students.  Self-study with webinars was not supported by 26, (47.2%) students. Eleven (20%) students strongly agree, 25 (45.5%) agree, eight (14.5) are undecided, and 10 (18.2%) disagree that the use of digital microscope images reduces microscope handling proficiency. The use of digital images instead of mounted glass slides during objective structured practical examination was supported by 20, (36.4%) students. Forty-seven (85.5%) reported interrupted classes due to faulty equipment.Conclusion: The challenge of developing ways for better delivery of pathology curriculum content to future doctors compels medical educators to explore easier ways of teaching and learning. This study has demonstrated that medical students in Nigeria favour technology enhanced learning and the integration of new teaching methods into already existing frameworks. Keywords: technology-enhanced learning, pathology, pathology education, student perspective

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

Is renal medullary carcinoma the seventh nephropathy in sickle cell disease? A multi-center Nigerian survey

Introduction: Previous studies had enlisted renal medullary carcinoma (RMC) as the seventh nephropathy in sickle cell disease (SCD). Clinical experience has contradicted this claim and this study is targeted at refuting or supporting this assumption.Objective: To estimate the prevalence of RMC and describe other renal complications in SCD.Materials and methods: 14 physicians (haematologists and urologists) in 11 tertiary institutions across the country were collated from patients’ case notes and hospital SCD registers.Results: Of the 3,596 registered sickle patients, 2 (0.056%) had been diagnosed with RMC over a ten year period, thereby giving an estimated prevalence rate of 5.6 per 100,000. The most common renal complication reported by the attending physicians was chronic kidney disease (CKD). The frequency of routine renal screening for SCD patients varied widely between centres – most were done at diagnosis, annually or bi-annually.Conclusion: The ten year prevalence of RMC in Nigerian SCD patients was determined to be 5.6 (estimated incidence of 0.56). RMC is not more common in SCD patients and therefore cannot be regarded as a “Seventh Sickle nephropathy”. Most of the managing physicians reported that the commonest nephropathy observed in their SCD patients was chronic kidney disease.Keywords: Renal medullary carcinoma, seventh nephropathy, sickle cell disease, Nigerian surve

Pain management in medical wards: A single centre experience in Nigeria

Background: Pain is the commonest reason for hospital presentation worldwide. Its prevalence, distribution and severity are similar across different wards. However, the management of pain in medical wards is sub-optimal. The study was aimed at the determination of patients' perception of adequacy of pain management in medical wards.Methods: A cross sectional hospital based study of patients admitted into the medical wards of Federal Medical Centre, Makurdi over a two year period using a validated questionnaire purposively administered to consecutive patients who had diagnoses with pain as a major component (e.g. Sickle Cell Crisis, Painful Neuropathies) to capture socio - demographic and clinical parameters, diagnoses and analgesics (type, dose, escalation frequency).Results: There were 1,986 patients made up of 1,019 females and 967 males with mean age 53±18 years. Up to 31.1% were in their seventh decade with majority (59.3%) living in urban areas. Respondents were admitted with various painful conditions (e.g. neuropathies from diabetes and chronic kidney diseases constitute 42%). They were on appropriate analgesics at rather low doses or one off doses. Up to 62% had used bioceuticals. Majority (95.2%) of respondents felt that pain management in the medical wards was inadequate.Conclusion: Most (95.2%) patients felt pain management while they were on admission was not adequate. Analgesia was based on patient's complaint and the judgment of the physician. Key Words: Pain, analgesics, medical wards, bioceutical