Frequency of Complete Remission With R-CHOP Therapy in Patients With Diffuse Large B Cell Lymphoma.

Background Diffuse large B-cell lymphoma (DLBCL) exhibits notable heterogeneity in clinical presentations and treatment responses, posing challenges in predicting outcomes and tailoring therapeutic strategies for affected patients. Despite advancements in molecular subtyping and prognostic assessment, uncertainties persist regarding the optimal management of DLBCL, highlighting the need for localized investigations to better understand treatment responses and outcomes within specific patient populations. Objective To assess the frequency of complete remission (CR) in diffuse large B-cell lymphoma (DLBCL) patients undergoing first-line rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) therapy within a specific adult population. Material and methods This descriptive study was conducted within the Department of Oncology Hayatabad Medical Complex, Peshawar, Pakistan from August 8, 2022, to April 8, 2023. The study included newly diagnosed DLBCL patients aged 20-70 years, excluding those who had received prior treatment. There were 55 (57.9%) males and 40 (42.1%) females. Data on demographic characteristics, disease duration, and CR outcomes were collected using a predefined data collection form. Results The majority of patients (80, 84.2%) achieved CR following R-CHOP therapy. In terms of age distribution, 43 (45.3%) patients were aged ≤45 years, while the remaining belonged to the >45 years age group. The duration of the disease was ≤ 3 months in 60 (63.2%) cases, whereas it exceeded three months in 35 (36.8%) cases. With regards to BMI classification, nine (9.5%) patients had a BMI < 18.5 kg/m2, 49 (51.6%) fell within the range of 18.5-24.9 kg/m2, and the remaining 37 (38.9%) patients had a BMI between 25-30 kg/m2. Conclusion Diffuse large B-cell lymphoma (DLBCL) remains a heterogeneous disease entity with variable clinical outcomes. While R-CHOP therapy demonstrates promising efficacy in achieving CR, concerns regarding late adverse effects persist. Addressing these challenges requires continued research efforts to validate novel prognostic markers and develop alternative treatment approaches, ultimately improving patient outcomes and reducing the global burden of DLBCL.

The TB Surge intervention: an optimized approach to TB case-finding in Nigeria.

INTRODUCTION: TB remains one of the leading causes of death in Nigeria, and despite progress in treatment coverage, a 56% gap in national case notifications remains. This gap is attributable in part to underdiagnosis due to missed cases in health facilities. The TB Surge intervention presented an opportunity to address barriers to optimal case detection in public health facilities. METHODS: KNCV Nigeria implemented the TB Surge intervention under the USAID-funded TB-LON Project in 1,041 public facilities from June 2020 to September 2022. Trained ad-hoc staff screened hospital attendees, linked identified presumptive TB cases to diagnosis and confirmed TB cases to treatment. Data were reported using the Commcare application. Robust project monitoring was used to address gaps. RESULTS: Of a total of 12,195,874 hospital attendees screened for TB, 729,369 identified as presumptive TB were tested and 65,029 TB cases were diagnosed; 8% of the TB cases were children. Overall TB yield was 9%. Medical ward service delivery point had the highest TB yield of 21%. The number needed to test was 11 and the number needed to screen was 188. CONCLUSION: The TB Surge intervention was of strategic importance in addressing missed cases and barriers to prompt TB diagnosis in health facilities.

INTRODUCTION: La TB reste l'une des principales causes de décès au Nigeria et, malgré les progrès réalisés en matière de couverture thérapeutique, il subsiste un écart de 56% dans la déclaration des cas à l'échelon national. Cet écart s'explique en partie par le sous-diagnostic dû aux cas manqués dans les centres de santé. L'intervention TB Surge a permis de lever les obstacles à la détection optimale des cas dans les centres de santé publique. MÉTHODES: KNCV Nigeria a mis en œuvre l'intervention TB Surge dans le cadre du projet TB-LON financé par l'USAID dans 1 041 centres publics de juin 2020 à septembre 2022. Le personnel ad hoc formé a dépisté les personnes présentes à l'hôpital, lié les cas de TB présomptifs identifiés au diagnostic et les cas de TB confirmés au traitement. Les données ont été communiquées à l'aide de l'application Commcare. Un suivi rigoureux du projet a permis de combler les lacunes. RÉSULTATS: Sur un total de 12 195 874 patients hospitalisés ayant fait l'objet d'un dépistage de la TB, 729 369 cas présumés de TB ont été testés et 65 029 cas de TB ont été diagnostiqués ; 8% des cas de TB étaient des enfants. Le rendement global de la TB était de 9%. Le point de prestation de services du service médical a enregistré le taux de TB le plus élevé (21%). Le nombre de tests nécessaires était de 11 et le nombre de dépistages nécessaires de 188. CONCLUSION: L'intervention TB Surge a été d'une importance stratégique pour traiter les cas non détectés et les entraves à un diagnostic rapide de la TB dans les centres de santé.

Blood pressure pattern and the relationship with body mass index among apparently healthy secondaryschool students in Sokoto metropolis, Nigeria

Background. Childhood obesity may result in the premature onset of cardiovascular risk factors, particularly hypertension, hence the need for proper screening. However, blood pressure (BP) is measured only once in most studies in Nigeria, probably because of difficulties in returning to the study areas for repeat measurement.Objective. To determine the BP pattern and assess its relationship with body mass index (BMI) in apparently healthy secondary-school students aged 10 - 18 years in Sokoto metropolis, Nigeria.Methods. This study was descriptive and cross-sectional, and carried out between 13 October 2014 and 30 January 2015. In total, 800students from 6 schools were selected through multistage sampling. BP was measured on three separate days according to the National High Blood Pressure Education Program charts. BMI was categorised according to the Centers for Disease Control charts. The relationship of BP level with BMI was determined.Results. There were 424 (53.0%) males and 376 (47.0%) females, with a ratio of approximately 1:1. BP increased with age. The mean systolic and diastolic BP was significantly higher in females than males (systolic 113.1 mmHg v. 110.5 mmHg, and diastolic 69.0 mmHg v. 66.5 mmHg, respectively; p=0.01). Females had a higher mean BMI than males (18.7 kg/m2 v. 17.9 kg/m2, respectively; p<0.01). BP increased as the BMI percentile increased (p<0.001). The prevalence rates of hypertension were 6.1%, 3.5% and 3.1% at the first, second and third screenings, respectively, while the corresponding prevalence rates of prehypertension were 14.3%, 8.4% and 7.1%. The prevalence of obesity and overweight was 0.3% and 5.9%, respectively.Conclusion. The prevalence rate of prehypertension and hypertension reduced with subsequent measurements, and the prevalence rates of overweight and obesity were low. However, higher BP levels were associated with higher BMI, supporting its predictive significance for elevated BP

Pattern of acquired heart diseases among children seen in Sokoto, North­Western Nigeria.

BACKGROUND: Acquired heart diseases (AHDs) are serious but largely preventable diseases. They are highly prevalent in developing countries where poverty, illiteracy, and poor socioeconomic conditions still pose a significant challenge. The prevalence and pattern of AHD among children have not been previously documented within the study area. OBJECTIVES: To determine the pattern and outcome of AHDs among children in Sokoto, North-Western Nigeria. SUBJECTS AND METHODS: A prospective study conducted at the Pediatric Department of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria from 1st July 2009 to 30th June 2014. Data from all the subjects with AHD were analyzed using Statistical Package for Social Sciences. RESULTS: Of the 3810 children, 110 (2.9%) children were diagnosed with AHD over the study period. The mean age of the subjects was 10.4±3.4 years with M: Fratio of 1.2:1. Rheumatic heart disease (RHD) was the most common AHD seen in 47 (42.7%) patients, followed by dilated cardiomyopathy/myocarditis in 36 (32.7%) and pericardial effusion in 12 (10.9%) patients. Endomyocardial fibrosis was seen in 7 (6.4%) patients while infective endocarditis and Kawasaki disease occurred in 6 (5.5%) and 2 (1.8%) patients respectively. Mortality rate was 17.3%. Commonly observed co-morbidities included heart failure, bronchopneumonia, and pulmonary hypertension. CONCLUSION: The pattern of AHD is similar to other studies in developing countries, with RHD being the most prevalent. There is a need for increased emphasis on primary prevention to reduce the burden of these diseases in the study area.

Profile and outcome of congenital heart diseases in children: a preliminary experience from a tertiary center in sokoto, north Western Nigeria.

AIMS AND OBJECTIVES: Congenital heart diseases (CHDs) contribute significantly to childhood morbidity and mortality in many developing countries, largely due to late recognition and lack of skill and facilities for definitive intervention. Though data is available from other parts of the country, little is known about the pattern of CHD in the study area. The profile and outcome of CHD among children presenting to Pediatric Department of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, North Western Nigeria is described. MATERIALS AND METHODS: A prospective study was conducted between 1st September 2011 and 31st August 2013. Study subjects included all children who presented to our hospital and had clinical and confirmed echocardiographic diagnosis of CHD. RESULTS: A total of 112 children were diagnosed with CHD during the 2-year study period. Male: Female ratio was 1:1.2, with a median age at presentation of 11months. Ventricular septal defect (VSD), atrial septal defect (ASD), patent ducuts arteriosus (PDA) and tetralogy of Fallot (TOF) were the most common lesions seen in 48(42.9%), 21 (18.8%), 13 (11.6%) and 11 (9.8%) patients respectively. Five (4.5%) patients had transposition of the great arteries while three (2.7%) had complete atrioventricular septal defect. Less frequent lesions included truncus arteriosus, total anomalous pulmonary venous return, isolated pulmonary stenosis, tricuspid atresia, single atrium, Ebstein anomaly, bicuspid aortic valve and cor triatriatum sinister. Definitive treatment was possible in only 12 (9.8%) patients whereas 15.3% of the patients who had no intervention died. CONCLUSION: The spectrum of CHD in our series is similar to reports from other centers in Nigeria. Only a few patients could afford definitive treatment abroad, highlighting the need for urgent establishment of well-equipped and functioning cardiac centers across the country.

Outcome and complications of permanent hemodialysis vascular access in Nigerians: a single centre experience.

BACKGROUND: It is widely accepted that autogenous arteriovenous fistula (AVF) carries less morbidity and mortality compared to all other forms of vascular accesses in maintenance hemodialysis patients. There is paucity of data on vascular access from sub-Saharan Africa. The aim of this study was to assess the outcome and complications of permanent vascular access in our center. MATERIALS AND METHODS: The study is a prospective, hospital-based, longitudinal study. All consecutive patients on maintenance hemodialysis in Aminu Kano Teaching Hospital who were referred to the surgical unit of for creation of permanent hemodialysis vascular access were included in the study. The patient's clinical and demographic data were documented. Data about vascular access types, outcomes, and complications were obtained over a 1-year period from the time of vascular access creation. RESULTS: One hundred and seventy four patients were operated upon between January 2008 and December 2010 with a mean age of 46.4 years (range 18-76 years) and a male to female ratio of 1.5:1. Brescio--Cimino fistula was performed in 110 (63.2%) patients, brachiocephalic (Kauffmann) fistula in 51(29.3%), and synthetic graft in 1 (0.6%) patients respectively. Ten patients (5.7%) had brachio-brachial transposition arteriovenous fistula and 2 patients (1.1%) had transposition graft using harvested long saphenous vein. One-year patency rate was 63.2%. Complications encountered include AVF failure in 47(27.3%), steal syndrome in 2(1.1%), distal venous insufficiency in 2(1.1%), and false aneurysm in 6(3.5%) patients. CONCLUSION: The outcome of permanent vascular access is favorable in our patient population with a one-year patency rate of 63.2%. The first choice of vascular access in our maintenance dialysis population should be AVF.

Organ transplantation: legal, ethical and islamic perspective in Nigeria.

Organ transplantation dates back to the ancient times and since then it has become one of the important developments in modern medicine; saving the lives, as well as improving the quality of life of many patients. As the demand for organ transplantation far exceeds the organ availability, the transplant program is often saddled with complex legal and ethical issues. This review article highlights the legal and ethical issues that might arise regarding organ transplantation and appraises the existing legal frame work governing organ transplantation in Nigeria. Information on legal, cultural, religious and medical ethical issues regarding organ transplantation in Nigeria was obtained by searching the PubMed and Google Scholar, conference proceedings, seminar paper presentations, law library and other related publications were collated and analyzed. In decision making for organ transplantation, the bioethical principles like autonomy, beneficence and justice must be employed. It was believed by Catholic theologians that to mutilate one living person to benefit another violates the principle of Totality. Among Muslim scholars and researchers, there are those who throw legal support as to its permissibility while the other group sees it as illegal. Organ/tissues transplantation is considered a medical intervention that touches on the fundamental rights of the donor or the recipient. Where there is an unlawful infringement of the right of such persons in any way may be regarded as against Section 34 of the 1999 Nigerian Constitution dealing with right to dignity of the human person. Worldwide, the researchers and government bodies have agreed on informed consent for organ/tissue donation and for recipient should be obtained without coercion before embarking on such medical treatment Worldwide organ transplantation has become the best medical treatment for patients with end stage organ failure. However, there is no law/legislation backing organ/tissues transplantation in Nigeria. The government should take measures to combat transplantation tourism and the problem of national and international trafficking in human tissues and organs, ethics commission and National Transplant registry should be established in order to monitor and regulate the programme in the country.

Prevalence of Uncomplicated Malaria in a Paediatrics Outpatient Department of a Tertiary Health Institution in Sokoto; Nigeria

Background: Malaria remains one of the major tropical health challenges in the world today. It accounts for more than 80of estimated 1.5 - 3 million deaths of children annually especially those aged 5 years and below. There is paucity of data on the prevalence of uncomplicated malaria in children in Sokoto. Objectives: To determine the prevalence of uncomplicated malaria in children aged 0 - 15 years. Methods: The health registers and outpatient cards of children aged 0 - 15 years that presented to the Paediatrics Outpatient Department/Clinic of Usmanu Danfodiyo University Teaching Hospital; Sokoto; Nigeria; between 1st June 2007 and 31st May 2009 were studied retrospectively. Information of the patients with regards to their age; gender; presenting features; date of presentation at the clinic; and diagnosis of malaria (clinical and parasitological) were extracted from the registers and case records and analyzed. Results: During the study period; a total of 15;909 children aged 0 - 15 years were seen in our clinic. Of this number; 7;224 had clinical and parasitological diagnosis of uncomplicated malaria giving a prevalence rate of 45.4.those aged 5 years and below were 5;782 (49.6) while the remaining 1;442 (34.0) were aged above 5 years. Males were 4;068 (56.3) while the females were 3;156 (43.7) with M: F ratio of 1.3:1. The main presenting symptoms were fever (100); reduced appetite (80.5); reduced activity (75) and chills (74). The main presenting signs were pyrexia (84.5); splenomegaly (38) and hepatomegaly (14). Malaria was the leading cause of paediatrics outpatient clinic attendance followed by acute respiratory infection and diarrhoeal disease. Though malaria occurred throughout the year; majority of the cases were seen during the raining and early dry reasons. Conclusion: Malaria is partly meso-endemic and hyper endemic in the studied area and children aged 5-years and below are the most susceptible. It is therefore; recommended that more efforts should be put in place towards malaria control and prevention particularly in this age group

The triad-iodine deficiency, hyperlipidaemia, high coronary risk- in a 'maternal-neonate' population of rural Africa.

In order to see the pattern of changes in differential serum lipid and lipoprotein fractions as a risk marker of coronary complication in paired 'maternal-neonate' blood samples in an iodine deficient zone, 26 pregnant women and their corresponding new born infants at term delivery from the iodine deficient Bassa region of Plateau state, Nigeria were assessed and the results were compared with those seen in a similar 44 group of women and their newborns assessed in non lodine deficient region of Jos. The serum thyroid function and lipid and lipoprotein profiles were determined by 'ELISA' and 'enzymatic' methods respectively. Urinary iodide excretion level was also measured in 14 pregnant women in Bassa, 23 pregnant women in Jos and 16 non pregnant control from Jos. Results indicate that the pregnant women assessed in Bassa were iodine deficient (P<0.01) and their thyroid status was strikingly reduced as reflected by a drop in serum level of T4/TBG ratio (P<0.01) and a rise in TSH (P<0.005) in comparison to that seen in Jos. There was marked hypertriglyceridaemia and total hypercholesterolaemia (P<0.005), with differential significant rise in LDL cholestotol fraction (P<0.005) in the women assessed in Bassa as compared to Jos. The HDL cholesterol however dropped less significantly in the group (P<0.05) with a concurrent marked rise (P<0.001) in the serum ratio of LDL cholesterol/HDL cholesterol, total cholesterol/HDL cholesterol and triglycerides/HDL cholesterol in the lodine deficient group. A similar pattern of changes were seen in the corresponding neonates in the Bassa group as compared to Jos group. It is concluded that the pregnant women and their newborn offsprings living in a longstanding environmental iodine deficiency run a higher risk of developing coronary complications than those living in non endemic region. It is striking that such newborns surrounded by a continued state of lodine deficient may at a later adult-period of life develop marked risk of coronary complication and other features of hyperlipidaemias associated with varying thyroid insufficiency and accompanied iodine deficiency disorders. Prophylaxis measures as intervention has been highlighted.