Analgesia Self-Medication Practice and Pentazocine Dependency in Adult Sickle Cell Patients in Southeast Nigeria

Background: Painful crisis is a debilitating hallmark characteristic feature of sickle cell disease (SCD). Analgesia medication is the standard of care. Self‑medication is becoming a quick fix for pain resolution for persons living with SCD. The aim of this study was to evaluate analgesia self‑medication practice and pentazocine dependency among adult sickle cell patients. Methods: A descriptive cross‑sectional study was conducted among 111 adults with SCD attending sickle cell clinic at the University of Nigeria Teaching Hospital (UNTH) Ituku Ozalla Enugu and Alex Ekwueme Federal University Teaching Hospital Abakiliki (AEFUTHA) Ebonyi. Data were analyzed using SPSS version 22. A P < 0.05 was considered statistically significant. Results: The proportion of adults SCD participants in the study was 45.4% from UNTH Enugu and 54.6% from AEFUTHA Ebonyi. The proportion of male and female who self‑medicated was 61.5% and 38.5%, respectively. The prevalence of analgesic self-medication was found to be 28.8%. Analgesics most and least frequently self‑administered were paracetamol 50.5% and morphine 0.9% most reported reason for self‑medication was “treatment delays in hospital” 73%. Dependency to pentazocine was 22.5%. Age was a significant predictor of self‑medication among adult SCD patients. Conclusion: This study shows high prevalence of self‑medication and dependency to pentazocine. There should be strict regulation on the use of pentazocine. Keywords: Analgesia, pentazocine dependency, self‑medication, sickle cell diseas

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

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\u2019 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 \u2013 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 \u201cSeventh Sickle nephropathy\u201d. Most of the managing physicians reported that the commonest nephropathy observed in their SCD patients was chronic kidney disease

Determinants of psychosocial health‑related quality of life of adults with sickle cell disease in a Nigerian setting

Background: With improved understanding of disease mechanism in sickle cell disorder, many persons living with sickle cell disease (SCD) are surviving unto adulthood. There is a growing concern that SCD may impair the psychosocial health‑related quality of life (HRQoL), witha resultant lack of psychosocial stability and integration. The objective of this study was to assess the determinants of psychosocial quality of life (QoL) among adults with SCD. Materials and Methods: This was a cross‑sectional study of adults with SCD. A multidimensional self‑administered instrument, prevalidated for use in adults with chronic disease, was used. It consisted of 31 items that assessed physical function, physical and emotional role function, bodily pain, vitality, social function, mental health, and general health within 2 weeks prior to the time of survey. Questionnaires were administered to adults with sickle cell anemia who presented for their routine visit to the Sickle Cell Clinic at the Hematology Clinic in University of Nigeria Teaching Hospital, Ituku‑Ozalla Enugu, or during sickle cell support group meetings. Psychosocial HRQoL was the primary outcome measured. Sociodemographic features such as marital status, gender, educational qualification, and SCD were the primary independent variables of interest. Results: A total of I16 adults with SCD were participated in the study. After adjusting for marital status, gender, and educational qualification of adults with SCD, gender and marital status did not significantly affect psychosocial HRQoL (P = 0.619 and P = 0.146), respectively, while educational status significantly affected their HRQoL (P = 0.013). Conclusions: Adults with SCD have impaired psychosocial HRQoL. There is a need to upscale patient‑focused interventions to improve self‑esteem and overall QoL

Severe amnestic immune mediated adverse skin reaction in a Nigerian patient with chronic myelogenous leukamia; a case report

SummaryBackground: Chronic myelogenous leukaemia (CML) and gastrointestinal stromal tumours (GIST) have been successfully managed with Imatinib mesylate (Gleevec, formerly STI571), an oral selective inhibitor of the tyrosine  kinase family.  Evidence support dose limiting toxicitieswith few reported cutaneous side effects. There have been no such reports among Nigerian CML and GIST patients. We report severe amnestic immune mediated hypersensitivity cutaneous adverse effect to imatinib mesylate. We present a case of 30- year-old female patient previously diagnosed of CML with disease relapse due to cost related discontinuation of therapy. She developed severe amnestic skin reaction to imatinib therapy, 3 years after her first exposure resulting in discontinuation of imatinib.  She was immediately commenced on antihistamines, steroids and hydroxyurea with resolution of skin lesions after 3 weeks. She was considered intolerant and immune sensitive to Imatinib and was commenced on Dasatinib a second generation tyrosine kinase inhibitor. This was well tolerated and there was no further reports of cutaneous side effects on follow up. The important aspect of our report is that Nigerians with CML and GISTs have been well tolerant to Imatinib as far as cutaneous adverse effects is concerned. This report highlights our first case report of cutaneous adverse effect. There is the need for increased index of suspicion of dose independent amnestic hypersensitivity response to Imatinib and need for a desensitization protocol.AbstraitContexte: La leucémie myéloïde chronique (LMC) et les tumeurs stromales gastro-intestinales (GIST) ont été prises en charge avec succès par le mésylate d'Imatinib (Gleevec, anciennement STI571), un inhibiteur sélectif de la famille des tyrosines kinases par voie orale. Les preuves appuient les toxicités limitant la dose, avec peu d'effets secondaires cutanés signalés. Il n'y a pas eu de tels rapports parmi les patients nigérians atteints de LMC et de GIST. Nous rapportons une hypersensibilité cutanée sévère à médiation immunitaire amnésique au mésylate d'Imatinib. Nous présentons le cas d`une patiente âgée de 30 ans ayant déjà reçu un diagnostic de LMC avec récidive de la maladie en raison d'un arrêt du traitement lié au coût. 3 ans après sa première exposition, elle a développé une réaction cutanée amnésique sévère au traitement par l'Imatinib, entraînant l'arrêt du traitement par l'Imatinib. Elle a immédiatement commencé à prendre des antihistaminiques, des stéroïdes et de l'hydroxyurée avec résolution des lésions cutanées après 3 semaines. Elle était considérée comme intolérante et immunosensible à l'imatinib et a été placée sous traitement avec du  Dasatinib, un inhibiteur de la tyrosine kinase de deuxième génération. Cela a été bien toléré et aucun autre effet secondaire cutané n'a été signalé lors du suivi. L'aspect important de notre rapport est que les Nigérians atteints de LMC et de GIST ont bien toléré l'Imatinib en ce qui concerne les effets indésirables cutanés. Ce rapport met en évidence notre premier cas d'effet indésirable cutané. Il y a un besoin accru d'indice de suspicion de réaction d'hypersensibilité amnésique indépendante de la dose à l'Imatinib et nécessité d'un protocole de désensibilisation.West Afr. J. Pharmacol. Drug Res. Vol. 32 January – December 2017; 25 - 2

Incidence and determinants of venous thromboembolism in cancer patients on chemotherapy and other anti-cancer drugs

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Low awareness of venous thromboembolism among the general population: a call for increased public enlightenment programs.: Awareness of VTE in general population

Background: Venous thromboembolism (VTE) is a notable but often ignored cause of disability and death. Improved public awareness of the symptoms and risks associated with VTE reduces the burden of disease. Aim: We aimed to determine the awareness of VTE among the general population. Methods: We conducted a population-based study using a pre-tested, pre-validated Ipsos-Reid questionnaire between October 2019 to March 2020. The questionnaire was distributed to consenting adults in the capital cities of Enugu and Ebonyi states of South-Eastern Nigeria to determine their awareness and knowledge of the symptoms and risk factors of VTE. Results: A total of 284 adults participated with a mean age of 32.73 ± 10.33 years and majority (70.8%) had a post-secondary education. While majority were aware of other medical conditions like a heart attack (96.1%), stroke (97.2%), diabetes (98.2%), HIV/AIDS (98.6%), cancer (97.2%) and malaria (98.2), just a few of the subjects were aware of thrombosis (41.5%) and DVT (33.8%). Less than half (42.4%) correctly described DVT as a blood clot in the vein and 13.7% of the respondents knew what PE feels like. A minority of them knew the risk factors of VTE included hospital stay (19.0%), surgery (37.2%), cancer (31.6%), pregnancy (31.6%) and old age (29.6%).  Age and gender showed no statistically significant association with awareness of VTE, p value, 0.491 and 0.287, respectively. Conclusion: The awareness of VTE in the general population is low. Public awareness programs should be a public health priority to reduce morbidity and mortality associated with VTE.&nbsp

A review of current and future prospects in cancer prevention and chemotherapy

The worldwide burden of non-communicable diseases, including cancers, continues to increase. There has been an increasing pace of research and progress globally in the development of treatments, cures and preventive strategies against cancers. The modalities employed include chemotherapy, radiotherapy, immunotherapy, hormonal agents and dietary interventions. This update and review will discuss these modalities, their mode of action, safety and efficacy, as well as strategies to reduce toxicities arising from their use, such as personalized immuno-targeting. Optimizing immune functionality by addressing the gene - environment interaction will become an important preventive strategy. This review is based on references from online searches conducted on the following databases: Google Scholar, PubMed, Biomed Central and SciELO, using “cancer chemotherapy” as keywords