Coagulation profile according to gestatonal age in pregnant Nigerian women

No Abstract

Renal Status of Multiple Myeloma Patients in Ibadan, Nigeria

Introduction: The spectrum of clinical manifestation in multiple myeloma (MM) ranges from asymptomatic disease to severely debilitative state. Unexplained renal disease is an indication for the investigation of patients for MM. This study is a retrospective analysis of the renal profile of patients with multiple myeloma in relation to management strategy in our institution.Methods: Medical records of 64 patients with multiple myeloma seen between 2000 and 2008 were retrospectively reviewed at an 850–bed tertiary hospital in South-Western Nigeria. The Mahn-Whitney test was used to compare laboratory features between patient with renal failure and those without renal failure. Subjects with serum creatinine >2mg/dL were regarded to have renal failure. Overall survival was calculated from diagnosis to death or lost to follow-upResults: A total of forty three patients were eligible. The renal status was categorized into three according to serum creatinine level; those with normal serum creatinine level (0.5-1.5mg/dl) were 26 (60.5%), serum creatinine level (>1.6-1.9mg/dl), and creatinine level >2mg/dl were 3(7%) and 14(32.5%) respectively. Hyperuricaemia was observed in 6(42.9%) of MM patients with renal failure compared with 7(26.9%) of patient without renal failure (p<0.05). Twenty–one percent of those with renal failure had hypercalceamia. Thirty–six percent of the renal failure patients had haemodialysis. The average survival for all patients with renal failure was 18 months after diagnosis.Conclusion: The outcome in patients with renal failure remained poor with early mortality despite supportive management. Hyperuricaemia and dehydration, given the hot climate might have worked in concert with other factors to worsen the renal status in these patients.Keywords: renal, creatinine, myeloma, dehydratio

Oral manifestations of HIV/AIDS infection in Nigerian patients seen in Kano

Objective: To determine the pattern and prevalence of oral lesions in HIV-infected Nigerian patients seen in a referral centre. Design: Prospective hospital based study. Setting: Aminu Kano Teaching Hospital, Kano-a tertiary health institution servicing the entire north-western Nigeria. Subjects: 205 HIV infected individuals who consented to participate in the study. Method: All patients were interviewed and examined by at least two Dental Surgeons trained in diagnosis of oral manifestations of HIV. Data were captured on adapted WHO recording form for oral lesions associated with HIV, transferred and analyzed using MINITAB12.21 (U.S.A). Results: The age range was18-61 years (mean=33.7, S.D =8.0).The M: F =1.2:1; There was statistically significant difference (t=8.1, DF=201, P-value = 0.001) between mean age for males (37.3; S.D.=7.8years) and females (29.5; SD=5.9 years). Overall, 140 (68.3%) patients had at least one oral lesion. Most common lesion was candidosis (60.5%) and the pseudomembranous (45.4%) type was most frequent. Other lesions were HIV gingivitis (27.8%), hairy leukoplakia (14.2%), aphthous ulcer (9.8%), Kaposi's sarcoma (8.3%), melanin hyper-pigmentations (7.3%), herpes simplex infection (5.4%), HIV periodontitis (4.9%), parotid enlargement (1.9%) and HIV-NOMA (0.5%). The mean CD4 counts were 301, 268 and 289 for those without oral lesion, with single lesion and multiple oral lesions respectively. These differences were not statistically significant (ANOVA F=0.36 DF=2 P=0.7). Conclusion: Oral lesions are frequently seen in HIV-infected Nigerian patients and the pattern of occurrence is not markedly different from those reported from other African countries. Nigerian Journal of Surgical Research Vol. 7(1&2) 2005: 176-18

Depleted circulatory complement-lysis inhibitor (CLI) in childhood cerebral malaria returns to normal with convalescence

BACKGROUND: Cerebral malaria (CM), is a life-threatening childhood malaria syndrome with high mortality. CM is associated with impaired consciousness and neurological damage. It is not fully understood, as yet, why some children develop CM. Presented here is an observation from longitudinal studies on CM in a paediatric cohort of children from a large, densely-populated and malaria holoendemic, sub-Saharan, West African metropolis. METHODS: Plasma samples were collected from a cohort of children with CM, severe malarial anaemia (SMA), uncomplicated malaria (UM), non-malaria positive healthy community controls (CC), and coma and anemic patients without malaria, as disease controls (DC). Proteomic two-dimensional difference gel electrophoresis (2D-DIGE) and mass spectrometry were used in a discovery cohort to identify plasma proteins that might be discriminatory among these clinical groups. The circulatory levels of identified proteins of interest were quantified by ELISA in a prospective validation cohort. RESULTS: The proteome analysis revealed differential abundance of circulatory complement-lysis inhibitor (CLI), also known as Clusterin (CLU). CLI circulatory level was low at hospital admission in all children presenting with CM and recovered to normal level during convalescence (p < 0.0001). At acute onset, circulatory level of CLI in the CM group significantly discriminates CM from the UM, SMA, DC and CC groups. CONCLUSIONS: The CLI circulatory level is low in all patients in the CM group at admission, but recovers through convalescence. The level of CLI at acute onset may be a specific discriminatory marker of CM. This work suggests that CLI may play a role in the pathophysiology of CM and may be useful in the diagnosis and follow-up of children presenting with CM

Data-driven malaria prevalence prediction in large densely populated urban holoendemic sub-Saharan West Africa

Over 200 million malaria cases globally lead to half-million deaths annually. The development of malaria prevalence prediction systems to support malaria care pathways has been hindered by lack of data, a tendency towards universal "monolithic" models (one-size-fits-all-regions) and a focus on long lead time predictions. Current systems do not provide short-term local predictions at an accuracy suitable for deployment in clinical practice. Here we show a data-driven approach that reliably produces one-month-ahead prevalence prediction within a densely populated all-year-round malaria metropolis of over 3.5 million inhabitants situated in Nigeria which has one of the largest global burdens of P. falciparum malaria. We estimate one-month-ahead prevalence in a unique 22-years prospective regional dataset of > 9 × 10^{4} participants attending our healthcare services. Our system agrees with both magnitude and direction of the prediction on validation data achieving MAE ≤ 6 × 10^{-2}, MSE ≤ 7 × 10^{-3}, PCC (median 0.63, IQR 0.3) and with more than 80% of estimates within a (+ 0.1 to - 0.05) error-tolerance range which is clinically relevant for decision-support in our holoendemic setting. Our data-driven approach could facilitate healthcare systems to harness their own data to support local malaria care pathways

Therapy related Acute Myeloid Leukaemia 8 Years after Treatment for Hodgkin\'s Disease – A Case Report

Hodgkin's Disease (HD) is a curable malignancy even in Nigeria, our limitations in health care delivery notwithstanding. However, secondary malignancies especially Acute Myeloid Leukaemia (AML) may occur as late complications following alkylating cytotoxic drugs therapy, with or without radiotherapy. This is a case report of a 52-year-old man who (between 1983-1985) received 4 cycles of combination chemotherapy, namely Mustine Hydrochloride, Oncovine, Procarbazine, Prednisolone (MOPP), and then 6 cycles of combination chemotherapy consisting of Cyclophosphamide, Oncovine, Procarbazine and Prednisolone (COPP) followed by 2 doses of Adriamycin. He developed AML 8 years after complete remission. The possibility of the development of secondary malignancies as late complication of cytotoxic drug therapy should be discussed with patients receiving these drugs and long-term follow-up should be mandatory. KEY WORDS: Hodgkin's Disease, secondary malignancy, acute myeloid leukaemia, alkylating cytotoxic drugs and long-term follow up. Nigerian Journal of Health and Biomedical Sciences Vol.4(1) 2005: 14-1

Cervical spine cord injury in pregnancy. Conservative management of 3 consecutive cases in Ibadan, Nigeria

Study design A prospective study of 3 patients with incomplete cervical spinal cord injury in the 3rd trimester of pregnancy. Objectives To determine the effect of spinal cord injury and treatment with Gardner-Wells\' Tong traction on pregnancy, labour and parturition; and ascertain the effectiveness and safety of this conservative form of management in pregnancy. Setting The patients were admitted and managed between September 2002 and May 2004, in the University College Hospital Ibadan, Nigeria - the major referral Centre in neurological diseases for about a quarter to a third of Nigeria\'s population. Methods From the point of admission into our Emergency Unit, data on each patient was documented prospectively until discharge to the out-patient clinic where each of them was followed up at appointed intervals. These data were then analyzed and compared with reports in literature. Results All the patients had good outcome from the conservative management as measured by complete neurological recovery, uneventful pregnancy and normal parturition. They however, seem to be disposed to pre-term labour, without being aware of the labour pains. Conclusion Spinal cord injury in pregnancy could be successfully manage with Gardner-Wells\' Tong traction without deleterious effects on pregnancy and parturition, but appears to induce pre-term labour, associated with regional analgesia for labour pains. Etude prospecitve de 3 patientes présentant un traumatisme du rachis cervical au cours du 3ème trimestre de la grossesse. Déterminer les effets du traumatisme rachi-médullaire au cours d\'un traitement par traction cervicale de Gardner-Well dutant le travail et l\'accouchement. Les patientes ont été admises entre septembre 2002 et mai 2004 au centre hospitalier et universitaire d\'Ibadan, Nigeria, centre réferent neurochirurgical pour environ le tiers voire la moitié de la population du Nigéria. Les données cliniques et paracliniques ont été recueillies de l\'admission jusqu\'à la sortie et au cours des consultations de contrôle puis analysées par rapport aux observations de la littérature. Tous les patients ont eu une évolution favorable avec le traitement conservateur que nous avons adopté, avec une récupération neurologique complète, une absence d\'événement indésirable lors du travail, de l\'accouchent et des suites de couches. Keywords: Cervical spinal cord. Gardner-Wells\' Tongs traction. Third trimester gestationAfrican Journal of Neurological Sciences Vol. 25 (2) 2006: pp. 6-1

Non-necrotising Facial Cellulitis in an Adult with Sickle Cell Disease – A Case Report

Streptococcus preumonae is a major pathogen commonly reported to cause widespread disease in subjects with sickle cell disease especially in developing countries, increasing the fatality of the conditon. Group B Streptococcus is infrequently reported as a cause of infections in patients with sickle cell disease although it causes fatal outcomes as well. Case Presentation: We report the case of a 60-year-old Nigerian woman with haemoglobin SC disease who presented with a facial cellulitis caused by Beta haemolytic Streptococcus. The clinical presentation and outcome of treatment with cheap, effective antibiotics is highlighted. KEY WORDS: Cellulitis, face, sickle cell disease. Nigerian Journal of Health and Biomedical Sciences Vol.3(2) 2004: 93-9

Splenic Size in Sickle Cell Anaemia Patients in A Tertiary Hospital

Sickle cell disease is one of the common haemoglobinopathies in the world. It can affect any organ in the body and one of the most common and an early organ to be affected in SCA is the spleen. Reports have shown that patients with sickle cell anaemia (HbSS) have an increased susceptibility to infection leading to increased morbidity and mortality. Autosplenectomy with the consequent absence or reduction of splenic function may explain the propensity to encapsulated bacteria infection. This study was carried out in order to provide an update on the incidence of anatomical autosplenectomy in sickle cell anaemia patients. A comparative cross sectional study of 40 sickle cell anaemia patients in steady state attending Haematology clinic and 40 age and sex-matched healthy HbA control was carried out. An interviewer-administered questionnaire was used to get information on biodata and malaria history. Splenic Ultrasound was done to determine spleen size. Data generated was analyzed using statistical package for social science version 17 (SPSS 17). Twenty (20%) of the sickle cell patients had autosplenectomy (spleen size less than 6cm) while 15% had splenomegaly (spleen size greater than 12cm) and 65% had normal sized spleen(spleen size of 6cm-12cm) on ultrasonography. There was no significance difference (p= 0.332) in the median spleen size of HbS and HbA individuals. Splenic ultrasonography is advocated in determining splenic size in patients with sickle cell anaemia, and could be done annually as a means of monitoring the trend of the size of the spleen in each patient.Key words: Sickle cell anaemia, Autosplenectomy, Splenomegaly, spleen Ultrasonograph