Haematology Consultations in a Tertiary Health Care Centre in Nigeria.

BACKGROUND AND OBJECTIVES: The ease with which investigations are done in this technological age increases the possibility of finding abnormal haematological values, which inevitably leads to haematologic consultations. The Department of Haematology at the University College Hospital (UCH), Ibadan provides a busy consultative service for in-patients and out-patients suspected of having a haematological disorder. This study reviewed the consultations received from different clinical departments to Consultant Haematologists at our tertiary hospital. METHODS: Analysis of consultation requests on in-patients received in the Haematology department, UCH between June 2015 and January 2016 was done. During this period, the department had six Haematologists and nine resident doctors. SPSS version 22 was employed for the statistical analysis. RESULTS: A total of 285 consultation requests were received during the study period, with an average of 36 consults per month. The highest number was received in July 2015. The patients reviewed had a mean age of 36.9±19 years, and requests on female patients exceeded those on males, with a M:F ratio 1:1.5. Consultation for a presumptive diagnosis of sickle cell disease (SCD) were the commonest indication (17%). The highest consultation was from Obstetrics and Gynaecology (O&G) (25%) while the least was from Radiation Oncology (0.4%). CONCLUSION: There is an increasing role for the Haematologist in sub-Saharan Africa as evidenced by the high frequency of consultations observed in this review. The management team of each teaching hospital should bear in mind the need to have adequate number of Haematologists so as to ensure optimal haematological services.

Knowledge, Experiences and Coping Mechanisms for Priapism among Persons with Sickle Cell Disease in Ibadan, Nigeria.

BACKGROUND: Priapism is a prolonged, painful penile erection common among males with Sickle Cell Disease (MWSCD) predisposing to erectile dysfunction (ED) when treatment is delayed. Unlike in women with sickle cell disease (SCD), there has been little attention to male reproductive health complications of SCD. OBJECTIVE: To investigate knowledge, experiences and coping mechanisms for priapism among MWSCD in Ibadan, Nigeria. METHODS: This descriptive cross-sectional study employed purposive sampling technique to select 95 consenting MWSCD attending haematology clinics in Ibadan for interview. A semi-structured, interviewer-administered questionnaire was used to collect information on knowledge, coping mechanisms, and experiences of priapism. Knowledge of priapism was measured and categorised as poor and good respectively. Psychosocial Experiences (PEs) were measured and categorised as mild, moderate and severe, while the Sexual Experiences (SEs) were recorded. Coping mechanisms for priapism were grouped into Medical, Psychosocial and Harmful coping mechanisms respectively. Data were analysed using descriptive statistics and Fishers' Exact test at p<0.05. RESULTS: Respondents' mean age was 23.6±8.8 years. Over half (55.8%) had good knowledge of priapism. Thirty-nine respondents (41.1%) had experienced priapism. Sexual Experiences reported include: total ED 10.3% and apathy for sexual intercourse 23.1%. Majority 30(76.9%) developed mild PEs especially fear of reoccurrence of priapism (56.4%) and sleeplessness (43.6%). The most used Medical Coping Mechanism (MCM) was cold shower (46.2%). There was no significant association between age and knowledge of priapism. CONCLUSION: Knowledge of priapism among respondents was good. Psychosocial therapy through appropriate health education, counseling and social support may help improve knowledge among people with SCD.

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-up. RESULTS: 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.

Audit of the red cell units supply of a busy hospital blood bank in Nigeria.

BACKGROUND/OBJECTIVE: Blood bank audit embraces all procedures from blood procurement to the long -term consequences of transfusion which helps to identify opportunities for improvement. We have therefore looked at red cell transfusion in our hospital to identify areas that will require improvement. METHOD: Data was collected retrospectively from the hard copy record of the blood bank for a period of one month. RESULTS: Request was made for 1210 red cell units; crossmatch was made for 64% of the request. All units crossmatched were issued, of these 4.15% were returned unutilized. 5.1% were issued as uncrossmatched. The Obstetrics/Gynaecology unit recorded the highest blood usage and the medical unit the least. The use of blood by the emergency and paediatric were the same. The crossmatch:transfusion ratio for the hospital was 0.9:1. This study has shown that the crossmatch and transfusion rates are almost equal and only a small percentage was returned unused. CONCLUSION: This showed that there is inadequate supply of blood. There is a need to assess the reason for transfusion and establishing a blood transfusion advisory committee by the hospital. This will ensure interaction and collaboration between blood suppliers and users to improve the quality of transfusion practice. The new policy establishing a national transfusion service will also improve the transfusion service but emphasis has to be put on donor recruitment and donor care.

Pitfalls in diagnosis of hepatitis B virus infection among adults Nigerians.

OBJECTIVE: Hepatitis B virus infection is common in Nigerians and its diagnosis is necessary for effective treatment and eradication. This study is aimed at highlighting the serological factors jeopardizing the diagnosis and treatment of the infection among Nigerians adults. PATIENTS AND METHODS: Three studies were carried out. The first study involved 56 Nigerian adults and it compared the assay of HBsAg by Haemagulation Method (HMA) with Enzyme linked immunoassay (ELISA). The second study was a comparison of Glaxo Welcome HB rapid test(GWHB) with ELISA in sero-assay of HBsAg and HBeAg among 25 Nigerian subjects while the third study was on the assay of the sera of HBsAg positive patients for HBeAg and anti-HBe in forty two Nigerian patients by ELISA. RESULTS: The sero - prevalence rates of HBsAg were 41.8% and 61.8% by HM and ELISA respectively with false HBsAg sero-positives and sero-negatives by HM of 5.4% and 25.5% respectively. Similarly, there was sero-detection of HBsAg in 84% and 80% by ELISA and GWHB respectively in 25 Nigerian adults. In addition, 19% and 64% of the 42 patients with HBsAg sero-positivity were also positive for HBeAg and anti-HBe respectively, while 31% of the patients were both HBeAg and anti-HBe sero-negative. CONCLUSION: Sero-diagnosis of HBsAg and other serological markers of infectivity in patients with HBV should be carried out by ELISA rather than HMA among adult Nigerians. Furthermore, high infectivity of the virus abounds among Nigerian with HBV infection.

Incidence of factor FVIIIC deficiency in live male infants undergoing circumcision in South West, Nigeria.

A prominent evidence of inherited bleeding disorder in newborn males is excessive post-circumcision bleeding. Male circumcision in Nigeria is the rule rather than the exception. Male siblings of some of the Nigerian haemophiliacs consequently died from severe post-circumcision bleeding. The aim was to determine the incidence of inherited factor VIIIc (FVIIIc) deficiencies in live male infants undergoing circumcision in South West, Nigeria. The study population was 244 male infants drawn from University College Hospital and Our Lady of Apostles Catholic Hospital, Oluyoro, Ibadan. Pre-circumcision prothrombin time, activated partial thromboplastin time and FVIIIc levels were determined. Clinical features of inherited bleeding disorder particularly family history of bleeding diathesis, history of cephalhaematoma and bleeding from the umbilical stump in neonatal life were determined with the aid of a questionnaire. Only one of the mothers (0.4%) gave a family history of bleeding disorder. A history of excessive bleeding from the umbilical stump post delivery was obtained in three (2%) of the patients. Five (2%) other subjects had cephalhaematoma post delivery. Two of the subjects (0.8%) had prolonged activated partial thromboplastin time. The factor VIIIc level was between 31% and 49% in 16.1%, while 1.6% of the neonates had levels between 20% and 26%. This study detected four of the 244 (1.64%) neonates with FVIIIc deficiency, suggestive of either mild haemophilia or von Willebrand's disease. A larger study (including family studies) will be required, so as to arrive at the exact incidence of both haemophilia A and vWD in live male infants in Nigeria.

Mortality rate in Sickle Cell Disease Patients in Crisis at a Haematology Day Care Unit (HDCU) in Nigeria

The Haematology Day Care Unit (HDCU) of the University College Hospital; Ibadan; Nigeria was established in 1975 with the main goal of providing immediate and specialized care to haematological emergencies; particularly sickle cell disease (SCD) patients. Since inception; a systematic analysis of its effectiveness has not been done; hence this study. A retrospective study of all registered patients attending the Haematology Day Care Unit of the University College Hospital; Ibadan; over a one-year period was conducted and analyzed. Demographic data; diagnosis; treatment received; outcome of such treatment as well as laboratory parameters were extracted from HDCU register and the data were then analysed using descriptive statistics. A total of 890 patients were seen during the period; January and December 2001; out of which 520 were sickle cell disease patients (HbSS accounted for 508 (92.7) cases and HbSC; 40 (7.3) cases). The mean age of the SCD patients was 25.8years; the median; 23years and the mode; 18years. The mean PCV was 21.2; median; 21.0 and mode; 20. Majority (246 or 47.3) of the patients were between 20 and 30 years; the lowest frequency being in the 50years group (14 or 2.7). One patient died during the period under review (31year old female with HbSC disease); giving a mortality rate of 2 per 1000 patients

Haematological profile of healthy pregnant women in Ibadan, south-western Nigeria.

There is a dearth of information on the reference values for haematological indices particularly according to the relevant trimesters of pregnant women in Nigeria. The objective of this study was to provide reference values for Nigerian pregnant women. The study took place at the Adeoyo Maternity Hospital and the University College Hospital, both in Ibadan. This descriptive study was carried out over a period of 8 months. Subjects were apparently healthy pregnant women that satisfied the inclusion and exclusion criteria. The mean values (and 95% confidence intervals, CI) of haematological indices were as follows -- First trimester: Haemoglobin (Hb) 112.44 (101.64 - 123.25) g/l, haematocrit (hct) 35 (32 - 38)%, WBC 5.488 (4.025 - 6.950) x 10(9)/l and platelet counts 227.56 (165.21 - 289.90) x 10(9)/l;Second trimester: Hb 100.39 (97.85 - 102.92) g/l, hct 29.3 (28.5 - 30.1)%, WBC 6.57 (6.19 - 6.95) x 10(9)/l, platelet count 229.56 (211.86 - 247.26); and the Third trimester: Hb 98.06 (96.12 - 100.00) g/l, hct 29.4 (28.7 - 29.9)%, WBC 6.92 (6.53 - 7.30), platelet count 186.52 (177.67 - 195.38) x 10(9)/l. These results were compared with those of 52 non-pregnant age matched women volunteers as controls whose mean haematological indices and 95% CI were: Hb 120.51 (116.61 - 124.41) g/l, hct 36 (25 - 48)%, WBC 5.28 (2.9 - 8.7) x 10(9), platelet count 330.87 (176 - 538) x 10(9)/l. The following haematological indices: WBC, platelet counts, RBC, PCT, and PDW, of women between the trimesters showed statistical significance (p value < 0.001 in each case). The WBC is inversely proportional to the PCT and the MCV in the pregnant women was slightly raised. In this study, pregnancy is characterised by lowest values of haemoglobin parameters in trimester three and there are statistically significant differences between the WBC, platelet counts, RBC, PCT, and PDW of women between the three trimesters.

Coagulation profile in Nigerian children with cerebral malaria.

OBJECTIVES: To determine the screening coagulation tests - PT, PTT(k), TCT, fibrinogen and absolute platelet counts. MATERIALS AND METHODS: There were 97 children with 35 cerebral malaria (CM) and two control groups 30 acute malaria (AM) and 32 healthy controls aged 6 months--11 years. This is the first documented report of coagulation profile in Nigerian children above 6 months. RESULTS: The means of the PT in the three groups were normal. There was no significant difference between the means of PTT(k) and fibrinogen, p values 0.51 and 0.20 respectively. Nine of the CM group had deranged PT while eleven had elevated PTT(k). Four of the thrombocytopaenic CM patients were hypercoagulable. Three CM patients had bleeding episodes without laboratory evidences of DIC. Thrombocytopaenia occurred in 46% of the CM group compared with 23% of the AM. The role of hypercoagulable state observed amongst the thrombocytopaenic CM group could not be determined. CONCLUSION: We suggest close monitoring of platelet count and coagulation profile in those with haemorrhagic complications.

HIV seroprevalence in Nigerian patients with surgical lesions of the brain: implications for management.

BACKGROUND AND OBJECTIVE: This study was done to estimate the seroprevalence rate among Nigerian patients presenting to hospital with neurosurgical disease. PATIENTS AND METHOD: We reviewed our patients' hospital records from October 1996 to October 2001 for clinical presentation and diagnosis, cranial CT findings, results of retrovirus screening and mode of management. RESULTS: Sixteen (10 males and 6 females) out of 601 patients screened for HIV by ELISA were confirmed by Western Blot to be positive, giving a seroprevalence rate of 2.7% . Twelve of the HIV-positive patients were asymptomatic for HIV disease. CONCLUSION: There is a low but definite risk of HIV transmission to health workers managing patients with surgical lesions of the brain in areas where HIV is prevalent. Asymptomatic seropositive HIV patients with surgically curable intracranial disease should be managed with the most minimally invasive procedure appropriate for the surgical lesion under universal protective measures.

Cranial computed tomographic (CT) findings in HIV-positive Nigerian patients presenting for neurosurgical evaluation.

INTRODUCTION: The central nervous system (CNS) is an important site of HIV infection. As many as one quarter of AIDS patients present with neurological symptoms and up to 75% of the patients may have CNS abnormalities at autopsy. Under these circumstances therefore, differential diagnoses in HIV-positive patients with neurological symptoms constitute a management challenge. OBJECTIVE: To describe the pattern of cranial computed tomographic (CT) findings in neurosurgical patients with HIV infection. STUDY DESIGN: Retrospective analysis. PATIENTS AND METHOD: A total of 1907 patients were admitted from October 1996 to October 2001. Sixteen patients were positive for HIV using the Western blot. We reviewed their biodata, clinical features and cranial CT findings. RESULTS: There were 10 male and 6 female patients. Twelve patients had cranial CT. Four patients had lesions that could be attributed to direct infection by HIV virus. Two patients had lesions that suggested immunosuppression from HIV infection. Diffuse breakdown in blood brain barrier (BBB) with contrast enhancement as well as mass effect that was disproportional to the enhancing lesion were common findings in three patients. The other lesions seen on cranial CT could not be directly linked to HIV infection. CONCLUSION: Apart from the diffuse breakdown in blood brain barrier with disproportional mass effect, our findings were similar to previous reports. Further study with a larger population of patients and, especially, biopsy of the CNS lesion will be needed to confirm our findings.

Malignant schwannoma of the nasal cavity and paranasal sinuses in a Nigerian.

An unusual case of malignant schwannoma with involvement of the forehead, external nose, right nasal cavity, paranasal sinus system (bilateral frontal sinus, right ethmoidal sinus), right orbit and anterior cranial fossa is reported in a Nigerian. Malignant schwannomas of the paranasal sinus are extremely rare, as only 20 well-documented cases have been previously published in English literature. No report in black Africans has been found in extant literature. The clinical features of this tumour are presented with detailed management. The patient had a wide surgical resection of the lesion with reconstruction of the resultant fronto-nasal defect using forehead musculofascial flap plus full thickness skin graft and adjuvant radiotherapy with satisfactory outcome. The good result of combined surgery and radiation regimens in this case demonstrates the usefulness of adjuvant radiation therapy in this condition.

Types of crises in sickle cell disease patients presenting at the haematology day care unit (HDCU), University College Hospital (UCH), Ibadan.

OBJECTIVE: The aim of the study was to determine the types of crises in Sickle Cell Disease (SCD) patients seen at the Haematology Day Care Unit (HDCU) of the University College Hospital (UCH), Ibadan. MATERIAL AND METHODS: The study is a retrospective survey using the registers of all patients seen in the year 2001 (January-December). Data extracted included demographic parameters, types of crises, haematocrit level and outcome of treatment received. The patients studied were both HbSS and HbSC in crises. RESULT: There were five hundred and eight HbSS and thirty seven HbSC patients seen during the survey period. Vaso-occlusive crisis had the highest prevalence of 91.6%, while haemolytic crisis had the least (0.5%). More females (56.7%) had crises than males (43.3%) in the vaso-occlusive group. The relationship between crises type and sex was not significant (p = 0.282). Young adults (20-29 years) had more crises (49.9%) than other age groups but crises were rare in children (0.2%). There was, however, a significant relationship between age group and crises type (p < 0.00). Eighty one percent of the subjects had PCV > 20%. The type of crisis is related significantly to the treatment received (p < 0.000). Fifty six percent of the subjects required analgesics alone while was admitted for blood transfusion and other medical, surgical, gynaecological and obstetric complications. There was only 1 (0.1%) recorded death within the 12 month survey period in a 31 year-old HbSC female who had painful and haemolytic crisis. CONCLUSION: There were six types of crises seen in the sickle cell disease subjects namely vaso-occlusive, sequestration, infarctive, aplastic, haemolytic and bone pain crises. Vaso-occlusive crisis was the most common and haemolytic crises the least. Vaso-occlusive crisis was more common among young adults (20-29 year age group). The mortality rate was found to be 0.1%.

Myelomatosis: a case report of an unusual presentation.

BACKGROUND: Multiple myeloma (MM) is a clonalexpansion of plasma cell characterized by skeletal dissemination of malignant plasma cells resulting in the production of homogenous monoclonal immunoglobulin termed the monoclonal (M) protein. MM is the most prevalent cancer after non-Hodgkin's lymphoma and is responsible for 2% of all cancer deaths. Several unusual presentation of MM have been described in the literature. Many serial reports have documented progression of Plasmacytoma to MM, or relapsed into MM after radiation therapy. STUDY DESIGN: This is a case report of a 36 yr old man with a huge fungating right clavicular mass, with a histological of plasmacytoma (anaplastic variant). RESULT: The patient's tumour was resistant to radiotherapy, terminating as multiple myeloma, with rapid progression to death within 19 months post diagnosis. CONCLUSION: This report helps to validate the rapid progression of the anaplastic plasmacytoma variant to disseminated myeloma, and indicates the poor response to radiation therapy. Our patient showed the important poor prognostic features in some plasmacytomas that are characterized by rapid progression to MM, namely tumour size > 5 cm, young age and spinal cord compression.

Lupus anticoagulant in Nigerian women with preeclampsia.

OBJECTIVE: The Lupus Anticoagulant (LA) which used to be known for its interference with coagulation studies in the 1950s, has now been recognised to be associated also with diverse disease conditions in the developed countries. Our aim therefore was to determine the prevalence of the lupus anticoagulant (LA) in women with pre-eclampsia and controls. SUBJECT AND METHODS: A total of seventy-six pregnant women, were studied, twenty-six pre-eclampsia and fifty who were apparently healthy served as controls. The Kaolin clotting time test (KCT) was performed in duplicates on plasma samples from subjects and controls. Mixing ratio was calculated in order to determine the presence of the lupus anticoagulant, Kaolin clotting time ratio of greater than or equal to 1.2 was taken to signify the presence of the lupus anticoagulant. RESULTS: Eleven (42.3%) of the women with pre-eclampsia had prolonged KCT as against 2(4%) of the pregnant control. The clotting time of 7 of the '11 pre-eclampsia with prolonged KCT, were correctd by normal plasma, while 4 were not corrected. The KCT ratio of all 4 were greater than 1.2 signifying the presence of LA (15.4% prevalence). One (2%) of the pregnant control had KCT ratio greater than 1.2 (2%) prevalence of LA). CONCLUSION: A number of Nigeria women with pre-eclampsia also have the lupus anti-coagulant therefore African women with pre-eclampsia should be screened for the presence of lupus anticoagulant.

Prevalence of lupus anticoagulant in multiparous women in Benin City, Nigeria.

Lupus anticoagulant which in the past was regarded as a laboratory nuisance is now known to be associated with numerous clinical conditions including thrombosis and recurrent foetal loss, however, no work has been done to assess its prevalence in non-pregnant healthy multiparous women. Our aim therefore was to determine the prevalence of lupus anticoagulant in non-pregnant multiparous Nigerian women of childbearing age. Fifty non-pregnant multiparous women who were considered healthy following verbal interviews were studied. An eligibility criterion was used. Coagulation studies were performed on plasma samples from all the women using the Kaolin clotting time. Mixing experiments were conducted on samples with prolonged clotting time to detect the presence of the lupus anticoagulant. The Kaolin clotting time ratio of greater than or equal to 1.2 was considered positive for the lupus anticoagulant. Forty-four (88%) of the 50 women had a normal cloning time, 2(4%) had subnormal clotting time while 4(8%) of them had a prolonged Kaolin clotting time. Mixing experiments on these 4 samples revealed Kaolin clotting time ratios of over 1.2, signifying the presence of the lupus anticoagulant (i.e. 8 per cent prevalence) among the population of women studied Multiparous women with the lupus anticoagulant may not be symptomatic therefore the anticoagulant should be screened for in women with unexplained prolongation of cloning time. We recommend that these women should be followed up especially in pregnancy to forestall any of the obstetric complications that have been associated with the lupus anticoagulant.

Leukaemia cutis in a patient with acute myelogenous leukaemia: case report.

Leukaemia cutis is a specific lesion of leukaemia in which there is leukaemic cell deposit in the skin. There are few reports of this condition in our environment. Several mechanisms have been postulated for the pathogenesis of the disease. One of which is the tissue selective homing of a unique sub-population of malignant clone of cells. The presence of leukaemia cutis does not seem to worsen the prognosis as the acute myeloid leukaemia is an equally lethal disease. The fatality of the disease is compounded by the unavailability of the right regimen in our patient. This paper documents a case of leukaemia cutis in a patient initially diagnosed to have AML who developed skin lesion in remission. A skin biopsy was found helpful in diagnosing the first sign of relapse in a patient in haematological remission.

Factors determining the outcome of management of patients with Burkitt's lymphoma at the University College Hospital Ibadan, Nigeria--an eleven year review.

In recent times, our experience in the chemotherapy of Burkitt's lymphoma patients in Ibadan, Nigeria has been that of poor outcome, hence this study was undertaken to determine the factors leading to the poor results of chemotherapy of Burkitt s lymphoma in Ibadan. A retrospective analysis of Burkitt s Lymphoma patients seen over eleven year period, between January 1987 to December 1997 at the Paediatrics and Haematology Departments of the University College Hospital, Ibadan was carried out. There were 67 patients, mean age 11+5 years (range 4 to 30 years), 42 males, 25 female giving M:F ratio of 1.7:1. Majority of the patients (76.2%) were stage D, only 4.5% were stages A and of the 67 patients, only 57 (83.6%) had chemotherapy, 40 of whom had COAP, 8 had COMP and 9 patients had either cyclophosphamide or cytosar as monotherapy. Only 22.8% of patients that received chemotherapy went into complete remission. In this study, we observed a declining overall complete remission rate of 22.8% (compared to 47% in 1979) in Burkitt s Lymphoma patients. The presence of large amount of fake drugs in the Nigerian market may imply that some of the cytotoxic drugs used in these patients could have been fake drugs. We suggest that the government should subsidize the therapy of these patients as well as eradicate the presence of fake drugs in the market, thereby increasing the chances of a cure.

Pattern of sexually transmitted diseases among commercial sex workers (CSWs) in Ibadan, Nigeria.

The purpose of this study was to determine the pattern of STDs among commercial sex workers (CSWs) in Ibadan, Nigeria. The subjects were 169 CSWs randomly selected from 18 brothels, majority of who were examined and investigated in their rooms. Another 136 women without symptoms who visited the special treatment clinic, University College Hospital, Ibadan were selected as a normal control group. Vaginal candidiasis was the most common STD diagnosed in both CSWs and the control group. The other STDs in their order of frequency were HIV infection 34.3%, non-specific vaginosis 24.9%, trichomoniasis 21.9% and gonorrhoea and "genital ulcers" had an incidence of 16.6% each. Other important conditions were tinea cruris 18.9%, scabies 7.7% genital warts 6.5% and 4.1% of them had syphilis sero-positivity. All the 13 CSWs that had scabies, the 4 (36.4%) with genital warts and the 19 (67.9%) with "genital ulcers" had HIV infection. While there was no significant difference between the CSWs with vaginal candidiasis, gonorrhoea, trichomoniasis and the control group, the HIV positivity was significantly higher (P < 0.001) in CSWs than in the control subjects. These findings suggest that women who exchange sexual services for money can no longer be ignored, and should therefore be identified and made to participate in STD prevention and control programmes.

Sensorineural hearing loss in adults with sickle cell anaemia.

Sensorineural hearing loss (SNHL) is one of the known complications of sickle cell disease (SCD). However, there is paucity of information on SNHL as a complication of SCD, especially in sickle cell anaemia (SCA) in our environment, hence this study. This was a prospective study of pure tone audiological assessment of 167 adult SCA patients in stable condition attending the adult Sickle Cell Clinic and 100 apparently healthy Haemoglobin AA adults as control in the University College Hospital, Ibadan. Their ages ranged from 15 to 56 years for SCA and 15 to 65 years for the controls, with a mean age of 24.2 (+/- 8.2) and 28.7 (+/- 11.9) years respectively. There were 94 females (56.3%) and 73 males (43.7%), fifty-two females (52%) and forty-eight males (48%), with a M:F ratio of 1:1.3 and 1:1.1 for SCA and controls respectively. Sensorineural hearing loss (SNHL) was observed in a total of 178 ears in 110 SCA patients and 68 ears in 47 controls with a prevalence of 66% and 47%, respectively. Sixty-eight patients (62%) and twenty-one controls (44.7%) had bilateral impairment, although only 18 SCA patients (11%) perceived hearing impairment. High frequency loss (4000-8000 Hz) was commonly affected in both the SCA patients and controls as compared to other frequency ranges. Low frequency range was involved in ten ears (9%) especially the right ear of some SCA patients. Decibel hearing level (dBHL) loss was in the mild range (26-40 dBHL) in 103 (58%) and 53 (78%) ears in the SCA and controls, respectively. Five patients had severe and profound dBHL loss. The range of dBHL loss was 26-43 dBHL especially in the high frequency range bilaterally for both the SCA and controls. Mean binaural hearing of 13 dBHL was recorded in both the SCA and controls for each octave frequency bilaterally in those with normal hearing while 26 and 23 dBHL were for those with impaired hearing respectively. Also, the mean dBHL for both ears was observed to be progressively worse with increasing age groupings, more especially in SCA patients. There was no significant correlation between the severity of hearing loss and the frequency of vaso-occlusive crisis. It is hoped that this study would have increased the awareness that SNHL is a common complication of SCA in our patients. There is thus the need for periodic evaluation of the auditory function of SCA patients in our environment.