Quality and Quantity of Nucleic Acids Extracted from Formalin-Fixed Paraffin-Embedded Lymphoma Biopsies from Nigerian Archived Biopsy.

BACKGROUND: Integrity of nucleic acids derived from archived formalin-fixed paraffin-embedded (FFPE) cancer specimens affects diagnosis, prognosis, and therapy. Several factors affect the quality and quantity of extracted nucleic acids and one of such factors is storage period. AIM: We investigated the impact of storage duration on the quality and quantity of nucleic acids extracted from archived FFPE lymphoma biopsies in Nigeria. MATERIALS AND METHODS: A total of 53 FFPE biopsies diagnosed as lymphoma stored over several years (2008-2019) were analyzed. They were 22 chronic lymphocytic leukemia (CLL) cases, 17 Hodgkin lymphoma (HL) cases, and 14 diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS). DNA was extracted from all the lymphoma samples which were analyzed for integrity and amplifiability using the four pairs of control genes polymerase chain reaction (PCR) primers of BIOMED-2 protocol, whereas RNA extraction was from 6 CLL cases used for qPCR analysis of RNU43. RESULTS: For CLL, the mean DNA yield was 193.6 ng/µl (range: 3.0-533.0 ng/µl), whereas the mean A260/A280 ratio was 1.7 (1.2-1.9). For DLBCL, NOS, and HL, 255.5 ng/µl (range: 32.9-605.4 ng/µl), 1.8 (1.5-2.0) and 242.7 ng/µl (range: 1.3-886.0 ng/µl), and 1.7 (0.9-1.8), respectively. The extracted DNA gave amplifiable products of at least 200bp, whereas the RNA analysis showed CT values of <38 in all the samples. The mean RNA yield was 462.2 ng/µl (range: 74.7-1082.1), whereas the mean A260/A280 was 1.7 (1.5-1.8). CONCLUSION: Quantity and quality of nucleic acids from FFPE tissues stored for different time periods showed no significant difference in yield and quality.

Detection of BCR-ABL1 fusion gene transcripts in the saliva of Nigerian patients with chronic myeloid leukemia.

BACKGROUND: The presence of BCR-ABL1 fusion gene resulting from a t(9; 22) reciprocal chromosome translocation is the molecular hallmark of chronic myeloid leukemia (CML). In the diagnosis and treatment of CML, peripheral blood or bone marrow samples are usually taken for analysis. However, both methods are invasive sample collection methods, thus a noninvasive saliva sample method for the detection of the fusion gene transcripts (BCR-ABL) was investigated in some Nigerians with CML. MATERIALS AND METHODS: Real-time (RT)-polymerase chain reaction (PCR) analysis was used to detect BCR-ABL1 fusion gene in the saliva and blood of 42 Nigerian CML patients. RNA was extracted using RNeasy kit and reverse transcribed by random hexamer priming using murine Moloney reverse transcriptase. BCR-ABL1 transcript types were first detected by multiplex PCR and then quantified by a duplex RT-PCR-TaqMan chemistry with MGB probe and Black Hole Quencher. RESULTS: Of the 42 subjects, transcript types were detected in 36 (85.7%) samples, e13a2 fusion transcript sub-type was detected in 9 (21.4%), whereas e14a2 subtype was found in 27 (67.3%); six (14.3%) of the samples did not reveal any of the fusion transcript subtypes. The median BCR-ABL1 messenger RNA values were 9.38 × 102 in saliva and 10.29 × 104 in blood (P < 0.05). Similarly, the median ABL1 value in saliva (3.11 × 103) was significantly lower (P < 0.01) than in blood (4.22 × 103). However, the median BCR-ABL1 ratio in saliva (14.5%) was not significantly different (P = 0.8) from that of blood (12.0%). CONCLUSION: Saliva may offer an alternative easy-to-collect, readily available, and noninvasive sample for the diagnosis and treatment of CML.

Influence of CYP3A5*3 and ABCB1 C3435T on clinical outcomes and trough plasma concentrations of imatinib in Nigerians with chronic myeloid leukaemia.

WHAT IS KNOWN AND OBJECTIVE: Imatinib mesylate is the first-line drug for the treatment of Philadelphia/bcr-abl positive chronic myeloid leukaemia (CML). It is known to be metabolized mostly by CYP3A4 and CYP3A5 isoforms while its efflux is mediated by the transporters ABCB1 and ABCG2. Genetic polymorphism of some of these enzymes and transporters have been linked with inter-individual variations in the pharmacokinetics of the drug. This study, therefore, investigated the influence of CYP3A5*3, ABCG2 421C>A and ABCB1 3435 C>T genetic polymorphism on the clinical outcome and steady-state trough plasma concentration (TPC) of imatinib in Nigerians with CML. METHODS: A total of 110 Nigerians with CML each of whom had been receiving a 400 mg daily dose of imatinib for at least 1 month were genotyped for CYP3A5*3, ABCG2 421C>A and ABCB1 3435 C>T. The TPC of all the patients were determined by a validated HPLC method and possible relationships between genotypes, age, clinical outcome, sex, TPC and ethnicity were analysed. RESULTS AND DISCUSSION: Subjects of TT genotype of ABCB1 C3435T had higher frequencies of complete haematological response (CHR), complete cytogenetic response (CCR) and major molecular response (MMR) but these were not statistically significant (P < 0·05). No genetic polymorphism in ABCG2 421C>A was observed. However, significant associations were observed between TPC and various genotypes in both CYP3A5*3 (P < 0·001) and ABCB1 C3435T (P < 0·001). The GG and TT genotypes in CYP3A5*3 and ABCB1 C3435T, respectively, were linked with higher TPC. WHAT IS NEW AND CONCLUSION: This is the first pharmacogenetics study of CML patients in the Nigerian population with ethnic differences in the distribution of ABCB1 C3435T. Genetic polymorphisms in CYP3A5*3 and ABCB1 C3435T are associated with TPC in CML patients in this population.

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.

Imatinib (Glivec) and gastrointestinal stromal tumours in Nigerians.

BACKGROUND: To assess the response and the impact on the overall survival (OS) on c-KIT-positive (CD117+) gastrointestinal stromal tumours (GISTs) patients treated with imatinib mesylate. METHODS: Between July 2003 and December 2012, consenting patients with advanced c-kit-positive GISTs were enrolled to receive imatinib mesylate therapy at a dose of 400mg - 800mg daily, supplied gratis by Novartis Pharma (Basel, Switzerland) under its GIPAP initiative. Disease severity was based on tumour site, size and mitotic index at diagnosis. Clinical features together with drug toxicity, haematological and biochemical parameters were monitored. Overall survival (OS) reviewed at 12 months intervals over 5 years was computed using Kaplan-Meier RESULTS: There were 27 patients in all (17 males and 10 females with a median age of 52 years (range 26 - 83). Twenty three patients, 15 males and 8 females that have been followed up for at least 6 months were evaluated, aged 26-83 years (median = 56). There were 17 (73.9%) gastric tumours and 6 extragastric including 3 cases of peritoneum and 1 each of small gut, colon and rectum. At diagnosis, 21 (91.3%) cases were high risk, and 1 each fell into the intermediate and low risks, respectively. Ten patients (43.4%) including 5 with metastases presented with unresectable lesions. Five patients (21.7%) had complete tumour resection, 5 (3 with metastases) had partial resections and 3 others with non-bulky, nonmetastatic diseases underwent no surgery. Imatinib was used as the primary therapy for all patients, except the 5 patients that underwent complete tumour resection. Nine (39.1%) patients were lost to disease progression with a median survival of 16.7 +/- 10.7 (+/- SE) (95% CI = 0-37.6) months. The overall survival at 2 years for all patients was 71.9%, which dropped to 65.9% at 4 years. CONCLUSIONS: Although a small number of GISTs, imatinib induced an extended remission in patients with advanced disease, most of whom would have been dead within a few months of diagnosis.

Risk factors and seroprevalence of hepatitis C virus antibody among blood donors in Lagos.

AIMS AND OBJECTIVES: This study was undertaken (i) to determine the seroprevalence of antibodies to Hepatitis C virus (anti -HCV) among blood donors (ii) to document the incidence of known risk factors for HCV infection among blood donors. PATIENTS AND METHODS: This is a cross sectional prospective study among apparently normal blood donors. Subjects were recruited from three different hospitals in Lagos metropolis. All recruited donors were evaluated for HCV infection- associated risk factors by questionnaire interviews. Sera samples from recruited donors were tested for anti-HCV using third generation Murex (Murex Biotech, South Africa) and fourth generation Dialab Enzyme Linked Immunosorbent Assay (ELISA) kits (Dialab. Austria). RESULTS: A total of three hundred and thirty four blood donors were screened, of which seven (2.1 %) were positive for anti-HCV. The blood donors comprised 15 (4.5 %) females and 319 (95.5 %) males. There was an association between anti-HCV positivity and history of multiple sex partners and previous sexually transmitted infections (X2-15.9; p < 0.05) Majority of blood donors were family replacement 317 (94.9 %) with anti-HCV prevalence of 2.2 % (7/317) while 5.1 % (17/334) were voluntary non remunerated with anti-HCV prevalence of 0% (p >0.05) CONCLUSION: Prevalence of anti-HCV among blood donors in Lagos (2.1%) is low as in most previous reports from Nigeria and some other parts of Africa.

An appraisal of kidney dysfunction and its risk factors in patients with sickle cell disease.

Sickle cell disease (SCD), a genetically inherited disease of blacks, often presents with disabling acute complications which can occasionally be fatal. Its renal manifestations are increasingly being recognized as affected patients now survive to middle and rarely old age. We set out to determine the magnitude of kidney dysfunction in our SCD patient population and evaluate its predictive factors. We reviewed the available case records of SCD patients managed in our hospital. Information on socio-demographic, clinical and laboratory data were retrieved and collated. A total of 374 (99.46%) were reviewed with complete data; the median age was 23 years (range 7-62), while median age at diagnosis of SCD was 4 years (range 0.25-31). 235 patients (68.2%) had no kidney disease while the remaining 139 (37.2%) had proteinuria, hematuria or reduced glomerular filtration rate (GFR) <60 ml/min. The age of patients was a significant predictor of kidney disease (p = 0.002) and correlated with the level of serum creatinine (r = 0.188, p < 0.001), GFR (r = 0.245, p < 0.0001) and the degree of proteinuria (r = 0.174, p = 0.006). Patients with kidney disease had a significantly higher number of crises/hospitalizations (p < 0.001). Seven patients died in all and 4 (57%) of them had end-stage renal disease. We concluded that kidney disease is a common complication of SCD and significantly contributes to mortality. The age of the patients, duration of SCD and frequency of crises/hospitalizations are strong predictors of development of kidney disease.

Relation between erythrocyte sedimentation rate, clinical and immune status in HIV-infected patients.

BACKGROUND: The objective of this study was to determine the clinical and immunologic implications of an elevated ESR in HIV-infected patients. METHOD: One hundred and four consecutive HAART naïve human immunodeficiency virus (HIV)-infected adult patients and fifty one controls were studied. Detailed history was taken and full physical examination was conducted. Erythrocyte sedimentation rate (ESR), CD4+ T lymphocyte count, and complete blood count were performed. RESULTS: The mean (+/- SD) of ESR in the patients was 84.5 +/- 36.8 mm/1st one hour and that for the controls was 20.4 +/- 17.6 mm/1st one hour. The patients' ESR was significantly higher than those of the controls (p < 0.0001). There was a significant difference between the mean ESR of symptomatic (87.6 +/- 37.0 mm/1st hr) and asymptomatic patients (61.0 +/- 26.1 mm/1st hr) (p = 0.018), and between asymptomatic patients (mean +/- SD = 61 +/- 26.1 mm/1st one hour) and controls (mean +/- SD = 20.4 +/- 17.6 mm/1st one hour) (p = 0.000).The mean (+/- SD) CD4+ lymphocytes count of the patients and controls were 155.4 +/- 90.6 cells/microL, and 655.7 +/- 17.6 cells/microL, respectively. The CD4+ cells count was significantly lower in the patients than in the controls (p < 0.0001). CONCLUSION: ESR may be useful in monitoring HIV/AIDS disease.

Polycythaemia vera in Nigeria.

BACKGROUND: There is a paucity of reports on polycythaemia vera (PV) in Nigeria. The aim of this review is to present the pattern of clinical presentation, method of diagnosis, therapeutic options and treatment outcome in the face of limited facilities. MATERIALS AND METHODS: Case notes of patients with confirmed diagnosis of PV managed at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria from 1997 to 2006, were reviewed for clinical and laboratory parameters. The relative proportion of PV to other cases of haematologic cancers seen within the same period was determined. RESULTS: Seven patients, 5 males and 2 females, aged 42-70 years (median, 53 years) were studied. All the patients were symptomatic at diagnosis with the majority presenting with headaches, visual disturbances, and tinnitus. Clinical signs include conjuctival suffusion in all the patients; splenomegaly, hepatomegaly and hypertension in 3 patients (42.8%). Pruritus was uncommon (14.3%). One patient (14.3%) presented with fatal cerebrovacscular accident on admission. The average follow up period was 39.9 months, and 2 patients (28.6%) were followed up for more than 7years. Therapy consisted mainly of regular phlebotomy and low dose aspirin for suppression of thromboxane synthesis and control of thrombocytosis and erythomelalgia. PV accounts for just 0.03% of all the haematologic cancers seen. CONCLUSION: PV has a low incidence in our population and affects significantly the middle age persons. The clinical presentation consisted of headaches, visual disturbance, hypertension, and organomegaly. Treatment outcome are not different from those previously reported. The need for life-long follow up must be emphasised to patients at diagnosis.

Relation between erythrocyte sedimentation rate, clinical and immune status in HIV-infected patients.

BACKGROUND: The objective of this study was to determine the clinical and immunologic implications of an elevated ESR in HIV-infected patients. METHOD: One hundred and four consecutive HAART naïve human immunodeficiency virus (HIV)-infected adult patients and fifty one controls were studied. Detailed history was taken and full physical examination was conducted. Erythrocyte sedimentation rate (ESR), CD4+ T lymphocyte count, and complete blood count were performed. RESULTS: The mean (+/- SD) of ESR in the patients was 84.5 +/- 36.8 mm/1st one hour and that for the controls was 20.4 +/- 17.6 mm/1st one hour. The patients' ESR was significantly higher than those of the controls (p < 0.0001). There was a significant difference between the mean ESR of symptomatic (87.6 +/- 37.0 mm/1st hr) and asymptomatic patients (61.0 +/- 26.1 mm/1st hr) (p = 0.018), and between asymptomatic patients (mean +/- SD = 61 +/- 26.1 mm/1st one hour) and controls (mean +/- SD= 20.4 +/- 17.6 mm/1st one hour) (p = 0.000).The mean (+/- SD) CD4+ lymphocytes count of the patients and controls were 155.4 +/- 90.6 cells/microL, and 655.7 +/- 17.6 cells/microL, respectively. The CD4+ cells count was significantly lower in the patients than in the controls (p < 0.0001). CONCLUSION: ESR may be useful in monitoring HIV/AIDS disease.

Selenium and aspirin in people living with HIV and AIDS in Nigeria.

OBJECTIVES: Aspirin and selenium have been shown in vitro and in vivo to inhibit HIV production through inhibition of the transcription factor, the nuclear factor kappa binding (NF-eB). The aim of this study was to examine the efficacy or otherwise of these drugs in people living with HIV and AIDS (PLWAS) in resource limited countries. PATIENTS AND METHODS: Consenting HAART-naive PLWAS with mean CD4 count of 256.8 +/- 67.6 cells/ul were recruited into the study. Pretherapy blood count, serum biochemistry, chest x-ray, urinary glucose and protein and microscopy and culture of both urine and stool were checked in all cases. Each patient was treated for six months and CD4 counts were repeated at the end of the study. Thirty two patients (23 (72%) females and nine (28%) males), aged 22-52 (median = 36) years were recruited. Twenty-three (72%) were randomised into selenium and aspirin (SAM) and nine (28%) into selenium (SM); multivitamin was added to each arm. RESULTS: Eighteen (56.2%) patients completed the study. Sixteen (88.9%) patients are already on HAART since the termination of the study; one absconded and one died of disease progression. Fourteen (43.8%) of the initial 32 patients dropped out (11 (78.6%) were lost to follow-up, two (14.3%) died and one (7.1%) opted for HAART before completing the study). The post-treatment CD4 count was 293.0 +/-102.2 cells/ml, compared to the pre-therapy mean of 256.8 +/- 67.6 cells/ul, an average rise of 36.2 cells/ul, the difference was not statistically significant (p = 0.059). The post-therapy mean weight was significantly higher than the pretherapy weight, 61.6+/-15.2 kg versus 60.0+/-14.3 kg (p = 0.015). CONCLUSION: The SAM/SM combination regimen improved the quality of life of PLWAS, however, a greater number of patients and a longer period of follow up, are necessary to arrive at a more meaningful conclusion.

Neurological complications of chronic myeloid leukaemia: any cure?

OBJECTIVE: To attempt to explain the non-reversal, contrary to the widely held view, of the neurological deficits complicating chronic myeloid leukaemia. METHOD: Using patients' case folders and haematological malignancy register all cases of chronic myeloid leukaemia seen in Jos University Teaching Hospital between July 1995 and June 2005 were retrospectively studied. All the available literature on the subject was also reviewed. RESULTS: Thirty-three cases of chronic myeloid leukaemia were seen within the study period. Five (15.15%) of them had one or more sensori-neural defects. Of the five, two (40%) patients presented with bilateral hearing impairment, each beginning with the left ear; one (20%) presented with left ear hearing loss; one (20%) came with severe left ear tinnitus; one (20%) presented with complete bilateral hearing and bilateral visual losses. Fundoscopy showed leukaemic deposits on the retina. Other causes of blindness and deafness, e.g. trauma and foreign body in the ear respectively, were excluded. CONCLUSION: While the complications due to hyperleucocytosis-induced stasis recover following the conventional treatment, those due to other pathogenetic mechanisms such as leukaemic deposits do not return to their pre-morbid states following disease control despite the use of the currently available treatment protocols. For future research, more still needs to be done to elicit other uncommon pathogenetic mechanisms underlying these complications with a view to finding specific treatment measures for worrisome chronic myeloid leukaemia-related sensori-neural deficits.

Challenges to Care and Medication Adherence of Patients With Chronic Myeloid Leukemia in a Resource Limited Setting: A Qualitative Study.

The factors related to care of patients with chronic myeloid leukemia (CML) often affects treatment outcome. We examined adherence to medication and other challenges to care in our patients on treatment of CML. This qualitative study involved in-depth interviews of 20 patients with CML receiving free imatinib (Glivec) from the Glivec International Patients' Assistance Program. Data collected were thematically analyzed. Findings revealed that despite free drug assistance, there was relative lack of awareness resulting in inappropriate health-seeking behavior. The challenges cut across situations such as poverty, fear of the sustenance of the compassionate drug program, and living far away from the clinic. Forgetfulness was reported as the cause of poor adherence in this study. Suggested solutions include increasing community awareness, ensuring sustainability of the program and establishing more treatment centers nationwide. Strategies such as reminders and patents' support will improve drug adherence among this cohort.

Ocular manifestations of Burkitt's lymphoma: experience in Ile-Ife south western Nigeria.

BACKGROUND: Burkitt's lymphoma is the most common childhood tumour in subSaharan Africa that typically affects the jaws and abdomen. Ocular involvement with blindness has been documented in some studies. OBJECTIVE: This was to evaluate the role of Burkitt's lymphoma (BL) as a cause of blindness in Nigerian children. METHODS: Cases of BL seen in the hospital between 1986 and 2003 were studied retrospectively. Some of the patients with orbital disease at presentation underwent ultrasonographic examination of the eyes. RESULTS: Forty-three (16.5%) of the 260 patients seen presented with orbital tumours; 29 (67.4 %) of the 43 patients had full ophthalmic examination. The patients studied comprised 22 males and 7 females with a M: F ratio of 3:1, and median(age range) of 7(3-15) years. Orbital tumours occurred concurrently with jaw masses on the same side in 19(65.5 %) of 29 patients; the eye diseases were unilateral in 23 (79.3%) and bilateral in six (20.7%) of the cases. Proptosis was the ocular presentation in 27(93%) of patients and it was associated with conjunctival injection in nine, chemosis in 11 and exposure keratopathy in five. Fourteen (48.3%) patients had associated blindness; 12 (85.7%) remained blind in the affected eye(s) and one regained vision to 6/36 after chemotherapy. The patients underwent Cyclophosphamide-Oncovin-Methotrexate (COM) regimen with intrathecal therapy. Eight (27.6%) patients had concomitant CNS disease; these included cases of 6th and 7th nerve palsies, one case of intra-cerebral extension of tumour and another case of total ophthalmoplegia. CONCLUSION: Burkitt's lymphoma is an important cause of childhood blindness in Nigeria and the orbital disease ismainly extra ocular.

AIDS-associated Kaposi's sarcoma in Northeastern Nigeria.

INTRODUCTION: Kaposi's sarcoma is an acquired immunodeficiency syndrome (AIDS)-defining illness, and with the size of the human immunodeficiency virus (HIV)/AIDS pandemic in sub-Saharan Africa, AIDS-related Kaposi's sarcoma (KS) are now being diagnosed more frequently, although the true incidence of HIV-associated KS is not known. The clinical presentations of AIDS-related KS varied markedly across the African continent. This article reports a series of unusual clinical presentations of the tumour in Northeastern Nigeria. METHODS: This is a prospective study carried out from September 2003 to August 2005, at the University of Maiduguri Teaching Hospital, Borno State, Northeastern Nigeria. RESULTS: 20 cases of histologically-confirmed KS were prospectively studied. There were 17 (85 percent) men and three (15 percent) women, giving a male to female ratio of 5.7:1. Their ages ranged from 21-45 (median 37) years. 18 (90 percent) of the patients were anaemic. Mean haematocrit value, CD4+ cell count and duration of symptoms for all the patients were 29.5 +/- 7.5 percent, 119.0 +/- 91.4 cells per microlitre and 3.5 +/-1.7 months, respectively. Multiple lesions were a common presentation affecting sites such as lower limbs, trunk, conjunctiva, upper limbs and rectum as well as penis, lymph node, scrotum and oropharynx. CONCLUSION: Contrary to other reports that KS is not associated with HIV infection, our study has demonstrated otherwise. This study also showed that both sexes are affected but with a male preponderance. KS is also a late presentation of the HIV/AIDS disease spectrum in our environment and has varied clinical manifestations. There is an urgent need to develop health education programmes to enhance the understanding of this disease and how it spreads, particularly among the young generation.

Peripheral blood and bone marrow changes in patients with acquired immunodeficiency syndrome.

There is dearth of information on the haematologic complications of HIV/AIDS in this country. The aim of this work was to evaluate the importance of peripheral blood and bone marrow changes in a population of adult Nigerians managed for symptomatic HIV infection at the OAUTHC, Ile-Ife, between 1995 and 2001. The study was prospective. Peripheral blood cells counts (haemetocrit value, total and differential leucocyte counts, and platelet counts) and bone marrow cytology of serologically confirmed HIV/AIDS patients seen within the study period were studied. The associated opportunistic disorder (s) was noted for each patient. Individuals with conditions that are ordinarily associated with haematologic disorders (e.g. cancer and inherited haemoglobinopathies) and patients diagnosed in pregnancy were not included. Significant levels of differences in mean values of blood cells within groups were determined by student's t-test. Seventy-two patients were recorded, out of which 49 (68%) were evaluable. There were 32 (65%) males and 17 (35%) females, all aged between 21 and 51 (median = 36) years. None of the patients had conventional antiretroviral therapy. Lymphopenia (lymphocytes < 2 x 10(9)/l) was seen in 64.4% of the patients, 50% and over 40% of the patients had moderate-severe anaemia and neutropenia, respectively. Blood cells values were not significantly different between patients with mild disease and those with moderate-severe diseases. The most characteristic marrow abnormality was the abundance of naked nuclei of megakarycytes in 20 (60.1%) of the patients. Dysplatic changes were evident in 15 (45.5%) of the bone marrow specimens studied. Such changes are characterised by dysgranulopoiesis, Pelger-Huet anomaly in some of the mature granulocytes, vacuolation of some erythroid and myeloid cells, unilobular micromegakaryocytes and megaloblastic erythroid precursors (15.1% of the marrow).

Determination of trace elements status of Nigerians with sickle cell anaemia using INAA and PIXE.

The clinical application of trace elements in the management of Sickle Cell Anaemia (SCA) has not become standard recommended practice despite decades of research. A major reason for this is the ambivalence in published results as to the relative importance of some of these elements in the disease. An attempt has been made in this work to correct some of the various factors that could contribute to such inconsistencies. Results from separate investigations carried out on Nigerian subjects by our group, using both INAA and PIXE methods have been holistically evaluated and compared. Trace and minor elements were determined in wholeblood, erythrocytes, plasma, headhair and nail obtained from SCA patients in steady state and compared with identical samples from normal controls. Twelve elements were determined in blood while 20 and 30 elements were analysed in nail and hair samples respectively from the total 225 subjects. The results indicate a general mild zinc deficiency, more serious for males, in Nigerian SCA patients. It is clear that the elements Na, K, Rb and Br play key roles in maintaining homeostasis in the steady-state SCA patients. Possible gender influence in the utilization of K, Br and Fe in SCA is also suggested.

Clinical and prognostic features of Nigerians with chronic myeloid leukemia.

AIMS AND OBJECTIVES: Chronic myeloid leukemia (CML). PATIENTS AND METHODS: CML patients confirmed at the OAUTHC, Ile-Ife between June 1986 and December 1999 were studied prospectively until death or the last visit to the clinic. Stages of the disease at diagnosis, presenting clinical features and laboratory parameters, as well as the drug history were noted for each patient. Survival of each patient was computed from the date of diagnosis until the date of death. Kaplan-Meier statistical technique was used for analysis of survival. Factors were compared with log rank test. Student's t-test was used for comparing means of presenting clinical and laboratory parameters between groups. P-value of <0.05 was considered significant. SPSS for windows Release 10 (Real Stats, Real Easy, 1989-1999) was used for all calculations. RESULTS AND CONCLUSION: There were 42 patients (27 males and 15 females, ratio of 1.8:1) with ages ranging from 12-74 (median=38.0) years. Philadelphia chromosome was positive in the five patients (12.0%) that underwent cytogenetic analysis. Thirty-three of the patients (78.6%) presented in treatable chronic phase and the other 9 (21.4%) were seen in advanced stages (7 in accelerated & 2 in blastic phase). The median survival of patients that presented in chronic phase was 31.7 months compared to 0.16 months in patients presenting in advanced stages, the difference was statistically significant (log rank=7.8, p-value=0.005). Significant positive correlation was obtained between spleen size and total white cell count at diagnosis (r=0.36, p=0.02). Univariate regression analysis showed negative relationship between survival and ages of patients at diagnosis, haematocrit value, spleen and liver sizes, and blast count. The relationships were statistically significant for only liver and spleen (b=-0.63, p=0.004 and b=-0.51, p=0.026, respectively). Regression of both the liver and spleen with survival, still confirms the significant negative relationship between hepatomegaly and survival.

Liver cirrhosis: Child-Pugh grading of cases seen in Nigeria.

Child-Pugh grading is an important determinant of treatment options, surgical interventions and prognosis in chronic liver disease. Sixty-four liver cirrhosis patients (49 men, 15 women) seen at Ile-Ife, Nigeria were graded according to the Child-Pugh parameters. Only one (1.6%) was in Class A, while 21 (32.8%) and 42 (65.6%) were in Classes B and C, respectively. Thirty-four either had coagulopathy or were already in encephalopathy at the time of presentation. Hepatitis B virus-associated disease was present in 64% of the patients. Most Nigerian cirrhosis patients present with very advanced disease; they are thus poor-risk candidates for diagnostic procedures and surgery. Efforts should be intensified at making the diagnosis at a much earlier stage and universal immunization with the hepatitis B vaccine should be commenced to reduce the incidence of HBV-related chronic liver disease in Nigeria.

Myelomatosis: clinical and laboratory features in Nigerians.

BACKGROUND: The objective was to investigate the factors influencing survival of Nigerians with Myelomatosis. MATERIALS AND METHODS: The pre-therapy clinical and laboratory features of patients managed at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, between June 1986 and May 2001 were studied. Diagnosis was based on history of bone pain, marrow plasmacytosis, osteolytic bone lesions, serum biochemical profile, monoclonal (M) band, and/or Bence-Jones proteinuria. RESULTS: Twenty-seven patients (22 males, 5 females) aged 15 to 81 (median, 60) years were managed within the study period. Of the 27, 5 (18.5%) were 40 years or younger while 14(51.8%) were 60 years or older. Multiple myeloma (MM) is the main sub-type seen (81.5%). Majority presented with bone pain, weakness, fatigue and inability to walk. Anaemia, high erythrocyte sedimentation rate and bone marrow plasmacytosis were the significant haematological findings. Serum protein electrophoresis showed M-band in 6 cases of MM, with 3 of them also having Bence-Jones proteinuria. Renal function impairment and hypercalcaemia occurred mainly in those with MM. Multiple osteolytic lesions and pathological fractures were recorded in 44% of those with MM and Solitary Myeloma of Bone. Twelve patients were already dead at the time of analysis, with renal failure being the cause in 8 and anaemia in the rest. The median survival was 1.2 months. CONCLUSIONS: We could conclude that the presenting features of Nigerian patients with myelomatosis are not different from reports elsewhere, but high default rate and short survival are particularly noted.