Preliminary report of HLA (DNA) typing of Nigerians using sequence-specific primer technique.

AIMS AND OBJECTIVES: This communication is an attempt to present the experience and a preliminary report of results over a one-year period. PATIENTS AND METHODS: From December 2011 to December 2012, a prospective determination of the HLA types of 20 individuals referred to the Tissue Typing Laboratory of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife was done. These consisted of prospective transplant recipients, their donors, and a migrant pair for kinship determination. DNA was extracted from the client's peripheral blood sample, using the QIAmp Blood DNA Mini kit, (Qiagen). PCR was done using OlerupR low-resolution PCR-SSP typing kit. The PCR product was resolved in 2% agarose gel, and the bands visualised under UV light. The HLA types were determined using provided tables and/or Helmberg software. Data were presented using descriptive statistics whileHLA antigen frequency (AF) was expressed in percentage and gene frequency (GF) was determined using square root method (1-(1-AF)1/2). RESULTS: A total of 20 individuals (13males and 7females) consisting of seven renal transplant recipients and seven prospective donors; a stem cell recipient and three donors and a migrant pair for kinship determination were typed. Age ranged from 4-65 years. 44 HLA alleles were detected, while HLA-A, B, C, DRB1 and DQB1 were 7, 10, 11, 8, 8 alleles respectively. The alleles were heterogeneous in distribution while 6 antigens (HLA-A*02, B*30, C*15, DRB1*03, DRB1*08 and DQB1*06) were having frequencies e"25%. CONCLUSION: This report confirms that DNA-based HLA typing is feasible locally, andit was observed that renal transplantation procedure is the most frequent indication. The HLA antigens observed to have very high frequencies (e"25% frequency) in this population were HLA-A*02, B*30, C*15, DRB1*03, DRB1*08 and DQB1*06. There is a strong need to develop a broad-based HLA data bank for Nigeria to further strengthening her transplantation programmes.

Review of vaginal birth after primary caesarean section without prostaglandin induction and or syntocinon augmentation in labour.

OBJECTIVE: To show the results of vaginal birth after primary caesarean (VBAC) without using prostaglandin for induction and/or syntocinon augmentation are comparable when induction is done with these agents but without the added risks of uterine rupture. METHOD: A review of the obstetric records of 16,498 parturient from 1 January 2001 to 31 December 2006 was carried out. The 229 cases of women who wanted VBAC were subjected to further analysis to determine the number of successful vaginal delivery after spontaneous onset of labour or membrane sweep. The instrumental vaginal delivery rate, analgesia commonly used and the complication rate were analysed. RESULTS: The result showed that 34.49% had spontaneous onset of labour, 27.07% laboured after membrane sweep and 38.42% had repeat urgent caesarean section as they failed to go into spontaneous labour. Of those who went into labour spontaneously or after membrane sweep, 67% had vaginal delivery, a further 13.97% had instrumental vaginal delivery and 16% had emergency caesarean section. There was no case of uterine rupture. CONCLUSION: VBAC can end successfully in a high proportion of cases without the use of prostaglandin or syntocinon for induction of labour and or syntocinon for augmentation in these women because of their associated increased relative risk of uterine rupture.

Which factors actually influence the development and progression of overt nephropathy in Nigerian diabetics?

OBJECTIVE: To determine the risk factors predisposing Nigerian diabetics to overt nephropathy with a view to developing strategies for its prevention. DESIGN: case control study. SETTING: Tertiary care hospital, a major nephrology referral centre in Nigeria. SUBJECTS: 30 diabetic nephropathy (DN) patients and 32 age and sex-matched diabetic patients without nephropathy. MATERIALS AND METHODS: 30 diabetic nephropathy (DN) patients with chronic renal failure who have been diabetic for a minimum of five years and satisfied the inclusion criteria for the study were compared with 32 age and sex-matched diabetic patients without nephropathy. Their socio-demographic parameters, clinical and laboratory profiles were determined and compared. RESULTS were analysed using the statistical package for social sciences version 10. Chi-square test, logistic regression analysis and Spearman's rank correlation coefficient were used, p-value < 0.05 was considered as significant. MAIN OUTCOME MEASURES: The study sought to compare socio-demographic, clinical and biochemical data between diabetic patients with overt nephropathy and those without. RESULTS: Duration of diabetes, blood pressures and blood sugar levels were significantly higher in DN patients than the controls (p < 0.05). A family history of renal disease, socio-economic status, cigarette smoking, body mass index and total serum cholesterol did not distinguish between DN patients from controls (p > 0.05). Systolic blood pressure positively correlated with serum creatinine (r = 0.057, p < 0.001) and duration of DM (r = 0.284, p = 0.02). There was a constellation of clinical features viz: retinopathy, peripheral neuropathy and left ventricular hypertrophy, which were significantly associated with DN (p < 0.05). CONCLUSIONS: Prolonged duration of diabetes, hypertension, retinopathy, and peripheral neuropathy, left ventricular hypertrophy and poor glycaemic control were the major risk factors for overt nephropathy among Nigerian diabetics. Apreventive strategy should include adequate blood pressure and glycaemic control.

Seizures associated with filariasis.

A case of epileptic seizures associated with multiple filariasis is presented. The possibility of an aetiological association between epileptic seizures and filariasis is explored in the light of available published literature.

The pathological basis of chronic renal failure in Nigerians. An autopsy study.

With the aim of determining the relative prevalence of the diseases underlying chronic renal failure (CRF) in a large homogeneous black tropical population, the autopsy records of the Obafemi Awolowo University Teaching Hospital over a four year period were studied. Out of a total of 702 cases coming to autopsy during this period, 66 (9.4%) died as a result of CRF. The highest number of cases of CRF fell within the 31-40 year age group with a male/female ratio of 1.28:1. Chronic glomerulonephritis was responsible for 40.9% of cases, malignant nephrosclerosis 16.6%, benign nephrosclerosis 7.6% while endstage renal disease (ESRD) was responsible for 15.4%. A miscellaneous group of diseases was responsible for 19.7%, about half of which was due to chronic pyelonephritis. Rarer causes of CRF were diabetic nephropathy, multiple myeloma, systemic lupus erythematosus and analgesic nephropathy.