Common Causes of Neonatal Death in Calabar, South-South Nigeria: An Autopsy Study

Background: Neonatal deaths are deaths of live born babies occurring before 28 completed days. The vast majority occur in low-income countries like Nigeria with a high neonatal mortality rate. There is paucity of autopsy studies due to refusal of family to give consent for such procedures. Aim: To identify the commonest causes of neonatal death in 53 neonatal autopsies in Calabar, Nigeria. Materials and Methods: Detailed postmortem was carried out using lettules techniques and bits taken for histological analysis to ascertain the cause of death. Other relevant contributory factors such as the gestational age, mode of delivery, place of birth, antemortem cause of deaths and maternal obstetric history were obtained from the medical records and autopsy request forms. Results: In the one-year retrospective study of 53 neonatal autopsies, male: female ratio was 1: 0.83 and mean age at death was 6.5 + 7.3 days, ranging from 1 to 28 days. The commonest cause of neonatal death was severe birth asphyxia seen in 10 cases (18.9%), followed by kernicterus in 6 cases (11.3%), birth trauma seen in 6 cases (11.3%), congenital heart disease seen in 5 cases (9.4%), and prematurity seen in 5 cases (9.4%). Conclusion: The study confirms the usefulness of neonatal autopsy in ascertaining the definitive cause of death. Severe birth Asphyxia was identified as the commonest cause of death in the neonatal period followed by birth trauma, kernicterus and congenital heart diseases.

Successful use of rivaroxaban achieving therapeutic anti-factor xa levels in a morbidly obese patient with acute intermediate-high risk pulmonary embolism / Uso bem-sucedido de rivaroxabana com níveis terapêuticos de antifator xa em paciente com obesidade mórbida e embolia pulmonar aguda de risco intermediário-alto

Abstract Direct oral anticoagulants (DOACs) have become the standard of care for acute and long-term therapy for venous thromboembolism (VTE) due to their efficacy and safety profiles. The 2021 International Society on Thrombosis and Haemostasis guidelines recommend using standard DOAC dosages in patients with BMI >40 kg/m2 or weight >120 kg. Use of DOACs remains uncertain in morbidly obese patients with VTE, including acute PE. A morbidly obese woman in her 30s who presented with acute worsening of dyspnea was diagnosed with acute intermediate-high risk acute pulmonary embolism and concomitant proximal deep vein thrombosis, constituting a clinically challenging scenario for treating her with rivaroxaban. Standard doses of rivaroxaban for acute and extended phase treatment of venous thromboembolism in individuals with morbid obesity at BMI>70 kg/m2 may be effective, and safe.

Resumo Devido à sua eficácia e aos seus perfis de segurança, os anticoagulantes orais diretos (DOACs) tornaram-se o padrão de cuidado para a terapia aguda e de longo prazo de tromboembolismo venoso (TEV). As diretrizes da Sociedade Internacional de Trombose e Hemostasia de 2021 recomendam o uso de dosagens padrão de DOACs em pacientes com índice de massa corporal (IMC) > 40 kg/m2 ou peso > 120 kg. O uso de DOACs em pacientes com obesidade mórbida e TEV, incluindo embolia pulmonar aguda, ainda não foi esclarecido. Uma mulher com obesidade mórbida na faixa dos 30 anos que apresentou piora aguda da dispneia foi diagnosticada com embolia pulmonar aguda de risco intermediário-alto e trombose venosa profunda proximal concomitante, com o cenário clínico desafiador de tratá-la com rivaroxabana. Doses padrão de rivaroxabana para tratamento e recorrência de tromboembolismo venoso em indivíduos com obesidade mórbida e IMC > 70 kg/m2 podem ser eficazes e seguras.

Risk factors associated with COVID-19 morbidity and mortality at a national tertiary referral treatment centre in Ghana: a retrospective analysis

Introduction: there is a substantial variation in COVID-19 case fatality rates across different locations, which may be due to differences in population age structure, patient factors, or health system factors. The study evaluated the clinical features and risk of COVID-19 morbidity and mortality among confirmed cases at COVID-19 referral treatment centre. Methods: the study was a retrospective analysis of routine data of cases admitted and treated between March 2020 to March 2021 at Greater Accra Regional Hospital (Ridge Hospital). The data were analysed using descriptive statistics, simple and multiple logistic regression. Results: the overall mortality rate among this cohort of patients was 34.4%. Compared to survivors, non-survivors were older patients, non-insured, had a higher frequency of hypertension, diabetes, heart disease, and were more prone to suffer from a severe form of COVID-19 infection. Compared to survivors, non-survivors showed elevated levels of white blood cell count, platelets, higher heartbeat per minute and lower levels of haemoglobin, creatinine, and oxygen saturation. The independent risk factors for COVID-19 mortality in the national treatment centre were shorter stay of hospitalizations, having a heart disease, difficulty in breathing, increased in concentration of platelets, and creatinine. A 1% increase in oxygen saturation decreased a patient's likelihood of dying from COVID-19 by 29.0%. Conclusion: this study showed COVID-19 mortality was associated with a shorter stay in hospital, having heart disease, dyspnoea, elevated levels of platelets and creatinine, and decreased oxygen saturation. There is a need for awareness creation about these risk factors to clinicians and public health officials.

Demographics and Overall Survival Pattern of Chronic Myeloid Leukemia in a Tertiary Hospital in South-South Nigeria: The Calabar Experience

Background: Chronic myeloid leukemia (CML) is a bi- or triphasic disease comprising of the chronic phase (present at diagnosis in approximately 85% of patients) which can easily be controlled with conventional chemotherapy, followed by unstable accelerated phase and terminating in a blastic phase. The treatment of CML has evolved over the years The availability of the tyrosine kinase inhibitors has distinctly changed the disease course for patients with Ph+ and/or BCR-ABL1+ (CML). This study aims to determine the demographics and overall survival patterns of CML patients in the University of Calabar Teaching Hospital (UCTH)l. Methods: The study is a retrospective study of twenty-two (22) CML patients seen and managed at the UCTH from June 2014 to August 2021. Male/female distribution was 9/13, with a median age of 42 years. Overall survival (OS) and progression free survival (PFS) were determined using the Kaplan-Meier techniques. The data were analyzed using Microsoft Excel 2016 and IBM SPSS version 21. Results: Total of 22 CML patients were seen over the 8-year-period of review. The mean age was 42.63, median age 42, and modal age was 37 years respectively. There were 9 males and 13 females. 20 of the patients were in the chronic phase while 2 were in the terminating blastic phase. The presence of mutation was seen in two patients while the remaining 20 showed no mutation. Of the patients, 6 were dead and 16 are alive at the time of review. The overall survival period ranges from 12 to 84 months. The survival distributions for mutation and state of the disease (chronic or blastic) were not statistically significantly different, X2= 3.204, p = 0.073. Conclusion: There is inconsistency in the demographic and overall survival pattern of chronic myeloid leukaemia in our environment. Further study is needed to identify the factors which can help to improve the overall survival pattern in our environment

Critical Congenital Heart Disease Sadly Diagnosed at Autopsy in Calabar, South-South Nigeria

Congenital heart disease (CHD) is the most common type of birth defect causing more deaths in the first year of life than any other birth defect. Medical practice in a third-world country is faced with numerous challenges, created by poor health facilities and the unavailability of basic imaging studies at the community level where the majority of the poor resides. We present a case series of 4 neonates with a ratio of 1: 3 admitted into the neonatology unit of the University of Calabar Teaching Hospital, Calabar, Nigeria. Two of the patients were delivered at home by a traditional birth attendant via spontaneous vertex delivery and the rest two were booked cases in a private and obstetric unit of the University of Calabar Teaching Hospital. Their age ranged were 18 hours to 27 days of life and their common presentation were poor sucking, difficulty in breathing, central cyanosis and failure to thrive. A fetal echocardiogram was carried out for one of the cases and there was strong clinical suspicion of congenital heart disease but the precise type is unknown. The other three could not afford the necessary investigations required. They were all oxygen-dependent till death. Pathologic-anatomic findings showed a rare Critical congenital heart defect of the univentricular heart chamber of various types for the three cases and a case of TGA. The Immediate cause of death for all four cases was congestive cardiac failure.

Commonness and Risk Factors Associated with Gastrointestinal Parasitic Infections among Inmates of Port Harcourt Children’s Home

Background: Gastrointestinal parasites are important health problems among most societies. Objectives: Prevalence and risk factors associated with gastrointestinal parasites among inmates of Port Harcourt children home. Methods: This prospective study was carried out in August and September 2019 at the Port Harcourt children home. Fecal samples were collected from 63 healthy looking inmates and examined macroscopically and microscopically (using normal saline and iodine wet mount, formalin-ether sedimentation and modified Ziehl Neelsen staining) methods. Finally, data was analyzed using descriptive statistics and Chi-square (X2) test. Results: Result showed that 74.6% (47/63) of the female and 25.4% (16/63) of the male tested positive for GIPs. Age group 11-15 years had prevalence of 17(44.8%). The common parasites identified were A. lumbricoides 10(15.9%), T. trichiura 7(11.1%) and hookworm (Ancylostoma duodenale) 2(3.2%). The educational level prevalence of 10(52.6%) was observed among the primary level (p<0.05). The risk factors such as: the use of drug in the last three months, hand washing with soap after using the toilet and washing of hands after contact with soil had significance of p<0.05 while putting on foot wear outside the house p>0.05. Conclusion: The distribution of gastrointestinal parasitic infections is high among the children. Necessary treatment intervention safety measures should be routinely carried out to reduce the spread to zero tolerance.

Impact and future of telemedicine amidst the COVID-19 pandemic: a systematic review of the state-of-the-art in Latin America / Impacto e futuro da telemedicina em meio à pandemia de COVID-19: uma revisão sistemática do estado da arte na América Latina

Abstract Significant progress has been made in using information and communication technologies in medicine, by impacting the quality of health-care delivery system and patient care, and paving the way for ground-breaking tools for e-health and clinical decision-support systems. This study investigates the extent to which the evolution of telemedicine applications has been used to support patient care in Latin America (LATAM) amidst the pandemic. Theoretically, the study applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to identify the impact of telemedicine in the region. Practically, the paper provides a systematic mapping study of the different domain areas and methodological progress in Telemedicine that occurred during the pandemic, and applied a text mining technique to understand the intensities of the terms expressed by the analyzed studies. The results show that while telemedicine has not been extensively used, a greater percentage of the studies report that telemedicine was effective. Approximately 70% positive emotional valence score was found. The paper also provides an empirical discussion and recommendations for the next steps in ample adoption of telemedicine.

Resumo Foram feitos progressos significativos na utilização de tecnologias de informação e comunicação na medicina, com impacto no sistema de prestação de cuidados de saúde e nos cuidados aos doentes, e abrindo caminho a ferramentas inovadoras para sistemas eletrônicos de saúde e de apoio à decisão clínica. O presente estudo investiga até que ponto o crescimento das aplicações da telemedicina tem sido utilizado para apoiar os cuidados aos doentes na América Latina (LATAM) em meio da pandemia. Teoricamente, o estudo aplicou a metodologia Preferred Reporting Items for Systematic Reviews e Meta-Analyses (PRISMA) para identificar o impacto da telemedicina na região. Na prática, o artigo apresenta um estudo de mapeamento sistemático das diferentes áreas de domínio e progresso metodológico em telemedicina que ocorreram durante a pandemia, e aplicou uma técnica de text mining para compreender as intensidades dos termos expressos pelos pesquisas analisadss. Os resultados mostram que, embora a telemedicina não tenha sido amplamente utilizada, um maior percentual de estudos informa que a telemedicina foi eficaz. Foi encontrada uma pontuação de valência emocional positiva de aproximadamente 70%. O documento também traz uma discussão empírica para os próximos passos na adoção da telemedicina.

USERS SATISFACTION INDEX FOR SUSTAINABLE RECREATIONAL OPEN SPACES IN AKURE, NIGERIA.

Recreational open space is the outdoor open-air space involving green, grey, water and air spaces which can be used for active and/or passive recreation such as park, garden, public golf course and general open spaces. Recreational open space has been seen to be inadequate to cater for the rising demand of public recreation due to the increase in the population of people in Akure city. Many researches carried out on recreation and open spaces in the study area have indicated that abandonment, misuse, conversion, mismanagement, dilapidation, encroachment to mention a few are reasons for the inadequacies of these recreational open spaces. Amidst these challenges and threats to recreational open spaces, the study was set to look at the possible indicators for these demands in relation to the issues facing recreational open spaces. Consequently, a mix method approach involving administration of 379 questionnaires through stratified random sampling technique and case study of recreational open spaces in the study area was adopted. Hence, the study examined the factors influencing users’ satisfaction and sustainability of recreational open spaces in Akure as its aim. The study revealed the relationship between the management condition, satisfaction and benefit of the provision of recreational open spaces as an insight to a healthy city and development. Findings revealed that greater number of the study population visit frequently the available recreational open spaces and would want the recreation facilities to be properly managed especially to meet their satisfaction. The paper further recommends that local and state governments should provide more recreational open spaces with the consideration of users’ satisfaction for a healthy living.

Ethnic Variation and Its Association With Malaria Awareness: A Cross-sectional Study in East Nusa Tenggara Province, Indonesia / 예방의학회지

Objectives@#This study investigated associations between ethnicity and malaria awareness in East Nusa Tenggara Province (ENTP), Indonesia. @*Methods@#A community-based cross-sectional study was conducted upon 1503 adults recruited by multi-stage cluster random sampling. A malaria awareness questionnaire was used to collect data, according to which participants were classified as aware or unaware of malaria. Logistic regression was applied to quantify the strength of associations of factors with malaria awareness. @*Results@#The participation rate in this study was high (99.5%). The participants were distributed relatively evenly among the Manggarai, Atoni, and Sumba ethnicities (33.0, 32.3, and 30.2%, respectively). Malaria awareness was significantly different amongst these groups; it was most common in the Manggarai ethnicity (65.1%; 95% confidence interval [CI], 59.9 to 70.3) and least common in the Sumba ethnicity (35.0%; 95% CI, 27.6 to 42.4). The most prominent factor influencing the malaria awareness in the Sumba and Manggarai ethnicities was education level, whilst it was socioeconomic status (SES) in the Atoni ethnicity. The likelihood of malaria awareness was significantly higher in adults with an education level of diploma or above (adjusted odds ratio [aOR], 21.4; 95% CI, 3.59 to 127.7 for Manggarai; aOR, 6.94; 95% CI, 1.81 to 26.6 for Sumba). Malaria awareness was significantly more common amongst high-SES adults in the Atoni group (aOR, 24.48; 95% CI, 8.79 to 68.21). @*Conclusions@#Low education levels and low SES were prominent contributors to lower levels of malaria awareness in rural ENTP. Interventions should focus on improving malaria awareness to these groups to support the Indonesian government’s national commitment to achieve a malaria elimination zone by 2030.

Coping with COVID-19 pandemic in blood transfusion services in West Africa: the need to restrategize

ABSTRACT Introduction The West African region has been lagging in terms of the availability of, and accessibility to, safe blood. According to the 2016 World Health Organization (WHO) Global Status Report on Blood Safety and Availability, none of the West African countries met the WHO benchmark of 10 blood units per 1000 inhabitants. This study is aimed at discussing the blood transfusion status of West African countries in the pre-COVID-19 period and analyze the capacity to respond to the COVID-19 blood crisis, as well as to outline the panacea. Methods Secondary data were extracted from published reports, journal articles and web pages, reviewed and analyzed. Result All the West African countries have recorded confirmed COVID-19 cases and deaths. The confirmed cases have reached 55,697, with 1069 deaths and a fatality rate of 1.9%, as of June 17, 2020. The assessed countries lagged in most of the WHO benchmarks for effective blood transfusion services. Conclusion Blood transfusion services in the West African region lacked the basic benchmark practice and policy, are not coordinated and may find it hard to tackle the blood transfusion crisis created by the COVID-19 pandemic.

Evaluation of Some Cytokines, CD4, Hepcidin, Iron Profile and Some Haematological Parameters of Pulmonary Tuberculosis Patients Coinfected with HIV in Southeast of Nigeria

The study was done to determine the levels of interferon-gamma, interleukin 6, interleukin 10, iron status, hepcidin and haematologicalparameters of patients with pulmonary tuberculosis co-infected with human immunodeficiency virus in Southeast, Nigeria. This study was carried out at the directly observed treatment-short course Tuberculosis (TB DOTS) centre of Federal Medical Centre, Umuahia, located in South-Eastern Nigeria. Therefore, sample size of 240 was used to give room for attrition. A total of two hundred and forty (240) subjects aged 18-60 years were enlisted for this study. Seven milliliters (7ml) of venous blood was collected from each subject and 2.5ml was dispensed into bottles containing di-potassium salt of ethylenediamine tetra-acetic acid (K2-EDTA) and was used for full blood count, CD4 count and HIV screening. Also, 4.5ml was dispensed into plain tubes. Serum was obtained after clotting by spinning at 3000 RPM for 10 minutes and was used for interferon gamma, interleukin-6, and interleukin-10, iron and hepcidin determination. Data was analysed using statistical package for social science (SPSS) version 20. Student t-test, ANOVA (Analysis of Variance), Pearson Product Moment and Chi-Square were the tools employed. Results were expressed as mean ± standard deviation and are presented in table and significance level was set at P<0.05.The results showed difference that was statistically significant (P<0.05) in IFN-γ (P=0.000), IL-6 (P=0.000) IL-10 (P=0.000), CD4 (P=0.000), hepcidin (P=0.000), Iron (P=0.000), TIBC (P=0.000), %TSA (P=0.001) ,WBC (P=0.000), Neutrophils (P=0.000), Lymphocyes (P=0.000), Monocytes (P=0.000), Eosinophils (P=0.000), Basophils (P=0.018), RBC (P=0.000), haemoglobin (P=0.000), PCV (P=0.000), MCV (P=0.000), MCH (P=0.000), MCHC (P=0.000), Platelets (P=0.000), ESR (P=0.000) when compared among control, TB, HIV and TB-HIV subjects respectively. The co infection of HIV on pulmonary TB patients increases the levels of the cytokines. The cytokines and hepcidin can be used as adjunct to prognostic and diagnostic markers as their levels decreased with increased duration of treatment of the patients. The study hasshown wide variations in the haemtological indices studied

Biochemical and liver histological changes in rats exposed to sub-lethal dose of Uproot-pesticide and the protective potentials of nutritional supplements

This study determined the therapeutic potentials of vitamin C, glutathione, and garlic on the hepatic andhistological changes induced by uproot-pesticide on albino Wistar rats. All animal groups (except normalcontrol) received intraperitoneally 50 mg/kg body weight of uproot-pesticide (a commercially formulatedglyphosate-based herbicide) on alternate days and daily oral administration (except Uproot control) of 20 mg/kg body weight of glutathione, vitamin C, and garlic as nutritional supplements singly and in combination for28 days. Liver function and oxidative stress parameters of the liver were determined using blood and liversamples. Histological studies were done on the liver tissue. The values obtained showed significant variationof measured parameters in Uproot control compared to groups administered nutritional supplements and thecontrol. These variations indicated oxidative liver damage and significant therapeutic potential of the nutritionalsupplements. Other observed significant and non-significant changes were discussed.

Pregnancy Malaria: Predisposing Factors, Burden and Management in Agrarian Settlements Southeast Nigeria

Aim:To evaluate predisposing factors, burden and management of malaria amongst pregnant women in some agrariansettlements southeast Nigeria.Study Design:Cross-sectional survey conducted in 4 randomly selected agrarian communities was conducted Place and Duration of Study:Isi-Uzo Local Government Area (Eha-Amufu, Ikem, Mbu, Neke and Umualor). The study lasted six months.Methodology: A total of 385 respondents participated. A cross-sectional survey was conducted in 4 randomly selected agrarian communities was conducted. Data were collected using a structured questionnaire.Results: Obstetric and socio-demographic characteristics of the participants showed that majority were age-bracket 25-34 (42.6%), 1sttrimester (56.4%) and multigravidae (52.8%), primary education group (32.2%), secondary education group (55.6%), farmers (73.1%) and Christians (93.5%). All the respondents (100%) agreed to the presence of overgrown bushes in their environs, many farming activities which is the main source of income and staying out late at night for relaxation. A high percentage of the women experienced fever (57.9), headache (61.6), cough & catarrh (54.5) and anorexia (53.8) monthly reflecting high malaria frequency in the locale. 20.3% had experienced stillbirth, 82.6% neonatal death and 65.5% infant mortality once, twice or more. And according to (58.7%) and (38.7%) of respondents, malaria moderately and highly affects their productivity during pregnancy respectively. Respondents that seek health/treatment in hospitals (50.9) differ insignificantly from those that seek health through traditional remedies (49.1). Cost of treatment was reported to be high and moderate by 31.9% and 65.5% respondents respectively. Poor healthcare delivery was implicated as major dissatisfaction with treatment by 76.4% of respondents.Conclusion:Malaria is a major health problem encountered by pregnant women in agrarian locales. Hence, girls should be exposed to malaria awareness programs an earlier stage of life

Relevance of Established Risk Factors for Carcinoma Breast in Indian Women.

Breast cancer is the most common cancer in women of India and across the globe. More than 2.1 million women were diagnosed to have breast cancer in 2018 worldwide. An incremental trend in incidence and mortality has been observed in South-Asian, low to middle income, developing countries. Age adjusted incidence in India is 25.8 per 100,000 women in India. The established risk factors for causation of carcinoma breast have been deduced primarily from Western studies and their applicability to Indian women remains varied. We wanted to evaluate the relevance of the established risk factors for carcinoma breast in patients presenting to our institute. METHODSThis case-control study included 65 patients with histologically confirmed diagnosis of carcinoma breast in the test group and 65 healthy women in the control group. All enrolled women were made to fill a questionnaire to assess for presence or absence of established risk factors in them. Results were obtained by calculating percentage of women with these risk factors in both arms. RESULTSAmong the established factors for carcinoma breast, 18.4% patients in the test group were obese compared to 12.3% women in the control group. This difference was found to be statistically significant with a p value of <0.02. However, there was no significant relevance between the two compared groups with respect to other risk factors studied. CONCLUSIONSWhile the established risk factors for carcinoma breast have been found to be relevant in multiple national and international studies, their applicability to specific populations such as those catered to by our institution varied. Out of all the established risk factors for carcinoma breast in the western population, the present study suggested significance only for obesity, with a BMI of ≥30 Kg/m2

Prevalence of hypoxaemia and its associated factors in children with pneumonia seen at a tertiary hospital in Southeast Nigeria

Background: Hypoxaemia is a common complication and a significant predictor of death from pneumonia in children under five years of age. Knowledge of the prevalence of hypoxaemia and clinical signs associated with it may guide use of oxygen in the management of childhood pneumonia in resource-poor settings. This study was carried out to determine the prevalence of hypoxaemia in children with pneumonia and assess the relation between hypoxaemia and age, duration of illness and clinical signs.Methods: This was a descriptive cross-sectional study undertaken between 1st July 2016 and 27th April 2017. Children with pneumonia, aged 2-59 months, who attended Federal Medical Centre, Owerri and met the inclusion criteria, were recruited into the study. Subject evaluation included history and physical examination. Their blood oxygen saturation was determined by pulse oximetry and value less than 90% indicated hypoxaemia.Results: Out of the 144 children with pneumonia, 93(64.6%) were males and 51(35.4%) females giving a male to female ratio of 1.8:1. Median age was 8 months and mean weight (SD) was 8.6 kg (3.6). The overall prevalence of hypoxaemia was 17.4%. Hypoxaemia prevalence was significantly higher in infants (p=0.026) and severe pneumonia (p<0.0001). There was statistically significant association between hypoxaemia and lower chest in-drawing, nasal flaring, suprasternal recession, grunting, lethargy, tachypnoea and tachycardia. With adjustment for confounding variables, only lower chest in-drawing (OR: 9.672; p=0.004), lethargy (OR: 8.103; p=0.020) and grunting (OR: 4.960; p=0.050) predicted hypoxaemia in pneumonia. Each of these signs had a poor combination of sensitivity and specificity.Conclusions: Hypoxaemia is common in childhood pneumonia. Though some clinical signs are significantly associated with hypoxaemia in childhood pneumonia, they may be unreliable in predicting hypoxaemia. Therefore, pulse oximeters should be provided in every health facility for accurate detection of hypoxaemia.

Antidiabetic effect of Chrysophyllum albidum is mediated by enzyme inhibition and enhancement of glucose uptake via 3T3-L1 adipocytes and C2C12 myotubes

Objective: To investigate the in vivo and in vitro antidiabetic potential of Chrysophyllum albidum. Methods: The effects of oral treatment with hydro-ethanolic extract (125, 250 and 500 mg/kg) of the stem bark of Chrysophyllum albidum and glibenclamide for 21 d on glucose level, serum enzyme markers for liver function, lipid profile, total protein, serum urea, serum creatinine, and body weight were evaluated in experimental diabetic rats administered with 45 mg/kg of streptozotocin. In vitro assays including glucose uptake in C2C12 cells and 3T3-L1 adipose tissues, α-glucosidase and α-amylase inhibition were employed to evaluate the possible mechanism of hypoglycemic action of the extract. DPPH and nitric oxide radical antioxidant activity of the extract was also measured. Results: The increased levels of blood glucose, triglycerides, low-density lipoprotein, total cholesterol, serum aspartate, and alanine transaminases, creatinine, and urea in the diabetic animals were reduced significantly (P<0.01) after treatment with Chrysophyllum albidum extract. The decreased total protein and high-density lipoprotein concentrations were normalized after treatment. In addition, the extract significantly (P<0.01) increased the transport of glucose in 3T3-L1 cells and C2C12 myotubes and exhibited considerable potential to inhibit α-amylase and α-glucosidase. It also demonstrated potent antioxidant action by scavenging considerably DPPH and nitric oxide radicals. Conclusions: Chrysophyllum albidum stem bark extract exhibits considerable antidiabetic effect by stimulating glucose uptake and utilization in C2C12 myotubes and 3T3-L1 adipocytes as well as inhibiting the activities of α-amylase and α-glucosidase.

Nephrotoxicological Effect of Water Soluble Fraction of Bonny Light Crude Oil in Wistar Albino Rats

This study evaluated the Nephrotoxic effect of water soluble fraction (WSF) of Bonny Light Crude Oil (BLCO). After preparation of the WSFand a range finding test, the Wistaralbino rats were administered three concentrations (25%, 50% and 100%) of WSF of BLCO for 30 and 60days. Data from the study showed that Urea concentration increased significantly (p≤0.05) with increasing dose of BLCO ranging from 14.71mg/dl in the control to 35.28mg/dl in the 100% group after 30days and 14.28mg/dl in the control to 41.08mg/dl in the 100% group after 60days, Creatinine concentration increased significantly (p≤0.05) from 0.22mg/dl in the control to 0.82mg/dl in the 100% group after 60 days administration while electrolyte (Na, K, Cl) concentration increased significantly (p≤0.05) with increasing dose of BLCO after 60days administration. Histopathological examination of the kidney was characterized by partial partitioning of the glomerular tufts, obliteration of the Bowman’s capsule and distortion of the renal tubules. The findings in this research suggest that WSF of BLCO induced nephrotoxicity.

Prevalence of Sickle Cell Disease and Other Haemoglobin Variants in Calabar, Cross River State, Nigeria

Background: Sickle cell disease (SCD) is the commonest genetic disorder worldwide with a global prevalence of 20-25 million. About 12-15 million affected persons are in Sub-Sahara Africa with Nigeria bearing the highest burden of people living with sickle cell disease. SCD is a disease characterized as an autosomal, recessive, heterogeneous, and a monogenetic disorder caused by an A-to-T point mutation in the β-globin gene responsible for the production of abnormal hemoglobin S (HbS), which polymerizes in the deoxygenated state and results in the sickling of erythrocytes. Haemoglobin variants are mutant forms of haemoglobin in a population usually occurring as a result of genetic changes in specific genes, or globins that causes change on alterations in the amino acid. They could affect the structure, behavior, the production rate and the stability of the specific gene. Well-known haemoglobin variants such as sick-cell anaemia are responsible for diseases and are considered haemoglobinopathies. Other variants cause no detectable pathology and are thus considered as non-pathological variants. Aim: The study is aimed at evaluating the burden of sickle cell disease and other haemoglobin variants in Calabar, South-South Nigeria. Methods: This is a retrospective study done at the haematology laboratory of University of Calabar Teaching Hospital, Calabar. Cellulose acetate electrophoresis at alkaline pH was used for the evaluation of haemoglobinopathies. The data were entered into Microsoft Excel 2016 spreadsheet and analysed with the IBM SPSS Version 22. Data were summarized into percentage of different phenotypes. Results: Results of the total 3648 haemoglobin electrophoresis recorded, 1368 (37.50%) were male while the remaining 2280 (62.5%) females given a male to female ratio of 1:1.7. Five haemoglobin phenotypes were identified as HbAA, HbAS, HbAC, HbSC and HbSS. The overall average values of their prevalence were HbAA 64.78%, HbAS 32.62%, HbSS 2.14%, HbAC 0.33%, HbSC 0.14%. Thus, the prevalence of SCD (Prevalence of HbSS+HbSC) was 2.28%. The highest proportion of SCD was observed in 2011 with least in 2016 and 2017 respectively. Conclusion: The prevalence of SCD and other haemoglobin variants in Calabar is similar to that of the national prevalence rate. There is need for continuous enlightenment and premarital counselling on the pattern of inheritance of SCD most especially with the increased burden of sickle traits in the environment has reported in this study.

Diabetes Mellitus in adult Nigerians: patients’ characteristics, laboratory profile, practices and management outcome

Background: Type 2 diabetes constitutes more than 90% of cases seen in Nigeria. Previous reports had shown that patients were poorly controlled and failed to meet management target across a broad range of parameters. Objectives of this study evaluated the characteristics and practices of patients attending the outpatient diabetes clinic. The study also examined to what extent they achieved management goals and what practices by the patients impacted negatively on treatment outcome.Methods: This was a cross sectional descriptive study. All patients were eligible. Consecutive patients attending the Diabetes Clinic were evaluated. Their demographic, behavioural, social, clinical and laboratory data were obtained. Data analysis was done with SPSS V 21.Results: There were 193 subjects, 78 males and 115 females aged 35-82(59.8± 9.1) years.  T2DM was diagnosed in 93.4%.  Hypertension was coexistent in 74%. Present or past foot ulcer was recorded in 11.9%. Only 37% of the subjects had an exercise program, 35% did the daily foot exam, and 45% had ophthalmology consult. Skipping medication was widespread (64%), mainly due to self-titration of medications (44%) and cost (23%). Fear of hypoglycemia (83%) and hypotension (79%) was prevalent. Their body mass index was 18.2-41.2(27.6±4.8) kg/m2. Subjects were prescribed a total of 2-14 medications (5.5±1.6). Metformin was the most commonly used glucose lowering medication (88.6%), followed by sulfonylureas (64%) and insulin (27.5%). HbA1c ranged from 5.3-16; 9.0±2.4%(33-151; 75±2.7 mmol/mol).Conclusion: Glycaemic control was poor in the study population. Intermittent medication to avoid hypoglycemia played a major role. The patients lacked competence to manage their diabetes from day to day. Diabetes Self-Management Education and Support (DSMES) and early use of insulin are recommended.

Antilithiatic effect of crinum giganteum andrews bulb extract on ethylene glycol-induced nephrolithiatic rat model

Ethylene-glycol (EG) induced nephrolithiasis is a known model of kidney stone in experimental rodents.Nephrolithiasis is treatable with an antilithiatic and lithotriptic drug. Decoction of Crinum giganteum Andrews(CG) bulb, a medicinal herb is used in folklore medicine to manage urinary tract diseases including kidney stone.The antilithiatic effects of Crinum giganteum Andrews bulb extract was investigated using biochemical andhistological parameters on ethylene-glycol nephrolithiatic rat model and compared with cystone (a knownantilithiatic drug). Twenty rats were randomized into a control group (N=4) which received water (vehicle) andexperimental groups (N-16) that received 1% ethylene-glycol in water and subdivided into negative control (only1% EG in drinking water) and treatment groups which were given 200mg/kg/bw, 400mg/kg/bw of ethanolic bulbextracts of CG and 100mg/kg/bw of cystone orally for 21 days. The EG elevated urinary and serum calcium,protein and creatinine, and reduced magnesium concentrations. These were accompanied by microcrystal depositsin kidney sections. But, the ethanolic bulb extract and cystone treatments reversed the above biochemical andhistopathological effects. The ethanolic bulb extract of CG exhibited comparable antilithiatic effect with cystoneon ethylene-glycol-induced nephrolithiasis. Thus, the extract showed positive indication of its use in folkloremedicine.