Clinical Audit of Low Dose Prophylaxis Programme for Nigerian Children with Haemophilia.

INTRODUCTION: The evidence of benefits for prophylaxis especially low dose prophylaxis is incontestable yet most children in developing countries as Nigeria do not have access to this treatment protocol. AIM: The aim was to audit the low dose prophylaxis treatment in Nigerian children with haemophilia. METHODOLOGY: A multicentre clinical audit of five haemophilia treatment centres; University of Nigeria Teaching Hospital Enugu, Lagos University Teaching Hospital, National Hospital Abuja, University of Port Harcourt Teaching Hospital Port Harcourt, and Federal Teaching Hospital Gombe. Eighteen children with mild-severe haemophilia were enrolled into low-dose prophylaxis treatment programme. The reduction of joint bleeding, improvement of joint function and Quality of Life (QoL) during prophylaxis were analysed. RESULTS: In total 18 children - 17males and 1 female (median age 8 years) were enrolled. The median duration of observation was 7 months (range 3-15months). Seven of the children were on primary prophylaxis (41%) while 10 of the children (59%) were on secondary prophylaxis. The number of joint bleeds decreased from a total of 162 (individual range 5-20, mean 10.3) to 42 (range 0-7, mean 3.0) during the observation period with an overall reduction of 74%. Joint function improved in 94.1% of disease joints, while only 5.6% reported no improvement (due to poor compliance). School attendance improved in all subjects, sports participation and daily activity improved moderately. CONCLUSION: Low dose prophylaxis was beneficial in reduction of joint bleeds, improvement of joint function and improvement of QoL of Children with haemophilia in Nigeria.

INTRODUCTION: Les preuves des avantages de la prophylaxie en particulier la prophylaxie à faible dose est incontestable cependant en pays en développement comme le Nigeria n'ont pas accès à ce protocole de traitement. OBJECTIF: L'objectif était de vérifier le traitement prophylactique à faible dose chez les enfants nigérians atteints d'hémophilie. MÉTHODOLOGIE: Un audit clinique multicentrique de cinq centres de traitement de l'hémophilie ; L'hopital universitaire de Nigéria, Enugu Hôpital universitaire de Lagos, Hôpital national d'Abuja, l'hôpital universitaire de Port Harcourt et l'hôpital universitaire fédéral de Gombe. Dix-huit enfants atteints d'hémophilie légèresévère ont été inscrits au programme de traitement prophylactique à faible dose. La réduction des saignements articulaires, l'amélioration de la fonction articulaire et de la qualité de vie (Qo) ont été analysées. RÉSULTATS: Au total, 18 enfants - 17 garçons et 1 fille (âge médian: 8 ans) ont été recrutés. La durée médiane d'observation était de 7 mois (de 3 à 15 mois). Sept des enfants étaient sous prophylaxie primaire (41 %) et 10 enfants (59 %) étaient sous prophylaxie secondaire. Le nombre de saignements articulaires a diminué, passant d'un total de162 (fourchette individuelle 5-20, moyenne 10,3) à 42 (fourchette 0-7, moyenne 3,0), pendant la période d'observation, soit une réduction globale de 74 %. La fonction articulaire s'est améliorée dans 94,1 % des articulations malades, tandis que seulement 5,6 % n'ont signalé aucune amélioration (en raison d'une mauvaise observance). n'ont signalé aucune amélioration (en raison d'une mauvaise observance). La fréquentation scolaire s'est améliorée dans toutes les matières, la pratique du sport et l'activité quotidienne s'est améliorée modérément. CONCLUSION: La prophylaxie à faible dose s'est avérée bénéfique dans la reduction des saignements articulaires, l'amélioration de la fonction articulaire et l'amélioration de la qualité de vie des enfants atteints d'hémophilie au Nigeria. MOTS-CLÉS: Prophylaxie à faible dose, Nigeria, Hémophilie, qualité de vie, concentré de facteur VIIII.

Immune erythrocyte antibodies in adult patients with sickle cell disease and blood donors in Lagos, Nigeria: a comparative study.

Sickle cell disease (SCD) poses a major public health challenge in sub-Saharan Africa, including Nigeria. Blood transfusion is a mainstay in SCD treatment. Erythrocyte alloimmunization is known to complicate the transfusional care of patients with SCD. Immune alloantibodies are associated with hemolytic transfusion reactions and transfusion refractoriness. We aimed to determine the prevalence, specificities, and clinical associations/risk factors of immune erythrocyte alloantibodies among adult patients with SCD compared with healthy blood donors in Lagos, Nigeria, through a cross-sectional study. All participants were interviewed using a structured questionnaire to obtain details on bio-data, hemoglobin phenotype, blood transfusion history, and SCD history where relevant. Blood specimens obtained from each participant were subjected to antibody screening/identification using tube agglutination method. The mean age of the SCD participants and healthy blood donors was 27.92 and 29.04 years, respectively. The majority (72.5%) of the SCD participants had received at least 1 unit of red blood cell (RBC) transfusion in their lifetime, compared with only 7.5 percent of blood donors. Six SCD participants (7.5%) tested positive for atypical erythrocyte alloantibodies, with none among blood donors. Most of the antibodies (75%) belonged to the Rh blood group system. The most frequent antibody was anti-E, followed by anti-C and anti-D. Advancing age (30 years or more), recent transfusions (last 4 weeks), higher transfusion rates, and established renal disease were significantly associated with alloimmunization (p values of 0.026, 0.043, 0.002, and 0.043, respectively). This study suggests blood transfusion as a strong risk factor for RBC alloimmunization in SCD patients. Extended RBC phenotyping is recommended for all patients with SCD, especially those receiving regular transfusions.Sickle cell disease (SCD) poses a major public health challenge in sub-Saharan Africa, including Nigeria. Blood transfusion is a mainstay in SCD treatment. Erythrocyte alloimmunization is known to complicate the transfusional care of patients with SCD. Immune alloantibodies are associated with hemolytic transfusion reactions and transfusion refractoriness. We aimed to determine the prevalence, specificities, and clinical associations/risk factors of immune erythrocyte alloantibodies among adult patients with SCD compared with healthy blood donors in Lagos, Nigeria, through a cross-sectional study. All participants were interviewed using a structured questionnaire to obtain details on bio-data, hemoglobin phenotype, blood transfusion history, and SCD history where relevant. Blood specimens obtained from each participant were subjected to antibody screening/identification using tube agglutination method. The mean age of the SCD participants and healthy blood donors was 27.92 and 29.04 years, respectively. The majority (72.5%) of the SCD participants had received at least 1 unit of red blood cell (RBC) transfusion in their lifetime, compared with only 7.5 percent of blood donors. Six SCD participants (7.5%) tested positive for atypical erythrocyte alloantibodies, with none among blood donors. Most of the antibodies (75%) belonged to the Rh blood group system. The most frequent antibody was anti-E, followed by anti-C and anti-D. Advancing age (30 years or more), recent transfusions (last 4 weeks), higher transfusion rates, and established renal disease were significantly associated with alloimmunization (p values of 0.026, 0.043, 0.002, and 0.043, respectively). This study suggests blood transfusion as a strong risk factor for RBC alloimmunization in SCD patients. Extended RBC phenotyping is recommended for all patients with SCD, especially those receiving regular transfusions.

Data on the rootability of Parkia biglobosa using pure honey, Coconut Water and Moringa Leaf Extract as an alternative hormones.

The data article contains the experimental data and figures on the number of rooted cuttings, number of cuttings with callus, cutting mortality and root length of Parkia biglobosa cuttings. The investigated data are related to the research article "Effects of alternative hormones on the rootability of Parkia biglobosa." (Dunsin et al., 2014) [1]. In the experimental data, number of rooted cuttings, number of cuttings with callus, number of cuttings with mortality, total number of roots, total root length of cuttings and length of longest root of cuttings data employing alternative hormone (Pure Honey, Coconut Water, Moringa Leaf Extract) on the semi-hardwood stem cutting of Parkia biglobosa have been exhibited. The data would be useful to researchers finding alternate growth and rooting hormones that are cost friendly and for vegetative propagation during enrichment planting program of important tree crops that are difficult to propagate via seeds.

Utility of a single mid-trimester measurement of plasminogen activator Type 1 and fibronectin to predict preeclampsia in pregnancy.

BACKGROUND: Preeclampsia (PE) is the second most common cause of maternal death after obstetric hemorrhage in Africa, a resource-limited region. This study was designed to examine the potential usefulness of a single screening plasma plasminogen activator inhibitor-1 (PAI-1) and fibronectin (FN) level for the prediction of PE in pregnant women. MATERIALS AND METHODS: In a cohort of 180 pregnant women who were normotensive at baseline, venous blood samples were obtained before 20 weeks of gestation for the assay of plasma levels of PAI-1 and FN levels measured by enzyme-linked immunoassay technique. Twenty nonpregnant normotensive women were also evaluated as a control group. Outcomes of gestation were evaluated and correlated with the plasma levels of PAI and FN measured at mid-trimester. Mean plasma values of PAI-1 and FN were also compared between the different outcome groups. RESULTS: Plasma PAI-1 level was significantly higher in the pregnant women (8.68 ± 0.56 ng/ml) than in nonpregnant controls (5.55 ± 0.32 ng/ml) (P = 0.01). However, plasma FN did not show any significant difference in pregnant women (2.60 ± 0.37 µg/ml) and nonpregnant controls (2.60 ± 0.23 µg/ml) (P = 0.9). Mid-trimester mean plasma PAI-1 level measured in women who developed PE (7.08 ± 5.49 ng/ml, n = 12) and gestational hypertension (GH) (9.78 ± 6.2 ng/ml, n = 13) was not significantly different in comparison to normotensive pregnant women (8.78 ± 5.63 ng/ml, n = 153) (P = 0.75). Likewise, the mean FN level in women who developed PE was also not significantly different from nonpreeclamptics; however, the FN level in the pregnant women who developed GH was significantly different from women who remained normotensive throughout pregnancy (P = 0.02). CONCLUSION: Single mid-trimester assessment of PAI-1 and FN levels in maternal plasma was not found to be useful in predicting PE as an outcome of pregnancy in the study population.

Immunological and Virological Outcomes of Patients Switched from LPV/r to ATV/r-Containing Second- Line Regimens.

BACKGROUND: Atazanavir/ritonavir (ATV/r) recently became the preferred protease inhibitor (PI) for use in Nigeria since it is dosed once daily, which may improve treatment adherence and has fewer side effects than lopinavir/ritonavir (LPV/r)--the most widely available PI in resource-limited settings. We, therefore, aimed to evaluate the immunologic and virologic effects of switching patients to an ATV/r-containing regimen. METHODS: In a large antiretroviral treatment programme at the Lagos University Teaching Hospital in Nigeria, 400 patients were switched to ATV/r-based second-line ART. We conducted a retrospective evaluation of immunologic and virologic outcomes following 24 months on the ATV/r regimens. RESULTS: Of the 400 patients switched to an ATV/r containing regimen, 255 were virologically suppressed on LPV/r prior to switch, 107 were switched due to failure on a first-line regimen, 28 were on saquinavir/ritonavir (SQV/r)-based regimen, while 10 were unintentionally switched while non-suppressed on a LPV/r-based regimen. Demonstrable and sustained immunological responses were documented as the median (IQR) CD4+ cell count increased steadily from 466 (323) cells/mm3 at the time of switch to 490 (346) cells/mm3 at 6 months, and 504 (360) cells/mm3 at 24 months. Of 99 patients evaluated 12 months after ATV/r switch, 2 (2%) had detectable viral load (VL). None of the 26 (0%) in this group evaluated at 24 months had detectable viral load. In a comparison group of 576 patients who were maintained on LPV/r-based second line regimens, 359 (62.3%) had undetectable viral loads. Of 318 patients with VL data 24 months later, 25 (7.9%) had detectable VL. There was no significant difference between the proportion of patients maintained on LPV/r (7.9%) and those switched to ATV/r (0%) in the development of virologic failure after 24 months of follow-up. CONCLUSION: Among patients that were switched to ATV/r-containing regimens, we found improvements in immunological responses and no increase in risk of virologic failure.

Prevalence of anti-A and anti-B hemolysis among blood group O donors in Lagos.

BACKGROUND: Group O donor blood is more readily available and is frequently used as universal red cell donor in our environment. The presence of hemolysins in the donors may however lead to hemolysis in the recipients. Attempts have been made to study the prevalence of hemolysins in various populations with results from our environment showing wide variation (20-80%). AIMS: To determine the prevalence and titer of anti-A and anti B hemolysins among blood donors at the Lagos University Teaching Hospital and compare results with that obtained elsewhere. Determine if the practice of transfusion of group O blood to nongroup O recipients is permissible in this environment. MATERIALS AND METHODS: Test for hemolysis was done using the standard tube method. Samples positive for hemolysis were then scored and titrated with the titers read visually and photometrically at 540 nm. RESULTS: Three hundred and fifty blood group O donors with age range 18-58 years and median age of 28 ΁ 8.4 years were enrolled in the study. The overall prevalence of anti-A and/or anti-B hemolysins obtained was 30.3%. Prevalence of anti-A and anti-B hemolysins only was 15.4% and 5.1% respectively whereas both anti-A and anti-B hemolysins were present in 9.7% donor samples. Though anti-A hemolysins were more prevalent than anti-B hemolysins, anti-B hemolysins had higher mean visual (6:7) and spectrophotometric titers (81:101). A visual titer of 8 and above which is considered significant was seen in 18.6% of donor samples. CONCLUSION: Anti-A and anti-B hemolysins exist in significant frequencies and titers among blood group O donors in Lagos. It is recommended that the use of group O donor blood for recipients who are non-O be discouraged. Clinical studies to determine the frequency and severity of hemolysis in non-group O recipients of blood group O are required.

Pharmacoepidemiology of antiretroviral drugs in a teaching hospital in Lagos, Nigeria.

OBJECTIVE: Prescribing, adherence, and adverse drug events to HAART in a large antiretroviral programme in Lagos was evaluated. DESIGN: A retrospective 5 year open cohort study. SETTING: The AIDS Prevention Initiative in Nigeria (APIN) clinic at LUTH is one of the United States Presidential Emergency Plan for AIDS Relief (PEP-FAR) funded centers for HIV relief program in Nigeria Participants The case files of 390 patients on HAART and attending the APIN clinic were reviewed sequel to random selection. MAIN OUTCOME MEASURES: Demographics of the patients and pattern of antiretroviral (ARV) combination drugs prescribed were extracted from their case files. The details of the adverse drug events (ADEs) were extracted from drug toxicity forms regularly filled for each patient. A Chi-square test with Yates correction was used to determine the association between adherence and therapeutic outcome. RESULTS: A total of 2944 prescriptions were assessed. Zidovudine + lamivudine + nevirapine (35.87%) and stavudine + lamivudine + nevirapine (35.63%) were the most frequently prescribed combinations. Over 2000 ADEs were reported with cough (13.3%), fever (8.75%) and skin rashes (8.01%) being the most frequently reported. Drug adherence was associated with good therapeutic outcome (χ(2) = 115.60, p<0.0001). CONCLUSIONS: Zidovudine + lamivudine + nevirapine was the most frequently prescribed ARV combination. Cough was the most frequently reported ADE. Interventions aimed at rational prescribing of ARV drugs and improving adherence to antiretroviral drugs is essential for good therapeutic outcome in the treatment of HIV infection.

Prevalence of activated protein C resistance (Factor V Leiden) in Lagos, Nigeria.

OBJECTIVES: Hereditary resistance to activated Protein C (Factor V Leiden) is the commonest genetic defect known to confer a predisposition to thrombosis. This study aims to determine the prevalence of activated protein C resistance (APCr) in Lagos, and to determine if any association exists between APCr and ABO, Rhesus blood types, and hemoglobin phenotypes. MATERIALS AND METHODS: A functional APCr test was conducted on healthy adult volunteers to get a Factor-V-related activated protein C ratio (APC-V ratio). APCr due to Factor V mutation was indicated when the APC-V ratio is below a cut-off value that was determined by calibration. Subjects' hemoglobin, red cell ABO, and Rhesus phenotypes were determined by standard methods. RESULTS: Six (2%) of 297 participants with normal baseline coagulation screening tests had functional resistance to activated protein C (APC-V ratio < 2). None of the six subjects with APCr had history of venous thromboembolism. One of the six subjects was a female but the male sex did not demonstrate a risk of inheritance of APCr (P = 0.39). Four (67%) of the six subjects with APCr were non-O blood group. Whereas only two (0.9%) of 226 non-A subjects (blood groups 0 and B) had APCr, 4 (6%) of 71 subjects with A gene (blood groups A and AB) had APCr. The inheritance of A gene appears to constitute a risk to inheritance of APCr (P = 0.03). No association was demonstrable between APCr and hemoglobin phenotypes. CONCLUSION: Only 2% of the studied population had resistance to APC. The inheritance of blood group A may be a predisposition to APCr.

Open heart surgery: preliminary report of blood transfusion practice and haematological changes. Experience from a Nigerian tertiary teaching hospital.

AIMS AND OBJECTIVES: The study aimed at reviewing the utilisation of blood / blood products and haematological profile changes, with a view to developing a hospital transfusion guideline in open heart surgery in Nigeria. MATERIALS AND METHODS: The surgeries were performed at the intensive care unit theatre of Lagos State University Teaching Hospital. Eligibility for surgery was determined by the Cardiologist and the cardiovascular Surgeon based on clinical presentation, electro- and echocardiography assessments among other tests. Fourteen open-heart surgeries were conducted. Blood products demand for different procedures and several peri-operative laboratory parameters such as full blood count, and coagulation profile were determined. RESULTS: The greatest demand for blood products was found in valvular surgery and atrial septal defect (ASD) where a mean of four units of red cell concentrate, fresh frozen plasma and cryoprecipitate were transfused. Other surgeries such as, patent ductus arteriosus, Tetralogy of Fallot did not require much transfusion of blood products. Overall, the pre-operative and post-operative haematocrit, white cell count, platelet count, and international normalized ratio (INR) mean were 37% /25%,4.9 X 10 9/L / 11.4 X 10 9/L, 182 X 10 9/L/ 97 X 10 9/L, and 1.15/ 2.2 respectively. CONCLUSION: It appears that transfusion requirement in most open heart surgeries aside from valvular surgery and atrial septal defect (ASD) repair, is minimal. Patients for valvular heart surgeries and ASD repair should be evaluated for possible autologous blood transfusion.

Haemoglobin and ferritin concentrations of pregnant women at term.

BACKGROUND: Anaemia in pregnancy is defined as haemoglobin (Hb) concentrations of less than 11 g/dL while low ferritin is defined as serum ferritin (SR) levels of less than 10 µg/L. Hb and ferritin concentrations of pregnant women at term were determined to establish their mean values and to determine the prevalence of anaemia in our locality. METHODS: Haemoglobin and ferritin levels of 170 non-smoking and HIV-negative pregnant women were determined at term. The majority 143 of 170 (84.1%) of the pregnant women recruited for the study, booked at the beginning of the second trimester and received 200 mg elemental iron in three divided doses and 5 mg folic acid daily which were commenced at booking. Five millilitres of blood were collected from each patient at term into EDTA bottles for full blood count analysis and another 5 mL into plain bottles for SR assay. RESULTS: The mean Hb and ferritin values were 10.9 ± 1.9 and 47.84 ± 98.39 µg/L, respectively. The prevalence of anaemia at term was 46.4%. Only 11.2% (19 of 170) of pregnant women at term had low SR (iron stores). A statistically significant relationship was found between women's education and SR (P = 0.032). Booking status also correlated directly with SR and haemoglobin concentrations, while increasing age and parity did not. CONCLUSION: About half of the patients were anaemic. Iron deficiency is not the major cause of anaemia in pregnancy in this study because the majority of the pregnant women had normal iron stores. Education and booking status are possible factors that contribute to anaemia.

Haemoglobin and ferritin concentrations in cord blood in a tertiary health centre in Nigeria.

BACKGROUND: Haemoglobin(Hb) and serum ferritin (SF) concentrations of cord blood of babies born at term at the Lagos State University Teaching Hospital, Maternity Centre (Ayinke House), Ikeja in the South-Western part of Nigeria were determined to establish mean values for these substances in our locality. OBJECTIVES: To establish the mean values for haemoglobin and serum ferritin concentrations of cord blood of babies born at term in our environment and to determine the prevalence of foetal anaemia and low iron store in cord blood in our locality. METHODS: Haemoglobin and ferritin levels in cord blood of 142 newborns were determined. Two millilitres of blood was collected from the cord of each newborn into EDTA bottle for complete blood count analysis and another 2mls into a plain bottle for serum ferritin assay. Cut-off values for cord blood Hb and serum ferritin concentrations were 12.5g/dL and 60 microg/L respectively. RESULTS: The mean Hb and ferritin values were 13.024 +/- 2.41 g/dL and 70.85 +/- 97.07 microg/dL respectively. The prevalence of foetal anaemia is 32.4 %. About 59.2% of full term newborns had low iron store. Birth weight was significantly associated with Hb concentration (p=0.039) and apga sscore (p=0.002). CONCLUSION: The prevalence of foetal anaemia was 32.4%. More than half (59.2%) of the newborns had low cord blood serum ferritin.

Seroprevalence of hepatitis C infection in HIV patients using a rapid one-step test strip kit.

BACKGROUND: Hepatitis C virus (HCV) and HIV are transmitted via similar routes making co-infection with these viruses a common event. In addition, HIV infection and related immunosupression in patients with hepatitis C may be associated with more rapid progression of liver disease to cirrhosis, end-stage liver disease and death. OBJECTIVE: The study is to determine the seroprevalence of HIV/HCV co-infection rate. METHODS: A cross -sectional study was carried out from January to March 2010 at the HIV clinic of the Lagos State University Teaching Hospital. About 5 mls of blood sample was collected from each consenting participant. Sera were subjected to HCV rapid kit as recommended by the manufacturer (Dia Spot HCV one step test strip). The descriptive data was given as means +/- standard deviation (SD). The chi-squared test was used for analytical assessment. The differences were considered statistically significant when P value obtained was < 0.05. RESULTS: The overall seroprevalence rate of HIV/HCV coinfection was 3.3%. Only 6 of 194 female HIV subjects screened tested positive for HCV (3.1%), while 3 of 73 male subjects tested positive for HCV (4.1%) (P value 0.001). None of the 9 co-infected HIV/HCV participants (both male and female) had CD4 count of 350 and above, 3 had a count of 1-100 cells/il., 4 had 100-200, while 2 had 201-350. CONCLUSION: There is the need to include hepatitis C screening routinely in all HIV-infected patients undergoing pre-HAART evaluation in HIV clinics in order to lower liver-related morbidity and mortality associated with them.

Seroprevalence of Toxoplasma gondii antibodies amongst pregnant women at the Lagos State University Teaching Hospital, Nigeria.

BACKGROUND: Toxoplasma gondii (T.gondii), an obligate intracellular parasite found in many species throughout the world, causes a variety of clinical syndromes in humans and animals. It is also associated with morbidity and mortality in pregnancy. Hence the need to determine the seroprevalence of antibody to toxoplasmosis gondii amongst pregnant women. SUBJECTS AND METHODS: A cross- sectional study was carried out using patients attending the ante-natal clinic of Lagos State University Teaching Hospital Ikeja. All consenting newly registered ante-natal patients were recruited consecutively into the study within a time frame of six weeks during which a total of 179 pregnant participants were recruited. Literate participants filled self administered questionnaires whilst the non-literate participants were interviewed by research assistants. Five milliliters of blood was collected from each participant after obtaining patient's consent. Sera were assayed for antitoxoplasmosis IgG antibody by enzyme linked immunosorbent assay. (ELISA.) RESULTS: A total of 179 pregnant women were studied. Almost 50.8% were between the ages of 25-30 years, 70.8% of the patients studied, had tertiary education. An assessment of the patients' status to anti-toxoplasmosis IgG showed 40.8% were positive while 59.2% were negative. Pet-keeping was a practice amongst only 6.1% of patients whilst 90.5% did not keep pets. Out of those who kept pets, 63.6% were positive while 39.5% were negative. Amongst those who did not keep pets, 39.5% were positive while 60.5% were negative. This difference was not statistically significant. (P=0.261) CONCLUSION: It appears that seroprevalence of toxoplasmosis IgG antibody amongst the pregnant women in this study population is high. Therefore, it is valuable to follow up the IgMantibody status of their off springs as its presence indicates recent exposure.